There is growing evidence that major depressive disorder (MDD) might be overdiagnosed at the expense of bipolar disorders (BPD).

To identify a subgroup of subthreshold BPD among DSM-IV MDD, which is distinct from pure MDD regarding validators of bipolarity.

Data come from the ten-year prospective-longitudinal EDSP-Study, a community survey from Munich, and were assessed with the DSM-IV/M-CIDI. Subthreshold BPD was defined as fulfilling criteria for MDD plus presence of manic symptoms, but never having met criteria for hypomania.

Among 488 respondents with MDD, about 60% had pure MDD and 40% subthreshold BPD. Compared to pure MDD, the subthreshold BPD group was found to have

1. (a) an increased family history of mania,

2. (b) considerably higher rates of nicotine dependence and alcohol use disorders,

3. (c) twice as high rates of panic disorder, and

4. (d) a tendency towards higher rates of criminal acts.

5. (e) In prospective analyses, subthreshold BPD converted more often into BPD during follow-up with the criterion D (symptoms are observable by others) being of critical predictive relevance.

Data suggest that MDD is a heterogeneous concept including a large group of subthreshold BPD, which is clinically significant and shares similarities with BPD. Findings might support the need for a broader concept and a more comprehensive screening of bipolarity.

To determine possible associations between guideline-concordant care and clinical outcome in general practice patients with anxiety and depression, and identification of patient characteristics associated with poor clinical outcome.

Data from the Netherlands Study of Anxiety and Depression (NESDA) was used. NESDA is a longitudinal cohort study to measure the long-term course and consequences of anxiety and depressive disorders. Adult patients were interviewed to measure DSM-IV diagnoses during the baseline assessment, and completed questionnaires measuring symptom severity, sociodemographic variables and social support at baseline and 12 months later. The definition of guideline adherence was based on an algorithm on care that was received.

721 patients with a current (6-month recency) anxiety or depressive disorder participated. While patients who received guideline-concordant care (N=281) suffered from more severe symptoms than patients who received non-guideline concordant care (N=440), both groups improved equally on their depressive or anxiety symptoms after 12 months. Patients who (still) had moderate or severe symptoms at follow-up, were more often unemployed, had smaller personal networks and more severe depressive symptoms at baseline than patients with low symptoms at follow-up.

The added value of guideline-concordant care could not be demonstrated in this study. While patients with comorbidity of both anxiety and depressive disorders, those with smaller social networks and the unemployed were more likely to suffer from moderate or severe symptoms after 12 months, severity of depressive symptoms at baseline was most strongly associated. Findings have practical implications as well as implication for future research.

Electroconvulsive therapy (ECT) cannot always be effective for Treatment Resistant Depression. Deep brain stimulation (DBS), a procedure that involves the direct implantation of stimulation electrodes in localized brain regions with the aim of modulating local and connected abnormal activity, has recently been gaining momentum as an alternative treatment modality for the most severe TRD patients. However, there is minimal experience with ECT in patients who have undergone DBS procedures.

We present two cases of patients who remitted from TRD after SCG-DBS, and some months after they suffered a relapse that was treated with ECT.

Before DBS intervention, ECT was not capable to sustain response more than two weeks beyond and was even bad tolerated by these patients. DBS was effective for both patients until a severe relapse occurred (after 4 and 14 months, respectively). Optimization of medication did not elicit response, given the seriousness of symptoms and their previous treatment resistance. Therefore, neurostimulator was turned off in order to administer ECT to both patients. After usual series of sessions set at corresponding parameters over 3 weeks, using bitemporal electrode placement, the episode remitted. Deep brain stimulator was turned on again, and they were in remission until the present moment.

The use of ECT proved to be effective without adverse effects to the patients or to the DBS hardware. The modulation of SCG activity and its downstream targets might also serve as a trigger for the therapeutic effect of formerly useful or even never-effective antidepressant strategies.

:

Extreme old Age

History of Hyponatremia

Co- therapy with other drugs known to be associated with Hyponatremia

Reduced renal function

Medical Co morbidity.

To monitor baseline investigations like urea and electrolytes at 0 weeks, 2 weeks, 4 weeks and 3 months when starting antidepressants, documentation of co morbid medical conditions, past history of Hyponatremia and monitoring of risk factors.

A total of 17 patients were randomly selected and the case notes were reviewed for demographic details, diagnosis, type and dose of Antidepressant, co morbid medical condition, risk factors and details of investigation at base line and follow up appointments.

:

1. - 41% had baseline investigations, 18%at 2 weeks, 12% at 4 weekly and 6% at 3 monthly.

2. - 6% had Abnormal Blood results and one patient was referred to medicine.

3. - None of these patients had developed Hyponatraemia.

47% patients had depression, 6% had bipolar affective disorder, 6% had Dementia, 6% had Mixed Anxiety Disorder, 12 % had vascular dementia and 6 % had Psychotic Depression.

24% of the patients were on diuretics, 12% on NSIADS, 6% each on Carbamazepine and Cancer Chemotherapy.

Our main goal is evaluation of marital satisfaction in depressed patients and researches of the rate of depression between men and women.

This investigation is descriptive and correlation study that 93 people (48M, 45F) as the accidental samples by GRIMS and Beck depression questionnaire are collected. Results of this study by Mann Whitney Test, Kruskal-wallis Tests, Chi-square Tests and Spearman’s rho are achieved.

Our study shows that 50.06% of people had relative marital satisfaction and 47.64% had minor depression. The marital satisfaction of women were more than men 49.23% the rate of women depression was high too 47.5%.

In this study there is no meaningful relation between age, duration of marriage, sex, educations, occupational situation and marital satisfaction and depression too but there is meaningful relation between marital dissatisfaction and depression. We advise to go to psychiatrists when spouses have several problems in their sexual relation ship.

The aim of this study is the investigation of depression prevalence in heart diseases patients and dialysis candidate’s we researched depression effects on heart and renal diseases and suggested new ways to patients’ management.

This study is a descriptive and correlation study that 21 heart disease patient and dialysis candidates as the samples by questionnaire are selected we used Beck depression Anxiety test and gained results by SPSS and statistical analysis.

In this study 21 patients are selected and 67.7% of them had depression. 30% minor depression, 17.5% mild depression and 7.5% had major depression. Around the 12.5% of them needed psychiatric consultations. Most of them were middle-aged (45%),men (22%),illiterate (32.5%), citizen (92.5%),illness (52.5%) and dialysis candidates (27.5%).

Our study shows that there isn’t meaningful relation between age, academic education, type of living and disease duration of patients. We knew that there is meaningful relation between periods of heart diseases’ patients, dialysis candidates and depression against the healthy people. this research says us to notice emotional problems of patients especially patient of heart diseases and dialysis candidates,

Our main goal of this study is the investigation of depression prevalence between addict people and normal people. We decided to show main emotional problems of addict people.

This investigation is a descriptive study that 30 normal people and 30 addict people as the accident samples by Beck Depression inventory test and with clustered way are collected. We have gained results by SPSS and statistical analysis.

Our study shows that 33.3% of people are normal and 66.7% of our cases are depressed, 51.7% are married and 51.2% poor, 36.7% young, 31.7% low grade educations and finally 83.3% of them are employed. 45% of cases have major depression.

Our research explains that there isn’t meaningful relation between depression, age, occupation, marriage situation, income and education status of addict people and their addiction. We suggest decreasing the reasons of depression in humans.

A single nucleotide polymorphism within the CACNA1C gene (rs1006737) has been found to confer increased risk of Bipolar Disorder (BD) and has been linked to altered neuronal gating and emotional behaviour. As current models of BD suggest abnormal integration within frontolimbic networks, our aim was to explore the effect of the CACNA1C genotype on prefrontal and limbic activation.

We genotyped 90 participants from the Vulnerability to Bipolar Disorder Study comprising of 41 euthymic BD patients and 49 healthy controls. Functional magnetic resonance imaging data were obtained while participants performed a fearful versus neutral facial affect processing task.

We found a significant diagnosis by genotype interaction with BD patients homozygous for the risk allele having reduced prefrontal activation compared to the other groups.

The present findings support the hypothesis that the rs1006737 polymorphism in the CACNA1C gene confers increased risk of BD by modulating amygdala and PFC activation during emotional processing.

To estimate the prevalence of depression and anxiety in caregivers of dependent grade II and III of a health center. Calculate the perceived social support for caregivers. Estimating the degree of caregiver stress. Assess the socio-demographic factors associated.

Descriptive and transversal.

Primary Health Care.

We selected 55 dependent caregivers grade II and III consecutive sample, according to the law of dependence, belonging to the health center Algeciras-North and were registered in the database of the Center on January 31, 2009. Exclude those who would not participate in the study, did not understand the Spanish language or could not contact with them.

We conducted through a questionnaire that contained heteroadministrated Hamilton scales for depression and anxiety, social support scale of the Duke, caregiver overload of Zarit and sociodemographic variables. The accomplishment was held at the home of the caregiver.

We detected the presence of depressive disorders in 47.3% (95% 14,6-39%) respondents and anxiety disorders in 25.5% (95% 23-6-61,1%). 36.4% (CI 95% 23,8-50,4%) of caregivers had low social support and overhead was 57.1% (CI 95% 43,2-70,9%).

Caregivers of Dependent grade II and III in our area are at risk of depressive disorders and anxiety. At the same time, they feel helpless, so we think it would be interesting to be given greater attention from health centers in order to identify them early.

The method chosen for these guidelines is a formalized consensus of experts. It enables, through a series of specific clinical situations proposed to the experts, to provide recommendations for the management of bipolar disorder. The situations where defined because they are not associated to evidence-based recommendations according to the lack of controlled studies.

40 experts participate to this consensus. As in most of the guidelines for the treatment of bipolar disorder, more than 50 % of experts (51,3 to 72,9%) recommend the same therapeutic strategies to treat major depressive episode whichever the type (bipolar I or II).

Unlike to other guidelines, French experts propose different therapeutic according to the presence or absence of rapid cycling. For major depressive episode without rapid cycling, 63% experts recommend a combination of an antidepressant with a mood stabilizer. In rapid cyclers, 51% experts recommend the use of a mood stabilizer in monotherapy or in combinaison, but never associated with antidepressant.

This methodological approach enables to get closer to everyday clinical practice and integrate specificities of prescription through a national panel of experts. On the other hand, this type of methodology highlights the research perspectives: i.e. management of acute depression with rapid cycle in bipolar disorder.

Mean BDNF serum concentration is lower in patients with major depression (MD) as compared to healthy controls. BDNF increases during the course of antidepressant treatment. This increase has been associated with symptom amelioration. The aim of this study was to analyse the relation between early and late BDNF changes during antidepressant treatment.

Forty-six patients with MD according to DSM-IV were included for this study. Patients were treated as clinically indicated. Depression severity was assessed by HAMD-17 by trained raters from baseline to week 6 in weekly intervals. Serum at each visit (baseline, V1-V6) was obtained from whole blood after centrifugation with 1.000 × g for 15 minutes. Aliquots were frozen at −80°C until analysis. BDNF serum concentration was determined with ELISA (R&D Systems). We analysed correlations between early changes of BDNF level (baseline to weeks 1 and 2) with BDNF changes in the later course of treatment (change from baseline to weeks 4, 5 and 6). Further, the association between early and late BDNF changes was calculated by means of linear regression analysis.

There was a high correlation between BDNF changes in the early course of treatment and final BDNF changes (p< 0.05 for each analysis). Early BDNF changes accounted for a high percentage of the variance of late BDNF changes (p< 0.05 for each analysis).

These results suggest that an early change of BDNF serum level is predictive for BDNF change in the later course of antidepressant treatment in patients with Major Depression.

There is a positive correlation between level of education and working function in the general population. Bipolar disorder (BD) is often associated with disability in social and working function. There is conflicting evidence considering educational achievements in BD patients.

Our aim was to investigate how education was related to social and occupational function in BD.

Patients with DSM-IV BD (N=257; 69.3% BD I, 25.7% BD II, 5.1% BD NOS, 51.4% females) were consecutively recruited from mental health clinics throughout Norway. The majority of patients were recruited when in-patients. About 1/2 had at least once experienced a psychotic episode. The BD sample was compared with a geographically matched reference sample from the general population (N=56.540) on levels of education, marital status, income, and disability benefits. Further analyses of association were carried out using logistic regression analyses.

A significantly higher proportion of subjects in the BD group than in the reference group was single, had low income, or was disabled. No between-group difference was found in educational level. In the reference group education was inversely correlated with the risk of being disabled, but no such relationship was found in the BD group. In BD patients rapid cycling and recurring depressive episodes were the only clinical characteristics associated with low educational level.

Despite similar levels of education, BD patients had lower socio-economic status than the general population, and no association was found between education and disability for BD patients.

To compare social adaptation level among psychiatric inpatients with an atypical and non-atypical depression.

140 inpatients at the age of 18-65 years were evaluated with SIGH-SAD (Williams J. et al., 1991) and Social Adaptation Self-evaluation Scale (SASS) (Bosc M. et al., 1997). Patients who got more than 7 points by SIGH-SAD atypical features were considered as AD-patients, they formed the main group. Patients who got 7 or less scores by SIGH-SAD atypical features formed the comparison group. Mann-Whitney test was used.

10 men and 60 women (1:6) at the average age 44.5±11.4 generated the main group. The comparison group was generated by 20 man and 50 women (2:5) at the average age of 48±10.7. Significant difference at the age was not observed. The average age for women of main and comparison groups are 44.6±11.2 and 49.6±10.6 years (p=0.01891). The middle score on SIGH-SAD at admission was 31.4±6.2 in main group and 24.9±6.2 in the comparison group (p=0.0000). The middle score on the SASS in the main and comparison group was 30.4±8 and 33±7.2 properly (p=0.04687). Significant differences in social adaptation level subject to gender among and in the groups were not found.

Women with AD were younger than non-AD women. More severe impairments on SASS were found in a group with AD.

We performed family psychoeducation for depression, and investigated the association between the education and expressed emotion of patients’ families and relapse of depression.

Of 103 patients diagnosed with major depressive disorder, and their primary family members, 53 patients and their primary family members gave consent. The patients were randomly allocated to an intervention or control group, consisting of 24 and 30 patients, respectively. The intervention group underwent 4 educational sessions and education in coping techniques. The relapse rate was compared between the intervention and control groups. In addition, the subjects were divided into high- and low-EE groups based on the EE judgment, and the effect of psychoeducation was compared in each group.

The relapse rate during a 9-month period was 8.3% in the intervention group, being significantly lower than that (50%) in the control group. The relapse rate in the intervention group was slightly lower than that in the control group in the high-EE group, and significantly lower in the low-EE group. Regarding the influence of EE, in the control group, the relapse rate was 70% in the high-EE group, being significantly higher than that (40%) in the low-EE group. On multiple logistic regression analysis, psychoeducation (odds ratio: 25.53, 95% CI: 2.83-229.92) and the Hamilton score at the time of entry (odds ratio: 1.16, 95% CI: 1.045-1.298) were significantly associated with relapse.

It was suggested that the psychoeducation of families is very effective for the prevention of relapse in adult depressive patients.

To investigate characteristics of prehospital period of patients with depressive disorders and their influence on the level of social functioning.

After informed agreement 102 patients with depressive disorders (DD) for the first time admitted to the psychiatric hospital were examined with RDC of ICD-10. For the assesment of the level of social functioning Social Adaptation Self-evaluation Scale (Bosc M. et al., 1997) was used.

The average duration of DD before psychiatric examination was 19,1 months (up to 312 months). The average age was 43,8±11,5 years. Most patient had first depressive episode (61,8%), second 8,9%, third 2,9% and 4,9% had «double depression». The most part of the patients (61,8%) with DD saw their primary care (PC) doctors, 47,1% of them did it more than twice. The average number of visits to PC was 3,6 (up to 49), the average number of investigations was 2,4 (up to 8). The most part of visits to primary care (PC) fell at patients with heart complaints (р=0,02), the less part to patients with loss of energy (р=0,0007). More visits to PC were associated with low level of social functioning (r>-0,2, р<0,05). Low level of social functioning correlated with older age, duration and severity of depression, number of previous episodes and PC attendance.

In ddition to some clinical characteristics of depressive disorders the level of social functioning depends on PC visiting.

Mefloquine is being used as malaria prevention by Plasmodium Falciparum in chloroquine-resistant zones. We describe a woman who developed a manic episode with psychotic symptoms during mefloquine treatment.

A 26-year-old Spanish woman had been working in Mali for the last six months and had started antimalarial prevention with mefloquine. In Mali, the clinical picture had a sudden debut and she related: excessive happiness, incapacity to sleep, and megalomania (she believed to have special powers and to be the mother of all the children). She was admitted in a hospital in Mali for seven days and received treatment with haloperidol and chlorpromazine. Then, she was repatriated to Spain without treatment and she continued suffering the same symptoms. After 15 days, she went to our hospital and she was admitted. Treatment started with risperidone (up to 6 mg/day) and clonazepam (up to 1.5 mg/day). At admission Young Mania Rating Scale (YMRS) was 25 points. Physical examination and complementary tests were normal, and was orientated as a manic episode with psychotic symptoms secondary to mefloquine. She had a quick symptomatic improvement (after 7 days of treatment YMRS was 5 points) and was discharged after 15 days.

Mefloquine more frequent adverse neuropsychiatric effects are: dizziness, vivid dreams and insomnia. Others are confusion, and auditory hallucinations. Side effects are dose dependent. Psychotic symptoms are frequently auto-limited when mefloquine is suppressed but treatment with atypical antipsychotics is often needed. MDR1/ABCB1 polymorphisms may play a role in neuropsychiatric side effects

The investigation included 60 patients. Assessment was made by means of the following instruments:Montgomery-Asberg Depression Rating Scale for DSM-IV (MADRS), Hamilton Rating Scale for Depression (HAMD) and Clinician-Administrated PTSD Scale for DSM-IV (CAPS). The differences between groups were evaluated using Student t test and by means of the correlational analysis of the data with p < 0.05.

Results obtained showed significal clinical severity of the depression commorbid with postraumatic stress disorder. The group of the symptoms: lassitude, inability to feel, suicidal thoughts and inner tension contributed mostly to the global severity of the comorbid clinical depression.

The interpretation of results in the light of patophysiological mechanisms underlying the symptoms will enable the insight onto possible mechanisams of interaction of two disorders. Both classical and current trends of the psychoanalytical thinking, reffering to melanholia and to transformation of the trauma in the internal world, enabled explanation of the deepening of depression observed after ten years follow-up of the traumatized population.

Like other European countries, the Defined Daily Dose (DDD) of antidepressants prescribed in Scotland increased almost fivefold in the 15y to 2007/8.

To assess the impact of stepped, collaborative care for depression on population antidepressant use.

A depression service (“Doing Well”) was implemented in 15/30 primary care practices in Renfrewshire, Scotland from July 2004 (population 76,013). Prescribing was compared with the remaining 15 “control” practices in Renfrewshire and Scotland nationally.

Doing Well offered prompt assessment and access to guided self-help or brief CBT or IPT. Clinical judgement guided antidepressant recommendations but drugs were not usually recommended for patients with a PHQ score < 15.

Antidepressant use followed a “rational” profile, increasing with depression severity:

Antidepressant use increased by 3.8% in Doing Well practices, 11.8% in control practices and 12.9% in Scotland. This represents a relative reduction in DDDs in the intervention area.

[Antidepressant use over time by area]

Providing rapid, local access to brief psychological therapies and rational prescribing support was associated with a relative reduction in the rise of antidepressant use, but a modest increase in prescribing overall.

Keeping off anxiety from mind & it's bodily symptoms is a challenging task through centuries. Cause of anxiety is broadly viewed as Heriditary & Environmental factors. We have some drugs to lessen acute/ generalised anxiety. What will happen if the environmental stimulus is sharpen or reduced gradually.

In eastern philoshopical doctrine anxiety is seen aroused as either sexual urges oriented or materialistic sences. In psycho-analytical theory of Sigmoid Freud, diguised libidonal senses that are trying to come in surface is viewed as the primary cause of anxiety. There is a similarity that libidonal or sex thoughts, usually socialy unacceptable are seen as the sole cause of anxiety mainly.

Unfolding of eastern spiritual or philoshophical doctrine will show some path in attaining a less anxiety state in an enduring pattern.

Hindu saints saying, “women and financial assettes or materiastic objects are all evils like poison, if you are diped into it, peace will not be achieved in your mind”-Sree Ramkrihna.

Anxiety reliefing is attainable through lifelong practice & devotion. According to Swami Vivekanata who delivered excellent speaches in Religions of Parliament in Chicago, in 1851 said “If you are honest for each moments…you have gained the highest state, nothing (worry or anxiety) could touch you.”

What is practice? Meditation meaning cutting the mind from external world for few minutes or hours and keep the body & mind calm, tranquil & free from all earthly thinking.

In perfoming Work, stay in a non self, or a non “I” doing way of thinking.

Meditation, nonattachment will bring relief.

Dispassionate, non myself sencse woking&de-atachement are key-factors.

Phobias & fearfulness shortly before examination are a common presenting feature in a section of teen aged students, ausing a stress in their own aswellas in their anxious parents. On a longitudinal evaluation of such 120 cases in a remote district clinic in the age group of 15-23 with a median age of 18 years will show their varied underlying morbidity ultimately.

Is it a normal phenomenon or much sressed those may shows some psychological disorders is ascertained here.

Here is a search for their such varient stress prior to examination & an attempt to identify their etiology so that some remedy is seen.

120 cases in those age group who complained of phobia 1-90 days before exam in the rural clinic in Midnapore 126k.m away from capital city of Kolkata & stayed for a follow up for 24 months were analysed. They constite 72 female & 48 males. They were followed up at 2 monthly interval & their pshychological assesment was done by psychologist. Their final diagonosis at the end of 2 year were tabulised asper criteria of ICD-10.

Mild mental retardation & lower side IQ< 80 were found in majority of cases (Apprxm.25%).Acute anxiety disorder was next (15%), followed by generalised anxiety disorders (10%),obsessive compulsive disorder is also revealed in about 5% cases, more in females. Other less common disorders were depressive disorders, conduct & personality disorders, & other bevavioral disorders. No pshycotic ilness like schizophrenia was revealed.

Anxiety Disorders in varient & obscured form may be a common presenting feature of teenagers as examination phobia in first & may yields to therapy with family.