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S U M M A R YDuring the peripartum period, women are at a greater risk of developing a mental disorder or experiencing an exacerbation of the pre-existing mental disorders. Therapeutic interventions are based primarily on psychotherapy, but if the symptoms are severe and pose a risk to the mother and the child, then the use of drugs, hospitalization or electroconvulsive therapy is considered. Cognitive-behavioral psychotherapy is the first line of treatment in postpartum blues and postpartum depression, panic disorder, generalized anxiety disorder, and mild to moderate obsessive-compulsive disorder. More recent conceptions regarding the use of drugs during the postpartum period indicate that medications should be prescribed if the risk of using them is lower than the risk of complications caused by the symptoms of mental disorders. Nortriptyline or desipramine are recommended from the group of tricyclic antidepressants, but newer generation antidepressants are shown to be safer during pregnancy. Fluvoxamine, paroxetine and sertraline can be used in postpartum period during breastfeeding, while fluoxetine and citalopram should be avoided. The use of first-generation antipsychotics haloperidol and trifluoperazine is recommended in the antepartum period, during which some of second-generation antipsychotics such as quetiapine, olanzapine, risperidone and aripiprazole can also be used. Clozapine should be avoided during breast-feeding. The use of mood stabilizers during pregnancy requires a thorough knowledge of the recommendations, and it is not advised to use them during the postpartum if the patient is breastfeeding. From the group of benzodiazepines, it is recommended to uselorazepam. Every form of therapeutic approach has proven to be more effective in the presence of emotional support from partners and other family members.

The aim of this study was to analyze the dermoscopic features in patients with pathohistologically confirmed basal cell carcinoma (BCC). Our retrospective study included 54 patients with 76 BCCs in total, diagnosed in 2016 and 2017. All lesions were classified into four clinical types: nodular, pigmented, superficial and infiltrative. Digital dermoscopic images were evaluated by three observers. We selected five dermoscopic features for analysis, including: the absence of pigment network, the presence of arborizing vessels, blue-gray globules and ovoid nests, leaf-like areas and ulcerations. In the total of 54 patients, there were 22 females and 32 males. At the moment of establishing the diagnosis, the patients’ age was in the range from 31 to 84 years (median age 67 years). The most frequent clinical type was the nodular type with 28 confirmed diagnoses. Nodular BCC was more frequently localized on the head and neck areas compared to the trunk and limbs (p < 0.01). Dermoscopically, the absence of pigmented network was verified in all cases. Arborizing vessels were present in 71 (93.4%) lesions, blue-gray globules and ovoid nests in 33 (42.1%), ulcerations in 44 (57.9%), and leaf-like areas in 5 (6.6%) lesions. Blue-gray globules and ovoid nests were significantly frequent in pigmented BCC in comparison to other clinical types of BCC (p < 0.01). In conclusion, using dermoscopy, it is entirely possible to make a reliable diagnosis of BCC as well as to differentiate it from others skin tumors.

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Myasthenia gravis (MG) is a chronic neuromuscular disease that leads to progressive weakness, fatigue of the skeletal muscles, and is often associated with psychological changes, especially with poorer quality of sleep. To evaluate the quality of sleep in patients suffering from MG in relation to sociodemographic and clinical characteristics of the dissease. A total of 70 adult patients have been classified according to Myasthenia Gravis Foundation of America classification and divided into groups with regard to the age of onset, gender, employment status and type of work, presence or absence of pathological changes on thymus and presence or absence of anti-nAchr antibodies. Severity of clinical manifestations was evaluated by using quantitative MG scores and MG composite scores. Pittsburgh questionnaire was used to assess the subjective quality of sleep. In addition, Hamilton's anxiety and depression scales and questionnaires for quality of life assessment were also implemented. The results of our research show a correlation between poor quality of sleep and prolonged duration of the disease, pathological changes on thymus, positive anti-nAchr antibodies. The correlation between poor quality of sleep with more severe clinical presentation, poor quality of life, anxiety and depression was confirmed. Quality of sleep is impaired in patients with MG, especially in the case of severe clinical manifestations and prolonged duration of the disease. Considering the lack of literature on the subject, a better understanding of the prevalence and severity of sleep disorders in MG requires further research.

Postpartum psychiatric disorders are mental disorders which occur after childbirth. Untreated depression and anxiety during pregnancy as well as stress and previous episodes of depression are significant risk factors for postpartum psychiatric disorders. Postpartum blues, postpartum depression and postpartum psychosis, as well as postpartum anxiety disorders, are most commonly reported after delivery. The occurrence of postpartum depression increases the likelihood of psychiatric morbidity later in life. The presence of psychotic symptomatology with psychomotor agitation and unpredictable behavior is a significant risk factor for suicide or infanticide. Studies have shown that more than half of women with depression during pregnancy or postpartum have some comorbid anxiety disorder. The possibility of developing a panic disorder and obsessive-compulsive disorder increases after delivery, while the prevalence of generalized anxiety disorder is reduced during that period of time. A reliable instrument for screening the spectrum of postpartum mental disorders is the Edinburgh Postnatal Depression Scale-EPDS. Postpartum psychiatric disorders disturb the central psychological process, i.e. the development of emotional relationship between mother and child, and negatively affects on the behavior, cognitive development and physical health of the child.

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IntroductionIn treating schizophrenia, there is growing interest in introducing and renewing psychosocial therapies, including psychotherapy. In recent years, this has specifically entailed the adaption of particular cognitive behavioral therapy (CBT) approaches, which were previously only utilized for treating anxiety and mood disorders. The negative symptomatology of schizophrenia, which has proven to be especially difficult to treat, can be a challenge for CBT, particularly in terms of enhancing relationships with family and friends and work engagement.ObjectivesThe objective was to summarize the advantages of CBT treatment in schizophrenia briefly.MethodsPatients with schizophrenia frequently have comorbid problems, such as anxiety disorders (and disorders) and traumatic experiences, which can be effectively treated with CBT. In addition to pharmacological therapy, CBT is acknowledged as the gold standard in several countries for the treatment of schizophrenia. According to studies, combining CBT with medication can minimize psychotic symptoms.ResultsRegarding treatment, Beck describes the use of typical CBT techniques: building trust and engagement; working collaboratively to understand the meaning of symptoms; understanding the patient’s interpretation of past and present events, particularly those that the patient believes are related to the development and persistence of his or her current problems; normalizing these experiences and educating the patient about the stress-vulnerability model, and socialization. Clarifying the emotional and behavioral repercussions of a delusion’s activation leads to an initial examination of the evidence-based on more peripheral interpretations. It is recommended to treat negative symptoms such as amotivation, anergia, anhedonia, and social disengagement with behavioral self-monitoring, activity scheduling, ratings of mastery and enjoyment, graded work assignments, and assertiveness training.ConclusionsIn treatment settings where physicians are already utilizing high-quality psychoeducational materials to enhance adherence, an excellent foundation exists for introducing individual CBT for schizophrenia patients.Disclosure of InterestNone Declared