Antidepressants such as SSRI and SNRI are associated to sexual dysfunction (SD). Agomelatine, an antidepressant with an unique and different mechanism of action, didn’t produce SD in patients and healthy volunteeers (Montejo et al, 2010).

To evaluate the effectiveness of switching to agomelatine in patient's experiencing SD related to previous antidepressant treatment (AD-SD).

Observational prospective study of 2-6 months follow-up. Adult sexually active patients presenting AD-SD and switched to agomelatine monotherapy were included. SD was evaluated with the change at endpoint in the validated and specific questionnaire PR-Sex-DQ-SALSEX (Montejo et al, 2001).

51 patients were included. All of them presented moderate to severe SD at inclusion. Previous AD treatment was an SSRI (63.4%) or SNRI (36.6%). Mean time of follow-up was 10.38 weeks (Sd: 5.20). Mean dose of agometine was 28.43 mg/day (Sd: 10.02). Sexual dysfunction (sexual interest, orgasm delay, anorgasmia and arousal problems) improved after switching to agomelatine, as shown by the significant reduction in PR-Sex-DQ-SALSEX score (global and by items) at endpoint (p<0.001, Wilcoxon test). At endpoint 44.9% of the sample had resolved their SD. Moderate-severe SD was present only in 18.4%. 13.9% discontinued agomelatine due to lack of efficacy and 9.7% because tolerability issues, specially associated to discontinuation syndrome.

In our sample global and every domain of SD improved significantly after switching to agomelatine, what makes it an apparent successful option to manage Antidepressant-related Sexual Dysfunction. A gradual switching is suggested in order to avoid treatment failure due to discontinuation syndrome.

Routine Outcome Monitoring (ROM) is a new phenomenon in the mental healthcare system. Its introduction into daily clinical practice has not been straightforward. This study examines practical examples of the embedding of this innovation and its effective acceptance in clinical practice.

A case history illustrates how ROM was implemented in a large mental health hospital in The Netherlands. During implementation a number of weak points in the implementation process emerged. An intense analysis of the organization of the care process, in the context of care pathways and operations management, offered explanations of what went wrong in this case. Future improvements are suggested from an operations management viewpoint.

For the improved implementation of ROM in the mental healthcare sector implementation must be widely participatory, the process must be continuously monitored, and a leading, well-informed clinician must be appointed as process manager to guide the implementation process.

To describe principles and characteristics of mental health care in London.

Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways intocare, user/carer involvement and specific issues are reported.

London experiences high levels of need and use of mental health services compared to England as a whole. Inpatient andcompulsory admissions are considerably higher than the national average. Despite having more psychiatric beds and mental health staff, London has higher bed occupancy rates and staffing shortages. At the same time there is a trend away from institutionalised care to care in the community.

Mental health services in the UK are undergoing considerable reform. These changes will not remove the greater need formental health services in the capital, but national policy and funding lends support to cross-agency and pan-London work to tackle some of the problems characteristic of mental health in London. Whilst various issues of mental health care in London overlap with those in other European capitals, there also are some specific problems and features.

To study the dyadic adjustment in couples with a schizophrenic offspring.

140 married couples, 67 with a children with schizophrenia, and two control groups: 41 couples without pathology and 32 couples with pathology, were assessed with the Dyadic Adjustment Scale, the Beck Depression Inventory and the Self-Rating Anxiety Scale.

The couples with a schizophrenic offspring evidenced significantly worse dyadic adjustment than did the normal controls, especially low consensus and cohesion in husbands, and low cohesion and satisfaction in wives. Anxiety and depression in mothers of schizophrenics is significantly higher than in mothers of controls.

These findings suggest that the poor dyadic adjustment of the parents with a schizophrenic offspring could be an effect of the burden.

The treatment on the schizophrenia should be supplemented by interventions aimed at parents’ dyadic adjustment, and mothers’ anxiety and depression, so that they can be in better conditions to help their child.

The efficiency DCASNS method to restore cognitive function in patients with organic amnestic syndrome.

Three patients with clinical organic amnestic syndrome resulting of brain damage (poisoning, alcohol and trauma) held inpatient treatment for at least 12 months in the neurology or psychiatry department without a significantly improvement.

Determine of the effectiveness of the DCASNS method to restore cognitive functions.

DCASNS method implemented using an electrical pulse generator that delivers the spatially-distributed field of the carefully-controlled current pulses in the nervous structures of the neck (Kublanov V.S., 2008). This allow to control of autonomic regulation activity (by stellatis ganglion) and stimulate stem neural centers. Patients were assessed using the clinical method, neuropsychological scales: Frontal Assessment Batter? (FAB), Montreal Cognitive Assessmnet (MCA), Mini-Mental State (MMSE), MRI, EEG, Heart rate variability (HRV).

The initial clinical state of the patients was severe, with structural damage on MRI and low rates of neuropsychological tests. As a result of seven DCASNS procedures improved significantly neuropsychological assessments: FAB (from 5,7±3,1 to 12±4,0); MCA (from 11,3±3,0 to 16,3±4,0); MMSE (from 15,3±6,2 to 21,3±8,3). EEG comparison analysis showed an increase in power of Alpha waves and power reduction of Delta waves on all leads. HRV comparison analysis showed an increase total power and the change in autonomic balance.

DCASNS method can be used for the effectiveness treatment of cognitive dysfunctions resulting organic lesions of the central nervous system.

To document patient characteristics and treatment patterns in a real-world population diagnosed with attention-deficit/hyperactivity disorder (ADHD).

This was a retrospective chart review of children/adolescents (6–17 years) diagnosed with ADHD in the UK, Germany and Netherlands who initiated stimulant monotherapy (SM), non-stimulant (atomoxetine) monotherapy (NSM) or polypharmacy (SM/NSM ± SM/NSM or other psychotropics) on/after 1-1-2012. To facilitate descriptive comparisons, cohort quotas were imposed: ∼50% SM; ∼25% NSM; ∼25% polypharmacy. Index date was first SM, NSM or polypharmacy treatment on/after 1-1-2012. Patients were required to have ≥ 6 months’ pre-index (baseline) history and ≥ 12 months’ post-index follow-up. Analyses were descriptive.

In total, 497 patients were included (mean [SD] age: 10.8 [2.9] years; 77% male); 65% (SM), 63% (NSM) and 83% (polypharmacy) had at least marked baseline ADHD severity based on Clinical Global Impressions scale (P < 0.05 SM/NSM vs polypharmacy). Ninety percent (SM), 75% (NSM) and 73% (polypharmacy) were pharmacotherapy naïve at index (all P < 0.10); 61% (SM), 65% (NSM) and 72% (polypharmacy) received previous behavioural therapy. In SM patients, methylphenidate was predominant (most frequent brands: Concerta® [29%], Medikinet® [28%]); in polypharmacy patients, methylphenidate plus atomoxetine (22%) or other psychotropic (19%) was most common. Index therapy switch was common, particularly in polypharmacy patients (25%) (P < 0.05 vs SM [14%] and NSM [13%]). Switches were precipitated by poor response in 75% of cases overall.

Polypharmacy patients generally presented a more complicated history (including higher ADHD severity) and treatment pathway versus monotherapy patients. Index therapy switches were commonplace and more frequent in polypharmacy patients, often due to poor response.

The authors have not supplied their declaration of competing interest.

To examine the more than 70-year history of a connection between University and Institutional Psychiatry.

Relevant archival material as well as primary and secondary literature were examined.

As early as 1818 Johann Michael Leupoldt (1794–1874) held a seminar on “madness” as an assistant professor in Erlangen. But the University Psychiatric Clinic did not begin until 1903 within the association of the mental asylum founded on a contract agreement between the Friedrich-Alexander, University Erlangen and the County Senate of Middle-Franconia. The history of the “Hochschulpsychiatrie Erlangen” reflects part of the history of German psychiatry. The plans to accomplish independence were doomed to impracticability by the social-political situation before, during and after the First and also Second World Wars. Clinic patients were registered as “Institutional residents”, the Clinic had no income of its own, the Head of Department and Director of the Clinic was formally considered as the “senior doctor of the asylum”.

The complicated duty dependence of the Head of Department on the Director of the asylum undoubtedly contributed to their decades spanning “mésalliance tradition”. A public scandal arose in 1978 from an accusation of dereliction of duty to the government of Middle-Franconia because of lacking protection of patient documentation and medications during the relocation of the former institution departments to the newly constructed Regional Hospital on the Europakanal.

Cooperation between the University Clinic and the Regional Hospital exists in altered form today. The Psychiatric Clinic can thus include patients from the Regional Hospital in scientific studies.

The authors have not supplied their declaration of competing interest.

The term “Hikikomori” is known as social-withdrawal which is characteristic to young Japanese recently. the hikikomori syndrome is defined as withdrawal from society for 6 months or longer by Japanese Ministry of Public Welfare. According to previous studies, “hikikomori” occurs during puberty and adolescence. On the other hand, it is also reported that not a few “hikikomori” occur after adulthood.

The aim of this study was to compare the factors between teen-onset hikikomori groups and adult-onset hikikomori groups.

We have retrospectively reviewed the clinical course of 46 patients of the hikikomori syndrome from 13 years old to 28 years old through medical records for 48 months. There were 27 males and 19 females. all the patients were allocated into 2 groups, A: teen-onset hikikomori, B: adult-onset hikikomori. We investigated diagnosis during treatment, duration of social-withdrawal before treatment, presence of domestic violence, human relations of the family, and prognosis on the end of treatment, respectively.

Group A is composed of 24 patients. Group B is composed of 22 patients. Referred tables further factors.

The factor which effects prognosis of teen-onset hikikomori was positive social support of the parents. Otherwise, the factor which effects prognosis of adult-onset hikikomori was to treat psychiatric disorders.

In earlier studies, loneliness strongly correlates with depression and depressive symptoms. Longitudinal studies are rare.

The aim of the study was to investigate in a longitudinal setting the prevalence and risk factors of maternal loneliness as well as the associations between maternal loneliness, depressive symptoms and child's subsequent psychosocial adjustment.

Mothers’ reports of loneliness were explored in a sample of 133 mothers during pregnancy (T1) and when the firstborns were 8-9 years old (T2). Maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale (EPDS) at three time points: T1, T2 and at 16-17 years of child's age (T3). Child psychosocial adjustment was assessed with the Child Behavior Checklists (CBCLs) at T2 and T3 and with the Youth Self Reports (YSRs) completed by the adolescents at T3.

The prevalence of loneliness (sometimes, often or always) was 36% at T1 and 32% at T2. Loneliness during pregnancy was associated with physical illness or disability, weaker life satisfaction and change in the pair relationship. Lonely mothers reported higher levels of depressive symptoms simultaneously and longitudinally. Mothers reporting loneliness at T1 and/or T2 showed higher depressive symptom levels at T1, T2 and T3 and reported more emotional and behavioural problems in their child at T2 and T3. The adolescents also reported more problems if the mother had reported loneliness at T1 and/or T2.

Loneliness is common among mothers and co-occurs, predicts and is predicted by depressive symptoms. It may expose the children to poorer psychosocial outcomes.