Emotional dysregulation represents a typical trait of many psychiatric disorders. One aspect of emotional regulation deficiencies are acceptance and suppression of negative and/or positive emotions. Changes of acceptance and suppression during the course of illness have not been investigated yet.

Investigation of the course of emotional regulation strategies.

The purpose of this study was to investigate,

1. 1. whether acceptance and suppression are related to positive and negative emotions;

2. 2. if there is any change of acceptance and suppression over time;

3. 3. whether depressive patients and healthy controls differ regarding acceptance and suppression levels.

Subjects were 40 patients with depression and 29 healthy controls. The study was conducted in the Clinic of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany. The patients were diagnosed according to DSM–IV criteria. BDI was used to assess the level of depressive symptoms. For the assessment of acceptance and suppression of negative and positive emotions the questionnaire FrAGe (Questionnaire of the acceptance of emotions) was used at the begin (T1) and at the end (T2) of inpatient treatment.

Depressive patients reported reduced acceptance of positive and negative emotions. Although the level of acceptance was higher at T2, they still accepted their emotions less than the healthy controls. Patients also suppressed emotions more intensively than controls.

There are significant differences between depressive and healthy subject in terms of the acceptance and suppression of negative and positive emotions. Nevertheless, the suppression and acceptance of emotions are changing during treatment towards a more adaptive level.

the clinical interview with the patients, Beck Depression Inventory, State Trait Anxiety Inventor, the questionnaire ‘Analysis of family anxiety’ (E.G.Eydemiller, V. Yustitskis), «Questionnaire marital satisfaction» (V. Stolin, T. Romanova, GP Butenko), The scale of perception of social support «MSPSS» (Sirota, Yaltonsky).

Analysis of the results obtained showed an association between the characteristics of social functioning, such as family situation, the presence of different kinds of support from others, and the degree of patient's compliance. Patients with good compliance said that they receive emotional support and sure that will immediately have tool support when needed; describe their family as a loving, wife as the best, perfect, caring; often have a small child. Patients with low adherence reports that they don’t have any support and don’t need it; couldn’t describe their family or talk about the absence of close contact, formal interaction.

Body- art is associated with an increased risk of self- harming behaviours and suicide attempts (SA) in adolescents, but there is no concluding evidence for adults yet.

We investigate the relationship between ‘body art’ (i.e. tattoos, piercings) and SA in adult patients.

All patients admitted to the Psychiatric Clinic of Genoa for a SA between October 2012 - January 2013 were enrolled. Age, gender, education, previous SA, psychiatric diagnosis were analyzed. The patients underwent first a clinical interview where the presence of body-art, type, number, location, time between its performance and previous or present SA were assessed along with its meaning for the patient, then SCID I & II.

44 patients were enrolled (24 females). Mean age 47 years. 26 had at least a tattoo, among them six females. Eight had at least one piercing, of whom six were females. 58,3% had a diagnosis of MDD, 41.6% of PD (BPD 72%;NPD 34%; OCPD 42%; PPD 23%). 75% of patients with more than one tattoo had a diagnosis in both axes and attempted suicide more than once. These results show that 40% of our sample has a tattoo and one third a piercing, which presence in the same-age American population is estimated to be 26%. However, these results have a limited statistical significance because of the small sample size.

These results suggest a particular mind-body bond which would correlate SA and body art in adult patients, while previous studies found such evidences only in the adolescent population.

Research about psychological manifestations in right hemisphere damage (RHD) has increased in recent decades. The most characteristic alterations affect social cognition, which involves skills related to social interaction, as Theory of Mind, use of humor or metaphors comprehension inter alia. One of them is Facial Emotion Recognition (FER), which has been investigated in brain damaged patients, although studies present small samples and other metodological limitations.

Comparing FER skills in a single RHD patients and non-brain damaged control group.

Identifying the FER patterns, analyzing differences according to the type of emotion.

46 patients with RHD due to stroke (mean age 68.93;SD12.62. 52% males) and 46 control subjects (67.28;SD18.29. 50% males), were assessed in sociodemographic and clinical variables. Mini-mental State Examination and Hamilton Depression Rating Scale were administered. To assess FER, 60 photographs from Pictures of Facial Affect (POFA) collection (Ekman, 1993) were shown to the sample, which identified them according to the type of emotion (i.e. happiness, fear, surprise, sadness, disgust, anger).

Both samples, despite having similar characteristics, showed significant differences in FER (T=−2.751;p=0.007). In total sample, lowest performance was recorded in identifying fear (mean correct answers 0.45;SD0.252) and anger (0.48;SD0.301). RHD patients presented a deficit in FER skill compared to controls. Significant differences were found in recognizing anger (T=−2.043;p=0.044), disgust (T=−2.059;p=.042), happiness (T=−2.371;p=0.020), and sadness (T=−2.633;p=0.010).

Results confirm a probable relationship between single RH and FER, suggesting RH involvement in anger, disgust, happiness and sadness processing.

Anxiety is one of the most common disorders in the elderly, twice as prevalent as dementia and four to eight times more prevalent than major depressive disorder. 90% of late-life anxiety are accounted for by either generalized anxiety disorder (GAD) or specific phobia and is often comorbid with depression, therefore older adults being particularly vulnerable to suicide.

This study sought to determine the prevalence of suicidal behavior among older patients with GAD hospitalized in the Psychiatry Department of Arad between 2009–2012.

To evaluate the suicide risk in late-life anxiety.

Our research is based on the study of 65 subjects (52 female and 13 male) diagnosed with GAD; the mean age was 68.3. The diagnostic of GAD was based on the DSM-IV and ICD-10 criteria. The study protocol assessed age, sex, social support, economic status, length of illness, recent traumatic events, medical or another psychiatric illness. The severity of the suicide risk was estimated according to: presence of thoughts of death, severity of suicidal ideation, history of suicide attempt, severity of suicide attempt.

The onset of GAD for the majority of patients was in earlier life with late-life exacerbation. 41 patients had associated minor depression. Our study revealed a risk of suicide of 4.6% (three patients).

Patients diagnosed with GAD have a higher suicide risk, especially in association with depression, medical illnesses or lack of social support. In the future, specific diagnostic criteria for late-life anxiety will be needed, in order to prevent suicidal behavior.

Many studies have observed hyperactivity of the hypothalamic-pituitary-adrenal axis in depression. In general, cortisol levels are tend to be lower in the evenings and exogenous corticosteroids administered around this time are known to cause insomnia.

We planned to compare data on evening cortisol levels in subjects with initial insomnia versus those without initial insomnia. We also used peak morning cortisol levels to establish the specificity of our effect.

To test the hypothesis that high evening cortisol is associated with initial insomnia among depressed adolescents.

Data from the baseline results of the Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) trial were used. There were 471 depressed subjects aged 11–17. Saliva was collected at waking, waking plus 30 minutes and late evening on two consecutive days for cortisol assay. Insomnia was defined as present or absent based on the insomnia item of the K-SADS-PL. Non-parametric analysis was used due to nonnormal data.

Median evening cortisol for subjects with initial insomnia was 0.070μg/dl, whereas it was 0.050μg/dl for those without initial insomnia (n=151, Mann-Whitney z = 2.33, p=.02). In contrast, there was no statistically significant difference in morning cortisol levels between the two groups (n=151, p=.93).

As hypothesised, high evening cortisol was associated with initial insomnia. It is possible, therefore, that high evening cortisol drives insomnia among a sub-population of depressed adolescents. However, interpreting the direction of causality is difficult, as sleep deprivation has also been shown to cause high evening cortisol.

Pregnancy may cause somatic alterations and possible transformation in women's behaviour, emotions and cognition.

To analyse monthly somatic and cognitive changes in pregnancy.

To examine the pattern of cognitive (depressed mood, lack of self-esteem, guilt, lack of concentration, sensitivity to criticism, thoughts of death) and somatic (decreased energy, feelings of heavy limbs and feeling worse in the morning) symptoms throughout the 9 months of pregnancy.

N=374 women were interviewed once (6 weeks postnatal) using a modified version of the Structured Clinical Interview for DSM IV. Women were asked whether they had experienced each symptom at any time during pregnancy and if they said yes, the monthly symptom occurrence was assessed. Repeated measures General Linear Model analysis was used.

There were both linear (a) and quadratic (b) significant changes over time for sensitivity to criticism (Fa=20.9(1), Fb=7.02(1), pa,b=0.00), lack of concentration (Fa=37.0(1); Fb=10.3(1); pa,b=0.00), decreased energy (Fa=13.4(1), Fb=62.6(1); pa,b=0.00) and feelings of heavy limbs(Fa=92.9(1), Fb=67.7(1) pa,b=0.00). Guilt (F=0.00(1); p=0.93) showed no change over pregnancy, lack of self-esteem (F=10.15(1); p= 0.00) showed linear significance while depressed mood (F=5.15(1); p= 0.02) showed quadratic significance. After controlling for covariates, no significant interactions between them and all symptoms were found.

Cognitive symptoms changed throughout pregnancy as much as somatic symptoms. Most symptoms showed a different pattern from depressed mood (Figure 1). Sensitivity to criticism, lack of concentration, feelings of heavy limbs and decreased energy were especially high during late pregnancy.

Figure 1

Depression pattern through 9 months of pregnancy

Studies aimed at the identification of potential risk factors of the alcohol dependence syndrome (ADS) and, consequently, of risk groups of this condition that should be subjected to preventive programs, are being undertaken since many years.

The aims of this study were (1) to analyze the effects of polymorphisms in the GABRA2 gene on the risk of alcoholism; (2) to determine associations between some genetic markers basing on haplotype analysis;

The study included 305 Caucasian males, among them 156 patients with ADS and 149 controls. These two groups, were compared as to the frequencies of haplotypes of the following polymorphisms: rs 279826, rs 279871, 279845 of the GABRA2 gene. All subjects were recruited in the North West region of Poland. Alcohol use and family history of alcoholism were assessed by means of a structured interview, based on the Polish version of Semi-Structured Assessment on Genetics in Alcoholism (SSAGA). Genomic DNA was extracted from venous blood. Polymorphisms were detected using PCR real time method.

Significant relationships documented by the haplotype analysis of ADS patients point to the usefulness of haplotype constructions in etiopathogenetic studies of ADS. The protective haplotype was G-G-A (p=0,01).

In conclusion, larger – possibly multicentre – studies are needed to finally uncover the role of

GABRA2 gene in determining ADS. Moreover, other candidate genes with a possible impact on the phenotype of alcohol-dependent individuals should be sought.

Supported by grant of Ministry of Science and Higher Education (MNiSW no.: NN 402466540).

The mass media have a sufficient impact on the adolescent to develop their perfect image of themselves. Unfortunately the majority of the celebrities are under their BMI perfect weight. When we add one impact to the another fact it all could end up with some serious eating disorders (ED). According to recent studies 1 in 20 students in Polish schools suffers from pathologies in the area of ED and nearly half want to lose weight.

The aim of our study was to assess how schoolchildren see themselves in the society in Silesia region as well as the factors affecting the results of the tests.

In 2011–2013, 1,482 students aged 14–18 were surveyed by EAT-26 questionnaire and all the responses were statistically analysed.

6,67% of the surveyed were underweight while 13,14% were above BMI=25. We also have asked about the perfect weight. Then 8,36% were underweight while 5,38% overweight what statistically significant differ from origin results. People who have higher actual weight from the ideal by more than 3 kg had higher levels of disordered eating than the other two groups. People who have similar real to the ideal weight have a lower risk level of ED then others. (Kruskal–Wallis Test, p <0.001).

Conducted studies indicate that the problem with self-esteem and ED exist in the Silesian schools. Specific socio-cultural factors are a challenge for the parents and public services.

The English health system has recently undergone significant change via the Health and Social Care Act 2012. The Royal College of Psychiatrists successfully lobbied for an amendment to this Act which explicitly recognised the importance of both physical and mental health. This became known as the ‘parity of esteem’ amendment.’

The College has since published an extensive report on how to achieve parity between mental and physical health in England. Many of the areas considered by this report (such as avoidable premature mortality, the stigma associated with mental illness and the low levels of treatment compared to incidence) are also significant problems in parts of Europe.

To inform delegates about the English experience regarding parity of esteem, in order to inform their own engagement with nation-specific issues as necessary.

The detailed aims of this session are to outline the English experience in (1) securing a legislative basis for parity of esteem, (2) defining parity of esteem as a concept and (3) identifying the England-specific issues which needed to be addressed in order to achieve parity. It is intended that delegates will be able to use the information provided as a template for action in their own country, as necessary.

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The longstanding lack of parity between mental and physical health remains inequitable and socially unjust. It is hoped that English experience will lead to improvements which can be exported to other European nations as necessary.

Alcohol dependence (AD) is a highly prevalent disorder that is associated with serious morbidity and mortality. The development of alcohol dependence is the result of an interaction between environmental and hereditary factors. Previous studies have implicated GABRA2 receptor genes with AD, alcohol use patterns, and levels of response to alcohol. The aims of this study were to analyze the effects of polymorphisms in the GABRA2 gene on the risk of alcoholism ; associations between genotypes and alleles were studied;

This study included a group of 161 Caucasian subjects, with no history of psychiatric disorders other than alcohol or nicotine dependence as classified by ICD-10. The control group comprised 150 unrelated individuals matched for ethnicity and gender, and excluded for mental disorders using the Primary Care Evaluation of Mental Disorders questionnaire. All subjects were recruited in the North West region of Poland. Alcohol use and family history of alcoholism were assessed by means of a structured interview, based on the Polish version of Semi-Structured Assessment on Genetics in Alcoholism (SSAGA). Genomic DNA was extracted from venous blood. Polymorphisms (rs 279826, rs 279871, rs279845) were detected using PCR real time method.

Significant associations for genotypes and alleles were observed in rs 279871 polymorphism (p=0,31). The advantage of this research is that the genetic analysis of GABRA2 gene rs 279871 polymorphism was conducted on quite large and, most importantly, homogenous subgroups of alcohol-dependent patients.

Supported by grant of Ministry of Science and Higher Education (MNiSW no.: NN 402466540).

Neuropsychological and neuroimaging studies of response inhibition in cannabis users have reported inconsistent results. The age of onset of cannabis use and individual genetic differences may play a critical role in the regulation of inhibition in cannabis users.

We examine the influence of COMT Val158Met functional polymorphism on the response inhibition brain network in a group of early-onset chronic cannabis users compared with healthy controls.

fMRI data was acquired from 27 chronic cannabis users who began use cannabis before 16 years of age, and 29 non-using control subjects matched in terms of age, educational level and intelligence quotient while undergoing the Multi-Source Interference Task (MSIT). Participants were male, Caucasians aged between 18 and 30 years. All were assessed by a structured psychiatric interview (PRISM) to exclude any lifetime Axis-I disorder (DSM-IV). COMT genotyping was performed and resonance imaging data was analysed by voxel-based morphometry (VBM).

Both groups did not differ on their behavioural performance and brain responses during the MSIT task. A significant group-by-genotype interaction was observed on task-related brain activation (and on MSIT reaction times), in which met carrier load was associated with increased activation in cannabis users and val carrier load with increased activation in controls. The interaction pattern included the medial frontal cortex, ACC, inferior frontal gyrus, ventral striatum, anterior mesencephalon, inferior parietal and superior temporal cortices and the PCC.

Chronic cannabis exposure interacts with the genetically driven dopamine function in the modulation of the neural mechanisms related to response inhibition.

Grants:PNSD/2011/050, PNSD2006/101, SGR2009/1435.

Less than half of depressed patients achieve remission. Identification of biological markers may help clinicians to predict remission and improve patient's treatment.

To identify brain regions whose activity during self-referential processing at baseline could predict long-term remission among patients with Major Depressive Disorder (MDD) and to investigate the brain effects of Agomelatine.

Nineteen acutely depressed patients and fourteen healthy controls performed self-referential judgments on emotional pictures during two fMRI sessions: before treatment and after 6 to 7 weeks of Agomelatine in patients or one week of placebo in controls. Patients were treated during 6 months and remission was assessed (HAM-D≤7).

Activation in dorsomedial prefrontal cortex (dmPFC) and precuneus, during self-referential processing at baseline, was lower in future remitters than in non-remitters and remained stable after 6/7 weeks of treatment in both groups of patients. Pre-treatment activation of dmPFC and precuneus predicted clinical remission at 6 months with a sensitivity of 100% and a specificity of 71.6%. After 6–7 weeks of Agomelatine, the brain activation of MDD patients during self-referential processing was normalized i.e. decrease in the excessive activation of the dorsolateral prefrontal cortex and increase in the ventral anterior cingulate cortex activation.

Pre-treatment activation of precuneus and dmPFC during self-referential processing appears to be a valid predictor of clinical remission. Such results are consistent with the idea that cortical midline structures activity may play a major role in treatment outcome of MDD and may help developing biomarkers-based treatment of MDD.

The analysis of medication discontinuation may allow the comparison of the effectiveness of different medications and may help us understand treatment patterns in depression. Clinical guidelines recommend at least six months of antidepressant maintenance treatment for major depressive disorder (MDD).

To determine the duration of antidepressant treatment in Asian patients treated with antidepressants for a major depressive episode and to understand the reasons and factors associated with discontinuation.

Nine hundred and nine in- and out-patients from Asia, of which 569 started an antidepressant medication at the baseline visit, presenting with a new or first episode of MDD were enrolled in a 3-month prospective observational study. The Kaplan-Meier method and Cox models were used to estimate discontinuation rates and factors associated with discontinuation. Survival analysis with competing risks was used to analyze the influence of different reasons for discontinuation.

Of the 569 patients included in the study, 430 (75.6%) were evaluated at three months and analyzed. Of them, 242 (56%) discontinued the treatment during the three months follow-up and 188 maintained it. Of the overall sample, half of the patients discontinued the medication within 70 days. The most frequent reason for discontinuation was inadequate response (n=155, 64%), followed by adequate response (n=62, 26%). A relatively high proportion of patients with adequate response (30% at 130 days) discontinued the medication. Country and type of antidepressant were associated with medication discontinuation.

Medication discontinuation in Asian patients with depression is high, even for patients who respond adequately to treatment.

To evaluate the effect of Souvenaid (a multicomponent nutritional drink for early AD) on cognition, behavioral and psychological symptoms of dementia (BPSD), activity of daily living (ADL) and well-being of M.Alzheimer patients in a real-life prospective clinical setting.

Patients (and caregivers) with M.Alzheimer, using Souvenaid, were evaluated after 6 months on cognition, behavior, ADL and wellbeing, based on the KATZ Activity of Daily Living, Mini Mental State Examination (MMSE) and Neuro Psychiatric Inventory (NPI).

58 Alzheimer patients were included and 43/58 were evaluated after 6-months. 15/58 did not have a follow-up visit yet. 2/58 patients stopped using Souvenaid. 24/43 patients (58,1%) were better or stable on the 4 items mentioned above. 28/43 patients (65%) improved when only evaluating ADL-functions, BPSD and Cognition. Sub-group analyses (1. start Souvenaid and Alzheimer medication together, 2. start Souvenaid < 6 months after start Alzheimer medication, 3. Start Souvenaid > 6 months after start Alzheimer medication); a positive outcome on 4 items was observed in group 1 (57%, 4/7 patients), group 2 (53%, 8/15 patients) and group 3 (57%, 12/21 patients). Another sub-group analyses (MMSE < 20 vs ≥ 20) showed an improvement in 4 items of 28% (2/7 patients) vs 58,8% (20/34 patients).

Souvenaid is well tolerated in a real-life prospective clinical setting, also in conjunction with standard care Alzheimer medication. Souvenaid may be more beneficial in early stage AD patients and seems to improve quality of life.