In recent years, both abstinence- and harm-reduction strategies for managing opium dependency are being generalized. In those who use detoxification, maintenance therapy with Naltrexone, an opioid antagonist protects them against relapse. This is important to know the best time of Naltrexone discontinuation to lower the risk of relapse.

This study tried to determine the efficacy of Naltrexone in prevention of opioid relapse and the factors interfere to the outcome.

150 opium addicts who were admitted in Kermanshah Rehabilitation Centre for Naltrexone maintenance therapy contributed in this 18 month length study. They received Naltrexone for 6 months and followed then after for another 12 months. Opium test (TLC) were done monthly in the first 6 months, and then in 3 month intervals for 12 subsequent months to find out the relapse.

1. 1) The relapse rates were 56.7%(85) after 6-month, and 4.7%(7)after one-year.

2. 2) The succession rate was 38.6%(58).

3. 3) The lowest succession rate was in 18–25 year old, The highest was in 35–40 year old adults(10).

4. 4) In person with diploma and higher the succession rate(43.8%) was higher than poor educated(34.7%) ones.

5. 5) The succession rate was higher in those who: were employee(72.7%), were addicted to heroin(44.9%), didn’t have positive family history(41.3%), and had more incomes(46.7%).

1. 1) In those who the relapse is delayed until 9 months after detoxification, the chance of long term abstinence is higher.

2. 2) The employees and those who have more social disciplines are more successful in ceasing opium abuse.

Neurochemical mechanism of TIA action is not clear.

To develop possible mechanism of TIA action in patients with anxious depression (Uzbekov et al., 2006, 2009).

It was found twofold increase of platelet monoamine oxidase (MAO) activity in depressed patients and its significant decrease under TIA action.

Synapse is considered as a complex biological system (nerve ending + astrocytes). It is supposed that at normal conditions about 75% of serotonin released in synaptic cleft undergoes functional inactivation by its reuptake in presynaptic ending. The remaining serotonin is taken up by astroglia and is undergone its irreversible (chemical) inactivation under MAO action.

According to our hypothesis TIA enhancing serotonin reuptake decreases serotonin level in synaptic cleft. Simultaneously in patients-responders we have established the decrease (inhibition) of MAO activity that promotes increase of serotonin concentration in synaptic cleft. It has been shown that TIA activates serotonin release from presynaptic ending (Labrid et al., 1992). Thus TIA enhances not only serotonin reuptake but simultaneously activates its surge from the ending into synaptic cleft. We conclude that under TIA action serotonin turnover rate in the synapse is increased that promotes increase in the unit of time serotonin concentration on postsynaptic receptors; this process is accompanied by decrease of MAO activity.

The first time in the literature we propose the hypothesis about neurochemical mechanism of TIA action. Proposed mechanism mainly refers to the first acute phase of TIA action directed on the normalization of serotonergic neurotransmission.

The rate-corrected Q-T interval (QTc) prolongation is a risk factor for sudden death and may be produced by antipsychotic drugs.

To determined the frequency and psychopharmacological correlates of baseline prolongation of QTc in a large pediatric cohort.

The QTc was measured on the electrocardiograms obtained on 811 children and adolescents (404 males and 407 females, mean age: 15.5 ± 2.4 years) consecutively evaluated in the admissions unit of a psychiatric hospital. Each patient with QTc > 440 msec was age- and gender-matched with 5 patients with QTc< 420 msec. The psychiatric diagnoses and psychotropic treatment of patients with prolonged QTc and control subjects were compared in univariate and logistic analyses.

QTc duration was > 440 msec (mean 454 ± 10 msec, range 442–481 msec) in 16 patients (1.97%; 95% confidence interval (CI): 1.17%–3.25%). The 80 control subjects had a mean QTc of 391 ± 21 msec. The groups were similar with regard to the proportion of patients on antipsychotics (43.8% vs. 40.8%, p = 0.78) and chlorpromazine equivalents (165.5 ± 109.7 mg vs. 167.6 ± 217.8 mg, p = 0.98). Logistic regression identified schizophrenia as the only psychiatric predictor of baseline QTc prolongation (odds-ratio: 6.17, 95% CI: 1.24–30.69, p = 0.042).

In a large cohort of children and adolescents with psychiatric disorders, baseline QTc prolongation was infrequent and, at most, of moderate severity. The findings argue against performing electrocardiograms prior to the initiation of antipsychotics in all patients from this age group.

The management of normal daily tasks may be complicated for adults with ADHD (attention-deficit/hyperactivity disorder) due to executive dysfunctions. ADHD may thus increase the risk of chronic stress in everyday life.

To study endocrinological and psycho physiological stress markers in adults with ADHD in association to performance in test of executive functions (EF) and self-perceived stress.

Cardiovascular stress markers were assessed in 30 adults with ADHD with no psychoactive medication, and 30 healthy controls during: (1) non-stress baseline; (2) cognitive stress; and (3) non-stress recovery. The Visual Analogues Scale was used to assess self-perceived stress. Salivary cortisol was measured pre- and post-experiment. To measure stress in everyday life we assessed diurnal cortisol values, stressors and self-ratings of stress.

The group with ADHD showed higher self-perceived stress but attenuated or atypical cardiovascular stress reactivity during experimentally induced stress, and stress reactivity predicted performance in the executive test. Baseline cardiovasular values did not differ from the controls. The diagnosis of ADHD significantly increased the risk of belonging to the group with high post-stress cortisol levels. The two groups were comparable with respect to overall diurnal cortisol levels and rhythm. The ADHD group reported significantly higher self-perceived stress and these values correlated with level of stressors in everyday life.

The overall baseline values in biological stress markers may be comparable between adults with ADHD and healthy controls, while the stress reactivity and recovery pattern may differ between the two groups.

The authors examined the association between tobacco smoking and suicidal ideation and planning in schoolchildren from 10 countries in Africa, the Americas, and the Western Pacific region.

Data were collected through the Global school-based Student Health Survey (GSHS), a collaborative surveillance project between the World Health Organization (WHO), the United Nations, UNICEF, UNESCO, UNAIDS, and the US Centers for Disease Control and Prevention (CDC). Suicidal ideation and planning, tobacco smoking, and drug and alcohol use were included in loglinear models to analyze, separately for each sex, higher order interactions among suicidality and regional and country differences.

Schoolchildren who reported suicidal ideation and/or suicidal planning had a higher risk of smoking cigarettes even after controlling for drug and alcohol misuse. Furthermore, analyses indicated higher order interactions between suicidal ideation and planning and countries belonging to different regions with different exposure to tobacco smoking among schoolchildren.

Future studies analyzing the mechanism and sequencing of the relationship among suicidal ideation and tobacco smoking should explore cultural factors.

Evidence from previous small trials has suggested the effectiveness of early social communication interventions for autism.

The Preschool Autism Communication Trial (PACT) investigated the efficacy of such an intervention in the largest psychosocial autism trial to date.

To provide a stringent test of a pre-school communication intervention for autism.

152 children with core autism aged 2 years - 4 years 11 months in a 3 site 2 arm single (assessor) blinded randomised controlled trial of the parent-mediated communication-focused intervention added to treatment as usual (TAU) against TAU alone. Primary outcome; severity of autism symptoms (modified social communication algorithm from Autism Diagnostic Observation Schedule-Generic, ADOS-G). Secondary outcomes; blinded measures of parent-child interaction, child language, and adaptation in school.

At 13 month endpoint the treatment resulted in strong improvement in parental synchronous response to child (adjusted between-group effect size 1.22 (95% CI 0.85, 1.59) and child initiations with parent (ES 0.41 (0.08, 0.74) but small effect on autism symptomatology (ADOS-G, ES -0.24 (95% CI -0.59, 0.11) ns). Parents (not blind to allocation) reported strong treatment effects on child language and social adaptation but effects on blinded research assessed language and school adaptation were small.

Addition of the PACT intervention showed clear benefit in improving parent-child dyadic social communication but no substantive benefit over TAU in modifying objectively rated autism symptoms. This attenuation on generalisation from ‘proximal’ intervention effects to wider symptom change in other contexts remains a significant challenge for autism treatment and measurement methodology.

A data cube containing registration and visit data for all mental health cases was constructed and matched on age and sex in a ratio of 1:8 with non-mental health cases (n TOTAL = 681,676). Four groups emerged in the final dataset:

Group 1 - Those with mental health problems treated in publicly funded tertiary care (n = 61,479);

Group2 - those with mental health problems treated in their doctors’ offices (n = 272,120);

Group 3 - those with mental health problems treated in publicly funded tertiary care without treatment in their doctors’ offices (15,135); and

Group 4 - those without mental health problems (n = 332,942).

At present we have examined the Physician billing data for those old and younger than or equal to 18 years of age, with the overall finding that the health costs (total costs - mental health costs) were greater for those with mental health problems in

Group 1 Case ($3,039 average per individual (API) over 8 years) and

Group 2 comparison ($2,554 API over 8 years) as compared to

Group 3 case ($1326) and

Group 4 comparison ($1089) API over 8 years).

Having a mental health problem has a profound impact on health-related expenditures.

High risks of mental illness within the deaf community are reported. The assessment of the level of mental distress and quality of life in the deaf community is difficult due to communication problems in spoken and written language. The deaf community is characterized by the use of sign language.

This study aims to compare levels of psychological distress and the quality of life with levels reported by the signing deaf people and the hearing population.

A measure of acceptable reliability using sign language is described. The interactive computerised package including special versions of the WHOQOL-BREF, the GHQ-12 and five subscales of the BSI was administered to a large community sample of deaf people (n = 236), and results were compared with normative data for German speaking hearing people.

The deaf sample has a significantly poorer quality of life than the general population for the physical and psychological domains (p < 0,01) as measured by the WHOQOL-BREF. However, in the domain of social relationships no significant difference (p = 0,19) was demonstrated. All findings with the GHQ-12 and the BSI show much higher levels (p = 0,01) of emotional distress among the deaf.

Although a poorer quality of life and a higher level of mental distress is demonstrated the similarity to the general population in the domain social relationships shows that this does not affect all domains. These findings show the need for easily accessible health services for the deaf which offer sensitive communication with them.

It is likely that’real-life patients’ differ from randomized controlled trial (RCT) patients and from non-treatment seeking populations. However, much of what is known about characteristics of patients with depression and anxiety is based on RCTs and studies in the general population. Data on’naturalistic’ or’real-life patients’ are scarce.

In several studies so far, we investigated specific characteristics of patients with depression and anxiety in routine psychiatric specialty care. We studied gender differences in depression, and differences in age of onset of depression. Another study aimed to establish predictors for deliberate self-harm and suicidal ideation (DSHI) in patients with depression and anxiety.

We used baseline data of the Routine Outcome Monitoring (ROM) study. From 2004–2007, 3798 patients had been routinely assessed with ROM, by specially trained nurses. ROM consists of both self report and observational instruments.

Female patients with depression reported more severe complaints on self-report instruments, as well as worse general health. Observational instruments showed no differences. In addition, patients with depression onset before the age of 18 reported more current suicidality and previous suicide attempts. Finally, low education, being unmarried, comorbidity, more severe symptoms of anxiety and depression, and emotional instability were independent predictors of DSHI.

Our findings in naturalistic outpatients differed from previous findings based on RCTs and studies in the general population. Since our findings are based on routinely obtained measurements in treatment seeking patients, these data may reflect the phenomenology of real life patients more closely.

Understanding factors that affect treatment adherence may help to prevent non-adherence and increase the quality of care as well as cost-effectiveness.

To measure the level of adherence to clinical guidelines and to examine the correlates of adherence among outpatients with mood, anxiety and somatoform disorders in a routine clinical setting.

We developed quality measures and assessed adherence during up to 3 years of follow-up in a randomly selected sample of 300 outpatients who started routine psychiatric treatment. Patients were treated with pharmacotherapy, psychotherapy or a combination. At baseline, a standardized diagnostic interview (MINI-PLUS), the brief symptom inventory (BSI), general health status (SF-36) and demographics were assessed, as part of the usual intake procedure. Using multivariable regression analysis we identified independent predictors associated with guideline adherence.

Most indicators were highly positive, indicating that most treatment was delivered according to guidelines. The combined treatment group as compared to the two other groups had lower scores on indicators “correct treatment module” and “stepped care” (p < 0.005). Patients receiving psychotherapy scored best on the separate indicators. Only a minority was treated in complete accordance with guidelines. Low-adherence was independently predicted by a low score on the SF-36 vitality-subscale. No significant differences were found within socio-demographic variables, comorbidity and BSI-scores between the adherence groups.

Assessment of guideline adherence is feasible with this cross-diagnostic set of process indicators. Patients with low scores on the vitality-subscale of the SF-36 were at the highest risk to receive low guideline-concordant care.

Mental Health entails significant economic costs, not only the provision of health services but also lost economic output. Mental Health has been estimated to cost Ireland up to €3 billion annually. Social determinants are a major contributory factor to mental health problems and inequity.

To illustrate economic cost of mental health in Ireland, importance of social determinants in mental health inequity and provide guidelines on how to improve the overall level of mental health.

Examine economic cost of mental health in Ireland and discuss how negative social determinants might be tackled to reduce mental health inequities.

Review hardcopy and internet reports and studies since 2000 on Irish mental health policy, the economic costs and social determinants of mental health, the obstacles to reducing health inequities and what should be prioritised to achieve good mental health in Ireland.

Mental Health problems incur a significant cost. Furthermore, mental health problems occur more frequently amongst those groups with negative social determinants. These health inequities need to be tackled to reduce the overall level of mental health illness.

Given current global economic difficulties it is more important than ever to reduce economic costs. Mental health is one such significant cost. Negative social determinants lead to mental health inequities and therefore greater economic costs in terms of health care and lost economic productivity. They must be tackled by an holistic approach, one which not only involves the health sector but also other relevant social and economic sectors.

There are three well-known theories of psychodynamic of suicide: Freud's (suicide as a result of displacement of murderous impulses from a love object that are directed toward an internalized object), Menninger's (wish to destroy the lives of the survivors) and Fenichel's (fulfillment of reunion whish with a lost loved figure).

We described results from an empirical study of psychodynamic concepts of suicidal behavior in the sample consists of 30 hospitalized persons following a suicide attempt by self poising treaded at Clinic for toxicology in Military Medical Academy Belgrade Serbia.

In the view of three well-known theories of psychodynamic of suicide we presented some vignettes that described each of the theory.

To put suicide attempt in a psychodynamic context, clinicians must understand psychodynamic of suicide behavior, which can help them in their work with patients’ crisis intervention

To determine the clinical effectiveness of Cognitive Behaviour Therapy (CBT) delivered in primary care for older people with depression and evaluation of a talking control (TC).

A single-blind, randomized, controlled trial with 4- and 10-month follow-up. 204 people, aged 65 years or more, with a Geriatric Mental State diagnosis of depression were recruited from primary care. The interventions were: treatment as usual (TAU), TAU plus TC, or TAU plus CBT. The TC and CBT were offered over 4 months. The TC was to control for common effects in therapy. The Beck Depression Inventory-II (BDI-II) was the main outcome. Subsidiary measures were the Beck Anxiety Inventory, Social Functioning Questionnaire, and Euroqol. Intention to treat analysis (ITT) and Compliance Average Causal Effect (CACE) analyses was employed. The Cognitive therapy scale (CTS) evaluated common and specific factors in therapy.

A mean of 7 sessions of TC or CBT were delivered. ITT analysis found improvements of −3.07 (95% confidence interval [CI], −5.73 to −0.42) and −3.65 (95% CI, −6.18 to −1.12) in BDI-II scores in favour of CBT vs TAU and TC respectively. CACE analysis found a benefit of 0.4 points (95% CI, 0.01 to 0.72) per therapy session of CBT over TC. Ratings for CBT on the CTS were high (mean [SD], 54.2 [4.1]) and showed no difference for nonspecific, but significant differences for specific factors in therapy.

CBT is an effective treatment for depressed older people. Improvement appears to be associated with specific factors in CBT.