Studies from Pakistan reveal a high prevalence of depression in women. Evidence based and effective treatments are available, yet there is a significant gap between the number of women in need of treatment for depression and those who receive the services. This qualitative study identifies the barriers in access to mental health services for women with depression in Karachi from key informants' perspectives.

19 key-informant interviews were conducted with psychiatrists, psychologists, general health practitioners, pharmaceutical representatives, a government health department official and NGO workers working on women health issues.

Key-informants reported lack of awareness, misconceptions, self-medication, being young and unmarried and financial status as barriers for women in accessing mental health services. In addition, provider's lack of medical education about depression, mismanagement of cases by GPs, opposing mental health care and lack of referral system are also considered barriers to mental health services. Larger societal issues are stigma, gender bias, as well as poor resource allocation and management.

Key-informants considered women's education, mental health literacy and referrals as facilitators for women.

The study highlights the need for multipronged and multi-sector approach for increasing the access to mental health services for women in an urban context of developing country where mental health services are present but not accessed by women.

Study of clinical and social-psychological aspects of mental disorders associated with somatic diseases with distinguishing the basic pathogenetic factors and development of stepwise therapeutic programs.

Analyzed material – persons seeking for psychiatric help at primary care units on eastern frontier territories of Kazakhstan and Russia. Factorial analysis has identified the most significant factors (somatic-vegetative, psychopathological syndromes, somatic pathology, age peculiarities) in formation of combined mental and somatic diseases. With account for specifics of the contingent of patients, age structure, therapeutic-diagnostic complex of general primary care units, stepwise rehabilitative programs have been developed.

Basic stages of therapy have been distinguished: initial, basic and maintenance. Rehabilitative programs have been developed and introduced: for patients with neurotic disorders, organic mental disorders, personality disorders, affective disorders, alcohol dependence, and separately for persons of younger and elder age. Basic principles of rendering of medical assistance have been structured: complexity, sufficiency, individual-differentiated approach, continuity, cooperativeness.

Use of base of general somatic primary care units, integrative approach during rendering of specialized psychiatric assistance to patients with mental disorders appeared to be most effective and lesser economically expensive as compared with institutional assistance at a profile institution.

Nowadays, numerous definitions of placebo and the placebo effect have been proposed. Mechanisms of action have been intensely studied and interesting theories have emerged. It is well-known that the effects of the drugs are influenced by the clinical setting. The complexity of human mind and the social context make the patient highly suggestible to (auto)suggestion.

To assess factors influencing placebo effect in Romanian patients with mental disorders.

We present 5 clinical cases from our medical practice and compare them to cases from medical literature: 68 years old woman, psychiatric inpatient complaining of insomnia, with medically treated hypertension; 65 years old woman, neurological inpatient complaining of severe back pains that were neurologically uncommon, but impaired her walking and caused sleep disturbances and were not alleviated by a complex and combined analgesic pharmacotherapy; 70 years old woman, known for doctor shopping, came at the Neurology Emergency Department at 1:30 am for headache, foot burns, and abnormal gait; 48 years old man, psychiatric inpatient complaining of ‘paralyzed bowels”, ‘pain in the legs”, and ‘paralyzed muscles” after undergoing a surgical intervention for an abdominal hernia; 50 years old woman, inpatient suffering from schizophrenia at a Chronic Psychiatric Disorders Department, often complaining of headaches. Patients received different forms of placebo therapy.

All patients were placebo-responders. We noticed decrease of placebo effect in some patients in chronic use, and spectacular amelioration of symptoms when there was a high rate of allegiance.

Allegiance is an important factor for placebo effect.

The relationship between mental illness and travel can take many aspects. Travel may be underpinned by a psychiatric disorder out, reveal it or precipitate its decompensation.

The target of our study is to describe the sociodemographic and clinical characteristics of patients hospitalized in the psychiatric department E of the razi hospital during a cross-border travel and clarify the relationship between mental illness and travel.

We have conducted a retrospective study including all patients hospitalized in the psychiatric department E of the razi hospital from January 2004 to September 2014, during a cross-border trip.

Data was collected through a predetermined form, exploring the socio-demographic and anamnestic patient parameters, trip characteristics, and finally clinical and evolutionary data of the disorder.

Our population consists of 12 patients, 83% are male. The average age of patients is 41 years.

In our study, the majority of patients were followed by a psychiatrist. The admission mode of our patients was 80% without their consent. 72, 2% of patients were smokers, 63, 6% drinks alcohol regularly, and 9% used cannabis.

In our study, the beginning of troubles came before the trip in 5 cases. This is assuming the existence of a pathological travel in these cases.

Our patients had essentially psychotic disorders, mood disorders and related substance use disorders. These disturbances were precipitated by the travel in 7 cases out of 12. Thus, anticipating changes and preparing the necessary adjustments could help to reduce the risk of decompensation.

The relationship between basic educational skills andpsychological characteristics in Roma is not fully explored.

This study examined the potential association amongbasic skills of reading and writing and psychopathology, shame, hostility andanxiety as trait in Romani community members.

To test the link between basic school skills and psychologicalcharacteristics in Roma citizenships in Greece.

In this study 361 Roma residents in region of Greece were participated. The sample consisted of 125 men and 236women with mean age 34 years (SD = 13, ranged 18-73)The participants completed:a) question for the recording of social-demographic characteristics a) The Symptom Checklist-90-Revised, b) The Other as Shamer Scale, c) The Experience of Shame Scale, d) The Hostility and Direction of Hostility Questionnaire, and e) The State-Trait Anxiety Inventory.

One hundred thirty two out of361 Roma have the skill of reading while 131 out of those have the ability towriting. There were no statistical significant differences between the twosexes (reading p=.094 and writing p=.127) We did not found any significantassociations among the skill of reading and the psychological characteristicsthat investigated in the present study, by using general linear models (MANCOVA). Regardingskills of writing statistical significant associations were found in terms ofdepression (p=?<?.05) and trait anxiety (p?<?.05).

The analysis of Roma education related to theirpsychological profile is important, as it tries to reveal the ambivalence ofthe psychological situation in which the Gypsies may exist.

Paranormal believes are prevalent in general population, and it may interfere with compliance medication.

Level of Paranormal believes and medication adherence in patient with depression.

To know the level of paranormal belive, and its relationship with sociodemographic & clinical variables and medication adherence in patient with depression.

Fifty seven patients with depression in remission were recruited as perselection criteria and assessed with sociodemographic proforma, Revised Paranormal Belief Scale (BPBS) and Morisky Medication Adherence Scale (MMAS).

Statistically significant correlation was observered for traditional religious belief with marital status (P<.01), knowledge about illness (P<.001), family history of mental illness(p<.05) and knowledgeof treatment option(p<.001). Psi had a similar correlation with a family history of mental illness (p<.001), while witchcraft with family history of mental illness (p<. 05) and knowledge of treatment option (p<.001). Spiritualism subscale also had a correlation with religion (p<.001) and family history of mental illness (p<.05), while precognition found to have correlation with marital status (p<.05), family history of mental illness (p<.05) and method of treatment sought before (p<.05). Total score of MMAS had a significant correlation with subscale spirituality (p<.05) and Psi (p<.05) of BPBS.

Based on this finding it may be concluded that paranormal belief vary with demographic and clinical variable, while medication adherence may vary with levelof sipirituality and Psi.

The shift to the online world supported by parents who actively encourage children to remain in the home; and typically justify the purchase of new technologies because of the danger of outside spaces as well as the educational role they are expected to play. The prevalence of social networking sites has certain implications for identity .

Determining the dominance of social networking sites (which largely of course means Facebook and Twitter at present) in the lives of the majority of teenagers which involve them dealing with three key public elements – profiles, friends and comments – which all have implications for the performance of identity.

Explaining the ways to reduce the effects of social networks on the identity crisis of youths.

The study was carried out on 150 boys and 100 girls from 11 to 15 years of age studying in schools, in Hamedan. In the 4 months of October to January,2013, the students were asked to write the summary of subjects they communicate online and the time they spent averagely online.

70% of boys exchanged songs and videoclips and photos related to sports and cinema actors of which 40% were abnormal. 40% of girls exchanged fashion and songs. Only 20% of both sexes talked about their school subjects online.

Social phobia has driven children to have a hidden identity to let them enter virtual world which can destroy their natural and real identity. It is necessary to construct special chatrooms for students to get involved in scientific and social affairs freely.

Exhaustive literature is available in the portrayal of mental illness in the English language films. However no major studies are available around the portrayal of mental health in Bollywood movies which in fact is consumed by nearly 25-30% of the world population.

in the era of unprecedented growth in visual medium, we wish to study the portrayal of mental illness in Bollywood cinema and how effective this medium is to create awareness around mental health and stigma.

Literature search with a specific purpose to identify any available literature on mental illness in South Asian cinema was undertaken. to create a synthesis of portrayal of mental illness, its impact on cultural consumption with its advantages and deficiencies. This was followed by a listing a cluster reviews of Bollywood films that have characters with mental health problems to identify how these illustrate both the condition and reactions to them.

These findings were compared with the literature surrounding mental health and the Indian culture to show if the perceptions correlate. The information was collated to see any patterns and 6 such patterns were identified.

Results

Recognising these motifs are crucial for public and clinician alike in contact with the population open to the influence of these films to not only understand the phenomenology of mental illness in this populace but also some of unique cultural factors, medication, stigma and charting out appropriate management plan. (On-going)

The details of the synthetic factors will be presented in the results and discussion.

The success of treatment of depression in rural Sri Lanka is under-assessed. Given the limited facilities, social stigma associated with mental illness and cultural beliefs, clinic attendance and treatment compliance was expected to be poor

To ascertain the default rates of patients treated for depression

This study was conducted at the psychiatry unit of the Provincial General Hospital, Ratnapura, Sri Lanka. All newly diagnosed patients with depression (with ICD 10 criteria) over a 4 month period were enrolled in to the study and were followed up for further 6 months. Each patient had their socio-demographic details recorded at the beginning. They were followed up at monthly intervals for 6 months and treatment response was assessed. At the end, statistical correlations between socio-demographic factors and defaulting were assessed.

Fifty patients (n-50) diagnosed with depression were recruited and the overall default rate was 70% (33). Of those who were lost to follow up, 19 (57.6%) only came for the initial visit and the rest did not come beyond a maximum of three monthly visits. On assessing correlations to defaulting; gender, monthly income, relationship status, being employed, severity of depression and living closer to hospital (less than 30 km) did not show a significant association with defaulting (chi square test, p>0.05).

Cultural beliefs and social stigma were not assessed in this study and may contribute significantly to high default rates. Identification of contributory factors to high default rates is urgently needed to improve treatment success in depression.

Psychopathological and biological markers that predict response to antidepressant drugs that selectively increase serotonin and/or chatecholaminergic neurotransmission will considerably increase the effects of currently available treatment options.

Comparison of tryptophan depletion (TD) and catecholamine depletion (CD) regarding the pathogenesis of depressive symptoms.

To elucidate the differential symptomatology and neurocircuitry in response to reductions in serotonergic and catecholaminergic neurotransmission in subjects at high risk of depression.

Using identical neuroimaging procedures with [18F] fluorodeoxyglucose positron emission tomography after TD and CD, subjects with remitted depression were compared to healthy controls in a double-blind, randomized, crossover design.

While TD induced significantly more depressed mood, sadness and hopelessness than CD, CD induced more inactivity, concentration difficulties, lassitude and somatic anxiety than TD.CD specifically increased glucose metabolism in the bilateral ventral striatum and decreased glucose metabolism in the bilateral orbitofrontal cortex, whereas TD led to a specific increase in glucose metabolism in the right prefrontal cortex and in the PCC. While we found direct associations between changes in brain metabolism and induced depressive symptoms following CD, the relationship between neural activity and symptoms was less clear after TD.

This study showed that serotonin and catecholamines play common and differential roles in the pathophysiology of depression. Thus, the development of psychopathological and neuronal markers predicting response to selective monoamine inhibition is feasible, and current efforts to develop antidepressants with dual and triple reuptake inhibition (serotonin, norepinephrine, dopamine) are supported by this study.

Previous studies on depression reporting expert survey results have focused primarily on symptomatology (Cheung et al., 2007) or used a narrow selection of experts, e.g. only clinicians or social workers (Collimore Rector, 2014; Caan et al., 2006). The current study is the first to explore the whole range of interventions and psychosocial difficulties (PSDs) in depression, combining information from psychologists, psychiatrists, nurses, social workers and primary health care doctors.

The general objective of the ongoing project (part of <a href="http://www.maratoneproject.eu/">www.maratoneproject.eu</a>) is to provide comprehensive clinical recommendations on available interventions for PSDs in depression by means of a multi-informant approach.

This particular study aims to go beyond symptomatology and gather expert perspective on interventions for improving a wide range of PSDs in depression where literature might be scant.

The online survey will be available in 2015. Experts will rank the efficacy of existing interventions, specify the treatments effective for particular PSDs and report the determinants of efficacy according to their expertise. PSDs definition is based on World Health Organization's International Classification of Functioning, Disability and Health (ICF).

Preliminary results and expert data will be shown. We intend to attract part of our pool of experts during the 23^rd European Congress of Psychiatry.

Worldwide experts in the field of depression are invited to take part in this online survey. The future course planned out by literature focuses on potential personalization of interventions; therefore the current study is an excellent starting point in this direction.

Depression is an alarming burden in India causing substantial disability and cost to society. Recognizing depression is difficult because patients present predominantly with somatic symptoms or because attention is primarily focused on the co-morbid physical disorder. The cases of depression presenting in primary-care settings are either not identified or treated with inappropriate drugs or inadequate doses of anti-depressants.

To analyze current level of intervention done by non-psychiatrists to detect and manage depression in patients with chronic medical illnesses.

A panel of nine specialists (Cardiologists, Neurologists, Endocrinologists and Psychiatrists) discussed current Indian scenario of management of co-morbid depression by non-psychiatrists.

The panel agreed that

• Prevalence of co-morbid depression in India is not well-documented except for few regional studies.

• It is frequently witnessed but is hardly recognized or managed as a concurrent disease.

• There is a need to differentiate between depressive 'feeling” and 'disease”.

• The clinicians should increase duration of history-taking to include questions like, 'Do you feel sad/low? Are you disinterested?” in suspected cases.

• There is a need for developing Indian consensus to identify co-morbid depression, to decide when to start an antidepressant drug, in what dosage and duration with special focus on the when to refer to a psychiatrist.

Concrete steps are required towards large-scale data generation and development of Indian consensus on the management of co-morbid depression in patients with chronic medical illnesses for the non-psychiatrists to improvise patient health outcome.

Effective preventive strategies could reduce disability and the long term social and health complications associated with depression, but options are limited. Cognitive bias modification (CBM) is a novel, simple, and safe intervention that corrects the attentional and interpretive biases associated with depression.

To determine if CBM decreases the one-year onset of major depression in adults at risk.

This randomised controlled trial will recruit adults with subsyndromal depression living in Australia (parallel design, 1:1 allocation ratio). The intervention will be delivered via the internet over 52 weeks. The primary outcome of interest is the onset of a major depression according to DSM-IV-TR criteria. Secondary outcomes of interest include change in the severity of depressive (Patient Health Questionnaire, PHQ-9) and changes in attention and interpretive biases. Outcomes will be collected 3, 6, 9 and 12 months after randomisation.

Preliminary data on a subsample of 20 participants showed that the mean±SE PHQ-9 score of controls was 7.5±0.9 at study entry and 7.1±1.5 at week 6 (paired t-test=0.29, p=0.779), whereas the mean±SE score of active CBM participants was 7.4±1.0 and 4.4±1.1, respectively (paired t=6.00, p<0.001). The mean PHQ-9 difference between control and active CBM participants over 6 weeks was 2.6±1.5 points (t=1.79, p=0.090). One of 11 controls (9.1%) and 0/9 active CBM participants showed evidence of clinically significant depressive symptoms at week 6 (i.e., PHQ-9≥15).

By March 2015, 6-months preliminary data will be available on 165 participants.

A substantial obstacle to carry out a timely diagnosis and an effective therapy of depressive disorders (DD) is their combination with other forms of pathologies. Specific difficulties occur in diagnosis and treatment of DD with comorbid other mental disorders.

The aim of the study was to investigate typologies of DD with comorbid anxious disorders, alcohol dependence, and personality disorders.

A complex of methods included clinical-psychopathological and psychometric methods with application of the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale. In the study 189 patients with DD (F32.0-F32.1) accompanied by anxious disorders (F41.0 and F41.1), personality disorders (F60.3 and F60.0), and alcohol dependence (F10.20) were examined. The control group consisted of 52 patients with DD without comorbid pathology.

It was demonstrated that patients with comorbid anxious disorders predominantly had senesthopathic-hypochondriac depression (42.9%, p<0.05) with an expressed somatization, somatic anxiety, and hypochondriac equivalents. For DD with comorbid personality disorders a clinical picture of depression was determined by a predominance of mournful (41.8%) and obsessive (32.7%) variants with anhedonia and obsessive-compulsive symptoms. Depression with comorbid alcohol dependence was characterized with a presence of asthenic-anergic (24.0%) and apathic-adynamical (21.3%) variants with expressed somatic-vegetative manifestations.

These results stipulate a necessity of using of differentiated approaches to pharmacotherapy and psychotherapy in patients with comorbid DD.