To carry out a cost-consequences analysis for 50mg-desvenlafaxine in the second-line outpatient treatment of major depressive disorder (MDD) from the payer (National Health System) perspective in Spain.

The model (Markov simulation) follows a cohort of MDD patients through 1 year after failure of first-line treatment with a SSRI and estimates outcome measures (% remission and depression-free days) accrued and costs incurred during outpatient treatment of MDD. Selected comparator is usual care (UC), which is assumed to be made of a mix of duloxetine and venlafaxine that make up the majority of the serotonin-norepinephrine reuptake inhibitor (SNRI) market in Spain. The model also considers drug treatment beyond the second-line of therapy (3rd and 4th-lines) in cases of patient discontinuation or lack of remission according with outcomes from STAR-D trial and other clinical trial published. The model generates outcomes and cost from the NHS in year 2014.

Due to fewer discontinuations, desvenlafaxine was associated with numerically more depression-free days and a higher percentage of patients in remission versus UC: 1.7 days and 0.5% more in remission. Also, healthcare costs were lower with desvenlafaxine than with UC: €1,114 vs. €1,224 (-110€).

In patients who have not responded to a first-line SSRI therapy, desvenlafaxine-50mg was clinically similar in effectiveness but a less costly option, approximately 9% lower, compared with a weighted average of duloxetine and venlafaxine for the second-line treatment of MDD patients from a payer (NHS) perspective in Spain.

To model the cost and consequences of desvenlafaxine and venlafaxine in the second-line outpatient treatment of major depressive disorder (MDD) from the payer (National Health System) perspective in Spain.

The model (a Markov simulation) follows a cohort of MDD patients through 1 year after failure of first-line treatment with a Selective-Serotonin-Reuptake-Inhibitor (SSRI) and estimates outcome measures (% in remission and depression-free days) accrued and costs incurred during outpatient treatment of MDD. Selected comparator is venlafaxine because its actual generic price. The model also considers drug treatment switching beyond the second-line of therapy (3rd line) or changing to another drugs in 4th-line in cases of patient discontinuation or lack of remission according with outcomes from STAR-D trial. Efficacy of drugs was extracted from clinical trial published. The model generates outcomes and cost from the NHS in year 2014.

Due to fewer discontinuations, desvenlafaxine was associated with numerically more depression-free days and a higher percentage of patients in remission versus venlafaxine: 1.7 days and 0.5% more in remission. Also, healthcare costs were a little bit lower with desvenlafaxine than with venlafaxine: €1,114 vs. €1,166 (-52€).

In patients who have not responded to a first-line SSRI therapy, desvenlafaxine-50mg was clinically similar in effectiveness but a less costly option (about 5% lower) compared with venlafaxine for the second-line treatment of MDD patients from a payer (NHS) perspective in Spain.

Saikosaponin B is one of the main ingredients of Bupleurum. Among the many effects of Bupleurum, saikosaponin B may be contributing molecules.human neuroblastoma cell line SH-SY5Y is a tumor cells of low degree of differentiation. Its cell morphology, physiology and biochemical functions similar to normal nerve cells, are widely used to study the mechanism of diseases and drug, of the nervous system.

To investigate the effect of Saikosaponin B on SH-SY5Y cells.

Cultured SH-SY5Y cells and drawed cell growth curve. Then based on the cell growth curve, using hydrogen peroxide of different doses(110?120?130?140?150?160?180?200?220μmol/L) to treated SH-SY5Y cells. At same time, volume fraction 0.05 serum contained Saikosaponin B was added. Cultured SH-SY5Y cells were observed by morphology and tested by the MTT assay.

Less than 140μmol/L hydrogen peroxide, SH-SY5Y cells does not be caused damage. Saikosaponin B of volume fraction 0.05 can relieve the damage of SH-SY5Y cells treated with 140μmol/L hydrogen peroxide, also can increase the survival of the SH-SY5Y cells.

Saikosaponin B can strongly protect the cultured SH-SY5Y cells from damage induced by hydrogen peroxide.

Dopamine D2 receptors (D2R) are the primary target of antipsychotic drugs and have been shown to regulate Akt/glycogen synthase kinase-3b (GSK-3b) signaling through scaffolding protein b-arrestin 2.

In the present study, we researched the effects of saikosaponin B1 on the b-arrestin 2-mediated Akt/GSK-3b pathway in human neuroblastoma cell lineSH-SY5Y cells.

To determine whether saikosaponin B1 affected neuronal morphology in human neuroblastoma cell line SH-SY5Y cells.

We investigated the effects of saikosaponin B1 on neurite outgrowth using immunostaining. We examined the effects of saikosaponin B1 on Akt and GSK-3b and its well-known downstream regulators, cAMP response element-binding protein (CREB), brain-derived neurotrophic factor (BDNF), and Bcl-2 levels using Western blot analysis.

Saikosaponin B1 was found to enhance neurite outgrowth. Small interfering RNA (siRNA) for b-arrestin 2 knockdown blocked the increase in saikosaponin B1-induced neurite outgrowth. Furthermore, saikosaponin B1 increased the levels of Akt and GSK-3b phosphorylation. The elevation of Akt phosphorylation induced by saikosaponin B1 was reduced by b-arrestin 2 siRNA. Moreover, saikosaponin B1 effectively increased the levels of phospho-CREB, BDNF, and Bcl-2.

Together, these results suggest that regulation of the b-arrestin 2-dependent pathway via blockade of the D2R in SH-SY5Y cells is one mechanism underlying the neuroprotective effect of saikosaponin B1.

To study clinical efficacy of the main representatives of SSRI (citalopram, paroxetine, sertraline, fluoxetine, fluvoxamine) in treatment of depressive episode, recurrent depressive disorder, bipolar depression moderate and severe degree. To reveal features of clinical dynamics during therapy above mentioned medicines and to establish optimal dosing regimen depending on type and severity degree of depression.

Examined 3 groups of patients treated with SSRI: 131 with a depressive episode, 194 with recurrent depressive disorder, 230 with bipolar affective disorder. During the research analyzed following indicators: severity of general therapeutic effect (number of responders on a scale general clinical impressions of effectiveness of therapy); degree of reduction of depression’s symptoms on scale Hamilton depression; timing of positive therapeutic effect; general frequency and severity of side effects, the most frequently reported side effects (on a scale of evaluation of side effects).

When evaluating effectiveness of SSRI treatment revealed a number of clinico-pharmacological patterns. In the group with BD is determined statistically significant a slower decrease in level of depression with correlation relationship between dynamics of improvement of depressive affect and degree of cognitive impairments. Maximum side effects in all groups was observed during first three weeks of treatment.

Determined factors of choice for treatment with each of above mentioned SSRI and optimal dosage regimen; estimated range of timoanaleptical activity in relation to different as typological structure, and degree of severity of depression in various age groups of patients; described features of timoanaleptical action on different quantitative and qualitative components of depressive episode.

As we know antipsychotic drugs are associated with the presence of side effects thar impair adherence, the course of the disease and the patient's functionality. Besides drug efficacy, tolerability is a factor which we consider in the choice of treatment.

Descriptive cross-sectional study of inpatients between June and September 2014 in treatment with paliperidone and with any psychiatric diagnosis according to the diagnostic criteria Statistical Manual of Mental Disorders (DSM-IV). To evaluate the presence of side effects we use the UKU (Udvalg für Kliniske Undersogelser), which is a comprehensive measure of side effects of psychotropic drugs. It consist of 54 items grouped into psychological, neurological, autonomic and other symptoms.

18 patients (12 men and 6 women) were included. The average age was 37 years. 16 patients (88.8%) had a diagnosis of Tr. psychotic and 2 of them (11.1%) Tr. personality. 8 patients had started treatment with oral paliperdione two weeks before evaluation, while the remaining 10 patients had longer treatment (mean 9.4 months).

Symptoms found in the psychic area were astenia, lassitude, fatigability, decreased sleep duration and emotional indifference. No symptoms were described in the neurological area. Among the autonomic effects: increased sweating and inside the area “others”: decreased sexual desire, erectile dysfunction and weight loss. All of them were obtained as slight maximum score.

These data give us guidance on the tolerability profile of oral paliperidone short to medium term. The values obtained in the UKU scale indicate good tolerability of the treatment.

The association between cannabis and psychotic outcomes is systematically reported. Δ9-tetrahydrocannabinol (THC) is the main psychoactive component of cannabis products and studies emphasize the concentration of THC as the main measure of cannabis potency. Cannabidiol (CBD) is another component of cannabis and studies have suggested that CBD might have antipsychotic properties and could therefore modify the paradigm of pharmacologic treatment in psychotic disorders.

This work aims to describe the latest knowledge about CBD, its molecular targets and possible therapeutic use in psychiatric disorders.

This revision was based in articles published in PubMed/MEDLINE, using the following terms 'cannabidiol” 'cannabis”, 'psychotic symptoms”, 'molecular targets” and 'treatment”.

CBD has multiple molecular targets (CB1 receptors, vaniloid system, hydrolysis of anandamide, agonist in 5HT-1A receptors, nuclear receptors of PPAR family and other ion channels), but a full comprehension about them is lacking. Like other cannabinoid compounds, CBD has a biphasic effect in anxiety (lower doses tend to produce anxiolytic-like effect and higher doses produce an anxiogenic-like effect), though the mechanism is not completely understood. The use of high cannabidiol content cannabis and its association with significantly lower degrees of psychotic symptoms have been reported, nevertheless CBD’s antipsychotic properties are still controversial.

The higher concentration of CBD in cannabis preparations has been related with fewer psychotic symptoms, compared with a higher THC/CBD ratio plants. Further studies must be held to conclude about CBD’s antipsychotic properties, but its effects in anxiety disorders seems to be promising.

Even though the most common cause of galactorrhea in adults is medication-induced, SSRIs are very rarely incriminated. Among SSRIs, sertraline appears to be one of the least reported drugs, whereas escitalopram and paroxetine appear to be the most.

To outline the occurrence of sertraline-induced (and more generally SSRI-induced) galactorrhea and to discuss the possible underlying mechanisms and the subsequent therapeutic implications.

Case report and review

We report the case of a female patient aged 40, with a family history of amyotrophic lateral sclerosis and with a personal history of fibromyalgia on pregabalin.

The patient presented with anhedonia, asthenia, panic attacks, restlessness as well as decreased appetite and insomnia.

The diagnosis of a major depressive disorder, single episode, moderate with anxious distress was made (DSM-5 criteria).

The patient was started on sertraline 50mg qd and lorazepam 1 mg qd. In the absence of adequate improvement, sertraline dosage was increased to 100mg qd. About two months later, the patient started to complain of galactorrhea.

Prolactin level was not obtained. MRI examination of the brain and the pituitary gland was normal.

Sertraline was, then, withdrawn and galactorrhea ceased a few days later.

The patient was switched to venlafaxine, which was well tolerated.

Although SSRI-induced galactorrhea seems very rare, the high number of patients on SSRIs makes the prevalence of this side effect probably significant and thus worth monitoring. A patient who develops galactorrhea on one SSRI might tolerate (and can thus be switched to) other SSRIs or SNRIs.

Combination different antipsyhotics with ECT in treatment resistant schizophrenia has been reported. However, the result are controversial. Our study investigated the long-term effects of combination ECT with three different antipsyhotic (haloperidol, amisulpride, olanzapine) in treatment of resistant schizophrenia.

The aims of our study were to investigated the long-term effects of combination ECT with three different antipsyhotic in treatment in resistant schizophrenia.

The clinical study was a naturalistic, prospective, open labelled, active controlled study in adult outpatients of both genders suffering from treatment resistant schizophrenia, (Dg F20) with follow-up of 2 years. The patient received amisulpride n=16 in range 50-200 mg/ mean daily doses 75,42. Haloperidol n=19, range 10-15 mg/day, mean daily doses 14,20 – 24,00. And olanzapine n=21, 5-15mg daily, mean daily doses 7,43.ECT was applied (8.0sec, and 0.8 amp) (Thymatron system IV somatic) in nine applications, twice a week. Clinical efficacy, was estimated using the ICD-10, PANNS and CGI psychometric scales.

According to the result, the most effective treatment was combinatin with olananzapine plus ECT, than haloperidol plus ECT, while amisulprid plus ECT had lower clinical efficacy. Olanzapine plus ECT, was significantly superior in all scale scores vs amisulpiride plus ECT, as well as haloperidol plus ECT except for PANSS-P (t=1,85, p>0,05). During the study, 38 of 70 patients were withdrawn due to treatment failure (n=21), side effects (n=6)and non compliance (n=11).

Our steady show that the combination of different antipsycotic and ECT, is more effective in treatment of resistant schizophrenia.

The current psychopharmacological and psychotherapeutic treatment strategies are not successful in all subtypes of Major Depressive Disorder (MDD). Electroconvulsive therapy (ECT) has an important role in the treatment of the melancholic subtype of MDD. We are however currently not able to accurately predict the response to ECT. Earlier studies suggested a role for psychomotor retardation and agitation, but included only small numbers of patients and often made no distinction between psychomotor retardation and agitation.

Our project will validate psychomotor retardation and agitation as prognostic factors for ECT-response. This will help us to optimalize treatment of the severely depressed patient.

50 unipolar and bipolar depressive ECT-candidates will be evaluated with the CORE Assessment of Psychomotor Functioning (CORE) <1 week before starting ECT. A score on the different subscales will be registrated. The Hamilton Rating Scale for Depression (HAM-D) will be scored < 1 week before starting ECT and weekly after start of ECT to guide treatment. Within a week from the last treatment, the definitive HAM-D score will be registered. Patients can be classified as non-responders (<50% lower HAM-D score), responders (>50% lower HAM-D score) or as being in remission (HAM-D ≤ 7).

Patients are currently recruited. Patients with more severe psychomotor disturbance seem to respond better to treatment with ECT (more response, remission). Further analysis of the score on CORE-subscales has to be executed.

We carefully conclude that psychomotor disturbance assessed by CORE, is a good predictor of response to ECT.

The Multiple Self States model of CAT was developed in response to practical difficulties encountered in understanding and reformulating patients with Borderline Personality Disorder (BPD).

The impact of 40 sessions of CAT on a woman at the mild end of the borderline spectrum.

A 46-year-old woman, presented with panic attacks and somatization. She was feeling lonely, worried and stressed, had difficulties in engaging in relationships, and needed to be loved. Moreover, she was incapable of coping with real life, afraid to work and used fantasy to avoid real world. CAT was the mainly psychotherapeutic treatment.

Early history revealed emotional deprivation. At first, two self states were identified, labeled “Victim” and “forms of Idealization". Later, a third self state was added labeled “ I am Bad". The use and constant enrichment of the Sequential Diagrammatic Reformulation (SDR) throughout the therapy was very effective in the progress of the therapeutic process, concerning the recognition and revision of the reciprocal roles and the target problems procedures. Once the patient understood the idea of separate partly dissociated self-states she was capable of identifying and characterizing them on the SDR. After session 20 her symptoms almost disappeared, she started to deal with her anger and with her fear to cope with real world.

The use and constant enrichment of SDR throughout the therapy with partly dissociated self states enables a better capacity for self reflection and integration. It seems that a long term CAT for BPD patients is more beneficial.

In psychotherapy, the object of study is not directly perceptible and material, but involves human mind complexity and specific content

In psychotherapeutic relationship we propose a method to inspect by deduction non-conscious mind, patient hidden mood, hate, affectivity.

The aim of this work is using a modern physics research method in psychotherapy, in order to focus on what is not directly perceptible in clinical practice.

We can examine, instead of 'inductive method”, the 'deductive method”, adapted from physics theoretical approach. We have taken into consideration 'Human Birth Theory”, formulated in 1971 by psychiatrist Fagioli. The author conceived the beginning of human life as a neuropsyche reaction to light. Given the intrauterine dark, Fagioli deducted that brain at birth are activated by 'the absolutely new stimulus”, light. He also deducted 'vitality” and 'capability to imagine” as non-conscious mind features. We have checked recent neurobiological data in literature.

Functional maturation of 'subplate zone”, light-inducted Immediate Early Genes activation, SATs variations, from foetus to newborn, retina instant activation by photon, 'viability” support Fagioli’s theory.

In relativistic physics and quantum field theory, deduction is finalised to discover hidden processes, in order to know the primum movens, not perceptible. In psychodynamic psychotherapy, the object par excellence is not just brain, like in neurology, but psyche. Its content is not directly knowable, but can be known also by deductive method, involving intuition, together perception of patient. In psychotherapy physics method can be applied, to discover the non-conscious thought, previous to pathological behaviour. Clinical examples can be reported.

Meta is a multi-faceted concept. This concept includes knowledge, beliefs, processes and strategies that, knowledge evaluation, supervision or control of the

The object of this research is to compare met cognition beliefs and controlling thought in Obsessive Compulsive Disorder and depression disorders to normal groups.

The statistical society of this research includes 50 persons afflicted by thought-action obsession, 50 persons afflicted to obsession disorder, 50 persons in normal groups in any group (25men, 25women). Also; normal person has been selected randomly through peering to disease groups in variables like gender, age, economical status and education level among Zare hospital employee.

The findings show the dimension of obsession thought in depressed persons and normal persons is different. Also, there is positive meaningful relation among the score of thought control approaches and obsession signs. Among sub scales of thought control, angry approaches forecast obsession signs.

Therefore, research findings are follower of obsessive compulsive Disorder met cognition pattern and shows thought blending beliefs and thought control approaches could be influential on the beginning and continuing obsessive compulsive disorder and depression.

Oncology disease often results in severe emotional trauma, psychological crisis is caused by a special attitude to the disease. Once the oncology pathology is diagnosed it becomes a stress factor that often leads to a severe psychological trauma with strong emotional experiences: anxiety; fear; apprehension; uncertainty; feelings of loss; depression.

The psychotherapeutic approach used with the oncology clients after the operation is based on person-centered features and is built on individual peculiarities, attitude to the disease, and psychosocial and somatic factors which negatively influence state of mind, as well as life quality of these patients.

The choice of which form of psychotherapeutic treatment to administer is based on the individual peculiarities of the patient, the stage of treatment, and their reaction to the disease.

While undergoing psychotherapy we use tactics based on the opposition of a negative attitude to oncology disease and a totally pessimistic attitude to possibility of recovery on the one hand and a system of positive images according to scientific data about a fairly positive forecast at the vast majority of oncology diseases in case on their early recognition and proper treatment on the other.

All above mentioned psychotherapeutic measures provide an effective change in psychological status, changes in the existing problem perception and shaping remedial perspective, as well as certain reconstruction of their social position.

The paper shows the possibility of using the Christian-Orthodox spiritual experience and Orthodox personality anthropology in psychoanalytic individual and group psychotherapy.

Protocols of group psychoanalytic psychotherapy are relating to the working with addicts in the Orthodox community. Reviews of individual psychotherapy are in private practice.

We follow the manifestations of narcissistic psychopathology, as well as investments of false self. The goals of psychotherapy and Orthodox spirituality are to realize the true self. Knowledge of the Orthodox faith is particularly useful in working with patients who say for themselves to be Orthodox. The Orthodox community for the rehabilitation of drug addicts is based on the Community. Orthodox Christian anthropology points to the Trinity God – the maturity of personality exists only in the Community of Three Personalities in One. In individual psychotherapy Community is the transfer?nce-countertransference relationship.

Observation is made in two Christian-psychoanalytic entities: envy and forgiveness. We start from the Orthodox determinants:

1. - Using feelings to tell us something else is considered as an indicator that we have not overcome that in ourselves;

2. - Interpretation of possibilities of giving / not giving, in terms of the p?tient having or / not having;

3. - We emphasize self-esteem and respect for others. In the ?rthodox literature we read that 'no one can humiliate us if we do not let him.'

Therapist's spiritual experience of the Orthodox faith opens the possibility of extending psychoanalytic psychotherapy techniques. Christianity has been enriching psychoanalytic developmental theory.

Many psychiatric patients suffer from self-stigma. One consequence of these internalized prejudices is decreased treatment efficacy. Much has been written about the effects of self-stigma in patients with severe mental disorders. However, individuals with minor psychiatric disorders also suffer from self-stigma. It is therefore necessary to explore the effect of self-stigma on treatment efficacy of neurotic patients.

Aim of out study was to investigate relationship between self-stigma, severity of symptoms, and presence of comorbidit disorder and treatment outcome in neurotic patients. Patients were treated by combined psycho and pharmacotherapy. Level of self-stigma was measured by Internalized Stigma Of Mental Illness scale. Severity of anxiety and depressive symptoms was assed by Beck Anxiety Inventory, Beck Depressive Inventory and Clinical Global Impression Scale.

Level of self-stigma was significantly correlated with the levels of anxiety, depression and global evalutions of a mental state on the beginnig of the therapy. Up to our results patients with higher level of self-stigmatization had lower improvement after combined treatmet in respect to perceived anxiety symptoms.

Self-stigma seems to be an important factor influencing efficacy of combined treatment. More researches focused on self-stigmatization should be done to find an optimal therapeutic strategy for patients with higher level of self-stigmatization.

In our opinion there is still confusion about the exact meaning of the term negation. As a consequence of this the importance of negation in the psychotherapeutic work is until now underestimated.

For psychiatrists who work according to Fagioli's human birth theory the concept of negation is fundamental. Negation is a notion that refers to unconscious reality.

The task of the psychiatrist is to identify and to interpret the negation in the deformed dream images during the psychotherapeutic process.

In contrast to an intentional lie, which is communicated through verbal speech, negation corresponds to unconscious thoughts, which we can find in dreams. During sleep a transformation occurs, language is altered and expressed through images. Negation deforms the image. This deformation of the image happens in an unconscious process. This negation distorts the reality of the patient and his ability to interact with the other. Corresponding the relationship will be aggressive/destructive. The only way to identify this deformation is dream interpretation.

Through this therapeutic process the patient will be able to intuit and realize instead of negate the positive qualities of the other and integrate these into his reality. Only human interaction that is free from negation enable the patient to overcome the ideo-affective splitting, which allows recovery of positive affects and the possibility of developing evolutive relationships.

Only a clarification of the term negation allows a psychotherapeutic process with the aim of developing evolutive relationships.