To determine the clinical effectiveness of Cognitive Behaviour Therapy (CBT) delivered in primary care for older people with depression and evaluation of a talking control (TC).

A single-blind, randomized, controlled trial with 4- and 10-month follow-up. 204 people, aged 65 years or more, with a Geriatric Mental State diagnosis of depression were recruited from primary care. The interventions were: treatment as usual (TAU), TAU plus TC, or TAU plus CBT. The TC and CBT were offered over 4 months. The TC was to control for common effects in therapy. The Beck Depression Inventory-II (BDI-II) was the main outcome. Subsidiary measures were the Beck Anxiety Inventory, Social Functioning Questionnaire, and Euroqol. Intention to treat analysis (ITT) and Compliance Average Causal Effect (CACE) analyses was employed. The Cognitive therapy scale (CTS) evaluated common and specific factors in therapy.

A mean of 7 sessions of TC or CBT were delivered. ITT analysis found improvements of −3.07 (95% confidence interval [CI], −5.73 to −0.42) and −3.65 (95% CI, −6.18 to −1.12) in BDI-II scores in favour of CBT vs TAU and TC respectively. CACE analysis found a benefit of 0.4 points (95% CI, 0.01 to 0.72) per therapy session of CBT over TC. Ratings for CBT on the CTS were high (mean [SD], 54.2 [4.1]) and showed no difference for nonspecific, but significant differences for specific factors in therapy.

CBT is an effective treatment for depressed older people. Improvement appears to be associated with specific factors in CBT.

Emigration is a complex process of social changing through which an individual moves from a certain cultural environment/context to another, aiming to achieve persistent or long-term residency, causing distress. There is sustainable evidence that incidence of all forms of psychosis is higher in migrants.

This study aims to gather data of other research conducted in the field according to emigration as a risk factor for development of different psychosis.

Scientific articles searched in MEDLINE, regarding the incidence of mental disorders in different emigrant populations, for the period 1995 - 2015.

The average relative risk of schizophrenia and of other psychosis occurrence among first generation emigrants was 2.7 (95% confidence interval [CI]=2.3-3.2). Statistical analysis performed among studies of first and second generation of emigrants, and among studies which don’t make difference between generations, results in a relative risk of 2.9 (95% CI=2.5-3.4) of mental illness.

The data presented in this study emphasize the impact of migration on central symptoms of schizophrenia. Emigration process, cultural and social adaptation, play an important role on the individual mental health.

No significant relationships.

Commitment to sports is especially important for well-being in people with disabilities (Malm et al., 2019), although mental health problems are common among Paralympic athletes (Hunt et al., 2019). Importance of representations of and regulation in sport situations was supported for different kind of sports (Moran, 1993, Suinn R., 1982, Hardy et al., 1996) but Paralympic ones.

The aim was to reveal aspects of psychological regulation important for achievement and longer commitment to Paralympic sports comparing to non-Paralympic sports.

51 athletes from Paralympic sports (49.1% candidates and masters of sports) filled Questionnaire of Image Representations of Professional Activity of Athletes (Leonov et al., 2020) measuring general importance and self-appraisals of different aspects of image representation and regulation in sport activities: control of temporal, spatial, informational, technical and tactical, energetic aspects, game intelligence, motivational, emotional and social aspects (Cronbach’s alphas .61-.89). Data were compared to 399 athletes without disabilities (48.4% candidates and masters of sports).

Comparing to athletes without disabilities, Paralympic athletes higher appraise general importance and their capacities for emotion regulation during sport situation (t=2.26-3.35, p<.01). High-level Paralympic atheletes report marginally better emotion regulation (t=1.74, p<.10). Longer experience in sport in Paralympic athletes is associated with better representations of spatial and social aspects of sport situations and better emotion regulation (r=.25-.29, p<.05).

Data suggest that improvement of emotion regulation in sport situation in Paralympic athletes could be helpful for longer participation and better achievement. Research is supported by the Russian Science Foundation, project No. 19-78-10134.

Research is supported by the Russian Science Foundation, project No. 19-78-10134

In the past decade, millions of Syrians have sought refuge in neighboring countries and Europe. Refugees are at increased risk for the development of common mental disorders (CMD), such as depression and posttraumatic stress disorder (PTSD), but only a small percentage access mental health services. Problem Management Plus (PM+) is a brief, scalable intervention targeting symptoms of CMDs that can be delivered by non-specialist helpers in communities affected by adversity, such as refugees.

The aim of this randomized controlled trial (RCT) is to evaluate the effectiveness of PM+ among Syrian refugees in the Netherlands.

Adult Syrian refugees and other Arabic-speaking refugees of 18 years and older with self-reported psychological distress (K10 >15) and functional impairment (WHODAS 2.0 >16) are included. Participants are randomized into PM+ or care as usual. Follow-up assessments are conducted at one-week, three-month and twelve-month follow-ups. Clinical outcomes are symptoms of depression/anxiety (HSCL-25), PTSD (PCL-5), and functional impairment (WHODAS 2.0).

By November 2021 [recruitment ends by December 2021], 214 participants were screened for eligibility and 184 participants were included. Participants are M=36.5yrs old (range 18-69yrs), and 73 participants are female (39.7%). We will present preliminary results for the effects of PM+ on depression, anxiety, PTSD, and functional impairment at one-week follow-up, as well as barriers and facilitators for implementing PM+ in a European country.

After positive evaluation of peer-refugee delivered PM+, the Arabic manual and training materials will be made available through WHO to encourage scaling-up.

No significant relationships.

Alcohol dependence and depression are often combined, patients with comorbid pathology have a more severe course of the disease, a high risk of suicide and therapeutic resistance. Enzyme dopamine-beta-hydroxylase (DBH) is a key player in a link between dopamine and norepinephrine neuromediations and may be involved in alcohol dependence and depression comorbidity and genetic markers in DBH gene may be associated with the risk of comorbid state.

To test an association of DBH gene polymorphisms rs161111580 and rs1108580 with depression risk in alcohol-dependent patients.

Our sample consisted of 104 inpatients diagnosed by ICD-10 criteria: 40 with alcohol dependence (AD group) (age 45.6 (SD 10.853), 5% females), 64 with depression and alcoholism comorbidity (AD+D group) (age 41.2 (SD 9.903), 22% females) and 112 healthy controls (age 35.5 (SD 8.286), 15% females). rs1108580 and rs1611115 were detected by RT-PCR.

For rs161111580, frequencies of minor T allele (p=0.031) and ТТ genotype (p=0.017) was higher, СС genotype (p=0.042) was lower in AD group vs. controls. rs161111580 T allele and TT genotype increases the risk of AD (OR=3.715, 95%CI [1.728-7.986], P=0.001 and OR=4.009, 95%CI [1.502-10.699], P=0.006). For rs161111580, frequency of ТТ genotype (p=0.009) was higher in AD+D group vs. controls. For rs1108580, frequency of major А allele (p=0.059, trend) was higher in AD+D, then in AD group. Major А allele rs1108580 increases the risk of depression in alcohol-dependent patients (OR=2.74, 95%CI [1.283-5.855], P=0.001).

It was shown that the DBH rs1108580 increases the risk of depression in patients with alcohol dependence.

No significant relationships.

A variety of psychological determinants, such as vulnerability to stress, low levels of psychological well-being and several comorbidities, have been hypothesized to play a role in the development, and maintenance of Internet Gaming Disorder (IGD). However, evidence has been insufficient to sustain an overarching model of the causal pathways leading to IGD.

. This study aimed to depict a model of the causal links between vulnerability to stress, psychological well-being, and symptoms of common mental disorders (e.g., depression, generalized anxiety, phobic anxiety, obsessive-compulsive disorder, somatization, and hostility).

. A community-based sample of Portuguese gamers (N = 153; Mage = 21.92; 15.29% female) completed measures of IGD (IGDS9-SF), mental health (SCL-90-R), psychological well-being (EBEP), and vulnerability to stress (23QVS). A machine learning algorithm – Greedy Fast Causal Inference – was used to infer a model of the causal pathways linking those psychological determinants to IGD.

. Hostility and psychological well-being were directly involved with a subgroup of IGD symptoms (i.e., gaming used as escape, tolerance, withdrawal, and loss of control). Stress vulnerability and symptoms of mental disorders were only indirectly implicated in the causal pathways leading to IGD.

. It is likely that several psychological factors implicated in the causal pathways leading to IGD, have not been yet identified. Future research should directly test specific models of the causal pathways involved in the development and maintenance of IGD symptoms.

No significant relationships.

Whereas some research suggests that acknowledgment of biogenetic factors in mental illness could reduce mental illness stigma by diminishing perceived responsibility (Corrigan et al 2003), other research has cautioned that emphasizing biogenetic aspects of mental illness could produce the impression that mental illness is a stable, intrinsic aspect of a person (“genetic essentialism”), increasing the desire for social distance (Phelan 2002).

We assessed genetic and neurobiological causal attributions about mental illness among 85 people with serious mental illness and 50 members of the public. The perceived responsibility of persons with mental illness for their condition, as well as fear and social distance, were assessed by self-report. Automatic associations between Mental Illness and Guilt and between Self and Guilt were measured by the Brief Implicit Association Test.

Among the general public, endorsement of biogenetic models was associated with less perceived responsibility, but also greater social distance. Among people with mental illness, endorsement of genetic models had only negative correlates: greater explicit fear and stronger implicit self-guilt associations.

Genetic models may have unexpected negative consequences for implicit self-concept and explicit attitudes of people with mental illness. An exclusive focus on biogenetic models may therefore be problematic for clinical practice and anti-stigma initiatives.

To assess gender differences in the clinical presentation of GAD and response to pregabalin (PGB) treatment.

Data were pooled from 6 randomized, double-blind, placebo-controlled, 4- to 6-week trials of outpatients who met DSM-IV criteria for GAD with a minimum HAM-A total score >18. Response was evaluated for 3 fixed-dosage groups: 150 mg/d, 300-450 mg/d, and 600 mg/d.

Baseline presentation of GAD was similar for women and men, respectively, for mean (±SD) age (38.6±12.3 vs 39.4±11.5 y) and severity of concurrent depressive symptoms (HAM-D score, 13.7±4.4 vs 13.4±4.3). However, women had a modest but significantly higher mean HAM-A somatic factor score (11.5±3.2 vs 10.8±3.1; P<0.01). For both sexes, treatment with PGB resulted in significantly higher LOCF-endpoint improvement in HAM-A total score: Women: PGB-150 mg, -10.7±0.82; PGB-300/450 mg, -11.8±0.68; PGB-600 mg, -12.4±0.59 vs. placebo, -9.5±0.51; P<0.0001 for all comparisons; Men: PGB-150 mg, -10.8±0.81; PGB-300/450 mg, -12.6±0.59; PGB-600 mg, -11.6±0.51 vs placebo, -8.7±0.47; P<0.0001 for all comparisons. CGI-I responder rates were significantly higher (P<0.001) on PGB (combined doses) vs. placebo for both women (50% vs 35%) and men (53% vs 38%). There were no gender differences in attrition due to adverse events, or in proportion of severe adverse events.

Women and men with GAD showed similar clinical presentations, with women reporting somewhat more somatic symptoms. Pregabalin was an effective and well-tolerated treatment for GAD for both sexes.

Funded by Pfizer Inc

Stigma is a serious concern for people with bipolar disorder (PBD). It may have critical yet insidious repercussions on the course of the illness and may represent a barrier to recovery.

To determine the influence of social stigma and internalized stigma on residual affective symptoms, treatment adherence, global functioning and metacognitive functioning in a population of euthymic PBD.

A Cross-sectional study was conducted on 32 outpatients with bipolar disorder I (BDI). Residual affective symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD). Social stigma and internalized stigma were evaluated using the Discrimination and Stigma Scale (DISC). The Medication Adherence Rating Scale (MARS), the Global Assessment of Functioning (GAF) and the Metacognition Assessment Interview (MAI) were also used.

Higher rates of social stigma were correlated with poorer global functioning (p=0.029) and poorer adherence to medication (p=0.022). However, higher social stigma correlated with better metacognitive capacities (p=0.0001, r=-0.61); good metacognition may lead to a better perception of social stigma. Self stigma was significantly correlated to residual depressive symptoms (p=0.0001) and to poorer global functioning (p=0.018) and poorer adherence to treatment (p=0.002). Better metacognitive capacities were also correlated with the ability to overcome stigma.

Social stigma and self stigma may have negative impact on several aspects of the BD that are essential to the outcome such as medical adherence, functioning and residual symptoms. Targeting stigma may help PBD achieve recovery.

A challenging medicine dissertation: to design a psychiatric therapeutic community.

A medical student winning a grant addressed to architects and farm laborers aimed to convert a rural area through Social Innovation programmes, a group of young enthusiastic psychiatrists and a donor involved in psychiatric circumstances are the actors of the project for turning a rural building located in the small village of “Villa San Bartolomeo” (Reggio Emilia, Italy) into a psychiatric social-rehabilitation community.

The project started reviewing the literature concerning community-based psychiatry residential facilities. Later, a structured interview has been carried out with the village's inhabitants in order to investigate both their perception of stigma towards mental illness and the perceived needs of their city. The answers have then been used to organize the activities within the psychiatric community, ranging from recreational through sportive until occupational ones, such as farming vegetable gardens, breeding domestic animals, producing handiworks. These labors are intended both to satisfy the village demands and realize a greater integration of the community itself within the surrounding social network.

The therapeutic interventions that are going to be realized within the residential home will be aimed to promote patients’ personal growth and adapting capacity. These interventions are intended to allow the accomplishment of a greater housing independence of the hosts by restructuring their affective, relational and social backgrounds.

This is an ambitious project, started by chance, representing the desire and the hope for curing mental illness by establishing a contact with the natural environment.

Individual Cognitive Remediation Therapy (CRT) for AN has been found to improve patients’ neuropsychological functioning and short term outcome. No French speaking country has tested its effectiveness. Moreover, the question whether it is similarly efficient for both restrictive and binge-purging AN remains unanswered. We thus designed a randomized clinical trial on the effectiveness of individual CRT in AN adolescents or young adults.

120 female AN [16-35 years old] (60 AN-R; 60 AN-BP) from three specialized care units (P.Brousse, IMM, Cochin- MDA). Patients of each AN type are randomly allocated to one of the two treatment arms: CRT or Sham Therapy (ST). The Sham therapy (ST) has been designed to match the CRT format: an individual manualised therapist-led 10-sessions long program (2 sessions/week). ST sessions have been designed so as to avoid set-shifting and central coherence training and rather tap 3 domains: soft physical activity, emotional expression and recognition and interpersonal functioning. Primary outcomes are neurocognitive improvement at the end of therapy (TMT, WSCT performances) and better clinical status (GOAS) at the end of therapy and at follow-up (6 months, 1 year). Secondary outcomes are changes in BMI, central coherence, selfreported eating disorders symptoms and cognitive flexibility, and motivation to change.

Inclusions started in September 2012. Preliminary findings (at least 15 participants in each arm are expected by then) on short term CRT effectiveness will be presented.

Stress is a risk factor for developing psychopathology. Emerging evidence suggests that daily experiences of stress may also predict symptoms during the day. It is unclear to what extent the influence of stress on psychopathology during the day is the same across individuals (including across diagnostic boundaries), and which effects are individual-specific

This study aims to reveal how stress and symptoms are interrelated in a cross-diagnostic context by modeling individual level temporal networks, and examining subgroups with similar dynamics.

Hundred twenty two young adults (43.4% women) with a wide range of psychopathology in terms of severity and type of problems completed a six-month daily diary study. We used a temporal network approach (i.e., group iterative multiple model estimation) to model how stress and ten specific symptoms (e.g., feeling down, paranoia, restlessness) were related across time at the individual-specific, subgroup, and group level.

After controlling for the lagged influence of stress on itself, stress level predicted the level of restlessness, worrying, nervousness, and feeling down during the same day for >70% of individuals. We observed three larger subgroups with each over 20 individuals, whose temporal networks showed different dynamic patterns involving specific symptoms. Effects of stress on other specific symptoms differed across individuals, and these were not subgroup-specific.

This study showed important overlap between individuals in terms of impact of stress on psychopathology in daily life. Subtle differences between individuals were also observed. Possibly, such differences are relevant for examining individual-specific vulnerability for future psychopathology. This requires further investigation.

No significant relationships.

Many outpatients with schizophrenia experience severe metabolic side effects such as metabolic syndrome that occurs frequently in the treatment with some atypical antipsychotics that especially with clozapine and olanzapine.

To determine whether antipsychotic-associated metabolic abnormalities identified through intensive monitoring can be changed by switching from olanzapine medication to ziprasidone in patients with schizophrenia.

Stable outpatients with metabolic side effects on olanzapine (n=20) therapy were switched to a flexible-dose trial of ziprasidone (40-160 mg/day) in this 13-week naturalistic study. All patients underwent an extensive metabolic evaluation at baseline, at 6 weeks, and at 13 weeks post switch. Metabolic abnormalities included the following medical complications: new onset diabetes impaired fasting glucose, impaired glucose tolerance, metabolic syndrome according to various definitions, and dyslipidemia. After 13 weeks of treatment with ziprasidone (mean daily dose 136.4 mg), there was a significant decrease in body weight, body mass index, and waist circumference. There was a significant reduction in fasting glucose, fasting insulin, and serum lipids levels (cholesterol, triglycerides, low-density lipoprotein (LDL), LDL/HDL, Chol/HDL, and non-HDL cholesterol). The metabolic syndrome was reversed in 70% of patients at 3 months.

Switching stable outpatients with schizophrenia from olanzapine to ziprasidone was generally well tolerated and was associated with improvements at 13 weeks. Results support the reversibility of olanzapine-induced metabolic abnormalities when detected early and followed by a switch to ziprasidone.

Balance deficits are heterogeneous among children with Developmental Coordination Disorder (DCD). Balance performance depends on different balance domains, each associated with specific underlying neurological systems. In DCD, any of these domains can be affected, but the control mechanisms are poorly understood. The mirror neuron system (MNS) seems to play a key-role in DCD-related deficits. To understand the role of MNS as a control mechanism underlying the balance deficits, simultaneous registration of cortical MNS activity while performing balance tasks is imperative. Therefore, a protocol for combining real-time registration of cortical MNS activity during functional balance tasks in children with DCD, CP and TD is introduced. Methods: Children with DCD, CP and TD (n=108) aged 5-10yr perform preselected tasks of the Kids-BESTest, representing specific balance domains (mixed design): leaning with eyes closed (stability limits/verticality), single-leg-stance, alternate stair touching (anticipatory balance), in-place response, compensatory stepping backward (reactive balance) and walking over obstacles (gait stability). Simultaneously, functional Near-Infrared Spectroscopy (fNIRS) monitors cortical activity involving the MNS: premotor, inferior and superior parietal cortex and supplementary motor area. An 8-8-optode bundle, making 22 channels, targets this region of interest. Outcome measures are: (de)oxygenated hemoglobin concentration changes per task per channel. Results: In this ongoing research, the protocol was already feasible in 19 children (7.52±1.19). Conclusion: Simultaneous registration of cortical MNS activity (fNIRS) and Kids-BESTest scores will help increase the understanding of the control mechanisms underlying the heterogeneous balance problems in DCD. Consequently, first steps are made to confirm whether DCD shows deviant or delayed development.

No significant relationships.

Adolescence is a high risk period for the development of anxiety and depressive disorders. Very few studies have investigated the epidemiology of common mental disorders in adolescents attending school and using structured psychiatric interviews. The aim of the presentation is to report on the methodology used to assess the common mental disorders in schools of the region of Epirus in Greece, using a computerized version of the revised clinical interview schedule (CIS-R).

A two stage design will be used: Adolescents will first complete the 12- item general health questionnaire (GHQ-12) and then a stratified random sampling will be selected for the psychiatric interview. The latter will be delivered using a computer network version of the CIS-R

We used an open source program (phpsurveyor) to develop the computerized version of the CIS-R. We modified the program accordingly to include the full algorithm of the interview. Use of this interview to assess the common mental disorders was acceptable for adolescents and comparable with face to face interviews.

It is possible to use an internet-based structured interview to assess the common mental disorders in adolescents. Delivering this interview using the school-based computer laboratories may facilitate school-based epidemiological research.

Therapeutic Drug-Monitoring (TDM) for bupropion is limited by bupropion's instability at room temperature and by the absence of a well-defined therapeutic reference range. Further it is unclear to what extent bupropion and its metabolites contribute to therapeutic effects, though hydroxybupropion seems to account for the major antidepressant effects.

The aim of this examination was to check if measurement of only hydroxybupropion is useful to guide the antidepressant therapy with bupropion.

Hydroxybupropion plasma levels were measured by high performance liquid chromatography with ultra violet detection and related to therapeutic effects measured by the Clinical Global Impression Scale for improvement.

The study included 52 patients (50% female). Patients who were very much improved according to CGI had significantly (p=0.042) higher hydroxybupropion serum levels than patients with moderate or minimal improvement (mean±SD, 1113±576 ng/ml, 825±398 ng/ml and 475±331 ng/ml, respectively). Receiver operating characteristics analysis revealed significant predictive properties of hydroxybupropion serum levels (p=0.002) for improvement with a lower threshold level of 858 ng/ml. Women attained significantly higher serum levels than men and also exhibited a better therapeutic effect (p= 0.018), though they did not receive significantly higher doses.

Measurement of hydroxybupropion plasma levels can be used to optimize the therapeutic outcome of patients treated with bupropion. Plasma levels between 850 and 1500 ng/ml can be regarded as optimal. Potential sex differences in bupropion pharmacokinetics, probably due to differential activities of CYP2B6, should be taken into account.

Clinical trials suggest that patients receiving atypical antipsychotics are less likely to develop movement disorders than those receiving conventional antipsychotics. We determined incidence of treatment-emergent TD during long-term treatment of schizophrenia or schizoaffective disorder with aripiprazole or haloperidol.

In a post hoc analysis of pooled data collected from two 52-week double-blind trials involving 1,294 patients treated either with aripiprazole 20-30mg/d (n=861) or haloperidol 5-10mg/d (n=433), treatment-emergent TD was identified based on Research Diagnostic Criteria (RDC) extracted from the Abnormal Involuntary Movement Scale (AIMS) (Schooler-Kane criteria).

In patients without baseline TD (n=1,177), the rate of new-onset TD at any time point following randomization was 5.09% for aripiprazole-treated patients and 11.76% for haloperidol-treated patients (p<0.0001). Using a stricter definition of RDC-defined TD on the last two study visits, new-onset TD was seen in 0.25% of aripiprazole-treated patients versus 4.09% of haloperidol-treated patients (p<0.0001), and was mild in 100% of aripiprazole-treated patients, and mild in 68.75% and moderate or severe in 31.25% of haloperidol-treated patients. Mean baseline to endpoint increase in AIMS score was significantly greater in haloperidol- versus aripiprazole-treated patients in both LOCF (n=1177, p=0.0001) and OC (n=427, p<0.0001) analyses.

Aripiprazole is associated with a significantly reduced risk of new-onset tardive dyskinesia compared with haloperidol in patients with schizophrenia or schizoaffective disorder treated for up to 52 weeks. Aripiprazole's dopamine D2 partial agonist and/or serotonin 5HT2A antagonist receptor binding profile may contribute to this.