Non-persistence with antidepressants results in poor benefit-risk trade-off. Although antidepressant use in youth is has increased markedly, few utilization studies have been conducted in this population. The objectives were to determine non-persistence with antidepressant treatment in the Quebec youth and identify factors associated with non-persistence.

A retrospective cohort study was conducted using the Quebec health databases (RAMQ). All children (2-14 year-old) and adolescents (15-19 year-old) who were new users of antidepressants between 1997 and 2005 were followed for up to 12 months after treatment initiation. Non-persistence was defined as treatment duration with any antidepressant of less than 6 months. Independent variables included i) treatment characteristics; ii) patient characteristics.

53% of children and 29% of adolescents who were dispensed antidepressants were males. Only 60% of children and 75% of adolescents had received a psychiatric diagnosis that may require antidepressants. SSRIs were less prescribed in children than in adolescents (33% vs. 59%) unlike tricyclics (51 % vs 20%). General practitioners were the main prescribers in adolescents but not in children. Overall, 58% of patients were non-persistent. Non-persistence was associated with low maintenance dosages, absence of medical follow-up and being prescribed tricyclics as opposed to SSRIs. [respectively, OR 1.2 (95%CI 1.1-1.3), OR 1.6 (95%CI 1.4-1.7), and OR 2.3 (95%CI 2-2.4)].

Children and adolescents appear to be two distinct sub-populations with respect to antidepressant use; adolescents being very similar to adults. However, factors associated with non-persistence are similar for both age groups.

Most patients with depression have symtoms of anxiety. Aim of our study was to investigate the efficacy of Mirtazapine on symptoms of anxiety in patients with depression. Mirtazapine is a noradrenergic and specific serotonergic antidepressant(NaSSA).Sedation may be a useful side-effect in the treatment of depressed patients with insomnia and severe anxiety.

Total of 40 patients, with diagnosis F 32.0-F 32.2 or F 33.0-F 33.2 (according to ICD-10), with a high degree of anxiety, were enrolled. Anxiety was assessed using the Inner Tension item (item 3) of the Montgomery-Asberg Depression Rating Scale (MADRS). Patients received Mirtazapine 30mg/day 6 weeks, without concomitant medication. The visits were organized at the beginning of treatment, after 2,4 and 6 weeks of treatment.Gathered data were statistically processed.

There was a significant improvement for Mirtazapine-treated patients in the Item 3 of the MADRS at weeks 2,4 and 6 versus baseline.

Mirtazapine showed a significant beneficial effect in reducing symptoms of anxiety in depressive patients with high degree of anxiety, with early onset of action.

The province of Quebec holds one of the highest rates of adolescent suicide in the world. Moreover, it appears that the vast majority of its teenage suicide completers are Canadians of French origin, although the highest incidence is being found in the Native Canadians communities. Adolescent suicide risk factors already recognized in the literature include mood disorders, older age, male gender, poor parent-child communication and substance abuse. Recent studies have been showing that adolescent suicide rates and antidepressant prescriptions appears to be negatively correlated. The main goals of this retrospective study were 1) to study the correlations between Quebec regional adolescent suicide rates and regional 2nd-generation prescriptions in 2004-2005 and 2) to study the consequences on teenage suicide rates of the 2004 U.S. FDA black-box suicidality warning made for adolescents taking antidepressant medication.

All (n = 533) files on suicides committed by individuals 19 years and younger in a seven-year period (1999-2005) were reviewed at the Quebec Coroner Office. Socio-demographical, clinical and psychosocial variables were used to compare suicide completers according to their region. Antidepressant prescriptions data for 2004 and 2005 was obtained from IMS Health Canada.

The negative correlation established between regional suicide rates and regional antidepressant prescriptions was not statistically significant in 2004 but became statistically significant in 2005 (p = 0.018).

The results are so far concordant with current literature findings. This ongoing study (until 2009) will hopefully result in recommendations on the use of antidepressants in the pediatric population.

Duloxetine (DLX) is approved for treatment of Major Depressive Disorder (MDD).

Aims of this study were to assess the clinical outcome of DLX in the treatment of MDD, with efficacy measures based on clinician and patient assessment, and to evaluate the predicitve value of DLX plasma levels on clinical response.

45 out-patients affected by MDD were included in the study and prescribed 30-120 mg/day of DLX for 12 weeks.

Patients were evaluated at T0, after 2 (T1), 4 (T2), and 12 weeks (T3), by using HAMD21, HAMA, CGI-S, and the self-rating scales BDI and VAS. Plasma samples were collected at T2.

Responders (50% reduction in HAMD21) were 60% and remitters (HAMD21 ≤7) were 56%. HAMD21 showed a significant improvement at T1, T2, T3 vs T0. HAMA and CGI-S showed a significant improvement at T2, T3 vs T0.

15 (33%) patients discontinued the treatment.

Blood pressure, heart rate, and body weight did not show relevant changes.

DLX plasma levels ranged from 5 ng/ml to 135 ng/ml (mean 53.56 ± 39.45 SD). The incidence of side effects irritability and anxiety was found to be significantly correlated with the highest DLX level/dose (mean 1.6 ng/ml/mg ± 0.29 SD) (p=0.02).

We observed a curvilinear relationship between HAMD21 percentage of amelioration at T2 and DLX plasma levels/dose (mg/kg) (y=22.74+0.78x-0.0038x2, R2=0.134; p=0.23).

Good medium-term clinical response, but plasma levels showed an increased of adverse events at higher values, reducing the advantages of dose escalation.

This study will be done at the PZO Filip II-Skopje and are included 30 hospitalisated patients with aorto-coronary by pass, age from 20 to 60 yaer old, male and female.These pacient will be treated with the clinical psychiary interview and HAMA-14.

All the pations manifested increased level on HAMA results. The anxioty is the chalenge for the psychology-psychiatrist team to work with the cardiovascular pation at the cardio-surgery unit.

Social support has its role in maintaining of mental health and modification of the effects of aversive life events. It can be defined with respect to numerous variables: 1) The level of social integration, 2) Subjective experience of the quality of interpersonal relationships, 3) Help and support by other persons, 4) Supportive behavior actually taking place. The objective of our investigation was to establish the level of social support in patients suffering from Panic Disorder with Agoraphobia (PDA), in the course of the manifestation of the disorder.

40 patients who fulfilled DSM-IV criteria for the PDA (mean age 39.25, SD 6.96) and 40 matched healthy controls were assessed by Social Support Index, Family Hardness Index, Family Coping Coherence Index, Relative and Friend Support Index (Mc Cubbin, et al., 1982).

The patients having PDA, compared to the healthy controls, had statistically significantly lower scores (p<0.001) on all the indexes except on the Relative and Friends Support Index, where there was no statistically significant difference.

In the course of the disorder, patients suffering from PDA, compared to the healthy controls, had a significantly lower level of social integration in the social community and poorer quality of family relationships, but not a lower level of help and support by relatives and friends outside the close family.

Participants were 549 undergraduate students of Islamic Azad university of Azadshahr . The mean age of the participants was 22.7 years (SD = 4.58) and ages ranged from 18 to 30 years old. The were 245 men and 324 women. Measures: All participants completed a questionnaire booklet containing two self- report measures. The State – Trait Anxiety Inventory (STAI) of Spilberger and Religious Attitudes Inventory (Bahrami, 2000).

The results of the present study demonstrate that: 1)-Correlation between religious attitudes and student's anxiety is meaningful and negative(r=-0.442).2)-Correlation between female student's anxiety and religious attitudes is (r=-0.497).3)-Correlation between male student's anxiety and religious attitudes is (r=-0.427).

The present study revealed that a more positive attitude toward religion is associated with a lower level of self-reported anxiety. This contradicts the findings of O'Connor et al (2003).

Functional imaging studies during viewing of visual threat stimuli, show faster detection of threat-related cues and activation of the visual cortex, but the functional visual processes underlying these phenomena have not been determined.

Eighteen healthy subjects were pre-selected on the basis of their trait anxiety, in order to form a low- and a high-trait anxiety group. Pattern VEPs were elicited in a baseline and a verbal threat condition with two stimulus contrast magnitudes.

Compared to baseline, threat accelerated contrast perception in the low- but not the high-trait anxiety group, as evidenced by significant reductions in P100-latency. This reduction in the low anxiety group was greater with increasing stimulus contrast magnitude, consistent with a multiplicative gain control mechanism.

The efficiency of the P100-latency reduction mechanism depends on trait anxiety, in a manner reminiscent of the inverted U-shape curve which relates anxiety to motor/behavioral performance responses. These results are compelling because they extend the effects of anxiety from response systems to perceptual processes. Data based on the effects of threat on visual search studies should be reappraised to include an effect of threat on contrast perception.

To evaluate the efficacy and tolerability of once-daily quetiapine XR monotherapy in outpatients with moderate-to-severe GAD without major depressive disorder.

10-week (8-week active treatment, randomised phase; 2-week post-treatment drug-discontinuation/tapering phase), multicentre, double-blind, placebo-controlled, parallel-group comparison with paroxetine study (D1448C00011). 873 patients were randomised to receive quetiapine XR 50mg/day (n=221), 150mg/day (n=218), paroxetine 20mg/day (n=217) or placebo (n=217). Primary endpoint: change from baseline to Week 8 in HAM-A total score. Secondary outcomes included: change from baseline to Week 8 in HAM-A psychic and somatic clusters.

Mean HAM-A total score (overall baseline mean, 26.98) was significantly reduced at Week 8 by quetiapine XR 50mg/day (-13.95, p<0.05), 150mg/day (-15.96, p<0.001) and paroxetine (-14.45, p<0.01) versus placebo (-12.30).

At Week 8, mean HAM-A psychic cluster score (overall baseline mean, 14.40) was significantly reduced by quetiapine XR 50mg/day (-7.42, p<0.01), 150mg/day (-8.64, p<0.001) and paroxetine (-7.70, p<0.001) versus placebo (-6.27). Mean HAM-A somatic cluster score (overall baseline mean, 12.58) was significantly reduced by quetiapine XR 150mg/day (-7.37, p<0.001) versus placebo (-6.00), but not quetiapine XR 50mg/day (-6.54, p=0.15) or paroxetine (-6.74, p=0.05).

The incidence of serious AEs was low (<2%) in all treatment groups. During Weeks 1-8, most common AEs (>10%) were dry mouth, somnolence, fatigue, dizziness and headache with quetiapine; headache with placebo; and somnolence, dizziness, headache and nausea with paroxetine.

Once-daily oral treatment with quetiapine XR (50 and 150mg/day) was well tolerated and significantly reduced anxiety symptoms, demonstrating effects on both somatic and psychic symptoms, in patients with GAD.

Social anxiety disorder (SAD) is a disabling condition. Individuals with SAD use behaviours to lessen their fears of negative judgement and danger and manage social situations better. Research suggests that SAD often co-occurs with other psychiatric disorders including substance use disorders. However, individuals are directed to seek treatment for SAD only after they have managed their other comorbid psychiatric problems. They are usually excluded from SAD treatment studies because of the belief that their concurrent disorders are a barrier to SAD treatment. Individuals with SAD may use avoidance strategies including substance use and problematic eating to manage their perception of danger in social situations. This presentation examines the efficacy of a 12-week CBT group modified for the treatment of concurrent SAD and substance use from existing CBT protocols for social anxiety (see Heimberg et al., 1999).

Participants with a DSM-IV diagnosis of SAD and substance use disorders were administered a series of social phobia, anxiety sensitivity, and expectancies on social evaluative situations pre and post SAD treatment. In addition, they completed weekly avoidance and fear hierarchies of social situations from pre to end of treatment. Treatment involved the identification and challenging of cognitive distortions, behavioural experiments and in vivo exposure.

Multiple comparison analyses suggested that individuals experienced a decrease in fear, avoidance, and physiological symptoms related to social anxiety.

CBT can reduce symptoms of SAD in substance users. Strategies to address substance use and problematic eating while delivering SAD treatment will be also presented.

The diagnostic frontiers of social anxiety disorder (SAD) are still controversial, since it could be described as part of a continuum of severity rather than as a disorder based on an arbitrary threshold with qualitative distinctions. The present study aims to investigate possible differences among subjects along the social anxiety spectrum using the Simulated Public Speaking Test (SPST), an experimental model of human anxiety. Afterwards, the anticipatory measures of SPST among groups were correlated with different volume of gray matter areas by MRI using the voxel-based morphometry method.

We evaluated patients with generalized SAD (n=25), subjects with subclinical SAD (with fear of a social situation without avoidance or impairment; n=14) and healthy controls (n=22).

The subjective SPST findings showed that avoidance and functioning impairment were due to a negative self-evaluation in SPST and not to the level of anxiety experienced. When all groups were pooled together, there was a positive correlation between levels of anxiety experienced and the volume of the right amygdala. The negative self-evaluation of performance in the SPST was associated with a reduction in the volume of the anterior cingulated complex (ACC) only in the SAD group.

These results suggest that the association between anxiety and amygdala volume may be a part of a continuum of social anxiety. However, the correlation between self-evaluation of performance with reduced ACC volume only in the SAD group does not support the idea that this association may be also part of a continuum.

It seems that the family of heroin addicts carry certain characteristics which constitute the base for the indulgence in psychosocial deterioration . Objectives : To clarify the elements constituting family structure and family function in heroin addicts and to compare it with that of non addict group . Methodology : A sample of 80 heroin dependents diagnosed according to DSM IV TR was studied and compared to a control (non addict) group composed of 20 persons . Data were collected using a pre-designed questionnaire.

parental separation/divorce was higher in the group of addicts compared to control group. Comparing the main caring person among the two groups revealed the following : father (11.3% : 0%), mother (8.8% : 35%), both parents (33.8% : 60%), Addicts were moved to grandparents in 6.3% of cases (0% in non addicts), to other relatives in 11.3% of cases (0% in non addicts), and to others (non relatives) in 7.5% of cases (5% in non addicts), which reflects the unstability and change of caring persons for addict . Positive family history for substance abuse was higher in the group of addicts compared to non addicts. Negative feelings towards father and mother were more predominant in heroin addicts' group and also perception of negative attitude from parents.

The family of heroin addict involves a lot of deformities and dysfunctions which need to be considered and highlighted in all therapeutic programs designed for such patients .

this study designed to determine the prevalence of posttraumatic stress disorder among patients visited following an orthopedic traumatic injury and to identify changes in vital signs and demographic variables associated with the disorder.

In a descriptive study with ex-post-facto design, one hundred patients admitted to outpatient orthopedic clinic in ImamReza Hospital (Mashhad, IRAN) who had the study criteria were included. Upon admission, demographic information, pain intensity, pulse rate, blood pressure were assessed and General Health Questionnaire-28 was filled. Then symptoms of PTSD were evaluated after one and three months follow up based on DSM-IV criteria. Finally the initial data from the patients developing PTSD after one and three months were compared with those without the disease.

After one month, 5 patients (8.3%) and after three months 6 patients (12.8%) had complete PTSD criteria and 10 patients (16.7%) after one month and 6 patients (12.8%) after three months developed subsyndromal PTSD. Presence of high pulse rate (P=0.000), high intensity of the tolerated pain (p=0.000), more somatization symptoms (p=0.041) and more anxiety symptoms (p=0.039) predicted the development of PTSD after one month and presence of high pulse rate (P=0.000), high intensity of the tolerated pain (P=0.000), high maximum blood pressure (P=0.047), more somatization symptoms (P=0.019) and more anxiety symptoms (P=0.024) predicted the development of PTSD after three months.

High Blood Pressure, pulse rate and pain as well as more anxiety and somatization symptoms upon experience of trauma may increase rate of PTSD in sever orthopedic patients.

The Iraq-Iran war lasted for 8 years and ended approximately 20 years ago. It left many physically and mentally injured individuals. Many of these veteran have been suffering from chronic post-traumatic stress disorder (PTSD).. We observed a percentage of them, suddenly died which could be attributed to self over-medicated. In this research we evaluate tendency to suicide in them.

One hundred and four patients with chronic PTSD who referred to Beheshti psychiatric hospital in Kerman/Iran were included in the study. Subjects should met DSM-IV criteria for PTSD. After collecting demographic data, the risk of suicide was evaluated with California risk estimator for suicide. History of opium dependence and one to one fight were obtained from patients.

The mean±SD of age was 39.90±4.33 years and the mean duration of disease was 18.31±1.99 years.. Severity of suicide based on California test showed 15.4% had high and 63.5% and very high tendency to suicide. History of substance dependence (t=6.58, P<0.0001) and history of one to one fight (t=2.9111, P<0.01) were two factors which are contributed to high suicidal tendency.

Veterans with chronic PTSD are patients who are at risk for many consequent problems. One of these is suicidal tendency. Suicide is a matter which was not paid sufficient attention. Veterans who had specific problem such as drug dependence and whom which were involved in one to one fight are more at risk of suicide.

Yoga has been considered a stress decreasing method in treatment of depression and anxiety disorders whose prevalence is unfortunately increasing gradually.The goal of this study is to evaluate the influence of yoga on depression and anxiety in women referred to yoga clinic.

This is a clinical trial study on all persons who were referred to a yoga clinic for women, from July 2006 to July 2007. All new cases were evaluated on admission using a personal information questionnaire, Beck and Speilberger tests, and then divided into two groups of case and control randomly. The case group (n=34) participated in two weekly yoga classes of 90 min duration for two months. The control group (n=31) were assigned to a waiting list. Both groups were evaluated again after two months.

The average prevalence of depression in the case group before and after yoga course was 12.82 ±7.9 and 10.79 ±6.04 respectively, a statistically insignificant decrease (p=0.13).

However, compared with the control group, the women who participated in yoga classes showed a significant decrease in state anxiety (p=0.03)and trait anxiety (p<0.001).

Participation in a two month yoga class is very likely to lead to significant improvement in anxiety of women who suffer from anxiety disorders.

This study suggests that yoga can be considered as a complementary therapy or an alternative method for medical therapy in the treatment of anxiety disorders.

Presence of childhood abuse is considered a psychological factor in etiology of anxiety disorders. Our aim was to study the effects of childhood/adolescence abuse and suicidal/self-mutilative behaviour on sexual functions in patients diagnosed with panic disorder.

Subjects were 81 patients treated for panic disorder at the psychiatric outpatient clinic of Sisli Etfal Research and Training Hospital, Istanbul, whose diagnoses were established using the SCID-I. Childhood Trauma Questionnaire and Arizona Sexual Experiences Scale (ASEX) were administered to the subjects. A score of 1 is the most favorable score in ASEX while a score of 6 is the least.

71.6% (n=58)of the subjects were female, 28.4%(n=23) of the subjects were male and the average age was 35.8±11.6. Those with history of childhood and adolescence violence/neglect [48% (n=39)] had sexual desire, stimulation, orgasm, orgasm satisfaction and ASEX total points; those with a history of sexual harrasment/rape [9.9% (n=8)] had sexual arousel, orgasm and ASEX total points: and those with a history of attempted suicide/self mutiation [19.8% (n=18)] had sexual desire, orgasm and orgasm satisfaction points which differed to a stastistically significant degree.

This study revealed that a history of abuse and suicide/self mutilation effects phases of sexual function in panic disorder. It is important to question sexual function in panic disorder and to question childhood abuse in those cases where there is sexual disfunction. A history of attempted suicide and self mutilation adversely effects sexual functions in panic disorder.

Clinical trials in psychiatry rely on subjective outcome measures, where poor inter-rater reliability can negatively impact signal detection and study results. One approach to this challenge is to limit the number of raters thereby decreasing expected variance. However, sample size requirements—even those based on high reliability— often necessitate many sites. The implementation of comprehensive rater training combined with validated assessment of inter-rater reliability at study initiation and throughout the study is critical to ensure high inter-rater reliability. This study examined the effect of rater training and assessment to reduce inter-rater variance in clinical studies.

After rigorous training on the administration and scoring guidelines of the HAM-A, 286 raters independently reviewed and assessed a videotaped HAM-A interview of a GAD patient. Measures of inter-rater agreement across the pool of raters, as well as for each individual rater relative to all other raters were calculated using kappa statistics modified for situations where multiple raters assess a single subject1.

The overall level of inter-rater agreement was excellent (kappa = .889), with levels of inter-rater agreement of each individual rater relative to all other raters ranging from .514 to .930. Of the 286 raters participating, more than 97.2% (278) achieved inter-rater agreement > 0.8.

This study demonstrates that robust rater training can result in high levels of agreement between large numbers of site raters on both an overall and individual rater basis and highlights the potential benefit of excluding raters from study participation with inter-rater agreement below 0.8.