Multiple neurotrophic factors, including vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF)-2, nerve growth factor (NGF) and insulin-like growth factor(IGF)-1, have been shown to play important roles in the pathophysiology of mood disorders. However, insufficient clinical data supporting the importance of these neurotrophic factors in mood disorders, especially manic episode, have made inconclusive to make a connection between these factors and the disorder.

This study intended to investigate possible peripheral biomarkers in serum of manic episode of bipolar disorder.

We aimed to investigate whether or not serum levels of VEGF, FGF-2, NGF and IGF-1 varied in manic state.

Serum levels of VEGF, FGF-2, NGF and IGF-1 were examined in 70 drug-naïve patients with manic episode of bipolar disorder (BM) as well as 50 healthy controls, using an ELISA method.

The mean serum levels of VEGF, FGF-2, NGF and IGF-1 were 168.13±225.61pg/ml, 279.09±378.62pg/ml, 61.38±171.67pg/ml and 162.01±72.00ng/ml in BM patients, and 140.80±143.71pg/ml, 275.46±235.29pg/ml, 36.34±15.14pg/ml and 138.90±80.11ng/ml in healthy controls, respectively. Serum levels of FGF-2, NGF and IGF-1 in patients were significantly higher than those in healthy controls (Z=−2.896, P=0.004; Z=− 2.050, P=0.040; Z=−2.188, P=0.029; respectively), although there was no statistical difference in the serum levels of VEGF between two groups (Z=-0.468, P=0.639). Moreover, serum levels of NGF in patients correlated with the duration of disorder (rs=−0.241, P=0.044).

The increase in serum levels of FGF-2, NGF and IGF-1 in manic state may reflect a neuroprotective role for these factors, and these factors may be considered biological markers for manic episode.

In Brazil, the public health system is universal and regionalized. Currently, it is being restructured starting from the primary care system.

In Rio de Janeiro there is a lack of children and adolescents mental health professionals, and there is a deficient system to attend the demand, without integration between health and educational systems and insufficient and inadequate psychology, pedagogy, speech therapy, occupational therapy and medical care.

The city of Rio de Janeiro is divided in 10 Programmatic Areas (PA). The Child and Adolescent psychiatry of Piquet Carneiro Policlinic (PPC)/ UERJ covers, amongst three more units, the PA 2.2 of 371.120 habitants, amid those, 74.257 are under 15 years old (IBGE, 2010).

Analyze the Child and Adolescent Psychiatric demand in PPC/ UERJ in 2013, arising from the primary care system.

A sample of 50 patients that were evaluated in this policlinic referred from the primary care system were attended and directed through consultations. Those evaluations were made by psychiatrists and reports and counter-referrals were fulfilled. The patients in need of psychiatric care are being accompanied.

Out of the 50 patients, we analyzed gender, age, diagnosis, familial background, social-economical background, educational achievement and prescribed drugs.

Among the analyzed patients, we found that the majority of the cases regard learning disabilities and family issues that could have better prognosis with an integrated and multidisciplinary care.

The existing units covering Child and Adolescent Mental Health in the referred PA are not enough to provide the necessary care.

The benefits of Tai-chi on relaxation, mental focus, motor coordination, balance, and stress reduction may help improve symptoms control and physical functioning in schizophrenic patients. The study aims at evaluating the effects of Tai-chi and developing this mind-body exercise in residential care of schizophrenia in long term.

The RCT included a pilot trial and an on-going 3-arm main study. A pilot trial with 30 participants randomly allocated into a 12-session (6-week) Tai-chi program and control group was conducted. Gross motor coordination, negative symptoms and functional disabilities were assessed at baseline, 1 week and 6 weeks post-intervention. Recruitment of 150 participants for the main study was conducted at the same hostel. They were randomly allocated into Tai-chi group, exercise group and wait-list control group. The study is still in progress and will be reported in the presentation.

For the pilot trial, participants in the control group showed marked deteriorations in the above areas throughout the study period. Tai-chi showed a protective effect from deteriorations in gross motor coordination (Z=-2.28; p=.023), and interpersonal functioning which could be sustainable for 6 weeks after the program (Z=(2.56; p=.01). Preliminary results of the main study will be presented in the conference.

The pilot trial demonstrated the positive effects of Tai-chi on promoting movement coordination and alleviating functional disabilities. The group exercise format encourages socialization and interpersonal functioning. Tai-chi emphasizes movement rhythm and inner calmness which may further help symptoms control. The main study will confirm the results of the pilot trial.

There are no effective programs on return-to-work (RTW) despite an increase of stress related disorders. We developed an original rehabilitation program,’Ultra-short daily briefings care (USDBC)’. USDBC is based on a key concept of European Framework for Psychosocial Risk Management (PRIMA-EF; WHO, 2008) that provides the good practice guidelines at the workplace. We carried out USDBC at the worksite of Panasonic Healthcare Co., Ltd. to determine whether USDBC facilitates RTW.

To develop and establish the appropriate intervention that reduces depressive severity of sick-listed employees.

The aim of the study was to determine whether USDBC strengthen the sense of coherence (SOC; Antonovsky, 1985).

We compared two groups in a cross-sectional study design: 16 depressed RTW employees (USDBC group) vs. 121 healthy employees (control group) (Fig.1). USDBC group was received the instant face-to-face rehabilitation program in every workday (Fig.2). The primary outcome was the ability to cope with stress, measured by self-reported 13-items SOC scale for Japanese (Yamazaki, 1999).

In the USDBC group, significant changes were observed between baseline and measurement point in SOC score (40.3 vs. 54.4; 95% CI (20.6 to (7.5), whereas in the control group, no significant changes were observed (58.3 vs. 57.9; 95% CI (0.1 to 0.9) (Table.1).

The study suggests that USDBC strengthen the depressed employees’ SOC.

Fig. 1

Participant now climt

Flow diagram showing the selection of USDBC group and control group

Fig. 2

Intervention with USDBC

Depressive employees behave according to this flow in every workday.

Table 1

Subjects’ characteristics and SOC.

Data from the American National Comorbidity Survey Replication (Martin et al., 2013; JAMA Psychiatry) - a nationally represented mental health survey - provides evidence that current diagnostic criteria for depression in men may be incomplete.

To conduct and present findings of a systematic review of the biological, psychological and social depression research literature relating to men.

(1) To provide a comprehensive summary of current knowledge about the expression of depression in men; (2) To examine the accuracy of current diagnostic criteria for identifying depression in men.

The PRISMA statement was used to guide a multiple database search in February and July 2012 and June 2013. Search terms included: ‘men’, ‘depression’, ‘signs’ or ‘symptoms’, ‘gender’, and ‘sex differences’. Initial database searches together with forward and backward searches found 15,966 studies that were assessed for eligibility. Thirty studies met selection criteria and were included in the review.

The review challenges findings that are commonly reported in the depression literature. The majority of studies in the review did not find significant differences between males and females in global depression rates, but instead, found significant differences between males and females in specific depressive symptoms that are expressed. Depressed men commonly reported alternative symptoms, including social withdrawal, functional impairment and sexual disturbance, together with maladaptive coping mechanisms.

Current diagnostic criteria may not accurately identify depression in men. Targeted research needs to further clarify which symptoms are required to accurately detect depression in men.

Despite the significant prevalence of adolescent depression, little is known about the neuroanatomical basis of this disorder. Functional dysregulation in frontolimbic circuitry has been suggested as a key neural correlate of adult and adolescent depression impeding emotional regulation. However, less is known about whether this dysregulation is overlaid on impaired white matter microstructure. Guided by neuroimaging findings, we test the a priori hypotheses that adolescent depression is associated with alterations in white matter microstructure in the 1) uncinate fasciculus (UF) 2) cingulum bundles, and 3) fibers linking subgenual anterior cingulate cortex (sgACC) and amygdala.

Diffusion tensor magnetic resonance imaging (DTI) data were obtained on 52 un-medicated adolescents with major depressive disorder and 42 matched controls. We calculated fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD) for bilateral UF, cingulum, and sgACC-amygdala fibers using probabilistic tractography. We also completed a voxelwise comparison of depressed and control participants using tract-based spatial statistics (TBSS).

Depressed adolescents had significantly lower FA and higher RD in bilateral UF and right sgACC-amygdala tracts. TBSS results additionally revealed lower FA values in the white matter associated with the limbic-cortical-striatal-thalamic circuit, corpus callosum, and anterior and superior corona radiata.

Adolescent depression is associated with reduced white matter integrity in emotion regulatory networks, which may underlie the functional differences in frontolimbic circuitry often observed in adolescent depression. We offer evidence that poor myelination of the white matter tracts supporting emotion regulation may contribute to the etiology of early-onset depression.

A previous 40-week, randomised, double-blind placebo-controlled core study [comprising of dose confirmation (9-week), real-life dose optimisation (5-week) and maintenance of effect phases (6-month)] reported the safety of MPH-LA in the treatment of adult ADHD. Here, we report the long-term safety from the extension phase (6-month) of this core study.

During the extension phase, patients initiated treatment with MPH-LA 20 mg/day; up-titrated to an optimal dose of 40, 60 or 80 mg/day in increments of 20 mg/week. Safety was analysed from baseline of maintenance of effect phase (core study); and from baseline of extension phase to end of extension phase. Adverse events (AEs) and serious adverse events (SAEs) were reported.

Incidence of AEs occurring anytime starting from baseline of the maintenance of effect phase (core study) until the end of extension phase was 80.5%. The incidence of AEs occurring in the extension phase period was 69.8% (Table). Incidence of serious AEs (SAEs) reported during both periods were similar (0.7%). Most common AEs were nasopharyngitis, headache, decreased appetite, dry mouth and nausea. No deaths were reported. No new or unexpected results were observed for laboratory findings, vital signs or ECGs. None of the patients had QT, QTcB or QTcF ≥500ms during the study.

Long-term treatment with MPH-LA in adult ADHD patients was well-tolerated.

Table: Number (%) of patients with most frequent AEs and SAEs

The safety profile of MPH-LA in the paediatric population has been well studied. However, there are very limited studies reporting safety of MPH-LA in adults. We present the safety profile of MPH-LA in adults and from a pooled analysis in children.

Data from 3 multiple-dose, double-blind, placebo-controlled studies of 7-12 weeks duration in children with ADHD; MPH-LA (10-80mg/d) (n=314) & placebo (n=318) (aged 6-12 yrs in 2 studies &13-17 yrs in one study) were pooled for this analysis. In addition, data from 722 adult patients, 18-60 yrs of age with ADHD receiving MPH-LA 40-80 mg/d (n=542) or placebo (n=180) from double-blind dose confirmation phase of 9-week duration from one study was included in the analysis.

Common adverse events (AEs) reported by both adult and paediatric ADHD patients were decreased appetite, headache, nasopharyngitis, nausea, and insomnia (Table). Incidence of serious AEs (SAEs) was low with MPH-LA in both adults (0.7%) and children (0.6%) compared with placebo group (1.1% in adults and 0.3% in children).

Our findings show that safety profile of MPH-LA in adults is similar to that observed in the paediatric population.

Table

Adverse events (>5%) by preferred term in multiple dose, placebo-controlled studies In adult and paedlatrlc ADHD patients

alcohol abuse induce neuroadaptive alters of benzodiazepine receptors (BDR) that modulate GABAAR, mediation of GABA and activity of dopaminergic neurons in brain regions, associated with reward function in the brain that serve alcohol addictions.

properties of BDR’central’ (CBR) and’peripheral’ (PBR) types were studied in synaptosomal and mitochondrial membranes from different brain areas of alcohol abused patients and non-alcoholic persons (early postmortem material, less 5 hours after death) by radioreceptor assay with using selective ligands: [3H]flunitrazepam and [3H]PK-11195.

comparative study of kinetic parameters (affinity and capacity) of [3H]flunitrazepam and [3H]PK-11195 binding with synaptosomal and mitochondrial membranes in autopsy samples from different areas of human brain was showed that affinity of BDR was decreased: CBR – in 1,2 times in prefrontal cortex and n.caudatus, less – in cerebella cortex; PBR – in 2,1 times in n.caudatus, 1,3 times – in prefrontal cortex and cerebella cortex in patients with alcohol addiction.

Capacity of BDR was increased in different areas of human's brain under influence of alcohol abuse. More alters of CBR appeared in prefrontal cortex (179%) and cerebella cortex (176%), less – in n.caudatus (145%); PBR – in n.caudatus (262%); and cerebella cortex (205%), and less in prefrontal cortex (123%).

These results showed that alcohol addiction induce more alterations in PBR (mitochondrial) than CBR (synaptic) that agree with maintaining function of glial cells in CNS under influence of different toxic factors.

our findings suggest hypothesis of difference in response BDR from various brain areas on alcohol influence.

Research data indicate that many dermatological conditions may be related to stress and emotion dysregulation. Increased attention has recently been given also to mindfulness, the ability of attending present experiences in both a non-evaluative and accepting way. In fact, dispositional mindfulness and mindfulness-based interventions have found to influence rates of skin clearance in patients with psoriasis, while reducing pain, and improving the quality of life (QoL).

The main aim of the current study was to test differences in the mindfulness ability of individuals affected by psoriasis vs. in absence of any chronic skin condition. Additionally, we also aimed at investigating the link between mindfulness and QoL.

Participants were 42 patients with psoriasis and 42 healthy controls. All completed the Five Facets Mindfulness Questionnaire (FFMQ;a self-report measuring five aspects of mindfulness, i.e., Observe, Describe, Act with Awareness, Nonjudge, and Nonreact), and the Dermatology Life Quality Index (DLQI;a self-report assessing the impact of dermatological diseases on the QoL). The two groups were fairly well balanced in terms of gender and age (all p>.05).

When compared to the healthy controls, the patients with psoriasis overall showed lower mindfulness scores, although most of the results were only marginally significant. The strongest difference was observed for the Nonjudge mindfulness facet,t(82)=1.97,p=.05,d=.43. No correlation between DLQI and FFMQ was observed.

This study provides further support for the link between psoriasis and mindfulness, but fails to demonstrate an association between mindfulness and QoL. Accordingly, psoriasis treatment might benefit from a multidisciplinary approach that includes, but is not limited to mindfulness techniques.

Evaluation of mood and personality interaction

Patients underwent evaluation with MCMI-III, clinical interview for psychological or non psychological reasons (4300) and Beck's or Hamilton (320). Scores of mood and personality were studied for correlation. A model of cis-action and trans-action was developed.

1. 1. Schizotypal, borderline, avoidant, dependent and self destructive personalities are more prone to mood disorders with more intense symptoms and less responsiveness to medication. P<0.03

2. 2. Schizoid, paranoid, narcissistic and histrionic personalities are less prone to mood disorders than the general population. P<0.04

3. 3. Schizoid, schizotypal, borderline and histrionic patterns show higher subclinical scores in mood disorder. P<0.1

4. 4. Major depression augments schizoid, schizotypal, borderline, narcissistic, avoidant and dependent personality symptoms. Patients showed reduced personality scores and less symptoms after treatment for mood disorders. P<0.02

5. 5. These latter personalities improve with their symptoms after antidepressants even if they do not fulfill clinical criteria for mood disorders as (MCMI-III and clinical interview). P<0.03

6. 6. Curiously, almost all personality patterns improve with their symptoms even without mood problems if treated for short courses of antidepressants. P<0.01

7. 7. Antidepressants probably disrupt persistent maladaptive neural circuits in almost all patients with different psychopathologies.

1. 1. Mood and personality interact in a cis pattern: they augment each other and trans pattern: they reduce the chance of the development or the expression and intensity of the other.

2. 2. Personality disorders are not extreme of a spectrum of points of view and … but categorically distinguishable patterns with neuro-humoral backgrounds.

Evaluation of oscillation pattern of GnRH release by the hypothalamus in different mental states

Twenty two patients were evaluated by a computer algorithm to find oscillation of LH/GnRH pulsation measured on four sessions (day 6 and 14) every 10 minutes within two consecutive cycles in addition to the MCMI-III and Hamilton test.

The pattern of oscillation was indirectly correlated with Hamilton scale and the anxiety state and showed statistically significant lowering of frequency during anxiety and depression states. Besides, the slope of GnRH between two consecutive sessions (d0GnRH0/GnRH1dt) showed also a prominent reduction and even flattening. In addition the time to ovulation was also postponed in cycles with prominent anxiety.

1. 1. Psychological stress exerts its effect through a reduction of pulsation frequency in GnRH release.

2. 2. Pattern of GnRH pulsation changes in the range of ¼ to 1/15 of the baseline and external stimuli have strength of changing hormonal milieu in this range.

3. 3. MCMI-III is an excellent tool for evaluating psychological state of the patient.

4. 4. Patients with borderline, schizoid, dependent, depressed and passive aggressive personality suffer most from irregularity of menstruation cycles.

5. 5. Patients with chronic major depression are subject to menstrual irregularity highest during stabilization of disease and in the early phases of recovery after treatment with SSRI.

6. 6. Treatment of depression/anxiety causes a reduction of menstrual cycle length.

7. 7. Measurement of GnRH, FSH, LH and Estradiol on two sessions one week apart is a nice marker for regularity and ovulation.

To study sexual problems of our patients and standardizing it for patients with or without religious and cultural restrains we developed a questionnaire with 240 phrases that were extracted from a pool of 1400 sentences addressing sexual problems. Sixty four scales under four headings (sexual general characteristics, deviations, dysfunctions and psychodynamic syndromes) (16 items each) were evaluated based on criteria of DSM-IV and ICD 10. Five validity scales (honesty, desirability, debasement, guilt feeling and overall validity) were also used for better assessment.

A total of 1300 patients in the four variants of the test were evaluated during a time span of 7 years. The questions were presented to examinees at 8th. Grade and higher in a calm environment and the results were evaluated by a computer software specifically developed for this purpose.

The last version of the test was completed by 734 patients with excellent compliance. It was of nice politeness and comprehensiveness. For almost all scales the sensitivity and specificity were around 85 and 92% respectively.

We conclude that QSAF 2009 is an excellent tool both in clinics (diagnosis and follow up) and epidemiology with high sensitivity and specificity. It has also application in cross cultural studies, medico – legal issues and medical documentation. It prevents face to face interviews, breaks patients’ resistance and is less time consuming than scheduled interviews.

To evaluate mutual interaction between sexuality and personality we tried to study 111 patients with QSAF 2009 and MCMI-III.

Hundred and eleven consecutive patients with sexual problems (76) or personality disorders (35) were examined with two tests. Only volunteer personality disorder patients were enrolled to this trial. The results were compared with 325 examinees evaluated with QSAF and 1600 patients evaluated with MCMI-III.

All patients with sexual problems showed at least two scores higher than 72 in their MCMI-III. This was more prominent in sexual deviations than dysfunctions. Homosexuals had higher scores in schizoid and schizotypal, pedophiles in schizoid and antisocial, voyeurs in schizoid and avoidant, masochists in dependent and self defeating personality scales ….

Sexually deviated persons remain clinically latent and show themselves as alien, aloof and eccentric. Almost all deviated persons show high scores in personality disorder scales. On the contrary, only a minority of personality disorder patients show prominent sexual problems in the form of deviation. They predominantly have disturbed sexual self image, show inhibited sexual desire problems (dependent, schizoid and avoidant) personality, dyspareunia and vaginism (avoidant and schizotypal personality), spouse abuse (borderline and antisocial personality) postcoital disorders (borderline, dependent and narcissistic personality) and extramarital relationship in a series of disorders including histrionic personality …. as studied by the QSAF 2009 which evaluates 64 sexual scales.

Evaluation of personality disordered patients in regard to sexuality and vice versa is essential for better understanding the pathogenesis of each disease and helps in smoother treatments.

Since January 2012, there has been an aggregation of the 36 self-care and self-sufficiency tasks into ten basic living needs, i.e. mobility, orientation, communication, food intake, putting on clothes and shoes, body hygiene, using the toilet, health care, personal activities, and household cleaning.

Transformation of the medical assessment paradigm used for dependence degree assessment for the purposes of care allowance according to the principles of personalised medicine.

A change in the medical assessment criteria for consideration of the degree of dependence level, based on the assessment of Activities of Daily Living and principles of the International Classification of Functioning, Disability and Health. So far, more than 150 thousand assessment cases have confirmed that personalised assessment of functional disabilities represents a significant improvement in the individualised approach to all clients of the social security system.

There was an increase in the number of acknowledgements of the degree of dependence by 26.6 % from 24 317 cases in 2011, to 30 809 cases in 2012; in the number of persons with the degrees of dependence III - serious (5 457 in 2011 and 7 138 in 2012) and IV – very serious (4 719 in 2011 and 6 772 in 2012).

The increase in the number of patients with confirmed dependence degrees has demonstrated that modern functional assessment is beneficial especially for patients with mental disorders. Personalised medical assessment service represents the pursuit of an improved medical assessment of clients’ functional disabilities.

The increased interest in the phenomenology, etiology, and treatment of Obsessive-Compulsive Disorder (OCD) follows the recognition that OCD is a more pervasive and serious problem that was previously thought. Family studies indicate a modest tendency for OCD to occur among biological family members. Studies on twin and family-genetic analysis show that non-heritable factors present as great and possibly greater risk to the development of OCD. Psychological and familial issues are also implicated in the development and maintenance of OCD.

This study explored the relationship between parental style and OCD among a clinical sample of children and adults in Tehran, Iran.

Subjects consisted of 190 patients who had sought treatment for OCD during the period from 2002 to 2009. Designation of parenting style was based on interviews using Baumrind typology. Two clinical psychologists assigned each subject to one of the four family styles: authoritative, authoritarian, permissive and neglectful.

The data replicate previous findings in relation to gender differences, the age of onset, family history of OCD and comorbid disorders. Patients who had experienced authoritarian, permissive, and neglectful parenting styles were significantly more likely to experience OCD. A hitherto unreported finding is the positive relationship between a mixed parenting style and OCD.

The present study indicates that the positive relationship between parenting styles and OCD extends beyond cultural boundaries. The psycho-social and cognitive dynamics of family-styles in relation to development and maintenance of OCD and treatment implications are discussed.