The purpose of writing letters is to experience and to understand their own feelings, to cope with strong emotional experiences, which are related to the injuries in the childhood. We present specific examples of the letters from our patients in last 15 years of our experience, when this technique is mainly used in patients with personality disorders, affective and anxiety disorders.

The letter-writing process is carried out in a safe atmosphere of the therapeutic relationship, where the patients can learn to deal with these emotions. Then the result is a profound change in beliefs about themselves and others. The basic types of therapeutic letters are these four: not censured letter, emphatic letter from the “other side”, the letter to the “inner child” of the significant person and the letter “visit-card”. In not censured letter the patients primarily reflect the negative feelings that hurt them in childhood. The emphatic letter from the “other side” is the ideal answer the patients would have wanted to get away from the significant person; patients formulate the particular wishes and expectations, which meet in a fictional response (encouraging self-confidence, assurance of love, respect). The “visit-card” letter is the censured letter in “adult to adult” mode, written with respect for oneself and significant person, directed towards reconciliation.

By IGA MZ CR NT 11047-4/2010.

We describe approach in processing these painful events during the therapy. Among basic principles in the treatment of the patients who developed psychiatric disorder and have stressful events in childhood or adolescence belongs the creation of collaborative therapeutic relation, explanation and psychoeducation what happens with the patient and reducing or correct stigmatization and guilt feelings. Therapist helps the patient to understand, how symptoms connected with the events from childhood and how they are interconnected with actual problems in life. The transcription of traumatic or stressful events follows after cognitive restructuralization of core schemas and conditional assumptions. Therapeutic process can be divided into of several steps:

1. (a) creation of therapeutic atmospheres (with feelings of security and control, acceptance, approbation);

2. (b) exposition to the painful memories in imagination;

3. (c) expression of negative emotion to the aggressors, or persons that the didn't guard against stress or trauma;

4. (d) formulation the needs of the child to significant adult person;

5. (e) experience better end in imagination - transcription of the story;

6. (f) general calm down. The aim of therapist is to help the patient memorizing the stressful events and expressing affective experience and then help him/her to rescript experience to less painful.

There are some examples of traumatic rescription in the article.

Eight themes summarised factors perceived to be related to becoming homeless: Relationship breakdown, Behavioural rebelliousness, Childhood abuse, Foster care/Frequent childhood relocation, Substance use, Eviction, Job loss, Jail; 5 themes categorised factors that participants thought contributed to continued homeless: Adverse life events, Substance use, Avoidant coping, Criminal offense, Ill-health. Chi square analysis indicated that females and young adults reported that relationship breakdown was a triggering factor for becoming homelessness. Young homeless were likely to see adverse life events as a risk factor for continued homelessness whilst mature adults more often reported alcohol/drug abuse as a triggering factor.

This study found that different subgroups experienced that different risk factors had led to their becoming and staying homeless. There may be a role for psychologically informed services to explore self-reported traumatic/trauma-like experiences to increase the ability to successfully intervene in the vicious cycle of events that prolong homelessness for many.

Since the Freudian construction of Psychoanalytic purposes, the foundations for the psychotherapy treatment have suffering profound transformations. However the understanding of the outcomes for patients in the therapeutic strategies used in the psychotherapeutic relationship need to be better discussed. Although the technique has been used in various contexts and submitted to a technical theoretical-structure, it lacks elements that help to evaluate both whether pedagogical actions employed to this education to potentize the professional actuation and whether they are effectives for the establishment of pillars for this practice.

To discuss the psychological meanings of outcomes of a psychoanalytic psychotherapeutic process for young and adults ex-patients who has used a clinical-school of a Brazilian federal university.

Clinical-qualitative method whose sample was closed by information of saturation. The data was collected through semi-directed interviews, registered and transcribed for further Qualitative Content Analysis of Enunciation, based on a psychoanalytic theoretic framework.

Preliminary data have emerged three thematic categories: the treatment as an escape from a death the life generates, expressed by pain of the overload's life; the maternal function attributed to the therapist and demonstrated through idealizations; and the pain felt by him/herself regarding perceptions of being a different one.

These categories support the reflection of treatment goals currently in public services and they permit to improve the approach to these users and to explore constitutive elements of the teaching-learning process.

Heart rate variability (HRV) reflects the oscillations of successive heartbeats (variability of R-R periods). It is considered to be decreased in various psychiatric conditions, for example in depression (1). We ask if a treatment with psychotherapy can have a positive effect on HRV.

To assess whether a 10-week systematic dynamic group psychotherapy treatment influences HRV. There were the following parameters of HRV assessed: high frequency (HF), low frequency (LF), total power (TP), mean square successive differences (RMSSD), stress index (SI).

The measurement of HRV was carried out under standard conditions. We have recorded ECG with the use of TESLAGRAPH® device.

10 women and 5 men attending a 10-week treatment. The psychiatric diagnoses were various anxiety and neurotic disorders.

(median: before treatment - after a 10 week treatment): HF (442 Hz - 305 Hz; p = NS); LF (709 Hz - 556 Hz; p = NS); TP (1835 ms2 - 2371 ms2; p = 0,NS); RMSSD (28 ms2 - 33 ms2; p = 0,NS); SI (106 – 66; p = NS).

An improvement was found in all characteristics of HRV after the treatment, however the differences are not statistically significant.

The family members of a person with serious mental illness experience social, economic, emotional and environmental problems as a result of their caregiving responsibilies. The mental status arising from these problems is considered as the burden of the family. To be aware of what can be called as burden to the family members or the caregivers and the severity of the burden provides important clues in the treatment.

The aim of this study is to investigate the burden of the caregivers of bipolar disorder patients and the relationship of this caregiving burden with sociodemographic and psychopathological variables.

Forty chronic Bipolar patient's caregivers were participated in this study. The patients symptoms were assessed with Clinical Global Impression Scale. The aim of the study was explained in a plain language before they were asked to complete the Zarit Burden Interview.

Educational status of the caregivers (p = 0.037), the severity of the illness (p = 0.06), caregiver relationship to patient (p = 0.01), the precence of a psychiatric disorder of another individual from the family (p = 0.01) were found as important variables that increase the burden of the caregiver.

To uncover the the factors that affect the burden of the caregivers is important for predicting relapses. Bipolar disorder significantly affects not only the patients but also their family (or caregivers). At this stage the responsibility of the clinician is not only the prescription but also to educate the patients and their families as well with particular emphasis on identifying and modifying burdensome symptoms.

Psychoeducation is currently considered an essential intervention in the management of bipolar disorders. A psychoeducation group programme for patients with bipolar disorders named “Porta Aberta” (Open Door) has been implemented since 2007 at the Day-hospital of our psychiatric department.

To assess the efficacy of group psychoeducation in reducing the average number and duration of readmissions and to determine the individual characteristics (gender, marital status and disorder subtype) that might influence these outcomes.

Review of the clinical records of a consecutive sample of patients with bipolar disorders discharged from the inpatient unit, attending at least 4 out 8 programme sessions, and with a one-year follow-up since 2007. Variables assessed were: gender, age, marital status, subtype of bipolar disorder (I or II), and number and duration of psychiatric admissions in the year before and in the year following the programme attendance.

The 69 patients included were 37.3 ± 10.7 years old, mainly women (68.1%), and single (47.8%). A statistically significant reduction in the average duration of readmissions (24.7 versus 17.3 days, p = .028), and in the average number of readmissions (1.3 versus 0.3, p = .032) was found. Only 15 patients were readmitted. Patient's gender and marital status, as well as disorder subtype had no influence in the results.

Group psychoeducation is an effective intervention in reducing the number and duration of readmissions in bipolar patients despite gender, marital status and subtype of bipolar disorder.

The mental health system reform agenda has a core objective of delivering better health and social care for all. National Programme of Mental Health which has been lately legally supported by the government (28.12.2010) strictly depicts direction of health care development. The main goals of National Programme of Mental Health are:

1. 1. Promotion mental health and prevention of mental disorders.

2. 2. Provision of support and easy access to psychiatric health care and other forms of care necessary for living in families and society.

3. 3. Development of research and information about mental health.

To assess the availability and quality of psychosocial rehabilitation for outpatients in Wroclaw, Poland (second goal of National Programme of Mental Health).

Quality assessment: interviews with beneficiaries, interviews with empolyees (social workers, psychologists, therapists), analyses of programmes and interventions, analyses of distribution of mental health care services.

Availability and access to psychiatric services financed by public mental health resources and NGO differs. Lack of standarisation in programmes' assessment prior to their implementation results in hardships in coordination of activities and beneficiers' support in use of suitable training or services.

There is a need of coordination in service planning and access to rehabilitative activities for mentally disturbed people/ patients.

Mass media have become the main source of information on mental illness. In recent years, numerous studies documented a relationship between a stigmatizing presentation of psychiatric disorders and negative perception of mental illness by general population. This paper aims at analyzing how mental illness is described in scientific articles published by journals and magazines and delineating the average portrait of a psychiatric patient offered by media to the general population.

Scientific articles published from 1957 until August 2010 were reviewed, collecting positive and negative expressions commonly associated to mental illness; a qualitative assessment method of these was then applied.

Negative descriptions of mental illness resulted by far more common than positive ones; generally, the tone and the negative attitude that describes mental illness are in the titles and in short articles, often sensational and dramatic, put on the front page, referring to stories of crime and danger. The titles are often inconsistent with the contents of the article. Moreover, there is a discriminatory and derogative language or a language of derision or pity. If there are positive descriptions, they are associated with the involvement of mental health experts, the active role of the psychiatric patient in the mass media or the effect produced by anti-stigma campaigns towards journalists.

Although negative and stigmatizing depictions predominate, there are still opportunities for improving media reporting of mental illness, which should be taken up in future media strategies.

Living with Parkinson disease is a daily challenge. A program of physical therapy and occupational therapy can help people; rehabilitation therapy enhances the lives of people with Parkinson's disease. The goal of this paper is to improve PD patients' independence and quality of life by improving movement, function and relieving pain.

study that looked at the use of this therapy in PD patients assessed the effects of a 6-week rehabilitation program; Over 10 treatment sessions (30 minutes each) considered both motor and cognitive training including learning about new movement techniques strategies and equipments. A physical therapist can teach exercises to strengthen and loosen muscles. Many of these exercises can be performed at home.

At the end of the 6-week training period, patients showed a significant improvement on several standardized cognitive tests of creativity and memory. Allowing patients to enjoy their meals helps them maintain their independence and self-respect. Certain forms of speech therapy can also be valuable in improving voice problems. Such therapy can also help increase their endurance, strength, general fitness, energy level, elevate their mood and even decrease their anxiety. They also demonstated significant improvement in abilities such as organizing performance of a task compared to those who did not receive the treatment. This improvement was independent of individuals' age, intelligence or health.

Physical therapy cannot cure Parkinson's disease, because at this time, neurological damage cannot be reversed. But therapy can enable patients to compensate for the changes brought about by the condition.

The fight against discrimination and stigmatization of consumers of mental health services is a priority for the WHO and WPA. The purpose of the psychoeducation - destigmatisation of mental disorder and mental health care, an understanding of the society daily living of the consumers of psychiatric care and their families.

Comprehensive survey of 97 patients with schizophrenia in a period of stabilization. The main group - 67 patients in whom therapy used psychopharmacotherapy, psychoeducation and training. Control - 30 patients receiving psychopharmacotherapy.

To estimate the effectiveness of psychoeducational programs in the treatment of patients with schizophrenia.

Trainings were conducted in closed groups, the number of participants from 6 to 12 people. Each cycle consisted of 12 psychoeducation sessions lasting 2.0 hours with a frequency of 2 times per week. In our work we used an integrative model of psychoeducation includes information modules, techniques of cognitive-behavioral therapy, problem-oriented discussion, family therapy.

Analysis of the dynamics of social functioning and quality of life of patients with schizophrenia before and after psychoeducation showed that they increased in the intervention group significantly greater and more sustained than in the control group, especially in areas such as the general welfare, health, performance, family relationships and social contacts

Psychoeducation not only increases the volume of knowledge increases confidence in combating the disease, but it solves the problem of social reintegration of the patient.

To qualitatively anaylze the use of CTO.

All CTO examined from 2008 to 2011.

Total number 89.

The age range shows a wide distribution.

This year 53.9% access to a car and unemployment was at 100%. 82% were previously on a Section (3) but 6.74% were previously on a Section (37) and 11% were on a Section (25). There does appear to be an increase in the use of Section 37s being converted over to a CTO, which does raise the issue of the role of Risk Management usage of CTOs.

On examination of the diagnosis, those with Schizophrenia on a CTO were approaching 80%. The actual diagnosis of Schizophrenia combined with drugs and alcohol misuse was that of 47.2%.

On examination of the medication used in CTOs, there appears to be a peak with the use of Depot, particularly that of Clopixol at 22% and Risperidone Consta at 23%. This year's audit also looked at combination medication, particularly that of dual anti-psychotics (23.6%) and the combination of anti-psychotic and mood stabilisers (13.5%).

Conditions of the CTO note medication use at 94%. The other conditions that scored highly was appointments with Community Mental Health Team and Assertive Outreach Team as well as Outpatients with the Consultant.

Substantial increase in variance of conditions at 14.6%

Ethos of a CTO is enhancement of engagement. It is a flexible tool both for use in different diagnostic subgroups, Risk Management as well as compliance with medication.