Despite recent recent evidence and subsequent guidelines that have suggested factors such as side-effect profile and cost should be taken into account when prescribing antidepressant medication, relatively little evidence exists on decision-making in clinical practice.

Our Pan-European Research Group looked at clinical practice regarding antidepressants amongst Psychiatry trainees, treatments trainees would desire themselves, and factors influencing decision-making.

A semi-structured survey was constructed from recent literature, was piloted, and a homogenous sample size of at least 50 agreed upon from each country, with 50% the minimum response rate. It was distributed via web-link, questioning preference of antidepressant for patients, and factors influencing choice. Trainees were asked for their preference should they develop a moderate to severe depressive episode, and require medication.

Treatment choices are summarised in Table 1. 79% of trainees would prescribe similar antidepressants for themselves as for patients.

Factors influencing decision-making mapped onto three main domains: cost, efficacy and side-effect profile (5% other reasons). 86% (n = 548) of those who responded felt efficacy most important, 38% (n = 237) felt side-effect profile most important and 6% (n = 33) considered cost of most importance.

Some differences exist in choice of antidepressant for European trainees and their patients, and factors affecting choice conflict with evidence base and guideline suggestions.

Risperidone long acting injection (RLAI) has in recent years gained widespread use in the treatment of schizophrenia and schizoaffective disorder. It is considered safe, tolerable, and the efficacy has been established in several studies. However, all these studies were funded by the manufacturer of RLAI.

To compare the efficiency of RLAI vs. conventional depot antipsychotics (CAD).

This study includes 9197 patients with schizophrenia being treated with depot injections in Denmark from January, 1996 until December, 2007. Prescription data were obtained from the national prescription database which contains information of sold defined daily dosages (DDD).

Of the 9197 patients 1056 had originally received a CAD treatment (zuclopentixole, haloperidol, perphenazine, fluphenazine or flupenthixol), but where switched to RLAI. The two periods were compared with regard to number of admissions and time spent in hospital. A Cox regression analysis of any-cause-discontinuation was performed on 9105 incident depot antipsychotic periods.

When receiving CAD treatment patients had 0.08 (95% CI [0.07; 0.08]) admissions to hospital per month vs. 0.50 (95% CI [0.47; 0.54]) when treated with RLAI. On average the patients spent 33 percent (95% CI [32; 35]) of the time during the CAD-period as admitted to hospital vs. 48 percent (95% CI [46; 50]) during the RLAI-period. Of the 1056 patients 83% where eventually switched back to a CAD.

Furthermore the RLAI patients have a higher hazard of discontinuing their treatment than the CAD patients (HR = 2.26, 95% CI [2.05; 2.48]).

RLAI was inferior compared to conventional depot antipsychotics.

Since the black box warning of the FDA (Food and Drug Administration) regarding an increased risk of suicidality in children and adolescents treated with antidepressants, cautious prescription of antidepressant drugs in young patients became even more important. In the light of potentially severe side effects the comparative effectiveness and harms of antidepressants should be known to clinicians to provide optimal treatment.

To compare the benefits and harms of second-generation antidepressants for the treatment of Major Depressive Disorder (MDD) in children and adolescents.

To provide an evidence base for clinicians and policymakers when making informed decisions regarding the prescription of Selective Serotonin Reuptake Inhibitors and other newer antidepressants.

We updated a comparative effectiveness report of the Oregon Drug Effectiveness Review Project searching MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to August 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias.

We could not identify any head-to-head trials. There is insufficient evidence to compare one second-generation antidepressant to another in pediatric outpatients with MDD. Evidence from a systematic review of published and unpublished data indicates, that in children and adolescents only fluoxetine shows a good risk-benefit ratio.

To date, the evidence is insufficient to make any clear inferences about the comparative benefits and harms of second-generation antidepressants for the treatment of MDD in children. Clinicians must be aware of the small benefits and the high potential risks when prescribing antidepressant medications to children and adolescents.

At present there is a discussion whether cholesterol level, aggression and violence are connected for they are characteristic behavioral patterns in combatants suffering particularly from PTSD.

With the help of the Aggressive Behaviour Assessment Scale we examined 337 combatants and 116 healthy people, also we held an additional investigation of serum concentration of lipid profile. Reliability of results was evaluated by the Mann-Whitney U-test. Also the correlation analysis (Spearman rank correlation coefficient) was carried out.

Combatants showed an integrated overall index of aggression twice as much in comparison with the control group (2,44 ± 0,09 and 1,08 ± 0,08, Ð < 0,00001), impulsive aggression was five times greater (2,08 ± 0,12 and 0,39 ± 0,06, Ð < 0,00001), premeditated aggression was 1,7-fold (3,15 ± 0,11 and 1,78 ± 0,13, Ð < 0,00001). The highest points of emotional (impulsive, hostile) aggressive behaviour revealed negative links with concentrations of cholesterol (r = −0,109, Ð < 0,05), LDL total cholesterol (r = −0,109, Ð < 0,05), triglycerides (−0,137 ≥ r ≥ −0,108, Ð < 0,05). Certain positions of premeditated (instrumental) aggression positively correlated with level of total cholesterol (0,140 ≥ r ≥ 0,126, Ð < 0,01), LDL total cholesterol (0,141 ≥ r ≥ 0,161, Ð < 0,01).

Reduction of cholesterol level and its most atherogenic fractions increases intensity of impulsive aggression and diminishes instrumental aggression of aggressive behaviour whereas increase of lipid profile leads to opposite results. The obtained data can be of great importance for treatment and prophylaxis of cardio-vascular disorders which are so typical for combat veterans.

To present a case of a patient with depression who stopped smoking during therapy with bupropion.

Patient, 55 years old, diagnosed with depression, was in psychiatric treatment for two year before she discontined her treatment. She decided to discontinue psychiatric treatment and stopped taking antidepressants because she was feeling better and was functioning at work and in her social environment. For the past one year she was taking only lorazepam occasionally. She came again to our hospital when avolition and fatigue intensified, along with depressed mood. She was not able to function at work any more. She smoked about 20 cigarettes daily and tried to stop smoking on several occasions, but unsuccessfully. Because of worsening of symptoms of depression, treatment with bupropion was initiated in daily dosage of 150 mg. After five days of such treatment daily dosage of bupropion was elevated to 300 mg. The patient reported having headache for the first two days of treatment with bupropion, but after the headache stopped. After ten days of treatment she reported feeling better and was smoking less cigarettes (five per day). She said that didn’t have such pleasurable feeling any more when smoking. Also, after smoking she felt mild nausea. At control examination, after one month of treatment with bupropion, the patient reported feeling well, without symptoms of depression and that she stopped smoking. She continued outpatient treatment regularly and was functioning well again at work and in her social environment.

Antidepressant-related sexual dysfunction (ADr-SD) is a frequent and underestimated adverse event that may lead to medication non-adherence.

To explore ADr-SD in regular clinical practice.

1. 1. To stablish the prevalence of sexual dysfunction (SD) in patients following antidepressant treatment.

2. 2. To compare ADr-SD between different antidepressants.

Cross-sectional multicentric naturalistic study. Patients in antidepressant treatment from at least two months before inclusion without previous SD were included. SD was evaluated with the specific questionnaire PRSexDQ (SALSEX, Montejo 2001).

1988 out of 2000 patients recruited resulted eligible for the analysis. According to PRSexDQ criteria, most of the antidepressants recorded in the sample (venlafaxine, duloxetine, escitalopram, citalopram, paroxetine, fluoxetine, fluvoxamine, sertraline and clomipramine) were associated to high rates of moderate to severe SD (>70%), with the exception of bupropion (39.6%) and mirtazapine (44.4%). Orgasm delay and reduced libido were the most affected areas of sexual function in all cases. Based on PRSexDQ mean global score bupropion and mirtazapine were associated to a lesser extent of SD vs. the other antidepressants (p < 0.01). Some risk of discontinuing treatment was showed by 8.5%–23.6% of patients presenting SD, depending on the antidepressant.

These results stress the relevance of SD related to most of the antidepressants, showing both bupropion and mirtazapine a better profile regarding this adverse event. Given that ADr-SD may lead to medication non-adherence, individual patient's perception of sexual life and the profile of each antidepressant regarding SD should be considered by clinicians before initiating any antidepressant treatment.

Major depressive disorder associated the increase of cortisol level and high level of cortisolemia is correlated with the decrease of neuroprotection. Hippocampus low volume is a marker for depressive disorder. The cognitive impairment in depression is linked with hippocampus - enthorinal structures-frontal cortex disconectivity. Melatoninic agonists can increase the neuroprotection and improve depressive mood.

We formed 2 study lots each constitued of 5 male adults rats (200–250 g), held through the study duration in temperature, humidity, food and ambient stress less conditions, compared to a control lot. The studied substances were administrated intraperitoneal, daily, for 10 days, saline solution equivalent to dexametasone (0.20 mg/kg/day) (N1); 14 days we administered 10 mg/kg/daily of agomelatine through a stomach tube and the following 10 days of dexametasone and agomelatine in the same dosage (N2). The N1 lot was sacrificed in the day 11, and the N2 lot was sacrificed in the day 25.

The sample brain was histopathologically processed: formalin (10%) and ethyl alcohol (96%) fixation and paraffine embeded. Microtome slices were stained in hematoxyline-eosine, trichromicGS, PAS-hematoxyline, toluidine blue and methylen blue for Nissle corpuscles. The obtained slices were studied with optical microscopy, the target of our study was hippocampus and frontal cortex.

The hippocampus and frontal cortex presents important histopathological abnormalities (neuronal death, vacuolisation, axonal fragmentation) for N1 after dexametasone. These changes are decreased in N2.

Agomelatine on the animal model actioned with a neuroprotective effect in the hippocampus and frontal cortex front of cortisolic aggresion (marker for depression).

Schizophrenia is a mental health disorder associated with high rates of osteoporosis. Studies have suggested antipsychotics as a major cause of accelerated decrease in bone mineral density.

Oestrogen deficiency contributes to osteoporosis and causes increased osteoclast numbers/osteoclastic activity. Prolactin suppresses hypothalamo-pituitary-ovarian axis activity, leading to decreased oestrogen concentrations.

Aripiprazole, an ‘atypical’ antipsychotic, is a partial agonist at dopamine D2-receptors, while other atypical antipsychotics are antagonists at these receptors. Dopamine inhibits prolactin release via these receptors at the anterior pituitary. Aripiprazole has been found to decrease prolactin concentrations in chronic schizophrenics and may be protective against osteoporosis.

Quantitation of specific markers of osteoclastic (cross-linked N-telopeptide (NTX)) and osteoblastic activity (bone alkaline phosphatase (BAP)) can be correlated with bone resorption and bone formation, respectively.

Exploring whether aripiprazole is effective in stabilising bone turnover.

Investigate changes in urinary markers of bone turnover.

We performed 52 week, open-label, intention-to-treat study, offering either a switch to aripiprazole or aripiprazole as add-on to initial antipsychotic medication.

Serial measurements of prolactin, testosterone, 17-β-oestradiol, serum BAP, albumin, urinary creatinine, and urinary NTX concentrations were taken between 0 and 52 weeks.

At the end-point of study, versus the baseline, there were significant decreases in concentrations of urinary markers of bone resorption (P = 0.002 for NTX) and bone formation (P = .026 for BAP). Additionally, a significant decrease in prolactin (P = 0.004) and significant increase in 17-β-oestradiol concentrations (P = 0.015) were found.

Our results show decreased overall bone turnover; and increased long-term bone stability in patients who changed medication.

The use of conventional depots (CDs) continues to have a great importance in our psychiatric sectors due to the unavailability of atypical depot formulations.

The aim of this work was to assess psychiatric nurses’ perspectives of CDs.

Forty nurses from our psychiatric department completed a questionnaire which included both open and multiple choice questions concerning the following topics:

1. - CDs and improvement in adherence to treatment,

2. - efficacy and tolerance of CDs,

3. - interest and indications of CDs.

1. * Psychiatric nurses (PNs) reported that CDs allowed avoidance of oblivion (83%) and regular intake of treatment (54%). But, several PNs believed that the injections of CDs were complex (67%) and the majority considered that CDs did not have positive impact on patient adherence (85%).

2. * PNs thought that CDs :

1. - were more effective (fewer relapses 56%) and better tolerated than oral formulations.

2. - did not require more precautions (80%).

3. - provided more security to the patient (no risk of toxicity 97%).

1. * PNs reported lots of indications: lack of family support (75%), multiple relapses (72%), poor adherence (70%) and self or hetero-aggressive behavior at relapse (52%).

They supported the advantages of CDs: improving social life (85%) and patient's autonomy (68%) and permitting remission (25%).

The findings suggest that PNs have positive attitude towards efficacy and tolerance of CDs but negative ideas about their indications, which could be the cause of patient stigmatization. That's why providing a clear piece of information seems necessary.

Steroids have been used effectively for many years to treat a wide variety of both acute and chronic medical conditions. Despite of some well known side effects, the association of psychiatric disturbances with the use of these drugs has not been well established and documented.

We aimed to describe the case of a 46-year-old man with a recent diagnosis of optic neuritis that has psychotic symptoms appear to be induced by methylprednisolone.

The results will be discussed.

Psychiatric symptoms emerged after the first dose of methylprednisolone and diagnosis of steroid-induced psychosis was made. After discontinuation of steroid therapy, psychiatric symptoms did not improve. But after four weeks of risperidone, he recovered completely. This case adds to small but progressive body of evidence supporting the incidence of steroid-induced psychiatric symptoms in patients with optic neuritis.

We suggest that the prevalence of this phenomenon might be considerably higher than has been reported in the current literature.

The effects of acute infections of the CNS can be complete recovery or partial recovery with consequences.

The aim of this study is to establish differences in the assessment of the components of life quality in relation to the outcome of the illness,separately for each of the three groups of the examinees -1CR-completely recovered,-2 RC-recovered with consequences and 3-C control group., as well as to establish the differences between groups in relation to the assessment of life quality.

We also wanted to point out the differences in the level of anxiety between these 3 groups.

The study includes 130 examinees that were treated at the Clinic for Infectious Diseases from 2003 to 2009. All of the examinees were diagnosed as suffering from acute CNS infection.

Medical Outcomes Study Short Form 36-SF36 questionnaire was used as a source of information, while Hamilton Anxiety Rating Scale was used as a measuring instrument.

77%of the examines from the CR group had no symptoms of anxiety, 89%preserved social functioning skills and 69% felt calm and happy.

There is a significant degree of differences in the level of anxiety between the examinees of these three groups.

The analysis of the differences between groups in relation to the assessment of mental components showed that there is a moderate distance between the control group and the group of completly recovered.

In patients from RC group the use of Paroxetine, shows significant improvement in the reduction of symptoms of anxiety.

It is well known that actual mechanisms which explain depression are very exhaustive and at same time extremely limited. Among these ones, it had been given the priority, maybe too quick, to serotonin hypothesis. Even so, the actual SSRI and SRNI classes doesn’t do. really, a lot in alleviating the course of the disease. Recent randomised clinical trials and clinic -epidemiological studies support the idea that something more effective must be offered. On the other side addiction reveals more and more in depth correlations with all major psychiatric disorders.

It is possible to develop in the close future new chemical products which could act in more effective way for the reduction or even cancelling of the symptoms determined by the alteration of major neurotransmitters-, GABA and glutamate.

Based on huge interconnection which exists between depression and drug dependence at various levels-especially through the effects exerted by particular anti depressant and some of anti craving medications, it is possible to evaluate the impact which some new pharmaceutical compounds -derivated from glutamate type of receptor NMDA-might exert upon various types of depression elicited by patients with associated drug dependence.

Had been realised a thematical reanalysis of the studies published on Medline, EMBASE and OVID about this subject.

The conclusion of the studies reveals the huge potential represented by treatment with some types of NMDA antagonists-Ketamine. The putative site of action is prefrontal cortex and is had been proved highly efficient in MDD patients.

The effect of BDZ in mood and affective disorders and also in major psychotic sdr-Schizophrenia realise an reduction of hyper GABA influence. acting on specific neuronal populations which posses particularly alpha 5 GABAa receptors they produce sedative but non anxiolytic effect. Also is still an “mistery” how only retrograde amnesia is produced and why plasticiticity occurs after a longtime use of BDZ facilitating the development of tolerance.

By a better intimate description of mechanisms by which GABAa receptors realise the sedative action and development of less side effects comparing with actual BDZ in use, even from different classes.

In this communication we had realised a thematical analysis of all studies (randomised clinical trials, clinical case study) but also various experimental research with this subjects-sleep, memory, plasticity. All had been indexed in PubMed, EMBASE, www.ionchannels.com and Science Direct.

The conclusion of our tematical study and also, our previous research suggests antagonists of GABA a or agonists of beta carbolines could be proven solid point of start for more efficient therapeutic substances.

Compliance is essential to achieve the best results in serious mental illness like schizophrenia.

It was expected that the use of second-generation oral antipsychotics with less extrapyramidal side effect profile would improve the compliance, but the results do not support these expectations except in the case of risperidone long-acting injection.

The aim of this study is to assess the degree of compliance in outpatients who were started treatment with RLAI while they were hospitalized for an acute psychotic episode in psychiatric unit.

A retrospective study was conducted by reviewing medical records of hospitalized patients for psychotic episodes over the past 5 years in three hospitals in Mallorca (Balearic Islands, Spain) -Hospital de Manacor, Hospital son Llatzer and Hospital de Inca). Due to computerization of medical records, we knew the degree of compliance with treatment and outcome in outpatient clinics. We designed a case report data (CRD) to assess specific variables in our study that was completed for each patient.

The mean duration of treatment in patients who continue with RLAI was 38.8 months. Overall. 69.5% continued with the treatment after 5 years. The patients who continued treatment were rehospitalazed 20% less than the ones who discontinued.

The compliance with RLAI in outpatients was high even in patients with substances abuse. The patients who remain on treatment from hospital discharge have less readmissions. The most common dosis of RLAI is 50 mg. Lack of insight was the most frequent cause of discontinuation.

Antidepressant-related sexual dysfunction (ADr-SD) is the most frequent and long-lasting adverse event, often underestimated and rarely spontaneously communicated. Strategies to manage it haven’t been explored to date.

To explore ADr-SD clinical management in regular practice.

1. 1. To stablish the prevalence of SD in patients following antidepressant treatment.

2. 2. To describe the therapeutic interventions used when SD is detected.

Cross-sectional, multicentric and naturalistic study. Patients taking antidepressant for at least two months without previous SD were included. SD was evaluated with the specific questionnaire PR-Sex-DQ (SALSEX, Montejo et al 2001).

1988 out of 2000 patients recruited resulted eligible for the analysis. According to PRSexDQ scores SD was present in 87.5% ot the sample. Only 44.2% communicated it spontaneusly. 66.2% reported regular to poor tolerance of SD and 19.6% had thought about discontinuing treatment due to it. Regarding the therapeutic interventions used for managing ADr-SD, waiting for its spontaneus remission was the most frequent strategy reported (36.8%), followed by changing the antidepressant (32.5%) and reducing the dosage (18.5%); 5% chosed “weekend holidays”, 4% discontinued the antidepressant, 2.5% associated another antidepressant and 1.3% added a 5-phosphodiesterase inhibitor. Bupropion and mirtazapine were the antidepressants most frequently selected for the switching and association strategies.

These results study highlight the high rates of SD related to antidepressants and its potential association with non-adherence to treatment. Despite this unfortunatelly clinicians do prefer to wait rather than performing any active strategy to manage this adverse event.

Antipsychotic therapy is the cornerstone of the treatment of psychotic disorders. Although clinical guidelines recommend the use of antipsychotics in monotherapy, the combination of two or more antipsychotics is a common habit in clinical practice, especially in cases resistant to treatment with one antipsychotic, although there are few controlled trials that support this treatment modality.

To analyze the characteristics of antipsychotic therapy in patients admitted to hospitalization with diagnoses of schizophrenia and other psychoses, to determine if there are differences between diagnostic groups.

We analyzed a sample of 241 patients admitted during 2009, 97 women and 144 men, with schizophrenia and other psychoses.

We designed a protocol of collecting data based on clinical histories of patients, reflecting the gender, age, diagnosis and treatment regimen (monotherapy or combination therapy), and performed a statistical analysis using SPSS.

Of the sample, 40.2% were females and 59.8% were males. The mean age was 39.7 years old.

The diagnosis of schizophrenia was obtained in 60.2% of patients, while the remaining 39.8% were diagnosed with other psychoses (schizoaffective disorder, chronic delusional disorder, schizophreniform disorder, brief psychotic disorder, psychotic disorder not otherwise specified and other.)

The combination therapy was used in 62.2% of patients, while the remaining 37.8% were treated with monotherapy.

Combination therapy is used more often in male patients and in patients diagnosed with schizophrenia, while monotherapy is used more in women and patients with other psychoses.

Second-generation antidepressants dominate the medical management of major depressive disorder (MDD). Two published comparative effectiveness reviews (CER) provide conflicting evidence about the comparative efficacy and safety of second-generation antidepressants for treating MDD.

To compare the benefits and harms of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for the treatment of MDD in adults.

We updated a CER published in 2007 by the Agency for Healthcare Research and Quality searching MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts up to May 2010. Two persons independently reviewed the literature, abstracted data, and rated the risk of bias. If data were sufficient, we conducted meta-analyses of head-to-head trials of the relative benefit of response to treatment. In addition, we conducted mixed treatment comparisons to derive indirect estimates of the comparative efficacy among all second-generation antidepressants.

Overall, no substantial differences in efficacy could be detected among second-generation antidepressants. Statistically significant differences in response rates between some compared drugs are small and likely not clinically relevant. Differences exist in the incidence of specific adverse events and the onset of action. Venlafaxine leads to higher rates of nausea and vomiting, sertraline to higher rates of diarrhea, and mirtazapine to higher rates of weight gain than comparator drugs. Bupropion caused lower rates of sexual dysfunction than other antidepressants.

Our findings indicate that the existing evidence does not warrant the choice of one second-generation antidepressant over another based on greater efficacy and effectiveness.