Doctors face difficulties when they are sick and have to take the patients’ role, and those barriers can be insurmountable when the problem is an addiction or other mental health disorders. On the other hand, treating sick doctors is more challenging than addressing the same problems in the general population, but not much has been published on the difficulties experienced by doctors treating doctors, specially when this happens in the psychiatric arena. The Physician Health Program (PAIMM) of Barcelona (Spain) is dedicated to the attention of doctors affected by mental disorders and / or addictive behaviours. The program is has also links with psychiatrists all over Spain who take care of patients once discharged.

The goal is to present the results of a survey that describes the experience of psychiatrists who treat sick doctors. The survey itself consists of 25 items, scored on a Likert scale of 5 points and three qualitative questions about their experience as psychiatrists treating patients. The survey were sent to 57 psychiatrists a link to allow for anonymous response through an online system was included in the invitation.

41 responses (74, 5%) have been collected. Psychiatrists believe that treating physicians is more difficult than treating other patients. The difficulties identified are the need of better communication skills and longer interviews. The assessment of readiness to return to work is also very challenging. However, despite the difficulties, the majority of respondents are satisfied with the experience of treating colleagues.

Individuals with schizotypal personality disorder (SPD) exhibit disturbed emotional processes. However, it is not clear whether different symptoms of the SPD are associated to less efficient or in contrast increased attention to emotions and to subsequent difficulty to regulate them.

We used Event-Related potentials (ERPs) to examine the relationships between different dimensions of SPD and two facets of emotional processing: the perception of emotions from other's face and the ability to regulate one's own emotions while viewing emotional pictures.

ERPs were recorded from fifty-five individuals, who completed the Schizotypal Personality Questionnaire (SPQ), during the passive presentation of neutral and emotional faces (study1) and pictures (study 2). ERPs data were analyzed in order to encompass early (perception and attention: P100, N170, P200, P300) and late (emotional regulation: Late Positive Potential -LPP) stages of emotional processing.

Higher SPQ score was related to lower P100 amplitude following face but not following picture presentation. Lower P100 amplitude was correlated with higher “Ideas of Reference” and “Suspiciousness” scores. In addition, higher “Suspiciousness” score was related to lower P300 amplitude evoked by face but not by picture presentation. Following the presentation of pictures with high emotional intensity, higher SPQ scores were related to larger and longer-lasting LPP.

Individuals with high SPD traits exhibited less efficient processing of emotions from human faces in early stage of emotional processing. They also showed difficulties to regulate their own emotions provoked by emotional pictures.

The core mechanism of maladaptive stress response includs aberrant phosphorylation of the glucocorticoid receptor (GR) at serine 221 (pGR211) or GR serine 226 (pGR226), which enhance or attenuate GR transcriptional activity, respectively. In the current study we tested a hypothesis that alterations in the nuclear levels and/or ratios of GR, pGR211 and pGR226 in peripheral blood mononuclear cells (PBMC) may reflect individual level of distress and/or psychological vulnerability.

In 36 healthy adults we evaluated the relation of total PMBC nuclear level of GR (tGR), pGR221, pGR226 and activated JNK1 (pJNK1) and its relation to environmental stress exposure, self reported distress (Depression Anxiety Stress Scale) and personality traits (Eysenck Personality Questionnaire). Molecular and psychometric data were cross-correlated by SPSS MannWhitney statistics.

In women, self reported distress (DASS score) correlated more with neuroticism, while in men it correlated with environmental stressor. Also, in women, PBMC nuclear tGR level correlated with pGR211, while in men it correlated with pGR226. Cross-analysis of psychometric and molecular data indicated that in women both neuroticism and self reported distress correlated positively with nuclear pGR226, while in men the only correlation was between environmental stressor and pJNK1.

This findings provide preliminary support that the nuclear level of pGR226 and pGR211/pGR226 ratio in PBMC may serve as a measure of affective vulnerability in healthy women, while nuclear level of pJNK1 may reflect environmentaly imposed distress in healthy men. The relevance of these molecular parameters as biomarkers requires broader verification in healthy and in clinical settings.

The primary aim of the present study was to compare the effects of agomelatine and venlafaxine XR on anhedonia in patients with Major Depressive Disorder. Secondary endpoints were to test its antidepressant and anxiolytic efficacy.

Sixty patients received randomly agomelatine (25–50 mg/day; N = 30) or venlafaxine XR (75-150 mg/day, N = 30). Psychopathological assessment was performed at baseline and over eight weeks of treatment with the Snaith Hamilton Rating Scale (SHAPS), the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A) and the Clinical Global Impression (CGI).

Both groups showed an overall significant reduction in times for SHAPS, HAM-D and HAM-A. A significant difference between times was observed for SHAPS scores in Agomelatine group: from baseline of 6.5 (T0) to 4 at week 1 (−2.5) (T1), 3.5 at week 2 (−3.0) (T2), and 3.4 at week 8 (−2.9) (T3). In the venlafaxine group, the reduction on SHAPS scores was not significant between visits (p = .08). At the last observation a significant difference between groups in favour of agomelatine was observed for SHAPS scores (D = 2.2; p < 0.05); moreover, only patients treated with agomelatine showed a significant improvement in CGI scores from baseline (D = 2.94, p < 0.05).

Agomelatine showed significantly greater efficacy on anhedonia and at least similar antidepressant efficacy to venlafaxine in patients with Major Depressive Disorder, with a better clinical improvement. Therefore, the efficacy of agomelatine on anhedonia, a potential trait marker of vulnerability for depression, holds particular importance in the treatment of patients with depressive features.

Alcoholism leads to a wide range of impairments, among which affective and social interaction alterations seem crucial at a clinical level. Brain alterations linked to the emotional deficits have been recently explored, but the cerebral correlates of social interaction disturbances are still unknown.

Here we used a validated paradigm inducing social rejection feelings to investigate the cerebral activations associated with disturbed social interactions in alcoholism.

Twenty alcoholics and 20 matched controls were scanned using fMRI while playing a virtual ball-tossing game (i.e. “cyberball paradigm”). Participants were first included in the game by the two other players, then excluded and finally re-included.

Controls presented increased activations in the anterior cingulate and ventral prefrontal cortices during social exclusion as compared to inclusion, while alcoholics only presented increased anterior cingulate activation, but no ventral prefrontal activation changes. Moreover, alcoholics had a persistence of the anterior cingulate activation during re-inclusion.

In the control group, social exclusion led to increased anterior cingulate cortex activation (associated with the distress due to social rejection feelings) and ventral prefrontal cortex activation (reflecting the inhibition of this feeling). More critically, our results show that alcoholics present: (1) impaired regulation of the social rejection feelings (absence of increased ventral prefrontal cortex activation during exclusion); (2) persistent rejection state (increased anterior cingulate activation), even when the actual rejection is terminated. We report the first evidence that reduced ventral prefrontal activation in alcoholism is linked to reduced ability to regulate emotional reaction during social exclusion.

Physical exercise has shown promising results as an adjuvant therapy for depression. However, follow-up information assessing its long-term effects after the exercise program is suspended, is scarce.

To assess depression and functional parameters at follow-up, 6 months after a population sample of patients with treatment-resistant Major Depressive Disorder (MDD) finished a moderate intensity 12 week exercise program.

Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with treatment-resistant MDD were initially screened. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). All participants maintained their usual pharmacotherapy. Study protocol Exercise group: moderate intensity exercise program for 12 weeks. Control group: regular daily activities. Follow-up After 12 weeks the exercise program was suspended, and patients were assessed after 3 and 6 months. Assessed parameters HAMD17, BDI, GAF, CGI-S.

47% of participants in the exercise group continued to exercise at follow-up. Those who continued to exercise at follow-up maintained the same depression and functional parameters they showed after the 12 week exercise program, which were all improved compared to the initial values (lower HAMD17, BDI and CGI-S and higher GAF, p < 0.05). Those who did not continue to exercise showed worse HAMD17, GAF and CGI-S (p < 0.05) at 6 months follow-up than at the end of the exercise program.

Results suggest that positive effects of exercise as an adjuvant therapy for treatment-resistant MDD patients only persist if the exercise is continued over time.

We recently found that, in mice, independently of orosensory input, sucrose consumption is sufficient to condition the development of spout preferences and dopamine release in the ventral striatum.

To clarify if the appetitive behavioral and dopaminergic responses to the postingestive effects of calorie-containing sugars reflect preabsorptive or postabsorptive events.

To understand if endovenous injection of glucose is sufficient to condition spout preferences and dopamine release.

Measurements of the behavioural, metabolic and neurochemical effects of the administration of glucose solutions, enterically, and in the jugular (JV) or hepatic-portal (HPV) veins of rats.

High concentration glucose solutions administered in the JV were sufficient to condition spout preferences in a two-bottle behavioral task. Additionally, a low concentration glucose solution conditioned robust behavioral responses when administered in the HPV, but not the JV. Finally, using fast-scan cyclic voltammetry we found that, in accordance to behavioral findings, a low concentration glucose solution caused an increase of spontaneous dopamine release events in the nucleus accumbens shell when administered in the HPV, but not the JV.

The postabsorptive effects of glucose are sufficient to mimic the behavioral and dopaminergic responses that result from sugar consumption. Furthermore, glycemia levels in the HPV contribute more significantly for this effect than systemic glycemia, arguing for the participation of an intra-abdominal visceral sensor for glucose.

The core of social phobia is a desire to make a good impression to others and a lack of confidence about one's ability to do so. People who suffer social phobia present negative self-statements, negative thoughts about the impression they make in others and biases in the evaluation of their performance. Furthermore, cognitive processing of information could be determined by deeper cognitive structures such as schemas.

To study the relationships between maladaptive schemas, automatic thoughts and social anxiety in adolescents.

To assess the relationship between maladaptive schemas and social anxiety and to test whether this relationship was mediated by automatic thoughts related to social anxiety.

A total of 1350 adolescents aged between 13 and 18 took part in this longitudinal study. They filled in questionnaires about schemas (Schema Questionnaire; Young, 1990), thoughts related to social anxiety (Social Cognitions Questionnaire; Stopa, Wells, & Clark, 1993) social anxiety symptoms (Social Anxiety Scale for Adolescents; Olivares et al., 2005) at Time 1 and six months later (Time 2).

Results showed that abuse, defectiveness, subjugation, and sociotropy schemas predicted social anxiety. This model explained 22% of the variance. Automatic thoughts related to social anxiety partially explained the relationships between defectiveness, subjugation and sociotropy schemas and symptoms. The abuse schema directly predicted social anxiety symptoms.

Some maladaptive schemas predict automatic thoughts which in turn predict social anxiety. These results have important implications for intervention with adolescents who suffer social anxiety.

Oncological diagnosis is considered to be a major traumatic event and results in post-traumatic stress disorder (PTSD) in a percent of patients ranging between 34 and 80. The aim of the study was to investigate for the first time the functional evidence of possible PTSD in a large cohort of Hodgkin Disease patients (HD).

Forty-nine HD underwent metabolic positron emission tomography (18F- FDG-PET) within a week from diagnosis (PET0) and after two 28-days adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) cycles (PET2). Thirty-five patients were examined after further four 28-days ABDV cycles (PET6). FDG uptake was compared between conditions by paired t-test implemented in statistical parametric mapping.

As compared to PET0, PET2 showed a highly significant increase in 18F-FDG distribution in right superior temporal gyrus and right inferior parietal lobule (Brodmann area 39). When PET2 data were subtracted to PET0 a highly significant hypometabolic area including a large portion of the prefrontal and orbitofrontal cortex (BAs 10, 11 and 32), bilaterally, was found. The 18F-FDG uptake distribution changes found at PET2 disappeared at PET6 in which no significant changes were found.

After the first two months of chemotherapy, we found in HD a significant reduction of brain glucose metabolism in prefrontal and orbitofrontal cortex, typical neurobiological correlate of PTSD. Such finding was not present any more after four months in those HD in which chemotherapy was completed suggesting that acute PTSD disappeared in this cohort of patients following the improvement of general physical and psychological conditions due to successful therapy.

To evaluate temporal trends, gender effects and methods of completed suicide among children and adolescent (aged 10–17) compared with temporal trends of deaths from other causes.

Data were extracted from the Italian Mortality Database, which is collected by the Italian National Census Bureau (ISTAT) and processed by the Statistics Unit of National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS) at the National Institute of Health (Istituto Superiore di Sanità).

A total of 1,871 children and adolescents, age 10–17 years, committed suicide in Italy from 1971 to 2003 and 109 died by suicide during the last 3-year period of observation (2006–2008). The average suicide rate over the entire period of observation was 0.91 per 100,000; the rate was 1.21 for males and 0.59 for females. During the study period the general mortality of children and adolescents, age 10–17 years, decreased dramatically. The decrease was observed, for both genders, for all causes of deaths except suicide.

This study highlights that over the course of several decades suicide is a far less preventable cause of death compared to other causes of death among children and adolescents. Our study demonstrated that suicide rates in adolescents is not a stable phenomenon over the 40 years period of study. It suggested that rates for males and females differed and varied in different ways during specific time periods of this study. National suicide prevention actions should parallel prevention measures implemented to reduce other causes of death.

By the project IGA, MZ CR NT 11047-4/2010.

The most frequent psychiatric disorder is depression. Half of patients treated by tianeptine present a positive response. In Fact, tianeptine response, as well as, other antidepressants is modulated by genetic factors. This molecule was shown acting on glutamate and serotonin pathways.

We analyzed polymorphisms of 12 candidate genes involved in glutamate and serotonin pathways in 3536 outpatients treated with tianeptine for a major depressive episode (MDE) to find an association to a positive treatment response.

The aim of this study was to identify the pharmacogenetic response to tianeptine treatment in MDE.

A total of 3536 outpatients with a MDE were treated with tianeptine. The criteria for a MDE were characterized by clinicians according to the DSM-IV diagnosis and, the duration and intensity of each symptom was recorded during the inclusion at 4 to 8 weeks of treatment. The Hospital Anxiety and Depression Scale (HAD) was evaluated at the two visits. DNA was extract from saliva samples and genotyping of 49 single nucleotide polymorphisms (SNPs) in 12 genes was performed by Taqman assay.

All clinical and genotype data were collected for 3536 tianeptine-treated patients. A total of 7 SNPs, located in 4 different genes, were found associated to a positive treatment response, corresponding to a reduction of 50% of the HAD. This was confirmed in the Caucasians subgroup of 3040 patients.

We detected pharmacogenetic associations between glutamate and serotonin genes and the response to tianeptine in major depressive episode.

The aim of iSPOT-D is to identify biological pretreatment measures that predict or moderate MDD treatment response or remission to escitalopram, sertraline or venlafaxine; and develop a model that incorporates multiple predictors and moderators.

The iSPOT-D study is a multi-center, international, randomized, prospective, open-label trial (1). It is enrolling 2016 MDD outpatients (ages 18–65) from primary or specialty care practices (672 per treatment arm; 672 age-, sex- and education-matched healthy controls). Study-eligible patients are antidepressant medication (ADM) naïve or washed-out with no protocol ADM contraindications. Baseline assessments include symptoms; distress; daily function; cognitive performance; electroencephalogram and event-related potentials; heart rate and genetic measures. A subset of these baseline assessments are repeated after eight weeks of treatment. Outcomes include the 17-item Hamilton Rating Scale for Depression (primary) and self-reported depressive symptoms, social functioning, quality of life, emotional regulation, and side-effect burden (secondary). Participants may then enter a naturalistic telephone follow-up at weeks 12, 16, 24 and 52. The first half of the sample will be used to identify potential predictors and moderators, and the second half to replicate and confirm.

First enrolment was in December 2008, and enrollment of the first 50% (1008 MDD participants) was completed in Dec 2010. iSPOT-D evaluates clinical and biological predictors of treatment response in the largest known sample of MDD collected worldwide.

Initial findings reveal a remission rate of 45.4% and a response rate of 62.6% after 6–8 weeks of treatment. Initial findings will be discussed including factors for response prediction and MDD subtype differences.

In the present study, the effects of Levetiracetam on the development and expression of tolerance to the morphine-induced antinociception was evaluated using tail-flick test.

To assess the Levetiracetam effects on tolerance development, the animals received Levetiracetam (60, 300 or 900 mg/kg; i.p.), 30 min prior to morphine (50 mg/kg; s.c.) administration during tolerance induction period once daily for 3 days. Also, to evaluate the effects of Levetiracetam on tolerance expression, different doses of Levetiracetam was administered 30 min before challenge dose of morphine (5 mg/kg; s.c.) following morphine-induced tolerance. In each experiment the antinociceptive response to the challenge dose of morphine was evaluated after 30-min interval by tail-flick test. Furthermore, the analgesic effect of various doses of Levetiracetam alone was evaluated as well.

The results showed that Levetiracetam at the doses of 300 and 900 mg/kg could inhibit the development of tolerance. Also, Levetiracetam at the dose of 900 mg/kg attenuated the expression of morphine-induced tolerance. Levetiracetam injection was associated significantly with higher latency period when compared to the control group. Moreover, Levetiracetam (900 mg/kg) significantly enhanced antinociceptive effect of morphine in a dose-dependent manner.

These data indicated that, while Levetiracetam can attenuate both development and expression of morphine-induced tolerance, it can enhance morphine-induced antinociception. These effects may have important clinical implications.

A considerable number of patients at clinical high risk of psychosis (CHR) are found to meet criteria for co-morbid clinical psychiatric disorders.

It is not known how clinical diagnoses correspond to transitions to psychosis (TTP).

We aimed to examine distributions of life-time and current Axis I diagnoses, and their association with TTP in CHR patients.

In the European Prediction of Psychosis Study project, 245 young help-seeking CHR patients were examined, and their baseline and life-time diagnoses were assessed by the Structured Clinical Interview for DSM-IV (SCID-I). TTP was defined by continuation of BLIPS for more than seven days.

Altogether, 71 % of the CHR patients had one or more life-time and 62 % one or more current SCID-I diagnosis; about a half in each category received a diagnosis of life-time depressive and anxiety disorder. Currently, 34 % suffered from depressive, 39 % from anxiety disorder, 4 % from bipolar and 6.5 % from somatoform disorder. During follow-up, 37 (15.1 %) TTPs were identified. In multivariate Cox regression analyses, current bipolar disorder, somatoform and unipolar depressive disorders associated positively, and anxiety disorders negatively, with TTP.

Both life-time and current mood and anxiety disorders are highly prevalent among help-seeking CHR patients and need to be carefully evaluated. Among them, occurrence of bipolar, somatoform and depressive disorders seem to predict TTP, while anxiety disorder may predict non-transition to psychosis. Treatment of bipolar, somatoform and depressive disorders may prevent CHR patients from developing full-blown psychotic disorders.