To investigate serotonin (SERT) and dopamine (DAT) transporter availabilities in depressed patients under treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram.

27 patients (10m, 42±16y) underwent [123I]β-CIT SPECT to assess SERT and DAT availabilities at baseline and after four weeks of treatment with escitalopram. Hamilton Rating Scale for Depression (HAMD) and Beck Depression Inventory (BDI) were used for clinical ratings. Parametric maps with specific to nonspecific ratios (BPND) were calculated for each voxel using cerebellum as reference region. VOI-based BPND were calculated in striatum (DAT) and midbrain/pons (SERT).

At baseline, mean DAT-BPND was 6.06±0.81 in striatum and SERT-BPND 1.94±0.18 in thalamus. There were negative correlations with age of DAT in striatum (R=-0.60; p<0.01) and SERT in thalamus (R=-0.45; p<0.05). Under treatment there was a 20% occupancy of SERT in thalamus (p < 0.0001), whereas DAT availability increased by 17% in striatum (p<0.001), notably in the younger patients; higher SERT occupancy was associated with lesser DAT increase (R=0.55, p<0.05). There was a negative correlation of baseline HAM-D and DAT availability in putamen (R=- 0.45, p<0.05).

DAT and SERT availabilities decreased age-dependently comparable to studies in healthy volunteers. The SSRI-induced increase in DAT was less pronounced in elderly patients, even though occupancy of SERT was higher. These findings might have implications on dosage and side effect profile of SSRI medication in older patients.

At baseline, mean DAT-was 6.06±0.81 in striatum and SERT-1.94±0.18 in thalamus. There were negative correlations with age of DAT in striatum (R=-0.60; p<0.01) and SERT in thalamus (R=-0.45; p<0.05). Under treatment there was a 20% occupancy of SERT in thalamus (p < 0.0001), whereas DAT availability increased by 17% in striatum (p<0.001), notably in the younger patients; higher SERT occupancy was associated with lesser DAT increase (R=0.55, p<0.05). There was a negative correlation of baseline HAM-D and DAT availability in putamen (R=- 0.45, p<0.05).

27 patients (10m, 42±16y) underwent [123I]β-CIT SPECT to assess SERT and DAT availabilities at baseline and after four weeks of treatment with escitalopram. Hamilton Rating Scale for Depression (HAMD) and Beck Depression Inventory (BDI) were used for clinical ratings. Parametric maps with specific to nonspecific ratios (BPND) were calculated for each voxel using cerebellum as reference region. VOI-based BPND were calculated in striatum (DAT) and midbrain/pons (SERT). Results At baseline, mean DAT-was 6.06±0.81 in striatum and SERT-1.94±0.18 in thalamus. There were negative correlations with age of DAT in striatum (R=-0.60; p<0.01) and SERT in thalamus (R=-0.45; p<0.05). Under treatment there was a 20% occupancy of SERT in thalamus (p < 0.0001), whereas DAT availability increased by 17% in striatum (p<0.001), notably in the younger patients; higher SERT occupancy was associated with lesser DAT increase (R=0.55, p<0.05). There was a negative correlation of baseline HAM-D and DAT availability in putamen (R=-0.45, p<0.05).

Previous studies have shown that structural brain changes are among the best-studied candidate markers for schizophrenia (SZ) along with global functional connectivity (FC) alterations of resting-state (RS) networks. Only few studies tried to combine these data domains to outperform unimodal pattern classification approaches. We aimed at distinguishing SZ patients from healthy controls (HC) at the single-subject level by applying multivariate pattern recognition analysis to both gray matter (GM) volume and FC measures.

The RS functional and structural MRI data from 74 HC and 71 patients with SZ were obtained from the publicly available COBRE database. The machine learning pipeline wrapped into repeated nested cross-validation was used to train a multi-modal diagnostic system and evaluate its generalization capacity in new subjects.

Both functional and structural classifiers were able to distinguish between HC and SZ patients with similar accuracies. The RS classifier was showing a slightly higher accuracy (75%) comparing to GM volume classifier (74.4%). Ensemble-based data fusion outperformed pattern classification based on single MRI modalities by reaching 76.6% accuracy, as determined by cross-validation. Further analysis showed that RS classification was less sensitive to age-related effects across the life span than GM volume.

Our findings suggest that age plays an important role in discriminating SZ patients from HC, but that RS is more robust towards age-differences compared to GM volume. Single neuroimaging modalities provide useful insight into brain function or structure, while multimodal fusion emphasizes the strength of each and provides higher accuracy in discriminating SZ patients from HC.

Asylum Seekers experience different kinds of trauma, such as tortures, threats and loss of family members in the countries of origin, but also desperate journeys and legal concerns in the accepting countries. Our aim is to investigate mental health disorders among AS and to study the importance of torture in the development of their symptoms.

We recruited 45 AS (males, age 29±6), guests of a reception center in Borgo Mezzanone (Foggia, Italy). The following instruments were administered: MINI, SCL-90-R and Davidson Trauma Scale (DTS). Pre-migration, migration, and post-migration stressors were assessed using a self-administered scale.

75,6% of our patients reported a Major Depressive Episode currently, while 20% in the past. 35,6% suffered from PTSD, 13,3% agoraphobia. and 88,9% GAD. 2,3% reported psychotic symptoms and 13,3% alcohol or drugs abuse in the last year. Torture showed a correlation with PTSD (p<0,01), while physical injuries correlated with alcohol abuse (p<0,02), but not with other psychiatric disorders. Tortured ones had greater scores in pre-migration stressors scale (p<0,001) and greater DTS avoidance (p=0,03), DTS global gravity (p=0,003) and DTS total score (p=0,04). Both torture and PTSD did not correlate with SCL-90-R scales.

most of AS showed depressive and anxious symptoms and one-third had PTSD. All of them experienced different kinds of traumas, but only torture seems to play a major role in developing PTSD, while all kinds of trauma are equally important as to the perceived symptomatology, since both torture and PTSD did not correlate with higher SCL-90-R scores.

Asylum Seekers (AS) often experience stressful situations that may lead to psychiatric disorders. Our hypothesis is that the subjective perception of stressors and the resulting psychiatric symptoms may depend on the length of staying, length of the journey, level of education and age.

45 AS, guests of a reception center in Borgo Mezzanone (Foggia, Italy), were assessed by means of: Addiction Severity Index, MINI, SCL-90-R and Davidson Trauma Scale (DTS). We investigated the length of the voyage and the number of nations they passed through before reaching the final destination.

35,6% of the patients reported PTSD, 75,6% current Major Depressive Episode, 90,5% GAD, 2,3% psychotic symptoms, 15,6% alcohol abuse and 11,1% cannabis abuse; moreover, 26,7% attempted suicide at least once. Younger ones were less concerned about physical health and scored higher at most of SCL-90-R subscales. People who have been migrated for less time are more worried about family members left home and have higher scores at DTS subscales intrusion (p=0,02), hyperarousal, frequency, as well as total score. The number of nations they passed through or stayed in during their journey, negatively correlates with DTS hyperarousal and total gravity scores. Migrants with higher education showed lower scores in SCL somatization subscale.

younger people seems to have more severe psychiatric symptoms despite minor concerns about health and it seems that concerns about family members and various PTSD symptoms tend to decrease with time. Moreover a higher level of education may be protective from the tendency to somatize.

ADHD has long been considered to affect males more than females. It has been suggested that this difference is not as marked in the adult population. Differences in prevalence in adolescents may be contributed to by underdiagnosis in females. While these differences have been explored in children, there are limited data for the adult population with ADHD. Our study looked at a community sample of adults with ADHD and we examined differences in varying areas of comorbidity between males and females.

We looked at a sample of 50 patients in the adult ADHD clinic. On the basis of gender, differences were recorded in a variety of areas including alcohol and illicit drug use (including cannabis), forensic history, age of diagnosis of ADHD, family history and psychiatric comorbidity.

The full results are pending. Preliminary findings suggest an increased prevalence of substance misuse amongst males. Male patients were more likely to have a forensic history. Female patients are more likely to suffer with comordid anxiety and depression while male patients have a higher prevalence of autistic spectrum disorders and learning difficulties.

Service provision for adult ADHD has to be structured according to the needs of the population served rather than focussing on provison of prescribing services alone. The treatment approach for females with ADHD may diiffer from that for males. The use of psychotherapy in this population is particularly benficial. Comorbidity amongst females may complicate treatment with stimulants as this may worsen features of anxiety and depression.

Because the biologically related members of a family shareunique properties, identifications with family members are the strongest andhardest to change. Hence, beliefs about self and the balance ofconfidence or doubt depend, in part, on the behaviors of all members of thefamily.

To investigate therelationship of family identifications in female anxiety and fear related tohealth behaviors.

To examine the impact offamily identifications in women with specific fears which are raised from bodilysensations.

A community sample of 101women (mean age 20.81 years, SD = 0.91 ranged 20-25) participated to thepresent study. The girls completed a) the Symptom Check-List Revised (SCL-90) b)the Cardiac Anxiety Questionnaire (CAQ) c) the Fear of Pain and b)questionnaire concerning socio-demographic information and questions for familyidentifications.

Themajority of women reported that they matched to the father in terms ofidentifications (47.1%). Age and birth order were not contributed on familyidentifications (F (5)= 2.188, p=.062 and F(3)=1.244, p=.299 respectively). Multivariate analysis by using ANOVA found statistical significant associationsbetween family nature identifications and fear of pain, while the most stronglyadvocacy to a family member was correlated with heart focused anxiety. Theresults are summarized in table 1.

On the whole our resultshighlighted the role of family identifications and increasing female fear andavoidance behaviors.

Table 1. Impact of family identifications on female Cardiac Anxiety and Fear Bodily Pain.

A proinflammatory state in a subgroup of depressed patients has been reported repeatedly, for example an increase in interleukin-6 and tumour necrosis factor-a is well documented. Treatment with COX-2 inhibitors down-regulate increased inflammatory markers. Therefore an adjunctive treatment of depression with COX-2 in combination with an antidepressant might lead to a better clinical outcome.

To prove or disapprove the hypothesis of a better clinical outcome in the group with add-on celecoxib to sertraline in terms of improvement of HamD-17 and MADRS scores from baseline to endpoint.

This is a dual-center, randomized, double-blind, placebo-controlled, parallel group phase IIa study to investigate the mean change in clinical outcome and in serum expression of inflammation markers from baseline to endpoint (week 6) in patients with major depression (HAMD-17 ≥ 22) treated with celecoxib in combination with sertraline compared to sertraline combined with placebo. 51 depressed patients of both gender, aged between 18 and 60 without any recent inflammatory related disease were enrolled. The study comprises six study visits (6x ratings including HAMD-17 and MADRS, 3x blood collections) during six weeks of treatment and a follow-up visit 10 weeks after baseline.

The study was completed quite recently and the results are in progress.

Deep brain stimulation (DBS) for Tourette’ s syndrome (TS) in various targets has been in the focus for some years. However, there are hardly any data on ‘psychosocial’ outcome after DBS for TS.

The aim of the present study therefore was to focus on the functional outcome and ‘psychosocial changes’ in TS patients after DBS.

Six patients with treatment-refractory TS underwent GPi-DBS. The Yale Global Tic Severity Scale (YGTSS) was used to evaluate symptomatic outcome. Psychosocial changes were assessed applying the Global Assessment of Functioning Scale (GAF) and the Gilles-de-la- Tourette-Syndrome Quality-of-Life scale (GTS-QOL) with additionally documenting psychosocial changes. Follow-up ranged between 12 and 72 months.

In all symptomatic responders (4 of 6) we found a significant functional improvement (mean GAF increasing from 53.75 (± 7.5) preoperatively to 83.75 (± 7.5) at last follow-up) along with a positive correlation with the course of GTS-QOL (R2 = 0.62).

Treatment success should not only be assessed with the classic ‘tic-scales’, but also with the GAF and GTS-QOL. Although improvement of tics seems to be positively correlated with improved functional outcome, symptomatic improvement may lead to unexpected major psychosocial changes – which both the patient and the clinicians in charge – should be prepared for.

Schizophrenia is a debilitating mental disorder with similar prevalence across different cultures and geographical regions. The prevalence of schizophrenia and non-affective psychosis has previously been shown to vary by age, gender and socio-economic status in a subset of the Stockholm county population.

To investigate the entire Stockholm county population of patients with schizophrenia and non-affective psychosis regarding variations in age, gender, socio-economic status and pharmacological treatment.

To gather reliable data to guide decision-makers in the optimal allocation of resources.

Individuals with a registered diagnosis of non-affective psychosis (ICD-10 F20 – F29) between 1/1 2000 and 31/12 2012 with any contact with the Stockholm regional health care in 2012 were identified in the regional health care data warehouse (VAL). Data regarding outpatient visits in primary and specialist care, hospitalizations and dispensed prescriptions were retrieved.

Of the study population containing 18000 patients with non-affective psychosis, 34% had a schizophrenia diagnosis. 56% of the schizophrenia patients were men. The highest prevalence was observed in the 50 – 59 year olds, followed by 40 – 49 year olds. The schizophrenia prevalence was higher in municipalities of lower socio-economic status within the Stockholm county. A similar pattern for nonaffective psychosis patients was observed. The difference in prevalence was considerably smaller between the municipalities for the nonaffective patient population than for the schizophrenic patient population.

This study population will provide new insights into the burden of disease of psychosis diagnoses as demonstrated by differences in prevalence from various aspects.

The vast number of psychopathological syndromes that can be observed in clinical practice can be described in terms of a limited set of elementary syndromes that are differentially expressed. In the past, principal component analysis (PCA) has been used to identify such elementary syndromes (dimensions of psychopathology). Here, we show that elementary syndromes can be defined as modules within a network of interacting symptoms.

To examine the modular structure of psychopathology using network community detection (NCD) and principal component analysis (PCA) and to define critical areas of the network that could be primary targets for intervention.

192 heterogeneous psychiatric patients were tested on the Comprehensive Psychopathological Rating Scale (CPRS). PCA was performed on the bootstrapped correlation matrix of symptom scores to extract the principal component structure (PCS). An undirected and weighted network graph was constructed from the same matrix. Network community was optimized using a previously published technique.

NCD showed an optimal match (93.2%) with a 6-PCS of psychopathology. Some 6 network clusters were found, including ‘Depression’, ‘Mania’, ‘Psychosis’, ‘Psychomotor retardation’, ‘Behavioral disorganization’, and ‘Somatic anxiety’. The psychopathology network displayed a Small World structure. Nodes with singular network metrics were identified as possible targets for treatment.

We present the first comprehensive network graph of psychopathology: a ‘Psychopathology Web’. Clusters within this network represent elementary psychiatric syndromes. Individual symptoms with key roles in maintaining network connectivity were identified as possible targets for treatment.

Subjective well-being(SWB) is the scientific name for how people evaluate their lives, and since Thalassemia is an inherited blood disorder that requires lifelong adherence to a complicated and burdensome medical regimen, SWB could be easily underevaluated.

To measure the impact of SWB in adult patients with thalassemia.

To explore possible demographic, physical, and psychosocial correlates in SWB.

117 patients(23-60 years old, Mean age=37.2±9.3; 73% females) took part in the study. Satisfaction with Life Scale(SWLS-Ed Diener) was used for SWB, along with SF12 for health related quality of life, Depression Anxiety Stress Scale (DASS), life orientation test(GrLOT-R) for dispositional optimism and a questionnaire about sociodemographic characteristics. Statistical analysis was performed with SPSS 21.

16.8% of patients were substantially to extremely dissatisfied with their lives(SWLS=5-14). 16.4% were slightly below average(SWLS=15-19), 19.8% had an average score (SWLS=20-24) and the rest had a high(29.8%-25-29) and very high score(17.2%-30-35) respectively. There was a significant difference between males(M=20±7) and females(M=22.8±7.2)(t=-1.906-p=0.05). Multivariate analysis revealed that optimism(beta=-.403), stress(beta=-.415), spouse existence(beta=.155), and gender(beta=.228), explained 56.4% of the variance in SWB(adjusted R2=.564-p=0.026). Age, SF12, depression, anxiety and education had a Non Significant effect in the model.

Given these findings, almost half of thalassemia patients have average to low life satisfaction, something which implies that they are sometimes not functioning well because their unhappiness serves as a distraction. Talking to a psychologist or psychiatrist can often help the patient get moving in the right direction, although positive change will be up the person

The Montreal Cognitive Assessment(MoCA) is a psychometric tool measuring cognitive function that detects Mild Cognitive Impairment(MGI), a clinical condition which often results in dementia.

To measure the psychometric properties of the assessment.

To explore the discriminant validity and internal consistency of the assessment.

The study included 132 patients, 56(42.2%)men and 76(57.6%)women. Of them, 12(9.1%) had dementia, 54(40.9%)psychiatric diseases, 7(5.3%)vascular strokes, 3(2.3%)organic psychosyndrome, 17(12.9%) cases were to be investigated and 36(27.3%) were patients without psychiatric illness, who were evaluated under Liaison Psychiatry. The psychometric properties of MoCA were evaluated in comparison to the Mini-Mental-State-Examination(MMSE) and Golden Standard, which was the diagnosis of the treating physician. Statistical analysis was performed with SPSS21.

The total scale of MoCA had a coefficient alpha of .885 and all the subscales between .878-893. MoCA had a significant high correlation with MMSE(r=-.544 p =.001) and with age(r =-.544 p =.001). No significant differences were found between men and women (t=-.707 p>.05). There was a statistically significant difference between the assessments in moderate and severe cognitive impairment, where MoCA was more sensitive (99%) than MMSE (likelihood ratio=115.3 p =.001) in all diagnostic categories. The specicifity of MoCA was 93% due to fact that it was reduced in patients with organic psychosyndrome when the golden standard found no cognitive impairment.

MoCA is a brief screening tool of cognitive decline with higher specificity and sensitivity in detection of mild cognitive impairment in patients who scores in normal levels of MMSE.

Subjective well being (SWB) is really an umbrella term, that includes several different components and these components are somewhat independent, while Diabetes Mellitus (DM) is a chronic condition affected by many biopsychosocial factors.

To measure the impact of SWB in adult patients with DM

To explore possible demographic, physical, and psychosocial correlates in SWB.

293 DM patients(115(39.2%) males/178(60.8%) females), in two outpatients’ clinics in Athens-Greece took part in the study. Satisfaction with Life Scale(SWLS) was used for SWB, along with SF12 for health related quality of life Depression Anxiety Stress Scale(DASS), Life Orientation Test(GrLOT-R) for dispositional optimism and a questionnaire about sociodemographic characteristics. Statistical analysis was performed with SPSS 21.

internal Almost half of the patients(54.5%) scored below average(<24) in SWLS while 20% were highly satisfied (score 30-35) and 25% satisfied(25-29). No existing differences were present in SWB according to sex(t=1.605-p=NS). Multivariate analysis revealed that depression(beta=-.423), Physical component score (SF12-PCS) (beta=.317), fatigue(beta=.211), income(beta=.186), stress(beta=-.150) and pain intensity (beta=.139), explained 52.9% of the variance in SWB(adjusted R2=.529-p=0.001). Sex, education, marital status, anxiety, Mental Composite Score, HbA1c, insulin therapy, and diabetes complications had a NS effect in the model.

Our results indicates that SWB is affected equally from biological, psychological and societal variables, giving strong evidence to the biopsychosocial model of subjective health and suggests that multidisciplinary treatment with psychological screening should be applied in these patients in order to help and motivate them feel better.

Internet addiction(IA) has been proposed to separate into three subtypes, gaming, sexual preoccupation and email/text messaging and since use for social networking has increased significantly it may represent a fourth subtype in this model.

To examine the effect of more than two hours/day use of the social networking with facebook application, in relation to negative emotions of depression, anxiety and stress.

To estimate the possibility of this use in leading to negative emotions.

257 adults(17-68 years old, Mean age=33.1±10.1; 76(29.6%) males and 181(70.4%) females) took part in the study. An online form of Depression Anxiety Stress Scale (DASS) was used for measuring negative emotions as well as sociodemographic characteristics. Statistical analysis was performed with SPSS 21.

Statistical significant differences were found between males(x=14.8±8.4) and females(x=18.5±9.9) in stress(t=2.886 p=0.004). Multivariate analysis revealed that age(beta=.143) and social activity(beta=.123), explained 18% of the variance in depression(adjusted R2=.188- p=0.028). In stress and anxiety, social activity(beta=.177 and .130) and education(beta=-.170 and -.216), explained 23% of the variance (adjusted R2=.231-p=0.004) and (adjusted R2=.239-p=0.037) respectively.

Odds ratio of depression for those who used the Internet for more than two hours/day was: OR=1.0254(95% CI:0.5682-1.8504 p = 0.9337), for stress OR=0.7826(95% CI:0.4352-p= 0.4130) 1.4074 and for anxiety OR=1.1140(95% CI: 0.6200- 2.0018 p=0.7180).

Results suggested that social networking users who are initially free of mental health problems but use the Internet pathologically do not develop negative emotions as a consequence especially when they have social activities as a protective factor.

In the UK, 1/4 people are considered overweight or obese. National Health Service (NHS) employees are no exception with ½ workers affected. There are myriad factors that contribute to these statistics such as mental health, occupation and lifestyle.

Studies reveal that 35% of people with bipolar disorder are clinically obese, which is the highest percentage of any psychiatric illness. The suggested factors that may be contributing to this problem include co-existing eating disorders and treatment with medications that cause weight gain.

Religious periods i.e. Christmas and Ramadan are associated with weight changes. 50% of annual weight gain has been reported during the Christmas period. Conversely weight loss has been reported in Muslims who fast during the Islamic month of Ramadan.

To qualitatively illustrate how religious, psychosocial, physical and occupational factors can cause significant weight changes.

We provide an autobiographical narrative from a doctor- the primary author- employed by the National Health Service who suffers from bipolar disorder and who has experienced dramatic oscillations in his weight.

Ramadan provided the primary author with a platform to make major modifications to his lifestyle. He substantially reduced his carbohydrate consumption and also exercised 7 days/week. Dr Hankir lost 30 kg in weight over a 3 month period. His waist size decreased from 36 inches to 32 inches.

Fasting during Ramadan can provide an opportunity to lose weight as is evidenced in this case report, however structured and consistent lifestyle modifications are necessary to maintain sustained weight loss.

Quis custodiet ipsos custodes? Who will watch the watchmen?

The incidence of most psychiatric disorders is higher in doctors than in the general population. Surveys have revealed that up to 25% of doctors have depressive symptoms. Suicide rates are also high with 400 doctors in the US alone lost every year lost to suicide.

Doctors are notoriously bad at seeking help for their own psychiatric problems often only presenting when a crisis arises. Reasons for this include symptom concealment owing to fears of exposure to stigmatisation.

A stigma was a scar on the skin of ancient Greek criminals. It was a sign to all that these people were unsafe, unclean and unwanted. Stigma still persists today in the attitudes towards those who have mental health challenges. Nowhere is this more apparent than in the medical profession.

To take a stand against the stigma associated with mental health challenges in the medical profession and to debunk the many myths that abound.

The primary author composed an autobiographical narrative about his personal experiences with oscillations in his mood in attempt to illustrate the factors that influence disease detection, progression, treatment and outcome.

Mental health challenges do not prevent you from realising your dreams as evidenced in this case report. Dr Hankir received the 2013 Royal College of Psychiatrists Foundation Doctor of the Year Award. It is through making it more acceptable to share our experiences with low mood that the number of suicides among medics will fall.