Major depression affects 1.5%-19% general population. High use of healthcare services and increase in morbidity and mortality are common consequences. Despite of appropriate pharmacological treatment, 30-40% of patients don't achieve significant improvement. TRD refers to no remission after two adequate trials of antidepressants: these patients qualify for ECT.

Our Mood Disorder Unit treats about 600 patients/year, 4% undergo ECT for TRD.

Ongoing, retrospective, observational study on 73 TRD patients treated with ECT 2/week, considering acute and late responsiveness 1 and 12 months later.

Sample of 52 (71.22%) patients with Recurrent Major Depression and 21 (28.78%) with Bipolar Disorder, collecting epidemiological and clinical data. Clinical course assessment through weekly Hamilton Rating Scale for Depression (HRSD); follow-up evaluation after 12 months, with telephone interviews.

73 inpatients, 26(35.62%) males, 47(64.38%) females with 4.31±3.43 previous episodes; mean age 59.42±11.60 years. Average duration of reference episode 52.71±39.42 weeks with HRSD initial score 30.16±4.76. Each patient was treated with 6.92±2.90 ECT applications. 64(87.67%) patients responded to treatment (50% reduction of HRSD initial score), 33(45.21%) achieved remission (HRSD≤8); 18(24.66%) patients maintained 12-months remission.

Our experience strengthens pivotal role of ECT in TRD. Each patient had long-lasting, severe episode under 1 year-long unsuccessful pharmacological therapy. ECT managed to quickly ameliorate their clinical course. We didn't record any adverse event. ECT showed similar relapse rates compared to conventional pharmacological treatment. This procedure requires further studies about long-term outcome.

To evaluate in adults the associations between persistent ADHD and comorbid psychiatric disorders and gender differences, among subjects from a population-based birth cohort.

Subjects were recruited from a birth cohort of all children born during 1976–1982 who remained in Rochester, MN after five years of age. Participating subjects with research-identified childhood ADHD (n = 232; mean age 27.0 years; 72% men) and non-ADHD controls (n = 335; mean age 28.6 years; 63% men) were administered a structured psychiatric interview (MINI-International Neuropsychiatric Interview) to assess current ADHD status and comorbid psychiatric disorders.

Among the 232 with research-identified childhood ADHD, 68 (49 men and 19 women) had persistent adult ADHD. Compared to subjects without childhood ADHD, adults with persistent ADHD were significantly more likely to have any (81% vs. 35%, P < 0.001) as well as each of the specific psychiatric comorbidities. The associations retained significance when stratified by gender and there were no significant gender by ADHD interactions on psychiatric disorders except for dysthymia with which ADHD was more strongly associated in women than men. Among subjects with persistent ADHD, externalizing psychiatric disorders were more common in men (73%) and internalizing disorders were more common in women (53%).

Persistent ADHD is associated with an increased risk of comorbid psychiatric disorders in both adult men and women. Clinicians treating adults with persistent ADHD need to be aware of comorbid psychiatric disorders, especially externalizing disorders for men and internalizing disorders for women.

The authors have not supplied their declaration of competing interest.

Sleep is the most important biological circadian rythm. Researches have shown that sleep deprivation causes reduction of hypothalamus function, decrease glucose tolerance and increase cardio-vascular diseases, hypertension and also decrease their mental and intellectual activity of human. This research investigate insomnia in adult people (Kashan city,Iran.)

This cross-sectional research has been done in Kashan,2008 by using classified randomized sampling in 39 health centers among persons with 18 years old and over (N= 1155). Written consent was taken from subjects, and all of them answered to demographic questionnaire,and researcher-made insomnia questionnaire. Test-retest Reliability of this test was 99% and its internal consistency was 82% by using α kronbach. Data was analyzed by using Fisher exact test.

Prevalence of insomnia was (n=684, 59.2%). The highest rate of insomnia were found among adult with age of 42 to 65 years old (n=266, 67.9%) and then in sex of feminity (n=387, 56.5%). There was significant relationship between insomnia and psychiatric history [PV< 0/0001, OR=2.24], sleep disorder in family [PV< 0/0001, OR=4.67] and drinking caffeine before sleep [PV< 0/001, OR=1.64].

The majority of adult person suffer from insomnia and most sleep problems are observed among middle age group. Since sleep disorders can be related to social, psychological and physical problems, paying attention to quality and hygiene sleep in general population is essential.

It is distinctive for Kosovo population that before the war of 1999 Kosovo has had the lowest rate of suicides in Europe. Now, after the war the data and findings tell us for a considerate increase of number of suicides.

Presentation of suicide cases in Kosovo in period from 2008–2012 analyzed from aspect of social reasons that has influenced an increasing number.

Identification of social factors and their possible direct/indirect impact in phenomena of suicides and as well the reflection in their prevention.

Data on cases were collected retroactively, by the Internal Affairs of Kosovo and Psychiatry Clinic. Analysis of data was done with Excel and SPSS 14.

In the period 2008–2012, 270 persons were found to have committed suicide. This is an increase compared to before the war. In over 80% of cases come to the expression of social factors: unemployment level (44.9%), low income per capita, the population on average 26 years old, enormous growth of drug users and alcohol (20.000), low budget for mental health, dominance in rural settlements, debt, domestic violence, inability to buy drugs, the inability of the education of the children, war trauma/PTSD, large number of people who are missing or dead after the recent war in Kosovo (8 cases).

The number of suicide cases has increased. Social factors play a major role in this.

Severe behavioural problems (SBPs) in childhood are highly prevalent, impair functioning, and predict negative outcomes later in life. Over the last decade, clinical practice guidelines for SBPs have been developed across Europe to facilitate the translation of scientific evidence into clinical practice. This study outlines the results of an investigation into academic experts’ perspectives on the current prevalence, implementation, and utility of clinical guidelines for SBPs in children aged 6–12 across Europe.

An online semi-structured questionnaire was completed by 28 psychiatry and psychology experts from 23 countries.

Experts indicated that approximately two thirds of the included European countries use at least an unofficial clinical document such as textbooks, while nearly half possess official guidelines for SBPs. Experts believed that, although useful for practice, guidelines’ benefits would be maximised if they included more specific recommendations and were implemented more conscientiously. Similarly, experts suggested that unofficial clinical documents offer a wide range of treatment options to individualise treatment from. However, they stressed the need for more consistent, evidence-based clinical practices, by means of developing national and European clinical guidelines for SBPs.

This study offers a preliminary insight into the current successes and challenges perceived by experts around Europe associated with guidelines and documents for SBPs, acting as a stepping stone for future systematic, in-depth investigations of guidelines. Additionally, it establishes experts’ consensus for the need to develop official guidelines better tailored to clinical practice, creating a momentum for a transition towards European clinical guidelines for this population.

Although there is general consensus that only prolonged and intensive psychotherapy can provide real recovery from Borderline Personality Disorder (BPD), almost nothing is known about the relative effectiveness of different approaches. The present study compared the (cost-)effectiveness of two psychotherapies for BPD aiming at a fundamental change: a modern psychodynamic approach (Transference-Focused Psychotherapy, TFP) and schema-focused cognitive therapy (SFT).

In a multicenter trial 86 patients were randomised to either TFP or SFT and treated for max. 3 years. In Maastricht, patients also participated in fundamental studies on emotion regulation (attentional bias, fMRI, peripheral nervous system responses).

TFP had more (early) drop-outs than SFT. SFT was about twice as effective as TFP in terms of recovery from BPD. This effect could not be explained by differences in drop-outs. SFT was superior to TFP on all other measures. On cost-effectiveness ratios, SFT was superior with respect to recovery, and equivalent when quality-of-life was considered. Functional MRI and other indices indicated that recovery from BPD was associated with normalizing of emotion regulation.

The results indicate that it is possible to successfully and cost-effectively treat these difficult patients by prolonged psychotherapeutic treatment. Assessment of attentional bias and amygdala/hipocampal responses to threat cues indicates that ‘symptomatic’ cure is accompanied by normalizing of these processes, suggesting a deep and fundamental change. Moreover, results of a 1-year follow-up indicate that recovery continues.

Delivery of information about his/her disease and its treatment to a schizophrenic patient is essential but no consensus exists concerning to what extent and how to deliver the information.

To study the therapeutic impact of internet mediated knowledge an internet site was built particularly for the use of schizophrenic patients and contained information about pharmacotherapy, symptoms management and patients’ rights.

The patients enrolled in the study were randomly divided into 4 groups. Each of the three study groups was given a task to study different topic (pharmacological treatment, symptoms management or patients’ rights) by means of the internet site. The forth group was a control one. Based on analysis of the questionnaires filled out by the patients before and two weeks after the information delivery we have analyzed whether the site is user friendly, emotional responses of the patients, extent of information catching, satisfaction change and contribution to pharmacotherapy.

Patients diagnosed as suffering from schizophrenia and being hospitalized more than once.

28 patients were enrolled, among them 25 being hospitalized. In the study groups, satisfaction from the therapy has improved after browsing the site. Compliance to pharmacotherapy has improved in the groups that had learned about pharmacotherapy and symptoms management. Compliance did not improve in the group instructed on the patients’ rights and in the control group.

Paraneoplastic syndromes (PS) result from indirect effects of neoplasms. In 50% of the cases the symptoms precede the diagnosis and run independently. PS may involve the peripheral or central nervous system, resulting in symptoms from sensory neuropathies to several neuropsychiatric manifestations.

To review the psychiatric manifestations of paraneoplastic syndromes affecting the nervous system.

Selective literature review via PubMed search, using the keywords “paraneoplastic syndromes”, “endrocrine paraneoplastic syndromes”, “neuropsychiatric manifestations”, “limbic encephalitis”.

The prevalence of PS varies with the type of cancer (<1% for breast and ovarian cancers; 3-5% for small cell lung cancer; 20% for thymomas). The general mechanisms behind PS are related to the production of substances by the tumor that directly or indirectly cause distant symptoms, the depletion of substances or the host response to the tumor. Frequently there are autoimmune phenomena involved, with the production of antineuronal antibodies that recognise various antigens at the nervous system. Paraneoplastic neurological disorders include limbic encephalits that can present subacutely with symptoms of depression, irritability, hallucinations, cognitive impairment associated with sleep alterations, confusion and seizures. Others include psoclonus-myoclonus ataxia syndrome, neuromyotonia and cramp fasciculation syndrome. Metabolic and endocrine paraneoplastic syndromes (hypercortisolism, carcinoid tumors, pancreatic cancer) can result from the production of cytokines and hormones by the tumor and produce mood disorders, confusional states and psychosis.

PS can be related to various neuropsychiatric manifestations affecting consciousness, cognition, mood and perception. The recognition of this association can alert for the possibility of a cancer diagnosis specially when facing a patient with unusual clinical presentation.

No significant relationships.

Depression is difficult to diagnose in schizophrenic patients although it represents a frequent motive for suicide. In clinical practice nonspecific sadness is more often observed than major depressive episodes. Our analysis of these states led us to the concept of demoralization.

The objective of our study was to demonstrate the existence of demoralization in psychotic patients as a real entity and to see how it could be correlated with other dimensions.

A total of 55 ambulatory patients diagnosed with a schizophrenic disorder were included and distributed in 2 groups according to the level of demoralization. The correlation with residual psychotics symptoms (PANSS), depression (CDSS), despair (BHS), and quality of life (SQoL) as well as the sociodemographic characteristics and past history of suicide attempts was assessed.

More than 94% of our patients were found demoralized, 16,36% of them severely. The degree of demoralization was correlated with the intensity of positive symptoms (p = 0.016), depression (p < 0.001), despair (p = 0.015), suicidality (p < 0.01) as well as poor quality of life (p = 0.007) and low self-esteem (p < 0.000).

Demoralization appears to be a relevant concept during schizophrenia, bound in schizophrenic and depressive process, and impacting the suicidal risk. It could represent an important stake in the care of schizophrenic patients especially for the prevention of relapse and suicidal risk.

Stigma toward mental illness is an international phenomena and it has negative consequences on the patients and their families. Studies on public attitudes toward people with mental illness (PWMI) in the Arab world initially reported less prevalence of stigma compared to other societies; however, follow up studies showed that stigma was influenced by specific socio-cultural factors.

This study aims to examine public attitudes toward people with mental illness in Oman and the impact of socio-demographic factors.

This is a cross-sectional survey conducted among the general public in Oman. The attitude was measured via the Attitude toward Mental Illness (AMI) questionnaire. Various demographic factors were examined including age, place of residence, occupation and previous encounter with PWMI. The data were collected using online research methods.

A total of 601 subjects participated in this study, (M: 41.4%, F: 58.6%). 48% of the participants were aged 15–30 years while 46% were aged 31–45 years. The majority of the participants were employed and 10% were students. After adjusting for all other variables, subjects aged (15–30years) had less positive attitude compared to those aged (46–60 years) (P = 0.06). Socio-demographic factors such as gender, occupation and previous contact were correlated with the endorsement of positive attitudes toward PWMI.

This study illustrated that public attitudes toward PWMI in Oman is generally sub-optimal. The observed attitudes were strongly influenced by age, gender, occupation and previous exposure to PWMI. Future studies with robust methodology are recommended to scrutinize the present findings.

The authors have not supplied their declaration of competing interest.

Studies point to an adverse effect of detention on the mental health of asylum seekers, yet the use of detention has been rising in several recipient countries. In general, many asylum seekers suffer from psychological disorders and symptoms, and a large percentage has been subjected to torture. The UNHCR recommends that torture survivors generally should not be detained. Due to a lack of systematic screening it is often unknown whether the asylum seeker is a torture survivor. This causes several hindrances for the protection of this vulnerable group from potentially harmful factors such as deprivation of liberty.

To examine the impact of detention on the mental health of adult torture survivors.

To produce a comprehensive review of the literature and bring attention to a potentially harmful praxis.

The systematic review follows the PRISMA guidelines. The search was made in PubMed (Medline), PsychINFO, PILOTS and IBSS. A screening of reference lists identified additional studies. The search was broadened to ‘asylum seekers’ as very few studies were found on torture survivors specifically.

Presently (Oct. 2012) the review is in the stage of analyzing, thus results are preliminary. Currently the identified studies amount to 26. All studies report mental health problems among the asylum seekers and some identify detention itself as a contributing factor to these problems.

Detention does pose a risk factor in regard to deteriorating the mental health of asylum seekers. Although torture survivors might be an especially vulnerable group, research is almost non-existent.

Weakness in grammar understanding is key future of specific language impairment (SLI) in children. There has been a considerable amount of work on the language abilities of children with SLI, but we still know relatively little about their other cognitive abilities –in particular their non-linguistic cognitive strengths and weaknesses.

The aim of this research was to examine the hypothesis that Russian-speaking children at the age of 4 with deficit in executive abilities have a risk for emerging weakness in grammar understanding at the age of 6.

One hundred and twenty-five children at the age of 4 were assessed with the NEPSY to reveal children with different level of executive abilities. We have revealed 21 children with deficit in executive abilities. The control group included 21 children with typical level of executive abilities. The children from experimental and control group were matched for IQ and gender. In the framework of longitudinal research, children at the age of 6 from both groups were assessed by Grammar Understanding Test from Luria's neuropsychological assessment technique.

Two-way ANOVAs with repeated measures revealed significant differences between groups for scores in the Grammar Understanding Test. Children from experimental group had weakness in grammar understanding.

We have revealed that children at the age of 4 with weakness in executive abilities have a risk for emerging weakness in grammar understanding at the age of 6. In view of the obtained results, it can be assumed that executive abilities have influence on the development of grammar understanding in preschool children.

The author has not supplied his/her declaration of competing interest.

Vitamin D deficiency has been associated with an increased risk of depression and schizophrenia in some studies. However, a few epidemiological studies do not show consistent results.

Comparing serum level of Vitamin D, parathyroid hormone, Calcium, and phosphorus in schizophrenic and depressed patients with healthy subjects in Iranian people.

In a cross-sectional study, 100 patients with schizophrenia and 100 major depressed ones in Arak-Iran from October 2009 to April 2010, and also 100 healthy subjects were enrolled. After informed consent, serum levels of Vitamin D, Calcium, Phosphorus, and parathyroid hormone were assessed by using routine laboratory methods.

Data was analyzed by using SPSS V17, one-way ANOVA, the post-hoc test of Tukey and also in general linear models.

The three groups were different in Vitamin D (PValue < 0.001). Post-hoc analysis of Tukey showed that Vitamin D level of healthy participants was significantly higher than depressed patients (PValue < 0.001) and schizophrenics (PValue = 0.001) while there was no significant difference between Vitamin D levels in depressed and schizophrenic patients (PValue = 0.563). Serum levels of Ca, P and PTH were the same in three groups.

Our findings suggest that Vitamin D affects the brain independent of hormonal pathways which regulate serum level of calcium. Lack of difference between the serum levels of Vitamin D in schizophrenia and depression suggests that the independent effect of Vitamin D in the brain is a general effect and is not specific for a region or pathway in the brain.

The “nootropic” or simplified as a “smart drug”, is a common term that will tag along with the compound responsible for the enhancement of mental performance. Certain individuals with a history of mental or substance use disorders might be particularly vulnerable to its adverse effects.

A review was conducted aiming to clarify the mechanisms associated of how these drugs increase mental functions including memory, motivation, concentration, and attention; and which kind of individuals are at risk of developing adverse effects when taking these drugs. The literature search was conducted in PubMed data reviewing articles dating between 2015 and 2016.

– Glutaminergic Signalling, Cholinergic System, Amyloid Precursor Protein and Secondary Messenger may be related to the cognitive enhancement achieved by Nootropics. Others, like insulin and angiotensin receptor may involved too.

– Some of them, like Ginkgo biloba, seem to have neuroprotective effects observed in human and animal models, acting as antioxidant and antiapoptotic, also inducing inhibition effects against caspase-3 activation and amyloid-aggregation toward Alzheimer's disease.

– Synthetic nootropics, a lab created compound such as piracetam, especially in people with history of drug abuse, may be associated with psychiatric exacerbations of some patients.

Young adults all over Europe, especially university students, are starting to use nootropic drugs to improve their academic results. Some of them seem to have beneficial effects over mental health but others are sometimes related with sudden and unexplained exacerbations in stable psychiatric patients. It is important to early identify symptoms and to treat them properly.

The authors have not supplied their declaration of competing interest.

Urban living has consistently been associated with higher risk of developing schizophrenia when compared to rural living. Exposure to green space has been associated with better mental health outcomes and, more recently, childhood exposure to green space has been linked with lower rates of schizophrenia. The reasons for these findings remain unknown, although lower levels of pollution and psychological factors may play a role.

We aim to review the literature regarding exposure to green space and its relationship with the risk of developing schizophrenia.

We performed an updated review in the PubMed database using the terms “green space” and “schizophrenia”. The included articles were selected by title and abstract.

Growing up surrounded by non-urban environments is associated with lower schizophrenia rates. Upbringing in urban areas is associated with higher schizophrenia rates when compared with non-built-up areas. Schizophrenia risk seems to decrease with vegetation density in a dose-response relationship for urban and agricultural areas. Risk of schizophrenia has been found to be associated additively with green space exposure and genetic liability. No evidence for gene-environment interaction has been reported so far in this regard.

Exposure to green space during childhood appears to lower the risk of developing schizophrenia later in life and can be a preventive strategy. Further research in this area is needed.

Individuals with anorexia nervosa (AN) are often thought to show heightened self-control and increased ability to inhibit desires. In addition to inhibitory self-control, antecedent-focused strategies (e.g., cognitive reconstrual—the re-evaluation of tempting situations) might contribute to disorder maintenance and enable disorder-typical, maladaptive behaviors.

Over a period of 14 days, 40 acutely underweight young female patients with anorexia nervosa (AN) and 40 healthy control (HC) participants reported their affect and behavior in self-control situations via ecological momentary assessment during inpatient treatment (AN) and everyday life (HC). Data were analyzed via hierarchical analyses (linear and logistic modeling).

Conflict strength had a significantly lower impact on self-control success in AN compared to HC. While AN and HC did not generally differ in the number or strength of self-control conflicts or in the percentage of self-control success, AN reported self-controlled behavior to be less dependent on conflict strength.

While patients with AN were not generally more successful at self-control, they appeared to resolve self-control conflicts more effectively. These findings suggest that the magnitude of self-control conflicts has comparatively little impact on individuals with AN, possibly due to the use of antecedent-focused strategies. If confirmed, cognitive-behavioral therapy might focus on and help patients to exploit these alternative self-control strategies in the battle against their illness.