In the last decade, accumulating evidence has been produced on the role of dissociation in Obsessive Compulsive Disorder (OCD). Understanding which dissociation dimensions are specific to OCD could suggest the integration of therapeutic strategies for dissociation in the treatment of patients with OCD.

The current study explored the role of dissociation in a sample of patients with OCD, patients with anxiety disorders and healthy controls with the aim to understand which dissociation dimensions could be specific to OCD.

One hundred seventy-one participants were included in the study (56% females, mean age = 35.96, SD = 12.61), of which 52 were patients with primary OCD, 59 were patients with Anxiety Disorders (AD), and 60 were healthy controls. The Dissociative Experiences Scale (DES), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were administered.

Patients with OCD had significantly higher dissociative amnesia symptoms than patients with AD and health controls (F = 6.08, P < 0.01) and higher depersonalization/derealization symptoms than healthy controls but not than patients with AD. Patients with OCD did not report significantly higher dissociative absorption than healthy controls and patients with AD.

Strategies targeting dissociative amnesia and depersonalization/derealization symptoms in OCD are discussed. Future studies should examine which OCD subtypes are more strongly associated to dissociation dimensions.

The authors have not supplied their declaration of competing interest.

Pathological Skin Picking (SP) is a psychiatric condition with a 2–5%-prevalence in the community and consists of repetitive picking behaviours associated to marked distress, which can cause significant skin damage. Research has evidenced a Focused SP subtype, typically occurring in response to negative emotions, an Automatic subtype, occurring without awareness during activities not related to the picking behavior, and a Mixed one. Mindfulness skills have been studied as a protective factor involved in the treatment of several psychiatric disorders. Studying Mindfulness deficits in SP might help to identify interventions tailored for specific subtypes of SP behaviours.

The current study examined the relationship between Mindfulness skills and pathological SP behaviours.

The study aimed to investigate whether Mindfulness skills deficits uniquely predicted SP subtypes behaviours after controlling for general distress in a community sample.

Ninety-seven community individuals (mean age = 39.71, SD = 16.37, 59% females) completed measures of SP, Mindfulness skills and general distress (anxiety and depression).

Lower Mindfulness skills of Describing Internal Experiences (B = −0.12, P < 0.05) and higher anxiety (B = 0.08, P < 0.05) predicted more severe Automatic SP. Lower Mindfulness skills of Non-judging Inner Experiences (B = −0.12, P < 0.05), higher anxiety (B = −0.12, P < 0.05) and higher depression (B = −0.12, P < 0.05) predicted more severe Mixed SP. Focused SP was not associated to Mindfulness skills and general distress.

Mindfulness skills deficits could be associated to Automatic and Mixed but not Focused SP. Future studies should investigate whether Mindfulness programs are effective for individuals reporting Automatic or Mixed SP behaviours.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Obsessive-Compulsive Disorder (OCD) is a mental disorder characterized by obsessions and/or compulsions. Although some epidemiological studies take part in literature, which claim that traumatic life events in childhood ages are observed more in patients with OCD compared to healthy population, the number of these studies is limited. In this study, it is aimed to compare OCD patients with healthy volunteers in terms of traumatic life events in childhood ages.

With 25 consecutive patients who are diagnosed as OCD and whose treatment continues, 25 healthy controls equivalent in terms of sociodemographic features are included in the study. Sociodemographic Data Form, Childhood Age Trauma Quarter (CTQ) and Maudley Obsessive Compulsive Question List (MOCQL) are applied to the participants. Significance Value in statistical level is accepted as P < 0.05.

In OCD patient group, CTQ scores are found high in statistical level compared to healthy controls. It has been determined that there is a significant relationship between total score of MOCQL slowness subscale scores, subscale scores of sexual and emotional abuse, MOCQL rumination subscale scores and CTQ sexual abuse scores.

Compared to healthy controls, more findings of traumatic life event in childhood age are observed within OCD patients.

The authors have not supplied their declaration of competing interest.

Psycho-Oncology (PO) is a specific psychiatric approach to cancer patients. The main psychiatric disorders observed are delirium and adjustment disorders (AD) and the most frequent treatments used are pharmacologic and psychotherapeutic.

With regard to the type of cancer, the most frequent in Portugal are breast, digestive and prostate.

Analyze the activity of PO in a district general hospital in Portugal.

Demonstrate that the main core in PO is similar in the world.

Prospective longitudinal study, during one year.

The sample had 130 patients (369 evaluations), mainly male, with the mean age of 64.22 years. The most frequent psychiatric diagnoses were delirium (56 cases; 43%) and AD (44; 34%) and the main interventions used were pharmacologic and psycho-education. The most common frequent cancers were digestive (54; 42%), urologic (16; 12%) and breast (15; 11%). This high frequency of urologic cancer was interpreted as a consequence of the sample and its geographic location, but it was also a reflection of the large number of requests made by this specialty. The majority of cancers had an advanced stage (84% vs 16%) that can be explained by the sample but also by health culture in Portugal, which is reflected in the inpatient services: Oncology (51; 39%) and Palliative Care (25; 19%).

The type of psychiatric disorders and treatments offered in PO is preserved around the world. The authors propose to do more studies, namely if the relation with others specialties affects psychiatric treatment of the patient.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Multiple Myeloma (MM) is a cancer formed by malignant plasma cells. On a worldwide scale, it is estimated that about 86,000 incident cases occur annually. The aim of this report is to investigate the experience among multiple myeloma caregivers, assessing the mental adjustment to cancer diagnosis and the most prevalent psychopathology in the caregivers. This paper also attempts to establish the influence of the symptoms has in the caregiving experience.

All eligible caregivers will be approached during a regularly scheduled patient clinic visit and informed consent will be obtained prior to study participation. Data will be collected using the Mental Adjustment Scale to the Cancer Scale Partner (EAMC-F), Memorial Symptom Assessment Scale – Short Form, and Depression, Anxiety and Stress Scale (DASS-21).

According to the literature caring for patients with MM can be different comparing with another form of cancer. It is an incurable form of cancer, although treatments improve life expectancy and quality of life. The authors are expecting to find high rates of depression, anxiety, unmet needs, and burden of care. The symptoms of the patients will probably influence the caregiving experience.

MM accounts for about 14% of all newly diagnosed hematological cancer, and it is estimated that its incidence will rise. The importance of psychiatric intervention in the multidimensional approach is becoming a recognized reality. This is essential in the treatment of psychiatric disorders, to improve prognosis and quality of life but also to reduce side effects of treatments and symptoms related to cancer.

The authors have not supplied their declaration of competing interest.

Describe the history of psycho-oncology in Portugal. Research articles and theses related to Psycho-oncology in Portugal and do his description statistics.

Literature review of articles and theses on Psycho-oncology made in Portugal, using the following search engines: “Pubmed”, “Medline”, “ScieloPortugal” and scientific repositories of Portuguese universities.

Until 1997, psycho-oncology did not arouse the interest of researchers; however, since then, the Psycho-oncology has grown exponentially, with regard to the investigation. There was a period of increase in publications between 2005 and 2012 as well as, increase in the number of undergraduate theses, master's and doctorate. Disclosure of publications within the Psycho-oncology lies spread by various magazines in different specialties, demonstrating that this area arouses the interest not only of psychiatrists and psychologists, but also of other health professionals.

Despite growing research in Psycho-oncology and growing interest among clinicians and researchers, there is still some shortcomings, warning that the psychological support is also scarce in some Portuguese institutions.

The authors have not supplied their declaration of competing interest.

In Riga, Latvia, people who have been diagnosed with cancer at various stages, are not offered any group or individual psychological intervention. This applies for the immediate relatives as well.

The aim of the study was to collate a homogenous understanding of the resources and standards of extant practice in psychological needs of patients and their family diagnosed with cancer. Further aims include to identify any deficiencies in the service delivery and make appropriate recommendations.

The collective survey tool is devised to reflect the psychological needs of the aforementioned patients were devised by the authors, one a practicing psychiatrist in UK and the other with background in group work and support in Riga. The tool extended to ask coping skills, understanding, impact on relationship, work and general well-being of patients and carers and their family members alike. The collated survey was distributed and results collated.

The results of the survey indicate number of deficiencies in the organization and service delivery. There is also a huge lack of psychological support to family members who have been affected by a diagnosis of cancer or loss to cancer in the family. We also discuss means of improving service delivery in groups for this sample.

The authors have not supplied their declaration of competing interest.

Nowadays, it is well known that a cancer diagnosis has an important impact on the patient and his family. Given a stressful life event, such as cancer, the family is in crisis, so it is crucial how they facing the process. Two families with different adaptation process at the time of diagnosis are presented and the differences are analyzed.

Family 1: Woman, diagnosis of breast cancer. She lives with her husband and she has two children. Troubled family relationships before the diagnosis. Following the cancer diagnosis, family conflicts increase, both with their children and with her husband. The family is not able to adapt to the new situation and the patient perception is that her family do not care what is happening to her.

Family 2: Woman, diagnosis of breast cancer. She lives with her boyfriend, she has no children. She has a good relationship with her family before the diagnosis, without unresolved conflicts in the past. Since cancer diagnosis the whole family has turned to the patient, being more available for her needs, physically and emotionally. She is feeling supported by them and this is making the adaptation process and family adjustment easier, feeling the patient stronger to cope with illness.

In families with unresolved crisis before the disease, the psychological stress increases after diagnosis. The family finds it difficult to react and adapt to the changes caused by the disease and the relationships between its members deteriorate. Conversely, if the family dynamic is good, it is a positive factor in the recovery.

The authors have not supplied their declaration of competing interest.

For the most part, central nervous system (CNS) tumors present themselves with focal neurologic sing or manifestations resulting from increased intracranial pressure. However, in particular cases, these tumors may present exclusively psychiatric symptoms.

This communication explores importance of CNS tumors as differential diagnosis of various psychiatric disorders.

Highlight the need of acknowledging this important differential diagnosis (CNS tumors) in current psychiatry practice, while presenting a clinical case as an example of the subject.

It is exposed a bibliographic review of the topic, followed by the description of a clinical case regarding a patient with pituitary adenoma and simultaneous installation of psychotic symptoms namely delusional paranoid ideation.

The authors present a case report of a 66-year-old patient admitted compulsively in a Psychiatric ward in the context of behavioral changes associated with delusional ideation of paranoid content. Multidisciplinary assessed by specialties of Psychiatry, Neurology, Neurosurgery, Endocrinology and Psychology, concluded by the presence of nonfunctioning pituitary adenoma associated with cognitive major disturbance.

The tumors of the CNS can be associated with a whole variety of psychiatric symptoms such as psychosis, anxiety, depression or cognitive impairment, even in the absence of organic/neurological symptoms. Its role in the genesis of psychiatric symptomatology makes these neoplasias an important differential diagnosis, whose clinical approach should include different medical specialties integrated as a multidisciplinary team.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Liaison psychiatry is based on a practice that lies on the interface between psychological, sociological and biological factors of illness. Cancer is a devastating disease. For many patients the occurrence of it is synonymous of chronic, severe or lethal outcome. It is important for health professionals to be aware of the psychological suffering of these patients and promote a proper use of specialized consultations in order to increase and improve adherence to treatment.

To make known the reality of referral to a Psycho-Oncology Liaison consult and its context in literature.

Data collection on applications for the 1st request to Psycho-Oncology liaison consults occurred between 2010–2012 in the variables, gender, age, reason for referral, psychiatric history, cancer diagnosis, knowledge of the referral and who does (patient/family/service) and psychiatric diagnosis. Statistical analysis with Microsoft Excel 2010®.

It was found that there were 83 applications during the three years, 24 men and 59 women. The most prevalent cancer diagnoses were breast cancer (29.89%) and colorectal carcinoma (19.28%). Most patients had knowledge of the request (75.9%). The reason was mostly for Anxiety and Depression (33.73%).

Cancer disease coupled with feelings of loss of autonomy, hopelessness and pain can lead the patient to develop psychopathology of anxious-depressive disorders. This condition may hamper the normal recovery of the patient. The promotion of mental well-being in cancer patients is critical to recovery and leads to a better adherence to treatment, inclusive can influence survival.

The authors have not supplied their declaration of competing interest.

The sedation could consist in a therapeutic strategy in advanced cancer conditions.

To study the drugs administered to patients under Palliative Care Sedation (PCS) audits effects on vital signs.

Our retrospective study included 101 oncological patients with mean age of 66.5 ± 13.4 years old and mean weight of 48.5 ± 3.36 kg, under PCS. The data were analysed applying the test of Wilcoxon.

The drugs administered to these patients under PCS were morphine 55 mg/kg/day associated to midazolam 52.5 mg/kg/day (Morph/Midazo) or the association of morphine 55 mg/kg/day, midazolam 52.5 mg/kg/day and neuroleptics such as chlorpromazine 54.5 mg/kg/day or haloperidol 13.25 mg/kg/day (Morph/Midazo/Neurol). The values of vital signs of these patients when the sedation was initiated were: systolic blood pressure 116.55 ± 16.98 mmHg, diastolic bloodpressure73.17 ± 10.55 mmHg, heart rate 83.41 ± 16.25bpm, respiratory rate 19.39 ± 3.97 rpm and body temperature 35.91 ± 0.57 °C. No significant differences between these groups were observed. Vital signs measures were collected 48 hours before the patient's death. Significant reduction in systolic blood pressure 77.5 mmHg, diastolic blood pressure 43.3 mmHg were observed in the group (Morph/Benzo/Neurol). The Wilcoxon test for independent samples to a significance level of 5% we obtain a P-value of 0.01. The sedation period was 2.56 ± 0.23 days.

Neuroleptic, a central nervous system (CNS) depressant drug, when associated to other two depressants (morphine/midazolam), conducted to the patient's vital signs reduction.

Considering the short period of time between the beginning of sedation and the patients’ death; and that palliative sedation should not include the hastening of patients’ death, we suggest a better drug association criteria.

The authors have not supplied their declaration of competing interest.

Emotionally unstable personality disorder (EUPD) is characterised by Pain Paradox. The response for acute, self-induced pain seems to be attenuated while chronic, endogenous pain is usually intolerable. Pain management of this group of patients poses many difficulties, including discrepancies between subjective and objective pain assessment, patients’ demands for strong analgesics and impact on relationship with other professionals.

The purpose of the study was to review pain management options for persons diagnosed with EUPD and complaining of chronic pain.

MEDLINE and PsycINFO databases were searched for all English-language articles containing the keywords “chronic pain”, “pain management”, “borderline personality disorder”, and “emotionally unstable personality disorder”.

Seventeen relevant papers were identified. Suggested first step in pain management was ongoing clarification with EUPD patients that analgesics are unlikely to fully treat their pain and support of non-pharmacological approaches to pain, including cognitive-behavioural strategies. Regarding pharmacology, liberal use of non-addicting analgesics was recommended with highly conservative use of opioid analgesics. Importance of evaluation and treatment of any underlying mood and/or anxiety syndromes was stressed as well as liaison with other professionals (e.g. psychologists, neurologists, orthopaedics, and physiotherapists).

Patients with EUPD often report chronic pain, which can only be managed by close collaboration of professionals from different disciplines.

The authors have not supplied their declaration of competing interest.

About 15–20% of the population suffering from the chronic pain. Over time, chronic pain can result in different emotional problems, social isolation, sleep disturbances, which reduce the quality of life. Chronic pain syndrome (CPS) indicates persistent pain, subjective symptoms in excess of objective findings, associated dysfunctional pain behavious and self-limitation in activities of daily living. Duloxetine is a potent antidepressant approved by the Food and Drug Administration for the chronic musculoskeletal disorder, diabetic neuropathic pain, fibromyalgia, generallized anxiety disorder and major depressive disorder.

To determine the effect of duloxetine on the reduction of pain and psychosocial suffering.

The goal of the treatment should be to effectively reduce pain while improving function and reducing psychosocial suffering.

Thirty-six adult, nondepressed patients, already on tramadol therapy were included. Patients with VAS (visual analogue scale) ≥ 4were treated with duloxetine for 13 weeks. We measured pain intensity with the McGill Pain Questionnaire-Short Form (MPQ-SF) and compared VAS before starting the treatment with duloxetine and weekly for 13 weeks.

Pain response was defined as a 30%decrease in the MPQ-SF. A total of 62.5% of the sample met these criteria for response. Among them, 13.8% of patients were discontinued because of adverse effects. Duloxetine significantly improved functioning and the quality of life in patients with CPS.

Because of it is analgesic properties, duloxetine in the lower antidepressant doses (60 mg taken ones daily) combined with tramadol (another analgesic agent) can be useful in CPS for patients who do not respond satisfactory to monotherapy.

The authors have not supplied their declaration of competing interest.

Understanding of factors related to chronic pain in elderly is limited.

To estimate the prevalence of pain categories based on spreading of pain on the body and to investigate how such spreading is related to demographic variables, pain intensity, comorbidities and medication in an elderly general population in southeastern Sweden.

A total of 6611 adults aged ≥ 65 years participated (mean age = 76.2; SD = 7.4). Pain categories were assessed by a self-reported postal questionnaire covering 45 anatomical predefined pain regions along with demographics, pain intensity during previous seven days, comorbidities and medication. Poisson regression models with robust error variance were used for data analyzing.

The prevalence of pain spreading categories was: chronic local pain (CLP) 16%; chronic regional pain medium (CRP-Medium) 17%; chronic regional pain heavy (CRP-Heavy) 5% and chronic widespread pain (CWSP) 2%. Overall, increased prevalence for CRP-Heavy and CWSP in subjects 75–79 years old compared to those 65–69, 70–74, 80–84 and ≥ 85 years were revealed. In men, 75–79 years old, CRP-Heavy was more common than in the other pain categories. In women, 75–79 years old CWSP, was more common than in the other pain categories. Pain intensity was strongly associated with all pain categories (P < 0.001). CLP was associated with trauma, rheumatoid arthritis, cancer, prescribed and non-prescribed analgesics. CRP-Medium was associated with rheumatoid arthritis, CRP-Heavy with rheumatoid arthritis and lung diseases and CWSP with rheumatoid arthritis and prescribed analgesics (P < 0.001).

Our findings elucidate heterogeneity of pain in elderly which has to be further investigated.

The authors have not supplied their declaration of competing interest.

There is a lack of research on subtypes of chronic pain (CP) characteristics in the elderly.

To scrutinize major subgroups based on pain aspects and psychological factors on an elderly population.

To determine possible differences between the derived subgroups with respect to pain aspects and anxiety-depression symptoms, health aspects and health care costs.

A cross-sectional study was implemented. A large sample of 2300 individuals (M = 75.9 years, SD = 7.4) participated. Self-reported postal measurements regarding pain intensity, spreading of pain, anxiety and depression (General well-being schedule [GWBS]), and pain catastrophizing [PCS]) were used as classification variables. A two-step cluster analysis was employed. We further investigated whether the derived subgroups experienced different quality of life and general health. Calculations regarding health care costs were also performed.

Two major subgroups were identified: one low symptom severity subgroup (Cluster 1; n = 1326; 58%) and one high symptom severity subgroup (Cluster 2; n = 974; 42%). There were statistical significant differences on pain intensity, spreading of pain, anxiety, depression and pain catastrophizing between the two subgroups (P < 0.001). Significant lower levels for quality of life and general health (P < 0.001) were found for the high symptom severity subgroup. Health care costs in the high symptom severity subgroup were significantly higher than those of the low symptom severity subgroup (P < 0.001).

Our findings exhibit the necessity for subgroup-specific treatment services for improving pain management and reducing health care costs in the elderly.

The authors have not supplied their declaration of competing interest.

Ziconotide is a new class of non-opioid analgesic that selectively blocks the neuron-specific (N-type), voltage-gated calcium channels, preventing the release of substance P and calcitonin gene-related peptide.

A literature search was conducted in September 2015 using Pubmed and Scopus databases. No articles speaking about the direct correlation between ziconotide and amnesia were found.

A 56-year-old female patient, in treatment with ziconotide for chronic phantom pain syndrome, reported amnesia and dysgeusia symptoms. No psychiatric pathologies were diagnosed except for the high anxiety state correlated to the amnesia for recent events. The ziconotide treatment was reduced from 2,4 μg/day to 1,5 μg/day. Clonazepam was prescribed to treat the anxiety state. The subject clinical conditions did not require hospitalization.

It is recommended that patients in treatment with ziconotide be monitored for changes in mood, suicidality ideation, thoughts or consciousness. Ziconotide could have serious neurological or psychiatric signs/symptoms (Table 1). Amnesia is a rare side effect of intrathecal administration of ziconotide. Severe psychiatric adverse effects may require ziconotide discontinuation, treatment with psychotropic agents and/or acute hospitalization.

The authors have not supplied their declaration of competing interest.

Maxillofacial surgeons and dentists often (up to 10%) deal with the phenomenon of atypical facial pain (AFP) – painful condition of maxillofacial area without clear organic pathology. Psychiatric studies of this disorder are almost lacking.

The aim of this study was to define psychopathological disorders in patients with AFP and to set up psychopharmacological treatment strategies.

The study used clinical psychopathological and psychometric (Pain measurement scales: Brief Pain Inventory, VAS, Pain Catastrophizing Scale) methods. We included patients with AFP examined in the clinic in December 2014 - September 2015.

Study sample consists of 54 patients with AFP: 45 women (83.3%), 9 men (16.7%), 18-70 years old (39.5 ± 14.7 years). In 67.8% of patients (33 women, 4 men), AFP was associated with affective disorders; among them, recurrent major depressive disorder was verified in 9.2% (4 women, 1 men), single depressive episode – in 33.6% (15 women, 3 man), bipolar II depression – in 3.6% (2 women), cyclothymic disorder – in 7.1% (4 women), dysthymia – in 14.3% (8 women). In 10.8% of patients (6 women), AFP was considered as a symptom of somatoform pain disorder. In 21.4% (6 women, 5 men), AFP was related with schizotypal personality disorder. Psychopharmacological agents used were SSRIs (fluvoxamine, escitalopram), SNRIs (venlafaxine, duloxetine), agomelatine and antipsychotics (quetiapine, amisulpride, alimemazine). The pain subsides in 87,04% of patients and the severity of pain decreased in 12.96% of patients.

Patients with AFP should be examined by psychiatrist in order to determine psychopathological disorders and to elaborate psychopharmacological treatment strategies.

The authors have not supplied their declaration of competing interest.