To evaluate the relative efficacy of Cognitive Behavioral Therapy (CBT) and Specialist Supportive Clinical Management (SSCM) for adults with severe and enduring anorexia nervosa.

Randomised controlled trial.

Sixty-three participants aged 18 and over (range 20-62) with a DSM-IV diagnosis of anorexia nervosa with at least a seven year illness history.

Thirty outpatient visits over 8 months. Participants were assessed at baseline, end of treatment (EOT), and 6-month and 12-month post-treatment follow-up. At EOP and follow-up, both groups improved significantly on the majority of outcome measures. However, there were no differences between treatment groups at EOT. At 6- and 12-month follow-up, analyses indicate greater improvement for those in CBT compared to SSCM. At 6-month follow-up, CBT participants had higher scores on the social adjustment scale (p = .038), and at 12-month they reported lower eating disorder examination global score (p = .004), and higher readiness for recovery (p = .013) compared to SSCM.

Patients with severe and enduring anorexia nervosa can make significant and meaningful improvements with therapy. CBT shows significant advantage over SSCM in terms of social adjustment, core eating pathology, and readiness for change over time.

Binge drinking and mental health problems in the depression/anxiety spectrum often begin in adolescence as co-occurring phenomena.

To evaluate the mediating role of socioeconomic status in the association between binge drinking and adolescent depression/anxiety.

A prospective cohort study of adolescents (n=3008), with 4 follow-up assessments between July 2006 and July 2010.

Family Panel, Institut d’Infància i Mon Urbà, Catalonia.

Adolescents and their parents.

The presence or absence of a diagnosis of depression/anxiety was determined at T1 and at T4 in interviews with parents. Binge drinking, defined as 2 monthly binges or more, was assessed at T1, T2 and T3 through interviews with the adolescent study participants, and the responses recorded as variables (yes or no). Age, sex, income, parents’ level of education, number of friends, peer pressure, parental pressure, and risk-prone friends were included as variables in data analysis. Descriptive and inferential statistics and simple and multivariate logistics models were applied to study the long-term effect of alcohol consumption on depression/anxiety.

Binge drinking is a risk factor for depression/anxiety in the last year of follow-up T3 (OR:1.7, IC 95%: 1.1-2.5). After adjusting for age and sex, the risk remains. The risk of depression decreases as household income increases (OR: 1.47, IC 95%: 0.9-2.4].

Binge drinking increases the risk of depression and anxiety disorders mainly in adolescents from low-income families. Mental health interventions and treatment for addiction should be sensitive to the effect of socioeconomic inequalities in this age group.

Disordered eating has a strong genetic component which is not fully understood.

Possible associations between certain genetic markers and disordered eating at adolescence were tested in the Nord-Trøndelag Health Study (HUNT).

Logistic regression was employed to test for association with the gene variants rs6277 (DRD2), rs569356 (OPRD1), rs10195252 (GRB14), rs35683 (GHRL), rs4074134 (BDNF), rs10838738 (MTCH2), rs1121980 (FTO), rs17782313 (MC4R) and rs11084753 (KCTD15) in participants aged 13 to19. EAT-7, a shortened version of EAT-12 was used to identify cases as those scoring above cutoff on EAT-7(456 cases) and its anorexia (EAT-A, 259 cases) and bulimia subscale (EAT-B, 433 cases), compared against 5405 controls. A haplotype analysis was performed for markers within FTO, MC4R and BDNF genes. Associations were adjusted for gender, age and BMI.

In males, rs6277 showed significant association with EAT-B (OR: 1.32, p = 0.03) after adjustments for age and BMI.

The A-allele of rs11084753 showed positive associations with EAT-A (OR: 1.25, p = 0.01) in the combined sample. In females, after adjusting for age and BMI, the C-allele of rs10195252 was positively associated with EAT-A (OR: 1.30, p = 0.01).

After adjustments for age and BMI in females, rs10195252 showed significant association with EAT-7(OR: 1.18, p: 0.02).

Haplotype analysis on FTO gene revealed a 'collective reinforced effect' of the GCT alleles from rs1121980, rs8050136 and rs9939609, respectively, compared to rs1121980 variant alone.

We found evidence in support of associations between DRD2, FTO, GRB14 and KCTD15 with disordered eating. Associations seem to vary based on gender.

- to assess the severity of depression

- to Identify depression structure

The study involved 50 patients with a diagnosis of recurrent depressive disorder. All patients were diagnosed with non-insulin-dependent diabetes mellitus. Assessment of patients was carried out twice: on admission to a psychiatric hospital and at 1 year. Used psychometric method – HDRS-21 scale.

<a name="_GoBack"></a>Results: we found an association between the severity of depressive symptoms and an increased risk of complications of type 2 diabetes mellitus. New complications developed in 30% of patients after a year of observation. These patients had a comparatively high level of depression on a first visit (mean score on a scale of HDRS 19.2 (SD = 7.5) vs. 16.3 (SD = 6.2) with the rest of patients). The difference of the average score was conditioned by differences in the level of mental anxiety (1.33 points, 95% CI = 0.8-1.87, p <0.0001), somatic anxiety (0.64 points, 95% CI = 0.05-1.23, p <0.05), and hypochondriasis (1.03 points, 95% CI = 0.65-1.41, p <0.0001).

The increase of depressive symptoms level in patients with diabetes mellitus type 2 can indicate decompensation in endocrine disease.

Deregulations of peripheral control of food intake in anorexia nervosa (AN), hunger signals (Ghrelin & obestatin) and satiety signals (leptin & insulin), have been reported. However, these differences could be a consequence or a risk factor of the disease. The genetic approach seems to be a good strategy to analyse this issue. Indeed, AN has a high heritability of ~50-80%.

The aims of this study are to confirm deregulation of hunger and satiety signals in AN and to analyze these results according to genetic polymorphisms. Furthermore, we search for an endophenotype by the screening of the AN mothers.

This work recruited 3 populations: 100 anorexic patients recruited at CMME (Sainte-Anne Hospital, Paris), their mothers, and 200 control women, matched with the patients or relatives for age. All subjects were assessed during a morning day at CMME. They arrived at 8:30am, fasting since the day before, to take a blood sample, in order to carry out genetic and physiologic analyses. Then, they were analysed for Body Mass Index and eating behaviors, including a psychiatric interview (DSM-IV-TR criteria) and self-questionnaires. Dosage of ghrelin, obestatin, and leptin were done by EIA or RIA. Single nucleotide polymorphisms were genotyped by Taqman assay.

We have confirmed that peripheral control mechanism of food intake is deregulated in AN patients and we observe difference also between mothers and controls.

Leptin dosage might be an endophenotype for anorexia nervosa.

Agomelatine, a melatonergic agonist and 5-HT_2c-antagonist, has demonstrated antidepressant efficacy and safety in clinical trials.

Metaanalysis of non-interventional-studies of agomelatine-treatment in depression to evaluate tolerability and antidepressant effectiveness of agomelatine under routine conditions in a large patient-population in Germany.

Pooled data-analysis from 4 non-interventional-studies (2009-2013). 9601 outpatients aged>18 years were observed by 2770 psychiatrists and general practitioners in Germany. Analysis was performed after 12 weeks (W12) and after 24/52 weeks (W24/W52) of treatment with agomelatine 25-50mg once daily. Antidepressant effectiveness was evaluated by Clinical-Global-Impression-Severity/Improvement (CGI-S/I). Liver-function-tests (LFT) were documented as available, ADRs at every visit.

Baseline CGI-S mean-value (4.7) improved over 12/24/52 weeks of treatment with agomelatine (to 3.0/2.8/2.6), corresponding improvement in 81%/82%/87% of patients. According to CGI-I, 24.3% responded (CGI-I≤2) after 2 weeks, 63.0% (W6), 87.7% (W12), 79.3% (W24) and 81.7% (W52). 34.5% of patients were classified as remitters (CGI-S=1 or 2) after 12 weeks, 38.1% (W24) and 47.5% (W52). Adverse drug reactions (mainly headache, nausea, dizziness) were reported for 5.32% (W12), 0.49% (W12-W24) and 0.99% (W24-M12) of patients, sADR in 0.2%/0.05%/0%. 49 patients (0.5%) had ALT/AST>3ULN (W0-W13), thereof 19 patients with preexisting transaminase-elevations at baseline. One patient with reversible hepatitis was documented (W10-W17), treatment was stopped. All other patients were without clinical symptoms. Mean weight (76.9 vs 77.0kg) and BMI (26.4 vs 26.5) remained unchanged.

This metaanalysis documents good tolerability of agomelatine and antidepressant effectiveness in a large population of unselected patients in German daily practice over 3, 6 and 12 months.

Anhedonia is one of the two symptoms, along with depressed mood, indispensable for the DSM-5 diagnosis of major depressive disorder. However, anhedonia in depressed patients is poorly explored in terms of prevalence or correlation with other clinical features.

The HEDONIE study aimed to explore the patterns and course of anhedonia in major depressive disorder.

1657 patients were followed over 10 to 12 weeks and assessed with the QIDS-SR, MADRS, CGI, SHAPS and SDS.

At inclusion, the mean QIDS-SR score was 17.4 ± 4.2 and the mean MADRS score was 32.6 ± 7. The mean SHAPS score was 9.8 ± 3.6 and 86.2% of the patients had a SHAPS > 5, which can be considered as a severe anhedonia. Patients with severe anhedonia had a significantly higher QIDS-SR mean score. The SDS total score was 22.1 ± 4.7. Patients were mainly treated with agomelatine (91, 3%).

At last visit, significant reductions were observed in QIDS-score (−11.0 ± 5.7, P<0.0001), MADRS score (−21. 2 ± 9.3, P<0.0001), SHAPS score (−6.9 ± 4.6, P<0.0001) and SDS score (−12.7 ± 7.8, P<0.0001). The correlation between improvement of anhedonia and improvement of functioning was strong (r=0.646; P<0.0001).

This study emphasizes the high prevalence of anhedonia in depression and the importance of its screening and evaluation, given its consequences in terms of functionality. The improvement in anhedonia and functioning observed in this study may be due to the specific antidepressant efficacy profile of agomelatine, already demonstrated in other trials.

The rate of mental disorders among children and adolescent has doubled in the Calgary Health Region over the last 15-years.

To examine prevalence of depression in children and adolescent and determine the most frequent ICD diagnosis given a physician-assigned depression diagnosis.

We examined the annual and 15-year cumulative prevalence of major depression in a population of children and adolescent in the Calgary Health Region and determined the most frequent diagnosis of physical disorders given a depression diagnosis.

We used direct physician billing data for the Calgary health region (Calgary, Alberta) from 1994-2009 for treatment of any presenting concern (n = 763449). We identified 537 unique individuals (191 males) with a physician-assigned diagnosis of major depression. Odds ratios were used to identify the most frequent physical disorders given a depression diagnosis.

The 15-year cumulative prevalence among help-seeking population for major depression was 22.6 per 10,000. The annual rates of major depression increased twofold from 1.7 to 4.5 per 10,000. The cumulative prevalence rates of major depression were 29 (CI 26-33) per 10,000 for females and 16 (CI 14-18) per 10,000 for males. ICD codes under injury and poisoning were found to have the highest odds ratio followed by genitourinary system in relation to Major Depression diagnosis.

The twofold increase of major depression is consistent with the overall doubling of mental disorders among children and adolescent in the Calgary health region and has important planning and policy implications.

Previous research failed to uncover a replicable structure of dimensions or subtypes underlying the symptoms of depression. One reason might be that research failed to separate co-variation between symptoms due to overall depression severity vs. due to specific symptom profiles.

The study tested the hypothesis that a replicable dimensional structure of depression would be uncovered when depression severity is eliminated from symptom scores. Additionally, the study explored differences in the dimensional structure in general population vs. depressed people-only samples.

The cohort study on substance use risk factors (C-SURF), a large cohort of young Swiss men, and young men from the national health and nutrition survey in the US (NHANES 2009-2012) were analyzed. DSM-IV symptoms of depression were assessed via the Major Depressive Inventory (WHO-MDI) in C-SURF and via the Patient Health Questionnaire 9 (PHQ-9) in NHANES. Dimensionality was examined using principal component analysis in full samples vs. samples of participants with a current depressive episode for raw vs. severity-adjusted symptom scores.

When using severity-adjusted symptom scores, correlations between depressive symptoms largely disappeared and there were no replicable dimensions. When using raw scores in the full samples, one single dimension of depression consistently emerged. When using raw scores in depressed participants, only rudiments of dimensions were found across samples.

It is unlikely that there are stable dimensions underlying the DSM-IV symptoms of depression. The set of symptoms capture the disorder in the general population, but the disorder's manifestation is highly individual.

In several countries including Hungary no emergency care guidelines are available, and studies regarding everyday clinical emergency practice are also lacking.

The aims of the present study was to assess practice related to emergency care of agitated-psychotic patients in emergency settings in Hungary as well as to compare it with internationals trends.

Anonymous survey questionnaires were dispatched to 210 institutions providing psychiatric care in Hungary in 2013 consisting of questions related to care of an agitated patient showing psychotic symptoms. The results were compared with data from the latest international studies carried out in this field.

155 completed questionnaires were returned. Of the participating clinicians 18.7% would apply monotherapy, 76.1% dual combination, 5.2% a triple combination of medications. 92.9% of participants indicated haloperidol among first-line medications. 80.6% of participants would take a combination with benzodiazepines. 59.4% would use IV and 23.9% IM therapy, and 9% would apply the combination of these two. 7.7% of participants did not answer this question.

Our results indicate that administration of haloperidol and benzodiazepines is a widespread practice in the emergency care of agitated psychotic patients in Hungary which corresponds to dominant trends in international practice as reflected by the latest international survey. The international survey including 21 countries indicate that three countries (India, Romania, Slovenia) regularly use IV medications, whereas others do not do this at all, and only use IM medication. Hungarian clinicians disagree on mode of administration, but the majority would prefer IV therapy.

Premenstrual syndrome (PMS) is associated with many risk factors and its prevention through identification of modifiable risk factors such as diet is of primary importance.

Current literature suggests that diet is involved in either the development of PMS or contributes to symptom severity but to date, there are no studies evaluating the eating attitudes of adolescents with PMS.

To evaluate dietary intake and eating attitudes in adolescents with PMS.

This study was conducted with 383 adolescents (214 with and 169 without PMS), aged 13-19 years. PMS was diagnosed using the PMS Scale (PMSS). Food Frequency Questionnaire(FFQ) and 24-hour dietary recall were used to assess dietary intake. Eating Attitudes Test-26(EAT-26) and Three-Factor Eating Questionnaire-R18(TFEQ-R18) were used to evaluate eating attitudes. Anthropometrical measurements and bone mineral content were measured.

PMS prevelance was 55.9%. According to PMSS subscales, 88.8% of adolescents with PMS had depressive feelings, 53.7% anxiety, 93.5% fatigue, 91.6% irritability, 77.1% depressive thoughts, 76.6% pain, 74.8% changes in appetite, 73.8% changes in sleeping habits, 52.3% swelling (p<0.05). No significant difference in dietary intake, anthropometrical measurements and bone mineral content was observed whereas disordered eating attitudes determined by EAT-26 was detected in 23.8% in adolescents with PMS and 11.8% of adolescents without PMS (p<0.05). In the PMS group, total TFEQ-R18 score, emotional eating behaviour and uncontrolled eating behaviour scores were significantly higher (p<0.001).

This is the first study documenting that not only dietary intake but also eating attitudes are associated with the development of PMS in adolescents.

The purpose of this study was to test the Suicide Severity Screen tool's ability to identify patients who present to the Emergency Department (ED) with non suicide related illness who might be at risk for suicide. The secondary purpose was to assess whether the patient followed up with the referral services after being discharged from the ED.

A convenience sample of patients who presented to the ED with non suicide related illness were given the Suicide Severity Rating Screen, a validated tool to measure suicidality and given a referral of services. The patient was contacted two weeks afterwards to determine if they contacted any of these services.

A total of 311 patients were enrolled in the study. Twenty one percent of patients tested positive for at least one module: suicidal ideation, intent, or plan, and three percent tested positive for entire survey. Of the three that tested positive for the entire survey, all presented with psychiatric related illnesses. There was a significant relationship between the patient's disposition and whether they tested positive to the survey (F=14.096, sig=.000). Initial follow-up on use of referral services had a 50% success rate.

The Suicide Severity Screen identified patients who presented to the ED with non suicide related illnesses who were at risk for suicide. Almost half of those patients were found to be successful in accessing the referral service given to them.

Frequent users of the ED contribute to the problem of overcrowding and are more likely to have psychiatric problems and a higher than average 90 day re-admittance rate. In addition, ED visits due to mental health problems have increased in recent years, thus driving up 90 day re-admission rates.

Objectives – To determine the reasons for readmissions of psychiatric patients who had previously presented to the Emergency Department.

Methods – This is a retrospective chart review of a random sample of 350 psychiatric patients who presented to the ED and had a return visit within 90 days. The study was IRB approved.

There was a significant difference (p = .01) between the reasons for psychiatric patients to be re-admitted to the hospital between their first, second, and third ED visit. The most common reason for admittance on the first visit was depression, schizophrenia, schizoaffective disorder, bipolar disorder, and psychosis. The most common reasons for the second and third visit however, were psychiatric (61.9%), musculoskeletal (9.2%), cardiovascular (5.7%), neurological (4.3%), and dermatological (3.2%).

Psychiatric patients are not returning to the ED repeatedly for the same complaints or for only psychiatric complaints. A total of 30% of patients who presented for a second and third time within 90 days who were admitted for medical illness versus their initial psychiatric presentation.

The studies show that both spirituality and religiosity are protective for mental health. Personality is related with course and outcome of depression, as well as spirituality and religiostiy, and their relations towards to recovery from depression are underresearched. Aim: This study followed influence of spirituality and religiosity on course and outcome of depression in patients with depressive episode, controlled for personality dimensions.

The patients were assessed with self-report measures of depression (BDI), spirituality (WHOQOL-SRPB), religiosity (DUREL) and personality (TCI). Ninety nine patients finished a year long follow up.

Higher spiritualiy influenced recovery of depression in patients with depressive episode, but religiosity that did not show to be significant predictor of recovery for depression. Dimension harm avoidance was significant predictor of improvement of depression in all points of measurement.

Spirituality and dimension harm avoidance are significant predictors of recovery of depression during a year long follow up.

Since 2008 Greece has entered a long period of economic crisis with adverse effects on various aspects of daily life. In this frame it is quite important to examine the suicide trends in Greece during the period 1992-2012 with particular consideration given in the recent period of economic crisis [2008-2011].

Population data and crude data on suicides were obtained from the Hellenic Statistical Authority (EL.STAT.). We assessed the Age-adjusted Standardized Suicide Rates (SSR). Age-adjustment was performed by the direct standardization method, using the European Standard Population (ESP). Trends in sex SSR were analyzed using joinpoint regression, in which trend data are characterized by a number of contiguous linear segments and join points (points at which trends change).

During the study period, 8025 cases of suicide occurred. Total SSR presented statistically significant annual decrease of 0.89% (95% CI -1.7, -0.1), during the period 1992-2009. After 2009 the trend in SSR increased statistically significantly (annual increase 12.48%, 95% CI 0.3%, 26.1%). SSR in males presented an initial period of modest annual decrease (-0.84%, 95% CI -1.6%, -0,1%), during the period 1992-2008. Joinpoint regression analysis revealed a change in male SSR trend during 2008, after which the average annual increase was 9.25% (95% CI 2.7% – 16,3%). No change in female SSR trend was observed during the studied period.

Data indicate a clear evidence of an increase of the overall suicide rates and male suicide rates in Greece during the period of the current financial crisis.

Both youngsters and adults with same-sex attraction are at greater risk for negative health outcomes. It is argued that early biological events generated by genes and prenatal sex hormones determine an individual's sexual orientation. However, despite mounting efforts, a satisfactory conclusion has not been reached and there is a need to explore alternate factors like functioning of thyroid system during pregnancy.

This study was conducted to explore the relationship between maternal thyroid dysfunction in pregnancy and same-sex attraction/gender nonconformity in the offspring.

A retrospective chart review was undertaken of 790 eligible children and adolescents who had been admitted to child psychiatry between 2005 and 2013. This population consisted of 520 (65%) males and 270 (35%) females, aged 8 to17 years. Children who were victims of sexual and physical abuse and who had mental retardation, autism and psychosis were not included.

Fifteen mothers (1.8%) were found to have a history of thyroid dysfunction during pregnancy. Sixteen youngsters (2%) had a history of same-sex attraction/gender nonconformity. Twelve overlapping cases with both same-sex attraction/gender nonconformity and maternal thyroid dysfunction during pregnancy were identified, which was extremely significant (p < 0.0001, by Fisher's exact test). The association was also significant for each sex (p < 0.0001, by Fisher's exact test).

There is evidence that thyroid gland and its hormones play a crucial role in determining sexual orientation in people. Maternal thyroid dysfunctions during pregnancy may result in homosexual orientation in the offspring.

Suicide is a major problem in public health and is related to many risk factors as unemployment and changing in a labour market.

This article aims to undesrstand the current escalating impacts of work on menatl health workers from the study of the relationship between unemployment and suicide as the direct effects of this new morphology of labour.

The search was conducted using the following databases: PubMed, Medline, Web of Science, Scopus, Library of Knowledge online (b-on), Social Care Online, EBSCO, PsycINFO, to ensure that search strategy in the literature examined thoroughly covered the areas of medicine, sociology and psychology, beyond the textbooks and official documents of the above areas. The terms used in the search were: “unemployment”, “mental health”, “suicide”, “mental disorder”. Using the PRISMA methodology, the 628 articles were considered if the search terms were included and published in the period 2005-2014; after a review of the title and summary, 53 eligible studies in english, french, german, spanish, portuguese and italian were included. Duplicates and documents dealing with mental health in retirees, children and adolescents were excluded.

Findings suggest that long-term unemployment is associated with greater incidence of suicide. Changes in the workplace, such as the reduction of employment, expansion of unemployment, have led to an increase in unemployment, which, in turn, has led the worker to the disease process, especially mentally. Community programs mental and psychotherapeutic strategies evidence-based health can help reduce and prevent suicide in the working world, a global imperative.