Burnout is a syndrome consisting of physical and mental exhaustion and depersonalization. Work burn out may be caused by job specification and environment. Medical and paramedical staff because of their job is at high risk and burn out is more common in this group.

In this research 104 nurse including 52 nurses from psychiatry ward and 52 nurses from other hospital wards were randomly selected and evaluated for signs of burn out, anxiety, depression. We applied maslach (MBI) questionnaire to assess the prevalence of burn out, beck questionnaire for prevalence of depression and Hamilton questionnaire for anxiety.

The results showed no significant differences in the average grades of work burn out, depression, anxiety among the nurses serving psychiatry wards and other hospital wards.

As a result being in contact with psychiatric patient cannot essentially lead to anxiety and depression in their caring nursed and so psychological disorder are not transmissible.

Symptoms have a major influence on expectations to the degree to which they affect patients’ perceptions of what might be wrong (cognitive states) and reactions to illness (emotional states).

This study investigated the relationship of patient and caregiver's expectations of illness to the diagnosis.

Two hundred new cases with their caregivers were consecutively included from the Out-Patient Department of psychiatry and assessed through a semi-structured proforma and Clinical Global Impression scale.

Somatic symptoms were the predominant complaints compared to psychic complaints. Patients presenting with more psychological symptoms had more uncommon and unmet expectations compared to those with biological symptoms. Most considered their illness to be of medical nature (71% in patients; 83% in caregivers). Patients gave social causes a higher priority (23.5% in patients and 6.5% in caregivers) while caregivers give higher priority to supernatural cause (5.5% in patients and 13% in caregivers). 54.5% patients and 63.5% caregivers considered the illness to be severe which on objective assessment was for only 38%. 54% patient had co morbid psychiatric illness and 46% had only psychiatric illness and 9% had only medical illness. More was the severity of illness; more the treatment in form of medication prescription was expected.

Objective severity of patients' disease condition, and their awareness of illness, can predict their adherence and can contribute to better targeting of health messages and treatment advice by providers.

People with a mental disorder are at increased risk for physical illness and therefore their risk of premature death is raised. An unhealthy lifestyle, living conditions, medication side-effects and a lack of physical health monitoring are regarded as the main causes of high somatic morbidity. But up to now only little research has addressed the physical co-morbidity in mentally ill. At present, there are no specific policies to improve the health status of residents in mental health care facilities.

Against this background a multi-disciplinary network of experts from 15 European countries was set up. Working together with researchers, stakeholders, professionals, networks, practitioners, and relevant organizations, the HELPS network developed a “physical health promotion toolkit” for routine application in a wide range of mental health care facilities across Europe. The HELPS toolkit intends to empower patients and staff to identify the most relevant risk factors in their specific context and subsequently select the most appropriate action out of a range of defined health promoting interventions. In doing so, the toolkit takes into account the heterogeneity of mental disorders, the high number of somatic problems, aspects of lifestyle, environment, medical care system, personal goals of patients and their motivation for health behavior.

The poster presents the HELPS toolkit. It illustrates the individual components of the tool and the processes of its implementation and evaluation. First results of the pilot study concerning the feasibility of the toolkit will be presented and discussed.

Analysis of the mental health system in Portugal reveals some positive aspects in its development through recent decades, namely in what concerns the creation of decentralised services and rehabilitation programs. Despite this, Portuguese mental health services (MHS) still suffer from significant deficiencies, in terms of accessibility, equity and quality of care. There is a large gap between the number of people affected with mental disorders and those receiving treatment: for an estimated prevalence of 16.07%, the number of people receiving treatment in MHS was estimated to be 1.7%.

The major objectives of the new National Mental Health Plan are:

1. 1) Assure equal access to care,

2. 2) Promote and protect human rights

3. 3) Reduce the impact of mental health disorders

4. 4) Promote community delivery of care,

5. 5) Promote the integration of MHS in the general health services.

A National Coordination Body for Mental Health has been empowered to assure the implementation of the National Mental Health Plan, with external monitoring by WHO.

Since the last three years, there has been significant changes and improvements at the following levels: new legislation, creation of new MHS, forensic services, financing model, residential facilities (long term care), deinstitutionalization, training, programs for homeless people, domestic violence, advocacy and stigma.

The implementation of the mental health plan can help to overcome some of the problems present in MHS in Portugal. Special attention should be given to the financing model, has it represents a crucial restraint to the development of the MHS.

DD represents a common issue in clinical practice, with relevant effects on symptoms, course and treatment of disease. It's often associated with negative outcome as a greater severity of symptoms and resistance to drug treatment.

To assess how the characteristics (sociodemographic, clinical and related to substance abuse) of patients discharged with DD have changed taking into account the FA occurred in three different five-year periods (1990–1994, 2000–2004, 2005–2009). We also compared the characteristics of patients discharged with only psychiatric diagnosis with those of patients with DD to look for possible risk factors for abuse among people with psychiatric illness.

We conducted a retrospective study of medical records of patients at FA to our Institute in three different periods. We divided the patients discharged with DD from those discharged with only psychiatric diagnosis.

Among the FA occurred in the periods examined we noticed an increase of DD cases (12% from 1990 to 1994, 21% 2000–2004, 28% 2005–2009). The incidence of each diagnosis was changed in several years, but each time the diseases more represented remain schizophrenic or affective psychosis and personality disorders. Alcohol is the most widely used psychotropic drug in each period. There is also a progressive increase in the abuse of cannabis, cocaine and in the incidence of multi-drug abusers. Compared with patients discharged with only a psychiatric diagnosis, patients with DD were more frequently:male, younger, unmarried, unemployed, with legal issues, grown up in a family with serious problems, and history of etero-aggressive episodes.

Due to continued increase in cases of DD, we want to highlight the importance of early identification of cases of comorbidity in order to provide adequate treatment and support.

Theory of mind represents the ability to attribute mental states to oneself and others and to use these mental representations to decide one's own and predict others’ behavior. In our study, ToM is investigated in a non-psychiatric setting: a university students sample.

The aim of this study is to evaluate the presence of subthreshold alterations in our sample and, on the other hand, if altered cognitive functioning can worsen study performance. Moreover it investigates a possible correlation between the faculty chosen and cognitive functioning. We considered 228 students attending the Faculty of: Economy (n = 26), Dental hygienists(n = 7), Law(n = 16), Medicine (n = 54), Pharmaceutics(n = 27), Physiotherapy(n = 15), Mathematics, Physics and Biology (n = 12), Midwifery (n = 14), Chemistry and Pharmaceutical techniques (n = 17), Liberal Arts (n = 3), Nursing (n = 37).

We administered the following tests to 228 university students: EYSENCK PERSONALITY QUESTIONNAIRE (EPQ-R): evaluating some personality dimensions including psychoticism, neuroticism, introversion, extroversion;SCL-90-R: self-evaluation scale of some symptom dimensions as somatization, obsessive-compulsiveness, depression, anxiety, anger, hostility, sensitivity, phobic anxiety, paranoid ideation and psychoticism; TEST OF EMOTION ATTRIBUTION: composed of 58 short scenes concerning seven emotions (sadness, fear, shame, disgust, happiness, anger, envy) that the student must identify.

TEST OF ToM: consists of 13 short stories describing social and family situations; the student must identify why the protagonist behaved in a certain manner.

The statistical analysis is still in progress. Preliminary data suggest that people with subthreshold symptoms belonging to the depression, obsessive-compulsiveness, anxiety and phobic-anxiety clusters show deficits of theory of mind. Data concerning the correlation between cognitive functioning and faculty chosen and between cognitive functioning and poor study performance will be examined in a further work.

Our results together with data from literature suggest the chance to apply this set of tests to screen deficit of Theory of Mind in a non mentally ill population.

Psychotropic polypharmacy is widely used in routine clinical practice although there is still a substantial deficit in established knowledge about combination and augmentation treatments. Polypharmacy is related with a higher risk of adverse drug reactions and incompliance.

On two reference days per hospital and per year, the following data are recorded for all patients on the wards under AMSP surveillance: all drugs applied on that day with the daily dosage for psychotropic drugs, ICD diagnosis, age, and sex. Data is stored at the study center in Munich. We evaluated data from 2000 (N = 5669) and 2007 (N = 8346).

From 2000 to 2007 inpatient prescriptions including three or more drugs increased significantly from 59.4% to 69.3% (chi2: 144.913; df:1; p < 0.001). Furthermore the percentage of inpatients being prescribed three or more psychotropics increased significantly from 36.5% in 2000 to 47.97% in 2007 (chi2: 180.01; df:1; p < 0.001).

Investigating further, which inpatients, diagnosed according to ICD-10, tend to be treated with more than two psychotropics, we found that this was more common in inpatients, who had an F2., F3. or F9. ICD-10 diagnosis. Especially inpatients with a bipolar disorder (F31.) showed an extremely high rate for psychotropic polypharmacy with three or more psychotropic drugs, with rates of 63,8% in 2000 and 75,2% in 2007.

Polypharmacy is still gaining ground. Our results show that psychotropic agents are commonly used in combination; therefore further studies evaluating assumable positive results of psychotropic combinations are needed.

Two randomized, controlled trials of L-methylfolate augmentation of SSRIs for major depressive disorder (MDD) were conducted using a novel study design (sequential parallel comparison design- SPCD).

To evaluate the efficacy of L-methylfolate augmentation using the Hamilton Depression Rating Scale.

In study one (TRD-1), 148 outpatients with SSRI-resistant MDD were enrolled in a 60-day, SPCD study, divided into two 30-day periods (phases 1 and 2). Patients were randomized 2:3:3 to receive L-methylfolate (7.5mg/d in phase 1, 15mg/d in phase 2), placebo in phase 1 followed by L-methylfolate 7.5mg/d in phase 2, or placebo for both phases. Study two (TRD-2) involved 75 patients and was identical in design to TRD-1 except for the dose of L-methylfolate (15mg only).

In the TRD-1 Study, L-methylfolate 7.5 mg/d was not found to be more effective than placebo. In phase 1 of the TRD-2 Study, 37% of patients on L-methylfolate 15mg/d responded and 18% of placebo patients responded, while in phase 2 among placebo non-responders, the response rates were 28% on L-methylfolate 15mg/d and 9.5% on placebo. When phases 1 and 2 were pooled according to the SPCD model, the difference in response rates was statistically significant in favor of L-methylfolate (p = 0.0399). The rates of spontaneously reported AEs and rates of study discontinuation appear r comparable between L-methylfolate and placebo in both studies. Rates of study discontinuation were also comparable

These studies suggest that L-methylfolate 15 mg/d may be a safe and effective augmentation strategy for inadequate response to SSRIs.

Postnatal depression is a serious disorder affecting 10–20% of postpartum women. It has a negative impact on the whole family system and on the child's development.

It is important to identify possible risk factors for PND, due to its frequency and severity. It has been hypothesized that the hormonal fluctuatios of the immediate postpartum period could be a risk factor for the appearance of PND.

This study aimed at inquiring the possible correlation of hormonal parameters in the 1st week postpartum with the appearance of PND.

95 postpartum women were recruited, in the process of validating the Greek EPDS. Of them, 40 consented to give blood on the second postpartum day, so that the plasma levels of TSH, T4, T3, FSH, LH, Progesterone, Estradiol, Prolactin and Cortisol were measured. 81/95 women consented to be reassessed at 8 weeks postpartum, and 10/81 were diagnosed with depression, major or minor. Plasma levels of the hormones were correlated with the diagnosis of PND and with the EPDS.

Women who suffered from PND did not differ from the non-PND subjects in the levels of all measured hormones. There was a statistically significant negative correlation of the levels of prolactin with the EPDS on the second postpartum day (p < 0.001, correlation coefficient -0.56).

Our study failed to show a definite correlation of the hormonal levels in the immediate postpartum period with PND. In other studies the role of hormones in the appearance of PND remains as well questionable.

Depression is a common condition that does not spare any age, gender and group. Marriage, an important life event, that too in early age in relation to this disorder, is the focus of this study.

To assess married male and female cases with age< 18 years for depressive disorder.

This study was conducted in psychiatric out-patients at Neuro-spinal & medical Institute, Karachi. 564 cases below 18 years consulted. Among them 44 married cases fulfilling the including criteria were selected. They were assessed on semi-structured proforma. Criteria of ICD-10 were applied for diagnostic purpose. Ethical issues were taken care off. Results were analyzed through SPSS.

Forty four cases (7.8%) were married among total 564 cases < 18 years. Among them 15 (34%) were males and 29 (66%) were females. Their age ranged between 9-< 18 years with mean ages ± SD was 16.1 ± 1.8 years. Most of the females (51.7%) were illiterate while 46.7% of the males were students of primary classes. Most were from joint families with family members of up to 18 members. According to ICD-10, 33.3% of the males and 62.1% of the females were suffering from depressive disorder.

Early marriage is still prevalent (7.8%) among of children and adolescents in this part of the world. Depressive disorder was almost double among females below 18 years.

A depressive disorder is an illness that involves the body, mood, thoughts, and behaviors. It affects the way a person eats, feels, sleeps and thinks about things. A research about depression in Urmia University of medical sciences was done to propose some methods for solving of problems of the students. This study aimed to identify the presence of depression among medical students

This study designed to determine prevalence of depression in student of Urmia, Iran. A descriptive cross-sectional study was conducted on 700 undergraduate medical and basic students in Urmia University of medical science, west Azerbaijan Province, Iran. BDI questionnaire has been used for data gathering.

Mean score of students was 10.4 ± 0.8 and 52.6% of students scored under the threshold of Beck depression inventory questionnaire indicating depressed. 2% of them have a major depression. Results didn’t observe any significant relationship between ages, education, sex, rank of birth, duration of education. Depression level in Urmia medical science university was very high that can affect on the quality of education and social behavior of the students.

It is important to research the causes of depression and plan to omit them. Establishment of consulting and recreation and problem solving centers that they will have in the future can be helpful.

Factors pertaining to religion and spirituality have been linked with well-being and adequate coping. Few studies have investigated negative aspects of religious coping, such as spiritual struggle.

Based on multidisciplinary literature and previous findings, our study's objectives are to estimate the parallel psychophysiological pathways from pre-operative distress to post-operative depression in patients undergoing open heart surgery.

The study's aims are to examine the association in depression, anxiety, and how coping, spiritual struggle and interleukin-6 play a role in patients following open heart surgery.

Plasma samples for interleukin-6 (IL-6) were obtained before open heart surgery. Patients’ history and demographic information obtained through interviews 2 days before surgery. Follow up interview for mental health and religious were conducted before and after surgery.

The results showed that a link between spiritual struggle and IL-6 mediated the indirect effects of pre-operative anxiety on post-operative depression. Anxiety had positive indirect effects on post-operative hostility. Further, hope played a protective mediating role to moderate the undesirable influences of the spiritual struggle-IL-6 link and maladaptive coping on post-operative mental health attributes.

Our study estimated important psychophysiological pathways from pre-operative distress to post-operative maladjustment. To our knowledge, this model is the first analysis to demonstrate the significant mediating effect of the spiritual-IL-6 link, alongside that of positive religious copping and other maladaptive coping, in this population.

The serotonin transporter (SERT) occupancy after long-term antidepressant treatment (steady-state) at minimum clinical doses has been reported to be approximately 80% (e.g., Meyer 2007, J.Psychiatry Neurosci;32(2):86-102, review). However, this value is mostly calculated in the striatum, therefore the occupancy values in other brain areas might be better associated to clinical parameters.

To compare the SERT occupancy of the striatum to occupancy values in six other brain areas.

18 patients with major depressive disorder (MDD) received either escitalpram (10mg/d) or citalopram (20mg/d) in a double-blind, longitudinal study. They underwent three PET scans using the radioligand [11C]DASB: PET1 baseline, PET2 six hours after the first drug intake and PET3 after three weeks of treatment. Occupancy of SERT at PET3 was analyzed in seven regions partly associated with alterations in MDD: striatum, subgenual part of the anterior cingulate cortex (sgACC), ACC, amygdala, inferior frontal cortex (IFC), superior frontal cortex (SFC), superior parietal cortex (SPC). ROI-based quantification was performed in PMOD.

There was a huge range in occupancy values of different areas: amygdala (93.5% ± 6.9%, mean ± SD), SPC (90.8% ± 8.0%), ACC (86.0% ± 13.2%), sgACC (79.1% ± 23.6%), striatum (78.8% ± 4.9%), SPF (64.0% ± 26.4%), IFC (54.4% ± 21.7%). We found significant differences in occupancy values between striatum and the ACC, amygdala, IFC, SFC, SPC (t-test, p < 0.05).

In this study we show significant differences in SERT occupancy between brain areas ranging between 54.4% and 93.5%. According to the area-specific effects of changes in serotonergic neurotransmission, regional occupancy values, especially in limbic areas, might be considered in the association to clinical response.

Ustun et al estimated that depression is the fourth leading cause of global disease burden. The burden of depression on the healthcare system is equally significant with an estimated US annual cost of approximately $26 billion (1990). In a European epidemiologic study of mental disorders involving six countries, major depression was the single most common disorder assessed, with a 12-month prevalence of 3.9%.

Our aim was to find the optimal tool with the highest accuracy in comparison to the (MINI) for depression.

We aimed to find the depression rating scale with the highest accuracy when applied by psychiatrists in Iraq.

We recruited 400 subjects; The (MINI) was used as a gold standard to define the presence of major depression according to DSMIV criteria stratified into 200 patients with primary depression and 200 non-depressed subjects in Kurdistan region of Iraq. We examined the symptoms of depression using the Hospital Anxiety and Depression Scale (HADS) and Clinical Global Impression (CGI). Interviews were performed by three psychiatrists who were blinded to the group allocations. ROC curve analysis was used.

Both HADS and CGI performed with high accuracy compared with the MINI interview for DSMIV major depression. Clinicians using the CGI were accurate in their clinical judgement with sensitivity of 97% and specificity of 99%.

We found the psychiatrist's opinion alone was very accurate with higher sensitivity and specificity than the HADS and therefore it is unclear from our sample if questionnaires would help clinicians in their diagnoses.

Importance of current research is determined by the need to find the clinical and functional evaluation criteria for the systemic patterns of changes in physiological reactivity of the patient at various stages depression treatment.

Optimization of diagnostics and planning of treatment of patients with depression based on analysis psychopathological state and autonomic reactivity during active treatment using SSRI antidepressants.

System analyze of clinical-psychopathological characteristics and autonomic reactivity of major depression. Main group included 62 patients with the diagnosis of depressive episode. Control group: 64 healthy persons.

Clinico- psychopathological, clinico- anamnestic, Hamilton Depression Rating Scale (HDRS-17), the analysis of heart rate variability for investigation of autonomic regulation.

Results of the depressive patients autonomic regulation study show the reduction of total heart rate variability is observed at rest and in orthostatic test. The balance of sympathetic, parasympathetic and suprasegmental parts of autonomic nervous system was preserved at rest in depression. However after orthostatic test the activity of sympathetic baroreflex mechanisms is decreased and the hyperactivation of suprasegmental ergotropic systems is revealed. During the 4–6-weeks treatment the positive dynamics of psychopathological characteristics is observed but the changes of autonomic reactivity are not revealed. After 6-months therapy only 30, 6% of patients demonstrate signs of normalisation of autonomic regulation.

Obtained data, apparently, attest to the fact that the emotional and autonomic symptoms are restored with different speed. The results of study should be used in the planning of treatment in the psychiatric practice and in the primary medical care.

Season mood changes are a phenomenon recognised by almost everyone. Who did never experience a little energy decrease or light depressive feelings with the beginning of Autumn or Winter? And the season recurrence of some Psychiatric Disorders, like MDD and BD are sufficiently acknowledged by patients and specialists. There is even a nosologic entity called Seasonal Affective Disorder, which shows more prevalence among Nordic places (where winter days are shorter) and in which light therapy seems a good therapeutic option. Not only in Psychiatry the properties of light therapy were recognised, NR Finsen won the Nobel Prize in 1903 for his work with Heliotherapy (found benefits with sun exposure in some skin diseases). There are various theories that try to explain those assumptions, like summer-winter difference in duration of nightly melatonin release, inability to synchronize circadian rhythms with sleep/wake rhythms and even Vitamin D production.

The aim of this work consists on a scientific revision of the origins and the influence extension of seasonality in Psychiatric Disorders (PD) and in therapeutic implications, particularly with some new anti-depressants.

We make a bibliographic investigation about more recent findings in origins and influence extension of seasonality in PD and the role of new psychopharmacologic approaches in these cases.

There are some scientific papers in which those maters are analysed.

There are some scientific theories about the mechanisms and degree of influence of seasonality in some PD, but the whole process have not been explained nor have been tested.

Major depression is one of the most common mental diseases, and quite a number of patients are resistant to several psychopharmacological interventions, even when applying current treatment guidelines. To date, it remains unclear as to how the serotonergic system is implicated in treatment-resistance found in melancholically depressed patients.

In this study, we examined the involvement of post-synaptic 5-HT2A receptors in the pathophysiology of treatment resistance in major depression with 123I-5-I-R91150 SPECT, focusing on the frontal cortex and hippocampus.

15 unipolar antidepressant naïve (ADN) patients and 15 treatment-resistant depressed (TRD) patients, all of the melancholic subtype, matched for age and gender were studied. All subjects were antidepressant free when they underwent a static 123I-5-I-R91150 SPECT scan.

Compared to ADN patients, TRD patients displayed significantly less 5-HT2A receptor binding index (BI) in the dorsal regions of the prefrontal cortex and in the anterior cingulate cortex. No hippocampal 5-HT2A receptor BI differences were observed.

Our results suggest that when confronted with treatment resistance in melancholic depression the 5-HT2A receptors in the DPFC-ACC axis are significantly more down-regulated when compared to depressed ADN patients. This might to some extent explain the observed continued cognitive problems and might reflect the long-term serotonin depletion with reduced neurogenesis in treatment resistant patients.

Cardiovascular disease (CVD) and major depressive disorders (MDD) are frequent diseases worldwide with a high comorbidity rate. Omega-3 fatty acids have been suggested as disease modulators for both CVD and MDD.

Therefore, we studied whether polyunsaturated fatty acids and the Omega-3 Index may represent markers for assessment of the cardiovascular risk in physically healthy patients suffering from MDD.

Case-control study in 166 adults (86 MDD patients without CVD, 80 matched healthy controls). Baseline examinations included depression ratings, conventional cardiovascular risk factors, fatty acid, and interleukin-6 determinations.

Several conventional risk factors were more prevalent in MDD patients. The Omega-3 Index and individual omega-3 fatty acids were significantly lower in MDD patients. An Omega-3 Index < 4% was associated with high concentrations of the proinflammatory cytokine IL-6.

Conventional cardiovascular risk factors, the Omega-3 Index and IL-6 indicated an elevated cardiovascular risk profile in MDD patients currently free of CVD. Our results support the employment of strategies to reduce the cardiovascular risk in yet cardiovascularly healthy MDD patients by targeting conventional risk factors and the Omega-3 Index.

Evaluate the efficacy and tolerability of escitalopram and duloxetine in depressive patients with pain.

Sample A (escitalopram): 22 patients (15 female and 7 man, mean age 51.75); Sample B (duloxetine) 25 patients (18 female, 7 man, mean age 53,85). They were diagnosed with major depressive disorder according to ICD 10; assessed with HAMD 17 items in baseline, 14, 28, 42, 56 days; CGIS at baseline, 28 and 56 days; CGII at 28 and 56 days.

Escitalopram 10–20 mg/day; duloxetine 60–120 mg/day. Sample A HAMD 17 items: baseline-21.8; 14 days-19.7; 28 days- 17.2; 42 days-13.5; 56 days-11.8. Sample B HAMD 17 items: baseline-22.3; 14 days-19.9; 28 days- 17.4; 42 days-13.2; 56 days-10.5. Item 13(somatic/general) -diffuse or vague muscle aches or heaviness in the arms or legs mean baseline score for Sample A -1.65; Sample B-1.75; 56 days: Sample A-0.80 and Sample B-0.65. CGIS: mean baseline Sample A: 4.2 and Sample B-4.3; 56 days Sample A-1.9 and Sample B-1.5. CGII 56 days: Sample A 7/22 (31.8%) -much improved and 10/22(45.45%) very much improved; Sample B 11/25 (44%) much improved and 14.25(56%) very much improved. We noted mild nausea 20/47, mild restlessness 12/47, mild dizziness 9/47 at the beginning of the treatment (both samples).

1. 1) Escitalopram and duloxetine are safe and effective treatment.

2. 2) Coexistence of depression with physical pain negatively affects the performance in daily activity and quality of life; in such cases the first treatment option could be duloxetine.

3. 3) Escitalopram is also efficient in such cases.