Research has consistently documented the significance of severe life events for the onset and course of major depression. However, no research has been done on whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to those who have not.

We investigated whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to depressed primary care attendees who have not.

We undertook a prospective cohort study involving 5,442 consecutive primary care attendees with evaluations at baseline and at 6 months. Patients aged 18-75 years were recruited in six Spanish provinces between October 2005 and February 2006. The incidence of major depression was assessed at 6 months with the Depression Section of the Composite International Diagnostic Interview (CIDI). Stressful life events were measured with the List of Threatening Experiences (LTE).

3,804 (70%) were interviewed at 6 months of follow-up. Among 200 attendees with a first episode of major depression, 24.5% had experienced no stressful life events, 30.5% had suffered one, 20.5% had experienced two and 24% had suffered three or more in the 6 months prior to the onset of depression. Depressed primary care attendees who had experienced three or more stressful life events differed from depressed patients with no stressful life events in the following variables: economic difficulties, dissatisfaction with unpaid work, relational variables, psychiatric co-morbidity and family history.

Stress-related major depression differs from non-stress-related depression in primary care.

Transcranial direct current stimulation (tDCS) is a novel somatic treatment proposed for depressive illness.

We aimed to assess the efficacy of tDCS in patients with severe, depression and whether hospitalized patients respond differently from non-hospitalized subjects.

28 patients (aged 36-79 year) with drug-resistant Major Depressive Episode in major Depressive Disorder or in Bipolar Disorder, according to DSM IV-TR, were enrolled. Patients were divided into two groups: ‘outpatients’ (N=14) and ‘hospitalized patients’ (N=14).HAM-D (21 items) were administered as outcome measure, before and after tDCS, to assess treatment response. tDCS delivered by a Newronika stimulator (Milano, Italy) was delivered over the dorsolateral prefrontal cortex (anodal electrode was placed on the left DLPC and cathode electrode on the contralateral area) at the intensity of 2mA, for twenty minutes, twice a day for 5 consecutive days.

All the patients well tolerated the treatment with no side effects. Despite the different severity at the baseline between the two groups (p=0.03), after five days of tDCS the mood scores improved in both groups, by 22% in outpatients group ([baseline vs post stimulation: mean± SE] HDRS: 20.3± 1.3 vs 15.9±1.8, p= 0.009) and by 32% in hospitalized patients (HDRS: 28.7± 2.7 vs 19.7±2.8, p= 0.0006). The improvement after tDCS did not differ between the two groups (p=0,3).

tDCS significantly improves patients with severe major depression after five days of treatment without significantly different effects in hospitalized and non hospitalized patients. Hence, tDCS treatment could be suitable also for non hospitalized patients at low suicidal risk.

Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) has been suggested to improve depressive symptoms in treatment-resistant depression (TRD). We now report preliminary results of DBS and one-year follow up in six patients.

Six patients with severe TRD (Thase Resistance Index>4) underwent DBS surgery and subsequent monthly assessments. DBS response was defined as ≥50% reduction in the 17-item Hamilton Depression Rating Scale (HDRS) or HDRS< 8 (remission). Electrodes location was assessed in each patient by means of pre/post-DBS MRIs co-registration.

DBS led to early and late reductions of average HDRS (from 22.5 to 9.8 and 6.25 respectively, see Figure 1 for evolution of HDRS mean scores). One month after surgery 16.7% of patients met criteria for response and for remission. Three months after response rates increased to 66.7% while remission rates were maintained. At six months, 66.7% of patients were responders. After 9 months, response rates arose up to 83.4% and these rates were largely maintained at 12 months. Remission rates showed similar growth over follow-up. No substantial differences were observed in electrodes location, and they were not found to be related to response or remission rates. The number of serious adverse effects was small with no patient experiencing permanent deficits.

This study suggests that DBS is relatively safe and provides significant improvement in patients with TRD. Improvement on average seems to be linearly progressive and, once melioration is achieved, it is maintained for at least one year. The procedure is well tolerated.

Depression and mortality have been studied separately in patients with coronary heart disease (CHD) and in populations healthy at study inception. This does not allow comparisons across risk-factor groups based on the cross-classification of depression and CHD status. We prospectively examined the effects of depressive symptoms, assessed in 2002-2004, on all-cause and cardiovascular -mortality in a large sample of 5936 middle-aged participants, with and without established CHD, followed over 5.6 years

We created 4-risk-factor groups based on the cross classification of depressive symptoms and CHD status. The age-and-sex-adjusted hazard ratios for all causes death were 1.67-fold (p< 0.05) higher for participants with only CHD, 2.10-fold (p< 0.001) higher for those with only depressive symptoms and 4.99-fold (p< 0.001) higher for those with both CHD and depressive symptoms when compared to participants without either condition. The two latter risk-factor groups remained at increased risk after adjustments for relevant confounders. Further comparisons indicated that the risks of all-cause death were also higher, but to a lesser extent, for participants with both depressive-symptoms and CHD when compared to those with only one of these conditions. These associations were also observed for cardiovascular mortality

This study provides evidence that depressive symptoms are associated with an increased risk of all-cause and CVD death and that this risk is particularly marked in depressive participants with co-morbid CHD. Several clinical guidelines have recommended screening, referral, and treatment of depression in primary and cardiovascular care units. These findings suggest that these recommendations need further consideration.

The aim of this study was to investigate the distribution of the regional cerebral blood flow (rCBF) in occupational related PTSD subjects and to seek for possible correlations between brain perfusion and self-rating scales (SRSs) in order to cross-check their diagnostic value and to look for their neural correlates.

Sixteen traumatized underground and long-distance train drivers developing (S) and 17 not developing (NS) PTSD after having experienced a “person-under-train” accident underwent clinical assessment and 99mTc-HMPAO-SPECT during trauma scripts. Statistical parametric mapping (SPM2) was applied to analyse rCBF changes in S as compared to NS, and to search for correlations between rCBF and SRSs scores, modeling age, months since trauma and the ratio ‘gray matter/intra-cranial volume’ as nuisance variables.

Significantly higher activity was observed during trauma script in left posterior insula, posterior cingulate, inferior parietal lobule, precuneus, and caudate in S as compared to NS. Impact of Event Scale (IES) and World Health Organisation (ten) Well-Being Index (WHO-10) scores highly correlated with tracer uptake to a great extent in the same regions in which rCBF differences between S and NS were found.

These findings support the involvement of posterior insular, cingulated, and parietal cortices (as well as the caudate) in the pathogenesis of PTSD and in the processing of related subjective well-being and distress. Our findings seem to provide a cross-validation for IES and WHO-10 scales by means of SPECT data, supporting their validity in the diagnosis of PTSD, and suggesting their use in future works.

DTNBP1, which encodes dysbindin-1, is one of the best-supported susceptibility genes for schizophrenia, and hippocampal volume reduction is one of the major neuropathological findings in schizophrenia. Consistent with these findings, dysbindin-1 has been shown to be diminished in glutamatergic hippocampal neurons in schizophrenic patients. The aim of this study was to directly investigate the effects of two single nucleotide polymorphisms of the DTNBP1 gene on regional brain volumes in human subjects.

128 subjects participated in the study. All subjects were genotyped with respect to two single nucleotide polymorphisms of the DTNBP1 gene (rs2619522 and rs1018381) and underwent structural magnetic resonance imaging (MRI). MRI data were preprocessed and statistically analyzed using standard procedures as implemented in SPM5, in particular the voxel-based morphometry (VBM) toolbox.

We found significant effects of the DTNBP1-SNP rs2619522 on regional brain volumes bilaterally in the hippocampus as well as in the anterior middle frontal gyrus and the intraparietal cortex. T/T homozygotes showed significantly lower grey matter volumes in these brain regions than carriers of the G allele.

Compatible with previous findings on a role of the dysbindin-1 gene in hippocampal functions as well as in major psychoses, the present study provides first direct in-vivo evidence that the DTNBP1-SNP rs2619522 is associated with variation of grey matter volumes bilaterally in the human hippocampus.

We aimed to describe aggression according to the subscales formed in the Life History of Aggression (LHA) in relation to life-time psychiatric diagnoses.

178 adults referred for psychiatric evaluations of childhood-onset neuropsychiatric disorders (outpatients) and 92 perpetrators of violent crimes referred to pre-trial forensic psychiatric investigations had comprehensive, instrument-based, psychiatric assessments, including the LHA scales. Total and subscale LHA scores were compared to the categorical and dimensional diagnoses of childhood and adult DSM-IV axis I and II mental disorders, general intelligence, GAF, and personality traits according to Cloninger's biopsychosocial model.

The two groups had similar LHA scores (despite higher scores on the Antisocial scale in the offender group). Higher total LHA scores were independently associated with the hyperactivity facet of attention-deficit/hyperactivity disorder (AD/HD), childhood conduct disorder, substance-related disorders, and low scores on the Cooperativeness character dimension according to the Temperament and Character Inventory. IQ and GAF-scores were negatively correlated with the LHA subscale Self-directed aggression. Autistic traits were inversely correlated with aggression among outpatients, while the opposite pattern was noted in the forensic group.

In these study groups, aggression was predicted by childhood behaviour aberrations, adult substance-related problems, and character immaturity rather than by symptoms associated with the major mental disorders. AD/HD in combined or hyperactive, but not inattentive, forms, was associated with high scores on aggressive behaviours.

To describe reasons for not seeking professional help at the age of 17-18 years, when a need for mental help is present.

In a person identifiable survey among 3278 Finnish adolescents 15-16 years old at baseline, reasons for not seeking professional help were studied among respondents of a two-year follow-up, who had reported a need for help for a mental health problem but had not sought professional help(n=128). The respondents were instructed to choose from the following list all alternatives describing their situation: thought that the symptoms will eventually alleviate anyway, unsure about who to turn to, felt too exhausted to get help, anxious of somebody finding out, negative experiences of dealing with health professionals, distrusted the effectiveness of professional help, turned to parents for help, parents estimated that there was no need for professional help, turned to friends for help,. friends estimated that there was no need for professional help.

The three most common reasons for not searching for professional help were, the notion that the symptoms would alleviate without help (71%), exhaustion (43%) and turning to friends for help (26%). Uncertainty about to whom to turn and exhaustion were more common among those with depression compared to those with no depression (33% vs 14%, p=0.025 and 55% vs 35%, p= 0.042).

Mental health literacy of late adolescents must be enhanced in order to make them take mental health problems seriously enough to get professional help.

Suicidal behavior in adolescence is now well documented with regard to biological and psychological traits, family-environmental factors, and clinical management. In despite of this knowledge, few interventions are based on family therapy.

To examine the association between suicide attempt in the adolescent population in Quebec and family constellation with regard to family structure and family functioning adjusted for socio-economic factors.

Data: Social and Health Survey of Children and Adolescents in Quebec State performed in 1999 (Institut de la Statistique du Québec, Canada). Subjects: 1186 adolescents aged 13 years and 1160 adolescents aged 16, and their parents. Outcome: suicide attempt during lifetime. Independant variables: family structure, witnessing interparental violence and parental emotional support. Covariates: family socioeconomic background and demographic variables.

Statistics: logistic regression analysis.

81 adolescents reported one suicide attempt or more during lifetime, with a significant risk for girls but this risk was independant of age and ethnicity. The adolescents had a 2.5-fold higher risk of suicide attempt when they live in monoparental household (OR=2.46; 95% CI=[1.37-4.42]), a 3.8-fold higher risk when they witnessed interparental violence (OR=3.76; 95% CI=[2.10-6.74], and a 2 to 6-fold higher risk when parental support is low, particularly paternal support. These associations are not modified by familial socioeconomic status.

These results are concordant with family stress perspective in the un derstanding of suicidal beahvior in adolescents, and this independently of familial socio-economic deprivation. They give arguments for family centered therapy in the panel of interventions in health promotion in adolescence.

Neurodegeneration and cognitive deficits may influence the pattern of co-morbid disorders and their possible effects on mortality in late-onset Alzheimer's disease (AD). However, subjects with AD have to live long enough to experience and be diagnosed with dementia. We investigated whether the pattern of co-morbidity and its relevance for later death differed between hospitalised AD and elderly controls subjects.

Diseases with a prevalence of more than 1% were compared between 634 hospitalised AD and 72244 control subjects aged above 70 years referred to the University of Birmimgham NHS Trust. Predictors of mortality within the seven year follow-up were identified using regression regression analyses. Confidence intervals of relative risks were used to compare the relevance of risk factors for later mortality between groups.

Subjects with AD suffer more infections, brain diseases and neck of femur fractures than other hospitalised elderly patients. In contrast, cardiovascular diseases and diabetes mellitus were less prevalent in AD subjects in comparison with hospitalised controls. Diseases that might contribute to later mortality in AD were pneumonia, ischemic heart disease and gastroenteritis, but there were no significant differences in their impact on mortality compared to other hospitalised elderly control subjects.

Patients with Alzheimer's disease have a different pattern of co-morbidity, but die from the same diseases as other hospitalised patients. Infections including pneumonia, and diseases that may occur secondary to neurodegeneration and confusion may need special attention in patients with Alzheimer disease who might not be able to identify or report the early symptoms.

To examine whether cognitive testing can be tailored to individual patients by selecting only items of appropriate difficulty from a large and precise neuropsychological battery. The advantage is a combination of measurement precision with the brevity (of shorter tests).

39 patients with cognitive complaints and 8 partners who visited a geriatric day care clinic were randomly assigned to administration of the CAMCOG or an extended CAMCOG i.e. with ADAS-cog and neuropsychological tests. Item difficulties were estimated and their validity examined with Rasch analysis. Tailored testing was achieved by Computerised Adaptive Testing (CAT). CAT repeatedly selected an easier item after an incorrect response and a more difficult item after a correct response to estimate the total score. CAT finished the item selection after reaching sufficient reliability (standard error < 0.15).

For test reductions by CAT ranging from 25 to 15 items, intraclass correlations between the CAT estimated total score and actual total score (CAT administered plus remaining items) ranged from .99 to .98 for the CAMCOG and from 0.98 to 0.91 for the extended CAMCOG. Testing time reduction ranged from 42-55% for the CAMCOG (M testing time CAMCOG 39.6 minutes, M testing times CAT 22.9 to 17.8 minutes) and from 45-68% for the extended CAMCOG (M testing time extended CAMCOG 111.3 minutes, M testing times CAT 61-35 minutes).

Substantial test reductions and excellent agreement with the whole battery supports the use of tailored cognitive testing to economically administer batteries that are time consuming in their entire form.

The aim of this study was to determine the gender differences in knowledge, attitudes and practices toward Mental Illness in a sample of Qatari and other Arab expatriates residing in the State of Qatar.

This is a cross sectional survey.Setting: Primary Health Care Centers.

A multistage sampling design was used and a representative sample of 3300 Qatari and other Arab expatriates above 20 years of age were surveyed. Of the study sample of 3300, 2514 subjects (76.2%) expressed their consent.

Face to face interviews were based on this questionnaire that included variables on socio-demographic characteristics, knowledge, attitude and practice toward mental illness.

Of the study sample, 49.2% were men and 50.8% were women. More women than men believed that mental illness is due to possession by evil spirits (43.5% vs 34.5%; p< 0.001). Also, less than half of the studied women (42.3%) thought traditional healers can treat mental illness. Women were considering people with mental illness as dangerous (58.1%), compared to men (51.5%) (p=0.001). More than women (76.8%), men (82%) were willing to visit a psychiatrist for their emotional problems (p=0.002), while more women (43.7%) preferred a traditional healer (p< 0.001). Women were more afraid to talk to mentally ill (39.5%) than men (28.8%) (p< 0.001). 24.8% of women and 31.1% of men identified schizophrenia as a common mental disorder.

The knowledge of women towards mental illness was poor. Most of the women were afraid and not willing to keep friendship with the mentally ill.

To study the association between school bonding dimensions (school commitment and school attachment) and current adolescent smoking in Chile, controlling for confounding variables using the Fifth Chilean School Population National Substance Use Survey, 2003 (CHSS-2003) dataset.

The CHSS-2003 is a stratified cross-sectional survey which gathers information about personal, familial, peer, school factors and cigarette use using a self-reported questionnaire. Complete data from 21,956 adolescent students for all the variables of interest were used in the analyses. An Exploratory Factor Analysis (EFA) was performed in order to test the construct validity of the questionnaire and create the main exposure and potential confounding variables. Multivariable logistic regression analyses were undertaken to study the association between school bonding and smoking.

The construct validity of the school attachment and school commitment scales was supported by the EFA. Multivariable analyses showed strong evidence that, after adjusting for factors from different domains, school commitment (student's good grades and school attendance) appears to have a clear inverse association with current smoking (OR=0.46; 95%CI: 0.38-0.56). On the other hand, school attachment (their feelings towards their school and their teachers) was not associated with adolescent smoking (OR=1.16; 95%CI: 0.88-1.53)

School commitment was strongly associated with current smoking. It is important to study further this variable with the aim of ascertaining whether or not interventions that improve school commitment may prevent or reduce smoking amongst adolescent students.

Treatment of alcohol addiction remains challenging, since only half of all patients achieve long-term abstinence by currently available therapies.

In the last 2 years, there have been promising reports on deep brain stimulation (DBS) of NAc in addiction (animal models, one case report of a patient with severe anxiety disorder and secondary addiction). Our group treated 5 patients with treatment resistant alcohol addiction with DBS so far. Our initial data of the first 3 patients has just been published. However, these very positive results arise from a continuous open stimulation and have not been placebo controlled.

To assess the impact of discontinuation of bilateral DBS of the NAc on craving for alcohol in patients whose addiction remitted after initiation of DBS.

Crossover, double-blinded phase of 2 × 4 weeks with sham-stimulation in one and stimulation in the other 4 weeks.

Until now, one patient finished the 8 weeks of study (remaining patients will finish experiment in December 2009). In this patient, stimulation was continued in the first and stopped in the latter 4 weeks. While he experienced no changes or side effects in the first part, he showed a massive craving for alcohol one day after discontinuation, which again remitted when the experiment was stopped and the stimulator was turned on again after 3 days.

DBS of NAc seems to selectively alleviate craving for alcohol thus enabling patients to remain abstinent. These results justify clinical studies in larger samples of patients with treatment resistant alcohol addiction.

To determine the association between functional impairment, as reported in a lay-administered structured interview (CIDI), and severity of depression, depressive symptoms and risk factors for depression.

We undertook a cross-sectional study of 5442 consecutive attendees at general practices in seven Spanish provinces participating in the PredictD-Spain study on predictors of depression. Participants were administered the depression section of the Composite International Diagnostic Interview (WHO-CIDI 2.1), allowing diagnoses by the ICD-10 and DSM-IV classifications for depressive episodes. Impairment was measured using the CIDI question about whether symptoms seriously interfered with important areas of functioning, such as work or looking after the house and family. We measured a set of 39 known risk factors for depression.

Firstly, the 6-month prevalence of a depressive episode according to ICD-10 was 28.7% (1563) and of major depression according to DSM-IV it was 13.6% (742). Secondly, out of the 1563 patients with a depressive episode according to ICD-10, nearly half (47.9%; n=749) had no impairment in important areas of functioning.

As the ICD-10 criteria for depressive diagnoses do not include the criteria that symptoms cause impairment in social, occupational or other important areas of functioning, a large number of false positive cases are included in reported prevalence rates; and secondly, the measurement of functional impairment, at least operationalized using a lay-administered structured interview such as CIDI, is not enough, in epidemiological research studies, to assess the clinical importance of depressive symptoms.

Historically, the treatment of mental illness in Australia has been inadequate. Clinical Supervision [CS], a structured staff support arrangement, has shown promise as a contribution to the clinical governance agenda; however, little is yet known about CS implementation issues. This study aimed to examined the effects of providing regular Clinical Supervision to nursing staff who worked in mental health settings, on their levels of personal well being, the quality of care they delivered and the outcomes for patients

A large scale landmark Australian randomised controlled trial [RCT] of CS, funded by the Queensland Treasury/Golden Casket Foundation [A$248,000], was located in 17 mental health facilities, across the State. The RCT trained 24 Supervisors and tracked their subsequent year-long personal experience [the Intervention] using psychometrically established instruments, supplemented by qualitative data, which was also collected from mental health nurses, other clinical staff, patients and administrators.

Supervisors and Supervisees were found to value Clinical Supervision. The positive effect this had on the quality of care and patient outcomes was demonstrated in a controlled setting within this RCT, but remained elusive across a broad front. The importance of the prevailing service/managerial culture to the outcome of CS implementation was revealed.

Novel findings will help to conceptualise Clinical Supervision education, management and policy decision making in the future. They will provide the basis for the best contemporary advice for service development and/or a framework for future CS evaluation, sufficient to be tested in another environment with other mental health disciplines.

Social implications and long-term consequences of mental disorders regarding sick days at work, unemployment rates and early retirement are substantial. There is no clear understanding

1. 1) whether and which social psychiatric strategies of vocational rehabilitation and

2. 2) whether and how atypical antipsychotics are successful in supporting vocational rehabilitation in schizophrenia.

Primary objective was to demonstrate the enhanced ability of schizophrenic patients to be successfully in employment after attending specific “job-consulting” programs. Secondary objective was to demonstrate positive effects of ziprasidone and risperidone on work-related functions.

Aim of the study was to enlighten the complex relationship between working performance of schizophrenic patients, their social psychiatric and medical treatment, and their cognitive capabilities in a first step.

The study was conducted in inpatients, day-clinic- or outpatients diagnosed with schizophrenia, paranoid type (ICD 10: F20.0). All patients received regular pharmacological treatment and intense cognitive training, additionally one group completed specific “job-consulting” programs. ANT, CPT, WCST, PANSS and WBN were performed after 3, 6, 12 and 24 months.

At present eighteen schizophrenic patients (6 female and 12 male, mean age: 33.6 years) have been included in the study. Analyzing the data after 3 months the results are:

1. 1) specific “job-consulting” programs increase the probability of employment

2. 2) both, ziprasidone and risperidone, exert positive and comparable effects in work-related functions,

3. 3) the better the cognitive capability the better the vocational outcome.

Specific “job-consulting” programs constitute a clinically relevant therapeutic option in vocational rehabilitation of schizophrenic patients.