In this study we examine among those under the age of 18 years having somatoform disorders, the relationship between physical health and mental health costs in comparison to those with other psychiatric disorders.

Based on approximately 10 Million billing records, we compared the average number of visits and average costs per unique individual for “physical diagnoses” (non-psychiatric) and psychiatric diagnoses over the 16 year study period across case and comparison groups. Here, we report the 16 year prevalence of somatoform disorders in the population.

Somatoform disorders ranked 15th in terms of overall cost in the comparison group which was randomly selected from the physician billing data pool. Somatoform disorders ranked 22nd of 25 in terms of frequency of diagnosis. The cumulative frequency of somatoform disorders over the 16 year interval for individuals was 169 within the 26,392 cases and 479 within the 205,281 comparisons, representing approximately 0.8% of the sampled population total population in catchment ∼300,000).

The prevalence of treated Somatoform disorders indicates that they are are relatively rare in the study population. Lieb et al. (2002) found a lifetime prevalence of 12.5% of any somatoform condition in German adolescents. Kebede and Alem (1999) reported a one month point prevalence of 2.5% for Ethiopian youth. Somatoform disorders are most commonly seen in children and adolescents and appeared to be diagnosed much less frequently among Canadian children and adolescents. Differences are likely based on sampling methodology used epidemiological surveys compared to population utilization.

To evaluate the effectiveness of TMS in depressed patients with chronic pain in a naturalistic outpatient treatment setting.

To evaluate the significance of improvement in depressive symptoms in response to TMS course and to compare the response of two groups of patients: with changes in psychotropic medications during the TMS course and without changes.

A retrospective cohort study queried the database of patients with treatment resistant depression and comorbid chronic pain. The severity of depressive symptomatology was assessed with 21-item Hamilton Depression Rating Scale (HAM-D) before and after TMS. Patients were distributed to Group A (N = 53; with changes in psychotropic medications) and Group B (N = 21; without changes in psychotropic medications). Data were charted and analyzed by t-tests and percent change.

HAM-D percent changes between Groups A and B revealed a significant difference (p < 0.01). Based on Group B results, a population can expect at least 30% decrease in

HAM-D scores following TMS (p < 0.05). Conversely, according to Group A, 30% decrease cannot be expected (p < 0.05). Furthermore, Group B demonstrated greater percentage of patients with >50% decrease in HAM-D scores over Group A.

TMS is effective in decreasing symptoms of depression in patients with chronic pain.

TMS was more effective in patients who did not have changes in psychotropic medications during treatment.

Electroconvulsive therapy (ECT) was first used in the United Kingdom in 1939. Although its use has been declined for several decades, it is given to about 11,000 people a year. ECT is commonly used in depression in the majority of patients, but occasionally used for catatonic schizophrenia and severe mania. Unfortunately, there have been issues raised regarding its negative impacts on memory capacity of the patient.

ECT until now has gained the support of most professional psychiatric associations, although there are still some health professionals who are doubtful about its effectiveness.The aim is to find out psychiatrists' attitude toward ECT in the Dudley and Walsall Mental health Partnership NHS Trust in The UK.

A self administered mail survey was used to gather demographic data and information on attitudes toward ECT. 11 quetions were use.

:

1. • About 60 % responded the mail survey.

2. • Respondents have mean age of 47.

3. • Consultants and middle grade doctors are major participants.

4. • About 96% administered ECT before.

5. • 100% think that ECT should be available to their patients and 96% found that ECT is useful. 88% believed that ECT is safe.

6. • 79% would consider ECT for themselves or family member if indicated.

Most had the positive attitude toward ECT and they believed that ECT was safe alternative treatment for their patients and would consider for themselves and their family members regardless of whether they had ever administered ECT. Therefore the majority of psychiatrists in our trust supported the use of ECT.

Transcranial Direct Current Stimulation (tDCS) is a non-invasive, technique for brain stimulation. Anodal stimulation causes neuronal depolarisation and long-term potentiation, while cathodal stimulation causes hyperpolarisation and long-term depression. Stressors are associated with an increase in sympathetic cardiac control, a decrease in parasympathetic control, or both. Associated with these reactions is a frequently reported increase in Low Frequency (LF) Heart Rate Variability (HRV), a decrease in High Frequency (HF) power, and/or an increase in the LF/HF ratio.

The present work aims to explore the tDCS potential in the modulation of the Autonomic Nervous System (ANS), through indirect stimulation of Anterior Cingulate Cortex (ACC).

Two subjects, a 39 year old female and a 49 year old male, gave informed consent. Saline soaked synthetic sponges involving two, thick, metalic (stainless steel) rectangles, with an area of 25 cm2 each have been used as electrodes, connected to Iomed Phoresor II Auto device. It has been delivered a 2 mA current, for 20 minutes, over the left Dorsolateral Prefrontal Cortex (DLPFC) (Anode). Spectrum analysis (cStress software) of HRV has been performed before and after tDCS administration.

The female/male suject results of LF power, HF power and LF/HF ratio, before tDCS administration, were, respectively: 50,1 nu/60 nu, 46,1 nu/21,7 nu and 1,087/2,771; and, after tDCS administration, respectively: 33,5 nu/52,7 nu, 47,6 nu/22,8 nu and 0,704/2,312.

tDCS over the left DLPFC (left ACC) increased parasympathetic activity and decreased sympatethic activity, sugesting the importance of tDCS in the management of stress-related disorders.

To measure the change of mental status, medication dosage, and adverse effect of medication in patients with treatment refractory schizophrenia after administering ECT.

To objectively demonstrate the change of pharmacological response in patients with treatment refractory schizophrenia after receiving ECT.

A retrospective study of seventeen patients was done. All patients were diagnosed with schizophrenia and received ECT as secondary indications in a psychiatric hospital in Japan from 2004 to 2010. As part of the evaluation protocol, Clinical Global Impression (CGI) scale was administered at the baseline and twelve months after taking ECT. The dosages of antipsychotics were also evaluated as Chlorpromazine (CPZ) equivalents.

On twelve months, nine patients were able to maintain their improvement with pharmacological treatment only. On the contrary, eight patients failed to pharmacological treatment and were rehospitalized. Five of them required additional course of ECT. Two patients continued to take maintenance ECT. Mean CPZ equivalents were reduced from 1,505 mg to 1,130 mg.

ECT may revitalize the pharmacological response to antipsychotic medications even if the same medication failed to gain satisfactory improvement before. ECT may also reduce the dosage of antipsychotics required to avoid relapse although the change of dosage was small. We need large samples and further studies to determine the clinical significance of these findings.

The aim of our study was to examine whether the change of current density detected by standardized low resolution brain electromagnetic tomography (sLORETA) is different between responders and non-responders to prefrontal repetitive transcranial magnetic stimulation (rTMS).

A total of 25 inpatients with depressive disorder (DSM-IV criteria), who previously did not respond to at least one antidepressant treatment underwent 4 weeks of rTMS treatment (1 Hz, 100% of motor threshold, 600 pulses/session, 20 session) applied over the right dorsolateral prefrontal cortex. 19-channel EEG was recorded before treatment and 3 days after rTMS treatment. The effect of rTMS on brain electrical activity (revealed by the use of sLORETA, Pascual-Marqui RD, 2002) was measured separately in responders (reduction of MADRS≥50%) and non-responders.

The significant current density increase in alpha 1 band was detected in prefrontal and limbic cortex (Brodman areas 6, 8, 9, 32) bilaterally (p < 0.05, corrected) in a group of nine responders. No significant changes were detected in non-responders.

Our findings implicate that the antidepressant effect of 1 Hz rTMS is connected with a current density increase in alfa 1 band in the prefrontal cortex. Supported by 1M0517 and MZ0PCP2005.

Many MRI studies have cited major depression, with or without anti-depressive treatment, associated with structural plasticity changing in several brain regions. Few of these studies researched the effect of the anti-depressive treatment, electroconvulsive therapy (ECT), on depression.

To assess the influence of ECT on the brain structure change during the treatment process by utilizing the voxel-based morphometry (VBM) analysis.

To determine whether ECT alter brain structure.

We performed HAMD ratings and MRI scans on 12 depressive patients during ECT, analyzing the data by VBM with SPM8 software's family-wise error correction (FWE).

The researchers found volumes changes in white matter in 37 regions between pre-ECT and post-ECT1, but only one region changing between pre-ECT and post-ECT8. Seven regions changing in grey matter between pre-ECT and post-ECT 1⌧but none regions changing between pre-ECT and post-ECT8.

The density changes in several brain regions after a single ECT stimuli, but return to the original level after completing the eighth ECT. Our finding supports that ECT may play a temporary role in treating major depression but do not permanently alter the structures of brain.

There is robust evidence recommending electroconvulsive therapy (ECT) in treating severe acute affective disorders. The clinical use of bitemporal electrode placement is still favoured to unilateral placement with just a relative disadvantage in cognitive side effects. Recently, bifrontal placement has gained popularity but there is still limited evidence on its relative benefits.

Compare bitemporal and bifrontal ECT efficacy in patients with pharmacologically resistant affective disorders, based on the number of acute phase treatments required to reach symptomatic remission.

Review of all patients' charts submitted to acute phase ECT, between June 2006 and June 2011. A total of 70 ECT treatment courses performed in a group of 67 patients met inclusion criteria. Thirty-eight of the total 70 courses received bitemporal ECT, and 32 received bifrontal ECT. A statistical analysis was performed. An attempt to use t-test was foiled due to breach of population variance homogeneity (p = 0,021). The non-parametric Mann-Whitney test was the alternative choice (M-W = 534;p = 0,377).

Bitemporal and bifrontal groups matched for age and sex. Bitemporal patients received on average five ECT treatments, while the average of bifrontal treatments to remission was six, but this difference was not statistically significant (p > 0.05).

Our results showed that bitemporal and bifrontal placements are equally effective. According to the largest randomised controlled trial conducted on ECT in depressive illness (Kellner et al,2010), bitemporal placement led to a faster rate of improvement. Additional studies and larger samples are required to understand if bifrontal placement's efficacy and cognitive advantages justify its popularity.

Schizophrenia is one of the most severe and chronic forms of mental illness. Quantum resonance spectrometer (QRS) test may be useful as a biological marker for the clinical diagnosis of psychiatric disorders of Schizophrenia.

To evaluate reliability and psychiatric clinical value of QRS via thought disorder detection.

We studied 1014 schizophrenic patients, 155 patients with bipolar disorders patient, and 100 normal controls. Thought disorder symptoms of same subjects obtained from QRS test and psychiatrists' diagnoses were compared. Also Thought disorder symptoms of renumbered 65 schizophrenia patient and 100 normal controls were discriminated using QRS test.

Kappa values of thought disorders detection and diagnosed were more than 65% in 6/9 symptoms of schizophrenia, and more than 74% in all 3 symptoms of bipolar disorder. Same consistency could also be seen in Pearson R value, and ROC AUC. In the discriminated analysis, sensitivity, specificity, positive predictive value and negative predictive of delusion, looseness of thought and paralogism thinking detected utilizing QRS are more than 70% same compared with psychiatrists diagnoses.

QRS in thought disorder detection seem to have a predictable value for outcome in schizophrenia and bipolar disorder, would become an objective identification and diagnosis instrument, and might promote psychiatric clinical diagnosis.

To study the efficacy of cognitive functions in patients receiving Electro Convulsive Therapy. Electro Convulsive Therapy has been used for many years, but it remains one of the most controversial psychiatric treatments.

Patients suffering from major depression with and without suicidal ideation were recruited for the study. Which was done at Ram Psychiatric Hospital, Madurai (n = 60).Baseline cognitive functioning was assessed with Mini Mental Status Examination questionnaire and Mundane Memory Questionnaire during admission. Those who scored less than 15 in MMSE, after 1st Electro Convulsive Therapy were given injection Citicoline 500 mg to 1 gm IV in the next 2–3 Electro Convulsive Therapy and were re-assessed with MMSE following each Electro Convulsive Therapy and finally at the time of discharge.

Patients receiving Citicoline injections following ECTs had better outcome in response to the cognitive functioning, when compared to the patients without Citicoline Post-Electro Convulsive Therapy in depressive patients. The detailed statistical analysis will be discussed during the presentation.

The effectiveness of Citicoline following ECTs has been found to have better outcomes with regard to cognitive functioning.

Many studies have explored the relationship between abnormalities of the hypothalamic-pituitary-adrenal (HPA) and anxiety disorders, nevertheless data on post-traumatic stress conditions are still controversial.

To find a link between neurosteroids alterations and PTSD.

To explore cortisol and dehydroepiandrosterone sulfate (DHEA-S) serum levels in a sample of patients with post-traumatic stress disorder (PTSD), recruited from the general population, compared with a group of healthy control subjects.

We recruited 26 patients with PTSD (mean age: 43.69 ± 10.03 years), assessed by the SCID-I / P for the DSM-IV-TR diagnosis, and 26 healthy control subjects (mean age: 42.12 ± 10.39 years), without current or lifetime psychiatry disorders. The neurosteroid levels were measured in 10 ml of venous blood, between 9 and 10 am, at least 2 hours after awakening to minimize the physiological increase of cortisol in the morning. Patients and controls were assessed by Trauma and Loss Spectrum Self-Report [5] .

Significantly lower cortisol levels, but not DHEA-S, were detected in patients with PTSD (c 2 = 15.97, p < .001) compared with control subjects. In addition, significant correlations emerged with domains of the TALS-SR.

Our results confirm the existence of a relationship between alterations in HPA axis and post-traumatic spectrum symptoms, although further studies are needed.