To diagnose and treat the depression illness in diabetic patients.

A sample of 30 diabetic patients (15 women, 15 men), mean age 59,6 years was assessed for depression - ICD 10 criteria. HAM-D (Hamilton for depression scale), CGI-S (Clinical global impression –severity) and CGI-I (Clinical global impression –improvement) were performed at baseline, 7, 14, 21, 28 and 42 days. Patients received antidepressive medication: tianeptine 37,5 mg/day or venlafaxine 75-150 mg/day.

Mean score HAM D at baseline was 21.4. The reassessment after 7, 14, 21, 28 and 42 days revealed significant decrease of depressive symptomathology after 4 weeks of medication (HAM D was 15.4). After 42 days the mean score HAM-D was 9,5. CGI-S at baseline was 4.5 and on 42 day 1.8. Mean blood glucose was evaluated from 215,5 mg/dl at inclusion and 142,3mg/dl on day 42.

1) Successful treatment of depression is associated with improvements in glycemic control. 2) Improvements in mood increase the functioning and quality of life. 3) Further studies are important to demonstrate the role of maintenance antidepressant treatment for the prevention of recurrence.

To evaluate the efficacy and tolerability of once-daily quetiapine XR adjunctive to antidepressant therapy versus antidepressant alone in patients with MDD showing an inadequate response to antidepressant treatment (mainly SSRIs/SNRIs).

6-week, multicentre, double-blind, parallel-group study (D1448C00007). Patients were randomised to receive quetiapine XR 150mg/day (n=167), 300mg/day (n=163) or placebo (n=163) as add-on to maintained antidepressant treatment. Primary endpoint: baseline to Week 6 change in MADRS total score. Secondary variables included: baseline to Week 1 change in MADRS total score; baseline to Week 6 change in HAM-A total and psychic anxiety subscale scores. Safety assessments included AE reporting.

Mean change in MADRS total score (overall baseline mean, 28.4) from baseline to Week 6 was significant (p<0.01) for quetiapine XR 150mg/day (-15.26) and 300mg/day (-14.94) versus placebo (-12.21). Separation from placebo in MADRS total score was apparent from Week 1 for both quetiapine doses (p<0.001).

At Week 6, mean change from baseline in HAM-A total score (overall baseline mean, 20.8) was significant for quetiapine XR 150mg/day (-10.27, p<0.01) and 300mg/day (-9.70, p<0.05) versus placebo (-7.92). Mean change from baseline in HAM-A psychic anxiety subscale score (overall baseline mean, 12.83) was significant with quetiapine XR 150mg/day (-6.82, p<0.001) and 300mg/day (-6.47, p<0.01) versus placebo (-5.11).

Most common AEs (>10%) were dry mouth, somnolence, fatigue, sedation, constipation and dizziness with quetiapine XR.

In patients with MDD with an inadequate response to antidepressant treatment, adjunctive quetiapine XR 150mg/day and 300mg/day was well tolerated and effective at reducing depressive and anxiety symptoms.

Major depression is a significant problem for people with a traumatic brain injury (TBI) and its treatment remains difficult. A promising approach to treat depression is Mindfulness-based cognitive therapy (MBCT), a relatively new therapeutic approach rooted in mindfulness based stress-reduction (MBSR) and cognitive behavioral therapy (CBT). We conducted this study to examine the effectiveness of MBCT in reducing depression symptoms among people who have a TBI.

Twenty individuals diagnosed with major depression were recruited from a rehabilitation clinic and completed the 8-week MBCT intervention. Instruments used to measure depression symptoms included: BDI-II, PHQ-9, HADS, SF-36 (Mental Health subscale), and SCL-90 (Depression subscale). They were completed at baseline and post-intervention.

All instruments indicated a statistically significant reduction in depression symptoms post-intervention (p < .05). For example, the total mean score on the BDI-II decreased from 25.2 (9.8) at baseline to 18.2 (11.7) post-intervention (p=.001). Using a PHQ threshold of 10, the proportion of participants with a diagnosis of major depression was reduced by 59% at follow-up (p=.012).

Most participants reported reductions in depression symptoms after the intervention such that many would not meet the criteria for a diagnosis of major depression. This intervention may provide an opportunity to address a debilitating aspect of TBI and could be implemented concurrently with more traditional forms of treatment, possibly enhancing their success. The next step will involve the execution of multi-site, randomized controlled trials to fully demonstrate the value of the intervention.

It is often reported that patients with diabetes have increased risk of suffering from major depression (1). We wanted to study the frequency of depression in an special unit for diabetes at the University Hospital.

Fiftythree patients were recuited at this outpatient clinic. They were diagnosed using the structured clinical intervju MINI (2).

Of the 53 patients with diabetes, 12 (23%)had an ongoing depressive episode. In addition 8 patients had suffered from previous episodes of depression. Thus 20(38%) had a lifetime history of major depression. Of the 12 patients with an ongoing depression, 58% had a first degree relative with psychiatric disorder, in contrast to 33% in those with no history of depression.

The propotion of depressive disorders in patients with poorly regulated diabetes, is very high. An astonishing finding is the very high frequency of first degree relatives with affective disorders.

It may be speculated that diabetes and depression have some pathophysiological features in common (3).

According to recent findings stress experiences represent significant condition in pathophysiology of depression and influence abnormal development in the brain. Repeated stress and cognitive conflict also may determine limbic irritability and temporal-limbic epileptic-like activity. Because recent findings indicate that epilepsy and epileptiform processes are related to increased neural chaos, in the distinct contrast to normal brain activity, aim of this study is to find relationship between neural chaos in autonomic responses reflecting brain activity during stress activation and limbic irritability.

For empirical examination of suggested hypothesis Stroop word-colour test, ECG recording, calculation of chaos indices i.e. largest Lyapunov exponents (LLEs) in nonlinear data analysis and psychometric measures of limbic irritability (LSCL-33) and depression (BDI-II) in 35 patients with unipolar depression and 35 healthy controls were used.

Significant correlation r=0.68 (p<0.01) between LLEs and LSCL-33 found in this study indicate that degree of chaos in autonomic responses during conflicting Stroop task reflected by LLEs is closely related to limbic irritability. Significant correlation r=0.47 (p<0.01) also has been found between LLEs and symptoms of depression assessed by BDI-II. In the control group similar correlations have not been found.

The results are in agreement with findings that epileptiform activity represents typical form of chaotic organization. Because limbic irritability is linked to seizure-like processes in the temporo-limbic structures, the correlation between LSCL-33 and LLEs might represent useful finding for understanding of neurobiological mechanisms underlying stress-related sensitization and could be useful for future research regarding anticonvulsant treatment of depression.

Recent developments in the field of polydrug use along with alcoholism provide growing insights into how cognitive, affective, motivational and neurobiological pathways are altered in addictive persons. Few of these insights have as yet been implemented in everyday care.

Framed within the multi-site FACE© program (Facilitating Adjustment of Cognitions and Emotions), this paper presents an integrative scientist-practitioner model that aims to translate the above insights into systematized multidisciplinary practice. The pathways from model to structured care are specified using a mixed-method design of bottom-up and top-down approach. Their practice implementation over a three month course is illustrated with case series data in the context of an open-access, first-line addiction centre in the suburban Paris region.

In as few as seven weeks, dramatic therapeutic improvements come forward. All polydrug patients referred due to long-term treatment refusal, are found to comply with the structured scientist-practitioner model approach. Multidisciplinary practitioner-observed benefits include increased or first-time therapy adherence and drug treatment compliance. Patient self-reported benefits moreover include increased addiction insight and mastery, along with enhanced cognitive-emotional regulation to gain control over addictive craving versus pleasure-seeking behaviours.

Applying an integrative model that focuses on the cognitive–emotional dynamics at hand in the addictive course with the polydrug using patient, and rigorously implementing related assessment and therapeutic methods manifestly bears immediate and middle-term benefits. Evaluation of longer term benefits is recommended, along with larger scale quantitative outcome analyses. Further research and practice implications are discussed to this respect.

To investigate the plasma levels of IL-18, MIP-1α, MCP-1, SDF-1 and RANTES in major depression before and after treatment.

Twenty healthy volunteers and 40 patients with major depressive disorder (MDD) were involved in the current study. Depressed subjects had moderate or major depression according to the DSM-IV criteria. The HAMD scale was used to measure the efficacy after the 8-week treatment with fluoxetine hydrochloride. All subjects gave their written informed consents and were recruited from outpatients and inpatients of Sir Run Run Shaw Hospital between October 2004 and November 2005.The plasma levels of IL-18, MIP-1α, MCP-1, SDF-1 and RANTES in major depression were measured by ELISA before and after fluoxetine treatment.

HAMD score were significantly decreased after the treatment (P<0.001), there were seven cases score of after treatment <7,. At the time of admission, the plasma levels of IL-18, MCP-1, MIP-1α, SDF-1 and RANTES were significantly higher in the MDD than those in the healthy controls (P<0.001). In MDD, the cytokine values were significantly decreased after the treatment, including IL-18 (P=0.005), MCP-1 (P=0.001), MIP-1α (P<0.001, SDF-1 (P=0.004) and RANTES (P<0.001), but still significantly higher than those in the healthy controls (P<0.001).

These findings suggest that major depression is accompanied by the immune activation, and the antidepressant treatments have anti-inflammatory effects. The remaining depression symptom after treatment may be related to the higher level of cytokines.

This study presents the psychometric characteristics of the Centre for Epidemiological Studies Depression Scale (C.E.S.-D) in a sample of Portuguese young women analysing the severity.

The sample was randomly selected using stratification by age. 177 young women with mean age of 20 participated in the study. The outcome variables included the C.E.S.-D and specific sub-scales. Internal consistency and factor analysis were conducted, as well as correlations.

Cronbach's alpha and factor analysis show a very similar pattern of psychometric characteristics found in the original study.

The implications of the results for both theory and practice were discussed. Future research topics were discussed in terms of the development of new depression evaluation instruments for women.

Deliberate self-harm is an increasing problem (6-7% prevalence rate) in teenagers.The aims of the study was to present diagnoses of Hungarian self-injurious adolescents and to identify features of SIB.

Sample. 48 female adolescent outpatients collected from a total of 396 new outpatients recently referred and treated in 4 Child Psychiatric centres of Western-Hungary over a one-year admission period.

Assessment methods.a) Hungarian pilot version of the Ottawa Self-injury Inventory for adolescents (OSI), b) M.I.N.I. Plus diagnostic clinical interview,Hungarian standard version.

The leading diagnoses were major depression, one from the anxiety syndromes (social phobia or GAD) and the third leading diagnosis was suicidal behavior.83 and 64 % reported comorbid suicidal behaviour. The more frequent type is that of self-cutterers, the regions affected best are upper and low-arm, hand, thigh, legs. The preferred methods are cutting, scarifying, wound-making and burning of a body region.40% of SIB patients shares no information (even with her closest friend) about her self-destrutive impulses.Motivations are: crisis in romantic relationship, academic or social failure and feeling of denial.The task the girls aim at are to appease her rage, depression, irritable mood and feelings of hurt.40% continues the risk behavior although she is highly conscious of the disadvantageous consequences.

The majority of SIB adolescents suffer from an episode of MD often in comorbidity with anxiety disorder or with suicidal behavior.SIB has not only an impulsive but an incubated form too.Few SIB patients utilize substitute activities to divert herself from self-destructions and only half is motivated to change.

In this meta-analysis we compared the effects of venlafaxine and SSRIs on work activity in MDD patients classified according to baseline severity

Data from the work and activity item 7 of the HAMD17 of 31 pooled studies comparing venlafaxine with SSRIs were used. Subjects were divided into two groups based on their baseline HAMD17 total score ≥30/< 30.Score distributions and the proportions of patients achieving full work functionality were summarized for both LOCF and Completers at week 8. Fisher's exact test was used to compare the treatment effects..

5836 patients with a baseline HAMD17 <30 were identified. The OR for all subjects achieving full work functionality is 1.22 (95%CI 1.08, 1.36), p<0.001 for LOCF and 1.19 (95%CI 1.04, 1.38), p=0.015 for completers. The OR for subjects with work impairment at baseline is 1.17 (95%CI 1.02, 1.35), p=0.029 for LOCF and 1.13 (95%CI 0.95, 1.35), p=0.18 for completers. 656 patients with a baseline HAMD17 >30 were identified. The OR for all subjects achieving full work functionality is 1.80 (95%CI 1.24, 2.63), p=0.002 for LOCF and 1.64 (95%CI 1.05, 2.58), p=0.032 for completers. The OR for subjects with work impairment at baseline is 1.93 (95%CI 1.30, 2.87), p=0.001 for LOCF and 1.81 (95%CI 1.12, 2.92), p=0.017 for completers.

This analysis demonstrates that venlafaxine is superior to SSRIs in improving work functionality in both mild/moderate and even more pronounced in severe depression. These results emphasize the impact of the treatment with venlafaxine on patients returning to normal social life.

Increased physical co-morbidity in depressive individuals is a clinical reality often confronted by clinical practician. Frequently, there are no evidence for a linear connection between severity symptoms of depression and the physical co-morbidity levels. Despite this, the causality of high physical co-morbidity remains an important challenge that continues to concern researchers and clinicians.

We performed a cross-over study, on 45 subjects admitted in our Clinic for unipolar depression. After, collecting socio-demographic and clinical data, we administered COPE scale (Coping Orientations to Problem Experience) to identify he profile of coping styles and Karolinska Scales of Personality for a dimensional assessment of personality traits. All data were statistical analyzed.

In our sample we found highly statistical prevalences for physical disease, especially for cardiovascular disease, comparatively with prevalence data coming from National Health System. The cardiovascular disease was correlated with impulsiveness (p=0,056) and aggressiveness (p=0,202) Karolinska scales, but the scores remains as trends that possibly became statistical significant in larger samples. Also, regarding coping styles, those having cardiovascular disease showed statistical significant high levels of acceptance (p=0,034) and psychoactive substance (p=0,038) use in COPE scales.

We consider that personality and coping styles aspects could explain the high clinical association of unipolar depression with physical disease, in general, and with cardiovascular co-morbidity especially rather than clinical and demographical data. We must take into account this results in our therapeutically approach, giving the sense for psychotherapeutically efforts in this cases.

To identify the minimal clinically important difference (MCID) for the Montgomery-Asberg Depression Rating Scale (MADRS) in randomised studies of depression, and to cross-validate the estimated MCID.

Placebo-treated patients from three similarly-designed, 8-week, double-blind, randomised depression trials with a stable health status between baseline and Week 1 (‘no change’ rating on the Clinical Global Impression-Improvement scale) were eligible. To calculate the MCID using the distribution-based approach, the standard deviation was estimated using baseline MADRS data while the reliability parameter was measured as the Intraclass Correlation Coefficient (ICC) between baseline and Week 1. For cross-validation, patients from an observational study were matched to identify the ‘MCID change’ (MADRS change from baseline to endpoint score plus the estimated MCID) and ‘control’ groups. Comparisons of clinical and health-related quality of life (HRQoL) measures were performed.

In total, 177 placebo-treated patients were identified. MCID estimates for MADRS ranged from 1.6 to 1.9. A total of 105 matched pairs were identified for the cross-validation analyses. Mean change from baseline in MADRS scores (10.6 +/- 8.5 vs. 12.5 +/- 7.9, p=0.038) and remission rates (71.6% vs. 57.1%, p<0.05) significantly differed between the ‘MCID change’ and ‘control’ groups at endpoint. Numerically higher response rates and greater improvements in HRQoL scores in the ‘MCID change’ group were also found.

These preliminary findings support the value of the estimated MCID for the MADRS and may aid decision makers in evaluating antidepressant treatment effects and improving long-term patient outcomes.

Dissociation is traditionally attributed to trauma and other psychological stress that are linked to dissociated traumatic memories. Although recent studies regarding the neuroendocrinology of traumatic dissociation are rare, they suggest possible dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. The aim of the present study is to perform examination of HPA axis functioning indexed by basal prolactin and cortisol and test their relationship to psychic and somatoform dissociative symptoms.

In clinical and laboratory study of 35 consecutive inpatients with diagnosis of unipolar depression (mean age 42.71, SD=12.21) assessment of psychic and somatoform dissociation (DES, SDQ-20), depressive symptoms (BDI-II) and basal serum prolactin and cortisol was performed.

Data show that prolactin and cortisol as indices of HPA axis functioning manifest significant relationship to dissociative symptoms. Main results represent highly significant correlations between psychic dissociative symptoms (DES) and serum prolactin (r=0.55, p<0.01), and relationship between somatoform dissociation (SDQ-20) and serum cortisol (r=-0.38, p<0.01).

These results indicate relationship between HPA-axis reactivity and psychosocial stress as a function of dissociative symptoms in unipolar depressive patients that could reflect passive coping behavior and disengagement.

Emerging research highlights the importance of the timing of the onset of a depressive episode. This study examines the risk factors and psychiatric features of participants who experienced their first major depressive episode as children, teenagers or adults. This study is unique in that it emphasises the importance of examining onset of an episode during critical developmental periods.

Participants were 372 depressed outpatients who were either treated with psychotherapy (IPT or CBT) or medication as part of two separate randomised clinical trials. Participants completed a number of assessment measures including clinician ratings of DSM diagnoses. Personality was also assessed using Cloninger's (e.g., 1994) Temperament and Character Inventory.

Participants with childhood onset and teenage-onset depression had a higher number of co-morbid diagnoses and more DSM III/IV personality disorder diagnoses than those with adult-onset depression. Specifically, more participants with childhood or teenage onset depression had diagnoses of avoidant and borderline personality disorder. Women who had childhood onset depression were over three times more likely to have attempted suicide compared to other participants. Participants with childhood onset depression were also more likely to report being threatened with abuse, have experienced psychological abuse and reported more abuse incidents. Age of onset was also associated with a number of differences in temperament and character.

This research emphasises the significance of understanding the age of onset of a depressive episode. Depressive episodes that begin in childhood/adolescence are associated with higher co-morbidity and greater personality dysfunction.

The gap between evidence-based clinical guidelines and their use in medical settings is well recognised. There is a need for studies on the implementation of clinical guidelines in psychiatric care and there is specifically a lack of studies of long-term effects.

The aim of this study was to measure the compliance to clinical guidelines for depression and suicide attempters 6, 12- and 24 months after implementation.

Clinical guidelines for depression and suicidal patients were implemented at two multidisciplinary psychiatric outpatients clinics and two psychiatric emergency clinics. At two control units the clinical guidelines were only administered.

2 165 records from patients with an ICD-10 or DSM-IV diagnose of depression and persons appraising the clinics after a suicide attempt were included. Compliance to the guidelines was studied using documentation of quality indicators.

The presences of the quality indicators in the patient records improved from baseline in the four clinics where an active implementation was done, whereas there were no changes, or a decline, in the control clinics. The increase was recorded at 6 months and persisted over 12 and 24 months.

After implementation there was a significant increase in the documentation of the suggested quality indicators 6, 12 and 24 months after implementing clinical guidelines. These results demonstrate that quality indicators can be used as measures of sustainable compliance to clinical guidelines.