Given the profound life changing event that having a child represents, women are at an increased risk of developing psychiatric illness during the postpartum period. Although postpartum depression and psychosis have been widely studied, postpartum onset obsessive compulsive-disorder (OCD) seems to be an overlooked condition, remaining many times undiagnosed and untreated.

Objectives/Aims

This work aims to review the prevalence, clinical features and characteristics of postpartum onset OCD.

A review of relevant literature was conducted alongside online database research (PubMed and Medscape).

In postpartum onset OCD obsessions are typically related to the baby and include: fear of intentionally or accidentally harm the newborn, fear of contamination, obsessions of symmetry/exactness, aggression and religiousness. These intrusive and obsessional thoughts, especially aggressive obsessions, create great distress and fear on acting on them.

To relieve the anxiety common compulsions include: avoiding taking care of the baby, repetitive and ritualistic washing, checking, ordering, counting, reassurance seeking, and praying.

The lifetime prevalence of OCD in general population is about 2 – 3%, however the prevalence of postpartum onset OCD is not known.

Further investigation is necessary to clarify the epidemiology, risk factors, and clinical course of postpartum OCD. Is it crucial to reassure parents that these intrusive thoughts are frequent, and do not translate any unconscious desires.

These symptoms should be screened appropriately and identified in the early postpartum period, in order to reduce the associated distress, family dysfunction, and the negative impact in the mother-infant bonding.

The association between obsessive-compulsive disorder (OCD) or symptoms (OCS) and schizophrenia has been accounted in literature for more than hundred years. Early conceptions stated that OCD could be a 'neurotic defence' or a protection against incipient psychosis. In spite of that, during many decades both pathologies were held as unrelated, namely because their phenomenological differences and because only few cases of OCD developed into psychosis. Nevertheless, OCS are present in many cases of schizophrenia, sometimes as first symptoms. Recently the hypothesis of OCD and schizophrenia being related is seen with more plausibility since they share same neurobiological pathways. Intrusive thoughts and delusions may form a continuum making, perhaps, OCD and schizophrenia two extremes of a spectrum.

To preform a non-systematic review about the relation of OCD with schizophrenia

Search for literature about the topic in PubMed using 'OCD AND schizophrenia' as keywords

OCD and schizophrenia co-morbidity has a prevalence six times higher than expected. OCD could be present in a psychotic prodrome. In some studies, both pathologies appeared to be risk factors for the development of each other. Moreover they appear to share some neurobiological correlates and neuropsychological aspects.

OCD and schizophrenia could be correlated and may be at extreme points of a spectrum of pathologies with intermediate clinical manifestations.

Difficulties in controlling symptoms such as pain, breathlessness or delirium in palliative care patients, may require sedation as therapeutic strategy.

To study the drugs administered to patients under Palliative Care Sedation (PCS) and its possible side effects.

Our retrospective study included 40 oncological patients with mean age of 69+14.12 years old, under PCS.

Morphine 0.35mg/kg/day, administered to 22,5% (9) patients, caused reduction of systolic blood pressure in 23.61%, diastolic blood pressure in 27.08%, heart rate in 6.09%, body temperature in 2.59%, respiratory rate in 18.26%. Morphine 0.35mg/kg/day associated with midazolam 0.42mg/kg/day, given to 35%(14) patients, caused reduction of systolic blood pressure in 24.63%, diastolic blood pressure in 27.58%, heart rate in 1.56%, body temperature in 1.58%, respiratory rate in 27.66%. The association of chlorpromazine 0.62mg/kg/day to morphine 0.35mg/kg/day and midazolam 0.42mg/kg/day administered to 42,5% (17) patients, also caused reduction of systolic blood pressure in 22.38%, diastolic blood pressure 20.00%, body temperature 1.79%, respiratory rate 22.00%, but the heart rate increased in 15.88%. The variations of vital signs were obtained by records registered right before the palliative care sedation had initiated and the values recorded in patients’ last day of life. The sedation period was 2,40+0,23days.

The association of neuroleptics could conduct to extrapyramidal motor agitation, in this case of deeply sedated patients it could be signed by the incresase of the heart rate. 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.

Nosogenic (related to stress) dissociative disorders (NDD) induced by cancer are of high prevalence and may be associated with poor compliance. However till now NDD in oncology have been studied predominantly in the context of psychological (denial) or behavioral (procrastination in seeking medical help) paradigm.

Clinical psychiatric assessment of oncological stress induced NDD and personality disorders as a basis for NDD manifestation and phenomenological differentiation.

20 oncology patients with NDD given informed consent were selected according to binary model of dissociation – detachment-dissociation (DD) and compartment-dissociation (CD), assessed using psychiatric interview (10 patients per group).

Key clinical features of NDD studied were as follows: DD – negation of the fact of cancer and/or its life threatening nature, non-compliance (complete/partial rejection of medical help); CD - negation (complete/partial) of emotional and/or cognitive components of stress reaction, good compliance. In all cases studied NDDs were presented as secondary psychopathological phenomena. DD is manifesting on the basis of overvalued ideas of full somatic well-being in schizophrenic nosogenic reactions in patients with schizotypal PD. CD is manifesting with binary structure (anti-hypochondria with 'la belle indifference” behavior in front and illness anxiety behind) in neurotic nosogenic reactions in patients with hysterical PD features.

Nosogenic dissociative disorders in oncology patients are clinically and behaviorally (in terms of compliance) heterogenous, may influence cancer outcome (especially DD type - procrastination in seeking medical help) and deserve further clinical research to clarify their symptomatology and elaborate matching methods of therapy.

Confrontation with cancer is emotionally challenging in patients. Interestingly, depressed metastatic breast cancer patients show blunted cortisol awakening responses and reduced respiratory sinus arrhythmia, reflecting a physiologic profile often associated with chronic stress. These endocrine changes could alter immune defense mechanisms or act directly on tumor metabolism affecting cancer progression.

Explore the relationship between perceived stress, depression symptoms, neuroendocrine and immune function and cancer progression in breast cancer patients

Elucidate the mechanisms translating psychosocial conditions and lifestyles into individual risk factors for cancer growth and recurrence, allowing the delivery of biomarkers for disease prevention.

Cortisol was assessed in the saliva 30 days after surgery and at months 6 and 12 after chemotherapy. On the same days serum Brain-derived Neurotrophic Factor (BDNF) levels, cytokines (TNF-α, IL-1, IL-6), Cytochrome C, estradiol, IGF-1, leptin, adiponectin, anti-estrogen receptors α and β antibodies was measured and psychological tests administered to assess depressive symptoms, coping style and anxiety.

After six months of chemotherapy, patients showed increased levels of depression as well as plasma cortisol and serum chemokine MIP-1b LFA-IV-, which has not only a tumor-promoting role but also is directly related with a poor prognosis. Interestingly, we found cortisol and depression levels grown up at 12 months follow-up.

Preliminary data indicate that psychological factors can affect physiological responses in breast cancer patients. This is especially relevant since stressful events and negative affective states can amplify the consequences of the pathology precipitating disease progression and promoting recurrence.

The impact of the diagnosis of an oncologic disease is well-known in terms of psychological adjustment and quality of life. On the other hand it is known that depressive symptoms may also overlap the physical symptoms of cancer and cancer treatment, which may interfere in their detection and appropriate treatment approach.

The aim of the current study was to explore the relationship between psychological adjustment to lung cancer, self-compassion, social support and emotional negative states in patients with lung cancer.

Fifty-five patients diagnosed with lung cancer (38 men and 17 women) with ages ranging from 44 to 87 years old participated in the study. A set of self-report instruments was used: the Mini Mental Adjustment to Cancer Scale (MiniMac), the Self-compassion Scale (SCS; Neff, 2003), the Social Support Satisfaction Scale (SSSS) and the Depression, Anxiety and Stress Scale (DASS-21).

Significant correlations were found between psychological adjustment and emotion regulation strategies (self-compassion), social support and psychopathology. The predictive model for depressive symptomatology and psychological adjustment (as assessed by the helpless/hopeless dimension) includes mindfulness as a significant predictor. Regarding the predictive model for stress, the satisfaction level with support from friends revealed to be an important element.

Our findings suggest that these patients may benefit, in their therapeutic approach, from the development of this kind of strategies (new ways of relating themselves with their emotional experiences and quality of their social networks) in order to promote a better psychological adjustment to their clinical condition.

Brain tumors (BT) sometimes present with psychiatric symptoms, with or without neurological ones, and BT patients with psychiatric symptoms are sometimes mistakenly oriented towards psychiatric/psychological care. Case studies concluded that atypical psychiatric symptoms should lead to neurological investigation, but no description of such atypical symptoms has been provided.

The present study aims to quantify the prevalence and further describe psychiatric symptoms occurring before a BT diagnosis.

We aim to sensitize physicians to consider more systematically neurological options, and to provide them with a description of atypical pattern of psychiatric symptoms occurring in patients with BT.

Fifty patients with a first diagnosis of BT (21 males and 29 females, aged 25-81 years) completed an anamnestic interview, the Mini International Neuropsychiatric Interview, and the Beck Depression Inventory (BDI-II), in order to investigate and describe current and past psychiatric symptoms. A neuropsychological evaluation was also conducted.

Most patients (45/50) reported at least one psychiatric symptom during the months before the BT diagnosis. About half of them presented anxious or depressive symptoms according to the clinical interviews and the BDI-II. Interestingly, somatic symptoms of depression (tiredness, slower reactions, appetite changes…) were often reported, in contrast to cognitive ones (guilt, self-criticalness…). The influence of the BT characteristics and the neuropsychological profile will be discussed.

The results confirm the frequent occurrence of psychiatric symptoms before a BT diagnosis and provide a first description of these symptoms, as the basis of future recommendations for physicians.

Pain is a personal experience that widely varies between people and even within an individual. It dependson numerous factors which can change over the time. The psychological state of the person, such as cognitive and emotional factors, has an important influence on pain perception. In chronic pain it can occur anatomical and functional alterations in regions involved both in pain control and cognitive or emotional functioning.

The authors aim to clarify the role of cognition and emotion in pain modulation and its disruption in chronic pain.

Literature review in PubMed database using the following key words: 'pain”, 'chronic pain”, 'pain modulation”,'emotion” and 'cognition”.

Recent studies demonstrate that cognitive – attentional variations – and emotional factors can modulate pain perception. The attentional state changes the perceived intensity of pain, while emotional state changes the perceived unpleasantness of the pain without changing its intensity. Such evidence takes usback to that cognition and emotion modulates pain by different mechanisms. Emotional state activates anterior cingulatecortex, prefrontal cortex and periaqueductal gray. On the other hand, attention activates projections from the superiorparietal lobe to the primary somatosensory cortex and insula. Cross-sectional studies have demonstrated that chronicpain can change these modulatory pathways.

Despite the personal and interpersonal differences in pain perception, it is established that cognitive and emotional factors are important in pain modulation and perception. However, in chronic pain there are changes in these mechanisms which need to be clarified.

There have been lots of psychological studies on the difference between the West and East; however, it was mainly focused on the cultural and social outlook rather than the personality perspective of the individuals. The difference in personality construct between the West and East needs to be examined with objective and validated instruments.

We used Temperament and Character Inventory (TCI) and NEO Personality Inventory (NEO-PI) along with Sasang Personality Questionnaire (SPQ). SPQ measures the psychological traits with three subscales of behavior (SPQ-B), cognition (SPQ-C) and emotionality (SPQ-E) based on the Yin-Yang and traditional Korean medicine. We analyzed the correlation between TCI, NEO-PI and SPQ with 104 college students in Korea (age, 28.8±4.8; male/female, 52/52).

The personality structure of SPQ showed distinctive features with emotionality (SPQ-E) which generally perceived as concurrent with behavior and cognition. SPQ-B/SPQ-C were correlated negatively with TCI Harm-Avoidance (r=-0.542 and -0.387) and NEO-PI Neuroticism (r=-0.285 and -0.340), however SPQ-E positively with Harm-Avoidance (r=0.283) and NEO-PI Neuroticism (r=0.398). In addition, SPQ-B/SPQ-C were correlated positively with TCI Novelty-Seeking (r=0.355 and 0.369) and NEO-PI Extraversion (r=0.67, 0.283), but SPQ-E not significant with them.

The disparities in personality construct might be originated from difference in the definition of emotionality; the West accentuates the emotional stability, however the East emphasizes the level of emotional activity. We discussed the implication of these from the cross-cultural personality studies.

Narcissistic pathology and its presentation has been a part of our cultural heritage since times immemorial. Aside from the myth of Narcissus, the narcissistic bipolar self and its constant pain which arises from disharmony of mental representations of actual and the ideal self can be found in folk tales, written literature, films and even definitions of the present society. Shiva, Dr. Jekyll &Mr. Hide, Kent Clark& Superman are just a few examples of the above mentioned dichotomy of impotence and power, of fragile and grandiose self. Sometimes the sense of entitlement and unrealistic goals results in failure and uncontrollable aggresion, which often includes rebellious and manipulative suicidal behaviour.

Exploring the types of defence mechanisms used by therapists dealing with narcissistic patients and their agressive behaviour.

Presenting the diversity of possible clinicians' emotional responses and in parallel raising awareness of deficient literature and lack of quantitative studies on that matter

Case presentation of a 40-year-old narcissistic patient with manipulative behaviour and suicidal threats, including a range of personal responses of the involved members of our team in addition to integrative psychopharmacological and psychodynamic approach.

Several clinician-focused researches and our own experience indicate the provocation of various emotions and defense mechanisms, which consequently may alter the treatment efficacy.

The awareness of one’s spontaneous emotional reactions to a patient may be useful in understanding the patient’s intrapsychic dynamics, thereby considered as an important factor in therapeutic alliance and treatment outcome.

Borderline personality disorder is associated with numerous symptoms that interfere with interpersonal relationships. Both mental health professionals and the general population often think negatively about patients suffering from this disorder, which may worsen the creation and maintenance of the supporting therapeutic relationship.

Research and review articles were identified using the Web of Science, Medline and Scopus. Keywords were represented byterms 'borderline”, 'stigma”, 'internalized stigma”, 'therapy”, 'treatment”, 'psychotherapy” and 'psychosocial treatment”.

Psychiatric staff´s opinions on the patients with personality disorders are strongly judgemental and stereotypic. Mental healthprofessionals stigmatize the patients with borderline personality disorder even more frequently than the general population does. The rule is that there is a conviction about incurability of the disorder, manipulative nature of self-mutilation or other symptoms, and thestrong traits of the patient are overlooked. The considerable percentage of medics tries to avoid the contact with these patients. Thesereactions partly arise from the patient’s real maladaptive behaviour; however they are partly the result of prejudice, negative stereotypes and unprocessed countertransference. Negative attitudes of medics lead to the marginalization of patients with borderline personality disorder within the health care system.

The health professionals often negatively and stereotypically evaluate the patients with borderline personality disorder, which can lead to an increase of maladaptive symptoms and worsening of treatment effectiveness in these patients.

Pathological narcissism has been a subject of scientific debates in recent years, with a growing recognition of two phenotypic forms, grandiosity and vulnerability. Because of the lack of consensus on the nature of grandiose and vulnerable narcissism, one way to develop a cohesive literature on pathological narcissism is to investigate it using dimensional models of general personality.

The goal of the present study was to investigate similarities and differences in the relations of narcissistic grandiosity and vulnerability within the Cloninger’s Psychobiological model of temperament and character.

A sample of 801 Hungarian adults (72% female; mean age 23.85 years), mostly graduate students, was gathered using a convenience sampling method. The participants completed the Pathological Narcissism Inventory (PNI) and the Temperament and Character Inventory – 60 (TCI-60).

Narcissistic vulnerability exhibited positive correlations with temperament dimensions Harm avoidance and Novelty seeking and a negative correlation with Reward Dependence, whereas narcissistic grandiosity was positively correlated with Novelty seeking and Persistence. Both features of narcissism had negative correlations with character dimensions Cooperativeness and Self-directedness. However, hierarchical regression analyses demonstrated unique negative associations between narcissistic vulnerability and the abovementioned character dimensions, whereas their relations with grandiosity were non-significant.

There are various differences in the relations between grandiose and vulnerable narcissism and the seven dimensions of temperament and character. Given that the Cloninger’s model delineates both the core features and distinguishing features of personality disorders, our findings might facilitate more nuanced understanding of pathological narcissism and its more valid diagnostic classifications.

The occurrence of both civilian- and war-related post-traumatic stress disorder (PTSD) is related to greater frequency of suicidal thoughts and behaviors. Understanding factors present within individuals with PTSD that increase suicide risk may inform prevention efforts.

The present study aimed to determine whether the dimensions of temperament and character, derived from Cloninger's psychobiological model of personality, are associated with various aspects of suicidality (i.e., lifetime suicidality, suicidal ideation over the past 12 months, threat of suicide attempt, and risk for future suicidal behavior) among patients with PTSD.

A sample of 67 psychiatric outpatients treated for either civilian- or war-related PTSD (68% male; mean age 45.52 years) completed the Temperament and Character Inventory - Revised (TCI-R) and the Suicidal Behaviors Questionnaire - Revised (SBQ-R).

Zero-order analyses revealed that temperament dimension Harm avoidance and character dimension Self-directedness were moderately associated with the total risk for suicide (i.e., the SBQ-R total score), while Persistence and Cooperativeness showed significant but weaker relations. Different dimensions of suicidality were associated with different personality traits. Character dimension Self-transcendence was shown by linear regression to be uniquely and positively related to the total risk for suicide.

Notwithstanding some limitations of this study, such as relatively small sample size and heterogeneous types of trauma, these findings should help extend our understanding of the elevated suicide risk in PTSD. There is a need for detailed assessment of personality traits in order to facilitate prevention of various aspects of suicidality in this population.

environmental factors and features of parental behavior undoubtedly play a significant role in the development of personality disorders in children and adolescents.

Study of patients with personality disorders (PDs) in families without alcohol abuse (AA) and in families with alcohol abuse.

performed a comparative catamnestic study of 198 young people whom at the time of the psychiatric and general health examinations before joining the army were diagnosed PDs. In families, not abusing alcohol (FNAA) were identified 119 PDs, in families regularly abusing alcohol (FAA) were examined 79 PDs. Statistical study was conducted by the following characteristics: the abuse of alcohol, substance abuse, drug use, drives to the police for disorderly conduct and drinking alcohol in public places, crime activity. Used ×2-test and Student's test.

were studied difference in age of onset criminal activity: 18,6 ± 3,1 years old in the FNAA group and 17,1 ± 3,2 years old and FAA (p<0.05). There was a large proportion of AA in patients with PDs 49 (62%) PDs at the moment of research in the group FAA compared with group, where parents do not abuse alcohol - 56 (47%) (p<0,05). Also observed differences in numbers of police detentions for drinking alcohol: 33 (28%) in the first group and 41 (52%) - in the second (p <0,001).

By the other characteristics the differences between the groups weren't detected.

in the group of parents who abuse alcohol in next generation marked AA and involvement in criminal activity in earlier age.