To investigate the role of perfectionism in the development of disordered eating behaviours.

382 female university students completed the Hewitt & Flett MPS and the EAT-40 at baseline, one year after (T1) and two years later (T2).

Perfectionism at baseline was significantly associated with long-term abnormal eating attitudes/behaviours. Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) were significant predictors of disordered eating behaviours. SOP at baseline was predictive of diet concerns, at T1 and T2. Baseline SPP was correlated with overall eating disturbance at T1 and T2. Regression analysis revealed that only SPP was a significant predictor of bulimic behaviours and social pressure to eat at T1, but not at T2.

Our findings contribute to a more clear understanding of the association between perfectionism and eating disorders. SOP and SPP were prospectively associated with abnormal eating attitudes/behaviours and SOP was found to be predictive of diet concerns.

Proper diagnosis and choice of adequate treatment have essential influence on the course and prognosis in eating disorders. Resent research (Thompson-Brenner, Eddy, Satir, Boisseau, Westen 2008) and our clinical practice (Jakubczyk, Zechowski, Namyslowska 2003) has shown that anorectic patients are not homogenous group, and they differ in the character of clinical symptoms and personality profile. Aim of the study is differentiation of anorexic patients on the basis on personality pathology, comorbidity and outcome.

50 hospitalized anorexic adolescent girls (14-19 y.o.) were investigated by SWAP-200-A procedure, EDI, YBOCS, STAI, GAF, Hamilton Scale, Beck Scale, PAS, Developmental Impairment Questionnaire. Authors also assessed parameters of outcome such as a body mass change (kg/BMI), recurrence of menses, pharmacotherapy, kind of therapy preferred by patients and length of hospital treatment.

Preliminary results revealed three subgroups of anorexic patients different in personality pathology (well functioning/perfectionist, emotionally deregulated and avoidant), comorbidity and outcome. (Detail description of the study will be presented at the conference).

The study confirms clinical observations and the results of other studies that there are three groups of anorexic patients different in clinical symptoms, comorbidity and profiles of personality.

The underlying physiological mechanisms as to why repetitive transcranial magnetic stimulation (rTMS) can treat depressed patients remains unclear and no clear biological markers are available to indicate a positive outcome for a given patient. Some data suggest that rTMS can influence hypothalamic-pituitary-adrenal (HPA) processes. In this study, we wanted to evaluate whether one session of high frequency (HF)-rTMS applied on the left dorsolateral prefrontal cortex (DLPFC) can predict a successful treatment outcome in a sample of antidepressant free unipolar depressed patients of the melancholic subtype.

Twenty one right-handed treatment resistant depressed patients were studied. Fifty two percent of the patients were considered as treatment responders, as defined by a 50% reduction in her/his baseline 17-item Hamilton Depression Rating Scale (HDRS) score. To examine acute HF-rTMS effects on the HPA- axis, we analyzed salivary cortisol levels, using a sham-controlled, ‘single’ blind, crossover design. Areas under the curves (AUC) were calculated for both real and sham HF-rTMS.

Real HF-rTMS resulted in salivary cortisol decreases, however only in HF-rTMS non-responders. No HF-rTMS influences were found in the responder group. Sham stimulation did not affect the HPA-axis. Non-responders were found to display a higher level of co-morbid personality disorders.

Our results may provide more insight into the underlying working mechanisms of HF-rTMS and could add further information about endocrinological functioning in affective disorders. Furthermore, personality features in combination with a ‘super-sensitive’ HPA system could be of importance to predict clinical outcome.

To describe a comprehensive survey of the practice of electroconvulsive therapy (ECT) in Asia.

Between 2001 and 2003, a 29-item questionnaire was sent to 977 psychiatric facilities in 45 Asian countries.

Completed questionnaires were returned by 334 (34.2%) institutions in 29 (64.4%) countries. ECT was available in 257 institutions in 23 countries. During the year before the survey, 39,875 patients (62% male) received a mean of 7.1 ECT treatments. Most patients (73.1%) were 18-44 years old; few were < 18 (6.0%) or >64 (4.4%) years old. Indications for ECT were schizophrenia (41.8%), major depression (32.4%), mania (14.0%), catatonia (6.9%), drug abuse (1.8%), dysthymia (1.6%), and others. Brief-pulse ECT devices were used in only 103 (40.1%) institutions. Routine EEG monitoring was conducted in only 59 (23.0%) institutions. Bilateral electrode placement was invariable in 202 (78.6%) institutions. Unmodified ECT was administered to 22,194 (55.7%) patients at 141 (54.9%) institutions in 14 countries. Continuation ECT was available in only 115 (44.7%) institutions in 17 countries. No institution had a formal ECT training program.

The practice of ECT in Asia may appear suboptimal: schizophrenia, not depression, is the commonest indication; most institutions offer sine-wave ECT; unmodified ECT is commonly administered; bilateral electrode placement is invariable in most institutions; EEG monitoring is uncommon; continuation ECT is infrequent; and no formal training in ECT is available. We speculate that the suboptimal practices reflect felt needs, and ground realities in standards of medical care in developing countries, rather than a misuse of ECT.

To prove the clinical effect rTMS neuronavigation vs. standard coil positioning vs. controlls in the therapy of madication-resistant auditory hallucinations.

10 patients with medication-resistant auditory hallucinations on stabile antipsychotic medication, examined by MRI, PET, then treated by 1) neuronavigated, 2) standard positioning and 3) sham rTMS (controlls).

Double-blind randomized sham-controlled parallel design was used in the study.

rTMS parameters: 0.9Hz, 100%MT, 1080 pulses/session, 10 rTMS sessions within 2 weeks:

1. 1. Neuronavigated rTMS: coil focused over the highest contrast of metabolic activity in the left temporo-parietal (T-P) area (according to the SPM analyse 18FDG PET data).

2. 2. Standard rTMS: coil administered over the left T-P region defined as the midway between the T3 and P3 sites according to the international 10/20 EEG electrode system.

3. 3. Sham: coil angled 90° away from the skullPsychometric measurement: PANSS, Hallucination Change Scale (HCS) and the Auditory Hallucination rating scale (AHRS).

Confirmation of a significant decrease in the Hallucination item as well as in the total of the positive score of PANSS, HCS and AHRS. Sham rTMS did not show a trend for improvement over time. Between-group comparisons of AHRS scores revealed significant differences, which confirmed efficiency of using neuronavigated rTMS.

Compared to standard positioning in future studies, we believe to find rTMS neuronavigation more precise and effective. Studies monitoring a continuing effect of rTMS over long time periods are needed.

Supported by the CNS, MZČ;R MZ0PCP2005 and MŠMT 1M0517, VZ 00 216 208 16.

Current evidence suggests that high frequency repetitive Transcranial Magnetic Stimulation (HF-rTMS) of the left dorsolateral prefrontal cortex (DLPFC) might be a promising treatment strategy for depression. However, due to rather modest clinical results, the efficacy of rTMS in depressed patients is still under debate. As melancholic depression seems to affect psychomotor activity, in this study, we wanted to evaluate whether HF-rTMS treatment affects psychomotor activity. We also wanted to examine whether the severity of psychomotor retardation could predict clinical outcome.

Our group consisted of twenty antidepressant-free unipolar depressed patients of the melancholic subtype. All were considered at least stage II treatment resistant. Depression severity was assessed with the Hamilton Depression Rating Scale (HDRS) and psychomotor symptoms with the Depressive Retardation Rating Scale (DRRS). All received 10 sessions of HF-rTMS delivered on the left DLPFC.

Forty percent of the patients showed a reduction of at least 50% on their initial HDRS score and were defined as HF-rTMS responders.

The severity of psychomotor retardation, as measured with the DDRS, did not predict clinical outcome. HF-rTMS treatment resulted in significant decreases in DDRS scores for responders as well as for non-responders. However: the better the clinical outcome, the higher the observed level of psychomotor improvement.

Our results suggest that HF-rTMS might act on the ‘psychomotor’ level and this might add some further information as to why this kind of treatment can be beneficial for severely depressed patients of the melancholic subtype.

1. i. To establish the sociodemographic profile of the subjects who attempted suicide in the Health Area IV of Asturias (Northern Spain);

2. ii. To determinate the mental disorders more frequently associated with suicide attempts (SA);

3. iii. To study the relationship between repetition of suicidal behaviour and severity of the SA;

4. iv. To determinate the more commonly used methods for SA.

1,633 suicide attempters who attended the Emergency Room of the University Central Hospital of Asturias during the period 2003-2005 were included in the study. Evaluation of these patients was made using the WHO/Euro Multicentre Study Protocol. Psychiatric diagnoses were made following ICD-10 criteria.

Sociodemographic data: mean age (SD) = 38.66 (15.13); females: 62%; single: 39.8%; living with their family: 83.8%; lowest educational level: 67%; economically inactive: 33.8%. More prevalent psychiatric diagnoses were affective disorders (24.1%) and anxiety disorders (21.6%). Previous SA were present in 49.2% and 40% repeat the attempt during the monitoring period. Severity of the attempt (lethality of method and intentionality) was related with repetition of the behaviour during the monitoring period (p = 0.001). More frequent methods were overdose (74.8%) followed by cutting (18.5%).

SA was more prevalent in a single woman with age between 30 and 50 years who suffering for affective or anxiety disorders. Many of the patients repeat the suicidal behaviour and this was related to the severity of the attempt. Individuals appear to use the methods that are available to them to attempt suicide.

To investigate the process of help seeking for child and adolescent psychopathology at Child and Adolescent Mental Health Service (CAMHS) in UHC “Mother Teresa”, Tirana.

Participants were 5-18years old, newly referred children/adolescents in CAMHS during 2006. Measures: Strengths and Difficulties Questionnaire for parents/children, Pathways Encounter Form. Pathway diagram was drawn showing the main routes of care seeking. Patterns of care seeking, durations and previous treatments for diagnosis within ICD-10 groups were prescribed. Analysis: Comparisons between groups, diagnosis and predictive factors influencing help seeking care.

The main pathway of seeking care resulted to be from hospital doctors or to be direct access. General practitioners have a limited role as ‘gatekeeper’ for patients. 72% of individuals resulted with conduct, hyperactivity, depressive and some anxiety disorders, but fewer than 30% of individuals with specific phobias, separation anxiety and eating disorders.

A clear picture of pathway of seeking care in mental health for children/adolescents coming in CAMHS is provided. Findings highlight areas that require further attention if aspirations for community-oriented mental health care are to be realized in Tirana and Albania. Declaration of interest: None.

This study aimed to determine prevalence and correlates of suicidal attempts in an adult primary care population in Sousse (Tunisia).

Sampling followed a stratified multistage probability cluster design from witch a representative sample of adult primary care population of Sousse was obtained. The sample was composed of 1249 subjects aged 18 years or more. Subjects were interviewed by trained clinicians using the Tunisian version of Composite International Diagnostic Interview 2.1.

General and clinical characteristics of subjects who had reported previous suicidal attempts were compared with those of the remainder using t test and Chi-2 test.

Mean age in our sample was 43.4 ± 17.62 years, with female gender (70.9%) and urban residency (67.8%) predominance. 62.3% of participants were married, 27.3% celibates and 10.4% divorced or widowed. 68.4% of them had low educational level and 70% were out of work during the last 12 months. Suicidal attempts were found in 2.9% of participants. They were correlated to less than 40 years age (p=0.036) and to the diagnosis of major depressive episodes (p< 10-3), recurrent major depressive disorder (p=0.005) and dysthymic disorder (p< 10-3). Among major depressive episodes, only severe ones were associated to higher prevalence of suicidal attempts (p< 10-3).

Prevalence of suicidal attempts in Sousse primary care population was 2.9%. It was correlated to low age and to depressive disorders.

To evaluate the relationship between depression, somatic symptoms, cognitive impairment and disability in an elderly population.

216 subjects (65-84 years) were clinically examined for somatic symptoms, and underwent a mental health examination. Depression was defined by Geriatric Depression Scale scores >11/30; cognitive impairment by Mini-Mental State Examination scores < 24/30; functional status by Instrumental Activities of Daily Living Scale. Associations between depression, cognitive impairment or somatic symptoms and disability were evaluated by logistic regression analyses, estimating Odds Ratios (ORs) and 95% confidence intervals (95%CI) adjusted by sex, age, education.

Disability was common among depressed individuals (OR(95%CI)=3.60(1.63-7.96)) and among cognitively impaired subjects (OR(95%CI)=7.35(3.07-17.60)). An increasing number of somatic complaints increased the probability of functional impairment: compared with presence of 1-2 somatic symptoms, complaint of 3-6 and 7-12 symptoms were related to disability with OR(95%CI)=3.30(1.11-9.80) and OR (95%CI)=4.20 (1.17-15.09) respectively. Distinguishing pain, gastrointestinal, pseudo-neurological and general symptoms, only general somatic symptoms (palpitations, fatigue, sleep disturbances) were associated with disability (OR(95%CI)=1.81(1.25-2.62), independently by medical conditions (OR(95%CI)=1.57(0.98-2.52)). An additive effect toward disability was observed when general somatic complaints and cognitive impairment were co-existing (OR(95%CI)=23.68(5.50-101.86)). Including simultaneously cognitive impairment, somatic complaints and depression in the model, only cognitive impairment was still significantly related (OR(95%CI)=5.87(2.66-12.96)).

Among many possible causes of disability in the elderly, an important role could be attributed to cognitive deficits.