There are 80.000 patients undergoing replacement opiate programs in Spain, mainly methadone. Gender differences and the ratio of dual diagnosis in this population are unknown.

To describe gender differences in the current therapeutic management of opiate-dependent patients undergoing a replacement therapy program in Spain.

624 patients from 74 centers in Spain were included between September 2008 and February 2009 in an observational, cross-sectional, multicenter study. Patients were ≥ 18 years, had a diagnosis of opiate dependence according to DSM-IV-TR criteria, were currently scheduled in a replacement therapy program in Spain and were given written informed consent.

Only 16% of patients were female. Methadone average doses were significantly higher in man (57,59mg ± (SD 46,77) vs 52,81mg ± (SD 50,81) (p< 0.05)). Most women were caretaken by their partner (56.8% vs 34,2%) and man by their parents (61,6% vs 37,8) p< 0,05.Women were found to have significantly more sexual disorders than men (6% versus 2%; p=0.0316); but less delirium, dementia, amnesic and other cognitive disorders (none versus 6%; p=0.0486); schizophrenia and other psychotic disorders (3% versus 13%; p=0.0226); and adaptive disorders (2% versus 9%; 0.0427). No significant differences were found between sexes for other psychiatric comorbidities.

The ratio between men and women was close to 5/1, being bigger than that in the general opiate dependent Spanish population. Dual diagnosis rates vary by gender, but not in the number of diagnosis in Axis I or II. Gender differences must be considered when planning dependence services as women.

Much of the research concerning psycho-social stress and mental health within the South Asian community in Britain has centred around new communities settling in England and the associated issues of accommodation, assimilation and integration into the dominant British society. There is a paucity of empirical research concerning the outcomes of psycho-social stress and mental health of British South Asian women in England.

To explore the manifestations of psycho-social stress and mental health in the lives of British South Asian women.

A qualitative research design was employed. A total of 34 British South Asian young women, aged 16-29 years, in formal education and living in the North-West of England, were interviewed. Purposive sampling ensured the demographic characteristics of the sample were broadly representative of young British South Asian women living in the North West. Semi-structured, in-depth interviews were undertaken and analysed using a process of thematic analysis.

The emerging themes suggest that the outcomes of psycho-social stress in young British South Asian women manifest themselves in three folds: in psychological and physical ways and through negative behavioural practices. Depression and self-harm were the most occurring themes in the sample.

These findings have some fundamental implications for the practice and provision of counselling and support groups for British South Asian young women to help them to manage the psycho-social stress in their lives and improve their mental health. Positive action is required for the development of culturally appropriate services to encourage this group to seek help.

Contraceptive pregnancy methods can cause physical and mental disorders. This study was done to show the mental outcomes of tubal sterilized contraceptive methods (both of tubectomy and vasectomy's husbands) on Semnanian women.

In this study 69 married women with tubectomy or vasectomy husbands’ have been surveyed at three stages: before, six months and a year after that. Subjects have been interviewed by Scle-90-R.

The most common mental disorders that should be cured:

depression (5.8%), psychosis (2.7%), and paranoid thoughts, phobia, somatic complaints and aggression (each of them 1.4%);

depression (8.8%), paranoid thoughts, and phobia (each of them 1.7%); and

depression (5.3%), psychosis (1.8%), interpersonal sensitivity (1.7%), and aggression (1.4%). the most common disorders that need some consultation: first stage: paranoid thoughts and phobia (each of them 28.4%), somatic complaints (28.2%), interpersonal sensitivity (23%), obsession (20.8%), depression (20.3%), anxiety (19.7%), aggression (18.9%), psychosis (4.1%); second stage: somatic complaints (42.1%), obsession (25.5%), aggression (24.1%), anxiety (22.4%), interpersonal sensitivity (19%), paranoid thoughts and phobia (each of them 17.2%), depression (12.3%) and psychosis (11.9%); and final stage: paranoid thoughts and phobia (each of them 30%), somatic complains (28.1%), obsession (25.9%), depression and anxiety (each of them 21.1%), interpersonal sensitivity (15.3%) and psychosis (7%).

Although mental disorders tubal sterilized contraceptive methods users has not changed more, the high prevalence of them that need consultation confirms the need and necessity to form psychiatric and psychological sections for women at the health centers.

To study whether there are personality characteristics that discriminate between IPV women and non-abused control women, taking into account the effect of emotional state (depressive symptoms).

A total of 176 women victim of IPV and 193 non-abused control women were assessed with the Dimensional Assessment of Personality Pathology (DAPP-BQ; Livesley, 1990), the Beck Depression Inventory -II (BDI-II; Beck, 1996), and the Index of Spouse Abuse (ISA; Hudson & McIntosh, 1981). Women victim of IPV were recruited from Domestic Violence Centers, and non-abused control women were recruited from Primary Care Centers and Mental Health Services. A two way analysis of variance (IPV * Depression) were used for detecting differences in personality traits taking into account the effect of depression (BDI ≥ 17).

After controlling for depression, IPV victims scored higher than control women in submissiveness (F=6.41; p=0.01), cognitive distortion (F=4.35; p=0.04), intimacy problems (F=27.02; p< 0.001), suspiciousness (F=5.02; p=0.03) and self-harm (F=4.93; p=0.03), and lower in rejection (F=14.66; p< 0.001).

IPV victims showed high submission, low hostility, intimacy problems, suspiciousness, tendency to depersonalization or derealization, and suicidal ideation and attempts, as a result of chronic abuse. Some of these aspects could be explained by the presence of PTSD, more than by pre-existing personality characteristics. Traumatic and chronic stress can alter functional aspects of the brain and lead to the development of dysfunctional cognitive and behavioral characteristics that may be considered in the psychotherapeutic approach.

With purpose of establishment of influence of success of functioning of family where child with time-lagged psychical development is educated, on psychical health of its members, 200 families where child grows with violation of psychical development are investigated. On criterion of success of functioning the inspected families were parted on two groups: basic (164 families) - disfunctional and comparisons (36 families) - functional.

Assessment tools: surveillance, clinical and diagnostic interview, objective psychometric scales and test methods to identify the studied trait. Data were subjected to quantitative analysis with subsequent qualitative interpretation and meaningful generalization.

For all of women from disfunctional families neurotic and highly emotional disorders are diagnosed depressed, anxiously-depressed and fobial spectrum. For children, educated in disfunctional families, negative psycho-emotional state is set with predominance of alarm, depression, nervousness and depression, sense of unscreenedness, outcast and lonelyness.

Women from successful families demonstrated absence of psychical violations, and children time-lagged psychical development from families with favourable psychological atmosphere is differed an optimistic emotional background and predominance of sense of protected.

There is necessity of development and introduction in practice, of complex system of medical-psychological rehabilitation of families, educative child with violation of psychical development, including measures, directed on strengthening of health of family and increase of success of domestic functioning. Such complex approach will be given by possibility both to heave up efficiency of rehabilitation of children and promote quality of life of parents of children with violation of psychical development.

This paper aims

1. a) to explore the difficulties in differential diagnosis between epileptic crises and psychogenic non epileptic seizures (pseudoseizures),

2. b) to suggest therapeutic guidelines for psychogenic non epileptic seizures. Our purpose is to present a literature review on this subject and to discuss the problems involved.

Typical systematic review of recent articles regarding this topic at the internet search engines of PubMed and Scopus. We used the following keywords: psychogenic seizures, psychogenic non epileptic seizures (PNES), pseudoseizures, conversion disorder, dissociative disorder.

A large percentage of the seizures are found to be psychogenic non epileptic. Most of the patients are firstly treated by neurologists and only a percentage of close to 1/3 of these are referred to psychiatrists for further therapy. The differential diagnosis is difficult because most of the patients actually suffer from both epileptic and non epileptic seizures and usually come to the emergency clinics with either. Video EEG and therapeutic hypnosis are considered to be helpful techniques.

In order to treat patients suffering from psychogenic non epileptic seizures there must be a close collaboration between the neurologists, the psychiatrists and the emergency physicians considering both the medication prescribed and the therapeutic guidelines followed.

Atypical features are common among depressed primary care patients, but clinical trials testing the efficacy of psychopharmacological and/or psychotherapeutic treatment are lacking. This paper examines the efficacy of sertraline and cognitive behavioural therapy (CBT) among depressed patients with atypical features.

Analyses involve a double-blind comparison of sertraline versus placebo (N=47) and a single-blind comparison between CBT versus a guided self-help group (GSG) (N=48), with primary efficacy endpoints being the Inventory of Depressive Symptomatology (IDSC) and Hamilton Depression Scale (HAMD-17).

In intent-to-treat (ITT) analyses, the decrease on the IDSC scale (and HAMD-17) was greater after CBT compared to GSG: p=0.01 (HAMD-17: p=0.01). The difference between SSRI versus placebo was not significant: p=0.22 (HAMD-17: p=0.36). At endpoint, the CBT versus GSG difference in mean change from baseline IDSc scores was 7.69 points (HAMD-17: 4.97 points), the sertraline versus placebo difference was 3.07 points (HAMD-17: 0.59 points).

The data provide a preliminary suggestion that the mix of patients with minor or mild major depression with atypical features may not be best treated with an SSRI, but that these conditions might be amenable to CBT. Although SSRI were not superior to placebo, it would be premature to rule out SSRI as efficacious in atypical depression.

Although the subgenual anterior cingulate cortex (Cg25: Brodmann area 25) is an important target area in the treatment of affective disorders, its involvement in the evaluation of emotional salience of visual stimuli during depressed episodes is not quite understood. Research regarding the neurocircuitry in mood disorders suggests an important role of this anatomical region for affective information processing.

In this study, we focused on Cg25 neuronal responses in depressed females using a paradigm in which emotions are elicited without explicit cognitive control, relying on the salient nature of the mood inducing stimuli eliciting approach-related emotions (like happiness) or withdrawal-related emotions (like disgust).

Twelve treatment-resistant melancholic depressed women and 12 age-matched healthy female control subjects were asked to passively view blocks of baby faces when undergoing functional magnetic resonance imaging (fMRI).

Compared to the healthy females, the depressed patients displayed significantly higher bilateral Cg25 neuronal activities in both emotional experiences. Whereas in melancholically depressed women, right-sided Cg25 activity was comparable for both emotional experiences, we found significantly less leftsided Cg25 neuronal activity during the withdrawal-related emotional experience.

Our results could indicate that in depressed women the left Cg25 modulates intense visceral emotional responses to aversive visual stimuli. Our observations could help to explain why in unipolar melancholic depression the left Cg25 provides a valid target region for antidepressant treatment strategies, such as deep brain stimulation and anterior cingulotomy and nervus vagus stimulation therapy, which all seem to correlate with decreases in left Cg25 activity.

Evaluate the effects of once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy on sleep disturbance in patients with major depressive disorder (MDD).

Pooled data from four 6- or 8-week placebo-controlled quetiapine XR (50-300mg/day, administered in the evening) monotherapy studies (D1448C00001, D1448C00002, D1448C00003, D1448C00004) were analysed. Primary endpoint: change from randomisation in Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Post-hoc analyses assessed changes in: MADRS item 4 (reduced sleep); Hamilton Rating Scale for Depression (HAM-D) items 4 (insomnia-early), 5 (insomnia-middle) and 6 (insomnia-late) and sleep disturbance factor (items 4+5+6); Pittsburgh Sleep Quality Index (PSQI) total and item scores. MADRS total score change was analysed for patients experiencing high (baseline HAM-D sleep disturbance factor score >=4) and low (baseline HAM-D sleep disturbance factor score < 4) sleep disturbance.

In total, 2,116 patients were randomised. At last assessment, quetiapine XR (all doses combined) significantly (p< 0.001) reduced MADRS item 4, HAM-D sleep disturbance factor and items 4, 5 and 6 and PSQI total scores from baseline versus placebo. Quetiapine XR significantly (p< 0.001) improved MADRS total score from baseline versus placebo at all time points in patients experiencing high sleep disturbance (n=865, quetiapine XR; n=514, placebo). Quetiapine XR improved MADRS total score versus placebo in patients with low sleep disturbance (n=252, quetiapine; n=121, placebo): difference significant at Weeks 2(p< 0.001), 4(p< 0.05) and 6(p< 0.05).

Quetiapine XR monotherapy improved symptoms of sleep disturbance in MDD and was effective against depressive symptoms in patients experiencing high and low sleep disturbance levels. AstraZeneca funded.

Changes in mature brain-derived neurotrophic factor (mBDNF) have been associated with the pathogenesis of depression. The present study employed isolation-rearing from weaning in normal Sprague Dawley (SD) and genetically depressed Flinders Sensitive Line (FSL), as a model of gene-environment interaction, to study mBDNF alterations in the plasma, hippocampus and frontal cortex (FC).

21-28 days old male SD (n=8) and FSL (n=10) rats were housed in groups or in isolation for 39 days and sacrificed on the last day of housing. The hippocampus and FC were immediately dissected and the trunk blood collected for plasma separation. Pro-BDNF (36 kDa) and mBDNF (14 kDa) were detected in plasma using ELISA and in the hippocampus and FC using Western Blot. The mBDNF data were normalized to those of pro-BDNF to have an accurate index of changes in mBDNF production.

I. Under basal conditions group-housed depressed FSL rats showed significantly (p< 0.05) higher mBDNF in plasma and lower in the hippocampus compared to normal SD rats. No differences were detected in the FC. II. Isolation-rearing in depressed FSL induced a decrease in mBDNF in plasma (p< 0.05) and an increase in the hippocampus (p< 0.01) compared to group-housed FSL, the FC was not affected. In contrast, isolation-rearing did not affect mBDNF in normal SD rats.

Isolation rearing differentially affected plasma and brain mBDNF only in depressed FSL rats, supporting the idea that gene-environment interaction is an important factor in determining specific changes in molecular correlates of depression.

Although the therapeutic efficacy of newer antidepressants has been demonstrated in various studies there is only little research available about patients fitness to drive under newer antidepressants.

A sample of 60 depressive inpatients diagnosed according to DSM-IV criteria were randomly assigned to treatment with either mirtazapine (n=20), escitalopram (n=20) or reboxetine (n=20). To control for retest effects 15 healthy controls were examined in the same time schedule. Participants were tested before pharmacologic treatment (t0), and on days 7 (t1) and 14 (t2) with computerized tests related to car driving skills. Data were collected with the Act and React Testsystem (ART 90) and the Wiener- Testsystem (WTS) measuring visual perception, reactivity, stress tolerance, concentration and vigilance.

Patients showed significant improvements in most functional domains related to driving ability skills after 14 days of treatment with newer antidepressants. Statistically significant differences between treatment groups could not be shown. However, controlling for retest-effects only in vigilance-measures significant group by time effects could be found indicating an improvement over practice effects.

Partly remitted depressive patients treated with mirtazapine, escitalopram or reboxetine showed a better test performance in driving related skills than untreated patients. However, as most of these laboratory driving tests have a large speed component, retest effects have to be considered when interpreting results of repeated examinations.

The purpose of this study is to identify factors associated with diagnostic stability of Bipolar Mood Disorder (BMD) with statistical and clinical interest.

Retrospective cohort study, in which the medical records of 916 individuals admitted to Coimbra University Hospital, between 1989 and 2008 with first diagnostic of BMD, were analysed for the following characteristics: age, gender, occupation, educational level, age at first diagnostic, number and types of hospital admissions, presence of suicide attempts, pharmacological treatments, time between first diagnostic and the new one (Schizophrenia, Delusional Disorder or Dementia), type of cognitive impairment, assessment examinations (TC-CE and EEG) and presence of co-morbidities.

The analysed sample was divided in two groups: one that kept the first diagnostic (BMD) and another that later received a different diagnostic.

Diagnostic criteria according to International Classification of Diseases- 10th edition.

4,7% of the total sample received a different diagnostic in a posterior assessment: 41,9% Schizophrenia, 4,7% Delusional Disorder and 53,5% Dementia. The factors were analyzed with traditional statistical methods and Mann-Whitney's test. The authors found five main factors with statistical significance between the two groups, namely, age, age at first diagnostic, total number of admissions and number of admissions for maniac episodes, and educational level.

The aim of the study was achieved. In clinical practice the reported characteristics must receive a special attention in patient's assessment, in order to verify the diagnostic stability and eventual evolution to another diagnostic.

To assess the prevalence and correlates of childhood and adolescence sexual and/or physical abuse (SPA) in bipolar I disorder (BD) patients treated for a first episode of psychotic mania.

The Early Psychosis Prevention and Intervention Centre (EPPIC) admitted 786 first episode psychosis (FEP) patients between 1998 and 2000. Data were collected from patients’ files using a standardized questionnaire. 704 files were available, 43 were excluded because of a non-psychotic diagnosis at endpoint and 3 due to missing data regarding past stressful events. Among 658 patients with available data, 118 received a final diagnosis of BD and were entered in this study.

80% of patients had been exposed to stressful life events during childhood and adolescence and 24.9% to SPA: in particular, 29.8% of female patients had been exposed to sexual abuse. Patients who were exposed to SPA had poorer pre-morbid functioning, higher rates of forensic history, were less likely to live with family during treatment period and were more likely to disengage from treatment

Sexual and/or physical abuse is highly prevalent in BD patients presenting with a first episode of psychotic mania; exposed patients have lower pre-morbid functional levels and poorer engagement with treatment. The context in which such traumas occur must be explored in order to define if early intervention strategies may contribute to diminish their prevalence. Specific psychological interventions must also be developed.

To identify predictors of remission with placebo treatment in double-blind randomized controlled trials (RCTs) in major depressive disorder (MDD) based on baseline characteristics.

989 placebo-treated MDD subjects with baseline Hamilton Depression Rating Scale total score (HAMDT17) ≥15 who completed 7-8 weeks of treatment from 8 duloxetine RCTs with placebo lead-in were included. Remission was defined as HAMDT17 endpoint score ≤7. Stepwise logistic regression and classification and regression tree (CART) methods were used to identify predictors of remission. Data were randomly split into training data (N=791, 80%) for model selection and test data (N=198, 20%) for validation. Predictive quality of models was assessed by ROC curves.

In the logistic regression analysis, out of >50 potential pre-treatment predictors, the HAMDT17 score, age, Hamilton Anxiety Scale item 14 (HAMA14: behavior at interview) and length of current MDD episode (length) were found to be most predictive for remission on placebo. These variables were also identified as top predictors by the CART method that identified 2 subgroups: “HAMA14=0 OR (HAMDT17< 22 AND length< 18 weeks)” (45% remitted), “HAMA14>0 AND (HAMDT17≥22 OR length≥18 weeks)” (21% remitted). However, the predictive power was weak for both methods with areas under the ROC curve (test data) of 67% and 56%, respectively.

Baseline risk factors for non-remission after 7-8 weeks of placebo treatment were older age, more severe depressive symptoms, apparent anxiety, and a longer duration of current MDD episode. These results are consistent with previous findings and may aid in the design of RCTs.

Although numerous studies agree that bipolar patients demonstrate extensive cognitive deficits, it is still unclear to which extent these impairments persist across different mood states, including euthymia. Given that the emotional and cognitive processes are closely intertwined, we aimed to examine selective attention, cognitive inhibition, and social cognition within different emotional context in the group of remitted bipolar outpatients.

80 euthymic bipolar outpatients and 66 healthy volunteers matched for sex, age and education participated in the study. Internal State Scale and Barratt Impulsiveness Scale were used to assess self-reported affective states and trait impulsivity. Computerised versions of Colour-Word Stroop, Emotional Stroop, Affective Go/NoGo and Ekman Recognition of Facial Expression task were administered to assess selective attention, inhibition of cognitive control and social cognition.

Several cognitive deficits in selective attention, inhibition of cognitive control and social cognition tasks have been identified in the group of euthymic bipolar outpatients. They revealed worse recognition of negative, positive and neutral affect than controls. Besides cognitive disruptions which were reflected in longer reaction times and more erroneous performance to different emotional stimuli and in different emotional contexts, also trait impulsivity was considerably elevated in the group of bipolar euthymic outpatients.

Bipolar outpatients in our study demonstrated relatively marked impairments in cognitive functioning within different emotional contexts also during the euthymia. Applied neuropsychological inventory proved as useful tool for assessing specific cognitive impairments in bipolar mood disorder, and could contribute to more effective diagnosing and treatment of patients.

Lithium has been used in the successful treatment of bipolar disorders since the 1950's. Advancements in neuroscience show that it has neuroprotective properties suggesting a possible efficacy in stroke, Alzheimer's and dementia. There is also evidence showing lithium protection of neurologic injury by changing GSK-3 inhibition in animals.

The Lithium Archives Project research design is a retrospective, random paper based chart review of patients with mood disorders. The charts are examined for over 100 variables including demographic, symptom, mood, biochemical, neurologic, and medical items. The current sample of over 700 charts was analyzed by a skilled statistician using standard SPSS statistical software. Mean, standard deviation and significance of cerebrovascular disease, myocardial infarction, brain tumors, stroke, seizures, and eye diseases of patients treated with lithium and patients treated without lithium were compared and analyzed. Multivariate analysis was performed to analyze group (lithium/no lithium) and incidence of disease. The means of disease incidence in the lithium versus non-lithium groups were then charted.

The Multivariate Analysis of Variance of the current data shows that group is a significant variable in the incidence of diseases analyzed (Pillai's Trace F = 2.926, df = 11,416, p=.004). The patients treated with lithium show less incidence of cerebrovascular disease (p=.053), myocardial infarction (p=.012), seizures (p=.091), eye diseases (p=.011), stroke (p=.014) and brain tumors (p=.072).

The current analysis is very promising and indicates that in this patient population, lithium may have played a role in protection from these diseases.

Assessing impact of treatment from the patient perspective provides additional information about treatment efficacy in major depressive disorder (MDD) trials.

Pooled data from three identically designed clinical trials showed aripiprazole adjunctive to antidepressant therapy (ADT) was effective in treating MDD.1

Patients who completed an 8-week prospective ADT phase with inadequate response were randomized double-blind to 6-weeks adjunctive treatment with aripiprazole or placebo. The Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) is a 16-item, self-report measure to evaluate daily functioning, with higher scores indicating better satisfaction. Comparisons of mean change from baseline (Week 8) to Week 14 in Q-LES-Q-SF items and general subscores were performed using ANCOVA (LOCF).

There was significant improvement in the Q-LES-Q-SF Overall-General subscore (total of items 1-14 expressed as a percentage of the maximum possible score) in the aripiprazole-treatment group (9.49% [n=507]) vs placebo (5.71% [n=492] p< 0.001). Placebo was significantly higher than aripiprazole in Physical Ability (placebo 0.13 vs aripiprazole 0.02, p=0.020). Aripiprazole was significantly higher than placebo in all other items except Physical Health and Vision. Aripiprazole also produced significant increases in both the Satisfaction with Medication (Item 15) (aripiprazole 0.36 vs placebo 0.20, p< 0.01) and Overall Satisfaction (Item 16) (aripiprazole 0.61 vs placebo 0.35, p< 0.001) scores.

Results emphasize that assessment of patient functioning and quality of life may have utility both in clinical trials and clinical practice.2