The mental health burden on primary care is substantial and increasing. Anxiety is a major contributor. Stepped collaborative care (SCC) is implemented worldwide to improve patient outcomes, but long term real-world evaluations of SCC do not exist. Using routinely used electronic medical records from more than a decade, we investigated changes in anxiety prevalences, whether physicians made distinction between non-severe and severe anxiety, and whether these groups were referred and treated differently, both non-pharmacologically and pharmacologically.

Retrospective assessment of anxiety care parameters recorded by 54 general practitioners between 2003 and 2014, in the electronic medical records of a dynamic population of 49,841–69,413 primary care patients.

Substantial shifts in anxiety care parameters have occurred. The prevalence of anxiety symptoms doubled to 0.9% and of anxiety disorders almost tripled to 1.1%. Use of ICPC codes seemed comprehensive and use of instruments to support in anxiety level differentiation increased to 13% of anxiety symptom and 7% of anxiety disorder patients in 2014. Minimal interventions were used more frequently, especially for anxiety symptoms (OR 21 [95% CI 5.1–85]). The antidepressant prescription rates decreased significantly for anxiety symptoms (OR 0.5 [95% CI 0.4–0.8]) and anxiety disorders (OR 0.6 [95% CI 0.4–0.8]). More patients were referred to psychologists and psychiatrists.

We found shifts in anxiety care parameters that follow the principles of SCC. Future primary care research should comprehensively assess the use of the SCC range of therapeutic options, tailored to patients with all different anxiety severity levels.

Anxiety and depression disorders are common in patients with chronic pain. Studies using clinical interviews in patients with chronic pain report prevalence rates ranging between 30–54% for depression and 17–29% for anxiety. This is the first study using contacts with a hospital psychiatric ward to investigate prevalence of depression and anxiety in patients with chronic pain.

Estimate the prevalence of anxiety and depression in patients with chronic pain referred for interdisciplinary treatment.

To increase the knowledge about mental disorders and chronic pain in secondary health care.

All chronic pain patients referred to and treated at an interdisciplinary pain clinic at Odense university hospital, Denmark from 1 Jan 2005–13 Nov 2015 were included as participants. The Danish National Patient Register was used to collect information on contacts with a hospital psychiatric ward 10-year prior to the first contact at the pain clinic due to depression (ICD-10: F32-F33) and/or anxiety (ICD-10: F40-F41).

In total, 7204 patients (64% women; mean age: 48.2) were included. Altogether, 17.8% (95% CI: 16.9–18.7) of patients had contact to a psychiatric ward. The prevalence of unipolar depression were: 6.1% (95% CI: 5.5–6.6) and anxiety: 2.1% (95% CI: 1.8–2.5), while 0.7% (95% CI: 0.5–0.9) had both depression and anxiety.

The prevalence rates of depression and anxiety noted in this study were lower than those reported in previous studies. A hospital-based diagnosis seems likely to be less frequent than interview-based measures, yet, might have a higher validity due to the clinician-based assessment.

The authors have not supplied their declaration of competing interest.

Maternal depression is relatively common during pregnancy. However, follow-ups of the adult offspring of antenatally depressed mothers are scarce. Previously we found the risk of schizophrenia to be higher in the adult offspring with antenatally depressed mothers and parents with psychosis than in subjects with only one or neither of these risk factors. The aim was to study whether the risk of schizotypal or affective traits differ among adult offspring with antenatally depressed mothers with or without a parental history of psychosis when compared with offspring without antenatally depressed mothers and without parental psychosis.

In the general population-based Northern Finland 1966 Birth Cohort (NFBC 1966), the mothers of the cohort members were asked at mid-gestation whether they felt depressed. Parental psychosis (Familial Risk, FR) was detected using the Finnish Care Register for Health Care. In the 31-year field study, seven psychometric questionnaires surveyed schizotypal and affective traits in the offspring. The final sample included 4928 individuals (2203 males).

There were no statistically significant differences in mean scores on the schizotypal and affective scales between offspring with and without antenatally depressed mothers, or between subjects with and without parental psychosis. The scores were not highest in the subjects with both maternal antenatal depressed mood and FR.

Surprisingly, maternal depressed mood during pregnancy was unlikely to increase the risk of schizotypy or affective traits in adult offspring, and not even with parental psychosis (FR) in this general population-based birth cohort with about 5000 subjects.

The aim of the study was to determine whether patients with OCD resistant to drugs may improve using intensive, systematic CBT lasting six weeks and whether it is possible to predict the therapeutic effect using demographic, clinical and psychological characteristics at baseline.

There were 66 patients included in the study. Fifty-seven patients completed the program. The diagnosis was confirmed by a structured interview MINI. Patient were rated before the treatment using Y-BOCS (objective and subjective form), CGI (objective and subjective form), BAI, BDI, DES (Dissociative Experiences Scale), SDQ 20 (Somatoform Dissociation Questionnaire), and SDS (Sheehan Disability Scale), and at the end of the treatment using subjective Y-BOCS, objective and subjective CGI, BAI, and BDI. Patients were treated with antidepressants and daily intensive group cognitive behavioral therapy for the period of six weeks.

During the 6-week intensive cognitive behavioral therapy program in combination with pharmacotherapy, there was a significant improvement in patients suffering from OCD formerly resistant to pharmacotherapy. There were statistically significant decreases in the scales assessing the severity of OCD symptoms, anxiety, and depressive feelings. The lower treatment effect was achieved specifically in patients who:

– showed fewer OCD themes in symptomatology;

– showed a higher level of somatoform dissociation;

– with poor insight;

– with a higher level of overall severity of the disorder in the beginning.

The remission of the disorder was achieved more probably in patients with:

– good insight;

– the lower level of initial anxiety;

– without comorbidity with the depressive disorder.

The authors have not supplied their declaration of competing interest.

Obesity is an increasingly common chronic disease. Its biopsychosocial basis provides the rationale of multidisciplinary interventions, such as Therapeutic Patient Education (TPE, WHO 1998), which is effective for lifestyle change and awareness improvement, thus reducing the disease's prevalence and its health care-related financial burden. However, patients’ socio-demographic and psychopathological factors may influence TPE's effectiveness.

We aimed to assess the effectiveness of an 8-week TPE program in obese patients candidates for bariatric surgery and identify factors predicting its success.

We enrolled 159 patients with a BMI > 35 Kg/m2 and obesity-related comorbidities (females = 71.3%; age range = 18-35 years) at the C.A.S.C.O. (EASO COMs) of our University Hospital. They filled out the Binge Eating Scale (BES), the Symptom Checklist-90-R (SCL-90-R), and the Short Form-36 Health Survey (SF-36). We used Tukey's multiple comparison test to assess Quality of Life (QoL) improvement after TPE and multivariate logistic regression to estimate the size of the association between TPE and the aforementioned factors.

The SF-36 showed a significant improvement (P < 0.05) of physical and mental QoL post-TPE, especially in obese patients without binge eating disorder. The same applied to BES and SCL-90-R scores. The factors predicting TPE success were a short duration of obesity, a limited number of past diets, and low levels of anxiety/depression pre-TPE.

In obese patients candidates for bariatric surgery, TPE is useful to improve physical and mental QoL, eating behavior, and psychological status. Several factors are predictive of TPE success, allowing a personalization of the intervention to render it more effective.

The authors have not supplied their declaration of competing interest.

The DGPPN, as a German psychiatric professional society, demands a new, systematic viewing of the biographies, motivations, participations and defense patterns of important representatives of the discipline during the National Socialistic period.

A current evaluation of previously untapped sources makes it possible to assign an appropriate critical-historical position to Friedrich Meggendorfer’s role as NS-academic psychiatrist.

Relevant archive materials as well as primary and secondary literature have been reviewed.

Clinically and scientifically, Friedrich Meggendorfer worked under Emil Kraepelin (1856-1926), Max Nonne (1861-1959) and Ernst Rüdin (1874-1952). Meggendorfer earned a good reputation in genetic research during his activity as psychiatrist in Hamburg under Wilhelm Weygandt (1870-1939). This was the decisive reason why he was called to the Chair in Psychiatry in Erlangen in 1934. At the same time, Meggendorfer was appointed Director of the Erlangen Psychiatric and Neurological Hospital as an adnexe to the Erlangen asylum for the mentally ill. Because he had joined the NSDAP on 01.05.1933, he was suspended from office on 19.11.1945 by the military government. Meggendorfer was rated as a 'hanger-on' by the denazification court on 20.09.1946. In the post-war period, Friedrich Meggendorfer was confronted with comparatively strict restrictions. His removal from the faculty of the Friedrich-Alexander University can primarily be considered due to the post-war Director of the Erlangen asylum, Werner Leibbrand (1896-1974) and his reorganization of the psychiatric clinics.

Meggendorfer‘s role as an NS-academic psychiatrist is most likely trapped in the professional understanding of his time.

Trinucleotide repeats have been associated with schizophrenia, but the evidence, based on cross-sectional clinical information, is equivocal.

To examine the relationship between genomic CAG/CTG repeat size and premorbid development in schizophrenia.

Early development and premorbid functioning of 22 patients with DSM-IV diagnosis of schizophrenia were assessed by parental interviews. Repeat expansion detection (RED) technique was used to measure genomic CAG/CTG repeat size, and PCR for CAG repeat size at the ERDA-1 and CTG 18.1 loci.

There was an inverse association between CAG/CTG size and perinatal complications. Patients with speech and motor developmental delay had larger repeats. The results were not due to expansion in the ERDA-1 and CTG 18.1 genes.

CAG/CTG repeat expansion is associated with speech and motor developmental delay in schizophrenia. We propose that the developmental model may be useful for research into the genetics of schizophrenia.

To estimate efficacy of risperidone and olanzapine in treatment of DD.

135 patients with DD were divided into Haloperidol-control (41), Risperidone (49) and Olanzapine group (45 patients). Patients were observed for 6 months according to protocol, which included PANSS Scale and CGI1-4 Scale. Control group was treated with haloperidol 5–30 mg/24 h. Experimental groups were treated with risperidone 2–6 mg/24 h and olanzapine 10–20 mg/24 h.

Pretrial PANSS score was 57.28 in risperidone(R), 60.47 in olanzapine(O) and 58.45 in control(H) group. PANSS score after 180 days was 34.32 in R, 35.58 in O and 37.97 in H group. There was no statistical difference in pretrial scores for PANSS (p = 0.691), CGI1 (p = 0.733), CGI2 (p = 1.000), and CGI3 (p = 1.000) scores. There was statistical significance in PANSS and CGI1-4 score reduction after 180 days in all groups (p = 0.000). There was no statistical difference in PANSS score reduction between R and H (p = 0.114) and O and H group (p = 0.136). CGI1-4 scores reduction: CGI1, Rvs.H, p = 0.019 and Ovs.H, p = 0.032 with high statistical significance; CGI2, Rvs.H, p = 0.153 and Ovs.H, p = 0.179 with no statistical significance; CGI3, Rvs.H, p = 0.183 and Ovs.H, p = 0.161 with no statistical significance; CGI4, Rvs.H, p = 0.000 and Ovs.H, p = 0.000 with high statistical significance. Adverse effects were significantly lower in Risperidone (21.42%) and Olanzapine (21.81%) than in Haloperidol (57.5%) group.

Risperidone and Olanzapine have slightly better efficacy in treatment of DD comparing to haloperidol, with statisticaly significant lower adverse effects rate.

Body dysmorphic disorder is characterized by a preoccupation with an imagined defect in appearance that causes clinically significant distress or impairment in important areas of functioning.

This study aimed to evaluate body dysmorphic disorder, self-esteem, and depression in cosmetic rhinoplasty patients

250 cosmetic rhinoplasty patients completed a demographic questionnaire, dysmorphic concern questionnaire (DCQ), Rosenberg self-esteem scale, and Beck depression index-II (BDI-II). Data were analyzed by appropriate tests.

Of 250 patients, 30 (12.0%) were male and 220 (88.0%) were female. Mean ± SD was 24.0 ± 4.7 for age. Frequency of body dysmorphic disorder (BDD) was 18.0% (45). BDD showed a significant correlation with lower self-esteem and higher depression (both P<0.001). From patients who had BDD, 5(11.1%) showed minimal depression, 14 (31.1%) mild depression, 25(55.6%) moderate depression and 1 (2.2%) severe depression. Also, BDD showed a significant association with the job (Higher in students and housewives, P= 0.04) and cigarette smoking (P<0.001).

Lower self-esteem showed in the patients with age <25 years old (P<0.001), students (P=0.003), Lower education (P<0.001) and lower income (P=0.03).

The prevalence of depression (BDI score >13) was 107 (42.2%). Severity of depression was significantly higher in married patients (P=0.003), lower education (P=0.001), lower income (P=0.04), cigarette smoking (P=0.008), having more children (P<0.001) and having a history of previous cosmetic surgery (P=0.001).

There should be special concerns about psychiatric aspects of people who seek cosmetic surgeries.