Although there is a large amount of clinical evidence for a male-type depression, scientific evidence is still limited, especially in non-clinical populations with regard to gender differences in symptoms.

In a sample of college students (518 males, 499 females) the relationship between male depression, sex and gender-role orientation was examined. Contrary to expectations, female students had a greater risk of male depression than male students (28.9% vs. 22.4%; p< 0.05). Overall, depressive symptoms as well as male-type distress symptoms were more pronounced in females. In the subgroup of those at risk for male depression sex and kind of symptoms were unrelated. With regard to the impact of gender-role orientation, feminine and undifferentiated orientation predict significant higher risk of male depression (30.7% and 38.1%), independent of biological sex, and were associated with different symptom factors.

The results suggest that male depression might not only be a male phenomenon, at least in college students, since young women have adopted male attributes. In conclusion, gender studies in depression should not rely on biological sex, but include measures of gender-related selfconcepts and normative orientations.

Recent studies suggest an evidence for a “male depressive syndrome” in patients with major depressive disorder.

Because males are markedly overrepresented among suicide victims and the opposite is true for suicide attempters, we investigated the rate and global severity of Gotland Male Depression as measured by the Gotland Male Depression scale in 86 suicide victims (74 males, 12 females), 86 suicide attempters (21 males, 65 females) with current DSM-IV major depressive episode and in 144 normal controls (116 males, 28 females). The rate of Gotland “Male” Depression (total score of 13 or more) was significantly higher in depressed suicide victims (98%) and in depressed suicide attempters (93%) than in normal controls (2%, p=0.00001). Among depressed suicide victims 100% of males and 83% of females have had Gotland “Male” Depression (p=0.02) while the same figures among the depressed suicide attempters were 91% and 94%, respectively (not significant). The total Gotland Male Depression scores were significantly higher in depressive suicide victims (22.26) and depressive suicide attempters (23.23) than in normal controls (4.01, p=0.00001 and p=0.0001, respectively), with significant gender differences only among depressed suicide victims (males: 22.85, females: 18.58, p=0.009) and normal controls (males: 4.33, females: 2.71, p=0.05).

However, since male and female depressed inpatients do not show clinically significant difference in their mean total scores on Gotland scale symptoms (11.99 vs 12.04, Möller-Leimkühler et al, 2004), it would be premature to conclude from our present findings that compared to nonsuicidal female depressives, suicidal female depressives have male-type depression profile.

Mental health services in many countries undervalue the special needs of people with auditive disorders. The diagnosis and treatment of mental health issues in this group of people, however, requires special skills in communication and knowledge of language and, relevant medical, psychosocial and cultural issues related to the auditive disorder. The great variation between these aspects complicates the psychiatric diagnostic process. In addition, there is a remarkable diversity of psychiatric syndromes and special target groups; these include deaf and hard of hearing patients, deaf-blind patients, mentally retarded patients, patients with brain damage, immigrants, forensic patients, patients with special medical problems and patients who have been physically and sexually abused.In several European countries specialised services have been developed with multidisciplinary teams. These teams observed difficulties in the diagnostic process and classification. Neither were psychiatric and psychological scales reliable nor validated, because they needed to be adapted to the language skills of the patients. Symptoms such as auditive hallucinations presented differently. In special causes of deafness such as prenatal Rubella, special symptoms occurred.In this lecture, an overview of these diagnostic problems will be presented illustrated with case-histories. A research project into the validity of screening lists for mental disorders and autism in mentally retarded deaf people will be discussed.

Delivering appropriate psychiatric treatments to a Deaf population faces many challenges:

• • The geographical spread of this client group, who comprise about one in a thousand of the general population.

• • The complexity of the treatment needs of Deaf people, who may have neurological, psychiatric, social, emotional and psychological difficulties, in addition to a deprived history, which can include significant language delay or deprivation.

• • The challenge of delivering multi disciplinary treatment programs in conjunction with locally based mainstream resources. Most specialist Mental Health services for Deaf people do cannot provide out of hours or crisis services, and some do not have sufficient community based staff, or any day or in patient provision.

• • With any agency in contact with Deaf people, including Health, Mental Health and Social work and voluntary organistions.

• • With the Deaf Community to raise awareness of mental health issues, to give information and remove stigma.

In 2002 the first spanish mental health unit for the Deaf was set up at the Gregorio Marañón Hospital in Madrid.

From this moment that unit has seen more than 400 profoundly deaf patients which means more than 6500 consultations.

Only 3 professionals works in the unit. a psychologist, a social worker and a part time psychiatrist.

We have 3 principal goals in our presentation:

1. 1. First: Present the results of the unit. Number and kind of patients, disorders and treatments.

2. 2. Second: Explain how difficult is to set up this kind of spcialized units in a big general hospital.

3. 3. Third: Prsent our plans to improve our unit in the short term.

The resources for deaf persons’ mental health and the studies in the field of the psychopharmacology are nowadays inadequate to meet the specific needs of this population. The indications or the way of using the medication do not differ between deaf and hearing persons, but it is not well-known among professionals that during the psychopharmacologic treatment of deaf patients it is possible to observe the presence of intense and unexpected side effects of the medication, so that it does turn out to be indispensable to give special attention to the prescription of psychoactive drugs in deaf persons. This ignorance is partly due to the fact that the research in this area is deficient. The above mentioned side effects are more prevailing and intense in deaf persons than in hearings and often interfere with basic aspects of a person's daily life as it is his system of communication, the language of signs that becomes affected, for example, due to alterations in the vision or the movement, which means in practice (at the same time) a decrease in the quality of life. Therefore, our aim is to emphasize that the indications for pharmacological treatment in deaf persons are the same than in hearings and at the same time to emphasize the importance of knowing the specific needs.

In this study the performance on Wisconsin Card Sorting Test (WCST) in relation to the polymorphism of serotonin system genes - 5HT2A, 5HT2C, 5HTT, temperament using TEMPS-A scale in relation to the intensity of depression on Beck Depression Scale were evaluated in 150 subjects with pathological obesity, BMI>40. For assessment prefrontal dysfunction the WCST, and for 5 dimensions of temperament (depressive,cyclothymic, hyperthymic, irritable and anxious) the TEMPS-A scale were used. The results of WCST and TEMPS-A were compared with the results of healthy sex, age and education matched controls.

Subjects with obesity obtained significant worse results on WCST than controls. The results of TEMPS-A scale show the high prevalence of irritable and depressive temperament in patients group. Female patients show highest prevalence of depressive and anxious temperament, while males the irritable and hiperthymic temperament. The medium or serious intensity of depression was found in 50% of cases. The intensity of depressed symptoms correlated with depressive temperament in female. Interesting results were obtained in the case of 5HT2C: a known polymorphism (-759C>T) could not explain the banding pattern observed. It is possible that we have found a novel polymorphism that strongly correlates with obesity.

The results obtained show highest prevalence of depression, specific temperamental picture and prefrontal dysfunctions in patients with pathological obesity which may be related to the polymorphisms of serotonin and dopaminergic system genes and possible association of the obesity with the new polymorphism of 5HT2C gene.

In addition to its key roles in motor and reward systems, brain dopamine (DA) has also been implicated in integrative functions contributing to adaptive behaviors such as attention, learning and memory, which processing involved the plastic changes of synaptic strength. Since the first formal evidence for Long Term Plasticity mechanism (LTP) in the Hippocampal Formation (HF), the phenomenon of synaptic plasticity has been described in various brain areas. It is appealing to consider that this is particularly true for brain regions that receive DA inputs, including the striatum and the frontal cortex being those most studied beside the hippocampus.

We have observed, using mice lacking the dopamine transporter (DAT) which constitute a unique genetic model of persistent functional hyperdopaminergia, a strong deficit of LTD and an enhancement of LTP in the CA1 region of hippocampal slices. This finding suggests that the augmentation of endogenous dopamine by DAT knockout modulates the plastic property of bidirectional synaptic plasticity by inducing a metaplastic shift in the HF. This deficit of LTD can be reversed by the D2 antagonist haloperidol, whereas the LTP increase is not altered. In the same animals, we observed a major impairment of cued-learning in the Morris watermaze, as well as more subtle, but solid, deficits in the spatial learning. These deficits of behavioral flexibility are reversed using haloperidol. Finally, in control animals, the direct blockade of the DAT using GBR12935, can reproduce the LTD and the behavioral deficits, indicating that they are not a consequence of developmental changes.

Dysfunctions of the midbrain dopaminergic system are implicated in the psychopathology of schizophrenia and other disorders including drug addiction. Abnormalities in brain development play an etiological role in schizophrenia leading to altered dopaminergic function in adulthood and increased vulnerability to the effects of stimulant drugs. Netrins are proteins that organize neuronal connectivity during development and their receptors are highly expressed in dopaminergic neurons. We find that adult netrin-1 receptor deficient mice exhibit altered dopamine-related behaviors and show profound molecular and anatomical changes in dopamine systems that appear opposite to those observed in developmental animal models of schizophrenia or following chronic use of drugs of abuse. Significantly, the signs of this apparently ‘protective’ phenotype are not evident in pre-pubertal mice. We propose that variations in netrin-1 receptor function at critical periods in development could contribute to individual differences in susceptibility to psychopathology.

Since long working memory deficit has been considered as one of the major cognitive dysfunction encountered in schizophrenia. Working memory is critical for human reasoning, judgment and decision and depends upon the integrity of prefrontal and cingulate circuitry. As a consequence coupling pharmacological (amphetamine sensitization, subchronic phencyclidine administration, neurodevelopmental insult) and behavioral approaches of prefrontal functions in animals seems to be a cue totally appropriate for elucidating the mechanisms of this dysfunction in man (Castner,2004).

In rodent models aberrant dopaminergic and glutamatergic signaling in medial prefrontal cortex has undoubtedly an impact on memory and learning, But the analogy between these deficits and a true working memory deficit in man is not obvious. Due to the higher degree of homology between human and non-human primates behavioral tests in apes seem to be more relevant but once again they can not be considered as reflecting strictly the consequences of working memory dysfunction in schizophrenia. Another approach is to extend the insights gained from the study of normal brain organization in animal models to better understand the neural basis on which working memory functions are based (Tanaka, 2006). Dissecting the cellular and circuit basis of prefrontal and cingulate cortices can give an idea how direct and indirect intercellular mechanisms are modulating working memory Nevertheless the behavioral part of this type of study remains non conclusive. It seems in fact that working memory itself is probably not a good candidate and that contextual-binding tasks (which explore encoding and retrieval) are more appropriate (Boyer,2007).

Elder abuse is a serious problem-each year hundreds of thousands of seniors are abused. Although the problem is described, defined and legislatures exist in many countries elder abuse is not still recognized as public health problem. Red Cross of Serbia has organized education of volunteers in Elder Abuse and Discrimination topic which is very important in sensibilisation among community-dwelling. Volunteers (N=226) were informed with generally accepted definitions, research in the field and legislature in Serbia concerning this issue and proposed network for prevention of elder abuse. Interactive workshops gave us data: distribution and types of elder abuse in their local communities and obstacles in referring and positive examples from practice as problem solving models.

In Turkey, in the families who moved from rural settlements into city, the young peoples go to work and the grand parents take care of the little children at home. When the grand parents become old, there will be no one who can take care of them. This situation shows two solutions: to move back to their native environment or to be settled in a nursing home. If they have no where to go, these nursing homes are their only chance.

The private nursing and caring homes, from the point of quality, are not in the same equality. The low-quality institutions are more familiar to the abuse. The residents of these institutions expect kindness, affection and warmth, but they never receive these expectations.

A new kind of elderly abuse in Turkey is the Automatic Transfer Machines thefts. On the paydays the thief comes next to the machine, offers help to the elderly who came to take his retirement salary from the machine; the thief takes the ATM card, put in the hole, ask the password, enter it and take the money and run with a high speed. The poor old person looks after.

There are no criminal codes yet which cover the elderly abuse in Turkey. Those kinds of incidents are taken as ordinary police incidents. The administration is now in preparation of a new program and a new regulation.

Aging of the world population risks to be accompanied by an increase of chronic health problems, and most particularly of mental health problems. To face to these problems the organization of care and education in old age psychiatry is still quite insufficient worldwide. Like in all countries in this part of the world, the geriatric psychiatry is still not enough represented. Only in some countries in Europe old age psychiatry is a recognized specialty (18% of European region countries responded at a WPA survey of teaching and training in OAP). The number of professionals working in the field is still very low to satisfy the needs of care of elderly with mental disorders. There is inadequate training for formal caregivers and lack of support for informal ones. This is the reason to support the development of postgraduate education on old age psychiatry as a priority in Europe. We discuss about teaching and training in old age psychiatry, psychiatric and psychological expertise exams and the assessment of competence in dementia and ethical aspect of care and research in elderly demented people.

We also present some aspects of elderly sexuality and abuse and about mental health from strategy to reality and dementia care in different Europe countries.

Chairs: Horacio Firmino-Portugal, Nicoleta Tataru-Romania.

Speakers:

1. 1. Alexandra Milicevic-Kalasic, Serbia: ‘Mental Health in Serbia-from Strategy to Reality’.

2. 2. Horacio Firmino, Portugal: ‘Education on Old Age Psychiatry at Europe: facts and proposals’.

3. 3. Ilkin Icelly, Turkey: ‘Elderly abuse in Turkey’.

4. 4. Jerzy Leszek, Poland: ‘Dementia care in Poland’.

Poland one of the central European countries has a population of about 40 milion, 7,4% of whom aged 60 and over.

The number of elderly in Poland is expected to rise dramatically to 16% by 2020. The health status of Poland’s middle aged and elderly population is not satisfactory; there is high mortality from cardiovascular diseases and malignancies. Poor health status results in higher consumption of health care especially by the elderly. For all mentally ill people there are about 2000 psychiatrists in university psychiatric clinic, psychiatrics departments and in ambulatory practice. A very small number of of psychiatrics(from general number 2000) are qualified in gerontopsychiatry in Poland. Among growing number of elderly patients are persons with dementia, incl. dementia Alzheimer’s type (about 250 000 patients). For their disposal are 4 psychogeriatry wards with small number of beds (average 15 for one ward). Memory clinic, aimed at elderly diagnosis, therapy and rehabilitation for patients with dementia are planned. First centre of this kind(with programme of training in psychogeriatry) for Alzheimer patients was opened in 2007 yr in Scinawa, near Wroclaw (Lower Silesia Province). Important role in caring of dementia patients is playing by families and self-service organization of families. The first organization of this kind was founded in Lower Silesia in 1991 (Wroclaw) as The Lower Silesia Alzheimer Association Family Support.

Dementia care in Poland as not satisfactory up to know, is currently under discussion and a new concept of caring will be prepared.