The aim of our ongoing study is to investigate the effectiveness of Zonisamide augmentation to Duloxetine in partial and non-responder patients in course of Unipolar Major Depressive Episode.

35 outpatients will be enrolled in a 12-weeks open-label study including both genders, 18 to 65 years old subjects. Unipolar Major Depressive Episode diagnosis will be performed at screening time using “Structured Clinical Interview for DSM-IV-Axis-I Disorders- Italian 1996 version” (SCID-I, First et al., 1996) and by a ≥14 total score for the “Quick Inventory of Depressive Symptomathology-Self Rated” (QIDS-SR, Rush et al., 2003). Patients will be repeatedly evaluated during the course of the study using a wide range of mood and anxiety rating scales and monitoring biomarkers such as electroretinogram b-wave amplitude, interleukins, flogosis and BDNF factors etc. At week 6, Duloxetine partial/non responders will be augmetated to Zonisamide and further evaluations of mentioned markers will be repeated. A “Fisher-test” or χ² analysis will be performed at the end of the study. Expected p will be ≤ 0,005.

We expect Zonisamide augmentation to be an effective treatment for SNRI-resistant Major Depression.

High work demands (i.e. a heavy workload, tight time pressures, conflicting work tasks) put individuals at high risk of depression. Our aim was to test whether the relationship between high work demands and depression is moderated by genetic vulnerability to depression and by work control.

Participants are members of the Dunedin Study, a 1972-73 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (96% response rate). This analysis included all participants who were employed at age 32. Depression was measured using the Diagnostic Interview Schedule. Work demands and work control were assessed in an interview. Genetic vulnerability to stress was ascertained by the serotonin transporter gene (5-HTT).

Among individuals exposed to high work demands, symptoms of depression were significantly higher among those who carried two short alleles of the 5-HTT gene (‘s/s’ group) than among ‘l’ carriers (interaction between 5-HTT gene and work demands: β=4.22, se=1.86, p=0.02). However, this gene-environment interaction was only present among those individuals who had low control over their work (interaction between 5-HTT gene and high work demands: β: 7.21, se: 2.73, p=0.009), not among those who had high work control (interaction between 5-HTT gene and high work demands: β: 1.32, se: 2.53, p=0.60).

Pending replication, the serotonin transporter gene appears to moderate the effects of high work demands on symptoms of depression. This gene-environment interaction is attenuated by high work control.

To evaluate efficacy and tolerability of quetiapine XR monotherapy in patients with MDD.

Data were analysed from two 6-week, multicentre, double-blind, placebo-controlled studies (D1448C00001, D1448C00002), prospectively designed to be pooled. Outpatients received quetiapine XR 150mg/day (n=315), 300mg/day (n=323), placebo (n=330). Primary outcome: change at Week 6 in MADRS total scores. Other assessments: MADRS individual item scores, HAM-A total scores, MADRS response and remission; AE reporting.

Quetiapine XR 150mg/day and 300mg/day reduced MADRS total scores at Week 6 (-14.7 and -14.7; p< 0.001) versus placebo (-11.1); significant reductions were also seen at Week 1 (p< 0.001).

Subgroup analyses showed the therapeutic effect of quetiapine XR was neither limited to nor driven by factors such as gender, age or depression severity.

Quetiapine XR demonstrated consistent improvements in MADRS items: both doses significantly improved 8/10 items at Week 6 versus placebo. At Week 6, MADRS response (≥50% decrease in total score) was 52.7% (p< 0.001), 49.5% (p< 0.001) versus 33.0%; MADRS remission (total score ≤10) was 33.7% (p< 0.01), 34.7% (p< 0.01) versus 24.2% for quetiapine XR 150mg/day and 300mg/day and placebo, respectively. Quetiapine XR 150mg/day and 300mg/day improved HAM-A total scores versus placebo at Week 1 (-4.6 [p< 0.01], -4.7 [p< 0.01], -3.6) and Week 6 (-8.1 [p< 0.001], -7.9 [p< 0.001], -6.2). Common AEs (≥10%) were dry mouth, sedation, somnolence, dizziness, headache and nausea with quetiapine XR.

In patients with MDD, quetiapine XR monotherapy improved a broad range of depressive symptoms, with improvements seen from Week 1. Quetiapine XR was generally well tolerated.

We have pursued the association between clinical and socio-demographic characteristics and the suicide attempts at inpatients with major depressive disorder.

We ran an historical case control study to analyse the individual characteristics associated with suicide attempts in the depression inpatients admitted into the 9th Department of the Clinical Psychiatric Hospital “Al. Obregia” between 01 January 2007 - 01 January 2008. A total of 168 subjects with major depressive disorder (MDD) were included in the study. The patients were separated into two subgroups: “S” - the group with suicide attempt as reason of the present admission into hospital and the comparative group “C” - those without a suicidal attempt at the present admission (used as control group). The two groups were compared with respect to the individual characteristics, following their possible association with the suicidal attempts risk. We used the chi-square (x2) statistic for categorical variables.

Our findings suggest that the most robust predictors of suicide attempts in depression are the younger age of the depression onset, previous psychiatric hospitalizations, low socio-economic status, “single” marital status (widowed/divorced), with no children, heredocolateral history of suicidal attempts and the comorbidity with the problematic alcohol consumption.

The risk factors associated with the suicidal attempts are useful for the screening, finding, prediction and prophylaxis of suicide attempts in major depression.

To assess the benefit and harm of exercise training in adults with clinical depression.

The DEMO trial is a randomized pragmatic trial for patients with unipolar depression. Patients with unipolar depression (n=165) were allocated to supervised strength, aerobic, or relaxation training during a four-month period. The primary outcome was the Hamilton depression scale and the secondary outcome was percentage of absence from work.

At 4 months, the strength increased in the strength group and the maximal oxygen uptake increased in the aerobic group vs. the relaxation group. At 4 months the change in HAM-D17 was -1.3 (-3.7 to 1.2; p =.3) and 0.4 (-2.0 to 2.9; p= .3) for the strength and aerobic vs. the relaxation group. At twelve months, the differences were -0.2 (-2.7 to 2.3; p = .8) and 0.6 (-1.9 to 3.1; p = .6). At twelve months, the differences in absence from work was -12.1% (-21.1 to -3.1; p = .009) and -2.7% (-11.7 to 6.2; p = .5) for the strength and aerobic vs. the relaxation group.

These findings do not suggest a biologically mediated effect of exercise on symptom severity in depressed patients, but support a beneficial effect of strength training on work capacity.

Depression is the predominant psychological disturbance in Multiple Sclerosis (MS) with lifetime prevalence around 50% and annual prevalence of 20%. Depression is commoner during relapses and may exacerbate fatigue and cognitive dysfunction. The aetiology of depression is multifactorial and likely associated with psychological stress, focal demyelinating lesions and immune dysfunction. There is no correlation between age, gender, duration of illness and sex. Unlike it was believed for the treatment with interferon β, recent side effects data from clinical trials have failed to confirm that this medication is associated with an increased risk of depression in patients with MS. Treating depression improves quality of life and improves adherence to disease-modifying drugs. Treatment with pharmacotherapy is particularly challenging given the somatic symptoms overlap between MS and depression and the increased burden of their side effects.

To demonstrate the relationship between depression and MS.

We report a case of depression in a 32 year old woman with MS, treated twice with bolus of metilprednisolone, taking interferon β at present. Her psychopathological symptoms have been sadness, terminal insomnia, anorexia, fatigue, social isolation, anhedonia, increased worry, pessimism, loss of self-esteem and suicidal ideation (not structured). The pharmacotherapy used to treat the depression was firstly fluoxetine and lately venlafaxine.

There has been an improvement on the patient's symptoms related both to the depression and to the MS.

This case demonstrates once more, the complex relationship between those two clinical entities.

The demonstration of differences in grieving process between children mourning for the parent and adults grieving for their spouse.

Sub-structured clinical interviews were given to 10 adults and 10 children using the services of the Psychiatric Hospital of Petra Olympus to evaluate their reactions and grieving process.

2 of the evaluated children had outbursts of cries during the sessions. This behavior was the same at home.

8 played the role of the ‘supportive adult’ to the grieving parent, not allowing themselves to express feelings of anger, grief, guilt, and fears. They didn't ask for support, in fear of becoming a burden to the rest of the family.

Their parents noticed changes in sleep patterns, eating habits, and behavior.

One child wasn't well-informed about the loss and didn't fully understand what had happened to the deceased.

As for parents, 8 asked and received medical support and medication,

whilst 2 started consuming alcohol. 6 were avoiding talking to their children and sharing their feelings, whereas 3 mentioned incapability to go on with their life.

Children mourn in a different way from adults. Their grief may not be easily detected.

The proper way of informing the child, the encouragement to the expression of feelings, the living memories of their late parent and the participation in the family grieving process (both for children and adults) are not causes of further stress and anxiety but lead to a better way of resolving the grieving process, offering comfort and relief.

Immigration to Spain is a recent but rapidly growing fenomena. The prevalence of psychiatric disorders in the immigrants relative to natives is an inconclusive theme, given that several studies have found contradictory results.

This study presents sociodemographic characteristics and the prevalence of mood disorders (detected with MINI) of 842 adults (411 Latinos and 431 Natives), attending primary care in the greater Barcelona metropolitan area.

Most of the sample was female (n=591; 70.2%), the mean age was 34.7 (±9.8) years, range 18-65. Significant (p< 0,001) differences were found between the two groups in: scholarization, housing, work status, income and percived social network.

The prevalence of actual major depresssive disorder (MDD) was 12.7% in the total sample, with a higer prevalence in the Latinos (n=68; 16.5%) than Natives (n=39; 9.0%); p=0.001 X2=10.57.There was no difference in total prevalences of other mood disorders between the two groups. Analysis -through logistic regression- of only those patients with complete data, (n=613; 307 Latinos and 306 Natives) showed that the probability of MDD was higer in Latinos than in Native patients (OR= 2.4; 95% CI= 1.5-4.0). After adjusting for gender and all the significantly different variables, the higer risk of MDD in Latinos disappeared (OR= 1.3; 95% CI= 0.7-2.4).

From these data we can conlude that the relation between immigrant status and depression is not direct but rather mediated by disadvantaged social conditions. In further similar studies social variables should be considered.

Five factor model of personality tends to measure basic personality structure. Some authors clam that this model is not enough to explain every psychological phenomenon and that sixth factor model is a better solution especially in prediction of psychopathology. The objective of this research is to investigate this hypothesis, whether is possible to explain psychotic symptoms in depression using the five factor model and which is a better option five or sixth model of personality in prediction depression with psychotic symptoms.

Sample consisted of 30 inpatients diagnosed depression with psychotic symptoms and 30 inpatients diagnosed depression without psychotic symptoms. Depression was assessed by ICD-X criteria and confirmed by Hamilton Rating Scale for Depression (21-item form) and by clinical scales from Milons Clinical Multiaxial Inventory (MCMI III). All the participants were administered Neo Pir (five factor model of personality-measures basic personality structure) and DELTA-9 (measures psychoticism proneness).

We found one statistically significant canonical function that discriminate two groups of depressed patients. This function shows that domains of sixth factor-psychoticisam better discriminate psychotic symptoms then dimensions from Neo Pir.

Our findings suggested that the five factor model is not enough to explain and predict psychotic features in depression and that using a new concept of psychoticisam or six factor model of personality could be a better solution in clinical setting.

Acute coronary syndromes (ACS) are a major cause of morbidity and mortality in western industrialized countries and account for disability and loss of productivity. Type D personality and depression are established psychosocial factors with a negative impact on prognosis following acute events.

We evaluated 65 patients admitted to a coronary unit with ACS regarding type D personality (DS-14), depression (BDI-II, HADS), anxiety (HADS), clinical depression (clinical interview following DSM-IV-TR criteria) and quality of life (SF-36). SPSS 12.0 was used for statistical analysis and significance considered for p< 0.05.

We found that 38.5% of patients had type D personality and divided the sample into two groups. No significant differences were found regarding social and demographic factors but differences were found regarding diagnosis on admission: type D patients had more AMI with ST elevation (p< 0.05). Type D patients had significantly higher scores in depression and anxiety scales of the HADS (p< 0.01) and worse quality of life in most SF-36 subscales (p< 0.01). There was a negative and significant correlation between the HADS and all the SF-36 subscales, strongest in the mental health subscale (p< 0.01).

Type D patients have higher indices of anxiety and depression and worse quality of life when compared with other patients, and constitute a high risk group of worse prognosis. Our results also suggest differences between groups regarding the type of acute event but these results require further confirmation.

Dissociation is traditionally attributed to trauma and other psychological stress that are linked to dissociated traumatic memories. Although recent studies regarding neuroendocrinology of traumatic dissociation are rare, they suggest possible dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. The aim of the present study is to perform examination of HPA axis functioning indexed by basal prolactin and cortisol and test their relationship to psychic and somatoform dissociative symptoms.

Clinical and laboratory study of consecutive inpatients.

Patients treated at the university hospital, Psychiatry department of Charles University in Prague.

40 consecutive inpatients with diagnosis of unipolar depression mean age 43.37 (SD=12.21).

Assessment of psychic and somatoform dissociation (DES, SDQ-20), depressive symptoms (BDI-II) and basal serum prolactin and cortisol.

Data show that prolactin and cortisol as indices of HPA axis functioning manifest significant relationship to dissociative symptoms. Main results represent highly significant correlations between psychic dissociative symptoms (DES) and serum prolactin (r=0.55, p=0.0001), and relationship between somatoform dissociation (SDQ-20) and serum cortisol (r=-0.38, p=0.008).

These results indicate relationship between HPA-axis reactivity and psychosocial stress as a function of dissociative symptoms in unipolar depressive patients that could reflect passive coping behavior and disengagement.

Pregnancy and postpartum both imply high risk for developing psychiatric disorders in women.

To study the relationship between life events (LE) and social support degree (SS) during pregnancy and depressive symptoms in early postpartum period.

A cross-sectional study of 309 consecutive Spanish women, evaluated the second day postpartum. They were all over 18 years old and have signed the informed consent. We excluded: illiteracy, cognitive impairment or severe medical illness, psychiatric disorders during pregnancy and decease of the newborn. We collected socio-demographic and obstetrical data, as well as family and personal psychiatric history, the Edinburgh Postnatal Depression Scale (EPDS), LE (Saint Paul Ramsey) and SS (DUKE-UNK).

Mean age (SD) was 31.6 (4.7). Most of women were married, had intermediated or high level of education. Sixty-one percent were primiparous. Twenty-six percent had family history and 22% had personal psychiatric history. Mean (SD) of LE was 0.95 (0.89) and of SS was 53.1 (7.6). The prevalence of depressive symptoms according to EPDS scores was 18%. This subgroup of depressed women had more psychiatric family history (p=0.046), less LE (p< 0.001) and more SS during pregnancy (p=0.048). Logistic regression analysis showed that SS was the only significant variable (OR=1.085; 95%CI=0.997-0.994; p=0.001). LE did not achieve statistical significance (OR=1.085; 95%CI=0.997-1.180; p=0.059).

Low social support degree during pregnancy is associated with depressive symptoms during immediate postpartum.

This study has been done in part with grants Instituto Carlos III: G03/184, FIS: PI04178; 05/2565.

To assess the efficacy of pharmacotherapy (citalopram) and cognitive therapy, alone or in combination for the treatment of major depressive disorder.

This study was a randomised controlled clinical trial. We randomly assigned 120 adults with a major depressive disorder to 8-week treatment with either citalopram, cognitive therapy, or both. Major depressive disorder was diagnosed using DSM-IV criteria. Patients were assessed with the Beck Depression Inventory before and after treatment.

Statistical analysis showed that cognitive therapy, pharmacotherapy, and combined therapy were effective in the treatment of depression. There was no significant difference between medication and cognitive therapy. Treatment with the cognitive therapy intervention and citalopram combined yielded better responses than treatment with citalopram or cognitive therapy alone.