Personality (according to Cloninger) responds to Biological aspects (temperamental) and Psychosocial (characterological), thereby forming the complex pattern of human behavior. High level of avoidance of harm and stiffness are factors associated with depressive disorders, closely linked to the Serotoninergic System. Melancholicus Typus (MT) is characterizes by its seriousness, scrupulousness of conscience, perfectionism, responsibility and order at all levels among other features.

Develop an inventory psychometrically to assess the influence of personality traits Melancholicus Typus in the appearance of resistant depression throughout life.

Retrospective observational study. We designed a questionnaire with a total of 70 items that shaped the personality of Melancholicus Typus. We explored the internal consistency using statistical factor analysis, as well as discriminate validity of these. This questionnaire was applied to the sample of 100 patients signed informed consent prior. They met criteria for inclusion/exclusion. The patient population is from the Institute of Psychiatry Rafael Coullaut. Madrid.

The existence of personality traits of Melancholicus Typus identifies a vulnerability to developing relevant resistant depression over the life of individuals. The inventory developed for this study is a useful test to assess personality traits such as Melancholicus Typus both clinical populations and general population.

The scale shows good construct validity, as well as good internal consistency through correlations Item/Total. The reliability of the scale is high.

Heavy drinking commonly complicates treatment of depression. This study evaluated how the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviations perform in mild and moderate depression.

In a subsample (2086/4020, response rate 51.9 %) of the National FINRISK 2007 Study a modified Beck Depression Inventory (short form) was administered to evaluate depression. The AUDIT, AUDIT-C and AUDIT-3 were tested against the gold standard of heavy drinking according to the definition of the World Health Organization calculated from the Timeline Followback.

Mild depression was found in 32 % of men and 40 % of women, moderate depression in 13 % and 18 %, respectively. In the mildly depressed, 44 % of men and 30 % of women were defined as heavy drinkers, in the moderately depressed 49 % and 27 %, respectively.

The AUDIT and AUDIT-C performed consistently in mild and moderate depression. The optimal cut-offs (sensitivity and specificity ≥ 0.75) for men were of ≥ 8 or ≥ 9 for the AUDIT and ≥ 6 for AUDIT-C. The optimal cut-offs for women were ≥ 5 for the AUDIT and ≥ 4 for AUDIT-C. The AUDIT-3 did not perform well in women, but in men a good level of sensitivity and specificity was reached with a cut-off of ≥ 2.

The AUDIT and AUDIT-C performed well in screening for heavy drinking among the depressed. In depressed men, the AUDIT-3 i.e. a single question was efficacious in detecting heavy drinking. The need for sex-specific cut-offs was highlighted.

To evaluate the safety of aripiprazole as adjunctive treatment in major depressive disorder (MDD) without psychotic features within different patient subgroups.

Data were pooled from three multicentre, randomized, double-blind, placebo-controlled studies (CN138-139, CN138-163 and CN138-165). Patients who did not respond adequately to an 8-week course of standard ADT were randomized to receive adjunctive aripiprazole or placebo for a further 6 weeks. To assess differences in the adverse events (AE) profile of aripiprazole for demographic subgroups, the incidence of AEs was presented for the pooled placebo-controlled MDD studies by gender, age, and race. An odds ratio (OR) estimate was calculated and the ORs compared across all categories using the Breslow-Day test for AEs with incidence ≥5% in the pooled aripiprazole group.

In total, 14.3% of aripiprazole-treated patients and 12.5% of placebo-treated patients discontinued treatment. Treatment-emergent AEs were reported by 65.4% and 82.3% in the adjunctive placebo and adjunctive aripiprazole groups, respectively. Most aripiprazole-related AEs were, however, mild to moderate in severity. With the exception of blurred vision, which occurred in white patients only (p=0.002), there were no significant differences in the incidence of treatment-emergent AEs across different age groups, racial groups or between the genders in the aripiprazole- and placebo-treated groups.

Adjunctive aripiprazole was generally well tolerated and most treatment-emergent AEs were of mild to moderate severity. The AEs profile of adjunctive aripiprazole did not show significant variation in relation to age, gender or race, compared with that of placebo.

To evaluate the efficacy of aripiprazole adjunctive antidepressant therapy (ADT) with regard to functioning in patients with major depressive disorder (MDD) who did not achieve an adequate response with standard ADT.

Pooled data were analyzed from three nearly identically designed randomized, double-blind, placebo-controlled trials: CN138-139, CN138-163 and CN138-165. These included patients with MDD, without psychotic features, who had failed at least one ADT treatment in the present episode. Patients completing an 8-week prospective ADT phase with inadequate response were randomized to 6-weeks’ treatment with adjunctive aripiprazole (n=508) or placebo (n=494). Functioning was assessed using the Sheehan Disability Scale (SDS). Comparisons of mean change from baseline in total SDS score, and domains of family life, social life and work/school were performed using ANCOVA.

Adjunctive aripiprazole produced significant improvements in total SDS (-1.2 on an adjusted scale of 1-10, with 10=worst level of functioning/1=best) vs adjunctive placebo (-0.7, p< 0.001). Adjunctive aripiprazole produced significant changes in the family life domain (-1.4 for adjunctive aripiprazole vs -0.7 for adjunctive placebo, p< 0.001) and the social life domain (-1.4 for adjunctive aripiprazole vs -0.7 for adjunctive placebo, p< 0.001). No difference between groups was observed on the work/school domain (-0.8 for adjunctive aripiprazole and -0.6 for adjunctive placebo, p=0.34).

Adjunctive aripiprazole showed significant improvements in overall SDS scores, and family and social life domains. Less change was observed in the work/school domain. The results emphasize that assessment of patient functioning may have utility both in clinical trials and clinical practice.

Several chronobiologic techniques were proposed as an alternative to antidepressant medications. The current article reports the design and the initial outcome results of a new chronobiologic multistage intervention (CMI) that is comprised of the following techniques:

1. (i) partial sleep deprivation during the second half of the night(wake therapy),

2. (ii) medium (green) wavelength light in combination with dawn simulation (DS),

3. (iii) bright light therapy (BLT), and (iv) sleep phase advance (SPA).

The study was conducted as a set of 12 single-case designs with moderate-to-severe depressive volunteering patients. Depression, anxiety and tension measurements were taken on a daily basis beginning with a baseline measurement (T0), followed by a set of four consecutive morning measurements during the therapeutic intervention (T1-T4),and with a final measurement carried out at the end of 4 weeks of follow-up (T5).

A clinically significant rapid improvement of the depressive symptoms was demonstrated and maintained for at least 4 weeks after the end of the intervention. No dropouts or compliance difficulties were observed. Sleepiness in the late afternoon hours was reported by several of the participants, but did not reach a level that interfered with their ability to function.

These initial findings showed the procedure to be effective and well tolerated. It affords many advantages, such as the achievement of a rapid response, no extinction of the therapeutic effect after 4weeks of follow-up, safety, high patient compliance and cost effectiveness.

According to CBT theory, belief system has an important role in etiology of depression. Absolutistic, rigid and irrational beliefs might have influence on development and persistence of depressive psychopathology. The aim of our study was to examine characteristics of irrational beliefs in the cognitive scheme of patients with Major Depressive Disorder (MDD).

The sample consisted of sixty inpatients diagnosed as MDD by using the ICD-X criteria. The assessment of irrational beliefs was carried out by Beck's Personality Belief Questionnaire (PBQ).

Our findings have shown that irrational beliefs related to histrionic, schizoid and paranoid cognitive system were the most prevalent in patients with MDD. We also found significant and high correlation between opposite way of thinking - histrionic beliefs pattern correlated with avoidant and schizoid beliefs patterns. Also, dependent belief pattern was in a significant correlation with avoidant, schizoid and paranoid beliefs. In addition to rigidity, absolutistic and imperative cognitive schemes, we also found ambivalent cognitive tendencies. The existing ambivalence could be an important factor in the maintenance of depressive symptoms.

Our study has shown high prevalence of irrational beliefs in MDD patients. By recognizing the exact cognitive biases underlying depression, it might be possible to direct the therapeutic interventions more specifically and provide a highly personalized approach in the treatment of patients with MDD. We also believe that there is a need for a psychotherapeutic work on irrational beliefs during remission, which might prevent relapses.

Bipolar disorder (BD) is associated with impaired psychosocial behaviours. Little is known about deficits in neurocognitive functions like decision-making possibly related both to these behaviours and to the nature of the disorder.

To determine whether decision-making impairments exist in manic (M), depressed (D) and euthymic (E) bipolar patients (BP) and to determine whether illness and course-of-illness characteristics can predict participants’ performance

A power analysis was conducted. A total of 315 subjects, including 45 M and 32 D inpatients and 90 E outpatients with BD I, medicated, and 150 Healthy Controls (HC), age, IQ and gender-matched, were included. Decision-making ability and sensitivity to punishment frequency were assessed with the Iowa Gambling Task (IGT).

On the IGT, MBP (p< 0.001), DBP (p< 0.01) and EBP (p< 0.05) selected significantly more cards from the risky decks than HC with no significant differences between BP groups. Unlike HC, MBP (p< 0.001), DBP (p< 0.05) and EBP (p< 0.05) showed little capacity to learn from incurred losses with no significant differences between BP groups, but, like HC, BP preferred decks that yielded infrequent penalties over those decks that yielded frequent penalties. In a multivariate analysis, decision-making impairment in the BP was significantly (p=0.001) predicted by low level of education, high total number of admissions and family history of BD.

BP clearly show defects in decision-making predicted by course-of-illness illness characteristics. Impaired decision-making might be a trait-related neurocognitive deficit in BD and partly explain impaired psychosocial behaviours of BP.

It has been demonstrated that there are differences in efficacy and acceptability of commonly prescribed anti-depressants (Cipriani et al. 2009). Escitalopram, sertraline, venlafaxine and mirtazapine were the most effective.

We wished to see whether our own data showed similar outcomes to the data from the metanalysis using decrease in suicidality as an outcome measure.

To compare the efficacy of anti-depressant monotherapies in patients with unipolar depression at Bedford Hospital, using suicidality (suicidal ideation and behaviour) as the outcome measure.

We included all patients with unipolar depression on an antidepressant monotherapy in Bedford hospital in our analysis (145 in total). We examined the clinical notes for each patient to assess whether they demonstrated suicidality after being prescribed the antidepressant. This allowed us to calculate rates of suicidality for each antidepressant monotherapy.

The prescription of sertraline was associated with the greatest reduction in suicidality, closely followed by citalopram.

Our results support the findings of the meta-analysis. None of the patients on Escitalopram expressed suicidality, so a reduction in suicidality rates could not be demonstrated for this monotherapy.

This audit in a small group of patients suggests that sertraline is associated with the greatest reduction in suicidality compared to the other monotherapies prescribed.

There are differences in efficacy of commonly prescribed anti-depressants. Escitalopram, sertraline, venlafaxine and mirtazapine (‘the four’) were the most effective.

To compare the efficacy of ‘the four’ with other anti-depressant monotherapies prescribed either for the treatment of unipolar depression or other indications, using discharge rates as the outcome measure.

We studied all patients on an antidepressant monotherapy in Bedford hospital (206 in total). We examined the clinical notes for each patient prescribed antidepressants to assess whether they were discharged from the out-patient clinic. Hence we calculated rates of discharge for ‘the four’ and other antidepressant monotherapies for patients with unipolar depression or another psychiatric condition.

For patients with unipolar depression, discharge rates were higher for ‘The four’. For patients with other indications, discharge rates were higher for other antidepressant monotherapies. A greater percentage of patients with unipolar depression were discharged from clinic compared with people treated for other indications

This suggests that indication for which the antidepressant monotherapy is prescribed will affect the efficacy of treatment, as measured by discharge rates. The fact that a greater percentage of patients with unipolar depression were discharged from clinic compared with people treated for other indications may suggest that people with ‘treatment resistant depression’ may really have another disorder, for example borderline personality disorder, bipolar disorder or PTSD.

This audit suggests that ‘the four’ are more effective for the treatment of unipolar depression compared with other indications, using discharge rates as the outcome measure.

Patients who can be treated in Primary care should receive their treatment in Primary Care.

We aim to identify depression treatments used by Bedford East Community Psychiatric Team (BECMHT) and hence identify those patients who could be appropriately managed in Primary care.

We identified 299 patients from the BECMHT database with depression (F32,F33, F41.2 and uncoded). Potential patient groups to discharge were identified by analysing these patients’ data; their medications were compared to NICE guidelines and other evidence-based-treatments.

Many patients were on different combinations of medications but there were 153 (51.2%) on one antidepressant only. Half of the patients’ medication was in accordance with NICE guidelines (157/52.5%), 11 patients were on medication with a different evidence-base and 101 patients were on medication without either of these. However, 36.5% of patients had an inter-current psychiatric diagnosis.

Prescribing patterns within BECMHT demonstrate groups of patients who are more likely to need Secondary care, including those with inter-current psychiatric diagnosis and patients on medications that are not backed by NICE or a known evidence-base. Provided adequate symptom control, the patients who could be discharged include those on one antidepressant and patients on medications in conformity with NICE guidelines who do not need monitoring in secondary care. The patient's notes should be reviewed before discharge to ensure adequate future treatment. There should be good communication with Primary care, with joint protocols and the possibility for patients to easily access services appropriate to their needs.

Depression treatment outcomes within British Community Mental Health Teams have not been adequately described.

To describe factors which influence outcome of depression within Bedford East CMHT.

Patients with Depression F32, Recurrent Depression F33, and Depression and Anxiety F42.1 were identified from a database. Factors affecting outcomes, including Suicidal ideation, Alcohol problems, Drug problems, and use of Augmentation therapy, were identified. Outcome as measured by patient discharge was compared in the three groups.

The percentage of each group discharged was 12.24 for F32, 30.53 for F33, and 29.17 for F42.1.

For F32 patients, the percentage of patients with suicidal ideation was 55.10, with alcohol problems was 32.65, with illicit drug problems was 14.28, while the percentage of patients on augmentation strategies was 38.77.

For F33 patients, the percentage of patients with suicidal ideation was 27.37, with alcohol problems was 9.47, with illicit drug problems was 1.05, while the percentage of patients on augmentation strategies was 27.37.

For F42.1 patients, the percentage of patients with suicidal ideation was 25, with alcohol problems was 8.33, with illicit drug problems was 8.33, while the percentage of patients on augmentation strategies was 54.17.

Fewer discharges occurred from the F32 group, mirroring increased suicidality and drug and alcohol use in this group. There is no significant difference in the number of patients using augmentation strategies between the F32 and F33 groups. It does not appear that augmentation strategies for treating depression are having a clear influence on outcomes.

To discuss a case study that suggests advantages for the combination of 5HT transporter inhibition plus 5HT1A receptor agonism over transporter inhibition alone.

Naturalistic clinical case study.

The patient had a documented 10 year history of poor response to SSRI's including s-citalopram. There was no suggestion of placebo response in the past. He responded well to Lu AA21004 and sustained this remission over a period of 9 months. He relapsed after Lu AA21004 was ceased. He recovered and again achieved a sustained remission after being prescribed a combination of s-citalopram plus pindolol.

The addition of pindolol (a 5HT1A receptor partial agonist) to s-citalopram adds 5HT1A receptor agonism to the 5HT transporter inhibition of s-citalopram. This is a similar profile to Lu AA21004. It is noted that Lu AA21004 also has 5HT3 receptor antagonism which is postulated to impact more on side effect profile than antidepressant efficacy. The current case strongly suggests that (in some instances at least) the addition of 5HT1A agonism to 5HT transporter inhibition might convert non-responders to responders and thus offer clinical advantage over transporter inhibition alone.

The purpose of this study is to contribute to the knowledge of the clinical characteristics of the bipolar spectrum by examining factors associated to course of symptoms in BP patients. We evaluated differences between acutely depressed versus subthreshold mixed patients.

90 depressed patients (Group 1, HDRS: 18.2±4.6, YMRS: 1.4±2.9) and 41 patients presenting a mixed subthreshold symptomathology (Group 2, HDRS: 9.1±3.2, YMRS: 9.6±6.4) were included in the study. All patients underwent structured diagnostic interviews for axis I and axis II disorders (SCID-I, SCID-II) and have been submitted to psychometric assessment with Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Young Mania Rating Scale (YMRS), Global Assessment Scale (GAS), Social Adjustment Self-reported Scale (SASS), Quality of Life Scale (QoL), at baseline and repeated follow-up (1, 3, 6, 12 months). Personality dimensions were evaluated by Temperament and Character Inventory (TCI-R).

The most important result is the slight increase in depressive symptoms in subthreshold mixed patients after 3 months of treatment. These patients were more likely diagnosed as BP-I, were non-SUD patients and/or non-comorbid for axis II personality disorders and had a shorter duration of current episode prior intake. Measures of social and functional adjustment were not different in the two groups, though a slight trend for depressed patients to report a poorer quality of life. No difference in personality traits were observed among the two samples.

Our study confirms the importance of considering subthreshold symptoms in the evaluation and treatment of patients with Bipolar Disorder.

Asenapine is indicated in adults for acute treatment of schizophrenia and manic or mixed episodes associated with bipolar I disorder with or without psychotic features. We report the safety, tolerability, and efficacy of asenapine in patients with bipolar I disorder completing up to 52 weeks of treatment.

Patients completing either of two 3-week efficacy trials and a 9-week double-blind extension were eligible for this 40-week double-blind extension. Patients in the 3-week trials were randomized to flexible-dose asenapine (5 or 10 mg BID), placebo, or olanzapine (5-20 mg QD; included for assay sensitivity only). Patients entering the extension continued their preestablished treatment; those originally randomized to placebo received flexible-dose asenapine (placebo/asenapine, 5 or 10 mg BID). Safety and tolerability endpoints included adverse events (AEs), extrapyramidal symptoms, laboratory values, and anthropometric measures. Efficacy was measured as the change in Young Mania Rating Scale (YMRS) total score from 3-week trial baseline to week 52; the placebo/asenapine group was included in the safety analyses.

Incidence of treatment-emergent AEs was 71.9%, 86.1%, and 79.4% with placebo/asenapine, asenapine, and olanzapine, respectively. The most frequent AEs included headache and somnolence (placebo/asenapine); insomnia, sedation, and depression (asenapine); and weight gain, somnolence, and sedation (olanzapine). Mean ± SD changes in YMRS score at week 52 among observed cases in the intent-to-treat population were -28.6±8.1 for asenapine and -28.2±6.8 for olanzapine.

In this 52-week study, asenapine was well tolerated and long-term maintenance of efficacy was supported in patients initially presenting with bipolar mania.

Previous studies have suggested structural and physiological changes in Major Depressive Disorder (MDD). Unfortunately, there isn’t a consensus when defining the neuropathophysiology of depression. Hence, there isn’t a biological measure used in the clinical practice to define the differences between patients with depression and controls.

To test differences in Lempel-Ziv complexity (LZC) values between patients with major depression and controls.

Comparison of spontaneous oscillatory neuromagnetic activity using MEG between groups.

20 patients matching DSM IV-TR criteria for MDD, and 19 sex- and age-matched controls.

We found a significant positive correlation between age and LZC values within controls. This correlation was not found in MDD patients. Depressive subjects showed a tendency of higher LZC values when compared to controls. We found significant differences between groups in anterior and right regions. After six months of treatment with Mirtazapine (30 mg V.O. O.D.), we studied the Hamilton-17 rating scale values and found that this treatment was clinically effective in most patients. The main pharmacological treatment's effect was besides reducing the LZC values in patients, to recuperate the tendency observed in controls.

We could suggest that there is a relationship between a physiological metric and depression as well as symptom relief or remission after an effective treatment. According to our results we found physiological changes in the brain dynamic in depressive patients when compared to controls which means there are neurophysiological changes in depressive patients with time.

Little is known about the influence of patients’ preferences and expectations about offered treatments for depression on treatment outcome. Therefore, we investigated whether in primary care patients with depressive disorders receiving a preferred treatment is associated with a better clinical outcome.

Within a randomized, placebo-controlled, single-centre, 10-week trial with five arms (sertraline; placebo; cognitive-behavioural group therapy (CBT-G); moderated self-help group control; treatment with sertraline or CBT-G according to patients’ choice), 145 primary care patients with mild-to-moderate depressive disorders according to DSM-IV criteria were investigated. Preference for medication versus psychotherapy was assessed at the time of patients’ screening using a single item. To assess therapy outcome, the post-baseline sum scores of the Hamilton Depression Rating Scale (HAMD-17) were used.

Depressed patients receiving their preferred treatment (sertraline or CBT-G) (N=63) responded significantly better than those who did not receive their preferred therapy (N=54) (p = 0.001). The difference in outcome between both groups was 8.0 points on HAMD-17 for psychotherapy and 2.9 points on HAMD-17 for treatment with antidepressants. This result is not explained by differences in depression severity or drop-out rates.

Patients’ preference for pharmaco- versus psychotherapy should be considered when offering a treatment because receiving the preferred treatment conveys an additional and clinically relevant benefit (HAMD-17: +2.9 points for drugs; +8.0 points for CBT-G) in outcome.

The issue of the association between depression and neurocognitive functions is of special interest due to the strong relation between primary depressive symptoms and cognitive impairments, but this relationship in PD is far from clear at present.

To examine the influence of depression on cognitive and speech performance in various stages of PD.

Forty four patients with PD were recruited from the neurology department, University Hospital of Patras in Greece. All patients satisfied PDSBB criteria and dementia was ruled out (MMSE < 24) in all cases. Patients were then divided into six groups, based on severity of PD symptoms and presence of depression. Stage of disease severity was determined using the Hoehn - Yahr Rating Scale. Presence and severity of depression was established using the Beck Depression Inventory and DSM -IV-TR diagnostic criteria for major depressive disorder and dysthymia. Patients were further assessed with a detailed neuropsychological battery and the dysarthria examination battery. All patients were receiving standard medications for their PD symptoms.

Deficits in executive functions, prosody and speech intelligibility were most profound in the late stage depressed PD group. Phonetic impairments were most profound across all stages compared to articulatory and prosodic impairments.

Depressed mood may exacerbate cognitive and speech impairments and affective variables should be an integral part in the treatment of PD in all stages of the disease process, but especially in the later stages.