This study aimed to investigate the independent correlation of the severity of fatigue in female patients with Major Depressive Disorder (MDD) with age at illness onset.

We studied 70 female patients (34 inpatients), aged 23-65 years (mean 48.2±10.6 years), with MDD as assessed with the M.I.N.I. version 5.0.0. All patients were currently in a Major Depressive Episode, with a 17-item Hamilton Depression Rating Scale (HDRS) score ≥17, and free of major fatigue-associated conditions. Reported fatigue was assessed with the 14-item Fatigue Questionnaire (FQ). Pearson's (r) or Spearman's (rho) correlations between FQ, age, inpatient status, HDRS and age at onset were calculated. A multiple regression analysis was then performed, with FQ as the dependent variable.

The FQ score was significantly correlated with HDRS (r=0.406, p< 0.001) and age at onset (r=-0.281, p=0.02). In the multiple regression model, HDRS and age at onset turned out as significant independent predictors of the FQ score, with standardised beta coefficients of 0.419 (p< 0.001) and -0.3 (p=0.006), respectively (R2=0.255).

The severity of fatigue in female patients with major depression is independently correlated with earlier age at illness onset.

517 patients with a diagnosis of major depressive disorder were evaluated in the period January to December 2008 in First Psychiatry Clinic of Tirgu Mures. The data obtained were entered into computer, processed and were compared statistically with data from literature.

380 of the 517 patients suffer from one or more psychosomatic diseases. The majority patients with depressive mood disorders and psychosomatic illness associated were between 50 and 59 years old. The incidence of these diseases is more common in female sex. 75% of all patients hospitalized for these diseases are women. The most common disease associated with depression was hypertension. It is followed by coronary artery disease, gastrointestinal disorders, hypothyroidism, type 2 diabetes mellitus and duodenal ulcer. The most common gastrointestinal disorders were chronic gastrointestinal, chronic recto colitis and gastro duodenal ulcer.

Depression is one of the most common disease for which patients are presented in specialty medical practices and psychiatric hospitals. Frequently, the psychiatric disorder is associated with some psychosomatic diseases that can decrease compliance of these patients and worsen long-term prognosis of the psychiatric disease.

Low testosterone levels in men are associated with the metabolic syndrome (MetS) as well as with depressive symptoms, low vitality and sexual dysfunction.

To assess the effects of testosterone administration on these subjective symptoms, which have not extensively been studied in hypogonadal men with the MetS.

In a randomized, placebo-controlled, double-blind, phase III trial, 184 men suffering from both the MetS and hypogonadism were included. They were treated for 30 weeks with either parenteral testosterone undecanoate (TU; 1000 mg IM testosterone undecanoate, at baseline, and after 6 and 18 weeks; Nebido®) or placebo injections. 105 (92.9%) men receiving TU and 65 (91.5%) receiving placebo completed the 30 week trial. The Beck Depression Inventory (BDI), Aging Males’ Symptoms (AMS) scale, and International Index of Erectile Function 5-item (IIEF-5) scale at baseline, 18 and 30 weeks were analysed using multilevel analysis.

The mean age was 52.1 years (range: 35-69), with a mean body mass index of 35.5 kg/m2 (SD 6.7), and a mean total testosterone level of 8.0 nmol/L (SD 4.0). There were significant improvements in BDI (mean difference vs. placebo after 30 weeks: -2.5 points; 95% confidence interval [CI]: -0.9;-4.1; P=0.003), AMS (-7.4 points; 95% CI: -4.3;-10.5; P< 0.001), and IIEF-5 (+3.1 points; 95% CI: +1.8;+4.4; P< 0.001). The effects were strongest in men with baseline total testosterone levels < 7.7 mmol/L.

TU administration may improve depressive symptoms, aging male symptoms and sexual dysfunction in hypogonadal men with the MetS.

To conduct a subgroup analysis of the efficacy of adjunctive aripiprazole as treatment in patients with major depressive disorder (MDD) who demonstrated an inadequate response to standard antidepressant therapy (ADT).

Data were pooled from three identical, short-term, double-blind, placebo-controlled studies (CN138-139, CN138-163, CN138-165) with an 8-week phase of placebo plus ADT and a 6-week double-blind phase with ADT plus adjunctive placebo or aripiprazole. Only MDD patients without psychotic features were eligible for entry. The primary efficacy endpoint was the mean change in the Montgomery Asberg Depression Rating Scale (MADRS) total score in the double-blind phase. Subgroup analyses of the primary efficacy endpoint were performed for age, race, ethnicity, MADRS response, number and choice of previous ADTs, episode duration, and use of selective serotonin re-uptake inhibitors (SSRI).

Compared with the adjunctive placebo group, adjunctive aripiprazole was associated with greater reductions in MADRS total score in all subgroups. Mean change in MADRS total score ranged from -10.71 to -5.89 with adjunctive aripiprazole and -7.57 to -4.10 with adjunctive placebo. No statistically significant treatment-by-subgroup interaction effects were observed for any subgroup except gender (p=0.039). This difference is, however, primarily because of results from study CN138-139 results; consistent results between men and women were reported in CN138-163 and CN138-165.

Pooled data indicate that in patient populations with similar baseline characteristics, treatment with adjunctive aripiprazole and ADT is efficacious in improving the symptoms of MDD in subgroups of patients having an inadequate response to ADT.

To evaluate the efficacy of aripiprazole as adjunctive treatment in patients with major depressive disorder (MDD) without psychotic features and an inadequate response to standard antidepressant therapy (ADT).

Data were collected from three identical, short-term, double-blind, placebo-controlled studies (CN138-139, CN138-163, CN138-165). After a single-blind prospective phase with placebo plus ADT, patients with inadequate response were randomized to 6-weeks’ treatment with adjunctive aripiprazole or placebo. The primary efficacy endpoint was the mean change in the Montgomery Asberg Depression Rating Scale (MADRS) total score during the double-blind phase. Secondary endpoints were response (≥50% reduction in MADRS total score), remission (MADRS total score ≤10 and ≥50% reduction in MADRS total score), and mean change in Hamilton Depression Rating Scale (HAM-D17) total score.

In all three studies, adjunctive aripiprazole was associated with a significantly greater reduction in MADRS total score than adjunctive placebo, with a treatment difference ranging between -3.73 and -2.84 (p≤0.001 in each study). Response and remission rates with adjunctive aripiprazole (32.4-46.6% and 25.4-36.8%, respectively) were also significantly higher than with adjunctive placebo (17.4-26.6% [p< 0.05 in each study] and 15.2-18.9% [p< 0.05 in each study]). Mean change in HAM-D17 total score ranged from -7.64 to -6.77 with adjunctive aripiprazole and from -5.12 to -4.41 with adjunctive placebo (p< 0.001 for each study).

Results of the three studies indicate that treatment with adjunctive aripiprazole and ADT is effective in improving the symptoms of MDD in patients who have had an inadequate response to ADT.

Suicide is a multicausal phenomenon posing a great challenge to medicine and society, yet we still have limited knowledge concerning underlying biochemical, neuroanatomical and genetic factors. Research increasingly points to a role of the serotonergic system, both on the level of suicidal behavior, and such behavioural traits which may serve as important intermedier endophenotypes in suicide research. Although results are conflicting, several studies described an association between the 5-HTTLPR polymorphism and suicide, as well as this polymorphism and certain aggressive traits. Impulsive aggression is also thought to play a major contributory role in suicide. The aim of our research was to investigate the association between the 5-HTTLPR and aggressive traits in depressive patients carrying a higher risk for suicide and healthy controls.

137 major depressive and 164 healthy controls women were recruited. Participants completed the Buss-Durkee Hostility Inventory and were genotyped for 5-HTTLPR. Association of aggressive traits and indeces with 5-HTTLPR genotype in the two groups were analysed using ANCOVA.

Diagnosis and 5-HTTLPR genotype showed a significant association with aggressive traits. The pattern of association was different in the depressed and control groups. The strongest interaction effect between genotype and diagnosis was observable in case of Resentment.

We found a significant association between 5-HTTLPR and several aggressive traits. In case of depressive patients the association was more marked. In depressed women the 5-HTTLPR shows a stronger association with aggressive traits related to aggression turned inward, which may play a role in the background of suicide.

The issue whether the clinical characteristics of unipolar psychotic major depression (PMD) vary according to the age of onset remains still unclear. In this study we assess comparatively the clinical characteristics of young early-onset (n=30), elderly early-onset (n=34) and elderly late-onset (n=35) psychotic depressives.

Ninety-nine inpatients suffering from DSM IV unipolar PMD were assessed on the basis of SCID IV, HRSD and a physical impairment rating scale.

The elderly late-onset patients suffered from overall more severe depression compared to both categories of early-onset ones, more gastrointestinal symptoms compared to young early-onset patients and more psychic anxiety compared to elderly early-onset patients. Moreover, they expressed significantly more frequently delusions of somatic content and had higher scores on the HRSD item of hypochondriasis than their young early-onset counterparts. The group of elderly early-onset PMD patients was found to hold an intermediate position between the young early-onset and elderly late-onset PMD patients with regard to hypochondriacal ideation, gastrointestinal symptoms and delusions of somatic, guilt and paranoid content.

The findings of the present study suggest considerable differences between young, elderly early-onset and elderly late-onset PMD patients with respect to their clinical features.

The G72/G30 gene is one of the common loci shared both by schizophrenia and bipolar disorder. Studies accumulating since the discovery of this gene complex in 2002 produced controversial results in both disorders in different populations.

We investigated the association between G72/G30 gene and bipolar I disorder (BPI) in the Romanian population paying special attention to the association of G72/G30 locus with lifetime psychosis in BPI patients.

Fourteen G72-SNPs were genotyped in a Romanian sample of 198 BPI patients and 180 controls screened for psychiatric disorders in the Institute of Human Genetics, Life & Brain Center of the University of Bonn, Germany. Statistical analysis was performed with FAMHAP and Haploview-v3.32. The significance level of the results was corrected for multiple testing through permutations in 100,000 Monte Carlo simulations.

None of the fourteen SNPs was associated with the global diagnosis of BPI in our total patient sample or with the psychotic BPI subtype. But four SNPs reached nominal significance in the non-psychotic BPI subgroup [rs3916965 (M12) (P=0.044), rs1935057 (P=0.037), rs3916967 (M14) (P=0.043), rs2391191 (M15, non-synonymous) (P=0.043)]. In the non-psychotic subgroup, the haploblock including M14 and M15 (GA) remained significantly associated with BPI after correction through permutations (P=0.0524; OR=1.82).

Our results are the first replication of the study by Williams et al. (2006) reporting the same G72-SNPs [M12(A) and the functional SNP M15(A)], with the same alleles, to be associated with non-psychotic BPI disorder.

As part of a process to improve bipolar disorders (BPD) treatment and outcome in France, AFBP developed recommendations in the management of patients with bipolar disorders for French practitioners. The recommendations aim to reflect both evidence-based practice and real-world experience. Here, we will focus on the management of BPD with comorbid addictive disorders.

A formalized method by expert consensus panel was used. 239 questions were developed and sent to a panel of 40 French experts in order to assess six domains:

1. 1) screening and diagnosis,

2. 2) acute phase treatment,

3. 3) maintenance and non pharmacological treatment,

4. 4) somatic comorbidities,

5. 5) psychiatric comorbidities and suicide risk management and

6. 6) special populations.

Special attention was made to situations where evidence based treatment are lacking.

The treatment of BPD and comorbid addictive disorders should be concurrent. The only exception is during an alcohol withdrawal where mood state may be reassessed for a second time. Experts recommend the use of atypical antipsychotics or anticonvulsants during a manic, mixed or depressive episode as well as in prophylaxia. During a depressive episode, the adjunction of an antidepressant may be considered. If adjunctive sedative treatment is necessary, a sedative classical antipsychotic seems to be a better choice that benzodiazepine. Substitution treatment for opioid must not be stopped. A psychotherapy focused on the addiction should be systematic in susbtance dependence and proposed in substance abuse.

The French expert panel recommends different therapeutic options for patients with dual diagnosis compared to usual BPD patients.

Theory of mind (ToM) has been proved to play a crucial role in social cognition and functioning. In our study, higher order mentalization performance of euthymic bipolar I patients were compared with that of healthy controls. The impact of demographic data, course of the disorder and patients’ current functioning were also considered while interpreting mentalization data.

The mentalizing performance (computerized faux pas task and false irony task), neurocognitive functioning, and IQ of twenty-three euthymic bipolar I patients and 31 matched (IQ, age) healthy controls were examined. In the patients group, the age at onset, the occurrence of psychotic symptoms, age, education, current employment status, and global functioning were also taken into account.

Bipolar patients scored significantly lower in false irony tasks than healthy controls (p< 0,02). The deficit in irony tasks positively correlated with the number of episodes. Among the examined variables, the performance in the faux pas task predicted most closely the functional outcome in bipolar I disorder. No correlation was found between the ToM and irony deficits and the occurrence of psychotic symptoms, the length of the bipolar disorder or neurocognitive functioning.

Our results showed impaired performance in faux pas and irony tasks, which correlates with the number of previous episodes. Additionally, the impairment of ToM functions predicts a worse functional outcome.

The aim of the present study was to thoroughly investigate the existing comorbidity between Axis II and Bipolar Disorder (BD) pointing out as well the meaningful existing comorbidity between Personality Disorders and Cyclothymia.

A study group composed of 70 patients affected by Bipolar Disorder (Type I, Type II, and Cyclothymia) was enrolled at the Bipolar Disorders Unit of the Catholic University of the Sacred Heart of Rome. Axis I diagnosis was made by SCID-I; Axis II diagnosis was made by SCID-II.

In a sample of 70 patients in euthymic phase, 39 patients (55.7%) showed comorbidity with Axis II Disorders. Clusters were represented as follows: 2 patients (5.1%) fell within cluster A; 24 patients (61.5%) within cluster B; 9 patients (23%) within cluster C; and 4 patients (10.4%) turned out to be affected by NAS Personality Disorders. On the whole 39 patients - 24 patients (61.5%) affected by BD I, 6 patients (15.3%) affected by BD II, and 9 patients (23.0%) affected by Cyclothymia were found to have comorbidity with Axis II Disorders. Besides, in our sample there was a significant comorbidity between Cyclothymia and Personality Disorders.

More than half of patients (55.7%) showed comorbidity with Axis II Disorders. Moreover most of patients turned out to be affected by Personality Disorders falling within cluster B while 23% of Cyclothymic patients were found to have comorbidity with Axis II Disorders.

The aim was to:

1. 1) identify the prevalence of depression in diabetic women presenting in a primary care clinic;

2. 2) determine if the primary care physician detected depression in these patients; and

3. 3) determine if a relationship existed between depression and glycemic control (Hgb A1C) in these patients.

Prospective, convenience sample. All women with a diagnosis of Type I or II Diabetes Mellitus were included. Participant's charts were audited for documentation of Hgb A1C levels, and the diagnosis of depression. Patients were asked to complete Beck Depression Inventory (BDI II) scale. Participants who score 16 or higher on the BDI were considered depressed. Participants' scores on BDI II and their Hgb A1C levels were compared with demographic data, and chart verification of depression. Statistical analyses was accomplished using Chi-Square for categorical variables and student's t-test for independent variables all analyses was run using SPSS v. 10

61 patients participated. When prevalence of depression in diabetic participants was compared with BDI II scores, 47% (N=24) of participants were found to be depressed. Primary care physician recognized and documented depression in 4% (N=2) of the depressed participants. The mean Hgb A1C was higher for depressed participants (9.31%) when compared to non-depressed participants (8.03%), but was not statistically significant I II (p =.788).

Depression was a major problem for patients with diabetes presenting to primary care clinic, and that diabetes was under diagnosed. Contrary to previous studies, patients in this study with diabetes and depression had similar glycemic control.

The present study aimed to explore the association between stressful life events (LE) and the development of affective psychopathology.

Thirty patients with unipolar disorder and 30 patients with bipolar disorder were compared to 60 matched healthy controls as regards the rate of stressful LE. Measures included the Beck Depression Inventory, the Adult Life Events Checklist and the Childhood Life Events Questionnaire.

The entire sample had more LE in general, more negative and loss-related LE in the year preceding their first depressive episode as compared to normals. Subjects with unipolar disorder had more positive LE and more achievement LE, whereas subjects with bipolar disorder had more uncontrollable LE in the year preceding the first depressive episode. The relationship between LE and manic episodes was prominent in the year preceding the first manic episode, with bipolar subjects reporting more LE in general and more ambiguous events in that year. A significant relationship was found between childhood LE and the development of affective disorders in adulthood, with unipolars exhibiting less positive and achievement LE.

The major impact of LE on the onset of affective disorders was found in the year prior to the first depressive or manic episodes, in the unipolar and bipolar groups. This suggests that the accumulation of LE at this crucial period contributes to the precipitation of a pathological response mechanism. Once established, this mechanism would be reactivated in the future by even less numerous and less severe stressors, compatible with the kindling hypothesis.

Schizophrenia is still one of the most mysterious and costliest mental disorders in terms of human suffering and societal expenditure that affects about 1.1 percent of the world population. But is there any difference for treating schizophrenia due to its cause? In this study we evaluate the therapeutic effect of haloperidol and risperidone in patients with positive familial history.

We had chosen 110 men with schizophrenia with positive familial history, who refer to psychology institute of Rasul Hospital in Tehran in 2000 to 2009. We divided these patients into two main groups by random, each group have 55 patients. For case group Haloperidol was used to control their symptoms and for the control group risperidone was used. During a period of one year we evaluate their response to the treatment in different groups.

The mean age of patients in case group was 34.8 and for control group it was 34.4. From the case group 45.2% show decrease in their symptoms and in control group just 36.6% so the therapeutic effect of haloperidol was significantly better than risperidon for patients who have positive familial history. In addition after 6 months of therapy just 12% of patient in case group have remission but is control group we faced 28.3%.

It is better to use the first line anti psychotic, haloperidol, in patients with positive familial history. This help to more decrease in symptoms and also the less chance for remission.

The treatment of depressive phases of bipolar disorder is challenging. Electroconvulsive therapy (ECT) is generally considered to be the most effective treatment even if there are no randomized controlled trials (RCT) of ECT in bipolar depression. The safety of ECT is well documented, but there are some controversies as to the cognitive side effects.

To compare the effects and side effects of ECT with pharmacological treatment in treatment resistant bipolar depression. Cognitive changes during the treatment will be measured, as well as quality of life.

A prospective, randomised controlled multi-centre trial. 6- week acute treatment trial with 7 clinical assessments. Follow up visit at 26 weeks or until remission (max 52 weeks). A neuropsychological test battery designed to be sensitive to changes in cognitive function will be used.

Nine study centres across Norway, all acute psychiatric wards

132 patients aged 18 and over, who fulfil criteria for treatment resistant depression in bipolar disorder, MADRS score of at least 25 at baseline

Intervention group: 3 sessions per week for up to 6 weeks, total up to 18 sessions. Control group: algorithm-based pharmacological treatment as usual.

Six departments have included 43 patients since start in May 2008.

This study is the first randomized controlled trial that aims to investigate whether ECT is better than pharmacological treatment as usual in treatment resistant bipolar depression. Possible long lasting cognitive side effects will be evaluated. The study is investigator initiated, without support from industry.

Erectile dysfunction is twice common in patient with depression. Testosterone plays vital role in erectile function. Low testosterone level is found in patients of depression. High level of prolactin has depressive effect on libido function. Hypogonadism and hyperprolactinemia can be the causative factor for depression. Hormonal changes can be both cause and effect of depression with ED.

In sample of 76 patients having depression with co morbid ED blood levels of prolactin, and free testosterone were determined.

Half of patients were treated with sex friendly antidepressants while in other half mesterolone and piribedil were used as adjunct medicines.

In 9.2% free testosterone level was below than reference value. In 28.9% prolactin level was high .51 .31% were found having border line free testosterone level.

In younger age group free testosterone level was lower than older age group. There exist inverse relation between prolactin level and free testosterone level. Patients who were given adjunct medication showed rapid improvement both for depression and erectile dysfunction.

Reduced level of free testosterone and high level of prolactin has bilateral relation with depression with co morbid ED. Although prevalence of hypogonadism and hyperprolactinemia is low in the study yet high numbers of borderline cases are of great significance. It is postulated that fall in sexual function is directly proportional to change in levels of these hormones from the base line that are reversed by adjunct medicines.

In patients with concomitant major depression and erectile dysfunction hormonal changes plays important role.

The study aims to investigate depression in sample of women in divorced situation and comparison with normal ones (undivorced women).

Method research is causative-comparative (Ex post facto). 30 divorced and 30 undivorced women age between 25-30 randomly were selected and Beck's depression questionnaire was administered on them. T independence test was used to analyze the data.

Findings shows significant differences between tow groups. Divorced women have high scores in depression questionnaire. Also 70 percent of divorced women were in deep depression.

The findings indicated rate of depression in divorced women range from moderate to deep with affective and emotional disturbances that shows psychiatric disorders in the women and is needed plans and programs to relieve their depression and back them to social life.

The neuroleptics, which were invented in the middle of the last century, have changed psychiatry as the clinical discipline, and a problem of the pharmacological resistance insensibly has become the main problem. A radical way to overcome the resistance of the anxious and depressive disorders lies in the field of the modern neurosurgical techniques. However, the verification of the resistance still requires more developed approach.

The main aim of our study was to develop and test an integrated neuropsychiatric approach in order to objectify the resistance and the disease severity for the selection of patients for surgical treatment.

We used different types of neuroimaging techniques for reviewing clinical and neurophysiological correlations: positron-emission tomography (PET), functional magnetic resonance imaging (fMRI), diffusion-tensor imaging (DTI) and its relations to the electroencephalography (EEG) data.

We examined 110 patients with depressive and anxious-obsessive disorders. 40 of them were examined using fMRI, 35 using PET and 35 using DTI. The patients were divided into groups by the ICD-10 criteria. The average age of the group was 46.3 years, the number of males and females in groups was approximately equal.

It was revealed that the degree of resistance had a significant correlation with the number of functional and structural neuroimaging indicators.

We obtained data which objectifies the concept of resistance. We also represent our understanding of clinical and physiological approach to the selection of target structures for stereotaxic neurosurgical exposure (in particular for deep brain stimulation) in the complex treatment.

Bipolar affective disorders contribute significant mortality and morbidity in the management of mental disorders in developed and developing countries. A recent review reported 12- month estimates of approximately 1% (range 0.5% - 1.1%). The current practice reveals large variations in the standards of care delivery with non existent protocols in third world countries. National Institute of Health and Clinical Excellence (NICE, United Kingdom) has developed guidelines that dictate the best practice in the management of Bipolar disorder in England and Wales.

We compared local adherence to and uptake of NICE guidelines for Bipolar affective disorders (supposedly the best practice).

To feedback Managers and practicing psychiatrists in the local trust about the shortcomings in the best practice as per national guidelines.

We reviewed the clinical notes of nearly one-third of all the service users diagnosed with Bipolar Affective Disorder (ICD code F31) in a rural county in England.

The need to discuss pharmacological options with the patients to help make them an informed choice as well as offering psychological treatments and life style advice were the most deficient areas of practice. We plan to reaudit the practice to document changes in practice.

To study the evolution of Functional Psychoses through continual supervision.

A sample of 123 cases with Functional Psychotic Disorder were studied, observed and treated continually by the same team in the framework of the STEPF project that studies the evolution of psychoses through a Case Register established and exploited since 1985. The average period of evolution was 13 years. We studied the metamorphosis of the diagnosis over time in correlation with the demographic parameters and therapy.

The stability of the diagnosis, in the sense of persistence of the first year diagnosis, was: Schizophrenia (41 cases) - 85%; Bipolar Disorder (22 cases) - 81%; Recurrent Depressive Disorder (20 cases) - 100%; Persistent Delusional Disorder (10 cases) - 80%; Paranoid Depressive Disorder (11 cases) - 27%. The majority of changes in the diagnosis happen during the first 5 years of illness. The last 10 years see changes in approximately 30% of the cases.

The stability over time of the diagnosis of Functional Psychoses is relative.