Genital pain is a heterogeneous chronic pain condition and the relationship between biological, psychological and social factors sets a complex clinical challenge. The importance of negative thoughts and emotions has opened up an opportunity for the role of third generation cognitive-behavioral therapies (CBT). While the majority of evidence revolves around female sexual desire and arousal problems, research on genital pain disorders is beginning to take shape.

To review the evidence of third generation CBT on genital pain disorder.

Review of literature using the Pubmed platform.

We identified 21 publications. Evidence shows that mindfulness-based CBT (MbCBT) improves reduction of fear linked to sexual activity, pain acceptance, catastrophizing and decentering. MbCBT shows significant improvements on secondary outcomes (overall sexual function, sexual satisfaction, depression and anxiety) while reduction of genital pain has yielded contradictory results. Acceptance and commitment therapy (ACT) has been studied for chronic pain disorders with improvements on pain acceptance, psychological flexibility, anxiety, depression and functioning. Compassion-focused therapy (CFT) has yielded favorable results on pain distress and intensity, self-efficacy, self-acceptance, anxiety and depression. Self-compassion may be a promising protective factor in genital pain. Both ACT and CFT have not yet been studied specifically for genital pain.

Third generation CBT are most commonly used for depressive, anxiety and chronic pain disorders which signals the logical role that these interventions may have in genital pain. While MbCBT has started to present favorable results in treating genital pain (as well other sexual problems), ACT and CFT require more research.

In mental health nursing, the therapeutic relationship is central to the care process, since the restoration of the balance of the person in mental suffering relies on significant interpersonal relationships.

This scoping review aims to map which personal qualities of the nurse favor the therapeutic relationship in mental health nursing.

A question was formulated according to the PICo method: What are the nurse’s personal qualities that benefit the therapeutic relationship with the patient in mental health settings? For the selection of studies were used the following databases: Cochrane Database of Systematic Reviews; CINAHL; MEDLINE. A survey was carried out, with the following Boolean conjugation (nurse AND patient) and (personal AND qualities) and (mental AND health) and (therapeutic relation OR relation*). The limit applied to this research was the full text.

A total of 12 studies were analyzed. These are predominantly qualitative with different methodological approaches. The nurse’s personal attributes or qualities imply not making judgments, be patient, be open and genuine. It was also evidenced the importance of the professional and personal dimensions in the therapeutic relationship.

In all studies, it was clear that the therapeutic relationship is influenced by attributes of the professional dimension that are linked, mainly, with the theoretical domain, technical knowledge and by attributes of the personal dimension that are related with the professional’s personal qualities or characteristics. The strategies used for the development of the therapeutic relationship imply the involvement of the person nurse, using this to elements of the personal and social sphere.

No significant relationships.

Social anxiety disorder (SAD) typically develops during late childhood or early adolescence, and often runs a chronic course if left untreated. Maladaptive processing of social information has been suggested to contribute to the etiology and maintenance of SAD. Scanpaths are a succession of visual fixations and saccades through which individuals extract information during face perception. Atypically long scanpaths have previously been reported in adults with SAD but no studies have been conducted on youth samples. SAD has previously also been linked to atypical arousal during face processing.

This study aimed to investigate differences in visual attention and arousal to emotional faces comparing children and adolescents with SAD to a non-psychiatric population of youths.

In one of the largest eye-tracking studies of pediatric SAD to date, children and adolescents with SAD (n = 62) and healthy controls (n = 39) completed a task where they were meant to recognise different emotional expressions in pictures of faces while their eye movements were recorded. The visual scanpath and the pupil dilation response were examined.

Youth with SAD showed restricted scanpaths, suggesting they scanned a more limited part of the face during face perception. Higher pupil dilation was also observed in the children and adolescents with SAD.

The restricted pattern of scanpath observed in youth with SAD is contrary to findings among adults, but similar to what has been reported in neurodevelopmental disorders associated with social interaction impairments such as autism. Restricted scanpaths may partially contribute to the maintencance of social anxiety disorder.

No significant relationships.

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is an inherited disease caused by mutations in the Notch3 gene in chromosome 19.The clinical features are primarily neurological, which include recurrent transient ischaemic attacks, strokes, and migraines.However, psychiatric manifestations such as severe depression, psychosis, changes in behavior and personality have also been reported in CADASIL. Symptoms and disease onset vary widely, with signs typically appearing in the mid-30s.Some individuals may not show signs of the disease until later in life.

In this case report, we present a possible case of CADASIL, a 67-year old female patient diagnosed with schizophrenia fifteen years ago to discuss the co-occurrence of these conditions in the light of the literature.

Hospitalization records of the patient viewed.

Our patient suffered from sleep disturbances, hearing religious voices and in psychiatric examination resistant to treatment psychotic symptoms such as blunted affect, mystic, persecutory delusions, auditory hallucinations were present.Cranial magnetic resonance imaging scan was performed and revealed leukoencephalopathy, high-signal intensity lesions in the periventricular white matter consistent with a diagnosis of CADASIL.Atypical antipsychotics found to be effective in treating psychotic symptoms in our case.

Persistent psychotic symptoms despite adequate antipsychotic treatment in patients diagnosed with schizophrenia, also with pathological findings in MRI an organic cause such as CADASIL must be considered. Further studies are needed to better understand the exact impacts of cerebral tissue lesions and psychiatric symptoms in CADASIL patients.

No significant relationships.

Depression in the elderly represents a major public health problem, due to its high prevalence and its deleterious consequences in terms of morbidity and mortality, in particular by suicide.

1-Draw up the socio-demographic and clinical profile of elderly patients hospitalized in psychiatry for a major depressive episode 2-Determine the semiological and therapeutic characteristics of depression in the elderly.

Participants were outpatients of Psychiatry B department in Hedi chaker University Hospital Center in Tunisia, over the age of 65, hospitalized in psychiatry for a major depressive episode, recruted between 2000 and 2015. The data was collected using a pre-established sheet containing socio-demographic information, the clinical and evolutionary characteristics of the depressive episode and the therapeutic data concerning the depressive episode.

30 patients were included in this study with an average age (69 Y) and sex ratio (0.66). More than half (53.3%, 16 patients) had a history of chronic somatic disease. The average length of hospitalization was 26 days. The most frequent reason for hospitalization is sadness of mood (43.3%) with cognitive impairment as the predominant clinical symptomatology (40%). 93.3% of the population received as treatment an antidepressant mainly Fluoxetine (50%).

Depression and its different modes of expression in the elderly is a serious condition with direct effects on quality of life. Early detection is desirable in order to set up appropriate management, and thus prevent the occurrence of complications such as suicide.

The relevance of this research is determined by the fact that an important scientific task of the modern clinical classification of mental disorders is the productive combination of the most valuable for the practical use of categorial and dimensional (in terms of the weight and depth of each dimensia) of the characteristics in in a particular clinical picture of a disease.

The goal of the research is to validate the new categorical-dimensional criteria necessary for the verification of schizotypal disorder.

The information base of the research included medical data on 150 patients with schizotypal disorder. Categorical characteristic used according to the systematics of schizotypal disorder (Kotsiubinskii A.P, 2018) published in the National Guide «Psychiatry», which includes the following syndromes: obsessive-phobic, dysmorphophobic, non-delusional hypochondria, heboid, histrionophoric, impulsive-dysfunctional, schizoaffective, dissociative-disintegrative, autistic, dismotivative, amotivative. Our systematics was used with following demensia: positive, affective, negative, cognitive, disordered behavior, dissociative and coenestesipatic. Guided by the principle of five-level representation of each dimensia (from «0» to «4») in accordance with DSM-V and the informative systematics of dimensia was developed with each of dimensia also has rate from «0» to «4».

This diagnostic approach made it possible to correlate the categorial and dimensional characteristics, both to each other and to the criteria of the condition of the patients’ state with the prototype of schizotypal disorder (in the range of «1» to «5»).

This has made it possible to more accurately diagnose non-psychotic forms of mental illness, in particular: differentiate schizotypal disorder «sui generis» and schizotypal personality disorder.

No significant relationships.

Psoriasis is a chronic inflammatory skin disease that affects approximately 2% of the population. It seems to have a multifactorial aetiology and it can be considered as a psychosomatic disorder.

To determine risk factors for anxiety and depression in psoriasis

Case-control study including 44 subjects with psoriasis and 50 controls without psoriasis. All participants answered the Hospital Anxiety and Depression Scale (HADS) to measure the severity of anxiety and depression

Descriptive study: We solicited 44 patients and the average age was 45.8 years. The majority of patients were married (70.5%), unemployed (40.5%), without medical heredity (84,6%). Psoriasis was in plaque (65.9%), guttate (20.5%), pustular (13.6.5%).Its severity, assessed by BSA, was mild to moderate in 72.7% of cases and associated arthropathy was noted in 29.5% of patients.the prevalences of anxiety and depression estimated at 29.54% and 18.18% respectively. Analytical study: Subjects with psoriasis, as opposed to controls, showed higher levels of anxiety (29,54% vs 15,9%) and depression (18,18% vs 4,54%) but there was no significant difference (p=0,335, p=0,573) Depression was significantly more important for single (p=0.043), for patients with associated arthropathy (=0.005) and for guttate form (p=0.015) According to the severity of the disease: patients with mild disease are more anxious and patients with severe disease are more depressed

Higher scores in anxiety and depression is common in psoriasis. Dermatologists should give special attention to this subgroup of persons with psoriasis in order to prevent future psychopathology.

We all have the innate ability to tell our story and the way we do it can determine the impact that each problem has on our lives. Storytelling can play a critical role in psychiatric practice and, from this premise, a new way of practicing psychiatry has recently emerged: narrative psychiatry.

The objective is to offer a unified vision of narrative psychiatry, providing details on the historical and academic context of this approach.

A narrative-type literary review focused on narrative psychiatry will be presented.

Narrative psychiatry is an innovative clinical approach in line within narrative medicine and with a specific subtype of postmodern psychotherapy, the narrative therapy of Michael White and David Epston. This novel way of practicing psychiatry arises from critical movements within the discipline but it is an integrative and collaborative perspective: the position of each problem in the patient’s personal narrative is discussed and different therapeutic proposals are addressed, including for instance psychotropic drugs. This integrative posture gives the narrative psychiatrist enough flexibility to equally integrate the scientific achievements of biological psychiatry and the humanizing component of narrative practice. In this literature review, the key tools proposed by the main narrative psychiatrists worldwide for the narrative clinical interview will be exposed.

Narrative psychiatry is a novel approach that narrows the therapeutic relationship and that puts in evidence the history of resistance of the consultant, healing through its own storytelling.

Patients diagnosed with vascular dementia often present with apathy, executive dysfunction or/and memory impairment. Some of these psychiatric domains are not responsive to antidepressants or acetylcholinesterase inhibitors. Since methylphenidate enhances frontal lobe function, it may be a valid therapeutic option.

To report a case where methylphenidate was used as a therapeutic approach in vascular dementia.

We present a case of a patient diagnosed with vascular dementia with substantial clinical improvement after treatment with methylphenidate.

A 67 year-old male was observed in a psychiatric consultation reporting memory loss, inability to retain information and inattention. According to her spouse, the patient has been mostly isolated at home and recently he has become unable to accomplish some daily living activities. There was no history of previous psychiatric disorder. Cognitive assessment was performed using MoCA test: 19/30 points (predominantly in executive, attention and delayed recall domains). After this evaluation, it was introduced bupropion 150mg od and donepezil 5mg od with insignificant clinical improvement. The patient underwent a routine workup which was unremarkable and a brain computed tomography scan that revealed ischemic leukoencephalopathy. Three months later no clinical benefit was reported. Attention and functional improvement were observed after introduction of methylphenidate with progressive dose adjusting till 30 mg/day.

Besides not being a consensual therapeutic approach, considering that there is a lack of efficient pharmacological strategies in vascular dementia, methylphenidate may play a significant role in this field contributing to clinical improving and ultimately to an enhanced quality of life.

In spite of the historically consolidated psychopathological perspective, neuroscientific research applied to schizophrenia has so far almost entirely neglected the first-person experiential dimension of this syndrome, mainly focusing on higher-order cognitive functions such as executive function, working memory, theory of mind, and the like. An alternative view posits that schizophrenia is a self-disorder characterized by anomalous self-experience and awareness. This view may not only shed new light on the psychopathological features of psychosis but also inspire empirical research targeting the bodily and neurobiological changes underpinning this disorder. Recent empirical evidence on the neurobiological basis of a minimal notion of the self, the bodily self, will be presented. The relationship between the body, its motor potentialities and the notion of minimal self will be illustrated. I will posit that this approach can shed new light on the self-disturbances and social deficits characterizing schizophrenia. I will propose that cognitive neuroscience can today address classic topics of psychopathology by adding a new level of description, finally enabling the correlation between the first-person experiential aspects of psychiatric diseases and their neurobiological roots. To this purpose, I’ll describe putative neural mechanisms underpinning the blurring of self-other distinction in schizophrenic patients. I will posit that brain function anomalies of multisensory integration, differential processing of self- and other-related bodily information, mediating self-experience, might be at the basis of the imbalance in the pre-reflective relationship of the embodied self to the social world observed in schizophrenia.

No significant relationships.

In a serial compound conditioning paradigm, a sequence of several conditioned stimuli (CS) is predictive to an unconditioned stimulus (US) (e.g., CSA->CSB->US). Animal research showed that, when the US is aversive, CSA elicits the strongest conditioned response, while CSB appears redundant. These effects of primacy and proximity have never been investigated in humans.

To study the effects of temporal proximity of imminent threat and safety in serial compound conditioning.

Twenty-two participants were presented with sequences [CSA->CSB->CSC->CSD]. In 55 trials all four CS were identical vowels (e.g, [oh]), and no US was presented. In the other 55 trials, the CSA was different (CSA+, e.g., [uh]), and the CSD was followed by an electrical shock (US) 2.5 times higher than the individual pain threshold.

No ERP component distinguished between CS- and CS+ for the first three stimuli in the sequence (i.e., CSA, CSB, CSC). The last CS (CSD) elicited a strong fronto-central CNV only when it was followed by US. Moreover, already after the CSA- (which signalized that no shock would be presented on that trial) the power of alpha oscillations over the somatosensory cortex significantly increased, particularly on the side contralateral to the hand that was electrically stimulated on US trials. The alpha increment lasted up to the onset of the US.

The data indicate two possible mechanisms of adjustment to predictable threat, one of which relies on safety signals (manifested in alpha increment), and the other is related to flight response (manifested in the CNV immediately preceding the shock).

Mental health problems are frequent among children and seems to predict mental disorders in adulthood.

The study aimed whether the gender differences affects the Strengths and Difficulties Questionnaire (SDQ) assessments performed by parents and teachers in Republic of Georgia.

In 2019 a cross sectional survey in four main cities of Georgia was conducted; Totally 8-10 y old 16654 children from 211 public schools were included. SDQ completed by parents and school teachers was used to determine emotional and behavioral problems among Georgian children.

16654 (74%) parents out of 22553 were agreed to participate in the study. 1565 (9.39%) children were rated screen positive in top five percentile by either parent or teacher or both of them. Cut-off scores for 99-95 percentiles (top 1-5%) was defined. Boys were more likely to be rated screen positive than girls, especially by teachers: parents rated screen positive 7.5% of females, teachers - 7.2%, while males 9.4% and 11.5% respectively. Pairwise correlation coefficients (0.53) revealed moderate correlations according to p-values (< 0.05) between scores and all correlations were statistically significant.

The study defined the cut-off scores of SDQ for 8-10 y old children and a gender differences in prevalence of mental health problems in Georgia. SDQ could be used in primary healthcare and school settings to identify children with special needs. This work was supported by Shota Rustaveli National Science Foundation of Georgia (SRNSFG), grant - FR-18-304.

No significant relationships.

Literature shows overlapping alterations in brain structure in Attention-deficit/Hyperactivity Disorder (ADHD) and substance use disorder (SUD), suggesting shared pathophysiological mechanisms. It is unclear to what extent family history (trait) effects and/or substance misuse (state) effects explain the observed overlap.

Our aim was to examine the effects of (i) SUD family history (FH) and (ii) substance misuse on brain structure in ADHD.

We compared structural MRI data (cortical thickness; subcortical volumes) between (i) ADHD subjects and controls with or without FH (ADHD-FH+: n=139; ADHD-FH-: n=86; controls-FH+: n=60; controls-FH-: n=74), and (ii) FH-matched ADHD groups with and without substance misuse and controls (ADHD+SM, ADHD-only and controls, n=68 per group). Furthermore, we explored whether FH effects were more pronounced in subjects with SUD in both parents (n=63) compared to subjects with one SUD parent (n=105) and without FH (n=160).

There was no main FH effect on brain structure. ADHD+SM showed decreased CT in inferior frontal gyrus (IFG) compared to controls, while no difference was found between ADHD-only and ADHD+SM or controls. Subjects with SUD in both parents showed decreased thickness of IFG and volume of nucleus accumbens (NAcc), compared to those with one SUD parent.

Substance misuse in ADHD might result in smaller IFG, which is in line with findings in SUD-literature. A contribution of premorbid alterations, due to FH, could not be ruled out, particularly for IFG thickness. Future studies should further investigate the potential role of these regions in treatment and prevention strategies.

No significant relationships.

Currently, alcohol dependence is characterized by immediate onset of dipsomania states (code F10.26, ICD-10) interpreted in clinical addictology as reliable diagnostic signs of morbid alcohol dependence. These are classified clinically by rate, severity, therapeutically resistant post alcohol comorbidities (alcohol-induced polyneuropathy, hepatic dysfunctions, etc.), and by the presence of “lucid spaces”, when patients, depleted physically and mentally by hypertoxic alcohol abuse states, periodically (after binge drinking) intake no alcohol.

Effectiveness improvement and reducing time of treatment for hypertoxic alcohol abuse states by reasonable pathogenetic use of highly effective drugs, wide polymodality and synergistic pharmacological range, with few side effects, potential for inclusion to the conventional standard treatment patterns according to thiamine concepts.

Valid clinical-diagnostic, laboratory, biochemical, electrophysiological, psychological (scaling, testing), statistical methods for identification of alcohol dependence complicated by hypertoxic alcohol abuse states.

A new method of alleviating the hypertoxic intoxication in alcohol dependence has been developed on representative clinical material, which involves conventional pharmacological and drug-free symptomatic remedies and methods. Along with psychotherapeutic potentiation, a therapeutically targeted pharmacological complex was prescribed: intramuscular Vitaxon № 10 per course; Sibazon 0.5% solution, 2 ml intramuscular, 3-5 injections per course; oral Phenazepam, one tablet (0.001g) twice a day for 10-14 days; Cocarnit one ampoule daily intramuscular injection, for a course of 3-10 injections.

The effectiveness of the proposed pharmacological complex has been proven by the statistical reliability method and illustrated by clinical examples of patient-specific research.

Psychotic disorders often cause a drastic change in the life situation of the affected individual. Personality is an aspect that can affect the symptoms and social function in psychotic disorders.

No study has examined stability of personality traits exceeding five years in patients with schizophrenia. The aim of this study was to investigate the stability of personality traits over a 13-year period among patients with psychotic disorder and healthy individuals and to evaluate case-control differences.

At three occasions during a 13-year period patients with psychotic disorders (n=28) and non-psychotic individuals (n=57) completed Swedish universities Scales of Personality (SSP). For all the individuals within- and between-subject analyses were performed at three occasions for all 13 subscales and the three overall factors of SSP. Correlations, means and SDs were calculated.

Tests of within-subject correlations showed differences in two subscales: Lack of Assertiveness, which were influenced by age and Physical Trait Aggression, where patients ratings were stable, whereas controls rated themselves less aggressive at higher age. Between-subjects correlations showed differences regarding any of the parameters diagnosis, time, age, gender or age x gender in nine of the 13 subscales as well as in factor Neuroticism.

Long term follow-up showed a generally high stability of personality traits measured with SSP, especially among patients. Between-subject analyses over the 13 years showed that patients differed compared to controls for the SSP factor Neuroticism as well as the subscale Detachment, which is in accordance with previous studies.

Obsessional slowness (OS) is a rare condition of disabling slow motor performance, first described in 1974, by Rachman, who documented 10 cases of “primary obsessional slowness”. Rachman argued that, although his patients with OS had Obsessive Compulsive Disorder (OCD), their motor symptoms were not related to the presence of motor-slowness-triggering obsessions/compulsions (e.g. checking and mental rituals). Whether OS truly is a distinct and “primary” entity is still a controversial issue, however.

To present and discuss the phenomenology of OS.

Case reports of OS published in the literature, including Rachman’s descriptions.

The literature on OS is extremely limited, with no published, large-scale descriptive studies or randomized controlled trials. Some authors doubt that OS is a “primary” condition, pointing out the clear overlap between OS and catatonia and emphasizing that the latter disorder also occurs in non-schizophrenic patients, for example, ones with OCD. Additionally, OCD and depression often co-occur. Thus, in severe cases, it may be challenging to disentangle the separate contribution of both disorders to psychomotor slowness. It is also crucial to exclude the possibility that a patience has juvenile parkinsonism or other causes of motor slowness before diagnosing him/her with OS, given that the diagnostic approaches and treatment strategies for OS and the aforementioned disorders differ.

OS seems to be a rare but often disabling motor manifestation of OCD, rather than a primary disease entity. However, some cases sit on the edge of current diagnostic criteria. Future research should help define OS more precisely.

No significant relationships.

Impulse control disorders (ICDs) are an adverse effect of dopamine agonists (DAAs) that affects the quality of life and can lead to legal, criminal and familiar problems.

Presenting a review of the mechanisms, prevalence and factors associated with the development of an ICD due to DAA use.

Search on Pubmed database with combination of the following keywords were used: “Impulse control disorders”, “dopamine agonist” or “therapy”. We focused on data from studies published between 2015 and 2020. The articles were selected by the author according to their relevance.

DAAs are mainly indicated in the treatment of Parkinson’s Disease (PD), and are also used on symptoms of restless legs syndrome (RLS) and prolactinoma or lactation inhibition. Dopamine replacement therapy act on dopamine receptors in the nigrostriatal and the reward pathways, which plays a role in addictive behavior. The prevalence of ICDs ranged from 2.6 to 34.8% in PD patients and a lower prevalence in RLS patients. Some of the ICDs reported were pathological gambling, hypersexuality, compulsive shopping, obsessive hobbying, punding, and compulsive medication use. The factors associated with the development include the type of DAAs, dosage, male gender, younger age, history of psychiatric symptoms, earlier onset of disease, longer disease duration, and motor complications in PD.

Further studies are needed to clarify the pathophysiology of the ICD in DAA therapy and determinate premorbid risk factors. The percentage of patients with ICDs is underrated, so it’s important to improve the patient’s evaluation, using validated and consensual assessment tools.

The only FDA approval therapeutic for schizoaffective disorder is paliperidone. Hiperprolactinemia is one of the most frequent side effects induced by first generation antipsychotics (FGA) or by second generation antipsychotic (SGA), such as risperidone and paliperidone. Prolactin related symptoms (PRS) include amenorrhea, galactorrhea, gynecomastia and fluctuations in psychotic symptoms.

To report the case of a patient with schizoaffective disorder difficult to manage due to symptom resistance and PRS, that improved symptomatology when prolactin serum levels were reduced.

Clinical-demographic data collected by clinical interview and clinical process consultation. Non-systematic literature review, searching “psychosis”; “prolactin”; “antipsychotic”; “schizoaffective disorder” on Pubmed database.

We report the case of 33 years-old female, admitted to our psychiatry inpatient unit for persecutory delusions, loosening of association, auditory hallucinations, and irritability with functional impairment. Symptoms began 13 years before. She was medicated with paliperidone 100mg IM monthly, lithium 800mg daily and clozapine 225mg daily. When admitted she wasn’t adhering to oral medication. On physical examination presented some PRS. The serum presented hyperprolactinemia and lithium in non-therapeutic levels. Initially was re-introduced the previous therapeutic without improval. It was made a therapeutic switch to associate aripiprazole 400mg IM monthly and clozapine 225mg daily, and lithium 800mg daily resulting in prolactine normalization and subsequent improval of psychotic symptoms previously presented.

This case reports challenges in management of patients diagnosed with Schizoaffetive Disorder due to therapeutic refractoriness and side effects. PRS can be ruling, therefore impacting therapeutic choices. We propose a possible role of combination of clozapine and aripiprazole in this scenario.

No significant relationships.

For the first time in N. Macedonia we had the experience to include peer workers as an equal members in the newly formed community mental health teams. For the purpose of the RECOVER-e project we engaged 2 patients to be the new peer workers.

To evaluate the initial period of peer worker involvement in the community mental health teams and to identify the next steps for them.

Conducting interviews with the peer workers.

One important aspect that is worth mentioning is their motivation to continue their work in the community mental health teams and continue to improve. Another finding is their will to establish a user led organisation. A user led organisation in the field of mental health in our country is rare to be find, with only a couple of them functioning in N. Macedonia. So if our peer workers can make it, it would be a great step in the right direction.

Overall, taking into consideration all that the peer workers have achieved in the last period, including the ups and downs of being the first official peer workers in N. Macedonia, they are looking forward to improve their knowledge and continue building their practical experience. A great plus of it all is that they have a financial stability for this troubled pandemic period.

No significant relationships.

This lecture will present a therapeutic group that took place at a closed-unit in a psychiatric hospital. The members of this group were patients suffering from psychotic disorders

Patients suffering from psychotic disorders.

The patients had difficulty in organizing their thoughts as well as with the expression of their internal-world and emotions. Moreover, they were suspected of the units’ staff members. These circumstances led us to create a theme group that combines a verbal-affective metaphoric instrument - literature. Art, such as literature, represents the mind of its creator and when incorporated into the therapeutic process, can serve as a third-voice - a symbolic language that conveys an idea indirectly and arouses the patient’s personal associations and emotions. The use of literature, while relating to content that aroused from a poem or a short story, led to a connection or an identification with the emotion expressed in the writing stimuli or in opposition to it, and from there to a projection of the internal world of the patient.

Through the possibility of alternating between proximity and distance, regard the metaphoric instrument, patients could organize their associations and emotions and express them in a more beneficent way – “normalization” of the cognitive and expressive process.

The analysis of the different group’s sessions, points to the potential of using literature in a therapeutic group with patients in their acute state, at the closed-unit. Examples of verbal reports from different group settings, in which literature was used, will be presented.

No significant relationships.