Cancer is a life-threatening disease, characterized by a great deal of uncertainty and unpredictability. Thus, several stressors and emotional upheavals pervade the everyday life of cancer patients and can lead to the development of depression.

To review the recent research related to depression in cancer patients.

Literature review based on PubMed/MEDLINE, using the keywords “cancer” and “depression”.

It is estimated that 20–25% of cancer patients meet the criteria for major depressive syndrome at some point in their illness. Depression is associated with a negative impact on treatment adhesion, cancer progression and quality of life, besides increasing suicide risk. However, it is often unrecognized and untreated. Importantly, the mistaken belief that depressive symptoms are expected in this group, the overlap between the neurovegetative symptoms of depression, the somatic symptoms of cancer and its treatment, as well as the effects of comorbid diseases make the diagnosis of major depression so complex in these patients. Some of the most helpful diagnostic indicators are feelings of hopelessness, worthlessness, excessive guilt, loss of self-esteem, and wishes to die. The several risk factors for the development of depression in cancer patients can be divided into four broad categories, namely cancer-related factors, cancer treatment-related factors, psychiatric history, and social factors. Effective management of depression consists in a combination of psychotherapy and psychopharmacology.

Depression in cancer patients has serious consequences, however appropriate psychiatric intervention can do it over. Thus, its early recognition and appropriate management is imperative.

The authors have not supplied their declaration of competing interest.

Efavirenz, a non-nucleoside analogue inhibitor of the reverse transcriptase, has become commonly used in the treatment of HIV infection. Although highly effective, efavirenz is associated with causing neuropsychiatric side effects in approximately 50% of patients.

To provide an overview of efavirenz-induced neuropsychiatric effects.

Literature review based on PubMed/Medline.

The neuropsychiatric side effects of efavirenz usually begin quickly, commonly peak in the first two weeks after the start of therapy, and can include depression, anxiety, sleep disturbances, impaired concentration, aggressive behavior, paranoia, psychosis. Generally, these events are mild to moderate in severity and time limited, however, in a small number of cases, are late, persistent or intolerable. They are often associated with a negative impact on treatment adhesion. Some factors are known to increase the risk of neuropsychiatric effects in HIV-positive patients. The behavioral effects of efavirenz appear to be dose-dependent and mediated predominately by the 5-HT2A receptor, a primary site of action of lysergic acid diethylamine (LSD). Importantly, the efavirenz-induced neuropsychiatric effects may be difficult to distinguish from HIV-related neuropsychiatric symptoms, preexisting mental disorder or substance use. The neuropsychiatric effects should be treated with non-pharmacologic or pharmacologic interventions, according to severity. The psychiatric status of patients should be closely monitored for at least the first 6 to 12 months of treatment.

Taking into account the high rates of neuropsychiatric side effects, it is crucial that the physicians are familiar with this important subject, and the decision to initiate efavirenz in psychiatric patients is individualized.

The authors have not supplied their declaration of competing interest.

Management of HIV/AIDS “worried well” people is among the most complex and challenging psychiatric problems in HIV care.

To provide an overview of HIV/AIDS “worried well”.

Literature review based on PubMed/Medline, using the keywords “HIV” and “worried well”.

The HIV/AIDS “worried well” are those individuals who are intensely worried about being infected with HIV, despite overwhelming evidence to the contrary. Indeed, they will rapidly return with the renewed conviction that the physician has “got it wrong” or “missed something”. So, they tend to over-utilize health care services. Seven HIV/AIDS “worried well” sub-groups have been identified: those with past sex or drug use history; those with relationship problems; the partners/spouse of those at risk; couples in individual or family life transitions; past history of psychological problems; misunderstanding of health education material; and pseudo and factitious AIDS. These patients have several striking consistencies in their presenting phenomenology and background features and usually have psychiatric problems associated. The authors will analyze all these aspects. Currently there are no guidelines to deal with this clinical condition, however cognitive-behavioral therapy along with selective serotonin reuptake inhibitors has been an effective approach. It is also important to ensure follow-up discussion to these patients, especially where unresolved life issues may cause future vulnerability in absence of intervention.

Patients may express their concerns about HIV infection by several ways, directly or indirectly, and psychiatrists need to be aware of this reality, which causes much suffering as well as severe monetary loss.

The authors have not supplied their declaration of competing interest.

Studies of the association between blood BDNF levels and delirium are very few and have yielded mixed results.

To investigate the blood BDNF levels in the occurrence and recovery of delirium.

Prospective, longitudinal study. Participants were assessed twice weekly with MoCA, DRS-R98, APACHE-II. BDNF levels of the same were estimated with ELISA method. Delirium has been define as per DRS-98R (cut-off > 16) and recovery of delirium as at least two consequently assessments without delirium prior to discharge.

No differences in the levels of BDNF between those with delirium and those who never developed it. Excluding those who never developed delirium (n = 140), we analysed the effects of BDNF and the other variables on delirium resolution and recovery. Of the 58 remained with delirium in the subsequently observations (max = 8) some of them continue to be delirious until discharge or death (n = 39) while others recovered (n = 19). BDNF levels and MoCA scores were significantly associated with both delirium cases who became non-delirious (resolution) during the assessments and with overall recovery. BDNF (Wald χ2 = 11.652, df: 1 P = .001), for resolution. For recovery Wald χ2 = 7.155; df: 1, P = .007. No significant association was found for the other variables (APACHE-II, history of dementia, age or gender)

BDNF do not have a direct effect in the occurrence of delirium but for those delirious of whom the levels are increased during the hospitalisation they are more likely to recover from delirium.

The authors have not supplied their declaration of competing interest.

Antidepressants are the first-line treatment of major depressive disorder, but response rates following the first antidepressant medication are moderate.

Clinical efficacy requires to overcome the blood-brain barrier where p-gp molecules are located. If they recognize and bind an antidepressant, they pump it back into the circulation. If the antidepressant is not recognized, the passage is not impaired by p-glycoproteins.

We studied whether variants in the ABCB1 gene that encodes the p-glycoprotein have an effect on blood-brain passage of antidepressants and as consequence on their clinical benefit.

ABCB1 gene variants were determined with sequencing (Illumina Bead), substrate property analysis employed mice with deletion of ABCB1-analog genes. Clinical protocols followed those of the MARS-project.

– The SNPs rs2032583 and rs2235015 provide the best clinical information about blood-brain-penetrance, with CC/CT and TT/GT being the favourable gene variants whereas TT and GG are less favourable. This distinction holds only true if antidepressants are p-glycoprotein substrates;

– in the presence of the favourable gene-variant patients treated with an antidepressant that is a p-glycoprotein substrate are more likely to remit in shorter time;

– in the presence of the less favourable gene-variant treatment with a substrate, higher dosages and augmentation strategies, or switch to non-substrates are recommended.

From these data, a treatment algorithm was developed that maximizes treatment benefit and minimizes adverse effects.

The authors have not supplied their declaration of competing interest.

Self-stigma is a maladaptive psychosocial phenomenon that may disturb many areas of patient's life and have the negative impact on their quality of life. The present study explored the association between self-stigma, quality of life, demographic data, and the severity of symptoms in patients with depressive disorder.

Patients, who met ICD-10 research criteria for depressive disorder, were enrolled in the cross-sectional study. All probands completed these measurements: the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), the Internalised Stigma of Mental Illness Scale (ISMI), demographic questionnaire, and the severity of the disorder measured by objective and subjective Clinical Global Impression severity scales (CGI).

Eighty-one depressive patients (with persistent affective disorder – dysthymia, major depressive disorder or recurrent depressive disorder) and 43 healthy controls contributed to the study. Comparing with the healthy control group, there was a lower quality of life in patients with depression. The level of self-stigma correlated positively with total symptom severity score and negatively with the quality of life. Multiple regression analysis discovered that the overall rating of objective symptoms severity and self-stigma were significantly associated with the quality of life.

Present study suggests the lower quality of life in outpatients with depressive disorder in comparison with healthy controls, and the negative impact of self-stigma level on quality of life in patients suffering from depressive disorders.

The authors have not supplied their declaration of competing interest.

The quality of life is a multidimensional phenomenon which represents all aspects of patient's well-being and various areas of the patient's life. Specific coping strategies may be connected with the quality of life and also with the severity of the disorder. The objective of this study was to explore the relationship between the coping strategies and quality of life in outpatients with depressive disorder.

Eighty-two outpatients, who met ICD-10 criteria for depressive disorders, were enrolled in the cross-sectional study. Data on sociodemographic and clinical variables were recorded. Individuals with depression filled out the standardized measures: The Stress Coping Style Questionnaire (SVF-78), The Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), and The Clinical Global Impression (CGI).

The patients overuse negative coping strategies, especially, escape tendency and resignation. Using of positive coping is in average level (the strategy Positive self-instruction is little used). Coping strategies are significantly associated with quality of life. Higher using of positive coping has a positive association with QoL. The main factors related to QoL are the subjective severity of the disorder, employment and positive coping strategies according to regression analysis.

This study revealed the connection between coping strategies and quality of life in patients with depressive disorders. Strengthening the use of positive coping strategies may have a positive effect on the quality of life, mental conditions and treatment of patients with depression.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Atypical depression is linked to bipolarity and specific response to mono amino oxidase inhibitors (MAOI), treatments not commonly used due to their complex handling. We describe a successfully treated case.

Clinical description. Depression severity is assessed with Montgomery Asberg depression rating scale (MADRS).

Female, 54-year-old. Major depression, since 2011, refractory to venlafaxine/aripiprazol and escitalopram 20 mg/day. Manic episode with psychotic symptoms after potentiation with duloxetine. Diagnose of schizoaffective disorder was made, treated with aripiprazol 10 mg/day, with established chronical depressive symptoms, despite addition of valproate and venlafaxine, and partial response to pramipexole up to 1 mg/day.

– Decision of cleaning up aripiprazol during 8 days and switch to moclobemide monotherapy was made due to atypical features. Baseline MADRS: 31. At week 2, there is change in mood, expression, psychomotor features and speech formal and content alterations. At week 4, activity increases, and biorythms normalize. At week 8 (with 600 mg/day increased dose), full response is obtained, including drive, and anxiety, with MADRS 12.

– After one year of treatment, she has kept stability with no manic or psychotic symptoms emergence. Reduction in dose are linked to depression relapses. She still struggles with psychosocial recovery.

– Tolerance has been good in all moment, except for headache crisis, not linked to high blood pressure or diet.

MAOI still has a role in affective disorders treatment, given its effectiveness, unique mechanism of action and good tolerability. Targeted psychopharmacological and phenomenology knowledge can be the key to a recovery.

The authors have not supplied their declaration of competing interest.

Depression is treatable, but many people with depression do not seek help. When studies are conducted assessing barriers to and reasons for help seeking, it is common to combine responses from people with and without depressive symptomatology.

The goal of the current study was to assess if people with and without heightened levels of depressive symptomatology perceive reasons/barriers similarly.

Prior to the main study, two pilot studies were conducted which resulted in sets of 10 reasons and barriers rated as those participants were most aware of as influencing their decision to seek help for depression. Participants (n = 520) rated the importance of these reasons/barriers to their decision regarding help seeking. Two groups were created based on their Beck depression inventory-II score: no to minimal and mild to severe depressive symptomatology.

Although, the order across the reasons/barriers varied between the groups, the most important reason for both groups was seeking help to enjoy life again, while the most important barrier for both groups was negative side effects of depression medication. The no to minimal group rated reasons to seek help as significantly more important to their help seeking decision process than the mild to severe group, while the mild to severe group rated barriers to seeking help significantly more important to their help seeking decision process than the no to minimal group.

Greater importance of barriers to seeking help could partially explain why help seeking decreases as depressive symptomatology increases. Interventions should increase the importance of reasons to seek help.

The authors have not supplied their declaration of competing interest.

Depression and somatic disorders are closely interrelated. Depressed mood is recognized to contribute to the development and progression of wide range of somatic diseases, while at the same time somatic diseases may increase the risk of depression. Co-morbidity research still represents huge research and clinical challenge to contemporary psychiatry and medicine.

To check whether the correlation of NSC and poor prognosis of MDD treatment is merely the consequence of age and duration of illness.

We investigated a cross-sectional sample consisting of 290 psychiatric diagnosed with MDD. Outcome was the number of psychiatric rehospitalizations (NPR) since the first diagnosis of MDD treatment success. Predictor was NSC. Covariates controlled were sex, age, BMI, marital status, number of household members, education, work status, duration of MDD, CGI-severity of MDD at diagnosis, treatment with antidepressants and anti-psychotics.

After adjustment for all confounders, mediation analysis revealed insignificant indirect effects of NSC on NPR through patient's age (P = 0.296) and duration of MDD (P = 0.180). Direct effect of NSC was significant and clinically relevant (P < 0.001). Effect of NSC was significantly moderated by duration of MDD (P = 0.019). NSC and NPR were not significantly associated if MDD lasted for less than a year. The more MDD lasted the stronger was correlation of NSC and NPR.

Correlation of NSC and poor prognosis of MDD is not a mere consequence of patient's age and duration of illness. To treat MDD effectively we have to treat simultaneously somatic comorbidities.

The authors have not supplied their declaration of competing interest.

Insomnia is a common sleep disorder for patients with depression. This has a major impact on the quality of life for the individual. A randomized controlled trial (RCT) will address the use of music as a non-pharmacological treatment to reduce insomnia in depression.

The aim is to investigate, whether music listening is effective to:

– improve sleep quality;

– reduce symptoms of depression;

– improve quality of life;

– limit or replace medication.

A RCT will address the use of music as a treatment modality in depression using an explanatory mixed methods design. In the first phase of the study, patient data is collected from 3D accelerometer, log files from a new app for iPad called ‘the music star’ and questionnaires (MDI, HAM, PSQI and WHO-QOL). ‘The music star’ is an app for iPad used to select music from special designed playlists developed by Danish music therapists in psychiatry. An exploratory follow-up (semi-structured interviews) aims to explain quantitative results from accelerometer and ‘the music star’ log files. Participants enrolled are registered at the clinic for unipolar and bipolar affective disorders at Aalborg University Hospital – Psychiatry. The participants test whether a sound pillow and special designed playlists is effective to reduce insomnia in depression in a 4 week period.

A feasibility study has been conducted on 11 participants showing positive results in terms of participation and sleep quality.

The authors have not supplied their declaration of competing interest.

The postpartum depression screening scale (PDSS; Beck & Gable, 2002) is a widely used measure to assess women's depressive symptoms after their children's birth. Pereira et al. adapted, validated and developed a short-version of PDSS for Portuguese women (PDSS-21).

To examine the factor structure of the PDSS–21, using confirmatory factor analysis (CFA) in a sample of Portuguese women in the postpartum period.

The sample was composed of 208 women (mean age = 32.72; SD = 4.49) who completed the PDSS–21 approximately at the 6th week postpartum. CFA was used to test the model suggested by prior exploratory factor analyses of PDSS–21. AMOS software was used.

After two items were deleted and some errors were correlated, CFA indicated a good fit for the second-order factor (χ2/df = 1.793; CFI = 0.957; GFI = 0.889, rmsea = 0.062; P [rmsea ≤ 0.05] < 0.056). The 19–item PDSS showed excellent internal consistency (α = 0.92) and the four dimensions presented Cronbach's alphas ranging between good (α = 0.83) and excellent (α = 0.93).

These findings suggest that the 19–item PDSS obtained through CFA is a reliable and valid measure to assess depressive symptoms among women in the postpartum period.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Despite its high effectiveness, electroconvulsive therapy (ECT) is not a widely used method to treat depression. One of the reasons for this could be the fear of cognitive side effects. The aim of this study was to investigate effects of ECT on cognitive function.

We conducted a prospective study with a sample size of 23 patients (10 male), who met the criteria of treatment-resistant depression according to ICD–10 and gave their informed consent for ECT treatment. Before and after ECT, the following investigations have been performed: Beck depression inventory (BDI), Montgomery-Asberg depression rating scale (MADRS), Mehrfachwahl-Wortschatz-Intelligenztest (MWT-B), trail making test (TMT) A and B, stroop-test, mini mental state examination (MMSE) and the German version of the California verbal learning test (MGT).

After ECT treatment, we found highly significant changes of depression-scales BDI (P = 0.028) and MADR-Scale (P = 0.001). IQ as measured by the MWT-B (P = 0.851), executive functions as measured by trail making test A (P = 0.568) and B (P = 0.372) and stroop-test, memory functions as measured by the MGT (P = 0.565) (Figure 1) and MMSE (P = 0.678) did not differ significantly after ECT treatment.

There were no significant differences in cognitive function before and after ECT treatment. To confirm these findings, it would be necessary to perform larger studies.

The authors have not supplied their declaration of competing interest.

To examine 5 years trajectories of secondary-treated late-life major depressive disorder (MDD), and evaluate whether pre-existing cerebrovascular disease and related risk factors are associated with more severe trajectories of late-life MDD.

Data were obtained from Danish registers. The sample included 11,184 adults ≥ 60 at index MDD diagnosis. Trajectories of in or outpatient contact at psychiatric hospitals for MDD over the 5 years period following index MDD diagnosis were modeled using latent class growth analysis. Risk factors included cerebrovascular disease, cardiovascular disease, hypertension, diabetes, and vascular dementia defined based on hospital diagnoses and prescription medications, demographic characteristics and characteristics of the index MDD diagnosis.

The final model included classes with consistently low (66%), high decreasing (19%), consistently high (9%) and moderate fluctuating (6%) probabilities of contact at a psychiatric hospital for MDD during the 5 year period following the index MDD diagnosis (Fig. 1). Older age, greater severity, inpatient treatment and > 12 antidepressant prescriptions within 5 years of the index MDD diagnosis predicted membership in more severe trajectory classes. Cerebrovascular disease and related risk factors were not associated with trajectory class membership.

A substantial proportion (34%) of individuals diagnosed with MDD in late-life require specialized psychiatric treatment for extended periods of time. We found no evidence that cerebrovascular disease or related risk factors predicted course trajectories in secondary-treated late-life MDD.

The authors have not supplied their declaration of competing interest.

It is known that there is a cognitive decline in major depressive disorder. Most studies were performed on patients whose sum on a Montgomery and Asberg depression rating scale was greater than 30.

In our work, we concentrated on mild and moderate depression, MADRS > 30 was not criteria. Patients included were diagnosed with mild to moderate depressive episode.

To determine how depressive episodes affect cognition.

We included 30 patients diagnosed at the clinic for psychiatry in Nis. We covered the age group between 20 and 40 years, regardless of the gender and educational level. For the assessment of cognition, we used digital symbol substitution test (DSST), Rey audio verbal learning test (RAVLT), trail making test (TMT), stroop color naming test (Stroop), and patients were evaluated with Montgomery and Asberg depression rating scale (MADRS). Tests were conducted on the first visit to a psychiatrist. Patients were compared with the results of the healthy population with the same characteristics, and in the same period (August 2016). Mean values were compared and groups were compared by Student's t-test.

There was a statistically significant difference in all of the tests, and all of the parts of tests conducted on the patients and the control group.

There is a statistically significant cognitive decline in patients with mild and moderate depression.

The authors have not supplied their declaration of competing interest.

Clinicians need to make the differential diagnosis between unipolar depression and bipolar disorder to guide their treatment choices. Looking at the differences observed in the emotional schemas might help with this differentiation. This study is an exploratory investigation of schema theory's Leahy's emotional schemas among individuals diagnosed with bipolar disorder and unipolar depression.

Three groups of subjects 56 unipolar depression in the remission period, 70 bipolar eutimic and 58 healthy controls were asked to fill out the Leahy Emotional Schema Scale (LESS). The clinicians diagnosed the participants according to the criteria of DSM-IV-TR with SCID-I, and rated the moods of the subjects with the Beck Depression Scale, and the Young Mania Rating Scale (YMRS). Statistical analyses were undertaken to identify the group differences on LESS.

The bipolar eutimic and unipolar depression patients’ scores on the LESS dimensions were significantly different from the healthy participants in the areas of control, consensus, acceptance of feelings, dissimilarity and simplistic view of emotions.

These results suggest that the metacognitive model of unipolar depression might be extrapolated for patients with bipolar disorder. Bipolar disorder may be associated with a general activation of the emotional schemas.

The author has not supplied his/her declaration of competing interest.

COPD is a common disease, has an impact not only on psychical but also on psychological well-being. Anxiety, stress, depression are common comorbidities for COPD patients.

This paper proposes to study from a qualitative point of view the effect of depression on COPD patients.

A qualitative methodology was chosen in order to explore 75 (male n = 69, female n = 6) COPD patients’ symptoms and signs of anxiety, stress and depression.

Data were collected through semi-structured interviews. All patients also completed the Beck Inventory and the GDS 15 questionnaires. The interviews were conducted both in the general university hospital of Larissa and in patients’ homes.

We enrolled 75 patients (15: normal, 17: mild depression, 7: moderate and 1 severe). Persistent low mood and lack of interest was expressed by most of the participants. “Before I get this thing, I was in a good mood, but not now”. Poor self-management was associated with anxiety disorders and high temper: “I withdrew, due to my health”…“I was really stressed, and depressed, and quick-tempered”. COPD diagnosis was difficult for some patients: “At the beginning, I wasn’t in the mood for anything, just sleeping and more of watching TV”. Other patients seemed to be in a good mood: “I was never scared of anything, I am happy”.

This research shows that depressive and anxiety symptoms are common among COPD patients. Depression has a significant impact on the daily life of patients while breathlessness made patients feel housebound and social isolated.

The authors have not supplied their declaration of competing interest.