The use of nasogastric-tube feeding (NGT) in the treatment of Anorexia Nervosa (AN) in children and adolescents is recommended by current guidelines. Nonetheless, the literature lacks studies assessing prognostic factors for modifications of AN-specific psychopathology treated with NGT.

To assess potential prognostic affecting improvement in AN-specific psychopathology in children and adolescents hospitalized for AN, treated with NGT.

Retrospective study assessing young inpatients with AN, treated with NGT. Considered outcomes (admission vs discharge) were AN-specific psychopathology (Eating Disorder Inventory-3 (EDI-3): Drive for Thinness (DT); Body Dissatisfaction (BD); Eating-Disorders Risk (EDRC)) and body-mass index (BMI). Considered potential predictors were demographics, duration of untreated illness (DUI), severity (admission BMI), diagnoses, early vs late (0-7 vs 8+ days after admission) start of NGT, drugs). Models for specific contributions of predictors related to outcomes were assessed with analysis of covariance (ANCOVA).

Fifty-three inpatients (F=53, mean age 15.1±2.0 years) were enrolled. Both higher DT (F(1,22)=15.07, p<0.001) and BD improvement (F(1,22)=7.73, p=0.011) were predicted by lower admission BMI. Higher BMI improvement was predicted by lower admission BMI (F(1,47)=10.39, p<0.001) and age (F(1.47)=6.12, p=0.011. AN subtypes, comorbidities, antidepressants, and different antipsychotics did not predict any outcome.

In this study, greater improvement in AN-specific psychopathology (DT and BD) and weight in patients treated with NGT was predicted by lower admission BMI. These results suggest that young patients with greater severity may highly benefit from NGT. These findings, if confirmed in wider and controlled samples, could help in optimizing the treatment with NGT in young inpatients with AN.

No significant relationships.

COVID19 lockdown is having a significant impact on mental health, patients with eating disorders (ED) are particularly vulnerable.

1) To explore changes in eating and other psychological features due to confinement in patients with ED from various European and Asian countries; and 2) to assess differences related to diagnostic subtypes, age and geography.

The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID19 Isolation Scale (CIES).

On one hand, patients with Binge Eating Disorder experienced the highest impact on weight and ED symptoms due to confinement. Together with subjects diagnosed with Other Specified Feeding and Eating Disorders (OFSED), they also experienced a deterioration in general psychological state. On the other hand, there was less symptomatic impact on people with Bulimia Nervosa or Anorexia Nervosa and asian and younger individuals appeared to be more resilient in this situation.

The impact of COVID varied by cultural context and individual variation in age and form of illness. Services may need to target preventive measures and adapting therapeutic approaches for the most vulnerable patients.

No significant relationships.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by symptoms of inattention, hyperactivity, and impulsivity, which only rarely remits in adulthood[1]. A positive association between ADHD and obesity has been repeatedly observed, especially in adult samples[2]. However, only a few studies investigated the prevalence and correlates of ADHD in obese patients seeking bariatric treatment[3,4].

Our study was aimed to examine the prevalence of probable ADHD comorbidity in a sample of obese patients referred for bariatric surgery. Secondly, we sought to characterize differences in eating behaviour between obese subjects with and without probable ADHD.

The study sample was composed of 110 adult obese patients (BMI ≥ 30 kg/m2) consecutively referred for bariatric surgery to the Obesity Center of the Endocrinology Unit in Pisa University Hospital between November 2010 and May 2012. Probable ADHD was identified using a recently developed screening scale based on items selected from Symptom Check‐List‐90‐R (SCL-90-R)[5]. The extent of binge-eating/purging and night-eating behaviours were respectively estimated using the Bulimic Investigatory Test, Edinburgh (BITE)[6] and the Night-eating Questionnaire (NEQ)[7]. Wilcoxon test was used for statistical comparisons, with a significance level of p<0.05 set for all tests.

Probable ADHD was found in 14 subjects (12.7%, 95%CI=7.1-20.4%). Patients with probable ADHD showed significantly higher BITE symptom score (20.4±9.3 vs. 12.1±7.5, r=0.31, p=0.001) and NEQ total score (16.1±9.2 vs. 9.5±3.9, r=0.27, p=0.005).

ADHD is a relatively common comorbidity in obese patients seeking bariatric treatment, which is positively associated with disordered eating habits, such as binge-eating/purging and night-eating behaviours.

No significant relationships.

Hepatic ones are some of the most described somatic complications in anorexia nervosa (AN) affected patients. They can be due to malnutrition, which is the more usual thing, or due to re-feeding. The first one can lead to more marked elevations of the hepatic enzymes, especially alanine-aminotransferase (ALT). It’s been also described the relation between a sharply decreased body mass index (BMI) and this kind of complications, but there are still to determine more predictors.

Identifying clinical predictors of hepatic complications in AN.

We analysed data from 71 AN affected patients hospitalized at Bellvitge Hospital from January 2016 to October 2021. We used IBM SPSS Statistics 22 to do all the statistics in this work.

The medium age of the sample was 27.66 years with 10.8 years of evolution of AN. The medium BMI was 13.88. 33.80% of them had some sort of hepatic enzymes elevation, two of them a several one. AST, ALT and ALP were significantly more elevated in those patients with lower BMI. GGT was significantly more elevated in patients with more years of disorder development. We didn’t identify correlation between any purgative method and hepatic alterations.

The elevation of ALT, AST and ALP seems to be related with the BMI of the patients, while the elevation of the GGT turns out to be related to the time of evolution of the eating disorder. Purgative methods don’t seem to be related to the development of hepatic alterations in AN.

No significant relationships.

Theory of Mind (ToM) is defined as the ability to understand mental states of other people. Recent studies explored its role in various psychopathological disorders, but evidence lacks on the relationship existing between specific psychopathological domains and ToM.

We aimed to investigate the relationship between psychopathology of Anxiety Disorders (AD) and Theory of Mind.

We enrolled 35 patients admitted to the Psychiatric Unit of Careggi Hospital in Florence with diagnosis of AD. We administered them: Zung Anxiety Scale (ZSAS), Metacognition Questionnaire-30 (MCQ-30), and Reading the Mind in the Eyes (RMET). Pearson’s correlation was used to assess relationships between variables.

A significant positive correlation was detected between RMET scores and ZSAS total scores (r=0.385, p=0.022), MCQ-30 Negative Beliefs about Uncontrollability and Danger subscale (MCQ-30-Neg, r=0.407, p=0.015), and MCQ-30 Cognitive Self-Consciousness subscale (MCQ-30-CSC, r=0.349, p=0.040).

Such preliminary data suggest a relationship between Theory of Mind and AD psychopathology. In particular, some dimensions of AD psychopathology seem to predict higher Theory of Mind levels.

No significant relationships.

Histamine intolerance (HI) is a disorder associated with an impairment of ability to metabolize ingested histamine. The incidence of HI in general population is 1-3%. Clinical manifestation of HI contains nonspecific predominantly gastrointestinal, but also extraintestinal symptoms. HI could be primary with genetic predisposition, or secondary with lower activity of diaminooxidase (DAO) without positive genetic screening.

This study aims to evaluate the prevalence of HI by patients with anxiety disorders. HI can imitate anxiety symptoms, therefore we predict higher prevalence HI in patients with anxiety disorders than in general population.

It is observational cross-sectional study on cohort of anxious patients for detecting the prevalence of HI. Patients were screened by scale for histamine intolerance questionnaire. Patients with positive questionnaire were examined for serum DAO and genetically examined.

113 patients fulfilled the HI questionnaire. From this cohort 35.4% (40 subjects) were positive at screening. Biomarkers of HI were screened only in case of positivity in this questionnaire. Table No. 1: Results of our study from cohort with positive screening, 35.4 % (40 subjects).

This pilot study shows that the prevalence of HI could be higher in group of patients with anxiety disorders than in general population. For further confirmation other studies with control group and larger cohort should be done.

No significant relationships.

The pilot clinical study of GB-115, a new peptide antagonist of central cholecystokinin-1 receptors, revealed that drug was clinically effective in patients with generalized anxiety disorder (GAD) at dose 6 mg daily. Here, we provide results of post-hoc analysis of changes of anxiety and fatigue symptoms to give characterization of its clinical effects in clinically relevant doses.

To research the changes of anxiety- and fatigue-related symptoms during GB-115 treatment in patients with generalized anxiety disorder (GAD).

Patients with GAD without somatic diseases aged 18-55 years were eligible in the study. Patients were prescribed with GB-115 6 mg daily for 21 days. Anxiety and fatigue symptoms were assessed with Hamilton Anxiety Rating Scale (HARS) and Multidimensional Fatigue Inventory (MFI-20). Variables are described as medians and interquartile range (IQR). Pre-post comparisons were performed using the Friedman ANOVA at 2-side p-value <0.05.

25 patients diagnosed with GAD (8 males, 17 females; median [IQR] age: 34 [29.75, 43.0]) included in the analysis. Median [IQR] HARS total score decreased from 22 [20, 24.5] to 19 [16, 20], 13 [10.5, 15.5], 9 [5.5, 11] and 5 [3.5, 8] on the Day 3,7,14 and 21, respectively (χ2=95.07, df=4, p<0.001). Median [IQR] MFI-20 score decreased from 70 [46, 75.5] to 59 [41, 74.5], 52 [37.5, 64.5], 37 [26.5, 63] and 28 [24, 48.5] on the Day 3, 7, 14 and 21, respectively (χ2= 55.41, df=4, p<0.001). None of patients had stimulation-related side effects.

GB-115 action in the treatment of GAD patients is characterized with anxiolytic action with mild psychostimulant properties.

No significant relationships.

The self-report version of the Panic Disorder Severity Scale (PDSS-SR) is a reliable and valid instrument to assess panic disorder, but is unavailable in French.

The aim of this study was to conduct a transcultural validation of the French-Canadian PDSS-SR and examine its psychometric properties.

This study is part of a pragmatic RCT of group transdiagnostic CBT for anxiety disorders, and includes 272 adults meeting DSM-5 panic disorder diagnostic criteria. At baseline, participants completed the Anxiety and Related Disorders Interview Schedule (ADIS-5), the French-Canadian PDSS-SR and self-report measures. Convergent validity was assessed with Spearman correlations, Cronbach’s α was used to analyse internal consistency, and confirmatory factor analysis (CFA) evaluated its factor structure. Sensitivity to change was assessed with paired sample t-tests in patients (n = 72) meeting DSM-5 criteria for panic disorder at baseline with posttreatment data.

108 patients met DSM-5 criteria for panic disorder, including 58 with agoraphobia. The majority were women (85.3%) and mean age was 37.1 (SD = 12.4). Internal consistency (Cronbach’s α) was 0.91. For convergent validity, the highest correlation was with the Beck Anxiety Inventory (r = 0.64). CFA suggested a two-factor model. Optimal threshold for probable diagnosis was 10. Analyses support sensitivity to change when comparing transdiagnostic group CBT and control conditions.

With its good psychometric properties in primary care patients, the French-Canadian self-report version of the Panic Disorder Severity Scale is an efficient and practical instrument for both clinicians and researchers working in the field of mental health.

No significant relationships.

Adrenal insufficiency is a rare medical condition which can occur in children. Parents, being the primary support and support for the child, are generally involved in the care of their sick child.

To estimate the prevalence of anxiety symptoms and associated factors in parents of children with adrenal insufficiency.

This is an analytical cross-sectional case-control study over a period of 4 months in 2019, carried out with parents of children with Adrenal Insufficiency followed at the pediatric outpatient clinic in Taher Sfar Mahdia University Hospital. We used an anonymous questionnaire that included a socio-demographic fact sheet and the Hamilton anxiety scale for exploring anxiety symptoms.

A total of 38 parents of children with Adrenal insufficiency and 38 control parents participated in the study. The current age of the child was between 1 and 16 years old with an average of 9.1 and standard deviation of 4.22 For the assessment of anxiety, 55.3% of the parents had a score greater than 20 attesting to the presence of an anxiety symptomatology. In addition, only 26.3% of control parents presented anxious symptoms. There is a significant difference between the two populations (p = 0.010 OR = 3.459). Anxiety was associated with having a child with SI (OR=3.4), female gender (OR=4.2), unemployment (OR=6.33), and low socioeconomic status.

Parents have a considerable burden in the care and management of their child with a chronic illness, which takes time and a lot of patience. Detecting anxiety symptoms in this population will help them manage it.

No significant relationships.

Maladaptive defense mechanisms can play a role in maintaining the inadequate social and psychological adaptation of patients.

This study aims to establish if denial is one of the central psychological defense mechanisms in patients with somatoform disorder.

10 female patients at Moscow Clinical hospital №33 with somatoform disorder and panic attacks (aged 20 to 43) and 20 female participants of the control group (aged 19 to 35) were presented with 10 pictures of the Thematic Apperception Test. Pictures were previously annotated into 4 groups: neutral stimuli (2, 6GF), provoking self-blame / depression ideation stimuli (3GF,14, 15, 17GF), provoking aggression ideation stimuli (8ВМ, 18 GF, 9GF), provoking aggression/self-blame ideation stimuli (13 MF). We conducted content analyses of stories. Mann-Whitney U-test was used.

Table 1 presents analyses categories, examples of stories, and group differences.Table 1

Patients with the somatoform disorder tended to use descriptions without interpersonal or internal conflicts and/or to deny any characters‘ negative intentions or the negative consequences of their actions.

No significant relationships.

Anxiety disorders are very common and burdensome mental illnesses worldwide, characterized by exagerated feelings of worry and fear. These disorders are highly comorbid with other conditions.

The aim of our study is to explore the physical and psychiatric comorbidities and their clinical correlates. The second objective is to identify the predictors of recurrence of anxiety disorders.

Our study concerned 436 outpatients who met DSM-V diagnostic criteria for anxiety disorders and were followed in the Department of Psychiatry of Monastir (Tunisia) between 1998 and 2017. Selective mutism and seperation anxiety were excluded for lack of cases.

Our results demonstrated that Generalized Anxiety Disorder (GAD) was significantly associated with cardiovascular comorbidity (OR=3.208). Social Anxiety Disorder (SAD) was significantly correlated to avoidant personality disorder (OR=17). Patients with suicide attempts are more likely to have a comorbid personality disorder (OR=11.606). Being married and having a later age of onset are predictors of having comorbid depressive disorder. Furthermore, being married, having an anxiety-anxiety comorbidity and a longer duration of untreated illness (DUI) are predictors of recurrence.

Our study highlights the fact that comorbidities (physical and psychopathological) call for a closer follow up due to the higher risk of recurrence, the higher risk of suicide attempts and the poorer treatment response.

No significant relationships.

The clinical differentiation of anxiety can play an important role, particularly in response to treatment. Patients with generalized anxiety disorders (GAD) reflect anxiety, therefore questionnaires are effective. Previous attempts to create a questionnaire assessing the quality of anxiety assessed only one aspect – tolerance to uncertainty (3). The new questionnaire covers such aspects of anxiety as behavioral manifestation, hypochondria, relation to cognition, personal trait and expectation from treatment.

Clinical testing of the questionnaire.

38 GAD patients (total score of Hamilton depression rating scale 27±4.7), aged 42.5±13, 75% females and 38 healthy volunteers aged 36.5±11, 74% females. The questionnaire included 8 statements, (two of them have subparagraphs). The testing version does not include statement about expectations from treatment. It takes 10 minutes to fill it out.

The difference between groups were found in following statements:

“I am often told that a am worried about small things” (χ2 22 p=0.00001)–behavioral presentation of anxiety.

“When I am anxious, I find it difficult to concentrate” (χ23,6 p=0.059)–cognitive aspect.

“My anxiety is getting worse, when I can’t complete the task strictly according to the instruction” (χ2 13.6 p=0.0002) -obsessive aspect.

“My anxiety is getting worse, when something goes wrong” (χ2=9 p=0.002)-obsessive aspect.

“My anxiety is getting worse, when I need to make my own decision” (χ29 p=0.003)- narcissism

“My anxiety is getting worse when I have to hold back irritation or discontent” (χ24.2 p=0.04)-narcissism.

Only part of statements differs GAD patients from healthy volunteers, but they cover different fields of mental functioning.

No significant relationships.

Personalized approach in drug therapy is an essential line of modern psychiatry. Experimental and clinical studies of anxiolytics have shown differences in drug effects in dependence on genetically determined reactions to stress and personal features.

To evaluate of the therapeutic effects and effectiveness of bromodihydrochlorophenylbenzodiazepine and fabomotizole in dependence on individually-typological features of patients with anxiety disorders.

45 patients (mean age 33,3±9,7 years) with generalized anxiety disorder (n=22) and panic disorders with agoraphobia (n=23) participated in this open-label study. 13 patients treated with typical anxiolytics bromodihydrochlorophenylbenzodiazepine at dose 2 mg daily and 32 patients treated with atypical fabomotizole at dose 30 mg daily. The duration of treatment was 14 days. Minnesota Multiphasic Personality Inventory, Psychiatric Symptoms Severity Evaluation Questionnaire and CGI-E were administered.

Asthenic features (high pessimism, anxiety, individualism) were revealed in 26 patients and stenic features (high impulsivity, rigidity and optimism) were revealed in 19 patients. Patients with asthenic features had tranquilo-activating effect of bromodihydrochlorophenylbenzodiazepine, whereas patients with stenic features had tranquilo-sedative effect. The tranquilo-activating effect of fabomotizole was revealed in patients with stenic features. High efficacy of bromodihydrochlorophenylbenzodiazepine was observed in patients with asthenic personality traits (χ 2 = 7,8), whereas in fabomotizole-in patients with stenic individual typological features (χ 2 = 9,1).

Patients with stenic and asthenic features had differences in therapeutic effects and the effectiveness of anxiolytics. Personality features determine the sensitivity of patients with anxiety disorders to psychotropic drugs.

No significant relationships.

The authors presents an overview of the schools of learning in the area of modern psychosomatic medicine.

The author presents different variants for the concept of disease in psychosomatics.

Groddeck was of the opinion that illness was a “creative endeavour”. Adler speaks of the will to be ill. Schulz Henke found that there are “gaps” where one would expect “normal life coping”. Heraclitus said the character of the human is his fate. In psychosomatic medicine, we must focus attention on the character failings. Viktor von Weizäcker spoke of the revolving door principle. Gebsattel concentrated on the inhibition in becoming. Arthur Jores described psychosomatic disorders as human illnesses. Humans become sick when they find themselves in a “dead-end-street of destiny”. They lose their core of being. Günther Ammon describes the psychosomatic reaction as the expression of a disturbed interaction process and advocates the psychoanalytical group therapy in the treatment of psychosomatic illnesses.

In psychosomatics one looks for a special personality type or for a special trigger situation. One asks about the childhood anamnesis and the biography, about the characteristic drives and the character problems for the respective illness.Those who have lost their core of being can regain it through self-education and self-reflection. However, a “core of being” must be present.

Depending on the illness, character and social environment, it can happen that a patient “learns to express his wishes and fantasies, needs and sensitivities through his respective physical symptoms and complaints.

No significant relationships.

Haphephobia is a morbid fear of being touched or touching. The symptoms of Haphephobia are very similar to other specific phobias.

Presentation of a case of haphephobia due to childhood sexual abuse

Mrs. X., A 22-year-old Bangladeshi female, presents to the psychiatric consult service with an intense fear of being touched by her husband. She told that whenever her husband comes closer to her, her heart starts to pound fast, she feels discomfort in the chest, a burning sensation on her whole body, and loses control over the environment. Furthermore, she can’t sleep properly for the fear of being touched. Her in-laws’ parents concluded that some ‘evil spirits’ might cause the symptoms. So her husband brought her to a Psychiatrist. On an in-depth assessment session, ensuring all the confidentiality issues, she told the Psychiatrist that she has a history of brutal sexual abuse followed by the threat to kill her by her stepfather at the age of fourteen.

After a thorough medical workup and history gathering, her consultant psychiatrist could elucidate the source of the presenting picture and told her that she developed haphephobia, and suggested taking psychotherapy along with prescribed medicines.

Fear of being touched is a particularly difficult fear to cope with. Patients with haphephobia after sexual assault should be handled very cautiously by the experts keeping confidentiality issues in mind. Cognitive-behavior therapy, Exposure therapy, Virtual reality exposure therapy, practicing mindfulness, using daily coping strategies, and medications like beta-blockers, anxiolytics, antidepressants can help a person to overcome haphephobia.

No significant relationships.

Contemporary in Ukraine the special priority has been the somatoform disorders increase. The most significant complications belong to the patient’s self-evaluation of the influence of the disease on their social functioning, influence essential part of the self-evaluation of the disease and the important point of therapeutic personality accomodate intervention.

Develop the stages of personalized models of psychotherapy

On the basis of the examined 270 somatoform disorders patients and 190 ischemic cardial disease patients we have elaborated a formal test that allows to evaluate quantitatively the influents of the disease on various spheres of patients´ social status.

It was absolutely unrespectable the common for ischemic cardial and somatoform disorders patients rise of significance of personal individual, common life factors in cases of aggravation of the main disease course. We created the personification accomodate psychotherapy system consist with CBT, suggestive and autosuggestive implementations. Elucidation of peculiarity of personal perception of the disease served as basis of elaboration of psychotherapy system, consulting, psychological support for patients with high-effectiveness 1,5 - 3 years catamnes in 85% patients.

The retrospective results showed the necessity the personification oriented models of psychotherapy, parted on stages. On the first stage - sedative-adapting the receptions of CBT and suggestive psychotherapy are used. There is group therapy on second stage. On the third stage-supportive elements of the autogenic training mastered.

No significant relationships.

It’s well known the challenge of differential diagnosis between Obssesive compulsive disorder and autism since their symptoms (intrusive, recurrent thoughts and repetitive behaviours) often overlap.

We report a case of a 14 years old boy diagnosed of ASD who was hospitalized for the first time due to difficult management of repetitive behaviours that made him incapable of doing basic activities without help. To interrupt them led to anxiety, aggressive responses and to insistence on sameness behaviours. Only with this information and with the literature research we made, anyone could tell the problem was probably an ASD symptom. However, during his evolution it was difficult to know whether this behaviour was due to ASD or OCD: after adjusting the medication, and when he started trusting his therapists, he told us about a theory he believed so he could explain the uncomfortable ideas that crossed his mind more than often, so he used those behaviours as an anxiety-reduction technique. This new situation was the fuel to make the present review.

To report a case.

The results are included in the “conclusions” section.

Although there is an ongoing debate concerning the nature of the symptoms in ASD versus those observed in OCD, there are commonly used criteria to differentiate them according to the articles we reviewed:

No significant relationships.

Anxiety disorders represent one of the most common mental disorders following a chronic course.

The aim of our study is to determine the prevalence, incidence and clinical characteristics of these disorders.

We conducted a retrospective and descriptive study about 436 outpatients fulfilling the DSM-V diagnostic criteria for anxiety disorder and followed in the department of psychiatry of Monastir (Tunisia) between 1998 and 2017. Selective mutism and separation anxiety were excluded for lack of cases.

The overall prevalence was 5.51%. Panic Disorder was the most prevalent anxiety disorder subtype (3.2%). The incidence of anxiety disorders in the last years has increased from 3.31% in 1998 to 7.5% in 2017. The mean age at diagnosis was 37.76±12.87 years [16-77]. Female gender was the most prevalent in overall anxiety disorders with a sex ratio of 0.78, however, a significant male predominance was recorded in Social Anxiety Disorder (SAD) with a sex ratio of 1.85. Generalized Anxiety Disorder patients were more likely to have low educational level (OR= 1.879), to be laborers (OR=2.55), to be married (OR=2.418) and to have children (OR=2.564) whereas SAD patients were more likely to have higher education (OR=9.118), to be students (OR=5.565), to be single (OR=11.325) and have no children (OR=7.464).

This study highlignts the frequency of anxiety disorders and the fact that being a middle-age married woman with kids make oneself more prone to have an anxiety disorder. Specific attention should be paid to these anxiety disorders with early preventive programs.

No significant relationships.

Contemporary anxiety disorders are the main medical problem.

On the basis of complex psychopatological, pathopsychological research, were obtained reasons and conditions of formation, psychopathological structure, syndrome peculiarities, emotional disfunctions of patients on episodic paroxismal and generalized anxiety disorders and mixed anxiously depressed disorders.

The basic method was a group psychotherapy with the elements of rational, positive, suggestive and family psychotherapy. In relation to disfunctions of emotional sphere, CBT was used for the phobic-depressive and anxious-depressive syndroms.

180 anxiety disorders patients were examined, by the stationary course of treatment.Decrease of general level of anxiety and internal anxiety was obtained for most patients. No spontaneous emergence of fear was practically observed. While active interviewing, patients stated that their former worries and fears have lost actuality and apparent emotional colouring become. Considerable reduction of symptomatic of the depressed circle also took place, patients started to feel joy and optimism.

To correct emotional disfunction of patients with episodic paroxismal disorders, generalized anxiety disorders and mixed anxiously depressed disorders, psychotherapeutic correction system is optimal to use, which is built based on stepwise and multimodal principles.

No significant relationships.

Body dysmorphic disorder (BDD) is a relatively common disorder characterized by a preoccupation with non-existent or slight defects in appearance. It was first described in 1886 by Morselli as dysmorphophobia.

This work reviews the current available data on BDD and its treatment options and describes a clinical case that reports an improvement in symptomatology after surgery.

Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “body dysmorphic disorder”, “dysmorphophobia”. Clinical file consultation.

The usual treatment involves a combination of psychotherapy and pharmacotherapy. Antidepressant medication, mainly selective serotonin reuptake inhibitors (SSRIs) have been used. If the symptoms do not improve, a different SSRI can be considered or clomipramine, venlafaxine or second-generation antipsychotics can be useful.

The role of surgery remains controversial, several studies indicating that the symptoms typically worsen after an aesthetic procedure because the preoccupation shifts to a different body area. However a recent study reported 32 of the 41 patients that underwent surgery were highly satisfied with the outcome. In our clinical case, our patient, a 20-year-old female with non-delusional dysmorphic ideas about her nose initiated treatment with paroxetine with poor response and was, against medical opinion, submitted to a rhinoplasty. Three weeks after the surgery there was an improvement in preoccupation about her nose. More research should be made to clarify the role of surgery in this disorder that often lacks adequate therapeutical response.

No significant relationships.