A critical review of current models of clinical staging of depressive disorders and their potential contribution to routine clinical practice will be presented.

The main objective was to establish the correlation between the clinical staging model proposed by Hetrick and McGorry (modified by our group) with the severity of depression, the associated disability and the treatment resistance degree.

It is a descriptive cross-sectional study carried out in a sample of 135 patients, 15 or more years old, with a diagnosis of DSM-IV-Major Depression (single or recurrent episode) that were in contact with the outpatient and inpatient Units of the Institute of Psychiatry of the San Carlos Clínico Hospital in Madrid. Socio-demographic and clinical variables were collected: diagnosis, global impression of illness, severity of depressive symptoms, functionality and disability degrees and resistanceto treatment.

In spite the sample size limitations, it can clearly note that clinical stage model correlates in a statistically significant way with the scores of the Clinical Global Impression (CGI), and especially with the Global Assessment of Function (GAF) and the resistance to treatment degree.

We will discuss the utility of clinical staging model in the clinical practice and the interest to study the correlations between this proposed model and the established biomarkers of Major Depression.

Depression is a most widely researched psychopathology, both psychologically andphysiologically. The best known psychological theories focus on maladaptive cognitive responses, which are largely surface manifestations of depression. The cognitive orientation theory (Kreitler Kreitler) can amplify them by providing an assessment of depression based on deeper insights into the underlying dynamics of depression.

To test the validity of the Cognitive Orientation Questionnaire of Depression (CO-D).

To test hypotheses that the CO-D differentiates between high and low scorers on twomeasures of depression, between women high and low on postnatal depression, andindividuals diagnosed with depression and other patients.

The CO-D was administered to 50 undergraduates who also responded to the Beck Depression Inventory and the Goldberg Depression Questionnaire, 100 women who gave recently birth and responded also to the Edinburgh Postnatal Depression Scale,and 25 patients in a psychiatric clinic 13 of whom were diagnosed with depression. The CO-D items represented four belief types (about self, reality, norms and goals) referring to themes identified as relevant in pretests, e.g., harm avoidance, perfectionism, responsibility.

The scores of the CO-D differentiated significantly between the high and low scorers on depression in the Beck, Goldberg and Edinburgh scales and in the psychiatric group. All four belief types had significant contributions. The major significant themes were responsibility and guilt.

The CO-D is a valid tool that may be used for the assessment and treatment of depression, and for constructing a broader theoretical approach to depression.

Several effective treatment alternatives exist for depression, however, not everyone responds to antidepressants and the time lag to response can be long. Bright light therapy (BLT) has successfully been used as an adjuvant treatment to antidepressants in severe depression among inpatients.

The aim of this study was to evaluate the implementation of BLT as an adjuvant treatment among inpatients with depression.

BLT was introduced as an adjuvant therapy to patients admitted to a psychiatric department in October 2013. The protocol included exposure to 10,000 lux for 30 minutes every day for one week. The first 18 patients completing BLT were compared to 36 inpatient-controls matched for age, sex and diagnosis. All participants filled in Montgomery-Åsberg Depression Rating Scale (MADRS-S) and Insomnia Severity Index (ISI).

The groups did not differ in age, sex or diagnosis. The mean MADRS-S end score was 27 points for the BLT-group and 13 point on the ISI compared to 23 and 13 for the control group (p=0.52 and p=0.89, respectively). The mean length of stay was 16 days for the BLT-group and 19 for the control group (p=0.60). The daily dosage of diazepam was 4.3 mg/day in the BLT-group compared to 4.8 mg/day in the control group (p=0.73).

There was no statistically significantly decrease in length of stay in patients treated with BLT. Although the results are non-conclusive from this historical comparison, BLT may provide shorter length of stay and decrease the need for benzodiazepines.

Rats produce high-frequency sounds (USVs) inaudible to the human ear. When rats are tickled their sound production increases – this is said to reflect positive emotions. The Flinders Sensitive Line (FSL) rat is a genetic rodent model of depression; hence, its altered emotional state may result in a distinct USV profile.

To investigate whether USV profiles differ between rat strains and whether tickling has an antidepressant effect. To examine the effect of ketamine, a presumed rapid-acting antidepressant, on the USV profile. Lastly, to study tickling's effect on genes involved in feeding-regulation in hypothalamus and stress-sensitive genes in the submandibular glands.

To explore the utility of USV production during tickling stimulation as a screening method for depressive-like behavior in preclinical research.

We investigated the FSL rats’ USVs during six weeks of tickling. Flinders Resistant Line rats, Sprague Dawley rats and a light-touch group were used as controls. Depressive-like behavior was evaluated with the forced swim test. Ketamine or a vehicle was administered acutely after five weeks of tickling.

Preliminary results show a significant difference between strains in their USV production during tickling. However, data analysis is still in progress and further results will be presented at the congress.

The study will elucidate the differential development of USVs following tickling stimulation in the FSL, FRL and SD rats, and furthermore shed light on the effect of tickling on the behavioral phenotype and gene expression.

The problem of prevalence and medical-social consequences of depressions stipulates for necessity of improvement of diagnosis and efficacy of therapy for such patients. In this aspect an important role belongs to adherence to the therapy which provides both cure and preventive influence of pharmacotherapy.

The aim of the study was to investigate medication compliance in male patients with depression.

The clinical-psychopathological method, the investigation of the compliance level and type, statistical methods were used. In the study 117 male patients with depressive disorders (62 with F43.21 and 55 with F32.0, F32.1) were examined. The control group consisted of 98 female patients (51 with F43.21 and 47 with F32.0, F32.1).

It was demonstrated that male patients had a complete compliance in 25.6%, a partial compliance in 36.8%, and a poor compliance in 37.6% of cases. In male patients with depression a passive compliance type prevailed in 28.3% and a formal compliance type prevailed in 24.8% of cases. Wherein a formal compliance type predominated in male patients with depressive reaction F43.21 (32.2%) and a passive compliance type predominated in male patients with depressive episode F32.1 (41.48%). As compared with the control group, a statistically significant predominance of partial and poor compliances was detected in the group of male patients with depressions.

These data suggest that derelictions of adherence to the therapy occur more often in male patients with depressions than in female patients. It determines a necessity of measures to improve the compliance.

The primary care (PC) patients’ diagnosis of Depressive Disorder (DD), their therapy is the main strategy of world clinical medicine.

To use Patient Health Questionnaire-9 (PHQ-9) in DD diagnostics in general medicine for PC physicians.

390 patients in PC were inspected with the help of PHQ-9 questionnaire and ICD-10. The statistic process has been made with the help of Pearson agreement criterion.

Among them 270 (69, 7%) are women and 120 (30, 8%) are men. Average age of examination was 44, 3±6, 7. During the screening research 163(39, 6%) patients had no depression, 139(35, 6%) had mild depression (MD) or several symptoms. There were 2 diagnosed chronic diseases for one patient and 4 up-to-date physical complaints. MD patients often complained about periodic anxiety (27%), its intensification drawing to the evening (33, 8%), experienced social isolation (43, 8%). 28% patients in this group took pain relievers or sleeping pills. 58(14, 9%) of patients were diagnosed moderate (major) depression. In total, patients of this group had anxiety, panic and phobia (57, 9%), which masked the main symptoms of depression. 24(6, 2%) patients were diagnosed severe depression. Every patient in this group had 8 physical complaints and 3 chronic physical diseases. The variability of DD and physical diseases shows r±0, 63, P<0,001.

PHQ-9 is a representative screening DD in PC. Taking into consideration the high level of anxiety symptoms in research, Generalized Anxiety Disorder 7-item (GAD-7) scale should be used.

In major depressive disorder (MDD), response and remission are the goals of treatment strategies.

To describe factors associated with response and remission in MDD, we conducted a longitudinal study exploring response to treatment in a large sample of depressed patients in general practice.

General practitioners (GPs) recruited depressed patients consecutively and evaluated them using the QIDS-SR and the Snaith-Hamilton Pleasure Scale. Patients were treated with agomelatine and evaluated after 6 to 8 weeks. Response was identified as a 50% improvement in QIDS score and remission as a QIDS score below 5 at endpoint. We conducted a logistic regression to identify the variables associated with response and remission.

1752 patients were included (62.4% women, 37.6% men). Average QIDS-SR score was 15.7 (SD=4.3). The average duration of the current episode was 6.1 weeks (SD=6.2) and it was the first episode for 65.7% of the patients. In 91.15% of the patients, anhedonia was considered as severe (score above 5). Level of anhedonia, duration of the episode and recurrence were associated with a higher probability of response to treatment (respectively p< .0001, p= 0.0181 and p= 0.0323). Remission was correlated with the absence of recurrence and professional activity (p< .0001).

Level of anhedonia and the characteristics of the episode are associated with the probability of achieving a response. Taking into account these parameters in order to specify treatment strategies is one way to improve the course of MDD.

Lately postnatal depression has a growing prevalence, in part because of a rise in awareness in the general population and also, the medical staff.

The present research was intended to assess the predictive value of obstetrical and neonatal parameters in postnatal depression.

A 2 year nonconsecutive cross-sectional survey was performed on 163 women between 6 to 8 weeks after delivery, monitored in Obstetrics Outpatient Department of Bega Clinic Timisoara and Resita County Hospital. Postnatal depression was assessed by Edinburgh Postnatal Depression Scale using a cut-off > 13. Also, obstetrical and neonatal data were collected from medical records of new mothers, using also information gathered from the mothers and the medical care staff. A binary logistic regression on aforementioned parameters was performed to determine their predictive role on postnatal depression.

The rate of postnatal depression was in concordance with data existing in international literature (N= 39; 23,93%). Among the obstetrical and neonatal parameters that have had a predictive contribution on the postnatal depression occurrence, it has been found the following: the parity (OR = 0.506; 95%, CI: 0.315 – 0.812; p = 0.005); prematurity (OR = 6.079; 95% CI: 1.326 – 27.886; p = 0.012); and the presence of complications during pregnancy (OR = 7.544; 95% CI: 1.791 – 31.779; p = 0.004).

In our research, some of the obstetrical and neonatal parameters proved to be predictive factors in postnatal depression, thus enabling to detect new mothers at high risk for depression.

Depression affects around 35% of patients with Parkinson's disease. There are some overlapping symptoms between both illnesses, and some evidence seems to suggest that there may exist a common underlying etiological factor, namely changes in cortico-striatal-thalamo-cortical circuits and in the locus coeruleus.

To review the potential role of locus coeruleus alterations in patients with Depression and comorbid Parkinson's disease.

A literature review was performed through MEDLINE and PsycINFO using the terms 'Depression”, 'Parkinson's disease”, 'neurobiology”, 'locus coeruleus”, 'substantia nigra”, 'neuromelanin”, 'neuroimaging”, 'magnetic resonance imaging”, 'Positron emission tomography”. All articles found were selected according to their adequacy to the subject in question.

Noradrenergic pathways are important in the pathophysiology of Depression in Parkinson's disease. Magnetic Resonance Imaging (MRI) studies, with neuromelanin measurements have shown there is neuronal loss not only in the substantia nigra but also in the locus coeruleus. These changes in the locus coeruleus are different when patients with Parkinson's disease are compared with schizophrenic and normal controls. Patients with comorbid Depression and Parkinson's disease have a reduced uptake of [11C]RTI-32 in the locus coeruleus, with an inverse relationship between those changes and symptom severity. There is a higher prevalence of histopathologic changes (neuronal loss 7 times higher, gliosis) in the locus coeruleus of depressed vs. non-depressed patients with Parkinson's disease.

These findings seem to substantiate the potential role of noradrenergic pathways in the aetiology of Depression in Parkinson's disease.

Lecture representative of a unique project in the area of ??expanding the awareness of eating disorders in early childhood feeding among parents and professionals, caregivers, infants and toddlers.

This is an innovative project created by the collaboration between the Academy – and the Eating Disorder ambulatory clinic at the hospital. The populations in treatment are babies and young toddlers with feeding and eating disorders. Graduate students in clinic social work study this course as well as involved in the community for the purpose of study initial diagnosis and raising awareness among the different populations. Activity will be carried out by students and various communities such as clinics, pediatric primary care clinics, day care centers and kindergartens.

In the community will use various practices to influence and achieve the desired change. Intervention shall be informal conversations, observations, discussion with parents and children, as well as with teachers and Nurses.

Academic activities include training of students, reviewing their positions by research to be performed before the start of training and at the end of training and operations. The lecture will focus on the processes that students go through the community as well as customers.

The model included teaching, research and community activities to promote a change.

The lecture will include a report on the results of the study as well as the demo movies.

Feeding and Eating Disorders

Consciousness

Diagnosis

Anorexia Nervosa is the commonest cause of death in college age females and the relapse rate is 50%. The main treatment apart from refeeding is fluoxetine with the occasion supplementation of olanzapine and benzodiazepines.

to find out which combination therapies can be tolerated for this group of inpatients and with the least side effects.

to establish some ideas on which to base the development of novel therapies to give clinicians more choices.

The hospital has ten beds for eating disorders in the independent sector in the north of England. Patients are accepted with BMI 9-15. Many have comorbid conditions like depression and OCD. We looked at psychotropic medications for a group of current and recently discharged patients.

We have used combinations of escitalopram, mirtazapine, quteiapine and buspirone. We have also tried some unusual combinations involving aripiprazole and venlafaxine but the combination of clomipramine and buspirone is showing most promise. Aripiprazole seems to aid the refeeding process. These may seem random choices but many have been chosen from existing algorythms for affective disorders and psychosis.

Over the last nine months we have been trying to find either single or combination therapies that suited the patients best. All of the patients were quite intractable, had tried other medications, and had been ill for over ten years. This is a neglected area in Anorexia Nervosa and there are few studies in this topic. Controlled trials are needed.

Many qualitative studies have been carried out on the personal experience of relatives living with patients affected by Eating Disorders (EDs). However, quantitative studies on strategies adopted by relatives to cope with the disorder are lacking.

To develop a questionnaire to specifically assess coping strategies of relatives of people with EDs.

To develop and to validate a new instrument, the Family Coping Questionnaire for EDs, which is designed specifically to explore coping strategies adopted by relatives of patients with EDs.

The preliminary version of the questionnaire was developed through a multi-step methodology, including analysis of the relevant literature and focus groups. Subsequently, patients with EDs and their relatives were recruited at three Italian University sites and were asked to fill in the pre-final version of the questionnaire.

The final version of the questionnaire consisted of 32 items, grouped in five subscales according to the Cronbach's alpha analysis. Through the confirmatory factor analysis, the five subscales were grouped in two factors, the problem-oriented and the emotion-focused coping strategies.

The final version of the questionnaire shows good psychometric properties, and requires a short time to be completed. The five subscales identified correspond to those adopted by relatives of patients with other severe mental disorders, such as schizophrenia and bipolar disorders. Further analyses from the same dataset will be performed to better describe the coping strategies adopted by relatives of patients with EDs and to identify predictors of maladaptive coping strategies.

Eating disorders (ED) are long-term psychiatric illnesses defined by abnormal eating habits and associated with a number of psychological and environmental factors. The underlying psychological components of ED are difficult to detect and patients frequently can be strongly ambivalent about changing, although their apparent willingness to recover.

The study of the subjective meanings of the patients' ambivalence has a positive function to address treatment resistance.

To consider patients' perspectives on pervading ambivalence supports the empathically comprehension of the feelings, defenses and thoughts that underpin ED.

We describe a clinical case of an out-patient attending at the Department of Psychiatry, University of Sassari.

I.O. is a 36 years-old woman, with anorexia (AN) binge/purging since she was 19, with low academic and social functioning. She made a residential treatment for 6 months when she stopped binge/purging behavior. In outpatient setting the binge/purging behavior restarted with blame, incapacity and resignation feelings. Empathic comprehension of ambivalent motivation contributes during treatment to disclose the adaptive function of AN, the interior conflict between need and fear of autonomy, need of differentiation from her mother and her mother's endorsement, with reduction of blame feelings and binge/purging behavior.

Weight restoration should be considered the starting point of a treatment whose main goal should be the modification of the inner world, the defenses and the thoughts that underpin ED.

Patients presenting with psychosis to general hospital emergency departments can present challenges to assessment but it is essential to exclude any organic aetiology.

This study measures compliance with recommendations from the BMJ Best Medical Practise guidelines (1). They recommend that organic causes be investigated as follows:

• All patients undergo full neurological assessment

• All patients undergo basic blood tests

• All patients undergo urine dip and urine drug screening

Retrospective study of 31 inpatients seen in A&E department at the Norfolk and Norwich University Hospital January 2013 – April 2014.

• Clinical case notes were reviewed to identify those with documented psychotic symptoms

• 124 patients identified

• 27 excluded – notes unavailable

• 29 excluded as there was no A&E attendance

• 37 patients excluded as no documented psychotic symptoms.

This left 31 patients to be included

• No patients underwent all investigations recommended

• 71% of patients had a recorded GCS/AVPU score.

• 90% of patients underwent at least one blood test investigation

• 12% of patients underwent urine dip and 0% urine drug screening

• The standard of practice was unacceptable

• All staff should be reminded of the importance of clear documentation in patient notes including any refusal/ un-cooperation of patients to examination or treatment

• Local guidelines/ educational sessions should be developed to review assessment of this patient group

• Clinical staff should be reminded of recommended investigations for patients presenting with altered mental state

1. 1) http://bestpractice.bmj.com/best-practice/monograph/1066/diagnosis/step-by-step.html

Knowing the factors that can predict the occurrence of suicidal ideation in mental health patients assessed in Emergency Rooms (ERs) will enhance patient risk assessments.

To examine the factors that can predict the likelihood that a patient presenting to the Emergency Room will have suicidal ideation

Twenty-four independent demographic and clinical factors contained on a data assessment tool for 337 patients assessed by the crisis team in the ER over 6 months were compiled. Data was analysed using SPSS Version 20 with univariate analyses and logistic regression.

Only two (reason for presenting to the ER and Global Assessment of Function (GAF) score) of the seven-predictor variables on univariate analysis made unique statistically significant contributions to a logistic regression model. The odds ratio for ‘reason for presenting to the ER’ was 7.53, which suggests that patients who presented with a complaint of ‘low mood’ were seven and a half times more likely to report suicidal ideation compared with those presenting with other complaints, controlling for other factors in the model. Also the odds ratio for ‘GAF score’ was 9.92, which suggests that those who had GAF scores of 50 or less were ten times more likely to present with suicidal ideation compared with those who had GAF scores of more than 50, controlling for other factors.

Patients presenting to the ER with ‘low mood’ and those with a GAF score of less than 50 should be properly assessed for the presence of suicidal ideation.

Agitation is a broadly defined phenomenon that is associated with many physical and mental illnesses. The core features of agitation generally include: irritability, excessive or semi purposeful motor activity, heighted responsiveness to internal and external stimuli and an unstable course. Inhaled Loxapine is recently available as a new approach in the management of these episodes.

To present case reports of Inhaled Loxapine in the treatment of agitated patients in our clinic.

We have selected representative case reports form our acute unit characterizing the patients´ history and the circumstances of present admission, the evolution and the management of these episodes during the admission.

Inhaled loxapine as a new treatment option allows rapid control of agitation in these unstable patients who can suddenly turn into aggression or violence, facilitating the therapeutic alliance between the patient and physician without resorting to mechanical or physical restraint.