To determine the efficacy of vagus nerve stimulation (VNS) for treatment of depression.

We conducted a systematic review and meta-analysis of analytical studies. Efficacy was evaluated according to severity of illness and percentage of responders.

We identified 687 references. Of these, 14 met the selection criteria and were included in the review. The meta-analysis of efficacy for uncontrolled studies showed a significant reduction in scores at the Hamilton Depression Rating Scale endpoint, and the percentage of responders was 31.8% ([23.2% to 41.8%], P<0.001). However, the randomised control trial which covered a sample of 235 patients with depression, reported no statistically significant differences between the active intervention and placebo groups (OR=1.61 [95%CI 0.72 to 3.62]; P = 0.25). To study the cause of this heterogeneity, a meta-regression was performed. The adjusted coefficient of determination (R2Adj) was 0.84, which implies that an 84% variation in effect size across the studies was explained by baseline severity of depression (P<0.0001).

Currently, insufficient data are available to describe VNS as effective in the treatment of depression. In addition, it cannot be ruled out that the positive results observed in the uncontrolled studies might have been mainly due to a placebo effect.

To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.

One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics.

Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.

In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.

Paraphilias are defined as sexually arousing fantasies, urges, or behaviors involving either nonhuman objects; suffering or humiliation of oneself or one's partner; or children or other non-consenting persons. In the DSM classification, paraphilias are subsumed under sexual disorders, while in the ICD paraphilias are classified as disorders of adult personality and behavior (disorders of sexual preference). Historically, some have advocated eliminating paraphilias or radically revising their definitions, while others suggested adhering to their traditional definitions. The classification and definition of paraphilias is complicated by cultural and societal underpinning, and the unclear boundaries between “normal” and “abnormal” sexuality. The diagnostic criteria of some paraphilias (e.g., pedophilia) are also complicated by the differences between the medical and the legal concepts of these entities. The recent attempts to introduce two new diagnoses, hypersexual disorder and paraphilic coercive disorder, into the DSM system stirred passionate scientific discussions about those two diagnoses and about paraphilias in general.

This presentation reviews the pros and cons of classifying paraphilias as sexual disorders and of including the new diagnoses of hypersexual disorder (unclear borders with “normality”) and paraphillic coercive disorder (unclear distinction between this entity and sexual sadism). In addition, this presentation reviews some of the more and/or less accepted methods of paraphilia management, such as pharmacotherapy and castration (chemical, surgical).

Several aspects of the classification and diagnosis of paraphilias remain controversial and some of the proposed changes seem unwarranted. Resolving diagnostic and management controversies could be helped by large multicenter and international field trials.

Raised rates of psychoses among ethnic minorities have been reported. Exposure to antipsychotic medications can give information on mental illness management and ethnic-related differences.

To compare exposure to antipsychotic medications in immigrant and native-born populations in Spain.

Descriptive cross-sectional study of the dispensation of antipsychotic medications to the population aged 15 to 64 years, in a Spanish Health Region during 2008.

1.9% of the native-born population was exposed to antipsychotic medications as compared to 0.4% of the immigrant population. Native-born women were exposed from 1.8 to 5.3 times more and native-born men from 3.6 to 6.3 times more than immigrants of the same gender. The least exposed were persons from Eastern Europe and men from sub-Saharan Africa. Active ingredients prescribed were similar between the two groups. Of the immigrant group, 15.7% were admitted to a psychiatric ward as compared to 6.4% of the native-born population. In the former, non-specific diagnoses were predominant.

All immigrant groups had lower exposure to antipsychotic medications, were admitted to inpatient care more often and had less specific diagnoses. Both diagnostic processes and adherence to treatment need improvement in the regional immigrant population.

Awareness of attention deficit hyperactivity disorder (ADHD) in adults has been growing over the last decade. One of the most interesting issues related to this topic is these adults’ self-awareness of their ADHD symptoms and their estimation of their own impairments. Our hypothesis while studying young adult ADHD populations was that there would be a significant difference between their self-report and their clinical assessment.

One hundred and three students volunteered for this study. In order to validate our ADHD screening questionnaire (ADHD-SQ), and to assess the level of awareness they have of their own symptoms, participants underwent a complete clinical assessment for ADHD. They were divided into a control group (n = 24), and an ADHD study group (n = 79), which in turn was composed of two sub-groups, one comprising 24 ADHD predominantly inattentive (ADHD-I) and the other 55 ADHD combined type (ADHD-C).

Factor analysis yielded two factors explaining 41% of the variance. The Inattention (IA) subscale score tended to be higher in both ADHD sub-groups as compared to the control group (6.5±2.1 vs. 2.34±2.3 with P<0.001), with no significant difference between the two ADHD sub-groups. Hyperactivity Impulsivity (HI) subscale was significantly higher for the ADHD-C sub-group than in the ADHD-I sub-group, whose score was similar to that of the control group (control: 1.6±2.1; ADHD-I: 1.55±1.0; ADHD-C: 4.5±2.6, P<0.0001). Receiver Operating Characteristics (ROC) analysis showed similar results. The area under the curve (AUC) of IA subscale score was 0.90 (95% confidence: 0.83–0.96) and for HI subscale score was 0.75, (95% confidence: 0.63–0.86). Classification into groups used a cut-off point of 3+ items out of nine, in the SQ and 6+ items out of nine in the clinical assessment. These two classifications showed 68% agreement (46% sensitivity and 95% specificity). In both ADHD sub-groups, the self-reported average number of positive symptoms per student was relatively low for both clusters; this phenomenon was pronounced in the specific subtypes. The self-rated HI cluster score was considerably low in the ADHD-C sub-group (4.5±2.6), and the IA one was particularly low in the ADHD-IADHD-I sub-group (5.9±1.9).

This study's results indicate that ADHD symptoms are under-reported for both inattentive and hyperactive-impulsive clusters, indicating that adults with ADHD tend to under-estimate their own ADHD-related impairments. We suggest that this questionnaire may be used both in research and academic settings to help counsellors and students to obtain early indication of ADHD and to refer students suspected of having ADHD to full clinical assessment.

The perinatal period is a time of high risk of relapse for women with a history of bipolar affective disorder (BPAD). We describe the pregnancy management of women with BPAD and identify risk factors for postpartum relapse.

The case records of 78 women with BPAD referred to perinatal mental health services before conception, during pregnancy or the postpartum period, between 1998 and 2009 in Birmingham UK, were screened. In women who were managed during pregnancy, those who relapsed in the postpartum were compared with those who remained well.

Forty-seven percent of women with BPAD referred in pregnancy suffered postpartum relapse. Women who were unwell at referral, younger, with unplanned pregnancy, previous perinatal episodes or a family history of BPAD were more likely to suffer postpartum illness.

Identifying risk factors for postpartum relapse enables us to individualise the estimation of a woman's risk and modify care plans accordingly. Duration of wellness prior to pregnancy is not associated with a lower risk of postpartum illness and so it is imperative that all women with BPAD receive referral in pregnancy.

To compare the treatment of patients with early psychosis, 2 years after the introduction of an integrated model of enhanced management within a public adult mental health service, with an historic cohort from the same service.

Variables examined in the 2001 cohort were compared with 2008 patients. Computer database review and a file audit were conducted for all patients with early psychosis across the first 2 years of the program.

Compared to the historic cohort, patients in the current cohort were 24% less likely to have been admitted (P = 0.004). There were statistically significant reductions in involuntary status and use of a locked unit. Rates of police involvement in admission and use of seclusion were also reduced, though this trend was not significant. Average length of stay was reduced. Median duration of untreated psychosis was 3 months in both 2001 and 2008 cohorts.

The introduction of an integrated model of management within an area mental health service for patients with early psychosis contributed to significant reductions in admissions, involuntary status and use of a locked ward. The data suggests that enhanced treatment of early psychosis patients can be offered within generic services.

Nonadherence to antipsychotic medication is highly prevalent in patients with schizophrenia and has a deleterious impact on the course of the illness. This review seeks to determine the interventions that were examined in the past decade to improve adherence rates.

The literature between 2000 and 2009 was searched for randomized controlled trials which compared a psychosocial intervention with another intervention or with treatment as usual in patients with schizophrenia.

Fifteen studies were identified, with a large heterogeneity in design, adherence measures and outcome variables. Interventions that offered more sessions during a longer period of time, and especially those with a continuous focus on adherence, seem most likely to be successful, as well as pragmatic interventions that focus on attention and memory problems. The positive effects of adapted forms of Motivational Interviewing found in earlier studies, such as compliance therapy, have not been confirmed.

Nonadherence remains a challenging problem in schizophrenia. The heterogeneity of factors related to nonadherence calls for individually tailored approaches to promote adherence. More evidence is required to determine the effects of specific interventions.

This study aimed at using latent variable modelling to explore the significantly contributing variables to functioning in schizophrenia patients.

The study cohort comprised 296 schizophrenia patients evaluated once for demographic characteristics, functioning (FROGS, SWN-K, QLS) and symptomatology (Positive and Negative Syndrome Scale [PANSS]). First exploratory multivariate analyses were conducted and then a model with functioning as a latent variable was proposed and tested with the data.

Symptomatology as negative, cognitive and excitation factor are significant predictors of functioning assessed through FROGS (P<0.0001), SWN-K and QLS (P<0.001). The model was constructed with functioning defined as a latent variable, indicators are subscores on FROGS, SWN-K, QLS and exogenous variable included symptomatology, Duration of Untreated Psychosis (DUP) and educational level.

Using the five clinical dimensions of the PANSS, (Positive, Negative, Cognitive, Anxiety/Depression and Excitation) the negative and cognitive dimensions are highly correlated via the latent variable to the three dimensions of functioning evaluated by the FROGS: “daily life”, “social functioning” and “treatment” and the QLS subscores (interpersonnal, common object, instrumental role). Educationnal level is positively linked to functioning but not DUP. The model emphasizes the need for treatment strategies that have an effect on cognitive-factors, to improve functioning in schizophrenia.

The efficiency of continuation of care (COC) treatment by inpatient caregivers as compared to treatment administered by outpatient services for “revolving door” psychiatric patients was tested in this study. Number and days of hospitalization were examined.

All patients who were hospitalized three times or more during the past 12months were offered continuing follow-up in the ward, by the same staff, instead of being referred to the outpatient department. Information on number and length of hospitalizations before and after initiation of this care model was retrieved from the hospital computerized database.

Of the 36 patients meeting the criteria, 35 patients agreed to participate. The number of hospitalizations in the 18months following the index hospitalization was 1.79±3.51 as compared to 4.67±1.79 before the index hospitalization (p = 0.0002), and the number of days of hospitalization 18months after was 24±41.65 as compared to 119.71±69.31 before (p<0.0001).

COC via inpatient follow-up significantly reduces the number and length of hospitalizations in “revolving door” psychiatric patients as compared to the traditional system of follow-up in an outpatient clinic.

Lower participation rates of ethnic minorities in health research studies and potential participation barriers are commonly reported.

Four semi-structured focus groups of individuals with Turkish migration backgrounds living in Germany were conducted to identify potential participation barriers. Documented statements and superscripted presentation cards by the participants were evaluated with a qualitative content analysis.

The following eight potential reasons for the lower participation rates were identified: role of women, lack of knowledge, lack of interest, German-Turkish interactions, mistrust, anxiety, data privacy protection and benefits of the study. Additionally, the following recruitment strategies to enhance participation rates were found: public relations, especially word-of-mouth promotion and contacting Turkish key figures, (non-) tangible incentives and trust building through transparent communication of the project and its conditions.

The findings provide a wide range of potential participation barriers and implications that should be considered to enhance the participation rates of minority populations.

The willingness to participate in health research studies can be increased through particular efforts, which should be tailored to the recruitment of the underrepresented target population.