Study of the clinical features in the group of somatoform and psychosomatic disorders.

The results of clinical and epidemiological study of 2181 patients (average age-54 ± 0.8) are presented.

inventory for clinical-anamnestic behavior sign of adaptation form of disease of patients with comorbid phenomenon and standard scales for value of anxiety and depressions were used.

The homogeneous group of disorders in which somatic as well as psychical symptoms are equivalent 6,7 (P< 0,05).The phenomenon of comorbidity as the independent clinical adaptive mechanism was revealed 8,3 (P< 0,05). In the research group the positive response for the psychotropic therapy was registered 5,3 (P< 0,05).

The phenomenon of comorbidity in practice area reduces to new understanding of the coexistence of the psychic and somatic register, illustrates the possibility of the valuation of indicator of quality of manifestation of symptom and syndrome in context of social functioning. The social functioning is the indicator of quality and optimization of the diagnostic and therapeutic processes, which are demanding independent culturally dependent diagnostic directives from existing classifications (ICD-10, DSM-IV). The somatic symptom is the integral part of psychopathologic syndromes.

The aim of this study was to estimate the prevalence of disorders eating among patients with diabetes mellitus.

Studies have shown that The Eating Attitudes Test (EAT-26) can be an efficient screening instrument as part of a two-stage screening process in which those who score at or above a cut-off score of 20 are referred for a diagnostic interview. 44 patients with diabetes mellitus (28 women and 16 men) were recruited for this study. Height, current weight, body mass index (BMI) were determined. The EAT- 26 for Eating Disorders was completed. Results were compared with measurements in 32 nondiabetic subjects (22 women and 10 men).

The prevalence of disorders eating among patients with diabetes mellitus was 18.18%. Of the 44 patients with diabetes mellitus, 8 scored higher on EAT (average score 32.01, BMI 31.36 kg/m2) than the remaining 36 patients with diabetes mellitus, whose score averaged 14.22 (BMI 26.32 kg/m2). In this study we found significant differences for the recorded parameters between diabetic patients with and without disorders eating. Age were similar in both groups, but BMI were higher, and scored on EAT were higher in diabetic patients with disorders eating. The prevalence of disorders eating among nondiabetic subjects was 6.25%. Two patients with diabetes mellitus develop a clinical eating disorder and needs cognitive-behavioral, interpersonal psychotherapy and pharmacologic treatment. The EAT-26 score at or above of 20 needs expertise in eating disorders, and nutrition.

Nowadays several authors defend the existence of an obsessive-compulsive (OC) spectrum in which eating disorders (ED), especially anorexia nervosa, would be include. We investigated the presence of OC symptoms in bulimic and anorexic patients and its relationships with personality traits.

The Maudsley Obsessive Compulsive Questionnaire (MOCQ) and the revised version of the Temperament and Character Inventory (TCI-R) were administered to patients and healthy controls.

Patients show higher scores than controls in the global punctuation of de MOCQ, and in the checking and doubt subscales. Cases also score higher in harm avoidance (dimension associated with personality disorders of cluster C) and in its subscale anticipatory worry. No differences were found between patients subgroups.

Patients present more OC behaviours in comparison with healthy population but measures of obsessivity do not differ between the types of ED. Traits of personality characteristically associated to cluster C and to anxiety disorders seem to be also common features. These results do not support a separated classification of RAN into the OC spectrum.

Major depression and post-traumatic stress disorder (PTSD) are commonly associated with coronary heart disease (CHD) as well as hyperhomocysteinemia and hypercholesterolemia. Personality types A and D are claimed to be risk factors for CHD.

To evaluate relations between risky personality types, cholesterol and homocystein serum levels in patients with major depression compared to PTSD patients with and without depression.

Personality types A and D, cholesterol and homocysteine level were assessed in 40 patients with major depression and 40 male PTSD patients with and without depression.

Hypercholesterolemia and hyperhomocysteinemia were found more frequently in patients with major depression and PTSD patients with depression than in PTSD without depression. Personality type D (tendency to experience negative emotions and social inhibition) was more frequent among PTSD patients compared to patients with depression, while there was no difference in personality A type (competitiveness, time urgency, aggressiveness and hostility) distribution.

Hypercholesterolemia and hyperhomocysteinemia may be useful clinical markers related to specific treatment options in patients with major depression as well as in PTSD patients.

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorder. The aim of our study was to assess the prevalence of irritable bowel syndrome (IBS)-like symptoms in Crohn's disease (CD) patients in remission. Furthermore, the possible relation of IBS-like symptoms with quality of life was studied.

Sixty-four patients with known Crohn's disease were invited to complete the SF-36 (to assess quality of life) while in clinical remission and were studied for the possibility of IBS-like symptoms. Diagnosis of IBS was made according to ROME III Criteria. Physical health summary score (PCS) and mental health summary scores (MCS) of CD patients with IBS-like symptoms were compared with PCS and MCS of CD patients without IBS-like symptoms.

IBS-like symptoms were found in 55% of Crohn's disease patients in remission. CD patients with IBS-like symptoms had lower well-being scores than those without IBS-like symptoms.

The presence of irritable bowel syndrome-like symtoms impaired the quality of life of patients with Crohn's disease.

Anorexia nervosa (AN) is a chronic and relapsing disorder, characterized by aberrant patterns of weight regulation and eating behaviour, body image distortion and resistance to treatment.

This study aims to investigate the reversibility of the most important structural and functional cerebral alteration found in the illness state after weight recovery, in order to distinguish between state-dependent abnormalities and neurological signs of traits vulnerability.

The most significant neuroimaging studies are reviewed from the scientific literature of the last ten years, using the following keywords: “neuroimaging”, “anorexia”, “reversibility”, “weight recovery”, “cerebral blood flow”, differently matched together.

Structural neuroimaging techniques show a widening of internal cerebrospinal fluid filled spaces and a brain gray and white matter volume loss. These alterations take place in the low-stages of AN, as body weight decreases, and generally reverse with weight restoration, as a function of re-feeding. Functional neuroimaging studies reveal a reduced global and regional cerebral glucose metabolism in the acute state, that reverses with recovery. On the other hands, techniques based on stimuli provocation reveal a greater activation in the medial prefrontal and anterior cingulate cortices in response to food stimuli, that persists after recovery, suggesting that these alterations could be primary abnormalities related to trait vulnerability.

Other studies needs to distinguish between primary neural disturbance and secondary phenomena due to starvation, in order to individuate patterns of vulnerability and to develop new strategies of treatment and prevention.

Hemodialysis as a treatment manner in chronic renal failure is a stressful process and has several various psycho-cognitive and social complications. This procedure can made mental disorder in these patients. Therefore it is better that moreover prescription of medication in hemodialysis centers, psychological interventions is done for patient's rehabilitation too.

This research is a quasi experimental and clinical trial study. Samples were young adults who were 18- 45 aged. The Beck depression & anxiety inventories were used as a measure of psychological symptoms at pretest and post test. Cognitive-behavioral group therapy as intervention was done at 12 week. Information were analyzed with SPSS-16 and Paired t-test and Analysis variance one way.

The result showed a significant difference between anxiety and depression before and after intervention in case group (p=0/0001) and there was not a significant difference among variables such as: age, sex, education and economic level, dialysis long time with anxiety and depression among in studied group.

This research shows that group therapy (cognitive- behavioral) has been decreased depression and anxiety remarkably in dialysis patients. Therefore it is suggested that moreover description of medication, psychological interventions are done for this patients.

We present a case study of Anorexia Nervosa and Obsessive Personality Disorder as an argument to describe the main therapeutic interventions used framed in so-called third-generation therapies.

The sessions were recorded on videotape by independent observers. Both the particularities of the therapeutic relationship (based on functional analytic psychotherapy) and contextual strategies used (based on acceptance and commitment therapy) were analyzed.

During the therapy, several changes where observed. Among them: Better social behavior, congruence between vital values and vital actions, resolution of the eating disorder, greater openness to experience and decrease of obsessive thoughts.

The changes that were observed during the therapeutic process will be associated with specific interventions resulting from the contextual-functional approach.

The paper gives an overview about classic psychoanalytic formulations of psychic trauma and compares them with recent contributions from trauma therapy, attachment research, and neurobiology.

Brain research and psychotherapeutic methodes.

Results of the brain research show that early traumatization affects brain areas in emotional states which verbalization cannot reach.

For early traumatized patients a treatment concept of non-verbal methods as well as verbal are necessary,

Several studies, carried out to assess the efficacy of psychological and pharmacological treatments for depression, have shown thar combined treatments are, in general, more efficacious than an unique approach. We will present the preliminary results of an on-going research, being carried out with the main purpose of analysing the efficacy of two psychological empirically supported treatments, Cogntiive-Behvioral therapy (CBT) and Interpersonal Therapy (IPT), combined with a pharmacological antidepressive (AD) intervention, for recurrent depression.

A sample of 20 adult females has been randomly assigned to one of three conditions: a) CBT plus AD, b) IPT plus AD, and c) AD only.

A multimodal assessment matrix was developed and is being used to evaluate depression features (including suicidal ideation, intention and attempts), and the main individual, social, and environmental factors commonly related to the onset and mantainance of the disorder, namely hopelessness and pessimism, cognitive processing, interpersonal relations, and life events.

Repeated measurements are being collected at 0, 2, 4, and 6 months, and follow-up.

We expect that both combined approches will be more efficacious for the reduction of depressive symptoms, including suicidal behaviors, compared to the pharmacological approach. we also expect to understand the sensitivity to change of the assessed psychological processes underlying each form of psychotherapy.

Mindfulness meditations (MM) are a group of meditation practices which are recently receiving growing attention. Following the increasing interest towards the neural correlates of meditation, particularly Mindfulness meditations (MM), the aim of the present work is to review current findings about the neural correlates of MM and compare such findings to those of further specific and non specific treatments.

A literature search was undertaken using MEDLINE, ISI web of knowledge, the Cochrane database and references of retrieved articles. Studies which focused on the functional neural correlates of MM, psychotherapy, pharmacotherapy and placebo published up to August 2009 were screened by the reviewers in order to be considered for the inclusion.

Main findings suggest that long term MM practice could allow a more flexible emotional regulation by engaging frontal cortical structures to dampen automatic amygdala activation when it is needed. A great overlap could exist between cerebral areas activated during MM, psychotherapy,pharmacotherapy and those activated by expectancy in placebo studies. However, while MM, psychotherapy and placebo could act through a top-down regulation, antidepressants could act through a bottom-up process.

MM could target specific brain areas related to emotions and emotional regulation. Consistent similarities could exist between MM and other interventions, particularly psychotherapy. Despite these promising findings, however, further research is needed in order to extend current findings, to more deeply compare MM to other treatments and to better investigate the neurochemical correlates of MM.

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.