To develop and validate a prognostic model for predicting recurrence of major depression using data from a population-based, nationally representative cohort.

Wave 1 and wave 2 longitudinal data from the US National Epidemiological Survey on Alcohol and Related Condition. Participants with a major depressive disorder at baseline and who had visited health professionals for depression were included in this analysis. Mental disorders were assessed based on the DSM-IV criteria. For this study, we included the wave 1 (baseline) participants who reported current or lifetime major depressive episode. We included eligible participants from South and West region in the training data (n = 1,518). Eligible participants from Northeast and Mid-West region were kept in validation data (n = 1,195).

With the training data, a prediction model with 19 unique factors had a C statistics of 0.7504 and excellent calibration. The model had a C statistics of 0.7195 in external validation data (n = 1195) and 0.7365 in combined data. The algorithm calibrated very well in validation data. In the combined data, the 3-year observed and predicted risk of recurrence was 25.40% and 25.34%, respectively.

The developed prediction model for recurrence of major depression has acceptable discrimination and excellent calibration and is feasible to be used by physicians. The prognostic model may assist physicians and patients in quantifying the probability of recurrence so that physicians can develop specific treatment plans for those who are at high risk of recurrence, leading to personalized treatment and better use of resources.

The high number of suicides drew attention to medical professionals. In Europe suicide is one of the leading cause of death caused by intentional and unintentional injuries. Alcohol abuse is linked to poor impulse control, aggression and suicide behaviour.

We tried to evaluate the level and the impact of alcohol usage in individuals which committed suicide.

There were collected all the date provided by the archives of forensic services of Brasov county between 2002 and 2012 regarding age, sex, marital status, methods of suicide and blood alcohol concentration.

The statistics included 589 men (83%) and 121 women (17%), sex ratio B:F=4.87. The mean age of the study group was 48.15 years. The individuals which had used alcohol before committing suicide were significantly younger than those who didn't used alcohol (45.87 vs. 50.19, p<0.005). There were a significant difference between individuals with violent methods of suicide compared with others in terms of age and blood alcohol concentration.

The abuse of alcohol is strongly linked with suicide, especially when individuals exhibit high levels of blood alcohol concentration. This behaviour is linked with younger age of suicide.

In this study, women with primary infertility compared with fertile women in terms of their attachment style and psychopathology. Furthermore, the relationship between psychopathology and attachment style is also investigated in women with primary infertility.

Forty-eight primary infertile women admitted to the infertility clinic for in vitro fertilization (IVF) or Intrauterine Insemination (IUI) treatment were consecutively enrolled. Diagnosis of primary infertility in women was determined by Gynecologists and it is defined as undetermined cause of infertility in men and women despite necessary laboratory investigations. The control group consisted of 48 women with at least one living child, who had become pregnant through natural methods and having no previous psychiatric admission. Control group is matched with primary infertile women in terms of their age and level of education. Socio-demographic characteristics and clinical features of the study group and the control group were determined. Symptom Checklist 90R (SCL-90-R), Beck Depression Inventory (BDI), Adult Attachment Style Questionnaire (AAS) were given to the both groups. These scales' scores were compared between infertile and fertile groups.

No significant difference was found between primary infertile and fertile women in terms of secure, avoidant, anxious-ambivalent attachment scores. Secure attachment scores in both groups were higher than other forms of attachment. Insecure attachment scores were associated with the increasing level of psychopathology in primary infertile women.

We suggest that management of insecure attachment should positively affect the chances of pregnancy in primary infertile women.

The aim of the study was to investigate the development of the psychiatric emergency situation in the city of Ulm, Germany, over a decade ranging from 2004- 2013.

All reports regarding medical emergencies in the city of Ulm (110,000 inhabitants) from 2004 to 2013 were examined. Psychiatric emergencies were identified and worked off retrospectively with respect of demographic variables, diagnosis, pharmacotherapy, general medical treatment and time trends.

Data were available of 933 psychiatric emergency care episodes. 40% of episodes concerned male patients (60% female). Average age was 45.3 years. Diagnoses were made on a syndromal level on the basis of a classification by Hippius (Hippius H: Psychiatrie. Springer, Berlin, 1979). The most frequent syndromal diagnoses were 'state of psychomotor excitement', 'suicidal syndrome', 'syndrome of addictive behaviour' and 'acute intoxication'. These syndromal diagnoses occurred with increasing frequency later in the day. Medication interventions comprised mostly midazolame followed by haloperidol, diazepam and lorazepam.

The results of our study are roughly in line with those described in the literature based on studies dating back to the 1980s and 1990s. Emergency medicine is an multidisciplinary subject, in which psychiatric disorders account for a substantial proportion of episodes of care.

Eating Disorders (ED), including obesity, with and without Metabolic Syndrome (MetS), are associated with anxiety and depression. Increased levels of cytokines and their consequences on the pathway of kynurenine (KYN), the main metabolite of tryptophan, have been proposed to account for these associations.

To review the evidences suggesting biochemical connections between the Depression and Anxiety Spectrum (DAS), MetS and ED, respectively, focusing on the role of the KYN pathway.

Three PubMed searches of the literature conducted in October 2013 (key words:‘kynurenine’ ‘eating disorders’; ‘kynurenine’ ‘waist circumference’; ‘kynurenine’‘obesity’‘metabolic syndrome’) provided 2, 3 and 7 references, respectively.

The metabolism of L-tryptophan through the KYN pathway depends on the following three factors: 1) NUTRITION; in underweight ED LKYN metabolites (quinolinic acid, kynurenic acid, 5-hydroxyindoleacetic acid) are significantly reduced until the restoration of normal body weight. In overweight and obesity with and without MetS, increased KYN levels and KYN/tryptophan ratio are found, with abdominal fat content as strongest factor for an increase of the KYN/TRP ratio. 2) AGE; KYN/TRP ratios are markedly increased vs. decreased in overweight and obese adults vs. juveniles, respectively. 3) INFLAMMATION; IFN-gamma induces the indoleamine 2,3- dioxygenase (IDO)-catalyzed synthesis of KYN, whose derivatives increase in diabetes (xanturenic acid), psychosis (kynurenic acid), and depression (quinolinic acid).

The KYN pathway may link DAS, MetS and ED explaining the frequent association of DAS to so many different disorders. Further studies are needed in order to understand these complex connections.

Corticosteroids have either somatic and psychiatric side effects. Somatic adverse effects are well described while neuropsychiatric have received less attention. Psychiatric symptoms such as depression, psychosis and especially mania are common side effects of corticotherapy.

Describe a case of a 53-year-old female patient, with no psychiatric history, who developed psychiatric symptoms during the treatment of an acute exacerbation of multiple sclerosis with large parenteral doses of corticosteroids. Three days after the onset of corticotherapy she developed increased energy, elevated mood, increased motor activity, racing thoughts, and diminished need for sleep. She subsequently developed grandiose and persecutory ideation and then feared her grandson was going to die. This lead to her admission to psychiatric unit of our hospital to address these behavioral problems. Her husband noticed that she had become’hyper’ in the past when she received pulse corticosteroid therapy, but the most recent episode was by far the worst.

Revision of the scientific literature through Pubmed, Embase and Psychinfo using search terms including corticosteroids, mania, depression, psychosis and mood.

Prednisone was suspended and Risperidone 2mg was begun for presumed steroid-induced mood disorder, and the patient became calmer and much less guarded over the next 2-3 days. After a week she recovered complete euthymic mood and reverted to normal functioning.

These data suggest that Risperidone is well tolerated and appears to be useful for mood disturbances associated with corticosteroid therapy. Controlled trials seem warranted to confirm these observations.

In this study, it was aimed to evaluation of alexithymia in male patients before open-heart surgery. The correlation between alexithymia and psychopathology was also investigated.

Thirty-two male patients who had cardiovascular disease were enrolled before open-heart surgery. Socio-demographic characteristics and clinical features of the patients were determined. Symptom Checklist-90-Revised (SCL-90-R), Toronto Alexithymia Scale (TAS), Hospital Anxiety and Depression Scale (HADS), State-Trait Anxiety Inventory (STAI) were applied.

The mean age of the patients was 55.20± 11.72 years. The mean scores were 51.71±9.90 for alexithymia, 6.44±3.86 for anxiety, 5.06±3.61 for depression, 38.91±10.21 for state anxiety and 41.22±7.46 for trait anxiety. The positive correlations between Toronto Alexithymia Score and Depression, Interpersonal sensitivity, Hostility, Paranoid Ideation, Psychoticism and Global Severity Index subscales of SCL-90-R were statistically significant. There were no statistically significant correlations between TAS and HADS, and STAI scores.

The most interesting finding was that there is a correlation between alexithymia and paranoid ideation, and psychoticism in these patients. Contrary to expectations, this study did not find a significant correlation between alexithymia and anxiety and depression. Further research should be done to investigate the comparative studies in patients with different diseases at pre-and post-operative period.

The aim of the study was to investigate the influence of agomelatine and venlafaxine on driving skills and on driving performance in an on-road driving test in depressed inpatients.

40 depressed inpatients were randomly assigned to treatment with either agomelatine (n=20) or venlafaxine (n=20). Patients were tested before pharmacologic treatment (t0), and on days 14 (t1) and 28 (t2) with computerized tests and additionally were rated in an on-road driving test on day 28 by a licensed driving instructor. To control for retest effects a group of 20 healthy subjects was examined in the same time schedule.

After two weeks of treatment with agomelatine or venlafaxine patients showed a significant reduction in depressive symptoms, and a distinct improvement in concentration and stress-tolerance. Furthermore, prior discharge to outpatient treatment (day 28), 72.5% of patients were labeled abundantly fit to drive in the on-road driving test, in 22.5% of cases a satisfactory performance was certified and in 5% of our patient sample there were slight concerns with respect to fitness to drive. Patients did not however reach performance level in functional domains of healthy controls. Significant differences between treatment groups could not be observed.

Our results indicate that depressed patients treated with agomelatine or venlafaxine show a better test performance on tasks related to driving skills than do untreated patients Besides, most patients could be rated as fit to drive, on an actual driving test conducted by a licensed driving instructor, prior discharge to outpatient treatment.

Homosexuality and bisexuality have been associated to increased risks of substance use. Affiliation with the gay culture is one of the explanatory models. According to this model, homosexual persons should, compared to heterosexual persons, preferentially use (or at least try) substances which are usual within the gay scene.

To explore the choice of lifetime substance use among heterosexual, bisexual and homosexual men.

The C-SURF study concerns young Swiss male adults who have to go through the mandatory recruitment process at the Swiss army. Data were collected between August 2010 and November 2011. The questionnaire was about the participants’ socioprofessional and family background, their consumption of alcohol, cannabis and other drugs, as well as their personality. The final sample included 5990 males between 17.9 and 31.4 years old (mean=20.01, sd=1.24).

5371 (89.7%) of subjects declared being exclusively attracted by females, 442 (7.4%) by males and females and 62 (1.0%) by males only. A multinominal logistic regression revealed an increased risk of homosexual men to have ever used poppers (OR 1.57), party drugs (Ecstasy, GHB etc.) (OR 2.18) and cannabis (OR 1.34). Homosexual men had an increased risk of lifetime use of poppers (OR 7.29), and cocaine (OR 4.47), and a reduced risk of alcohol use (OR 0.45).

The choice of drugs seems to be influenced partly by sexual affinities. In addition to the affiliation with the gay culture (especially poppers), the minory stress model may help to explain cannabis use among bisexual subjects

To define neural correlates of cognitive dysfunction in major depression and to disentangle the role of cognitive, default mode and limbic networks in emotional and cognitive problems of depressed patients

We will review brain imaging studies of executive function and rumination in depression. We will also describe results of a recent study conducted in healthy volunteers (n=41) using cognitive tasks related to ruminative processes. During fMRI acquisition subjects were asked to read sentences and to engage in an analytical or an experiential self-referential task.

Several studies using executive tasks related cognitive effort in depressed patients with increased activation of the dorsolateral prefrontal cortex. This hyperactivity of lateral prefrontal cortex is associated with abnormal deactivation of medial brain structures such as the medial prefrontal cortex. Consistent with this review, our study in healthy volunteers showed that subjects with High score in rumination showed lower activity in medial brain structures in relation with difficulties to differentiate analytical and experiential self-focus.

Overall these findings support the hypothesis of abnormal interaction in cognitive and default mode network in depression and may help to refine our understanding of how rumination promotes depression through maladaptive self-focus.