IntroductionPsychiatry's viewpoint of sexual deviance has waved between the normal and the pathological. “Normal” is not determined by nature but by the values of a specific society.AimsTo review the main landmarks in paraphilias history and the importance of social and cultural dimensions to it.MethodsPubMed database was searched using the keywords perversion, sexual deviance, paraphilia, culture and society.ResultsThroughout Middle Age and Renaissance any sexual act that differed from the natural/divine law was considered a vice. Unnatural vices (masturbation, sodomy, bestiality) were the most severely punished, as they could not result in conception. In 1886, Krafft-Ebing stated perversions were functional diseases of the sexual instinct caused by “hereditary taintedness” in the family pedigree and worsened by excessive masturbation. Proper perversions were sadism, masochism, antipathic sexuality (homosexuality, transvestism, transsexuality) and fetishism. Later, Havelock Ellis and Hirschfeld claimed sexual interest in the population followed a statistical norm, opposed the idea that masturbation led to diseases and demanded the decriminalization of homosexuality. Freud believed the “perverse disposition” to be universal in the childhood giving rise to healthy and pathological adult behaviors. In 1950's, Albert Kinsey surprised America when he proved many supposedly deviant sexual practices were quite common. The first Diagnostic and Statistical Manual (1952) was mainly psychoanalytic. Later, by 1973, homosexuality was removed from classifications. Recently, DSM-5 distinguishes between paraphilias and paraphilic disorders.ConclusionA progress in the paraphilic instincts’ acceptance has occurred. We hypothesize, in the future, paraphilias will follow homosexuality out of the diseases’ classifications.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Aim of the work: To follow the significance of some psychological risk factors in patients with anxiety and depression symptoms with cardio-vascular diseases. Materials and methods: During the research we included 30 patients with anxiety and depression symptoms diagnosed with cardio-surgical diseases after cardio-surgical intervention. They were chosen randomly, hospitalized and treated in the Specialized cardio-surgical clinic Filip II, Skopje. The patients were of both sexes, aged 30-70. They were evaluated by HAMD and HAMA and non-standardized questionnaire. The patients were tested once two weeks after the cardio-surgical intervention. Results: In 25 patients there was a score increase in HAMD and HAMA in correlation with the psychological risk factors (stressful events: losing the job, losing someone you love, hostility, high professional plans and ambition) Conclusion: Psychologically unfavourable situations are risk factors which lead to anxiety and depression symptoms in cardio-vascular diseases.

Sleep disturbances are often present in addictive disorders. The atypical antipsychotic quetiapine has a favourable tolerability profile,

IntroductionElectroconvulsive therapy (ECT) is considered a gold-standart treatment of severe and treatment-resistant depression. Lack of response to ECT often causes distress in psychiatrists regarding the next therapeutic decisions.ObjectivesTo present a case report of a patient with psychotic depression with partial response to ECT.MethodsClinical interviews and review of literature using the Pubmed platform.ResultsThe authors present a case of a 60 year-old woman admitted for severe depressive episode with psychotic symptoms. Due to lack of response to multiple antidepressive and antipsychotic treatments, 15 sessions of ECT were performed with improvement of behavioral and psychotic symptoms. However, endogenous depressive symptoms with functional impairment persisted. It was then initiated Bupropion 300mg/day resulting in vast improvements on drive, energy and activity levels with restored functionality. Previously to ECT, Bupropion was not considered a valid option due to the psychomotor restlessness that was present. This case exposes the limitations of ECT and the therapeutic conundrums that arise when there is partial response. The symptoms expressed in the patient after ECT course correlate with deficits in noradrenergic and dopaminergic pathways that are involved in endogenous depression. The use of Bupropion, with its effect on noradrenaline and dopamine receptors, may offer a therapeutic lifeline in these cases.ConclusionsECT still stands as a gold-standart for severe depressive disorder, especially when several psychopharmacological therapies have failed. In cases of partial response to ECT, the neurobiological correlates of clinical presentation can guide the therapeutic management towards improved outcomes.DisclosureNo significant relationships.

IS MANCHESTER TRIAGE ADEQUATE TO PSYCHIATRIC EMERGENCIES? AN OBSERVATIONAL DESCRIPTIVE STUDY OF A PORTUGUESE HOSPITAL BACKGROUND Triage in portuguese emergency departments is conducted using the MTS 1 . Psychiatric assessments focus on assessing the level of danger presented to others or the level of severity of impairment to social functioning 1-3 . Current medical triage scales focuses on medical and surgical presentations, such as the MTS, present insufficient data that proves its validity and reliability in psychiatric emergencies 2.4 .

To conduct a review of the existing literature regarding the established treatments for female sexual dysfunctions (FSD) and the novel pharmacological approaches that have been studied as well its clinical effectiveness.

IntroductionGenital 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.ObjectivesTo review the evidence of third generation CBT on genital pain disorder.MethodsReview of literature using the Pubmed platform.ResultsWe 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.ConclusionsThird 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.