Bipolar disorder is a frequent and serious psychiatric disease. Antipsychotics are habitually required for its management especially during an acute manic episode. The association of cancer with bipolar disorder may impact psychiatric management. The choice of the adequate antipsychotic drug remains a challenge in this case. The clinical benefit of tamoxifen is obtained after the hepatic metabolism with cytochrome P450 2D6 which generates endoxifen, the potent metabolite of tamoxifen. Evidence has emerged that antipsychotics may potentially inhibit the CYP2D6. Study data supporting this interaction are rare.

In this work, we aimed to illustrate the modalities of care of bipolar disorder in a patient receiving tamoxifen.

Presentation of a clinical case of a patient treated by Tamoxifen for her breast cancer and who was admitted in our department for acute mania with psychotics features, followed by a literature review.

A 53-year-old woman with past history of breast cancer diagnosed in 2018, treated with lumpectomy and radiation, followed by tamoxifen. She has been admitted in 2019 in our department for an acute mania with psychotics features. Olanzapine was prescribed with good clinical evolution. The psychiatric and oncologic status of the patient was stable after one year under tamoxifen and olanzapine.

Psychiatrists must be aware that some of the prescribed medications co-administered with tamoxifen interfere with the CYP2D6 function, which may potentially increase the risk of breast cancer recurrence. A close collaboration between psychiatrists and oncologists is required to adapt therapeutic protocols.

Tamoxifen is an antioestrogen agent used in breast cancer treatment. According to some guidelines, this molecular was also proposed for the treatment of acute mania. In fact, Tamoxifen inhibits the intracellular action of the protein kinase C (PKC), which is the direct target in the treatment of mania episodes. Lithium and valproate have also the same action.

We aimed to show the case of an acute mania under an inhibitor PKC treatment and insisted that other studies are recommended.

Case report description and research on medline, pubmed with the keywords: Tamoxifen, Bipolar disorder, protein kinase C,mania.

We reported a case of a 53-year-old woman with past history of unipolar depression. In 2018 when she was diagnosed with breast cancer. She received antidepressant drugs but she interrupted the treatment after a few months. She was treated for her breast cancer with mastectomy, radiotherapy, and 20 mg per day of Tamoxifen prescribed since Mars 2018. She had been admitted in June 2019 in our department for acute mania. The patient received Tamoxifen as it was prescribed. She was not taking any concomitant medications. No history of drug abuse was reported. Medical examination, laboratory, and radiological investigations did not indicate any medical pathology.

In our case, Tamoxifen had not ovoid the acute mania in spite of its Known anti-manic properties as reported in the literature. Possible neurobiological effect of tamoxifen on the nervous system should be studied to evaluate the safety of this treatment mainly in patients with bipolar disorder.

Depression is frequently observed in carcinology. Many patients with breast cancer, receiving Tamoxifen, may need antidepressants to treat depression. Tamoxifen is a synthetic non-steroidal antioestrogen metabolized by the cytochrome P450 2D6(CYP2D6) to endoxifen which is the active metabolite of this drug. It was reported that the concomitant prescription of Tamoxifen and some antidepressant agents such as paroxetine and fluoxetine may decrease the anticancer effect of tamoxifen as they may inhibit the CYP2D6 pathway.

The objective of this case was to highlight the particularity of management of depression in patients under tamoxifen.

Case report description of a patient treated with Tamoxifen for her breast cancer and who was admitted for major depression, followed by a literature review.

A 36 –year- old woman, had breast cancer and she underwent a mastectomy followed by chemotherapy. Since September 2016, she received 20 mg per day of Tamoxifen as an antihormonal treatment. In November 2018, she was referred to our psychiatry department for depressive symptoms. The patient was sad, she reported social withdrawal, insomnia, anhedonia, and low self-esteem. She had no history of mania or hypomania. A major depressive episode was diagnosed. We prescribed Escitalopram 10 mg per day with clinical improvement. The psychiatric and oncologic status of the patient was stable after two years under tamoxifen and Escitalopram.

The choice of the adequate antidepressant agent in patients under Tamoxifen remains a challenge and requires a thorough knowledge of drug interactions.

Contextualization: health professionals’ anguish towards the patient with head and neck cancer (HNC) permeates clinical issues: the location of the tumour, if advanced diagnosis, the psychosocial features of the patient. The perception, coming from patients as undesirable, refers to the conflict of how to deal with one’s own anguishes.

AIM: To explore and interpret how anguish experienced by physicians and nurses are mobilized regarding to the clinical and psychosocial peculiarities of patients with HNC.

Strategies: Clinical-qualitative design; semi-directed interview with open-ended questions in depth. Trigger question: “Tell me about the management of the patient with …”. Ten interviewees (06 nurses and 04 resident doctors) from a university oncology outpatient. Intentional sample. Clinical-Qualitative Content Analysis with psychodynamic concepts. Findings validated by peers at the Laboratory of Clinical-Qualitative Research at the University of Campinas, Brazil.

Topics: the treatment of the speeches resulted in three emerging categories: (1) Cancer is literally on the face: self-perception of peculiarities; (2) An appalling illness: dealing with the ‘deteriorated’; (3) To naturalize without trivializing: handling with their own anguish.

Final considerations: The anguish of health professionals who deals with the HNC patient consists of the feelings, which are not exposed, because they are not organized and neither understood as natural feelings. It is up to them to seek neutrality to minimize the anguish present in the conflict of not manifesting thoughts considered inadequate by the patient, avoiding moral judgments and conflicts. Balint groups are recommended to attend emotional demands of health professionals.

Treatment representation is an important factor of motivation and well-being during treatment (Horne, 2002).

The aim was to reveal the relationship between treatment representation and well-being in oncological patients first referred to chemotherapy.

40 oncological patients (10 males, 20-72 years old, mean age 50.49±13.75 years old, localizations included gastrointestinal tract and genitourinary system) first referred to chemotherapy filled Satisfaction with Life Scale (Diener et al., 1985), Scale for Positive and Negative Experiences (Diener et al., 2009), Hospital Anxiety and Depression Scale (Zigmond, Snaith, 1983) and Beliefs about Medication Questionnaire (Horne, 2002) that was slightly modified for the situation of chemotherapy. Disturbance of functioning was assessed in the interview as an opportunity to cope with job, home responsibilities or self-care (1-5-point Likert scale).

Cronbach’s alphas for Necessity and Concern scales were .69 and .76. Despite high appraisals of necessity of chemotherapy (mean 4.24±.53 on 1-5 Likert scale), concern about it was rather high (2.83±.82). Hierarchical regression analyses revealed that, after adjusting for disturbances in social functioning, concern about chemotherapy (but not its subjective necessity) predicted more severe negative emotions (β=.32, p<.05, ΔR2=10.0%). After control for general level of anxiety and depression, this relationship became weaker but marginally significant (β=.32, p<.10, ΔR2=8.4%).

Concern about chemotherapy in patients first referred to this treatment could be important predictor of well-being demanding for interventions aimed at stabilization of emotional reaction to chemotherapy regardless belief in its necessity.

There are wide-spread fears and expectations about radiotherapy in people referred to it that are not only unrealistic (Shaverdian et al., 2018) but also lead to poorer compliance with doctors and poorer satisfaction with treatment (Dong et al., 2014).

The aim was to reveal relationship between different aspects of subjective perception of radiotherapy in patients and their well-being.

34 patients first referred to radiotherapy, 23-70 years old (mostly females with breast cancer) filled modified version of Beliefs about Medication Questionnaire including items about radiotherapy (Horne et al., 1996), Satisfaction With Life Scale (Diener et al., 1985), Scale of Positive And Negative Experience (Diener et al., 2009).

Six scales were revealed by factor analysis in the structure of beliefs about radiotherapy (Cronbach’s alphas .74-.85): confidence in the effectiveness of radiation therapy, subjective need for it, lack of understanding of it, concern and general negative attitudes towards radiotherapy, doubts about the effectiveness of radiation therapy. Elder patients reported higher need for radiotherapy but also higher concerns about it (r=.35-.37). Concerns about radiotherapy were related to lower satisfaction with life and positive emotions (r=-.44 - -.34) while subjective need of radiotherapy was related to higher health anxiety (r=.71) and lower positive emotions (r=-.41).

Subjective concerns of patients regarding radiotherapy are related to poorer well-being and could be addressed in psychotherapy.

Breast cancer is a severe pathology that once detected completely changes the patient’s perception of life.

Evaluating the relationship that is established between the level of stress, the type of surgery applied and, the instructive level of women.

We selected 67 patients which were divided into 2 groups: group I(31) women who benefited from immediate reconstruction and group II(36) subjects who benefited from a late reconstruction. We split each group into two subgroups: women with secondary education and women with higher education. A socio-demographic questionnaire and the DASS-21 scale were applied.

Comparing the two groups we noticed that stress level was more present in group I(38,7%) than in group II(25%). The differences were not statistically significant(p>0,05). In the subgroup of women with higher education in group I, high levels of stress were observed at 23,08% and, in the subgroup of patients with secondary education, 50% had high levels of stress. The differences were not statistically significant (p>0,05). We also analyzed the two subgroups of group II and we identified increased levels of stress in 20% of patients with higher education compared to those with secondary education where 26,93% had high levels of stress. Also, the differences were not statistically significant(p>0,05). A statistically significant difference(p<0,05) was found when we compared the level of stress between women with secondary education of group I and those of group II.

The study revealed that stress levels tend to be higher in women with immediate breast reconstruction and secondary education.

Cancer-related cognitive impairment (CRCI) is one of the most frequent and worrying side effects experienced by non-central nervous system (CNS) cancer survivors, generally related to cancer treatments. Considering its detrimental impact on quality of life, including work-related outcomes, it is necessary to identify effective intervention options. Cognitive rehabilitation is considered the first-line intervention to address CRCI, being effective at improving cognitive functioning. Internet-based interventions are emerging as important means of intervention in the field of cognitive rehabilitation (known as cognitive telerehabilitation), considering the potential to overcome accessibility issues and being cost-effective.

To assess the acceptability and expectations regarding such interventions, considering the scarce literature.

A nationwide online survey was disseminated to Portuguese non-CNS cancer survivors, aged 18-65 years, who had finished active treatments, with no metastases/history of neurological or psychiatric disease/alcohol or drug abuse. Preexisting knowledge about CRCI, expectations for support to cognitive difficulties, Internet use for health and support purposes, and intervention needs and preferences in the context of cognitive telerehabilitation were examined; sociodemographic and clinical variables (e.g., age, education, employment status, cancer treatments), as well as cognitive complaints (Portuguese version of the Functional Assessment of Cancer Therapy-Cognitive, FACT-Cog), were also assessed.

Findings from this study are important to help health professionals and researchers understand and identify cancer survivors’ needs regarding cognitive telerehabilitation interventions.

This information could be used as a support and guide for the development and delivery of these interventions for non-CNS cancer survivors.

Fibromyalgia is a chronic condition, with a high degree of psychiatric comorbidity and an insufficiently explained pathogenesis. Therefore, its therapeutic management is challenging, with both pharmacological and non-pharmacological approaches being suggested as treatment options.

To analyze the current level of evidence in favour of pharmacological treatment for fibromyalgia.

A literature review was performed through the main medical databases using the search paradigm “fibromyalgia” AND “pharmacological therapy” OR “antidepressants” OR “moodstabilizers” OR “anxiolytics”. All papers published between January 2000 and August 2020 were included in the primary analysis.

A gradually increasing interest for the treatment of fibromyalgia has been observed in the last decade, and the number of clinical trials for this indications has almost doubled in this period, when compared to the previous decade. Pregabalin, duloxetine, and milnacipran are the most supported by evidence pharmacological treatments for fibromyalgia, especially for the pain component. Amitriptyline, gabapentin, cyclobenzaprine, and tramadol have also been studied in various clinical trials, but tehre are less evidence to support their use. Cognitive dysfunctions, sleep disorders, and mood disturbances benefit from far less investigation in clinical trials, therefore no clear recommendation can be made regarding the superiority of an agent over another.

The pain component of fibromyalgia benefits from treatment with pregabalin, duloxetine, and milnacipran, while the affective component and the cognitive dimension still need more research from the psychopharmacological perspective.

Chronic fatigue syndrome (CFS) is a complex condition, with an insufficiently known pathophysiology, that raises multiple challenges to the treating physicians. Due to its yet mostly unknown underlying mechanisms, there is no consensus treatment recommendation for CFS. The risk to associate major depression, anxiety disorders or substance use disorders is frequently reported, and this co-morbidity further complicates the evolution of CFS.

To search the existing literature for pharmacological and psychotherapeutic recommendations in CFS.

A literature search was performed using the main electronic databases using the paradigm „chronic fatigue syndrome” AND „psychopharmacological treatment” OR „psychotherapy”. All papers published between January 2000 and August 2020 were included in the primary analysis.

Anti-inflamatory drugs (corticosteroids and non-steroidal drugs), antidepressants, moodstabilizers, anxiolytics, immuno-modulatory drugs, and antivirals have been investigated for CFS, but the trials had low-quality designs, used various definition of CFS, and different criteria for monitoring the efficacy of treatment. Cognitive behavioral therapy (CBT) may be promising for decreasing the fatigue severity, but larger trials are needed. Graded exercise therapy (GET) also may be of some use for improving patients ability to engage in activities, but caution should be in order because of the risk of over-exercising that may exacerbate the core CFS symptoms.

Larger trials are needed in order to validate pharmacological and psychotherapeutic recommendations for CFS. No drug may be considered first line treatment for this indication, while CBT and GET may be useful, although they do not address all the central symptoms of CFS.

Empathizing with others’ pain appears to recruit the whole pain matrix, including a collection of frontal regions involved in the affective, motivational, cognitive, and attentional dimension of pain.

This research explored how the modulation of interoceptive attentiveness (IA) can influence the frontal (dorsolateral prefrontal cortex -DLPFC- and somatosensory cortices) activity related to the emotional regulation and sensory response of observing pain in others.

22 healthy participants were required to observe face versus hand, painful/non-painful stimuli in an individual versus social condition while brain hemodynamic response (oxygenated [O2Hb] and deoxygenated hemoglobin [HHb] components) was measured by functional Near-Infrared Spectroscopy (fNIRS). The sample was divided into experimental (EXP) and control (CNT) groups and the EXP group was explicitly required to focus on its interoceptive correlates while observing the stimuli.

In the individual condition, higher brain responsiveness was detected for painful confronted to non-painful stimuli, and a left/right hemispheric lateralization was found for the individual and social condition, respectively. Besides, both groups showed higher DLPFC activation for face stimuli displayed in the individual condition compared to hand stimuli in the social condition. However, face stimuli activation prevailed for the EXP group, suggesting the direct interoceptive phenomenon has certain features, namely it manifests itself in the individual condition and for pain stimuli.

We can conclude that IA modulation promoted the recruitment of internal adaptive regulatory strategies engaging both DLPFC and somatosensory regions towards emotionally relevant stimuli (painful faces displayed in the individual condition). Therefore IA could be trained for promoting emotion regulation and empathic response.

A decrease in pain sensitivity has been observed in patients with schizophrenia since the beginning of the twentieth century. This hypothesis further emerged during the last decades due to many clinical findings.

To study pain responsiveness in patients with schizophrenia and explore its physiopathological mechanism through a review of the literature.

We searched the Medline database with no time restrictions, and we hand searched the references of all retrieved reviews. After removing duplicates, we selected Full-text articles in both French and English languages. Keywords: “schizophrenia”, “pain”, “pain threshold”, “nociceptors”, “opioid receptors”, “opioid peptides”

We have collected 399 references, we finally included 50 Articles only. Many case reports with heterogeneous types of pain concluded that despite the high prevalence of somatic comorbidities in patients with schizophrenia, there was no significant difference in pain complaints between patients with schizophrenia and controls. There was a positive correlation between the decrease in pain sensitivity and schizophrenia. Experimental studies supported a decrease in pain perception and a high pain threshold in those patients. The neurobiological hypothesis suggested the lack of pain transmission by the dysfunctional glutamatergic system and the involvement of the opioid system. these findings have been reported in patients even before starting treatment. The psychopathology theory pointed to the impact of psychotic defenses such as denial and cleavage in the phenomenon of pain insensitivity.

The meticulous research of pain symptoms should be systematic in patients with schizophrenia and the hypoalgesia should be considered when dealing with somatic conditions in this specific population.

Chronic pain is common, costly, and associated with significant disability and negative effects on well-being and mental health. The treatment is challenging, requiring a multidisciplinary approach. Acceptance and commitment therapy (ACT) aims to help patients in engaging in a flexible and persistent pattern of values-directed behavior while in contact with continuing pain and discomfort.

To provide an updated review on the efficacy of ACT for the management of chronic pain.

We conducted a systematic review based on the PubMed® and EBSCO databases up to April 2020.

Fifteen trials were included. The results were in favour of ACT in pain acceptance, functioning and pain intensity with small to large effect sizes. Few studies evaluated quality of life, but half of those were favourable to ACT. We also focused our analysis on ACT online interventions, considering the current demands due to the COVID-19 pandemic.

The current systematic review points in favour of ACT for the management of chronic pain conditions, though the studies included suffered from methodological limitations, which may have led to overestimated effects. Methodologically robust trials are required to further understand the clinical efficacy of ACT for chronic pain and which patients most benefit from this intervention.

Chronic low back pain (CLBP) is one of the most resistant pain conditions and is often combined with psychoemotional disorders [1].

To analyze the frequency of prescribing adjuvant analgesics among patients with CLBP by specialists of the outpatient department and specialized pain clinic.

The prospective study included 269 patients (group 1) with CLBP treated in an outpatient department and 253 patients (group 2) of specialized pain clinic. We analyzed gender, age, duration, and severity of pain (using the visual analogue scale-VAS), frequency of prescribing anticonvulsants and antidepressants, as well as their combination in both groups. The data were analyzed with IBM SPSS Statistics.

Among the patients of both groups, women predominated (65.3% in group 1 and 57.2% in group 2). The average age was 61.8±14.5 and 58.9±12.7, in the first and second groups, respectively. The disease duration was longer in group 2 (6.8±3.9 years, and 4.5 ± 2.7 in group 1, p<0.05). Pain intensity was comparable in both groups (4.3±2.8 and 5.1±2.5, p<0.067 on VAS). Antidepressants there were prescribed 16.1% and 52.9%, p<0.05, anticonvulsants - 18.8% and 33.2 %, p<0.05, their combination - 2.2% and 13.8%, p<0.05 in the first and second groups, respectively.

Adjuvant analgesics are more often prescribed to patients of specialized pain clinics. It may be associated with more severe descriptions of chronic pain syndrome, as well as insufficient awareness of modern approaches to the management in this category of patients by specialists in primary health care. References: 1.Zagorulko, Medvedeva Russ Pain J. 2019

The study of gender-related peculiarities of vertebral pain syndrome course in order age patients appears to be highly relevant.

Study population included 46 female patients and 38 male patients in the age between 60 and 75 years old; mean age was 67,4±6,6 years old.

Pain syndrome intensity was assessed using the visual analogue scale (VAS), vegetative disfunction was assessed using A.M. Wayne Questionnaire; the Toronto Alexithymia Scale

The conducted comparative study showed that the male patients perceived the pain syndrome as more intense as compared to the female patients in lumbar spine: 4,5 ±0,8 vs 3,6±0,5 scores (р <0,001) and in thoracic spine: 4,1 ±1,0 vs. 3,4±1,0 (р <0,05). On the other hand, in vegetative dysfunction assessment, the male patients demonstrated generally lower score: 43,3±7,5 scores vs. 59,6+10,3 in female patients, р <0,001. The results of correlation analysis pf interrelations between alexithymia and pain intensity revealed the differences between the study groups in emotion recognition accuracy (Mann-Whitney U-test = 109,00, р = 0.09): female patients showed lower scores (60,7 ±3,5) as compared to the male patients (74,2 ±2,1).

Therefore, the vertebral pain syndrome tends to be more pronounced in older age male patients as compared to the similar population of older age female patients. Therefore, vertebral pain syndrome correction requires multidisciplinary approach, including psychotherapeutic support.

Epilepsy and its psychiatric comorbidities have been studied frequently over the course of the last years. However, few studies have aimed to establish the relationship between psychogenic non-epileptic seizures (PNES) and personality disorders.

The aim of the current study is to discuss the relationship between different personality disorders and PNES in comparison to patients diagnosed of epilepsy but no PNES.

A case of a 48 year old female patient who attends an intensive following unit at a psychiatric day hospital is presented. The patient was diagnosed with epilepsy at 25 years old. In the last 10 years she has grown completely dependent on her family, presenting at least one epileptic seizure or PNES during the day. She attends the psychiatric unit after neurologists diagnose highly frequent PNES with interference in her day to day routine. During her follow-up at the psychiatric unit different personality disorders are considered. Furthermore, PubMed, Web of Science and PsycInfo databases were searched, using a pre-established strategy in order to identify recent related studies. Afterwards, studies were selected in a systematized manner.

According to different studies up to 75% of patients with PNES have a comorbid personality disorder. Borderline personality disorder seems to be the most frequently simultaneous axis II diagnosis.

Psychiatric disorders are more frequent in patients with psychogenic non-epileptic seizures than patients with only epileptic seizures

Physical exercise is a well-documented treatment for individuals with mental disorder. It helps improve symptoms and functioning of these individuals. Moreover, recent studies indicated that exercise improve emotional regulation which is one of the main target in borderline personality disorder (BPD) treatment. Therefore, exercise might have important benefits in this population. However, no previous study examined this effect.

This pilot study documents the facceptability of a protocol testing the effects of exercise on the response to a negative emotion in adults with BPD.

28 adults with a diagnosis of BPD have been recruited in a psychiatric hospital. Participants filled several questionnaires then viewed a scene from Silence of the Lambs to induce negative emotions. They were then assigned to 20 minutes of exercise or a neutral video of 20 minutes. Affects were assessed 7 times during the protocol.

In this sample, 9 participants reported at least equal levels of affect after the induction than before. Preliminary results show a tendency of higher response of physical exercise than control on positive affects and no participant had any adverse effect from exercise.

This pilot study was the first to test the effects of exercise on symptoms of BPD. It also informs on the best way to conduct the principal study. First, the mood induction was poor, thus it will be changed for a stronger induction strategy. Then, the control intervention will be a placebo exercise. These modifications will enable a better understanding of the effects of exercise on emotion regulation with BPD population.

DSM-V includes near-psychotic symptoms as new criteria in borderline personality disorder (BPD). This change makes more difficult the differential diagnosis between considering psychotic symptoms as part of the BPD or as part of a comorbid psychotic disorder.

Recognize the difficulty of the differential diagnosis in clinical practice between BPD and comorbid diagnosis of BPD with psychotic disorders, and how it can affect the patient’s outcome.

Patients’ data is obtained from medical history and psychiatric interviews carried out during their hospitalizations.

32 year-old female patient with previous diagnosis of BPD, psychotic episodes and cannabis abuse, was admitted due to paranoid ideation and aggressiveness, with massive borderline defense mechanisms (frequent displays of anger, high impulsivity, low frustration tolerance, self-destructive behavior…). Psychotic symptoms ceased two weeks after admission, and considering the patient’s individual characteristic it was believed BPD fitted more with this clinical case, although different psychotic disorders were considered. 30 year-old female patient began intensive psychiatric treatment with previous diagnosis of BPD, psychotic disorder and cannabis abuse. It was observed that the paranoid ideation and bodily experiences she suffered lasted months and were characterized by a strong belief. These two reasons were put into consideration when it was decided to judge this clinical case as a comorbid diagnosis of BPD with a psychotic disorder.

It is necessary to assess the difficulty of the differential diagnosis in these patients, and offer them specialized treatment depending on the diagnosis, as it can affect the patient’s outcome.

Borderline personality disorder (BPD) is characterized by instability of interpersonal relationships, self-image, and emotions, and by impulsivity. Although patients with BPD are misdiagnosed, some of them receive mental health treatment. Even if the first-line treatment of this disorder is psycotherapy, the patients with BPD may be highly symptomatic and are often prescribed multiple medications in a manner unsupported by evidence.

The aim of this study is to study the available evidence about the pharmacotherapy for borderline personality disorder.

A review of the available literature about the management of borderline personality disorder and de pharmacotherapy for personality disorders was performed.

First-line treatment of the personality disorders is psycotherapy. The treatment plan for BPD may include individual and group therapy, medication, self-education, specialized substance use disorder treatment, partial hospitalization, or brief hospitalization during times of crises. Medications are generaly used only as adjuncts to psychotherapy and the adjunctive use of symptom targeted medications has been found to be useful. There is limited information to guide pharmacotherapy; preliminary evidence limits the practice of polypharmacy. Sympton-domain focused medication treatment is recommeded by some guidelines: cognitive-perceptual symtoms (low-dose antipsychotic drugs), impulsive-behavioral dyscontrol (mood stabilizers), affective dysregulation (mood stabilizers and low-dose antipsychotic drugs) and self-harm (omega-3 fatty acids).

BPD cause significant distress and impariment of social, occupational and role functioning. The first-line treatment for BPD is psychotherapy; however symptom-focused, medication treatment of BPD is generally considered to be an adjunct to psychotherapy. The data support the efficacy of low dose antipsychotic drugs and mood stabilizers.

The presence of low-activity alleles of the MAOA gene increases the risk of hostility.

To study the association of hostility with high and low-active variants of the MAOA gene in an open population of men 45-64 years.

Under the WHO International Program MONICA-psychosocial and HAPIEE a representative sample of men aged 45–64 years (n = 781 men, average age was 56.48 ± 0.2 years) examined in 2003-2005. All respondents independently completed a questionnaire on hostility. From the surveyed sample using the random number method 156 men were selected who were genotyped for MAOA-uVNTR polymorphism.

It was found the level of hostility in the population of men was 60.3%. In persons with low-active alleles of the MAOA-L gene (allele 2 and 3) a high level of hostility was more common - 50.9%. The results of building a logistic regression model showed that the presence of low-active alleles (2; 3) of the MAOA gene increases the likelihood of hostility OR = 2,103 (95% CI 1,137-3,889, p = 0.018).

Our findings allow us to conclude that the low-active allele of the MAOA-L gene is associated with hostility.