This study assessed the efficacy of agomelatine (1,2,3), in the prevention of relapse in non-depressed out-patients with DSM-IV-TR defined Generalized Anxiety Disorder (GAD) and the tolerability.

GAD patients received open label agomelatine (25–50 mg/day). At week 4 the dose was increased for patients with insufficient improvement (blinded criteria). At week 16, responders were randomised to maintenance treatment with either agomelatine, or placebo for a 26 week period. Then, agomelatine treated-patients were re-randomised to an agomelatine arm or to a placebo arm, to confirm the lack of discontinuation symptoms (on the DESS check-list).

The primary outcome was the time to relapse (days) during the 26 week double-blind treatment period, as estimated using the Kaplan-Meier method. Relapse was defined as HAMA total score > = 15 or withdrawal for lack of efficacy (in the investigator's opinion, based on both HAM-A and CGI scores).

477 patients entered the open-label phase and 329 completed this period. 228 patients were randomly assigned to receive agomelatine (114 patients) or placebo (114 patients).

The incidence over time of relapse was significantly lower with agomelatine compared to placebo (19.7% versus 31.7% log rank test p = 0.046) during the double-blind treatment period.

During the double-blind treatment period 12.4% patients with agomelatine and 9.6% with placebo reported at least one emergent adverse event related to the study treatment. There was no discontinuation syndrome in agomelatine treated patients.

Agomelatine was efficacious in preventing relapse in GAD, with maintenance of efficacy over 6 months, and good tolerability.

Some theory and empirical-driven classification systems of disgust have stimulated the creation of several self-report instruments for the assessment of disgust sensitivity [e.g., the Disgust Scale-Reviesed (DS-R,Haidt et al., 1994) and the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R; van Overveld et al., 2006;Sandín et al., 2008)]. Two main problems of current self-report scales of disgust are that

1. (a) there is not a consensus about the domains of disgust to be assessed, and

2. (b) all self-report scales were developed in the Anglo-Saxon culture.

Given the particular relationship of disgust to the individual's culture, it is desirable to construct self-report instruments based in other cultures.The aim of this work was to develop a new self-report instrument based in a Spanish-speaking population.

The 11 domains (see Sandín et al.) in which Spanish people experience disgust served to define a broad range of disgust elicitors in our Cuestionario de Sensibilidad al Asco (CSA) [Disgust Sensitivity Questionnaire]. The initial questionnaire (92 items) was given to a sample of undergraduates at Universidad Nacional de Educación a Distancia. Based on factor and item analysis, sixty-two items were finally retained.

Exploratory factor analysis of the 62 CSA items revealed a robust eleven-factor structure, describing the following 9 dimensions of disgust: hygiene, socio-moral, sex, envelop violations/death,animals, disease,atypical food, animal decomposition, and unacceptable food. Internal consistency (alpha coeffients and corrected item-total correlations) was excellent.

Findings suggest that the CSA is a promising new measure of disgust. The CSA demonstrated excellent factorial validity and reliability.

Sleep disturbance is one of the key DSM-IV criteria for generalized anxiety disorder (GAD), and represents the chief complaint in approximately one-third of patients presenting in the primary care setting.

To evaluate the extent to which improvement in anxiety is a direct effect of treatment with pregabalin, or is an indirect effect mediated by improvement in sleep disturbance, and vice-versa.

Data were pooled from 4 double-blind, placebo-controlled (n = 406) short-term trials of pregabalin (all doses combined; n = 853) in the treatment of generalized anxiety disorder (GAD). The effect of treatment on anxiety was measured using the Hamilton Anxiety Rating Scale (HAM-A), effect of treatment on sleep disturbance was measured using the 3-item Hamilton Depression Rating Scale (HAM-D) sleep factor. Path analyses, using a set of multivariate regression models, were used to evaluate the reciprocal effects of pregabalin on improvement in anxiety in the presence of improvement in sleep disturbance, and vice-versa.

Sleep disturbance was common in this GAD sample, with 51.2% (placebo) and 52.2% (pregabalin) of patients, respectively, reporting moderate-to-severe insomnia (HAM-D sleep factor score ≥3). The results of the path analysis indicated that 91.7% (P < 0.0001) of improvement in anxiety was a direct effect of treatment with pregabalin, while 8.3% of improvement in anxiety was an indirect effect, mediated by improvement in sleep disturbance.

In this pooled 4-study data set, the anxiolytic efficacy of pregabalin appears to be primarily a direct effect, with only a small (8.3%) indirect effect, mediated by improvement in sleep disturbance.

Obsessive-Compulsive Disorder (OCD) is characterized by recurrent intrusive thoughts and/or repetitive behaviors carried out in a ritualistic fashion. Both obsessions and compulsions are ego-alien and produce anxiety if resisted. Cognitive behavioural therapy (CBT) based on exposure and response prevention (ERP) and pharmacotherapy are currently the most popular choices of treatment.

Individual CBT/ERP with or without psychopharmacological treatment has been established as the treatment of choice for OCD, but group CBT/ERP has received little attention although it has been proposed as a cost-effective alternative. The aim of this paper is to explore its pros and cons.

Review of the current literature.

Group CBT/ERP appears to be equally effective as individual, although the latter has been associated with a more rapid rate of improvement. Both achieve similar reductions in anxiety and depressive symptoms and have similar dropout rates. Group theray is also acceptable to most patients and saves time and money to both patients and doctors. It is not documented whether it achieves change of the same magnitude as the individual format of the respective treatment. Patients with more severe global symptoms are less likely to respond to the group format, therefore an attempt to reduce these symptoms prior to the treatment of OCD may be necessary.

Group treatment is an effective treatment for OCD in the long term, but more research needs to be done to compare the effectiveness of group and individual treatment formats.

To evaluate the long-term safety and efficacy of adjunctive aripiprazole (ARI) to lithium (LI) or valproate (VAL) in delaying time to relapse in bipolar I disorder.

Bipolar I disorder subjects with a current manic or mixed episode received LI or VAL for at least 2 weeks; inadequate responders (YMRS score ≥ 16 and ≤35% decrease from baseline at 2 weeks) received adjunctive ARI. Subjects maintaining mood stability (YMRS and MADRS ≤ 12 for 12 consecutive weeks) were randomised 1:1 to double-blind ARI (10 to 30 mg/day) or placebo (PBO) plus LI or VAL. Relapse was monitored up to 52 weeks.

337 subjects were randomised to continuation of mood stabiliser plus adjunctive ARI or PBO; 61.3% and 52.7%, respectively, completed the study. Adjunctive ARI significantly delayed the time to any relapse, hazard ratio = 0.544 (95% CI: 0.33, 0.89, log-rank p = 0.014). Overall relapse rates at 52 weeks were 14.9% and 25.4% in ARI vs PBO subjects. A superior reduction in CGI-BP Mania Severity of Illness from baseline at 52 weeks was also observed (0.3 vs. 0.0, respectively, p = 0.01). Adverse events generally were as expected per known drug and illness profiles with no significant difference in mean change in body weight between adjunctive PBO (0.60 kg) and adjunctive ARI (1.07 kg) (p = 0.49 Week 52, LOCF).

Continuation of aripiprazole treatment increased time to relapse to any mood episode compared with placebo plus LI/VAL over 1 year, indicating a long-term benefit in continuing adjunctive aripiprazole to a mood stabiliser after sustained remission is achieved.

AS-18 has good basic psychometric properties. It takes only a few minutes for patients to perform and is suitable for routine use in outpatients with bipolar 1 disorder.

Agitated Unipolar Depression and Bipolar mixed states combine depressive and manic symptoms, reflecting severe forms of affective disorders with an increased suicide risk. These states have not been defined with adequate consensus and hence present a diagnostic and therapeutic challenge.

We searched the records of patients with Affective Mixed States in a community Mental Health Team to identify patients with affective mixed states.

We assessed the treatments prescribed and the time it took to treat the Mixed states so that they then suffered from depression or were euthymic.

Ten out of 17 patients were suicidal when experiencing a mixed state. Of the 6 patients that were agitated, 5 were suicidal. Best results were achieved with a combination of -Reducing antidepressant -Increasing mood stabilisers (Depakote, Lithium) -Increasing/adding atypical antipsychotics. With such treatment, the average duration to resolution was 2.5 weeks. The worse results were achieved by adding antidepressants to a patient experiencing low mood with a mixed state such treatment led to resolution in 10 weeks

Agitation is a strong predictor of suicide risk. Reducing antidepressants is important thus Increasing/adding antipsychotics and mood stabilisers without changing antidepressants led to an 8.5 weeks duration of treatment.

Patients with mixed states should be reviewed regularly and risk-assessed -We suggest weekly due to increased suicide risk. With very high-risk patients, referral should be made to the Crisis Team. Care coordinators should be involved for regular contact with services.

Studies into social cognition in psychiatric disorders have recently been expanded to address the questions whether or not “theory of mind” (ToM), that is, the ability to represent own and others’ mental states, is impaired in bipolar affective disorder (BPD).

Results have been mixed so far, mainly due to possible confounding effects of neurocognition, as well as, clinical factors such as acuity and current mood. Here, we explored ToM and its associations with neurocognitive functioning in BPD.

33 patients with bipolar I disorder (of which 12 were currently depressed, 10 manic, and 11 remitted) and 29 healthy controls were assessed using a test battery that was identical to the one that was used in previous studies into schizophrenia, comprising diverse neurocognitive tasks, including measures of intelligence, executive functioning, and ToM tasks.

The bipolar patient group as a whole, as well as all three clinical subgroups, were impaired on all measures of ToM relative to controls, but did not differ from each other in most ToM scores. Patients’ poorer performance on executive tasks did not fully explain ToM differences between patients and controls, suggesting a partially selective ToM deficit in BPD.

Patients with BPD are impaired in ToM, partially independent of other cognitive dysfunctions and current mood.

Many authors support the idea that Mood Incongruent Psychosis is a subtype of affective illness, although no clear definition or etiopathogenic basis of the congruent or incongruent subtype has been found.

In this study we intend to evaluate clinical and biological differences between Psychotic Bipolar I patients who have mood congruent or mood incongruent psychotic symptoms.

The study has been carried out in 80 Psychotic Bipolar I Patients before, and after, four weeks of treatment with Olanzapine plus Lithium. We studied the correlation between the plasma concentration, before treatment, of the dopamine metabolite 3,4 Dihydroxyphenylacetic acid (DOPAC) and the clinical response to treatment.

The most remarkable result found was that Clinical Improvement after 28 days of treatment correlated positively with the initial concentration of DOPAC, but ONLY in the subgroup of patients with congruent psychotic symptoms.

From our results it seems that the Congruence and Incongruence of psychosis in bipolar I patients can provide a basis to objectively divide these patients. Both groups can be distinguished based on the relationship established between their concentration of DOPAC before treatment and their clinical response to the pharmacological treatment.

Universidad del País Vasco Grant N° EHU 09/21 and Fondo de Investigación Sanitaria and Feder Founds Grant N° 09/01760.

The literature indicates that most patients with Major Depression mention sudden short “mood swings” (MI) when asked. MI is known to be distressing but little is known about the treatment.

To determine whether MI changes with community treatment of depression.

To study changes in MI with 3-6 months of treatment for depression in patients with Major Depression and complaints of MI.

34 patients with Major Depression and complaints of “mood swings” were recruited from 4 psychiatric practices. They were interviewed with the MINI diagnostic interview and the Mood Disorders Questionnaire. They completed the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory Trait Form (STAI-T), and Visual Analogue Scales for Depressed Mood (VAS) and Anxious Mood twice a day for a week. The Mean Square Successive Difference Statistic (MSSD) was calculated from the VAS readings. The BDI, STAI-T, and VAS were repeated after 6 months of treatment.

25/34 patients reported past hypomania. Most patients were treated with a combination of antidepressants and mood stabilizers. The BDI and STAI-T scores improved with treatment. There was no overall change in depressed and anxious MI. Change in Depressed MI and Anxiety MI correlates with change in BDI from T1 to T2

Anxiety and depression improved with treatment as expected. Change in MI is inconsistent. Research into medications and psychosocial treatments that improve MI is needed and this will probably improve depression treatment outcome.

Driving is a daily activity for most people in developed countries and is important in maintaining independence. Bipolar patients may have an impaired driving behavior because of the pathology itself, with psychomotor and cognitive disturbances. Additionally, adverse effects of pharmacologic treatment may be detrimental.

24 remitted bipolar outpatients diagnosed according to ICD-10 criteria were enrolled in the study, receiving either lithium (n = 12) or lamotrigine (n = 12). Participants were investigated under steady state plasma level conditions. According to the German Guidelines for road and traffic safety data were collected with the Wiener Testsystem (WTS) measuring visual perception, reactivity, stress tolerance, concentration and vigilance.

Psychopathologic symptoms were rated with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale - Clinician rated (YMRS-C).

About 40% of patients were without clinically relevant psychomotor disturbances. In 40% of cases mild to moderate impairments could be seen, and 20% of the patients were considered as severely impaired. Data show that patients under lamotrigine had an altogether better test performance than patients treated with lithium. Especially in visual perception and stress tolerance differences were most pronounced.

About 20% of remitted bipolar outpatients treated with lithium or lamotrigine must be considered unfit to drive. In 40% of the cases it seems justified to counsel patients individually, taking into account compensational factors. Analysis of our data point to an advantage for bipolar patients treated with lamotrigine when compared with lithium. However causal relationships can not be drawn from our data.

31 years old, married, female patient. She is having bipolar disorder treatment for three years. About her diseases she said that “ıt is the worst illness among all of the illness, because mind is the organizatör of the human body, if you loss your mind you can not move your hand or arm”.About public stigma she told that “people afraid because of harming by us, when they see us on street they enter their home, they don’t give permission to touch their child and run away from us. My brothers wife saying me afraid from me and don’t want to be alone with me.” Also patient said that “I’m not having a talk with my neighbour because I feel they won’t take seriously me. I stayed in hospital for 28 day because illness after discharged I didn’t told anyone about staying in psychiatry clinic. In the past I done eveything but now I’m doing nothing. I feel all of the weight of the world on me. I feel myself weak both as physical and mental”

Stigmatized people believe that others will devalue and reject the people with mental illness and experiencing negative outcomes such as demoralization, decreased self esteem, impaired social adaptaion, unemployment, decreased psychiatric treatment adherence.

46 years old, housewife. Her daughter disease occured seven years ago in pospartum period. Mother said “three months after birth my daughter came to me with her child. she gave up the child on my arms and said “look after this baby, I want to be free and I’m going”, I didn’t understand what is happening and felt afraid. At the same time her self care was very bad, also there was only a diaper on baby. Before ilness my daughter was working in a factory because of the illness she gave up working. Now she wants to work but if she has an episod when working and says again “I want to go”, what can I do. When she is with me I can control her but out I can’t.When she is good or when she is worse isn’t clear, if something happen to her. My daughter is pure, if someone around her want to utilieze from her what will be happen. I often follow her, she knows this and get angry to me, but it is beyond my power. She have to use drug for a long time, drugs are expensive and although using drugs her illness show recurrence. It is a very difficult condition, knowing ever will be fully recovered thouth me every efforts are unnecessarily”.

Today's, families of individuals with bipolar disorders are actively participating in the care of their relative. Successful management of bipolar disorder in the community relies significantly on family caregivers. The need and experiences of such caregivers have been little studies with respect to bipolar disorder.

The aim of the study was to identify of family caregivers needs of patients with bipolar disorder.

In a qualitative research of phenomenological methodology, the family member’s caregivers of bipolar disorder in farshian psychiatric hospital in Hamedanl were selected by purposive sampling in the year 2010. By reaching data saturation the number of participant was 12. Data were gathered through in-depth interviews and analyzed by “Van manen” method.

Five main themes were identified in this study analysis: educational needs, consult needs, economical needs, care and nursing needs and supports needs.

Identified the need of family member caregiver with bipolar disorder patient for mental health services to be helped and to identify the specific caring interventions that are effective in helping to sustain family caregiving.

The presence of cognitive dysfunction in bipolar disorder is well established, but in the euthymic phase appear a few studies that point to the absence of cognitive deficits.

Alert to cases of euthymic bipolar disorder with no cognitive dysfunction.

Review of relevant literature and description of a clinical case with psychological tests that assess memory and executive functions.

Description of a clinical case: FP is a middle age woman, early retired, with a bipolar disorder type 2, which begins at age 30.

Her disease has several depressive episodes, and in the last 10 years, she spent most of the days lying in bed and repeatedly resorted to the emergency department for excessive voluntary drug intoxication or simply because she “wanted” to be hospitalized; her husband could not stand this situation. In September of 2009, in addition to the medical and psychological consultations, she starts attending group therapy; over the next 6 months her medication was changed and finally her disease goes into remission.

The psychological tests, made at euthymic phase, show’s no significant deficits in verbal memory and executive functions.

This patient has a disease with prolonged course and multiple hospitalizations and drug treatments, but don’t present relevant cognitive deficits, which may point to the fact that cognitive impairment is determined by biological factors.

The etiology of bipolar disorder (BD) is still poorly understood and it has been proposed that altered expression of multiple mRNAs, affecting neurotransmission, in psychotic subjects may be due to epigenetic mechanisms (e.g., DNA methylation or histone modification).

The present collaborative study was aimed to investigate, in subjects with BD, dysregulation of DNA methylation, in the brain-derived neurotrophic factor (BDNF), previously associated with psychosis and linked to epigenetic changes at promoter regions, and in the nociceptin gene (N/OFQ), a new proposed target in psychiatric disorders.

DNA was isolated from blood of patients diagnosed with BD (either type I [n = 19] or II [n = 20]) according to DSM-IV criteria, and from healthy controls (n = 20) and, thereafter, bisulfite conversion was performed. Real-Time Methylation Specific PCR (MSP) was used for the quantification of the methylated promoters in all samples.

A hypermethylation of BDNF promoter region was observed in BD II patients (but not in BD I) compared to controls (CONT: 19.0 ± 3.2%; BD I: 27.2 ± 4.0%; BD II: 36.3 ± 6.2% * P = 0.0167; ANOVA F = 3.464; P = 0.0384; Bonferroni’s post hoc test). No significant differences were found for DNA methylation of N/OFQ promoter.

Present preliminary findings suggest selective changes in DNA methylation of BDNF promoter in type II bipolar patients and highlight the importance of epigenetic factors in mediating the onset and/or susceptibility to BD, providing new insight into the mechanisms of gene expression.

Despite the number of rating scales for mood disorder and semi-structured interview in psychiatry, they are few evaluations focused on bipolar disorder. Here, we report the validation of the French version of the ADE used in STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder) studies.

A total of 63 bipolar patients completed the ADE and French version of the DIGS (Diagnostic Interview for Genetic Studies). We compared the results between the two evaluations.

There was a very good concordance between the two interview for the diagnosis of the type of bipolar diagnosis (κ = 1) and non-significative difference between the age at onset. The concordance coefficient was weak for addictions: alcohol (κ = 0.22) and cannabis (κ = 0.16), for anxiety disorder: panic attacks (κ = 0.35), phobia (κ = 0.36), obsessive-compulsive disorder (κ = 0) and anorexia (κ = 0.04), but stronger for psychosis: delusion (κ = 0.78), hallucinations (κ = 0.69), suicidal attempts (κ = 0.97), violence (κ = 0.47) and bulimia (κ = 0.47).

The affective disorder evaluation seems to be a useful instrument in clinical practice and in psychopharmacological studies, but not when the diagnosis of comorbities is necessary.