Mindfulness meditations (MM) are an important group of meditative practices which have received growing attention. The aim of the present paper is to systematically review current evidence on the neurobiological changes and on the clinical benefits related to MM practice in psychiatric disorders, physical illnesses and in healthy subjects.

A literature search was undertaken using MEDLINE, ISI web of knowledge, the Cochrane collaboration database and references of retrieved articles. Controlled and cross-sectional studies with controls published in English up to November 2008 were included.

Electroencephalographic studies found a significant increase in alpha and theta activity during meditation. Neuro-imaging studies showed that MM practice activates the prefrontal cortex, the anterior cingulate cortex and that long term meditation practice is associated to an enhancement of cerebral areas related to attention. From a clinical point of view, Mindfulness based Stress Reduction showed efficacy for many psychiatric and physical conditions as well as for healthy subjects, Mindfulness based Cognitive Therapy was mainly efficacious in reducing relapses of depression in patients with 3 or more episodes, Zen meditation significantly reduced blood pressure and Vipassana meditation showed efficacy in reducing alcohol and substance abuse in prisoners. However, given the low quality designs of current studies it is difficult to establish whether clinical outcomes are due to specific or non specific effects of MM.

Despite encouraging findings, several limitations including small sample size, absence of randomization and inappropriate control groups affect the significance of current evidence and further better designed studies are required.

Mindfulness based Cognitive Therapy (MBCT) is a standardized meditation program which has been proposed as a therapeutic option for the prevention of relapses in patients suffering from major depression (MD). The aim of the present review and meta-analysis is to provide an estimate of the efficacy of MBCT for MD patients.

A literature search was undertaken using MEDLINE, ISI web of knowledge, the Cochrane database, Google scholar and references of retrieved articles. Controlled studies investigating the efficacy of MBCT for MD were entered in the Cochrane Collaboration Review Manager Software (RevMan version 5.0).

Reviewed data showed that MBCT in adjunct to usual care was significantly better than usual care alone for reducing MD relpases in patients with 3 or more past episodes of MD. MBCT plus gradual discontinuation of maintenance antidepressants was similar to continuation of antidepressants alone with respect to relapse prevention. The augmentation of MBCT could be useful for patients with current residual symptoms of depression as well.

Current studies showed preliminary evidence about the efficacy of MBCT for patients with 3 or more past episodes of depression and for currently depressed patients with residual symptoms. However, methodological shortcomings of reviewed studies including small sample size, frequent lack of replications and the absence of studies comparing MBCT to control groups designed to distinguish specific from non specific effects of meditation imply the necessity for further research.

To discuss the paradigm of melancholy in hysteria.

case report of M., a 45 year-old woman, who is under psychotherapy and psychiatric treatment at the General Hospital of the University of Campinas (HC Unicamp).

K. is a 45 year-old divorced mother and former teacher, who started psychotherapy and psychiatric treatment at HC Unicamp in 2007, two years after the death of her father.Since such loss,K. made several violent suicide attempts: she jumped from the balcony of her apartment, took an overdose of medications, and set fire to her body in front of the mirror, which caused permanent scars. During both the psychotherapy sessions and the psychiatric consultations, K. frequently expressed how her life had lost its meaning after the death of her father. She mentioned she was no longer able to love and had no reason to continue living. She also complained about her ex-husband, from whom she was divorced after being betrayed, and about her children, who did not give her, according to her point of view, enough attention and care.

The patient is inside a typical hysterical scene, a “spectacle” composed by dramatic acts against her life. However, it is undeniable her identification with the lost object, her father. By setting fire to her own body in front of the mirror, she shows a melancholic kind of satisfaction with the pain, caused by a massive and destructive narcissism turned against herself.

To improve the quality of psychotherapy, computer-assisted feedback and monitoring systems to evaluate continuously an ongoing course of therapy have gained increased importance in psychotherapy research. They can provide both therapists and the patients themselves with feedback about the progress of the treatment to date while psychotherapy is still taking place. The information gained from them can be used to match the treatment better to patients’ individual needs.

This work presents an Internet-based real-time monitoring method, the Synergetic Navigation System (SNS). This is based on a daily self-assessment by the patient, and is thus characterized by recording the therapy process at particularly narrow time intervals. The technology is illustrated by means of a single case example of a patient with obsessive-compulsive disorder who took part in a two-month inpatient behavioural therapy.

It can be shown that SNS time-series analysis enables the whole course of therapy to be depicted well, without any serious time delay, and it is possible to record phases in which therapeutic interventions are particularly effective (phases of critical instability).

On the one hand monitoring a psychotherapy is useful for psychotherapy research because it enables the dynamics of the therapy progress to be investigated better and it is possible to identify exactly which therapeutic intervention at which time produces what effect on the patient. On the other hand it is useful for the psychotherapist who is working mainly clinically, because the regular feedback enables him to match his therapy to the patient's specific needs.

At resent 3desaides management of chronic mental disorders at psychiatric health association tobe high attention.

Determining effect of psychodrama on depression among women with chronic mental disorder.

This study was a quasi-experimental study that done in RAZI comprehensive psychiatric center. Community of this research consists of chronic mental patients bedridden at RAZI comprehensive psychiatric center that among them 30 women with chronic mental disease possess entrains criterions selected and with randomized permuted blokes´ allocation to two control and intervention groups. Then them depression examined with beck depression inventory (BDI). Then 12sessions hours long of psychodrama, 2ice per week, 6 weeks for intervention group enactment but control group received routine treatments. When the program ended depression of ills reexamined whit study instrument and analyzed with independent T test, paired T test kolmogroph smernophand Leven and covariance analyzes tests.

Main of depression before and after intervention at control group was not significant but at Intervention group was significant (P=0.000).

At two groups after Intervention depression differences revolve significant (P=0.000). Comparison between main of depression after psychodrama even after modification of age and before intervention depression effect by covariance analyzes at two groups showed significant deferens.

Psychodrama leads to decrease of depression at intervention group.

To report and discuss the use of psychoanalytic treatment for children victims of sexual abuse.

We report the psychoanalytic therapy of a seven year-old boy, sexually abused, discussing the “play technique” developed by Melanie Klein.

The boy does not speak to the analyst about the abuse. He has serious changes in his behavior and attempted suicide after that. In the first session with play materials, he draws a heart and partially paints it black, writing his name in it. He is very uncomfortable with the stains caused by black pencil on the white paper sheet. With scissors he cuts the heart and places it on the stretcher. He throws away the stained paper in the waste paper basket. Then he plays the game of catch-rods. At the end of the session, he puts all the toys in the box, and gives to the analyst the “cut up heart” that was on the stretcher, saying that it should be kept under the analyst's care.

With the use of the toy, Klein was able to extend the psychoanalytic concepts proposed by Freud from the analysis of adults, allowing children to be analyzed. By playing, children symbolically represent their fantasies, anxieties and defenses, expressing their models of relationship with the world. In the session of “play therapy”, children can communicate their anxieties and also find resources for the overcoming of their traumas. With his “cut up heart”, the child communicates his suffering, requiring care from the analyst.

To discuss the use of the psychoanalytic method in clinical research and treatment in cases of child sexual abuse, through the account of assistance to a 9 year old female victim of incest.

Session-report of the child.

The girl, abused by her father, shows up in her introspective first hour of play, refusing to address the abuse. Draws three hearts by writing down their names. In the first, writes her name inside the heart and the name of the mother. Under the second, she writes the name of her stepfather whom she calls “father”. Under the third “mother” and writes her name. Delivers to the design analyst and cries, saying she wants her father, calling the name of her stepfather. Later assembles a puzzle of Noah's Ark. She says that God sent Noah to build the ark to bring an animal of each species. The analyst wonders whether it would be a couple of animals. She curtly replied no.

Through the session hour, we observed the injuries produced by emotional abuse, and the child's need to seek a trusted father figure, represented in the drawing of her stepfather. Because of the loss of confidence, the analyst is an element of persecution for the child, and the “analytic couple” still cannot be formed. Note the importance of understanding the symbolic communication expressed in the play, which highlighted situations of psychic damage and the need to repair the damaged parts of the self.

Family-based interventions have shown to be effective in the treatment of major depression. In a recent RCT, systemic family groups led to significantly higher rates of treatment responders and higher rates of patients no longer using antidepressant medication at 15 months follow-up compared to standard care.

In order to better understand the underlying mechanisms of change, helpful treatment experiences of depressive patients and their partners in the family groups were explored.

34 depressive patients and their partners were asked to fill out an open-ended questionnaire investigating helpful experiences during treatment at the end of a 6 bi-weekly group session cycle. Responses were analyzed using the interpretative phenomenological approach (IPA) by three different researchers.

Ten recurring themes were reported as helpful by both the depressed patients and their partners:

1. (1) Presence,

2. (2) Cohesion,

3. (3) Support,

4. (4) Openness,

5. (5) Discussion,

6. (6) Self revelation,

7. (7) Insight,

8. (8) Progress,

9. (9) Observational experiences and

10. (10) Guidance from therapist.

The results of this study help to get insights in the therapeutic factors, which should be emphasized in family groups.

Negative life events can result in adjustment disorders. If there are feelings of having been treated unfair, been let down or been humiliated one type of reaction are prolonged states of embitterment, which has been described as Posttraumatic Embitterment Disorder, PTED. A new approach in the treatment of PTED is cognitive behavioral psychotherapy which uses special strategies based on wisdom psychology. Wisdom has been defined as the capacity to cope with unsolvable and serious problems and questions in life.

In a controlled clinical trial psychosomatic inpatients which suffered from PTED, were randomly assigned to “wisdom therapy” (N=28), which focusses on the reframing of the traumatic event and to “wisdom and headonia therapy” (N=29), which additionally encourages patients to focus on positive aspects in life. Another group of PTED patients (N=50) and patients with other mental disorders (N=50) received treatment as usual.

PTED patients who were treated with wisdom psychotherapy showed a reduction in the SCL-90-PST score of initially 55,7 and at the end of 40,1 and those treated with hedonia therapy of initially 58,7 and at the end of 41,3. Measures of therapist adherence showed that therapists in both groups used wisdom strategies. PTED controls started initially with a SCL-90-PST score of 52,2 and ended with 50,2. Other patients started treatment with 39,3 and finished with 25,9.

This first treatment study on cognitive wisdom therapy suggests that wisdom can be helpful in the treatment of adjustment and embitterment disorders.

Many studies showed the efficacy of interpersonal psychotherapy (IPT) on depression; however, there were limited studies concerning the universality of the IPT problem areas in different countries. This study identified whether the interpersonal triggers of depression defined in the manual were present in Thai depressed patients.

Thai Hamilton Rating Scale for Depression (Thai HRSD) and Thai Interpersonal Questionnaire were used to assess the 90 depressed and 90 non-depressed subjects in King Chulalongkorn Memorial Hospital, during July 2007 - January 2008. The association between interpersonal problem areas / sociodemographic variables and depressive disorder were analyzed by chi-square test. The logistic regression was performed to identify the predictors of depressive disorder.

Most of subjects were young and middle-aged females, living in Bangkok. All four interpersonal problem areas (grief, interpersonal role disputes, role transitions, and interpersonal deficits) were increased in the depressed as compared to the non-depressed subjects as well as in sociodemographic variables (low education, unemployment, low income, and having a physical illness). Logistic regression showed that all interpersonal problem areas still remained the significant predictors of depression. (grief: adjusted OR = 6.01, 95%CI = 1.93 - 18.69, p < 0.01; interpersonal role disputes: adjusted OR = 6.01, 95%CI = 2.18 - 16.52, p < 0.01; role transitions: adjusted OR = 26.30, 95%CI = 7.84 - 88.25, p < 0.01; and interpersonal deficits: adjusted OR = 2.92, 95%CI = 1.12 - 7.60, p < 0.05)

All four interpersonal problem areas are applicable to Thai depressed patients.

Systemic family therapy as psychosocial intervention is focused on family on the whole.It is considered that multidimensional approach is the most appropriate way of treatment.

We described psychoeducative working model in work with families with young schizophrenic member, aged 20-30years. We worked simultaneusly and paralelly with five families each, total 15 families, in form of network seances lasting 1,5 to 2 hours, during period of three months.Data were obtained through interview and unstandardized test questionnaires - beginning and evaluation one.

We got expected results, meaning that complete disfunctionality of actual organisation was confirmed. The feelings of helplesness, shame, guilt, uncertain future and anxiety prevails. Identified patient is central point, he/she occupies the top of hierarchy scale. Families have diffuse internal subsystem borders, rigidity of outer borders, and many alliances, triangles and coalitions.In communication there is no directivnes, and there is a presence of paradox, avoiding, denial, and emotional exchange varied from network to extremely distant.

Based on responses from our evaluation questionnaire, we concluded that implementation of this type of work is necesarry. Our clients accepted it, as it leads to improvement of everyday life, induce self-respect and sense of ones own efficiacy. Family members became supportive network to each other in specific conditions. Instead of network of professionals, the network of people with similar hard expirience and their own ways of help in family crisis situations was formed.

Outpatient group psychotherapy began in our department in 2002 as a complement to the acute inpatient unit. Patients with heterogeneous diagnoses were included before or after a short-duration stay in the unit. Clinicians’ impression was that re-entries to the acute unit were less frequent and shorter after group therapy.

The objective is to determine the real impact of group psychotherapy on the number and mean duration of these re-entries.

Data was collected for 156 patients during period of two years. The number and mean duration of hospitalization in the psychiatric acute unit were registered for each patient during the year before and in the year after therapy to be analyzed and compared.

Before attending group psychotherapy 60.3% of the patients were hospitalized in the acute unit (39.1% once, 12.8% twice, 6.4% three times, 1.9% four times). 65.4% had no re-entries in the following year; 71% of those who did had one re-entry. The mean number of entries per year in the acute unit before therapy was 0.92, while the mean after therapy was 0.52. The mean stay was 7.86 days before therapy, and 4.62 days after. The mean differences between before and after entries were significant in statistical analyses.

Group psychotherapy seems to have effects on number and duration of re-entries to the acute unit for most patients in the different diagnostic categories. These findings have important implications, as this form of therapy is cost-effective and available for a wide range of psychiatric patients.

Therapeutic Writing ist not yet commonly used in Psychiatry and Psychotherapy although it seems to be a promising supportive and well accepted therapeutic tool. Over the last years we have implemented group therapy for Therapeutic Writing at four psychiatric clinics.

Exclusion criteria were insufficiant knowledge of language, illiteracy or insufficiant ability to participate in therapeutic groups. We treated in-patients in a secure environment, on general psychiatric wards and in a day-clinic setting from adolescence to seniority mainly with Schizophrenia, Depression, Bipolar Disorders, Personality Disorders, Anxiety Disorders,and Eating Disorders.

This poster outlines our theoretical framework as well as practical aspects of implementing Therapeutic Writing as a group therapy in a psychiatric/psychotherapeutic setting.

To evaluate the changes in perceived social support in patients treated due to neurotic and personality disorders with intensive group psychotherapy.

An analysis of structural and functional social support and personality descriptors evaluated at the beginning and at the end of intensive group psychotherapy has been performed in the group of 60 patients. Social support has been evaluated in terms of informative, emotional and instrumental aspects with the use of Berlin Social Support Scales and in terms of the structure and functional properties with the use of Bizoń’s method of social network and social support assessment. Personality descriptors have been obtained using Neurotic Personality Inventory KON-2006 and NEO-PI-R.

Results of this research support previous findings that successful psychotherapy (in terms of favorable changes in personality descriptors) alters the perceived structure and function of social support. Less populated social support networks become more effectively utilized. Individual members of the networks become perceived as providing social support in a wider range of functional properties. Moreover an overall increase in patients’ satisfaction with available social support has been observed.

Promising results of this study, that support previous findings, show the need for further research on the subject matter. Further analysis of relationship between changes in limited personality traits and particular aspects of social support will provide additional valuable data.