To study reasons for not receiving treatment, and examine characteristics and one-year outcome of untreated anxiety and depression.

Data were used of 743 primary care patients with a six-month anxiety or depressive disorder in the Netherlands Study of Anxiety and Depression (NESDA). Diagnoses were confirmed by the Composite Interview Diagnostic Instrument (CIDI). Patients’ perceived need for care, service utilisation, and reasons for no treatment were assessed by the Perceived Need for Care Questionnaire (PNCQ).

43% of the respondents received no treatment. Of these untreated patients, 25% did not perceive a mental problem; 26% perceived no need for care; and 49% expressed a need for care which was not met. Untreated patients with a treatment need showed the same symptom severity and disability as treated patients, and reported even more loneliness. Compared to other untreated patients, they were more handicapped regarding clinical and psychosocial functioning.

After one year, treated and untreated patients with a treatment need showed a poorer outcome than untreated patients without a self-perceived mental problem or need for care.

Many patients with anxiety or depression do not seek treatment. Half of them are probably right: they do not perceive a mental problem or treatment need, suffer from relatively mild symptoms, and show a favourable one-year course. Untreated patients with a perceived treatment need, however, suffer from severer symptoms, and show a poorer outcome than other untreated patients. Therefore, care providers should pay considerable attention to this worrisome group.

The new standard computerized reading span test (RST), which is a complex verbal working memory test, was used for the first time in the assessment of verbal working memory capacity (Van den Noort et al., 2008) in two clinical populations.

Sixty participants, divided over three different groups; 20 patients with chronic schizophrenia, 20 patients with chronic depression, and 20 healthy participants, entered the study. The selection of the participants was based on strict inclusion and exclusion criteria. There was no comorbid depression in the patients with schizophrenia, as measured by the BDI-II. A comparison was made between the 3 different groups with respect to their verbal working memory capacity. The new standard computerized RST (Van den Noort et al., 2008) was used.

In this study, in line with previous studies, a significant decrease in verbal working memory capacity and a general slowing down was found in chronic patients with schizophrenia and chronic patients with depression in comparison with healthy participants. In addition, patients with schizophrenia showed a nearly significant higher reading span score but were significantly slower than the chronic patients with depression.

The new standard computerized RST (Van den Noort et al., 2008) is a suitable complex verbal working memory test that could be used for clinical applications, for instance, for the assessment of verbal working memory capacity in patients with chronic schizophrenia and chronic depression.

Untreated disrupted sleep is an important precursor for the development of depression. Several studies have confirmed the negative impact of pre-sleep cognitive and emotional activity such as worry and negative affect on subsequent sleep. Emotional stress may affect latencies to sleep onset, to REM-sleep and other markers of sleep disruption such as arousals. The way we cope with emotional stressors and events may have important effects on subsequent sleep.

In this study we investigated the effects of a failure-experience on polysomnographically recorded sleep in volunteers. Furthermore we explored whether dispositional coping factors such as emotion regulation moderate this effect.

In contrast to the control condition the effect of the failure induction was clearly observed in emotional experience as well as within the physiological sleep architecture. Furthermore, we notice a tendency in which not only emotional experience, but also sleep physiology was affected by low and high emotional approach as emotion regulation style (cf. Stanton, 2000).

The present study has shown that emotional stress as a failure experience before sleep-goes together with a worsening of mood, an increase of level of rumination and enhanced sleep fragmentation with a moderating effect of emotion regulation as dispositional factor.

To evaluate the impact of conflicting patient and psychiatrist conceptualizations of the depression over the treatment response and general prognosis.

A group of 25 patients, mean age 36.8, diagnosed with major depressive disorder, first depressive episode, according to DSM IV TR criteria, have completed a closed-ended questionnaire that included their perspective over the depression (on a 7 points Likert scale, from the pure medical/pharmacological, to the pure psychological/reactive paradigm). Psychiatrists who managed their treatment responded to a similar questionnaire regarding their preferred method of treatment. Patients were evaluated initially and after 3 and 6 months using Hamilton Depression Rating Scale-17 items (HAMD), Beck Depression Inventory (BDI), Global Assessment of Functioning. Patients satisfaction over the treatment (on a 10 points visual analogic scale) was evaluated at endpoint.

Patients who received a treatment corresponding to their preferred paradigm (n=17) responded better (−5.6 on HAMD, −4.5 on BDI, +7.6 on GAF, p< 0.01) to the treatment, compared to the group where the paradigms weren’t the same. The satisfaction over the treatment was also significant higher in the first group (+2.5, p< 0.01). Patients who have discussed their beliefs about the disorder and were informed by their psychiatrists about the advantages of the treatment had a greater rate of response to treatment (p< 0.05).

Psychiatrists should routinely explore the patient conceptualization of the depression and to discuss together the best treatment approach. Prognosis, patient satisfaction and treatment response are significantly influenced by exploring the patient beliefs about its disorder.

140 patients have been observed: basic group - 70 patients with depressive disorder with anxiety disorder; control group - 70 patients with depressive disorder alone. All patients were treated with SSRIs. We used in study 17-item HRS-D and CGI.

Baseline average score according to CGI has constituted 4,8±0,6 and 4,5±0,7. Comparative assessment of clinical picture of depression in groups has shown that in basic group more frequently (p< 0,05) dysphoric (31,4% and 12,9%) and conversion (21,4% and 11,4%) syndromes were noticed, while in the control group - adynamic (30% and 12,9%,). Statistical analysis of data of age at the onset of depressive disorder has revealed intergroup differences (p< 0,05), testifying to emerging depressive disorders in patients of basic group at younger age (39,6±12,1 years), as compared with patients of control group (43,9±12,9 years).

Index of cyclicity of disease in patients with RDD was calculated as ratio of disease duration in years to cycles of disease. Average value of the corresponding index in basic and control groups differed reliably (p< 0,05) and has constituted 3,2±1,1 and 7,6±1,6. I.e., in the basic group exacerbation of depressive symptoms in recurrent depressive disorder was noticed more frequently as compared with control group.

Thus, comorbidity of depressive and anxiety disorders results in complicating symptoms, change of its syndromal validation, more adverse course (acceleration of depressive phases in recurrent depressive disorder).

To assess the efficacy and tolerability profile of treatment with escitalopram under naturalistic conditions, in elderly outpatients (≥65 years and above) with depression.

2050 patients completed 8 weeks of treatment with escitalopram in a multi-centre naturalistic study. Rating scales included a short version of the Montgomery-Åsberg Depression Rating Scale (svMADRS) for the assessment of response.

Most patients improved in their general state of health and showed a decrease in the severity of their depression. The majority (83.8%) of patients received 10mg/day escitalopram. The mean svMADRS total score decreased from 31.9 (SD=7.9) at baseline to 14.2 (SD=8.5) at Week 8. On completion, 63.9% of the patients were responders (≥50% decrease of svMADRS from baseline) and 48.6% were remitters (svMADRS≤12). Statistically significant more patients aged ≤75 years responded to treatment and achieved remission than those aged >75 years. Logistic regression was used to model response to treatment. Statistically significant positive factors were having a current episode of less than 1 month and duration of illness of less than 1 year. The diagnosis showed increasing responder rates from affective disorder (F31 or F34; odds ratio=1.00) over involutional depression (F03; odds ratio=1.68) and depressive episode (F32; odds ratio=2.21) to recurrent depressive episode (F33; odds ratio=2.32). The differences between affective disorders and involutional depression were significant, while F32 and F33 showed no relevant differences in the responder rates.

The results from this observational study corroborate the effectiveness and tolerability of escitalopram treatment of elderly patients in a naturalistic treatment setting.

To probe the factors that contributes to the relapse of the major depression after being hospitalized for a period of three consecutive months in a psychiatric clinic.

22 patients (8 men) who were in the clinic were examined (average age 49.2, SD=7.2) suffering from major depression and who fully recovered between episodes. The criteria for their participation in the sample were according to DSM-IV®, and the >2 relapses/year.

By the stepwise multiple regression analysis it was found that by hierarchy the factors that cause the relapse are, the fact that the patient does not respond to the first antidepressant treatment (parameter estimate p< 0.002), child or teenage depression background (p< 0.002), the presence of stressful facts (diseases, financial problems, loss of 1st degree relatives, p< 0.004) and the co morbidity with character disorders in the II (p< 0.01) axis.

The importance of a negative outcome of the major depression should be co estimated with the danger of self-destruction as a result of the illness, the difficulties of the interpersonal relationships, the professional activities, the impact on the family, alcoholism, drug abuse etc. and mainly the empirical impact on the patient.

Affective temperaments (AT) are suggested as antecedents of mood disorders (MD) currently. MD especially depression is very common in epilepsy. In this study we investigated AT in epilepsy as probable predictors of MD.

83 epileptic patients and 83 healthy controls were included and evaluated using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A) and SCID-I.

In epilepsy group 16 depressive, 3 cyclotimic, 12 irritable, 9 anxious temperaments; in healthy group 4 depressive, 3 irritable, 4 anxious temperaments were diagnosed. The difference was significant in depressive (x2: 8.36, p< 0.05) and irritable temperament (x2: 6.06, p< 0.05). Depressive, cyclotimic, irritable, anxious temperaments mean scores were significantly higher in epilepstics (depressive 8.35±4,37; cyclotimic 9,86± 4,67; irritable 7,00±4,58; anxious 9,18±5,94) than healthy controls (depressive 5,89±3,68; cyclotimic 6,87±4,55; irritable 3,39±3,57; anxious 5,11±4,78) (all p< 0,001). 16 patients in epilepsy group and 6 patients in control group were diagnosed as Major Depressive Disorder (MDD) and the difference was significant (x2: 5,38, p< 0,05). Anxious temperament predicted MDD in epileptics and none of the temperaments were significant predictor of MDD in controls in logistic regression analysis.

Epileptic patients had higher scores at all AT except hypertimic. Anxious and irritable temperaments were diagnosed more in epileptics and anxious temperament was related with MDD. The tendency of epileptics to MD are known but this is the first study shows tendency of epileptics to AT. Further investigations are needed to explain the etiology and treatment relationship between MD and AT in epilepsy.

Chinese trials were rarely included in western meta-analyses. This systematic review investigates the efficacy of venlafaxine in the treatment of major depression (MDD) in Chinese populations.

Chinese databases (VIP and CNKI) were searched for blinded randomised clinical trials (RCTs) comparing venlafaxine with any other pharmacotherapy and/or placebo. Quality of included studies was assessed with the Jadad scale. Furthermore, fulfilment of the CONSORT items was recorded. Final mean HAM-D scores and response rates were extracted and combined using a fixed-effects model. Subgroup analyses by drug class were performed to assess further differences.

23 blinded RCTs were included in the analyses. Six compared venlafaxine with selective serotonin reuptake inhibitors (SSRIs), 15 with tricyclic antidepressants (TCAs) and two with tetracyclic antidepressants. The average Jadad score was 2.7 and on average 55% of all CONSORT items were reported. On average, 36 patients were randomised per group. Only three trials included more than 80 patients per group.

Mean final HAMD scores were significantly lower in the venlafaxine groups compared to TCA (Hedges’ g 0.14, 95%-CI, 0.01-0.26), but not in comparison to SSRI treated groups (Hedges’ g 0.05, 95%-CI, -0.12-0.21). These findings were confirmed by analyses of response rates. (MH RR Ven vs. TCA: 1.11, 95%-CI, 1.04-1.18, Ven vs. SSRI: 1.01, 95%-CI, 0.93-1.11).

These results suggest that venlafaxine is significantly more effective than TCAs, but not than SSRIs in depressive Chinese populations. However, large high quality trials are needed to verify these findings.

There is a need for more research on women with coronary disease and potential gender differences. This paper report a study of gender differences in psychological distress, health behavior, and coronary health in patients having coronary artery bypass graft surgery (CABG).

229 patients (41 women) having CABG treatment at a hospital in Northern Norway completed a questionnaire 3-15 months after discharge (mean = 8.8, SD = 3.2), and medical data were gathered from their hospital records. Age ranged from 35 to 65 years (Mean = 60.5, SD= 7.4).

No gender differences were found on age, education, work status, or living alone, on coronary health measured by LVEF, NYHA, blood pressure, diabetes, on health related life style measured by smoking, BMI, and physical activity, or the number of days treated at the hospital, or time since hospital discharge.

In univariate analysis, women (compared with men) reported higher levels of mental distress (SCL10; mean = 1.85 versus 1.57, t = 2.73, p< .006). Furthermore, women experienced the time at home following hospital discharge as more difficult than what men did. In a logistic regression analysis of gender, SCL10 together with LVEF were significant predictors, controlling for time since hospital discharge and days treated at the hospital

The higher rate of depression among female CABG patients in this study from Northern Norway is comparable to studies elsewhere. Results are discussed in light of theories of coping and self-regulation, other studies on gender differences in CAD, and implications for treatment.

To overcome these limitations, we combined CBT with mindfulness meditation.

In our mood clinic, two different programs have been proposed to this day:

• - A short mindfulness-based, stress-reduction program (8 weekly sessions), well-adapted to bipolar patients :

• - A program of 20 weekly relapse prevention sessions, including 5 consecutive constructive therapy stages (T. Bonvalot et al.: Constructive Psychotherapy of Bipolar Disorder: A New Approach (abstract) - Bipolar Disorders, special issue, June 2009).

Bipolar patients with more extensive clinical conditions are successively invited to participate to both programs.

Every session has been facilitated by a mindful attitude progressively developed by the patients all along the programs.

We observed that mindfulness meditation, along with CBT, presents most often a high acceptation level on the part of most bipolar patients, and a capacity to restore self-image, self-confidence and hopefulness.

The patients’ involvement in the treatment programs have developed on a regular basis, and consequently a low dropout rate has been observed.

These observations are to be now formally evaluated.

Current treatment approaches for depression center on various forms of psychosocial therapy and the use of antidepressant drugs. The response rates for both of these approaches are similar, with mostly reduction, but not complete remission, of symptoms. Poor adherence to recommended treatment is an issue complicating the management of depression and prevention of recurrent episodes. This study evaluated the efficacy of a novel form of receptive music therapy which can be easily adminstered to out patients.

Enrolled subjects (n=203, average age 49.6 ± 13.1 years, 28.1% male) were randomized into four arms: Music Therapy 1 (MT1), Music Therapy 2 (MT2), Placebo (nature sounds) and waiting-list Control. Subjects listened for 30 minutes, twice daily. Multivariate linear regression models assessed depressive symptom changes over five weeks, based on a composite scale (COMP) and the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS-D) alone.

On average, a significant, positive change in COMP was observed for MT1 (β=1.44, p=0.030), but not for MT2 (β=1.14, p=0.059) or Placebo (β=0.57, p=0.397). After 15 weeks, study participation was associated with a mean HAM-D score reduction of 60% for 89,1% of the compliant probands.

Newly composed receptive music therapy, as explored in this study, is associated with reduced depressive symptoms and high treatment compliance, and may therefore potentially represent an effective depression treatment alternative or adjunctive therapy to pharmacological and psychosocial approaches.

Cognitive control of emotions by reappraisal strategies is a psychotherapeutic technique reducing emotional load and anxiety in stressful situations. A previous study in healthy subjects resulted in a top-down regulatory effect by reappraisal during the anticipation of negative and unknown cued emotional stimuli as expressed by increased medial prefrontal cortical activation and accordingly reduced amygdalar activity. We were now interested in neurobiological changes in patients with major depressive disorder (MDD) compared to healthy controls during the application of cognitive control.

20 patients suffering from a depressive episode in the course of MDD and 20 healthy subjects underwent functional magnetic resonance imaging. All subjects were instructed and trained to apply a ‘reality check’ as cognitive control strategy during the cued anticipation of known negative and possibly negative, thus unknown (50% positive/negative) emotional stimuli.

Applying cognitive control during the anticipation of negative and unknown cued stimuli, depressed patients had lower brain activity compared to healthy controls in thalamic and occipital regions as well as in the right extended amygdala, in the anterior cingulate cortex and the right anterior insula. Brain activity was increased in depressed patients in the right precentral gyrus and the left superior temporal gyrus/posterior insular region (close to Wernicke region).

We found several areas with reduced and also increased activations in MDD compared to healthy controls. We found no obvious deficits in this preliminary analysis in regions as the amygdala and the MPFC, corresponding to the hypothesized deficits in cognitive control mechanisms in MDD.

Extraversion and neuroticism are differentially correlated with affective disorders: Neuroticism is strongly correlated with depression and anxiety disorders, whereas extraversion is rather negatively correlated with anxiety disorders. Theories have implicated a common biological basis of neuroticism and affective disorders.

This study examined neural correlates of neuroticism and extraversion as well as of affective measures with functional magnetic resonance imaging using a task addressing pessimistic emotion processing during the cued anticipation of emotional stimuli in 14 healthy subjects. The measures of personality and affectivity were used as primary covariates for the correlation with brain activity during the anticipation of emotional versus neutral stimuli to identify brain regions in which individual brain activity was strongly correlated with psychometric measures.

Neuroticism, depression and anxiety were correlated with brain activity in parieto-temporo-occipital regions, functionally involved in visual-perceptual processing and attentional modulation, and also in caudate regions. Extraversion was correlated with brain activity particularly in prefrontal regions.

Our results point to possible common neural correlates of neuroticism and the affective measures, whereas extraversion seems to have a differential neurobiological basis. Particularly, the correlation with caudate regions, involved in implicit patterns of reaction, points to possible “automatized” biases in neuroticism and depression.

Numerous researches show significant presence of cardiovascular disorders, especially hypertension in depressed patients that show up several years after first depressive episode.

Mortality caused by cardiovascular disorders in depressed patients is 50% higher than in general population. Comorbid depression and cardiovascular disorders is making worse health condition, increasing suffering, making hard treatment, and outcome is not good.

The goal is to confirm presence of hypertension in depressed patients as the most common comorbid cardiovascular diseases.

A retrospective study has been conducted using data from medical history of 274 depressed patients hospitalized and treated at the Psychiatric Clinic, Clinical Center Banjaluka. These parameters were assessed: sex, age, number of hospitalizations, marital and employer status, comorbid disease, BMI, presence of hypertension, lipid status and glicemia's level. Data were presented using tables and graphs.

Results obtained in our study were:

Hypertension in comorbidity with depression was found in 106 patients (38,5%), 75 of them were males and 31 of them were females. The majority were at age 40-60 years. Obesity was found in 21% of them. High lipid's level was found in 20% of them. 11% of patients had high level of glicemia. More than half of the patients had lower socio-economic status.

Depression is often accompanied by cardiovascular disorders. It is very important to recognize this comorbidity in order to treat it successfully and to make better treatment's outcome.

Mixed state, since Kraepelin's pioneering contribution, refers to an affective condition in which various admixtures of depressive and manic symptoms occur simultaneously.

To evaluate the efficacy and safety of quetiapine plus ADs, both SSRIs and SNRIs in the treatment of acute mixed episodes of Bipolar I Disorder patients.

We pooled data from two ours independent studies for a total of 44 inpatients, 21 male and 23 female, diagnosed with type I mixed Bipolar Disorder (DSM-IV-TR). After receiving open-label quetiapine for 2 weeks, patients were subsequently randomised to receive either treatment with quetiapine + ADs or quetiapine alone for 18 weeks. Pooling the data, 22 received quetiapine alone (10 XRquetiapine) and the other were treated with an association of quetiapine plus an antidepressant. We evaluated these patients every week during the first month and every two weeks after that, using YMRS, HAMD-21.

The efficacy over depressive symptoms was similar in both groups. Compared with the baseline YMRS, at week 6 the percentage of improved YMRS responder was better in the group receiving quetiapine plus antidepressants than quetiapine alone. Three YMRS item scores improved significantly at week 6 in the group quetiapine plus AD(irritability, disruptive-aggressive behaviour and insomnia).

We suggest that adding an AD in order to treat every main features of mixed episode further improved the outcome, probably due to a specific action on a particular subtype of mixed state. In particular, the dysphoric subtype along with irritability and insomnia manic factors, seem to be better responsive to AD supplementation.

To compare the effectiveness of a psychoeducational group program and conventional treatment versus individual conventional care in patients with a mild/moderate depression disorder in urban primary healthcare centers (PHCC).

:

randomized controlled trial of two groups.

patients aged 20 years attended in 13 PHCC, identified by general practitioners and nurses with diagnosis of mid/moderate depression disorder (BDI scale) between December 2008 and April 2009.

The intervention group received a psycoeducational group program (12 weeks, two nurses). The program provided health education about the illness, pharmacological treatment, diet, physical exercise, problem solving, and cognitive-behavioral therapy.

The control group received conventional care.

The evolution of patients is monitoring up to 1 year after the inclusion by an individual interview (baseline and 3, 6, 9 months).

The battery of assessment included: Sociodemographic, BDI and EuroQol-5D questionnaires.

241 patients (126 intervention Group (IG); 115 control Group (CG)), 217 women (53% IG and 47%CG) with a mean age of 54, 11 (SD=12,656). 92% Spanish. 45% married. Academic level: 76, 5 % study and 13,5% non-study.

The mean BDI in the baseline GI 21, 66 (SD=6,87) and CG 19.62(SD=6.85), follow up 3 months, GI 13,91(SD=8.22) and CG 17,07(SD=7,930). The mean of EuroQoL in the baseline IG 48, 29 (SD= 17,77) and CG 53,0 (SD= 19,06), follow up 3m, GI 56,57(SD=22,12) and CG 45,28(SD=23,74).

The two groups are comparable for all variables analyzed. There is an improvement in the IG versus CG on depressive symptoms and quality of life.

This case is a presentation of three siblings diagnosed as affective disorder with polycythaemia vera during the episodes. Polycythaemia dissappearing with the remission of affective disorder is focus of attention of these cases.

First sister is 28 years old, single, treated for manic and subclinic depressive episodes for almost ten years. Polycythaemia vera has been developed with beginning of every manic episode and disappeared with the remission of episode. The patient made venopunction of 500cc weekly during the manic episode. Second brother is 26 years old, single, polycythaemia and psychotic depression were developed rapidly after a stressful life event. Venopunction was made for four times during one month medication. Polycythaemia and depression remitted at the same time. Third brother is 24 years old, single, polycythaemia and nonpsychotic depression were developed after his brother's depression. Venopunction was made for three times during three weeks of treatment. Again polycythaemia and depression remitted at the same time.

The siblings had no internal disease. Only first sister was on lithium treatment, 600mg/day for chronic affective disorder but her first polycythaemia attack was prior to lithium treatment. We found only one report upon the relationship between affective disorder and polycythaemia vera in which mania, delirium and polycythaemia rubra vera were documented. #Freeman MP, Wiegand C, Gelenberg AJLithium. İn Textbook of Psychopharmacology. Third Edition. Schatzberg AF, Nemenoff CB (editors) American Psychiatric Publishing, Washington DC. 2004, 547-565.

The present study was aimed at evaluating psychological well being (PWB) among subjects with affective disorders and healthy controls.

83 subjects with affective disorders were compared to 83 healthy controls. Measures of PWB, psychological symptom status, basic social skills underlying social and emotional competence, and health-related quality of life (QoL) were obtained from standardised, self-administered rating scales. Statistical analyses focused on between-groups differences and on correlations among the major variables under study.

Cases showed significantly higher levels of psychological symptoms, and lower PWB, social competence, and QoL than healthy controls. Between-groups differences in emotional competence did not attain statistical significance. When correlations were evaluated, cases showed negative correlations between PWB and psychological symptoms, and positive correlations between PWB and QoL. Only some PWB constructs correlated with the social competence, while no correlation was found between PWB and emotional control.

In healthy controls, similar correlations between PWB and social competence as well as between PWB and QoL were found. On the other hand, no correlation was found between PWB and emotional competence, between psychological symptoms and the two PWB constructs named “purpose in life” and “personal growth”.

Subjects with affective disorders seemed to link their PWB to psychological symptoms, QoL, and social skills with the exception of emotional control. Healthy subjects seemed, on the other hand, to link their PWB to QoL and social competence, only in part to psychological symptoms, and not at all to the emotional competence.