Depression and pain symptoms are often comorbid and share common neurobiological and psychological background.

To find out the prevalence of painful physical symptoms (PPS) in otherwise healthy patients hospitalized due to recurrent unipolar (UD) and bipolar depression (BD) and to compare socio-demographic and illness related characteristics.

180 somatically healthy patients were recruited in the study. Symptoms of depression were evaluated with standard clinical tools. The presence of somatic illness was excluded. Visual Analogue Scale was used to evaluate the intensity and location of painful symptoms. Sociodemographic, illness and therapy related data, substance use, and suicidality were recorded as well.

41 patients met criteria for BD and 139 for UD. The average age was 50 years (75% females). Higher prevalence of PPS in group of UD (72.6%) in comparison to BD (58.5%) was found. The average intensity of painful symptoms was high. Patients with UD+PPS had higher total number of PPS and scored higher on HAM-D21 and Zung Self Rating Depression Scale than patients with BD+PPS. Use of analgesics and anxiolytics was high.

The study offers an insight in the high prevalence of PPS in patients with acute severe unipolar and bipolar depression and the results warn of possible over prescribing of analgesics and anxiolytics. Lower prevalence of PPS in BD might be explained with less severe depression symptoms. The results offer new information on PPS in acute bipolar depression since there is very little research data on this topic.

Symptoms that are linked to schizophrenia and other psychotic disorders, such as auditory verbal hallucinations (AVH), are also commonly reported by individuals who function well in society. These individuals are not in need for care, do not suffer from schizotypal personality disorder or other psychotic disorders, and provide the opportunity to investigate the relationship between nonclinical psychotic symptoms and brain morphology.

Fifty individuals with nonclinical AVH, 50 patients with a psychotic disorder and AVH, and 50 healthy controls underwent structural magnetic resonance imaging. The three groups were matched for age, gender, handedness and years of parental education. Cortical thickness was assessed using the FreeSurfer software suite.

Cortical thickness in the left pars orbitalis, left paracentral gyrus, right fusiform gyrus and right inferior temporal gyrus was lowest in patients, intermediate in the nonclinical AVH group, and highest in controls. The patients also showed additional cortical thinning in widespread frontal, temporal and parietal areas compared to both other groups. In additional analysis, ranking the levels of cortical thickness per brain region across groups revealed that for the large majority of brain regions (88%), the patients had the lowest cortical thickness, the nonclinical individuals with AVH were in between, and the control subjects had the highest cortical thickness.

Individuals with nonclinical psychotic symptoms show a similar but less pronounced pattern of cortical thinning as patients with a psychotic disorder, which is suggestive of a similar, but milder underlying pathophysiology in the nonclinical hallucinating group compared to the psychosis group.

Various psychological factors (personality traits, acute stressors, etc.). are involved in development of psychiatric disorders after acute coronary syndrome (ACS).

More passive personality traits might have protective effect in development of particular type of ACS [ST-segment elevation (STEACS) or non–ST-segment elevation (NSTE-ACS)].

To investigate the development of psychiatric disorders and dimensions of personality in the subjects with ACS, and their changes retesting them after one month and after 6 months.

Research has been conducted in three phases: the 1st after stabilization of ACS, the 2nd after one month and the 3rd after six months. The first phase of the study included 121 subjects, the second phase included 80 subjects and the third phase 56 subjects. Dimensions of personality were measured by Emotions Profile Index (EPI). Psychiatric disorders were diagnosed using the Mini International Neuropsychiatric Inventory (MINI).

A group profile of subjects matches the profile of the normal population. The dimensions of personality were stable over 3 phases of research. In the first phase dimension of impulsiveness was more prominent in subjects with STE-ACS, while dimension of deprivation was more prominent in subjects with NSTE-ACS. NSTE-ACS patients who develop PTSD manifest personal dimension of deprivation.

It is important to consider potentially negative personality traits, especially in chronic diseases such as cardiovascular disease, since personality traits determines the behavior of the patients that consequently affects the adhesiveness to therapy and positive outcome of the treatment.

The objective of our study is to describe the prevalence of insomnia during active consumption and hospitalisation for detoxification, and its influence on relapses at 3 and 6 months in drug-dependent patients.

We conducted a prospective study of drug-dependence inpatients admitted to the hospital detoxification unit between June 2008 and November 2012, and performed psychiatric follow-up on an outpatient basis over the six months following discharge. Insomnia prior to admission was measured by clinical interview from the patient concerning sleep habits, and during hospital stay using a sleep log filled out by nurse team. Demographic, clinical and diagnostic variables were recorded and a structured clinical interview (SCID) was conducted to assess psychiatric diagnoses. Relapse was deemed to be renewed use of the substance that brought about admission, which was assessed by alcohol testing and/or urinalysis.

We included 434 patients. Insomnia during consumption was reported by 64.3% of patients and 66.1% reported insomnia during hospital stay. Of the patients with preadmission insomnia, 68.3% relapsed at 3 months from discharge, as did 71% of patients with insomnia during hospital stay. Patients who relapsed at 3 months of follow-up showed significantly greater sleep initiation dysfunction prior to and during hospitalisation. Of the patients with preadmission insomnia, 69.2% had relapsed at 6 months from discharge. Patients who relapsed at 6 months of follow-up showed significantly greater sleep initiation dysfunction and global insomnia prior to and during hospitalisation.

Sleep disorders should be study as a prognostic factor in drugdependent patients.

Narrative, unsystematic reviews revealed no differences in terms of efficacy between the various first-generation antipsychotics (FGAs) resulting in the psychopharmacological assumption of comparable efficacy between the different FGAs. Because this assumption contrasts with the clinical impression a high-quality systematic evaluation of this issue appeared highly necessary.

A systematic literature survey was applied to identify all randomized controlled trials (RCTs) that compared oral haloperidol with another oral FGA in schizophrenia. Primary outcome was clinically important response to treatment and secondary outcomes were overall acceptability, efficacy, tolerability, and specific adverse effects. Study selection and data extraction were carried out independently by at least two authors. All analyses were based on a random-effects model.

We included 63 RCTs with 2819 participants in our meta-analysis. In short term studies (up to 12 weeks) there was no statistically significant difference between haloperidol and the other FGAs in achieving response to treatment (40 RCTs, n=2132, RR 0.93 CI 0.87-1.00). In medium term trials haloperidol was significantly less effective than the other FGAs (1 RCT, n=80, RR 0.51 CI 0.37-0.69). There were no significant between-group differences regarding the other outcomes with the exception that haloperidol produced less akathisia in the medium term.

The findings of this meta-analysis support the statements of previous narrative, unsystematic reviews suggesting comparable efficacy of FGAs. Additionally, we demonstrated that haloperidol is characterized by a similar risk profile compared to the other FGAs. The results were limited by the low methodological quality in many of the included original studies.

Individuals with serious mental illnesses experience poor physical health, particularly increased rates of cardiometabolic disorders. There are corresponding increases in premature mortality.

To assess the nature and extent of cardiometabolic risk factors and comorbidities in bipolar disorder and depression compared to controls.

Cross-sectional analysis of records for 502,602 participants within the UK Biobank database. Mood disorder was identified using an internally developed algorithm. Presence of cardiometabolic conditions and risk factors was examined. Multinomial logistic regression analyses were applied.

Compared to controls, individuals with bipolar and depression were significantly more likely to smoke. Rates of smoking were particularly elevated in the bipolar group, with a RRR of 3.18 (95% CI 2.790–3.632) compared to controls.

Individuals with bipolar disorder or severe recurrent depression were significantly more likely to be underweight, and have classes I, II and III obesity. All mood disorders were significantly associated with Class II and Class III obesity.

Bipolar disorder was significantly associated with increased rates of hypertension, diabetes, MI, angina and stroke. Severe depression was also associated with an increased risk of hypertension, diabetes, angina and stroke and individuals with moderate depressive disorder showed increased rates of MI, angina and stroke. Rates of ‘no cardiovascular illness’ were significantly reduced across the mood disorder spectrum.

Individuals with mood disorder have significantly increased rates of both cardiovascular risk factors and cardiometabolic illness. These findings using a large and extensive national dataset highlight a significant health inequality.

To establish the prevalence of metabolic syndrome and its parameters in group of patients with schizophrenia in polypharmacy – receiving first generation antipsychotics versus clozapine alone treated group.

48 outpatients with schizophrenia divided into two groups: the first group of 21 patients in polypharmacy with first generation antipsychotics, and the second group of 27 patients treated with clozapine alone were assessed for the presence of metabolic syndrome. We used logistic regression models to assess the relationship between metabolic syndrome and antipsychotic therapy, gender and age.

metabolic syndrome was found in 52.1% of all subjects. Compared to first generation antipsychotics polypharmacy, the monopharmacy with clozapine was associated with elevated rates of metabolic syndrome (28.6% vs. 70.4%, p= 0.004). With regard to particular parameters of metabolic syndrome, the elevated plasma triglycerides were significantly more present in subjects within Clozapine group (p=0.03). Logistic regression analysis showed that female gender (p= 0.004), older age (p=0.56), and clozapine treatment (p= 0.005) were significantly associated with metabolic syndrome.

Results of this study are consistent with other studies, which showed that patients receiving Clozapine are at higher risk for metabolic abnormalities.

Compared to polypharmacy with first generation antipsychotics, the higher prevalence of metabolic syndrome is found in patients treated with Clozapine alone. The most prevalent metabolic disorder is dyslipidemia. Female gender, older age, clozapine treatment are significantly associated with metabolic syndrome.

Aim of this study was to investigate whether agomelatine relieves both symptoms of depression and physical symptoms in women in the perimenopausal transition

This study is an open, randomized, non-controlled pilot study. Agomelatine was administered at the single daily dose of 25mg over 6 weeks to 50 women with first-onset perimenopausal depression (mean age 52-SD 4.8-years). Perimenopause was determined by subjetcs’ reports and hormonal assessment. Outcome measures included MINI (once for assessment of DSM-IV diagnosis of depression) at the beginning of the study and Hamilton Depression Rating Scale (HAMD), Montgomery Asberg Depression Scale (MADRS), Pittsburgh Sleep Quality Index (PSQI) as well as Menopause Rating Scale II, which were assessed weekly. Adverse drug reactions (ADRs) were documented at every visit.

At inclusion, women had moderate depression with a mean HAM-D-score of 17 and a mean MADRS-score of 19. Over the study period, agomelatine significantly improved depression and perimenopausal physical symptoms in all women. This was particularly evident for hot flashes, decreased performance, sexual problems, heartaches and joint/muscle pain. In addition, anxiety, irritability and disordered sleep improved as well. At the end of the study, women reported to be basically free of both physical and psychological symptoms of perimenopause. Agomelatine showed good tolerability, majority of the women reported no side-effects. Only in the first 2 weeks tiredness was reported by about 10% of the subjects.

The findings demonstrated that agomelatine significantly improved symptoms of depression and physical symptoms related to perimenopause over 6 weeks. Further, good tolerability was observed.

Emotional dysregulation represents a typical trait of many psychiatric disorders. One aspect of emotional regulation deficiencies are acceptance and suppression of negative and/or positive emotions. Changes of acceptance and suppression during the course of illness have not been investigated yet.

Investigation of the course of emotional regulation strategies.

The purpose of this study was to investigate,

1. 1. whether acceptance and suppression are related to positive and negative emotions;

2. 2. if there is any change of acceptance and suppression over time;

3. 3. whether depressive patients and healthy controls differ regarding acceptance and suppression levels.

Subjects were 40 patients with depression and 29 healthy controls. The study was conducted in the Clinic of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany. The patients were diagnosed according to DSM–IV criteria. BDI was used to assess the level of depressive symptoms. For the assessment of acceptance and suppression of negative and positive emotions the questionnaire FrAGe (Questionnaire of the acceptance of emotions) was used at the begin (T1) and at the end (T2) of inpatient treatment.

Depressive patients reported reduced acceptance of positive and negative emotions. Although the level of acceptance was higher at T2, they still accepted their emotions less than the healthy controls. Patients also suppressed emotions more intensively than controls.

There are significant differences between depressive and healthy subject in terms of the acceptance and suppression of negative and positive emotions. Nevertheless, the suppression and acceptance of emotions are changing during treatment towards a more adaptive level.

the clinical interview with the patients, Beck Depression Inventory, State Trait Anxiety Inventor, the questionnaire ‘Analysis of family anxiety’ (E.G.Eydemiller, V. Yustitskis), «Questionnaire marital satisfaction» (V. Stolin, T. Romanova, GP Butenko), The scale of perception of social support «MSPSS» (Sirota, Yaltonsky).

Analysis of the results obtained showed an association between the characteristics of social functioning, such as family situation, the presence of different kinds of support from others, and the degree of patient's compliance. Patients with good compliance said that they receive emotional support and sure that will immediately have tool support when needed; describe their family as a loving, wife as the best, perfect, caring; often have a small child. Patients with low adherence reports that they don’t have any support and don’t need it; couldn’t describe their family or talk about the absence of close contact, formal interaction.

Body- art is associated with an increased risk of self- harming behaviours and suicide attempts (SA) in adolescents, but there is no concluding evidence for adults yet.

We investigate the relationship between ‘body art’ (i.e. tattoos, piercings) and SA in adult patients.

All patients admitted to the Psychiatric Clinic of Genoa for a SA between October 2012 - January 2013 were enrolled. Age, gender, education, previous SA, psychiatric diagnosis were analyzed. The patients underwent first a clinical interview where the presence of body-art, type, number, location, time between its performance and previous or present SA were assessed along with its meaning for the patient, then SCID I & II.

44 patients were enrolled (24 females). Mean age 47 years. 26 had at least a tattoo, among them six females. Eight had at least one piercing, of whom six were females. 58,3% had a diagnosis of MDD, 41.6% of PD (BPD 72%;NPD 34%; OCPD 42%; PPD 23%). 75% of patients with more than one tattoo had a diagnosis in both axes and attempted suicide more than once. These results show that 40% of our sample has a tattoo and one third a piercing, which presence in the same-age American population is estimated to be 26%. However, these results have a limited statistical significance because of the small sample size.

These results suggest a particular mind-body bond which would correlate SA and body art in adult patients, while previous studies found such evidences only in the adolescent population.

Research about psychological manifestations in right hemisphere damage (RHD) has increased in recent decades. The most characteristic alterations affect social cognition, which involves skills related to social interaction, as Theory of Mind, use of humor or metaphors comprehension inter alia. One of them is Facial Emotion Recognition (FER), which has been investigated in brain damaged patients, although studies present small samples and other metodological limitations.

Comparing FER skills in a single RHD patients and non-brain damaged control group.

Identifying the FER patterns, analyzing differences according to the type of emotion.

46 patients with RHD due to stroke (mean age 68.93;SD12.62. 52% males) and 46 control subjects (67.28;SD18.29. 50% males), were assessed in sociodemographic and clinical variables. Mini-mental State Examination and Hamilton Depression Rating Scale were administered. To assess FER, 60 photographs from Pictures of Facial Affect (POFA) collection (Ekman, 1993) were shown to the sample, which identified them according to the type of emotion (i.e. happiness, fear, surprise, sadness, disgust, anger).

Both samples, despite having similar characteristics, showed significant differences in FER (T=−2.751;p=0.007). In total sample, lowest performance was recorded in identifying fear (mean correct answers 0.45;SD0.252) and anger (0.48;SD0.301). RHD patients presented a deficit in FER skill compared to controls. Significant differences were found in recognizing anger (T=−2.043;p=0.044), disgust (T=−2.059;p=.042), happiness (T=−2.371;p=0.020), and sadness (T=−2.633;p=0.010).

Results confirm a probable relationship between single RH and FER, suggesting RH involvement in anger, disgust, happiness and sadness processing.

Anxiety is one of the most common disorders in the elderly, twice as prevalent as dementia and four to eight times more prevalent than major depressive disorder. 90% of late-life anxiety are accounted for by either generalized anxiety disorder (GAD) or specific phobia and is often comorbid with depression, therefore older adults being particularly vulnerable to suicide.

This study sought to determine the prevalence of suicidal behavior among older patients with GAD hospitalized in the Psychiatry Department of Arad between 2009–2012.

To evaluate the suicide risk in late-life anxiety.

Our research is based on the study of 65 subjects (52 female and 13 male) diagnosed with GAD; the mean age was 68.3. The diagnostic of GAD was based on the DSM-IV and ICD-10 criteria. The study protocol assessed age, sex, social support, economic status, length of illness, recent traumatic events, medical or another psychiatric illness. The severity of the suicide risk was estimated according to: presence of thoughts of death, severity of suicidal ideation, history of suicide attempt, severity of suicide attempt.

The onset of GAD for the majority of patients was in earlier life with late-life exacerbation. 41 patients had associated minor depression. Our study revealed a risk of suicide of 4.6% (three patients).

Patients diagnosed with GAD have a higher suicide risk, especially in association with depression, medical illnesses or lack of social support. In the future, specific diagnostic criteria for late-life anxiety will be needed, in order to prevent suicidal behavior.

Many studies have observed hyperactivity of the hypothalamic-pituitary-adrenal axis in depression. In general, cortisol levels are tend to be lower in the evenings and exogenous corticosteroids administered around this time are known to cause insomnia.

We planned to compare data on evening cortisol levels in subjects with initial insomnia versus those without initial insomnia. We also used peak morning cortisol levels to establish the specificity of our effect.

To test the hypothesis that high evening cortisol is associated with initial insomnia among depressed adolescents.

Data from the baseline results of the Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) trial were used. There were 471 depressed subjects aged 11–17. Saliva was collected at waking, waking plus 30 minutes and late evening on two consecutive days for cortisol assay. Insomnia was defined as present or absent based on the insomnia item of the K-SADS-PL. Non-parametric analysis was used due to nonnormal data.

Median evening cortisol for subjects with initial insomnia was 0.070μg/dl, whereas it was 0.050μg/dl for those without initial insomnia (n=151, Mann-Whitney z = 2.33, p=.02). In contrast, there was no statistically significant difference in morning cortisol levels between the two groups (n=151, p=.93).

As hypothesised, high evening cortisol was associated with initial insomnia. It is possible, therefore, that high evening cortisol drives insomnia among a sub-population of depressed adolescents. However, interpreting the direction of causality is difficult, as sleep deprivation has also been shown to cause high evening cortisol.