Compare quetiapine+antidepressant (AD) with lithium+AD, and quetiapine monotherapy with lithium+AD in open, rater-blinded treatment.

Patients with treatment resistant depression (Thase et al 1997 stage 1 and 2) with severity of MADRS ≥25 received: quetiapine XR 300mg/day plus AD (SSRIs or venlafaxine) (n=229), lithium (monitored to between 0.6 to 1.0 meq/l) plus AD (n=221) or quetiapine XR alone (300mg/day) (n=225) for 6 weeks. Primary efficacy measure was change from baseline in MADRS total score. The pre-specified non-inferiority limit was 3 points on the MADRS.

Fewer patients discontinued on quetiapine+AD (15.2%) than lithium+AD (20.5%) and quetiapine monotherapy (21.5%). Quetiapine+AD and quetiapine monotherapy, were not inferior to lithium+AD in the primary (per protocol) analysis with a mean difference (97.5%CI) on the MADRS of -2.32 (-4.6 to -0.05) favouring add-on quetiapine and -0.97 (-3.24 to 1.31) favouring quetiapine monotherapy. This mandated superiority testing on the modified ITT population showing no significant difference at endpoint.

In a post hoc analysis discounting multiplicity, quetiapine+AD was significantly more effective than lithium+AD on the MADRS change from baseline, p=0.046. The advantage was observed at day 4 (p=0.007) and persisted throughout. Efficacy was supported by CGI-I (p=0.07). Quetiapine+AD showed a numerically greater advantage over lithium+AD in those with two failed treatments (Stage 2) rather than one (Stage 1).

Quetiapine+AD and quetiapine monotherapy, were non-inferior to lithium+AD in treatment resistant depression. There was an early significant and persistent efficacy advantage on MADRS for quetiapine augmentation compared with lithium augmentation of SSRI or venlafaxine treatment.

A recent metanalysis has demonstrated that there are differences in efficacy and acceptability of commonly prescribed anti-depressants (Cipriani et al. 2009). Escitalopram, sertraline, venlafaxine and mirtazapine were the most effective.

We wished to find out whether the data from our own practice corresponded with the data from the metanalysis.

To compare the efficacy of anti-depressant monotherapies in patients with unipolar depression at Bedford Hospital, using discharge rates as the outcome measure.

We included all patients with unipolar depression on an antidepressant monotherapy in Bedford hospital in our analysis (145 in total). We examined the clinical notes for each patient to assess whether they had been discharged from the out-patient clinic after being prescribed the antidepressant. This allowed us to calculate discharge rates for each antidepressant monotherapy.

A higher percentage of patients prescribed Escitalopram were discharged from clinic compared to theother anti-depressant monotherapies.

Our results support the findings of the meta-analysis. The discharge rates from Bedford hospital suggest that Escitalopram in particular is the most efficacious.

This audit in a small group of patients suggests that Escitalopram leads to the highest discharge rate compared to the other monotherapies prescribed.

Since it has been shown that depressed individuals experience deficits in executive cognitive functions, current study investigates the impairments of working memory in patients suffering from major depressive disorder (M.D.D) in comparison with normal control group in terms of DSM-IV criteria.

The two groups (25 patients and 25 normal) were matched via gender, age and education. All completed Beck Depression Inventory and participated in two working memory tasks: “Paced Auditory Serial Adding Test (PASAT)” and “Wechsler Digit Span Scale”.

Using T test for independent groups, the results indicated that the patient group were experiencing significant impairments in working memory in comparison with control group(p< 0.0001) and results of Regression Analysis showed that severity of depression has a significant effect on the amount of impairments that subjects had experienced in working memory.

Depression had impaired working memory performance in individuals and the amount of impairment will increase as the severity of depressive symptoms are increasing.

Major depression (MDD) presents among other symptoms with cognitive impairment and diurnal fatigue. Residual fatigue in non-remitted patients often shows neuropharmacological treatment resistance. The relationships between cognitive dysfunction, vigilance, fatigue and affective symptom intensity is poorly described in treatment-resistant MDD (TRD).

During a prospective study protocol, 17 in-patients hospitalized for TRD were compared to a healthy control group (n=17). Patients were under SNRI or SSRI and free from diurnal benzodiazepines. All subjects underwent structured psychometry (HAMD, HAD), cognitive assessment and vigilance measurements (behavioral sleep résistance task, BSRT; psychomotor vigilance test, PVT; Auditory Verbal Learning, AVLT; trail making test, TMT). Subjective fatigue and sleepiness were assessed by the Fatigue Severity and the Epworth Sleepiness Scales respectively. All measures have been performed at two time points (T1 and T2) with a 10-day interval.

T1 and T2 showed higher fatigue and sleepiness in MDD (p< 0.05). With exception for the BSRT, between group comparisons showed significant differences for all variables.Comparison for repeated measures (T1 and T2) showed improvement in depressive symptom intensity (HAMD, p< 0.0005) but cognitive and psychomotor performances only improved for the TMT (TMT-B, p=.001).

TRD presents here with psychomotor slowing, with impaired mental flexibility (executive function) and declarative memory dysfunction. Interestingly, despite subjective complaints (ESS), objective sleepiness (BSRT) had not been revealed. Furthermore affective symptom improvement was not associated to an increase in declarative memory or psychomotor performances.

Developed as an antipsychotic, quetiapine displays moderate, transient occupancy of dopamine D2 receptors. Characterization of norquetiapine indicates this major human metabolite potently inhibits the norepinephrine transporter and binds to D2 receptors with affinity similar to quetiapine. Clinical pharmacology studies indicate pharmacodynamic differences between the immediate-release (IR) and the recently developed extended-release (XR) quetiapine formulation. The objectives of this study were to further investigate the pharmacokinetics of these formulations, and to relate D2-receptor occupancy to quetiapine and norquetiapine exposures.

Eleven healthy male volunteers, aged 20-45 years, underwent PET using the radioligand [11C]raclopride. After baseline measurements, quetiapine XR was administered once-daily for 8 days, with titration to 300 mg on Days 5-8. Quetiapine IR was administered at 300 mg daily on Days 9-12. PET measurements were repeated after the last doses of XR and IR at predicted times of Cmax. D2-receptor occupancy was calculated using a reference tissue model. Concomitant pharmacokinetic measurements were performed.

For quetiapine XR, mean D2-receptor occupancy at Cmax was 32% (SD ±11%; n=11). For quetiapine IR, mean D2-receptor occupancy at Cmax was 47% (SD ±9%; n=10). Quetiapine XR produced lower peak D2 occupancy than quetiapine IR in all subjects.

Pharmacokinetic differences between quetiapine XR and IR formulations translate to different profiles of brain receptor occupancy. Quetiapine XR was associated with lower peak D2-receptor occupancy than quetiapine IR at corresponding doses. This observation may provide important mechanistic underpinnings for emerging clinical data comparing the 2 quetiapine formulations.

Supported by funding from AstraZeneca Pharmaceuticals LP.

Symptoms of mania in geriatric patients (> 65 years old) have received much recent attention, in part due to Akiskal's Bipolar Spectrum classification (Akiskal, 2000), in which subtype VI is «bipolarity in the setting of dementia». The authors present a through revision of the issue, and 3 clinical cases are presented.

Data was collected through Medline/Pubmed website research, literature revision and other sources. Three clinical cases are presented (identifying data and sociodemographic details, history of present illness, personal history, …), which were obtained through direct observation of the patient and consultation of hospital inpatient clinical file.

We found 11272 articles, of which 458 were reviews. We were involved in direct care to 3 elderly manic patients, in our clinical activity in 2 Psychiatric Hospitals in Lisbon.

Elderly mania is a relatively rare and ill-defined syndrome, with many possible causes (genetic, iatrogenic, metabolic, infectious, oncological, traumatic SNC injuries, epilepsy, and many other neurological disorders). Appropriated exclusion of organic pathology through a correct differential diagnosis is mandatory to obtain a suitable therapeutic approach and favorable prognosis. The growing life expectancy suggests that this neuropsychiatric syndrome should be a focus of attention for psychiatrists, internists, and other health care technicians, especially those directly involved in the care of elderly patients in settings such as state/private hospitals, private clinics, day care facilities and nursing homes.

There is growing evidence that major depressive disorder (MDD) might be overdiagnosed at the expense of bipolar disorders (BPD).

To identify a subgroup of subthreshold BPD among DSM-IV MDD, which is distinct from pure MDD regarding validators of bipolarity.

Data come from the ten-year prospective-longitudinal EDSP-Study, a community survey from Munich, and were assessed with the DSM-IV/M-CIDI. Subthreshold BPD was defined as fulfilling criteria for MDD plus presence of manic symptoms, but never having met criteria for hypomania.

Among 488 respondents with MDD, about 60% had pure MDD and 40% subthreshold BPD. Compared to pure MDD, the subthreshold BPD group was found to have

1. (a) an increased family history of mania,

2. (b) considerably higher rates of nicotine dependence and alcohol use disorders,

3. (c) twice as high rates of panic disorder, and

4. (d) a tendency towards higher rates of criminal acts.

5. (e) In prospective analyses, subthreshold BPD converted more often into BPD during follow-up with the criterion D (symptoms are observable by others) being of critical predictive relevance.

Data suggest that MDD is a heterogeneous concept including a large group of subthreshold BPD, which is clinically significant and shares similarities with BPD. Findings might support the need for a broader concept and a more comprehensive screening of bipolarity.

To determine possible associations between guideline-concordant care and clinical outcome in general practice patients with anxiety and depression, and identification of patient characteristics associated with poor clinical outcome.

Data from the Netherlands Study of Anxiety and Depression (NESDA) was used. NESDA is a longitudinal cohort study to measure the long-term course and consequences of anxiety and depressive disorders. Adult patients were interviewed to measure DSM-IV diagnoses during the baseline assessment, and completed questionnaires measuring symptom severity, sociodemographic variables and social support at baseline and 12 months later. The definition of guideline adherence was based on an algorithm on care that was received.

721 patients with a current (6-month recency) anxiety or depressive disorder participated. While patients who received guideline-concordant care (N=281) suffered from more severe symptoms than patients who received non-guideline concordant care (N=440), both groups improved equally on their depressive or anxiety symptoms after 12 months. Patients who (still) had moderate or severe symptoms at follow-up, were more often unemployed, had smaller personal networks and more severe depressive symptoms at baseline than patients with low symptoms at follow-up.

The added value of guideline-concordant care could not be demonstrated in this study. While patients with comorbidity of both anxiety and depressive disorders, those with smaller social networks and the unemployed were more likely to suffer from moderate or severe symptoms after 12 months, severity of depressive symptoms at baseline was most strongly associated. Findings have practical implications as well as implication for future research.

Electroconvulsive therapy (ECT) cannot always be effective for Treatment Resistant Depression. Deep brain stimulation (DBS), a procedure that involves the direct implantation of stimulation electrodes in localized brain regions with the aim of modulating local and connected abnormal activity, has recently been gaining momentum as an alternative treatment modality for the most severe TRD patients. However, there is minimal experience with ECT in patients who have undergone DBS procedures.

We present two cases of patients who remitted from TRD after SCG-DBS, and some months after they suffered a relapse that was treated with ECT.

Before DBS intervention, ECT was not capable to sustain response more than two weeks beyond and was even bad tolerated by these patients. DBS was effective for both patients until a severe relapse occurred (after 4 and 14 months, respectively). Optimization of medication did not elicit response, given the seriousness of symptoms and their previous treatment resistance. Therefore, neurostimulator was turned off in order to administer ECT to both patients. After usual series of sessions set at corresponding parameters over 3 weeks, using bitemporal electrode placement, the episode remitted. Deep brain stimulator was turned on again, and they were in remission until the present moment.

The use of ECT proved to be effective without adverse effects to the patients or to the DBS hardware. The modulation of SCG activity and its downstream targets might also serve as a trigger for the therapeutic effect of formerly useful or even never-effective antidepressant strategies.

:

Extreme old Age

History of Hyponatremia

Co- therapy with other drugs known to be associated with Hyponatremia

Reduced renal function

Medical Co morbidity.

To monitor baseline investigations like urea and electrolytes at 0 weeks, 2 weeks, 4 weeks and 3 months when starting antidepressants, documentation of co morbid medical conditions, past history of Hyponatremia and monitoring of risk factors.

A total of 17 patients were randomly selected and the case notes were reviewed for demographic details, diagnosis, type and dose of Antidepressant, co morbid medical condition, risk factors and details of investigation at base line and follow up appointments.

:

1. - 41% had baseline investigations, 18%at 2 weeks, 12% at 4 weekly and 6% at 3 monthly.

2. - 6% had Abnormal Blood results and one patient was referred to medicine.

3. - None of these patients had developed Hyponatraemia.

47% patients had depression, 6% had bipolar affective disorder, 6% had Dementia, 6% had Mixed Anxiety Disorder, 12 % had vascular dementia and 6 % had Psychotic Depression.

24% of the patients were on diuretics, 12% on NSIADS, 6% each on Carbamazepine and Cancer Chemotherapy.

Our main goal is evaluation of marital satisfaction in depressed patients and researches of the rate of depression between men and women.

This investigation is descriptive and correlation study that 93 people (48M, 45F) as the accidental samples by GRIMS and Beck depression questionnaire are collected. Results of this study by Mann Whitney Test, Kruskal-wallis Tests, Chi-square Tests and Spearman’s rho are achieved.

Our study shows that 50.06% of people had relative marital satisfaction and 47.64% had minor depression. The marital satisfaction of women were more than men 49.23% the rate of women depression was high too 47.5%.

In this study there is no meaningful relation between age, duration of marriage, sex, educations, occupational situation and marital satisfaction and depression too but there is meaningful relation between marital dissatisfaction and depression. We advise to go to psychiatrists when spouses have several problems in their sexual relation ship.

The aim of this study is the investigation of depression prevalence in heart diseases patients and dialysis candidate’s we researched depression effects on heart and renal diseases and suggested new ways to patients’ management.

This study is a descriptive and correlation study that 21 heart disease patient and dialysis candidates as the samples by questionnaire are selected we used Beck depression Anxiety test and gained results by SPSS and statistical analysis.

In this study 21 patients are selected and 67.7% of them had depression. 30% minor depression, 17.5% mild depression and 7.5% had major depression. Around the 12.5% of them needed psychiatric consultations. Most of them were middle-aged (45%),men (22%),illiterate (32.5%), citizen (92.5%),illness (52.5%) and dialysis candidates (27.5%).

Our study shows that there isn’t meaningful relation between age, academic education, type of living and disease duration of patients. We knew that there is meaningful relation between periods of heart diseases’ patients, dialysis candidates and depression against the healthy people. this research says us to notice emotional problems of patients especially patient of heart diseases and dialysis candidates,

Our main goal of this study is the investigation of depression prevalence between addict people and normal people. We decided to show main emotional problems of addict people.

This investigation is a descriptive study that 30 normal people and 30 addict people as the accident samples by Beck Depression inventory test and with clustered way are collected. We have gained results by SPSS and statistical analysis.

Our study shows that 33.3% of people are normal and 66.7% of our cases are depressed, 51.7% are married and 51.2% poor, 36.7% young, 31.7% low grade educations and finally 83.3% of them are employed. 45% of cases have major depression.

Our research explains that there isn’t meaningful relation between depression, age, occupation, marriage situation, income and education status of addict people and their addiction. We suggest decreasing the reasons of depression in humans.

A single nucleotide polymorphism within the CACNA1C gene (rs1006737) has been found to confer increased risk of Bipolar Disorder (BD) and has been linked to altered neuronal gating and emotional behaviour. As current models of BD suggest abnormal integration within frontolimbic networks, our aim was to explore the effect of the CACNA1C genotype on prefrontal and limbic activation.

We genotyped 90 participants from the Vulnerability to Bipolar Disorder Study comprising of 41 euthymic BD patients and 49 healthy controls. Functional magnetic resonance imaging data were obtained while participants performed a fearful versus neutral facial affect processing task.

We found a significant diagnosis by genotype interaction with BD patients homozygous for the risk allele having reduced prefrontal activation compared to the other groups.

The present findings support the hypothesis that the rs1006737 polymorphism in the CACNA1C gene confers increased risk of BD by modulating amygdala and PFC activation during emotional processing.

To estimate the prevalence of depression and anxiety in caregivers of dependent grade II and III of a health center. Calculate the perceived social support for caregivers. Estimating the degree of caregiver stress. Assess the socio-demographic factors associated.

Descriptive and transversal.

Primary Health Care.

We selected 55 dependent caregivers grade II and III consecutive sample, according to the law of dependence, belonging to the health center Algeciras-North and were registered in the database of the Center on January 31, 2009. Exclude those who would not participate in the study, did not understand the Spanish language or could not contact with them.

We conducted through a questionnaire that contained heteroadministrated Hamilton scales for depression and anxiety, social support scale of the Duke, caregiver overload of Zarit and sociodemographic variables. The accomplishment was held at the home of the caregiver.

We detected the presence of depressive disorders in 47.3% (95% 14,6-39%) respondents and anxiety disorders in 25.5% (95% 23-6-61,1%). 36.4% (CI 95% 23,8-50,4%) of caregivers had low social support and overhead was 57.1% (CI 95% 43,2-70,9%).

Caregivers of Dependent grade II and III in our area are at risk of depressive disorders and anxiety. At the same time, they feel helpless, so we think it would be interesting to be given greater attention from health centers in order to identify them early.

The method chosen for these guidelines is a formalized consensus of experts. It enables, through a series of specific clinical situations proposed to the experts, to provide recommendations for the management of bipolar disorder. The situations where defined because they are not associated to evidence-based recommendations according to the lack of controlled studies.

40 experts participate to this consensus. As in most of the guidelines for the treatment of bipolar disorder, more than 50 % of experts (51,3 to 72,9%) recommend the same therapeutic strategies to treat major depressive episode whichever the type (bipolar I or II).

Unlike to other guidelines, French experts propose different therapeutic according to the presence or absence of rapid cycling. For major depressive episode without rapid cycling, 63% experts recommend a combination of an antidepressant with a mood stabilizer. In rapid cyclers, 51% experts recommend the use of a mood stabilizer in monotherapy or in combinaison, but never associated with antidepressant.

This methodological approach enables to get closer to everyday clinical practice and integrate specificities of prescription through a national panel of experts. On the other hand, this type of methodology highlights the research perspectives: i.e. management of acute depression with rapid cycle in bipolar disorder.

Mean BDNF serum concentration is lower in patients with major depression (MD) as compared to healthy controls. BDNF increases during the course of antidepressant treatment. This increase has been associated with symptom amelioration. The aim of this study was to analyse the relation between early and late BDNF changes during antidepressant treatment.

Forty-six patients with MD according to DSM-IV were included for this study. Patients were treated as clinically indicated. Depression severity was assessed by HAMD-17 by trained raters from baseline to week 6 in weekly intervals. Serum at each visit (baseline, V1-V6) was obtained from whole blood after centrifugation with 1.000 × g for 15 minutes. Aliquots were frozen at −80°C until analysis. BDNF serum concentration was determined with ELISA (R&D Systems). We analysed correlations between early changes of BDNF level (baseline to weeks 1 and 2) with BDNF changes in the later course of treatment (change from baseline to weeks 4, 5 and 6). Further, the association between early and late BDNF changes was calculated by means of linear regression analysis.

There was a high correlation between BDNF changes in the early course of treatment and final BDNF changes (p< 0.05 for each analysis). Early BDNF changes accounted for a high percentage of the variance of late BDNF changes (p< 0.05 for each analysis).

These results suggest that an early change of BDNF serum level is predictive for BDNF change in the later course of antidepressant treatment in patients with Major Depression.

There is a positive correlation between level of education and working function in the general population. Bipolar disorder (BD) is often associated with disability in social and working function. There is conflicting evidence considering educational achievements in BD patients.

Our aim was to investigate how education was related to social and occupational function in BD.

Patients with DSM-IV BD (N=257; 69.3% BD I, 25.7% BD II, 5.1% BD NOS, 51.4% females) were consecutively recruited from mental health clinics throughout Norway. The majority of patients were recruited when in-patients. About 1/2 had at least once experienced a psychotic episode. The BD sample was compared with a geographically matched reference sample from the general population (N=56.540) on levels of education, marital status, income, and disability benefits. Further analyses of association were carried out using logistic regression analyses.

A significantly higher proportion of subjects in the BD group than in the reference group was single, had low income, or was disabled. No between-group difference was found in educational level. In the reference group education was inversely correlated with the risk of being disabled, but no such relationship was found in the BD group. In BD patients rapid cycling and recurring depressive episodes were the only clinical characteristics associated with low educational level.

Despite similar levels of education, BD patients had lower socio-economic status than the general population, and no association was found between education and disability for BD patients.

To compare social adaptation level among psychiatric inpatients with an atypical and non-atypical depression.

140 inpatients at the age of 18-65 years were evaluated with SIGH-SAD (Williams J. et al., 1991) and Social Adaptation Self-evaluation Scale (SASS) (Bosc M. et al., 1997). Patients who got more than 7 points by SIGH-SAD atypical features were considered as AD-patients, they formed the main group. Patients who got 7 or less scores by SIGH-SAD atypical features formed the comparison group. Mann-Whitney test was used.

10 men and 60 women (1:6) at the average age 44.5±11.4 generated the main group. The comparison group was generated by 20 man and 50 women (2:5) at the average age of 48±10.7. Significant difference at the age was not observed. The average age for women of main and comparison groups are 44.6±11.2 and 49.6±10.6 years (p=0.01891). The middle score on SIGH-SAD at admission was 31.4±6.2 in main group and 24.9±6.2 in the comparison group (p=0.0000). The middle score on the SASS in the main and comparison group was 30.4±8 and 33±7.2 properly (p=0.04687). Significant differences in social adaptation level subject to gender among and in the groups were not found.

Women with AD were younger than non-AD women. More severe impairments on SASS were found in a group with AD.