There is a strong association between depersonalization (DP) and panic disorder (PD), as documented by Roth (1960) and later by Cassano (1989)1. In the PD is shown a prevalence of 7.8% to 82.6% from the DP. The aim of our study was to evaluate the association between depersonalization symptoms and PD in a sample of patients with anxiety disorders and mood.

A sample of 310 patiens was assessed with: SCID-P for axis I diagnosis and SCI-DER (structured clinical interview for depersonalization and derealization symptoms, lifetime version)2.

Through a linear regression analysis we underline that, the presence of depersonalization symptoms, irrespective of age, gender and mood disorder, is significantly associated with the PD diagnosis (total score SCI-DER Tot p = 0.001; derealization p = 0.001; somatopsychic depersonalization p = 0.001; autopsychic depersonalization p = 0.003; affective depersonalization p = 0.047).

The presence of depersonalization symptoms must carefully assess in clinical setting and suggest the presence of panic disorder.

Pathological skin picking is a repetitive picking of the skin that leads to tissue damages and to significant distress. One of the most important aspects of skin picking is inability to inhibit one's notorious behavior; however, very few studies have examined whether the general impulsiveness underlies this disorder.

The aim of the current study was to investigate whether the PSP sufferers exhibit a tendency to be more reactive in general and represent the impulsive reaction style characterized by faster response and incorrection rely on the tendency to react to irrelevant stimuli rather than missing the correct reaction.

30 students suffering from pathological skin picking and 30 healthy controls were administered the Moroń Clock Test which allows to examine the basic mechanisms of information selection. The participants’ task was to search for, among the various distractors, the one predefined icon as quickly and as correctly as possible.

The individuals with pathological skin picking did not differ from healthy controls neither in the speed of signal detection nor in the number of ‘false - alarms’ being made; however, skin picking sufferers demonstrated the pattern of signal detection which seems to be characteristic of individuals with high level of anxiety. At the very beginning of the task they performed slowly and carelessly but gradually improved their performance when the task became more familiar to them.

The results demonstrate that individuals with pathological skin picking do not show an impulsive reaction style.

To compare healthcare costs from the perspective of the Spanish National Healthcare System (NHS) of initiating treatment with pregabalin or SSRI/SNRI as add-on therapies in patients with generalized anxiety disorder (GAD), who are resistant to benzodiazepine-based therapy (BR).

BR patients with GAD (DSM-IV criteria) included in a prospective, multicentre, observational cohort study carried out in outpatients attending mental health centers, were selected in this post-hoc analysis. BR was defined as insufficient response with persistence of symptoms of anxiety (HAM-Anxiety scale≥ 16) after a 6-month course of BR (standard dose). Healthcare resource utilization (HRU) associated with GAD included drug treatments, medical visits, hospitalization and non-pharmacologic therapies which were collected twice (baseline and end-of-trial visits) during a 6-month period. Related costs were estimated in each visit and adjusted changes between visits compared using ANCOVA models.

A total of 128 patients received pregabalin and 126 SSRI/SNRI. Compared with SSRI/SNRI, pregabalin was associated with significantly lower adjusted mean increment use of anxiolytics; 0.55 vs. 1.12, p < 0.001, and greater reduction in medical visits; −15.12 vs.−12.99, p = 0.029. Mean adjusted healthcare costs were significantly decreased in both medication cohorts; −€;289: pregabalin (p = 0.003) and −€95 (p = 0.052) with SSRI/SNRI. Drug acquisition costs for SSRI/SNRI were lower than pregabalin, however adjusted healthcare cost reduction was numerically higher with pregabalin; −€289 versus −€194, p = 0.488.

Initiating treatment with pregabalin was associated with significant reduction in HRU and total cost for GAD compared to SSRI/SNRI in BR patients in the Spanish NHS setting.

SSRI/SNRI and pregabalin are recommended therapies for the treatment of GAD, particularly in case of benzodiazepines refractory (BR) patients. The aim was to compare the use of anxiolytic treatments in BR GAD patients initiating treatment with pregabalin or SSRI/SNRI as add-on therapies.

BR outpatients with GAD (DSM-IV criteria) enrolled in a prospective, multicentre, observational cohort study were included in this post-hoc analysis. BR was defined as insufficient response with persistence of symptoms of anxiety (HAM-Anxiety scale ≥ 16) after a course of a standard dose of benzodiazepines, for 6 months. The use (% of users and dose) of pregabalin, SSRI/SNRI and benzodiazepines was evaluated during the 6-month study period.

128 subjects treated with pregabalin and 126 with SSRI/SNRI were analyzed. Both cohorts presented a similar pattern of anxiolytic drugs utilization at baseline: Alprazolam (33% pregabalin and 27% SSRI/SNRI), diazepam (20% vs. 11%) and lorazepam (17% vs. 30%) were among the most used benzodiazepines. At the 6 month visit, pregabalin treated patients showed a significant decrease in the % of users of alprazolam (16% vs. 27%; p = 0.032), lorazepam (14% vs. 27%; p = 0.013) or ketazolam (0% vs. 7%; p = 0.002) compared with SSRI/SNRI. 57% of patients in pregabalin group, compared with 87% in SSRI/SNRI, were still receiving a benzodiazepine concomitantly at the 6 month visit (p < 0.001).

Compared with SSRI/SNRI, initiating therapy with pregabalin reduced the use of concomitant anxiolotic treatment in BR outpatients with GAD in routine medical practice.

To carry out the psychometric validation of the Spanish version of the 2-items self-administered GAD-2 scale for screening probable patients with Generalized Anxiety Disorder (GAD).

The content validity was assessed by inter-ratter-agreement (item-goal congruence index of Rovinelli-Hambleton). The GAD-2 was self-administered to patients with GAD according to DSM IV criteria and their respective controls, matched by age and sex, who were recruited at random in Mental Health and Primary Care centres. Criteria validity was explored using ROC curve analysis, and sensitivity, specificity, predictive positive value and negative value for different cut-off values were determined. Concurrent validity was also explored using the HAM-A, HADS, and WHO-DAS-II scales.

The study sample consisted of 212 subjects (106 patients with GAD) with a mean age of 50.38 years (SD = 16.76). No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to fill in the questionnaire. Reliability (internal consistency) was high; Cronbach′α = 0.875. A cut-off point of 3 showed adequate values of sensitivity (91.5%) and specificity (85.8%), with AUC being statistically significant [AUC = 0.934; p < 0.001] to distinguish GAD patients from controls. Concurrent validity was also high and significant with HAM-A (0.806, p < 0.001), HADS (anxiety domain, 0.825, p < 0.001), and WHO-DAS II (0.642, p > 0.001) scales.

The Spanish version of the GAD-2 scale was shown to have appropriate psychometric properties to promptly detect probable cases of GAD in the Spanish cultural context under conditions of routine clinical practice.

Acupuncture is a low-risk intervention that is increasingly used. Some studies examined the potential effects of acupuncture on anxiety and the bispectral index of the EEG (BIS), used as an objective and indirect measure of anxiolysis. Those studies used the same acupuncture point and achieved conflicting results.

To objectively assess the effects of acupuncture on anxiety and the BIS on a clinically relevant population.

To evaluate the impact of alternative, low risk interventions, such as acupuncture in anxiety.

15 anxious volunteers were recruited for this prospective, controlled, blinded, crossover study with random allocation. Acupuncture was performed at the experimental point He7 (Heart 7) and at a control point Lu 9 (Lung 9). BIS was evaluated at 3 different stages, rest state, during electro-acupuncture and post acupuncture.

BIS mean values and minimums means were significantly reduced by acupuncture on He7 compared to acupuncture on Lu9 (means: 90,7 ± 4,3 to 86,5 ± 7,2; p = 0,009 | minimums: 80,6 ± 9,6 to 71,9 ± 12,3; p = 0,011). None of the groups had a significant decrease in BIS comparing acupuncture to the rest state, however acupuncture on He7 was related to a relevant (but statistically nonsignificant) decrease in BIS mean compared to the rest state.

Acupuncture on He7 was superior over acupuncture on Lu9 to decrease BIS in anxious volunteers and showed objective and measurable cerebral effects.

We will describe the case of a 35-year-old black female who developed PTSD secondary to cerebral aneurysm rupture and hemorrhage.

Ms. X is a 35-year-old African American female with a history of depression who was admitted to the inpatient unit of a teaching hospital for suicidal ideation. Ten months prior to admission, she suffered from subarachnoid hemorrhage from a ruptured anterior communicating artery aneurysm with resulting hydrocephalus. At that time, her CT angiogram confirmed anterior communicating artery aneurysm. She denies history major traumatic events in her life. Her symptoms included flashbacks surrounding the day her cerebral aneurysm ruptured which occur 3x/week. She described symptoms of hypervigilance and panic attacks and she avoids environmental stimuli that remind her of the events surrounding the ruptured aneurysm. These symptoms were not present prior to her ruptured aneurysm.

We hypothesize that her cerebral aneurysm may have reduced blood flow to her prefrontal cortex (PFC) resulting in ischemic damage. The PFC regulates responses from the amygdala in response to stimuli. An intact PFC is necessary for appropriate extinction of conditioned fear responses. Patients with PTSD are known to demonstrate intense reactions when recollecting the traumatic events related to the PTSD. Such patients have also demonstrated hypoactive medial PFC. Neuroimaging research and functional connectivity studies have revealed cognitive activation, and the role of the medial PFC, amygdala, and hippocampus, in mediating symptom formation in PTSD.

Practitioners should be aware that damage to the PFC may contribute to development of PTSD.

Migraine is one of the most common primary headaches which worldwide affects more than 10% of people. Anxiety disorder and depression often accompany this disease and increase the number and severity of migraine attacks. Detection and treatment of psychiatric disorders with migraine provides a major contribution to effective pain control. The purpose of this study is to determine the prevalence of anxiety and depression disorders in patients with migraine.

Two groups are formed with migraine patients and healthy volunteers. So far 51 patients are included to migraine group by the neurologist according to “The International Classification of Headache Disorders, 2nd edition” (ICHD-2). There are 60 subjects in the healthy control group. After being examined by the psychiatrist both of the groups meet the psychologist and have the Beck Depression Inventory (BDI)and Beck Anxiety Inventory (BAI).

Until now, in the migraine group BAI is high with 15 patients (29%) and BDI is high with 19 patients (37%) whereas in the control group BAI is high with 6 subjects (10%) and BDI is high with 10 subjects (16%). Both test scores are significantly higher in the migraine group than the control group (p < 0.001).

The study is ongoing and according to the current findings the prevalence of anxiety and depression in patients with migraine is higher than the normal population. For this reason migraine patients should also be questioned and treated at psychological aspects.

Migraine is one of the most common primary headaches which worldwide affects more than 10% of people. Anxiety disorder and depression often accompany this disease and increase the number and severity of migraine attacks. Detection and treatment of psychiatric disorders with migraine provides a major contribution to effective pain control. The purpose of this study is to determine the prevalence of anxiety and depression disorders in patients with migraine.

Two groups are formed with migraine patients and healthy volunteers. So far 51 patients are included to migraine group by the neurologist according to “The International Classification of Headache Disorders, 2nd edition” (ICHD-2). There are 60 subjects in the healthy control group. After being examined by the psychiatrist both of the groups meet the psychologist and have the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).

Until now, in the migraine group BAI is high with 15 patients (29%) and BDI is high with 19 patients (37%) whereas in the control group BAI is high with 6 subjects (10%) and BDI is high with 10 subjects (16%). Both tests have significantly higher scores than the control group (p < 0.001).

The study is ongoing and according to the current findings the prevalence of anxiety and depression in patients with migraine is higher than the normal population. For this reason migraine patients should also be questioned and treated at psychological aspects.

The research was conducted on the base of Donetsk Regional Antitumoral Center. For a screening of the anxiety disorders in 450 patients with cancer we used the Hospital Anxiety and Depression Scale, in the positive case we applied the Hamilton Anxiety Scale and the structured clinical interview with diagnostic criteria of ICD-10.

The anxiety were revealed in 141 (31,3 ± 2,19%) patients with malignant neoplasms. The anxiety disorders were presented mainly as a reaction to severe stress and adjustment disorders (F43) as the mixed anxiety and depressive reactions (F 43.22) and the reactions with predominant disturbance of other emotions such as anxiety, worry, tensions and anger (F 43.23) and the somatogenic anxiety disorders (F 06.4).

Clinically the most typical for the cancer patients are almost constant feeling worried and impossibility to relax, irritability and insomnia. The oncologic patients experience fear of pain, disfigurement, disability and they suffer from obsessive representations about character of the disease and consequences of antitumor treatment, fear of possible intraoperative death and development of the remote complications, uncertainty in restoration of the functions of their organism broken by operative intervention.

High frequency of anxiety disorders in the patients suffering from different cancer localization determines actuality of organization of renderings specialized help in cancer care departments.

Disturbed prefrontal cortex (PEC) functions as consequent upon a hyperresponsive amygdala (bottom-up) or/and a lack of PFC-amygdala top-down control are discussed as main reasons for affective disorders. Here we aimed to investigate the specific function of the dorsolateral-PFC (DLPFC) on emotional processing by a temporary deactivation of this region by means of 1-Hz rTMS.

Before and after rTMS (1 Hz, 1800 stimuli, N = 15) or sham (N = 15) treatment of the right DLPFC, subjects viewed pictures of fearful (40) or neutral (40) emotional faces, while visual evoked magnetic fields were acquired with a 275 sensor whole head MEG system.

There was a clear increase of neural processing within bilateral parietal areas as consequence of rTMS but not sham treatment starting around 90ms after stimulus onset. While this parietal treatment effect occurred for both affective conditions, an area at the right temporo-parietal junction (TPJ) showed an increases sensory processing specifically for fearful faces.

RTMS associated decrease of DLPFC function diminished the known inhibitory impact of this region on limbic and paralimbic structures such as the orbitofrontal cortex, leading to a valence independent modulation of parietal top-down attention areas and an eventually amplified sensory processing of emotional material at right TPJ.

Supported by: DFG-TRR-58-C1

Bipolar, migraine and epilepsy disorders are often co-morbid conditions. This link may help explain their pathogenesis, diagnosis and treatment. The more understood mechanisms by which epilepsy and migraine arise may offer new insight into bipolar disorder neurobiology. Here, we examine the prevalence of these disorders in a UK community mental health team. We then report on a wide-ranging literature review highlighting shared features of the conditions and suggest how they may develop along a similar pathway.

1. • Examine co-morbidity prevalence in Bedford East Community Mental Health Team outpatients.

2. • Identify overlapping aspects of neurobiology.

3. • Explain how these may relate to each other.

1. • Add to existing co-morbidity data.

2. • Offer insight into bipolar neurobiology.

Manual search of an outpatient database covering January 2010 to February 2011 (n = 615), identifying cases of bipolar disorder, migraine and epilepsy.

Diagnoses Prevalence

Bipolar 19.8%

Migraine 5.4%

Epilepsy 1.1%

Bipolar + epilepsy 0.16%; 0.82% of bipolar patients.

Bipolar + migraine 1.1%; 5.7% of bipolar patients.

Contrasting with previous studies, co-morbidity was much lower - likely to reflect under-reporting of secondary diagnoses. Most literature supports a connection between the disorders. Common features exist regarding disease course, pharmacological treatment, altered cellular and loss of network stability.

We discuss the relationship between genes and environment, and hence impact on Metabolic factors, Ion Channels and neurotropic factors, which affect network changes, Hyper-excitability,Cellular vulnerability and Loss of ‘stabilising’ circuits. We suggest an accumulating pathological change towards disease and we note accompanying Inflammatory/Immune responses.

There is an increasing evidence that several cognitive areas as executive functioning, verbal memory and visual-spatial abilities, are impaired during the acute phase of Bipolar Disorder (BD) and persist even in the euthymic periods.

The aim of the study was to characterize cognitive profile in subjects affected by BD-I and BD-II and to compare them to healthy controls (HC), in order to analyse the possible influence of depressive or euthymic phase on neuropsychological performances.

We recruited 35 outpatients with BD (DSM-IV TR), 20 BD-I and 15 BD-II, in both euthymic or depressive phase clinically assessed. All subjects affected by any other DSM-IV TR axis I disorder were excluded. Results were compared to HC group composed by 11 subjects without neurological disorders, alcohol or drug abuse and any lifetime psychiatric treatment. Each group underwent a comprehensive neuropsychological assessment.

Our results indicated that case group (BD-I/II) showed significantly lower scores at the Raven Test (p < 0.001) and executive tests (p = 0.007) compared to HC. No difference were observed between depressed and euthymic patients. Compared to healthy group euthymic and depressed patients showed significantly lower scores at Raven Test.

In our sample cognitive impairment is present, as indicated in literature, in each phase of Bipolar Disorder. Logical reasoning seems to be the assessment tool more influenced by the clinical phase of the pathology. The analyses of the impact of depressive/euthymic phase did not show any difference between depressed and euthymic subgroups.

Rapid cycling (RC) is a severe form of bipolar disorder (BD) with an increased rate of episodes. Circadian disturbances are common in BD, and those with RC might be even more vulnerable.

To investigate if the P2RX7 gene would be involved in the circadian rhythm and in part thereby be implicated in RC.

Gene expression was analyzed in peripheral mononuclear cells (PBMCs) from healthy volunteers (n=8) at the sleep research center, University of California, Irvine Medical Center, USA. Swedish outpatients recruited from psychiatric clinics for BD, diagnosed with BD type 1(n=569; RC: n=121) and anonymous blood donor controls (n=1,044) was investigated in case-case and case-control SNP/haplotype association analyses.

P2RX7 RNA levels were dramatically increased during sleep deprivation in PBMCs from the healthy volunteers (p=2.3*10-9). The P2RX7 rs 2230912 _A allele was more common (OR=2.2, p=0.002) and the ACGTTT haplotype in P2RX7 containing the protective rs2230912_G allele was less common, among RC cases compared to nonRC bipolar patients and blood donor controls.

Sleep deprivation activates P2RX7 expression in healthy persons which suggests that P2RX7 is involved in, or downstream, circadian rhythm regulation. The putatively low-activity P2RX7 rs2230912 allele A variant was associated with RC in BD which supports earlier findings of P2RX7 associations to affective disorder.

Several characteristics can be found in bipolar disorder according to the polarity of the first episode. This may affect the clinical course of the illness.

The current study explored the relationship between the polarity of the first episode and the sociodemographic characteristics of patients and clinical implications.

This was a retrospective and descriptive study. It involved 49 patients with the diagnosis of bipolar disorder I (DSM-IV) who were hospitalized in the department of Psychiatry “C” in Sfax University Hospital (Tunisia), between January 2010 and March 2011. These patients were divided into two groups according to the polarity of the first episode: those with depressive polarity (D) and those with manic polarity (M).

All the patients were male. Group (M) consisted of 33 patients and group (D) of 16 patients. The onset age of bipolar disorder, the origin of patients, their marital status and their socio economic level did not vary significantly depending on the polarity of the first episode. However, the level of education was greater and the irregular works was more frequent, significantly, in group (D) (p respectively: 0, 03 and 0,01). The depressive first episode was correlated with a depressive dominant polarity (p = 0,007) in the course of bipolar illness, bad quality of free intervals (p = 0,005) and more suicide attempts (p = 0,003).

This study indicates that first episode depressive polarity seems to have a relatively poor prognosis with a negative psychosocial impact.