Our cases suggest that bipolar OCD has episodic course, treatment resistant symtomatology, high family loading and high frequency of recurrence.

Following resolution of acute symptoms (manic and depressed), most patients with bipolar disorder experience affective recurrences and residual functional impairment. This indicates a need for a treatment that not only manages the acute phase of illness but also maintains the stabilized patient.

Data are presented to support the effectiveness of quetiapine in: managing the acutely ill patient; maintaining the euthymic patient by preventing mood event recurrence; and improving patient-perceived functioning.

Quetiapine monotherapy demonstrates efficacy against mania symptoms as early as Day 4 (Trials 104 and 105 [pooled datasets]; P< 0.05 vs placebo) and Week 1 in bipolar depression (BOLDER and EMBOLDEN [pooled datasets]; P< 0.001 vs placebo). The acute antidepressive effect was significant for both bipolar I and II populations. As continuation therapy in bipolar depression, quetiapine is associated with a significant reduction in the risk of depressive mood event recurrence (EMBOLDEN I and II; P< 0.001 vs placebo). Moreover, quetiapine significantly reduces the risk of recurrence of mania or depression events as an adjunct to lithium or divalproex (Trials 126 and 127; P< 0.0001), and as monotherapy (Trial 144; P< 0.001). Quetiapine is generally well tolerated in all phases.

Quetiapine fulfills mood stabilization criteria by demonstrating efficacy in all phases of bipolar disorder. To date, quetiapine is the only treatment to show robust efficacy against both poles of bipolar disorder, without causing an excess shift to the opposite pole, and to prevent mood episode recurrence irrespective of the index episode.Supported by funding from AstraZeneca Pharmaceuticals LP.

To evaluate the 12-months prospective evolution of metabolic and cardiovascular risk factors in patients with types I or II Bipolar Disorder (BD) in Spain.

The BIMET study is a 12-month, prospective, multicentre, naturalistic study which enrolled patients with type I or II BD according to DSM-IV TR criteria. Fasting blood levels of glucose, total, HDL, LDL cholesterol and triglycerides as well as weight, height, waist circumference and blood pressure were recorded. The National Cholesterol Educational Program (NCEP)-ATP III definition was applied to consider presence of metabolic syndrome (MS).

A total of 524 patients were enrolled; 73% type I and 27% type II. 61.9% women, mean age 46.3 years. 28.4% of subjects work regularly. Smokers were 42.2%, 15.1% had a substance abuse history, 34.2% were obese according with WHO criteria (obesity class I; 23.2%, class II; 7.5%, and class III; 3.5%) and overweight was found in 37.4% of sample. Prevalence of diabetes was 7.3%, hypertension was present in 24.7%, 18.5% had cholesterol ≥240 mg/dL and 36.2% had triglycerides ≥150 mg/dL. Overall prevalence of MS was 27.0% (95% CI: 22.7%-31.3%), with 27.3% (22.2%-32.3%) in type I BD and 27.1% (19.0%-36.6%) in type II (p=0.973).

The prevalence of metabolic syndrome in type I / II BD patients was considerably higher than in the general population. As an excess of mortality due to metabolic and cardiovascular reasons pointed out in these patients, it is recommended a close clinical monitoring of such parameters in the routine medical practice.

To estimate the 10-years coronary heart disease and cardiovascular mortality risks in a Spanish population of bipolar disorder (BD) patients.

BIMET study is a 12-month, prospective, multicentre, naturalistic study which enrolled type I or II BD patients according to DSM-IV TR criteria. A fasting blood sample was drawn to evaluate glucose, total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Weight, height, waist circumference at the umbilicus and blood pressure were also recorded. Framinghan and SCORE functions were used to calculate the 10-year risk for coronary hearth disease or cardiovascular death respectively.

A total of 320 and 417 patients, mean age 46.3 (13.0) years, were included for the Framingham and SCORE calculations respectively. The overall mean (standard deviation) risk for coronary heart disease was 7.3% (7.8) according to Framingham algorithm, with 6.3% of patients classified as having a high risk of coronary disease (Framingham higher than 10%). The mean overall risk for cardiovascular mortality was 1.2% (2.4) according to SCORE algorithm, with 6.5% of patients falling within the high cardiovascular mortality risk segment; SCORE higher than 5%. No statistically significant differences were observed between type I and II patients.

This study reflects a substantial risk for cardiovascular events or mortality in a Spanish cohort of bipolar disorder patients. Results were comparable to those seen in subject with schizophrenia spectrum disorders. Therefore, an effort for controlling all cardiovascular risk factors in bipolar disorder patients should be carried out by clinicians and health decision makers.

Bipolar disorder is a chronic, recurrent and debilitating mood disorder with a major impact on several aspects of everyday life. Although pharmacotherapy plays a central role in bipolar disorder treatment, psychosocial interventions are essential to a more complete and successful treatment.

To present a psychoeducation program for bipolar patients runned in a Portuguese psychiatric hospital - Hospital de Magalhães Lemos, Oporto. To review the impact of psychoeducative measures on bipolar patients.

A psychoeducative program for bipolar patients was developed and adapted, based on the Barcelona Bipolar Disorders Program"s experience. The psychoeducative program was applied to bipolar patients as an adjuvant of maintenance treatment.

Fifteen sessions were runned during 15 weeks. Twelve patients were recruited to integrate the psychoeducative group. The sessions addressed several topics including information about the illness, early detection of prodromal symptoms and symptoms management, stress management and the importance of maintaining routines.

The best treatment available for patients with bipolar disorder includes, along with the pharmacological treatment, psychosocial interventions aimed to target issues as early identification of prodromal symptoms, coping skills, medication adherence and understanding of the disorder. This broader approach of bipolar disorder treatment has proved to be efficient in reducing relapse rates, and improving patients’ feelings of self-efficacy and quality of life.

Recent studies have suggested that functional impairment in bipolar disorder may be strongly associated with residual depressive symptoms. However, there is a notable disparity between functional recovery and symptomatic recovery. This study was carried out to investigate clinical factors as potential predictors on functional impairment in a well defined euthymic bipolar sample.

Seventy-one patients were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. A Structured Clinical Interview for DSM-IV-TR, HAM-D and YMRS were used to diagnostic assessment and euthymia criteria. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment. The FAST is a reliable and valid, interview-administered scale, rapid and easy to apply (3-6 min). It consists of 24 items which allow to assess six specific areas of functioning such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time.

The sample comprised 36 (51%) men, aged 48±13.56 years. Several clinical variables were associated with poor functioning on a linear regression model, such as age, depressive symptoms, number of previous mixed episodes and number of previous hospitalizations. This model explained 44% of the variance (F=12.54, df=58, p< 0.001).

In this study, specific clinical and socio-demographic characteristics were identified as predictors of functional impairment in remitted bipolar patients. Poor functioning was identified in patients with older age and more severe illness course.

Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are omega-3 polyunsaturated fatty acids (ω-3 PUFAs) involved in the structure and function of cell membranes in the brain. Because both compounds must be obtained from diet, by eating oily fish or fish oil, the consumption of fish or supplements of omega-3 could be correlated with neuropsychiatric disorders, as depression disorder.

Search of relevant studies in Scirus database.

Epidemiological studies suggest that populations with high consumption of fish have low annual prevalence of major depression. Laboratorial research verified that major depression in acute coronary syndrome patients is associated with significantly lower plasma levels of ω-3 PUFAs, in particular of DHA; red blood cells membrane levels of total ω-3 PUFAs and of DHA are significantly lower in depressive patients; low plasma concentrations of DHA predict low concentrations of 5-hydroxyindolacetic acid, a marker of brain serotonin turnover, which, in turn, is strongly associated with depression and suicide. Clinical trials demonstrated the efficiency of EPA in the alleviating the symptoms of major depression in adults, childhood depression and postpartum depression.

Although the depression appears to be related with low levels of DHA in plasma and blood cells, controlled trials have found no effect of DHA supplementation in depression. On the contrry, EPA might have an adjunctive therapeutic value in the treatment of depression disorder. Much research is required to compare the effectiveness of the different fatty acids in the treatment of depressive disorder, as well as the relevant dose-response curves.

Although a relationship between experience of problematic life events and suicidal behaviour has been recognized during last decades, few studies of life events have been realized among depressive adults.

The aim of this study was to determine the correlations between life events and suicidal attempts among depressive adult patients.

Eighty adult outpatients were recruited from the psychiatric department of Farhat Hached hospital of sousse (in Tunisia). All patients were followed up for a Major Depressive Disorder (MDD) according to the DSM IV criteria. They also were in remission for at least four weeks. For life events we used the EVE scale of Ferreri which permitted to assess event nature, event number and patient strategies in front of stressful life events.

The gender ratio of the sample was 1.35 and the mean age was 44.4 ± 12.9 years.

Twenty five percent of the sample have committed at least one suicidal attempt.

Suicidal attempts were positively correlated with the total number of life events (p = 0.001), the number of early life events (p = 0.024) and the number of stressful life events (p < 0.001). Patients with a history of suicidal attempts were more likely to cope negatively with life events (p < 0.001).

To prevent suicide, psychotherapies focusing on stress coping could be a good therapeutic alternative among patients with MDD.

Fibromyalgia is an entity that affects approximately 2% of the population, mainly women.

According to many studies, approximately half of women with fibromyalgia have a history of traumatic events during childhood or adulthood.

Affective disorders before and after fibromyalgia diagnosis are particularly frequent.

Comprehensive review of the scientific literature (Medline, Psychoinfo, Medex) on psychiatric comorbidity in women diagnosed with fibromyalgia published over the last three years.

40-60% of women diagnosed with fibromyalgia report sexual abuse during childhood or adulthood; A higher percentage of women (over 70%) report other kinds of physical or emotional trauma.

Fibromyalgia has been linked to mood disorders in 50-70% of patients. More precisely, it appears in combination with major depression in 20% of cases. To a lesser but still noteworthy extent, women with fibromyalgia are also diagnosed with dysthymia, anxiety disorders, phobias or panic disorders.

Despite the common characteristics of these patients there is no such thing as a “fibromyalgic personality”.

As for comorbidity, mood disorders are highly prevalent, more specifically depression, even though no direct relationship has been established between them. Fibromyalgia symptoms are more acute in patients with comorbid psychiatric disorders.

Previous studies demonstrated predictive effect of reduction of prefrontal cordance for non-resistant outpatients or resistant inpatients treated by various antidepressants or venlafaxine. The aim of the present study was to examine whether the reduction of theta prefrontal QEEG cordance value after 1 week of bupropion administration is associated with response to 4 weeks treatment in patients with resistant depressive disorder. We extended our previous pilot data.

We analyzed 18 inpatients, who finished 4-week treatment with venlafaxine. EEG data were monitored at baseline and after 1 week of treatment. QEEG cordance was computed at 3 frontal electrodes in theta frequency band. Depressive symptoms were assessed using Montgomery-Åsberg Depression Rating Scale (MADRS).

Nine of 11 responders (reduction of MADRS ≥50%) and no one of 7 non-responders decreased prefrontal QEEG cordance value after the first week of treatment. Positive and negative predictive value (PPV, NPV) of cordance reduction for response to treatment was 1.0 (95% CI, 0.8-1.0) and 0.78 (95% CI, 0.57-0.78), respectively.

Based on our results, the prefrontal QEEG cordance might be helpful in the prediction of the response to bupropion treatment in resistant patients.

This study was supported by a grant from Internal Grant Agency of Ministry of Health of Czech Republic No. NR/9330-3 and a grant from Ministry of Health of Czech Republic MZ0PCP2005.

To examine the psychometric properties and test-theoretical quality of the German version of the Centre for Epidemiological Studies Depression Scale for Children (CES-DC), a 20 items comprising screening instrument which measures the frequency of parent- and self-reported depressive symptoms in children and adolescents.

Using a population-based, representative sample of N=2.863 7 to 17 year old German children and adolescents, factorial validity by means of linear structural modelling, cross-sectional coefficients of reliability, inter-rater agreement and normative scores are determined.

In a population-based German sample, the 4-factor version of the CES-DC following Radloff (1977) is considered to have good factorial validity and stability across age and informant version. The main problems of the questionnaire are the high difficulties of the items, strong floor effects of the scales and low cross-sectional reliability, which is just acceptable for screening purposes. The low inter-rater agreement indicate that parental assessment can replace self-assessment only to a limited degree.

The strengths and weaknesses of the CES-DC are discussed taking into consideration previous data and comparable tests. Particular advantages are the existence of the parent report form and the adult version, as well as its multifactorial structure. Parental assessment should be supplemented by self-report data whenever possible.

Worldwide data are extensively lacking in regard to patients with depressive symptoms under therapy with antidepressants in the primary care setting. We hypothesized that the magnitude of pain reduction under treatment with venlafaxine differently relates to regional origin of patients.

We conducted a prospective naturalistic observational trial on 420 pain sufferers with depressive symptoms from all over Switzerland who were treated with venlafaxine by 122 physicians in primary care. Previous and additional antidepressant medication was not taken into account. Physicians rated illness severity using the Clinical Global Impression severity scale and pain intensity by means of visual analogue scales.

Compared with Middle European patients (ME), those from Eastern Europe (EE), and Southern Europe (SE) were younger and presented more intense overall pain mainly affecting the head, extremities and back. In addition, SE patients suffered more intense thoracic pain than ME patients, and EE patients suffered less frequently from abdominal pain compared to their ME and SE counterparts. Furthermore, 3 months after study entry, ME patients were found to profit more from treatment with venlafaxine in terms of overall illness severity and pain intensity than patients from EE and SE.

Excessive pain perception may lead to unnecessary diagnostic testing or invasive procedures to result in iatrogenic complications and prolonged disability. Naturalistic studies on depressed patients with chronic pain investigating the impact of medical speciality on treatment outcome in a primary care setting are lacking.

In this observational study, we examined whether the magnitude of pain reduction in 444 depressed patients under venlafaxine would differently relate to the medical speciality of the 122 treating physicians, namely psychiatrists (n=110 patients), general practitioners (n=236 patients), and internists (n=98 patients).

Independent of demographic factors, comorbidity, severity of pain and illness at study entry, and the duration of pain and depression, patients seemed to profit significantly less in terms of pain reduction (p< .001) and of reduction in severity of their illness by psychiatrists as compared to general practitioners (p< .019) and internists (p< .002).

Document the healthcare resource utilization and costs by severity for persons in the workforce with major depressive disorder (MDD).

Using the National Comorbidity Survey-Replication data, workforce respondents (n=4,465) were categorized by clinical severity (not clinically depressed, mild, moderate, severe) using standard scales (CIDI/QIDS-SR). Outcomes measured over 12 months included prevalence of medical services/antidepressant use, average number of visits and days on antidepressants, prevalence of treatment adequacy, and medical/drug costs. Costs represent insurer payments to providers and were estimated by weighting utilization measures by unit costs obtained for similar services used by depressed patients in a U.S. employer claims database for the corresponding period (2000-2001). Outcomes were compared across depression severity groups using multivariate analyses adjusting for demographics.

Among the 539 depressed workforce respondents, 13.8% were mildly, 38.5% moderately and 47.7% severely depressed. A significant association existed between severity and prevalence of mental health services usage (19.1%, 27.2%, and 40.3% respectively, p< 0.01) and average number of mental health practitioner visits. The use of antidepressants increased with depression severity (21.1%, 27.3%, and 39.5% respectively, p< 0.01). Similarly, the adequacy of mental health services increased with depression severity (6.2%, 11.8%, and 21.3% respectively, p< 0.05). Average 12-month costs per MDD patient were substantially higher for severe vs. mild (mental health services: $697 vs. $388; general medical services: $138 vs. $53; anti-depressant usage $256 vs. $88).

Among workforce respondents, there was a significant association between depression severity and treatment usage and costs, and between treatment adequacy and severity.

Emotional intelligence is the measure of the comprehension of one's emotional state and the capability to manage emotions, to recognize emotions in others and to react to those emotions appropriately (Salovey & Mayer, 1990).

In previous studies a strong correlation was found between low emotional intelligence and depression. (e.g.,Berrocal, Alcaide, Extremera, & Pizarro, 2006).

Since antidepressants attempt to solve depression by numbing patients’ emotions and making the emotions more controllable (Arce et al, 2008; Davison, 2005), it was our hypothesis that antidepressants will lower emotional intelligence.

A package of questionnaires was distributed to 195 undergraduate students. Included in the package was a questionnaire asking subjects whether depressed, and were they taking antidepressants. Also included were the SCL-90 used to assess emotional distress (Derogatis,1985), the Beck Depression Inventory used to assess level of depression (Beck, 1981), and the Schutte Emotional Intelligence Scale used to evaluate level of emotional intelligence.

The results not only agreed with the findings of previous research linking low levels of emotional intelligence to depression, but also supported the hypothesis that the use of antidepressants would be linked to lower levels of emotional intelligence (r (191)= -.158, p< .029) This is a powerful finding, considering that the sample size was rather small. Only about 15% of the sample reported being prescribed antidepressants to treat their depression.

The results of this study suggest that taking antidepressants as a form of treatment for depression might impact negatively on patients’ ability to handle their emotions.