Cannabidiol (CBD) constitutes up to 40% of cannabis sativa plant and has quite different psychological effects to the plant's best-known constituent, delta-9-tetrahydrocannabinol (delta-9-THC). This study examines the current knowledge of the effects of CBD on anxiety.

Articles were identified through a search of MEDLINE using the key word cannabidiol and anxiety. No search limits were included. Additional references were located through review of the bibliographies of the articles identified.

In animal studies CBD has shown similar effects to anxiolytic drugs in conditioned emotional paradigms, the Vogel conflict test, and the elevated plus maze test. In humans, oral administration of CBD in healthy volunteers decreases and antagonizes the anxiogenic effect of high doses of delta-9-THC. CBD may thus posses inherent anxiolytic properties unrelated to THC-type activity. This is consistent with its anxiolytic effect on anxiety elicited by simulated public speaking test. In addition, SPECT and fMRI neuroimaging studies have confirmed that CBD has anti-anxiety properties and that these effects are mediated by an action on limbic and paralimbic brain areas.

These results support the hypothesis that CBD may be a future therapeutic option for anxiety. However, future studies of CBD in clinical anxiety such as panic and social anxiety disorder and comparative studies of its anxiolytic effects with those produced by benzodiazepines and other anti-anxiety compounds are clearly indicated.

The study sought to examine the neurophysiological effects of cannabidiol (CBD) on the emotional processing using functional Magnetic Resonance Imaging (fMRI).

Fifteen healthy male participants (age range 18-35) with a lifetime exposure to cannabis of 15 times or less were recruited in a double blind event-related fMRI design. Prior to each scanning session, participants were given an oral dose of either 600mg CBD or a placebo. The blood levels of drugs were monitored via an intravenous line, while systolic and diastolic blood pressure and heart rate (beats per minute) were recorded manually. During the scan, subjects were presented with 10 different facial identities, each identity expressing 50% or 100% intensities of fear or a neutral expression. Neuropsychological performance and symptoms ratings were recorded at baseline, immediately before scanning (1 hr), immediately after scanning (2 hr), and one hour post scanning (3 hr).

CBD had no significant effect on the gender discrimination task. Reaction times were significantly faster when processing 100% fearful faces than compared to 50% fearful and neutral faces. CBD had a significant effect on brain activation in response to faces with emotional expressions, decreasing activation in the right posterior cingulate gyrus and in the right cerebellum, when compared to placebo. Furthermore, a significant interaction effect was observed. In the right cingulate gyrus CBD attenuated activation during the processing of intense fearful faces but had no effect of neural response to neutral or mild fearful faces.

CBD significantly modulates the neurophysiological response associated with anxiety.

Deinstitutionalisation may put part of the severe mentally ill patients at risk to deteriorate in the community, mainly because they are difficult to engage with services. Assertive community treatment (ACT) is widely seen as an adequate answer for these difficult to engage patients. ACT is now rapidly implemented in many European mental health services, but recently the evidence base is questioned. Positive results of randomised trials in the US could not be replicated in the UK.

In Groningen (The Netherlands) a psychiatric case register (PCR) is in operation since 1986, and now covers a catchment area of 1.6 million inhabitants. It is a perfect tool to study the transition from inpatient to community care.

We did a randomized controlled trial (RCT) to study the effectiveness of the first ACT team in our region, using the PCR to measure primary outcomes. It is the only RCT of ACT in the Netherlands. In total 118 patients were randomized to two conditions. The primary research questions were:

1. • Is ACT better than standard care in maintaining contact with patients?

2. • Is ACT better than standard care in reducing the use of inpatient care?

ACT was superior in engaging patients to services, but no effect on the use of inpatient beds were found. Moreover, we did not find benefits in functioning, quality of life and unmet needs.

Too many patients are lost in standard care and therefore we highly value the sustained contact ability of ACT.

Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare. In Germany, until now no such intervention has been implemented, let alone subjected to a clinical trial.

“Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services” (NODPAM) is a multicentre RCT conducted in five psychiatric hospitals in Germany (Günzburg, Düsseldorf, Regensburg, Greifswald, and Ravensburg). Subjects asked to provide informed consent to participate have to be of adult age with a primary diagnosis of schizophrenia or affective disorder, and a defined high utilisation of psychiatric care during two years prior to the current admission. Subjects are asked to provide detailed outcome data at four measurement points during a period of 18 months. Recruitment (which started in April 06) is still ongoing. Thus, baseline data of about 350 participants will be presented.

Recruitment has been quite successful and the study has been generally well accepted by participating patients and their clinicians in in- and outpatient treatment settings. Subjects showed substantial initial impairment on outcome measures (e.g. needs, psychopathology, quality of life, and level of functioning) and high utilisation of mental health care. Further results on conduct and feasibility of the trial will be presented.

The first phase of this mulicentre trial was promising. The potential of this study to strengthen the integration of mental health care provision in Germany will be discussed.

Aim of this contribution is to describe the intervention used in the study “Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services” (NODPAM). This intervention applies principles of needs-led care and focusses on the inpatient-outpatient transition. The NODPAM intervention manual includes a range of predefined standardised options based on number and type of needs.

For the intervention group, a trained intervention worker provides a coherent package of needs-oriented discharge planning and monitoring focussing on the care process. He or she emphasises continuity of the care process vis-à-vis both patient and clinician (and carers if possible) via providing two manualised intervention sessions): (a) A discharge planning session takes place just before discharge with the patient and responsible clinician at the inpatient service; (b) A monitoring session takes place three months after discharge with the patient and outpatient clinician (office-based or public outpatient mental health service-based). A written treatment plan is signed by and forwarded to all participants after each session.

Acceptance of the intervention by patients and clinicians has been high so far. Further results on duration, participant characteristics, and participants' appraisal of the NODPAM intervention will be presented.

These first results indicate that the NODPAM intervention is feasible in inpatient mental health services in Germany. Discussion will focus on its applicability in other service systems.

To stimulate the discussion on the implementation of mentoring models for women in psychiatry.

Mentoring is regarded as an important tool in many disciplines and also in medicine to advance the academic careers of young professionals. It has, however, been so far hardly used for supporting young (female) psychiatrists.

Different models of mentoring will be presented, and a short review of different studies on mentoring in academic medicine and its success will be given. The Basel experience with a mentoring programme at the University Hospital will be reported as an example.

Mentoring can positively influence professional medical careers and can be especially helpful for young women to promote their research career. Special mentoring programmes considering gender specific needs should also be implemented in psychiatry.

To describe the characteristics of psychiatric research and their development over one decade with respect to the researchers' gender as captured in the articles published by three high impact general psychiatric journals.

All articles published in the American Journal of Psychiatry, the British Journal of Psychiatry and the Archives of General Psychiatry in 1994 and 2004 where considered for analysis. Articles were classified as research or non-research articles and further categorised according to a number of variables, including the methodological approach, the field of research, specific topic areas and number of participants studied. For all articles, the gender of the first and all co-authors was assessed as well as the academic degrees of the first and corresponding authors. Descriptive data anaylsis was performed.

Not surprisingly, first authors were significantly more often male than female. The difference declined markedly between 1994 and 2004 but remained highly significant. At the symposium, detailed data on gender specific differences and changes over time in publication patterns will be presented for the first time. Issues to be discussed will include the relationships between gender and specific research fields, study size, the choice of biological or social outcome variables, the reporting of funding sources and more.

This systematic gender specific analysis of publication trends reflects the status of women at the leading-edge of psychiatric research. It may serve to highlight the impact of recent policies supporting women's careers in research and can act as a baseline for future gender specific monitoring.

Results of long-term studies show that businesses’ scores for promoting women correlate positively with profitability. This might well be the case also in the field of psychiatric practice and research.

A review of gendered data on psychiatrists and their professional situations in different countries was undertaken.

The data base that would allow to assess the role of women in psychiatry and their impact on the developments of this field is fragmentary. Europe has gender-sensitive data for careers in medical sciences with almost one third of researchers being female, but these data cannot be broken down to the level of specific specialities. In most European countries women receive less research grants altogether, but are as successful with their applications as men. Data from the USA show that women faculty fare better in psychiatry compared to medicine overall. Data on gender and psychiatric consultants’ subspecialities from the UK indicate an excess of men in almost all fields. However, for most European countries data on gender ratios regarding clinical psychiatrists, researchers and leadership positions are not published.

An effort of the AEP Section of Women's Mental Health to gather data from European countries on gender ratios of psychiatrists in different parts of the field and leadership positions on national levels is underway in order to allow comparisons and serve as benchmarks for further efforts towards gender parity in psychiatry. The presentation will include design and feasibility issues of this project as well as first feedbacks.

To examine prospectively the natural course of major depressive disorder (MDD) and to test the effects of personality disorders (PDs) on remission and relapse over six- year follow-up.

Subjects were 302 patients (196 women, 106 men) with current MDD at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS), a NIMH-funded multi-site study (Yale, Brown, Columbia, Harvard). MDD and psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV and PDs with the DIPD-IV. The course of MDD was assessed with the Longitudinal Interval Follow-up Evaluation and the course of PDs with the Follow-Along version of the DIPD-IV at 6- and 12-months and then yearly for 6 years. Good inter-rater and test-retest reliabilities were established.

Lifetable survival analyses revealed an overall 24-month remission rate of 74% for MDD that differed little by gender but was significantly lower among patients with PDs (range 52% to 81%) than without PDs (89%). Cox proportional hazards regression analyses revealed that MDD patients with co-existing PDs had significantly longer time to remission than did MDD patients without any PD even when controlling for other negative prognostic predictors (psychiatric co-morbidity, dysthymia, gender, ethnicity, early-onset and recurrent MDD, and treatment). Among patients who achieved remission from MDD, the probability of relapse was significantly greater and time to relapse was significantly shorter in patients with PD than without PD.

PDs are a robust predictor of slowed remission and accelerated relapse in MDD.

The term depressive pseudodementia has proved to be a popular clinical concept. Little is known about the long-term outcome of this syndrome.

To compare depressed elderly patients with reversible cognitive impairment and cognitively intact depressed elderly patients.

All patients suffering from moderate or severe depression admitted to St Margaret's Hospital, UK as inpatients or day hospital outpatients between January 1, 1997 and December 31, 1999 (n=182) were screened for entry into the study. Eligible patients were divided into those presenting with pseudodementia and those who were cognitively intact and followed up for 5 to 7 years.

Seventy one percent point four percent of those suffering from pseudodementia had converted into dementia at follow up compared to only 18.2% in the cognitively intact group. The relative risk was 3.929 (95% CI: 1.985 to 7.775) and the ‘number needed to harm’ 1.88.

Reversible cognitive impairment in late-life moderate to severe depression appears to be a strong predictor of dementia. Patients with pseudodementia should probably have a full dementia screening, comprehensive cognitive testing and ongoing monitoring of their cognitive function.

The short allele of the serotonin transporter gene 5’ promoter region polymorphism (5-HTTLPR) is reported by A. Caspi and others to be associated with susceptibility to depression and suicidality in response to stressful life events. We examined the relationship of a triallelic 5-HTTLPR polymorphism to stressful life events (SLE) and severity of major depression and suicidality.

Mood disorder subjects (N=191) and healthy volunteers (N=125), all Caucasians of European origin, were genotyped for the triallelic 5-HTTLPR polymorphism, two low expressing alleles (LG, S) and a higher expressing LA allele. All subjects underwent structured clinical interviews for DSM IV diagnoses, ratings of psychopathology, stressful life events, developmental history and suicidal behavior. Cerebrospinal fluid (CSF) 5-HIAA was assayed in a sub-sample.

Lower expressing alleles independently predicted greater depression severity and predicted greater severity of major depression with moderate-severe life events compared with the LA allele. No associations with suicidal behavior and CSF 5-HIAA were found.

Low expression transporter alleles explain 31% of the variance in major depression severity and increase the impact of stressful life events on severity. The biological phenotype responsible for these effects remains to be elucidated

Many evidences stress the implication of dopamine systems in the pathophysiology of depression. Currently, few and uncertain results are available on pre-synaptic dopaminergic dysfunction during depression. Our aim was to assess dopamine transporter (DAT) density in Major Depressive Disorder (MDD) with marked psychomotor retardation or anhedonia using 123I-FP-CIT SPET.

15 drug-free patients (F/M=8/7, mean age=44.6 SD=12.6 years) with MDD according to DSM-IV-R criteria, were enrolled for:

1. 1. Psychometric assessment (of depression, anxiety, anhedonia and psychomotor impairment using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Snaith-Hamilton Pleasure Scale and Depression Retardation Rating Scale);

2. 2. DAT measurement with 123I-FP-CIT SPET.

14 healthy subjects, comparable for gender and age, formed the control group.

Patients had moderate-to-severe depression. They showed a significant decrease in DAT density in whole striatum bilaterally compared to controls. Furthermore, mean 123I-FP-CIT uptake ratios were significantly lower in caudate and putamen bilaterally. Patients were then divided into two subgroups: 7 had a relevant psychomotor retardation without anhedonia; 8 had severe anhedonia without retardation. The psychomotor retardation group showed significantly lower 123I-FP-CIT uptake ratios in left putamen compared to the anhedonic group. An inverse correlation between DAT density in left putamen and retardation scores were observed.

Present results confirm a decrease of DAT binding in MDD. Low DAT availability could represent a compensatory mechanism following dopamine reduction. Moreover, DAT reduction seems to be related more to retardation than anhedonic features, in agreement with previous PET imaging findings.

Variations of circadian activity profiles and sleep patterns are altered in various neurospsychiatric disorders. In this context, changes in heart rate (HR), -variability (HRV) and related parameters have been reported, too. However, data situation is presently heterogeneous and nonstandard-ized. As long-term evaluation may provide more valuable information, applicability and data us-ability of a new data acquisition system was tested in patients with major depression.

The course of a depressive episode in inpatients was assessed by standard psychometric in-struments. ECG and motor activity were recorded continuously with a new wearable sensor sys-tem (EP04106001.3) consisting of a textile with three electrodes for 1-lead ECG recordings, and an electronic module (2D-accelerometer, microcontroller, memory, rechargeable batteries, Bluetooth unit) to be attached to the waistband of standard underpants.

ECG signal quality highly depended on physical activity, but sufficient data quality was obtained during sleep. From the accelerometer signal, time in bed and movement time were identifiable. Preliminary data of patients (n=15) versus healthy controls (n=9) showed a reduction of HRV in several time domain parameters, high frequency (HF) power, and daytime activity (24h/day, mean 8 weeks).

This first pilot study demonstrates alterations of physiological parameters potentially relevant for depression, with continuous monitoring of inpatient treatment period. Facing long-term monitoring the device proved to be robust and safe and might provide a psychobiological profile of the clini-cal course of depression, useful for evaluation of disorder and therapy.

This work is part of the European research project ‘MyHeart’ (6th framework, IST 507816).

The course and outcome of depression could be influenced by several clinical characteristics, medical comorbidity being one of them. Our main purpose was to identify the medical comorbidities in depressive clinical population and to compare them with the figures encountered in other diagnostic categories.

We performed a retrospective study on 248 subjects (studied sample) admitted in our Clinic during 2001 – 2004 with a diagnosis of Recurrent depressive disorder, accordingly with ICD-10. There were collected several demographic and clinical data. Also, it was done two comparable control samples, one with persistent delusional disorder (N=60) and the other with Bipolar disorder (N=44). All data were statistical analyzed.

In our studied sample, we found a highly statistical significant difference regarding cardiovascular diseases (p<0.001), digestive (p<0.001) and musculoskeletal disease (p<0.001), depending on the time elapsed form the onset of depression. Interestingly, only the digestive diseases were not correlated with the age. Also, comparatively with control samples there was a statistical significant difference regarding cardiovascular diseases (the figures were influenced by age and gender in sense that male aged subjects were more affected). The endocrine diseases were more prevalent in Bipolar sample while in Persistent delusional sample we found more nephrological and urological diseases.

We consider that depressive population is more vulnerable to develop medical comorbidities. In consequence, the clinicians must pay more attention on physical health status in depressive patients and to take into account it in therapeutically management of these patients.