Bipolar patients have an increased risk of cardiovascular diseases for lifestyle habits and the use of antipsychotics that correlates with endothelial dysfunctions, in particular the decrease of eNOS activity and plasma NO levels. We aimed to examine the effects of the new atypical antipsychotic Asenapine on NO release and oxidative stress in porcine coronary endothelial cells (CEC).

NO production was measured in CEC isolated from coronary arteries of pigs and plated in 0.1% gelatin-coated dishes with starvation medium overnight at 37 °C with 5% CO2. Cells were treated with asenapine 10 pM-100 μM and asenapine+inhibitors. Oxidative stress was generated with 200 μM hydrogen peroxide in the presence of asenapine for 15 min. The cells undergoing apoptosis were measured and proteins extracted from cell lysates were quantified and used for electrophoresis and immunoblotting studies.

Asenapine increased NO release in CEC in a time-dependent way (p<0.05) by the phosphorylation of eNOS and plateau was reached at 120s stimulation; no effect was observed on iNOS activation. The association of asenapine and inhibitors suggested the involvement of cAMP/PKA, PLC, p38MAPK, PI3K and ERK1/2 in the intracellular signaling and the β2 adrenergic receptors-related pathway. Data were confirmed by Western blot analysis. Pre-treatment of CEC with asenapine prevented cell death and mitochondrial membrane potential collapse caused by hydrogen peroxide (p<0.05) and counteracted the activation of apoptotic markers.

Asenapine could play a protective role on endothelial function and cardiac cell survival, reducing the risk of cardiovascular disease in maniac patients.

The prodrug lisdexamfetamine dimesylate (LDX) is licensed in several European countries for treating attention-deficit/hyperactivity disorder (ADHD) in children and adolescents with an inadequate response to methylphenidate (MPH) treatment.

To evaluate post hoc the impact of ADHD medication history on the efficacy of LDX.

In this 7-week, dose-optimized, double-blind, study, patients (6–17 years) were randomized 1:1:1 to LDX, placebo or osmotic-release oral system methylphenidate (OROS-MPH). Efficacy assessments included ADHD Rating Scale IV (ADHD-RS-IV) and Clinical Global Impressions-Improvement (CGI-I) scores.

The full analysis set (FAS) comprised 317 patients. Baseline characteristics were similar across treatment groups and previous treatment subgroups. At endpoint, the mean change from baseline in ADHD-RS-IV total score and proportions of responders based on a CGI-I of 1 or 2 for LDX, OROS-MPH and placebo are presented below.

LDX and OROS-MPH were associated with clinically relevant improvements in ADHD symptoms irrespective of ADHD medication history.

Study funded by Shire

Implementation research is crucial in the mental health field given that evidenced-based care still lack implementation, even in developed countries. In Portugal, the National Mental Health Plan included actions to change the operational model for mental health teams and a case-management (CM) training program was launched by the Ministry of Health.

This study aims to evaluate the fidelity of a CM programme implementation process, according to the measurement of intervention techniques and resources used by mental health professionals.

The study was carried out at public and private mental health services in mainland Portugal. The implementation process started with a CM course (SAMHSA procedures), in which mental health professionals were trained by means of guidelines, demonstrative videos, scenarios and role-playing. Implementation fidelity was assessed by the Illness Management Fidelity Scale (Mueser, 2009).

Mental health professionals assessment (n=71) showed a 15% good implementation rate and a 43% fair implementation rate, but still not enough implementation in 42%. Mean use of the model resources (e.g. duration and family involvement) was lower when compared with the use of techniques (e.g. goals definition, psychoeducation and relapse prevention).

Despite the fair global implementation rate of the CM model in the Portuguese mental health services, the rate of good implementation is still low. Implementation science may help to reduce the gap between evidence-based practices and their use in routine care, and thus contribute to improve the fidelity of evidence based care models for patients with severe mental illness.

According to Torre's approach, dynamic images from movies may help to reflect on empathy-related issues, to develop a compassionate approach to patients and their sufferance, and to enhance awareness about stigmatizing attitudes. Since its development this method has been used by the Psychiatric Institute of the Università del Piemonte Orientale Amedeo Avogadro, Novara, for the education and training of medical students and, broadly speaking, of people involved in helping professions.

To describe the preliminary results about the impact of this intervention in a sample of medical students.

cinemeducation seminars lasted 6 months, and included 12 meetings. Movies were discussed from a psychological perspective in a group setting and experiences were integrated with the help of the group-leader. Data were collected anonymously via self-report questionnaires from 40 randomly selected participants. Assessment scales (Attitudes Towards Psychiatry, ATP-30; Social Distance Scale, SDS; Interpersonal Reactivity Index, IRI; Rosenberg Self-Esteem Scale, RSES; Toronto Alexithymia Scale, TAS) were administered both before and after the workshops.

a significant increase was found in the ATP-30 score (p = .034), and a reduction of the SDS (p = .022) and IRI-PD (p = .010) scores.

although these results are preliminary, an improvement in students’ attitudes towards psychiatry was found, together with an increased ability of students to tolerate their own anxiety when experiencing others’ distress. This approach to movies allows developing both cognitive and emotional knowledge, which should be considered particularly important in medical education.

was to study familiar and cytogenetic risk factors of depressive disorders in children.

Genealogical and cytogenetic analysis has been carried out in 50 children and adolescents with depressive disorders, aged 6 to 16 years. Statistical treatment: Excel, SPSS Statistics 17,0.

It has been found that 48% of the patients’ families had DD cases among relatives to the third degree. Non-infectious diseases such as mental disorders, DD included, were more frequent in the first-degree relatives (17,2%) as compared to the second- and third-degree relatives (4,3% and 2,6%, ?<0,001). Neurological diseases also prevailed in the first-degree relatives (19,7%) as compared to second- (8,7%) and third- (0,8%) degree relatives. Endocrine diseases (thyroid gland pathology, diabetes mellitus type 1 and type 2, obesity) and oncopathology (lung, stomach, uterine, breast cancer) occurred with the same frequency.

Cytogenetic analysis has shown that the occurrence of chromosomal abnormalities in the patients with DD is 13,1% which is 6,7-fold as compared to the level of spontaneous mutations in healthy peers (1,95%). The occurrence of chromatid (6,9%) and chromosomal (3,4%) aberrations was higher than their level in healthy peers (1,5% and 1,2%).

Socio – cultural factors play an important role in people’ s perception of child mental health problems and services.

To measure the perception of child and adolescent psychiatry in a small town, from the south-western part of Transylvania, Romania.

To analyze whether the level of medical training influences the addressability to psychiatric services.

The 90 respondents of the study included 27 doctors (other than psychiatrists), 32 nurses from the local hospital and 31 teachers. We randomly selected the participants, by consulting the list of the two institutions’ employees, in a specific day.

The questionnaire consisted of 12 questions about demographic profile and perception of pediatrics psychiatry, as a medical specialty. Participation was voluntary and anonymous. Two questionnaires were precluded because of not having all the items answered. To examine the statistical significance of the differences, one way ANOVA and nonparametric Kruskall Wallis test were used.

More than half (51%) considered that psychiatric medication may both diminish the symptoms, but can also have side effects on subjects. 68% of respondents said that a child is stigmatized when being in psychiatric service evidence. There was a valid statistical correlation between the medical level of training and the addressability to psychiatric services (r +0.39, p<0.001). Doctors would take their child to psychiatric services, as a personal decision, while teachers would apply to psychiatric services at recommendation of general practitioner/pediatrician (p<0.05).

The addressability to psychiatric services is related to the level of medical training.

The use of best practice guidelines had an exponential growth in the last 15 years, including in mental health. However the dissemination and use of guidelines has not always been followed by the critical appraisal of the their quality, specially when translation and cultural adaptation for other countries is involved. To increase the odds that a guideline will generate a better practice, they must be evaluated and strategies to their improvement need to be developed.

This study aims to evaluate a clinical guideline used to implement a case management model in the Portuguese mental health services.

The guideline was assessed by two health experts working in the field of evidence based practices implementation: one from the mental health field and one from the communicable diseases field. The assessment was made with the AGREE Instrument 2 (second Portuguese version). Scores were calculated according with the rules of the AGREE Collaboration Group, 2011. Results

The assessment of the guideline on case management for people with sever mental illness showed good scores on the domains 1-Scope and Purpose (72%) and 4-Clarity of Presentation (77%), medium score for the domain 5-Applicability (54%) and low scores in the domains 2- Stakeholder Involvement (41%) and 3-Rigour of Development (28%).

Critical appraisal of guidelines is crucial for the development of best care. The identification of faulty domains in guidelines offers an opportunity to improve and to shape recommendations considering national and local needs. New guidelines can be organised by considering AGREE II dimensions.

was to estimate the level of spontaneous mutagenesis in children with DD.

Cytogenetic analysis has been carried out in 24 children of both genders with mental disorders (MD) in their family history, aged 9 to 17 years, examined in SI ‘ICAHC NAMS’. Control group I consisted of 23 children with DD and with no family history of MD; control group II consisted of 52 healthy peers. Statistical treatment: Excel, SPSS Statistics 17,0.

The level of chromosomal abnormalities in the patients with DD was 13,2%, being 7-fold as frequent as in healthy children (1,9%); the most prevailing were single fragments (7,3 and 0,9%) and paired fragments (3,7 and 0,8%); less frequent were polyploidy (0,7% and 0,1%) and premature centromere division (0,7% and 0,03%). The level of spontaneous mutagenesis in the lymphocytes of peripheral blood in the patients with and without family history of MD was more frequent than in healthy children (13,2; 12,9 versus 1,9%). Regardless of their family history of MD, the patients with DD had more significantly frequent occurrence of chromatid, chromosomal and genomic aberrations as compared to healthy children; nevertheless, the significant difference between the patients with DD and control group I was only found for the occurrence of premature centromere division.

Previous studies in other countries have reported that cyberbullying was related to Information and Communication Technology (ICT) use. Helweg-Larsen, (2011) reported that knowledge about safe internet use did not decrease the prevalence of cyberbullying. Less is known about this relationship with family functioning.

To examine the rates of cyberbullying and their relationships with ICT use and family functioning in a sample of secondary students in the UK

To study 1) associations between cyberbullying and ICT use 2) associations between family functioning and parental controls with ICT-use and cyberbullying.

A cross-sectional questionnaire of 2218 secondary students was completed

included demographic data, ICT use (levels and nature), Olweus bullying questionnaire adapted for cyberbullying, General Functioning subscale of the Family Assessment Device and parental controls (type and levels).

Response rate 80%, 45% males, mean (SD) age 14.97 (1.9) years. Cyberbullying seems to be related to the time spent online and to the general family functioning. Bullies or bully-victims spend significantly more time online than those who are not involved. The majority of students have been told how to be safe online; however only a few have parental controls on their computers. There is a significant positive correlation between worse family functioning and time spent online and with being involved in cyberbullying, even after controlling for the time spent online.

Our results suggest that increasing family communication may contribute to reduce children involvement in cyberbullying

Mental disorders require a comprehensive and specialized psychiatric and psychological assistance, so it is necessary to evaluate patients' mental state with specialized tools. The usability of Barratt Impulsiveness Scale and Liebowitz Social Anxiety Scale and their correlation with the Beck Depression Inventory to determine the mental state of the patient.

The study included 67 patients. The study group had 30 patients treated in open ward of the Department of Psychiatry and Psychotherapy GCM SUM throughout 11/2012-03/2013. The control group included 37 patients without mental disorders. Three questionnaires were used: Beck, Barratt and Liebowitz.

Analyzed groups had significant differences in terms of Beck Scale (U Mann-Whitney test p=0.000001).) Average score in study group: 22.8+/-12.8 median 22; in control group: 7.51+/-6.7 median 6. Groups had significant differences in terms of Liebowitz Scale (U test Mann- Whitney test, p = 0.0067). Average score in study group: 56.8+/- 29.3 median 57; in control group: 37.2+/-26.2 median 28. Groups had significant differences in terms of Barratt Scale (t-student test p=0.001). Average in study group: 66.7+/-10 median 67; in control group: 59.1+/-8.2 median 58. Significant positive correlation was observed between the results of Beck Scale and Liebowitz Scale (r = 0.602289).

The intensity of the Liebowitz Social Anxiety is directly proportional to the severity of depression according to Beck. The degree of impulsivity with Barrat scale does not correlate with the level of depression according to Beck scale.

Anorexia nervosa (AN), rare in young men, is potentially associated with severe medical complications. Mild liver involvement is common. However, rare cases of severe liver dysfunction associated with AN have been described.

To present a rare, severe case of an adult male with AN.

Describe uncommon, potentially lethal, medical complications associated with liver dysfunction.

Describe medical/psychiatric presentation, course of disease and interventions during hospitalization and follow-up.

Male 35 y.o. with AN for 20 years (purging type with use of diuretics/ laxatives and intensive exercise) was transferred involuntarily to the Psychiatric Department from Gastroenterology because of continuing weight loss, excessive exercise, non-compliance of food/fluid intake recommendations and use of diuretics. The patient on admission had BMI 13.5 kg/m2 (recent weight loss of 20 kg), ascites, ankle edema, severe transaminases elevation (x20), and electrolytes dysregulation. In addition, the patient presented depressive symptoms, hoarding, and obsessive compulsive/avoidant personality traits. Feeding was started with parenteral administration, and then through nasogastric tube. Also, the patient was restricted to his room and energy expenditure was controlled. In addition, behavioral/family/cognitive psychotherapeutic interventions were employed. Patient was treated with S-Citalopram, Olanzapine, and Lorazepam. Weight gradually increased. After 4.5months of hospitalization, liver function was normal, BMI was 21 kg/m2, mood was elevated, and hoarding was diminished. In a 6 months outpatient follow-up the patient's BMI was 23 kg/m2 and he was both socially and personally functional.

Long hospitalization using an integrated approach that combines medical and psychotherapeutic interventions, may reverse severe liver dysfunction in life-threatening NA.

The psychological consequences on the caregivers taking care of mentally ill patients are well known; however, little evidence exists as to whether taking care of a mentally ill patient affects the physical health of the caregiver.

To examine the effect of caregiving on emotional and physical health.

To study the association between caregiving for mentally ill and physical illness.

One hundred twenty-eight caregivers, relatives of patients suffering from schizophrenia or bipolar disorder, who were hospitalized consecutively during the past three years (2011–2013), and 117 controls completed over telephone a structured questionnaire. Eligible patients were all those with duration of illness more than 5 yrs. Data included demographics and detailed information about past or present mental and/or physical illness. Data were analyzed using the Pearson's chi-square test and multivariate binary regression controlling for BMI, age, sex, and smoking.

Significant correlation was found between caregiving and anxiety (OR=4,1, p<0,0001), depression (OR=3,5 p=0,03), sleep disturbances (OR=2,6, p=0,05), arthritis (OR=2,5, p=0,03), rheumatopathy (OR=2,8, p=0.09) and allergies (OR=2,5, p=0,09). The association of caregiving with allergies/ arthritis was independent of anxiety and depression. No correlation was found with diabetes, hypertension and cardiovascular disease.

The stress of taking care of a mentally ill patient appears to affect physical health, specifically increasing the risk for autoimmune disorders (allergy, arthritis), independently of anxiety, depression and sleep disturbances.

Twenty percent of psychiatric inpatients have co-morbid substance abuse/dependence and their management is challening.

To investigate co-morbidity and patterns of substance use among inpatients in a general psychiatric unit.

To examine specific patterns and risk factors associated with substances/alcohol in psychiatric inpatients.

Participants included 487 inpatients consecutively admitted to the Psychiatric Unit, University Hospital of Crete between Nov 2011- Jun 2013. Data were analyzed using the Pearson's chi-square test and multiple regression.

Our sample, mean age 42.7±14.5yrs, consisted of 57.9% males, whereas 51.9% were admitted involuntarily. In addition, 60.3% were unemployed, 24.3% had a spouse and 38.1% had no previous psychiatric hospitalizations. Furthermore, 354 (72.8%) used no substances, while 16.1% used alcohol, 12.3% cannabis, 3.8% opioids, 2.5% cocaine, and 5.5% anxiolytics. Mean age of those abusing alcohol was 41.8yrs, cannabis 34.1yrs, opioids and cocaine 31.6yrs and anxiolytics 36.9yrs. In patients with Major Depression, alcohol (21.1%) and anxiolytics (9.8%) were the most prevalent, whereas, in patients with psychotic disorders and bipolar disorders, alcohol (9.8% and 5.8% respectively) and cannabis (11.9% and 15.2%) were the most frequent. Unemployment, and involuntary admission weren’t significant risk factors for alcohol/substance use.

Substance/alcohol abuse/dependence is present in 1/3 of our psychiatric population with alcohol, cannabis and anxiolytics the most commonly used. Alcohol was more frequent in older patients with depression, whereas cannabis was more frequent in younger patients with psychotic/bipolar disorder. Development of dual diagnosis centers, very scarce in Greece, are needed for the management of psychiatric patients with substance co-morbidity.

Research focused on the intrafamilial environment of people experiencing their first episode of psychosis (FEP) is limited.

To investigate possible differences in family environment between FEP patients, chronic psychotic patients and healthy controls.

To compare family variables between relatives of FEP patients, chronic patients and healthy controls.

Family cohesion and flexibility (FACES-IV) and psychological well-being (GHQ-28) were evaluated in relatives of 50 FEP patients, 50 chronic patients and 50 controls, whereas expressed emotion (FQ) and family burden (FBS) were assessed between the two clinical groups.

Multivariable linear regression analysis adjusted for several confounding variables revealed statistically significant differences in the total ratio for family cohesion and flexibility between the three groups indicating poorer family functioning for chronic families as compared to FEP families (β coefficient −0.47, 95% CI: −0.77, −0.18) and lower scores for FEP families as compared to controls (β coefficient −0.59, 95% CI: −0.81, −0.37). Chronic families scored significantly higher in critical comments (β coefficient 7.17, 95% CI: 3.45, 10.89), and reported higher subjective (β coefficient 2.85, 95% CI: 0.69, 5.01) and objective burden (β coefficient 8.25, 95% CI: 4.67, 11.84) as compared to FEP families. Non-significant differences were found in psychological well-being between FEP and chronic families, whereas FEP families reported higher levels of psychological distress as compared to controls.

Having a family member with a major psychiatric disorder is a general stressor for families and family interventions should be considered to minimize disruption to family life.

Co-morbidity between depression and diabetes is a common underdiagnosed condition. Individuals with diabetes have about a 2- fold increased risk for major depression, affecting one of every 10 diabetic patients. The association between depression and diabetes may be due to biologic effects of depression on the hypothalamic-pituitary axis, platelet adhesion, inflammation or the autonomic nervous system; alternatively, the association may be due to non-adherence with medication leading to worse control of glycemia.

To investigate the association between diabetes and depression symptoms within a community-based sample with type 2 diabetes mellitus, while controlling for socio-demographic, diabetes-related characteristics and complications, disability, other chronic illness and other health-related variables.

180 patients with diagnosis of diabetes mellitus type 2 were tested to evaluate mood (Montgomery-Asberg Depression Rating Scale, MADRS), health status (Short Form 36, SF-36) and personality (Temperament and Character Inventory, TCI) related to variables (sex, age, education, marital status, socioeconomic status).

We found 1) mild depressive symptoms in 73% of patients (6≤ MADRS score ≤20), with a greater prevalence in female gender (94% females vs 53% males) and in older age (58% males vs 94% females); 2) a poor quality perception of health status in 68,7% of diabetics/depressed patients (subthreshold ISM, mental health index); 3) frequency methodical type personality (low NS, high HA, low RD) in 53% of sample (48% males, 71% females).

Diabetic population has increased risk of developing depression. Early identification of depressive symptoms may occur through the study of risk factors.

Assessment of neuropsychiatric symptoms is crucial to the management of dementia. In this context, the Neuropsychiatric Inventory (NPI) is the most widely used comprehensive tool, assessing twelve domains (delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, aberrant motor activity, night-time behaviour and appetite/eating abnormalities). NPI records severity, frequency and caregiver distress. It has been translated and validated into a number of languages and shown to be reliable in cross-cultural studies.

To present preliminary results of the NPI Portuguese validation study.

A cross-sectional study was conducted with a convenience sample of institutionalized elderly (≥ 60 years old) in three Nursing Homes in Portugal. All patients were also assessed with MMSE (cognition) and GDS (depression). NPI was administered to a formal caregiver, usually from the clinical staff. Inter-rater and test-retest reliability were assessed in a subsample of 25 randomly selected elderly.

The sample included 166 elderly, with a mean age of 80.9 (10.2sd). Three out of the NPI behavioural items had significant negative correlations with MMSE: delusions (r=−0.177, p=0.024), disinhibition (r=−0.174, p=0.026) and aberrant motor activity (r=−0.182, p=0.020). The NPI subsection of depression/dysphoria correlated positively with GDS total score (r=0.166, p=0.038). NPI showed good internal consistency (overall α=0.766; frequency α=0.737; severity α=0.734). The inter-rater reliability was excellent (ICC=1.00, CI95% 1.00–1.00), as well as test-retest reliability (ICC=0.91, CI95%0.80–0.96).

These results suggested that the Portuguese version is a valid and reliable instrument for the evaluation of neuropsychiatric symptoms in elderly people.

Major depressive disorder (MDD) is a complex disorder and recent research suggests that muliple genetic and environmental factors seem to underly MDD criteria as well as seem to influence brain structure and function.

Aim of the study was to investigate whether epigenetic regulation and mRNA expression of glucocorticoid inducible genes (SGK-1, GILZ) are associated with structural alterations in hippocampal subfields and functional brain changes. Moreover, we investigated whether there are interactive effects between the genetic variant of the BICC1 gene and ELA.

Patients with MDD and healthy controls were investigated using structural magnetic resonance imaging (MRI) and functional MRI with an emotion inhibition task. Analysis of a single nucleotide polymorphism in the BICC1-1 (rs999845) gene as well as mRNA expression and methylation of DNA was performed.

Hippocampal subfield volumes of dendate gyrus and CA2 were reduced in patients with MDD. These were associated with reduced mRNA expression of glucocorticoid inducible genes and with DNA methylation. Moreover, MDD patients with a history of ELA, who carry the protective T-allele, had smaller hippocampal head volumes compared to MDD patients without ELA. FMRI showed that patients and controls carrying the protective T-allele of BICC1 activate the emotion regulation system significantly more compared to those participants homozygous for the major C-allele (p<0.05, family wise error corrected).

These results are suggestive for environment x gene interactions in MDD and for the impact of epigenetic regulation on brain structure and function.

Spherocytosis is an inherited hemolytic anemia, most common on northern Europe, that causes variable degrees of anemia, jaundice, splenomegaly and in severe cases adolescents are transfusion-dependent prior to esplenectomy.

Chronic illnesses are known to provoke psychosocial dysfunction in affected children and their families. The risk of psychiatric disorder increases with the number of such family's adverse factors as marital discord, low social status and parental psychiatric disorders. It has been reported that children with two family risk factors have a fourfold increase in rate of disorder.

This paper aims to describe the features of psychiatric and psychosocial maladjustment in a patient firstly diagnosed as having sickle cell disease.

We describe a 16-year-old girl with homozygous hereditary spherocytosis admitted to the outpatient Child and Adolescent Psychiatry Department who developed progressive social isolation.

Her psychiatric condition had been evolving since fifth grade, when she started blood transfusions and stricter clinical surveillance. A favorable trend was observed after strategic family therapy and individual cognitive-behavioural therapy focusing on anxiety and shyness desensitization intending to overcome friendship difficulties and improve social assertiveness.

In psychosocial management of physical illnesses, assessment and care should include a focus on families besides the affected individual only. This study suggests that the bio psychosocial approach to health care and consultation-liaison psychiatry should be emphasized.

Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost.

1. - To establish the course of the first major depressive episode (MDE) in a population of students.

2. - To identify the various factors involved in this process.

Retrospective and descriptive study on 40 students followed in Psychopedagogie’ consultation in the department of Psychiatry B, Hedi chaker hospital in Sfax Tunisia from 2009 to 2013. The statistical analysis was performed by the SPSS (version 18).

The average age of the group was 22,8 years. Twenty-three women (57,5%) were included. All of patients were single. The socioeconomic level of the group was fair in 62,5% of cases. Twelve subjects had a family history of psychiatric illness. Prevalence of unipolar depression was 82,5%. Majority of patients were treated with only pharmacological means (77,5%). The general evolutif course in our subjects tends to improvement (37,5%). Six patients had a complete recovery. The persistence of residual symptoms was found in 12 patients. Deterioration in social and professional functioning was reported in12 patients. Six patients have had relapse. The recurrence of MDE was reported in 2 patients. Chronicity was founded in 4 patients. Two patients had a new suicide risk. One patient had an emergence of mood episode. No patient had spontaneous improvement. Nine patients have stopped the follow. The main reason of worsening was the emergence of an intercurrent stress factor (52,5%).

The negative impact of depression in our patients explains the necessity of a well adapted management.