bluuebunny/crossref_metadata_2025 huggingface dataset:
Comorbidity of Pain and Psychoaffective Diseases — an Update
Authors: Sommer Claudia
Published: June 2010

Objectives

To give an update on current knowledge about the comorbidity of pain and psychoaffective diseases

Methods

Literature search (MEDLINE, PsycINFO, SCOPUS), summary of recent own data

Results

Epidemiological studies report a mean prevalence rate of major depressive disorder in patients with chronic pain assessed in pain clinics of 52%, and a mean prevalence of pain in depressed patients of 65%. Patients with the fibromyalgia syndrome are 4.3 times more likely than healthy control subjects to develop major depressive disorder and 4.7 times more likely to develop an anxiety disorder. The prevalence of anxiety disorders in patients with chronic arthritic pain is elevated relative to the general population (35 vs. 17%). Similar numbers have been reported for migraine and chronic back pain. Many biological factors overlap in patients with depression, chronic pain, and the fibromyalgia syndrome. For example, both patients with depression and patients with chronic pain often have cytokine profiles shifted toware the pro-inflammatory side. The downregulation of the neurotrophic factor brain-derived neurotrophic factor (BDNF) is another common finding in pain and depression. Common genetic determinants have been described.

Conclusions

There is a high comorbidity between pain, depression, and anxiety. The causative connection between these disorders remains to be elucidated. A common biological basis has been hypothesized.
Clinical Effectiveness of Psychotropic Drugs: Pharmacokinetic and Pharmacogenetic Determinants
Authors: Baumann P.
Published: June 2010

As nowadays, the introduction of novel psychotropic drugs is a relatively rare event, the use of those presently available should be optimised in order to increase their efficiency. Ideally, medication should be personalized, in order to obtain a maximal efficacy and minimal risks for adverse effects. Knowledge about the neurobiological basis of the major psychoses and the biological consequences of pharmacological treatments has dramatically increased. This situation has prompted the development of tests in patients, to be carried out at baseline and during the treatment, in the aim to improve the diagnosis of the underlying disease, to select the optimal treatment and to monitor the clinical evolution of the patient. These tests are available both on the pharmacodynamic and on the pharmacokinetic level: (1) analysis of neurotransmitters (biogenic amines, neuropeptides, hormones) in blood or CSF; (2) pharmacogenetic tests at the pharmacodynamic (receptor proteins, neurotransmitter transporter proteins) and the pharmacokinetic (drug metabolising enzymes (e.g. cytochrome P-450), drug transporter proteins (e.g. P-glycoprotein)) levels; 3) monitoring techniques (drug receptor binding in the brain using imaging techniques, therapeutic drug monitoring in the blood, phenotyping for metabolising enzymes). There is much evidence about the usefulness of these techniques for diagnostic and monitoring purposes, but also about their limits in the clinical context and in their performance regarding sensitivity and specificity. In particular, there is a lack of studies, which combine pharmacodynamic and pharmacokinetic tests. The present state of research suggests that tests in relationship with the pharmacokinetic behaviour of a drug are useful tools to personalise drug treatment.
Coercive Measures in Europe
Authors: Raboch Jiri
Published: June 2010

Coercive treatment in European inpatient psychiatric facilities remains to be used in daily practice with high variety of its frequency, type and legal background. Use of coercive measures is sometimes sharply criticized by various bodies. It was proclaimed that these procedures are regarded as signaling failures in care. Others are of that opinion, that even if elimination of restraint and seclusion should be a goal, it may be difficult to accomplish it if we endeavor to treat individuals with acute psychosis who have a history of violence and whose recent violent behavior led to hospitalization.

In last decade in many countries several programs minimizing use of coercive measure during psychiatric treatment were launched and published to be successful. However, the ideal of avoiding all coercive measures in facilities hospitalizing all acute patients from defined catchment area seems to be an unrealistic goal for the time being. Country socio-cultural traditions as well as treatment habits in individual psychiatric facilities play decisive role in this very sensitive area. Future research projects should identify those factors in legislation and clinical practice that could be specifically relevant for achieving more constructive cooperation of all engaged parties. But even at present time it is necessary to introduce programs and practice guidelines that would rationalize and minimize use of coercive measures in psychiatric facilities. In any case, patient’s rights should be granted and interventions be provided according to the principle of the “least restrictive alternative”.
FC02-03 - Suicide attempt and family-environmental factors in adolescence: advocacy for family centered interventions
Authors: Roustit C. , Chauvin P.
Published: June 2010

Introduction

Suicidal behavior in adolescence is now well documented with regard to biological and psychological traits, family-environmental factors, and clinical management. In despite of this knowledge, few interventions are based on family therapy.

Objectives

To examine the association between suicide attempt in the adolescent population in Quebec and family constellation with regard to family structure and family functioning adjusted for socio-economic factors.

Methods

Data: Social and Health Survey of Children and Adolescents in Quebec State performed in 1999 (Institut de la Statistique du Québec, Canada). Subjects: 1186 adolescents aged 13 years and 1160 adolescents aged 16, and their parents. Outcome: suicide attempt during lifetime. Independant variables: family structure, witnessing interparental violence and parental emotional support. Covariates: family socioeconomic background and demographic variables.

Statistics: logistic regression analysis.

Results

81 adolescents reported one suicide attempt or more during lifetime, with a significant risk for girls but this risk was independant of age and ethnicity. The adolescents had a 2.5-fold higher risk of suicide attempt when they live in monoparental household (OR=2.46; 95% CI=[1.37-4.42]), a 3.8-fold higher risk when they witnessed interparental violence (OR=3.76; 95% CI=[2.10-6.74], and a 2 to 6-fold higher risk when parental support is low, particularly paternal support. These associations are not modified by familial socioeconomic status.

Conclusions

These results are concordant with family stress perspective in the un derstanding of suicidal beahvior in adolescents, and this independently of familial socio-economic deprivation. They give arguments for family centered therapy in the panel of interventions in health promotion in adolescence.
FC02-04 - Co-Morbidity and Mortality in Alzheimer's Disease: a Seven Year Follow-Up
Authors: Heun R. , Potluri R. , Natalwala A. , Malik A.
Published: June 2010

Objectives

Neurodegeneration and cognitive deficits may influence the pattern of co-morbid disorders and their possible effects on mortality in late-onset Alzheimer's disease (AD). However, subjects with AD have to live long enough to experience and be diagnosed with dementia. We investigated whether the pattern of co-morbidity and its relevance for later death differed between hospitalised AD and elderly controls subjects.

Methods

Diseases with a prevalence of more than 1% were compared between 634 hospitalised AD and 72244 control subjects aged above 70 years referred to the University of Birmimgham NHS Trust. Predictors of mortality within the seven year follow-up were identified using regression regression analyses. Confidence intervals of relative risks were used to compare the relevance of risk factors for later mortality between groups.

Results

Subjects with AD suffer more infections, brain diseases and neck of femur fractures than other hospitalised elderly patients. In contrast, cardiovascular diseases and diabetes mellitus were less prevalent in AD subjects in comparison with hospitalised controls. Diseases that might contribute to later mortality in AD were pneumonia, ischemic heart disease and gastroenteritis, but there were no significant differences in their impact on mortality compared to other hospitalised elderly control subjects.

Conclusions

Patients with Alzheimer's disease have a different pattern of co-morbidity, but die from the same diseases as other hospitalised patients. Infections including pneumonia, and diseases that may occur secondary to neurodegeneration and confusion may need special attention in patients with Alzheimer disease who might not be able to identify or report the early symptoms.
FC02-06 - Gender Differences on the Knowledge Attitude and Beliefs Towards Mental Health Illness in a Very Rapid Developing Society
Authors: Bener A.
Published: June 2010

Aim

The aim of this study was to determine the gender differences in knowledge, attitudes and practices toward Mental Illness in a sample of Qatari and other Arab expatriates residing in the State of Qatar.

Design

This is a cross sectional survey.Setting: Primary Health Care Centers.

Subjects

A multistage sampling design was used and a representative sample of 3300 Qatari and other Arab expatriates above 20 years of age were surveyed. Of the study sample of 3300, 2514 subjects (76.2%) expressed their consent.

Methods

Face to face interviews were based on this questionnaire that included variables on socio-demographic characteristics, knowledge, attitude and practice toward mental illness.

Results

Of the study sample, 49.2% were men and 50.8% were women. More women than men believed that mental illness is due to possession by evil spirits (43.5% vs 34.5%; p< 0.001). Also, less than half of the studied women (42.3%) thought traditional healers can treat mental illness. Women were considering people with mental illness as dangerous (58.1%), compared to men (51.5%) (p=0.001). More than women (76.8%), men (82%) were willing to visit a psychiatrist for their emotional problems (p=0.002), while more women (43.7%) preferred a traditional healer (p< 0.001). Women were more afraid to talk to mentally ill (39.5%) than men (28.8%) (p< 0.001). 24.8% of women and 31.1% of men identified schizophrenia as a common mental disorder.

Conclusion

The knowledge of women towards mental illness was poor. Most of the women were afraid and not willing to keep friendship with the mentally ill.
FC03-02 - Deep Brain Stimulation of the Nucleus Accumbens in Treatment Resistant Alcohol Addiction - a Novel Treatment Option?
Authors: Mueller U. , Voges J. , Galazky I. , Heldmann M. , Heinze H.-J. , Sturm V. , Bogerts B.
Published: June 2010

Introduction

Treatment of alcohol addiction remains challenging, since only half of all patients achieve long-term abstinence by currently available therapies.

Objective

In the last 2 years, there have been promising reports on deep brain stimulation (DBS) of NAc in addiction (animal models, one case report of a patient with severe anxiety disorder and secondary addiction). Our group treated 5 patients with treatment resistant alcohol addiction with DBS so far. Our initial data of the first 3 patients has just been published. However, these very positive results arise from a continuous open stimulation and have not been placebo controlled.

Aims

To assess the impact of discontinuation of bilateral DBS of the NAc on craving for alcohol in patients whose addiction remitted after initiation of DBS.

Methods

Crossover, double-blinded phase of 2 × 4 weeks with sham-stimulation in one and stimulation in the other 4 weeks.

Results

Until now, one patient finished the 8 weeks of study (remaining patients will finish experiment in December 2009). In this patient, stimulation was continued in the first and stopped in the latter 4 weeks. While he experienced no changes or side effects in the first part, he showed a massive craving for alcohol one day after discontinuation, which again remitted when the experiment was stopped and the stimulator was turned on again after 3 days.

Conclusions

DBS of NAc seems to selectively alleviate craving for alcohol thus enabling patients to remain abstinent. These results justify clinical studies in larger samples of patients with treatment resistant alcohol addiction.
YSFC01-02 - Preliminary Validation of the Arabic Version of the Behavioral and Emotional Rating Scale
Authors: Almutairi H.
Published: June 2010

In correspondence to the call for moving beyond symptoms reduction to helping children reach their potentials, Epstein and Sharma (1998) have developed the Behavioral and Emotional Rating Scale (BERS), consisting OF 52 items, taping several area of strengths.

This study attempted to ascertain the factor structure as well as the psychometric properties of this instrument in a non-western country, namely, the State of Kuwait.

A stratified probability sample was drawn from private and public schools in all counties. A trained coordinators administered the Arabic versions of BERS- parent form (the scale under investigation) and the Strengths and Difficulties Questionnaire (SDQ), developed by Goodman (1997).

Results were encouraging and speak to the sound psychometric properties of the Arabic version of BERS. With respect reliability, the overall reliability was excellent (Alpha= .903). By retaining items with factor loading of .50 and above, 28 items were retained with a factorial structure consisting of six components, partially different from the original five-factor solution. Coefficients pertaining to CFA, namely, RMR and GFI indicated a good model fit. Finally, the total strength index of BERS correlated significantly with SDQ and its subscales.

Unlike the original form, the resultant 28-item scale is more consistent with recent calls for use of shorter form of scales (Rapid Assessment Instruments, RAI). The six areas of strengths are very conducive in terms of planning interventions and evaluating outcomes. Differences in the extracted latent variables in both versions will be discussed from theoretical as well as cultural points of view.
YSFC01-03 - Young Patients Admitted to an Italian Acute Psychiatry Unit: a Case-Control Study
Authors: Bonafede R. , Tomassi S. , Moretti F. , Pedrini E. , De Ronchi D. , Atti A.R.
Published: June 2010

Objectives

To describe the main features of the younger group of patients hospitalized (January 1st and December 31st) in the Acute Psychiatry Unit of a General Hospital in Bologna (Northern Italy), comparing their socio-demographic and clinical characteristics and their needs with those of the adult patients admitted.

Methods

Retrospective consultation of case-histories concerning 111 subjects (60.4% men) randomly selected. Chi-square and independent sample T-test used to compare 33 cases (≤21 years) and 78 controls (35-49 years).

Results

Young-cases had a higher prevalence of parental separation (31% vs 2.7%; p< 0.001) and were more frequently adopted (18.8% vs 0%; p=0.01). Psychomotor agitation or etero/self-aggressiveness (36.4%) and personality disorders (12.1%) were the most prevalent causes of hospitalization among the younger group, whereas psychosis (32.1%), mood disorders (19.2%) and alcohol-substances dependence (11.5%) were more common in controls (p< 0.001). Presence of unfavorable life-events was two-fold higher in cases than in controls (p=0.074). In particular, quarrels with family (40%) or friends (20%) and substance abuse (13.3%) occurred especially in young individuals. In adults, mournings/separations and rejection therapy were more frequent (p=0.017).

Hospitalization's features (type, length, number of laboratory and instrumental exams) were not significantly different among the two groups, except for frequency and number of interviews and childpsychiatrists and educators’ care provided that prevailed in cases.

Conclusions

The young population admitted in our acute psychiatric ward has a complex sociorelational and clinical situation requiring a multi-professional management. The frequent need of care in emergent/urgent situation highlights the importance of further studies on this issue.
YSFC01-05 - Risk Factors of Deliberate Self-Harm Behavior Among Psychiatric Hospitalized Adolescents
Authors: Butwicka A. , Lewandowska A. , Gmitrowicz A.
Published: June 2010

Objectives

To investigate the risk factors of self-harm behavior in Polish adolescents.

Methods

Patients hospitalized in Adolescent Psychiatric Clinic during a 4-year period were surveyed by attending psychiatrists. The survey contained categories such as: demographic data, familial, social and school problems, history of violent experience, and mental disorders. Stepwise logistic regression was used to evaluate predictors of self-harm behavior.

Results

Out of 611 (362 females and 249 males, mean age 16.1±1.5 years) adolescents who participated in the study, 261 (42.7%) patients admitted to deliberate self-harm behavior by having attempted suicide. Patients with a diagnosis of behavioral or emotional disorders were more prone to selfharm behavior (p< 0.001). Risk factors retained in the final regression model were: female gender, diagnosis of behavioral disorders, skipping classes, romantic disappointment, sexual abuse and family conflicts (table).

Conclusions

Acts of deliberate self-harm in adolescence are due to an accumulation of several factors. School-based programs focused on dealing with psychosocial stressors may be considered a feasible means of self-harm prevention.
PL02-01 - Neurobiology of Reward Systems: Relevance for Learning, Addiction and Psychosis
Authors: Heinz A.
Published: June 2010

Neurotransmitter systems such as dopamine and glutamate play a major role in encoding prediction errors and in learning of cue-triggered and goal-directed behaviour. Dysfunction of these neurotransmitter systems affect prefrontal-limbic neurocircuits and thus contribute to the formation of delusions, and to motivational and affective deficits. For example, reduced activation of the ventral striatum during reward anticipation has been associated with craving for drugs of abuse and with motivational deficits such as apathy, a so-called negative symptom in schizophrenia. Dopamine-dependent learning dysfunctions in alcohol dependence impairs learning of alternative, non substance-associated behaviour. On the other hand, aberrant activation during feedback of negative outcomes correlated with delusion formation in schizophrenic psychoses. Multimodal imaging studies implied glutamatergic and dopaminergic dysfunction to be associated with altered functional brain activation. Human genetic and imaging studies revealed that candidate genes, which affect monoamine metabolism, interact with neurotransmission and task-relevant activation in these brain areas; furthermore, first and second-generation neuroleptics differentially interact with functional brain activation in these neurocircuits. Together, these findings suggest that the combination of genetic and imaging studies may help to elucidate the neurobiologcial correlates of dysfunctional learning processes in psychosis and addiction and to identify new targets for behavioural and pharmacological interventions.
PL01-01 - Recent Developments in the Treatment of Alzheimer Disease
Authors: Hampel H.
Published: June 2010

Alzheimer's disease (AD) has significant global impact on the individual, ethical and socioeconomic level. Increased understanding of the underlying molecular mechanisms and pathology for AD has led to the development of new therapeutic strategies. Currently approved clinical treatments target the neurotransmitter dysbalances resulting from progressive synaptic disconnection and regional neuronal loss. Advances in the understanding of the amyloid metabolism, tau hyperphosphorylation and tangle formation in AD have gained center stage in current clinical development. These mechanistic aspects will be discussed in terms of their hypothesis-based therapeutic potential and clinical trials currently underway.We need to develop meaningful primary prevention and disease modifying therapies for AD. Matching increasing public awareness of the problem is the accelerated pace and number of compounds entering clinical trials. In addition, the development of biological markers, diagnostic tools and imaging modalities have improved dramatically. Unfortunately, the use of these scientific tools in clinical trial practice has not yet aligned and optimized. Most agents still target clinical endpoints rather than focus on modulation of the biological mechanisms and pathologies. This needs to be considered by the academic, industry and regulatory AD field and has already been achieved in more advanced areas of drug discovery and development, such as cardiology and oncology.
PL03-01 - Recent developments in the treatment of schizophrenia
Authors: Höschl C.
Published: June 2010

The classical antipsychotic drugs exert primarily antidopaminergic properties, which are responsible also for their side-effects such as hyperprolactinemia and extrapyramidal syndrome. Nevertheless, psychotogenic pathways in the brain involve several different mechanisms, which could serve as targets of antipsychotic modalities, e.g., facilitation of glutamatergic and cholinergic neurotransmission, blockade of serotonin 5-HT2 receptors, expression of BDNF and bcl2, inhibition of GSK-3β phosphorylation and thus apoptosis etc.[1] Recent naturalistic trials brought updated experience with regard to efficacy, effectiveness and side-effect profile of antipsychotics and the comparison of antipsychotics of the first and second generation. In addition, recent developments in the treatment of schizophrenia involved also psychoeducation[2] and so called ITAREPS (Information Technology Assisted Relapse Prevention in Schizophrenia)[3], which improve adherence to treatment and therefore decrease significantly the relapse rate.
P01-01 - What are the Newer Option for Treating Acute Bipolar Depression
Authors: Acharya A.
Published: June 2010

Introduction

Bipoler Depression in it's acute psase is a very distressing state for the suffering patient & a chalanging job for the Psychaitrist to treat to alliavete in a reasonable period of time.

In acute state Bipolar patients, mostly women in their middle age, moderately overweigted often presents with a crying state or even with potent suicidal ideation that continiue to go on inspite of treatment with pharmacological treatments.

Aims

Here is an attempt to search for a remedy to these set of patients.

Methods

72 acutely ill Bipolar depressed patient were assigned with 3 treatment regimens, after their diagnosis was confirmed on the criteria of DSM-4 TR.

There age group were 46 to58 years with a median age 52 years. There were 12 Ist episode depressive phase and 60 patients both male 24 & women 36 are recurent sufferers.The Study was conducted in the O.P.D patiends attending Calcutta Pavlov Hospital during 2008-09.

1st. group receive only Fluoxotine & olanzapin combination for 6 weeks.

2nd group recieve FLuox+Olanzapin +lithium carbonate in 900 mg/day dose.

3rd group recieve Lith. carobonate+Olz.+fluoxotine +Lamotrigine in 25-50mg/d.

The 1st group with a combo of olanzapin+Fluoxotine were the least responsive.

They were evaluated in the Psychologist table usinng ASPER-Montigegmy Depression rating scale.

Results

Allthe groups shows improvement in different items of the scale.

3rd group using a tripple drug Combo therapy do the best.

Conclusions

Is a poly combo drug therapy or E.C.T or +Psychotherapy combo a best answeer to these criticaly depressed BPD patients.
P01-06 - Bipolar Depression of the II type: Psychopathology, Therapy
Authors: Antokhin E. , Bardyurkina V. , Budza V. , Kryukova E. , Baldina O.
Published: June 2010

50 patients with difficult depressive episode without psychotic symptoms were examined: 25 in the structure of bipolar depression of the II type (BD), 25 recurrent depression (RD).

Methods

Clinico-psychopathological with the data verification to SCL-90-R, statistic - Mann-Whitney U-test, Spearmen Rank Order Correlations, Wilcoxon Matched Pairs test. Among patients BD, as opposed to the patients RD, the stronger direct correlation interconnection of “depression” and “somatization”, “obsessivness” is defined (r 0,62-0,81). Compared indications of depression level and basical “index of symptoms’ evidence” (p>0,05) in droups, the patients BD as opposed to the patients RD at p< 0,05 the indications of “anxiety” (2,08&1,67), “somatization” (1,97&1,68), “obsessivness” (1,76&1,4) are higher. These data may show the “residual manic equivalent” in the form of somatization, obsessivness symptoms in the structure of the BD depression, its atypical type and differential - diagnostic symptoms with depression in RD structure is identified. The effectiveness of hospital complex therapy of BD patients is estimated. During 56 days the patients got Seroquel therapy in a dose 150-600 mg/day, group behavioral therapy, sociotherapy. Up to the 10th day of the treatment the indications of “anxiety” (p< 0,05), “depression” (p< 0,05), up to 14th day “somatization” (p< 0,05), up to 21st day “obsessivness” (p< 0,05) were reduced. After hospital complex therapy patients got supporting Seroquel therapy in a dose 50-200 mg/day. In catamnesis in 6 months 11 patients were examined, their state was defined as “stably positive”. These data indicate that the complex therapy of bipolar depression of the II type patients, including Seroquel is effective.
P01-07 - Duloxetine-first Therapeutic Option for Depression with Pain
Authors: Baloescu A. , Vochescu C.
Published: June 2010

Objective

The purpose of this study was to evaluate the antidepressant duloxetine in depressive patients with pain.

Method

The sample: 28 patients (18 female and 10 male, mean age 53,85) were diagnosed with major depressive disorder (MDD) according to ICD 10. They were assessed with HAMD17 items in baseline and at 14, 28, 42, 56 days, CGIS at baseline, 28 and 56 days, CGII at 28 and 56 day.

Results

Patients received duloxetine (Cymbalta) 60-120 mg/day. All treated patients had a good evolution with a significant improvement on HAMD score. Total score HAMD 17 items was: baseline - 21,9; 14 days - 19,9; 28 days - 17,1; 42 days - 13,1; 56 days - 11,6. At item 13 -diffuse muscle aches in arms or legs the mean score was 1,65 at baseline, and 0,75 at 56 days. The evolution of CGIS was: mean 4,2 in baseline and 1,9 at 56 days. Significant improvement was noted at 56 days: 13/28 (46,42%) were much improved and 15/28 (53,58%) were very much improved. We noted mild nausea at 10 patients, mild restlessness at 7 patients, mild dizziness at 5 patients at the beginning of the treatment.

Conclusions

1)

Our results suggest that duloxetine is a safe and effective treatment for depression.

2)

The concomitant action for different aches is very important for depressive patients with pain.

3)

Coexistence of depression with physical pain negatively affects the performance in daily activity and quality of life; in such cases the first treatment option could be duloxetine.
P01-08 - Mania, Mania with Delirium and Delirious Mania
Authors: Barahona-Corrêa B. , Fernandes J. , Alves da Silva J. , Neto B. , Almeida J.
Published: June 2010

Since Bell's original description delirious mania (DM) has been repeatedly rediscovered and renamed, resulting in much confusion as to its meaning.Definitions range from mania with self-limited temporal-spatial disorientation to a fatal, delirious catatonic syndrome with euphoric mood, high fever and autonomic instability. Moreover, it remains unclear whether DM is a specific clinical entity or an unspecific, unpredictable complication of mania, and whether it is a useful diagnostic category.

Objective

To identify the frequency and clinical features of DM and mania with delirium.

Methods

We reviewed all admissions to our acute inpatient unit with mania, hypomania or mixed affective state, in 2006 and 2007. Cases with delirious features and cases with a working diagnosis of DM, were reviewed in detail. The three groups (no delirium, delirious features and DM) were compared for general demographic and clinical variables, as well as features specifically associated with DM (e.g., catatonia; nakedness; inappropriate toileting; unexplained fever, etc).

Results

We found 100 patients with mania, hippomania or mixed affective state. 14 had medically unexplained delirium, 4 of them with a final diagnosis of DM. DM cases (but not non-DM mania cases with delirious features) had extremely long durations of stay, acute onset, hypertermia, catatonia, autonomic instability, anarchic sleep, shouting/coprolalia, delirium persisting for over a week, and were more likely to receive ECT. Moreover, in three of them DM occurred in most manic/mixed affective episodes.

Conclusion

DM is a rare occurrence in bipolar disorder. It has typical clinical features and may be recurrent.
P01-09 - Antidepressant Monotherapy and Combination of Antidepressants in the Treatment of Resistant Depression in Current Clinical Practice. A Retrospective Study
Authors: Bares M. , Novak T. , Kopecek M. , Stopkova P.
Published: June 2010

Introduction and objectives

Resistant depression is a long-term, disabling illness. The aim of this study was to compare the efficacy of antidepressant monotherapy (ADM) and combinations of antidepressants (CAD) in the treatment of resistant patient (≥1 unsuccessful antidepressant treatment) in current clinical practice.

Methods

We reviewed chart documents of resistant patients hospitalized at Prague Psychiatric Center for major depressive disorder (DSM IV) and had finished at least 4 - weeks of treatment with ADM or CAD. Clinical status was assessed using MADRS, CGI and BDI-S at baseline, after 2 weeks and in the end of treatment in the framework of regular evaluation during the hospitalization. Response to treatment was defined as a reduction of MADRS score ≥ 50%.

Results: We analyzed 78 inpatients (CAD=27, ADM=51). Both groups were equal in baseline characteristics (number of previous treatments, severity of depression etc.) and in the length of index treatment. The CAD group was superior to ADM group in the MADRS score reduction (14.6 vs 10.2 pts, p=0.02) and the proportion of responders (67% vs. 39%, p=0.03) in the end of treatment. The post-hoc effect size of CAD compared to ADM was moderate (Cohen's d=0.54).

Conclusion: The results of this study suggest that combinations of antidepressants may be more effective than a monotherapy in patients with resistant depression.

This study was supported by a grants from Internal Grant Agency of Ministry of Health of Czech Republic No. NS 10368-3 and a grant from Ministry of Health of Czech Republic MZ0PCP2005.
P01-104 - Association between Obesity, Central Obesity and Depression in Greek type 2 Diabetic Patients
Authors: Tsirogianni E. , Kouniakis F. , Baltatzi M. , Lavrentiadis G. , Alevizos M.
Published: June 2010

Objectives

To estimate the association between obesity, central obesity and depression in a population sample of Greek type 2 diabetic patients.

Methods

A total of 200 patients with type 2 diabetes were enrolled in the study. They were stratified according to sex, obesity and central obesity (BMI≥30 Kgr/m2, waist>102cm in men and >88cm in women). Beck Depression Inventory II scale was used to establish the presence of a depressive disorder (DD).

Results

The frequency of DD among the whole population was 31.5% (34.6% for the female vs. 26% for the male patients, p=0.207). BMI was statistically significant increased in depressive diabetic patients compared to non depressive diabetics, in the total (p=0.003), in women (p=0.013), but not in men (p=0.200). In addition, DD rates were statistically significant increased in diabetic patients with central obesity compared to those without central obesity, in the total (p=0.011) and in men (p=0.014). In female diabetic patients, DD was not related to central obesity (p=0.489).

Conclusions

Our data support a strong association between type 2 diabetes and depression in Greek patients. A significant association between obesity and depression is also observed in type 2 diabetic patients. Increased BMI is strongly related to depressive type 2 diabetic women, while central obesity is more related to depressive type 2 diabetic men.
P01-11 - Serotonin Serves as a Maintenance Factor in adult Neural Stem Cells
Authors: Benninghoff J.
Published: June 2010

Here we studied serotonin (5-HT) as key regulator of adult neural stem cell (ANSC) proliferation, since 5-HT and drugs increasing 5-HT have been linked to increased neurogenesis in the dentate gyrus of the hippocampus. In our in-vitro model, we cultured neurospheres derived from mouse hippocampus in serum-free medium containing epidermal (EGF) and type-2 fibroblast growth factor (FGF2). Under the given conditions ANSC express both isoforms of tryptophane-hydroxylase (TPH). Consequently, ANSC production of 5-HT was confirmed by high pressure liquid chromatography (HPLC). Blocking TPH function by para-chlorophenylalanine (PCPA), ANSC proliferation was significantly reduced, which was rescued by adding exogenous 5-HT. Further, 5-HT action was conveyed to the ANSC predominantly by the serotonin receptor subtype 5-HT 1A, as we have shown by antagonising this receptor with WAY100635, a highly selective inhibitor of 5-HT 1A function. To a lesser extent, 5-HT 2C receptor modulated ANSC proliferation as seen by SB206553 driven blockade of this receptor subtype in co-culture experiments. Finally, we proved chemotactic properties of 5-HT on ANSC migration. Taken together, we claim a meaningful serotonergic impact on proliferation, survival, and migration of ANSC, which is mainly mediated by 5-HT 1A receptor.
P01-110 - A Naturalistic Trial in Germany with Escitalopram in Depressed Outpatients aged at Least 65 Years
Authors: Flürenbrock W.
Published: June 2010

Objective

To assess the efficacy and tolerability profile of treatment with escitalopram under naturalistic conditions, in elderly outpatients (≥65 years and above) with depression.

Methods

2050 patients completed 8 weeks of treatment with escitalopram in a multi-centre naturalistic study. Rating scales included a short version of the Montgomery-Åsberg Depression Rating Scale (svMADRS) for the assessment of response.

Results

Most patients improved in their general state of health and showed a decrease in the severity of their depression. The majority (83.8%) of patients received 10mg/day escitalopram. The mean svMADRS total score decreased from 31.9 (SD=7.9) at baseline to 14.2 (SD=8.5) at Week 8. On completion, 63.9% of the patients were responders (≥50% decrease of svMADRS from baseline) and 48.6% were remitters (svMADRS≤12). Statistically significant more patients aged ≤75 years responded to treatment and achieved remission than those aged >75 years. Logistic regression was used to model response to treatment. Statistically significant positive factors were having a current episode of less than 1 month and duration of illness of less than 1 year. The diagnosis showed increasing responder rates from affective disorder (F31 or F34; odds ratio=1.00) over involutional depression (F03; odds ratio=1.68) and depressive episode (F32; odds ratio=2.21) to recurrent depressive episode (F33; odds ratio=2.32). The differences between affective disorders and involutional depression were significant, while F32 and F33 showed no relevant differences in the responder rates.

Conclusion

The results from this observational study corroborate the effectiveness and tolerability of escitalopram treatment of elderly patients in a naturalistic treatment setting.
P01-112 - Affective Temperaments in Epilepsy
Authors: Yazici E. , Yazici A.B. , Aydin N. , Orhan A. , Kirpinar I.
Published: June 2010

Objective

Affective temperaments (AT) are suggested as antecedents of mood disorders (MD) currently. MD especially depression is very common in epilepsy. In this study we investigated AT in epilepsy as probable predictors of MD.

Methods

83 epileptic patients and 83 healthy controls were included and evaluated using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A) and SCID-I.

Results

In epilepsy group 16 depressive, 3 cyclotimic, 12 irritable, 9 anxious temperaments; in healthy group 4 depressive, 3 irritable, 4 anxious temperaments were diagnosed. The difference was significant in depressive (x2: 8.36, p< 0.05) and irritable temperament (x2: 6.06, p< 0.05). Depressive, cyclotimic, irritable, anxious temperaments mean scores were significantly higher in epilepstics (depressive 8.35±4,37; cyclotimic 9,86± 4,67; irritable 7,00±4,58; anxious 9,18±5,94) than healthy controls (depressive 5,89±3,68; cyclotimic 6,87±4,55; irritable 3,39±3,57; anxious 5,11±4,78) (all p< 0,001). 16 patients in epilepsy group and 6 patients in control group were diagnosed as Major Depressive Disorder (MDD) and the difference was significant (x2: 5,38, p< 0,05). Anxious temperament predicted MDD in epileptics and none of the temperaments were significant predictor of MDD in controls in logistic regression analysis.

Conclusion

Epileptic patients had higher scores at all AT except hypertimic. Anxious and irritable temperaments were diagnosed more in epileptics and anxious temperament was related with MDD. The tendency of epileptics to MD are known but this is the first study shows tendency of epileptics to AT. Further investigations are needed to explain the etiology and treatment relationship between MD and AT in epilepsy.
P01-113 - Venlafaxine for the Treatment of Depression: a Meta-analysis of Chinese Trials
Authors: Zhang Y. , Kösters M. , Becker T.
Published: June 2010

Objectives

Chinese trials were rarely included in western meta-analyses. This systematic review investigates the efficacy of venlafaxine in the treatment of major depression (MDD) in Chinese populations.

Methods

Chinese databases (VIP and CNKI) were searched for blinded randomised clinical trials (RCTs) comparing venlafaxine with any other pharmacotherapy and/or placebo. Quality of included studies was assessed with the Jadad scale. Furthermore, fulfilment of the CONSORT items was recorded. Final mean HAM-D scores and response rates were extracted and combined using a fixed-effects model. Subgroup analyses by drug class were performed to assess further differences.

Results

23 blinded RCTs were included in the analyses. Six compared venlafaxine with selective serotonin reuptake inhibitors (SSRIs), 15 with tricyclic antidepressants (TCAs) and two with tetracyclic antidepressants. The average Jadad score was 2.7 and on average 55% of all CONSORT items were reported. On average, 36 patients were randomised per group. Only three trials included more than 80 patients per group.

Mean final HAMD scores were significantly lower in the venlafaxine groups compared to TCA (Hedges’ g 0.14, 95%-CI, 0.01-0.26), but not in comparison to SSRI treated groups (Hedges’ g 0.05, 95%-CI, -0.12-0.21). These findings were confirmed by analyses of response rates. (MH RR Ven vs. TCA: 1.11, 95%-CI, 1.04-1.18, Ven vs. SSRI: 1.01, 95%-CI, 0.93-1.11).

Conclusions

These results suggest that venlafaxine is significantly more effective than TCAs, but not than SSRIs in depressive Chinese populations. However, large high quality trials are needed to verify these findings.
P01-13 - The Bipolar Patients Observance and Participation in Cognitive Behavioral Therapy Groups Tend to be Improved Through Mindfulness Meditation
Authors: Bonvalot T. , Placines B. , Bouché C. , Le Moigne L. , Boldi I. , Millet B. , Thym Breizh
Published: June 2010

Cognitive-behavioral therapy (CBT) is being used, individually or in group format, to improve outcome and prevent relapse of patients with bipolar disorder (BD). CBT shows nevertheless limitations with regard, mainly, to patients having undergone a great number of mood episodes. In one published study, patients with more than 12 mood episodes typically did not respond favorably to the procedures, and for some, their clinical condition worsened.

Understandably, a high dropout rate has also been observed in other studies.

Objectives

To overcome these limitations, we combined CBT with mindfulness meditation.

Methods

In our mood clinic, two different programs have been proposed to this day:

- A short mindfulness-based, stress-reduction program (8 weekly sessions), well-adapted to bipolar patients :

- A program of 20 weekly relapse prevention sessions, including 5 consecutive constructive therapy stages (T. Bonvalot et al.: Constructive Psychotherapy of Bipolar Disorder: A New Approach (abstract) - Bipolar Disorders, special issue, June 2009).

Bipolar patients with more extensive clinical conditions are successively invited to participate to both programs.

Results

Every session has been facilitated by a mindful attitude progressively developed by the patients all along the programs.

We observed that mindfulness meditation, along with CBT, presents most often a high acceptation level on the part of most bipolar patients, and a capacity to restore self-image, self-confidence and hopefulness.

Conclusion

The patients’ involvement in the treatment programs have developed on a regular basis, and consequently a low dropout rate has been observed.

These observations are to be now formally evaluated.
P01-14 - Efficacy of a Newly Developed Method of Receptive Music Therapy for the Treatment of Depression
Authors: Brandes V. , Terris D.D. , Fischer C. , Loerbroks A. , Jarczok M.N. , Ottowitz G. , Titscher G. , Fischer J.E. , Thayer J.F.
Published: June 2010

Objectives

Current treatment approaches for depression center on various forms of psychosocial therapy and the use of antidepressant drugs. The response rates for both of these approaches are similar, with mostly reduction, but not complete remission, of symptoms. Poor adherence to recommended treatment is an issue complicating the management of depression and prevention of recurrent episodes. This study evaluated the efficacy of a novel form of receptive music therapy which can be easily adminstered to out patients.

Methods

Enrolled subjects (n=203, average age 49.6 ± 13.1 years, 28.1% male) were randomized into four arms: Music Therapy 1 (MT1), Music Therapy 2 (MT2), Placebo (nature sounds) and waiting-list Control. Subjects listened for 30 minutes, twice daily. Multivariate linear regression models assessed depressive symptom changes over five weeks, based on a composite scale (COMP) and the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS-D) alone.

Results

On average, a significant, positive change in COMP was observed for MT1 (β=1.44, p=0.030), but not for MT2 (β=1.14, p=0.059) or Placebo (β=0.57, p=0.397). After 15 weeks, study participation was associated with a mean HAM-D score reduction of 60% for 89,1% of the compliant probands.

Conclusions

Newly composed receptive music therapy, as explored in this study, is associated with reduced depressive symptoms and high treatment compliance, and may therefore potentially represent an effective depression treatment alternative or adjunctive therapy to pharmacological and psychosocial approaches.
P01-19 - Patients with Depression in Primary Care: Approach Through Psychoeducational Group Intervention
Authors: Casañas R. , del Val Garcia J.L. , Raya A. , Romero T. ,   The Research Group on Depression (Psychoeducational Group Program)
Published: June 2010

Objectives

To compare the effectiveness of a psychoeducational group program and conventional treatment versus individual conventional care in patients with a mild/moderate depression disorder in urban primary healthcare centers (PHCC).

Methods

:

Design

randomized controlled trial of two groups.

Sample

patients aged 20 years attended in 13 PHCC, identified by general practitioners and nurses with diagnosis of mid/moderate depression disorder (BDI scale) between December 2008 and April 2009.

The intervention group received a psycoeducational group program (12 weeks, two nurses). The program provided health education about the illness, pharmacological treatment, diet, physical exercise, problem solving, and cognitive-behavioral therapy.

The control group received conventional care.

The evolution of patients is monitoring up to 1 year after the inclusion by an individual interview (baseline and 3, 6, 9 months).

The battery of assessment included: Sociodemographic, BDI and EuroQol-5D questionnaires.

Results

241 patients (126 intervention Group (IG); 115 control Group (CG)), 217 women (53% IG and 47%CG) with a mean age of 54, 11 (SD=12,656). 92% Spanish. 45% married. Academic level: 76, 5 % study and 13,5% non-study.

The mean BDI in the baseline GI 21, 66 (SD=6,87) and CG 19.62(SD=6.85), follow up 3 months, GI 13,91(SD=8.22) and CG 17,07(SD=7,930). The mean of EuroQoL in the baseline IG 48, 29 (SD= 17,77) and CG 53,0 (SD= 19,06), follow up 3m, GI 56,57(SD=22,12) and CG 45,28(SD=23,74).

Conclusions

The two groups are comparable for all variables analyzed. There is an improvement in the IG versus CG on depressive symptoms and quality of life.
P01-23 - Compliance with Treatment - a Prerequisite for Diagnosing and Treatment Efficacy
Authors: Dadic Hero E. , Ruzic K. , Medved P. , MacDonald E. , Tatalovic Vorkapic S.
Published: June 2010

Aim

Lack of patient compliance in a general psychiatric ambulatory causes delays in diagnosing as well as in patient treatment efficacy.

Method

a 30 year old patient underwent a psychiatric treatment which lasted two yaers. He was treated with a combination of psychopharmacs and psychotheraphy.

Results

The patient contacted a psychiatrist for the first time exhibiting the following symptoms: loss of will and interests, weight gain, lowered general mood, avoidance of social contacts. A depressive episode was diagnosed and and antidepressive was introduced to his therapy (fluvoxamine). He did not comply to the therapy assigned nor he attended his scheduled examination.

His medicamentous therapy was intensified (fluoxamine, alprazolam, promazine). After six months, the patient returned in company with his family, and his non-compliance with the therapy was revealed.

After a sucessfful therapy an improvement in his mental state was noticed. During the last year, he was regular at his examinations and medication, with psychotherapy once a week.

Conclusion

Patient compliance is a prerequisite for diagnosing and a successful treatment. Combined treatment methods (psychopharmacotherapy, psychotherapy) with an adherend patient guarantee a good remission.