Although mental disorders are a major contributor to the Global Burden of Diseases, in many low- and lower-middle-income countries, mental health care is still accessible to only a minority.

Psychiatric disorders haven’t benefited from dramatic progresses seen in other fields as pandemic diseases.

To increase equity in access to care for psychotic patients in low- and lower-middle -income countries.

Through mental health facilities at the primary care level, availability of psychosocial support, accessibility of medicines, awareness and reduced stigma, the program addresses what is seen as the main barriers to access to care. To achieve this objective, institutional partners (Ministries of Health), a worldwide NGO (World Association for Social Psychiatry), and a leader of the pharmaceutical industry (sanofi-aventis) are associated through PPPs. The complementary expertise and resources of the partners are pooled to build-up the existing health infrastructures and increase efficacy in patient care.

In partnership with local psychiatric networks, pilot projects have been launched in Morocco and Mauritania, and others are in preparation (such as Armenia and Guatemala).

The programs combine actions dedicated to:

• • Advocacy efforts towards political and administrative decision makers;

• • Increase awareness of communities of mental health issues;

• • Psycho-educate patients and families;

• • Encourage the creation of associations of patients’ families;

• • Train health care professionals;

• • Organize a sustainable supply of high quality antipsychotics.

The FAST project encourages the collaboration of all partners. It could be an example of innovative ways to address mental health challenges in developing countries.

Working memory (WM) deficits are among the core cognitive abnormalities in schizophrenia. WM is subserved by widely distributed fronto-parietal networks and is undergoing robust development during adolescence. Studying the neural correlates of WM dysfunction in early-onset schizophrenia (EOS) will advance our understanding of aberrant neurodevelopmental processes in the disorder.

Nineteen patients with EOS aged 13-19 and 20 matched healthy participants underwent functional Magnetic Resonance Imaging (fMRI) as they performed a N-back verbal WM task with 3 levels of difficulty (1-back, 2-back, 3-back). Following matching for task performance, 14 patients were compared to 20 controls, using non-parametric whole brain and region of interest approaches followed by psycho-physiological interaction analysis (PPI) with seed voxel from the left parietal cluster.

Regions within the left prefrontal cortex, the left insula and bilateral anterior cingulate cortex showed reduced activation in EOS patients compared to healthy participants at the 2-back condition. In addition, ROI analysis at the same condition revealed hypoactivation in the EOS group with large effect sizes for left prefrontal and parietal regions. The PPI results revealed negative functional connectivity in the healthy participants’ group but not in EOS between left parietal and right parietal and bilateral frontal regions.

Our results support compromised function within the left prefrontal-cingulate network and left insula during the N-Back verbal WM task in patients with EOS compared to healthy participants. They also indicate the possibility of more widespread fronto-parietal network dysfunction, most noted in the left hemisphere in the disorder.

To describe the main features of the younger group of patients hospitalized (January 1st and December 31st) in the Acute Psychiatry Unit of a General Hospital in Bologna (Northern Italy), comparing their socio-demographic and clinical characteristics and their needs with those of the adult patients admitted.

Retrospective consultation of case-histories concerning 111 subjects (60.4% men) randomly selected. Chi-square and independent sample T-test used to compare 33 cases (≤21 years) and 78 controls (35-49 years).

Young-cases had a higher prevalence of parental separation (31% vs 2.7%; p< 0.001) and were more frequently adopted (18.8% vs 0%; p=0.01). Psychomotor agitation or etero/self-aggressiveness (36.4%) and personality disorders (12.1%) were the most prevalent causes of hospitalization among the younger group, whereas psychosis (32.1%), mood disorders (19.2%) and alcohol-substances dependence (11.5%) were more common in controls (p< 0.001). Presence of unfavorable life-events was two-fold higher in cases than in controls (p=0.074). In particular, quarrels with family (40%) or friends (20%) and substance abuse (13.3%) occurred especially in young individuals. In adults, mournings/separations and rejection therapy were more frequent (p=0.017).

Hospitalization's features (type, length, number of laboratory and instrumental exams) were not significantly different among the two groups, except for frequency and number of interviews and childpsychiatrists and educators’ care provided that prevailed in cases.

The young population admitted in our acute psychiatric ward has a complex sociorelational and clinical situation requiring a multi-professional management. The frequent need of care in emergent/urgent situation highlights the importance of further studies on this issue.

To investigate the risk factors of self-harm behavior in Polish adolescents.

Patients hospitalized in Adolescent Psychiatric Clinic during a 4-year period were surveyed by attending psychiatrists. The survey contained categories such as: demographic data, familial, social and school problems, history of violent experience, and mental disorders. Stepwise logistic regression was used to evaluate predictors of self-harm behavior.

Out of 611 (362 females and 249 males, mean age 16.1±1.5 years) adolescents who participated in the study, 261 (42.7%) patients admitted to deliberate self-harm behavior by having attempted suicide. Patients with a diagnosis of behavioral or emotional disorders were more prone to selfharm behavior (p< 0.001). Risk factors retained in the final regression model were: female gender, diagnosis of behavioral disorders, skipping classes, romantic disappointment, sexual abuse and family conflicts (table).

Acts of deliberate self-harm in adolescence are due to an accumulation of several factors. School-based programs focused on dealing with psychosocial stressors may be considered a feasible means of self-harm prevention.

Depression is one of the most common mental health problem and it grows greater every year around the world.

The main aims were to analyze the possibility of using functional and structural neuroimaging methods in diagnosis of different depression types and to find the predictors of pharmacological resistance.

46 patients with depression syndrome were distributed into 3 groups: 1) Neurotic Depression (Diagnosis: Adjustment disorders) - ND group; 2) Endogenous Depression (Diagnosis: Recurrent Depression, Bipolar Affective Disorder - current depressive episode, Schizoaffective disorder, depressive type) - PD group, 3) Depression due to organic pathology (Diagnosis: Organic depressive disorder, Organic mixed affective disorder) - OD group. Controls were 18 years old- and gender-matched healthy participants. We used several methods of functional (positron-emission tomography, functional magnetic resonance imaging) and structural (voxel-based morphometry, diffusion-tensor imaging) neuroimaging.

We found several functional and structural abnormalities in limbic structures within all three groups. Some of them were the same, some were different. Also we found several functional and structural predictors of pharmacological resistance.

We found several functional and structural abnormalities in all three depressive groups. Almost all of them were parts of so-called frontal-subcortical circuits, dysfunction of which, according to the present knowledge, could play crucial role in depression pathogenesis.

Summarizing our own results and analyzing the data of our colleagues, we complement a theory of depression pathogenesis and propose an original point of view for neurobiological basis of different types of depressive disorders and its pharmacological resistance.

Pain complaints are frequent in psychiatric and primary care settings. Furthermore, in pain clinic, depression and pain disorders are common comorbidities. On the other hand, several antidepressants are effective in the management of chronic pain and in alleviating pain complaints in depressed patients.

In this lecture, we summarize the current knowledge with regard to the use of antidepressants in chronic pain conditions and in pain as a somatic complaint in depression. We review the pharmacological mechanisms and the neurobiological substrate of these properties.

To give arguments for the recognition of antidepressants as useful tool to treat pain in depression and depression in chronic pain patients, and to provide information about the right choice of an antidepressant in chronic pain.

The monoaminergic system participates both in the regulation of mood and in the modulation of pain. Antidepressants have several properties modulating monoamines. Some of these properties are critical to understand the mechanisms of action of these compounds in chronic pain and in alleviating pain as a somatic symptom in depressed patients. The discussion about whether antidepressants alleviate pain acting on mood or pain transmission is a matter open to discussion, however there is no doubt about the utility of these drugs in pain. Recent studies in modified genetic animals reinforce the idea the not only monoamines but also other neurotransmission systems underlie these effects.

Bipoler Depression in it's acute psase is a very distressing state for the suffering patient & a chalanging job for the Psychaitrist to treat to alliavete in a reasonable period of time.

In acute state Bipolar patients, mostly women in their middle age, moderately overweigted often presents with a crying state or even with potent suicidal ideation that continiue to go on inspite of treatment with pharmacological treatments.

Here is an attempt to search for a remedy to these set of patients.

72 acutely ill Bipolar depressed patient were assigned with 3 treatment regimens, after their diagnosis was confirmed on the criteria of DSM-4 TR.

There age group were 46 to58 years with a median age 52 years. There were 12 Ist episode depressive phase and 60 patients both male 24 & women 36 are recurent sufferers.The Study was conducted in the O.P.D patiends attending Calcutta Pavlov Hospital during 2008-09.

1st. group receive only Fluoxotine & olanzapin combination for 6 weeks.

2nd group recieve FLuox+Olanzapin +lithium carbonate in 900 mg/day dose.

3rd group recieve Lith. carobonate+Olz.+fluoxotine +Lamotrigine in 25-50mg/d.

The 1st group with a combo of olanzapin+Fluoxotine were the least responsive.

They were evaluated in the Psychologist table usinng ASPER-Montigegmy Depression rating scale.

Allthe groups shows improvement in different items of the scale.

3rd group using a tripple drug Combo therapy do the best.

Is a poly combo drug therapy or E.C.T or +Psychotherapy combo a best answeer to these criticaly depressed BPD patients.

Patients with untreated obstructive sleep apnea often report depressive symptoms, such as low mood, loss of interest and reduction of drive. In this study we examined the frequency of significant depressive symptoms amongst patients with untreated obstructive sleep apnea over a one year period.

From January to December 2008 we screened 1260 consecutive patients with untreated obstructive sleep apnea (AHI > 9) seen at our Center for Sleep Medicine were screened for depression. Based on self-administered questionnaires, patients with significant depressive symptoms were defined as having either a BDI II score ≥ 14 or WHO-5 ≤ 13. Additionally, severity of depression was rated based on BDI II scores.

Depressive symptoms were reported frequently. Based on BDI-II, 27.9% of patients report significant depressive symptoms. Of these, 46.2% were mild, 35.9% moderate and 17.9% severe. In addition, 52.6% of patients self-reported feeling unwell based on their WHO-5 scores.

Significant depressive symptoms measured by standardised self-rating scales were detected in over a quarter of our patients with untreated sleep apnea. It remains unknown whether treatment of OSA alone abolishes depressive symptoms, or whether depressive mood may reduce the compliance with treatment. Patients may need an interdisciplinary approach to initial treatment.

Patients with Bipolar Affective Disorder have high rates of somatic comorbidity and it's necessary to know the characteristics of these patients to develop preventive and therapeutic strategies.

To describe twelve patients diagnosed with BAD admitted to a Brief Hospitalization Unit.

Evaluation by a questionnaire which recorded sociodemographic data (sex, age, marital status, education, occupation, employment status); medical management indicators (average stay, number of previous admissions and if re-entering during the study); previous treatments (antipsychotics, antidepressants and benzodiazepines); somatic background (presence of cardiovascular risk factors that contrasted with taking blood pressure, BMI calculation, ECG and complete analytical) and consumption of toxic substances.

58.33% are women with a mean age of 41.91 years and 58.33% in single cases. 58.33% has secondary education, although the 41.66% isn’t working.

The average stay of admission is 20.83 days. 50% had between 1 and 4 more admissions and 33.33% re-enters.

25% doesn’t take medications. Of the rest, 77.77% taking neuroleptics, being the most common option with 57.14% treatment with quetiapine. The 88.88% takes mood-stabilizing and the 44.44% benzodiazepines.

No patient has altered the glucose profile. The 8.33% has high blood pressure control and 25% altered lipid profile. The average BMI is 28.64

The 66.66% smoke. The 33.33% consumed alcohol and cannabis on 16.66%.

Patients with BAD have high proportions of cardiovascular risk factors and important consumption of toxic substances. Reflected the impact of the disease in the sociolabour field and the need for many hospital admissions because of the chronic course and poor therapeutic adherence.

Clinico-psychopathological with the data verification to SCL-90-R, statistic - Mann-Whitney U-test, Spearmen Rank Order Correlations, Wilcoxon Matched Pairs test. Among patients BD, as opposed to the patients RD, the stronger direct correlation interconnection of “depression” and “somatization”, “obsessivness” is defined (r 0,62-0,81). Compared indications of depression level and basical “index of symptoms’ evidence” (p>0,05) in droups, the patients BD as opposed to the patients RD at p< 0,05 the indications of “anxiety” (2,08&1,67), “somatization” (1,97&1,68), “obsessivness” (1,76&1,4) are higher. These data may show the “residual manic equivalent” in the form of somatization, obsessivness symptoms in the structure of the BD depression, its atypical type and differential - diagnostic symptoms with depression in RD structure is identified. The effectiveness of hospital complex therapy of BD patients is estimated. During 56 days the patients got Seroquel therapy in a dose 150-600 mg/day, group behavioral therapy, sociotherapy. Up to the 10th day of the treatment the indications of “anxiety” (p< 0,05), “depression” (p< 0,05), up to 14th day “somatization” (p< 0,05), up to 21st day “obsessivness” (p< 0,05) were reduced. After hospital complex therapy patients got supporting Seroquel therapy in a dose 50-200 mg/day. In catamnesis in 6 months 11 patients were examined, their state was defined as “stably positive”. These data indicate that the complex therapy of bipolar depression of the II type patients, including Seroquel is effective.

The purpose of this study was to evaluate the antidepressant duloxetine in depressive patients with pain.

The sample: 28 patients (18 female and 10 male, mean age 53,85) were diagnosed with major depressive disorder (MDD) according to ICD 10. They were assessed with HAMD17 items in baseline and at 14, 28, 42, 56 days, CGIS at baseline, 28 and 56 days, CGII at 28 and 56 day.

Patients received duloxetine (Cymbalta) 60-120 mg/day. All treated patients had a good evolution with a significant improvement on HAMD score. Total score HAMD 17 items was: baseline - 21,9; 14 days - 19,9; 28 days - 17,1; 42 days - 13,1; 56 days - 11,6. At item 13 -diffuse muscle aches in arms or legs the mean score was 1,65 at baseline, and 0,75 at 56 days. The evolution of CGIS was: mean 4,2 in baseline and 1,9 at 56 days. Significant improvement was noted at 56 days: 13/28 (46,42%) were much improved and 15/28 (53,58%) were very much improved. We noted mild nausea at 10 patients, mild restlessness at 7 patients, mild dizziness at 5 patients at the beginning of the treatment.

1. 1) Our results suggest that duloxetine is a safe and effective treatment for depression.

2. 2) The concomitant action for different aches is very important for depressive patients with pain.

3. 3) Coexistence of depression with physical pain negatively affects the performance in daily activity and quality of life; in such cases the first treatment option could be duloxetine.

To identify the frequency and clinical features of DM and mania with delirium.

We reviewed all admissions to our acute inpatient unit with mania, hypomania or mixed affective state, in 2006 and 2007. Cases with delirious features and cases with a working diagnosis of DM, were reviewed in detail. The three groups (no delirium, delirious features and DM) were compared for general demographic and clinical variables, as well as features specifically associated with DM (e.g., catatonia; nakedness; inappropriate toileting; unexplained fever, etc).

We found 100 patients with mania, hippomania or mixed affective state. 14 had medically unexplained delirium, 4 of them with a final diagnosis of DM. DM cases (but not non-DM mania cases with delirious features) had extremely long durations of stay, acute onset, hypertermia, catatonia, autonomic instability, anarchic sleep, shouting/coprolalia, delirium persisting for over a week, and were more likely to receive ECT. Moreover, in three of them DM occurred in most manic/mixed affective episodes.

DM is a rare occurrence in bipolar disorder. It has typical clinical features and may be recurrent.