In everyday psychiatric practice it is often difficult to differentiate primary psychiatric illness of comorbid disease.

H.I., 45 years old, laborer, married, graduated on teacher Faculty. CMHC outpatients in three years of depression orally with antipsychotics, antidepressants and fluphenazine depot.

Came to the hospital treatmernt with the diagnosis of sch. catatonia.

Upon receipt, difficulty speaking, hypomimia, slow gait, upper limb in flexion and rigor muscle.

Clinical examination, psychiatric interview, psychological testing, biochemical testing, radiographic testing and madopar test.

Faster detection and differentiation of the existence of the clinical picture of primary disease and comorbid disease that was generated polipragmatic medicament approach.

The rapid differentiation of established diagnosis of primary and secondary neurologic disease. Body symptoms be reduced only after a month of treatment with symptomatic infusion and sedative. benzodiazepine 15 mg pro die. It was madopar test despite clinical neurologists and psychiatrists dilemma contributed fully that this symptom was not about schizophrenia but about medicament parkinsonism caused by various sort of therapy.

Side effects of depot antipsychotic therapy and pharmacotherapy lead to parkinsonism medicament which is wrongly recognized as depression and, unfortunately, later as an outpatient during the catatonia of schizophrenia. Include depot therapy with extreme caution, only in cases where the pre-clinical detail, examined the patient, especially when there is any organic changes in the brain or suspicion of intellectual inferiority.

VEGF exerts diverse effects on the cardiovascular system. VEGF and its receptors are also expressed in the central nervous system. Moreover, accumulating data suggest that VEGF is involved in the etiopathogenesis of depression. to date, the association of the −2578 C/A SNP with depression has been investigated only by two research groups but their results are conflicting.

In the present study we tried to assess the potential association of the −2578 C/A polymorphism with mood disorders (MDD and BD).

220 patients (MDD: 140; BP: 80) with a current episode of major depression (MDE) were recruited at our department. HADS was used for the assessment of the severity of depressive symptoms. Control subjects without psychiatric history were also enrolled (n = 410). VEGF −2578 C/A SNP was analyzed with quantitative PCR.

We found no significant differences in allele frequencies between cases and controls (neither in the comparison of whole patient sample vs. controls nor in comparisons of patients with MDD or BP vs. controls). Nevertheless, depression scores of patients with MDD who carry the C allele were significantly higher (p = 0.012).

Our preliminary results suggest that presence of the C allele might predispose to a more severe MDE in patients with MDD. This is in partial agreement with the results of Viiki et al. who found that the CC genotype was more frequent among patients with MDD than in control subjects and also associated with treatment resistant depression.

The study was supported by OTKA 80289 national grant.

There is a marked overlap between the neuronal pathways involved in sleep/wake regulation and depression. Both the structure and the organization of sleep are altered in depressed patients; they enter the rapid eye movement (REM) sleep earlier, the amount of REM is increased and also the non-REM sleep is reduced in the first sleep cycle.

Serotonin reuptake inhibitor antidepressants (SSRIs) exert their therapeutic effect on the serotonergic system, which has a central role in the modulation of mood and vigilance.

The aim of this study was to investigate the acute and long-term effect of the SSRI escitalopram on REM sleep in rats.

The effect of a single (10 mg/kg i.p.) and chronically administered (10 mg/kg/day, released by an osmotic mini pump for 21-day-long) escitalopram was studied in male Wistar rats. Electroencephalogram, electromyogram and motility were recorded for three hours starting at light onset.

The acutely administered escitalopram significantly reduced the time spent in REM sleep in the first three hours, compared to control. However, this REM-reducing effect was abolished after chronic administration.

There was a clear difference in the effect of escitalopram on REM sleep following acute and chronic administration, providing evidence for the adaptive changes of serotonin receptors, which take several weeks to evolve, and considered to have a role in the development of therapeutic effect of SSRIs in the treatment of depression. This study was supported by the TAMOP-2.2.1. B-09/1/KMR-2010-0001 and by Richter Gedeon Plc.

Obtaining early markers of predictive response in clinical practice has become a need in the management of depression.

To detect early (at week 2) clinical markers predictive of clinical response after 6 weeks of treatment with agomelatine in an open, naturalistic study.

2,780 outpatients were treated by Agomelatine during 6 weeks for MDD. They were assessed at baseline, week 2 and week 6 for the QIDS, a VAS assessing present level of mood, sleep complains (LSEQ), social functioning (SDS), and emotional state (MAThyS). ROC curves were used to assess the best balance between sensitivity and specificity for each parameter.

The patients were 47 years old in average (+/- 12.4), with 67% of females, with, in average, a 10-year course and 2 previous episodes.

The ROC curves showed that 20% improvement of the QIDS at week-2 had the largest area under the curve (AUC = .687). the CGI-EI (AUC = .671), and a simple VAS assessing the level of mood at week-2 (AUC = .659) had results in the same range. Treatment response, improvement of social functioning (SDS) or a decrease of sleep complains (LSEQ) were not significant, confirming that early improvement of sleep is not predictive of later response.

Early improvement at week 2 with agomelatine may be used to detect later responders. This improvement can be perceived both by clinicians (QIDS or CGI-EI) or patients (level of mood according to a simple VAS). to our knowledge, this positive predictivity has not been previously observed in a naturalistic study on MDD.

Unfortunately, many patients who remit fully or partially from an episode of major depression continue to have difficulty in achieving the recovery.

Our study assesses the effect of some probable risk factors on the non-recovery in a group of major depressive patients.

Sixty patients, 18 to 65 years of age, with current major depressive disorder defined using DSM-IV-TR criteria were participated in the study. They began a 24-week course of open-label acute plus continuation phase treatment mainly with SSRIs, especially escitalopram. Maintenance treatment was not planned for not affecting the natural course. All participants were evaluated by CGI-S, BDI, HAMD-17, PSQI, and ISI at weeks 0, 4, 12, 24, and 52.

Logistic regression analysis was done to predict the effect of some probable risk factors that obtained from 1st evaluation (at week 0) on the non-recovery (at week 52) and current age, number of previous episodes, age of first depressive episode, and episode type (first-episode versus double or chronic or recurrent) were found to be statistically significant.

Early recognition of the socio-demographic and clinical risk factors impairing the recovery process of the major depressive disorder may be important for developing an individualised treatment plan.

It has been widely pointed out the possible overutilization of antidepressants but needs of antidepressants have to be established through the prevalence of treatable disorders. in Portugal, utilization studies are scarce, relying in short time periods and no estimated utilization needs.

To describe the evolution of antidepressant utilization in order to ascertain if, in Portugal, there is excessive consumption of antidepressants.

We obtained raw data of number of units of pharmaceutical substance sold per year, using the WHO-ATC classification and the estimated annual population, and then we derived the assumed average maintenance dose per day for a drug used for its main indication in adults (DDD) per thousand inhabitants per day (DHD). We calculated an estimate of DHD that would meet the needs requirements established in the National Census of Psychiatric Morbidity for the year 2009, knowing that about 1% prevalence of treatable disorders correspond to 10 DHD.

Overall, there was an increase in DHD in the last 15 years. However, since 2002 there has been a slowing in growth.

The available data from the Census of Psychiatric Morbidity point to an annual prevalence of mental disorders of 22,9% and a treatable prevalence of 15.6% severe and moderate severity disorders. the resulting 156 DHD of antidepressants, is the double for 2009 figures (75 DHD), so it is not possible to state an excessive utilization.

To determine the association of religious moral beliefs and depression severity of war veterans in Bosnia and Herzegovina.

The sample consists of 65 male war veterans inpatients with clinically presented depression and 65 controls who were observed as healthy regarding results of previous psychological testing. Were applied the Bosnia-Herzegovina versions of Hopkins Symptom Checklist, Harvard Trauma Questionnaire and Religious moral beliefs questionnaire.

Depressed war veterans were older (mean±standard deviation=44.5 ± 7.3) years than not depressed (37.4 ± 3.4) (F = 50.651, P < 0.001, ANOVA). the trauma experiences' mean score of war veterans was (mean±standard deviation) 32.6 ± 12.5 with significant statistical differences between depressed (36.8 ± 13.4) and not depressed war veterans (28.4 ± 10.1) (F = 16.715, P < 0.001, ANOVA). Among depressed war veterans Index of Religious Moral Beliefs (IRMB) was significantly lower 40.1 ± 5.2 than among not depressed war veterans (42.0 ± 4.0) (F = 4.354, P = 0.039, ANOVA). in this sample of war veterans, we found that the IRMG was inversely correlated to age (Pearson's “r” = −0.193, P = 0.043), trauma experiences severity (Pearson's “r” = -0.234, P = 0.014) and depression severity (Pearson's “r” = -0.242, P = 0.011). Trauma experiences severity and depression severity positively correlated to age of war veterans (Pearson's “r” = 0.243, P = 0.005; Pearson's “r” = 0.562, P < 0.001, respectively). Depression severity positively correlated to trauma experiences severity of subjects in this study. Subjects with higher moral belief index were younger, reported significantly less trauma experiences severity and expressed significantly less depressive tendencies.

The religious moral beliefs may help protection of the war veterans’ mental health stability after surviving multiple war traumas.

Serotonin systems play a key role in the pathogenesis of major depression, SSRIs drugs are the first step in its treatment. Serotonin transporter (5HTT) gene is known as the responsible gene for Major Depression Disorder. Deletion or insertion in the 5-HTTLPR creates short and long alleles. Detecting the genotype regulatory region in (5HTT) can be useful and individual for everybody antidepressant treatment.

Western reports have demonstrated that l allele is associated with better SSRIs anti depressive effects than the s allele. Study of a Korea had contrasting finding.

There is association between treatment outcome phenotypes and HTTLPR in Iranian Major Depressive Population.

In this study, 105 patients with MDD (according by DSM-IV-TR) treated by Citalopram. on the other hand genotyping for alles of 5HTT and level of drug serum was obtained. Beck depression test was done in the first, 4th and 8th week. Dose Citalopram was 20–60 mg/D. Lack of clinical response was studied with mental state and Beck Depression test, then if there was no response the drug changed.(after 4 weeks).

In Iranian patients frequency of each allele base on the population study is near to 0.5 (L: 0.48 and S: 0.52). 69% of the patients with allele L (L/L or L/S) respond to Citalopram, while just 44% of the S/S patients did not need to change the drug.

Our study confirms the hypothesis that the L allele is associated with better response to antidepressant drug (P value=0.033. CI: 95%).

To associate the salivary cortisol levels, prior to antidepressant treatment, and the CRHR1 rs242939 polymorphism with the response to therapy with fluoxetine.

We performed a pharmacogenetic prospective longitudinal study including clinic follow-up, endocrine and genetic evaluations. After diagnosis, patients started the pharmacotherapy. the severity of the disease and clinical response were evaluated by the Hamilton Depression Rating Scale (HAM-D). Rapid and slow responses were considered as reductions in the HAM-D scores of at least 50% at the third and eight weeks respectively.

157 patients were recruited. Salivary cortisol levels at 8:00AM were lower in rapid responders than in not responders (p-value = 0.0122). No differences were observed after eight weeks of treatment. the rs242939 polymorphism was in Hardy Weinberg equilibrium (p = 0,24) and was significantly associated with early response (p = 0.019). there was no association after two month of therapy.

Alterations in the CRHR1 receptor may significantly impact the regulation of stress response. the association observed in this study may be related with some refractoriness in the regulation of CRHR1 gene in non responders.

By Fondecyt 1090219.

The study of self-referential brain activity may be of great importance in order to gain a better understanding about self-related symptoms at the psychopathological level in affective disorders.

A previous investigation in healthy individuals showed that emotional introspection in comparison to cognitive self-reflection was associated with enhanced activation in prefrontal regions as well as reduced amygdalar activity. Hence, emotional introspection is in accordance with a mindfulness based treatment potentially reducing emotional arousal.

In the present study, this was also investigated in depressed patients.

20 depressed patients performed either cognitive self-reflection (“who am I…”) or emotional introspection (“what do I feel..”),12 seconds each, while they were scanned with functional magnetic resonance imaging (fMRI). Results were compared with the data of 20 healthy individuals.

In the comparison of emotional introspection versus self-reflection, depressed patients showed greater brain activity in prefrontal and parietal cortical midline areas, including cingulate cortex. While activation in the left amygdala was reduced during emotional introspection, it was enhanced during the self-reflection condition. in comparison with healthy individuals, patients showed pronounced brain activity in medial as well as dorsal prefrontal regions during introspection versus self-reflection.

By means of mindfulness like emotional introspection, depressed patients are able to down-regulate their amygdala, which is in support with mindfulness based cognitive strategies in psychotherapy. Nonetheless, increased prefrontal activation in depressed patients may indicate a greater need for resources.

It is known that Sexual Dysfunction (SD) is higher in patient with depression than in the general population. Though antidepressant seems to worsen the situation, there are also indications that the gender may play a role on it.

Evaluate the gender effect of sexual function among unmedicated MDD, MDD receiving antidepressant, and healthy controls.

The sample was formed by male and female Taiwanese outpatients in three age and sex matched groups, with sixty nine participants per group: unmedicated MDD, MDD receiving antidepressant, and healthy controls. the diagnoses of depressions were performed according DSM-IV and Taiwanese Depression Questionnaire. SD was evaluated with the Chinese version of the Changes in Sexual Functioning Questionnaire. Finally, the data was analyzed using SPSS software v17. Mixed designed ANOVA was used.

There are significant differences between males and females CSFQ results (sex main effect F = 82.44, p < 0.001) and between groups (group main effect F = 3.48, p = 0.034). Additionally, the 2-way interaction between sex and group was also significant (F = 3.40, p = 0.036). Simple main effect analysis shows differences among male participants, between healthy and medicated males (F = 11.41, p = 0.002), but not in female (F = 1.58, p = 0.21). However the statistics weren’t different between females groups, the medicated expresses better results (similar to healthy group) than the unmedicated one.

SD is different between genders in each of the groups. Antidepressant seems to increase SD in man, while improves sexual satisfaction/function among depressive woman. We speculate that psychological improvement after treatment may have different impact between genders on sexual satisfaction.

Demonstrating the superiority of antidepressants over placebo in randomized clinical trials of antidepressants (RCT-ADs) has been difficult. A recent meta-analysis of six RCT-ADs, by Fournier et al., concluded that the efficacy of antidepressants was “nonexistent to negligible” in mild and moderate depression.

To reanalyze the same data in order to investigate if the meta-analysis was biased from insufficient measurement properties of the rating scale used, the 17-item Hamilton Depression Rating Scale (HDRS).

We got access to the primary data on item and individual level from 5 of the 6 meta-analyzed RCT-ADs. We reanalyzed these data by means of Item Response Theory (IRT).

In each of the five studies the reliability of measurement was rapidly decreasing with diminishing depression severity. This resulted in low precision of measurement at endpoint levels and an underestimation of score reductions in patients who initially had milder depressions. as a consequence, 38% of the combined sample was measured at endpoint with IRT estimates of reliability that were less than half of the maximal.

The HDRS biases randomized clinical trials of antidepressants by providing unreliable primary data. Low or absent effect sizes are to be expected because of the scale's low precision and low sensitivity to change, particularly in mild and moderate depression. the conclusion of the Fournier et al. meta-analysis was therefore unfounded. the clinical value of antidepressants cannot be evaluated from unreliable data. Better measurement techniques for depression severity are urgently needed.

The city of Patras participates in the “Healthy Cities” project implemented by the WHO - Europe office. Within this framework the “Profile of the city of Patras” was examined and depicted in a study conducted among the city's population.

To estimate the frequency of depressive disorders as reported by the citizens of the city and examine burdening as well as protective factors.

A representative random stratified sample was selected to be interviewed, including 769 men and 930 women, from the city area. Participants answered a questionnaire which enquired among other on self perceived physical and mental health. Participants were also asked the following questions: “Do you have/had in the past depression or/and anxiety?” and “Have you received a medical diagnosis for this disorder?”.

Approximately 55% of the sample reported they had experienced anxiety and depression (41% moderate and 14% severe episodes). Diagnosed depression was reported by 3%. Depressive disorders were more frequently reported by women (65%, p < 0.001), older aged citizens (62%, p < 0.001), people out of employment (59%, p = 0.001), married (59.1%, p < 0.001), lower educational status (70%, p < 0.001) and lower family income (< 1000€=62,6%, p < 0.001). Depressive disorders were more frequent among people with chronic diseases (p< 0.001).

Anxiety and depression are frequently reported disorders among the citizens of Patras although official medical diagnosis is rarely provided and consequently therapy is rarely offered. Specific population groups -women, elderly citizens, patients with chronic diseases- are more vulnerable to depressive disorders requiring specialized medical attention.

Cysts are common findings at magnetic resonance (MR) and computed tomographic(CT) brain imaging. Their histopathologic spectrum is broad, and differentiation of these cysts on the basis of imaging findings alone can be problematic

This is a case of a 32 year old man reported depressive syptomatology and after brain MRI examination a epidermoid cyst was found.

The relation between brain epidermoid cyst and depressive symptomatology

The patient had suddenly symptoms of severe headache accompanied, fatigue, depressed mood most of the day, marked diminished interest or pleasure in all, or almost all activites, insomnia and diminished ability to think or concentrate. there was no organic problem in his medical history and there were any difficulties in his professional or his personal life. there was no family history for neurological diseases but his brother is suffering from Gille de la tourette. the symptoms progressively increased and patient visited a psychiatrist who recommended an MRI examination and the result was the following:

Brain MRI Examination revealed a cystic lesion in the posterior part of the 3rd ventricle, with a maximum diameter of 2.8 cm approximatelly and obstucts the Sylvious aqueduct which causes more centrally dilatation of the 3rd ventricle and the lateral ventricles too. the images after the intravenous contrast administration show no abnormal enhancement. Pituitary gland and paranasal sinuses appeared normal.

Orbital structures appeared normal.

After a surgical intervention depressive symptomatology was remised.

Epidermoid cysts can be masked from depressive syptomatology.

Depression with psychotic symptoms or “psychotic depression” (PD) is a prevalent, under-diagnosed and under-treated mental disorder, which has received disproportionally little attention by clinicians, researchers and the pharmaceutical industry.

To document potential ambiguity in current treatment guidelines on PD and to determine whether such heterogeneity is reflected in the clinical practice of Danish psychiatrists.

To answer the following questions:

1. Is there consensus regarding first-line treatment of PD among the major treatment guidelines?

2. Do Danish psychiatrists treat PD in accordance with the guidelines?

3. Which antidepressants (AD) and antipsychotics (AP) are first-line choices among psychiatrists?

1. 1. Review and comparison of 10 international guidelines on the treatment of PD with main focus on first-line treatment.

2. 2. Questionnaire based survey on psychiatrists treatment of PD conducted at the annual meeting of the Danish Psychiatric Society.

Treatment guidelines had vastly different opinions on first-line treatment choice: 8/10 suggesting AD+AP combination therapy, 2/10 preferring AD monterapy and 6/10 finding ECT equally appropriate as first-line treatment. the 113 surveyed doctors reflected the same heterogeneity. the preferred first-line treatment choices where AD+AP combination therapy (41.6%), AD monotherapy (31.0%) and ECT (21.2%). the firstline choices regarding ADs and APs were TCA (51.3%) and quetiapine (62.0%) respectively.

There is clear evidence that the treatment of psychotic depression is heterogeneous, as seen in both various international guidelines and the survey of clinical practice. This is most likely due to a weak body of evidence to support clear recommendations in the guidelines.

Donepezil is a reversible, centrally-acting acetylcholinesterase inhibitor used in the treatment of mild to moderate symptoms of dementia associated with Alzheimer's disease. in recent years, there has been emerging evidence of its use in other conditions, such as Lewy Body dementia and autism. However, there have been few reports of the use of Donepezil to treat depression in the absence of cognitive impairment.

This is a case report of a 62-year old female with a long-standing history of major depressive disorder with no history of cognitive impairment, who failed to respond to antidepressants with augmentation therapy including antipsychotics, lithium and methylphenidate; but eventually improved on Donepezil.

A then-56-year old Chinese lady diagnosed with major depressive disorder, was treated with several antidepressants with poor response. Despite augmentation with dual antidepressants, antipsychotics, methylphenidate and lithium, her symptoms of avolition, depressed mood and irritability persisted. After 4 years of antidepressant treatment, she was started on donepezil 5 mg. Within a month of augmentation, significant improvement in symptoms were reported, notably in mood and volition, and the patient was able to engage in an active and meaningful lifestyle of semblance to her pre-morbid mental state.

This case highlights the possibility of Donepezil being used as an adjunctive therapy in major depressive disorder, even in the absence of cognitive impairment. Future studies to investigate the use of Donepezil may therefore be worthwhile to explore its use in this population of patients.