Early detection and indicated early intervention in the initial prodromal phase should considerably improve the course of psychoses. Yet, the benefits of such programmes still require an evidence-based evaluation on the basis of a sufficient sample-size.

This report presents an overview on the concept and design of the European Prediction of Psychosis Study (EPOS) an European 4-country naturalistic field-study of the initial Prodrome.

Across six participating centres (Germany: Cologne, Berlin; Finland: Turku; The Netherlands: Amsterdam; United Kingdom: Birmingham, Manchester), 16 to 40 year old putatively prodromal persons attending specialized services or general psychiatric services underwent multi-level baseline, 9-months follow-up, and 18-months follow-up examinations. Inclusion criteria were the presence of APS, BLIPS, at least 2 of 9 Basic Symptoms (BS), and Familial Risk or Schizotypal Personality Disorder plus Reduced Functioning (FR+RF). In addition, psychopathological, neurocognitive, neurobiological, psychosocial, and service and treatment-related assessments were carried out.

A substantial part of more than 250 subjects included into the study participated in their respective baseline, 1st follow-up, and 2nd follow-up examinations. A high percentage presented themselves with BS and/or APS, a smaller percentage with BLIPS or FR+RF. The rates of transition into psychosis and the levels of psychopathology, distress and functional decline found among this patient group underline the need for indicated early recognition and intervention.

EPOS provides for the first time a sound data base allowing an evaluation of the applicability and cost-benefit ratio of early detection and intervention programmes in Europe.

A main objective of EPOS is to provide a valid multifactorial model for the prediction of psychosis. One major element of such a model should be the clinical state.

In a European multicentre study, persons fulfilling clinical criteria thought to indicate an increased risk for psychosis (PAR) were assessed amongst others with different psychopathological instruments covering the whole spectrum from basic symptoms to frank psychotic symptoms. Inclusion criteria comprised attenuated positive symptoms (APS), brief limited intermittent psychotic symptoms (BLIPS), cognitive basic symptoms (CogDis) and a combination of family risk and reduced functioning (S&T).

246 PAR were included into the study, mostly by APS or CogDis. Analysis of demographical data showed a high amount of functional impairment, resulting e.g. in low mean GAF scores (51.0 ± 11.8 SD), and of non-psychotic axis-I disorders. In September 2006, the hazard rate for a conversion to psychosis was 15.3 at 12 and 20.0 at 18 months after baseline assessment. According to the inclusion criteria, the highest rate of conversion was observed among PAR with BLIPS. On a dimensional level, a low GAF score was among the best predictors of conversion.

The transition rates of EPOS were in line with recent studies. A first analysis of clinical data supports the notion that the functional state should be an inherent part of any set of clinical risk criteria. Further analysis will consider the contribution of single symptoms or symptom combinations and the impact of symptom duration.

The main aim of the European Prediction of Psychosis Study (EPOS) is to study a large sample of young patients who are at risk of psychosis and to estimate their conversion rate to psychosis during 18 months follow-up. The present presentation aims to describe premorbid adjustment in the patients at risk of psychosis.

In six European centres (Cologne, Berlin, Turku, Amsterdam, Birmingham, Manchester), 246 psychiatric patients at risk of psychosis were examined. Risk of psychosis was defined by occurrence of basic symptoms, attenuated psychotic symptoms, brief, limited or intermittent psychotic symptoms or familial risk plus reduced functioning during the past three months. Premorbid adjustment was measures by the Premorbid Adjustment Scale (PAS) and correlated with patient's baseline and outcome measures. Psychiatric patients without prodromal symptoms (not at risk) and healthy subjects, studied in one centre, acted as comparison groups.

PAS scores were poorer in the patients at risk of psychosis than in patients without prodromal symptoms or in healthy controls. In adolescence, differences in PAS scores were greater than in childhood or in adulthood. Within patients at risk of psychosis, men had poorer PAS scores than women. Childhood, adolescent and adulthood PAS scores associated extensively with patient's clinical and functional state at baseline examination. Adolescent and adulthood PAS scores correlated also with conversion to psychosis.

Disturbed premorbid psychosocial development, especially from adolescence on, may indicate vulnerability to and onset of psychosis.

The most important clinical problem with schizophrenia is the chronic course of this disease leading to severe medical and social problems. Most of the patients are unable to work at a regular base, to have a partnership or family due to persistent cognitive and emotional disturbances. This is probably caused by progression of the lost of gray matter and of cytoarchitectonical changes in the frontal and temporal lobe as well as in limbic structures. Several studies suggest that so early the patients received psychotherapeutic and/or pharmacological treatment, so better the prognosis. Neurobiological research in the early phase of the beginning schizophrenic psychosis, i.e. so-called prodromal phase, could provide information being relevant for the early recognition of those patients still far away before the acute onset of psychosis, who then can be treated adequately.

Our research is currently directed to parameters which are found changed in manifest schizophrenic patients, i.e. structural MRI and MR spectroscopy, to neuropsychological and neurophysiological examinations (serotonin indicator LDAEP, P300, P50, MMN).

Comparisons of prodromal patients versus patients with first or multiple episodes as well as of healthy controls revealed a continuum of neurobiological impairments from the early prodromal phase to the chronic state of schizophrenia.

To describe the rationale, design and methods of the Danish National Schizophrenia project, and to characterise its sample at inclusion and after 1 and 2 years concerning outcome, gender, treatment as usual and furthermore to describe interpersonal self-image as a predictor for outcome.

Prospective, comparative, longitudinal, multi-centre study (16 centres), including 562 patients with a first episode psychosis of ICD-10 F-2 type, successively referred during two years.

1. an assertive, integrative psycho-social and educational treatment programme; 2. a supportive psychodynamic treatment as a supplement to treatment as usual; and 3. treatment as usual. Symptoms, social function and sociodemographic data were registered regularly, and followed up after one and two years.

Comparison of the outcome of the three treatment methods showed that the two methods of intervention helped the patients significantly better on several outcome measures than the ‘Treatment as Usual’.

To describe the rationale, design and methods of the Danish national Schoizophrenia Project, and to characterise the sample at inclusion and after 1 and 2 ys.

Prospective, comparative,longitudinal multicenter-study (16 centers distributed all over Denmark), including 562 patients with a first episode psychosis, ICD 10 F- 2, sduccessively referred during two years.

1. supportive psychodynamic as a supplement to treatmen as usual, including antipsychotics (TAU), 2. assertive, integrated treatment with psychosocial and psychoeducation and antipsychotics 3. Treatment as usual. Data included psychopathology, social fundtion and sociodemographic data, at baseline, years 1 and 2.

Comparing the three interventions showed a significantly better outcome for the interventions 1 and 2 than 3, TAU.

Very few research projects describe the clinical routines and every day treatment procedures, and correlate these to the outcome.

To determine the possible correlation between continuity of treatment and compliance leading to a possitive impact on level of psychopathology and better social functioning.

Patients with FEP of F2-diagnosis in The Danish National Schizophrenia Project (N=269) were consecutively included during a two years period to be followed up for five years. Data were collected concerning continuity of relationship in treatment, treatment conditions, medication, psychotherapy and social support and training.

We will present data from the TAU-registration for the patients concerning continuity of relationship in treatment and the correspondance with level of psychopathology, compliance, social functioning, treatment and abuse at baseline, year 1 and year 2.

In FEP-patients, female gender is associated with better social function and a higher degree of compliance, while males seem to exhibit more negative symptoms and a higher degree of abuse.

The gender issue is relevant to explore in order to evaluate whether gender differences ought to result in gender specific treatment interventions.

A subgroup of 269 persons (181 men and 88 women) included in the DNS and receiving treatment as usual (TAU) was analyzed according to gender and possible variations in the expression of demography, psychopathology, drug consumption and abuse. Results of treatment and social function as expressed by rating by duration of untreated psychosis (DUP), PANSS, Strauss Carpenter and GAF were compared.

Data from 2 years follow-up of this group will be presented with focus on gender issues.

Various marked gender differences were confirmed in the study. As a consequence a number of gender specific interventions are suggested.

Several studies have indicated that a person's self-image is of central importance for psychological well being and mental health. A negative self-image has been associated with many mental health problems, but knowledge about self-image in psychosis is sparse. The present study examined self-image in psychosis and its importance for recovery from psychosis (Harder, 2006).

The sample (N=97) was a subsample from the DNS-sample. The patients recieved supportive psychodynamic psychotherapy in combination with standard treatment. Self-image was measured by SASB-Intrex questionnaire (Benjamin, 1989) and outcome measures were PANNS Positive and Negative Symptom Scale) and GAF (Global Assessment of Functioning).

Self-image at baseline was found to be a strong predictor for outcome in positive psychotic symptoms, negative psychotic symptoms and social functioning both one and two years later. Patients with presence of grandiosity and reduced acknowledment of actual illness had a more positive self-image at their percieved worst state, which was associated with better outcome.

This finding of a strong relationship between self-image and outcome has important implications for treatment, because preserving and enhancing self-image during treatment might help improve recovery from psychosis. Grandiosity and reduced acknowledment of actual illness might serve to protect the self-image, and reduce stress related to very negative aspects of self-image.

Bright light therapy (L.T.) is the recommended treatment for SAD; in addition, light therapy has new applications, as an antidepressant modality. In this study we focused the role of L.T. in pregnant patients with depression or anxiety.

Eleven patients were included in this naturalistic study about light treatment, with the following diagnosis: recurrent depression, depression in bipolar spectrum, cyclothymia, PAD, social phobia. “GAS” rating scale was adopted in determining the effect of the LT, before and after treatment, and then after one month.

Very satisfactory results had been obtained: the ”GAS” shows a clear cut final score. Any treatment-emergent adverse symptoms were not reported during this study.

Light therapy confirmed its efficacy and its wide action spectrum with several new applications and above all its tolerability and safety during pregnancy.

Postpartum depression (PPD) is on of the most common psychiatric disorders following delivery. This disorder can make serious problem for mother, child and family; therefore the identification of its risk factors is a must. One of these factors is “satisfaction from husband”. This study has been carried out to evaluate the relation ship between ppd and “satisfaction from husband” in Kashan, Iran 2006.

In this analytical case-control study 460 women during 2-3 first months after delivery divided in 2 equal groups. Case group was depressed mother and control was normal (not depressed) mother. The Beck and a researcher-made questionnaire were used for evaluation. Some factors effecting the depression were omitted in the study and some factors were matched in 2 groups. X2 and T test were used to analyze the data.

This study showed that there was a significant difference between satisfaction from husbands and PPD (p=0/00). High satisfaction from husband has seen in normal group, mild, moderate and severe depression group were 90/4%, 83/5%, 74/3% and 37/5% respectively and there was a significant relationship between PPD and husband's job (p<0/04) but no relationship with duration of marriage, husband's age and education.

There is a significant relationship between satisfaction from husband and PPD, reduction in satisfaction from husband can increase the rate of PPD.

Satisfaction of husband, Postpartum Depression

Elaborate studies have found sex ratio of patients with depressive disorder tends to decline with increasing age. The aim of this study was to evaluate if the sex ratio of depressed inpatients in Bavaria corresponds with the sex ratio found in epidemiological studies.

Based on AGATE – due date census for inpatients 2000 – 2004 in Bavaria, we examine the relationship between sex and age on depressive episode (ICD-10: F 32 or F 33). The drug safety program AGATE is supported by 28 psychiatric hospitals in Bavaria. Overall 41,699 patients on 10 target days during 5 years were evaluated. Spearman-correlation was conducted with SPSS.

A total of 7,487 patients were rated as “depressive episode” according to ICD-10. The sex-ratio F/M was 1.9. In the 5. and 6. decade of life the sex-ratio was 1.7. It climbed to a sex-ratio of 2.2 in the 7. decade of life and to 2.6 in the 8. decade of life. The Spearman coefficient of correlation was 0.731 (p=0.018).

Differently from epidemiological studies the predicted reduction of sex differences with increasing age was not found.

The Suicide Rate of Romania (12, 7/100,000 inhabitants) presents significant lower figures than those of surrounding countries: Hungary, Ukraine, Republic of Moldavia, Bulgaria, and Serbia. Inside Romania the regional suicide ratio varies enormously (from 33 to 5/100,000 inhabitants).

To compare the influence of psychopathology and cultural patterns on the model of suicidal behaviour in different ethic population of Romania.

The researchers collected the data on demography, psychopathology and quality of life of suicidal persons in the last 2 years, in 44 counties of Romania. The Beck Hopelessness Scale, SAD PERSONS scale (1), and The Multicultural Quality of Life Index (2), were applied to persons belonging to different ethnic groups.

It was found out the relation between the highest suicide rate and the prevalence of Hungarian population in Harghita, Covasna counties and of Slavic population in Salaj, Suceava and Tulcea counties. The lowest suicide ratio was registered in the counties with a Romanian non-mixed population. The morbidity by psychiatric disorders didn't explain the significant differences between suicide ratio among the Romanian and Hungarian, Slavic population. The cultural identity among Hungarian and Slavic ethnic groups was significantly correlated with the behavioural pattern of deliberate self-harm.

The behavioural pattern of deliberate self harm has a strong correlation with the culturally learned assumptions.

Depression is a major public health problem in European countries, and health systems need to ensure access to effective psychological and pharmacological treatments. Research suggests that improvements in depression care require “complex interventions” that implement change in several areas simultaneously.

We describe an observational study of the implementation of a “stepped care” model to provide care for all adults presenting with a new case of depression in a mixed urban-rural area of Scotland with a population of 76,000 people.

A team of 5.2 clinicians provided care for about 1,000 new cases of depression each year. “Guided Self-Help” was the baseline intervention for all patients, supplemented where necessary with pharmacological treatment and Cognitive Behavioural or Interpersonal Therapy.

Service delivery systems were reformed to provide: specialist treatment in primary care settings using primarily non-medical clinicians, comprehensive electronic clinical records, continuous outcome monitoring and intensive investment in staff training and support.

Clinical outcomes (measured by the Personal Health Questionnaire, Social and Work Adjustment Scale and EQ-5D) showed significant improvement despite relatively brief clinician contact (2.5 hours over 4.6 contacts). Savings of more than 50% were made on the antidepressant drug budget. Service user satisfaction ratings were high.

Population needs for depression care can be met using “stepped care” models such as that described above. A randomised controlled study of this approach would be required to fully test the model.

In this study we examined the role of various social relations and social conditions variables in the determination of depression among urban and rural pregnant women in Pakistan.

Both qualitative and qunatitative method was employed. 292 pregant women in urban and 152 pregnant women in rural areas of the province of Sindh Pakistan were included in the study. Social condition variables included socioecnomic status, illness and housing while social relations variables were relations with husband, in-laws, children and parents family. These variables were given scores when it applied to a situation of a pregnant women. Simultaneously, hassles related to pregnancy were also inquired from each women. Concurrently, in a blind set-up, translated and validated Center for Epidemiological Scale for Depression (CES-D) was administered. In multivariate regression linear analysis, scores of social relations and social condition variables were related with the scores of CES-D scores.

Social context vary in urban and rural areas. There is high prevalence of depression among pregnant women in urban (39%) and rural (42%) areas of Pakistan. Social relations variables are more important in determining depression in pregnant women of urban areas, while social conditions variables has more contribution for the development of depression in rural areas of Pakistan.

Social environment has major contribution for the development of depression among pregnant women (52% variance). Social environmental variables vary with the social context and its importance vary for the women of urban and rural areas.

Bipolar disorders have a high impact and are psychosocially very relevant. Their manifestation have a broad variety of forms and cognitive and neuropsychological functioning is impaired in acute illness. There is a lack of neuropsychological research during remission of bipolar illness. The aim of this study was to evaluate the cognitive status of remitted bipolar patients.

38 remitted bipolar patients underwent neuropsychological testing: MWT-B, TMT, VLMT, WMS-R, D2 and proactive interference. The results were compared with a sample of 32 schizoaffective patients.

The scores of bipolar patients were in average in most of the applied instruments. The patients had lower results in only some fields of cognitive functioning, e.g. proactive interference. Bipolar patients had significantly better results compared to the group of schizoaffective patients.

Remitted bipolar patients had fairly good results in neurocognitive functioning. Compared to schizoaffective patients cognitive flexibility, concentration and memory is better.

In the multilayered treatment of bipolar patients, medication treatment is the basic component. The relevance of additional psychosocial treatment has been shown in several controlled and uncontrolled studies. In particular, psychoeducation and Cognitive Behavioural Therapy (CBT) seem to be effective concerning relapse prevention and symptom reduction. The aim of this 12 months randomised study was to examine the efficacy of a psychoeducation programme integrating cognitive behavioural elements in bipolar patients. We are presenting data at 3 months follow-up.

Medicated bipolar patients (CGI ≤ 3) were randomised to psychoeducation (intervention group) or waiting list (control group). The psychoeducation programme took place once a week over a period of 12 weeks, focusing on the following major topics: information on the origins of the illness, medical and psychological treatment options, how to detect symptoms and early warning signs, crisis management and how to maintain a regular lifestyle. The patients' knowledge of bipolar disorder, symptoms, social functioning, quality of life and medication compliance were assessed before and after the intervention and every three months for a total of 12 months. For the statistical analysis, mixed models were applied in order to evaluate group differences over time.

Forty patients have been randomised. On the outcome variables (symptoms, social functioning, knowledge), the patients receiving the early psychoeducation programme did numerically better on all variables than the control group. However, in terms of statistical significance, only trends could be detected.

Our findings support the benefits of psychoeducation in the management of bipolar disorder.

In 1896 Adolf Erman, a famous Egyptologist, published the translation of Papyrus 3024 from the Egyptian Middle Empire: a dialogue of a man, tired of life, with his soul. Since than the manuscript has been considered as one the first accounts of a case of melancholia.

Occasionally historians make modern psychiatric diagnoses in historical figures. Sometimes this is done with the expectation than doing this will add new information. However, modern diagnostic concepts are themselves historical narratives and social constructs and do not especially convey new information. Viewed from the perspective of the Lacanian discourse analysis this is an example of ‘the master’ or ‘scientific’ discourse. In this contribution the internal dialogue of the man will be described from the Lacanian perspective.

Analytical reading, in which the attention is focused on the speaking subject en his relationships, does not generate post hoc diagnoses in the usual sense, but may be helpful to understand more of the writer of the papyrus and his interpreters. The ‘dialogue with his soul’ can be to be understood as the return to his origins, in which the Desire reappears again and again.

The Lacanian discourse analysis may be a suitable instrument to highlight the essential aspects of this old manuscript.

Few studies have been conducted looking at clinical features associated to treatment resistant depression (TRD) defined as failure to at least two consecutive antidepressant trials. The objective of this study was to identify clinical and demographic factors associated to TRD in a large sample of depressed patients who failed to reach response or remission after at least two consecutive adequate treatments.

A total of 702 patients with unipolar major depression were included in the analysis. 346 patients were considered as non resistant. The remaining 356 patients were considered as resistant with a HAM-D-17 score remaining ≥ 17 after 2 consecutive adequate trials. Cox regression models were used to examine the association between individual clinical variables and TRD.

Eleven variables were found to be associated with TRD. Anxiety comorbidity (p<0.001, OR=2.6), comorbid panic disorder (p<0.001, OR=2.6) and social phobia (p<0.008, OR=2.1), personality disorder (p<0.049, OR=1.7), suicidal risk (p<0.001, OR=2.2), severity (p<0.001, OR=1.7), melancholia (p<0.018, OR=1.5), a number of hospitalizations > 1 (p<0.003, OR=1.6), recurrent episodes (p<0.009, OR=1.5), early age of onset (p<0.009, OR=2.0) and non response to the first antidepressant received lifetime (p<0.019, OR=1.6).

Our findings provide a set of eleven relevant clinical variables associated to TRD which can be explored at the clinical level. The statistical model used in this analysis allowed for a hierarchy of these variables (based on the OR) showing that comorbid anxiety disorder is the most powerful clinical factor associated to TRD.