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Seria Nouă New Series
An XXVII nr. 3 (90) Year XXVII No. 3 (90)
Septembrie 2021 September 2021
Frecvența: Trimestrială Frequency: Quarterly
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EDITORIAL BOARD
Tudor Florea-MD
Chief Editor: Grigore T. Popa University of Medicine and
Professor Roxana Chiriţă-MD, PhD Pharmacy, Iasi, Romania
Grigore T. Popa University of Medicine and Anton Knieling-MD, PhD
Pharmacy, Iasi, Romania Grigore T. Popa University of Medicine and
Pharmacy, Iasi, Romania
Scientific Editor: Ioan Mihalache-MD, PhD
Professor Vasile Chiriţă-MD, PhD Socola Institute of Psychiatry, Iasi, Romania
Honorary Member of the Romanian Academy of
Medical Science Florin Mitu-MD, PhD
Grigore T. Popa University of Medicine and
Managing Editors: Pharmacy, Iasi, Romania
Alexandra Boloş-MD, PhD Petronela Nechita-MD, PhD
Grigore T. Popa University of Medicine and Socola Institute of Psychiatry, Iasi, Romania
Pharmacy, Iasi, Romania Matei Palimariciuc-MD
Romeo P. Dobrin-MD, PhD Grigore T. Popa University of Medicine and
Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
Pharmacy, Iasi, Romania Elena Popescu-MD
Deputy editors: Pharmacy, Iasi, Romania
Prof. Cristinel Ştefănescu-MD, PhD Raluca Ioana Prepeliță-MD
Grigore T. Popa University of Medicine and Socola Institute of Psychiatry, Iasi, Romania
Pharmacy, Iasi, Romania Dania Andreea Radu-MD
Prof. Călina Gogălniceanu Grigore T. Popa University of Medicine and
Al. I.Cuza University, Faculty of Letters, Iasi, Pharmacy, Iasi, Romania
Romania Irina Săcuiu-MD, PhD
Laura Pricop-researcher, PhD Socola Institute of Psychiatry, Iasi, Romania
Al. I. Cuza University –Interdisciplinary Research Laura Gheucă Solovăstru-MD, PhD
in Social-Human Sciences Iasi, Romania Grigore T. Popa University of Medicine and
Alin Ciobîcă-researcher, PhD Pharmacy, Iasi, Romania
Al. I. Cuza University Iasi, Romania Andreea Silvana Szalontay-MD, PhD
Editors: Pharmacy, Iasi, Romania
Radu Andrei-MD, PhD Șerban Turliuc-MD, PhD
Socola Institute of Psychiatry, Iasi, Romania Grigore T. Popa University of Medicine and
Ovidiu Eugen Alexinschi-MD, PhD Pharmacy, Iasi, Romania
Socola Institute of Psychiatry, Iasi, Romania Gabriela Ștefănescu- MD, PhD
Adrian Dumitru Cantemir- MD, PhD Grigore T. Popa University of Medicine and
Pharmacy, Iasi, Romania Ilinca Untu-MD
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Grigore T. Popa University of Medicine and Bianca Georgiana Secrieru -MD
Pharmacy, Iasi, Romania Socola Institute of Psychiatry, Iasi, Romania
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Summary
Editorial / 11
Health management / 13
Roxana Chiriță, Elena-Rodica Popescu
Articles / 15
Diabetes, obesity and metabolic syndrome models studied in zebrafish - further

relevance for the neuropsychiatric disorders-related manifestations / 17
Iuliana Simona Luca, Irina Dobrin, Alin Ciobîcă, Alexandru Ungureanu, Daniel Timofte
The psychological impact of the novel coronavirus pandemic on healthcare workers and
ways to adress it / 33
Amira Chehab, Laura Elena Bucur, Mirona Letiția Dobri, Codrina Moraru, Petronela
Nechita
Saccharin deprivation increases depression and anxiety levels through oxidative stress
biochemical mechanisms / 41
Sorin Ungurianu, Constantin Truş, Roxana-Rosmary Enciu
Medium-term religious support program applied to suicidal psychiatric patients / 51

Speranța-Giulia Herea, Roxana Chiriță, Andreea Silvana Szalontay, Gabriela Elena Chele,
Cristinel Ștefănescu
Dyslexia intervention to combat specific language disorder, a consequence of economic

migration / 63
Katalin Tiron
Meditation and melotherapy as adjuvant treatments of chronic dermatoses / 69

Bogdan M Tarcău, Ioana A Halip, Adriana I Pătrașcu, Laura Stătescu, Dan Vâță, Adrian
Cantemir, Laura Gheucă Solovăstru
Particularity of suicide in the countries of the European Union / 77

Andrei Scripcaru, Costel Marius Frăsilă, Silvia Şpac, Mădălina Maria Diac, Călin Scripcaru
The therapeutical role of psychedelic drugs in treatment of mental disorders / 87
Dan Cătălin Oprea, Loretta Epure, Vasile Chiriţă, Adrian Cantemir
The psychological impact of aesthetic procedures on the young patient / 97

Ioana A Halip, Laura Gheucă Solovăstru, Laura Stătescu, Ioana A Popescu, Adriana I
Pătrașcu, Andra G Salahoru, Bogdan-Marian Tarcău, Alina Stîncanu, Doinița Olinici
Temelie, Dan Vâță
Humanistic contributions / 107
Artificial intelligence, transhumanism and translation as a universal property of

thinking) / 109
Miroslava Metleaeva (Luchianchicova)
The hypocrisy – changing the vices into virtues / 121

Iosif Tamaș
Case reports / 131
Particularities and limitations of kinesiotherapy in genetic disorders and their medical

recovery – Russell-Silver Syndrome: a case report / 133
Adina Sorina Mitrică, Avram Carmen, Ada Bargau Petrache, Adrian Cantemir, Vlad Teodor
Iacob
Instructions for authors / 139

BPIPsychiatry
Bulletin of Integrative
Buletin de Psihiatrie Integrativa
Health management
Efficient people are the laziest, but they are brilliant lazy people.
(David Dunham)
Roxana Chiriță, Elena-Rodica Popescu
Roxana Chiriță - Professor, M.D., Ph.D., senior psychiatrist, “Grigore T. Popa” University of
Medicine and Pharmacy, Iași, “Socola” Institute of Psychiatry Iaşi
Elena-Rodica Popescu - M.D., Ph.D. student, psychiatrist, assistant professor, “Grigore T. Popa”
University of Medicine and Pharmacy, Iaşi, “Socola” Institute of Psychiatry Iași
Society is in continuous development and was found in the Old Testament of the
adaptation in all fields of activity, especially Christian Bible. Some practical managerial
in the medical area, necessary to improve concepts are still described today in the
the quality of life. World Health construction of the pyramids of Ancient
Organization defines this small discipline, Egypt; suggestions of good management
Public Health, the science and art of disease can be found in the Code of Good Manners
prevention, prolongation of life, and health of Babylon, 3000 years ago.
promotion through the organized efforts of
society to which can be added the Social Medicine was established for the first
improvement of notions of biostatistics, time in Bucharest under the leadership of
epidemiology over well-acquired Prof. Gh. Banu in 1942. In 1948, the
knowledge of general medicine. All this discipline Sanitary Organization was
with the aim of a good quality of life for all selected for the first time in Iași, led by
people, whether they are providers or lecturer Dr. Ion Spinu, and currently, this
providers of health services or simple discipline is called Public Health and
beneficiaries of health services, the role and Sanitary Management.
function being interchangeable.
The specialty of Public Health and Sanitary
The basic concepts of management were Management is included in the terminology
described in different ways for thousands of of medical things. The establishment of this
years. The first reference to management specialization initially conceived as a
14/Bulletin of Integrative Psychiatry New Series  September 2021  Year XXVII No. 3(90)
discipline that would come to the aid of Healthcare managers oversee financial
young doctors as a necessity of literacy in initiatives; the economic field is a vital
the integral medical field. For a start so that aspect of the hospital unit, designs and
later it could be known, in the true sense of analyzes, evaluates, communicates, and
the word management, which includes the reviews financial strategies, and recruits the
main management areas at the level of a appropriate human resource for the crew.
hospital and the main management It also plays a bridge role, a link between
activities. doctors and other heads of health units, both
territorial, inside the borders or outside
In general terms, management is a process them. All of the above require extraordinary
by which work is done through others - communication skills at all hierarchical
done on time and within budget, involves a levels, of all types (internal, external), with
series of integrated activities. Management the transmission of clear, consistent
determines a combination of means information in and for the benefit of the
(financial-budget, human-human resource, health unit. At the same time, managers
materials) to generate socially helpful need to ensure the quality-of-care standards
services. that govern all facilities in the medical
industry.
The basic terms that revolve around
management are effectiveness and The biggest challenge for a hospital
efficiency, precisely in this order, which manager is to do things consistently and
involves the availability of primary correctly every time.
conceptual skills, human skills, technical
skills (medical, financial, and legislative We conclude by saying that a manager or
knowledge), and adaptation to change. management is something or someone who
Conceptual skills and transformation to makes the resources of a health unit turn
change present together lead to good into results by focusing on the beneficiary
management. Change is understood as a of health services (patient), continuous
continuous confrontation, identification, quality improvement, teamwork.
evaluation, and action determined mainly by
political factors, political legislation, the
government's economic policy or other
countries, international regulations, wars,
trade union activity, technological factors,
and socio-cultural factors.
Isn't t it funny how day by day nothing

changes, but when you look back,
everything is different.
A good organization of the entire medical

system can prevent us from attributing the
above expression.
BPIPsychiatry
Diabetes, obesity and metabolic syndrome

models studied in zebrafish - further relevance
for the neuropsychiatric disorders-related
manifestations
Iuliana Simona Luca, Irina Dobrin, Alin Ciobîcă
Alexandru Ungureanu, Daniel Timofte
Iuliana Simona Luca - Department of Biology, Faculty of Biology, Alexandru Ioan Cuza
University, B-dul Carol I, no11, Iasi, Romania
Irina Dobrin - MD, PhD, psychiatrist, lecturer, ”Grigore T. Popa” University of Medicine and
Alin Ciobîcă - PhD, Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University,
Iasi, Romania, Academy of Romanian Scientists, Bucuresti, Center of Biomedical Research,
Romanian Academy, Iasi
Alexandru Ungureanu - Psychologist, Faculty of Psychology, Alexandru Ioan Cuza University,
Iasi, Romania
Daniel Timofte - Professor, MD, PhD, ”Grigore T. Popa” University of Medicine and Pharmacy,
Iasi, Romania
ABSTRACT
In the recent decades, the incidence of cardiovascular diseases, as well as endocrine and
metabolic diseases, which are affecting the quality of human life, is constantly increasing.
Currently, given that the prevalence of metabolic diseases, obesity and diabetes is constantly
increasing worldwide, there is an increased interest in developing new therapies and in
creating better experimental models for mimicking the complex human symptomatology. This
could result in a faster diagnosis with lower cost, as well as in advances of the so-called
personalized medicine. Among the animals that could be experimental models for these
diseases, there is an increased interest in the zebrafish (Danio rerio), giving that the qualities
that recommend it are its small size, the need for a small living space, relatively low costs of
use, high homology to the human genome, high fertility and mostly the formation of the major
organs at 24 hours after fertilization. In this way, the presence in zebrafish of all the key
organs that are important and necessary for the complex metabolic control, as well as the
similarities in lipid metabolism and the adipogenic pathway between zebrafish and mammals,
could make this small organism an ideal tool for the study and the better understanding of
adipogenesis, diabetes, obesity and the complex pathological processes which are
18/Bulletin of Integrative Psychiatry New Series September 2021 Year XXVII No. 3(90)
characterizing the metabolic diseases. This could have an increased relevance in the context of
our previous work describing neuropsychiatric models in zebrafish (focusing for example on
dementia), considering also the important connections that might exist between the general
metabolic disorders and most of the neuropsychiatric-related manifestations.
KEYWORDS:
Metabolic syndrome, obesity, diabetes, zebrafish.
experimental model on which this disease can

INTRODUCTION be modeled. (8).
The metabolic syndrome, generically called at
the beginning by Gerald Reaven's, syndrome METABOLIC SYNDROME
X in 1988, was then defined as an As mentioned, the initially called Syndrome
accumulation of abnormal disorders (1, 2). X, went through several definitions: obesity,
Syndrome X, later becoming the subject of along with a fasting blood glucose ˃ 100
several researchers, was finally defined as a mg/dl, accompanied by high blood pressure,
combination of 4 disorders (diabetes, blood high triglycerides ˃ 150 mg / dl and an
pressure, obesity, hypertrigligeridemia) increase in lipoproteins (Lower HDL) (9).
closely related to each other (3). Reaching another definition, practically an
association of increased glucose with at least
Regarding the endocrine and metabolic two other health problems: high blood
diseases, zebrafish is considered to have great pressure, increased plasma triglycerides,
potential in the investigation of thyroid abdominal BMI ˃ 30 kg / m² and
diseases, thyroid hormones and defects microalbuminoria (9).
related to their receptors, helped by the fact
that the zebrafish, like the mammals, has Finally, the European Insulin Resistance
molecular mechanisms and components Study Group (EGIR) defined X syndrome as
related to thyroid axis (4). Moreover, insulin resistance syndrome, along with 2
knowing that the organ systems of zebrafish other factors: high plasma glucose, but not
resemble those of humans, especially those necessarily a person with diabetes, high
related to metabolic control to regulate body triglycerides, low HDL, blood pressure. All
energy homeostasis, which results in obesity, definitions assigned to syndrome X show that
zebrafish has been used to study various the 4 disorders (diabetes, blood pressure,
diseases in the field of metabolic diseases obesity and hypertriglyceridaemia) are related
such as obesity, diabetes, nonalcoholic fatty to each other (9).
liver disease (NAFLD), nonalcoholic
steatohepatitis (NASH), atherosclerosis and Underlying the body's survival and
liver cancer (5) (6). functioning is the control of energy
homeostasis between cells and tissues. When
Thus, it was lately suggested that zebrafish this homeostasis is disrupted in the body, the
can be used successfully in modeling these toxic accumulation of carbohydrates, proteins
diseases because it has all the key organs to and lipids takes place. In diabetes, high blood
balance energy homeostasis and metabolism sugar causes both micro- and macrovascular
in mammals, as well as appetite regulation, diseases (10), which in turn can cause strokes,
insulin and lipid storage. (5) (6) (7) (8). heart attack, kidney failure, blindness and
neuropathy (11) (12) (13). In conclusion, the
Diabetes, known as a syndrome with high metabolic syndrome must be understood at
blood glucose levels and as a consequence of the system level precisely because of its
metabolic imbalance, also affects the quality multi-organ effects.
of human life and requires the creation of an
Bulletin of Integrative Psychiatry  New Series September 2021  Year XXVII No. 3(90)/19
Zebrafish has great potential for investigating (25) (26) (27) (28) (29) (30) (31) (32). Over
thyroid diseases and everything related to time, zebrafish have been used in the study of
them, because it has all the components many metabolic diseases, innate metabolic
related to the thyroid axis, similar to errors (33) (34) yper and hypothyroidism (35)
mammals; thus, by using transgenic lines, this (36), metabolic cancer (37), and in this review
model is suitable for developing new I will bring in discuss diabetes, obesity and
therapeutic approaches (4). It has also been dyslipidemia as the most common metabolic
observed that long-term exposure to tubing (38) (39). So zebrafish can be a model
environmental chemicals causes disorders for studying metabolic diseases due to
similar to those caused by endocrine functional preservation in lipid metabolism,
disorders. Chemicals that interfere with the adipose tissue biology, glucose structure and
components of the endocrine system are glucose homeostasis (40).
called endocrine disrupting components
(EDC). Zebrafish can be used to understand OBESITY
related mechanisms and to detect EDC by Obesity, a global health problem, is a disease
applying biomarkers, specific genes and a that results from the interaction of genetic and
transcriptomic platform (14). environmental factors, characterized by
increased fat storage in WAT (white adipose
The organ systems of zebrafish are similar to tissue). Causes of obesity include the quantity
humans in terms of metabolic control for and quality of food consumed by individuals,
regulating body energy homeostasis, and for as well as exposure to obesogens, a class of
this reason zebrafish has been used to model chemicals that disrupt the endocrine system,
metabolic diseases such as obesity, diabetes, and their presence in early life affects
NAFLD, NASH, atherosclerosis and liver adipogenesis and lipid metabolism (41) (42).
cancer (5) (6). The basic metabolic Obesity, the result of a positive balance when
mechanisms of zebrafish are similar to those the energy ratio is higher than its expenditure,
of humans (15). Other similarities of zebrafish causes the organs involved in maintaining
with humans consist in the development of balance, mean the brain, liver and adipose
the peripheral nervous system (16), and the tissue to interact to regulate this aspect. Due
development of adipose tissue takes place in to the similarities with the human body, the
both species, as well as the existence of zebrafish is used to study obesity (43) (44).
similar genetic factors (17). Zebrafish is a suitable model to study
metabolic dysfunction because it has digestive
Metabolic disease is a consequence of the organs, adipose tissue and skeletal muscle,
interaction of lifestyle, socio-economic organs that regulate energy homeostasis and
factors and behavioral factors (18) (19) (20). metabolism in mammals (45) (46).
Both energy metabolism by maintaining
energy homeostasis and the microbiome can In mammals there are 2 main classes of
certainly affect metabolism (18) (19) (20). In adipose tissue: brown adipose tissue (BAT)
zebrafish, organs such as the thyroid and which dissipates energy and generates heat,
endocrine pancreas develop within 48 hours and white adipose tissue (WAT) with the role
dpf (days after fertilization) and have the role of energy storage and regulation of energy
of secreting hormones essential for balance (47). BAT consists of several drops
maintaining energy homeostasis. (21) (22) of microvesicular lipids as well as many
(23) (24), and the maintenance of metabolic mitochondria that have the role of providing
homesostasis begins by regulating glucose. heat using lipids. WAT is a large unilocular
Returning to the influence of the microbiome lipid drop formed by the union of small lipid
on metabolism, a basic microbiome has been droplets that will be stored as a small energy
observed in zebrafish, and researchers have reserve (48). Adult zebrafish contain WAT in
begun to study how infection naturally or the pancreatic, visceral, esophageal,
induced alters the intestinal microbiota by mandibular, cranial, and tail fins (49). Being
disrupting carbohydrate and lipid homeostasis poikilothermic animals, they do not contain
BAT, although they have been shown to have lipid droplets, is deposited in both adipose
an approved coupling protein 1 (PCU 1) that and non-adipose tissues (63) (64).
can be associated with BAT in other species
(50). Excess nutrients cause adipocyte hypertrophy
and hyperplasia in adipose tissue; Among the
To better understand the physiological cells that inflame adipose tissue are
changes of an organism affected by obesity, macrophages and pro-inflammatory
zebrafish are used to monitor adipogenesis, molecules: tumor necrosis factor (TNF-α),
from egg fertilization to larval stage, precisely interleukin-6 (IL-6), monocytic
because zebrafish larvae develop outside the chemoattractant protein (MCP-1) (65) (66)
mother's body and due to the optical (67 ). Adipocytes and macrophages interact
transparency of them. Thus, with the help of and thus inflammatory adipocytokines
appropriate tools, defects in the absorption, decrease, leading to complications associated
transport and arrangement of lipids can be with obesity. In many organs it all causes
detected (51) (52). Zebrafish also contain some metabolic disorders, insulin resistance,
cells that specialize in the absorption and diabetes, cardiovascular disease, stroke and
processing of lipids (eg, intestinal enterocytes, even some cancers (68) (69). It has been
fat-storing adipocytes, liver hepatocytes, and shown that in order to assess the development
pancreatic acinar cells) (53) (54). Adipocytes of comorbidities related to obesity, the
that form in fish larvae can be observed with distribution of fat in a body is more important
the help of dyes: Sudanophilic dye Oil Red O than the total amount of fat (70) (71). When
(ORO), Sudan Nile Red, or Lipid Green (55), adipose tissue grows, plasma free fatty acids
and to observe the transport of fatty acids are (FAA) are released and in obese patients it
used BODIPY lipophilic floroflor by injection forms a link between obesity and metabolic
yolk, from fish food, the latter reaching the syndrome by promoting lipotoxicity in the
circulatory system very quickly, lasts about 3 liver and muscles, by altering the action of
hours (56). insulin and causing non-alcoholic fatty liver
disease (NAFLD) (72).
Zebrafish can be considered a suitable model
for human lipid metabolism because functions Knowing that the hypothalamus is the site of
such as regulating appetite (by the presence in appetite circuits (73), leptin receptors and
the hypothalamus of appetite circuits) of melanocortin system proteins (74) (75) we
insulin (through the pancreas) and lipid can highlight the similarities of fish with
storage are well preserved (57) (58) ( 59). humans in this regard. Intracerebroventricular
Excess nutrients increase plasma TGL levels administration of neuroactive peptides (NPY)
and the appearance of hepatic steatosis (60) as has also been shown to definitely stimulate
well as the presence in zebrafish of horses that food intake, and administration of CART
regulate lipid metabolism: SREBF 1, P PAR (regulated cocaine and amphetamine-
S, NR 1 N 3, LEP (60) make it a suitable transcription) of melanocortin peptides and
model . CRF (corticotropin-releasing factor) inhibits
feeding (76). A zebrafish model for obesity
The preservation of these metabolic pathways can be created by chromosomal translocation,
that intervene in the differentiation of which suppresses central melanocortin
adipocytes energy homeostasis (61) and receptors, knowing that the central
cholesterol metabolism make zebrafish an melanocortin system (CMS) controls and
ideal model for human lipid metabolism (62). regulates energy homeostasis. It contains
Obesity caused by the creation of a prolonged propriomelanocortin (POMC), peptides and
imbalance between calories entered and agouti-bound peptide (AgRP). Zebrafish
insufficient energy expenditure, is following this chromosomal translocation
characterized by adipose tissue hypertrophy increase in weight due to the high content of
and hyperplasia. Obesity occurs practically triglycerides (TGL), due to increased
when the excess energy, stored in the form of expression of AgRP, an endogenous
antagonist of melanocortin and due to visceral including BODIPY cholesterol analogs and
fat accumulation (36) (77). fluorescence reports such as PED 6 for
monitoring the metabolism and distribution of
Leptin, the main adipostatic factor, is a exogenous lipids in live zebrafish (88) (89).
hormone that informs the brain about the total Micro CT 3D is also available for this small
energy stored as TGL in fat cells; and by animal and allows the measurement of total
regulating the amount of adipose tissue in the adipocyte tissue volume as well as various fat
body, by inhibiting food intake, by deposits (90). Recently, Landgrof et al.,
stimulating energy expenditure, reducing compared the methodology for quantifying
body weight and fat percentage intervenes to the body fat mass of zebrafish using MR
maintain euglycemic status (78). Leptin leads imaging (MRI) and 4 in 1 Echo MRI (Echo
to the onset of hepatic steatosis and the onset MRI tm) (91). These methods provide
of insulin resistance (79). Deficiency of this accurate measurements of zebrafish
hormone causes the onset of deep adiposition and provide means for
hyperphagia and obesity, infertility and longitudinal monitoring.
diabetes. The difference is that in zebrafish
the leptin receptor is expressed in the liver It was also showed that a high-fat diet given
and other tissues, and not in adipose tissue as to zebrafish larvae increases adiposity, and in
in humans, and the deficiency of receptors in adult zebrafish it causes hepatosteatosis,
zebrafish larvae causes an increase in the hypertriglyceridemia, and high BMI (39) (92).
number of beta cells and insulin mRNA One of the methods of inducing obesity is to
levels, and larval zebrafish in response to a administer excess fat immediately after 5 days
fatty diet may have beta cell hyperplasia or after fertilization. Early larvae do not have
peripheral insulin resistance, so it can be said WAT (93), in which case lipid droplets
that leptin has a major role in maintaining accumulate in the bloodstream, and the
glucose homeostasis and a secondary role as amount of whole larval triacylglycerol is used
an adipostatic factor (80). as an indicator to quantify the progression of
obesity (94) (95). A high-fat diet consists of
Zebrafish, like mammals, have white adipose administering egg yolk (95).
tissue, initially made up of several small
drops of lipids, and as they develop, they turn Zebrafish larvae begin to eat 5 days after
into a single large drop of lipids (81). Visceral fertilization (dpf), until then they absorb the
adiposity is considered to be a critical risk essential fats, cholesterol and triacylglycerol
factor for other metabolic diseases and T2DM provided by a sac of maternal yolk (96). At 5
(82). Zebrafish contain lipid deposits in dpf the lipids become visible in several
visceral, intramuscular and subcutaneous tissues, with the formation of a small deposit
adipocytes (83) and can assess the degree of in hepatocytes; instead, the first signs of
metabolic disorders related to obesity. In adipogenesis can be seen at 8 dpf in the
humans, these quantitative measures consist visceral cavity, close to the pancreas.
of the calculation of body mass index and Adipocytes appear in the pancreas of larvae at
quantitative computed tomography (CT), and 12 dpf (96). To highlight adipocytes, at 15
in fish lipophilic dyes are used: red Nile, oil dpf, red Nile dye is used; 15 dpf being the day
Red O and Sudan Black B (84) (85). With when the adipocytes in the visceral area
zebra larvae having optical transparency, the (internal intra-abdominal and surrounding
researchers developed screens based on live organs become visible (97); a location
imaging and fluorescence to study digestive associated in humans with risk factors for the
physiology or lipid metabolism. Nile red has development of type 2 diabetes mellitus
been used to quantify intracellular neutral (T2DM) (98) (99). The number of adipocytes
lipid droplets and for vivid imaging (86) as correlates with the size of the larvae, rather
well as to purify adipose tissue (87). In than with their age; thus, it was observed that
addition, a variety of fatty acid analogs and at 17 dpf the larvae have WAT in the
fluorescent lipid tracers are available, pancreatic and visceral area, and at 20-22 dpf,
subcutaneous and cranial adipocytes develop, To understand exactly when and where TH
depending on the size (93). works in the pancreas, the thyroid is ablated
when treated with metronidazole. Thyroid
There is also an increase in microsomal ablation leads to loss of endogenous TH
triglyceride transfer protein (MTP) mRNA (105). A transgenic line can be used to
levels in the proximal intestine and liver, perform conditioned TH during the transition
following a high-fat diet (90). MTP has a 54% from larvae to the juvenile transition. After
identity with human MTP and is involved in thyroid ablation, insulin expression was
the breakdown of lipoproteins in the born decreased and glucagon expression was
ApoB, and these ApoB-MTP complexes can loaded, followed by increased blood glucose
prevent lipid degradation by proteasomes and during the transition from larval to juvenile.
increase plasma lipid levels. ApoB levels Decreased insulin secretion and increased
increased in response to overeating (100) glucagon secretion and the resulting increase
(101). in blood glucose continued in adult fish. The
TH treatment of adult thyroid fish increased
The high degree of conservation in the insulin secretion and reduced glucagon
distribution and formation of adipose tissue in secretion and reduced blood glucose levels.
zebrafish compared to mammals make it a These results suggest that TH is important to
suitable model to study obesity. generate α and β cells and to maintain their
maturation. In addition, glucose sensitivity
DIABETES was found to be improved in both α and β
Diabetes is a syndrome characterized by cells after T3 treatment (106). Thus, TH can
elevated blood glucose levels (hyperglycemia) regulate α and β cells in cell maturation by
and metabolic imbalance (102). increasing glucose sensitivity (105).
Chronic blood glucose is the major The pancreas is an organ with two sets of
biochemical diagnostic parameter observed in functions: those related to the digestive
the two major forms of diabetes: type 1 or system (acinar cells and ductal cells), and
insulin-dependent diabetes, caused by those of the endocrine system (islets). Several
autoimmune destruction of insulin-producing phylogenetic analyzes suggest that the
pancreatic beta cells, and T2DM or non- digestive system and the endocrine system
insulin-dependent characterized by insulin evolved differently (107) and that the single
insensitivity (102). unified pancreas developed as a new organ
through the fusion of endocrine and digestive
The development of the pancreas in the parts during fish evolution (107).
organs of vertebrates often involves a two-
stage process. First, the formation of a The zebrafish pancreas comes from two
functionally immature organ during progenitor domains called the dorsal bud
embryogenesis, which is followed by (DB) and the ventral bud (VB). However,
differentiation into mature form (103) (104). unlike dorsal and ventral pancreatic buds in
The second step most often occurs during the mammals, DB and VB in zebrafish have
postembryonic / postnatal period, when the distinct differentiation potentials (108). DB is
concentration of plasma thyroid hormone formed within 24 hours after fertilization
(TH) becomes high. In addition, mammalian (HPF) and consists of early endocrine cells
weaning, frog metamorphosis, and the larval- grouped to form the main islet. VB arises
juvenile transition of the zebrafish have been from the intestinal tract after 34 dpf and these
proposed to be functionally equivalent events cells migrate to swallow the main islet (108).
during postembryonic development, based on The endocrine compartment consists of alpha
cellular and molecular events in their cells that secrete glucagon, beta cells that
digestive organs, including the pancreas, and produce insulin, gamma cells that produce
increase in plasma TH concentration during somatostatin, epsilon cells that produce
these periods (103) (104). ghrelin, and pancreatic polypeptides that
produce PP (109) (110). In addition to the with obesity and considered part of the
pancreas, the development and function of metabolic syndrome (116). T2DM is
other organ systems involved in glucose accompanied by chronic inflammation and
homeostasis, including the brain, liver, oxidative stress (117) and patients often
adipose tissue and skeletal muscle are also develop non-alcoholic fatty liver disease
preserved (111). Preservation of pancreatic (118). Insulin is the cause of hyperglycemia
structure and system glucose homeostasis in T1 DM. The most common treatment for
makes zebrafish useful for identifying new this form of the disease is insulin injection.
targets in pancreatic-related diseases such as Antidiabetic drugs for T2DM can directly
diabetes. target hyperglycemia by promoting the
release of insulin from beta cells in the early
Pancreatic β cells secrete insulin in response stages of the disease by improving the insulin
to high glucose levels. In β cells in mammals sensitivity of target cells in various ways or
under high glucose conditions, this one moves by slowing the digestion of carbohydrates
into β cells through the glucose transporter, after meals. T2DM patients can also improve
GLUT2. Βeta cells then produce more ATP, their health by reducing obesity, inflammation
which increases the ATP / ADP ratio through and oxidative stress.
glucose metabolism. Increasing the ATP /
ADP ratio stimulates the closure of the ATP- Deficiency of glucose, the main fuel of the
dependent potassium channel (KAtp), brain, leads to coma, convulsions causing
subsequently evoking the depolarization of β permanent damage to the brain. Glucose
cells that leads to the activation of 2+ reaches the brain through CBF (119) cerebral
channels that stimulate insulin secretion. Like blood flow through endothelial cells, to the
mammals, GLUT 2 is expressed in pancreatic blood-brain barrier (BBB) (120) and
zebrafish β cells. In addition, KAtp and Ca2 + eventually to glial cells through facilitated
channels regulate insulin secretion according diffusion. Glucose is transported to glial cells
to blood glucose levels (112),(113). These and neurons by GLUT 7 carriers. Although
indicate that the pancreatic β cells of zebrafish insulin alters glucose metabolism in the CNS
function in the same way as other vertebrates. (121) it is not the main mechanism in the
On the other hand, these investigations were brain for neuronal absorption. But insulin
performed using main islets, but not with influences activities such as neuronal growth
secondary islets. The molecular mechanisms and survival, synaptic plasticity,
underlying the secondary development of neurotransmitter release, tubulin activity,
islets in zebrafish is similar to that of the cognitive improvement of memory, learning
development of mammalian islets. Thus, (123).
determining the functional differences
between the main islets and the secondary Destruction of pancreatic beta cells is the
islets could become important to understand leading cause of T1 DM and a consequence of
how vertebrates acquired functional islets. T2DM progression. The toxic glucose
analogue of alloxan is well known for its use
T1DM is an organ-specific autoimmune in rodent diabetes models and has been used
disease caused by the destruction of insulin- successfully in wild zebrafish larvae along
producing pancreatic beta cells by T cells with staining of the fluorescent analog 2-
(114). T2 DM is a metabolic disease NBDG for one hour and using a fluorescent
associated with insulin resistance. microscope (124) a green fluorescence is
Hyperglycemia in T2DM is initially obtained. For wild-type larvae, an alternative
accompanied by compensatory method of visualizing the pancreas is to use
hyperinsulinemia, but as the disease fluorescent conjugated antibodies against
progresses oxidative stress triggers beta cell insulin or glucagon (125).
apoptosis, and the amount of insulin produced
by the pancreas gradually decreases (115). T2 Glucose transporters (GLUT) in zebrafish
DM is an often associated lifestyle disease. have a structure and tissue distribution similar
to that of mammals (126) (127). Fluorescent During diabetes, inflammation in wild

analogues of glucose 2-NBDG and GB-2 Cy zebrafish larvae was achieved by exposure to
3 are both substrates known for GLUT and high concentrations of glucose or fructose
have been used to monitor glucose uptake in (136).
zebrafish larvae. Increased uptake of 2 NBDG
could be inhibited by the glucose transporter In fact, this mini-review of ours could open
inhibitor () and reduced in the presence of the discussion on the obvious connections that
excess D-Glucose to illustrate that uptake of 2 might exist between the digestive and
NBDG in zebrafish occurs through GLUTs in gastrointestinal-metabolic component that is
similar to that of mammalian glucose (129). associated with the neuropsychiatric one (137,
138), considering the latest expertise of our
The pancreas of the zebrafish is very similar group in this area (139), as well as the social
to that of humans in terms of cell types, as implications in this context (140, 141), and of
well as the secretion of hormones and course the neurological and psychiatric
digestive enzymes. Regulation of zebrafish manifestations related to the general
genes for insulin, glucagon, and other proteins metabolic disorders, in the context of the
involved in glucose metabolism has also been oxidative stress (another important expertise
shown to be similar in the two species (130). and perspective of our group -142) or not
Increased endogenous glucose levels in (143-146).
zebrafish larvae are associated with a
increased expression of the gluconeogenic We could also mention in this context, the
regulatory enzyme PEPCK (131). The major developing of the techniques for glucose
regulatory mechanism for this enzyme is the homeostasis in zebrafish, as many transgenic
activation of expression by cortisone and strains of zebrafish with fluorescent protein
glucagon and inhibition of glucagon receptor expression have been used to study pancreatic
signaling lead to a reduction in PEPCK which development and glucose homeostasis in
in turn improved insulin sensitivity and living vertebrates (148).
reduced blood glucose in models with severe
insulin resistance (132). In addition, Thus, methods for zebrafish pancreatic
hyperglycemia and excessive gluconeogenesis function have been established, including
are present in all forms of diabetes. (133). postprandial blood glucose measurement and
glucose tolerance tests as well as pancreatic
Direct measurement of in vivo glucose levels dissection techniques and islet cell culture
in larvae can also be used as an indicator of (150).
glucose homeostasis reflecting the net activity
of glycolysis and gluconeogenesis (134). In larvae, blood collection for glucose
Inflammation is triggered by numerous measurement is not a viable methodology, but
stimuli (microbiological, physical and free glucose in whole larvae can be measured
chemical) which activates the immune system by a coupled enzyme fluorescent test (151).
and recruits immune cells. It is accompanied For adult zebrafish, the small size (3-4 cm)
by the production of inflammatory mediators makes blood collection difficult. However,
such as proinflammatory cytokines several protocols have been developed for
(interleukin -6, IL-6, IL-8, IL-1beta, blood collection: lateral incision in the dorsal
macrophage granulocyte colony stimulating aorta, decapitation and tail ablation, although
factor and tumor necrosis factor alpha (135). these methods require animal sacrifice (153).
Inflammation and oxidative pathways are Measuring insulin function was a major
interconnected to form a positive feedback challenge in this context. As surrogate
loop. Immune cell recruitment and the indicators, insulin mRNA levels can be
secretion of cytokines and chemokines lead to determined directly by qPCR and insulin
the production of reactive oxygen species promoter activity can be determined indirectly
(ROS) and reactive nitrogen species (NOS). by measuring EGFP signal strength in Tg (-
1.oins.EGFP) over zebra (154). Insulin transient hyperglycemia, but persistent

sensitivity can also be assessed by hyperglycemia can be achieved in young
intraperitoneal injection of insulin into zebrafish by gradually increasing glucose
hyperglycemic zebrafish (156). Also, young concentration (157).
fish (4-11 months) acclimatize more easily to
the glucose exposure protocol compared to
older fish (1-3 years) so they showed a
CONCLUSIONS
In this way, the presence in zebrafish of all the key organs that are important and necessary for the
complex metabolic control, as well as the similarities in lipid metabolism and the adipogenic
pathway between zebrafish and mammals, could make this small organism an ideal tool for the
study and the better understanding of adipogenesis, diabetes, obesity and the complex pathological
processes which are characterizing the metabolic diseases. This could have an increased relevance
in the context of our previous work describing neuropsychiatric models in zebrafish (focusing for
example on dementia), considering also the important connections that might exist between the
general metabolic disorders and most of the neuropsychiatric-related manifestations.
ACKNOWLEDGEMENTS AND DISCLOSURES

The authors state that there are no declared conflicts of interest regarding this paper.
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Correspondence
Irina Dobrin,
MD, PhD, lecturer, psychiatrist, ”Grigore T. Popa” University of Medicine and Pharmacy, 16,
Universitatii Street, 700115, Iasi, Romania, [email protected]
Submission: 15 jul 2021

Acceptance: 28 aug 2021
BPIPsychiatry
The psychological impact of the novel coronavirus

pandemic on healthcare workers and ways to
adress it
Amira Chehab, Laura Elena Bucur, Mirona Letiția Dobri,
Codrina Moraru, Petronela Nechita
Amira Chehab - Second year Medical Resident in psychiatry, ”Socola” Psychiatry Institute, Iasi,
Romania
Laura Elena Bucur - Second year Medical Resident in psychiatry, ”Socola” Psychiatry Institute,
Iasi, Romania
Mirona Letiția Dobri - Fourth year Medical Resident in psychiatry, ” Socola” Psychiatry Institute,
Iasi, Romania
Codrina Moraru - Third year Medical Resident in psychiatry, ” Socola” Psychiatry Institute, Iasi,
Romania
Petronela Nechita - MD, PhD, Senior psychiatrist, ”Socola” Institute, Iasi, Romania
ABSTRACT
The spread of COVID 19 across the globe is challenging the capacity of response of all
healthcare systems. The uncertainty and the newness af this pandemic provoked a generalized
wariness and stress among all categories of population, but mainly among healthcare
professionals. Due to the lack of knowledge of the disease, the excessive amount of work, poor
resources and depletion of personal protection equipment, the huge media pressure and many
other difficulties, healthcare workers(HCW) are at high risk of developing many mental
health issues such as anxiety, depression, burnout, post-traumatic stress disorder, sleep
disorders, all of which could have a negative long-term psychological impact. In this context,
it is important to research and to have an real-time view on this topic, in order to find ways of
improving the psycological distress HCW are facing.
KEYWORDS:
Distress, anxiety, PTSD, burnout.
INTRODUCTION morbidities in HCWs in the result of SARS-

The novel Coronavirus disease started in COV2 was three times higher than the general
December 2019 in Wuhan, China and since public (3,4).
then, it is spreading rapidly all around the
world. In just months it was considered a WORK-RELATED STRESS FACTORS
world health emergency and it was declared a Work and personal-life stressors can
pandemic by the World Health Organization compromise physical, mental and emotional
(WHO) in March 2020 (1). As in any wellbeing of people. Studies done by Xiu et
pandemic situation, this global crisis requires al. showed that there are many factors that
intense and immediate response of medical have contributed to the development of
system , with thousands of professionals mental issues among HCW. The strict contact
delivering services to pacients, adressing the with infected pacients and the risk of getting
challenges posed to healthcare system by the infected themselves, the possibility to take the
huge number (over 60 million) of pacients virus at home and infect their families and
infected by the time we are writing (2). other people, not having rapid acces to testing
if needed were some of the difficulties faced
Previous viral outbreaks have shown that by HCW. Also, organizational factors, such as
healthcare professionals are at high risk of depletion of personal protection equipment,
infection and other adverse physical health concerns of not being able to provide
outcomes. Furthermore, HCW reported competent care if deployed to new area, lack
mental health problems associated with their of treatments, the limited number of beds and
ocupational activities during and years after the shortage of of ventilators so much needed
the epidemics. In order to have an idea of the by the increased number of critically ill
effects of this pandemic in the following pacients who require intubation, high volume
years, it is helpful to analize the outcome of workload, lack of both material and human
other epidemics/ pandemics that the world has resources could be triggers for distress. The
faced. In a study done by Lee et al., feeling of unknown and social stigmatization
performed after the SARS (Severe Acute are also important to mention. A preliminary
Respiratory Syndrome- associated study on trauma done by Lee et al. during
coronavirus) pandemic in 2015, for the COVID 19 pandemic showed that HCW may
hospital workers, the post-traumatic stress and experience traumatization due to frequent
depression symptoms associated to the experience of seeing pacients dying alone,
quarantine, can last up to three years after the with no possible contact with their loved
crisis finalizes. In addition, the healthcare ones. In addition to all the labor conditions,
workers placed in quarantine show greater the quarantine implemented to stop the
symptoms of post-traumatic stress than the expansion of epidemic has also have
average population. Similar concerns now consequences ont HCW’s mental health.
have been voiced out about the psychological
well-being of HCWs in facing the SARS- On the other side, Covid 19 provided also
CoV-2 outbreak. The number of COVID-19 positive elements that should be disscused.
patients is increasing dramatically. This leads The public response towards HCWs was a
to a heavier workload in life-threatening very heartening one. Reports showed that the
situations disturbing the psychological health population expressed a worldwide gratitude
of hospitals’ workforces. As studies done by and closeness to medical staff. This pandemic
Huang et al., shows, the rate of psychiatric has put the health system once again in the
spotlight, and for some, it has been an It is still too soon to determine the ultimate
important positive reinforcement (5). psychological and physical impact of Covid-
19 pandemic outbreak, but distress and
INDIVIDUAL STRESS FACTORS anxiety are normal reaction to a situation as
It is important to mention that there are some threatening and unpredictible as this. The
individual factors, such as: gender, age, main symptoms developed by HCW since
family background, history of psychiatric the Covid 19 crisis were anxiety, depression,
disorders that influence the mental health insomnia, post-traumatic stress disorder and
impact of this pandemic. A review on six burnout.
studies conducted in India and Canada by Cai
et al. analized the demographic variables that Burnout, a state of emotional, physical and
influence the mental impact. Findings mental exhaustion caused by excessive and
indicate that woman reported statistically prolong stress, was one of the major concerns
significant higher score in developing post- in HCW. The long- term consequences of this
traumatic stress disorder, anxiety and syndrome include job dissatisfaction,
depression. As in age, young medical staff abandonment and family deterioration, as
(age <30 years old) had higher self-related well as health issues. At a organizational
depression scores compared with those with level, workers with burnout syndrome have a
older age, but the difference wasn’t smaller capacity to give their patients the
statistically significant. The same article healthcare they need, they are more likely to
compared the subject matter of worry and make mistakes, therefore getting the quality
concluded that the younger staff was of healthcare services even worse. Burnout
concerned about infecting their families, Syndrome is declared by WHO as a labor risk
whereas HCW over 50 years old worried , with negative influence uppon life quality,
about their own safety. compromising individual’s mental and
physical health. Tendency to social
Findings that compared front-line workers isolation,fear, depression, anxiety, mood
(those working in Covid-departments) and changes, addictions, eating disoders and
professionals working in other departments weight fluctuations, memory loss, sleep
suggest differences in self-rated anxiety and disorders could suggest presence of burnout
depression scores. Being at the high-risk of syndrome. Studies showed that younger
contagion in such environments will increase respondands (age 21-30 years old) and
the psychological problems, including fear, especially woman had higher personal and
anxiety, stress, depression. Moreover, being work-related burnout. In the light of this
quarantined as a result of working in high-risk informations and the effects caused by
wards was another source of mental disorders. burnout in HCW at an individual level, as
The same study reported that nurses are well as the repercussion on health system, the
facing the highest level of anxiety and distress prevention and treatment of burnout
among all HCW. Nurses are the largest syndrome would be essential (6,7).
occupational group that directly and
intensively are in constant contact with their Mild to moderate and severe anxiety was
patients (6). another common issue found among
healthcare staff. Anxiety and fear of falling
PSYCHOLOGICAL IMPACT sick could amplify the sense of helplessness,
hopelessness, exhaustion and burnout. These
could also lead to depression, focusing limit negative psychological effects are
problems at work, self- depreciation, almost invariably lacking (as can be proven to
insomnia, health problems and an overall low be during other pandemics and global crises).
quality of life (6,8). Attention to mental health and well-being is
commonly superseded by urgent physical and
If it is not treated in time, the disorder or the public health needs during an emergency.
episode of acute stress could become a However, as we disscused in the present
chronic posttraumatic stress disorder (PTSD). review, the long-term mental damages that
Acordig to ICD-10, PTSD is a disorder can result from this pandemic are not to be
characterized by flashbacks or nightmares ignored and actions to help and support
about the traumatic event, which produce should be implemented as soon as possible
terror and strong physiological reactions, (10,11).
avoidance of memories or thoughts related to
the event, or to avoid activities, situations or COPING MECHANISMS
persons related to, and a lasting perception of In these framework, we considerate important
a current noticeable threat. Due to these to mention some of the coping mechanisms
symptoms, professionals working in intensive and solutions that had positive outcome
care units (ICU) may consider the possibility during other epidemics that humanrace had
of quitting their jobs. If these individuals faced. In 2012, after SARS, medical
develop post-traumatic stress, as a self- professionals reported that clear directiveness
protection strategy either being aware or and support from the supervisors, adequate
unaware, they may not want to return to training, social and family support were the
where it was produced. Therefore, the most effective support mechanisms.
psychological consequences derived from the Moreover, after MERS (Middle East
social situation to which the healthcare respiratory syndrome-related coronavirus),
workers are exposed could not only have medical staff sustained that strict protective
implications at individual level, but also measures and guidance, an cohesive team,
increase the burnout already mentioned and optimistic and an overall positive attitude in
may help degrade the health system the work enviroment and the recognition of
institution (6,9). their efforts by the hospial help them to
overcome the situation (12).
Studies and reviews, like this one, that
describe, asses and compare the Having several informations and taking the
psychological symptoms HCW are facing history as an exemple, several studies
during coronavirus pandemic can offer reported on the implementation of
service planners, strategies and methods on interventions to prevent or reduce
how to mitigate mental health risks and psychological trauma caused by Covid-19
preserve the wellbeing of this essential pandemic among HCW. WHO recognised the
workers. Eventually, such reasearch can help extremely high burden on health care workers
protect health system, a key sector in this and asked for action to adress the immmediate
society in all times, but especially during this needs in order to save lifes and prevent the
crisis. Unfortunatelly, existing evidence serios mental health and physical impact of
reguarding the mental health and well-being HCW (13,14).
of people emerging early in the COVID-19
pandemic shows that adequate resources to
One help-strategy implemented already in close proximity to the hospital, providing

many countries is a thelephone-based hotline support for childcare needs, dispatching fresh
set up to provide immediate psychological medical teams from other areas with less
support, allowing HCW to speak to trained number of patients, keep monitoring and
psychiatrists or psychologists. Although, check on HCWs’ physical and mental well-
several studies reported a low level of interest being , teamwork, identifying staff who are
in proffesional psychological support. In two exhausted or have psychological distress,
studies performed by Ho et al., participants taking all necessary measures to limit
specified that there is a greater need of a infections are some key factors in preventing
personal protective equipment than direct and indirect negative effects of this
psychological help (15, 16). So, an important pandemic (17,18).
role in reducing stress in this group of
workers belongs to hospital managers. Lack of family and social support leads to
Providing adequate and effective protective higher rates of depression and hopelessness.A
equipment, addressing HCWs physical needs, way of solving the distress is rechead with the
such as access to healthy meals and hydration, help of friends and family. Many people turn
considering regular rest breaks, designing a to mindfullness, meditation, exercise and
safe place for their rest, considering shorter self-distraction in order to cope with stress.
working hours and rotating shifts especially Others, consider that family support or talking
for those working in high-risk departments to friends is more efficient (19, 20).
(working in two or three weeks shifts,
followed by 2 weeks quarantine) could be a Regardless of the method used, health care
solution in order to protect medical staff and workers should seek help and take action in
their pacients. Accommodation and lodging timely manner in order to prevent and treat
for staff working in high-risk areas and those any psychological side effect of this
who are on rapid-cycle shifts that don’t live in pandemic.
CONCLUSIONS
In conclusion, healthcare workers battling the COVID-19 epidemic are facing a major physical and
mental stress which could have severe long-term consequences. Anxiety, depression, burnout, as
well as post-traumatic stress disorder are the main psyhological issues that medical teams are
dealing with during this pandemic. Various factors, both individual and work-related, are
contributing to the mental-health impact among HCW. Prevention and timely treatment of these
conditions is recomended in order to preserve the professional’s health.The wellbeing of the health
workers ensure a better quality of medical service, therefore being beneficial not only for HCW
themselves, but also for the pacients and the entire medical system. This review adds to our
understanding of mental health needs during this pandemic. However, further research is required to
understand and confirm in more detail the potential effects of a given outbreak.

The authors declare no conflicts of interest regarding this paper.
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Correspondence:
Petronela Nechita,
MD, PhD, senior psychiatrist Socola Institute of Psychiatry Iași, România, no. 36 Str. Bucium
[email protected]
Submission: 29 mar 2021

Acceptance: 29 may 2021
BPIPsychiatry
Saccharin deprivation increases depression

and anxiety levels through oxidative stress
biochemical mechanisms
Sorin Ungurianu , Constantin Truş,
Roxana-Rosmary Enciu
Sorin Ungurianu - Faculty of Medicine, Dunărea de Jos University, Galaţi, România

Constantin Truş - Department of Morphological and Functional Sciences, Faculty of Medicine,
Dunărea de Jos University, Galaţi, Romania
Roxana-Rosmary Enciu - Sf. Apostol Andrei, Emergency Clinical Hospital
ABSTRACT
Saccharin is a low-calorie artificial sweetener that has been extensively used in food products
since 1879. It has been proven in various studies that saccharin can stimulate the brain
centers of pleasure and reward centers in the brain. These brain centers are also proven to be
active in alcohol and drug abuse. Therefore, we wanted to study in the present paper the
repercussions of saccharin withdrawal on oxidative stress levels and then on depression and
anxiety-like behavior of rats. Our experimental design included 40 lab rats divided into two
groups, 20 rats in each group. The first group of rats had unlimited access to water and
saccharin bottles. The second group was considered the control group and had access only to
water. After 4 weeks, the rats in the saccharin group were deprived of saccharin for 14 days
to allow sufficient time for deprivation episodes to occur. Our statistical analysis revealed that
saccharin withdrawal produced a decrease in catalase activity and as a result an increase in
oxidative stress level. Furthermore, saccharin deprivation was associated with an increase in
the duration of immobility time in the popular forced swim test and a decrease in the time the
rats spent exploring the central area of the open field test. Therefore, saccharin deprivation
seems to produce high levels of oxidative stress which may lead to depression-like and
anxiety-like behaviors in rats. In conclusion, deprivation from the non-drug reinforcer
saccharin produces anxiety and depression-like effects on rats by decreasing the level of
certain antioxidant enzymes, such as catalase. These effects are often seen in withdrawn
models of abused drugs or alcohol.
KEYWORDS:
Oxidative stress, saccharin, catalase, depression, anxiety, deprivation.
INTRODUCTION are designed to restore serotonin-mediated

It has been proven in various studies that neurotransmission to a normal level may also
sugar can stimulate the brain centers of decrease the level of sugar cravings (14).
pleasure and reward centers in the brain. Therefore, eating an excess of sugars, sugar
These brain centers are also proven to be withdrawal, or psychological sugar cravings
active in alcohol and drug abuse (1). may cause neurotransmission dysfunctions
Interestingly, the same brain centers’ and negatively alter various brain processes.
activation has been associated with depressive
disorders (2,3). Furthermore, withdrawal Besides the before - mentioned
behaviors following excessive sugar neurotransmission alteration, sugars may also
consumption were demonstrated to be similar worsen symptoms of various psychiatric
to those induced by addictive narcotics (4, 5). disorders. For example, a study on ADHD
While there are many studies on addictive children showed that patients who received
drug withdrawal, relatively few authors aimed sugar presented higher levels of inattention
to discover the underlying mechanisms and aggressive behavior compared to the
behind the motivation, reward, and addiction control group (12). Another example is
of sugar or other artificial sweeteners. (6). represented by studies conducted on obese
individuals. A study on obese children
Regarding the available literature, a study that showed that the subjects who exhibited sugar
directly compared sugars to cocaine and craving also exhibited an increase in
nicotine have reported that their results depressive symptoms (17). In regards to sugar
proved that sugars are more rewarding than replacements, such as saccharin, it has been
these well-known very addictive substances shown that they also may have positive
(7). Other studies proved that mice preferred a effects. For example, a meta-analysis study
sucrose dosage to direct stimulation of showed that saccharin can moderately lower
dopamine neurons (8,9). Besides, it has also the body weight in obese individuals by
been shown in diabetes mellitus rats that regulating glucose levels (18).
sugar overeating accentuates sugar craving
behavior (10). The mechanism behind this Saccharin is a virtually zero calories artificial
addiction suggests that consuming hyper- sweetener which is approved by USFDA. The
palatable foods like artificial sweeteners history of this product shows that it has been
produces changes in dopamine, serotonin, and extensively used in food products since 1879.
glutamate levels. These changes in the However, individuals who suffer from
neurotransmitters pathways lead to the diabetes, obesity, or metabolic syndrome are
observed, pronounced psychological the most popular consumers of saccharin (19).
alterations (11, 12). Saccharin is considered safe in low amounts
and several studies presented results that
Furthermore, some literature indicates insulin suggested that no significant adverse effects
dysfunction as a plausible underlying occur after consuming low doses of this
mechanism behind sugar addiction (13). This artificial sweetener (20, 21).
theory that insulin dysfunction may cause
brain serotonin levels to decrease suggests But perhaps the most important biochemical
that a low level of serotonin will induce a effect that saccharin might have is its negative
condition in which sugar craving may cause impact on oxidative stress level. It has been
depressive symptoms (14). Another molecular established that saccharin induces oxidative
way in which sugar may increase serotonin stress on brain cells through two distinct
levels is through an elevation in the serotonin biochemical mechanisms. The first
precursor tryptophan (15, 16). By the same mechanism refers to the observed decrease in
mechanism, pharmacological treatments that catalase activity after saccharin ingestion. The
second biochemical mechanism is related to conducted in the same plastic water tank with
the decline in the total antioxidant the immobility time measured with a
concentration in a sanguine fluid that is stopwatch by a blind investigator. The
detected post saccharin consumption (22). stopwatch was started when the rats remained
Furthermore, other studies on various rats immobile and made no attempts to escape,
models, found that saccharin harmfully with no hind limb movement, just floating on
influences brain tissues and alters oxidative the water.
stress markers, on both low and high doses Experiment 2: Open field test
(23). The open-field test was constructed in a
plastic box. The open field was divided into
Therefore, given the increasing demand for two areas: a central zone and a surrounding
the use of saccharin to control the body margin zone. The rats from both groups
weight and the blood glucose level and its' (n=40) were positioned one at a time into the
possible negative effects on specific margin zone. They were allowed to explore
biochemical markers of oxidative stress, we the open field for 10 min. A blind investigator
wanted to study in the present paper the recorded the following parameter: the time
repercussions of saccharin withdrawal on each rat spent in the central zone.
catalase activity, as a biochemical marker of
oxidative stress. Furthermore, we also wanted Biochemical measurements:
to determine if catalase activity might act as a The activity of catalase in the brain of the
possible predictor of depression and anxiety- animals was measured with the previously
like behavior in a rat model. demonstrated method of Hadwan and Abeds
(24). Therefore, the activity of this
MATERIALS AND METHODS antioxidant enzyme was measured as an
Our experimental design was simple. We had absorbance variance of 0.01 as units/min.
40 lab rats divided into two groups, 20 rats in
each group. The first group of rats had RESULTS AND DISCUSSIONS
unlimited access to water and saccharin Saccharin withdrawal and catalase:
bottles. The second group was considered the The first analysis of our data showed that the
control group and had access only to water. saccharin deprived group was significantly
different regarding the catalase level when
After 4 weeks, the rats in the saccharin group compared to the control group F (1, 38) =
were deprived of saccharin for 14 days to 25.539, p < 0.001.
allow sufficient time for deprivation episodes
to occur. Specifically, the rats in the saccharin deprived
group had a significantly lower level of
Experiment 1: Forced Swim Test catalase (mean = 6.75 u/min, standard
The experiment was conducted similarly to deviation = 1.650) when compared with the
the previously developed model. Rats from rats that did not receive saccharin at all - the
both groups (n=40) were placed individually control group (mean = 10.6 u/min, standard
into a plastic water tank filled with 30 cm of deviation = 2.981). A better perspective of the
tap water. This initial phase of the model two groups can be seen in figure 1.
lasted for 15 min. Later a 5-min test was
Fig 1. The level of catalase activity for each experimental group
To be more precise, the rats in the saccharin

Saccharin withdrawal and depression: deprived group had a significantly higher time
The second analysis of our results proved that spent in immobility (mean = 103.95 seconds,
the saccharin deprived group was standard deviation = 2.488) when compared
significantly different regarding the time the with the rats from the control group (mean =
rats spent being immobile when compared to 88.65 seconds, standard deviation = 2.902). A
the control group: F (1, 38) = 16.018, p < better perspective of the two groups can be
0.001. seen in figure 2.
Fig 2. The time spent being immobile in the water tank for each experimental group
Saccharin withdrawal and anxiety:
The third analysis of our input, regarding the Test Field (mean = 76.45 seconds, standard
anxiety-like behavior, showed that the deviation = 19.667) in comparison with the
saccharin deprived group spent significantly rats which were saccharin deprived (mean =
different time in the center of the open field 62.35 seconds, standard deviation = 18.723).
test compared to the control rats F (1, 38) = A better perspective of the significant
5.393, p = 0.026. differences between groups can be seen in
figure 3.
Specifically, the rats in the control group
explored more time the center of the Open
Fig 3. The time spent exploring the center of the field for each experimental group
The results of our study demonstrate a an even more pronounced decline in catalase
positive relationship between saccharin activity.
withdrawal and oxidative stress, measured in
our experiment by catalase activity in the Furthermore, we also wanted to evaluate the
brain. The rats in the saccharin withdrawal behavioral outcomes of saccharin deprivation
group had a significantly lower catalase on depression and anxiety levels. Such results
activity compared to control rats. The can be used to measure anxiety and
biochemical explanation of these results may depression-like changes to help in the process
be related to the release of reactive oxygen of screening for antidepressant drugs. Our
species (ROS). To be more precise, saccharin statistical analysis revealed that saccharin
withdrawal could produce a release of ROS. deprivation was associated with an increase in
The body will respond with its’ ability to the duration of immobility time in the popular
generate antioxidants, such as catalase, forced swim test and a decrease in the time
superoxide dismutase, or glutathione the rats spent exploring the central area of the
peroxidase, as a result of cellular defense open field test. Therefore, saccharin
against ROS. When the initial release of ROS deprivation seems to produce depression-like
will overcome the production of antioxidants, and anxiety-like behaviors in rats.
high levels of oxidative stress will result
(25,26). Besides, if the deprivation persists, These results are not in contrast with those we
an increase in free radical production will found in the available literature. Drug
occur, which will further overwhelm the deprivation has been repeatedly shown to
defense antioxidant mechanisms and lead to result in high levels of oxidative stress,
anxiety, and depression-like behaviors (27).
The symptoms of withdrawal lead to a withdrawal symptoms are expected to be

decrease in motivation to gain any other exactly contrary to the acute administration.
common reinforcer besides the initial drug Therefore, it is expected that saccharin acute
(28). All these symptoms are translated to an administration will lead to a decrease in
observed increase in the immobility time anxiety and depression-like behaviors;
measured in the forced swim test (29). Much however, the withdrawals of saccharine will
of the before mentioned data refers to serious increase these behaviors. In this regard, a
drug administration, like cocaine or nicotine, previous study demonstrated exactly the
but there is also evidence suggesting that previously mention theory: ethanol
artificial sweeteners are not that different in administration presented an antidepressant-
regards to the withdrawal period (30). Even if like effect and was correlated with a decrease
these anxiety and depression symptoms were in the immobility of rats in the forced swim
observed in rats that received various drugs of test (34).
abuse, it is yet to be demonstrated if the
observed elevation in the withdrawal-induced The present study generated similar results to
symptoms is explained by random behavioral the available literature on the correlation
aspects or by the specific mechanism of each between saccharin deprivation oxidative
drug. For example, studies have shown that stress, anxiety, and depression. In the present
alcohol withdrawal was correlated with study, the increased immobility time,
elevated ICSS thresholds. Some authors have compared to the control rats, was detected
stated that this effect may be interpreted as a after 14 days of saccharin deprivation.
decrease in the function of the brain Regarding the deprivation time, this period
connected with the reward system (31). varies from study to study, with some data
Interestingly, other studies have found that suggesting that some drug withdrawal effects
acute administration of alcohol ethanol can typically diminish after 3–5 days (34).
have similar effects to antidepressants to rats However, studies on the effects of ethanol or
tested in the forced swim test (32). saccharin deprivation typically use longer
Furthermore, alcohol high dose administration periods of drug deprivation (35).
is shown to lower the ICSS thresholds (33).
Therefore, like every drug of abuse, alcohol
CONCLUSIONS
In conclusion, deprivation from the non-drug reinforcer saccharin produces high levels of oxidative
stress which leads to anxiety and depression-like effects on rats. These effects are often seen in
withdrawn models of abused drugs or alcohol. However, it is important to mention that the present
study has used very high doses of saccharin, doses that do not apply to daily human consumption of
saccharin.
CONFLICT OF INTEREST
None to disclose.
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Correspondence:
Constantin Trus,
Department of Morphological and Functional Sciences, Faculty of Medicine, Dunărea de Jos
University, Galaţi, Romania, [email protected]
Submission: 10 jun 2021

BPIPsychiatry
Medium-term religious support program

applied to suicidal psychiatric patients
Speranța-Giulia Herea, Roxana Chiriță, Andreea Silvana Szalontay,
Gabriela Elena Chele, Cristinel Ștefănescu
Speranța-Giulia Herea - PhD stud, "Grigore T. Popa" University of Medicine and Pharmacy,
"Socola" Institute of Psychiatry, Iasi, Romania
Roxana Chiriță - MD, PhD, professor, psychiatrist, "Grigore T. Popa" University of Medicine and
Pharmacy
Andreea Silvana Szalontay - MD, PhD, lecturer, psychiatrist, "Grigore T. Popa" University of
Medicine and Pharmacy
Gabriela Elena Chele - Assistant of professor, MD, PhD, psychiatrist, "Grigore T. Popa"
University of Medicine and Pharmacy
Cristinel Ștefănescu - Professor, MD, PhD, psychiatrist, "Grigore T. Popa" University of Medicine
and Pharmacy, 16 Strada Universității, 700115 Iasi, Romania
ABSTRACT
Psychiatric literature generally recognizes the importance of religion and spirituality in the
care of religious psychiatric patients. In this work we aimed to investigate the influence of a
supportive religious program on religious patients with suicidal ideation. The results
confirmed the theoretical predictions of the psychiatric literature regarding the broad positive
value of a complementary religious support applied to religious psychiatric patients. A
potential negative effect of the most influential Christian Orthodox religious practices used in
the therapy of suicidal patients was also noted. These findings may have significant
implications for medium and long-term psychiatric interventions in faith-based settings.
KEYWORDS:
Suicide, religious support, depression, spiritual/religious care practice.
INTRODUCTION psychiatrists to take into account the spiritual

The psychiatric literature recognizes largely and religious dimension of their patients since
the importance of religion and spirituality in it leads to the strengthening of the patient-
the care of religious psychiatric patients, physician relationship and the increase of the
recommending collaborative professional therapeutic impact of interventions.(1) Shin et
spiritual/religious approaches to support al. showed that physicians of higher
them. Moreover, a majority of clinicians religiosity/spirituality were more willing to
acknowledged their responsibility to address believe that medically unexplained symptoms
the religious/spiritual needs of patients. of their patients, accounting for 20–30% of
D'Souza et al. emphasized the need for primary care consultations, result from a
spiritual issue, underlining the importance of lack predicted an increase of the depressive
paying attention to the patients' spiritual symptoms and emotional disturbances.(10)
life.(2) Furthermore, in another study, the Other results have suggested that religious
majority of German psychiatric staff members support may not be automatically the result of
expressed their willingness to deal with simple religious attendance, but can however
patients' religiosity/spirituality in therapeutic afford exclusive benefits to religious persons,
settings, while clinical chaplains, even if they distinctly from social support.(11) In addition,
agreed to the psychiatrists' opening, offered Robinson et al. showed that relationship
however a different general perception, a between religious attendance and mental
result that recommended an increase in health differs when evaluated across ethnic
collaboration between psychiatrists and groups, infrequent religious attendance being
clinical chaplains by changing their views on associated with anxiety and suicidal ideation
religious/spiritual issues for clinical in Whites and Hispanics.(12) Moreover,
practice.(3) Also, Judge showed that nurse Koenig et al. found that while baseline
practitioners should take into account the religiosity does not moderate the optimism of
patients' spirituality needs, especially for the persons with major depressive disorder
chronic cases.(4) Such studies prove that and chronic medical illness, religiosity
religion and/or spirituality - as important predicts however increases in optimism over
components of people's lives(5) – are largely time.(13)
considered by the psychiatrists to be
important in therapy, at least at a functional Religion can as well protect against suicide
level.(6) For this reason, the World attempts, regardless of social functioning,
Psychiatric Association recommended a more psychopathology and substance use.(5,14)
direct and close partnership between Religion acts as a protective factor both
psychiatry and religion/spirituality at at the individual and societal levels.15 For
institutional level.(7) Moreover, because example, the frequent attendance of religious
religion can help religious psychiatric patients services significantly reduces the suicide
to cope with the stressful circumstances of an risk(16) while weekly attendance may lead to
illness, psychiatrists are advised to consider a 42 % reduction in suicide ideation.(17) In
the spiritual history of their patients, to another study performed on about 90,000
support healthy religious beliefs, to pray with women in the United States, the suicide rate
patients (if appropriate), and to consult or do for attending at least one religious service
joint therapy with the trained clergy.(8) once a week was about 5 times lower than
Nevertheless, it is warned that even if praying when never attending.(18) Hence, it seems
with religious patients could induce positive that even if simple religious affiliation might
effects and increase therapeutic success, the not automatically protect against suicidal
practice may still have some risky features ideation, it does reduce suicide attempts.(19)
and should only occur if the psychiatrist Similarly, people who were not involved in
would demonstrate a good understanding of religious activities had four times higher
patients' religious beliefs and if they have suicide rates than those with high
good knowledge of and experience with participation.(20) As a result, religious
religion.(9) support is positively associated with recovery
from severe mental illness(21) while, more
A series of reports emphasized the key role of specifically, religious attendance is considered
the religious factors in reducing the incident an important independent protection factor
depression and suicide rates. An extended against suicide attempts and depression.(22)
study performed on about 50,000 nurses in The reported findings have significant
U.S. found an inverse relationship of the risk implications for psychiatric interventions in
of incident depression with the attendance of faith-based settings and have emphasized the
religious service.(9) Likewise, religious social importance of considering religious practices
support was positively associated with the as influential protective factors against
decrease of depressive symptoms, while its suicide, depression, and psychiatric illness, in
general.(10,23) Hence, given the reported divided into two groups (34 and 33 patients,
positive impact of religious practices on each), the first group receiving continuous
religious patients, psychiatrists were advised religious support for about 6 months between
to be willing to work with members of faith 2018 and the beginning of 2020. A
communities, chaplains and pastoral workers, religiously-supported patient withdrew in the
and to encourage all fellow psychiatrists to do middle of the study. The patients were
the same, as religion and spirituality should diagnosed with schizophrenia, depression,
be seen as essential components of psychiatric bipolar disorder, organic personality disorder,
training and professional development.(24) In anxiety disorder, alcohol withdrawal
addition, clinicians who are familiar with the syndrome. Patients with dementia and
faith traditions regarding suicide are better oligophrenia were excluded.
prepared to address crisis situations by
religious means as well, and are better The religiously-supported patients (RSP)
prepared for consultation with religious benefited from religious support both during
professionals, when considered.(5) hospitalization and after discharging. Patients'
However, despite consistent findings and religious level was evaluated using a religious
recommendations on the benefits of religious questionnaire (Table 1), partially inspired
support for religious suicide patients, the from Curlin et. al.(25), while the efficiency of
specific content of such a religious supportive the religious program was assessed through a
program is neither detailed nor applied 21-item Hamilton Depression Rating Scale
effectively. Therefore, in this paper, we have (HAM-D) that estimates depressed mood,
designed a consistent and highly flexible guilt feeling, suicidal ideation, and somatic,
religious supportive program containing a vegetative and cognitive symptoms of
series of influential religious activities which depression.(26) A high score is an indication
were applied to a number of patients with of increased mental (and somatic)
suicidal ideation. The obtained data were degradation. Ratings were performed at
analyzed using a dedicated baseline and at the end of the study. Some of
psychological/psychiatric evaluation scale and the final interviews were conducted by phone.
a religious assessment questionnaire. Participation in this study was done
exclusively on a voluntary basis and no
METHODS reward or favor was offered to patients.
Study population and data collection. For Patients were allowed to completely stop the
this study, sixty-seven religious Caucasian religious support at any time.
patients with suicidal ideation were randomly
Table 1. Religious questionnaire applied for both admission in the study and general evaluation of
the religious level
a). Yes.
Do you consider yourself a practicing
b). Not.
believer?
c). Only in part
a). Twice a month or more.
How often do you attend religious b). Once a month or less.
services? c). Rarely.
d). Never.
a). I believe in God;
b). I only believe in the afterlife, but I don't believe in
What are your religious beliefs? God.
c). I believe in God and in the afterlife.
d). I have no religious beliefs.
a). Very religious.

How religious do you consider yourself b). My religiosity is average.
to be? c). My religiosity is low.
d). I'm not religious at all
a). I ask God for help;
b). I do not ask for God's help;
If you encounter difficult situations in c). I only ask for God's help if there is no other way to
life: solve problems
d). I believe that I can solve my problems only on my
own.
a). No, never.
b). Yes, to encourage me.
In case of more difficult medical
c). Yes, because I believe that through prayer, confession
problems, would you agree to have a
and other works of the Church I can be healed or I can
priest to help you along with the doctors?
more easily overcome my suffering.
d). I don't know what to do.
Assuming you know that one doctor a). The one who believes in God.
believes in God and another does not b). The one who does not believe in God.
believe in God, who would you choose to c). I don't know, my choice would depend on other
take care of you? factors.
a). I had no regrets.
If you ever tried to leave this world, what b). I was sorry for what I was doing.
were your thoughts in those moments? c). I was afraid of God's judgment.
e). I don't know what I was thinking at the time.
a). No, I wanted to die.
Did you want to be saved when you b). Yes, I wish I were saved, no matter by whom.
decided to leave this world? c). I prayed to the Lord to be saved.
d). I didn't care if I lived or died.
a). Family, friends.
Who do you think could help you stop b). The Church (God).
making such attempts? c). The society.
d). No one.
a). Nothing, everything is the same as before.
After going through this difficult b). Yes, I would never try to repeat such a gesture.
situation, did you learn anything? c). Yes, I pray more and go to church.
d). Yes. I think only God saved me.
a). I think so.
b). No.
Do you think that these dark thoughts
c). I do not know.
occur because of a sin of yours or of
d). Yes, and I believe that God can solve all these
some ancestors in your family?
problems.
were used. Reported p values for t-student test

Ethical approval. The patients were informed were two-tailed. Means and standard
about the subject of the study and offered deviations were calculated for quantitative
their informed consent. The institutional variables. The confidence intervals, CI, for
ethics committee approved the study. proportions were calculated through
Microsoft Excel 2007. Significance was set at
Descriptive statistic. To examine the standard 0.05.
differences between the two groups, the
Pearson Chi square test and t-student test
RESULTS AND DISCUSSIONS (p=0.459, CI=0.41-0.65). There were more

Characteristics of the patients are shown in patients married or living in cohabitation in
Table 2. The two groups were almost both groups, but the statistical difference was
identically structured, with an over unity also non-significant. The patients of both
women-to-men ratio. There was no significant groups, with a mean age near fifty, declared a
difference with respect to the mean age. The mean monthly income of about 160 euro. For
religiously-supported group included more both groups, the education was primarily
patients living in rural areas, but the secondary, with no statistical significant
difference is statistically non-significant difference.
Table 2. Characteristics of the psychiatric patients

Control Statistic Confidence
RSP
Defining characteristics patients significance interval (CI)
N % N % p* 95 %
Sex
Women 20 60 18 54.5 0.45-0.68
0.618
Men 13 40 15 45.5 0.31-0.54
Place of residence
Urban 14 42 17 51.5 0.35-0.59
0.459
Rural 19 58 16 48.5 0.41-0.65
Marital status
Married or living in
21 64 25 76 0.58-0.79
cohabitation 0.284
Single 12 36 8 24 0.34-0.57
Age (M±SD) 52.9 ±10.2 52.2±10.1

Women 52.1 ± 10.4 49.1 ± 12.5
0.743
Men 54.3 ± 10.1 56 ± 3.7
Declared income 160 (±70.8) 159 (±92.3)

(euro/month) (declared by 21 (declared by
persons) 17 persons)
Education
Higher 2 3 0.03-0.17
0.694
Secondary 29 30 0.8-0.95
* by Chi square test for 5% level of significance
decently and, further, to treat their illness,
From Table 2, the most notable characteristics they have a highly increased stress level. In
of patients are related to their income and such cases, they may find a viable refuge in
level of education. The extremely declared God.
low earnings could represent their pension
which, in a favorable scenario, might be part The results showed a statistical significant
of a larger family budged, given that 70% of difference between HAMD scores (Table 3)
the patients were not living alone. However, for both groups (p<<0.05 for RSP, and
such a personal low income might impact p=0.0031 for control group). However, while
highly negatively on the social living for RSP there is a positive difference (16 %)
standards, and even affect the physical between the mean scores obtained at the
existence of the patients. Hence, poverty itself beginning and the end of the study, a negative
can be one of the main causes of their suicide difference (-6.2 %) was found for the control
ideation as a way to get rid of mental pain group. This divergence highlights a mental
and, perhaps, to save dignity. Undoubtedly, by state destabilization of control outpatients in
lacking the basic financial resources to live the medium term compared to those who
received religious support. This result of HMAD means for the two groups,
suggests that even if the mental state of the indicating a clear positive role of religious
control patients is stabilized at discharge, it support applied to RSP in the medium term.
slightly degrades several months after.
Overall, analyzing the percentages, there is a
significant difference between the variations
Table 3. Statistical evaluation of the scores obtained by RSP using the HAMD scale and a religious
questionnaire
Statistical parameters HAMD Religious level
Control Control
RSP
RSP group group
<< <<
p (two-tail) 0.0031 0.12
0.05 0.05
Pearson Correlation 0.65 0.73 0.85 0.90
Difference between means obtained by using t-student test at -
16 -6.2 1.2
baseline and at the end of the study (%) 11.2
including those dedicated to the healing of the

The religious level improved significantly sick, consultation of specific religious
only for RSP (p<< 0.05), with a negative materials in audio/video format, religious
difference (-11.2 %) between the mean scores pilgrimages and (b) program conducted
obtained at the beginning and the end of the jointly with the therapist with theological
study. In other words, for this group, the training and the spiritual priest, respectively,
religious score was higher at the end of the which included common-offered prayers,
study. On the contrary, there is no statistically discussions, confession, Holy Communion,
significant difference between the religious and specific religious services in the patients'
scores obtained by control patients (p<< 0.12) home. Both the personal and the common
even if a slight decrease of religiosity (1.2 %) supportive program were adjusted according
was noted. The results are highly correlated to the degree of religiosity of the patients and
(Pearson correlation >50 %) for both groups their current psycho-mental state. The
and for both types of evaluations. supportive program included different series
The religious supportive program (Table 4) of activities agreed separately with each
was split into two main sections: (a) personal patient.
program based on personal prayer, religious
reading, attendance of religious services,
Table 4. Detailed, flexible religious supportive program of the RSP

a. Personal program
Recommended Recommended
Activities at the patients' choice
frequency allotted time
Prayers specific to the Christian-Orthodox ritual:
2 times a day 15 (+15) min
morning and evening prayers
Prayers addressed to the Lord Jesus Christ, the Mother
once a day 15-30 min
of God or a patient's favorite saint (akathist)
Reading some chapters from the Bible (Gospel)
once a day 5 min
regarding the healing of the sick
Reading specific Psalms (from Old Testament)
recommended by the Church for finding inner peace once a day 5-15 min
and strong support in God
Reading religious books which describe various good once a day 10 min – 1h
stories, parables and miracles either from the lives of

the saints or occurred today
Participation in the Holy Anointing - a specific
once a week 1-2 h
religious ritual dedicated to the healing of diseases
Participation in the Holy Mass once a week 1-2 h
Listening to religious songs that convey hopeful
1-2 times a day 10-20 min
messages
Listening to some spiritual advice and parables of
1-2 times a week 15 min
contemporary spiritual Fathers
Watching/listening to religious shows on a religious
(radio) television, including online attendance of once a day 30 – 60 min
religious services
whenever the
Practicing the so-called "prayer of the mind"* patient feels the
need
twice every 6
Pilgrimages to monasteries 1-4 days
months
b. Joint program
Made jointly with the therapist
Prayers offered by the therapist for the patient ** once a day 5 min
Prayers offered by the patient to other patients
once a day 5 min
experiencing a similar difficult life situation***
Supportive religious discussions with hospitalized
once a day 15-30 min
patients
Maintaining a telephone connection between therapist
once a week 30 min
and patient for supportive religious discussions
Made jointly with the spiritual priest
Discussions with the spiritual priest, including through
twice a month
confession
Prayers offered by the clergyman for the patient - -
Communion with the body and blood of the Lord, at the
once a week -
recommendation of the priest (Holy Communion)
Specific church services performed by the clergyman or once every 6
30 min
other minister priest at the patient's home months
* The consecrated formula of the "prayer of the mind" in the Christian-Orthodox ritual is as
follows: "Lord Jesus Christ, Son of God, have mercy on me, a sinner." However, patients were
able to use modified variants; instead of "have mercy on me," and "sinner" they could use any
other expressions they felt were more appropriate for them, e.g., "help me", "give me peace",
"protect me", "the suffering," "the helpless" or "the grieving". Patients could repeat the prayer
for a period of time of their choice depending on their inner mood. The form of addressing the
prayer was at the patient's choice.
** Patients were told that the therapist would pray for them at a certain time in the evening,
possibly simultaneously with them.
*** This is a method described in the spiritual-religious literature. Praying out of compassion
for another, the person in need prays or learns to pray in fact for himself.
reconciliation with himself, acceptance of

The religious program sought, first of all, to suffering, and by exercising the associated
induce a positive and balanced change of the religious practices with increased faith in
mental state of religious patients by God, but letting God decide what is best for
increasing the level of trust, hope, him. Secondly, the program sought to increase
the level of religious and social interaction advised to stop reading the prayer and to
within their religious community, through engage simply and calmly in a balanced living
pilgrimages and attendance to religious prayer of request and thanksgiving addressed
services of the Church, including healing directly to God. Most patients told they
ones, with direct influence on the mental preferred this approach, confessing that the
comfort of the patients. This two-pronged free and simple prayer, addressed with hope
approach could provide the patient with the and emotion to God, made them feel
means for mental rebalancing by deepening liberated, relieved, comforted in their hearts,
the knowledge and experiences of a religious and confident that God would support and
nature regarding the significance and will help them to accept and overcome the
transfiguring value of the suffering, the difficulties that have arisen in their lives, also
obligation to fight suicidal thoughts as a forgiving those they consider guilty to a
moral duty to God, the belief that the endured certain extent for their troubles.
suffering will be rewarded in the eternal life,
and the fact that Christians, be they sick, must A key role in improving the mental state of
be joyful, confident, active, seeing in every religious patients with suicidal ideation may
event of their life a pedagogy of God for be the practice of a very short prayer as often
them. as possible (in our case, "the prayer of the
mind") in a repetitive manner to keep the
Much of the above religious teachings and mind constantly filled with protective,
recommendations are well known to religious positive, optimistic impressions. Fighting in
patients. Therefore, they were only recalled, such a way against the mental state induced
supplemented, consolidated and suggested to by suicidal thoughts, the mind might be
be implemented in a more systematic and trained to quickly switch from a suicidal state
consistent way through a higher community to a stable state (of prayer). Over time,
religious integration that would provide through experience, the method can begin to
patients with moral, psycho-emotional, operate spontaneously as a reaction to any
possibly material support for difficult cases, a suicidal thought or even as a reaction to other
support offered under the spectrum of Church different negative mental states, other than
teachings in a sacramental setting. suicidal ones. However, most patients
reported that they were unable to practice this
Taken hierarchically, the personal prayer, as a prayer constantly and consistently due to the
means of direct relationship with God, was fact that they only could focus on the words
considered a main instrument of the of the prayer and its message for a very short
supportive program, given the relative ease of time. Even though they felt at ease, other
practicing it and the ability to generate supportive activities seemed easier to put into
positive emotions and living relationships practice. Probably this type of supportive
with God or Saints. Patients were asked to religious activity would find its utility only in
follow as much as possible the prayer the long-term, backed by a more reliable
program which they chose, but they were psychological motivation and only with well-
suggested to pray freely, simply, without any stabilized patients under uninterrupted
restrictions, without formalities, to speak with psychiatric supervision and psychiatric
God as they speak with the best friend or medication intake.
parent, generating positive emotions in any
discussion they have with the Divine. The religious books, afforded to patients from
Moreover, if during a usual, traditional prayer, the library of the clinic throughout the study,
which they read or say according to the included various stories with happy ending,
chosen program, they will be feeling the need parables and wonders, all rendered in simple,
to deprive themselves of the written words in accessible language, with the potential to
order to express themselves freely to God, in induce a positive emotional effect on their
their own words, being animated in those mental state. Religious reading had the largest
moments of positive emotions, then they were share during hospitalization, with patients
testifying however that, after discharge, they effect is a secondary topic that concerns
have unfortunately allocated less time to specialists more than patients.
religious readings due to lack of time and
socio-familial problems to which they were As regarding the reading of some
exposed. In the case of most patients recommended chapters in the Bible, some
readmitted in hospital during the study, there patients needed guidance, the biblical
was a strong desire to continue the same type message needing some simplification and
of simple religious readings, with happy clarification to be understood undistorted.
ending events, in which God or various saints During hospitalization, religious patients who
miraculously intervened in solving family, wished to be told of illustrative stories and
health or social problems of people who events described in the Bible related to their
believed in God and asked for His help in suffering, the example of Job, an Old
great faith. Testament character famous for his suffering,
was considered the most appropriate. From
Even though this type of religious support is the New Testament, religious patients were
built on an extreme simplicity in approach told about Jesus Christ's unconditional love
and content, the message that was conveyed for the sick, briefly describing some of the
to patients and the associated effects were miraculous healings of the sick people
likely to move positively, to encourage, to obtained through faith.
increase confidence, hope and even
resignation, leaving in God's care all the Attendance of religious services and
insurmountable problems that appeared or pilgrimages did not suffer interference from
will appear in their lives seemingly without a the therapist, being considered particular acts
logic of causality. In fact, it is in the human related to the privacy of patients. In fact, the
nature to overcome the hard times of life by patients' particular religious reflections and
accessing simple things, easily disconnecting feelings were not an object of investigation in
activities and uncomplicated readings with this study, the focus being only on the final
positive and motivating emotional messages effect of supportive activities on the psycho-
that may quickly rebalance mentally even the mental state of patients.
healthy and highly educated people.
As regarding the relationship between
During the study, it was observed that under therapist and patients, an important aspect that
the pressure of their major health problems, strengthened it was the friendly proposal that
patients paid no attention to the theoretical, the therapist pray for them. Patients accepted
theological, or philosophical aspects that the and confessed they would feel better knowing
religious support program might involve, that someone was thinking of their own good,
being more open to the faith-related praying for them. Hence, prayer, while
discussions based on practical examples, maintaining its intrinsic religious value, was
suggestions, and proposals for the purpose of also a mediator and catalyst for building a
immediate help. This could also be related to trusting relationship between therapist and
their education, mostly secondary, which suicidal patients by conveying a message of
allowed them to receive faith more naturally, affection to them. In addition, patients agreed
without any further inquiry, conditionality and to pray unconditionally for other patients,
reluctance. Therefore, many religious people known or unknown, for their well-being and
who have not had the opportunity to pursue health.
certain university education might probably
have the advantage of being protected from Discussions with patients were generally
academic dilemmas and theoretical complex conducted individually, the allotted time
analyzes, while maintaining their authentic, differing from case to case. To normalize the
unquestionable faith. And whether or not the psycho-affective state, the therapist used
belief in the healing power of the prayer and examples from the religious field in which
relationship with God might induce a placebo through prayer, patience, resignation,
forgiveness, mercy, love and trust in God, a sincerity. Even so, they need to be careful and
suffering person can overcome difficult aware of the specific type of patients they
situations, as was the paradigmatic case of support and that things can evolve in a
Job. In addition, patients with increased completely unexpected way. For instance,
religiosity were told about the cathartic or there may be cases in which psychiatric
even missionary valences of suffering, as was patients might enter the program by
the case with St. Paul. fabricating the answers to the religious
questionnaire, while actually not sharing the
As previously pointed out, due to the general traditional religious values expressed by the
and religious education of the patients, it was main teaching body of the state-recognized
considered that a religious support plan built religions. This is however a tolerable action
on basic and easy-to-understand theological simply because suicide patients may consider
knowledge would be better suited to the such a program a good possibility or
purpose of the study. However, we have to opportunity to be helped. Hence, a false
add that a psycho-social interference of failure may be part of the end result.
religious support simply could not be banned
due to the specificity of the support actions. In the end, it is worth noting the particular
Thus, since religion teaches about love and case in which one of the declared highly
good deeds that should be offered religious patients, belonging to the RSP,
unconditionally to fellow sufferers, 2-3 withdrew from the study after rejecting God
psychiatric patients in each group were and accepted the "demon". As a child born out
helped, at their request, to solve some of their a rape, divorced, recovered from cancer, and
problems, by facilitating their access to with multiple suicide attempts, she manifested
medical services, other than psychiatric, intense hatred against her mother, while being
clarification of medical documents required simultaneously subjected to similar hatred by
by medical commissions, listening to their her own fully-aged daughter. Submitted
acute problems when they called urgently continuously to an intense psychic pressure,
during an emotional crisis asking for psycho- she declared she had a high expectation to
emotional support, encouraging them to solve her problems, but since God didn't
socialize more within their close community, respond to her prayers, psychiatry couldn't
not necessarily a religious one, or referring solve the problem, family and society
them to some NGOs that might afford couldn’t come with a viable solution, she
immediate help. Therefore, a pure religious chose as an alternative the demonic way.
support is difficult to provide and manage Therefore, a double‐edged potential of
because at least a minimal psychosocial religion to improve the recovery of
influence will always have to be associated to psychiatric patients from a mental illness or to
implement it successfully. accentuate its symptoms27 is confirmed as
well by this case. Therefore, religious support
In order to increase the success rate, the must be conducted with high diligence, taking
program needs to be attractive, balanced, very into account the fragile mental condition of
flexible, both in content and development, patients, even after their discharging, and the
without interfering with the strong beliefs of possibility that some may no longer follow
patients, even if such beliefs might be the prescribed psychiatric drug therapy. Also,
theologically wrong. Any kind of obligation religious patients who ask for such support
or coercion imposed on patients in their state should not be given high expectations for the
of advanced psycho-emotional fragility would immediate resolution of their problems, but
nullify the positive effect of religious support. rather be reminded that the chosen religious
Likewise, the discussions and guidance must supportive program could only help them in
be conducted with great pedagogical tact by the long run along with psychiatric treatment,
the therapist who, by definition, starts from the latter remaining essential.
the premise that patients who have declared
themselves religious tell the truth and act with
LIMITATIONS OF THE STUDY assessment of the weight and influence of

Since the religious supportive program was some supportive activities to the detriment of
very permissive, the patients were free to others, due to the unequal time allocated by
choose and change, during the study, the different patients for the same supportive
activities they considered most appropriate for activity, and the subjectivity introduced by
them. The side effect was that the study patients in the implementation of a chosen
suffered from the lack of homogeneity of the activity. Also, larger groups of religious
applied supportive activities. Therefore, it was psychiatric patients would be needed to
not possible to perform a quantitative increase the accuracy of the results.
CONCLUSIONS
In this work, a detailed supportive religious plan comprising influential religious activities was
conceived and applied for approximately six months to a number of Orthodox Christian patients
with suicidal ideation. The results showed a statistically significant improvement of the patients’
mental state and a slight, but still statistically significant, mental degradation of the control group.
The level of religiosity has also improved significantly for the religiously supported patients. By
practicing personal or commonly-offered prayer, religious readings, attendance of religious
services, consultation of specific religious material, religious pilgrimages, religious discussions,
confession to the priest, Holy Communion, or specific religious services performed in the patients’
home, all based on the patients' faith in God, the mental state of religious psychiatric patients
positively changed in the medium term.
During the study, a declared highly religious patient lost her faith in God and declared she accepted
the "demonic" way. Therefore, the predicted risk that religious practices may also accentuate the
symptoms of a mental illness is confirmed as well by this particular case. For this reason, religious
support should be conducted with caution, taking into account the possibility that some patients
may place very high hopes in such a supportive program and even stop following the prescribed
psychiatric drug therapy during the program.
Overall, the obtained data confirmed practically the theoretical predictions and expectations of the
psychiatric literature regarding the broad positive value of a complementary religious support
applied to religious psychiatric patients. These findings may have significant implications for long-
term psychiatric interventions in faith-based settings, emphasizing the protective role of influential
religious practices against mental illness, in general, and suicide, in particular.

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Correspondence:
Speranța-Giulia Herea,
PhD stud, "Grigore T. Popa" University of Medicine and Pharmacy, "Socola" Institute of Psychiatry,
Iasi, Romania
Submission: 25 aug 2021

Acceptance: 12 sep 2021
BPIPsychiatry
Dyslexia intervention to combat specific

language disorder, a consequence of the
economic migration
Katalin Tiron
Tiron Katalin – PhD Student, Psychology and Education Sciences Faculty, ”Alexandru Ioan Cuza”
University of Iaşi
ABSTRACT
In the conditions of a strong economic migration, quite a few children are exposed to radical
changes, which affect their development, especially in terms of communication. In the present
study, we presented the case of a 7-year-old child who had a language disorder, stuttering and
dyslexia. Following the intervention, based on syllabic training, stuttering, dyslexia and
language were greatly reduced.
KEYWORDS
Specific language impairment, stuttering, dyslexia, intervention.
They moved with their parents, attended an

INTRODUCTION educational institution there, and then they all
After 1989, major economic changes took returned. Often children are put in a position
place in Romania. Many people have become to cope in a new world, without even knowing
unemployed and the lack of social support has the language well. Those who knew the
forced them to look for strategies to adapt to Romanian language on departure, adapt more
the transition period (1). With the opening of easily on return. Children born abroad, or who
the borders, thousands of people left Romania were very young on departure, often learn the
in search of a better life. One person left one adopted state language as a foreign language.
family, others both parents. Many children When they return, they have great difficulties
were left in the care of grandparents, friends. in adapting, behavioral problems, language
And there is another category of children, disorders, which lead to school failure. In the
those displaced once or even several times. present study we present the results of an
experiment performed on a 7-year-old component, highlighted by the fact that his

student, who has a language disorder, brother also has a language disorder. Not
stuttering and dyslexia. P. F. was born in having access to a developed internal
Italy. He lived there for 4 years, then his dictionary, every time he tried to speak, he
parents moved back to Romania. When he would get stuck and stutter. Stuttering usually
returned to the country, he had a rather good sets in at an early age, just before 18 months
receptive dictionary for the Italian language, (5). It is manifested by repetitions of sounds
for the Romanian language he is quite poor. and syllables or monosyllabic words and
He was enrolled in the kindergarten with induces anxiety in communication situations
extended program. Due to the fact that he did (2). These combined deficiencies led to a
not know the Romanian language when marked language disorder, which proved very
entering kindergarten, it made it difficult for difficult to compensate. The severity of the
him to communicate. Not only the ignorance problems, accompanied by inconsistent and
of the language was a difficulty, but also the inconsistent parental support, led to the fact
multiple sounds affected in pronunciation. that at the beginning of first grade, P.F. still
Interestingly, the tetism presented did not had an accentuated dyslalia, mainly due to the
prove to be a consequence of the wrong confusion of S -Ș-Ț. The speech was
setting, but of a very serious impairment of intelligible, and the degree of stuttering
phonemic hearing. At the time of presentation decreased. For this reason, we expected it to
in speech therapy, the child could not repeat develop dyslexia as well (6). Dyslexia is a
two-syllable words after the speech therapist. disorder that leads to reading difficulties,
The first word learned was "geam", which he characterized by reduced fluency (7). Fluency
said from the first meeting. In addition, he has three key elements: accuracy (degree of
had developed stuttering. correctness), speed (the number of words
reads correctly in a unit of time), and
Specific language disorder: is defined as intonation (7). In order to be able to read at
persistent difficulty and language acquisition, the appropriate speed, the child must first
due to hearing impairments and not due to learn the letters and then read them in turn
hearing impairment or sensory abnormalities, (decoding). Decoding ability is measured by
motor dysfunction or other medical or reading non-words. After a word has been
neurological disorders and cannot be encountered several times, we recognize it
explained by intellectual disability or global and the reading becomes fluent. From this
retardation of development (2). It is an out- moment we can focus our attention on
put disorder, which affects auditory understanding the text (8). The process of
perception, and prevents the development of literacy, although it seems relatively simple,
appropriate learning strategies (3). The is a complex process, which also involves the
disorder is accompanied by poorly developed development of related skills, such as:
short-term verbal memory, poor vocabulary, knowledge of letters, phonological awareness
and poor comprehension, especially if the and quick naming. These are the most
interlocutor speaks quickly (4). Language is a important predictors for reading in a language
tough process in the face of obstacles, and if with regular spelling (9). Phonological
one route is blocked, we usually find another. awareness is the ability to manipulate
But if two or more development pathways are phonological units (10). In languages with
blocked, language will be compromised (4). regular spelling, the difference of dyslexic
In this case, there was a strong genetic children compared to those with normal
development is only a lower speed (11), but can reduce dyslexia in case of a language
Romanian students are also affected by disorder.
accuracy (12). Intervention: is based on PGST
theory (13), according to which reading HYPOTHESIS
learning is influenced by the following H1: We assumed that with the syllabic drive a
factors: availability, consistency and secure fixation of the letters (LK) will be
granularity of language. By availability we achieved.
mean that some phonological structures are
not aware before learning to read (eg H2: The syllabic training intervention will
phoneme awareness), by consistency we develop decoding skills (NWRA accuracy and
mean that different sounds or spelling units NWRF decoding fluency).
can be written in several ways. This is
especially reflected in the regularity of H3: Following the intervention to combat
spelling. Granulation expresses the size of the dyslexia, the student will develop reading
spelling unit needed to learn to read. In skills, characterized by accuracy (WRA) and
languages with irregular spelling, such as fluency (WRF).
English, it is not enough to learn the letters to
be able to read. The PGST theory was H4: At the end of the intervention, the student
developed through the Theory of syllabic will present a developed phonological
connection (14). The latter highlights how the awareness. H5 : Following the intervention,
phoneme-syllable association is created. the student will have fewer words affected by
Romanian is a language with a fairly high pronunciation disorder.
orthographic regularity, but some sounds have
several letters associated with it: cum e and â / METHOD
î. Letter groups, CCV structures (consonant / Procedure: The entire WISC IV test was
consonant / vowel), CCVV, diphthongs, etc. administered before the intervention. The
raises special issues for children with score obtained IQ = 102. He easily solved the
dyslexia. In fact, they cannot make the nonverbal tests, and even in the verbal ones
transition from letter-to-letter decoding to he had high scores. We also administered the
word-reading. For this reason, we performed general visual ability assessment test:
the intervention based on syllabic training. developed by (19). VA = 12, presenting
The child was exposed to each new sound to spatio-visual abilities superior to his age. The
syllabic structures below the image of the language was evaluated with “Independent
corresponding word. I tried to include speech testing” developed by Vrăjmaș &
especially the frequent syllables and as much Stănică (1994). At the beginning of the
as possible in the initial position. Children intervention to combat dyslexia there were
with dyslexia have great difficulty identifying still confusions of sounds: Ș-S; J-Z; T-T. For
rhyme or a phonological unit in the middle of long words with 4 or more syllables omit
a word (15). This type of intervention has parts of the word. The grammatical structure
been shown to be used successfully by other of the sentences is correct, sometimes it
researchers (16, 17, 18). depends on the adjective-noun agreement or
on the plural of some nouns. The intervention
OBJECTIVES took place during the school year 2020 -
We wanted to see to what extent dyslexic 2021, with tests in the second half of January,
intervention, performed by syllabic training, respectively in mid-July. The series of tests
were presented in the following order: Phonological awareness was assessed by the
knowledge of letters, reading of words, deletion of syllables or sounds. For example:
reading of non-words, PA). We measured the bamu becomes mu by removing the first
time of the tasks. In the evaluation, we used, syllable. For the assessment of phonological
at both moments of the intervention (initial awareness (AP) we administered the Deletion
and final) DDE-2 (The Battery for subtests from “Onset Deletion Test from
Assessment of Dyslexia and Evolutive Battery d'evaluation du language ecrit et de
Dysorthography, Sartori et al., 1995; adapted ses disorders” (BELEC), by Mousty, et al.
for the Romanian population, 20). When 1994, adapted for the Romanian population,
assessing the knowledge of the letters we used 12).
Test 1, when reading the words Test 2, and
when reading the non-words (for decoding) RESULTS
Test 3. The knowledge test of the letters The results obtained from the measurements
contains 26 capital letters. Test 2 includes are presented in Table 1.
high frequency and uncommon words.
Table 1. The results obtained the main variables: LK- knowledge of letters; WRA- reading
accuracy, WRF-reading fluency, NWRA - decoding accuracy; NWRF- decoding fluency, PA -
phonological awareness with the three subtests: B1, B2 and C1, WPA- words pronunciation
affected
LK WRA WRF NWRA NWRF PA WPA
B1 B2 C1
Pretesting 4 0 0 0 0 0 0 0 60%
Testing 26 80 % 8 85 % 6 16 16 10 80%
The results obtained fully support our reached the ceiling level. The letter learning
hypotheses. The fact that the scores from the stage is also over. In terms of language: we
decoding samples are very close to those from have an improvement in the correctness of
the reading, shows us that PF still uses the speech, but in some words, there are still
sublexical route in reading (decoding, 12). pronunciation errors. Grammatical errors are
Although at the beginning of the intervention fewer, some sounds have been fixed correctly
the phonological awareness was not (eg J and Ț).
developed, until the end of the intervention, it
Table 2. The results for the main variables for normal developed first -grader children
N Minimum Maximum Mean Std. Deviation
LK 206 23 26 25.90 .388
RAN 206 8.75 46.00 18.0143 4.63380
B1 206 4 16 15.44 1.231
B2 206 1 16 15.37 1.543
C1 206 0 16 9.72 1.185
WRA 206 30.36 100.00 93.6720 9.45660
WRF 206 .01 .40 .0391 .04135
NWRA 206 .00 100.00 84.2536 18.26310
NWRF 206 .01 1.21 .0626 .09586
We compared his scores with the average other research (21, 22), which shows that
obtained by testing 206 students from schools students with dyslexia, even after an intensive
in Suceava County. Although PF has intervention, have delays compared to
improved results compared to the beginning children with normal development.
of the intervention, we notice that they are
still lower than those of normal development
colleagues. The results are in agreement with
DISCUSSIONS
Dyslexia is an unexpected reading disorder considering the child's IQ. Language disorder is
strongly correlated with reading difficulties (23). In the conditions of a strong economic migration, I
think that we will have, unfortunately, several cases like the one presented. Even this child's brother
has a language disorder, this time accompanied by behavioral problems. Intense speech therapy
reduces the extent of the language disorder, but if it is severe, it probably will not resolve until
school age. The aim of this study was to reveal the educational aspects specific to such cases.
Dyslexia itself is a disorder, which is quite difficult to compensate, things becoming much more
serious if the child is also struggling with a language disorder. Although PF has superior
intelligence, pronunciation problems prevent him from achieving good school results. The
intervention aimed to develop reading skills. In the conditions of an affected phonemic hearing, we
considered it useful to rely on syllabic structures and especially on their visual representations (24).
In addition to developing reading skills, we wanted to develop language and correct certain affected
phonological representations. The results show that the student managed to develop reading skills.
The scores obtained are below the average of students with normal first grade development. This is
not surprising, as children with dyslexia have lower fluency and reading accuracy than their peers,
even under intense intervention (25).
For the future, the intervention will have to be continued, which from now on will include more
varied activities, to motivate the student. I think that motivating parents, advising, and training them
so that they can help their children is very important.

The authors declare that they have no potential conflicts of interest to disclose
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Correspondence:
KatalinTiron,
PhD Student, Psychology and Education Sciences Faculty, ”Alexandru Ioan Cuza” University of
Iaşi, [email protected]

BPIPsychiatry
Meditation and melotherapy as adjuvant

treatments of chronic dermatoses
Bogdan M Tarcău, Ioana A Halip, Adriana I Pătrașcu, Laura Stătescu,
Dan Vâță, Adrian Cantemir, Laura Gheucă Solovăstru
Bogdan Marian Tarcău – MD, Dermatology Clinic, “Saint Spiridon” County Hospital, Iasi,
Romania
Ioana Alina Halip – MD, PhD, assistant professor, Department of Dermatology, “Grigore T. Popa”
University of Medicine and Pharmacy, Faculty of Medicine, Iasi, Romania.
Adriana Ionela Pătrașcu – MD, Dermatology Clinic, “Saint Spiridon” County Hospital, Iasi,
Romania
Laura Stătescu – MD, PhD, associate professor, Department of Dermatology, “Grigore T. Popa”
University of Medicine and Pharmacy, Faculty of Medicine, Iasi, Romania. Dermatology Clinic,
“Saint Spiridon” County Hospital
Dan Vâță – MD, PhD, associate professor, Department of Dermatology, “Grigore T. Popa”
Adrian Cantemir - MD, PhD, assistant professor, Department of Psychiatry, “Grigore T. Popa”
University of Medicine and Pharmacy, Faculty of Medicine, Iasi, Romania
Laura Gheucă Solovăstru – MD, PhD, professor, Department of Dermatology, “Grigore T. Popa”
ABSTRACT
Stress levels have increased overall, moreover since the beginning of the coronavirus disease
2019 pandemic. Several chronic dermatoses, such as psoriasis and atopic dermatitis, are well
known to be caused or aggravated by stress. It is common sense that, especially now, the
patients affected by stress need to be offered more alternatives in order to control their skin
conditions. Psychodermatology is a subspecialty of dermatology which through the joint
efforts of dermatologists, psychiatrists and psychologists targets the complex mind-skin
pathways. Meditation is a common arousal reduction intervention in the field of
psychodermatology and it works by redirecting one’s thoughts to calm one’s mind.
Melotherapy (music therapy) is another widely accesible stress reduction intervention, which
despite its simplicity could prove efficient and address the general low compliance to
psychological procedures.
KEY WORDS:
Psychodermatology, meditation, melotherapy, chronic dermatoses, psoriasis.
INTRODUCTION controlled trials. Only articles written in

COVID-19 (coronavirus disease 2019) is the English were reviewed.
disease associated with the novel coronavirus
2 of the Severe Acute Respiratory Syndrome PSORIASIS AND STRESS
(SARS-CoV-2) (1,2). The pandemic caused Psoriasis is a chronic inflammatory skin
by this virus led to several safety measures condition, with a prevalence varying from
such as home isolation, transport restrictions, 0.91% to 8.5% of the population worldwide
social distancing and the use of protection (6). Genetic, epigenetic, environmental and
equipment (3). All these measures, added to lifestyle factors are associated with the onset
the fear factor of COVID-19, contribute to the and recurrence of psoriasis (7). The course of
psychological discomfort, stress and anxiety the disease is defined by periods of remissions
among the general population. This context and exacerbations (8).
represents the premise to an increased burden
of the chronic dermatoses caused or Psychological stress does not only trigger
aggravated by stress. Now, more than ever, exacerbations, but also contributes to the
psychodermatology must step forward initial development of the disease in
through a mutidisciplinary team of predisposed individuals (9-12). Fortune et al.
dermatologists, psychiatrists and studied the clearence of psoriasis during
psychologists and help patients suffering from phototherapy, which was impaired in the
stress. patients who manifested excessive stress (13).
The link between stress and psoriasis was also
Psychodermatology is a relatively new observed in the general population, as in two
subspecialty of dermatology which is gaining retrospective studies on 491 patients, stress
momentum. It aims at aiding in the treatment was believed to be responsible for the
of cutaneous diseases by psychological and appearance or exacerbation of the psoriasis in
psychiatriac means which reduce the stress 37-88% of the patients (14, 15). Daily
levels and control the harmful thoughts and stressors cause increased itch and psoriasis
behaviours. The effects of such interventions severity, especially in the excessively worried
rely on the complex interactions between the individuals (16, 17).
nervous, immune, endocrine and cutaneous
systems (4). Several psychological techniques Manolache et al. investigated the degree of
can be used in the management of chronic stress in a targeted population and reported
dermatoses, such as: cognitive behavioural more stressful events in 169 patients with
therapy, hypnosis, auto-hypnosis, meditation, psoriasis than in the control group. In over
guided imagery and melotherapy (music half of these patients (54%), at least one
therapy) (5). stressful event in the previous year was linked
to the onset or recurrence of the disease (18).
METHODES
This review of the literature will present the A stress responder is defined as a psoriasis
results of meditation and melotherapy patient who deals with increased amounts of
recorded in the field of dermatology up until stress and holds the stress responsible for the
july 2021. The information presented includes worsening of his skin disease (19). It has been
evidences from peer-reviewed journals and reported that high stress responders have a
lower cortisol response to acute stress approaching one’s experiences with openness
compared with low stress responders (20). and acceptance (28).
Psoriasis is still an incurable condition in Several mindfulness-based stress reduction

which the physical burden is doubled by the (MBSR) studies have shown a non-specific
psychological one. Stigma, social anxiety, effect on stress reduction, similar to that
negative self-image and higher levels of observed with standard relaxation practices.
depressive symptoms are observed in the Meditation could reduce the stress levels by
patients with psoriasis, especially when the improving self-regulation, promoting
lesions are distributed on more visible areas neuroplasticity and by increasing the
such as the arms, hands, head and neck (21). parasympathetic activity which in turn
62% of the psoriasis patients suffer from interferes with the sympathetic-adrenal-
depression (22) and 43% from anxiety (23). medullary and hypothalamic-pituitary-adrenal
axes (29-31).
The lack of adequate depression management
is reflected in the fact that suicidal ideation is Jon Kabatt-Zinn (the author of the
not uncommon, with reports of 1 out of 5 mindfulness-based stress reduction
psoriasis patients with suicidal thoughts (24). programme), in a blinded randomized
The patients suffering from psoriasis are even controlled trial from 1998, investigated the
more prone to commit suicide or to develop effect of meditation on psoriasis patients
psychiatric disorders than the patients undergoing phototherapy. 37 patients with
diagnosed with melanoma, one of the most moderate to severe psoriasis were divided in 2
aggressive cutaneous conditions (25). major groups – ultraviolet B (UVB) and
Psoriasis may also be wrongly considered psoralen plus ultraviolet A (PUVA), and
contagious, contributing to the stigmatization subsequently each group was divided into
(26). control and meditation. The meditation
groups had to listen to a recorded mindfulness
PSORIASIS AND MEDITATION meditation audiotape during 40 phototherapy
Given the tremendous psychological impact sessions, while the control groups were
psoriasis can have and the obvious link instructed to relax by any means. The
between stress and the disease, researchers meditation group was instructed through the
have tested different approaches to reduce the tape how to increase their moment-to-moment
arousal levels in the psoriasis patients. nonjudgmenetal awareness of breathing, body
sensations, sounds, thoughts, feelings and
Meditation has long been used for reducing they were asked to visualize how the
stress and it originates from the eastern ultraviolet light alone (UVB group) or in
culture. Meditation can be practiced as combination with psoralen (PUVA group)
mindfulness meditation, mantra meditation, slowed down the growth and division of the
yoga, tai chi and chi gong (27). Mindfulness skin cells. The group receiving the
meditation is the most researched method and intervention through meditation reached skin
it has been succesfully used in various mental clearing significantly faster (halfway point
and physical health conditions. It is typically p=0.013; clearing point p=0.033). Neither
described as non-judgemental attention to group recorded any significant changes in the
experiences in the present moment and it psychometric assessment (Symptom Checklist
implies regulating one’s attention and 90 Revised, SCL-90-R) or in the anxiety level
(State-Trait Anxiety Inventory, STAI) in addition to the usual psoriasis therapy,

between pre-intervention and post- while the control group received only the
intervention. Although the results are psoriasis therapy. The MBCT group recorded
impressive, the patients have not been statistically lower Self-administered Psoriasis
observed over a longer period of time (follow- Area Severity Index (p=0.05) and
up period of 1 week) and so the duration of Dermatology Life Quality Index (p=0.2)
remission was not assesed. Moreover, an impairment scores than the control group.
attrition rate of 37.8% (n=14) was recorded However, the reduction in stress and distress
(32). levels, evaluated through the Perceived Stress
Scale (p=0.94) and Hospital Anxiety and
Gaston et al. randomly assigned 18 psoriasis Depression Scale (p=0.11), was non-
patients to 4 groups: meditation (n=5), significant. The follow-up time was not
meditation and imagery (n=4), waiting list described and the attrition rate was 45%
(n=5) and treatment-free control group (n=5). (n=10), patients dropping out of the study due
The meditation and imagery groups received to impracticality (34).
the same meditation training during the first 6
weeks, while afterwards the patients in the PSORIASIS AND MUSIC THERAPY
imagery group were taught how to imagine Lazaroff and Shimshoni investigated the
their lesions transforming and healing. After a effects of Medical Resonance Therapy Music
12-week intervention (4 weeks pre- and post- on 28 neurodermatitis and 20 psoriasis
baseline periods), the meditation group patients, while the control groups consisted of
recorded a significantly better improvement in 10 neurodermatitis and 10 psoriasis patients.
psoriasis severity, with no substantial benefits Medical Resonance Therapy Music was
from the addition of imagery techniques. The developed by the classical composer and
authors reported a positive correlation musicologist Peter Huebner in 1987. It is
between the psoriasis symptom severity and based on the ancient music medicine of
both psychological distress (p< 0.01) and Pythagorus, according to which the harmony
adverse life event impact (p< 0.05). The laws of the world of music are identical to the
limitations of this study consist in the reduced harmony laws of the biological life. All the
number of subjects, the lack of mean baseline psoriasis patients received their psoriasis
disease severity quantification and the lack of treatment over the course of 14 days. The
psychological assessment. The attrition rate patients in the experimental group were
was 25.0% (n=6) (33). additionaly offered 3 x 30-minute sessions of
listening to Medical Resonance Therapy
In a pilot study from 2015, Fordham et al. Music everyday, while the patients in the
examined 29 psoriasis patients who were control group were instructed to relax by any
randomly distributed in either the means. The degree of sickness was evaluated
mindfulness-based cognitive therapy (MBCT) by the doctors according to a five-unit scale.
group or the control group. The patients After the intervention, at the end of the 14
involved in the study were considered stress days, the degree of sickness in the psoriasis
responders according to their evaluation experimental group was reduced by 65%. The
through the Illness Perception Questionnaire control group recorded a reduction in the
(believed stress caused or exacerbated their degree of sickness of just 20%. The stimulus
psoriasis). The MBCT group received a 8- to scratch had reduced in the experimental
week mindfulness group therapy intervention group by 86%, while in the control group by
29%. The heart rate and the blood pressure Bostoen et al. investigated the effect of
had also lower values after the music therapy meditation on patients suffering from atopic
intervention (35). dermatitis (n=21). The intervention consisted
in a 12-week educational programme of 2-h
NEURODERMATITIS AND MUSIC sessions twice a week and had several
THERAPY components: education on the patient’s skin
In the same study conducted by Lazaroff and disease, education on a healthy lifestyle,
Shimshoni on psoriasis patients, the effect of application of stress reduction techniques
Medical Resonance Therapy Music was also (yoga, mindfulness meditation) and feedback.
tested on 28 neurodermatitis patients. After 14 At 3 months, the disease severity and quality
days of 3 therapy music sessions a day, the of life did not improve significantly in the
degree of sickness was reduced by 41%, atopic dermatitis experimental group in
versus 12% in the control group. The stimulus comparison to the control group, according to
to scratch in the experimental group reduced the evaluation through SCORAD (Scoring
by 59% versus 14% in the control group. Atopic Dermatitis), EASI (Eczema Area and
Blood pressure and heart rate were also Severity Index), DLQI (Dermatology Life
influenced, as lower values were recorded in Quality Index), Skindex-29 or QoLIAD
the experimental group (35). (Quality of Life Index for Atopic Dermatitis)
(36).
ATOPIC DERMATITIS AND
MEDITATION
CONCLUSIONS
Given the actual COVID-19 pandemic situation, arousal reduction techniques could play an even
greater role in reducing the burden of stress-associated diseases. Mindfulness meditation has been
investigated in several studies with promising results in psoriasis patients (32, 33, 34), in contrast to
atopic dermatitis patients (36). Melotherapy, however, was investigated in only one psoriasis and
neurodermatitis study and even though it proved to be an efficient adjunctive therapy (more in
psoriasis than in neurodermatitis), no statistical data was reported (35).
The studies investigating mindfulness meditation and music therapy share the same limitations as
any other psychological intervention, such as the lack of a standardized protocol, high attrition rates
and small sample sizes. This points to the need of more quality studies, comparing different
psychological interventions and investigating which intervention best suits specific subsets of
patients, in the effort to minimize the high dropout rates.

The authors declare that they have no conflicts of interest to disclose.
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Correspondence:
Bogdan Marian Tarcău,

MD, Dermatology Clinic, “Saint Spiridon” County Hospital, Bd. Independentei, nr. 1, Iasi,
Romania, [email protected]

BPIPsychiatry
Particularity of suicide in the countries of the

European Union
Andrei Scripcaru, Costel Marius Frăsilă, Silvia Şpac,
Mădălina Maria Diac, Călin Scripcaru
Andrei Scripcaru - MD, PhD student, Grigore T.Popa University of Medicine and Pharmacy Iasi
Costel Marius Frăsilă -”Ştefan cel Mare” University Suceava
Silvia Şpac - MD, Institute of Legal Medicine Iași
Mădălina Maria Diac - MD, PhD student, Grigore T.Popa University of Medicine and Pharmacy
Iasi
Călin Scripcaru - MD, PhD, professor, ”Ştefan cel Mare” University Suceava
ABSTRACT
Starting from the bio-psycho-social concept developed by Petre Brânzei it is obvious that
suicide has a complex motivation that combines genetic, psychological and social elements.
The paper aims to analyze the social motivation in various countries of the European Union as
the underlying mechanism triggering the suicidal gesture and especially the "trigger" factor
that determines the transition to the act, are still unclear. It is most likely that important
endocrine factors, possibly explaining the decrease in suicide rates in Europe from north to
south, are involved. The decrease from east to west seems to be the consequence of higher
living standards in the west, but also of more effective prophylactic measures in these
countries.
KEYWORDS:
Suicide attempt, prophylaxis, triggers.
SUICIDAL BEHAVIOUR AS A RESULT and, last but not least, to the public. A social
OF SOCIAL TRENDS AND PRESSURES problem - sociologists point out - is an
In its essence and by the multiple undesirable and harmful condition for society,
consequences it entails, suicide is an which affects its order requirements, prevents
extremely important social problem, which is social change and has a negative impact on
of a justified interest to sociologists, the existence, security and well-being of
psychologists, criminologists, lawyers, society members (1).
doctors, to different categories of specialists,
practitioners, representatives of the authority
The statistics or estimates compiled by the abundance and increased social vitality,
World Health Organization are relevant in this fosters suicide" (Durkheim,2).
respect, highlighting that suicide is a global Durkheim's theory seems, in one way or
problem of humanity, which manifests itself another, tested by the current economic crisis,
in all countries of the world with great although the data of various research carried
intensity, being amplified by the conditions of out in this field are contradictory to each
the current crisis.(1) other. Thus, some studies have shown that
periods of economic crisis lead to a
Consistent with this interpretation of suicide significant increase in suicides, other studies
as a social problem, sociologists believe that have stressed that in such periods suicide is
suicide rates can only be explained by social committed especially by vulnerable people
factors, independent of the biological traits, (who are already affected by stress, mental
characteristics and mental tendencies of the disorders, unemployment, alcohol
individual1. If the act of suicide as such may consumption, etc.), while other studies have
involve such individual characteristics and pointed out, on the contrary, that in periods of
motivations, suicide rates are necessarily economic recession the number of suicides
subjected to social trends and pressures, being decreases, due to the fact that individuals
- as the well-known sociologist É Durkheim mobilize more strongly than in "normal"
pointed out. - a consequence of the "social times to cope with life difficulties (Carey,
acts" that manifest themselves and act in a 2011). Research undertaken in the United
particular society. And such social acts are, in States has, on the other hand, highlighted the
fact, a product of social relations and types of fact that, contrary to Durkheim's conception,
human association, consisting of "ways of suicide rates decrease during periods of
working, of thinking and feeling, external to economic expansion, with some exceptions,
the individual and which are endowed with a related to age groups. Thus, during the
power of compulsion by virtue of which they economic boom of the 1960s, the suicide rates
are imposed on him" (Durkheim, 2). of the population in the 30 to 50 years interval
increased in the United States, and during the
SUICIDE, CRISIS AND ECONOMIC recession in the middle of the 7th decade,
PROSPERITY suicide rates decreased among the elderly
Émile Durkheim is probably the first population, who were the beneficiary, among
sociologist to point out that "every people has other things, of the Social Security program
a collective tendency towards suicide that is of the previous decade (Carey, 2011).
their own", as demonstrated (1999, pp. 247-
261) by the fact that as long as society does SUICIDE IN EUROPE
not change, the number of suicides remains R.B. Ginsberg (1966) pointed out that suicide
constant" (Durkheim,2). is "procyclical" in that suicide rates decrease
The increase in the extent of suicides - during periods of economic depression and
Durkheim observes - occurs when society is increase during periods of economic
changing, i.e. either in a state of economic expansion. On the contrary, A.F. Short and
crisis (in a negative sense) or in a state of J.F. Short (1954) have highlighted that suicide
economic prosperity (in a positive sense). is "anti-cyclical": thus, during periods of
"Any shaking of balance, even if it provokes economic prosperity, the suicide rate
decreases and during periods of economic
crisis it increases
A study by Bijou Yang (1992) on the American history were reached. On the
evolution of the suicide rate in the United contrary, in 2000, when the US
States between 1940 and 1984 disproved the unemployment rate did not exceed 4%, it was
assumptions circumscribed to Durkheim's the lowest suicide rate in the country's history
conception. In this regard, the study found (Sternheimer, 2011).
that: suicide rates did not increase during
periods of economic boom or economic crisis Beyond such findings, it can be pointed out
in the United States, any change in these rates that suicidal rates recorded during the crisis
being dependent on the characteristics of the that began in 2008 are much more
social groups involved. On the other hand, pronounced, at least in Europe, than during
unemployment rates had a significant the Great Depression (Stuckler, 2011).
negative effect only on the suicide rate
characteristic to white men, and the rate of As an example, the countries that faced the
participation of women in the workforce had a most difficulties during the economic crisis
beneficial influence on suicide rates, both that began in 2008, such as Greece and
those characteristics to white women and Ireland, recorded the largest increase in the
those specific to black women. suicide rate (according to Mediafax, 2011).
THE RELATION BETWEEN SUICIDE In Greece, the number of suicides increased

AND ECONOMIC CRISES by 17% between 2007 and 2009, and some
A suggestive example that points out that unofficial data even mention a 25% increase
suicide is determined by or is related to socio- in 2010 (Kentikeles, Stucker et al., 2011).
economic factors is the finding - resulting According to the Ministry of Health in
from social history studies - that, during Athens, in the first half of 2011, the number
periods of economic recession, the number of of suicides increased by 40% compared to the
suicides of the population included in the age same period the year before (Stancu, 2011).
range of 25 to 64 years, increases. Before the financial crisis, Greece had one of
the lowest suicide rates in Europe: 2.8 per of
The period of the Great Depression, for one thousand inhabitants. In 2011, this figure
example, which began a decade earlier than doubled. Suicide attempts have also increased
the Second World War, is a suggestive (Smith, 2011).
example from this point of view. Thus, the
sharp decline in economic indicators, in These trends, coupled with those aimed at
particular the decline in production, trade, doubling the number of murders and thefts
unemployment and, by implication, income, between 2007 and 2010, complementary to
has led to numerous suicides. the deterioration of the public health system
due to lack of funds, have led US researchers
In the United States, for example, the average at the University of Cambridge, Alex
death rate by suicide per 100,000 inhabitants Kentikeleris and David Stuckler, to appreciate
increased, compared to the previous period that a genuine "Greek tragedy" can be talked
(1920-1928), by almost 50% in 1929 and by about (Kentikeles, Stucker et al., 2011).
27% between 1930-1940. In the same
country, during the most pronounced period In Ireland, during the same time period (2007-
of crisis, 1928-1933, when the unemployment 2009), when Ireland felt the strongest effects
rate reached 24%, the highest suicide rates in of the economic and financial crisis, the
suicide rate increased by 15%. In line with the these authors predicted that the period of
data of the Report prepared by the Central economic crisis started in 2008 would have
Statistical Office of Ireland, from the end of similar consequences (Stuckler et al., 2009).
2006 to 2009, the suicide rate increased by
25%, the highest annual rate ever recorded in The authors of the study processed data on
this country (Queen, 2010). mortality causes by age groups from the data
compiled by the World Health Organization,
The largest increases in the suicide rate and the information on unemployment trends
occurred among the young population (15-24 characteristic to the adult population had
years): 23% for men and 13% for women. taken them from statistics published by
The suicide of young people was, during that EUROSTAT.3 (Euro-indicators Calendar).
period, the 5th place in Europe, after the ones As complete information on 17 of the 27
recorded in Estonia, Latvia, Lithuania and European countries was missing, the analysis
Finland (Queen, 2010). As a characteristic focused mainly on 10 countries, six of which
trend in Ireland, suicide acts were committed, joined the European Union before 2004
in the years of crisis, mainly by the heads of (Austria, Finland, Greece, Ireland, the
young families, who faced numerous financial Netherlands and the United Kingdom), and
problems, which led them to consume alcohol four others joined the Union after 2004
excessively. On the other hand, there has been (Czech Republic, Hungary, Lithuania and
an increase in suicides in rural areas and in Romania). Data on the situation in the two
the construction industry, which have been groups of countries were evaluated in ration
most affected by the economic and financial with the population size (Stuckler et al.,
crisis. Along with the effects of this crisis, 2011).
alcohol and drug abuse were the factors that
strongly enhanced suicidal behavior (Thomas, The findings of the study showed the
2012). following:
- in both groups of countries, officially
With the exception of these two countries, recorded unemployment rates did not increase
almost all European countries have seen until 2009, the year following the economic
increases in suicide rates caused by the crisis. Since this year, the unemployment rate
economic crisis. has risen rapidly in all 10 countries, by around
35% from the level reached in 2007, with an
A study carried out, for example, by David increase between 2% and 6% across the
Stuckler and his collaborators on the European Union.
evolution of the mortality rate recorded in 26 - however, the steady decline in suicide
European countries during the economic rates, which was observed in both groups of
crises of the last three decades, revealed that countries before the start of the crisis, was
unemployment is one of the main factors simultaneously reversed in all the countries
associated with the increase in suicides analysed. Thus, in 2008, the increase in
among the population under the age of 65 2 . suicide rates was less than 1% in countries
Thus an increase of more than 3% in the that more recently joined the European Union
unemployment rate has strong effects on the and by around 7% in those countries that
suicide committed by this category of joined the Union a longer time before.
population. Based on the analyses carried out, - in 2009, the growth trend increased in
all countries (at at least 5% compared to
2007), with the exception of Austria, which in themselves lead to an increase in suicide rates,
2009 recorded fewer suicides (with about 5%) but only through intermediate variables, such
than in 2007. as: unemployment, declining of incomes,
- surprisingly, Finland, which has one deterioration of quality of life, consumption
of the strongest social protection systems, has of alcohol or drugs, disruption of physical
seen an increase of more than 5% in suicides health, but especially of mental health, etc. A
compared to Austria, which also has a highly period of crisis is complementary, in fact, to
functioning social protection system; these changes in the lives of individuals,
- Greece and Ireland, as we have which affects - as the results of several studies
already mentioned, have had the greatest and research highlights - the social well-being
increases in suicides. Latvia also had an of the population. Suicide, as such, is a
increase of more than 17% between 2007 and significant indicator of the decrease in social
2008; well-being and, first and foremost - as many
- in the UK, the suicide rate increased experts in the field point out - of mental
from 6.14 per 100 000 people in 2007, to 6.75 health.
per 100 000 in 2008, thus increasing by 10%,
remaining at the same level in 2009; As defined by the World Health Organisation,
- despite these fluctuations, that study health, in its entirety, is an essential
could not identify a definite trend of deviation dimension of human life, which is an
during the crisis period, compared to the past, important indicator of social well-being and
in respect of all cases of mortality, except for quality of life. It is a "condition of physical,
suicides, which increased in magnitude and mental and social well-being" that actually
intensity, and car accidents, which decreased reflects the living standards of a particular
significantly, probably due to the decrease in community.3
the availability of machinery usage and of the
use of more worn-out vehicles, which did not However, as a whole, the findings of
allow excessive speed in traffic. empirical research focusing on the link
between periods of economic crisis and the
Except for the difficulties faced by the authors deterioration of social well-being, including
of that study, due in particular to the health status, are contradictory to each other.
difficulties in weighting the data, as well as Thus, some analysts consider that, excluding
the pronounced variations from one country suicides - which are an "exception" -
to another, in terms of their availability economic crises have no negative effects on
(Romania is mentioned, in this respect), this health (Anderson, 2011, p. 2). Paradoxically,
study suggestively highlighted the association during the Great Depression, which preceded
link (not necessarily causal) between periods the Second World War, the overall mortality
of economic crisis and the increase in suicide rate decreased for all age groups, but suicide
rates. rates increased.
SUICIDE, WELL-BEING AND HEALTH With the exception of the influence of

CONDITIONS OF THE POPULATION economic crises, there is an association link
Clearly, suicide is not an effect of factors or between the health of a population and its
processes that act in isolation or tendencies towards suicide, with variations
autonomously. It should be noted, in this from one country to another. Health status can
respect, that periods of crisis do not in
best be highlighted through mortality rates. recorded in Switzerland, Italy, Iceland and
But because mortality is different within Spain (between 490 and 520 deaths per
different age groups and from one country to hundred thousand inhabitants), and the
another, statistical institutes or offices have to highest rates were recorded in Lithuania and
sum them up and standardize them in Latvia (over 1,000 deaths per hundred
different comparable ways. thousand inhabitants). Bulgaria, Romania and
Hungary also had mortality rates of more than
In the period 2008-2009, for example, during 900 deaths per hundred thousand inhabitants
which the economic crisis began and (OECD, 2010, p. 30-31) - see fig. 1
expanded, the lowest mortality rates for all
cases of death in European countries were
Fig. 1 Death rate for all deaths in 2008 for ten European countries
Source: OECD Health Data 2010
(approximately between 32-25 per hundred

In terms of suicide rates, they were lower in thousand inhabitants).
Italy, Spain and Iceland (between 6.3 and
about 12 per hundred thousand inhabitants) Bulgaria and Romania, respectively, recorded
and higher in Lithuania (over 34 per hundred about 12 suicides per thousand inhabitants
thousand inhabitants), Hungary and Latvia (fig 2).
Fig 2 Suicide mortality rate in 2008 (2009) in ten European countries
Source: Eurostat Statistics Data, 2010
Based on the data mentioned, a positive Iceland, which had the lowest mortality rates
correlation between mortality rates - as among European countries, also had the
indicators of population health - and suicide lowest suicide rates. The exception is
rates can be inferred. Thus, Italy, Spain and Switzerland, which had the lowest mortality
rate in Europe, but recorded a medium-level One of the main objectives of studies focused
suicide rate (18 per cent of thousands of on the role of this cycle, in general, of socio-
inhabitants). By contrast, Lithuania and economic factors in increasing or, on the
Latvia, which had the highest mortality rates contrary, lowering suicide rates is the
of all European countries, also had the highest relationship between suicide and
suicide rates. An exception is the case of unemployment. Socio-economic variables
Hungary, which had an average mortality rate, seem to have the greatest contribution to the
but instead recorded one of the highest suicide impact of occupational status on suicide
rates. A particular situation was recorded in (Preti, 2003). Several studies have pointed out
Romania and Bulgaria, which, although had that a low level of occupational status of
high mortality rates (immediately after those individuals correlates with a higher risk of
recorded by Lithuania and Latvia), had suicide. In many European countries, changes
relatively low suicide rates, but about twice as in occupational rates have influenced suicide
high as those recorded, for example, by rates. Suicide risk is linked, among other
Switzerland. things, to the fear of employees losing their
jobs and the stress that characterizes the
These exceptions are explained, amongst unemployed with regard to the drastic
others, by the variations between different reduction of income and the deterioration of
countries in terms of unemployment, alcohol their living standards (Yur'iev et al., 2010).
and drug use, the state of depression that
characterizes individuals and, therefore, their Research carried out in the Member States of
mental health. the European Union has shown, for example,
that trends in the increase in national
It should be noted, on the other hand, that unemployment rates have been and are still
both mortality rates and suicide rates are associated with increased suicide rates and,
much higher among men than among women. among other factors, the increased incidence
Thus, the mortality rates of men exceeded of mental illness or mental disorders 4.
with 50 to 100% that of women, while the
suicide rates of the same men exceed those of Except for these findings, several studies and
women even 3-4 times (OECD, 2010). In the research (Kposowa, 2001) have concluded
case of suicide attempts, the differences that the effect of unemployment on suicide is
between the two sexes are smaller, among more pronounced immediately after
others, because women tend to use less lethal individuals become unemployed. As time
suicide methods than those used by men. goes on, the new unemployed adapt to their
new status, which is why they are less
SUICIDE, UNEMPLOYMENT AND inclined to commit suicide. In addition, with
MENTAL HEALTH the passage of time, the unemployed can find
In most countries with market economies work and leave the status of unemployed.
there is a 'business cycle', characterized by an These issues were ignored by studies dealing
increase in unemployment during periods of with the association link between
economic recession and a reduction in it unemployment and suicide and which did not
during periods of economic expansion take into account the duration of the period
(Kposowa, 2003). Such a cycle therefore has of unemployment.
a special impact on suicides, especially those
committed by the working population.
Summarizing the main characteristics and We can expect an acute economic crisis to
effects of the relationship between suicide, lead to a suicide risk among working adults
unemployment and health, the Strategic and in older adults whose retirement
Center for Suicide Prevention in the United security is threatened.
States highlighted the following findings
(Suicide Prevention Resource Center, 2008): SUICIDE IN ROMANIA, ABOVE THE
EUROPEAN AVERAGE IN THE MOST
UNEMPLOYMENT AFFECTS LIKELY AGE GROUPS
GENERAL HEALTH. Eurostat results were presented on Tuesday at
- Unemployment is associated with poor the launch of the study "Depressive Disorder5.
health and mortality through all cases of death New research directions", by doctors Camelia
(except cancer and strokes). Popa, clinical psychologist, researcher in the
Department of Psychology of the Romanian
UNEMPLOYMENT CONTRIBUTES TO Academy, and Adela Ciobanu, psychiatrist at
THE RISK OF SUICIDE BUT DOES NOT the "Alexandru Obregia" Hospital and teacher
"CAUSE" SUICIDE BY ITSELF. at the University of Medicine Bucharest.
- Occupational status is just one of the factors
that interacts with individuals, communities According to Eurostat, the age groups with
and societies, affecting suicide risk. the highest incidence of suicide are: 15 - 19
- Although unemployment is associated with years, 50 - 54 years and over 85 years.
increased suicide rates, many individuals may Lithuania, the European country with the
have lower employment rates due to poor most suicides, has a suicide rate ten times
mental health and drug use, which are also higher than Greece, the country with the
associated with increased suicide rates. fewest suicides.
Unemployment causes financial difficulties
and can lead to depression or other problems Suicide rates are low in southern European
that individuals perceive as a loss of personal countries - Greece, Cyprus, Italy, Malta,
control. Spain and Portugal - but also in the UK, and
high in the Baltic and Central and Eastern
Economic conditions, as such, are not European States - Lithuania, Hungary and
sufficient to cause a suicidal act; in fact, we Latvia, as well as Finland.
do not know any singular factor, i.e. sufficient
by itself, to "determine" a suicidal act. Suicide death rates are three times higher for
Stressors such as losing a job, housing or men than for women across the European
retirement can produce feelings of shame, Union, with wide variations between
humiliation and despair, and in this context countries.
can precipitate the suicide attempts of those
people who are already vulnerable or do not In Romania, suicide among young people
have enough resources to get support. In aged 15 to 19 has a rate of 6.3 deaths per
most, but not in all cases, mental health 100,000 inhabitants, compared to the
problems are among the factors that increase European average of 4.6. The male suicide
this vulnerability. rate is 9.2, compared to 6.9, the EU average
and the female suicide rate is at 3.2, compared
to 2.2, the EU average.
For the age group 50 to 54 years, Romania include Greece, Spain, the UK, Germany and
has a rate of 22 suicides per 100,000 France.
inhabitants for both sexes, compared to 18.3,
the European average. If the suicide rate A significant and steady decrease in suicide
among Romanian women aged 50 to 54 was rates among young people can be observed in
below the European average (5 deaths per the case of Hungary, which in 2010 had a
hundred thousand inhabitants, compared to suicide rate for the group 15 to 19 years lower
8.1 deaths per thousand inhabitants - the EU than that of Romania, after Romania for
average), the male suicide rate was extremely decades was at the top of the European
high - 40.6, compared to 28.7 per 100 000 ranking as a frequency of suicide.
inhabitants - the EU average.
On the other hand, in the group of suicidal
At the top of the EU as frequency of suicide risk 50 - 54 years in the first places are
among young people are the Baltic and Lithuanians, Hungarians, Slovenians and
northern European countries - Lithuania, Polish. The countries with the fewest cases of
Estonia, Finland and Ireland. European suicide in this age group are Spain, the United
countries with the fewest young suicides Kingdom and Greece.
ACKNOWLEDGMENTS AND DISCLOSURE

The authors state that they are no declared conflicts of interest regarding this paper.
REFERENCES
1. Rădulescu S, Suicide in Europe in the Context of the Global Economic Crisis. The Romanian
Journal of Sociology. 2012; 23(5-6):385-403.
2. Durkheim E. Suicide, Sociological Study, European Institute Publishing House. 1993.
3. A.F. Short, G.F. Short. SUICIDE AND HOMICIDE-SOME ECONOMIC, SOCIOLOGICAL
AND PSYCHOLOGICAL ASPECTS OF AGGRESSION.1954
4. Kentikelenis A., Stucker D. et al. Health effects of financial crisis: omens of a Greek tragedy.
The Lancet.2011;378(9801):1457−1458
5. E. Rădulescu. Sociologia sanatatii si a bolii. 2002
6. Health at a Glance: Europe 2000, OECD Publishing.2010.
7. World Health Organization. Impact of economic crises on mental health. Geneva. 2011
8. http://www.mediafax.ro/externe/criza-economicadetermina-mai-multe-sinucideri-dar-mai-
putine-accidente-auto-in-europa-8463984
9. De Gioannis A., De Leo D. Managing suicidal patientes in clinical practice. Open Journal of
Psychiatry. 2012; 2:49-60.
10. Diekstra R.F.W., Gulbinat W., Kienhorst I., De-Leo D. Preventive Strategies on Suicide. Vol.
2. Co-publication WHO, Geneva E.J. Brill,1995
Correspondence:
Călin Scripcaru,
MD, PhD, professor, ”Ştefan cel Mare” University Suceava, calinscripcaru

BPIPsychiatry
The therapeutical role of psychedelic drugs in

treatment of mental disorders
Cătălin Oprea, Loretta Epure,
Vasile Chiriță, Adrian Cantemir
Cătălin Oprea - Medical Resident in psychiatry, ”Socola” Psychiatry Institute, Iasi

Loretta Epure - Medical Resident in psychiatry, ”Socola” Psychiatry Institute, Iasi
Vasile Chiriță - Honorary Member of Academy, Professor, PhD, psychiatrist,
Adrian Cantemir - MD, PhD, assistant of professor, Grigore T. Popa University of Medicine and
Pharmacy Iasi
ABSTRACT
Psychedelic drugs (also called hallucinogens, psychotogenics, psycholytics, entheogens) are
substances that act mainly on the 5-HT2 serotonergic receptor. There are two main groups of
psychedelics: indoleamines (lysergic acid diethylamide-LSD, N, N-dimethyltryptamine-DMT,
and psilocybin) and phenethylamines (mescaline, dimethoxymethamphetamine–DOM,
methylenedioxyamphetamine–MDA, and methylenedioxymethamphetamine-MDMA). These
drugs have a long history, being used in the past in spiritual and religious ceremonies and also
in the treatment of physical and mental illnesses. Studies have been conducted over the years
on the therapeutic utility of these psychedelic drugs (especially psilocybin, LSD) in the
psychiatric field and their beneficial effect has been highlighted in conditions such as anxiety,
major depressive disorder, obsessive-compulsive disorder, alcohol addiction, smoking
addiction.
KEYWORDS:
Psychedelic, psychiatry, therapeutic role.
INTRODUCTION induce a psychosis), "psycholytics" (to

Despite a century of experimental data, there "loosen the mind"), "psychedelics" (to
is not even one psychedelic drug licensed for "manifest mind") and "entheogens" (to
medical application. The term used for generate the divine within) reflect the varying
psychedelics has evolved over the ages. medical and social attitudes to drugs. (1)
Different terms, including "hallucinogens" (to
induce hallucinations), "psychotomimetics" The history of psychedelics in medicine
(to mimic psychosis), "psychotogenics" (to begins in the middle-ages when the
physician's ancestors used psychotropic plants In the 1970s and 80s Nixon's 'war on drugs
(henbane, belladonna) to heal physical and led to the dark ages for psychedelics
mental diseases. (2) medicine, limiting the research. (8)
The earliest classification of psychoactive The first report on MDMA psychoactivity

drugs was provided by Louis Lewin in the was published by David E. Nichols in 1978
late nineteenth century, using the terms (9), which described the experience gentler
"euphoriants" (for opiates), "inebriants," (for and more euphoric that with LSD. (1)
alcohol), and "phantastica," which later
become the psychedelics. (3) In the early 1980 psychotherapists using
MDMA were keen to keep it for clinical use,
In 1912 the pharmaceutical company Merck but the substance's growing popularity for
synthesized 3,4 methylenedioxymetham- recreational use led to its ban by the DEA in
phetamine for the first time. (4) 1985.
In 1919 the mescaline was synthesized by In december 1990 Strassman revived

Ernst Spath, an austrian chemist. In 1927 a psychedelic medical research starting a DMT
german chemist, Kurt Beringer, proposes one pilot study with a strict methodology,
of the earliest models for psychosis based on demonstrating that the authorities can be
the mescaline induced psychedelic convinced to consider psychedelic studies
experience. (5) Also, Walter Frederking again (10)
explored in 1930 the mescaline as a tool in
psychotherapy. In 2000s researches related to psychedelic
drugs were conducted in centers including
In 1938 Albert Hofmann discovered LSD-25 Johns Hopkins University, the University of
while investigating the vasoconstrictor New Mexico, McLean Hospital in Harvard,
properties of ergot at Sandoz Laboratories. Imperial College London, and Bristol
After 5 years, in 1943, Hofmann, University in the UK (11)
accidentally, had the world's first LSD
induced experience, which led to a phase one After 2010 the golden age for publication on
study on the Sandoz staff; dozens of members the field had emerged, in 2011 Grob et al.
were included, trying to demonstrate its safety opened the road with the study ‘Determining
for human consumption. (6) the therapeutic value of psilocybin in
advanced stages of cancer anxiety’ the result
The development of the phenothiazines, being significant reduction at one and three
chlorpromazine being first synthesized in months after treatment and improvement of
1950, have been significantly helped by the the mood after 6 months. (12) Many studies
LSD and mescaline research. (7) have been made with optimistic results in the
field of addictions, depression, and anxiety
In the 1960s LSD was embraced by (13, 14, 15, 16, 17).
psychiatry being used for a wide range of
conditions including social anxiety, What are psychedelic drugs?
depression, anxiety disorder, autism, pain Psychedelics drugs are a grouped class of
relief, as well as sensible topics as molecules that can produce a non-
homosexuality and female frigidity. (1)
physiological state of consciousness, acting Albert Hoffman in 1957 from the fungus
on serotonergic receptor type 2. Psilocybe mexicana, the first synthetic
psilocybin product being produced in 1958. It
They are divided into two main classes, was used traditionally in religious and
indoleamines which include: lysergic acid spiritual ceremonies (along with mescaline
diethylamide (LSD), N,N-dimethyltryptamine and dimethyltryptamine), but also in the
(DMT), and psilocybin; and phenethylamines treatment of neuropsychiatric disorders. Dried
that include: mescaline, dimethoxy- mushrooms contain about 0,5% psilocybin
methamphetamine (DOM), methylene- (22, 23, 24). The most used mushroom is
dioxyamphetamine (MDA), methylene- Psilocybe cubensis which contains 10-12 mg
dioxymethamphetamine (MDMA). (18) of psilocybin per gram of dried mushrooms
(25).
How do psychedelics work?
Nichols et al. in the study ‘Psychedelics as Psilocybin is metabolized by the liver to the
Medicines: An emerging new paradigm’ active ingredient psilocin, which crosses the
propose that psychedelics destabilize the local blood-brain barrier and stimulates 5-HT2A, 5-
brain network hubs and global network HT2C, 5-HT1A, 5-HT1D serotonergic
connectivity by promoting neuronal receptors (26, 27,28). Psilocin is also active
avalanches which provide the opportunity for on histaminergic receptors H1, alpha 2A, and
the brain network to ‘reboot’, thus permitting alpha 2B adrenergic receptors and
a rewiring of the neuronal paths. (19) dopaminergic receptors D3 (29). It is
considered that the psychoactive effect of
Another mechanism is proposed by David E. psilocybin is due to its role as a partial agonist
Olson on ‘The Subjective Effects of on the 5-HT2A receptor which is associated
Psychedelics May Not Be Necessary for Their with increasing neuronal excitation,
Enduring Therapeutic Effects’, where the improving memory and learning, bronchial
ability of psychedelics to engage and gastric smooth muscle contractions,
neuroplasticity mechanisms promote rewiring cardiovascular and gastrointestinal anti-
of neuronal circuits. (20) inflammatory effect. 5-HT2C receptors
modulate propiomelanocortin activation and
Also, they promote the growth of cortical the release of CRH (cortisol releasing
pyramidal neurons by increasing dendritic hormone), which are involved in modulating
arborization and stimulate synapse formation, appetite, insulin sensitivity, glucose
which makes them well suited for a disease homeostasis, and response to anxiogenic and
characterized by prefrontal cortex neuronal stressful stimuli (30, 31). The dopaminergic
atrophy such as stress-related effects of psilocybin are minimal, mainly to
neuropsychiatric disease. (21) D3 receptors with unknown effects (30, 32).
The most common side effects are nausea,
PSILOCYBIN vomiting, diarrhea, anxiety, tachycardia,
Mushrooms are the main natural source of delusions and confusion (31). More serious
psychedelic drugs. Groups of psychoactive side effects include perceptual disturbances,
fungi include species of the genera seizures, and a hypothetical risk of heart valve
Conocycle, Gymnopilus, Panaeolus, Pluteus, disease (32).
Psylocibe, and Stropharia. Psilocybin is a
psychedelic substance that was isolated by
Preliminary studies have shown a positive therapeutic failure. Each patient received 4
role of psilocybin in psychiatric disorders different doses of psilocybin (25 mcg/ kg, 100
such as obsessive-compulsive disorder, mcg/ kg, 200 mcg/kg, 300 mcg /kg) at least
anxiety, major depressive disorder, alcohol one week apart. According to the Yale-Brown
dependence, tobacco dependence (33, 34). Obsessive-Compulsive Scale (YBOCS),
88.9% of patients experienced a reduction of
Depressed Mood at least 25% in symptoms 24 hours after
Hendricks et al. evaluated the relationship administration, and 66.7% of patients had a
between psilocybin and stress reduction. It decrease of at least 50 % of symptoms 24
was found that people who were using only hours after ingestion, without significant
psilocybin had a better mood and a lower risk adverse effects (37).
of autolytic ideas or attempts compared to
those who used other drugs.(22) In 2006 and Alcohol and Tobacco Dependence
2008, Griffiths et al. studied the psychological To evaluate the therapeutic role of psilocybin
effects of psilocybin in healthy volunteers in ethanol dependence, Bogenschutz et al.
who did 2-3 sessions of psilocybin. Two conducted a study on 10 patients, after 4
months after administration, there was an weeks of psychotherapy, they received a dose
improvement in mood, a more positive of psilocybin and after another 4 weeks, they
attitude, and a better social life, without any received a second dose of the drug. A
significant side effects 14 months after significant reduction in alcohol consumption
ingestion (35, 36). was observed in all patients after ingestion of
psilocybin, and the only adverse effect was a
Cancer and Anxiety mild headache on half of the patients, that
Among the first clinical studies published resolved within less than 24 hours (33).
about the therapeutic role of psilocybin, was
the one conducted by Grob et al. who used Due to the positive evidence for the efficacy
this psychedelic to treat anxiety in patients of 5-HT2A receptor agonists, Johnson et al.
with cancer. They received a dose with 200 conducted a study with 15 smoking
mcg/kg active psilocybin and several weeks participants from at least 10 cigarettes per day
apart, it was administrated 250 mg niacin, and with failed attempts to quit (without
used as a control and to prevent heat flashes substitution treatments or other drugs). The
given frequently by psilocybin. Before length of the study was 15 weeks, psilocybin
treatment, during treatment, and after was administrated at weeks 5, 7, and 13,
treatment, the State-Trait Anxiety Inventory combined with 4 weeks of cognitive-
Scale (STAIS) was measured, at 2 weeks, one behavioral therapy. The result of the study is
month, and 6 months post-therapy. According promising, as 80% of participants remained
to STAIS, anxiety decreased significantly abstinent 6 months after the end of the study.
after psilocybin treatment, with an Notable side effects were a slight increase in
improvement in mood for 2 weeks. (12) heart rate and blood pressure, headache, and
dysphoric manifestations (13).
Obsessive-Compulsive Disorder (OCD) Psilocybin may have some utility in treating
To evaluate the therapeutic role of psilocybin psychiatric disorders, but its use is limited by
in patients with obsessive-compulsive the low applicability of studies, the addictive
disorder (OCD), Moreno et al. conducted a potential of the drug (lower than other drugs)
study of 9 OCD patients with at least one that requires rigorous monitoring of patients.
However, extensive and rigorous studies are LSD was used in the treatment of anxiety,
needed for demonstrating the utility of depression, psychosomatic diseases and
psilocybin in psychiatry, opening new doors addiction (52). In patients with advanced
for the future. cancer, it has also been observed that LSD
could reduce pain, anxiety, and depression.
LYSERGIC ACID DIETHYLAMIDE LSD (53, 54, 55)
From the discovery of LSD in 1938 by Swiss
chemist Albert Hofmann who was searching Addiction
for a substance derived from ergot with the Fuentes et al., in his systematic review,
goal to reduce postpartum hemorrhage, analyzed 11 eligible papers from an initial
lysergide has maintained an unstable total of 3,668 and concluded that LSD may be
relationship with psychiatry (38, 39). The helpful in alcohol use disorder, having
potential psychiatric use of LSD began at the superiority over placebo with an odds ratio of
end of the 1940s, being used in Europe and 1.96 (95% confidence interval 1.36–2.84 OR,
the USA under the brand name 'delisin' p = 0.0003), being compared in terms of
marketed by Sandoz. (40). Even the US army efficacy with the daily intake of naltrexone,
and secret services have been using it as a acamprosate, or disulfiram (52, 56)
truth serum and as an incapacitant agent
without success (41). Anxiety, Depression, and Psychosomatic
Diseases
LSD chemical structure is similar to Denson et al. found significant difference
psilocybin and dimethyltryptamine (42), improvement in the symptomatology of
being a part of classical hallucinogens (40). It patients at 6 and 12 months (p<0.05). (57)
is one of the most potent hallucinogens with a Savage et al. found also a significant
half-life of approximately 3h and an active improvement in symptomatology after 6-8
dose between 0.5 and 2 mcg/kg (43, 44). The weeks, being greater in the LSD treatment
mental effects are a distortion of the sense of group compare to the classical treatment on
time and identity, alteration in depth and time the control group as well compared to the
perception, visual hallucinations, euphoria, placebo group(p<0.05). (58)
distorted perception of size and shape of
objects, movements, colors, sounds, touch and In the study by Gasser et al., anxiety
body image and delusions. (45) associated with chronic inflammatory disease,
chronic motor disease, and cancer, has been
One of the risk of administration is so called ' reduced, the reduction being observed 2
the bad trip', described as strong anxiety, months post ingestion and maintained after 12
confusion, dysphoria (46), and an months. (59)
exacerbation or the prolonging of psychotic In the future LSD is seen as a potential
disorder, depending on the previous state of therapeutic agent in the fields of addictions
the subject. (47) LSD does not create physical despite its controversy and difficulty of
dependence as the most recreational drugs do designing clinical trials. New and modern
(opioids, cocaine, and methamphetamine). studies are needed to increase the knowledge
(49) It has very low toxicity, without any in the field.
evidence of organic damages and
neuropsychological deficits. (50, 51)
METHYLENEDIOXYMETHAMPHETA MDMA is used for a number of mental

MINE (MDMA) disorders like anxiety and PTSD, increasing
MDMA interacts with several receptors in the social interactions. (64)
brain but it has the strongest affinity for
serotonergic receptors followed by In PTSD it was recently proved that MNDA
norepinephrine and dopamine receptors (60). is an effective adjuvant because it decreases
The main effect is on extracellular and extremely negative experience relieving thus
cellular concentration of serotonin (61, 62) being easier to revisit and integrate the
and also on the concentration of extracellular traumatic memories. (65, 66, 67)
dopamine and norepinephrine.
There have been a small number of studies to
MDMA is rapidly absorbed in the assess the effectiveness of MDMA in PTSD
gastrointestinal tract, reaching its peak within who meet DSM IV criteria, with preliminary
60 to 180 minutes; it has a half-life of finding being encouraging; however, is
approximately 8h (63)and it is metabolized important to consider that the effects that
mainly by hepatic enzyme P450 2D6 to MDMA can limit its use in psychiatry. (68,
methylenedioxyamphetamine (MDA). 69)
CONCLUSIONS
In conclusion, psychedelics, despite the controversy around them and the difficulty in designing
clinical trials, have a potential therapeutic use in psychiatry. New and modern standardized studies
are needed in order to enlighten the knowledge path.
A question that needs to be put on the table is related to the potential risk associated with the use of
psychedelics (the risk of neurotoxicity, persistent cognitive deficits, potential misuse).
By studying and understanding the mechanism underlying the positive effect of psychedelics in
psychiatry, new and more effective pharmacotherapies can be developed without the potential of
harm.
ACKNOWLEDGE AND DISCLOSURE

The authors declare no conflicts of interest regarding this paper.
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Correspondence:
Cătălin Oprea,
Medical Resident in psychiatry, ”Socola” Psychiatry Institute, Iasi, 36 Bucium road,
[email protected]
Submission: 02 may 2021

Acceptance: 08 jun 2021
BPIPsychiatry
The psychological impact of aesthetic

procedures on the young patient
Ioana A Halip, Laura Gheucă Solovăstru, Laura Stătescu, Ioana A Popescu,
Adriana I Pătrașcu, Andra G Salahoru, Bogdan-Marian Tarcău,
Alina Stîncanu, Doinița Olinici Temelie, Dan Vâță
Ioana-Alina Halip - M.D., Ph. D., Assistant Professor, Department of Dermatology, Faculty of
Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania
Laura Gheucă Solovăstru - M.D., Ph. D., Professor, Department of Dermatology, Faculty of
Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania. Senior
Dermatovenerolog in Dermatology Clinic County Emergency Hospital “St. Spiridon” Iasi, Romania
Laura Stătescu - M.D., Ph. D., Lecturer, Department of Dermatology, Faculty of Medicine,
“Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania. Senior Dermatovenerolog
in Dermatology Clinic County Emergency Hospital “St. Spiridon” Iasi, Romania
Ioana-Adriana Popescu - M.D., Ph. D. student, Department of Dermatology, of Medicine,
“Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania.
Adriana I Pătrașcu - M.D., Ph. D. student, Department of Dermatology, Faculty of Medicine,
“Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania. Senior Dermatovenerolog
in Dermatology Clinic County Emergency Hospital “St. Spiridon” Iasi, Romania
Andra Georgiana Salahoru - Ph. D. student, Department of Psychology, “Alexandru Ioan Cuza”
University, Iasi, Romania
Bogdan-Marian Tarcău - M. D., Dermatovenerology Clinic, “Sf. Spiridon” County Emergency
Hospital Iasi, Romania
Alina Stîncanu - Senior Dermatovenerolog in Dermatology Clinic County Emergency Hospital
“St. Spiridon” Iasi, Romania
Doinița Olinici Temelie - M.D., Ph. D., Lecturer, Department of Cell Biology, Faculty of
Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania. Senior
Dermatovenerolog in Dermatology Clinic County Emergency Hospital “St. Spiridon” Iasi, Romania
Dan Vâță - M.D., Ph. D., Lecturer, Department of Dermatology, Faculty of Medicine, “Grigore T.
Popa” University of Medicine and Pharmacy Iasi, Romania. Senior Dermatovenerolog in
Dermatology Clinic County Emergency Hospital “St. Spiridon” Iasi, Romania
ABSTRACT
The field of aesthetic medicine is a trend in modern medicine and nowadays patients not only
want to be healthy, they also want to enjoy life, be fit and minimize the effects of physiological
aging. Societal acceptance of aesthetic procedures is increasing and desire to improve the
external appearance may be related to the extensive media coverage which basically increases
the considered benefits. Young patients should understand that results of surgical aesthetical
procedures may lead to permanent change. A complete assessment of reason why the young
patient wishes to have the procedure, and what difference the patient thinks it will make to
his/her life, should be undertaken. Poor psychological outcomes are possible and unrealistic
expectations may should warn the doctor against procedure until the patient is emotionally
mature and may need a psychological referral in order to maintain the psychosocial health
and improve the quality of life.
KEYWORDS:
Aesthetic procedures, body dissatisfaction, psychological outcomes, quality of life,
psychosocial health.
INTRODUCTION
What is beauty? The concept of beauty and basically increases the considered benefits (3).
attractiveness seems to be similar across A survey of American Society for Aesthetic
cultures and religions and the characterization Plastic Surgery shows that 53% of women
of a person as beautiful, is often based on and 49% of men approved of aesthetic
some combination of inner beauty and outer surgery, while 27% of married Americans and
beauty. Whereas inner beauty includes 33% of young and unmarried Americans
psychological factors such as personality, would consider it for themselves in the future
grace, intelligence and elegance, physical (4).
attractiveness refers to physical attributes
which are valued on an aesthetic basis. The field of aesthetic medicine is a new trend
Research shows that subjective attractiveness in modern medicine and patients not only
is largely biological and can be influenced by want to be healthy, they also want to enjoy
social trends and advertising especially in life, be fit and minimize the effects of
younger people. Moreover, studies which physiological aging. Indeed, patients are
evaluated the consistency of physical requesting non-invasive procedures with very
attractiveness ratings across cultural groups little risk. Many of very valuable
showed that body attractiveness, and improvements of the face can be achieved by
especially facial beauty is species-specific, simple techniques and today many patients
not race-specific (1, 2). who want to improve their physical
appearance are young or mature. Similarly,
Physical aspect and particularly the face is the men and women are aware of such advances
public relations organ by excellence and may due to the media and their desire to improve
be considered the clock of age and the physical appearance may become strong.
barometer of feelings. Health is the first thing Moreover, having a good look is considered a
that is considered indispensable in life and the culture and it is even a need in many fields of
second one is a pleasant appearance. activity.
Nowadays societal acceptance of aesthetic
procedures is increasing and desire to Everybody at any age would like to have a
improve the external appearance may be pleasant aspect, without any blemish due to
related to the extensive media coverage which aging and aesthetic procedures are more
accessible. Young people want to remain sometimes the result of a major procedure.
young and they want to correct the first signs The satisfaction of the patient may be the
of facial aging, to treat a minor defect or to same as surgical treatment of skin neoplasia
enhance the beauty of a normal feature. In or tumors’ pathology of severe photo damage
contrast with younger persons, senior patients in senior persons (8, 9, 10).
do not want to change and very often want to
have several simple procedures together The largest age group of patients who demand
instead of a major one (5). aesthetic procedures (surgical and
nonsurgical) is between 35 and 50 years (11).
AESTHETIC PROCEDURES AND However, in 2016 statistical data from
PSYCHIATRIC APPROACH American Society for Aesthetic Plastic
Aesthetic procedures are an optional or Surgery show that 25.3% belongs to group
medically unnecessary procedure requested 19-34 years and 25.6% belongs to older age,
by a patient to correct imperfections and respectively 35-50 years (11). These results
improve appearance (6, 7). They are elective may be related to the increasing societal
and they comprise all medical procedures that acceptance of aesthetic surgery. Furthermore,
are aimed at improving the physical may be the result to the obsession of popular
appearance and satisfaction of the patient, media with body image which increases the
using non-invasive to minimally invasive focus on such procedures, particularly in the
procedures. Some aesthetic procedures are younger age group with internet navigation.
performed under local anaesthesia while some But how young is too young for aesthetic
of them do not require it. Mainly, aesthetic procedures? The number of teenage patients
procedures consist of: who are requiring such dermatologic
 injections of neurotoxins treatment is small and is reported that only
(botox) and dermal fillers, 1.8% of all patients undergoing surgical
 chemical peels, procedures in 2016. American Society for
microdermabrasion, Aesthetic Plastic Surgery indicated in data
 body contouring and treatment from the last 16 years similar rates every year
of cellulite, over the time period, ranging between 1 and
 skin nutrition, 3% (11).
 hair transplant or hair
reduction, Food and Drug Administration (FDA)
 lifting, fat grafting, reported that the greatest concern is that the
teen will have unrealistic expectations.
 Platelet Rich Plasma (PRP),
Clearly, the doctor should assess the
 lasers and IPL (Intense Pulsed
emotional and physical maturity of younger
Light) treatments,
patients before any invasive procedures. It is
 scars management,
mandatory that the young patient should
 venous treatment.
understand that results of surgical aesthetical
procedures may lead to permanent change. A
The real benefit of practicing aesthetic
complete assessment of reason why the young
medicine is the type of care that practitioners
patient wishes to have the procedure, and
are offering to their patients. Simple
what difference the patient thinks it will make
techniques for rejuvenation or associated with
to his/her life, should be undertaken.
other minor surgical techniques give a natural
Unrealistic expectations may should warn the
look and not a postsurgical look, which is
doctor against procedure until the patient is In a cross-sectional study (14) which included
emotionally mature and may need a 315 patients with an average age of 30 ± 8.4
psychological referral (11). years admitted to the Department of Plastic
Surgery in a General Hospital in China from
Unfortunately, the ideal patient (young or July 2016 to July 2017, investigated the
senior) who is referring to dermatologist for prevalence and risk factors in preoperative
aesthetic procedure does not exist. The ideal patients who visited a aesthetic plastic surgery
patient should be able to develop discussions clinic. The results indicated that the
and show understanding, having effective preoperative anxiety was more obvious than
communication skills. Moreover, he should be depression. Also, education level was
pleasant to the medical staff, well educated, associated with the diagnosis of anxiety (p =
and especially well informed regarding the 0.034) while education level (p = 0.001) and
aesthetical treatment. The ideal patient has occupation (p = 0.015) were associated with
realistic expectations of the outcome and a the diagnosis of depression (14).
full understanding of potential complications,
being compliant with pre and post procedure Gillen (15) investigated that subjects with
instructions. greater positive body image had less
depression, higher self-esteem, a smaller
On the one hand, aesthetic procedures percent of unhealthy dieting behaviours and
improve the quality of the patients’ lives after greater intentions to protect their skin from
they accepted the good results of procedures. sun exposure and photo damage and these
On the other hand, it was also reported that associations were not correlated with gender
some patients were considered to have (15). Therefore, Gillen concluded that
psychological problems, and the morbidity healthcare providers should promote positive
rate was reported to be higher (12). Young body image because of its potential health
patients may have social functional benefits (15). Similarly, other investigators
disturbance, and a considerable number of (16, 17) provided a great impact of aesthetic
these patients may seek aesthetic procedures surgery (breast augmentation or reduction,
rather than ask psychiatrists for help. abdominoplasty and facial procedure-
Anxiety, depression, obsessive-compulsive blepharoplasty, rhinoplasty, lipoplasty or scar
disorder, body dysmorphic disorder, correction) on body image with a connection
dependent personality disorder may be between aesthetic procedures and physical
identified according to psychological and mental health.
examination. These psychological disorders
might lead to a poor surgical outcome and Physical appearance is an integrative part of
high risk of dissatisfaction, and even recurrent personal identity and its relation to
surgical interventions (12). This is the reason individuals’ self-perception begins early in
why is necessary to understand the life (18). The socio-cultural environment may
psychological status of every person seeking influence perceptions of attractiveness (19).
aesthetic surgical or nonsurgical procedures, Tripartite Influence Model (20) sustain that
and patients’ selection is considered to be the attractiveness ideals are transmitted by three
first factor that determines the success or primary sociocultural influences: parents,
failure of it (13). colleagues and the media. A research about
influence of traditional media such as
television programs, adverts or newer types of
media (social networking sites) on women’s reference to the fields of interest (24). It was
consideration of aesthetic surgery enrolled examined the association between self-
118 women aged 18-29 years (20). The compassion components and body
participants were divided in two arms. One dissatisfaction and acceptance of aesthetic
arm received images from social networks surgery among women and physical
with young adult women who had appearance comparison. Analysis revealed
rhinoplasty, soft tissue fillers, Botox, laser that higher mindfulness was directly
skin resurfacing and microdermabrasion using associated to lower acceptance of aesthetic
an Analogue Visual Scale in order to evaluate surgery. Common humanity and self-kindness
satisfaction (20). The second arm received for were connected to acceptance of aesthetic
evaluation 30 travel images. Results showed surgery for social reasons (24). However,
that participants who had seen images of other experimental studies claimed that even
enhanced females revealed a tendency for an if their body dissatisfaction had decreased,
increased desire for aesthetic surgery body image quality of life and self-esteem
compared to participants who saw images of have not increased in women who had
travel. Moreover, the relationship between received aesthetical procedures (25).
social media use and desire for aesthetic
surgery was not mediated by body Overall, systematic reviews after 1950 which
dissatisfaction. The appearance pressures have analysed the impact of aesthetic
from social media may lead people who are procedures showed mixed results probably
more involved in their appearance to desire due to variation in the procedures or to the
changing strategies such as aesthetic methodological quality of life used in studies.
procedures and therefore may have greater Some of them revealed satisfaction, self-
expectations from therapies (20). In this way, esteem and improved psychological distress
screening measures should be used before following aesthetical procedures (7, 26),
aesthetic treatments in order to assess better others showed few positive long-term
patients’ motivations and their psychological psychological effects (27, 28). Predictors of
functioning. It is likely that aesthetic poor outcomes included clinically diagnosed
treatments will have negative outcomes if disorders with a psychological component
their motivations were based on resembling like depression or body dysmorphic disorder,
someone they have seen on social media (21). but they may also include non-clinically
diagnosed disorders such as anxiety, low self-
Other studies (22, 23) have shown a esteem and social parameters like age and
connection between body dissatisfaction and relationship status (29).
acceptance of aesthetic surgery among
women, suggesting that people may consider In a review of 37 studies (29), factors as being
aesthetic treatment as a method to obtain young, being male, having unrealistic
psychological benefits such as higher self- expectations of the procedure or previous
esteem and social benefits becoming more unsatisfactory aesthetic surgery, minimal
attractive. Self-compassion has positive deformity or motivation based on relationship
(mindfulness, common humanity, self- issues were associated with poor psychosocial
kindness) and negative (over-identification, outcome. Aesthetical surgical procedures
isolation, self-judgment) components. 220 were associated with both intimate partner
young Italian women with age between 19 violence and verbally abused women, smoker
and 31 years, completed a questionnaire with
or people taking medication for anxiety, Data (33) suggests that many providers have
nervous conditions or sleep disorders (30). identified patients with this condition during
A review of nine studies studied the effect of the preoperative consultation and refused with
aesthetic interventions on post procedure the required treatment. Specific questions
psychological outcomes (31). Various types should be prepared to assess for the presence
of aesthetic procedures such as botulinum of body dysmorphic disorder. Examples of
toxin type A injection and facelift were relevant questions may include the following:
included. Facelift was associated with 1. Is the patient preoccupied with the
improvement of self-esteem and quality of perceived physical defect?
life/social functioning, but had no positive 2. Does this preoccupation cause clinically
effects of anxiety or depression (26, 29). The significant distress like anxiety, depression or
impact on psychosocial health of aesthetic hopelessness?
procedure such as hyaluronic acid fillers and 3. Does the preoccupation with physical
botulinum toxin type A remains however defect cause clinically significant impairment
poorly defined. in functioning like difficulty with or
avoidance of family, school, social or work
Body dysmorphic disorder represents the activities?
disorder which is characterized as a
preoccupation with a slight or no observable Analysing patients answers, those individuals
defect in appearance and is associated with with no or minimal physical defect who
obsessive thinking and compulsive experience resulting clinically significant
behaviours and which leads to a disruption in distress or impairment in functioning and who
activities of daily life. This psychiatric perform at least one associated repetitive
condition is likely of greatest relevance to the behaviour are likely to have body dysmorphic
aesthetic doctor (32). It occurs in disorder. Due to the safety risks for both
approximately 1% to 2% of the general patients and aesthetic surgeons or
population and is estimated equally across dermatologists and the evidence that aesthetic
women and men (33). Patients with this treatment outcomes among people are poor,
disorder may present concern with any feature body dysmorphic disorder is considered a
of the body such as facial skin, nose, and hair. contraindication for aesthetic treatments.
They are often convinced that they will feel
better if they change their physical appearance Saying “no” to a patient can be difficult but is
and therefore they are seen frequently in sometimes necessary. You should listen to
aesthetic medical practices. The majority of your intuition and be cautious. If you have
studies of persons with body dysmorphic concerns, do not offer the patient aesthetic
disorder unfortunately suggested that greater procedure. So when to say “no”? The
than 90% of patients reported no change or a aesthetic doctor may consider the patient
worsening of their symptoms following an unsuitable for several reasons. According to
aesthetic treatment. Some of them reported Gorney and Martello, the patient may be
that the level of preoccupation with the given either anatomically or psychologically
feature was not improved and others indicated unsuitable for the procedure (34). From an
that they became concerned about another anatomic viewpoint, the feature that the
aspect of their physical appearance (33). patient wishes to have corrected must be
visible to the surgeon and able to be
corrected. The ideal patient fits around the
diagonal of Gorney's patient selection graph (25, 33). When women seek aesthetic surgery
(35). without changing their attitude toward the
self, is a great chance that they will have low
Lately, young women are being encouraged to self-esteem also after undergoing surgery.
embrace and accept the way that they look, This fact could lead them to look for further
and this may help to avoid aesthetic procedures, without ever feeling comfortable
procedures. For example, the number of with their body. Surgeons and dermatologists
aesthetic procedures conducted in 2016 fell might recommend alternative strategies, such
40% from a record-breaking high in 2015 as self-compassion trainings, that could help
(36). In this manner, the decreased societal women to change the way they relate to their
pressure for an idealized beauty standard may body image. Optimal levels of common
be encouraging women away from having humanity and mindfulness could decrease
aesthetic procedures (37). Psychological women’s acceptance of aesthetical procedures
assessment of young women who are as well, at least for psychosocial health. The
interested in aesthetic surgical or nonsurgical existence of self-kindness and acceptance of
procedures is highly recommended (38, 39). aesthetic procedures should be further
explored before considering the advantages
Aesthetic surgery does not necessarily help and disadvantages of trainings that
young people to improve their body image specifically focus on this dimension.
CONCLUSIONS
It is well known that minor imperfections of the skin or aesthetic anomalies can cause much
distress. Prevention is better than cure and mini invasive aesthetic techniques are frequently
indicated. In young patients simple procedures are very often enough. Aesthetic procedures today is
not only rejuvenation but it is also maintenance of youth and improvement of the mind. It is not rare
the situation when the social media and he publicity creates in the public’s mind an image that is
unreal and deceptive and may affect peoples psychosocial health.
In aesthetic medicine, it is necessary to know how and also why a procedure has to be selected. All
the problems of patient selection should be discussed as well as minor surgical details about all the
procedures used for physical appearance improvement of region of the face, neck, and scalp,
including also peelings, biological fillers, short access facial elevation or lifting, mesotherapy
techniques or removal of the fat.
Understanding the patients' motivations for aesthetic interventions and their expectations of the
outcomes are the keys to achieving satisfied patients. Vulnerable patients should be identified and
given appropriate care. Doctors should explore with patients the reasons for their request for
aesthetical procedures using validated screening tools that look at psychosocial issues in addition to
body image disorders. Practitioners should be aware of reasons underlying requests and of those
who are at risk of poor outcomes. Moreover, the dermatologist should require a full patient
education including discussions about the benefits and the possible risks. Favourable and
unfavourable results to aesthetic procedures should be considered and fully discussed. Similarly, a
second consultation after an aesthetic procedure is almost always necessary, with post procedure
follow-up including detailed written instructions for the recovery. Those patients with
104/Bulletin of Integrative Psychiatry New Series September 2021  Year XXVII No. 3(90)
unsatisfactory outcomes should be seen more often to improve communication in order to evaluate
the psychological outcomes.

The authors state that they are no declared conflicts of interest regarding this paper.
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Correspondence
Laura Gheucă Solovăstru,

M.D., Ph. D., Professor, Department of Dermatology, Faculty of Medicine, “Grigore T. Popa”
University of Medicine and Pharmacy Iasi, Romania
Adress: Dermatology Clinic County Emergency Hospital “St. Spiridon”, Bd. Independenței no. 1,
Iasi, Romania, [email protected]
Submission: 10may2021
Acceptance: 27 jul2021
BPIPsychiatry
Artificial intelligence, transhumanism and

translation as a universal property of thinking
Miroslava Metleaeva (Luchianchicova)
Miroslava Metleaeva (Luchianchicova) - Doctor of Philology, Researcher Institute of Romanian

Philology "Bogdan Petriceicu-Hasdeu", Republic of Moldova
ABSTRACT
Transhumanism assumes human improvement as an unfinished link in evolution based on its
fusion with technological elements. The new human-machine organism, from the author's
point of view, is a dubious boon for human civilization and the planetary ecological system.
This idea is, first of all, anachronistic and pursues the main goal - the singularity, i.e. control
over human intellectual energy by technology. Cognitive activity and one of its most difficult
aspects - translation of thought into linguistic form - represent an obstacle to the creation of
perfect Artificial Intelligence, since translation is not limited to formulas. The accuracy of
terminology and the absence of ambiguity of the word are the basis of Artificial Intelligence
and, at the same time, the limitation of the development of linguistic thinking. The article
outlines the sequence of the translation process, the difference between the mental operations
of Artificial Intelligence and humans. The author assumes that translation is a universal
property of human thinking, and the process of translating thought into speech form is due to
bio-genetic, emotional, socio-historical memory and experience, since a person translates his
thought from a fuzzy, vague thought-text into a linguistic form.
KEYWORDS:
Transhumanism, man-machine, singularity, Artificial Intelligence, translation process,
memory, experience.
INTRODUCTION the main goals of transhumanism - the

Transhumanism is an evolving trend in constant improvement of man as an
philosophy that has become increasingly unfinished link of evolution on the basis of
important in understanding the phenomena of scientific and technical discoveries and new
the main aspects of social life taking into technologies that can bring a person to a new,
consideration the future. It would seem that previously unattainable level, have good
intentions. However, while at the end of the together. “According to him, people will…
20th century this direction was perceived by constantly renew body tissues with the help of
futurologists positively as a whole, over time nanorobots injected into the bloodstream.
the assessment of the ideas of transhumanism Kurzweil predicts that by 2029 we will get
began to become clearly ambiguous. computers with intelligence comparable to
Opponents of this line of philosophical human, and the singularity point will be
thought have come to the conclusion that the reached by 2045 ” (3, p. 144).
realization of ideas of transhumanism will
undermine the traditional values of humanism Singularity as a term means the superiority of
in all spheres of human existence, developed machine intelligence over the human person
by millennia of human history. who created it. However, with all the
cybernetic improvements of the intellectual
Mark O'Connell, author of the book “To be a creature with the inclusion of a truncated
machine: Adventures among cyborgs, biostructure (mainly brain structures), its
utopians, hackers, and the futurists solving the modifiers - the technocratic elite - pursue the
modest problem of death” demonstrates that main goal - managing intellectual energy
in spite of all its aspiration for the future, within the strict framework of the technology.
transhumanism has the paradoxical power of
its anachronism. In the future, where That is, the question of power is again raised:
transhumanism is eagerly striving, it will there is a return to the old ideas of the creation
always still look back into the past ” (1). of human, starting with the creation of Adam,
continuing with the Golem, and then with
Without delving into the origins of the Frankenstein (we will not mention all the
emergence of transhumanist ideas in their automata imitating a person, which the great
modern understanding, one should Leonardo da Vinci did) right down to the
nevertheless turn to the teachings of Ludwig ideas the theoretical founder of
Feuerbach with his thesis that man created transhumanism Ludwig Feuerbach and the
God in his own image and likeness. earlier Thomas Hobbes. Hobbes argued that
order in society can be achieved only through
Feuerbach clearly traces the ideas of the conclusion of an agreement between
collective consciousness and the conclusion citizens and the state, to which each citizen
that the human community can never achieve cedes his power, receiving in return the
perfection and happiness, provided there are protection of life and property (1, p. 132).
individuals in it (2, p. 82).
The question is what is the relation of
Kai-Fu Lee, a renowned Chinese scientist in translation, as one of the types of human
the field of modern technology, emphasizes activity, to pressing philosophical problems,
that one can be optimistic in the development including transhumanism?
of Artificial Intelligence only by remembering
the responsibility in this area. As an example European organization COST - European
of the technocratic direction of Cooperation in Science & Technologies has
transhumanism, he cites the ideas of Ray developed a project with three strategic
Kurzweil, the inventor and the largest priorities: the promotion and dissemination of
ideologue of GOOGLE, who believes that in best practices, the development of
the future, people and machines will merge interdisciplinary research for breakthroughs in
science and the empowerment of attracting Translation, with all its antiquity and with all
young researchers and innovators. COST its significance in most spheres of human
fulfills its mission by funding upstream, activity, continues to remain terra incognita
excellence-oriented, open and inclusive in many of its aspects. The post-war
networks for peaceful purposes in all areas of information boom which led to significant
science and technology. changes in translation activities, as well as an
interdisciplinary approach to the problems of
In a document which was sent to the Institute linguistics, raised the issues of extralinguistic
of Romanian Philology "Bogdan Petriceicu- aspects of verbal communication, made
Hasdeu" by the Ministry of Education, possible the further development of the
Culture and Research of the Republic of science of translation. Humboldt's theory of
Moldova in order to attract employees who the impossibility of an adequate translation
want to join the participants of the COST reflected the philosophical idea of the
project in the direction chosen by the unattainability of perfection. It received a
applicant, I was interested in the direction tangible blow, since linguistic factors give
CA19102 Language in the Human-Machine rise not only to difficulties for translation, but
Era (pag.4): "Within the next 10 years, many also conditions for overcoming them:
millions of people will be … wearing “Regardless of the validity of one or another
relatively unobtrusive ... devices that offer an hypothesis, the presence of essential universal
immersive and high-resolution view of a features in all languages is beyond doubt.
visually augmented world". This is the This universality, of course, is an important
‘human-machine era’, a time when our senses prerequisite for a successful transition from
are not just supplemented by handheld mobile one language to another in the process of
devices, but thoroughly augmented. The translation ” (5, p.17).
language we see, hear and produce will be
mediated in real time by technology. This has OBJECTIVES
major implications for language use, and Translation, like an X-ray, reveals the words
ultimately language itself. Are linguists ready hidden behind the clothes. From our point of
for this? Can our theory, methods, and view, what is being translated, namely, the
epistemology handle it?” (4). author’s literary text, is a separate stable
mega-unit, i.e. a huge unchangeable
To some extent, the project developers combination of words united by the author's
identified the ethical consequences of the idea. The author’s literary text, is a stable
emergence of the language of technology: semantic mega-combination of words. With
inequality of access to technology, all the achievements of modern translation in
confidentiality and security problems, new the field of professional and technical
vectors for deception and crime, etc. translation, there are still gaps in the theory of
literary translation. The fact that only “input”
We list the areas of expertise in the scientific and “output” data are available to real
field related to the topic of our article - observation and scientific analysis, and the
languages and literature: translation and intellectual process of translation
interpretation; tongue; Artificial Intelligence; transformation itself occurs secretly, in the
human machine; interfaces, etc. COST project most complex psycholinguistic energy nodes
prioritizes languages and literature, translation of the translator’s brain activity, turns the
and interpretation. theory of translation into a comparative
discipline. All conclusions about the subjectivity, the "introspection method" is

translation mechanism are made on the basis considered one of the basic methods of
of a comparison of the initial and effective language research. Linguistic intuition is
data. The data for comparison are works - the characteristic to one degree or another of all
original (author's) and final (translation users of the language. These abilities are
result). examples of the manifestation of self-
observation, which allows a person to be
Schematically, the explicit sequence of the directly aware of certain aspects of the
translation process is a double logical language. However, we do not absolutize this
semantic chain, where the external level is an method, but use it in combination with others,
emotional manifestation → determining the using different approaches to the problems of
originality of the source text → establishing a translating poetry in our work. Reflections of
key lexical sign; and the internal writers and translators about the process of
(psychophysical) level is pondering / spiritual converting thought into linguistic form
attitude → the cognitive system → conflict at coincide with our observations.
the intercultural level → establishing the
interaction of the author/ translator. These two DISCUSSIONS
sides of the process are combined in the inter When translating, our main goal was to
- and extra steps of compiling a comment, the semantically convey the author's idea with
result of which is the selection and maximum fidelity to the artistic features of
reproduction of an adequate idiolectic key the original. The whole difficulty was that we
sign. had a linear text in front of us, and we had to
convey the bulk of the idea to the target
We have before us two sources of knowledge: language without departing from the text.
objects of the external world and the activity There was a risk awaiting each translator to
of our own mind. External feelings are sent to become a “slave” to the visible, linear part of
the first, as a result of which impressions the content.
(ideas) about external things are obtained. As
for the second source of knowledge, and it When translating, our main goal was to
includes thinking, doubt, faith, reasoning, semantically convey the author's idea with
cognition and desires, it is known by a special maximum fidelity to the artistic features of
inner feeling - reflection. Thus, a mental the original. The whole difficulty was that we
reaction can occur on two levels: a) had a linear text in front of us, and we had to
perception, thought, desire; b) observation, convey the bulk of the idea to the target
contemplation of these ideas, thoughts and language without departing from the text.
desires (6, p.257). There was a risk awaiting each translator to
become a slave the visible, linear part of the
MATERIAL AND METHODS content.
In my research on the interpretation of
translations of the world literature The transfer of the volume of an idea depends
masterpiece of the poem “Luceafer” by the on the volumetric understanding by the
Romanian poet Mihai Eminescu into Russian, translator of its meaning and its ability to
I place an emphasis on the introspective study identify nicks that are the key to opening
of my own thought processes that occurred doors to non-textual (subtext, intertext,
during the translation activity. For all its intratext, etc.) associative space.
All these elements of creative manifestations into the bizarre structures of another
are an integral part of the mental activity of language.
the translator of fiction (I emphasize, fiction),
inextricably linked with the imagination. This If we approach the problem of translation
mental activity is a field of collision of critical more broadly, then we come to the conclusion
thinking, directed both at other people's that translation is a universal property of
judgments and at the translator's own human thinking. Before we put thought into
judgments. This field of creative thinking is speech form, a process takes place in the
associated with generating your own ideas mind, the sequence of which, in our opinion,
and evaluating the ideas of the author of the is as follows: amorphous thought-form>
original text. thought-idea> thought-text> translation
(transmission) into the source language for
In psycholinguistics, there is the concept of a communicative exchange.
precedent text, that is, a text that is known to
culture and to which there are references in At this stage, we can talk about
speech. A reference may not be transformed decodification, interpretation, translation of
and transformed, up to a single component - a the "language" of the author’s thinking by the
word, increasing the semantic load of the text, author himself to reproduce what he wants to
and activates the reader (in our case, the convey to the receptor (reader). Reflections
translator). on the creative act of transforming the way of
thinking into verbal reflection, i.e., on
There is not a single writer in any of the translating inspiration into linguistic
epochs who began to engage in creativity parameters, is an object of interest not only to
from scratch: consciously or subconsciously, psychology and philosophy, but also to the
he has concentrated sufficient national and creators of literary texts themselves. This was
world literary experience, which M. M. very clearly expressed in his poem
Bakhtin called the “memory of literature”. In “Silentium” by the Russian poet F. Tyutchev -
a broader sense, this memory can be “The thought uttered is a lie”.
identified with the previous experience.
V.D. Psurtsev dwells on the aspect of sense
Bogdan Giu, commenting translation formation (both in generation and in
activities, concludes: “We do not do it in perception), noting that "the specificity of a
different ways and, to a different degree, do literary text (...) lies in the fundamental
nothing but translate, we initially translate. absence of its creator and its interpreter of the
We do what changes everything. Or, more installation of" simple evidence ", the one-
precisely: it can change everything ...” ( 7, dimensionality of meaning. (Therefore, the
p.2). antipode of the literary text will be a text that
does not have such an attitude)” (8, p. 251-
He brings us to a very important conclusion: 252).
the authors are the first translators and that
translation begins much earlier than inter- In this regard, the role of figurative-
linguistic translation itself, when an attempt is associative components becomes an
made to recreate the text of one language additional criterion. It is figuratively
within the framework of another, that is, an associative components that stylistically mark
attempt to transfer it from one linguistic space the literary text. It should also be noted a very
significant remark by V.D. Psurtsev, which is variants of the correlation of power and
directly related to the translation: “(...) the text language are possible: the cooperation of
of the original and the text of the translation language with the government and its
(...) are linear in their presence, while the opposition to it - linguistic neutrality with
concept and meaning are voluminous” (8, p. respect to power, according to R. Bart, is in
255) principle impossible, “some languages speak
out, develop, get their characteristic features
Artificial Intelligence is not able to cope with in the light (or under the shelter) of the
the tasks that the author faces when Authority ... Other languages are developed,
transforming his own thought-text from an acquired, armed outside the Authority and / or
amorphous thought-form into his native against it ”(10). In the terminology of R.
language. Likewise, no machine can cope Barth, the languages of the first type are
with the tasks of translating a literary source designated as “enkratic languages” (which
text into a target language. The transmission correspond to “enkratic types of discourse”),
of the author's volumetric thought is the languages of the second type are referred
associated with the codes of both the source to as “acratic” (and, respectively, “acratic
and target languages. This decoding depends types of discourse”) (11).
on the thinking of the translator and all
psychosocial and other components of the Translation and interpretation are
environment of both participants in the inseparable, and the influence of external
translation process. factors on translation activity is widespread,
as evidenced by numerous examples of
“Social influence is ubiquitous. It is carried inadequate translations created under the
out everywhere and always. This is a part of pressure of socio-historical factors of a
the structure of the world ”(9, p.15). One of particular era.
the founders of social psychology, Kurt
Lewin, gave us a long time ago a simple In this regard, Skopos theory, put forward in
equation: "behavior is a function of two 1984 by German scientists Katharina Rice (K.
variables - the unique personality of the Reiss) and Hans Vermeer (H. Vermeer) in the
individual and the situation in which he or she work “Grundlegungeiner allgemeinen
acts." (9, p.51). Translationstheorie” (12), gained quite wide
popularity. The authors proceed from the fact
It is impossible for both the writer and the that the parameters of the translation are
translator to distance themselves from this, determined by the needs and requests of the
despite the recognition of their individuality reader-customer, that is, the purpose of the
in the sphere of influence, are still under the translation is the intended recipient, and the
influence of a second, no less significant translator is free to either reproduce the
component of influence - the power of the original, or deviate from it, or completely
situation, the power of the temporal neglect it, not particularly paying attention to
environment. linguistic subtleties. In fact, this theory claims
to be the scientific justification for targeted
In the philosophy of postmodernism, the translation.
phenomenon of the power of language is
widely analyzed. According to the concept of From our point of view, this is one of the
R. Bart, theoretically only two alternative steps to mastering the thought process if it is
impossible to reproduce it in full in an was designed not to extend but to DIMINISH

artificial version of the brain-machine. That the range of thought, and this purpose was
is, if it is impossible to control thought indirectly assisted by cutting the choice of
processes from the inside, then it is much words down to a minimum” (14, p.376-377).
easier to influence them from the outside. And then follows: “Pre-revolutionary
literature could only be subjected to
R. Bart noted: “Incidentally, the encratic ideological translation—that is, alteration in
language (that which arises and spreads under sense as well as language (14, p.391)
the protection of power) is by its very nature a
language of repetition; all official linguistic In the coming Oceania, the emotional and
institutions are machines that constantly chew cognitive side of life is reduced to a
the same gum: school, sports, advertising, minimum: books are written on machines,
mass culture, song production, media non- knowledge of foreign languages is prohibited
stop reproduce the same structure, the same for the majority. Here the doctrine of the
meaning, and sometimes the same the same “moving past” operates, according to which
words: a stereotype is a political phenomenon, memory is criminal when it is true to the
it is the very embodiment of ideology " truth, and the past does not exist, minus the
(Quoted from the Russian translation by G.K. way it is constructed at the moment.
Kosikov, 13, p.494). Reality quite often coincided with the
predictions of seer authors. So “Translation
Thinking stereotypes narrow the horizons of activities in the Republic of Moldova, like all
consciousness, imposing automatic activities, were limited until 1991. ... The
algorithms, and suppress individual thinking. study of foreign languages and the
When translating a text into a target language functioning of the relevant areas (teaching,
for Skopos theory, the degree of its translation, etc.) were under constant control
correspondence to the original is insignificant (...), because related to activities that could
if it meets a specific goal. Before us is not a have a great ideological impact on individual
theory of translation, but a theory of text groups or society as a whole (...). Due to
alteration, a theory of its commercialization censorship, Moldavian journalists had to write
on the world market. their articles in Russian at first, and only then
the text was translated into “Moldavian”. (16
These ideas have long been reflected in the 15, p.24).
works of world literature. A harsh formulation
of this phenomenon, inherent in the coming The fate of Alexander Robot (Alter Rotman,
"society of technological ideas", which 1916 - 1941), a Romanian writer and avant-
destroyed the absurdity of the "consumer garde poet, journalist and literary critic,
society" and leads to a complete absence of whose work was especially influenced by the
freedom, was formulated in 1948 by George encratic language, is also very indicative. In
Orwell in his prophetic anti-utopia "1984": the work of A. Robot, whose poetry in the 30s
was perceived by his contemporaries as
“The purpose of Newspeak was not only to extremely experimental and to which such
provide a medium of expression for the outstanding figures of literature and culture as
world-view and mental habits proper to the G. Calinescu, E. Lovinescu, Perpessicius and
devotees of Ingsoc, but to make all other others, there is a creative degradation
modes of thought impossible… Newspeak associated with severe historical conditions of
the Soviet regime, where he finds himself, logical way. And if they are few and
seeing no other salvation from fascism. His impossible to obtain, creative intuition and
brilliant work of the early 30s. The twentieth imagination help by creating missing links
century, under the conditions of the literary and linking facts into the system ”(6, p. 106)
dominant - socialist realism, underwent until real facts and connections between them
cardinal changes that marked the victory of are found, confirming or refuting the work of
ideological pressure over the fate of the artist. the imagination. “This role of creative
Enormous talent has been brought to a imagination is not the same in various fields
common and anonymous denominator. For of activity: for example, its role in scientific
comparison, here are two lines from famous research is somewhat less than in literary
poems: a). A flower is like a butterfly. / And I creativity” (6, p. 106).
found myself, like in a seine, in the net of the
day (Landscape, 1932); b). Here is the first The process of literary translation, based on
Soviet collective farm spring. / And, crossing the recreational imagination of the translator,
the steppe, the Dniester blooms (Blossoming is a vivid embodiment of creativity. “A
Moldova, 1940) (16). person has never come down to a character
that could be covered with an acceptable
To translate, as noted by M. Leclerc-Olive, simplification as a whole. This is the vain
means an attempt to “avoid the imposed dream of many. As soon as he was understood
normativity” of concepts, i.e. create, feel, feel in its simplest aspect, how a person is
the need for a certain local re- affirmed again in his usual complexity ”(17,
“conceptualization" All transhumanist trends p. 596).
pursue a single goal - the creation of a person
devoid of physical disabilities. But practically It is strange to expect from a machine -
none of the founders of these philosophical artificial intelligence that it will think like a
concepts raises the question of the place of person or will be guided by the same morality
emotions, morality, culture in the as homo sapiens.
consciousness of the future person.
If we return to the thesis of B. Ghiu and
The fact is that they are simply not there: the assume that all of us (including ordinary
posthuman is represented by the highest bio- citizens) are constantly engaged in nothing
technological species. Artificial intelligence more than translation, i.e. this property is
will become the basis of his consciousness. inherent in all people, it is natural that in the
Thus, general human concepts about good and process of communication (we are social
evil, about human history, about relationships creatures) in the minds of everyone, to one
with his own kind will not have any meaning degree or another, the same processes occur
for the man-machine. He will lose a huge part as the author of an idea or a professional
of the all-round previous experience translator who transforms their thoughts into
unnecessary for him. linguistic semantic forms. That is, when we
say that the translation process at its internal
It should be noted that “creative imagination stage is a very complex psychophysical
often acts as temporarily fulfilling the duties system, completely different for each homo
of logical thinking. ... In the strict sense, sapiens, with many parameters common, we
logical thinking is possible when there is also mean that this is one of the most
enough information or it can be obtained in a powerful properties of its survival. In
connection with the division of labor, the examples are given of the ability of modern
emergence of professional languages and the computers to beat a person in chess or in the
complexity of the social hierarchy, an encratic Chinese game GO with countless
language, which has much in common with combinations. Hence the attempts to reduce
the practical manifestations of transhumanism everything (from socioeconomic interests) to
in its aspirations for Artificial Intelligence, a universal language of numbers, which does
has acquired special significance in enhancing not contain emotional, moral and cultural and
the impact on mass consciousness. historical components. But human existence
is not limited to games, no matter how
The bulk of the idea is not for transhumanism, complex they may be. They are, first of all,
because with all the desire it is impossible to regulated games. One way or another, the
create such an Artificial Intelligence that solution to game problems can be calculated
would include all the natural and with the help of AlphaGo, programmed by a
unpredictable intellectual identity of mankind. human.
Therefore, Perfect Artificial Intelligence can
unify only certain stages of the transfer of the Mark O'Connell emphasizes that
thought process into a visible and auditory transhumanists, no matter how rational they
form for the technical improvement of a think they are, cannot inspire confidence or
cybernetic device with the human organic sympathy with their humanitarian limitations,
system (or what remains of it). and living in their future is very problematic,
since they do not have a concept of life in its
Technical thinking as an applied part of usual sense.
unpredictable volumetric thinking inherent in
a certain high-tech caste of professionals has a However, O'Connell feels this future in
tendency to streamline, systematize and modern reality, because not always sure if he
regulate. The same applies to the scientific lives in the present.
and technical spheres of the language that do
not tolerate synonymization, i.e. variety. The Working with a computer, we noted the
incapacity for multidimensional perception of manifestation of a certain dependence on it in
reality inevitably turns into the indifference of everyday intellectual work. And this concerns
technocrats, and such indifference is a translation, above all. Modern machine
demonstration of the absence of humanitarian translation is unsuitable for transporting
tools of difference. figurative text to another language
environment. However, there is an easy
The bearers of a technocratic language - an opportunity to transform figurative text into
applied language that does not contain its opposite. You can verify this by resorting
emotional, psychological, ethnic, ethical, etc. to the GOOGLE translator. There are real
content, most often are the support of power, prerequisites for a satisfactory translation of
interested in the mechanistic curb of technical, scientific, professional texts, that is,
consciousness and the approach of an those for which polysemy is contraindicated.
ordinary person to the machine by The higher the terminological and structural
accustoming the latter to the idea of the accuracy (with the absence of figurative and
benefits of its improvement with the help of emotional features), which also has an
technologies that allow to overtake natural international character, the higher the quality
thinking and other abilities. Most often, of the machine translation, because it does not
require from the machine what it cannot do - thought, the user follows the lead of its linear
to be human in every sense of the word. reproduction according to the imposed
So, when urgently translating our own text patterns of machine thinking. This is how the
into another language, resorting to the help of user's "education" is gradually imposed and
a computer, quite deliberately (in which we carried out. So, it’s not the victory of
gave a report in the subsequent introspective Artificial Intelligence, but the defeat of the
observation of our own translation process), human in pursuit of the illusion of its own
we tried to formulate our thought lexically, improvement. For, by reducing our more
grammatically and stylistically as neutral as time-consuming, but immeasurably wider
possible adjusting to the algorithm of the creative opportunities for the sake of
machine. That is, we deliberately went actualizing immediate tasks, we contribute to
"towards the machine", depriving ourselves of the loss of many skills and abilities.
the possibility of figurative transmission of a
message in order to facilitate our work. Perversions in consciousness arise from
satiety. One of the most ancient and most
When it comes to translating an unambiguous dangerous is the desire to create technologies
thought-text, such an approach to translating for controlling human consciousness in the
its meaning both in the source and in the name of a very banal desire - unlimited power
target language is necessary, but if we are over their own kind, in the name of a
talking about a message that has precedent pyramidal hierarchy with the so-called
and other figurative aspects, then following "superintelligence" at its top. While extolling
the efficacy of the work, we lose in artistic science, current transhumanists primarily
expressiveness, and if we go further, then in extol its applied results, ignoring fundamental
the possibilities of creative self-expression sciences.
and the development of the language as a
whole. All that the encratic social system expects
from us is the reduction of linguistic
Realizing that the whole complex of communication to the language of formulas
recognition and decoding of human and numbers. Freeing ourselves from the
communicative ability is inaccessible to the associative series, the precedence of thinking,
machine, now, without thinking about the etc., we lose huge layers of human
consequences, being guided by pragmatics experience, the empirical part of ourselves,
and going towards artificial intelligence, the and as a result, there remains the encratic
computer user automatically goes to personal language and the rudiments of a truncated
rapprochement with the machine and the biological nature that responds to electronic
irreplaceable loss of the natural course of signals. It is becoming more and more
translation of the thought-text, to its obvious that it is easier to track individual
simplification of their own intellectual mental activity using a machine than to create
capabilities. a Perfect Artificial Intelligence.
The process will go further due to the initially The history of transhumanism testifies to its
inherent tendency of a person to make his life mechanistic view of human life, namely that a
easier, guided by socio-economic goals and person is a device, his duty is to become the
pushing aside the emotional and ethical best versions of himself, that is,
nuances. By reducing the amount of creative transhumanism is a liberation movement that
stands for complete liberation from biology complete enslavement from technology” (1, p.
itself. “There is another point of view on this 14).
matter: an equivalent opposite interpretation,
according to which such an apparent
liberation is nothing more than a final and
CONCLUSIONS
A technical or specialized text differs from an artistic one by its one-dimensionality
of meaning. Translation of such a text is available to Artificial Intelligence.
When translating artistic text, there is a significant difference between the mental
operations of the translator and Artificial Intelligence. The process of translating
creative thought into a speech form is due to numerous factors, namely: figurative
and associative elements, psychosocial components, biological, genetic, emotional
and historical memory, as well as culture and experience. The whole complex of
recognition and decoding of human communication skills is inaccessible to a
machine, that is, to Artificial Intelligence.
From our point of view, literary translation is an interdisciplinary activity. The

science of it, as a study on the transformation of the figurative-emotional reflection of
the world into a linguistic form, should become an independent part of the general
theory of translation.

The author state that there is no declared conflicts of interest regarding this paper.
REFERENCES
1. Mark O'Connell. Artificial intelligence and the future of humanity. Moscow: Eksmo, 2019.
2. A.I. Korsakov. Religion and Science in the Works of the Founder of the First Positivism. In: Bulletin of PSTGU.
Series I: Theology. Philosophy. Issue 2 (40).Moscow, 2012.
3. Kai-Fu Lee. AI Superpowers. China, Silicon valley, and the new worlds order. Houghton Mifflin Harcourt.- Boston,
New York, 2018.
4. www.cost.eu/cost-action/language-in-the-human-machine-era/
5. V.N. Komissarov Translation as an object of linguistic research. In: Problems of translation interpretation of the text
in the works of Russian linguists of the late 20th, early 21st centuries. Yerevan: Lingua, 2009.
6. Yu. Golovin. Practical Psychologist Dictionary.2nd ed., Rev. and add. Minsk: Harvest, Moscow: AST, 2001.
7. Bogdan Ghiu. Europa este traducere. Interviu consemnat de Matei Martin. Dilema veche. 2015, nr. 586, p. 7-13.
8. V.D. Psurtsev. On the problem of translation and interpretation of a literary text: on one criterion of adequacy. In:
Problems of translation interpretation of the text in the works of Russian linguists of the late 20th, early 21st
centuries.Yerevan: Lingua.
9. Philip Zimbardo, Michael Leippe. Social impact. - SPb. Ed. "Peter", 2000.
10. Le Conferenze dell’Associazione Culturale Italiana, 1973 В: Roland Barthes. Le bruissement de la langue P Seuil,
1984.
11. http://yanko.lib.ru/books/cultur/bart-all.htm
12. Katharina Reiss. Classification of texts and methods of translation. In: Questions of the theory of translation in
foreign linguistics. Moscow, 1978.
13. Roland Barthes. Selected works. Semiotics. Poetics. Moscow: Progress, 1989.
14. George Orwell “1984”, pdf, 393 p. Free eBooks at Planet eBook.com
15. Irina Condrea. Traducerea din perspectivă semiotică. Chişinău: Cartdidact, 2006.
16. Alexandru Robot. Scrieri. Poezie. Proză. Publicistică. Eseu. Chișinău: Știința, 2018.
17. Fernand Braudel. Structures of everyday life: the possible and the impossible. T.I, Moscow Progress, 1986 .
Correspondence
Miroslava Metleaeva (Luchianchicova),
PhD Philology, Researcher Institute of Romanian Philology "Bogdan Petriceicu-
Hasdeu", Chișinău, Republic of Moldova, [email protected]
Submission: 14 may 2021

BPIPsychiatry
The hypocrisy – changing the vices into virtues

Iosif Tamaș
Iosif Tamaș - PhD, researcher, Institute of Interdisciplinary Research, Departament of Social

Sciences and Humanities, Alexandru Ioan Cuza University of Iași
ABSTRACT
This article focuses on identifying and presenting the roots and consequences of hypocrisy
within the hidden pathological features of the human being. Hypocrisy belongs to the
hypocrite, that is, to the individual in his ontic integrity as an immortal body, spirit, and soul.
In this respect this scientific discourse has its place within the religious space as well, at the
spiritual level of the perfect process of creation, where the new spiritual individual is always
active; At the empirical, scientific and material level of the human activity there is only the
ideological individual, proficient or not, just like in the unfortunate case of the priest –
sacerdos in aeternum who became professor after he jumped the fence of the house and he got
into the yard of the University, with the passport in his pocket of course. We will approach the
subject strictly through the paradigm of the theological-philosophical discourse, framed by
the constitutive horizon of moral philosophy (philosophical ethics), which is defined as the
second strand of bioethics as a modern science, according to the traditional medical ethics (1).
Within this paper we will look at the following points: the formalism of religious hypocrisy;
the blindness of the hypocrite as a pathological manifestation and finally about the availability
as a permanent risk of hypocrisy.
KEYWORDS:
Vice, virtue, disease, [our] faith, pride.
INTRODUCTION „Pentru că poporul acesta se apropie de mine

Being a mistake against reason, truth, a cu gura şi mă preamăreşte cu buzele, dar
violation of a commandment, sin was called inima lui este departe de mine, iar teama de
by St. Augustine “a word, deed, or desire mine este o poruncă învăţată de la oameni, de
contrary to eternal law,” to the point of self- aceea, voi face din nou fapte minunate pentru
love and contempt for God (2). This is how acest popor, va pieri înţelepciunea celor
the wise prophets once said: „Domnul zice: înţelepţi şi priceperea celor pricepuţi va
dispărea. Vai de cei care-şi ascund planul Acestea trebuia să le faceţi, iar pe acelea să
departe de Domnul, iar faptele lor sunt în nu le neglijaţi! Călăuze oarbe! Voi strecuraţi
întuneric şi zic: «Cine ne vede şi cine ne ţânţarul, dar înghiţiţi cămila. Vai vouă,
cunoaşte?»!” (Is 29, 13-15), [“The Lord says: cărturarilor şi fariseilor ipocriţi! Voi curăţaţi
“For this people draweth nigh unto me with exteriorul paharului şi al farfuriei, dar în
their mouth, and honoureth me with their lips; interior sunt pline de jaf şi necumpătare.
but their heart is far from me, and their fear is Fariseu orb! Curăţă mai întâi interiorul
a commandment learned from men, therefore paharului ca să devină curat şi exteriorul
I will do wonders for this people again, and lui.” [“Woe unto you, scribes and Pharisees,
the wisdom of the wise shall perish, and the hypocrites! You tithe mint, dill, and cumin,
understanding of the prudent shall depart. but set aside the heaviest part of the law:
Woe unto them that seek deep to hide their judgment, mercy, faith. You had to do these,
counsel from the Lord, and their works are in and don’t neglect those! Blind guides! You
the dark, and I say, ‘Who seeth us, and who sneak in the mosquito, but swallow the camel.
knoweth us?’”(Is 29, 13-15)], (3). Thus, it is Woe unto you, scribes and Pharisees,
Jesus of Nazareth who will identify and reveal hypocrites! You clean the outside of the glass
the roots and pathological consequences of and the plate, but inside they are full of
hypocrisy. According to his principle that the robbery and intemperance. Blind Pharisee!
healthy do not need a doctor, Jesus turned to First clean the inside of the glass to make it
those who represented the verticality of the clean.”] (Mt. 23, 23-26). This is the starting
spiritual life of his time, to those who at that point. Where did I end up today? According
time took the “intelligence” (4) of the time, in to our scientific opinion, it is more difficult
a word to the teachers of the law, the scholars today: our “intelligence” translates to us what
and hypocrites. The central idea emphasized Jesus meant!
by Jesus was that the facts did not express the
intention, the causality of the actions THE FORMALISM OF RELIGIOUS
determining the results: the blind man unable HYPOCRISY
to see the light rises as a guide. Being aware Religious hypocrisy is not just a lie; it is a
that they were blind, they deceived case of psychiatric clinical study, because
themselves out of a perverse desire to deceive here we find ourselves in the field of the
others. Here is the edifying passage: „Vai pyramid apex syndrome. The religious
vouă, cărturarilor şi fariseilor ipocriţi! Voi hypocrite deceives his neighbor to gain his
daţi zeciuială din mentă, din mărar şi din esteem, with gestures, with folklore, with
chimion, dar lăsaţi la o parte ce este mai greu lyrical moments, with symposia, meetings,
din Lege: judecata, îndurarea, credinţa. synods and councils, with congresses, be they
Eucharistic, whose intention is not at all markets, that they may be praised of men.
simple, all bearing the confessional imprint. Truth be told: they have received their reward.
Only then will the non-Christian be able to And when thou prayest, thou shalt not be as
say about Christians: this is how much they the hypocrites are: for they love to pray
love each other! “Promoting the standing in the synagogues and in the corners
REBUILDING of UNITY among all of the streets, that they may be seen of men.
Christians is one of the main goals of the holy Truth be told: they have received their reward.
Second Vatican Ecumenical Council” (5). The When you fast, do not be as sad as hypocrites,
hypocrite, stirrer or propagandist, seems to act for they twist their faces to show people that
for God, when in fact, he acts only for himself they are fasting! Truth be told: they have
or for the institution he represents. The received their reward. They do all their deeds
formula of the cult of personality was to be seen by men: they enlarge their
abandoned and instead other formulas phylacteries and lengthen their tassels.”] (Mt
emerged, such as the citizen of honor, 6, 2.5.16; 23.5). To put a barrier between the
emeritus. The most recommended practices of heart and the lips this education teaches man
Christian piety, prayer, fasting and to hide evil intentions under a honeyed air,
almsgiving, are thus perverted by the concern hence the nicknames Machiavellian, Jesuit.
“to be noticed”, and the media abound with Such an episode occurred when a trap was
examples in this regard. „Aşadar, când dai de laid under the cover of a legal question for
pomană, nu trâmbiţa înaintea ta aşa cum fac Jesus: „Dar Isus, cunoscând răutatea lor, le-a
ipocriţii în sinagogi şi în pieţe, ca să fie zis: „Ipocriţilor, de ce mă ispitiţi? Arătaţi-mi
lăudaţi de oameni. Adevăr vă spun: şi-au moneda tributului!”. Iar ei i-au adus un
primit răsplata. Iar când vă rugaţi, nu faceţi dinár. El le-a zis: „Ale cui sunt imaginea
ca ipocriţii, pentru că lor le place să se roage aceasta şi inscripţia?”. I-au zis: „Ale
stând în picioare în sinagogi şi la colţurile Cezárului”. Atunci le-a zis: „Daţi-i, aşadar,
străzilor ca să se arate oamenilor! Adevăr vă Cezárului ceea ce este al Cezárului şi lui
spun: şi-au primit răsplata. Când postiţi, nu Dumnezeu ceea ce este al lui Dumnezeu!”.
fiţi trişti ca ipocriţii, căci ei îşi schimonosesc Când au auzit, au rămas uimiţi şi, lăsându-l,
feţele ca să arate oamenilor că postesc! au plecat.” [“But Jesus, knowing their
Adevăr vă spun: şi-au primit răsplata. Toate wickedness, said to them,” Why are you
faptele lor le fac pentru a fi văzuţi de oameni: tempting the hypocrites? Show me the tribute
îşi lărgesc filacterele şi îşi lungesc ciucurii.” coin! “And they brought him a penny. He said
[“Therefore when thou doest thine alms, do to them, “Whose is this image and
not sound a trumpet before thee, as the inscription?” They said to him, “Caesar’s.”
hypocrites do in the synagogues and in the Then said he unto them, Render therefore
unto Caesar the things which are Caesar’s; mask the professional incompetence of each
and unto God the things that are God’s. When specific competence, of many newcomers,
they heard this, they were astonished, and covered the personal “availability” with the
went away from him.] (Mt 22, 18-23). institutional mask. How to consider the
Nothing new under the sun would say the unqualified, proficient? Even then, the party
Ecclesiastes [Book of Qohelét], we have security “invented the ISBN” (6), and then the
heard the story: „Dar ei au zis: „Veniţi să propaganda of insane hypocrites blessed and
facem planuri împotriva lui Ieremía! Căci sanctified confessional television and radio
legea nu va pieri din lipsă de preoţi, nici stations. And the sad conclusion of the Savior
sfatul, din lipsă de înţelepţi şi nici cuvântul, who vibrates even today sends us back to the
din lipsă de profeţi. Haideţi să-l lovim cu ancient wisdom: „Ipocriţilor! Bine a profeţit
limba şi să nu ţinem cont de niciunul dintre despre voi Isaía, când spune: «Acest popor
cuvintele sale!”.” [“But they said, ‘Come and mă cinsteşte cu buzele, însă inima lor este
make plans against Jeremiah! For the law departe de mine. In zadar mă cinstesc
shall not perish from the absence of priests, propunând învăţături care sunt doar porunci
nor counsel from the wisdom of wise men, ale oamenilor»“ [“Hypocrites! Isaía
nor the word from the absence of prophets. prophesied well of you when she said, “This
Let us smite him with the tongue, and let him people honor me with their lips, but their
not regard any of his words.”] (Ier 18, 18). heart is far from me. In vain do I honor
Always determined to come out with a clean myself by proposing teachings that are only
face and forehead up, he didn’t eat garlic – the commandments of men.”] (Mt 15,7-9).
not even his mouth smells, the hypocrite
knows how to position himself between THE BLINDNESS OF THE
precepts or to arrange them in an intelligent HYPOCRITUS AS A PATHOLOGICAL
casuistry, shouting loudly: I have the answer, MANIFESTATION
who has the question!? And so the sapiential Formalism can be treated and cured in the
dogmatists were the ones who explained to us end, but hypocrisy with pathological
how logical it is to believe. And so the manifestation certainly leads to stoning.
mosquito could sneak in and swallow the Whitewashed graves end up swallowing
camel, only then could the divine teachings everything that flies, everything that they
return in the interest of greed and self- crave, all the truth, all justice, to make others
restraint or group, since the lie has ISBN. We accept, to “believe”. They consider
refer strictly to the rudeness of the themselves the pillars of justice: „A spus
Communist and religious confessional această parabolă unora care se credeau în
propagandistic ideology, which, wanting to sine drepţi şi-i dispreţuiau pe alţii; Şi
urmărindu-l cu atenţie, au trimis spioni care knowledge of the abominable deeds

se prezentau ca fiind drepţi, ca să-l prindă cu committed by those of their type. The pain
vreun cuvânt şi să-l dea pe mâna autorităţii şi and the will not to repeat the mistakes of the
a puterii guvernatorului” [“He told this past that is not to put us in the situation of
parable to some who believed themselves writing and presenting reports. We are the
righteous and despised others; And they ones who demand guarantees! We are the
followed him closely, and sent spies, ones who crush the broken reed, we
pretending to be righteous, to take him by the extinguish the smoking wick! We were lied
word, and deliver him into the hand of the to! „Durerea este însoțită de o privire de
governor and to the power of the governor”] speranță. Pentru ca aceste fenomene nu se
(Lk 18:9; 20:20) and become opaque to any mai repete, avem nevoie, pe lângă norme mai
call to conversion. Theater actors, Oscar eficiente, de o convertire a inimilor. Este
nominees (in Greek hypocrites), hypocritical nevoie de păstori credibili, vestitori ai
Christians continue to play their part, Evangheliei, și trebuie să fim cu toții
especially as they occupy a higher rank and conștienți că acest salt este posibil numai cu
their word is heard. Here is the text: „Atunci ajutorul harului Duhului Sfânt, încrezători
Isus s-a adresat mulţimilor şi discipolilor săi, fiind în cuvintele lui Isus: Fără mine, nimic
spunând: „Cărturarii şi fariseii s-au aşezat nu puteți face” [“The pain is accompanied by
pe catedra lui Moise. Faceţi şi împliniţi tot ce a look of hope. Because these phenomena do
vă spun ei, dar nu faceţi după faptele lor, not happen again, we need, in addition to
pentru că ei spun, şi nu fac! “ [“Then Jesus more efficient rules, a conversion of hearts.
addressed his people and disciples, saying,” We need credible pastors, heralds of the
The scribes and the Pharisees sat down on the gospel, and we must all be aware that this
throne of Moses. Do and do all that they tell leap is possible only with the grace of the
you, but do not do according to their deeds, Holy Spirit, trusting in the words of Jesus:
for they say, and do not!”] (Mt 23, 1-3s). Here Without me you can do nothing”] (7). Now
we meet all those hypocritical propagandists, we woke up from our dogmatic sleep, sorry!
who from the height of the altars turn into Exciting! It’s the night of the mind! Brotherly
electoral agents, throwing the seed of discord correction is necessary, it is healthy. But
between the parishioners, increasing here’s the dilemma: how can the hypocrite
confusion and duplicity. What does it matter take out the beam that prevents him from
where the money comes from! But more seeing, when it doesn’t even cross his head,
serious is the fact that under the pressure of and he has no other concern than how to take
public opinion, those installed in the chair of out the straw that is in the neighbor’s eye?
Moses send reports about the institutional „Sau cum vei spune fratelui tău: «Lasă-mă să
scot paiul din ochiul tău» şi, iată, bârna este of the times, that is, to reveal in Jesus of
în ochiul tău? pocritule, scoate mai întâi Nazareth the messenger of God. But the pride
bârna din ochiul tău şi atunci vei vedea bine of the hypocrite has no limits and so he wants
să scoţi paiul din ochiul fratelui tău” [“Or a sign from heaven: „Iar când bate vântul
how wilt thou say to thy brother, Let me pull dinspre miazăzi, spuneţi că va fi cald şi aşa
out the mote out of thine eye; and, behold, a este. Ipocriţilor, aspectul pământului şi al
beam is in thine own eye? poor thing, take the cerului ştiţi să-l interpretaţi; dar de ce nu ştiţi
beam out of your eye first, and then you will să interpretaţi timpul de faţă?” [“And when
see to it that you take the straw out of your the south wind blows, say that it will be warm
brother’s eye.”] (Mt 7: 4-5-5). Indeed, and so it is. You hypocrites, you know how to
spiritual guides are necessary, but haven’t interpret the appearance of the earth and the
they already taken God’s place on earth when sky; but why do you not know how to
they replaced divine law with human interpret the present tense?”] (Lk 12: 55-56);
traditions? Blind people who claim to lead blinded by his own wickedness, the hypocrite
others: Lăsaţi-i, ei sunt călăuze oarbe pentru does not need the meekness and salvation
orbi! Iar dacă un orb călăuzeşte un alt orb, brought by Jesus Christ and invokes the
amândoi cad în groapă” [“Leave them, they methodology, the law of the Sabbath, to keep
are blind guides for the blind! And if one him from doing good: „Atunci, Domnul i-a
blind man leads another blind man, they both răspuns şi i-a zis: „Ipocriţilor! Nu-şi
fall into the pit”] (Mt 15:14) and their dezleagă fiecare dintre voi boul şi măgarul de
propaganda is nothing but a bad mound: „În la iesle şi-l duce la adăpat [chiar în zi de]
timp ce mulţimea se aduna cu miile, încât se sâmbătă? Şi această fiică a lui Abrahám, care
călcau în picioare unii pe alţii, [Isus] a era legată de Satana de optsprezece ani, nu
început să vorbească mai întâi discipolilor: trebuia să fie dezlegată în zi de sâmbătă?”.
„Feriţi-vă de aluatul fariseilor, care este [“Then the Lord answered and said to him,”
ipocrizia, căci nu este nimic ascuns care nu You hypocrites! Doesn’t each of you untie his
va fi descoperit şi nici secret care nu va fi ox and the donkey from the manger and take
cunoscut! “ [“While the multitude was in the it to the water [even on Saturday]? And this
thousands, so they trampled on one another, daughter of Abraham, who was bound to
[Jesus] first began to speak to the disciples: Satan for eighteen years, was not to be loosed
“Beware of the leaven of the Pharisees, which on the Sabbath day?”] (Lk 13,15-16). The
is hypocrisy, for there is nothing hidden that climax of the intrigue takes place the moment
will not be revealed and no secret that will not the hypocrite claims that Beelzebub is the
be known!”] (Lk 12,1-2). This is the state of instrument of Jesus’ miracles, as if we were in
the blind, the inability to recognize the signs the Harry Potter movie series: “But when the
Pharisees heard it, they said, ‘This fellow doth THE AVAILABILITY AS A
not cast out devils, but by Beelzebub the chief PERMANENT RISK OF HYPOCRISY
of the devils’.” (Mt 12,24). We are surprised, Let us not deceive ourselves and think that
however, that they did not wonder if Jesus is a hypocrisy belonged only to the Pharisees of
Freemason! But He is the prince of life, and Jesus’ day, and since then we have been
in order to break down the gates of their immunized. No, the hypocrites have not
hearts, Jesus will shame them before the disappeared. Of course, the synoptic tradition
community, exposing to them their hidden sin pushed the presumption of hypocrisy to all
and decay: „Vai vouă, cărturarilor şi nations: „Apoi a spus mulţimilor:[...]
fariseilor ipocriţi! Voi zidiţi mormintele Ipocriţilor[...]” [“Then he said to the
profeţilor şi împodobiţi monumentele multitudes, [...] to the hypocrites [...]”] (Lk
drepţilor şi spuneţi: «Dacă eram în zilele 12: 54-56). We understand the aspect,
părinţilor noştri, n-am fi fost complici cu ei la however maybe it was good for the Savior to
[vărsarea] sângelui profeţilor». Astfel, voi make a statistic, a case study, a typology
înşivă daţi mărturie împotriva voastră că something; so St. John could no longer see
sunteţi fiii celor ce au ucis profeţii. Dar voi through the Jews the unbelievers of all times.
întreceţi măsura părinţilor voştri.” [“Woe It is within everyone’s reach to substantiate an
unto you, scribes and Pharisees, hypocrites! ideology-philosophical-theological of
You build the tombs of the prophets and opposites in society and to go with the sword
adorn the monuments of the righteous, and through the world in the name of Jesus Christ.
say, “If we were in the days of our fathers, we How? Has it already happened? Isn’t the
would not have been complicit with them in problem over? Who shouts, tolerance!? The
shedding the blood of the prophets.” Thus Christian! It is said that either St. Peter did
testify against yourselves that you are the sons not escape this danger during the Antioch
of those who killed the prophets. But you episode: „Dar, când a venit Chéfa la
surpass your parents’ measure.”] (Mt 23,29- Antiohía, l-am înfruntat făţiş, căci era de
32). And what is the end in the end? What we condamnat. De fapt, înainte de a fi venit unii
have to do? Here is the text: “But if that de la Iacób, stătea la masă cu păgânii, dar
servant say in his heart, ‘My lord delayeth his când au venit ei, s-a ferit şi a stat deoparte,
coming, he waits for the hour he does not temându-se de cei circumcişi. Împreună cu el
know, he will punish him severely and make au început să se poarte cu ipocrizie şi ceilalţi
him one of the unbelievers.” (Lk 12: 45-46). iudei, aşa încât şi Bárnaba a fost ademenit de
Let’s wait full of zeal, wakefulness and ipocrizie. Dar când am văzut că ei nu merg
confidence. drept, după adevărul evangheliei, i-am spus
lui Chéfa în faţa tuturor: Dacă tu, care eşti
iudeu, te porţi ca un păgân şi nu trăieşti ca un addition we have extended ourselves with

iudeu, cum îi poţi constrânge pe păgâni să hypocrisy to the spiritual level of the perfect
trăiască asemenea iudeilor?” [“But when creation, let us turn dizzyingly to apostasy:
Chéfa came to Antioch, I openly confronted „De altfel, Duhul spune clar că în timpurile
him, for he was to be condemned. In fact, de pe urmă unii îşi vor renega credinţa,
before some came from Jacob, he sat at the luându-se după duhuri înşelătoare şi
table with the heathen, but when they came, învăţături diabolice, [seduşi] de ipocrizia
he shunned and stood aside, fearing the discursurilor false ale celor însemnaţi cu
circumcised. Along with him, the other Jews fierul roşu în cugetul lor” [“In fact, the Spirit
began to behave with hypocrisy, so that clearly says that in later times some will
Barnabas was also seduced by hypocrisy. But renounce their faith, they are deceived by evil
when I saw that they did not walk uprightly, spirits and evil teachings, [seduced] by the
according to the truth of the gospel, I said to hypocrisy of the false speeches of those
Chéfa in the presence of all: live like the marked with red iron in their minds”] (1 Tim
Jews?”] (Gal 2: 11-15); but this is already 4: 1-2). Where is the meaning and why cannot
another discussion and we prefer a little we apply this quality, the availability of the
reserve. Let’s go back to the clinical risks of human after all, to the religious, theological,
our skidding. It didn’t take long and the spiritual discourse? Without determining
hypocritical scholars, from us and not only, pretentious linguistic analyzes, we find that
needed a panacea, a word to avoid the specialists have emphasized in the semantics
Christian criteria of performance, namely the of the word in question, that trait specific to
virtues. They found this miraculous word, the individual as a state of mind in which
availability, which emerged, to our feelings and reason are freely manifested and
knowledge, during the disaster of the French in their fullness. They, precisely the Christian
Revolution when, after shortening almost all teaching and the customs of the whole society
the country’s authority, they needed in mind, have established that the religious
replacements. And it was difficult to tell your and social individual needs the discernment of
relative, your unqualified people, the the facts and the moral-religious censorship.
proficient one, –so there the available The word I referred to is successfully used for
relatives and totally unqualified for those the human empirical, material, social plan.
positions gathered in all the key positions. And the remedy comes, of course, also from
And it was fine! We jump over times and Jesus Christ, through the rock of the
history and see that nothing is new under the foundation of his apostles, through St. Peter in
sun. We persevere and insist on mistakes and addition to the problem, strengthened and
no one has the courage to cure themselves. In persevering for good: “Therefore, removing
all evil and all deception, hypocrisy, envy, reason and communication. Even if most of
and all evil speech, as newborn babies, desire the time the thought process is associated with
spiritual milk, pure, that you may grow the particular effort of silencing and
through it to salvation if you have indeed distancing from the surrounding voices, in
tasted how good the Lord is”. (1 Pet. 1-4). So, order to become reason, as Kant says, must be
no psychiatric control. said and shared. Thinking becomes consistent
only when it is brought into light and made
For more than a year we have been going known to others, discussed, challenged,
through the sanitary pan-madness. We all questioned and understood, otherwise it is
remember that at the beginning of these simply an empty exercise. The state of
problems, they had to align with the sanitary isolation and distancing between people has
requirements and the church spaces. Indeed, disrupted this normal movement of man
the leaders of the religious edifices cheered in throughout the world. The individual’s need
unison. The people will follow us through the for humanity (to be a student, to be a child, a
internet, through television, the media is at the doctor, a researcher or anything else, to live in
service of the individual. We witnessed these times of crisis, to live, to care and
uplifting, emotional, funny moments, some educate those in need, to make discoveries,
really comical, regardless of the confession and to find the most appropriate solutions)
we were referring to. Later, the same religious can only be supported by effective
leaders began to moan, to tell us how sad it is communication, which goes beyond the
to see shepherds without sheep. What to do? barriers imposed by isolation and physical
A restart of inter-social communication is distancing. In a timely manner a responsible
required: “Humans are social beings and need and informative communication is able to
to manifest themselves as such in the simplest eliminate ambiguities while leading to
ways that affirm their belonging to humanity: understanding, knowledge and education” (8).
CONCLUSIONS
Hypocrisy belongs to the hypocrite, that is, to the individual in his ontic integrity as an immortal
body, spirit, and soul. The individual lives in the community, so its first concern must be to rethink
the work of sensitizing the people to the culture of life, not to the culture of waste and spoiled
graves. We must also start from within the Christian communities, reversing the pyramidal
structure, placing the people at the center of our concerns. With great clearness and courage to ask
ourselves what type of culture we promote today in the family, in schools and universities, in
research laboratories, in government forums. With clarity and determination let us discern the next
steps in the service of life with all the fullness of its truth. One of these steps is, of course, to
promote all environments of life in which justice and solidarity are expressed through every act and
gesture of love and where the pathology has been cured.
ACKNOWLEDGEMENTS AND DISCLOSURE

The authors declare that they have no potential conflicts of interest to disclose.
REFERENCES
1. Tamaș I, Tamaș C.Premisele bioeticii moderne în activitatea lui N. I. Camilli, primul episcop al Bisericii Romano-
Catolice din Moldova (1884-1894; 1904-1915).Revista Română de Bioetică. 2011;9(1).
2. Tamaș I.. Mic dicționar teologic. Sapientia. 2008:263-265.
3. Toate citările biblice sunt făcute după: Biblia. Sapientia. 2013.
4. Vocabular de teologie biblică. Ed. Arhiepiscopiei Romano-Catolice de București. 2001:273-274.
5. Decret despre Ecumenism, „Unitatis Redintegratio”.Conciliul Ecumenic Vatican II.Traducerea Arhiepiscopiei
Romano-Catolice de București. 1990:117.
6. Iosif Tamaș.Episcopul Marcu Glaser și dezlănţuirea urgiei comuniste.Vasiliana 98.2015:30.
7.Raportul Mccarrick, o pagină dureroasă din care Biserica are numai de învățat.10.11.2020.Vatican. www.Catholica.ro.
8. Pricop L.. Reason and communication: digital form of communication in response to the COVID-19 pandemic.
Bulletin of Integrative Psychiatry. 2020; 26: 3 (86).
Correspondence
Iosif Tamaș,
PhD, researcher, Institute of Interdisciplinary Research, Departament of Social Sciences and
Humanities, Alexandru Ioan Cuza University of Iași, [email protected]
Submission: 10 jun 2021

BPIPsychiatry
Particularities and limitations of

kinesiotherapy in genetic disorders and their
medical recovery – Russell-Silver Syndrome: a
case report
Adina Sorina Mitrică, Avram Carmen, Ada Bargau Petrache,
Adrian Cantemir, Vlad Teodor Iacob
Adina Sorina Mitrică - Senior Kinesiotherapist, County Clinical Hospital “Saint Apostol Andrei”,
Constanța
Avram Carmen - Senior M.D. in Physical Medicine and Balneology, Clinical Rehabilitation
Hospital “Băile Felix”, Children`s ward 1 Mai
Ada Bargau Petrache - Junior Pediatric Cardiologist, County Clinical Hospital “Gavril Curteanu”,
Oradea
Adrian Cantemir - M.D., PhD, Assistant Professor, “Grigore T. Popa” University of Medicine and
Pharmacy Iaşi, Romania
Vlad Teodor Iacob - M.D., PhD student, “Socola” Institute of Psychiatry, Iași, Romania
ABSTRACT
While some authors still separate the Russell-Silver syndrome as two independent disorders,
it is presently considered as one whole entity. It is a rare syndrome, with over 400 reported
cases (1). The first reported cases were in children with the syndrome’s characteristic facial
features, low birth weight, body asymmetry, and poor growth after birth (2), growth failure
being the primary abnormality (3). Patients typically present with intrauterine growth
retardation, difficulty feeding, failure to thrive, or postnatal growth failure (4, 5). The clinical
features are more evident in infants or young children (6).
Methods. We present a 19-month-old girl, admitted to our hospital for functional

rehabilitation due to mildly severe neuromotor retardation, associated with severe
malnutrition, low body weight, congenital heart malformation and gastroesophageal reflux.
We evaluated the child and her motion of joints and strength of muscles using, among other
tests, the Gross Motor Function Measure (GMFM) scale. She underwent a kinesiotherapy
program in order to enhance and rise her motor skills according to her chronological age.
Results. For one year, rehabilitation treatment improved muscle tone, motor skills, posture
and spine alignment. Also, a specific kinesiotherapy program at home resulted in a systematic
improvement in growth and development in this case.
Conclusions. Genetic anomalies are always a challenge for therapists. An early intervention
program, in this particular case, is highly beneficial.
KEY WORDS:
Kinesiotherapy, rehabilitation, Russell-Silver Syndrome.
INTRODUCTION Medical history

Russell-Silver Syndrome (RSS) is a rare Family history: healthy father, while the
congenital imprinting disorder with a wide mother was diagnosed with multinodular
array of clinical presentations, but also with goiter and hyperthyroidism.
many characteristic features such as:
- Low birth weight and short stature, which The patient is the first-born, with a premature
frequently lead to difficulties regarding birth by cesarean section and dysgravidy, at
diagnosis and treatment 36 weeks, with a weight of 1900 grams,
- Hypotonia, which is frequently related to length of 45 cm, Apgar score 7/8, resuscitated
neurological disorders, is more often present at birth using a bag valve mask and tactile
in newborns until they reach adolescence than stimulation.
in teenagers or adults. The increased
frequency of hypotonia is correlated with the Early postnatal, she has a functional
survival of children born prematurely with respiratory disorder, neonatal hypoglycemia,
consecutive neurological impairments. E. coli infection in the amniotic fluid, and was
treated with antibiotics and mixed feeding.
While RSS was first described separately by
the two authors, due to similarities, it is now At 2-months-old, she was diagnosed with
considered the same entity. dysphagia, hypoxic-ischemic encephalopathy,
neuromotor retardation, developmental
One of RSS’s main features is growth coordination disorder, craniofacial
retardation with a prenatal onset and a slow dysmorphism, moderate protein-calorie
developmental regression, to which are added malnutrition and treated with Pyritinol at the
some anomalies that give it a characteristic Children’s Clinical Hospital in Oradea.
facial appearance, easily recognizable.
At 3-months-old, in the Pediatric Clinic II in
CASE REPORT Cluj-Napoca, she is presumed to have
Reasons for admission esophageal stenosis, for which a nasogastric
The patient, aged 1 year and 7 months, was tube for feeding was inserted.
admitted for functional recovery treatment
due to growth delay with short stature and At 4-months-old, while admitted for
poor weight gain, and moderate delay in interstitial pneumonia in Oradea, she was
psychomotor skills. diagnosed with an atrial septal defect, type
ostium secundum, right to left shunt;
pulmonary hypertension and paroxystic
Bulletin of Integrative Psychiatry  New Series September 2021 Year XXVII No. 3(90)/135
supraventricular tachycardia, and  From the supine position, supported

megaesophagus. from the chest by the physiotherapist,
she does not raise her head.
At 5-months-old, while admitted to the  She does not get into a sitting position;
Pediatric Clinic III in Cluj-Napoca for She does not get into orthostatism
vomiting and growth failure (Ponderal Index without assistance.
= 0,66), a metabolic genetic disorder is  Walking is only possible with bilateral
suspected. support; walks with a wide base of
support, asymmetric, with stability
At 6-months-old, she is fed by gavage, her and balance disorders.
weight is stagnant, her caloric intake is
limited due to refusing food, all of which with Kinetic objectives
a lack of hypoproteinemia excludes  Obtaining orthostatism.
malabsorption syndrome.  Improved postural control.
 Enhancing sensorimotor and
From the age of 9 months, she slowly gained functional deficits.
weight and at 1-year-old, she was genetically
 Improvement of muscle tone and
investigated due to severe hypotrophy.
kinetic balance by learning balance
At the age of 1 year and 2 months, an MRI control strategies (ankle, knee, hip
showed adenohypophyseal hypoplasia and
strategy) and by learning controlled
demyelination of the periventricular white falls.
matter (secondary lesions due to hypoxia).
 Toning the muscle groups involved in
breathing.
At the age of 1 year and 3 months, she was
 Increasing physical training while
investigated at the Universita di Roma and
monitoring blood glucose levels.
underwent genetic testing, which led to a
 Correcting her dynamic and static
presumed diagnosis of Russell-Silver
body posture (reverting her
Syndrome
hyperlordosis).
Initial assessment
Results at her latest evaluation
 Hypotrophy due to growth delay, with
 Height of 80 cm and weight of 7000 g.
a height of 67 cm, weight of 5,2 kg
 Normal spinal curvatures
and head circumference of 47 cm
(ideal for her age being a height of  The upper limbs show normal muscle
81,5 cm and weight of 11 kg) development and the patient can use
them to achieve activities of daily
 Characteristic triangular facies,
living (ADL).
prominent supraorbital ridge,
fontanelle 2/3 cm, pigmented skin.  The lower limbs show a muscular
toning that allows the child to walk
 Axial hypotonia, accentuated dorso-
independently over long distances, to
lumbar kyphosis in the sitting
walk on rough terrain, to walk up and
position.
down a ramp, going up and down the
 Hypotonia in all four limbs,
stairs and running.
symmetrical muscular hypotrophy,
dynamic knee valgus.
 From the supine position, she can flex  Shows balance in all positions.
her head and neck while supporting  She cannot get in a seated position
her elbows. independently.
 She can independently obtain
orthostatism.
CONCLUSIONS
Early detection and treatment of children with RSS decisively influence recovery and future
integration possibilities.Motivation for movement is very important throughout treatment.
Teamwork that involves all the specialists who work with the child: recovery doctor,
physiotherapist, occupational therapist and the patient’s family can determine favourable
developments.
During physical therapy programs, the child should practise various postures to comprehend all the
different sensations that come with them.
The effectiveness and rigour of personal hygiene programs, nutrition (one hour before and after
physical therapy, it is recommended to not consume anything) must be observed, and in this case,
kinesiotherapy is contraindicated if it is not supported by a hypercaloric diet.
Special attention must be paid to the development of the body scheme.
In the recovery process, there is no standardized program, it varies from individual to individual,
which is why we consider it important to take into account all the neuro-psycho-motor and
physiological elements of each individual and the whole range of means kinesiotherapy has to offer.
Physical therapy will focus on achieving psychomotor skills, especially static function, dynamic
function, global coordination, manual dexterity, trunk flexibility, speed of arm movement, lower
limb strength.
Achieving a correct alignment of the spine has been the key to achieving the other goals
successfully and will soon allow the child’s integration into a kindergarten that addresses normal
children.

REFERENCES
1. Tubbs RS, Wellons JC, Oakes WJ. Russell Silver syndrome and tethered spinal cord. Child's Nervous System.
2004 Jul;20(7):473-5.
2. Price SM, Stanhope R, Garrett C, Preece MA, Trembath RC. The spectrum of Silver-Russell syndrome: a clinical
and molecular genetic study and new diagnostic criteria. Journal of medical genetics. 1999 Nov 1;36(11):837-42.
3. Şıklar Z, Berberoğlu M. Syndromic disorders with short stature. Journal of clinical research in pediatric
endocrinology. 2014 Mar;6(1):1.
4. Prasad NR, Reddy PA, Karthik TS, Chakravarthy M, Ahmed F. A rare case of Silver–Russell syndrome associated
with growth hormone deficiency and urogenital abnormalities. Indian journal of endocrinology and metabolism. 2012
Dec;16(Suppl 2):S307.
5. Yamaguchi Jr KT, Salem JB, Myung KS, Romero Jr AN, Skaggs DL. Spinal deformity in Russell–Silver
syndrome. Spine deformity. 2015 Jan 1;3(1):95-7.
6. Ranke MB, Price DA, Reiter EO, editors. Growth hormone therapy in pediatrics: 20 years of KIGS. Karger
Medical and Scientific Publishers; 2007.
Correspondence:
Adina Sorina Mitrică,
Senior Kinesiotherapist County, Clinical Hospital “Saint Apostol Andrei”, Tomis Blvd 145,
Constanța, Romania, [email protected]

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Abstracts in in English and Romanian, should have max. 300 words. For original articles is
advisable to include five paragraphs, labeled Background, Objective(s), Method(s), Result(s), and
Conclusion(s).
Keywords maximum of 6 keywords (minimum of 3). Keywords should not repeat the title of the
manuscript.
Original papers organized in:

 Introduction (no more than 25% of the text), material and methods, results, comments or
discussions and acknowledgements.
 Material and methods have to be described in enough detail to permit reproduction by other
teams. The same product names should be used throughout the text (with the brand name in
parenthesis at the first use).
 Results should be presented concisely. Tables and figures should not duplicate text.
 Discussions should set the results in context and set forth the major conclusions of the authors.
 Information from the Introduction or Results should not be repeated unless necessary for clarity.
The discussion should also include a comparison among the obtained results and other studies from
the literature, with explanations or hypothesis on the observed differences, comments on the
importance of the study and the actual status of the investigated subject, unsolved problems,
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V. et al). The name of the Journals cited in the References should be abbreviated according to ISI
Journal Title Abbreviations.
It is absolutely imperative that references to be entered in the text!!
Examples:
 Reference to a journal publication:
Amura SG.: Neurotransmitter transportor: recent progress. Ann Rev Neurosci 1993; 16; 73-93.
Tonis PJ, von Sandick JW, Nieweg OE, et al.: The hidden sentinel node,in breast cancer. Eur J Nucl
Med 2002; 29: 305-311
 Reference to a book:
Ashcroft FM.: Ion channels and disease, San Diego, London: Academic Press,
2000, pp. 26-52.
 Reference to a chapter in an edited book:
Pandiom MR, Fischer DA. Immunoradiometric assays. In: Scabes CG, editor.
Handbook of Endocrine Research Techniques. New York, London: Academic Press, 1993, 26-52
The punctuation and the general aspect of the text format must comply with the rules mentioned
above. This is a mandatory and eliminatory condition.
ACKNOWLEDGMENTS AND DISCLOSURE

Authors: an “author” is generally considered to be someone who has made substantive intellectual
contributions to a published study, and biomedical authorship continues to have important
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component of the work, should be able to identify who is responsible for each other component, and
should ideally be confident in their co-authors’ ability and integrity.
We strongly encourage developing and implementing a contributor ship policy, as well as a policy
on identifying who is responsible for the integrity of the work as a whole.
Disclosure: The authors must declare if they have or not a potential conflicts of interest to disclose.
Acknowledgments: All contributors who do not meet the criteria for authorship should be listed in
an acknowledgments section. Authors should declare whether they had assistance with study
design, data collection, data analysis, or manuscript preparation. If such assistance was available,
the authors should disclose the identity of the individuals who provided this assistance and the
entity that supported it in the published article. Financial and material support should also be
acknowledged.
PEER REVIEW PROCESS

Although the practice of peer review started 300 years ago, only since 198s the process has been
active to analyze if articles sent to journals are well-written, correctly edited and represent reliable
sources of information.
All manuscripts intended for publication will be subject to blind peer-review by a committee of
experts which assesses the scientific and statistical correctness of articles submitted. The committee
receives the manuscripts without knowing the authors' name and proposes possible changes, which
will be transmitted to the authors by the medium of Editorial Board. The authors have the obligation
to oversee the text in English language with the help of a professional translator.
When submitting a paper, a confirmation email is automatically sent back to the author. It contains
a unique registration number used as a referral in further correspondence.
Initially, the editorial team verifies whether the manuscript complies with the editing instructions. If
the paper does not meet the necessary requirements, it is rejected and the corresponding author is
notified to correct the errors. If all instructions for editing have been followed accordingly, the
editor selects two reviewers that will independently evaluate the paper. They have high expertise in
the "peer-review" system and are well-known specialists in the field. The reviewers have all
academic affiliations and may be already accredited by the Journal or specifically contacted for
certain papers. Their affiliation is usually different from the one of submitting authors.
The editor sends the paper in both electronic and printed format to each reviewer with the invitation
to evaluate it within 15 days. The reviewers will analyze the paper from several perspectives such
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is excellent and 1 is poor. The reviewers score the paper accordingly and issue a recommendation.
The existence of a manuscript under review is not revealed to anyone other than peer reviewers and
editorial staff. Peer reviewers remain anonymous and are expected to maintain strict confidentiality.
After the review process has been completed, authors will be informed by mail of the Editor's
decision.
Reviewers should inform the editor about suspected plagiarism.
Mandatory fill and send "Cover letter for submission of manuscript" and "Declaration of
Interests and disclosure form", which you can download from the website of Bulletin of
Integrative Psychiatry (www.buletindepsihiatrie.ro).
Ethical Considerations
Authors of articles should sign a statement assuming the responsibility for the originality, property
rights and ethical implications of their work. Authors should obtain permission or copy right to
publish figures, images or tables from other journals whose material they use.
A written consent must be obtained from patients when personal information or images of patients
are included in the article. Authors must state that the protocol has been approved by the Ethics
Committee of the institution where the research was conducted.
Address to send the manuscripts is:

Buletin de Psihiatrie Integrativa/ Institutul de Psihiatrie “Socola” Iasi
Lecturer Alexandra Bolos: Institutul de Psihiatrie “Socola” Iasi, Șos. Bucium 36, 700282, Iasi, jud.
Iasi; E-mail: [email protected]

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Bulletin of Integrative Psychiatry

New series of “Bulletins et Mémoires de la Société de Neurologie, Psychiatrie et

Editorial Board: "Socola” Institute of Psychiatry Iaşi

Free images from: httpsfreephotos.onlineitemfree-high-res-geometric-polygon-

Copyright © 2017 INSTITUTUL DE PSIHIATRIE „SOCOLA" Iaşi, România

Published by "Socola” Institute of Psychiatry Iaşi, Romania

„Gr. T. Popa” Publisher

Typeset by Tipografia Universităţii de Medicină şi Farmacie

ADVISORY BOARD: HULUBAŞ ADINA (Romania)

Editorial contact: [email protected]

Diabetes, obesity and metabolic syndrome models studied in zebrafish - further

Medium-term religious support program applied to suicidal psychiatric patients / 51

Dyslexia intervention to combat specific language disorder, a consequence of economic

Meditation and melotherapy as adjuvant treatments of chronic dermatoses / 69

Particularity of suicide in the countries of the European Union / 77

The psychological impact of aesthetic procedures on the young patient / 97

Humanistic contributions / 107

Artificial intelligence, transhumanism and translation as a universal property of

The hypocrisy – changing the vices into virtues / 121

Case reports / 131

Particularities and limitations of kinesiotherapy in genetic disorders and their medical

Instructions for authors / 139

Buletin de Psihiatrie Integrativa

Roxana Chiriță, Elena-Rodica Popescu

Isn't t it funny how day by day nothing

A good organization of the entire medical

Buletin de Psihiatrie Integrativa

Diabetes, obesity and metabolic syndrome

experimental model on which this disease can

to that of mammals (126) (127). Fluorescent During diabetes, inflammation in wild

1.oins.EGFP) over zebra (154). Insulin transient hyperglycemia, but persistent

ACKNOWLEDGEMENTS AND DISCLOSURES

Submission: 15 jul 2021

Buletin de Psihiatrie Integrativa

The psychological impact of the novel coronavirus

INTRODUCTION morbidities in HCWs in the result of SARS-

One help-strategy implemented already in close proximity to the hospital, providing

ACKNOWLEDGEMENTS AND DISCLOSURES

Submission: 29 mar 2021

Buletin de Psihiatrie Integrativa

Saccharin deprivation increases depression

Sorin Ungurianu - Faculty of Medicine, Dunărea de Jos University, Galaţi, România

INTRODUCTION are designed to restore serotonin-mediated

Fig 1. The level of catalase activity for each experimental group

To be more precise, the rats in the saccharin

The symptoms of withdrawal lead to a withdrawal symptoms are expected to be

Submission: 10 jun 2021

Buletin de Psihiatrie Integrativa

Medium-term religious support program

INTRODUCTION psychiatrists to take into account the spiritual

a). Very religious.

were used. Reported p values for t-student test

RESULTS AND DISCUSSIONS (p=0.459, CI=0.41-0.65). There were more

Table 2. Characteristics of the psychiatric patients

Age (M±SD) 52.9 ±10.2 52.2±10.1

Declared income 160 (±70.8) 159 (±92.3)

including those dedicated to the healing of the

Table 4. Detailed, flexible religious supportive program of the RSP

stories, parables and miracles either from the lives of