Study participants were: the caregivers of the patients admitted to the Republican Clinical Psychiatric Hospital, suffering from schizophrenia, affective disorders and the control group (participants from mentally healthy families).

The inclusion criteria were: 1) living with the patient in the same house; 2) age > 18 years; 3) absence of somatic and psychiatric pathology; 4) informed consent.

We used the following assessment instruments: the Medical Outcomes Study Short-Form36 (SF-36) survey; Family Experiences with the Stigma of Mental Illness Questionnaire by H.Stuart; the Coping Strategies Questionnaire by E.Heim; the Questionnaire of Family Burden according to the WHO «Quality Assurance in Mental Health Care».

The obtained results show that relatives of mentally ill patients suffer from negative consequences of stigma and discrimination. They have the burden in economic, psychological, social environment, family interaction areas. Relatives feel social isolation, shame, guilt, worry and distress.

One of the causes of such tragic consequences of stigma is the lack of specific information about mental illnesses and choice of inadequate coping strategies. We apply psychoeducational project in the families of patients with schizophrenia to reduce negative influence on their lives.

The authors presented their acitivities in prevention of mobbing, suiciality, pathological gambling, and antistigma programs aimed for the persons treated for combat PTSD.

Social dialogue is achieved through numerous outpatient activities that included systematic information and education, public discussions, conducted studies, public program promotions, performance presentations, koordination, and active engagement of various professionals (psychiatrists, psychologists, pedagogues, social workers, jurists, politicians, employees in civil service, associations and syndicate, employers, and volonteers).

Numerous public disscussions and professional gatherings have been held, professional and scientific studies have been conducted, programs have been presented in public through various media, web-pages have been created and brochures have been written. The created positve atmosphere leveled up the awarenes, what resulted in propositions for drawing up broader, national strategies, and some pending legal solutions.

Social dialoge is represented by all types of information exchange, conslutations, and discussions between social partners and government representatives about issues of common interest related to social or economic policy. In situations when some primalily social events partially participate in the genesis of psychological disorders, a psychiatrist may take part in the dialogue, pointing out the existance of the problem, defining the problem and offering professional solutions for prevention. In order to have a social dialogue it is necessary to have most extensive public support and understanding that only with joint endeavor of all citizens the problem may be, and must be, solved.

The family plays an essential role in individual and social life. That is the first center to grow and blossom the talents appropriately and a starting point for all social charges each modification should start from the family.

This is a descriptive analytic study. On 394 men and 404 women. The spouses' abuse behavior was defined by a questionnaire. Results:

The findings showed that there was a significant association between abuse behaviors such as aggression, screaming, punishment and physical fight, mutual scorning, contempt and criticizing, silence and not speaking, insulting not talking to each other, criticizing in public, throwing and breaking things, sleeping separately between men and women (p<0.001)

The findings showed 88% of the men and 51% of the women, stubbornness in 73% of men and 70%of women, aggression and screaming in 63%of men and 51% women, physical punishment and fight in 27% of men and 16%of women, leaving home in 14%of men and 22% of women, having undesired sexual relation with spouse in 47%of men and ignoring spouse's sexual needs in 35%of women and throwing and breaking things in 34%of men and 26%of women.

Regarding the findings, holding education before family formation is essential. Educating people concerning how to control their anger together with teaching appropriate communication skills are important.

Seclusion and mechanical restraint are widely used for people with serious mental disorders. In most countries one intervention is preferred while the other is considered as inhuman or not sufficiently safe, but identical arguments refer to different preferences. There is a lack of evidence from well-designed studies on compulsory measures in psychiatry.

We conducted a cohort study with optional randomisation comparing seclusion and mechanical restraint among in-patients with acute psychotic disorders. We determined an ethical aspect as main outcome variable: the restriction of human rights from the patients' point of view, measured by a scale developed for this purpose, Human DIgnity during COercive Procedures, DICOP-Score.

102 out of 233 patients exposed to coercive measures within 24 months could be included, 26 could be randomised (12 seclusion, 14 restraint). There were no significant differences between the two interventions referring to DICOP-score and duration of the intervention. The burdens most frequently reported were solitude, loss of dignity, and not having understood why the intervention was done. Watching pictures of several alternatives in the interview, including physical restraint and net bed (not available in Germany), most patients preferred seclusion.

Both from ethical and safety aspects the results do not yield evidence to prefer or forbid one of the interventions. Clinical decisions should take into account patients' preferences.

To evaluate trends in the use of antidepressant drugs in Lithuania between 2002 and 2004 years.

The data on total sales of antidepressant drugs in all Lithuanian regions over three years (2002-2004) were obtained from IMS Health Inc. Data were calculated by DDD methodology and expressed in DDDs per 1.000 inhabitants per day. DU95% was used as the quality indicator of the drug prescribing. The pharmacoeconomic analysis of antidepressants was performed by cost minimization and reference price methodology.

In Lithuania the total antidepressants consumption increased by 30,55% over three years (2002-2004) period reaching the value of 10,00 DDD/1000 inhabitants/day. Since 2002 the proportion of use of SSRIs has increased by 27,82% and the use of TCAs has declined by 10,78%, while the use of other (newer) antidepressants expanded almost three times. The expenditures of antidepressants has reached 26 mln Litas (in 2004 year), of which 68,15% was costs for SSRI agents. Setting the reference price of fluoxetine it would be possible to save costs by 60,7%, up to 18 mln Litas per year (1 = 3,4528 Lt).

The findings suggest that the use of total antidepressant drugs continues to increase because of the increased use of the SSRIs and other (newer) antidepressants. In comparison with the data in other countries the consumption of antidepressants in Lithuania is low. Due to high suicide rates in Lithuania and low consumption of antidepressant drugs we can assume that depression is diagnosed and treated insufficiently

This study examined low episodic memory scores as a potential risk factor for developing depression by using longitudinal data from the PART project in Stockholm, Sweden.

A population-based sample of non-depressed participants (20-64 years) were re-examined three years after the initial screening (n=708). At baseline, a neuropsychological test battery including tests of episodic memory was administered. Also, information about demographic and socioeconomic factors, alcohol use, and anxiety diagnoses was collected. The psychiatric data for depression diagnoses were collected both at baseline and follow-up.

Logistic regressions were conducted on three separate study groups that were defined according to three different assessments of episodic memory (i.e., free + cued recall, free recall or cued recall) among individuals who scored in the 25 lowest or highest percentiles in the memory tests. The results suggest that low episodic memory performance defined as the sum of free and cued recall of organizable words, constitute a risk for depression diagnosis three years later, even after controlling for differences in demographic, socioeconomic, alcohol use and anxiety levels. Also, female gender, low educational level, and financial strain constituted significant risk factors for developing depression.

This study indicates that low episodic memory performance predates depressive diagnosis and might be considered as a premorbid marker of incipient depression.

Postpartum psychiatric disorders constitute an important field of problems due to the fact that they lead to an increase in mortality both in infant and mother. A history of mental disorders and stressful life events during pregnancy and post partum period, poor familial and social relations are stated as important risk factors. The aim of this study is to specify the risk factors associated with PPD in Turkish women.

Among 185 women that gave birth in a state hospital, 80 were suitable and admitted to the study. One month after the birth, subjects were interviewed with an assessment battery including SCID-I, Edinburgh Postnatal Depression Scale and a semistructured interview form concerning the sociodemographic and risk factors for PPD.

Thirty percent of our subjects were diagnosed as PPD. Patients with PPD had more severe depressive symptoms during the last 3 months of pregnancy, higher rates of history of depression, PPD, postpartum blues, premenstrual dysphoric disorder, parental depression, poor social support, stressful life events during last 1 year, and problems in marriage as compared those without PPD. There was no significant difference between groups with respect to type of birth and pregnancy, history of abortion and curettage, and emotional response to oral contraceptive drugs.

Assessing the factors that increase the liability to PPD would make it easier to detect the individuals with high risk and to provide earlier professional support to those individuals.

Depression is one of the most frequent psychical disorders in patients with multiple sclerosis (MS).

The aim of this paper is to present the demographic characteristics of the depressive disorder in patients with MS with special emphasis on the character of the depressive manifestation.

We have prospectively evaluated 50 randomly chosen patients with various types of MS, who were clinically followed up for demyelinating diseases in the outpatient department at the Neurology Clinic Sarajevo. The depression was assessed with Beck Depression Inventory (BDI) scale.

There was 66% of males and 34% of females, mean age 40.47 years, SD 9.236. In 56% of patients a depression that ranged from mild depressive mood (30%) to severe depression (10%) was established with no statistically significant difference between the two sexes. Statistically significant difference between sexes (p<0.05) was found in the presence of suicidal thoughts and ideas which were marked in 17% of males. All patients older than 51 (31.9%) were in normal mood (X2-test = 13.749, p<0.05). The depression was present in all divorced patients (10.7%), in most unmarried (35.8%), a number of widowers (21.4%), in patients with higher education (46.4%), in unemployed and in retired (75%).

Depression more frequently occurs in younger unemployed patients suffering from MS who have no spouse and have high education without significant difference between sexes. The clinical presentation of depression with its symptomatology often intertwines with some symptoms of multiple sclerosis which sometimes may pose diagnostic and therapeutic dilemma.

To estimate the health-related quality of life (HRQOL) and impact of concurrent pain on HRQOL in patients seeking treatment for depression in a 6 month observational study in the United Kingdom (subsample results from pan-European study).

HRQOL was measured using two generic quality of life instruments: the Short Form 36 Health Status Survey (SF-36) and the EuroQol (EQ-5D). Pain was assessed using a visual analogue scale (range 0-100, no/mild pain [NMP] 0-29, clinically significant pain ≥30).

608 eligible patients were enrolled, mean age 42.8 years (SD 14.7) and 61.2% were female. 49.4% of patients reported NMP; 10.8% had significant pain from a co-morbid medical condition known to cause pain (PMC) and 39.8% had significant pain associated with a medical disorder not known to cause pain or without further co-morbidity (PD). SF-36 physical component scores were lowest in the PMC group, 36.7 (SD 9.7); with improving scores in the PD group, 44.4 (SD 10.0) and the NMP group, 54.5 (SD 8.3). There was no marked variation in mental component summary scores between the groups; 23.0 (SD 8.5), 20.4 (SD 9.1) and 21.7 (SD 10.8) respectively. A similar trend in HRQOL loss was observed for the EQ-5D health state index, where scores of 0.30 (SD 0.32), 0.41 (SD 0.30) and 0.60 (SD 0.25) were observed respectively.

A high proportion of patients presented with pain presumably related to depression. The presence of concurrent pain appears to be associated with reductions in SF-36 physical component scores and overall HRQOL (EQ-5D).

Life events play a role in the development of childhood depression. According to the literature major depression lowers subjective quality of life (QL). There are few studies about factors decreasing QL in general and even less on child and adolescent samples. The relationship between mental disorders and QL is not well studied either. In the present research we studied the quality of life in a school population and the relationship of QL to the number of stressful life events (SLE) and the severity of depressive symptoms.

The sample consisted of 9 elementary schools in Hungary. 2620 children were tested between 7-15 years of age (mean age: 10.45 years (s.d. 2.2). There were 1160 boys (44%) and 1460 girls (56%). Stressful life events were collected by parental report, depressive symptoms were assessed by short version of CDI, quality of life was measured by self-report and parental questionnaires (ILK).

Both stressful life events and depressive symptoms have a significant negative effect on subjective QL overall and individual QL domains. The effect of depressive symptom severity is much larger than that of the SLE. When comparing the parent and child opinions about the QL of the child, we can see that depressive symptoms are more important in childrens' opinion while SLE is more negative in parents' opinion. Stressful life events effect subjective QL directly (50%), indirectly (50%) through depressive symptoms. A complex study of the QL in childhood onset mental disorders would be important.

Depression is a risk factor for coronary heart disease (CHD) and for other cardiovascular diseases. It cause high mortality in known patients. SSRIs are safe and have a negligible effect on the cardiovascular system, even in cases of overdose.

To examine the antidepressant effect of sertraline and paroxetine in patients with CHD after the incidence of an acute coronary event.

46 patients (26 female, mean age 59,8; 20 male, mean age 57,8) diagnosed with CHD, after 1-3 months from an acute coronary syndrome, no depression in the past, met the criteria for major depressive disorder (MDD) according to ICD10. It was performed HAMD 17 items.

Patients received either sertraline 75-150 mg/day (n=23; mean dose 104,3 mg/day) or paroxetine 20-30 mg/day (n=23; mean dose 22,6 mg/day). They were examined on baseline and days 7, 28, 56, 112, 168 using cardiologic evaluation, and depression rating scale HAMD. All treated patients had a significant improvement on HAMD score (from mean 21,8 to 10,6). Significant improvement was noted at 28 days of treatment. 12/46 (26,08%) were mildly improved and 34/46 (73,92%) were much or very much improved. No important side effects were recorded.

1) Patients with no recent history of depression suffering a cardiovascular event were more likely to be diagnosed with depression. 2) Diagnosis and treatment of depression should be incorporated into the clinical management of CHD 3) Sertraline and paroxetine are a safe and effective treatment in patients with CHD without other life-threatening medical conditions.

Ortothopic Liver Transplantation (OLTx) is a therapeutic option for selected patients with severe hepatopatic diseases. Resources are precious and limited, and selection of “ideal” candidates is tough but necessary; the psychiatrist is involved in the assessment of compliance and adherence to the therapeutic process by the patient. Moreover, the inclusion in the waiting list for OLTx activates multiple psychological reactions in the patient, mainly anxiety and depression, and a need to test patients' coping capacity is also crucial.

567 patients from the Liver Transplantation Surgery Unit of Modena General Hospital were assessed by professionally-trained psychiatrists between January 2002 and December 2005. After a standard psychiatric assessment, the Transplant Evaluation Rating Scale (TERS) and Montgomery-Asberg Depression Rating Scale (MADRS) scales were administered to each patient. The TERS scale was specifically developed to test the attitude of the patient to receive a transplant. The MADRS quantifies the presence of anxious and depressive symptoms.

TERS and MADRS scores show a statistically significant inverse correlation one to each other: patients showing high levels of anxious and/or depression symptoms appear to be worse candidates at the TERS evaluation.

Psychiatric assessment of patients waiting for OLTx is relevant, not only for selection of candidates, but also to activate a psychological support and/or a psychopharmacological therapy, to improve patients' coping strategies in facing both a debilitating physical illness and a difficult therapeutic pathway.

To assess efficacy of fluoxetine, 60 mg per menstrual cycle, in the treatment premenstrual dysphoric disorder (PMDD).

114 female outpatients aged between 18 and 45 years old, who met DSM-IV-TR criteria for PMDD, were randomly assigned to receive either fluoxetine or amitriptyline during luteal phase for 4 menstrual cycles. Fluoxetine was administered in 3 doses according to the following scheme: 20 mg/day for 2 consecutive days starting from the beginning of luteal phase and 20 mg/day after 7 days since first dose. Amitriptyline was administered in dose of 25 mg/day continuously during the whole luteal phase. Efficacy measures included HAMD17 total score, individual HAMD17 items, HAMA total score, individual HAMA items, CGI-S and CGI-I scales.

Compared with amitriptyline, 60 mg of fluoxetine per menstrual cycle produced significantly greater baseline-to-endpoint mean change in HAMD17 total score, and items 8 (Retardation), and 13 (Somatic symptoms general) as well; HAMA total score, and items 5 (Intellectual), 8 (Somatic symptoms – Sensory), and 9 (Cardiovascular symptoms) as well; and the CGI-I scale (LOCF analyses; p<.01 for each variable). 50%-reduction from baseline of HAMD17 total score, as well as HAMA total score was observed at the end of 1 course of therapy (end of 1 luteal phase) in both treatment groups. There was no significant difference in CGI-S scale baseline-to-endpoint mean change between fluoxetine and amitriptyline groups.

60 mg of fluoxetine per menstrual cycle demonstrated comparative or superior efficacy as compared with amitriptyline in standard dose in the treatment of PMDD.

The purpose of the present study was to examine the relationship between depression and hostility among teacher.

Participants were 531 teachers of education organization of Golestan province in Iran. The mean age of the participants was 37.49 years (SD = 5.58) and ages ranged from 21 to 50 years old. There were 215 men and 316 women.

All participants completed a questionnaire booklet containing one self- report measures: The Symptom Checklist-90-R (SCL-90-R).

The results of the present study demonstrate that: 1) Correlation between depression and student's hostility is meaningful and positive (r = 0.714, p<0.001).

The present study revealed that a more depression is associated with a high level of self-reported hostility

Results of a co-morbid insomnia and depression study of eszopiclone and fluoxetine demonstrated that co-therapy produced greater improvements in sleep and depression than fluoxetine monotherapy. To determine if changes in the HAMD17 were due to sleep, individual HAMD17 items were evaluated.

Patients met DSM-IV criteria for MDD and insomnia, with screening HAMD17 >14. All patients received fluoxetine QAM for 10 weeks, and randomly received double-blind eszopiclone 3mg or placebo QHS for 8 weeks, followed by a single-blind placebo 2-week run-out. HAMD17 was completed at Weeks 4, 8, and 10. Individual items were compared with ANCOVA using an LOCF approach.

Mean baseline HAMD17 scores were 22 for each group. At Week 4, differences were noted between treatment groups in the total score, and the individual items of insight, the three insomnia items (p<0.02 vs monotherapy), with a trend for guilt (p=0.07). At Week 8, significant differences between groups were noted in total score (p=0.0005), in the clinician-administered Bech subscale (p<0.001), in the three insomnia items (p<0.001), guilt, work/activities, and anxiety psychic (p<0.05). At Week 10, the total score, guilt, the three insomnia items, work/activities, retardation, agitation, anxiety psychic, general somatic symptoms, and hypochondriasis demonstrated significant improvements (p<0.05 vs monotherapy) despite discontinuation of eszopiclone.

Eszopiclone/fluoxetine co-therapy resulted in significant improvements in the insomnia items of the HAMD17. In addition, several items related to core depressive symptoms were also improved with co-therapy compared with monotherapy.

Support for this study provided by Sepracor Inc.

One of the most frequent causes of going to cardiovasculor clinics is chest pain The origin of Chest pain can be cardic or noncardic. Noncardic chest pain may be due to psychicl disorders such as obsession, violence, anxiety, depression, paranoid, phobia, somatization, psychosis.

Present survey is a discriptive, cross sectional study which has been carried out on 400 patients with chest pain refferred to Semnan Fatemieh hospital. These patients did not have cardiovascular diseeses and related test and exercise test were negative. Data from these patients were collected by questionaire.

Fifty three percentage of patients were men and 47% were women. The most prevalence psychial disorder in this study was depression with 66.2% and the least one was psychosis with 16%. Depression intensity in 73% of patients was light. Moderate and vigarous intensities in patients were 26% and 1% respectively. The percentages of anxiety and obsession with different level intensites (light, moderate and vigarous) were 85%, 15%, 0% and 79%, 18%, 3% respectively.

In this study depression and agitation were the most common of psychial disorder agents in patients with chest pain, origin noncardiac. This fact showed a similarity with other studies, while agitation was the most common agent of the chest pain in some studies. It seems this difference arising from cultural diversity of patients. The most prevalance of psychial disorders in men and wonen (mid ages) were 47.18% and 47.8% respectively.

There were children with emotional and behavioural problems in the depressed group than in the control group. Children of depressed mothers commonly had eating difficulties, problems in relationships with peers or parents, and poor attention with over activity. However, there was no difference in sleep problems, mood disturbances, general intellectual levels, or language comprehension between children from the study group and the control group.

At the 6 month follow-up, 14 depressed mothers had recovered, whereas 10 were still depressed. Children of recovered mothers were somewhat less disturbed than those whose mothers were still depressed but more disturbed than children of non depressed mothers.

Depressed mothers appeared to be less responsive to their children than nondepressed mothers. Children of depressed mothers were more often distressed than children of nondepressed mothers.There was a wide variation in the quality of mother – child interaction within the depressed group.

assessment of depressive symptomatology and personality traits in patients with coronary artery disease (CAD).

forty-two males consecutively admitted to a cardiology unit due to an ICD-10 diagnosis of Acute Cardiac Syndrome (ACS). Twenty-two of them had unstable angina (UA) without myocardial infarction and 20 of them had confirmed myocardial infarction (MI).

short questionnaire assessing the clinical course of heart disease, the Beck Depression Inventory (BDI) and the Cloninger Temperament and Character Inventory (TCI) were applied.

The mean BDI score in the whole group of patients was 20. The MI patients had higher BDI score than the UA patients without MI. The patients with more serious clinical course of heart disease and those who shorter suffered from ACS had significantly higher BDI score than the other patients. The whole group of ACS patients revealed more pronounced temperamental Harm Avoidance (HA) and less pronounced Reward Dependence dimension of the TCI. The patients with more serious clinical course of CAD had more evident HA features and than patients with mild clinical course of the disease. The patients with longer duration of CAD had more pronounced Self-Transcendence (a character dimension of the TCI) as compared to patients with shorter duration of the illness.

Depressive symptoms are common and prominent in CAD patients particularly in those with shorter duration and more serious course of the illness. The relationships between temperamental and character dimensions of personality with the clinical course of CAD indicate multifactor and complex associations which need further studies.

Painful physical symptoms (PPS) in major depressive disorder (MDD) can obscure the diagnosis and impair treatment outcome. Antidepressants inhibiting serotonin and norepinephrine reuptake (SNRI) can be effective in the treatment of both emotional and PPS in MDD. This study evaluated efficacy and safety of duloxetine, an SNRI, in the treatment of patients with moderate pain associated with depression.

In this double-blind, placebo-controlled, European, 8-week study, outpatients ≥18 years of age, presenting with major depression (Montgomery-Asberg Depression Rating Scale [MADRS] ≥20 and Clinical Global Impression-Severity [CGI-S] ≥4) and moderate pain (brief pain inventory [BPI] average pain score ≥3) not attributable to a diagnosed pain syndrome were randomized to either placebo (N=165) or duloxetine 60mg (N=162) once daily. Primary outcome measure was the BPI average pain score at endpoint. Secondary measures were MADRS total score, CGI-S, PGI-I, SCL-90 R, response and remission in MDD, safety, and tolerability.

Duloxetine compared with placebo significantly (P <.001) improved the mean change of both BPI average pain (-2.57 vs. -1.64) and MADRS total scores (-16.69 vs. -11.31) with significant separation after 1 or 2 weeks. Remission in MDD (53% vs. 29%) and response rates in pain and MDD were significantly higher in duloxetine-treated patients. Duloxetine separated on most secondary outcome measures from placebo. Treatment-emergent adverse events (≥10%) observed in duloxetine- treated patients were nausea, hyperhydrosis, and dry mouth.

These results support duloxetine's efficacy and tolerability in the treatment of PPS and emotional symptoms in patients with moderate pain associated with depression.