There is still considerable disagreement as to what makes psychotherapy effective. The controversy about the comparative efficacy of different psychotherapy approaches has generated two different major perspectives on the active ingredients in psychotherapy: the specific ingredients model and the common factors model. However, conceptual analyses and empirical data rather suggest a synergistic view of specific and common factors.

The study aims at contributing to a clearer conceptualization of common factors by analyzing their associations with treatment techniques.

A comprehensive literature search was performed to identify the common factors discussed in psychotherapy research. Psychotherapy experts then rated the degree of associations between these common factors and a set of techniques in a web-based survey. A factor analysis was performed to analyze the dimensional structure of common factors, which underlies the rated associations between common factors and techniques. In addition, the techniques associated with the different dimensions of common factors were analyzed by regression analysis.

The factor analysis reveals that the variety of common factors can be described by a four-dimensional structure: common factors related to 1) cognitive processing, 2) emotional processing, 3) coping and 4) common factors fostering therapeutic alliance or therapy motivation. These dimensions are characterized by specific patterns of associated techniques.

Common factors have great potential to contribute to a clarification of the change mechanisms induced by psychotherapy. However, the construct suffers from major conceptual problems. The presented classification represents a first step towards a conceptual clarification of common factors in psychotherapy.

Depression is associated with various inflammatory-related physical conditions, such cardiovascular and neurodegenerative diseases. Yet, little is known about the association between depression and autoimmune diseases.

To examine the association between depression and risk of autoimmune disease, investigating the temporal and dose-response nature of these relationships.

A prospective study including approximately 1.1 million people is conducted using linked Danish registries. We have identified 145,217 participants with depression between 1995 and 2012. Survival analyses are used to estimate the relative risk of autoimmune disease among those with, compared to without, depression. Analyses are adjusted for covariates.

Preliminary analyses indicate an association between depression and an increased risk of several autoimmune diseases, with a potential dose-response correlation. Final results are still in progress.

Depression seems to be associated with increased risk of the onset of a range of autoimmune diseases. As such, depression may play a role in the etiology of certain autoimmune conditions.

The brain-derived neurotrophic factor (BDNF) is a neurotrophin fundamentally involved in the differentiation and growth during brain development. BDNF has pathogenically been linked to the schizophrenia neurodevelopmental hypothesis. Several studies have found lower BDNF blood levels in chronic schizophrenia than controls. Few studies suggest that BDNF levels in first-episode psychosis (FEP) are lower than in healthy controls (HC).

Comparing serum BDNF levels in a group of antipsychotic-naive FEP with HC and determining the serum BDNF pattern during the first year illness evolution.

Serum BDNF levels at admission of 28 inpatients with FEP were compared with 28 age/gender matched HC. BDNF was also measured at discharge, three, six, nine and twelve months. After discharge, antipsychotics were gradually decreased. Results are presented as mean±sd. and BDNF levels in ng./ml.

At admission, patients BDNF levels were significantly lower than controls (18.06±4.06 vs 26.55±3.22, p>0.001). At discharge FEP levels increase until HC levels without significant differences between gropus (25.95±3.93 vs 26.55±3.22, p=0.539). Upon the following determinations, BDNF FEP levels progressively decreased, reaching the admission values, and being significantly lower than the controls and that levels at discharge (patients: three months: 19.68±3.88; six months: 19.02±4.13; nine months: 17.64±5.24; twelve months: 17.51±3.45 vs controls: 26.55±3.22, all p>0.001).

Our results confirm the studies that found lower BDNF levels in chronic schizophrenia. Serum BDNF levels could be considered as a biological marker of treatment and evolution of FEP. Further studies with FEP patients with and without treatment are warranted.

Studies have indicated antidepressant effects of anti-inflammatory treatment; however, results have been conflicting and side effects may contraindicate anti-inflammatory treatment.

To systematically review the antidepressant and possible side effects of anti-inflammatory interventions.

To include trials published prior to December, 31st 2013, and evaluate depression scores after treatment and side effects.

We identified randomized, placebo-controlled trials assessing efficacy and side effects of pharmacological anti-inflammatory treatment in adults with depressive symptoms including adults fulfilling depression-criteria. We calculated standard mean difference (SMD) and Odds ratios (OR).

10 publications covering 14 trials (n=6,262) were included: 10 on non-steroidal anti-inflammatory drugs (NSAIDs) (n=4,258) and four on cytokine-inhibitors (n=2,004). Anti-inflammatory treatment reduced depression (SMD=−0.54; 95%-CI:-1.08 to −0.01; I2=68%) and depressive symptoms (SMD=−0.27; 95%-CI:−0.53 to −0.01; I2=93%). Sub-analyses particularly emphasized antidepressant properties for the selective cyclooxygenase-2 inhibitor celecoxib in general (SMD=−0.29; 95%-CI: −0.49 to −0.08; I2=73%), on remission (OR=7.89; 95%-CI: 2.94 to 21.17; I2=0%) and response (OR=6.59; 95%-CI: 2.24 to 19.42; I2=0%). Among 6 studies (n=2,523), we found no evidence of an increased number of gastrointestinalor cardiovascular events after 6 weeks nor infections after 12 weeks of anti-inflammatory treatment. All trials were associated with high risk of bias.

Anti-inflammatory treatment, in particular celecoxib, decreased depressive symptoms without increased risks of side effects. However, a high risk of bias and high heterogeneity made the mean estimate uncertain. This study supports a proof-of-concept concerning use of anti-inflammatory treatment in depression. Identification of subgroups that could benefit hereof might be warranted.

The results obtained in the last decade suggest that cystatin C plays an important role in the development of Alzheimer´s disease (AD) by inhibiting the aggregation of β-amyloid and its deposition. Cystatin C also demonstrate protective role via inhibition of cysteine proteases or by induction of autophagy and induction of proliferation (1–3).

The aim of the study concerns the influence of the ovocystatin derived from the new generation of eggs on cognitive decline in AD mice model.

Animals: Mice B6C3-Tg(APPswe, PSEN1dE9)85Dbo/Mmjax–Genotype HEMI and NCAR (The Jackson Laboratories). Specimen and administration: Ovocystatin [40μg/mouse] were administered with drinking water by 22 weeks. The placebo group received drinking water. The locomotor activity were tested by IR Actimeter. The evaluation of learning and memory was determined by Morris Water Maze test (MWM) (4). The study „Innovative technologies of bio-preparations’ production on the base of new generation of eggs” was co-financed by the European Union from the European Regional Development Fund under the Operational Program Innovative Economy, 2007-2013.

Mice from group with ovocystatin administration with drinking water have traveled statistically longer distance [D%] at Target quadrant than Placebo mice in MWM (p>0,05).

Ovocystatin given with drinking water has influence on learning and memory in HEMI group.

1. 1. Gauthier S, Kaur G, Mi W, Tizon B, Levy E. Front Biosci (Schol Ed), 2011; 1(3):541-554.

2. 2. Kaur G, Levy E. Front Mol Neurosci, 2012; 6(5):79.

3. 3. Zerovnik E. BioEssays, 2009; (6):597-599.

4. 4. Bromley-Brits, K., Deng, Y., Song, W. J Vis Exp, 2011, (53):e2920.

Intervention in the prodromal phase of psychosis remains controversial due to poor specificity of current criterion and ethical issues arising when developing interventions. There is less controversy regarding the need for specialist first episode psychosis intervention programs.

In the context of the implementation of an early intervention strategy in Lausanne, we focused on a first episode psychosis program and checked if need for an early detection program for UHR subjects would emerge over time. We recently structured a specialist At Risk Mental State (ARMS) clinic.

Help seeking patients aged 14–35, referred for a 'prodromal psychotic state” are assessed with: Mini-SCID; SPI-A; SIPS-PANSS; MARDS; Yung Mania scale and classified as ARMS on the basis of SPI-Cy (COPER and COGDIS criteria) and SIPS criteria (APS; BLIPS or Genetic Criterion).

Since January 2014, twenty-four patients were addressed to our clinic, and diagnoses were: ARMS (33%); first episode psychosis (8%); schizotypal disorder (25%); other axis I or II diagnosis (13%); drop out before diagnosis (5%); still in investigation (16%).

Our data shows that there is a need for specialist ARMS clinic when developing early intervention programs. The proximity with a well implanted first episode program offers the possibility to treat patients who have already developed full blown psychosis or for those who make the transition. Ethically, it is our impression that having both structures is necessary in order to have adequate treatment to offer is patients develop full blown psychosis.

Large variations in worldwide ECT utilization have been described (Leiknes et al. 2012) and concerns have been raised that ECT is being underused in some countries (with some patients being deprived of the most effective treatments available) While overused in certain locations (Smith et al. 1985).

To describe ECT utilization rates in European countries and to examine barriers difficulting its accesibility to ECT in Europe

A systematic review was conducted of studies which reported on ECT utilization rates in european countries in the last 25 years

Wide variations in the use of ECT have also been reported among neighbouring countries and even among different regions within the same country. For example, marked differences have been reported among baltic or nordic countries. In Norway, ECT utilization rate ranged from 1,83 to 3,44 treated per 10.000 inhabitants-year, in Belgium from in Flanders to 10,6 in Brussels and in Edinburgh 18-fold differences have been reported among different psychiatric teams within the same hospital. Lack of human and material resources, economic and legal restrictions, lack of agreement between psychiatrists and social prejudices against ECT might be behind these variations.

Action is needed that ensures a more uniform access to ECT. Health education campaigns, clinical practice guidelines development and implementation and ECT training courses promotion could contribute toward this.

ECT is an effective and safe treatment for severe psychiatric disorders including major depressive disorders, bipolar mania and depression and acute exacerbations of schizophrenia according to clinical guidelines. However, an overall decline in the use of ECT utilization has been reported worldwide and concerns have been raised that ECT is being underused in some countries.

To describe temporal trends in ECT utilization rates in european countries

A systematic review was conducted of studies which reported on ECT temporal trends in european countries in the last 25 years

Results

There had been a decrease in the use of ECT in recent years in Europe. However, recent publications suggest that its use may be stabilizing or even rebounding.

Early life adversities have been suggested to associate with immune dysregulation in later life. Nevertheless, most earlier studies have relied on retrospective self-reports of early adversity.

To investigate the association between serum high-sensitivity C-reactive protein (hsCRP) levels and objective and subjective measures of early adverse experiences in a population-based sample of 770 men aged 42–61 years.

To test whether objectively recorded early adversities associate with increased systemic inflammation more strongly than retrospectively self-reported early adversities.

Objective data on early adverse experiences were collected from primary and secondary school records. Subjective data were retrospectively inquired with a questionnaire at adulthood. The adverse experiences comprised family alcohol problems, parental divorce, and death of a family member. Having ≥ 1 adverse experiences was coded as having experienced early adversity. Serum hsCRP was measured with the Immulite High Sensitivity CRP Assay concurrently with the questionnaire data collection. Individuals with hsCRP>10 were excluded. The conducted logistic regression analyses were adjusted for age, marital status, education, smoking pack-years, alcohol use, maximal oxygen uptake, body mass index, cardiovascular disease, diabetes, regular pain medication, and depressive symptoms.

Objectively recorded early adversities (n=185) associated with hsCRP levels ≥ 3 (OR 1.73, 95% CI 1.02-2.95, p=0.04; reference hsCRP >1). No such association was detected with regard to subjectively reported early adversities (n=139; OR 1.63, 95% CI 0.92-2.92, p=0.10; reference hsCRP >1).

Objective measures of early adversity may more closely link with elevated systemic inflammation than self-reported retrospective measures of early adversity.

Research studies are increasingly interested in the factors that can contribute to a good outcome in psychosis, in order to develop effective interventions and preventive programs.

This study aims to analyze different aspects of the first-episode psychosis of subjects with a long-term favorable evolution.

The study included 40 subjects with a first-episode psychosis with an evolution of at least 10 years. They were chosen from the Case Register of Psychoses of the Psychiatric Clinic in Timisoara, based on demographic, clinical and social characteristics. All the subjects were re-assessed in 2014. 20 subjects have had a favorable evolution (no clinical relapses, a stable or better social and professional functioning after the episode). These cases were compared with 20 cases with similar clinical and demographic characteristics at onset, but with a less favorable outcome (frequent relapses, poor social and professional functioning).

Subjects with better outcome had less genetic heritage of mental disorders, significant social support, were more compliant to treatment and were more active professionally before and after the first episode of psychosis.

There are some characteristics of the persons having a first-episode psychosis which can guide the clinician regarding the prognosis.

To investigate the symptom dimensions of psychosis using factor analyses/FA of lifetime symptoms of a sample of Portuguese psychotic patients.

FA of the OPCRIT items (56 signs and symptoms) of 684 patients

- Schizophrenia/Sz (73.8%), Other non-organic psychotic disorders/ONPD (6.0), Schizoaffective disorders/SzA (1.4%), Bipolar disorders/BP (18.1%) and Severe depression with psychosis/SDP (.8%) – assessed with the Diagnostic Interview for Genetic Studies.

Delusions of poverty, guilty delusions, nihilistic delusions, primary delusional perception, and somnolence, problems with appetite and weight and grandiosity were excluded from the final solution, as each were present in less than 10% of patients and did not load at any factor.

Following the Kaiser and the Cattel's Scree Plot criteria, a four factors structure was selected, which explained variance (EV) was of 60.25%. Based on items content, the meaningful four factors were denominated as follows: F1 Depression (EV 21.77%; a=.97); F2 Mania (5.72%; a=.97); F3 Delusions and hallucinations (2.97%; a=.92); F4 Disorganization and Negative symptoms (2.07%; a=.90). Mann-Whitney U tests revealed that the symptom dimensions that distinguished better between Dx categories were Delusions and hallucinations (only SDP vs. BP and Sc vs. SzA did not significantly differ) and Disorganization and Negative symptoms (only SDP vs. BP and SDP vs. ONPD did not significantly differ), with Sz patients presenting the highest scores.

This factorial structure is in accordance with other reports. Given the Schizophrenia (Sz) and Bipolar disorder (BP) heterogeneity and overlap, the present study contribute to phenotypic refinement and formulation of alternative psychosis phenotypes.

Schizotypy and Cluster A personality profiles are more represented in first-degree relatives of patients with schizophrenia than in the general population. This study presents two diagnostic instruments for the assessment of cluster A personality profiles: the Structured Clinical Interview for personality disorders Axis II (SCID-II) and the Shedler-Westen Assessment Procedure (SWAP 200).

1. 1) Verify sensitivity of SCID-II and SWAP-200 to detect schizophrenia spectrum personality traits;

2. 2) Assess the prevalence of the traits and personality disorders (PD) related to cluster A.

Evaluate diagnostic sensitivity of these instruments in detecting schizotypy and cluster A personality profiles, that are ultra high risk predictors for psychosis.

25 schizophrenic patients(SchzP), 18 their first-degree relatives(FdR), 23 healthy-control(HC) subjects, have been subjected to personality assessment. MANOVA and subsequent planned comparisons were assessed to detect difference between PD profiles in the three groups.

SchzP present significant scores relative to cluster A in both evaluations. FdR show statistically significant differences compared with HC, with higher mean scores relative to cluster A profiles measured with SWAP-200 [PD: Paranoid F(1,63)=7.02;p=0.01. Schizoid F(1,63)=6.56;p=0.013. Schizotypy F(1,63)=6.1;p=0.016; Q-Factor: Schizoid (F(1,63)=6.47;p=0.013; Paranoid F(1,63)=2.11;p=0.151], but not with SCID-II.

Data suggest low sensitivity of SCID-II to identify traits related to cluster A. FdR scored for traits related to schizophrenia spectrum greater than in the general population. SWAP-200 is able to accurately evidentiate the presence of schizotypal traits in FdR of patients with schizophrenia and suggests the importance of a clinical dimensional diagnosis for a more reliable identification of schizophrenia spectrum.

Depressive/dysphoric personality (DP) is common in clinical settings, particularly among individuals with clinical depression.

The purpose of this research was to examine DP in two treatment settings (Study 1 and Study 2, respectively), and to determine whether those with comorbid DP would respond differentially to antidepressant medication, psychotherapy, or their combination as compared to those without DP.

The specific aim of the study was to evaluate pre- to post-treatment changes in depression severity levels between those with and without DP.

Study 1: Six hundred eighty (N=680) psychiatric outpatients with chronic depression were randomized to receive antidepressant medication, cognitive behavioral psychotherapy, or their combination for 12 weeks. Patients with and without DP were statistically compared on changes in levels of depression severity from pre- to post-treatment. Study 2: One hundred fifty-nine (N=159) psychotherapy clients were naturalistically followed from pre-to post treatment (average 6.5 months). Clients with and without DP were statistically compared on changes in levels of depression severity from pre- to post-treatment.

Thirty six percent (36%) of psychiatric outpatients and 44% of psychotherapy clients presented with DP at pre-treatment. There were no signficiant differences between those with and without DP on levels of depression severity in any treatment modality. In fact, among psychotherapy clients, those with DP made greater treatment gains than those without DP.

These findings suggest that in routine clinical situations, comorbid DP at pre-treatment should not be seen as an obstacle to successful treatment outcomes.

It has been assumed that a key difference between burnout and depression is that burnout is job-related and situation-specific whereas depression is context-free and pervasive. This view has recently been challenged at a theoretical level and additional empirical investigation has been called for.

The aim of this study was to examine whether chronic occupational stress—the putative cause of burnout—discriminated burnout from depression. Following a scope-based approach to the burnout-depression distinction, chronic occupational stress should be primarily related to burnout and only to a lesser degree to depression. This hypothesis was tested.

A total of 2124 French teachers took part in this study (mean age: 41.36; 73% female) during the last trimester of the 2013-2014 school year. Burnout was assessed with the Maslach Burnout Inventory and depression with the 9-item depression module of the Patient Health Questionnaire. The Effort-Reward Imbalance Questionnaire short form (ERIQ) was used for assessing chronic occupational stress.

Burnout and depression were almost identically correlated to effort-reward imbalance at work. Interestingly, the job over-commitment component of the ERIQ was slightly more correlated to depression than to burnout. Multiple regression analyses showed that effort-reward imbalance at work and job over-commitment predicted depression as much as burnout, controlling for gender, age, and length of employment.

Chronic occupational stress was not found to discriminate burnout from depression. These results further question the relevance of a scope-based distinction between burnout and depression and supports the idea that burnout overlaps with depression.

Only four of the fourteen-predictor variables on univariate analysis made unique statistically significant contributions to a logistic regression model. The odds ratios suggest that crisis nurses were twice as likely to refer patients who were not in any relationship or those who were known to psychiatric services compared to those who were in a relationship or not known to psychiatric services respectively; nineteen and six times respectively more likely to refer patients presenting with psychotic symptoms or a drug or alcohol problem compared to someone presenting with a medical problem and twenty and seven times respectively less likely to refer patients who were given a probable primary diagnosis of ‘drug/alcohol use disorder’ or ‘personality disorders’ compared to patients who were given the probable primary diagnosis of a ‘Depressive disorder’, controlling for other factors in the model.

In a task-shifting model of care, protocols need to be developed with clear guidelines around patients who need to be referred to a psychiatrist for further management.

Excessive use of emergency departments (EDs) for the treatment of mental health complaints (MHCs) suggests alternate interventions are required.

To understand attributes of patients who are high frequent users (HFUs) of EDs for the treatment for MHCs.

Suggest realistic changes that would make the health care system more effectively respond to HFUs needs.

Administrative data were used to analyze the use of all three emergency departments in Saskatoon Health Region by patients presenting with primary MHCs in 2012. A chart review of HFUs for the years 2011 to 2013 was also undertaken.

In 2012 approximately 1.2% (3,824) of the Region’s population made the 6,235 visits for a primary MHC. ED visits exhibit a Pareto distribution with most patients (72.8%) making a single visit however < 0.1 % (34) made 10+ visits. HFUs (10+ visits) used EDs in multiple years, over 3 years making an average of 59 ED visits (R=19 to 194). They were generally, young, male, unemployed, transient or homeless with many unmet social and economic needs. They could be categorized into: 1) suffering from severe alcohol abuse/withdrawal or illicit drug use; 2) chronic mood and anxiety disorders; 3) significant personal and social stressors; and 4) a complex combination of psychiatric disease(s) and cognitive impairment.

Action should be taken to identify ‘High Frequency Users’ early in their patient career and develop appropriate interventions taking into account their unique and diverse needs.

To examine incidence ofand factors associated with metabolic syndrome in patients with majordepressive disorder within a year.

All majordepressive disorder (MDD)patients who visited our psychiatric clinic were screened. All subjects were screenedby the metabolic syndrome criteria proposed by the American Heart Association/National Heart, Lung, and BloodInstitute (updated ATPIII). Subjects who did not meet the criteria of metabolicsyndrome would come after one year to screen for it again. Age and history ofused atypical antipsychotic use, duration of illness, severity of illness andfamily history of metabolic syndrome were assessed as factors associated withthe metabolic syndrome. Data was analyzed by using percentage, mean, standarddeviations, student t-test, chi-square test and Fisher's exact test.

There were 140 subjectsrecruited. 53 were excluded because they had metabolic syndrome. After one year77 of 87 came to the follow up visit for screening metabolic syndrome. The1-year incidence of metabolic is 16.9%(13 subjects) and 11.7%(9 subjects) dueto ATP III and IDF criteria respectively. Triglyceride and HDL at baseline wassignificantly associated with metabolic syndrome in patients with majordepressive disorder (p≤0.001). Age andhistory of used atypical antipsychotic use, duration of illness, severity ofillness and family history of metabolic were not associated with metabolicsyndrome.

Thai MDD patients are likely to have and developmetabolic syndrome. These findings support the importance of assessing andmonitoring metabolic syndrome in MDD patients especially in patients who havehigh triglyceride and HDL.