In light of the ongoing debate whether agoraphobia [AG] should be viewed as a severe phobic disorder similar to specific phobia [SPE] or as a complication of panic disorder [PD] we aim to study the vulnerability structure of PD, AG and SPE.

3021 14-24 year-olds from the general population were followed-up over 10 years. DSM-IV syndromes were assessed via computerized M-CIDI interview and vulnerability factors via questionnaires. Associations were assessed with odds ratios from logistic regression. Latent class analysis (LCA) regressed on vulnerability factors was used to derive classes that underlie panic and phobic syndromes and to assess their associations with vulnerability factors.

1. 1. Vulnerability patterns were largely similar between PD, AG and SPE.

2. 2. The LCA resulted in a best fitting model with 4 classes: a healthy class, a class with moderate frequency of phobias without PD, a class characterized by PD and AG and moderate frequency of SPE (PDAG class) and one class characterized by high frequency of AG and SPE situational type and lower frequency of PD (AGSIT class).

3. 3. All classes showed different associations with multiple vulnerability measures. Subjects in the PDAG class reported less SPE in parents (OR=0.2; 95% CI=0.0-0.6) and older onset-age of any psychopathology (OR=2.0; 95% CI=1.07-3.6) than the AGSIT class.

We found indications for separate latent classes underlying PD and phobias that were characterized by different vulnerability factors. We interprete the different classes as different vulnerability clusters and evidence of multiple pathways leading to panic and phobias.

To carry out cultural adaptation and validation into Spanish of the 7-items self-administered GAD-7 scale; a tool to identify probable patients with Generalized Anxiety Disorder (GAD).

The adaptation, conducted by an eight-expert panel, was performed by means of a conceptual equivalence process, including forward and backward translations in duplicate to the original language. The content validity was assessed by inter-ratter-agreement (item-goal congruence index of Rovinelli-Hambleton). The adapted version was administered to patients with GAD according to DSM IV criteria and their respective controls, matched by age and sex, who were recruited at random in Mental Health and Primary Care centres to verify scale feasibility and potential understanding problems.

The inter-ratter reliability confirmed the correct inclusion of items in the corresponding dimension of GAD. The study sample consisted of 8 patients with GAD and 8 controls (62.5% male), mean age 50.38 years (SD=16.76). The average time to completion was 2’30”. No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to fill in the questionnaire. All the items, except item 5 (p=0,105), showed statistically significant differences among groups (p< 0.05).

After the adaptation process, a Spanish version of the GAD-7 scale was obtained, confirming its content validity, pertinence and adequacy of items in the Spanish cultural context. The brief time to completion precluded a fast and easy self-administration in the routine medical practice to promptly detect probable cases of GAD.

Since the end of 19th century, mental health professionals have noticed that individuals who have experienced traumatic situations often present dissociative symptoms, such as amnesia or fugue states. Dissociation is a defensive mechanism that allows an individual to separate from conscience the psychological distress produced by the trauma. Our aim was to remark the association between Post-traumatic Stress Disorder (PTSD) and long-term dissociative disorders through the study of a clinical case.

A clinical case was followed and reviewed to illustrate this relationship.

Ten years ago, a 49-year-old man was diagnosed of PTSD after having witnessed several colleagues burnt in a tragic accident at work and having helped the emergency fire brigade to rescue other victims. His symptoms required treatment with antidepressants and psychotherapy, and fully remitted after one year. Nevertheless, during the last year, he has presented two dissociative amnesia episodes lasting for three days each, which were examined by a neurology service. More recently, he has suffered a ten-day episode of dissociative fugue, which required psychiatric hospitalization. Although the patient has been asymptomatic during a decade, it is remarkable that he has presented three dissociative episodes in a short period of time. One of them, the fugue state, is interesting because of its long duration and its relatively low prevalence in the general population.

This clinical case allows us to appreciate the long-term relationships between psychological trauma and dissociation, in addition to the well-known short-term effects.

The ethiopathogenic mechanisms of depression and anxiety overlap at a certain moment on most part of those of the sexual dysfunction. Hypercorticolezemia from the anxious depressive disorders, with direct impact on the hypocampus (reducing the volume), through the two mechanisms (biological and organic) may generate and especially accentuate the dysfunctions in the sexual activity.

In more than few cases, the anxious depressive disorders are accompanied by sexual dysfunctions, wh

During antidepressant therapy, especially with inhibitors specific for recapturing serotonine, different types of sexual dysfunctions may appear.

In a retrospective examination, out of 420 patients fulfilling the DSM IV R criteria for the anxious and depressive with anxious and depressive disorder, the presence of sexual dysfunction was highlighted in 340 patients (80,9%). In 260 patients (76,47%) the sexual dysfunction was present in the clinical board of anxiety and depression; in 78 patients (30%) the sexual dysfunction accentuated during antidepressant therapy (predominantly with specific inhibitors for recapturing serotonin). In 80 patients (23,53%), the anxious depressive symptomatology was preceded by sexual dysfunctions in various clinical forms. ich accentuate the anxiety and the depression.

The presence of sexual dysfunction in an anxious depressive board represents a negative predictive factor in the evolution of the affective disorder, delaying remission. The use of the mood stabilizer, by increasing GABA in the mezocortical circuit and equilibrating the GABA/DOPAMINE, can be beneficial for the improvement of the sexual dysfunction in the anxious depressive disorders.

To audit benzodiazepine prescribing in a Community Mental Health team, with a view to identifying areas for improvement.

All the 245 patient's case notes were audited, from October 2004 to October 2005, of those in the Outpatients Clinic's case load, in North Shields. A semi structured pro-forma was designed. On the basis of the guidelines from Committee on Safety of Medicines (CSM) (1988), DOH Document (1999), DOH Ireland report of benzodiazepine commission (2002), www.benzo.org.uk, Newcastle, North Tyneside and Northumbria NHS Trust Guidelines for hypnotic/anxiolytic use and Lanarkshire PCT guidelines, the standards were finalised. The audit tool looked at demographics, indications of benzodiazepine prescription, co-morbid medical conditions, substance misuse, psychotherapeutic intervention and follow up of patients prescribed benzodiazepines.

245 notes were audited. 24% of all patients were on benzodiazepines. Out of those, 56% were women. A third of these patients were between 41-50 year olds, while another third were older than 50years. Co-morbid substance and alcohol dependence was uncommon. The most common diagnoses in these patients were mood disorder (31%), schizophrenia (20%), and personality disorders (12%). Nearly two-third of patients suffered from co-morbid medical conditions. 25% patients had had psychological therapies. None of them were given advice about sleep hygiene and driving.

Older women with mood disorders are more likely to be prescribed benzodiazepines longer than recommended. Advice about driving, sleep hygiene, information about side effects and risks was not offered to most patients. Recommendations have been made, with a view to re-auditing and improving services.

The increasing number of patients with comorbide mental disorders, who were staying in multy-type hospitals, necessitates the organization of psychiatric service, which includes psychopharmacotherapy.

Observations were performed during 25 years in a multy-type emergency hospital.

Indications for psychopharmacotherapy were:

1. 1. Organic (somatogenic) mental disorders (F06) - 61%, among them are: organic delirium ((F05, 8) - 25%, organic hallucinosis (F06.0) - 10%, organic amnesic syndrome (F04) - 27%, organic anxiety phobic disorder with agitation (F06.4) - 9%.

2. 2. Mental and behavioral disorders due to psychoactive substance use (F10 - 19%, F10.03 -12%, F10.31 - 6%, F11.21 - 1%.

3. 3. Neurotic depression with suicidal behaviour (accomplished parasuicide) (F43, 24) - 1%.

4. 4. Anorexia nervosa (F50.0) - 3%.

5. 5. Dementia (F00-F02) - 16%.

The use of Nootropics (Pyracetam 20% 10-20ml, Cerebryl 250ml iv) and B vitamins stimulated reduction of psychosis.

Any of patients wasn't moved to the residential psychiatric facility.

We didn't use neuroleptics cause their iatrogenic activity by organic psychosis and incompatibility with some somatotropic medicaments, employing by multiplex somatic disorder.

Optimization of the psychopharmacotherapy in general hospital requires a regular psychiatrist on its staff. The treatment of the patient in the general hospital seems to be economic and moral effective.

Drug-induced increased libido has been reported mainly with dopaminergic agents. Although benzodiazepines may cause behavioural dishinibition, they were rarely related to sexual undesired urges.

A 62-year-old woman was seen for breast mucinous carcinoma. Besides mild hypertension and initial insomnia she was otherwise previously healthy. She was chronically medicated with ramipril and diazepam 5mg id. Tumour ressection was carried out and chemotherapy with FEC-T was began. One week after, in a follow-up visit, she complained having difficulties on sleep onset. Lorazepam 1mg at the bedtime was prescribed. After the first dose she felt an overwhelming sexual desire, the urge making her to repeatedly open and close her legs, feeling even the physical intercourse. This sensation fade gradually over the next few hours. On the following day she decided to take another lorazepam pill to be sure it was the cause of that strange feelings. The symptoms of the previous night were completely reproduced. She has now completed the chemotherapy and proposed to adjuvant radiotherapy. She never felt those symptoms again and did not take another lorazepam.

It is believed that dopaminomimetic drugs can heighten sexual desire by increasing dopamine concentration on the mesolimbic pathway. In this way, benzodiazepines, as GABA enhancers, would inhibit dopamine release leading to reduced libido. On the other hand, GABA also inhibits serotoninergic-mediated vigilance and impulse control, leading to dishinibition and impulsivity. In our patient, lorazepam has caused a “virtual intercourse” as previously found in electric and mechanic stimulation of septal region and amygdala.

14 bipolar, 10 cluster B personality disorder inpatients. Titres for rheumatoid factor (RA), antithyroglobulin (ATG), antiperoxidase (APO) antinuclear (ANA), anti-neutrophil cytoplasmic (ANCA) and antistreptolysin (ASO) antibodies were measured in all subjects. Psychiatric assessment: non-structured psychiatric interview, MINI International Neuropsychiatric Interview and Millon Clinical Multiaxial Inventory-II.

21,4% of bipolar patients had positive ATG titre vs 11,1% in the cluster B personality group. 28,6% of bipolar patients had positive APO titre vs 22,2% in the cluster B personality group. 16,7% of bipolar patients had positive ASO titre vs 30,0% in the cluster B personality group. None of this differences reached significance.

ASO titre correlated significantly with antisocial (rho=0,435, p=0,043) and autodestructive (rho=0,461, p=0,031) ratings and almost significantly with borderline (rho=0,420, p=0,052) ratings.

The results obtained partly agree with the existing studies. As far as we know a possible correlation between ASOs and impulsive behaviour has not been previously described. The results obtained call for further investigation in the subject.

Since adulthood antisocial, aggressive and delinquent behaviors often have their onset early in life, investigating the association between biological factors and disruptive behaviors in children and adolescents are important and are emphasized on in the recent years. Baseline cortisol level seems to be a valuable biological marker of individuals with Disruptive Behavior Disorder (DBD). This study examined the effect of parent training on salivary cortisol levels of children with DBD.

Saliva samples were assayed to determine cortisol levels in nineteen clinic-referred children with DBD (aged 8 through 13 years) before and after an eight-session parent training program. Children's disruptive behaviors were assessed by Child Behavior Check List before and after the intervention.

Children's salivary cortisol increased significantly after parent training sessions. Children with DBD who had lower basal cortisol levels had more severe disruptive behaviors and a better response to intervention by parent training as assessed by changes in cortisol levels and disruptive behaviour scores. However, post-interventional reduction of disruptive behaviors and increase in cortisol level was significant for all levels of baseline cortisol.

Parent training is an effective method for behavioral modification in DBD. Salivary cortisol may be considered a predictive factor for severity of the child or adolescent's disruptive behaviors and also for response of those behaviors to parent training.

The P2RX7 gene encoding for purinergic receptor P2X has earlier been associated with a susceptibility to anxiety and affective disorders. The aim of our present study was to investigate the association of this polymorphism with different aspects and symptom clusters of major depression.

192 inpatients diagnosed with DSM-IV major depression and bipolar I and bipolar II depression aged 21-69 years (mean=48.2±11.05) participated in our study. All participants were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS). All patients were genotyped for the P2RX7 Gln460Arg SNP (rs2230912) using PCR. Association between genotype and MADRS scores was analysed with ANOVA controlling for age and gender.

rs2230912 genotype showed a significant association with depression indicated by the total MADRS score. We also found a significant genotype effect in case of the Affective and Cognitive clusters, but not on the Somatic and Psychomotor clusters of MADRS.

We managed to confirm earlier results concerning the association of the P2RX7 rs2230912 with major depressive disorder and bipolar depression. Furthermore, we found that this association is carried by the affective and cognitive symptoms associated with depression. Our results bring us closer to decomposing depression to endophenotypes more suitable for research and also for understanding the nature of affective disorders.

This work was supported by EU-Hungarian fund, GVOP AKF 311 2004 050324/3.0, the Hungarian National fund, OTKA T048576 and Janos Bolyai Research Fellowship of the Hungarian Academy of Science.

A series of clinical studies demonstrated that QEEG prefrontal theta cordance value decreases after one week of treatment in responders to antidepressants and precedes clinical improvement. Ketamine, a non-competitive antagonist of NMDA receptors, has a unique rapid antidepressant effect but its influence on theta cordance is still unknown.

In a double-blind, cross-over, placebo-controlled experiment we studied the influence of ketamine (0.54 mg/kg) on theta cordance in a group of 20 right-handed healthy volunteers. Participants were evaluated with the Brief Psychiatric Rating Scale before infusion and after 10 and 30 min. Three EEG segments obtained at baseline and prior to BPRS examinations at 10 and 30 min after dosing were entered into spectral analyses and QEEG cordance values in theta frequency band were calculated for four regions (prefrontal, central, left and right temporal).

Ketamine infusion induced a decrease in prefrontal theta cordance at 10 (p=0.04) and 30 min (p=0.02) and a significant increase of theta cordance in central region at both time points (p=0.01). We observed no significant effect on cordance values in the left and right temporal regions.

Our data indicate that ketamine infusion immediately induces similar changes as monoaminergic-based antidepressants do gradually after a series of downstream signaling steps. The reduction in theta prefrontal cordance could serve as a marker of fast antidepressant effect of ketamine, a hypothesis that should be tested in antidepressants-refractory patients.

This study was supported by a grant of IGA MHCR NR/9330-3 and by a project of MEYS CR VZ0021620816.

Low platelet MAO-B activity has been associated with various forms of impulsive behaviour and suicidality. The present study investigated the relationship between MAO-B activity in platelets and aspects of suicidality in depressed patients and controls.

In 87 patients with affective spectrum disorders (58% suffering from a Major Depressive Episode - MDE) the potential association between platelet MAO-B activity and suicidality was examined. 59 of the patients had committed suicide attempt recently (SA - “suicide attempters”), 28 patients were acutely depressed without having shown suicidal thoughts or suicidal behaviour in the past (NA - “non suicide attempters”).

SA and NA were comparable as to their diagnoses and general demographic and psychopathological parameters. MAO-B activity did not differ between SA and NA. No systematic correlations existed between MAO-B activity and any dimensions of suicidal behaviour or psychopathology. As a single finding only a weak positive association of higher MAO-B activity in SA with a fatal intention of the suicide attempt was observed.

Our findings do not support a consistent association of platelet MAO-B activity and suicidal behaviour in general, but specific facts of suicidality might be associated.

To measure Anxiety, Depression and Qol in IBD patients through psychometric tools and correlate these results with the presence or absence of the inducible form of Heat Shock Protein 70 (HSP70i) in the histologic examination of the same patients. The HSPs are cellular proteins with ubiquitus presence in humans, known to exert cytoprotecive functions when induced under conditions of cellular stress ( heat, hypoxia, etc as well as psychophysiological stress).

The study was conducted between 2005 and 2008 in two general state hospitals in the broader area of Athens, Greece.

59 IBD patients hospitalized for the endoscopic investigation of a possible relapse of their disease participated in the study(37 UC, 21 CD, 1 Intermediate Colitis).

A cross-sectional study was conducted through administration of the inventories and the comparison of their values with the presence of HSP70i in the histologic examination of each patient.

1. a. WHOQOL-BREF;

2. b. Zung Depression Scale;

3. c. STAI (State Trait Anxiety Inventory);

4. d. Нospital Anxiety Depression Scale;

5. e. SPA-810 Antigen for HSP70i (Stressgen, Canada).

The X2 distribution for nominal data showed that the presence of the inducible form of HSP70 in the lymphoid tissue, the neutrophiles and the monocytes of IBD patients’ histologic examination is not the same (not homogeneous) regarding depression, anxiety and quality of life, suggesting its possible psychosomatic character (X2>6.635,d.f.=1,p< 0.01).