The front-line nature of mental health crisis services and the complex and acute presentations of their clients, require rapid decisions in response to medication requests. Prescribing is conducted by a combination of non-medical prescribers, advanced practitioners and medical professionals, with individual variation in prescribing habits and trends. This leads to an impact on the prescribing budget with spiraling costs evident.

We undertook an audit of the prescriptions issued for emergency medications over 6 months. We incorporated audit standards, from NICE guidelines for prescribing of psychotropic medications and local trust prescribing advice. We audited data to examine whether cost of medication had been considered, in the context of the efficacy and safety of medications.

Of 138 prescriptions issued, 72 (52%) were prescribed by advanced practitioners, 7 by non-medical prescribers (5%) and the remainder by doctors (43%). 213 items were prescribed costing £2828 during this period. We demonstrated, by introducing smarter prescribing methods, a reduction in the number of prescription items by 27.7% (59 items), resulting in a financial efficiency of 94.6% (£2677). We recommended implementing an acute care formulary acting as a guide to smarter prescribing.

The guide includes recommending generic versions of medications instead of trade brands, asking primary care to initiate medications, reducing quantities of drugs prescribed, increased accountability for prescribing decisions and stopping use of expensive psychotropics, where cheaper alternatives with similar efficacy and side effect profile are available. To assess impact, we would reaudit in 6 months, before consideration towards adopting the policy trustwide.

the development of a comprehensive system ofpsychotherapy and psychocorrection of anxiety disorders of neurotic case, based on the study of their clinical structure and peculiarities of emotional damages.

Clinical and psychological investigation, included the scales of anxiety and uneasiness CH.D. Spielberger, Eysenck Personality Questionnaire (EPQ), The Hamilton Rating Scale for Depression (HRSD), The studyof accentuation of personality by K.Leonhard.

100 patients with diagnostic categories: F41.0 - Panic disorder(episodic paroxysmal anxiety, F41.1-Generalized anxiety disorder, F41.2-mixedanxiety-depressive disorder who are on the examination and treatment at the psychiatric unit. A control group included 40 patients.

We performed the explorationof the peculiarities of clinical anxietyand patterns of therapeutic effect, based on the influence of short-term groupand individual psychotherapy in the treatment of anxiety disorders, andevaluation the effectiveness of its reconition.

The development of the methodology of applying a short-term group and individual psychotherapy in the treatmentof anxiety disorders based on combination relaxation, hypnosis, cognitive-behavioral teqniques in combination on with short-term group therapy.

In fact, this is a new realmodel psychotherapy based on integrative principles. The higt efficacy was shown in 82% patients, compared with 54% efficacy in control group patients.

We will offer a new comprehensive methodology in the treatment of anxiety disorders of neuroticcase that will improve the therapeutic efficacy of the treatment process, reduce the time of treatment, reduce the period of drug therapy

The suicide rate in Hungary is high in international comparison. The four-level intervention program of the European Alliance Against Depression (EAAD) is designed to improve the care of depression and to prevent suicidal behaviour. Our aim was evaluating the effectiveness of the EAAD on suicide rates in different areas.

The program was implemented in Szolnok, a town in a region of Hungary with exceptionally high suicide rate and in Miskolc, a town in a region with high unemployment and also high suicide rate. Effectiveness was assessed by comparing changes in suicide rates before to after the start of the intervention in the intervention region to corresponding changes of national suicide rates. In addition, changes in suicide rates were compared to those in a control region (Szeged). In Miskolc also the number of suicide attempts was used to measure the effectiveness of the program.

For the duration of the program and the follow-up year, suicide rates in Szolnok were significantly lower than the average of the previous three years (p=.0076). The suicide rate thus went down from 30.1 per 100,000 in 2004 to 13.2 in 2005 (-56.1%), 14.6 in 2006 (-51.4%) and 12.0 in 2007 (-60.1%). This decrease of annual suicide rates in Szolnok after the onset of the intervention was significantly stronger than that observed in Hungary (p=.017). Men had the same decrease in suicide rates as women in Szolnok. In Miskolc we observed changes in the types of suicide attempts, especially among males.

Needs assessment has been highlighted as a crucial factor in the development, organisation and evaluation of mental health services. Moreover, meeting self-reported needs is of prime importance for ensuring quality of life and reducing social disability for people with severe mental disorders.

Service evaluation based on patients’ need assessments has never taken place in Greece. Furthermore there are no standardized needs assessment instruments. Given the underfunding of psychiatric services due to the current economic crisis, systematic need assessment is expected to contribute to the efficient use of their limited resources.

To examine the concurrent validity, inter-rater and test-retest reliability of the Greek research version of the Camberwell Assessment of Need (CAN-R).

Fifty-three schizophrenia patient–staff pairs were interviewed twice to test the inter-rater and test-retest reliability of the CAN-R (Greek version). The WHOQOL-BREF and WHODAS 2.0 were administered to the patients to examine concurrent validity.

The inter-rater and test-retest reliability of patient and staff interviews for the 22 individual items and the eight summary scores of the instrument's four sections were good to excellent. Significant correlations emerged between CAN scores and the WHOQOL-BREF and WHODAS 2.0 domains for patient and staff ratings, indicating good concurrent validity.

Our results suggest that the Greek version of the CAN-R is a reliable instrument for assessing mental health patients’ needs. This is the first CAN-R validity study with satisfactory results using WHOQOL-BREF and WHODAS 2.0 as criterion variables.

Substance abuse by young people remains one of the most widespread and costly problems in Europe. Some previous studies reported an association between sexual orientation and substance use whereas it is assumed that religiosity could be a protective factor regarding substance use.

To better understand the relationship between substance use, sexual orientation and religious beliefs.

The C>SURF study concerns Swiss male adults who have to go through the mandatory recruitment process at the army. Data were collected between August 2010 and November 2011. A questionnaire about the participants’ socio-professional and family background, their consumption of alcohol, cannabis and other drugs, as well as their personality was sent to be filled in online. The final sample included 5990 males between 17.9 and 31.4 years old (mean=20.01, sd=1.24). 77% of subjects declared belonging to a religious community whereas 29% said they are atheists. 91% described themselves as being exclusively attracted by females, 8% by males and females and 1.0% by males only.

Belonging to a religious community or declaring not being atheist seems to be a protective factor regarding any substance use. Heterosexual men declare most often belonging to a religious community but they do not differ regarding being atheist. Logistic regression on predicting the belonging to a religious community additionally shows a significant interaction between cannabis use and being gay.

There are significant associations between substance use, sexual orientation and religious beliefs and a better understanding of these relations would lead to a relevant clinical impact.

Ever since the first description of Lemere in 1936 describing the capability to ‘……produce ‘good’ alpha waves…’ to be associated with the ‘…affective capacity of the individual…’ 1, research on this EEG measure in Depression (MDD) has attracted wide attention. Several studies have shown that responders to various antidepressant treatments are characterized by increased posterior alpha power in MDD (reviewed in 2). Another dimension of alpha is its frequency; also called alpha peak frequency (APF) and several studies have found a slow APF to be related to non-response to medication and rTMS 2. Therefore, in this study we aim to investigate in a large sample whether these two alpha measures can predict treatment outcome to antidepressants.

A multi-center, international, randomized, prospective open-label trial (International Study to Predict Optimized Treatment – in Depression, iSPOT-D), where MDD patients were randomized to: Escitalopram, sertraline or venlafaxine-XR. Treatment response was established after eight weeks using the Hamilton Rating Scale (HRSD) and the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR).

A total of 1.007 MDD patients and 336 healthy controls were included in the study.

Sensitivity, specificity, positive and negative predictive values for remission will be reported for all patients and for medication types

Genome-wide association studies indicate that two single-nucleotide polymorphisms (SNPs) in the ANK3 gene, rs10994336 and rs9804190, increase the risk for bipolar disorder (BD). The ANK3 gene encodes the ankyrin-G protein and influences neuronal firing by changing sodium channel functions, thus impacting on brain regional activation.

We examined the effect of the two ANK3 SNPs on brain activation during a working memory task.

The aim of our study is to investigate whether the genetic risk associated with the two SNPs is coupled with abnormal activation in the working memory network.

We used functional magnetic resonance imaging data to investigate the impact of ANK3 rs10994336 and ANK3 rs9804190, on brain activity during a 3-back working memory task in 41 BD patients, 25 unaffected first-degree relatives and 46 healthy individuals (HI).

For the ANK3 rs10994336 (risk allele T), significant diagnosis x genotype interactions were observed in the left prefrontal (BA10/BA11), anterior cingulate (BA32/BA25) and posterior cingulate (BA31) cortex. These regions, risk allele carriers who were either patients or unaffected relatives showed increased activation compared to healthy controls carrying the risk allele. For the ANK3 rs9804190 (risk allele C) a significant effect of genotype was found in the right anterior cingulate (BA24), where subjects carrying the risk allele showed decreased activation compared to subjects carrying the protective allele.

Our data demonstrate that the effect of ANK3 rs10994336 and ANK3 rs9804190 on the brain converges on key regions involved in working memory processing.

Personality assessment of individuals entering treatment for alcohol dependence appears to play a key role in planning the therapy as well as in establishing viable therapeutic treatment goals and their implementation. High Neuroticism and low Conscientiousness (NEO-PI-R) are associated with problematic drinking and alcohol dependence and promote relapse.

Investigation of the personality in alcohol-dependent people entering treatment.

The aim of the current study is to analyze the personality traits of alcohol-dependent people in relation to Polish population norms.

Results for 977 alcohol-dependent patients at the beginning of the treatment programme were subjected to analysis. The focus group comprised 743 men (76%) and 234 women (24%); the average age was 42 years. Personality traits were assessed using the NEO PI-R Personality Inventory adapted into Polish, taking into account age and gender.

The method of agglomeration and k-means clustering for k = 2 were used. A comparison of the sten scores of the entire group with population standards did not reveal any deviations in the core factors; however, three components of Neuroticism displayed higher values. Two clusters emerged: the first group consisted of 556 patients (59%), and the second of 421 patients (41%).

The first profile, characterised by high Neuroticism and low Conscientiousness, is compatible with the majority of results in various populations and predisposes to alcohol abuse, addiction and post-treatment recurrence. The second profile corresponded to the population standard and the presence of traits which are desirable resources in treatment.

According to the cognitive theory, negative automatic thoughts (NAT) and dysfunctional attitudes (DA) are important causal factors for the onset and maintanence of depression. There is limited data on the effects of NATs and DAs on the recurrence of depressive episodes. This study aims to compare the NATs and DAs of first versus recurrent episode depressive patients. The hypothesis of the study is that the intensity of negative cognitions will parallel the number of recurrences.

For the study, 100 first episode and 100 recurrent episode major depressive disorder diagnosed outpatients and 100 healthy volunteers presenting to the psychiatry clinics of three hospitals in Turkey were recruited. The participants were diagnosed by MINI, asked to complete the BDI, ATQ and DAS. Statistical analyses were undertaken to predict the variables affecting recurrence.

The groups were not statistically different on sociodemographic variables. The mean NAT and DA scores were highest in the recurrent depression group. Regression analyses for the prediction of recurrence revealed that perfectionistic attitude, severity of depression and number of hospitalizations were the most correlated variables. The number of recurrences was correlated with the perfectionistic attitude scores.

These results show that the NATs and DAs of first episode depression patients differ from those of the recurrent episode depression patients, and the number of recurrences are predicted by perfectionistic attitudes. This has clinical implications in the treatment of depression, particularly points out to the need to manage perfectionistic attitudes to prevent recurrences.

Dysregulation of the hypothalamic-pituitary-adrenal (HPA-)axis is hypothesized to play a role in the pathogenesis of bipolar disorder (BD). Conflicting results have been reported when saliva or serum was used to measure cortisol levels. A recently developed method is to measure cortisol in scalp hair, with one cm of scalp hair representing one month. We studied whether there are differences in long-term hair cortisol levels between BD patients and healthy individuals and whether there are associations between hair cortisol, life events and disease characteristics.

Hair samples were collected in 100 BD patients and 195 healthy controls. Long-term cortisol levels were determined in 3 cm hair segments. Saliva samples were collected on two consecutive evenings. Documented disease characteristics were disease state, age of onset, psychiatric co-morbidity, and life events.

Hair cortisol levels were not statistically different in BD patients compared to healthy controls (p=0.233) and were not associated with the disease state at the moment of sample collection (p=0.978). Clinical characteristics, such as age of onset ≥30 years (p=0.004) and psychiatric co-morbidity (44.87 versus 31.41 pg/mg hair; p=.021), appeared to associate with higher hair cortisol levels. Panic disorder associated with decreased cortisol levels (22.13 versus 34.67 pg/mg hair; p=0.019). The occurrence of recent negative major life events, but not of positive major life events, was associated with an increase in HCC in BD patients.

Major depressive disorder (MDD) has harmful effects on an individual's personal life. In the European Union, in any given year, about 7% of all adults suffer from it. Primary choice of medical management is pharmacotherapy - second generation antidepressants (SGA). Some SGA are available as both immediate-release (IR), and extended-release formulations. Advantages of extended-release formulations may be the potentially improved adherence, and tolerability.

The objective of this systematic review was to assess the comparative efficacy, risk of harms, and adherence of IR- and extendedrelease antidepressants for the treatment of MDD.

To systematically review the evidence on differences between IR and extended-release formulations to provide an objective basis for clinical decision-making.

Abstracts were retrieved from PubMed, EMBASE, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to October 2012 as well as from hand search. We dually reviewed abstracts and full-texts and assessed quality ratings. We conducted network meta-analyses using Bayesian methods, due to the lack of head-to-head trials. Response on the Hamilton Depression Rating Scale (HAM-D) was our outcome measure.

We located seven head-to-head trials and 94 placebo and active controlled trials for network meta-analysis. Overall, our analyses show that IR and extended-release formulations of bupropion, trazodone, venlafaxine and paroxetine have similar efficacy. However, evidence suggests that there might be a difference between formulations based on adverse events and adherence.

Current evidence couldn’t prove a significant difference in the efficacy of IR- and extended-release formulations.

To review the role of the precuneus in major depression

We will review the literature involving the precuneus in the pathophysiology of depression. We will also report a recent study of our group using structural MRI and VBM analyses to assess the role of precuneus in Autobiographical Memory (AM). Visual perspective during AM retrieval was assessed in two independent datasets of 45 and 20 healthy young adults with two different AM retrieval tasks.

Precuneus, a medial part of the parietal cortex, is a central component of the default mode network. Results from our VBM study show that the precuneus volume in healthy subjects is correlated with the ability to retrieve autobiographical memories with a first-person perspective. Consistent with its role in integration of self-relevant mental simulations with past experiences and visuo-spatial processes during AM retrieval, the precuneus may subserve emotion regulation processes in healthy subjects and depressed patients. The precuneus and the default mode network show abnormal connectivity in depressed patients that may indicate abnormal self-processing in depression.

Abnormal activity and connectivity of the precuneus within the default mode network is associated with impairment in self-processing in depression and may be related to the tendency of depressed patients to retrieve AM using third-person perspective. Further studies are needed to evaluate if impaired function or structure of the precuneus may predict the clinical response to antidepressant treatment.