There is considerable evidence in the literature that migrants experience higher rates of emotional distress and psychiatric disorders in comparison with non-migrants. There are further differences in rates between voluntary migrants and forced involuntary migrants.

To explore differences in rates and the relationship between these rates and the nature of migration. In particular, the lecture will explore the relationship between rates sand life events, including trauma.

The aim of the lecture will also be to explore the relationship between migration and stigma which may apply to involuntary forced migrants.

Using the literature and epidemiological data, the talk will explain the association between migration, trauma and stigma.

Forced migrants eg refugees and asylum seekers may experience difficulties in adjustment and acculturation. These may be related to the nature of welcome they receive as well as individual personal factors. In addition, the nature of the culture they belong to and the nature of the new society will play important roles in acculturation.

A knowledge of processes of acculturation and factors influencing these will lead to better clinical services and also to appropriate preventive interventions.

In 1-year prospective study in 140-bed university-based psychiatric clinic prevalence of violence among all hospitalized patients was 5%. Patients with organic disorders exhibited most violence (14%), followed by patients suffering from schizophrenia (7%).

While number of reports confirm rapidly growing rate of mentally disordered offenders, this does not apply to the Czech Republic.

In our first study (1) we analyzed prevalence of violence among schizophrenic patients in the years 1949, 1969, 1989, and 2000 in Prague (Czech Republic). Overall, violence was 41.8% for men and 32.7% for women. There was no increase in violence in schizophrenic patients between 1949 and 1989, and only a marginally higher prevalence of violence was reported in the 2000 sample. Family members and medical staff are the most frequent victims of violence.

In the second study, we have not found significant increase in admissions to a large forensic psychiatric facility between 2002 and 2007. Further, number of court ordered forensic treatments between 1991 and 2007 for o psychiatric and sex offences remained unchanged. However there was a steep increase (162%) in number of treatments imposed for abusing illicit drugs.

We have hypothesized that the high rate of adult psychiatric hospitalizations has protected patients with serious mental disorders from engaging in criminal behavior. It is necessary to identify the subgroup of patients for whom longer inpatient care is of benefit. In the Czech Republic, this process is important in the sense that there is a need to promote shorter hospitalizations and high quality community care for the vast majority of patients.

It is becoming increasingly clear that people with schizophrenia are more often victims than perpetrators of violence.

In our current study in psychiatric inpatients 39% female and 30% male schizophrenic patients were victimized during previous 6 months (using MacArthur Questionnaire) and and 7% men and 14% women suffered also from PTSD (using SCID module)

The high rate of PTSD in persons with schizophrenia has important clinical implications. Once PTSD will be diagnosed another therapeutic procedures (e.g. cognitive restructuring, exposure therapy) could be added to antipsychotic therapy. Effective treatment for those problems could improve both physical and mental health functioning.

Mounting evidence has suggested a pivotal role of immune dysfunction in the pathophysiology of autism spectrum disorders (ASD). In this study, levels of inflammatory cytokines were measured intrauterinely in amniotic fluid (AF) samples and postnatally in dried blood spots samples (DBSS) of children diagnosed later in life with ASD and their controls.

Study population was retrieved from a historic birth cohort (HBC) kept at Statens Serum Institute (SSI) in Copenhagen, Denmark. The HBC comprises AF and maternal serum samples collected during antenatal screening/diagnostic tests since 1980. All singleton ASD cases who had a corresponding AF sample in the HBC and born 1982–2000 were identified utilizing Danish nation-wide health registers. Controls were selected from the HBC and frequency-matched to cases on gender and year of birth. Corresponding DBSS were indentified in the Danish Newborn Screening Biobank. Levels of selected inflammatory cytokines in AF samples and DBSS were analyzed at SSI using Luminex xMAP technology. Case-control differences were assessed as categories (logistic regression) or continuous measures (tobit regression).

Total of 414 cases and 820 controls were included in the study. Measurements performed on AF showed elevated levels of TNF, IL-4, and IL-10 in ASD. Discrepant pattern was seen in DBSS with elevated levels of IL-8 and sIL-6rα. While findings in this study show that immune dysfunction in ASD starts intrauterinly, the discrepant intrauterine/neonatal patterns are of a special interest. Finally, further studies to examine the specificity of these findings to ASD are necessary.

To date, no treatment outcome study for anxiety disordered youth was able to follow a control group for the long term.

To examine Long term outcome of anxiety disordered children who were treated with Cognitive Behavioral Therapy (CBT) as opposed to comparable children who were not.

Subjects (N = 120) who were 8–12 years old at the time of initial assessment at an academic facility, were followed 8.2 (SD 1.5) years later. Children were equally divided between two groups, those treated with CBT and those who were not. A prospective “ex post facto” cohort design was used to compare the two groups. Psychiatric diagnoses were ascertained using the ADIS semi-structured interview. Primary outcome measure: Multidimensional Anxiety Scale for Children (MASC). Other measures were used to evaluate depression, functioning, global improvement, well-being, self-efficacy and self esteem.

The treatment group did not differ demographically from the non-treatment group. No significant difference was found between groups at base-line in measures of anxiety and depression and at Long Term Follow-Up (LTFU) in measures of anxiety, depression, functioning, global improvement, well-being, self-efficacy and self esteem by both child and parent report. A significant pre-post improvement was found in measures of anxiety, depression and level of functioning in both groups.

Anxious children improve over time in functioning and measures of anxiety and depression. No difference was found between those treated with CBT and those who were not at LTFU. Further studies are needed to elucidate the association between treatment and long term gain.

Individuals with Alcohol Use Disorder and depression (dual diagnosis) present greater challenge to treatment than individuals with a single disorder. Mobile phone technology has the potential to provide personalised support for this group of patients.

To explore the feasibility of using supportive text messaging as an effective strategy to improve outcomes in patients with dual diagnosis.

The study is a single-blind, randomised, trial of supportive mobile text messages. After randomisation of all fifty four eligible patients, those in the intervention group (n = 26) received twice daily supportive SMS text messages for 3 months. At three months, all the study participants completed a range of assessment tools relating to the outcome measures. Data was analyzed with a combination of statistical methods.

The end-point mean Beck's Depression Inventory score was significantly lower in the intervention group compared with the control group: 9.3 (SD = 7.5) vs. 16.0 (SD = 10.3), p = 0.01, Eta Square = 0.12. There was also a statistically significant difference in mean Global Assessment of Function (GAF) scores between the two groups, with the intervention group having a higher mean GAF score compared to the control group: 89.8 (SD = 12.2) VS. 76.1 (SD = 15.3), P < 0.01. Eta square= 0.2. There was also a trend to finding that the mean Cumulative Abstinence Duration in the text message group was higher than that for the control group {88.3 (SD = 6.2) vs. 79.3 (SD = 24.1), p = 0.8).

Supportive text messages have the potential to improve outcomes for patients with alcohol dependency syndrome and comorbid depression.

50% of patients with major depressive disorder (MDD) do not respond to first-line treatment with a selective serotonin reuptake inhibitor (SSRI). May specialist level inpatient care results differ from community studies?

To compare switching to venlafaxine (Dexcel Pharma Israel) versus switching to another SSRI in depressed inpatients after treatment failure with an SSRI.

A retrospective register study of inpatients in a tertiary care university center.

There was a preponderance of women in both groups. Mean age for both groups was older than 50 years.

A total of 401 MDD inpatients were assigned to antidepressant treatment. Of these, 232 records (47 venlafaxine, 185 SSRI) were included in the analysis. Patients assigned to venlafaxine treatment were older (mean age 64.3 ± 15 years versus 53.6 ± 17; pb0.01) and had more comorbid physical disorders (80% versus 57%; p < 0.001).

There was no statistical difference between groups in reduction in CGI-S total scores. The secondary end point of achieving a CGI-S score of 2 or less (1 = normal, or 2 = borderline mentally ill) was significantly better for venlafaxine treated inpatients (P = 0.02). AEs were reported less than 10% of patients in both groups.

It is important to note that in 117 patients switched to an heterocyclic antidepressant improvement was smaller than in the SSRI or SNaRI groups.

Patients who remain severely depressed following treatment with an SSRI may gain benefit from the dual-action drug venlafaxine, rather than switching to another SSRI. These findings need further support by prospective studies.

Pre- and perinatal insults, childhood maltreatment, and personality traits have been separately related to suicidal behavior.

To explore if all these factors act in an additive fashion.

To examine characteristics of suicide attempts in a life course perspective.

Sample and procedure: Cross-sectional study of 1042 suicide attempters. Indexes of pre- and perinatal adversity were hospitalization in neonatology, very premature birth (< 31 weeks of pregnancy), tobacco during mother's pregnancy, and mother's and father's age at patient's birth. All suicide attempters were evaluated using the French version of the Childhood Trauma Questionnaire, and the Tridimensional Personality Questionnaire. Characteristics studied in suicide attempters included violence of suicide attempt, age at first suicide attempt, and number of suicide attempts. Statistical Analyses: Comparisons between groups was made using c2 with crude and adjusted odds ratios, and 95% confidence intervals. All analyses were adjusted for gender, age, study level, Alcohol dependence or abuse, Substance dependence or abuse, Tobacco, Episode of major depression, Bipolar, Anxiety, Eating disorders, and Schizophrenia.

We found an additive effect between prematurity and sexual abuse (OR[95%] = 3.57[1.03–12.50];p < 0.001), emotional abuse (OR[95%] = 4.54[1.76–12.50];p < 0.05), novelty seeking (OR[95%] = 9.09[1.76-12.50];p < 0.001), and harm avoidance (OR[95%] = 5.88[2.38-14.28];p < 0.001) for a younger age at first suicide attempt. Tobacco during mother's pregnancy, and harm avoidance also had an additive effect on the age at first suicide attempt (OR[95%] = 4.76[1.96–11.11];p < 0.05) and number of suicide attempts (OR[95%] = 3.31[1.37–7.99];p < 0.05).

Pre- and perinatal insults, childhood maltreatment, and personality traits influence in an additive fashion characteristics of suicide attempts.

The Assertive Community Treatment (ACT) teams of Mount Sinai Hospital in Toronto and the KUINA Center, Hitachinaka, Japan, were compared with regard to ACT fidelity, organizational structure, populations served, and treatment outcomes. Ethnocultural adaptations to the ACT model made by both teams included enhanced family support and intervention, culturally and linguistically matched staff and patients when possible, culturally informed therapy, routine cultural assessments, culturally matched housing and community support, and flexible funding models.

Data were gathered by chart reviews (66 patients in Toronto and 40 patients in Japan), a satisfaction measure, a standard measure of ACT fidelity, a pre-post measure of treatment outcomes (the Brief Psychiatric Rating Scale), and hospitalization days.

Both teams achieved good fidelity to ACT and reductions in hospitalization and symptom severity. Family satisfaction scores were high.

With culturally informed adaptations, ACT can be effective in a Canadian mixed ethnocultural population and a homogeneous Japanese population.

To study in depth the neurotoxic effects of chemotherapy on the cognitive functions. Also, to explore relationships between Neurocognitive function and metabolite ratios of specific brain regions using magnetic resonance spectroscopy (MRS).

Observational analytical case control study which includes thirty patients with diagnosis of leukemia receiving chemotherapy “Cases” & another group of thirty patients with diagnosis of leukemia not receiving chemotherapy at all as “Controls”. All participants were subjected to Semi structured interview, Wechsler Intelligence Scale for Children (WISC) and Magnetic Resonance Spectroscopy (MRS).

The means of Wechsler Intelligence Scale for Children (WISC) Total, Performance and verbal among the patient group were lower than the control group (P < 0.001). There was statistical significant difference between the two groups regarding Magnetic Resonance Spectroscopy (MRS) in different brain areas. The means of Frontal Cho/NAA, Frontal Cho/Cr, Temporal Cho/NAA, Temporal Cho/Cr, Parieto-Occipital Cho/NAA, Parieto-Occipital Cho/Cr, Basal ganglia Cho/NAA and Basal ganglia Cho/Cr among the patient group were higher than the control group and the means of Temporal NAA/Cr and Parieto-Occipital NAA/Cr among the patient group were lower than the control group.

MR spectroscopy is more sensitive method demonstrating metabolite changes in the brain after chemotherapy treatment of leukemic children in the absence of structural white matter abnormalities at MR imaging. A significant cognitive function difference was detected in leukemic treated cases compared to controls and correlated to the metabolic brain changes detected by MRS.

Antidepressants are amongst the most commonly prescribed classes of drugs and their use continues to grow. Adverse outcomes are part of the landscape in prescribing medications and therefore management of safety issues need to be an integral part of practice.

We have developed consensus guidelines for safety monitoring with antidepressant treatments.

To present an overview of screening and safety considerations for pharmacotherapy of clinical depressive disorders and make recommendations for safety monitoring.

Data were sourced by a literature search using Medline and a manual search of scientific journals to identify relevant articles. Draft guidelines were prepared and serially revised in an iterative manner until all co-authors gave final approval of content.

A guidelines document was produced after approval by all 19 co-authors. The final document gives guidance on; the decision to treat, baseline screening prior to commencement of treatment, and ongoing monitoring during antidepressant treatment. The guidelines state or reference screening protocols that may detect medical causes of depression as well as screening and monitoring protocols to investigate specific adverse effects associated with antidepressant treatments that may be reduced or identified earlier by baseline screening and agent-specific monitoring after commencing treatment.

The implementation of safety monitoring guidelines for treatment of clinical depression may significantly improve outcome, by improving a patient's overall physical health status.