Research using fMRI indicates that sustained limbic activity is linked to processing negative words and self-reported rumination in currently depressed individuals. It is unknown whether this is also present in remitted depressed individuals. We tested the hypothesis that a tendency to ruminate constitutes a trait for depression by using a standard covert fMRI emotional task face in previously and never depressed volunteers and postulated that high rumination scores would correlate with activity in brain areas previously associated with depression.

37 controls (25 female) and 30 remitted depressed (RD, 22 female) were enrolled. Volunteers completed the Ruminative Responses Scale (RRS) and underwent fMRI scanning using a standard covert fMRI emotional task faces. Significance level was set at p < 0.05 (FWE).

With RRS score controlled for RD showed reduced subcortical and limbic activity to sad and fearful faces compared to controls. Correlations between RRS scores and neural activity in all participants and control participants alone were very limited. However, in RD, RRS score was negatively correlated with neural response to happy faces and positively correlated with neural response to sad and fearful faces, in cortical and limbic regions associated with depression (hippocampus, thalamus, caudate, insula and cingulate gyrus).

The results suggest that reduced limbic activity is associated with remission, possibly as a maintenance mechanism. However, within the remitted group the more ruminative participants show greater response in these areas to negative stimuli, and less to positive stimuli. This could be a neurobiological marker for risk of relapse

Depression symptoms in bipolar disorder have debilitating effects on functioning and quality of life (QoL).

To assess effects of 8 weeks of quetiapine monotherapy on functioning and QoL in patients with bipolar depression (BPD).

To evaluate functioning and QoL using patient-reported outcomes.

Data from 4 trials (BOLDER I and II; EMBOLDEN I and II) of quetiapine (300 and 600 mg/day) in BPD were combined (n = 2593). The Sheehan Disability Scale (SDS) measured functioning (BOLDER II; EMBOLDEN I and II) and the QoL Enjoyment and Satisfaction Questionnaire (Q-LES-Q)-Short Form measured QoL (BOLDER I and II; EMBOLDEN II).

Quetiapine improved overall functioning (mean change [SE] in SDS total score: -7.23 [0.49], -7.49 [0.49], with quetiapine 300 mg/day and quetiapine 600 mg/day, respectively vs placebo (-5.91 [0.54]); P < 0.01 for both). Both doses improved functioning in SDS domains of work/school, social life, and family life/home responsibilities vs placebo (P < 0.05). Quetiapine 600 mg/day reduced days missed from work/school and productivity losses vs placebo (P < 0.01). QoL was improved with both quetiapine doses vs placebo (P < 0.001; least squares mean changes (SE) in Q-LES-Q total score from baseline to Day 57: 9.69 (0.51), 9.95 (0.50), and 6.81 (0.54) with quetiapine 300 mg/day, quetiapine 600 mg/day, and placebo, respectively). Tolerability was consistent with the known safety profile of quetiapine.

Quetiapine treatment (300 and 600 mg/day) for 8 weeks significantly improved functioning and QoL vs placebo in patients with BPD.

Supported by funding from AstraZeneca Pharmaceuticals LP.

This study aimed to determine the effect of Electroconvulsive Therapy (ECT) on serum serotonin level of patients with major depressive disorder (MDD).

In this experimental study, 36 patients (age: 20–65 years old) with MDD were allocated to ECT group (n = 21) and non-ECT group (n = 15). Serum serotonin level of the ECT group was measured before ECT, 15 minutes and two, six, and 24 hours after the first session, and 24 hours and 30 days after the last ECT session. Measurements were performed at the time of admission and one month after hospitalisation in the non-ECT group. Data analysed with t-tests, repeated measures analysis of variance by SPSS16.

The mean serotonin levels of the two groups were significantly different 24 hours and 30 days after the last session of ECT (P = 0.048 and P = 0.04, respectively). The difference of mean serotonin levels in the ECT group before & 15 min after ECT (P = 0.044) before & 6 hour after ECT (P = 0.015), before & 24 hour after ECT (P = 0.007), before & 24 hour after last ECT (0.002) was meaningful.

Altogether, our results showed that serum serotonin levels significantly increase following ECT in MDD patients.

Youth nonideation suicidality (NIS), distinct from impulsive deliberate-self harm (DSH), is a potential consequence of adjustment disorder (AD) or selective serotonin reuptake inhibitor (SSRI) adverse reaction. It is characterized by the absence of transient or enduring ideation. A new measure was constructed to evaluate the impact of NIS on attempt rates.

Youth 8 to 24-years-old were recruited in this case control study. Entry criteria included DSH (n = 50), AD (n = 91), and SSRI (n = 29) emergent events with overt or suspected NIS, worsening of existing or new onset suicidality, or abrupt mental status or behavioral change. Exclusion criteria included sensorimotor deficit or primary depressive disorder. Ratings from the new measure utilized dichotomous as well as outcome scores, and compared to ratings from other validated scales, after controlling for depression and other matched factors.

High risk AD and SSRI groups presented with abrupt onset, high lethality attempt, intense motor restlessness, great intra-psychic distress, and irresistable suicidality. AD symptoms overlapped with SSRI presentations. Eighty-one percent of the AD sample reported no ideation; however, 96% made an attempt. For the SSRI group, 52% reported no ideation; however, 95% made an attempt. Sensitivity 80.3%, specificity 98.1%. Internal consistency 0.75 to 0.92. Test-retest scores 0.78 to 0.98, and neurodiagnostic correlations 0.70 to 0.98. Some scores correlated significantly with the “gold standard” Barnes Akathisia Rating Scale.

NIS is associated with alarmingly high rates of youth suicide attempt. The new neuropsychological measure demonstrates practical screening value in unobvious NIS proposed to represent a heretofore unrecognized neural mechanism.

The author has not supplied his/her declaration of competing interest.

Clozapine is an atypical antipsychotic medication which is mainly used in cases of treatment-resistant schizophrenia. Although it has several advantages over other typical and atypical antipsychotic medication, such as fewer relapses and lowering the risk of tardive dyskinesia and suicide it also has a range of adverse effects which makes compliance an issue for many patients.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis clinically characterized by painful pustules or nodules that rapidly evolve in ulcers with violaceous, undermined borders and raised periphery. The etiopathogenesis of the disease remains unclear, however PG is usually manifested in the setting of an underlying immune-mediated disease, more commonly inflammatory bowel disease, rheumatoid arthritis and haematological malignancies.

Nevertheless, in the literature there are scarce reports of drug-induced PG.

We present the case of a 56-year-old woman with a diagnosis of refractory schizophrenia on clozapine treatment for 4 months, who was admitted to the emergency department for a skin eruption localized on the trunk, genital area and extremities. The clinical examination revealed numerous, discrete erythematous macules, papules and plaques with central necrosis, and multiple, sharply marginated ulcers with undermined, red to purple border. Further physical examination disclosed no systemic findings and laboratory analyses and skin biopsy were performed.

On work-up, white blood cell count and C-reactive protein (CRP) were elevated, while blood and pustule cultures were negative. Histologic examination revealed dermal necrosis and inflammation, features consistent with the diagnosis of PG. The pathergy test was positive.

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Pyoderma gangrenosum is a rare autoinflammatory skin disorder of unknown etiology. The pathogenesis of the disease is not well understood, but drug-induced PG is considered to result from neutrophil dysfunction and dysregulation of the inflammatory response. Cases of drug-induced PG are rare and attributed to certain drugs. Clozapine is an antipsychotic medication for the treatment of refractory schizophrenia. It is suggested that clozapine alters plasma TNF-α levels and thus can modulate the inflammatory response. To date, a variety of adverse skin reactions (Stevens- Johnson syndrome, DRESS syndrome etc) have been previously described in the literature. However, to the best of our knowledge, this is the first case which strongly indicates the likely association between clozapine and drug-induced PG.

None Declared

Valproate is widely used in the treatment of maniac and mixed episodes and is well known to be safe with side effects being mostly related to hepatic disorders and psychomotor retardation.

Raising attention to valproate-induced hypothyroidism that despite the increasing evidence tends to be neglected.

Here, we report a case of a 55-year-old woman, with a previous diagnosis of schizophrenia, treated for many years with 200mg of zuclopenthixol triweekly and 2mg of risperidone daily. Patient developed a maniac episode characterized by elevated mood, sense of grandiosity, increased energy and psychomotor activity, disinhibition and insomnia. No laboratory abnormalities were detected and inpatient treatment was initiated with paliperidone up to 12mg/day and valproate 1000mg/day.

Patient showed progressive clinical recovery attaining full remission within 2 weeks. Despite the absence of clinical side effects and the valproate serum levels of 74.9μg/mL (range 50–100μg/mL), laboratory testing found progressive reduction F-T4 down to 0.45ng/dL (range 0.8–1.5 ng/dL) and a concomitant upregulation of TSH to 73.99mUI/L (range 0.55–4.8mUI/L). Thyroid autoantibodies and thyroid echography were negative. Considering that patient was previously medicated with risperidone, it was suspected that her hypothyroidism was caused by valproate. Normalization of thyroid function was observed after 21 days valproate withdrawal. Patient is currently being treated with 150 mg paliperidone (monthly) with no recurrence of mood or psychotic episodes and maintain normal thyroid function.

Our case emphasizes the need for extended laboratory testing upon prescription of new pharmacological medications as severe analytic alterations can take place in the absence of immediate clinical manifestation.

No significant relationships.

Abusive childhood experiences are claimed to be more prevalent in people with schizophrenia (SCZ) than in the general population. The exposure to childhood trauma can have adverse effects on cognitive function.

To investigate whether there is a relationship between childhood trauma (CT) and cognitive functioning in patients with SCZ.

Fifty-eight outpatients with stable SCZ were recruited. The participants completed the Childhood Trauma Questionnaire retrospectively assessing five types of childhood trauma (emotional, physical and sexual abuse, and emotional and physical neglect). They also completed a neurocognitive battery comprising the following tests: the Hopkins Verbal Learning Test–Revised (HVLT-R), the Letter Digit Substitution Test (LDST), the Stroop Test (ST), the “Double Barrage” of Zazzo (DBZ), the Modified Card Sorting Test (MCST), the Verbal Fluency (VF), the Trail Making Test-Part A (TMT-A) and the Digit Span (DS).

The patients with a history of physical abuse (P = 0.03) or emotional neglect (P = 0.07) performed worse at the delayed recall of the HVLT-R. A history of emotional neglect was also correlated to a significantly worse performance in theTMT-A (P < 0.0001), while physical abuse was correlated to worse DS (P = 0.015). High emotional abuse scores were significantly correlated to poorer efficiency in DBZ (P = 0.025).

The results need replication, but underline the necessity of investigating biological and psychosocial mechanisms underlying these subjects’ cognitive impairment.

The authors have not supplied their declaration of competing interest.

The differential impact of depression across different periods in life on mortality remains inconclusive. We aimed to examine the association of depression that occurs at different age with all-cause mortality, and to explore the roles of dementia, as well as genetic and early-life environmental factors, in this association.

From the Swedish Twin Registry, 44,919 twin individuals were followed for up to 18 years. Depression was ascertained using the National Patient Registry and categorized as early-life (<45 years), midlife (45–64 years), and late-life (≥65 years) depression according to the age of the first diagnosis. Deaths were identified through the Cause of Death Register. Generalized estimating equation, generalized structural equation, and conditional logistic regression were used for unmatched, mediation, and co-twin matched analyses, respectively.

In unmatched analyses, the multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of mortality were 1.71 (1.46–2.00) for depression at any age, 1.72 (1.36–2.17) for early-life, 1.51 (1.19–1.90) for midlife, and 4.10 (2.02–8.34) for late-life depression. Mortality was significantly higher in individuals with late-life depression than those with earlier-life depression (p < 0.05). The mediation analysis showed that 59.83% of the depression-mortality association was mediated by dementia. No significant difference in ORs between the unmatched and co-twin matched analyses was observed (p = 0.09).

Depression is associated with an increased risk of all-cause mortality, and dementia mediates approximately 60% of the impact of depression on mortality in late life. Genetic and early-life environmental factors may not play a significant role in the depression-mortality association.

Acceptance and commitment therapy for the treatment of panic disorder and agoraphobia has been a big boost in last years, and there are preliminary studies about its efficacy. However, most studies have used individual interventions.

Evaluate the effect of an acceptance and commitment group therapy in patients with panic disorder and agoraphobia.

The sample consisted of 24 patients, aged between 18 and 55 years old, who were referred to groups by psychologists and psychiatrists of Mental Health Center. The intervention in each group consisted of 12 treatment sessions of 1 h 30 m duration, weekly. One pretest and posttest evaluation was conducted. The variables studied were: severity of panic disorder (Panic Disorder Severity Scale [PDSS]), fear of physical sensations (Body Sensations Questionnaire [BSQ]), frequency of catastrophic thoughts (Agoraphobic Cognitions Questionnaire [ACQ]) and level of experiential avoidance (Acceptance and Action Questionnaire-II [AAQ-II]).

The mean scores for all variables studied decreased in the post-evaluation. Means in post-evaluation were significantly lower (t Student, a = 0.10) in three of the four variables studied: severity of the condition (P = 0.001), frequency of catastrophic thoughts (P = 0.038) and level experiential avoidance (P = 0.073). In other words, patients had fewer panic attacks after treatment, and those who had were less intense, they had less catastrophic thoughts about consequences of anxiety, and they were better to accept their feelings and thoughts.

Although it is necessary to continue the study with a larger sample, these preliminary results support the use of ACT in group format in the treatment of panic disorder and agoraphobia.

The authors have not supplied their declaration of competing interest.

Although Positive (PS) and Negative Schizotypy (NS) are considered distinct entities, prefrontal dysfunction seems to be a common underlying mechanism. According to recent evidence, PS can be divided into Paranoid (ParS) and Cognitive-Perceptual (CPS).

To explore NS’, ParS’ and CPS’ profiles of prefrontal function/psychopathology/stressful childhood experiences.

To examine associations between NS, ParS and CPS with the above phenotype in a community sample.

140 healthy adults completed the Schizotypal-Personality Questionnaire (SPQ), Symptom-Checklist-90-Revised (SCL-90R), Wisconsin Card-Sorting Test (WCST), CANTAB Spatial Working Memory (SWM), Parental-Bonding Instrument (PBI) and Child Abuse/Trauma Scale (CAT). Associations between schizotypal dimensions and outcome variables were examined with separate forward regression-analyses (confounders: age, smoking).

High ParS and NS but not CPS were predicted by high CAT score and low parental-care respectively (Ps<0.001). High NS and high ParS predicted inefficient SWM strategy and increased WCST perseverative-errors (Ps<0.001; R2:0.155 and 0.243) while high ParS also predicted fewer WCST-completed categories and increased total errors (Ps<0.001; R2:0.138 and 0.174). All schizotypal dimensions along with reduced parental-care predicted high SCL-90 psychopathology in all dimensions (Ps<0.001); NS predicted mostly interpersonal sensitivity, depression and phobic anxiety (R2range:0.211-0.426), ParS predicted mostly obsessive-compulsive symptomatology, anxiety, paranoid ideation and psychoticism (R2range:0.257-0.373) and CPS predicted mostly somatization and anger/hostility (R2:0.240 and 0.213).

ParS and NS were similar in terms of prefrontal dysfunction and childhood life experiences although they differed in their clinical psychopathology patterns. CPS seems to be a 'less severe” form of schizotypy in terms of prefrontal dysfunction and childhood experiences with minimal impact on current psychopathology.

The combination of dementia and depression in elderly patients is challenging for the differential diagnosis of the clinical situation

To examinethe comorbidity of dementia and depression in elderly patients

231 patients aged 70 years and older.

MMSE and clock drawing test, HADS and Cornell Scalefor Depression in Dementia (SCDD).

The study revealed the presence of mild cognitive impairment in 118 patients, unequivocally proven symptoms of dementia - in 113 patients.

Depressive disorders were found in 88 patients. Depressive symptoms were found in 136 patients. In patients with mild cognitive disorders prevailed depressive disorders of mild to moderate severity.

The relations of depression and dementia in Alzheimer's disease or vascular dementia are the following options:

1. 1. Depressive disorders are often detected in the patients who later developed dementia.

2. 2. The clinical picture of depression in Alzheimer's disease may occur with atypical symptoms, as well as a number of symptoms of dementia can be mistakenly classified as a manifestation of depressive disorder.

3. 3. In some cases, patients with incipient dementia can be set psychogenic the nature of depression.

The development of depression in elderly patients, especially without the presence of a ‘trigger’ social factor may be a predictor or risk factor for cognitive impairment in the future. This applies particularly to patients who have depressive disorder is an atypical clinical picture and the processes of the clinic ‘pseudodementia’ and to the patients, in addition to having a depressive disorder clinically significant neurologic deficit.

Stress is a risk factor for developing psychopathology. Emerging evidence suggests that daily experiences of stress may also predict symptoms during the day. It is unclear to what extent the influence of stress on psychopathology during the day is the same across individuals (including across diagnostic boundaries), and which effects are individual-specific

This study aims to reveal how stress and symptoms are interrelated in a cross-diagnostic context by modeling individual level temporal networks, and examining subgroups with similar dynamics.

Hundred twenty two young adults (43.4% women) with a wide range of psychopathology in terms of severity and type of problems completed a six-month daily diary study. We used a temporal network approach (i.e., group iterative multiple model estimation) to model how stress and ten specific symptoms (e.g., feeling down, paranoia, restlessness) were related across time at the individual-specific, subgroup, and group level.

After controlling for the lagged influence of stress on itself, stress level predicted the level of restlessness, worrying, nervousness, and feeling down during the same day for >70% of individuals. We observed three larger subgroups with each over 20 individuals, whose temporal networks showed different dynamic patterns involving specific symptoms. Effects of stress on other specific symptoms differed across individuals, and these were not subgroup-specific.

This study showed important overlap between individuals in terms of impact of stress on psychopathology in daily life. Subtle differences between individuals were also observed. Possibly, such differences are relevant for examining individual-specific vulnerability for future psychopathology. This requires further investigation.

No significant relationships.

To compare prescribing practices of hypnotics against NICE guidelines (National Institute of Clinical Excellence) and to develop recommendations with action plan. The NICE recommends:

• • Due consideration should be given to non-pharmacological measures prior to hypnotic prescription.

• • Hypnotics should be prescribed for short periods of time only (maximum 4 weeks)

• • The drug with the lowest purchase cost should be prescribed.

• • Switching from one hypnotic to another should only occur if a patient experiences adverse effects.

The audit tool was developed. The data was compiled using medical records of the patients who were seen during a specified three month time period in an out-patient setting. A total sample size of 308 was generated out of which 41(12.5%) were being prescribed hypnotics. The medical records of these 41 patients were scrutinised to gather evidence whether NICE guidelines were adhered to. The data was analysed using the tool recommended by NICE.

The significant results are:

• • Only 25% of the patients were advised Non-pharmacological measures.

• • Duration of prescription ranged from one week to more than 10 years, with 33% approximately being prescribed for less than one year, and 10% being prescribed for more than 10 years.

• • There is no evidence that consideration was given to cost while prescribing.

• • Only in one patient hypnotic was switched. However, there was no evidence of adverse reaction which could be directly related to the hypnotic prescribed.

The overall compliance with guidelines was found to be 42%.