A growing body of literature suggests that proinflammatory cytokines may be causally associated with psychiatric symptoms. Illnesses characterized by chronic inflammatory responses are associated with depression. Studies of cytokines and anxiety symptoms are rare, but provide robust evidence that subjects with anxiety have significantly increased levels of interleukin-6 and tumor necrosis factor alpha.

The authors report a clinical case of a 76-year-old man who was referred by the outpatient surgery clinic to liaison psychiatry consultation. He presented a history of chronic anxiety, mild suspicion, insomnia, anorexia and constipation. He was medicated sequentially with benzodiazepines, antidepressants and lastly antipsychotics - he had no response to any of these medications. Analytically he had mild leukocytosis and cranial computed tomography scan was normal. After two months of follow-up there was a clinical deterioration, with significant weight loss and hypotension. A month later he became seriously ill with prostration, abdominal pain and marked hypotension. He was admitted in an intensive care unit and died of peritonitis following rupture of a chronic appendicitis.

There is evidence that antidepressants reduce the release of proinflammatory cytokines and increase the release of endogenous cytokine antagonists. The literature shows less consistent findings on the potential anti-inflammatory effects of antipsychotics. Risperidone has been shown to reduce proinflammatory cytokines.

This case report suggests that treatment with antidepressants and antipsychotics masked physical symptoms, reduced pain and acute inflammation, contributing to the chronicity of the appendicitis process and delaying the diagnosis, with a fatal outcome.

Epidemiological data about surgeons’ mental health and wellbeing are alarming: burnout was reported in about 40% of surgeons, 19% met criteria for alcohol abuse, and 6% had suicidal ideation. Factors related to the surgical culture may have an influence and impede helpseeking (stigma, shame, and fear for career repercussion).

To explore surgeons’ account of their practice.

To obtain an international consistent description of surgeons’ experience, addressing the problem of their wellbeing.

Medline, CINAHL, EMBASE, PsycINFO, and SSCI have been accessed to identify relevant international qualitative research exploring how surgeons talk about their practice. Meta-ethnography (a systematic review and analysis of qualitative literature that compensates for the potential lack of generalizability of the primary studies and provides new insights by their conjoint interpretation and comparison) have been used to identify key themes and synthesize them.

51 papers have been identified. The six emerging themes have been clustered in two axes. First, patient-surgeon relationship: strong emotions come from this relation due to the extent of personal involvement in decision-making, responsibility and uncertainty. Second, group relations and culture: it shows the influence of the surgical hidden curriculum on behaviours, coping attitudes and help-seeking.

Strong emotional components overwhelm surgical practice, which potentially expose surgeons to vulnerability and isolation. They appeared unprepared for and had difficulties coping with these issues. Our findings suggest that taking into account the relational and emotional dimensions of surgical practice (both with patients and within the institution) might improve surgeons’ wellbeing and mental health.

The adverse experience in childhood (parental deprivation mostly) (AEC) has an important role in predisposing to mood and immuno-inflammatory rheumatic disorders in adults via chronic stress mechanisms. The primary Sjögren's Syndrome (SS) - a chronic, systemic autoimmune disease, which has some common pathogenic links with stress-related mental disorders.

To evaluate the AEC and MD presentation in SS patients.

80 inpatients (mean age 46,2+12,3 yrs) suffering SS were enrolled in the study. MD were diagnosed in accordance with ICD-10 criteria. The severity of depression, anxiety, stress were measured with HADS, MADRS, HAM-A, PSS-10.

The AEC had 78,7% of SS patients (recurrent events – 32,5%). Patients with AEC had an increased risk of developing dysthymia (OR=1,34; 95% CI=0,26–6,83) and depressive episode (OR=1,75 (0,35–8,65)) in adults. Recurrent depression was not revealed in patients with ACE. However, patients with AEC had no reliable differences in the MADRS, HAM-A, HADS, PSS-10 compared to patients without AEC. Patients with AEC had an increased risk of suicide attempts (OR=2,15; (0,25–37,2)) and suicidal thoughts (OR=4,58; (0,25–18,5)). The reliable correlations of the severity of SS symptoms (dry eyes/mouth, lymphoma) and AEC have not been confirmed. Patients with AEC had early onset SS (33,6±13,0 vs 38,1±14,2) and MD (28,4±12,6 vs 34,1±13,5) than patients without AEC.

AE? is a significant risk factor for depression and suicidal thoughts and attempts in patients suffering SS.

The internalized stigma of mental illness leads to negative outcomes (low self-esteem, demoralization, lower compliance to the treatment, unemployment). Previous studies have shown that the prevalence in psychotic patients is about 64%; furthermore, patients with non-psychotic disorders exhibit high prevalence, as well.

Our aim is to study internalized stigma, insight and social functioning in psychotic patients.

Through the investigation of low insight patients, we sought to verify the insight paradox theory and the impact stigma has on social functioning. We also investigated ISMI subscales (alienation, discrimination, stigma resistance, stereotype endorsement, social withdrawal) and the correlation between those elements.

Our sample included 19 psychotic patients: 11 with bipolar disorder; 3 with schizoaffective disorder; 5 with NOS psychosis. Patients were assessed with the following tests: SAI to evaluate insight; PANSS for clinical and psychopathological evaluation; GAF for social functioning; ISMI for the assessment of internalized stigma.

13 patients with mild or complete lack of insight reported low stigma, confirming the Insight Paradox theory. There is a positive correlation, measured with the Pearson correlation analysis, between insight and social functioning (R=0,752*) and between stigma and insight (R=0,024) while stigma and social functioning correlate negatively (R= -0,491*).

Results showed that lower levels of insight are related to higher stigma resistance and higher stigma leads to poorer functioning in social contexts. Higher sample numbers are necessary for further investigations on the subject.

Empathy is the human ability to understand and share other people's feelings through knowledge, observation and memory. Lower levels of empathy lead to poor social functioning, like in Major Depressive Disorder (MDD), Schizophrenia and Autism. Until today, very few studies have focused on empathic deficits in depressed patients.

Our aim was to evaluate whether MDD causes variations in empathy levels.

We wanted to assess cognitive and affective components of Empathy in a sample of women with MDD, and relate them to clinical issues. We compared these results to a control sample.

Our sample included 20 female patients with MDD and a control group, homogeneous for age and gender. We used the Hamilton scale for depression (HAM- D) to evaluate depression severity, the Interpersonal Reactivity Index (IRI) to evaluate cognitive and affective empathy, the Faux pas test to assess cognitive empathy; Pearson and Mann tests for statistic analysis.

In general, patients showed mild depression levels (HAM- D: 14, 41± 6, 07). Severity of symptoms and empathy levels were inversely related with Faux Pas and IRI results (R: −0, 5805; R: −0, 5145), with patients being worse than the control group. Patients showed deficits in personal distress and perspective taking IRI subscales.

Our study shows that in depressed patients both components of Empathy are modified; in particular, personal distress increases, while perspective taking decreases. Additional studies and higher numbers of patients will be necessary to further investigate whether empathic deficits are trait- or state-depending MDD characteristics.

Sleep disturbances are an integral part of the biological syndrome of depression and relief from this is often essential to enhance compliance with medications and psychological treatments. Anti-depressants, which are the mainstay of treatment of depressive illnesses, have varying effects on our sleep architecture. It is important for researchers and clinicians to be aware of these effects.

We looked at the available literature on how antidepressants affect sleep patterns and tried to synthesize the findings in this poster.

The primary aim of our effort was to look at how antidepressants alter our sleeping behaviour and how they affect the different stages of sleep.

We tried to look at the available literature and product summary sheets of various antidepressants and have attempted to summarize how they alter our sleep architecture.

SSRIs and TCAs have marked dose-dependent effects on REM sleep in both healthy volunteers and depressed patients, with increased REM-onset latency and decreased REM sleep. Other antidepressants have modest or minimal effects on REM sleep. The effects on sleep are most likely mediated by 5-HT1 receptors.

Most antidepressants affect sleep and the physiological patterns of different sleep stages. These effects are greatest and most consistent on rapid eye movement (REM) sleep, and tend to be in the opposite direction to the sleep abnormalities found in depression.

Considering that the indigenous ethnic groups of Central Asia have similar sociocultural characteristics, these factors may be reflected in individuals with schizophrenia who have committed serious assaultive acts in Uzbekistan.

Identify the sociocultural characteristics of schizophrenic representatives of indigenous ethnic groups of Central Asia who have committed violent crimes in Uzbekistan and have been found insane in regard to their offence, and to compare their sociocultural characteristics to those of the representatives of other ethnic groups.

The data were collected in 2010–2013 in the Tashkent High Security Psychiatric Hospital via face-to-face interviews and from forensic psychiatric examination statements.

The sample consisted of 201 individuals: 86.6%— indigenous ethnic groups of Central Asia, 13.4% — others; mean age = 36.7 years (SD = 9.91); 85.1% — male. The results of the study show greater representation of male individuals with low educational level, born in the countryside in the group of indigenous ethnic groups of Central Asia; the individuals were rarely referred to psychiatric care because of the popularity of alternative medicine and the stigma attached to mental illness. A positive correlation between violence and various psychotic symptoms, such as delusions, hallucinations, and thought disorder, has also been demonstrated in this group.

Sociocultural characteristics, such as delayed referrals for psychiatric care because of the popularity of alternative medicine and the stigma attached to mental illness among the indigenous ethnic groups of Central Asia, frequently factor into committing serious acts of assault because of developing psychotic symptoms.

Les hallucinations auditives sont un des symptômes fréquent et invalidants demeurant persistantes dans 20 à 30 % des cas et ce malgré les traitements antipsychotiques. Certaines théories suggèrent que les caractéristiques des hallucinations seraient liées à des dimensions psychologiques et émotionnelles pouvant expliquer le phénomène hallucinatoire, mais aussi à la croyance que le sujet halluciné accorde à ces voix [1,2].

L’objectif de cette étude est de mettre en évidence l’intérêt clinique des méthodes d’analyse de discours à travers des entretiens menés auprès de patients schizophrènes souffrant d’hallucinations auditives résistantes.

Des entretiens semi-dirigés ont été menés auprès de 10 sujets schizophrènes souffrant d’hallucinations résistantes. L’entretien a été construit autour de 10 thèmes principaux se rapportant aux croyances du sujet en rapport à son vécu hallucinatoire, tels que les intentions des voix, le pouvoir qui leur est attribué ou encore les stratégies de contrôle mis en œuvre. L’analyse des données s’est faite à l’aide du logiciel Alceste [3] permettant d’effectuer de manière systématisée et automatisée l’analyse d’entretiens ou de textes. Elle repose sur une classification descendante hiérarchique conduisant à la mise en évidence de mondes lexicaux par la construction de classes de discours mettant en évidence les mots les plus récurrents et significatifs dans le discours du sujet.

Les résultats de l’analyse sur 10 sujets ont permis de mettre en évidence des classes de discours renvoyant à des processus psychologiques particuliers, concernant le vécu et les relations qu’entretient le sujet avec ses voix. Nous pensons que ces processus, jusque-là sous-estimés et donc peu analysés pourraient constituer une piste d’exploration du caractère résistant des hallucinations.

la population source correspondait aux patients suicidants admis aux urgences psychiatriques du CH de Saint-Nazaire et le critère de jugement principal était le chronotype, établi à partir de la version courte du questionnaire de matinalité/vespéralité de Hörne et Ostberg (rMEQ).

Nous avons inclus 295 sujets, dont 29 % présentaient un diagnostic de trouble de l’humeur. Un pourcentage de 28,8 % avait un chronotype du matin, 55,6 % un chronotype intermédiaire et 15,6 % avaient un chronotype du soir. Les chronotypes du soir étaient significativement plus jeunes et le plus souvent des hommes. Les dépressifs, ainsi que ceux avec une forte intentionnalité suicidaire présentaient des scores au rMEQ plus élevés, étaient plus âgés, plus souvent des femmes et faisaient leur TS significativement plus tôt. Quarante-sept pour cent des sujets passaient à l’acte entre 13:00 et 20:59.

Même si nous avons retrouvé une prévalence accrue du chronotype du soir par rapport à la population générale, nous n’avons pas mis en évidence d’association entre vespéralité et dépression, et ni avec l’intentionnalité suicidaire, contrairement aux données de la littérature. Par contre, les patients qui faisaient leur TS le matin (05:00–12:59) étaient plus souvent diagnostiqués comme dépressifs, présentaient des scores de dépressions plus élevés et une intentionnalité suicidaire plus forte que ceux passant à l’acte aux autres heures de la journée. Les liens entre le chronotype, la dépression et la suicidalité semblent complexes et des études supplémentaires, notamment longitudinales, sur la population française et incluant la qualité du sommeil seraient nécessaires pour mieux comprendre ces liens.

Sleep problems are common in older people and often associated with mood disorders, such as anxiety or depression.

The present study examined the association between sleep disturbances in older adults and frequency of depressed mood and other aggravating factors.

The sample consisted of 139 subjects, aged >65 years, members of day care center for older people (KAPI) in the municipality of Tripolis, Greece. Geriatric Depression Scale (GDS-15) was applied, to screen the elderly for depression. Athens Insomnia Scale (AIS), a self-assessment psychometric instrument, was used to quantify sleep difficulty. Statistics was processed with SPSS 17.0.

56.8% of older people reported inadequate sleep, based on AIS. According to GDS-15, 53.3% of the studied population screened positive for depressive symptoms (43.2% moderate, 10.1% severe). In 79 persons who reported insomnia, 70.9% and 17.7% observed moderate and severe depression respectively, applying the GDS-15. Sleep disorders were more frequent in women (67.7% vs 48.1%, p=0.02), in not married, including divorced and widowed, (85.2% vs 44.7%, p=0.004) and in subjects without children (91.7% vs 53.2%, p=0.25). Insomnia was common in elderly with chronic diseases compared to elderly without co-morbidity (65.8% vs 9.1%, p<0.001), in participants with low monthly income (98.1% vs 1.9%, p<0.001) and in older adults suffering from depression (88.6% vs 6.7%. p<0.001).

Sleep disorders between the elderly of this study are common and strongly associated with depression. Determining the causality of the sleep disturbance could help to treat insomnia in the elderly and improve overall their health.