Emotional Disability Research Articles

Guided Imagery Intervention for the Treatment of Tension-type Headache Associated with State-Trait Anxiety

Introduction: Guided imagery (GI) is a mind–body intervention, in which individuals generate mental images of pleasant objects or events in their minds. These mental images produce positivity and alter the perception of headaches and other pain disorders. A review of literature suggests that GI is an effective psychological treatment for tension-type headache (TTH) and state-trait anxiety. Hence, the present study aimed to assess the efficacy of GI on TTH associated with state-trait anxiety and to compare its efficacy with treatment as usual (TAU). Materials and Methods: Forty treatment-naïve patients diagnosed with TTH were selected from the psychiatry outpatient department through purposive sampling method. The Henry Ford Hospital Headache Disability Inventory and the State-Trait Anxiety Inventory for Adults were administered on all the patients for baseline data. Experimental group (n = 20) were given eight sessions of GI along with TAU for 2 months, whereas waitlist group (n = 20) were given only TAU. Results: A Significant positive association was obtained between emotional and functional disability of headache and state-trait anxiety at baseline. Postassessment findings demonstrated a significant reduction in severity and frequency of TTH, emotional and functional disability, and state-trait anxiety in the experimental group receiving GI as compared to the waitlist group. Conclusion: Patients living with TTH more commonly suffer from state-trait anxiety. Those patients who were given GI along with TAU for 2 months improved on severity and frequency of TTH, emotional and functional disability of TTH, and state-trait anxiety more effectively than those patients receiving only TAU. Consequently, it can be said that GI is an effective treatment for TTH and state-trait anxiety as compared to TAU.

Examining Parental Perception of Inclusive Education Climate

Parental perspectives about the inclusion of their child with a disability has received limited attention in the literature. Considering parental voice plays an important role in determining the quality of inclusive education, the lack of reliable and valid tools to investigate parental experiences has significantly limited research in this area. One of the key objectives of this study was to build the evidence base in the field by testing the psychometric properties of the newly developed Parental Perception of Inclusion Climate Scale, using a systematic approach drawing on a review of available research in the field. The scale incorporates items that address parental perspectives regarding six key aspects of inclusion for their child including presence, participation, acceptance, achievement, happiness and belonging. Participants were recruited through social media, and data from 190 parents of children with additional learning needs attending a range of school settings were collected. Results suggested a three-factor structure, with strong internal consistency for the scale. These factors were: Teacher and School Support; Student Engagement; and Friendships. The scale showed that parents are generally moderately satisfied with their child’s inclusion in school overall. A series of independent sample t-tests and one-way ANOVAs revealed significant differences in parental perspectives of inclusion as measured by the scale according to school sector, disability type, and parent gender. Parents whose children attend government schools reported less satisfaction with their child’s inclusion at school and also with the support provided by teachers and schools more broadly as measured by the Teacher and School Support subscale, as compared to parents of children who attend independent schools. Results also suggested that parents of children with a social emotional disability reported less satisfaction with their child’s engagement in school as measured by the Student Engagement subscale as compared to parents of children without a social emotional disability. Finally, fathers reported higher levels of satisfaction with their child’s engagement in school as measured by the Student Engagement subscale and also higher levels of satisfaction with their peer relationships as measured by the Friendships subscale than mothers. This study provides a tool that researchers, school educators, and policy makers could use to collect evidence about the efficacy of inclusive practices for students with a disability or additional support needs. The scale could provide educators and researchers with a valuable tool to guide evidence-based practice and theory in inclusive education.

How Do You Treat Trigeminal Neuralgia in Your Practice?

How Do You Treat Trigeminal Neuralgia in Your Practice?

Distribution of congenital anomals in children, risk factors

In world congenital anomalies are serious medical and social problem. They doubled over last decade 20th century and played significant role in the structure pathology and mortality in the infant, perinatal and children. Now time is 1800 out of 10,000 children born with congenital anomalies. Through progress made in our country in the future reform health system strengthening and the protection of the health children, congenital abnormalities play leading role in the structure morbidity disability and mortality. Reasons development of 40-60% anomalies is unknown. Apply the term "sporadic the defect of birth", meaning unknown cause, accidental appearance and low risk re appearance have future children. For 20-25% of anomalies more likely "multi-factor" reason - complex interaction many small genetic defects and risk factors environmental environment. The rest 10-13% of anomalies associated with the influence environment. Only 12-25% of anomalies have purely genetic causes (Akhmadalieva et al., 2020). Statistics shows disproportionate a high proportion of the total number survivors newborns premature children who suffer physical, intellectual and emotional disability.

Are you listening? Parental protective factors and early onset drinking among students with disabilities in Delaware

BackgroundLittle is known about substance use disorder risk among youth with disabilities. The Delaware YRBS collects data on substance use and disability indicators. Data suggest that students with disabilities have a younger average age of onset for alcohol use, and therefore may be more at risk for developing an alcohol use disorder later in life. ObjectiveTo explore the relationship between parental listening and the age of substance use initiation among students with disabilities. MethodsUsing the 2017 Delaware High School YRBS, we conducted a logistic regression analysis to test whether there was a relationship between parental listening and early onset alcohol use among students with disabilities. Early onset drinking was operationalized as first drink at age 14 or younger, and sex, race, mother's highest level of education, and LGBTQ status were included in the model as demographic control variables. ResultsBoth disability status and parental listening were statistically significant predictors of early onset alcohol use. Having an emotional or learning disability was positively associated with self-reported alcohol use before the age of 15, while reporting that parents always or almost always listened to them was negatively associated with student alcohol use prior to 15. ConclusionsFindings suggested a relationship between parental listening and early onset alcohol use among high school students with and without disabilities. This did not fully explain the disparity in rates of early onset use among students with disabilities. The authors suggest additional analysis of other potential protective factors and emphasize the need for robust national data collection on disabilities.

A pilot pathway for people living with persistent widespread pain and fibromyalgia: Individualised assessment, care planning and stratified rehabilitation options

Keyword: Fibromyalgia Purpose: NHS Forth Valley does not have a pathway for patients with persistent widespread pain and fibromyalgia (FM). People with FM are often diagnosed and discharged by Rheumatology, as it is not an inflammatory condition. However, FM is characterised by emotional distress and/or functional disability and people often struggle to self manage due to lack of support, understanding and validation (Toye et al., 2021). The NICE (2021) and SIGN (2013) guidelines for chronic pain highlight the importance of a biopsychosocial assessment and individualised care plans that promote self-management. Pain Management Physiotherapy currently provides this; however, there is limited capacity (1.4WTE). People perceived to be coping by Consultants were often discharged with advice. The aim of this project was to address gaps and inefficiencies identified by people with FM and clinicians, through a comprehensive biopsychosocial assessment and care plan, with stratified options, including a physiotherapy-led group. Methods: A tool was developed by Pain Management and Rheumatology for GPs to help them with identification and diagnosis of FM in the community. Prior to this, people were referred to secondary care services for diagnosis. We reviewed 7 patient journeys within the Pain Management and Rheumatology caseloads. Patient feedback was collated to identify what improvements would be valued. We pragmatically developed a four session physio-led group using existing Pain Management Programme materials. Each patient was referred by a cnsulatant and assessed by a physiotherapist prior to commencing the group. Content of the group included understanding FM and the impact on people's lives. The project is currently staffed within current job plans. It is delivered via MS Teams, due to COVID 19 restrictions. A qualitative survey was completed by participants in the group. Results: Following a review of pathways for patients with FM in NHS Forth Valley, we identified inequities in patients’ healthcare experiences. As there are limited biomedical treatment options for people with FM, discussions with clinicians in Rheumatology, GPs and patients, identified that support to develop self management skills is needed. The feedback suggested that group sessions normalise symptoms, reduce isolation and stigma, validate experience and increases the access to an intervention that promotes recovery and behaviour change. Participants valued the discussion and reflection in the group format. They reported making meaningful changes to their lives. “I got more than I expected from the group” [P3] The facilitators “are very knowledgable and understanding” [P5] Conclusion(s): This pilot demonstrates that even when perceived to be functioning well, the validation, deeper understanding of their condition and guidance on how to move forward was valued by people living with FM. The physiotherapy-led group is an efficient and person-centred way to support this population. Efficacy data will continue to be collected. Impact: This project is part of a larger redesign project to equitably meet the needs of people living with FM. The physiotherapy-led group offers more options for people diagnosed with FM to learn how to self manage their persistent pain condition. The next phase of the project will involve collaboration with the Rheumatology Service to develop the pathway further. Funding acknowledgements: This project was not funded.

Effect of a Craniosacral Therapy Protocol in People with Migraine: A Randomized Controlled Trial.

Background: Migraine is a common neurological disorder, and it is the second leading cause of disability worldwide. Manual techniques based on physical therapy have been proposed to improve migraine aspects; however, further research is needed on their effectiveness. The aim of this study was to evaluate the effectiveness of a craniosacral therapy protocol on different features in migraine patients. Methods: Fifty individuals with migraine were randomly divided into two groups (n = 25 per group): (i) craniosacral therapy group (CTG), following a craniosacral therapy protocol, and (ii) sham control group (SCG), with a sham treatment. The analyzed variables were pain, migraine severity and frequency of episodes, functional, emotional, and overall disability, medication intake, and self-reported perceived changes, at baseline, after a 4 week intervention, and at 8 week follow-up. Results: After the intervention, the CTG significantly reduced pain (p = 0.01), frequency of episodes (p = 0.001), functional (p = 0.001) and overall disability (p = 0.02), and medication intake (p = 0.01), as well as led to a significantly higher self-reported perception of change (p = 0.01), when compared to SCG. In addition, the results were maintained at follow-up evaluation in all variables. Conclusions: A protocol based on craniosacral therapy is effective in improving pain, frequency of episodes, functional and overall disability, and medication intake in migraineurs. This protocol may be considered as a therapeutic approach in migraine patients.

Generalised anxiety and panic symptoms in the German National Cohort (NAKO)

Objectives Anxiety disorders (AD) are common in the general population, leading to high emotional distress and disability. The German National Cohort (NAKO) is a population-based mega-cohort study, examining participants in 16 German regions. The present study includes data of the first 101,667 participants and investigates the frequency and severity of generalised anxiety symptoms and panic attacks (PA). Methods The Generalised Anxiety Disorder Symptoms Scale (GAD-7) and the first part of the Patient Health Questionnaire Panic Disorder (PHQ-PD) were filled out by NAKO participants (93,002). We examined the correlation of GAD-7 and PHQ-PD with demographic variables, stress (PHQ-Stress), depression (PHQ-9) and childhood trauma (CTS). Results The total proportion of prior lifetime diagnoses of AD in the NAKO cohort reached 7.8%. Panic attacks were reported by 6.0% and possible/probable current GAD symptoms in 5.2% of the examined participants. Higher anxiety severity was associated with female sex, lower education level, German as a foreign language and younger age as well as high perceived stress and depression. Conclusions Clinically relevant GAD symptoms as well as panic attacks are frequent in the NAKO and are associated with sociodemographic factors, and high anxiety symptoms are accompanied by pronounced stress and depression levels.

Differential risks: How disability shapes risk in the transition to adulthood for youth who age out of foster care

ObjectiveThis study examines how disability is associated with risk during the transition to adulthood for youth who age out of foster care and considers how experiences in the child welfare system contribute to these associations. BackgroundThe transition to adulthood is important for later socioeconomic standing, health, and wellbeing. Youth who age out of foster care with disabilities may require a high level of support during this transition yet may lack support. MethodThis study employs linear probability models to estimate the association between disability and incarceration, homelessness, childbearing, and substance abuse between ages 17 and 21 using linked administrative data from the National Data Archive on Child Abuse and Neglect (N = 5,221). ResultsHaving a physical or sensory disability is associated with lower risk in the transition to adulthood. Alternatively, having an emotional or mental related disability is associated with increased risk of incarceration and homelessness, but the association with homelessness is accounted for by child welfare experiences. ConclusionDue to the importance of foster care and child protective histories in explaining some risky outcomes for youth with emotional and mental disabilities, policy makers and practitioners should include those early stages of care when seeking it improve outcomes in the transition to adulthood for youth with disabilities who age out of foster care.

Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers.

After breast surgery, women frequently develop chronic post-mastectomy pain (PMP). PMP refers to the occurrence of pain in and around the area of the mastectomy lasting beyond three months after surgery. The nature of factors leading to PMP is not well known. When PMP is refractory to analgesic treatment, it negatively impacts the lives of patients, increasing emotional stress and disability. For this reason, optimizing the quality of life of patients treated for this pathology has gained more importance. On the basis of the findings and opinions above, we present an overview of risk factors and predictors to be used as potential biomarkers in the personalized management of individual PMP. For this overview, we discuss scientific articles published in peer-reviewed journals written in the English language describing risk factors, predictors, and potential biomarkers associated with chronic pain after breast surgery. Our overview confirms that the identification of women at risk for PMP is fundamental to setting up the best treatment to prevent this outcome. Clinical practice can be planned through the interpretation of genotyping data, choosing drugs, and tailoring doses for each patient with the aim to provide safer and more effective individual analgesic treatment.

Cognitive Change and Relaxation as Key Mechanisms of Treatment Outcome in Chronic Pain: Evidence From Routine Care.

Despite effective treatment approaches within the cognitive behavioral framework general treatment effects for chronic pain are rather small to very small. Translation from efficacy trials to naturalistic settings is questionable. There is an urgent need to improve the effectiveness of well-established treatments, such as cognitive-behavior therapy (CBT) and the investigation of mechanisms of change is a promising opportunity. We performed secondary data analysis from routine data of 1,440 chronic pain patients. Patients received CBT in a multidisciplinary setting in two inpatient clinics. Effect sizes and reliable change indices were computed for pain-related disability and depression. The associations between changes in the use of different pain coping skills (cognitive restructuring, activity despite pain, relaxation techniques and mental distraction) and changes in clinical outcomes were analyzed in structural equation models. Pre–post effect sizes range from g = 0.47 (disability) to g = 0.89 (depression). Changes in the use of cognitive restructuring, relaxation and to a lesser degree mental distraction were associated with changes in disability and depression. Effects from randomized trials can be translated to naturalistic settings. The results complement experimental research on mechanisms of change in the treatment of chronic pain and indicate an important role of cognitive change and relaxation as mechanisms of change. Our findings cautiously suggest that clinicians should optimize these processes in chronic pain patients to reduce their physical and emotional disability.

A Latent Class Analysis of Health-Related Quality of Life in Korean Older Adults

The present study aimed to confirm latent classes in health-related quality of life (HRQOL) in older adults and investigate the characteristics of participants in each class. It aimed to provide basic data to develop interventions for each quality-of-life class by analysing the predictors of each class. Secondary data from a community health survey in G province since 2019 found a total of 41,872 participants. Of them, 9027 were 65 years or older and residing in G Province in 2019, participated in this study. Mplus 8.5 was used to conduct a latent class analysis of five domains of HRQOL. Four latent classes in the HRQOL of older adults, namely, stable type, physical disability type, emotional disability type, and crisis type were found. Certain variables predicted these classes. Based on the findings of the present study, training on functional mobility and balance to prevent falls in older populations and individualised programmes to promote mental health in them should be provided. Moreover, policies should increase medical accessibility and provide social support for older people with low-incomes. Additionally, since physical, psychological, and social health in older adults are inter-connected, a comprehensive care plan is needed to improve their HRQOL.

AFTERMATHS OF INFIDELITY AS EXPRESSED BY LITERATE WORKING CLASS WOMEN IN LAGOS STATE, NIGERIA

Background and Purpose: Globally, many married adults engage in infidelity. However, the repercussions of the act appear not palatable for couples, their children and the society at large. This study therefore, investigated the aftermaths of infidelity as expressed by literate working class women in Lagos State. The study also examined whether age and type of marriage would affect the respondents’ views.
 
 Methodology: The descriptive design was adopted for this study. A total of 300 literate working class women were drawn from the target population using purposive and simple random sampling techniques. A researcher-developed questionnaire tagged Aftermaths of Infidelity (AIQ) was used to collect data. The instrument was validated by five experts in Nigeria and Nusantara while its reliability was established through test re-test reliability method and a coefficient of 0.74 was gotten. The data collected were analyzed using t-test and Analysis of Variance (ANOVA) at 0.05 level.
 
 Findings: Results showed that divorce, unhappiness, contact of sexually transmitted diseases, emotional disability, hatred in the family, unwanted pregnancy, distrust and suspicion in the family, psychological trauma in children, and giving birth to illegitimate children are some of the aftermaths of infidelity as expressed by the literate working class women. Similarly, age and marriage type did not influence the expression of literate working class women in Lagos State on infidelity.
 
 Contributions: Infidelity has devastating aftermaths. Counsellors should enlighten couples on the aftermaths of infidelity; they should enlighten them on the negative effects which infidelity has on the home, children and the society in general.
 
 Keywords: Aftermath, infidelity, literate working class women, Lagos State, Nigeria.
 
 Cite as: Odebode, A. A., James, J. F., Adegunju, K. A., & Julia, J. (2021). Aftermaths of infidelity as expressed by literate working class women in Lagos State, Nigeria. Journal of Nusantara Studies, 6(2), 41-57. http://dx.doi.org/10.24200/jonus.vol6iss2pp41-57

Reconsideration of the nomenclature and disease definition of burning mouth syndrome: an international Delphi survey

<h3>Objectives</h3> We sought to determine whether the nomenclature, disease definition, and diagnostic criteria for burning mouth syndrome (BMS) should be revised on the basis of expert agreement using the Delphi method of consensus. <h3>Methods</h3> An international group of 30 BMS experts was invited to participate (April 2019). The study consisted of 3 iterative survey rounds, and findings were presented and participant feedback obtained in a fourth round. Qualtrics^XM survey software (Qualtrics, Provo, UT) was used to create an electronic self-administered questionnaire. The first survey included closed-ended and open-ended questions intended to generate suggested changes and gauge each participant's agreement (predefined as 70% in agreement) with the existing International Classification of Diseases, 11th Revision (ICD-11), nomenclature, diagnostic criteria, and disease definition for BMS. Subsequent rounds summarized and presented data from the previous round. Round 2 presented suggested changes and asked if participants agreed or disagreed (dichotomous variable); open-ended questions were for additional changes, comments, and rationales for their selections. Round 3 presented items that met with >50% but <70% agreement and new items that were suggested. Data were summarized using both quantitative (percentage agreement) and qualitative methods (thematic coding). This study was determined to be exempt by the Case Western Reserve University Institutional Review Board (20190366). <h3>Results</h3> Thirty screening e-mails were sent to international experts in BMS, and 22 expressed interest in participating. Nineteen experts completed round 1, 17 completed round 2, and 15 completed round 3 for 86%, 89%, and 88% response rates, respectively. Consensus was reached that BMS should not be classified as a syndrome (15 of 17) and that it should be renamed (15 of 19) "burning mouth disorder." Consensus included that the following should be removed from the diagnostic criteria: (1) emotional distress or functional disability and (2) the number of hours per day that symptoms occur. All other items that reached consensus clarified the disease definition and diagnostic criteria, including delineating the local and systemic causes of oral burning that should be evaluated before diagnosis. <h3>Conclusions</h3> International consensus among selected experts indicated that the proposed ICD-11 nomenclature, disease definition, and diagnostic criteria can be improved and clarified.

Consensus agreement to rename burning mouth syndrome and improve International Classification of Diseases-11 disease criteria: an international Delphi study.

The International Classification of Diseases (ICD-11) proposes revisions in the nomenclature, disease definition, and diagnostic criteria for "burning mouth syndrome" (BMS). This process could benefit from additional systematically collected expert input. Thus, the purpose of this study was to use the Delphi method to (1) determine whether revision in nomenclature and alternative names for "BMS" are warranted and (2) identify areas of consensus among experts for changes to the disease description and proposed diagnostic criteria of "BMS," as described in the ICD-11 (World Health Organization). From 31 international invited experts, 23 who expressed interest were sent the survey. The study used 4 iterative surveys, each with a response rate of ≥82%. Consensus was predefined as 70% of participants in agreement. Data were summarized using both descriptive statistics and qualitative thematic analysis. Consensus indicated that BMS should not be classified as a syndrome and recommended instead renaming to "burning mouth disorder." Consensus included deletion of 2 diagnostic criteria: (1) emotional distress or functional disability and (2) the number of hours symptoms occur per day. Additional items that reached consensus clarified the disease definition and proposed more separate diagnostic criteria, including a list of local and systemic factors to evaluate as potential secondary causes of oral burning. Experts in this study recommended and came to consensus on select revisions to the proposed ICD-11 BMS nomenclature, diagnostic criteria, and disease definition. The revisions recommended have the potential to improve clarity, consistency, and accuracy of diagnosis for this disorder.

Characteristics of Patients Returning to Work After Brain Tumor Surgery

Objective: To investigate the differences between patients returning to work and those who did not after brain tumor surgery.Methods: Patients were evaluated before surgery and after 3 months. The Montreal Cognitive Assessment test, Trail-Making Test (parts A and B), 15-word Rey–Osterrieth Word List (immediate and delayed recall), F-A-S tests, and Karnosfky Performance Status were used to assess cognitive status, attention, executive functions, memory, word fluency, and functional status. Patient-reported outcome measures (PROMs) used to evaluate emotional distress and disability were the Hospital Anxiety and Depression Scale and World Health Organization Disability Assessment Schedule. Clinical and work-related variables, PROMs, and cognitive tests were compared using chi-squared, t-test or Mann–Whitney U test.Results: Sixty patients were included. Patients returning to work were 61.3 and 31.0% among people with meningioma and glioma, respectively. They reported lower postoperative disability and lesser home-to-work travel time. Patients with meningioma also showed better preoperative and postoperative attention and executive functions, better postoperative functional and cognitive status, and lower frequency of treatments.Conclusions: These variables should be considered in a clinical context to plan interventions for people who need support during return to work and in future research to investigate preoperative and postoperative predictive factors of going back to work.

¿Crisis del presidencialismo o crisis de la presidencia? El liderazgo presidencial de Sebastián Piñera

El presente artículo analiza el liderazgo del Presidente Sebastián Piñera a lo largo del “estallido social” y sus consecuencias en el proceso político durante su segundo gobierno. La tesis guía es que el liderazgo presidencial es una variable indispensable para comprender el presidencialismo y la presidencia, en este caso de Sebastián Piñera. Nuestro punto de partida es que Piñera posee un liderazgo pobre según la definición de Helms, al no reunir las habilidades requeridas para ser un presidente efectivo, especialmente en su débil inteligencia emocional, que llegó a ser una discapacidad emocional de acuerdo a la definición de Greenstein. Estas debilidades del liderazgo están influidas por su experiencia como hombre de negocios y su inexperiencia política.

Hyperconnection and hyperperfusion of overlapping brain regions in patients with menstrual-related migraine: a multimodal neuroimaging study.

Menstrual-related migraine (MRM) results in moderate to severe intensity headaches accompanied by physical and emotional disability over time in women. Neuroimaging methodologies have advanced our understanding of migraine; however, the neural mechanisms of MRM are not clearly understood. In this study, fourteen MRM patients in the interictal phase and fifteen age- and education-matched healthy control females were recruited. Resting-state functional magnetic resonance imaging (fMRI) and pulsed arterial spin labeling (PASL) MRI were collected for both the subject groups outside of their menstrual periods. Eigenvector centrality mapping (ECM) was performed on resting-state fMRI, and the relative cerebral blood flow (relCBF) was assessed using PASL-MRI. MRM patients showed a significantly increased eigenvector centrality in the right medial frontal gyrus compared to healthy controls. Seed-based ECM analysis revealed that increased centrality was associated with the right medial frontal gyrus's hyperconnectivity with the left insula and the right supplementary motor area. The perfusion MRI revealed significantly increased relCBF in the hyperconnected regions. Furthermore, the hyperconnection positively correlated with the attack frequency, while the hyperperfusion showed a positive correlation with the disease duration. The results suggest that menstrual-related migraine is associated with cerebral hyperconnection and hyperperfusion in critical pain-processing brain regions. Furthermore, this elevated cerebral activity is correlated with different aspects of functional impairment in MRM patients suggesting that perfusion analysis, along with whole-brain connectivity analysis, can provide a comprehensive understanding of neural mechanisms of MRM.

“Imperfect Love”: The Effect of Borderline Personality Disorder Symptoms and Relationship Commitment on Relationship Satisfaction

This study aimed to determine the connection between borderline personality disorder (BPD) symptom-endorsement and relationship satisfaction. Individuals in romantic relationships often report higher levels of overall life satisfaction and functioning. However, the experience of emotional distress or disability may impair one’s ability to benefit from the protective effects of a romantic dyad. Therefore, understanding the impact that individual mental health may have on perceptions of satisfaction in romantic relationships may be of importance. Additionally, the role that relationship type, such as committed vs. non-committed relationships, can have on assessments of satisfaction for individuals who experience BPD symptoms is of interest. 433 participants self-reported their experiences with BPD symptoms using the Borderline Symptoms List 23 [1] and relationship type (committed vs. non-committed). The Relationship Satisfaction Assessment [2]was completed to determine individuals’ happiness and fulfillment within their interpersonal relationships. Findings indicated that endorsement of BPD symptoms had a significant negative association with self-reported relationship satisfaction. Relationship type was also a significant indicator of relationship satisfaction. Thus, those in committed relationships reported higher levels of overall satisfaction than those in non-committed relationships. This research suggests that both the experience of certain mental health issues and commitment to a relationship may determine overall feelings of fulfillment in romantic relationships. Additional research is necessary to replicate and explore the impact of this association.

Bilateral gestational gigantomastia.

Gestational gigantomastia is a rare disease characterized by diffuse, extreme, and incapacitating enlargement of one or both breasts during pregnancy. Although benign, it can lead to a great social, emotional, and physical disability. A good and complete knowledge regarding this rare but distressing clinical situation is a must among all practicing physicians especially obstetricians. We report the case of a 30-year-old woman, admitted for a bilateral massive hypertrophy of the breast occurring on pregnancy and with progressive evolution. She had four pregnancies and two born-infants. Biological exams have shown a hyperprolactinemia. Pathological exam of the mammary biopsy had shown a benign hyperplasia. Medical treatment of our patient by bromocriptin was inefficient. She has had a bilateral mastectomy. Physiological enlargement of the breasts occurs at puberty and during pregnancy. It is known as gestational gigantomastia when enlargement in pregnancy becomes excessive, uncomfortable and embarrassing. Gestational gigantomastia may have far reaching effects for the mother and fetus. This rare condition is associated with considerable morbidity but may be associated with good fetal outcome. Multidisciplinary team effort in the form of obstetrician, plastic surgeon and anesthetist, and pediatrician is required for a successful fetomaternal outcome.