Unintended pregnancy continue to many countries in the world especially among teenagers.

The aim of this study was to assess the prevalence of post-partum blues in teenage mothers with unintended pregnancy, compared with teenage mothers with planned pregnancy.

100 normal primiparous women with age less than 19 were studied and divided two groups who had unintended pregnancy and planned pregnancy. Maternity blues assessed in two groups.

There was postpartum blues in women with unwanted pregnancies more than women with planned pregnancies in 3 and 10 days after delivery and this deferences are statistically significant.

Unintended pregnancy may be a potential causal factor for maternity postpartum blues in teenagers.

Strategies for the treatment of refractory depression include “switching” and “augmentation”. in recent years, there has been particular interest in the use of augmentation.

The purpose of this audit was to define patient factors among people receiving augmentation therapy with either mirtazepine or atypical antipsychotics.

We searched an anonymised database of patients and identified those receiving augmentation with mirtazepine (group A), atypical antipsychotics (group B) or both (group C). for each of the three groups we recorded the following factors: (1) age, (2) sex, (3) suicidal ideation, (4) alcohol problems, (5) drug problems, (6) domestic problems (e.g. debts, child abuse & domestic violence) (7) psychotic symptoms and (8) co-existing physical diagnoses.

Group B spanned a wider range of ages than either of the other two groups. Group A contained the highest proportion of patients with suicidal ideation than either. Alcohol problems were most common in group A, drug problems most common in group B and domestic problems most common in group C. Perhaps unsurprisingly psychotic symptoms were present in a relatively high percentage of patients in group B. there was little difference in physical co-morbidities between the three groups.

The audit reveals some interesting differences in patient factors between the three groups. Knowledge about such differences is useful in practical terms because it allows doctors in the BCMHT to target therapy for different patients towards their specific needs.

Potential augmentation regimes include the addition of atypical antipsychotics or other antidepressants (e.g. mirtazepine). there is growing evidence in the literature to support the efficacy of both the aforementioned augmentation strategies.

The purpose of this audit was to compare patient outcomes between groups receiving different augmentation strategies.

We searched an anonymised database of patients and identified those receiving augmentation with mirtazepine (group A), atypical antipsychotics (group B) or both (group C). for each patient we noted

1. (1) The discharge status and

2. (2) The presence of suicidal ideation.

We then looked at clinical notes to find out whether or not patients were still reporting suicidality.

The proportion of patients who had been discharged was highest in group A. the percentage of patients still reporting suicidal thoughts was higher in group B than in groups A or C.

Augmentation with mirtazepine resulted in better outcomes in terms of both discharge rates and in terms of reduction in suicidality than augmentation with atypical antipsychotics. One explanation for this is that mirtazepine augmentation is a more effective method of treatment in patients with refractory depression. However, it is also possible that differences in patient factors (e.g. age and drug problems) between the different treatment groups could contribute to variability in outcomes. A previous audit (Holt et al, 2011) has already confirmed that such differences do exist among the patients being analysed in this audit.

Mental health among high school students represents an important and growing public health problem in developing countries particularly in Saudi Arabia.

The objectives of this study were to estimate the prevalence of mental health problems among high school students at Al-Hassa, Saudi Arabia and to determine the possible correlates of these disorders among them.

A self administered anonymous survey was administered to a multistage random sample of high school students. A total sample of 1652 were selected by multistage proportionate sampling method. Information about socio-demographics, presence of chronic disease conditions and other potential correlates as financial, personal, family problems were collected. Depressive and anxiety disorders were assessed using the Patient Health Questionnaire (PHQ).

The estimated prevalence of any depressive or anxiety disorder was 21.9%. Major depressive disorders have been encountered in 9.9%, other depression of 19.4% and any depression of 24.4%. Panic disorder was found in 4.0% and generalized anxiety disorders in 14.0%. Suicidal ideation in the past four weeks was reported by 1.1% of students. Mental health problems were more prevalent among students of scientific department. Major depression and depression and anxiety disorders were significantly higher among girls. Logistic regression revealed that the type of department, female gender, chronic disease condition, the presence of financial and personal problems were the significant predictors for major depressive disorders.

These findings highlight the need to address mental health in adolescent population, particularly among those of lower socioeconomic status.

Investigation of the pathogenesis mechanisms in depression remains an actual task of modern psychiatry.

The analysis of clinical-psychopathological characteristics, functional activity of autonomic nervous system and endogenous opioid system in endogenomorphic depression. the main group included 72 patients diagnosed with depressive episode.

Clinico- psychopathological, clinico-anamnestic, Hamilton Depression Rating Scale (HDRS-17), the analysis of heart rate variability (HRV) for evaluation of autonomic regulation. in 9 patients plasma levels of beta-endorphin were obtained. Patients were investigated 3 times - at baseline, and then during 2nd–3d and 4th–6th weeks of antidepressant therapy.

The reduction of total HRV was observed at rest and in orthostatic test during evaluation of autonomic regulation in depressive patients. the hyperactivation of suprasegmental ergotropic systems was observed in depressive patients before treatment. in responders subgroup despite on positive dynamics of clinico-psychopathological and psychometric characteristics, in the 2nd–3d week of therapy increase in general HRV was observed, in the 4th–6th week parameters come back to baseline level. the balance of sympathetic, parasympathetic and suprasegmental parts of autonomic nervous system did not change. the plasma endorphin levels were rising to 2nd–3d treatment week, and come back to baseline level at the 4th–6th treatment week.

Obtained data confirm evidence that the therapeutic dynamics of depression is characterized by a faster reduction of clinical symptoms, whereas changes in functional activity of stress-realizing and stress-limiting mechanisms can be kept much longer.

This research is supported by grant provided by Russian Humanitarian Research Foundation project 11-06-00869а

The main description of alexithymia is a personality construct characterized by difficulties in experiencing and verbalizing emotions, and a poor capacity for symbolic thought reflected as a tendency toward externally oriented thinking.

The aim of the present study is to investigate the effects of alexithymia on tendency of somatization and sleep quality in depressive patients.

Eighty-five major depression patientswere included in the study. the Beck Depression Inventory (BDI), Toronto Alexithmia Scale, Symptom Interpretation Questionairre (SIQ) and Pittsburgh Sleep Quality Index (PSQI) were used for assesments and measurements.

Patients with major depression were divided into two groups that alexithymic and non-alexithymic according to the aim of the study. there were significant differences in the BDI scores, the number of somatizating symptoms and psychologizing and somatizing scale scores in the SIQ, and daytime functionality scores in PSQI between alexithmic and non-alexithymic depressive patients.

Alexithymia seems to be related with depressive symptomatology. Depressive patients with alexithymia may display abnormal health belief and difficulty in expressing their complaints. Therefore, alexithymia is a feature that affects the pattern of depressive symptoms. This present study confirmed that depressive patients have high prevalence of alexithymia, somatization and difficulty in expressing the feelings. Because of the loss of daytime functionality in the alexithymic depressive patients, clinicians should consider alexithymia in clinical practices.

Two 6-week, double-blind, placebo-controlled studies evaluated quetiapine XR (QTP-XR) adjunct to ongoing antidepressant therapy in patients with MDD and an inadequate response to prior antidepressant treatment (D1448C00006/D1448C00007).

A post hoc pooled analysis examined clinical and demographic characteristics as potential predictors of response to adjunct QTP-XR

Pooled MITT population (n = 616 QTP-XR [both doses]; n = 303 placebo) data were analysed from the two adjunct QTP-XR (150 or 300 mg/day) studies.

Effects of psychiatric history and baseline demographic and disease characteristics on efficacy were evaluated in subgroups based on Week 6 MADRS total score reduction: ≥50% reduction (responders: n = 345 QTP-XR, n = 140 placebo) versus < 50% (non-responders: n = 271 QTP-XR, n = 163 placebo); ≥75% reduction (responders: n = 175 QTP-XR, n = 60 placebo) versus < 25% (non-responders: n = 125 QTP-XR, n = 89 placebo).

Impact of baseline CGI-S score and number of episodes (0, 1, 2–3, 4–10, ≥10) over previous year and lifetime on Week 6 MADRS total score change was evaluated. Effect of baseline MADRS individual item (1–10) scores on Week 6 change in CGI-I score was evaluated.

No major differences between responders and non-responders to QTP-XR were observed for patient characteristics. there was no predictive association between baseline CGI-S score, number of depressive episodes, and baseline MADRS item scores and efficacy outcomes for adjunct QTP-XR.

This pooled analysis showed no major differences between responders and non-responders, and no suggestion of a predictive association between the parameters assessed and efficacy outcomes for adjunct QTP-XR. Further investigation including logistic regression may be required.

AstraZeneca funded.

It has been proven that depression increases the risk of cardiovascular and cerebrovascular disease through activation of the hypothalamic-hypophyseal-adrenal axis, sympatho-adrenal hyperactivation, vascular inflammation and increased aggregation of thrombocytes. Increased production of cortisol and inflammatory substances in depression and stress negatively impacts glikoneogenesis, dyslipidemia, glycemic control and insulin resistance, and increases the risk of endocrine-metabolic disorders.

Research the incidence and types of somatic comorbidity in depressed patients.

Observation of 65 patients hospitalised during one year at the Cantonal Psychiatric Hospital with a depressive disorder (ICD-10 criteria).

The patients were 24 men (36.92%) and 41 women (63.08%). 48 (73.85%) had one or more somatic diseases. Somatic comorbidity was observed in 31 women (75.61%), average age 51.2 years, and 17 men (70.83%), average age 52.8 years. 20 (41.67%) had 1, 24 (50%) had 2, and 4 (8.33%) had 3 somatic diagnoses. the relationship between age and gender and incidence of somatic comorbidity was analysed based on the first two diagnoses (statistical analysis by x2 and t-test).

Most diseases are endocrine-metabolic, where dyslipidemia and diabetes mellitus are most frequent, and cardiovascular, where arterial hypertension is most frequent.

There was no statistically significant discrepancy in the incidence of somatic comorbidity and depressive disorder depending on gender (p = 0.29) and age (p = 0.25). Statistically significant discrepancy was observed between patients with somatic comorbidity (p < 0.05) and patients without physicall diseases.

Depressive disorder is accompanied by somatic comorbidity at a high rate, but there is no statistical discrepancy depending on gender and age.

Recent findings suggest that functional irregularities in oxytocin biology may play a role in the pathophysiology of depression. One of the proposed pathways is related to stress, as oxytocin exerts a regulatory effect over neuroendocrine stress axis. Moreover, stress exposure and stress axis dysregulation are likely connected to dissociative symptoms.

Therefore, the study investigates the relationship between depression severity, stress symptoms levels, dissociation and plasma oxytocin levels.

Depression severity was assessed by Beck Depression Inventory (BDI-II), symptoms related to stress were assessed by Trauma Symptom Checklist (TSC-40), psychological and somatoform dissociative symptoms were assessed by Dissociative Experiences Scale (DES) and Somatoform Dissociation Questionnaire (SDQ-20), respectively. Plasma oxytocin was measured using radioimmunoassays.

69 patients were included in the study, 34 in severe depression group (BDI-II≥29) and 35 in mild to moderate depression group (BDI-II≤28). the groups did not differ significantly in oxytocin levels. in severe depression group, negative correlations between oxytocin and TSC-40 and SDQ-20 were found (R = −0,55; p < 0,01 and R = −0,35; p < 0,05, respectively). Interestingly, no significant correlation was found between oxytocin and BDI-II.

The negative correlation between oxytocin and symptoms related to trauma and somatoform dissociation in severe depression group is, to our knowledge, the first finding in this context. It is consistent with stress-reducing effect of oxytocin in acute stress paradigms and suggests that stress and somatoform dissociation may represent important factors in complex relationship linking oxytocin to depression. the directionality of these relationships need to be assessed in longitudinal studies.

A number of studies of a possible relationship between duration of untreated illness (DUI) and various psychiatric disorders shown the possible role of DUI as negative prognostic factor in schizophrenia and psychotic disorders. on the other hand few data evaluate the role of DUI in the clinical outcome of major depressive disorder.

Analyze the duration of untreated illness and evaluate long-term outcomes in major depressive disorder.

Sample of 73 subjects (53F and 20M) with major depressive disorder according to DSM-IV-TR. We collected demographic, clinical and outcome data: Age, sex, family history, age at onset of illness, age of first antidepressant treatment and dosage, possible comorbidity with other diagnoses and substance abuse, number of depressive episodes before and after treatment, number of hospitalizations and suicide attempts.

Results show that the DUI is longer in the male than in the female sample (p = 0.049) and long DUI is related to an onset disorder at a younger age (p = 0.040) and with a longer duration of illness (p = 0.006). It was also demonstrated that the number of depressive episodes prior to the first antidepressant treatment is higher in the sample of patients with a longer DUI (p = 0.006).

These results show that the duration of untreated illness is longer in the male sample; other results are consistent with previous studies and show a better outcome of depression in patients with a short duration of untreated illness.

Fear of cognitive dyscontrol -one of the lower-order factors of the Anxiety Sensitivity (AS) construct - has been proposed as a vulnerability factor for depression (DEP). AS-cognitive dyscontrol is supposed to act as either a pre-existent enduring vulnerability trait or a psychological post-depression “scar” which would render an individual vulnerable to future episodes of DEP.

Results from previous research on this topic are limited and inconsistent, and most of them were addressed using cross-sectional design.

This study examined whether fear of cognitive dyscontrol did prospectively predict DEP.

A total of 182 subjects from the general population participated in the study (69% females; Mean age = 32.6, SD = 14.3, Range = 18–65). Participants completed measures of AS and DEP at T1 and T2 (one year later).

Hierarchical regression analyses, controlling for background variables and depression at T1, did not support the AS-cognitive dyscontrol domain as a significant predictor of DEP at T2. However, secondary analyses showed that scores on the AS-cognitive dyscontrol domain at T1 did significantly predict DEP at T2 among males and younger participants, while it did fail to predict DEP among females and older participants.

Findings support the AS-cognitive dyscontrol facet as a pre-existent enduring vulnerability trait for DEP, and provide preliminary support to the role of age and gender as moderators of such a relationship, suggesting new insights to explain previous inconsistent results in the field.

When treating people suffering from major depression just one third achieve a complete remission of the symptoms, another one third have a partial response and the last third don't obtain any kind of response. According to STAR*D study, in less than 40% of the cases treated with one SIRS symptoms improved totally. When changing the first SIRS for another antidepressant, in less than 25% of the cases remission was obtained. the next strategy used was to combine two antidepressant, getting just 5,8% more remission and finally, the last step when treating major depression is the potentiation between antidepressant and other therapies (lithium, T3), obtaining 6,3% of accumulated rate of benefit.Quetiapine with its triple action mechanism (dopaminergic, serotoninergic and monoaminergic) have demonstrated when used in combination with antidepressants to obtain remission stadisticaly promoved when compared with the other strategies explained above.

To demonstrate using a clinical example the remission of major depression symptoms when combining quetiapine and other antidepressant after the non response even with electroconvulsive therapy (ECT).

Hamilton scale is used to measured the improvement of the case explained.

Quetiapine used with dual antidepressants after non response to ECT and other basic steps to treat major depression, reduces depression symptoms until total remission (Hamilton scale < 7).

Quetiapine used in combination improves totally major depression symptoms. It can be an other clinical strategy when symptoms appear resistant.

The search for a reliable biological marker in depression is on-going. Visual contrast sensitivity has recently been reported to be lower in depressed patients compared to healthy controls. We aim to examine the consistency of this finding and to explore the underlying retinal electrophysiology.

Pattern electroretinogram and subjective visual contrast test were used to assess visual contrast sensitivity in 20 subjects with major depressive disorder and 20 healthy controls. Full-field electroretinography assessed the general neurophysiology of retinal function. Depression was diagnosed based on DSM-IV criteria and depression severity was measured by MADRS and BDI.

Visual contrast sensitivity was significantly lower in depresssed patients than controls based on Landolt C visual contrast test [Weber 2.25 ± 1.84(SD) vs. 1.20 ± 0.64(SD); p = 0.02]. No difference was found between the groups using PERG. Greater severity of depressive symptoms correlated with poorer visual contrast sensitivity (r = 0.49, p = 0.001).

Although depressed subjects clearly had reduced visual contrast sensitivity, this was not consistently demonstrated using PERG. the neurobiological link between major depressive disorder and visual contrast sensitivity requires further investigation.

Feelings and emotions are influenced by cultural factors. there are no specific words to refer to the emotional states of individuals in some cultures and sub-cultures around the world.Somatic metaphors and complains are the main outlets for emotional discharge in these cultures.

Analysis of presenting symptoms of the patients suffering from depression referred to the psychiatric clinic of Shiraz university of Medical Sciences.

Better understanding of distribution of the patient's chief complaints among people with different sex, marital status, place of residency and education.

300 patients with major depressive disorders referred to our clinic were selected by simple sampling. Diagnosis of the disorder was made based on the DSM-IV-TR criteria after a psychiatric interview. These patients had no history of any substance abuse or dependence. Also, their symptoms could not be explained by a general medical condition or other psychiatric conditions. Through psychiatric interview, we assessed the chief complaints and other presenting symptoms of these patients and then compared them according to such variables as sex, age, marital status, place of residency and education.

The most frequent complaints of the patients was headache and pain in other areas of body. Also this study showed a significant relationship between the chief complaint (physical vs. mental) and sex, marital status and place of residency.

Pain and other somatic complaints are important presenting problem among depressive patients.Paying proper attention to somatic complaints in some cultures, can lead to better understanding of patients and prevent unnecessary expensive interventions.

The main objective of this research is to determine the effect of group counseling with cognitive - behavioral approach on reducing depression in children of divorce supported by Tehran welfare centers.

The research method was quasi experimental with pre test-post test design and control group. A sample of 20 children who resident in two residential welfare centers in Tehran was selected by an available sampling method. Using Maria Kovacs (1977) children's depression questionnaire (CDI) as a pre test indicated that all participants were depressed. Then the two centers were randomly assigned to experimental and control groups. the experimental group received training - treatment program in 8 sessions (each one hour). Finally, all participants answered the questionnaire in post test and Hypotheses were tested by co-variance analysis.

Results indicated that the post-test values have been affected by the group counseling by 85.5% (F = 94.263, P < 0.01). Moreover, group counseling has an effect on decreasing the level of children's insufficiency by 25.3% (F = 5.088, P < 0.05).

According to the results it could be concluded that group counseling with cognitive-behavioral approach had a positive effect on reducing depression and insufficiency.