The aim of this presentation is to summarize the results of the published systematic reviews / meta-analyses of the randomized controlled trials that have investigated the effectiveness of medications for the treatment of obsessive compulsive disorder (OCD) in children/adolescents and adults and to present preliminary results from a new review study using network meta-analytical techniques

Medline, Cochrane database, and the register of controlled trials maintained by the Cochrane Collaboration Depression, Anxiety & Neurosis Group (CCDAN) were searched for relevant trials, systematic reviews and/or meta-analyses.

Regarding the new review study we were able to extract 103 pharmacological arms (preliminary results: 9 for Fluoxetine, 16 for Fluvoxamine, 11 for Paroxetine, 10 for Sertraline, 16 for Clomipramine, 7 for Citalopram / escitalopram, 2 for Venlafaxine, and 32 for Placebo) with a total number of 6572 patients randomized. The previous meta-analyses have confirmed the efficacy for all SSRIs and Clomipramine in all age groups while for other drugs further evidence is required. In the context of this presentation preliminary results of the relative efficacy of each drug, using network meta-analysis techniques will also be reported.

Several antidepressants have established their efficacy and acceptability for the management of non-resistant OCD. The major weakness of the literature so far is that head to head comparisons between antidepressants are few and therefore it is difficult to establish a clear hierarchy of the efficacy and acceptability of the various agents. This gap in the present literature will be filled by the present review.

Besides affective instability and identity diffusion, disturbances in social interactions are a core symptom of borderline personality disorder (BPD). Interpersonal problems in BPD have been suggested to be associated with oxytocin dysregulation. To directly address this hypothesis, we investigated oxytocin plasma levels during a social exclusion (ostracism) paradigm in female BPD patients.

Twenty-two female BPD patients (diagnosed according to DSM-IV) and twenty-one healthy controls matched for gender, age, and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball paradigm, a virtual balltossing game that evokes a social exclusion situation. Emotional reactions were assessed and oxytocin and cortisol levels measured at baseline and 5, 15, and 40 min after Cyberball.

After social exclusion, oxytocin plasma levels were lower in BPD patients than in healthy controls, whereas cortisol levels did not differ between groups. BPD patients showed distinct differences in emotion regulation compared to healthy participants and reacted to social exclusion with an increase of other-focused negative emotions, particularly anger and contempt.

Our pilot study suggests that the oxytocin system shows a differential response to social exclusion in BPD patients compared to healthy controls. This difference may be related to the high rejection sensitivity of BPD patients and their difficulties in resolving social conflict.

The aim of this case study is to illustrate what role factors such as culture and migration history play for the course of mental illnesses. Methods We present a report on a male patient from Iraq, age 48, suffering from depression and chronicle pain syndrome. Stressful experiences such as the loss of his wife and daughter were the trigger for depressive episodes.

There are three main challenges with regard to treating patients with different that recently immigrated: (1) the language barrier, (2) cultural differences that complicate communication, and (3) the use of stereotypes. In order to optimize treatment it is necessary to consider the specific background of migration as well as the details of the migration history itself.

There are specific difficulties that hamper the treatment of migrants, namely cultural differences and communication barriers. Support from complementary health care is necessary to prevent further social isolation.

In the last decades the unethiological approach in clinical medicine is very frequent (the ‘medicine of consequences’, N. Ilankovic). Because the syndromological diagnoses and (relative) effective symptomatic therapy in clinical psychiatry, in most cases the therapeutic targets are only the phenomenology of behavioral disorders and the neurochemical, imunological and morphological consequences, without precise etiopathogenetic approach.

Researchers have found that both medical and psychiatric comorbidity is common in patients with psychiatric disorders, particularly in children, adolescents and in old age.

To schow how many psychotic disorders have real and detectable etiology, very frequently extracerebral origin.

Clinical and etiological analysis of data of all clinical laboratory and neuroimaging investigationes by 100 patients with psychotic disorders with schizophrenic and schizophreniform clinical pictures.

In most of patient (29%) the cause of psychotic episode was the substance abuse, in 25% extracerebral focal and systemic infection (inflammation), in 16% endocrin-metabolic disorders (extracerebral origin), in 11% brain damage, in 7% cerebrovascular disorders, and in 7% neurodevelopmental disorders.

In about 70% of our patients with schizophrenic and schizophreniform psychotic disorders the primary causes of illness were extracerabral. The real etiological approach and diagnosis in clinical psychiatry open the door to most targeted etiological therapy of psychotic and other mental disorders.

Attachment and companionship are fundamental basic needs of human beings and contribute the feeling of security and social affiliation. It is assumed that dysfunctional attachment behaviour in people with Borderline Personality Disorder leads to difficulties in the interpersonal contact. Unsecure and especially disorganized manners of attachment seem to be frequently represented by mentally ill people. In this study the release of oxytocin according to attachment relevant situations was investigated and attachment representations of people with BPD have been analysed.

In order to determine attachment representations of healthy people and of people with BPD we used the validated ‘Adult Attachment Projective’/ ‘AAP’ by George, West and Pettem (1999). The projective contains eight contour drawings of attachment relevant situations. The participant should make up a story of each picture, which was evaluated by its coherence, its content and the used defence mechanisms. Attachment representations of 30 patients with BPD were surveyed. Furthermore we measured the release of oxytocin evoked by an activation of the attachment system via the ‘AAP’ in 10 healthy people. Therefor blood drawings were performed at four different points of time.

Here, we present pilot data on oxytocin measures induced via the ‘AAP’. We could detect a decrease of oxytocin in healthy people caused by an activation of the attachment system. Moreover attachment representations of patients with BPD will be presented and discussed. These preliminary data could lead to further studies on a possible dysregulation of the attachment- and the oxytocin system of people with BPD.

To investigate serotonin (SERT) and dopamine (DAT) transporter availabilities in depressed patients under treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram.

27 patients (10m, 42±16y) underwent [123I]β-CIT SPECT to assess SERT and DAT availabilities at baseline and after four weeks of treatment with escitalopram. Hamilton Rating Scale for Depression (HAMD) and Beck Depression Inventory (BDI) were used for clinical ratings. Parametric maps with specific to nonspecific ratios (BPND) were calculated for each voxel using cerebellum as reference region. VOI-based BPND were calculated in striatum (DAT) and midbrain/pons (SERT).

At baseline, mean DAT-BPND was 6.06±0.81 in striatum and SERT-BPND 1.94±0.18 in thalamus. There were negative correlations with age of DAT in striatum (R=-0.60; p<0.01) and SERT in thalamus (R=-0.45; p<0.05). Under treatment there was a 20% occupancy of SERT in thalamus (p < 0.0001), whereas DAT availability increased by 17% in striatum (p<0.001), notably in the younger patients; higher SERT occupancy was associated with lesser DAT increase (R=0.55, p<0.05). There was a negative correlation of baseline HAM-D and DAT availability in putamen (R=- 0.45, p<0.05).

DAT and SERT availabilities decreased age-dependently comparable to studies in healthy volunteers. The SSRI-induced increase in DAT was less pronounced in elderly patients, even though occupancy of SERT was higher. These findings might have implications on dosage and side effect profile of SSRI medication in older patients.

At baseline, mean DAT-was 6.06±0.81 in striatum and SERT-1.94±0.18 in thalamus. There were negative correlations with age of DAT in striatum (R=-0.60; p<0.01) and SERT in thalamus (R=-0.45; p<0.05). Under treatment there was a 20% occupancy of SERT in thalamus (p < 0.0001), whereas DAT availability increased by 17% in striatum (p<0.001), notably in the younger patients; higher SERT occupancy was associated with lesser DAT increase (R=0.55, p<0.05). There was a negative correlation of baseline HAM-D and DAT availability in putamen (R=- 0.45, p<0.05).

27 patients (10m, 42±16y) underwent [123I]β-CIT SPECT to assess SERT and DAT availabilities at baseline and after four weeks of treatment with escitalopram. Hamilton Rating Scale for Depression (HAMD) and Beck Depression Inventory (BDI) were used for clinical ratings. Parametric maps with specific to nonspecific ratios (BPND) were calculated for each voxel using cerebellum as reference region. VOI-based BPND were calculated in striatum (DAT) and midbrain/pons (SERT). Results At baseline, mean DAT-was 6.06±0.81 in striatum and SERT-1.94±0.18 in thalamus. There were negative correlations with age of DAT in striatum (R=-0.60; p<0.01) and SERT in thalamus (R=-0.45; p<0.05). Under treatment there was a 20% occupancy of SERT in thalamus (p < 0.0001), whereas DAT availability increased by 17% in striatum (p<0.001), notably in the younger patients; higher SERT occupancy was associated with lesser DAT increase (R=0.55, p<0.05). There was a negative correlation of baseline HAM-D and DAT availability in putamen (R=-0.45, p<0.05).

Previous studies have shown that structural brain changes are among the best-studied candidate markers for schizophrenia (SZ) along with global functional connectivity (FC) alterations of resting-state (RS) networks. Only few studies tried to combine these data domains to outperform unimodal pattern classification approaches. We aimed at distinguishing SZ patients from healthy controls (HC) at the single-subject level by applying multivariate pattern recognition analysis to both gray matter (GM) volume and FC measures.

The RS functional and structural MRI data from 74 HC and 71 patients with SZ were obtained from the publicly available COBRE database. The machine learning pipeline wrapped into repeated nested cross-validation was used to train a multi-modal diagnostic system and evaluate its generalization capacity in new subjects.

Both functional and structural classifiers were able to distinguish between HC and SZ patients with similar accuracies. The RS classifier was showing a slightly higher accuracy (75%) comparing to GM volume classifier (74.4%). Ensemble-based data fusion outperformed pattern classification based on single MRI modalities by reaching 76.6% accuracy, as determined by cross-validation. Further analysis showed that RS classification was less sensitive to age-related effects across the life span than GM volume.

Our findings suggest that age plays an important role in discriminating SZ patients from HC, but that RS is more robust towards age-differences compared to GM volume. Single neuroimaging modalities provide useful insight into brain function or structure, while multimodal fusion emphasizes the strength of each and provides higher accuracy in discriminating SZ patients from HC.

Asylum Seekers experience different kinds of trauma, such as tortures, threats and loss of family members in the countries of origin, but also desperate journeys and legal concerns in the accepting countries. Our aim is to investigate mental health disorders among AS and to study the importance of torture in the development of their symptoms.

We recruited 45 AS (males, age 29±6), guests of a reception center in Borgo Mezzanone (Foggia, Italy). The following instruments were administered: MINI, SCL-90-R and Davidson Trauma Scale (DTS). Pre-migration, migration, and post-migration stressors were assessed using a self-administered scale.

75,6% of our patients reported a Major Depressive Episode currently, while 20% in the past. 35,6% suffered from PTSD, 13,3% agoraphobia. and 88,9% GAD. 2,3% reported psychotic symptoms and 13,3% alcohol or drugs abuse in the last year. Torture showed a correlation with PTSD (p<0,01), while physical injuries correlated with alcohol abuse (p<0,02), but not with other psychiatric disorders. Tortured ones had greater scores in pre-migration stressors scale (p<0,001) and greater DTS avoidance (p=0,03), DTS global gravity (p=0,003) and DTS total score (p=0,04). Both torture and PTSD did not correlate with SCL-90-R scales.

most of AS showed depressive and anxious symptoms and one-third had PTSD. All of them experienced different kinds of traumas, but only torture seems to play a major role in developing PTSD, while all kinds of trauma are equally important as to the perceived symptomatology, since both torture and PTSD did not correlate with higher SCL-90-R scores.

Asylum Seekers (AS) often experience stressful situations that may lead to psychiatric disorders. Our hypothesis is that the subjective perception of stressors and the resulting psychiatric symptoms may depend on the length of staying, length of the journey, level of education and age.

45 AS, guests of a reception center in Borgo Mezzanone (Foggia, Italy), were assessed by means of: Addiction Severity Index, MINI, SCL-90-R and Davidson Trauma Scale (DTS). We investigated the length of the voyage and the number of nations they passed through before reaching the final destination.

35,6% of the patients reported PTSD, 75,6% current Major Depressive Episode, 90,5% GAD, 2,3% psychotic symptoms, 15,6% alcohol abuse and 11,1% cannabis abuse; moreover, 26,7% attempted suicide at least once. Younger ones were less concerned about physical health and scored higher at most of SCL-90-R subscales. People who have been migrated for less time are more worried about family members left home and have higher scores at DTS subscales intrusion (p=0,02), hyperarousal, frequency, as well as total score. The number of nations they passed through or stayed in during their journey, negatively correlates with DTS hyperarousal and total gravity scores. Migrants with higher education showed lower scores in SCL somatization subscale.

younger people seems to have more severe psychiatric symptoms despite minor concerns about health and it seems that concerns about family members and various PTSD symptoms tend to decrease with time. Moreover a higher level of education may be protective from the tendency to somatize.

ADHD has long been considered to affect males more than females. It has been suggested that this difference is not as marked in the adult population. Differences in prevalence in adolescents may be contributed to by underdiagnosis in females. While these differences have been explored in children, there are limited data for the adult population with ADHD. Our study looked at a community sample of adults with ADHD and we examined differences in varying areas of comorbidity between males and females.

We looked at a sample of 50 patients in the adult ADHD clinic. On the basis of gender, differences were recorded in a variety of areas including alcohol and illicit drug use (including cannabis), forensic history, age of diagnosis of ADHD, family history and psychiatric comorbidity.

The full results are pending. Preliminary findings suggest an increased prevalence of substance misuse amongst males. Male patients were more likely to have a forensic history. Female patients are more likely to suffer with comordid anxiety and depression while male patients have a higher prevalence of autistic spectrum disorders and learning difficulties.

Service provision for adult ADHD has to be structured according to the needs of the population served rather than focussing on provison of prescribing services alone. The treatment approach for females with ADHD may diiffer from that for males. The use of psychotherapy in this population is particularly benficial. Comorbidity amongst females may complicate treatment with stimulants as this may worsen features of anxiety and depression.

Because the biologically related members of a family shareunique properties, identifications with family members are the strongest andhardest to change. Hence, beliefs about self and the balance ofconfidence or doubt depend, in part, on the behaviors of all members of thefamily.

To investigate therelationship of family identifications in female anxiety and fear related tohealth behaviors.

To examine the impact offamily identifications in women with specific fears which are raised from bodilysensations.

A community sample of 101women (mean age 20.81 years, SD = 0.91 ranged 20-25) participated to thepresent study. The girls completed a) the Symptom Check-List Revised (SCL-90) b)the Cardiac Anxiety Questionnaire (CAQ) c) the Fear of Pain and b)questionnaire concerning socio-demographic information and questions for familyidentifications.

Themajority of women reported that they matched to the father in terms ofidentifications (47.1%). Age and birth order were not contributed on familyidentifications (F (5)= 2.188, p=.062 and F(3)=1.244, p=.299 respectively). Multivariate analysis by using ANOVA found statistical significant associationsbetween family nature identifications and fear of pain, while the most stronglyadvocacy to a family member was correlated with heart focused anxiety. Theresults are summarized in table 1.

On the whole our resultshighlighted the role of family identifications and increasing female fear andavoidance behaviors.

Table 1. Impact of family identifications on female Cardiac Anxiety and Fear Bodily Pain.

A proinflammatory state in a subgroup of depressed patients has been reported repeatedly, for example an increase in interleukin-6 and tumour necrosis factor-a is well documented. Treatment with COX-2 inhibitors down-regulate increased inflammatory markers. Therefore an adjunctive treatment of depression with COX-2 in combination with an antidepressant might lead to a better clinical outcome.

To prove or disapprove the hypothesis of a better clinical outcome in the group with add-on celecoxib to sertraline in terms of improvement of HamD-17 and MADRS scores from baseline to endpoint.

This is a dual-center, randomized, double-blind, placebo-controlled, parallel group phase IIa study to investigate the mean change in clinical outcome and in serum expression of inflammation markers from baseline to endpoint (week 6) in patients with major depression (HAMD-17 ≥ 22) treated with celecoxib in combination with sertraline compared to sertraline combined with placebo. 51 depressed patients of both gender, aged between 18 and 60 without any recent inflammatory related disease were enrolled. The study comprises six study visits (6x ratings including HAMD-17 and MADRS, 3x blood collections) during six weeks of treatment and a follow-up visit 10 weeks after baseline.

The study was completed quite recently and the results are in progress.

Deep brain stimulation (DBS) for Tourette’ s syndrome (TS) in various targets has been in the focus for some years. However, there are hardly any data on ‘psychosocial’ outcome after DBS for TS.

The aim of the present study therefore was to focus on the functional outcome and ‘psychosocial changes’ in TS patients after DBS.

Six patients with treatment-refractory TS underwent GPi-DBS. The Yale Global Tic Severity Scale (YGTSS) was used to evaluate symptomatic outcome. Psychosocial changes were assessed applying the Global Assessment of Functioning Scale (GAF) and the Gilles-de-la- Tourette-Syndrome Quality-of-Life scale (GTS-QOL) with additionally documenting psychosocial changes. Follow-up ranged between 12 and 72 months.

In all symptomatic responders (4 of 6) we found a significant functional improvement (mean GAF increasing from 53.75 (± 7.5) preoperatively to 83.75 (± 7.5) at last follow-up) along with a positive correlation with the course of GTS-QOL (R2 = 0.62).

Treatment success should not only be assessed with the classic ‘tic-scales’, but also with the GAF and GTS-QOL. Although improvement of tics seems to be positively correlated with improved functional outcome, symptomatic improvement may lead to unexpected major psychosocial changes – which both the patient and the clinicians in charge – should be prepared for.

Schizophrenia is a debilitating mental disorder with similar prevalence across different cultures and geographical regions. The prevalence of schizophrenia and non-affective psychosis has previously been shown to vary by age, gender and socio-economic status in a subset of the Stockholm county population.

To investigate the entire Stockholm county population of patients with schizophrenia and non-affective psychosis regarding variations in age, gender, socio-economic status and pharmacological treatment.

To gather reliable data to guide decision-makers in the optimal allocation of resources.

Individuals with a registered diagnosis of non-affective psychosis (ICD-10 F20 – F29) between 1/1 2000 and 31/12 2012 with any contact with the Stockholm regional health care in 2012 were identified in the regional health care data warehouse (VAL). Data regarding outpatient visits in primary and specialist care, hospitalizations and dispensed prescriptions were retrieved.

Of the study population containing 18000 patients with non-affective psychosis, 34% had a schizophrenia diagnosis. 56% of the schizophrenia patients were men. The highest prevalence was observed in the 50 – 59 year olds, followed by 40 – 49 year olds. The schizophrenia prevalence was higher in municipalities of lower socio-economic status within the Stockholm county. A similar pattern for nonaffective psychosis patients was observed. The difference in prevalence was considerably smaller between the municipalities for the nonaffective patient population than for the schizophrenic patient population.

This study population will provide new insights into the burden of disease of psychosis diagnoses as demonstrated by differences in prevalence from various aspects.

The vast number of psychopathological syndromes that can be observed in clinical practice can be described in terms of a limited set of elementary syndromes that are differentially expressed. In the past, principal component analysis (PCA) has been used to identify such elementary syndromes (dimensions of psychopathology). Here, we show that elementary syndromes can be defined as modules within a network of interacting symptoms.

To examine the modular structure of psychopathology using network community detection (NCD) and principal component analysis (PCA) and to define critical areas of the network that could be primary targets for intervention.

192 heterogeneous psychiatric patients were tested on the Comprehensive Psychopathological Rating Scale (CPRS). PCA was performed on the bootstrapped correlation matrix of symptom scores to extract the principal component structure (PCS). An undirected and weighted network graph was constructed from the same matrix. Network community was optimized using a previously published technique.

NCD showed an optimal match (93.2%) with a 6-PCS of psychopathology. Some 6 network clusters were found, including ‘Depression’, ‘Mania’, ‘Psychosis’, ‘Psychomotor retardation’, ‘Behavioral disorganization’, and ‘Somatic anxiety’. The psychopathology network displayed a Small World structure. Nodes with singular network metrics were identified as possible targets for treatment.

We present the first comprehensive network graph of psychopathology: a ‘Psychopathology Web’. Clusters within this network represent elementary psychiatric syndromes. Individual symptoms with key roles in maintaining network connectivity were identified as possible targets for treatment.