To assess the budget impact of the inclusion of quetiapine vs. aripiprazole or olanzapine on the top of standard bipolar disorder treatment scheme with atypical antipsychotics according to Russian healthcare system.

The 1 year budget impact analysis was conducted. Direct expenses associated with bipolar disorder and resulting follow-up costs were calculated using general tariff agreement of Russian obligatory insurance system and official national statistics. For reference, accepted exchange rate was 1 EUR = 40 RUB.

Quetiapine inclusion into the standard bipolar disorder therapy provided cost saving benefits vs. inclusion of aripiprazole or olanzapine in the bipolar disorder standard therapy scheme. Total healthcare costs of bipolar disorder therapy were approximately 396 539 RUB (9 913 EUR) per patient in quetiapine group, 1 023 089 RUB (25 577 EUR) per patient in aripiprazole group and 557 222 RUB (13 931 EUR) per patient in olanzapine group within one year. Treatment of bipolar disorder using standard therapy with quetiapine inclusion compared to one with aripiprazole or olanzapine leads to cost savings of 626 551 RUB (15 664 EUR) or 160 683 RUB (4 017 EUR) per patient-year, respectively.

The results of budget impact analysis illustrate that including quetiapine into the standard therapy of bipolar disorder in comparison with aripiprazole or olanzapine has potential to reduce Russian healthcare system total costs for bipolar disorder treatment.

There is substantial evidence that patients with schizophrenia present with impaired Theory of Mind (ToM). ToM impairment has been also reported in euthymic bipolar disorder (BD). However, data from direct comparisons of patients with schizophrenia and BD on ToM abilities are limited.

It has been suggested that different aspects of mentalizing processing, such as epistemic and emotional mental representations, i.e. cognitive and affective ToM, must be separately examined.

The aim of the study was to compare ToM ability and both its cognitive and affective components between schizophrenic and euthymic BD patients.

Fifty three BD type I euthymic patients, 54 patients with schizophrenia and 53 healthy controls (HC) completed a multi-facet battery of ToM tasks, including False belief task, Hinting task and Faux Pas Recognition Test (FP). Besides the overall ability to recognize Faux Pas, two specific components of ToM – cognitive and affective – were assessed with FP. The three groups were matched for gender, age and education.

BD and schizophrenia patients showed no impairment in the False belief task. Schizophrenia patients performed significantly lower than HC and BD patients in Hinting task, FP recognition and affective ToM. Both patient groups were impaired in cognitive ToM. However, only BD patients with a history of psychosis performed significantly lower than HC in affective ToM.

In contrast to schizophrenia patients, euthymic BD patients show a specific deficit only in cognitive but not in affective ToM. Further research on the impact of these deficits on social and occupational functioning is warranted.

To estimate the efficiency of the atypical antipsychotics (quetiapine, risperidone, aripiprazole or olanzapine) used to reduce relapses in bipolar disorder, taking into account costs and effectiveness (QALY).

The Russian health care system perspective and a five year temporal horizon have been used. An annual discount rate assumed was of 5%. Taking into account the last literature review on bipolar disorder, four fundamental aspects related with bipolar disorder management were analyzed: relapse rates, inpatient treatment, outpatient treatment and hospitalization rates. The health care direct costs corresponding to the drug acquisition costs have been analyzed together with the costs of inpatient diagnostics, costs of inpatient treatment and costs of hospitality relapses updated with data from Russian health care system.

Quetiapine or risperidone treatment presents the lower total costs (€13 562 and €13 097 respectively) versus the other strategies (aripiprazole = €36 328 and olanzapine = €19 957). Quetiapine presents the higher QALY compared with the alternatives (quetiapine = 3.551, risperidone = 3.534, aripiprazole = 3.528 and olanzapine = 3.525). With these results one can emphasize that quetiapine or risperidone treatment is dominant with the cost-effectiveness ratio (CER) of 3 819 and 3 706, respectively, versus aripiprazole or olanzapine groups (CER 10 297 and 5 662 respectively). The incremental CER (quetiapine vs. risperidone) is €27 322 per QALY.

The results illustrate that quetiapine is dominant versus aripiprazole or olanzapine. Also quetiapine therapy is within willingness to pay threshold in case of risperidone substitution in Russian patients with bipolar disorder

The research investigates the possibility of reducing the level of post-stroke dementia.

The research involved 92 patients after massive ischemic stroke aged 32–72. The patients underwent: CDR, MMSE, cerebral CT, MRI, SG, REG, cerebral multi-gated angiography (MUGA).

Initial dementia and cognitive impairment severity was identified among 33 patients (35.87%):

• moderate dementia (CDR-2) - 18 (54.55%) patients (MMSE 11–18);

• severe dementia (CDR-3) - 15 (45.45%) patients (MMSE 7–10).

Transluminal treatment was performed in 68 cases - Test Group.

Conservative treatment was performed in 24 cases - Control Group.

Test Group. Good immediate angiographic outcome manifested in the restoration of vessels lumen and patency, as well as in collateral revascularization, was achieved in 66 (95.59%) cases. The following positive trend was observed in 12–24 months:

1. ■ Absence of dementia signs, cognitive function restoration to MMSE 28–30 - 14 (20.59%) patients;

2. ■ Dementia severity reduction to CDR-1, cognitive function restoration to MMSE 21–27 - 30 (44.12%) patients;

3. ■ Dementia severity reduction to CDR-2, cognitive function restoration to MMSE 17–20 - 24 (35.29%) patients;

Control Group. The following was observed in 12–24 months:

1. ■ Dementia severity reduction to CDR-1, cognitive function restoration to MMSE 21–26 - 2 (8.33%) patients;

2. ■ Dementia severity reduction to CDR-2, cognitive function restoration to MMSE 17–20 - 5 (20.83%) patients;

3. ■ Absence of clear signs of declining dementia - 17 (70.85%) patients.

Transluminal laser revascularization of cerebral blood vessels is more efficient than therapy in the treatment of ischemic stroke; it can significantly reduce dementia level and bring patients back to their normal active life.

The Health Utilities Index-Mark 2 (HUI2), a generic instrument for assessing health status, is an important effectiveness input for pharmacoeconomic modelling. It has not previously been used in patients with attention deficit/hyperactivity disorder (ADHD).

To use HUI2 to assess health utility in patients aged 6–17 years with ADHD receiving the prodrug stimulant lisdexamfetamine dimesylate (LDX).

SPD489-325 was a 7-week, randomized, double-blind, placebo-controlled trial of LDX, with osmotic-release oral system methylphenidate (OROSMPH) as a reference treatment. Patients’ parents or guardians completed HUI2 questionnaires at baseline and weeks 4 and 7. Utilities were estimated for treatment responders and non-responders, with response defined as a Clinical Global Impressions-Improvement (CGI-I) score of 1 or 2, or a ≥25% or ≥30% reduction in ADHD Rating Scale IV (ADHD-RS-IV) total score.

Of 336 patients randomized, 317 were included in the full analysis set (LDX, n=104; OROS-MPH, n=107; placebo, n=106) and 196 completed the study. At endpoint, mean HUI2 utility scores across all treatment groups were higher for responders than non-responders when response was based on CGI-I score (responders: 0.896 [SD, 0.0990]; non-responders: 0.838 [0.1421]), on a ≥25% reduction in ADHD-RS-IV score from baseline (responders, 0.899 [0.0969]; non-responders, 0.809 [0.1474]), or on a ≥30% reduction in ADHD-RS-IV score from baseline (responders, 0.902 [0.0938]; non-responders 0.814 [0.1477]).

The HUI2 instrument is sensitive to treatment response in the child and adolescent ADHD patient population. Health utilities generated using HUI2 are therefore suitable for cost effectiveness evaluations of ADHD medications.

Supported by funding from Shire

The Weiss Functional Impairment Rating Scale–Parent Report (WFIRS-P) is an ADHD-specific instrument comprising 50 items, grouped into six domains. Parents score each item on a Likert scale (0–3 or not applicable).

To evaluate functional impairment using the WFIRS-P in two phase 3 studies (SPD489-325 and SPD489-326) of lisdexamfetamine dimesylate (LDX) in children and adolescents with ADHD.

Patients’ parents or guardians completed WFIRS-P assessments at baseline, and weeks 4 and 7 of SPD489-325, a 7-week, randomized, placebo controlled trial incorporating a reference treatment (osmotic-release oral system methylphenidate; OROS-MPH). Statistical comparison of LDX versus OROS-MPH was not pre-specified. In SPD489-326, WFIRS-P assessments were performed in the ≥26-week open-label period and the subsequent 6-week randomized-withdrawal period.

In SPD489-325, statistically significant placebo-adjusted effects of LDX were observed in WFIRS-P total score (effect size, 0.924; p<0.001) and in Family, Learning and School, Social Activities and Risky Activities; OROS-MPH effects were significant in total score (effect size 0.772; p<0.001) and in all domains. In SPD489-326, scores were improved or stable in the open-label period. In the randomized-withdrawal period, total score and all domain scores were stable in the LDX group, but worsened in the placebo group. LDX was significantly more effective than placebo in Family, Learning and School, Risky Activities and in total score (effect size, 0.908; p<0.001).

Short-term treatment with LDX or OROS-MPH led to improved functional impairment scores. These benefits were maintained during long-term LDX treatment, and scores declined following treatment withdrawal.

Supported by funding from Shire.

Psychosomatic families can usually be characterized by the problem of conflict management, which is associated with the low level of communication among the family members.

One of the characteristic properties of these dysfunctional families is the way they sweep the problems under the carpet and/or triangulation that always involves a pair of the family members and a third person in the conflict situation to divert the attention from the essential problem, which thus remains unresolved.

The aim of my study was to explore the manifestation of the hidden conflicts in the family structure if there is at least one psychosomatic patient in the family, as well as to investigate his/her position in the family structure.

There were 12 asthmatic and 18 healthy young adults in my study and I used Gehring's (2010) Family System Test (FAST) to learn more about the above-mentioned phenomenon. The applied method gave me the possibility to recognize the characteristic arrangement (triangulation), which is about the third person's involvement in the other two people's conflict.

Participants with asthma – primarily in the conflict situation - represented triangulation on the board and located their schematic wooden figure between the parents in a triangular shape more often than it was found in the healthy control group.

Thus in line with the previous studies the special position of the asthmatic patients in their family has been confirmed, and the significance of dyspnoea with its central, fire-fighting role was also found.

Orthodox theories of autism spectrum disorder (ASD) focused on cognitive impairments, but other kinds of problems can also be observed.

While play as a fundamental activity in the child's life supports several aspects of his/her development, certain forms show particularly large differences in ASD compared to the typical developing (TD) children's play.

The aim of my study was to explore the relationship between the child's sensitivity in his/her certain modalities and quality of object use/play.

On the one hand, I used Bogdashina's (2003) Sensory Profile Checklist Revised (SPCR) to know more about ASD-children's sensory-perceptual processes. On the other hand, video analysis was applied by Noldus Observer XT 8.0 program software to explore some characteristics of object play.

Different sensory-perceptual experiences and patterns of object use were explored in TD and ASD. The latter group usually demonstrated a higher level of sensitivity than control persons. Tactility was found to be in stronger correlation with exploration, and this type of object use also showed correlation with adequate object use in TD. Furthermore, conventional object use also correlated with creative object play. ASD-children rather demonstrated stronger association between taste and imitation but did not present a similar relation between the frequency and/or time duration of the diversified forms of play activity with objects.

In this way, ASD-children usually demonstrated unusual behaviour patterns. However, the various types of object use build on each other, thus the lack of any kind of play activity causes further problems in the individuals’ life.

While illegal drug abuse has been recently stabilized in western countries, iatrogenic opiod dependence is increasing. In EEUU, opioids abuse is more prevalent than other legal or illegal drug abuse. Prevention actions and strategies to optimize short and long term treatments need to be outlined.

Learning to prevent, diagnose and treat iatrogenic opioid dependence.

We review 9 cases of iatrogenic opioid dependence hospitalized in the Psychiatric department of a general hospital, considering demographic and personal data, treatment patterns and strategies followed. Pubmed bibliographic search was performed.

Patients came from different clinical resources (44,4% from pain center, 33,3% from emergency department, 22,22% scheduled admission).

N°1:48-year-old man with dependence to oral codeine (1200 mg/day). Maximum methadone dose required (MMR): 30 mg/day.

N°2:43-year-old woman with dependence to oral fentanyl (3000 mcg/day). MMR:25 mg/day.

N°3:50-year-old woman with dependence to fentanyl patches (2,25) and oral tramadol (300 g/day). MMR:20 mg/day.

N°4:55-year-old woman with dependence to oral oxicodone (60 mg/day). MMR:20mg/day.

N°5:39-year-old woman with dependence to subcutaneous meperidine (600 mg/day). MMR:25 mg/day.

N°6:61-year-old woman with dependence to oral codeine (600 mg/day). MMR:15 mg/day.

N°7:45-year-old man with dependence to transmucous fentanyl (600 mcg/day). MMR:90 mg/day.

N°8:49-year-old man with dependence to oral tramadol (450 mg/day). Progressive tramadol withdrawal until suppression.

N°9:38-year-old woman with dependence to transmucous fentanyl (2400 mcg/day). MMR:22,5 mg/day.

Classically, methadone has been the main opioid dependence treatment, as shown in almost all cases exposed. However, new treatments are being developed, e.g. monthly parenteral naltrexone. Opioid dependence treatment must be combined with other substances abuse/dependence or psychiatric comorbidities treatment and psycotherapeutical intervention.

Studies conducted in Pakistan reveal a high prevalence of depression, particularly in women. Evidence based and effective treatments are available, yet there is a significant gap between the numbers of women in need of treatment and those who receive services. This qualitative study identifies the barriers in access to mental health services for women screened for depression from primary care clinics in Karachi.

In-depth interviews were conducted with 30 women screened for depression from three purpose fully selected primary care sites in Karachi.

Interviewees reported that they mostly did not share their depressive symptoms and suicidal attempts with health care providers due to perception of these being their personal problems and health care providers also not asking about it. Interviewees perceived health care providers too busy, overburdened and not interested in their emotional problems. Those who shared their symptoms also did not receive proper diagnoses, treatment or referral from their health care providers.

The study highlights the need to increase mental health literacy about depression through mass media, community engagement, and educational institutions so that women can recognize the depression in themselves and other women around them and be able to share their symptoms with their health care providers. Religious scholars needs to be involved in raising awareness on depression as an illness for which women should seek medical treatment besides taking support from religion. It also indicates the need for a referral system to help women reach to the required mental health services.

Considering the importance of vascular disorders in AD progression, here presented are results of applying endovascular AD treatment method based on transcatheter revascularization and restoration of brain microvasculature by means of low-energy laser irradiation.

The research involved 46 patients aged 34-79 who had long had AD.

Survey plan included: CDR, MMSE, CT, MRI with subsequent calculation of the temporal lobes volume and AD stage determination using the Tomography Dementia Rating Scale (TDR), SG, REG, and cerebral MUGA.

Patients were divided into:

1. ▪ Group (TDR-0) - 4 (8.70%): preclinical AD stage;

2. ▪ Group (TDR-1) - 15 (32.60%): mild dementia, mild cognitive impairment, mild disease manifestations (medical history of up to 2 years);

3. ▪ Group (TDR-2) - 20 (43.48%): mild dementia, persistent cognitive impairment, more severe disease manifestations (history of up to 6 years);

4. ▪ Group (TDR-3) ??- 7 (15.22%): severe dementia, severe cognitive impairment, late-stage AD (7-12 years of history).

All patients had the signs of dyscirculatory angiopathy of Alzheimer's type. Transcatheter interventions were carried out against growing memory disorders in the period of 1-12 years after the symptoms onset.

Positive outcome accompanied by microcirculation restoration, dementia decline, memory improvement, cognitive disorders reduction was obtained in all cases; its degree depended on AD stage.

In early AD stages, transcatheter laser irradiation can restore cognitive functions and relieve patients from dementia. In late AD stages, the treatment helps not only halt further disease progression but also causes its regress. The process is accompanied by brain tissue regeneration.

Due to increasing lifespan, the number of patients with Binswanger's disease is growing.

The study of the effectiveness of brain transluminal laser revascularization in the treatment of Binswanger's disease.

6 patients, 4 male (66.7%) and 2 female (33.3%), aged 58-81 (average age 76) with Binswanger's disease were examined. Each patient underwent CT, MRI, SG, REG, cerebral multi-gated angiography (MUGA).

Single postischemic microcysts (3-5 mm) of brain's white matter were detected in 1 case; multiple microcysts including the merged ones - in 5 cases. All the patients had leucoariosis, inovolutive changes of the cerebral cortex, unocclusive hydrocephalus.

Intracranial atherosclerotic lesion type was detected in all cases. Multiple arteriovenous shunts of brain's white matter were detected in all cases.

All the patients underwent transluminal laser revascularization.

Low-energy laser systems were used for revascularization of distal intracranial branches. Postoperatively, the patients underwent desagrigatory, anticoagulatory and vasodilator therapy following advanced interventional radiology schemes. Clinical evaluation of postoperative results was carried out using the Index Bartels (IB).

Good immediate angiographic outcome manifested in the restoration of lumen and patency of the affected vessels as well as in collateral revascularization was obtained in all cases.

Good clinical outcome (IB-90-100) was obtained in 4 (66.7%) cases; satisfactory clinical outcome (IB-70-80) - in 2 (33.3%) cases. No negative effect was observed after the interventions.

The method of brain transluminal laser revascularization is an effective one in the treatment of atherosclerotic lesions of brain's white matter accompanied by the development of Binswanger disease.

To describe a new framework ‘SENSO’ (sensitivity to social signal) that emphasizes that acute depressed patients show abnormal cognitive, emotional and biological responses to positive and negative social signals with impaired monitoring of social acceptance.

We will review evidence that Major Depression is associated with increasing vulnerability to social rejection and social stress. We will also discuss a recent meta-analysis realized by our group evaluating neural correlates of social exclusion tasks in healthy subjects.

Major Depression is clearly precipitated by major social life-events. These social events increase the need for subjects to monitor their level of social acceptance and induce stress response. Self-propagatory processes (i.e. excessive reassurance seeking, negative feedback seeking) generate in depressed patients a vicious circle leading to increase sensitivity to social rejection. Social exclusion tasks in healthy subjects induce increased activation in ventromedial prefrontal cortex, subgenual cortex and insula, regions implicated in self-processing and production of negative emotion.

Results of our literature review and of our meta-analysis stress the importance of studying interpersonal processes and their neural correlates in depressive phenomena. They emphasize the role of salient and default mode networks in the pathophysiology of major depression.

Major Depressive Disorder (MDD) is a common health problem characterized by low mood, sadness and irritability. Sleep disturbances are a central feature of depression and adolescence is a period of rapid change in sleep physiology.

To evaluate the categorization of sleep change in three of sleep elements : REM changes; Slow weave sleep changes and fragmentation of sleep. We evaluated this as a tool to detect depression

To assess features of sleep macro architecture as markers for evaluating and detecting adolescent depression

Adolescents completed a two-week protocol that included a formal psychiatric interview, standardized scales, polysomnographic (PSG) assessment, actigraphy, salivary melatonin sampling, and holter monitoring.

Depressed adolescents (n = 22) differed from controls (n = 20) on features of sleep macroarchitecture measured by PSG. 59% of the depressed subjects had more than one PSG marker from each category as compared to control (N = 20). This indicates that subjects who were depressed on clinical assessments using the standardized scales and evaluations had changes in sleep suggestive of depression

The categorization of sleep change in three categories of sleep components (see above) can be a useful tool to detect depression. The results suggests that the individual markers of depression in children and adolescents may not be as effective as the categorization of sleep changes into three categories and using this general approach

It is estimated that 25,000 people in the UK die from preventable hospital-acquired venous thromboembolism (VTE) every year. Patients admitted to Old Age Psychiatric units clearly posses numerous risk factors relating to developing VTE.

The aim was to study inpatients admitted to the old age psychiatric unit and see if NICE and Department Of Health guidelines are being followed in relation to VTE (Venous thromboembolism) risk assessment and prophylaxis.

A prospective opportunistic sample of all the inpatients in the old age psychiatric unit during a 2 week period was audited. Standards were based on the NICE and Department Of Health guidelines.

13% of patients developed a deep vein thrombosis during the admission period audited. No patients had a VTE risk assessment completed on admission. Every patient had at least one risk factor for developing DVT (deep vein thromboembolism) due to being over 65 years old.

93% had at least 2 risk factors and 63% had at least 3 risk factors. Despite this no patients were treated prophylactically with graded compression stockings or enoxaparin.

It was evident that VTE risk assessment and prophylaxis was not something that was being considered for patients admitted to the old age psychiatric inpatient unit. However due to the risk factors this group of patients possess it is something vitally important. As a consequence of presenting the audit across the trust a service change was recommended with a VTE risk assessment planned to be introduced across the trust.