There are new materials in looking for objective tools of mental conditions of depression patients. Grant of Russian humanitarian scientific fund: 11-06-00869.

21 patient (7 male; 14 female; mean age - 38.2 years).

Assessment of beta-endorphin concentration in peripheral blood in patients with mild and moderate unipolar depression. Implementation of this parameter as a marker of treatment efficacy.

Ethically approved prospective study; HDRS; ELISA; statistical analysis

Changes in beta-endorphin level appeared to be more significant marker than peptides‘ absolute level. Degree of beta-endorphin changes and degree of HDRS score changes were significantly correlated (p = 0.009; Spearman correlation coefficient ρ = - 0.6). Individual change was calculated as ratio of previous value divided by subsequent value. Therefore, higher increase of beta-endorphin concentration was associated with higher decrease in HDRS score. Figure.

[Figure]

A0 - mean HDRS sample score (n=21); A1 - mean HDRS score in patients with beta-endorphin decrease (n=6); A2 - mean HDRS score in patients with beta-endorphin increase (n=15).

Preliminary data show that increase in beta-endorphin plasma level in patients with non-psychotic unipolar depression after 2 weeks of treatment is associated with positive response to treatment.

The proportion of international medical graduates (IMGs) in Ireland has increased from 13.4% in 2000 to over 33% in 2010. Many of their countries of origin have different cultures, expectations of the doctor–patient relationship and communication styles than Ireland. These differences can adversely impact on the quality of care provided by IMGs. There is a lack of research on the impact of cultural differences on communication in the Irish context.

Semi-structured interviews were conducted with 16 IMGs in Drogheda Department of Psychiatry. Transcripts were analysed using nVivo10, a specialised computer programme for conducting qualitative analysis and analysed thematically.

General themes emerged relating to IMG experience of cultural differences in medicine and psychiatry and cultural differences in communication. IMGs did not find their proficiency in English to be a barrier to communication but did find accents, culture-specific sayings and non-verbal cues to be challenging. Differences in doctors’ status relative to patients and different expectations of the doctor–patient relationship were challenging and, at times, frustrating and annoying. It was generally recognised that training in cross-cultural communication skills would be beneficial to new IMGs although a small minority recognised no such issues. Significant differences in attitude to patient confidentiality in Ireland versus the country of origin were identified.

Consideration should be given to providing specific cross-cultural communication skills training for all IMGs training in Ireland focusing not just on verbal and non-verbal communication but also differences in the doctor–patient relationship, patient and relative expectations and medical confidentiality requirements.

The authors have not supplied their declaration of competing interest.

With typical onset in late adolescence or young adulthood psychosis often have a chronic and relapsing course with potentially devastating functional implications. Research on the period that precedes the modal age of onset psychosis has become crucial for identifying the very early stage

This study aims to determine the pre-admission clinical, socio-demographic characteristics and prodromes associated to a first psychotic episode

It's a retrospective observational study. Fifty five Tunisian patients admitted in Hedi Chaker hospital between 2007 and 2013 were recruited. Socio-demographic and clinical data were collected and patients were diagnosed using DSM-IV criteria.

The mean age was 26.5. 61.8 %lived in a rural environment.

54.5% had a family history of psychiatric disorder. 12.7% had a history of head trauma

74.5% were schizoid, 1.8 % had avoidant personality disorder, and 1.8% had schizotypal personality disorder

10.9% suffered from irritability. 67.3% had anxiety .38.2% suffered from depression. 20% experienced mood fluctuations

29.1% had frequent fatigue; 10.9% had a loss of interest

18.2% complained about difficulties with concentration, 10.9% had difficulties of recall

14.5% had loss of appetite, 78.2% suffered from sleep disturbance, 23.6 % lost weight.

25.5% had marked impairment in personal hygiene and grooming .70.9% presented social isolation and withdrawal .7.3% had Impairment in role functioning .40% had odd believes.

Since there is a variety of unspecific signs which may precede a first psychotic episode and no specific biological markers; treating even with insufficient evidence may sometimes become an alternative.

There are often substantial delays before diagnosis and initiation of treatment in people bipolar disorder. Increased delays are a source of considerable morbidity among affected individuals.

To investigate the factors associated with delays to diagnosis and treatment in people with bipolar disorder.

Retrospective cohort study using electronic health record data from the South London and Maudsley NHS Foundation Trust (SLaM) from 1364 adults diagnosed with bipolar disorder. The following predictor variables were analysed in a multivariable Cox regression analysis on diagnostic delay and treatment delay from first presentation to SLaM: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder.

The median diagnostic delay was 62 days (interquartile range: 17–243) and median treatment delay was 31 days (4–122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18–3.06) and treatment delay (4.40, 3.63–5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33–0.41) and substance misuse disorders (0.44, 0.31–0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay.

Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder, particularly those with alcohol/substance misuse disorders. These findings highlight a need to better identify the symptoms of bipolar disorder and offer appropriate treatment sooner in order to facilitate improved clinical outcomes. This may include the development of specialist early intervention services.

The authors have not supplied their declaration of competing interest.

Earthquakes, one of the major natural disasters, tend to be unpredictable, uncontrollable, and highly destructive. They lead to strong initial trauma and significant long-term effects such as posttraumatic stress disorder, depression, anxiety, or other symptoms.

In this research, posttraumatic stress, anxiety and depressive symptoms were studied among adolescents 6 months after Van-Erciş Earthquake 2011.

In the present study a total of 738 Turkish high school students, aged 13-17 years, participated in the study in Van city affected severely by the earthquake. Participants completed a set of questionnaires including the demographic measures, posttraumatic stress reactions, depression, anxiety and dissociation.

The results of the present study showed the presence of probable diagnosis of PTSD in 295 (40.69%), of anxiety in 384 (53.04%) and of depression in 245 (33.70%) of the adolescent examined. Multiple logistic and linear regression analyses were conducted to explore the predictive values of independent variables on development of posttraumatic, anxiety, depressive, and dissociative psychopathology among adolescents experienced Van earthquake.

Our results show high rates of PTSD, anxiety and depression symptoms in adolescents who survived the October 2011 Van-Erciş earthquake. Further, our results highlight the relevance of gender differences, previous psychopathology, trait anxiety, anxiety sensitivity in the response to mass trauma that should be taken into account when facing such events. Our results confirm the pervasive effects of a disaster and risk factors, such as an earthquake, for mental health in adolescents.

31P MRS is a unique way of in vivo energy metabolism research. This method allowed revealing schizophrenia-induced disturbances of energy exchange in resting state [1]. We use 31P MRS in presence of visual stimulation that allows neuronal energy-consuming processes studying.

Revealing of stimulation effects on high-energy phosphates (PCr, ATP) in early-stage schizophrenia.

Discovery of energy processes contribution in schizophrenia pathogenesis.

Twelve right-handed 18–26 years old male patients with early-staged schizophrenia (F20, ICD-10) and 20 age-matched healthy right-handed controls. Spectra were acquired on Philips Achieva 3.0 T using Rapid Biomed 31P/1H birdcage coil and 2D ISIS pulse sequence. fMRI was used for accurate 2D slice positioning, spectroscopy voxels containing primary visual cortex (V1) were averaged (see Fig. 1). Two 31P spectra of V1 were obtained: firstly in resting state and then during 6 minutes of continuous stimulation by 6 Hz flashing checkerboard. Spectra were processed in jMRUI.

Excitation reduced PCr in the norm and had no effect on schizophrenia (see Fig. 2). No excitation-induced ATP changes in both groups were revealed.

Alteration in PCr behavior in this study witnesses for deviations in energy-consuming processes in schizophrenia. A new scheme of neuronal response to stimulation in schizophrenia is offered.

The authors have not supplied their declaration of competing interest.

Postnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.

The objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.

The aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.

A total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.

Outcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.

The results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.

The authors have not supplied their declaration of competing interest.

Several factors affect medication adherence in patients with schizophrenia; insight is among the most important ones.

The objective of our study was to assess insight in Tunisian patients with schizophrenia and to determine its impact on medication adherence.

We conducted a survey of all patients hospitalized in the department of psychiatry “C” in the Hedi Chaker University Hospital, in Sfax (Tunisia), during the period from January 2011 to April 2011, and in whom schizophrenia was diagnosed according to DSM IV-TR criteria.

We used the insight questionnaire Q8 and the 10-item version of the Drug Attitude Inventory (DAI) to assess insight and subjective response to antipsychotic treatment, respectively. The DAI is an indicator of future medication compliance.

Forty male patients were included. The mean age was 35 years. The average disease duration was 10.5 years. Paranoid schizophrenia was the most frequent type of schizophrenia (55%). The treatment perception was positive in half of our patients. Disorder awareness was good in only 30% of cases. We found a significant association between low level of insight and negative perception of treatment as measured by the DAI-10 (p = 0.038).

Tunisian schizophrenic patients had a low level of insight. Our results were consistent with data reported in the literature, namely that a low level of insight was associated with poor medication adherence; it would even be a predictive factor. This finding would be valid whatever the cultural context is.

Some studies have shown that more than 40% of patients with first episode psychosis (FEP) are nonadherent and treatment with long – acting antipsychotics (LAIs) could increase their compliance. However, studies on efficacy of LAIs versus oral antipsychotics for preventing relapse among schizophrenia patients have produced conflicting results.

With this study we want to asses if patients with FEP in treatment with LAIs have a decreased incidence of readmission compared with patients in treatment with oral antipsychotics over 6 month follow – up.

188 FEP patients were consecutively admitted to Hospital del Mar since January 2008 to September 2014. The included evaluation was, among others: sociodemographic data, duration of untreated psychosis (DUP), diagnosis, substance use and clinical data at baseline. Later, antipsychotic treatment and number of admissions and of emergencies over 6 months were also recorded. We studied difference sin readmission, number of emergencies between patients on LAI and oral treatment.

We found a significative decreased incidence of readmission (p=0,000) and a lower number of emergencies (p=0,017) in the group of FEP patients treated with LAIs versus the group treated with oral antipsychotics.

In our sample, treatment with LAIs is associated with a reduced readmission rate and a lower number of emergencies in patients with FEP. This finding are agree with the results of other studies that show a significantly reduced relapse and a lowest risk of rehospitalization in FEP patients treated with LAIs.

Dealing with art requires an active sensual involvement and, furthermore, art creates form and meaning. Research in phenomenological psychopathology finds, that schizophrenic psychopathology develops from a destruction of the patient's very primary sense of self (ipseity) leading to a breakdown of meaning. Art therapy may therefore be useful in the treatment of schizophrenia.

Art therapy research is very sparse and inconclusive although it is used rather extensively in psychiatry. The lack of a common theory and practice within this field may be an obstacle for further investigation.

This study describes a phenomenological based art therapy and presents a qualitative analysis of possible connections between the art making and the psychopathology.

Two groups of five patients received art therapy during one year. The logbooks, pictures, interviews and evaluations were used for a narrative description and a hermeneutic, phenomenological analysis.

All patients found the art therapy helpful. Common trends were that the patients obtained a more clear sense of who they were or that they accepted themselves and their illness better. In addition, the paranoid patients experienced a subjective reduction of anxiety while painting. These effects seem to be connected to the active and sensing interaction with the art material and the creation of meaning in the paintings.

The study shows that art making may affect psychopathology. A possible connection between art and psychopathology was established via phenomenological psychopathology and the philosophical concept of primary sense of self.

The efficacy of venlafaxine extended-release (XR) at doses between 75 mg/d and 300 mg/d has been demonstrated in patients with recurrent major depressive disorder (MDD) over 2.5 years. This analysis evaluated the long-term efficacy of venlafaxine XR ≤225 mg/d, the approved dosage in many countries.

In the primary multicenter, double-blind trial, outpatients with recurrent MDD (N=1096) were randomized to receive 10-week acute-phase treatment with venlafaxine XR (75 mg/d to 300 mg/d) or fluoxetine (20 mg/d to 60 mg/d), followed by a 6-month continuation phase. Subsequently, at the start of 2 consecutive, double-blind, 12-month maintenance phases, venlafaxine XR responders were randomized to receive venlafaxine XR or placebo. Data from the 24 months of maintenance treatment were analyzed for the combined end point of maintenance of response (ie, no recurrence of depression and no dose increase above 225 mg/d), and each component individually. Time to each outcome was evaluated with Kaplan-Meier methods using log-rank tests for venlafaxine XR-placebo comparisons.

The analysis population included 114 patients who had received venlafaxine XR doses less than or equal to 225 mg/d prior to maintenance phase baseline (venlafaxine XR: n=55; placebo: n=59). Probability estimates for maintaining response were 70% for venlafaxine XR and 38% for placebo (P=0.007), for no dose increase were 76% and 58%, respectively (P=0.019), and for no recurrence were 87% vs 65%, respectively (P=.099).

These data confirm venlafaxine XR is effective maintaining response at doses ≤225 mg/d for up to 2.5 years in patients with MDD.

It is difficult for a single investigator to study the psychosocial changes that occur over the life span of an individual affected with a chronic illness like β-thalassaemia major. Therefore, a developmental epidemiological perspective is required to understand the chain of events and problems of psychological nature.

We aimed to construct the picture of developmental epidemiology for psychosocial aspects in families of β-thalassaemia major patients attending a tertiary care hospital in north India.

The accelerated longitudinal design was used. The sample consisted of 100 children with β-thalassaemia and their 150 parents, both groups were subdivided further so that each group represented the continuum of longitudinal course.

Overall 54 per cent of children had significant psychopathology. Within the parents groups, 10 per cent had adjustment disorder, 33.3 per cent depressive disorder, and 10 per cent had anxiety disorder and 11 per cent somatoform disorder. There was significant difference only in the domain of psychological health in all the three groups of parents with respect to the quality of life. Among children, quality of life improved with their progression of illness.

Growing up with β-thalassaemic family was analyzed. Such a design can test the hypothesized aetiological or developmental function of a targeted risk factor within a developmental path and may be used in studying the psychological impact of even other chronic illnesses over the life span of an individual for conceptual and holistic understanding.

Cannabinoid hyperemesis syndrome (CHS), is characterized by recurrent episodes of severe nausea and intractable vomiting, preceded by chronic use of cannabis. A pathognomonic characteristic is compulsive bathing in hot water. The resolution of the problem occurs when cannabis use is stopped. However, patients are often reluctant to discontinue cannabis. Treatment with anti-emetic medication is ineffective. Case series suggested haloperidol as a potential treatment. Other antipsychotics as olanzapine has been used as anti-emetic treatment in chemotherapy.

To describe three cases of patients with CHS whom showed a successful response to olanzapine, even when, haloperidol had failed.

To present an alternative treatment for CHS which can offer benefits over haloperidol.

We present three cases of patients who suffered from CHS and were admitted to emergency department. All patients were treated with olanzapine after conventional anti-hemetic treatment failure. One patient was also unsuccessfully treated with haloperidol.

All three patients showed a good response to olanzapine treatment. Different presentations were effective: velotab and intramuscular. Their nausea, vomits and agitation were ameliorated. They could be discharge after maintained remission of symptoms.

Olanzapine should be considered as an adequate treatment for CHS. Its suitable receptorial profile, its availability in different routes of administration and its side effects profile could offer some benefits over haloperidol.

The authors have not supplied their declaration of competing interest.