Socially marginalised people with mental health disorders have complex needs that require integrated care. However, mental health and social care sectors are fragmented, and inter-organisational collaboration is challenging.

A cross-national whole Network Analysis was carried out to detect and interpret patterns of relations between mental health and social care services in several European cities and assess their levels of care integration, following Leutz's levels: linkage, coordination and full integration.

Data on referrals and service routine meetings were collected in deprived areas of 14 European cities and processed within a Social Network Analysis approach. Structural indicators included degrees, components and overlapping cliques, betweenness centrality and centralisation and brokerage roles. Patterns of collaboration were compared across cities.

Few cities had full integrated services. Whole networks had relatively low densities, including denser sub-networks of similar services. The linkage across sectors remained weaker than the linkage within sectors. Services situated in broker positions were not always integrated nor commissioned for care coordination. The centrality of these services was higher when the linkage density was lower.

Although differences between structural patterns of mental health and social care networks mainly depend on national care integration policies, the study revealed structural gaps in the achievement of these patterns, whatever the policy model. This could explain why different systems are basically facing the same problems in service delivery despite these differences. These gaps constitute potential weaknesses in the quality of mental health and social care integration at the system level.

Women bear most of the burden in taking care of a chronically ill family member, thus exposing their own health and quality of life to risk. It is consider that mental health is the most vulnerable and most frequently affected health domain.

The purpose of this study was to examine the health-related quality of life (HR-QOL) in women who have and have not a mentally ill adult for a family member.

MOS Short Form-36 Health Survey (SF-36) questionnaire was used in this study. A total of 118 women were questioned, 54 out of which were taking care of a schizophrenic adult family member, whereas 64 had families with no mentally ill members. The two groups were matched according to age and education level.

Women with a mentally ill family member had lower scores in all quality of life domains, with the lowest scores in vitality (VT = 48,1), mental health (MH = 51,9), role emotional (RE = 53,1) and general health (GH = 53,5). Exactly the same health dimensions were estimated as the worst by women with no mentally ill family member (VT = 50,1; MH = 57,5; RE = 57,9; GH = 61). Statistically significant difference was observed only in the general health (p < 0.05).

Women who are taking care of a chronically mentally ill family member are not so worried about the deterioration of their own mental health, as much as they are about their general state of health. Therefore it is necessary to put an accent on this subject as well, in creating future caregivers health programs.

Inmates present higher prevalence of mental and physical disorders and are subject of some kind of social exclusion than the general population. The assessment of unmet needs is crucial for care planning.

To assess and compare the need for care between male and female inmates undergoing psychiatric treatment.

Delivery of health and social care in prisons.

A cross-sectional, descriptive study of a non-probabilistic convenience sample of inmates referenced to a forensic psychiatric clinic in Lisbon region, during a year, was performed. The research protocol, besides a specific questionnaire, includes MINI; BPRS; GAF and Camberwell Assessment of Need, Forensic Version (CANFOR).

Seventy nine males (median age 36) and 35 females (median age 32) were receiving psychiatric treatment at the time of the study. Anti-social personality disorder in men (62%) and major depression in women (62.9%) were the most frequent disorders found. Males more often present moderate to high suicide risk (36.7%) than females (28.6%). The number of unmet needs was significantly increased in males (average 6 ± 2.2) than females (4.3 ± 2.2; p< o.oo1). For males, the more frequent unmet needs concerns sexual expression (79.7%), social benefits (77.2%) and psychological distress (63.3%) and for females it was psychological distress, social benefits (62.9% each) and company (51.4%).

The results indicate that male inmates have higher behavioral risk and more unmet needs than female inmates. The assessment of needs in prisons is important for the development of strategies concerning care, social integration and prevention of criminal recidivism.

Intensification of outpatient psychiatric care may improve the care quality in community but also increase the total care costs in the first period as well as reduce in-patient cumulative length of stay over the medium term.

We investigate the economic and clinical effects of establishing of a psychiatric outpatient-service in a South-Bavarian catchment area one year before and one year after establishing.

All admitted patients in a psychiatric acute ward corresponding to the catchment area of the new outpatient- service are registered one year before establishing (2007, n = 145) and one year after (2009, n = 167). Associations between clinical, demographic and economical variables were investigated by means of multivariate regression analysis. Control variables are sex, age and psychiatric diagnostic groups.

Cumulative length of stay (b = −1.72, p = 0.68) and number of admissions (b = −0.10; p = 0.28) decreased, but not significantly. In-patient as well as global care costs remains the same. Costs of prescribed psychopharmacological drugs (b = 54.4; p = 0.36) and outpatient psychiatric care (b = 67.8; p = 0.15) increase obviously, but not significantly.

Additional implementation of an outpatient-service is not related to increase of service use costs. We found out, that in the first year there is a demand increasing effect. The effects on in-patient parameters and diagnosis groups have to be observed for the following years.

Maternal stress during pregnancy has been associated with schizophrenia in some settings with evidence suggesting that male and female offspring might be affected differently.

In an outbreak of violence in 1941, at least 180 Jews died in Baghdad; rapes, beatings and property damage injured hundreds more in other towns. We questioned whether this stress might be reflected in any change in schizophrenia incidence in people born in 1941.

We studied admissions to psychiatric hospitals in 39,606 men and 41,208 women, parents of the population-based Jerusalem cohort. We used proportional hazards models to estimate relative incidence of schizophrenia in various groups, over time. Subjects were followed from age in 1950 or immigration, till age at first hospital admission, death or 2004. Schizophrenia was defined by discharge diagnosis, ICD-10 = F20–F29 at any hospital event. Models controlled for secular and cyclic time trends.

For all years combined, the 3,679 male immigrants from Iraq showed a schizophrenia incidence similar to other men (relative risk RR = 0.92, 95% confidence limits 0.67–1.26). But for 141 men born in Iraq in 1941, RR = 4.12 (1.67–10.2, p = .0021 based on 6 cases), compared with men from Iraq born in all other years. Among other men, RR for 1941 births was 1.21 (0.78–1.88,). Women from Iraq showed no significant findings.

These findings enlarge on long-term consequences of ethnic violence. They raise intriguing questions about the relative resilience of the sexes, but should be interpreted cautiously, given that all subjects in this cohort had been able to reproduce.

To investigate trends in health-related quality of life and health service use associated with diabetes and/or major depression in South Australia from 1998 to 2008.

Data analyzed were from 9,059 persons aged ≥15 years who participated in representative surveys of the South Australian population in 1998, 2004 and 2008. Major depression was determined using the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Diagnosed diabetes and health service use was determined by self-report. Health-related quality of life was assessed using the 36-item Short-Form Health Survey (SF-36) and the 15-item Assessment of Quality of Life (AQoL) instruments. Weighted age-standardized and multiple-adjusted means of dependent measures were computed.

The prevalence of diabetes only, major depression only, and comorbid diabetes and major depression increased by 74%, 36% and 53% from 1998 to 2008. Mean health-related quality of life scores were 9% to 41% lower (worse), and health service use was 49% higher for persons with comorbid diabetes and major depression than for those with diabetes only (all P-values < 0.05), consistently over the 10-year period.

If past trends continue, our results suggest that the population health and economic burden of comorbid diabetes and major depression will grow similarly over the next decade or so. These trends have important implications for making health policy and resource allocation decisions.

Depression symptoms in bipolar disorder have debilitating effects on functioning and quality of life (QoL).

To assess effects of 8 weeks of quetiapine monotherapy on functioning and QoL in patients with bipolar depression (BPD).

To evaluate functioning and QoL using patient-reported outcomes.

Data from 4 trials (BOLDER I and II; EMBOLDEN I and II) of quetiapine (300 and 600 mg/day) in BPD were combined (n = 2593). The Sheehan Disability Scale (SDS) measured functioning (BOLDER II; EMBOLDEN I and II) and the QoL Enjoyment and Satisfaction Questionnaire (Q-LES-Q)-Short Form measured QoL (BOLDER I and II; EMBOLDEN II).

Quetiapine improved overall functioning (mean change [SE] in SDS total score: -7.23 [0.49], -7.49 [0.49], with quetiapine 300 mg/day and quetiapine 600 mg/day, respectively vs placebo (-5.91 [0.54]); P < 0.01 for both). Both doses improved functioning in SDS domains of work/school, social life, and family life/home responsibilities vs placebo (P < 0.05). Quetiapine 600 mg/day reduced days missed from work/school and productivity losses vs placebo (P < 0.01). QoL was improved with both quetiapine doses vs placebo (P < 0.001; least squares mean changes (SE) in Q-LES-Q total score from baseline to Day 57: 9.69 (0.51), 9.95 (0.50), and 6.81 (0.54) with quetiapine 300 mg/day, quetiapine 600 mg/day, and placebo, respectively). Tolerability was consistent with the known safety profile of quetiapine.

Quetiapine treatment (300 and 600 mg/day) for 8 weeks significantly improved functioning and QoL vs placebo in patients with BPD.

Supported by funding from AstraZeneca Pharmaceuticals LP.

Periodicity, cyclicity, and annual rhythms are inherent characteristics of living organisms, and have also been reported for diverse physiological and pathological conditions and phenomena. Season of birth was also associated with central monoamine and monoamine metabolite levels in several studies. Furthermore, several studies indicate a significant effect of season of birth on personality traits and characteristics. A relationship between birth season and novelty seeking has been described and confirmed in several studies. However, affective temperaments have not so far been studied with respect to their association with birth season.

The aim of our present study was to investigate the possible association between affective temperaments and season of birth in a nonclinical sample.

366 university students completed the standardized Hungarian version of the TEMPS-A. Ordinary Least Squares regression was applied to explain the relationship between TEMPS-A subscales and birth season of the respondents.

We found a significant association between temperament scores and birth season in case of the Hyperthymic, Cyclothymic, Irritable and Depressive temperaments, while no significant results emerged for the Anxious temperament.

Our results provide further evidence for an association between season of birth and personality, extending the results to affective temperaments as well. Furthermore, our results can be related to clinical observations concerning the seasonal variation of onset and hospitalization due to affective episodes, thus our results also have clinical significance.

Cyclic changes in symptomatology, sleep disorders and changes in body temperature in bipolar disorder suggest a circadian rhythm disorder and its most important regulator, melatonin. Folate is both a melatonin enhancer and has been shown to be lower in manic patients.

To investigate the association between melatonin level (by its most important metabolite, urinary 6-sulfatoxymelatonin) and clinical score of bipolar patients after folate supplementation of their medication.

Forty eight patients (who had at least one manic episode based on DSM-IV) were included in the study and out of these patients 8 patients dropped out during the study due to changes in diagnosis and 40 were randomized to group A (21 patients, folic acid+lithium+resperidone) and group B (19 patient, placebo +lithium+resperidone). Also 8 controls were selected for comparison of urinary 6 sulfatoxymelatonin levels. Morning Urinary 6 sulfatoxy melatonin and Young Mania Rating Scale were measured in the beginning and at the end of the first month.

There were significant differences between group A and B in the alteration of level of urinary 6-sulfatoxymelatonin measured during the study period(11.7 ± 13.4 Vs -6 ± 16.2 p< 0.001)both groups had significantly lower 6MT than controls and this persisted till the end of the first month in both groups. Significant difference was seen between alteration of YMRS in two groups(34.5 ± 3.9 Vs 30.1 ± 3.8 p < 0.001).

Our findings showed that folic acid may be effective as an adjunct to main mania treatment, and it may exert its effect partially due to changes in melatonin profile.

The revolving door phenomenon of hospitalization and relapse is very common among psychiatric patients in Iran.

To examine the effectiveness of a home aftercare service for patients with schizophrenia and bipolar disorders.

Patients admitted to Roozbeh hospital (Tehran, Iran) were consecutively enrolled and were randomized into the home aftercare service and the treatment-as-usual groups. In the home aftercare group, multidisciplinary teams made home visits on a monthly basis that provided education and treatment. The treatment-as-usual group received the existing services. All patients were followed one year after discharge in 4-month intervals in which data about rehospitalisations, symptoms, functioning, quality of life, and service satisfaction were obtained.

A total of 130 patients were enrolled (70 with bipolar disorder and 60 with schizophrenia) and were randomized to receive either home aftercare (66) or treatment-as usual (64). Home aftercare led to greater reduction in mean rehospitalization rate in the follow-up (0.4 in home care vs 0.07 in TAU, p = 0.011). Moreover, patients in the home care group had more improvement in psychotic symptoms (p = 0.003), depressive symptoms (p = 0.003), and clinical global impression of illness severity (p = 0.008), as well as greater patient satisfaction with the service (p < 0.001). In multiple regression analysis, home aftercare and bipolar diagnosis were associated with less rehopsitalization.

Home aftercare is an effective service for patients with severe mental disorders after being discharged from the hospital. Its implementation in aftercare services is suggested.

The transition from adolescence into adulthood is a stage of human development characterized by a broad change of physical and psychological dimensions.

To examine the associations between affective temperaments (depressive, cyclothymic, hyperthymic, irritable and anxious) and attachment styles in a population of adolescents and young adults.

Sample: 760 nursing students from 4 Higher Schools. Data was collected by a self-report questionnaire, with several measures: Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), (Akiskal & Akiskal, 2005a, Figueira et al., 2008), the Intimate Friendship Scale (Sharabany, 1994; Cordeiro, 2007), Father/Mother Attachment Questionnaire - QVPM, Version IV (Matos & Costa, 2001a), Love Attachment Questionnaire - QVA, Version III (Matos & Costa, 2001b), Beck Depression Inventory (Beck, 1967; Vaz Serra & Pio de Abreu, 1973ab) and the State-Trait Anxiety Inventory - STAI - Forms Y-1 and Y-2 (Spielberger, Gorsuch & Lushene, 1997, Silva & Campos, 1998, Santos & Silva, 1997).

The participants are mostly female (83.3%) with an average age of 21.3 years.

The dominant affective temperament for the total of the studied population was the depressive temperament but the results suggested a balance between anxious and irritable temperaments and also between depressive and cyclothymic temperaments.

The attachment to a best friend has shown to be associated with anxious temperament. All temperaments were associated with several factors of attachment to the mother, the father or to love peers.

A correlation between temperament and anxiety and between temperament and depressive symptoms were also found.

Lipids appear to mediate depressive vulnerability in the elderly, however, sex differences and genetic vulnerability have not been taken into account in previous prospective studies.

Depression was assessed in a population of 1040 women and 752 men aged 65 years and over at baseline and after 7-year follow-up. Clinical level of depression (DEP) was defined as having either a score of 16 and above on the Centre for Epidemiology Studies Depression scale or a diagnosis of current major depression on the Mini International Neuropsychiatric Interview. Lipid levels, apolipoprotein E and serotonin transporter linked promoter region (5-HTTLPR) genotypes were evaluated at baseline.

Multivariate analyses adjusted by socio-demographic and behavioral variables, measures of physical health including ischemic pathologies, and genetic vulnerability indicated gender-specific associations between dyslipidemia and DEP, independent of the use of lipid lowering agents or apolipoprotein E status. Men with low LDL-cholesterol levels had twice the risk of prevalent and incident DEP whereas in women low HDL-cholesterol levels were found to be significantly associated with increased prevalent DEP (OR = 1.5) only. A significant interaction was observed between low LDL-cholesterol and 5-HTTLPR genotype, men with s/s or s/l genotype being at increased risk of DEP (OR = 6.0 and 2.7, respectively). No significant gene-environment interaction was observed for women.

DEP is associated with higher atherogenic risk in women (low HDL-cholesterol), whereas the reverse is observed in men (low LDL-cholesterol). Late-life depression may have a complex gender-specific etiology involving genetic vulnerability in men.

Despite a putative role for estrogen in depression, studies on the association between depression and estrogen receptor (ER) polymorphisms are surprisingly lacking.

To determine the association between ER polymorphisms and late-life depression in 6809 men and women and to investigate factors which could modify this association.

Community-dwelling elderly aged 65 years and older were recruited in France as part of the Three City Study. Depression was assessed using the Centre for Epidemiological Studies Depression Scale and the Mini-International Neuropsychiatric Interview, according to DSM-IV criteria. The association between five polymorphisms of the ER-α and ER-β with depression was determined using multi-adjusted logistic regression models.

Men with the AA genotype of the ER-β rs4986938 polymorphism had an increased risk of depression, while in women, carriers of the A allele for the ER-β rs1256049 had an increased risk. Subsequent analysis indicated that the increased risk in women occurred only in those not using hormone treatment. In women the CC and GG genotypes of the ER-α PvuII and XbaI, respectively were associated with a decreased risk of depression. A significant interaction between the ER-α PvuII and ER-β rs4986938 polymorphisms suggests they may act together to modify the depression risk.

Sex-specific associations between ER polymorphisms and depression have been identified, with HT appearing to be beneficial for genetically vulnerable women. These findings of distinct genetic susceptibility to late-life depression may be important for designing novel hormone-based therapies that would have optimal effectiveness in sub-groups of depressed women and men.

Neuropeptide Y(NPY) has potent antidepressant and orexigenic properties suggesting that altered NPY signaling can be relevant to etiology of altered mood and appetite commonly co-occurring in depressive disorder.

Study if plasma levels and affinities of anti-NPY immunoglobulins(autoAbs) are affected in depression.

Plasma levels of NPY-reactive total/free IgG, IgM and IgA autoAbs were measured by ELISA in 14 patients with mild and in 9 patients with moderate depression and 20 controls. Affinity of autoAbs was assayed by the plasmon resonance. Depressant-like effect of human autoAbs was studied in mice using forced-swim test(FST) after IV injections of patients’ and controls’ IgG. Effects of affinity anti-NPY to antagonize NPY-induced antidepressant and orexigenic effects were studied in mice.

Plasma levels of NPY total IgG autoAbs were lower in patients with moderate depression than in patients with mild depression and healthy controls. MADRS scores correlated negatively with levels of NPY free autoAbs but not with their affinity values were not significantly among study groups. Body mass index(BMI) correlated negatively with affinities of NPY IgG autoAbs. Immobility time in FST was increased by I.V. injection of IgG of patients and controls and correlated negatively with levels of NPY total IgG autoAbs. Low and high affinity NPY IgG autoAbs antagonized NPY-induced anti-immobility effect. Higher affinity autoAbs antagonized more NPY-induced food intake.

These data suggest that changes of plasma levels of anti-NPY autoAbs are relevant to altered mood while changes of their affinity may be involved in altered appetite in depressive disorder.

To investigate the effect of past depression, past and current eating disorders (ED) on perinatal anxiety and depression in a large general population cohort of pregnant women, the Avon Longitudinal Study of Parents And Children (ALSPAC).

Anxiety and depression were measured during and after pregnancy in 10,887 women, using the Crown-Crisp Experiential Inventory and Edinburgh Postnatal Depression Scale. Women were grouped according to depression and ED history: past ED with (n = 123) and without past depression (n = 50), pregnancy ED symptoms with (n = 77) and without past depression (n = 159), past depression only (n = 818) and controls (n = 9,660). We compared the course of depression and anxiety with linear mixed-effect regression models; and probable depressive and anxiety disorders using logistic regression.

Women with both past depression and past/current ED had high anxiety and depression across time perinatally; this was most marked in the group with pregnancy ED symptoms and past depression (b coefficient:5.1 (95% CI 4.1-6.1), p < 0.0001), especially at 8 months post-partum. At 18 weeks in pregnancy all women (apart from those with past ED only) had a higher risk for a probable depressive and anxiety disorder compared to controls. At 8 months post-partum pregnancy ED symptoms and/or past depression conferred the highest risk for a probable depressive and anxiety disorder.

Pregnancy ED symptoms and past depression have an additive effect in increasing the risk for depression and anxiety perinatally. Screening at risk women for anxiety and depression in the perinatal period might be beneficial.

Former studies show low treatment rates of outpatients with a diagnosis of depression. Various characteristics influence these treatment rates.

To examine the effects of individual and regional characteristics on getting depression-specific treatment in the federal state of Bavaria.

Outpatient treatment for depression as well as individual and regional characteristics of outpatients diagnosed with depression were analyzed based on secondary data from the Association of Statutory Health Insurance Physicians Bavaria in 2006 (N = 780,226). Depression-specific treatment was classified in “Threshold” and “Subthreshold” treatment according to its intensity. Descriptive analyses were followed by logistic regression analysis (STATA, PASW).

More than half of the patients diagnosed with depression did not use any depression-specific treatment within one year. Individual factors which heighten the rates of a depression-specific treatment were female gender, middle age, a moderate or severe depression, a psychiatric comorbidity and no somatic comorbidity. Interestingly, living in a more rural area increased the chance of using “Threshold” treatment.

The knowledge about the influence of individual characteristics on getting a depression-specific treatment is important to reach the risk groups. A possible reason for higher rates of “Threshold” treatment in rural areas is the higher rate of pharmacotherapy in rural areas, which was more often classified as “Threshold” treatment than psychotherapy according to our classification.

Ego defense mechanisms, defined by Freud as unconscious resources used by the ego to reduce conflict between the id and superego, are a reflection of how an individual deals with conflict and stress. Vaillants’ proposed Hierarchy of Defenses states that mature defenses are associated with better adaptive functioning and health, as opposed to immature defense which are correlated negatively with measures of adaptive adult functioning.

This study assesses the prevalence of various ego defense mechanisms employed by medical students of Karachi, which is a group with higher stress levels than the general population.

A questionnaire based cross-sectional study was conducted on 682 students from five major medical colleges of Karachi in November 2006. Ego defense mechanisms were assessed using the Defense Style Questionnaire(DSQ-40) individually and as grouped under Mature, Immature, and Neurotic factors.

Neurotic defenses had a higher mean score(5.62) than Mature(5.60) and Immature(4.78) mechanisms. Immature mechanisms were more commonly employed by males whereas females employed more Neurotic mechanisms than males. Neurotic and Immature defenses were significantly more prevalent in first and second year students. Mature mechanisms were significantly higher in students enrolled in Government colleges than Private institutions (p< 0.05).

Neurotic mechanisms are more commonly encountered than Mature or Immature mechanisms among medical students of Karachi, and this could reflect greater stress levels than the general population. Employment of these mechanisms was associated with female gender, enrollment in a private medical college, and students enrolled in the first 2 years of medical school.

This study explored the unknown psychiatric literacy of the public with regard to the Personality Disorders (PDs).

To find out -

1. i) Whether a lay person recognises the presence of a psychological problem in a person with a PD.

2. ii) What labels lay people give to people living with PDs.

3. iii) How lay people rate the quality of life of people living with PDs.

4. iv) Whether a history of psychological education or illness improves a lay person's ability to identify a PD.

To assess how much work is needed to be done in order to increase public psychiatric literacy to a satisfactory level with regard to the PDs.

A vignette identification methodology was employed. 223 participants responded to the questionnaire Eccentric people’. Results: Lay people recognise people with PDs as being unhappy, unsuccessful at work and as having poor personal relationships, but do not associate these problems with psychological causes. Rates of correct labelling were low; under 7% for 7/10 PDs. History of psychological education and illness were positively correlated with the correct recognition of 70% and 60% of the personality disorders respectively.

The psychiatric literacy of the public with regard to the PDs is low. This raises concerns about the health seeking behaviour and correct diagnosis of sufferers, as well as the stigma attached to them and their social neglect by others. Psychiatric literacy needs to be increased, psychological education achieves this. The media could be an effective tool to increase psychiatric literacy.

Exposure therapy with response prevention (ERP) is the most effective treatment for patients with obsessive-compulsive disorder (OCD), but associated with considerable temporary stress during initial sessions.

Amazingly, only scant information is available about stress hormone release during exposure therapy and its implication on therapy outcome in OCD.

To characterize hypothalamic-pituitary-adrenocortical activation during ERP treatment in OCD.

15 patients with OCD were studied twice from 13:00 to 16:00 - on the day before and of their first ERP therapy session (14:00 to 15:00). Subjective units of distress (SUD, 100 mm visual analogue scale) and salivary cortisol concentrations were assessed every 20 minutes.

Before and during (but not after) ERP SUD were significantly increased versus the control day (mean SUD before ERP: 49.8 vs. 31.4, mean peak vaules during ERP: 72.6 vs. 34.0). Salivary cortisol decresed significantly during the study period (as expected according to the regular diurnal rhythm), but no significant differences between ERP and the control day were detected at any time point.

Despite clear-cut psychological stress before and during ERP, no increased release of cortisol was observed. Our findings resemble respective results in panic disorder. Possible neurobiological underpinnings of this unexpected regulatory pattern will be discussed. Furthermore, we will speculate on the impact of lacking cortisol response on extinction learning during ERP.