Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by spinal and/or peripheral involvement, enthesitis, dactylitis, and several extra-articular manifestations. Chronic inflammation often leads to reduced spinal mobility and functional disability. The frequency of psychological problems has increased in AS patients.

The objective of this study was to determine the prevalence of symptoms of anxiety and depression among AS patients and explore the underlying associated factors.

The Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and other clinical measures were collected during the clinical trial. We evaluated also the hospital anxiety and depression scale (HADs). P values < 0.05 were considered statistically significant.

Sixty-two patients with AS were included in the study. The average age was 41 years [18-65]. The diagnostic delay varied from one year to 26 years with an average of 4 years. Twenty-nine years is the average age of onset of symptoms with a standard deviation of 10 years. The mean duration of the disease was 10 ± 8 years. At baseline, the mean BASFI score was 53.9 ± 2 and BASDAI was 4.5± 2.

Clinically significant symptoms of anxiety and depression were present in 48.4% and 54.8% of patients, respectively. Depression was noted with a mean HADS depression of 10,5 ± 5,2. Anxiety was noted with a mean HADS anxiety of 11,3 ± 4,6.

In univariate analysis, anxiety was associated with the low educational level of patients (p = 0.038) and with CRP level (p= 0.041). There was a significant association between depression and anxiety (p=0.000). There was no relationship between these psychiatric disorders and disease activity, treatment modalities or functional status (p>0.05)

In patients with Ankylosing spondylitis, the prevalence of risk of mental disorders is high.

Anxiety and depression are common in AS and even alter the quality of life.

Patients should be regularly screened for these disorders.

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The use of hallucinogens has accompanied the human being throughout history. In the 1970s, studies focused on the therapeutic potential of hallucinogens were blocked due to their misuse in the young population. At present, psilocybin is re-emerging as the center of attention due to its possible therapeutic potential in different psychiatric pathologies such as depression, anxiety or substance use.

The main objective of this work has been to review recent studies on the therapeutic potential of psilocybin in drug-resistant depressive disorder.

For the search for articles, the search strategy “psilocybin AND depression” was established in PUBMED. Regarding the inclusion criteria, it was established that they were recent articles, in Spanish or English and that the full text was freely accessible. On the other hand, those articles whose studies did not focus on humans and resistant depressive disorder were excluded. A total of 19 articles were obtained to review.

Focusing on Drug-Resistant Depressive Disorder, multiple studies have agreed that the administration of one or two microdoses (10-25mg) of psilocybin accompanied by psychotherapy improves the clinical picture for at least 6 months. These results make us feel optimistic in the search for new treatments in the field of mental health.

Psilocybin microdoses associated with psychotherapy improves depressive symptoms in a patient resistant to common antidepressants.

The psilocybin response in terms of improvement of the depressive symptoms persists after 6 months of evolution.

One or, in some two cases, two microdoses of psilocybin (10-25mg) are enough to obtain statistically significant results in the improvement of the depressive symptoms.

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Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation tool with a growing body of clinical evidence demonstrating positive outcomes in patients with treatment-resistant depression (TRD) as sole or adjuvant therapy. Theta-burst stimulation (TBS), specifically intermittent TBS (iTBS), uses short intermittent pulse trains to cut each session’s duration to 10% of the original repetitive TMS protocol sessions, making it a more appealing option given that it shows similar efficacy. Nevertheless, the number of sessions required remains the same, with a single protocol lasting around 4 to 6 weeks, or longer. However, a new protocol has very recently been approved by the FDA for application in TRD, called the SAINT (Stanford Intelligent Accelerated Neuromodulation Therapy), which reduces treatment duration to 5 days.

To ascertain what evidence supports the SAINT protocol and its efficacy by reviewing available published literature.

A PubMed database search was performed and the main findings of selected studies were summarized.

Three articles were found, which consisted of clinical trials with small study samples of TRD patients. One study found a 90% remission rate after the aforementioned 5-day treatment regimen, with another reporting a 79% response rate after a double-blinded trial. All studies reported no difference in tolerability compared with regular iTBS protocols.

The SAINT protocol shows promising preliminary results, with efficacy, tolerability and safety of use comparable with that of TMS protocols already in use. The reduction in treatment duration that this intensive option is based on is a significant improvement for applicability in clinical practice, which might increase patient compliance and offer quicker results. Further studies are required to evaluate whether the remission rates are maintained in the long term.

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Major Depressive Disorder (MDD) is associated with high mortality, disability and morbidity. Studies demonstrated mixed results on effects of depression treatments on quality of life (QOL).

To evaluate the severity of depression among Jordanian patients diagnosed with MDD before and after treatment and to find any relationship between QOL, depression severity and perceived cognitive dysfunction.

Patients from both genders, 18-65 years old and diagnosed with MDD were included to attend two visits; at baseline and 6 weeks after treatment, in each they completed three questionnaires: Patient Health Questionnaire (PHQ-9) for depression severity, patient-rated Perceived Deficit Questionnaire (PDQ-5) for cognitive function, and World Health Organization Quality of Life Brief (WHOQOL-BREF) format.

A total of 92 patients completed the study. The scores of the different questionnaires and their correlations before and after treatment are presented in tables 1 and 2. Correlations between PHQ-9 and PDQ-5 before and after treatment are illustrated in figs 1 and 2, respectively.Table 1:

Total scores for WHOQOL-BREF format, PDQ-5 and PHQ-9, before and after treatment

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Image 2:

Significant improvements were found in the symptoms of depression, cognition and QOL in patients with MDD after treatment. Depression severity significantly inversely correlated with QOL and cognition of MDD patients.

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Low and middle-income countries (LMICs) hold the majority of disease burden attributed to major depressive disorder (MDD). Despite this, there remains a substantial gap for access to evidence-based treatments for MDD in LMICs like Pakistan. Measurement-based care (MBC) incorporates systematic administration of validated outcome measures to guide treatment decision making and is considered a low-cost approach to optimise better clinical outcomes for individuals with MDD but there is a paucity of evidence on the efficacy of MBC in LMICs.

This protocol highlights a randomized trial which will include Pakistani outpatients with moderate to severe major depression.

Participants will be randomised to either MBC (guided by schedule), or standard treatment (guided by clinicians’ judgement), and will be prescribed with paroxetine (10–60mg/day) or mirtazapine (7.5–45mg/day) for 24 weeks. Outcomes will be evaluated by raters blind to study protocol and treatment.

National Bioethics Committee (NBC) of Pakistan has given full ethics approval. The trial is being conducted and reported as per recommendation of the CONSORT statement for RCTs.

With increasing evidence from high-income settings supporting the effectiveness of MBC for MDD, it is now necessary to explore its feasibility, utility. and efficacy in low-resource settings. The results of the proposed trial could inform the development of a low-cost and scalable approach to efficiently optimise outcomes for individuals with MDD in Pakistan.

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Major depressive disorder is one of the most common and disabling mental disorders. More than 30% of individuals do not achieve remission after several trials of antidepressants and treatment-resistant depression (TRD) is associated with premature mortality. Electroconvulsive therapy (ECT) is considered the gold-standard for TRD treatment,unfortunately it´s underused due to health care barriers and association with adverse cognitive impairment. So, scientists have sought to identify alternative treatments that approach ECT-equivalent efficacy. Trials with Ketamine and more recently with its S-enantiomer (Esketamine) has been made, revealing a rapid and robust antidepressant effect, emerging as an option for TRD treatment.

We we aim to conduct a qualitative review, comparing clinical efficacy, tolerability and acceptability between the use of Esketamine and ECT as a TRD treatment.

We conduct a non-systematic review of recent evidence between the use of Esketamine and ECT as a TRD treatment, using PubMed/Medline database.

To compare clinical efficacy, tolerability and acceptability between the use of Esketamine and ECT as a TRD treatment we analyzed outcomes of interest. First,ECT was superior to Esketamine improving depressive symptoms. Comparing suicidal ideation and suicide attempts, most results were not statistically different. About cognition impairment, Esketamine performed better than ECT, particularizing attention, verbal memory, and executive functions; no differences were found for immediate memory or visual memory.About adverse effects Esketamine has less risk of headache and muscle pain, but higher reports of transient, dissociative or depersonalization symptoms, blurred vision, diplopia and nystagmus. An important consideration for clinicians is the comparative tolerability and safety of Esketamine vs ECT; as ECT involves a full dose of anesthesia,it is expected that Esketamine would be better tolerated and safer than ECT. But no study assessed the relative tolerability or acceptability of these different adverse effect profiles.The best strategy for relapse prevention appears to be continuing ECT, continuing pharmacotherapy, or using some combination of both; but Esketamine continuing treatment is effective too.

ECT may be superior to Esketamine for improving depression severity in the acute phase, but long-term outcomes of these treatments are important to be considered. There are just two studies with long-term follow-up after the trial completed:one found no difference in depression severity during the 3-month follow-up, and the other reported that the remission rates were not different between groups by the 12-month follow-up period.Therefore,future research is needed to further optimize long-term treatment outcomes for both Esketamine and ECT to prevent relapse. Until then,treatment options should be individualized and patient-centered.

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Chronic diseases are a public health problem and high prevalent on depressed patients.

To describe the sociodemographic characteristics and the quality of life of a sample of depressed patients with hypertension and oder diabetes as comorbidity.

It is the baseline evaluation of 361 persons participating in a clinical trial that studies the effectiveness of a psychoeducational intervention for this type of patients.

Persons with moderate or severe depression and with hypertension and or diabetes attending 8 primary care centers in Santiago were invited to participate .

The sample consisted of 361 study participants,the majority female(89.97%).The mean age was 59.81 years(de=10.28),with an age range observed from 26 to 83 years.Most of the participants had primary(35,91%)or secondary (43.21%)education level.More than a third of the participants reported houshold chores(34.09%) and a quarter were working for income(28.41%).About half of the participants were married(44.48%).The mean PHQ-9 score was 18.73(sd=2.81).Most of the participants had a previous diagnoses of depression(60.39%).The sample obtained an average of 34.99 points(sd=20.82) in the mental health component of the 12-item Short Form Health Survey indicative of poor quality of life related to mental health.

Depressed patients with chronic diseases ,users of primary care clinics, have poor quality of life,so it is urgent to review care protocols to achieve better health results.

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Treatment-resistant depression (TRD) is the failure to accomplish and/or achieve remission after an adequate trial of different classes of antidepressant treatments. TRD presents with significant disability and high prevalence. It results in a substantive socio-economic burden at the community and global levels. TRD. Studies comparing pharmacotherapy and electroconvulsive therapy with repetitive transcranial magnetic stimulation (rTMS) have demonstrated evidence in support of the therapeutic efficacy of rTMS in TRD.

This comprehensive scoping review aimed to explore and garner information in the literature regarding the crucial role of rTMS and its therapeutic efficacy as a treatment modality for TRD.

Electronic data searches in PubMed, PsycINFO, Medline, Embase, and Cinahl were conducted to identify important articles on rTMS for TRD. The data search strategy was limited to articles written in English and published within the last five years, to the date of the data search (February 2022). Articles were reviewed if they reported on a completed randomized controlled trial of rTMS treatment in TRD. Articles were excluded if they were protocols of rTMS on TRD and studies with rTMS for the treatment of conditions other than TRD. The review process was reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR).

In total, 17 studies met the eligibility criteria for this review. The geographical breakdown of the extracted studies consisted of North America (n = 9), Europe (n = 5), Asia (n = 2), and Australia (n = 1). The frequencies of rTMS applied in the various studies ranged from 5 Hz to 50 Hz, with stimulation intensities ranging from 80% MT to 120% MT. Overall, 16 out of the 17 studies demonstrated evidence that suggested rTMS treatment was effective, safe, and tolerated in the management of patients with TRD.

Overall, rTMS appeard to provide significant therapeutic benefits for patients with TRD through the reduction of depressive symptoms. However, while there is progressive evidence in support of rTMS in TRD, more research is needed to define the standardized protocols of rTMS application in terms of localization, frequency, intensity, and pulse parameters to realize its full potency in TRD.

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Despite several treatment strategies for treatment-resistant depression (TRD) exist, including the use of repetitive transcranial magnetic stimulation (rTMS), new therapeutic options are being introduced. Text4Support is a form of cognitive behavior therapy that allows patients with depression to receive daily supportive text messages that seek to correct or alter negative thought patterns through positive reinforcement. Text4Support is deemed a useful augmentation treatment strategy for patients with TRD. It is however currently unknown if adding the Text4Support intervention will enhance patients with TRD’s response to rTMS treatments

This study aims to assess the initial comparative clinical effectiveness of rTMS when used with and without the Text4Support program as an innovative patient-centered intervention for the management of participants diagnosed with TRD.

This study is a multicentered prospective, parallel-design, two-arm, rater-blinded randomized controlled pilot trial. In total, 200 participants diagnosed with TRD will be randomized to one of two treatment arms (rTMS alone and rTMS with Text4Support). Participants in each arm will be made to complete evaluation measures at baseline, 1,3, and 6 months. The primary outcome measure will be the mean change to scores on the Hamilton Depression Rating Scale. Patient service utilization data and clinician-rated measures will also be used to gauge patient progress. Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses.

The result of the study is expected to be available 18 months after the start of recruitment. We hypothesize that participants enrolled in the rTMS plus Text4Support intervention will achieve superior outcomes compared with participants enrolled in the rTMS treatment alone.

The concomitant application of the combination of these two treatment techniques has not been investigated previously. Therefore, we hope that this project will provide a concrete base of data to evaluate the practical application and efficacy of using a novel combination of these two treatment modalities.

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Major depressive disorder (MDD) is a global health problem accounting for about 40.5% of disability-adjusted life years caused by mental and substance use disorders. Barriers to accessing healthcare services have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. Several clinical trials have proven the effectiveness of supportive SMS text messaging in ameliorating depressive symptoms, however, this approach can only be accessible to individuals having cell phones.

This paper aims to evaluate the effectiveness, feasibility, and user satisfaction of daily supportive email messaging as a non-inferior intervention compared to daily supportive text messaging as an add-on treatment for patients with depression.

This trial will be carried out using a hybrid type II implementation-effectiveness design. In addition to the usual care, patients with depression will be randomized to receive either supportive text messages or supportive email messages. The messages in both groups will have the same content and will be provided daily for 6 months. The implementation evaluation will be guided by the Consolidated Framework for Implementation Research and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Descriptive and inferential statistics will be employed in the analysis of the quantitative outcome measures, while thematic analysis will be used for Qualitative data.

The results are expected to be available 18 months after the start of recruitment. The results will highlight the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with depression as non-inferior to text messaging.

The outcome of this trial will have a translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation.

None Declared

Major depressive disorder (MDD) is a common and severe mental disorder. Although inpatient care may be needed in some cases, little is known on which factors are associated with risk for readmission.

To identify risk factors associated with an increased risk of readmission within 90 days, after being discharged from psychiatric inpatient care for depression.

A medical record review is ongoing based on consecutive inpatients admitted in 2019-2021 at Sahlgrenska University Hospital, in Sweden. Inclusion criteria are MDD-diagnosis, admission > 7 days, no admission during the past half-year. Exclusion criteria are blocked medical record, patients who expired within 90 days after discharge. Time to first readmission for discharged patients was examined within 90 days. Clinical and sociodemographic characteristics were compared between readmitted and no-readmitted patients.

To date, 446 cases have been included with a readmission rate of 19.5%. In a subgroup of 182 patients (admitted between April 2020 and March 2021), psychotic subtype of depression seems to be protective to re-admission (p < .003) while comorbid eating (p < .017) and neurodevelopmental disorder (p < .029) seem to be associated with high risk. At the congress, results from the whole cohort will be presented.

Medical record reviews can give good clinically relevant data for prediction of readmission. Comorbidities and depression subtypes may affect the risk for readmission.

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According to the WHO, approximately 280 million people in the world have depression. It is known that pharmacists are in an ideal position to offer proactive interventions to people with depression or depressive symptoms. However, pharmacists’ stigmatizing attitudes towards depression and patients with mental illness may decrease the quality of pharmaceutical care services provided to those patients. No research has been conducted on pharmaceutical care and pharmacists attitudes towards patients with depression in Lithuania.

The aim of the study is to evaluate stigma, confidence, attitudes, barriers and incentive factors in providing pharmaceutical care to patients with depression in Lithuania.

The prospective 3 years follow-up study will be carried out among the pharmacists in Lithuania. The sample size of 269 respondents is calculated. First of all, pharmacists will be provided with a training lecture by trained investigator (M.Z.) about depression and its pharmaceutical care. At the same day, after the lecture, pharmacists‘ stigma, confidendence, attitudes, barries and incentive factors in providing pharmaceutical care to patients with depression will be evaluated by 5 questionnaires:

1. 1. Participants will be asked to provide sociodemographic information included age, gender, years of practice, etc;

2. 2. The pharmacists’ stigma of patients with depression will be evaluated using eight likert-scale items that measure how patients with depression are perceived;

3. 3. Pharmacists’ attitudes toward depression will be evaluated using Depression Attitude Questionnaire;

4. 4. Pharmacists’ confidence in medication consultation for patients with depression will be evaluated using The Pharmacists’ Confidence scale about Medication Consultation for Depressive patients (PCMCD);

5. 5. A list of possible barries and incentive factors identified in the literature will be provided to pharmacists and they will be asked to choose as many barriers and incentive factors as they think are relevant.

Next trainings lectures will be performed repeatedly at the month 6, 12, 18, 24, 30 and at the end of the study - month 36. Also, pharmacists‘ position will be re-evaluated after each training lecture by the same 5 questionnaires.

The Lithuanian Bioethics Commitee approval is going to be received after the training program is confirmed (estimated time – the 1st quarter of 2023).

Stigma, confidence, attitudes, barriers and incentive factors in providing pharmaceutical care to patients with depression in Lithuania will be evaluated.

Conclusions will be drawn on stigma, confidence, attitudes, barriers and incentive factors in pharmaceutical care of patiens with depression in Lithuania. Also, practical recommendations will be introduced to The Ministry of Health of The Republic of Lithuania.

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Dysthymia is a chronic mood disorder with similar but less severe features than major depressive disorder. Compared to the latter, major depressive episodes of dysthymic disorder are more spaced, less intense, and more persistent.

The most effective treatment is usually the combination of serotonin reuptake inhibitor antidepressant drugs with behavioral, cognitive, interpersonal and group psychotherapies.

The reality is that there are few clearly effective treatments to treat this disorder which makes the symptoms even more chronic which has a negative impact on the functionality of patients with clear influence at a personal and work level. Without treatment, dysthymia sometimes progresses to major depression, called “double depression” what can be a most serious problem.

Finding new lines of treatment or management in these patients seems to be essential because of the inability that can occur in some of them and the high demand they can produce.

A 45-year-old woman diagnosed of dysthymia has been followed for more than 10 years. Multiple visits to the emergency room and several outpatient mental health services. absenteeism and great repercussion in the family environment. Many side effects to antidepressants and a benzodiazepine overuse tendency. She has been receiving psychotherapeutic treatment for many years with little effectiveness. Worsening of the symptoms with the appearance of obsessiveness around what is happening to her

Several alternative treatments are tested for the management of anxious depressive and obsessive symptoms being Aripiprazole 10mg the only effective one with almost complete recovery of symptoms. The patient returns to work and significantly improves her family situation.

Dysthyma is a disorder with difficult pharmacological and psychological management. Trying different little-used treatments can open up a different view about the disorder.

The use of serotonin reuptake inhibitor antidepressant drugs is not always effective and the risk posed by using benzodiazepines for long time forces us to look for other treatments for the control of the main symptoms The use of aripiprazole at moderate doses may be a good new way to control symptoms.

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The Mood Disorder ward, in San Raffaele Turro Hospital, is one of the reference centers for the cure of Treatment-Resistant Depression (TRD), mainly due to the use of Electroconvulsive Therapy (ECT). During the pandemic period, in particular, in 2020, such a procedure was discontinued because it is considered aerosolizing. For this reason, we enhanced already available treatments for TRD; among those one of the most effective is the use of endovenous (EV) ketamine. It’s been more than 20 years since the first time a double-blind randomized placebo-controlled study demonstrated the rapid antidepressant effects of endovenous (EV) ketamine after a single dose (0.5 mg/kg infused in 40 minutes) in 7 patients. Ketamine, an anesthetic drug, has also analgesic, anti-inflammatory, and antidepressant properties. These effects are mainly due to non-competitive antagonism on the NMDA receptor (N-methyl-D-aspartate). We introduce our clinical experience in 7 cases of treatment-resistant depressed (TRD) inpatients; all of them show a high level of pharmacoresistance, assessed in the third degree of Thase Stages (2 or more SSRI/SNRI + at least 1 TCA); 3 of them were previously treated with a complete cycle of Electroconvulsive Therapy (ECT).

Assess the efficacy and tolerability of EV ketamine with particular regard to patients previously treated with ECT.

7 TRD patients (4 females; 3 males) were recruited in San Raffaele Turro Hospital in April 2020. All patients (6 unipolar and 1 bipolar) were diagnosed with a Major Depressive Episode according to DSM-5 criteria. We administered, under anesthesiological supervision, EV ketamine, 0.5 mg/kg in 40 minutes, twice a week, for three weeks. Every morning medication was postponed on the days of infusion. Clinical scales (HAM-D, SSI, HAMD-A; MADRS, CADSS) were administered to assess symptoms and side effects before, during, and after every administration. Moreover, clinical efficacy’s been assessed in 2 follow-ups: at 3 and 6 months.

4 patients were in remission (final HAM-D score <8) at the end of the treatment. 4 patients confirmed clinical response (final HAM-D score < 50 % respect baseline value) at the first follow-up. 4 Out of 7 patients were in complete remission at 6 months, and just one of them was between those remitted at the end of the treatment. 4 Out of 4 patients were in complete remission at six months follow-up; 3 of them underwent a cycle of ECT during the course of their illness.

The use of EV ketamine in our TRD patients showed good effectiveness and tolerability. Data on long-term effectiveness are promising, a previous ECT seems to be a predicting factor of remission at follow-up, but not of the end-treatment response. Given that, future research is needed in order to identify predicting factors on relapse prevention efficacy.

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Depression is one of the most common chronic illnesses. It requires long-term multidisciplinary care, combining pharmacological and non-pharmacological treatments. Hence the need for an educational approach to improve the quality of life of these patients.

Our objective is to create a personalized educational program for patients followed for depression allowing them to acquire the necessary skills to become autonomous in the management of their pathologies on a daily basis.

The therapeutic education program is aimed at patients followed for depression and their families. Our team is multidisciplinary made up of a psychiatrist, a nurse and a dietitian. The educational tools are rich and varied, including computerized resources, written information, brochures and educational games.

The first step is the educational diagnosis which allows to identify the personalized needs of the patient. The caregiver-educator sets with the patient the objectives to be achieved throughout the course, thus defining the educational contract. Then the patient and his entourage can follow a personalized therapeutic patient education program. We offer a program consisting of 7 sessions at the rate of one session per one to two months (2 individual sessions and 5 group workshops). At the end of the program, evaluation and self-evaluation grids are completed.

Therapeutic patient education provides knowledge through which patients with depression develop personal and interpersonal coping skills. This program will allow them to give an acceptable place to their disease so that they can evolve well with it.

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Depression is the leading cause of disability worldwide and low and middle-income countries (LMICs) carry over 80% of this disease burden. Attempts have been made to address depression in LMICs, with improvements in the home environment and maternal knowledge. However paternal depression is a neglected and under-researched area. Since maternal depression is associated with depression in fathers there is a need for partner inclusive parenting programs to address parental mental health and improve child outcomes.

To evaluate the clinical and cost effectiveness of partner inclusive Learning through play plus (LTP+) intervention in reducing depression in fathers and mothers.

To evaluate the effectiveness of LTP + intervention in improving child outcomes.

To conduct process evaluation and identify challenges in transition to scale up of the intervention across Karachi, Pakistan from the perspective of fathers, mothers, and other stakeholders.

This is a cluster randomised controlled (cRCT) trial of partner inclusive group parenting program called (Learning Through Play (LTP+) across 18 towns in the city of Karachi. Over 5000 parents (fathers and partners) will participate in the study with a capacity building component of training 4000 Community Health Workers across Pakistan.

This large cRCT will confirm the clinical and cost-effectiveness of LTP+ in reducing depression in parents and improving child outcomes along with the barriers and facilitators to implement the LTP+ group parenting program and the possibilities to roll out the innovation at national level through engagement with policy makers.

Addressing depression in parents is hugely important because of its adverse effects both for child and parents. This low-cost group parenting program will help in scaling up the innovation across health services in Pakistan and other LMICs.

None Declared

There is a huge need to search for new treatment options for depression but as well as its comorbidities. Particularly, depression and metabolic abnormalities often coexist, while a pathophysiological overlap, including microbiota changes, may play a role. Thus, the trials of microbiota interventions (e.g., probiotics) may establish a safe and easy-to-use treatment option as an adjunctive therapy in patients only partially responsive to pharmacological treatment.

The paper presents preliminary results of an RCT on the effect of probiotic supplementation on depression, anxiety and stress level, anthropometric, metabolic, and inflammatory parameters in adult patients with depressive disorders.

The trial was a two-arm, parallel-group, prospective, randomized, double-blind, controlled design that included 43 participants and lasted 60 days. The probiotic preparation contained Lactobacillus helveticus Rosell®-52 and Bifidobacterium longum Rosell®-175 in the amount of 3 × 109 colony forming units (CFU). We assessed depression level with Montgomery-Asberg Depression Rating Scale (MADRS), depressiveness, anxiety and stress level with 21-item version of Depression, Anxiety and Stress Scale (DASS-21), quality of life, blood pressure, body mass index and waist circumference, complete blood count, serum levels of C-reactive protein, high-density lipoprotein cholesterol, triglycerides, fasting glucose, selected secondary markers of inflammation and metabolic risk, as well as noninvasive biomarkers of liver fibrosis (APRI and FIB-4).

There were no differences in sociodemographic traits and psychometric questionnaires scores, as well as in anthropometric and basic laboratory findings between placebo and probiotic group at the start of the intervention period. Interestingly, there was a statistically significant improvement in MADRS score in both, placebo (p=0,010) and probiotic group (p=0,037) after intervention (see figure). The same finding was observed in total DASS-21 score as well as anxiety subscale of DASS-21. However, there were no differences in anthropometric, inflammation or metabolic laboratory parameters at the end of the study regardless of intervention.

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Whilst probiotics may benefit some individuals who do not fully respond to antidepressant medications, our study did not show the superiority of probiotics over placebo in managing depressive and anxiety symptoms. However, the target clinical sample, as well as the intervention period and dosage of preparation for this intervention is not fully recognized. Moreover, larger clinical sample may be needed to detect differences between placebo and probiotics.

None Declared

Ketamine is a phenylcyclohexylamine derivative comprising a racemic mixture of S- and R-ketamine that possesses anesthetic, analgesic, anti-inflammatory, and antidepressant activity. Oral (including extended release [PO]), intravenous (IV) sublingual (SL), transmucosal (TM), intranasal (IN), intramuscular (IM), rectal (PR), and subcutaneous (SC) formulations have been developed since its commercialization in 1970.

To review and understand the impact of different forms and formulations on the pharmacokinetics of ketamine.

The extant literature on ketamine metabolism and formulations was reviewed and discussed.

IV (racemic) ketamine (KET) has been shown to improve depressed mood within 4 hours with maximal effect at 24 hours. KET is a chiral molecule with two optimal isomers, R- and S-KET. KET is stereoselectively metabolized by CYP2B6 and CYP3A4 initially via nitrogen demethylation to active metabolite, norketamine (NK); there is no interconversion between R- and S-KET. NK is further metabolized to hydroxynorketamine (HNK) by CYP3A4 and CYP3A5; and dehydronorketamine (DHNK) by CYP2B6. Additional metabolic pathways exist including a direct enantioselective hydroxylation of KET to 6-hydroxyketamine (HK). Bioavailablity is greatest (100%) with the IV racemic KET formulation, but as low as 8% for oral S-KET due to extensive first-pass metabolism; the KET: NK ratio is a measure of first pass metabolism. NK plasma levels are higher with oral S-KET than KET as a result of local intestinal metabolism effects. Additionally, greater plasma concentrations are noted with IV bolus doses of S-KET vs. racemic KET or R-KET. S-KET possesses a longer elimination half-life than racemic KET due to inhibition by R-KET. KET is primarily renally eliminated and twice as fast in children vs. adults.

Complex interactions are reported between ketamine form (racemic/enantiomer), formulation, dose, and route of administration that impact on clinical variables and thus, outcome.

None Declared

Catatonia is a psychomotor syndrome characterized by various motor, affective and behavioral symptoms. It can occur as a cause of various underlying organic and psychiatric disorders. In Psychiatric nosology is used to specify a subtype of the disorder underlying.Unlike what was assumed in the past, today it is accepted that catatonia is more frequent in affective disorders than in schizophrenia. But despite this, diagnosis and treatment are still late in affective cases on many occasions.

-A case of catatonia is presented to review the diagnostic difficulties that can sometimes entail.-Review treatment algorithm.

We present the case of a 62-year-old woman, initially diagnosed of major depressive symptoms with psychotic symptoms, showing no response to different treatments, evolving to catatonia, which is diagnosed after screening for neurological and medical diseases.

The patient had an adequate evolution after the withdrawal of antipsychotics and the application of ECT (Electroconvulsive therapy).

- It is important to carry out an adequate screening, because many times the symptoms are caused by medical or neurological diseases.

-Catatonia has a good prognosis with an early treatment, but it may increase the risk of mortality after 5 days from the onset of symptoms.

-It is important to avoid the use of antipsychotics or other dopamine blockers. The use of benzodiazepines and ECT is indicated.

None Declared

Patients with unipolar major depression often present with symptoms of anxiety. Presentations with high levels of anxiety, restlessness, and somatic correlates of anxiety can be clinically identified as anxious depression. The comorbidity of anxious and depressive symptoms is a marker of poor prognosis, with greater risk of relapse and increased suicidal risk.

Brief review of the role of pregabalin in the treatment of major depressive disorder (MDD), based on a case study.

Consultation of the clinical record and brief review of the literature on this subject.

We present the case of a 25-year-old woman, with no past psychiatric history, admitted to a psychiatric consultation with depressive symptoms, and marked anxiety and somatic complaints, such as restlessness, palpitations, gastrointestinal discomfort. She fulfilled diagnostic criteria for Major depressive disorder (MDD), and was initially treated with sertraline 50 mg, with partial response, but maintenance of prominent anxious symptoms with important functional impairment. Then, we raised the dose of sertraline to 100 mg and added pregabalin 50 mg, with up-titration to 150 mg per day, divided in three doses. We observed rapid response, particularly on the anxious symptoms, and subsequently on the patient functionality.

The anxiety symptoms can increase in the first days of treatment with a selective serotonin reuptake inhibitor, which is the first-line therapy for major depression. Those are particularly difficult to treat, resulting often in treatment resistance and functional impairment. Pregabalin has a proven rapid-onset anxiolytic effect, with less cognitive and motor effects and less risk for dependence than benzodiazepines. It has demonstrated efficacy for the treatment of generalized anxiety disorder, but the use for patients with MDD has not been clearly studied.

Although the evidence on this subject is sparse, pregabalin augmentation of antidepressants could be an adequate option for the treatment of depression, allowing a faster action on the anxiety symptoms, especially on the first weeks of treatment, without some of the risks of the benzodiazepines.

None Declared