Depression is an established risk factor for acute coronary syndrome (ACS), nonetheless the mechanisms underlying this association are still unclear and literature disagrees on the role played by anxiety. Moreover, most of the studies included subjects with a long lasting history of heart disease or recurrent depressive episodes that could bias the results.

We performed serial assessments of anxiety, depression and new cardiac events in a cohort of never-depressed patients in the two years after their first ACS.

Clarify the role of anxiety and depression in predicting new cardiac events.

Two hundred and fifty-one consecutive patients completed the two-years follow-up. The presence of depression was evaluated with the Primary Care Evaluation of Mental Disorders (PRIME-MD) and its severity with the Hospital Anxiety and Depression Scale (HADS). Evaluations were collected at baseline, when GRACE-score was calculated, and at 1, 2, 4, 6, 9, 12 and 24-months follow-ups.

Forty-two patients (16.7%) developed a second cardiac event and, of these, eighteen (42.9%) had a previous depressive episode. At Cox Regression, controlling for confounding clinical variables (e.g. GRACE-score), developing a first-ever depressive episode was a significant risk factor (OR = 2.38; 95%CI = 1.11–5.14; P = 0.027) whereas baseline anxiety was protective (OR = 0.56; 95%CI = 0.38–0.81; P= 0.002). The latter, moreover, moderated the effect of incident depression on new cardiac events.

Our results confirm the well-established detrimental effect of depression on cardiac prognosis and suggest clinicians to keep in mind anxious symptoms when facing a patient at his/her first ACS.

The authors have not supplied their declaration of competing interest.

Psychiatric disorders have a remarquable frequency in multiple sclerosis. The leading group of these disorders consists of affective disorders. These psychiatric conditions can worsen the outcome of multiple sclerosis, thus contributing to increase the burden of the disease to both patients and relatives. Managing such a complicated situation needs a focus on the underlying links between affective disorders and multiple sclerosis.

To examine the hypotheses proposed to explain the high prevalence of affective disorders in patients with multiple sclerosis.

Literature was reviewed using the Medline database and the following keywords “bipolar disorder” “affective disorder”, “mania” and “multiple sclerosis”.

PubMed research returned 13 results. After manual inspection, 10 articles were retained and examined. The cause of the high comorbidity between multiple sclerosis and mood disorders is regarded as being multifactorial: the medication used in multiple sclerosis possibly inducing/exacerbating mood disturbances, the demyelinazing brain lesions which could bring about depression or mania, genetic overlapping with affective disorders and last the psychological reactions and adjustment difficulties to the neurological handicap.

Despite the fact that the higher prevalence of affective disorders in multiple sclerosis is well established, these disorders still remain underdiagnosed and undertreated. A shift towards a better assessment of the psychiatric comorbidity in multiple sclerosis patients and the optimal treatment of those disorders is fundamental.

The authors have not supplied their declaration of competing interest.

Analyze the number of interdepartmental consultations carried out at Department of Psychiatry, Hospital Nuestra Señora del Prado from other areas of hospitalization during 2014.

The goal is to evaluate the prevalence of psychiatric disorders in patients who are hospitalized for other reasons, and which services are needed the most.

Retrospective cross-sectional descriptive study. A record of consultations carried out by the psychiatry service in 2014 was collected. The data were analyzed according to the origin of the consultation service, the month when it was performed and the sex of the patient. The monthly percentage of interconsultations and the percentage represented by each interconsultation service were calculated. They classified according to sex.

In 2014, 211 interconsultations were carried out, 104 men and 86 women. Surgery 16, 11%, pneumology 13, 74%, internal medicine 12, 32%, traumatology 8, 06%, digestive 7, 11%), I.C.U. 6, 64%, cardiology 6, 16%, hematology 5, 69%, oncology 5, 21%, pediatrics 4, 27%, gynecology 2, 84%, emergency 1, 90%, palliative1, 90%, endocrinology 1, 42%, urology 1, 42, nephrology 0, 95%, E.N.T. 0, 95%, obstetrics 0, 47%, dermatology 0%, ophthalmology 0%, rheumatology 0%. January 12, 8%, February 13%, March 9, 5%, April 6, 2%, May 5, 7%, June 8, 1%, July 6, 2%, August 4, 3%, September 8, 1%, October 12%, November 7, 6%, December 6, 2%.

Most of the interconsultations were carried out in January, February and October. However, August was the least busy month. The busiest service was the Surgery service, followed by the Pneumology and Internal Medicine one. There were no interconsultations of the Ophthalmology, Rheumatology and Dermatology services. The consults were in demand mainly by men rather than women.

The authors have not supplied their declaration of competing interest.

One of the dominant methodological principles of Russian clinical psychology (the Vygotsky-Luria School) is the principle of Psychological syndrome analysis (PSA). It can also be heuristically applied to psychosomatics.

To identify a psychosomatic syndrome in patients with mitral valve prolapse (MVP).

We applied various techniques for a qualitative and statistical data analysis of clinical and psychological study. We explored our patients’ individual personality profiles, anxiety level (Spielberger et al., 1983), features of achievement motivation (Heckhausen, 1963), emotion regulation strategies (ERS) (Zinchenko, Pervichko, 2014; Pervichko, 2015), dynamics of the patient's emotional state in stress conditions, and degrees of manifestation of MVP clinical symptoms. The study comprised 134 MVP patients, mean age was 24.8 ± 1.2 years, and 73 healthy subjects, mean age was 27.5 ± 1.3 years.

MVP patients proved to be more prone to emotional stress; they were also inclined to choose less effective ERS as compared to healthy subjects. ANOVA data revealed dependence of intensity of such clinical symptoms as cardialgia, tension headaches and psychogenic dyspnea on the degree of anxiety level and the presence of dysfunctional ERS in MVP patients. The interpretation of the study results with PSA method suggested that the patients’ psychological and clinical characteristics form into a psychosomatic syndrome. The first syndrome-generating factor is the presence of the approach – avoidance motivational conflict in achievement settings. Dysfunctions of emotion regulation appear as a second syndrome-generating factor in psychosomatic syndrome in MVP patients.

PSA (the Vygotsky-Luria School) can be used as a means to approach diagnostic and prognostic tasks in Clinical psychology and Psychosomatic medicine.

The authors have not supplied their declaration of competing interest.

Low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diets are strongly recommended to improve irritable bowel syndrome (IBS) symptoms. They are also hypothesized to improve the psychopathological status that often accompanies the syndrome. A study (Ledochowski et al., 2000) suggested that the ingestion of FODMAPs affected negatively the mood and that the elimination of dietary FODMAPs improved depressive symptoms.

We aimed to assess the levels of psychopathology pre- and post-diet in IBS patients free of any severe psychiatric disease (e.g., bipolar disorder, major depressive disorder, schizophrenia) or alcohol/substance abuse.

We consecutively recruited 75 IBS outpatients (68% females; age range = 21–68 years) at the Gastrointestinal Outpatient Center of our University Hospital. They filled out the Symptom Checklist-90-Revised (SCL-90-R), a visual analogue scale (VAS) to rate the intensity of abdominal bloating/pain, and a 2-week diary card registering the frequency of bloating/pain. Then, they were blindly assigned to a low-FODMAP diet, a low-FODMAP gluten-free diet and a control diet for 4 weeks. During the last 2 weeks they filled out a 2nd diary card and rerated the intensity of bloating/pain. Patients were reassessed after a 16-month follow-up. Independent t-test, χ2 test, and one-way ANOVA with Tukey post-hoc test were used.

Baseline characteristics did not differ between the three groups. Post-diet and at follow-up, the two low-FODMAP diets, vs. the test diet, improved not only the intensity and frequency of bloating/pain, but also the SCL-90-R GSI, anxiety, and phobic anxiety scores (P-values < 0.05).

The low-FODMAP diet may improve psychopathology in IBS patients.

The authors have not supplied their declaration of competing interest.

Epidemiological research has documented a strong association between medication-overuse headache (MOH)and psychiatric disorders, emotional disturbances, and disordered personality traits, which are associated with worse outcomes, poorer quality of life, and higher costs to the health care system.

Identifying risk factors for progression of headache into MOH represents one of the most relevant public health priorities and psychiatric comorbidity has been identified as a potential factor related to chronic phases.

The aim of the present study was to determine whether depression and insomnia complaints were associated with satisfaction and enjoyment with one's own life in Medication-overuse headache (MOH) patients, and whether insomnia complaints were able to explain part of the variance of QoL explained by depression.

Participants were 187 consecutive adult outpatients admitted to the outpatient headache clinic. Patients were administered the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Beck Depression Inventory–II (BDI-II), and the Athens Insomnia Scale (AIS).

The BDI was associated with all the dimensions of the Q-LES-Q, with more severe depression being associated independently with lower satisfaction and enjoyment with one's own life. The AIS was independently and significantly associated only with physical health, such that patients with more insomnia complaints were 3.1 times (P < 0.001) more likely to report lower physical health satisfaction.

Our findings confirmed that MOH has a negative impact on quality of life, and suggested that depression and insomnia were independently associated with satisfaction and enjoyment of life in MOH patients.

The authors have not supplied their declaration of competing interest.

Psoriasis has a significant impact on the mental and emotional functioning.

It has been reported that the risk of psychiatric comorbidity increases with the severity of the disorder, and the most frequent associations appear to be those with depression and anxiety.

To analyze the association between psoriasis, mental disorders and suicidal ideation in a sample of patients affected by psoriasis. To investigate the differences between psoriasis patients and patients with other dermatologic diseases.

Participants were 242 consecutive patients (142 women and 100 men), 112 patients with psoriasis (46.3%), 77 with melanoma (31.8%) and 53 with allergy (21.0%). All patients were administered a structured sociodemographic interview and the following measures: the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). We also assessed current and previous suicidal ideation and previous suicide attempts.

Patients with psoriasis (compared to other groups of patients) more frequently had a comorbid mood disorder (16.1% vs 3.9% and 0.0%, respectively for patients with melanoma and patients with allergy; χ22 = 14.98; P < 0.001), past suicidal ideation (33.9% vs 15.6% and 18.9%, respectively for patients with melanoma and patients with allergy; χ22 = 2.05; P < 0.01) and attempts (6.3% vs 0.0% and 0.0%, for the other groups of patients; χ22 = 8.37; P < 0.05). Patients with psoriasis reported higher HAM-D scores than melanoma patients.

The clinical evaluation of patients with psoriasis should include the assessment of psychiatric comorbidities and the routinely assessment of suicide risk.

The authors have not supplied their declaration of competing interest.

Parkinson's disease (PD) is a neurodegenerative disorder that is associated with a wide range of motor symptoms, cognitive deficits and behavioral disorders. Apathy and impulse control disorders (ICDs) are common in these patients and have been considered opposite ends of a reward and motivation disorders continuum.

To evaluate the association and impact of ICDs presence on apathy symptoms in PDs patients, considering the influence of other psychopathological symptoms on this association.

This is a cross-sectional, observational study in which 115 consecutive medicated PD patients without dementia (mean age 61.22 ± 13.5 years; 63.5% men) were recruited. All the patients underwent a psychiatric and neurologic evaluation. Motor dysfunction was assessed with the Unified Parkinson's disease Rating Scale (UPDRS), ICDs were evaluated with the Minnesota Impulse Control Disorders Inventory (MIDI) and apathy with the Lille Apathy Scale (LARS). The Hamilton Depression scale (HAM-D). The State-Trait Anxiety Inventory (STAI-S) and Barrat Impulsivity Scale (BIS) were also administrated.

Twenty-seven (23.5%) patients showed an ICD. Patients with an ICD scored higher in apathy (P = 0.012), trait anxiety (P = 0.003) and impulsivity (P = 0.008). There were no differences in depressive symptoms. In the linear regression analysis, TCI was associated with more severe apathy (b = 4.20, t = 2.15, P = 0.034).

ICDs and apathy are frequent in PD. Although ICDs have been related with a hyperdopaminergic state and apathy with low dopamine levels, the observed frequent association suggests common etiopathological mechanisms.

The authors have not supplied their declaration of competing interest.

Patients with conversive disorder could show atypical clinical presentations with neurological symptoms that are not frequently seen currently.

A 21-year-old female who was diagnosed of conversive disorder was admitted into a short-stay psychiatric unit for two weeks to introduce treatment and receiving a diagnosis. She presented few seconds long seizures in members without bitting her tongue and keeping control of sphincters, always surrounded by relatives. A neurological study was made with CT scan and electroencephalography and no evidences of neurological abnormalities were found. Various treatments were used but seizures went worse. Venlafaxine (150 mg/day) was prescribed after hipothymc reactive symptoms were observed, which together with pshycotherapy achieved clinical improvement in the two months follow-up.

Patients with conversive disorder don’t respond appropriately to pharmacologic treatment. In order for patients to understand the situation it is important to keep themupdated in an empathic manner. It is important to exclude other causes.

A detailed psychopathological exploration should be made in all conversive patients, to explore symptoms and comorbidities that could reveal new therapeutic treatment.

The authors have not supplied their declaration of competing interest.

Diabetes mellitus (DM) has been associated with major depressive disorder, schizophrenia, Alzheimer's, Parkinson's and mild cognitive impairment. To determine the psychiatric and somatic comorbidity in diabetic patients treated by our Liaison Psychiatry Unit.

Sociodemographic variables (age, sex, marital status, place of residence) and clinical (somatic disease that motivates the admission, comorbid somatic pathology, number of concomitant somatic diseases, drug consumption and its type, psychiatric history, previous psychiatric diagnosis, number of concomitant psychiatric disorders).

Epidemiological study of 172 diabetic patients, from the total of 906 consulted from 1 January 2012 until 31 December 2014.

The study complies with the principles of justice, non-maleficence, autonomy and beneficence.

The average age is 72 years, 50% are women, 49.4% are married, and 54.1% live in rural areas. Somatic diseases that most frequently motivate admission at the hospital are the endocrine-metabolic (14%), gastrointestinal (12%) and cardiovascular (12.2%). A total of 32.5% of the sample have six comorbid somatic diseases and 55.2% five. A percentage of 14.5 of patients recognize consumption of toxic (cigarettes–12.2%–7.6% Alcohol). One hundred and eight patients have a history of psychiatric disorders (62.8%), especially anxiety disorders (28.4%), depression (14.5%) and organic mental disorders (11.1%).

There is a high psychiatric and somatic comorbidity in diabetic patients, therefore it would be desirable early diagnosis and treatment to provide symptomatic control of both types of pathologies.

The authors have not supplied their declaration of competing interest.

In this study we aimed to identify the perceptions and thoughts and their association with state/trait anxiety, depression that may lead to resistance to insulin treatment in patients with previously diagnosed type 2 diabetes mellitus (DM) patients in order to facilitate their compliance with insulin treatment.

In this study, 120 patients were recruited with a previous type 2 DM diagnosis from the diabetes outpatient clinic. Patients were evaluated with sociodemographic data, State-Trait Anxiety Inventory, Problem Areas in Diabetes Scale, Insulin Treatment Appraisal Scale, Beck Depression Inventory.

A majority of the patients were found to have resistance for startinginsulin treatment. Most of the patientswho were on other treatment alternatives reported that they wouldn’t use insulin even if they were prescribed insulin. A significant number of patients reported negative perceptions and thoughts about insulin treatment such as “insulin is a punishment”, “it is a shame to use insulin where other people can see”. In women injection phobia was significantly higher. Injection avoidance was significantly high and was more related to feeling insufficient about administration instead of worries about pain. Psychological resistance to insulin was significantly related to depression but not associated with state or trait anxiety levels. Lack of education and knowledge was found to be another important contributor to this resistance.

Type 2 DM patients show psychological resistance to insulin treatment due to negative perceptions and thoughts about the treatment. Cognitive interventions targeting these factors may be useful to overcome psychological insulin resistance and faciliate glisemic control.

The authors have not supplied their declaration of competing interest.

Patients with medically unexplained physical symptoms (MUPS) may present frequently to hospital settings and receive potentially unnecessary investigations and treatments.

A sample of 49 patients was drawn and their handwritten and electronic clinical records were examined in detail to extricate all MUPS-related secondary care activity within six months of the MUPS presentation (emergency department, inpatient stays, outpatient appointments, and all associated investigations, procedures and medications).

We aimed to assess the frequency and type of MUPS presentations to clinical services and estimate the associated direct healthcare costs.

This study was undertaken at Waitemata District Health Board (WDHB), the largest DHB in New Zealand. All patients with a diagnosed presentation of MUPS in 2013 were identified using the WDHB clinical coding system. Their clinical records were screened to select all patients who matched the study inclusion and exclusion criteria. Standardised national costing methodology was used to calculate the associated healthcare costs.

Forty-five percent of patients presented to hospital settings at least twice over the one-year timeframe. The most common diagnoses were non-epileptic seizures (31%) and hyperventilation syndrome (30%). The total cost for the sample was NZ$179, 271 (mean NZ$3659). Costs were most significant in the areas of inpatient admissions and emergency care.

MUPS can result in frequent presentations to hospital settings. The costs incurred are substantial and comparable to the costs of chronic medical conditions with identifiable pathology. Improving the recognition and management of MUPS has the potential to offer more appropriate and cost-effective healthcare nationally and internationally.

The authors have not supplied their declaration of competing interest.

To discuss psychological meanings attributed to IFN alpha treatment's side effects and its symbolic relation with adherence or not to treatment, on viewpoint of interviewed outpatients at a Hepatitis Service.

Data collection was conducted using the Clinical-Qualitative Method, utilizing semi-directed interviews with open-ended questions in depth, fully transcribed. Qualitative Content Analysis employed for processing data, emerging meaning cores, with categorization into discussion topics. Sample closed by information saturation.

Nine interviews. The analysis revealed:

– coping attitude - handling the disease to have willpower; a moral feeling regarding the need to overcome the disease and treatment side effects to demonstrate “strength”, as well as to deny psychologically the occurrence of side effects;

– disruptive attitude: reports of anxiety regarding to patients presenting neuropsychiatric symptoms by medication;

– realistic attitude: speeches show perception of natural evolution and treatment real function.

Guilt feelings emerged regarding to difficulties of being loyal to treatment, a strongly valorative speech on being ill what must lead to “overcome the evils of life”. Health teams must understand these meanings to talk openly about human feelings on illness and treatment, promoting an adequate adherence.

The authors have not supplied their declaration of competing interest.

Systemic sclerosis (SSc) is a chronic, multisystem disease of unknown etiology characterized by autoimmune inflammation, abnormalities in small blood vessels, and progressive fibrosis of the skin and visceral organs. Mental disorders (MD), especially depression, occur quite often with SSc. The influence of childhood experience, relations’ traumatic events with SSc and MD, and MD's clinical specific have not investigated carefully still. The investigation has been realized in accordance with the interdisciplinary program “stress factors and mental disorders in auto-immune inflammatory rheumatic diseases”.

Sixty SSc patients (4 male and 56 female mean age 49.9 ± 13.5) were included. ICD-10 criteria were used for MD semi-structured interview. The stress factors were analyzed with the specially elaborated scale. The cognitive disorders and their severity were diagnosed by neuropsychology tests.

Early traumatic childhood experiences (parental deprivation mainly) observed in 90% cases. The significant stress factors were preceded SSc symptoms in 80% and MD in 70% cases. Most patients self-reported connection between stressful life events and exacerbation of SSc. MD preceded SSc in 76.6% cases. MD were diagnosed in 48 (80%) SSc patients: depressive episode (mild, moderate) − 26.6%, recurrent depressive disorder − 16.6%, dysthymia – 23.3%, adjustment disorder − 6.6% and schizotypal disorder – 40%. The mild or moderate cognitive impairments were diagnosed in all MD cases.

Individual history of stressful life events is important factor for the predisposition and provocation of the rheumatic disease and MD in SSc patients. Depressive, schizotypal and cognitive disorders are the common MD in SSc patients.

The authors have not supplied their declaration of competing interest.

Germany has always been an important host country for traumatized refugees and asylum seekers. Although, recently an increasing number of investigations about mental health of individual migrant groups have been published in Germany, there is a paucity of research concerning mental health of asylum seekers and refugees.

To investigate socio-demographic and clinical characteristics of traumatized refugees-asylum seekers who were applied to an outpatient psychiatry clinic in Germany.

A standardized data collection form (socio-demographics, diagnosis, suicidality, etc.) was filled by therapists for each traumatized refugee-asylum seeker who was applied to outpatient clinic of Klinikum Wahrendorff-Centre of Transcultural Psychiatry between April 2013 and October 2015.

Fifty-eight traumatized refugees-asylum seekers (F/M = 27/31, age: 34.7 ± 1.4) were assessed. 53 (91.4%) of them were assessed via interpreters. Thirty (51.7%) of them were staying in refugee-dormitories, 25 (43.1%) of them were living alone. They’ve been living in Germany for 19.9 ± 16 months (min: 1–max: 82). Psychiatric symptoms appeared before 29.9 ± 19 months. Time to reach to psychiatric care in Germany was 14.2 ± 11 months. Psychiatric diagnoses were posttraumatic stress disorder (PTSD): 12 (21%), depression + PTSD: 44 (76%), depression: 2 (3%). Fifty-three (91.4%) of them had suicidal ideation and 16 (27.6%) of them had at least one suicide attempt before.

Traumatized refugees in this study have high rates of suicidal ideation and suicide attempts and it takes months to years for them to reach a psychiatric care. Therefore, strategies should be developed for early detection of PTSD symptoms in traumatized refugees and access barriers to reach a psychiatric care should be overcome.

The authors have not supplied their declaration of competing interest.

Sleep paralysis (SP) is relatively frequent condition, occurring either at sleep onset or sleep offset. It occurs at least once in a lifetime in 40–50% of normal subjects. During SP, the patient experiences gross motor paralysis, while the sensory system is clear. Hypnogogic and hypnopompic hallucinations are common. This experience might be interpreted as a spiritual phenomenon in several cultures, each one with different interpretations and attributions.

The authors revisit the clinical presentation of sleep paralysis and how this sleep disorder is seen from a cultural perspective.

To describe several cultural interpretations of SP.

A literature review of the theme is shortly surveyed.

It is very common during an episode of SP sensing the presence of menacing intruders in one's bedroom. Supernatural accounts of this hallucinated intruder are common across cultures. It has been traditionally labeled “ghost oppression” among the Chinese. In the Abruzzo region (Italy), the supernatural interpretation of the phenomena is called the Pandafeche attack. One study found that nearly half (48%) of the participants from the general Egyptian population believed their SP to be caused by the Jinn, a spirit-like creature. In Southwest Nigeria, Ogun Oru is a traditional explanation for nocturnal neuropsychiatric disturbances. The characteristics of the ‘a dead body climbed on top of me’ phenomenon suggest that is identical to sleep paralysis and a frequent experience among Mexican adolescents.

Depending on the etiological interpretations of SP, which is largely culturally determined, patients react to the event in specific ways.

The authors have not supplied their declaration of competing interest.

To determine the frequency of marital adjustment in patients with depression.

Depressed patients, who were aged between 15–65 were included. Patients who had documented co morbid of substance use or any unstable serious general medical condition were excluded. The severity of depression was evaluated by using Urdu validated Hamilton Depression Rating Scale. Marital adjustment is determined by using Urdu validated version of Kansas Marital Satisfaction Scale.

Only 8.6% were well adjusted in their marital life, and all were females. The association of marital adjustment and severity of depression and difference in both genders on KANSAS was insignificant. The longer duration of illness was positively interrelated to the marital adjustment with odd ratio of 7.6. Being employed and above 30 years of age were inversely related to marital satisfaction with odd ratio of 6.1 and 5.4 respectively. However, the correlation between other independent variables and marital adjustment were insignificant in both genders.

This study confirms the presence of high frequency i.e. 91.4% of marital dissatisfaction in depression in both male and females, irrespective of their severity of depression.

The author has not supplied their declaration of competing interest.

Psychotic symptoms in the Egyptian community have always been mixed up with supernatural phenomena. This makes patients and their families seek help from traditional healers who can abuse them physically, financially and sexually.

The aim of the study was to assess the impact of the traditional healers on the psychotic patients in the Egyptian community.

To measure the percentage of patients going to traditional healers and how much they pay and for how long.

The study was conducted on a total of 555 psychotic patients. Four hundred and fifty-five psychotic patients from the Mamoura Mental state Hospital and 100 psychotic patients from a private hospital in Alexandria in duration of three months in 2006. A special questionnaire was designed and was run for all patients and their families.

A total of 67.4% of male patients consulted healers while 88.4% of the females consulted healers. Only 9.4% of the females who went to the healers were highly educated compared to 19.7% of the male patients. The majority of the patients who improved were illiterate or can only read and write. Lower socioeconomic groups tend to have a higher percentage in consulting healers and a longer duration of staying in treatment with them. Although therapy at the first session tended to be for free, from the second session forward patients pay more than they would pay seeing a psychiatrist.

Traditional healers have a negative impact on the psychiatry practice and are sources of patient's abuse in Egypt.

The author has not supplied their declaration of competing interest.

There is a lack of evidence regarding which kind of psychotherapy that is the most effective when treating traumatized refugees. Studies on the effect of psychotherapy among other patient groups with PTSD suggest a good effect using cognitive behavioural therapy (CBT). The competence center for transcultural psychiatry (CTP) has specialized in the treatment of traumatized refugees. The objectives were to study the effect of CBT with a focus on either stress management or cognitive restructuring in a clinical sample of traumatized refugees with PTSD and to identify predictors for the treatment effect.

All patients (n = 143) referred to CTP from June 2011–March 2012 and fulfilling the inclusion criteria were offered to participate in the study. Participants were offered combined treatment with a psychiatrist (psycho-education and psychopharmacological treatment when needed) and a psychologist (CBT). The duration of the treatment was 6–7 months. The participants were randomized to either CBT with a focus on stress management or cbt with focus on cognitive restructuring. The primary outcome was PTSD measured by the Harvard Trauma Questionnaire.

The results are presently being analyzed and will be presented at the congress.

Both research results and the clinical experience at CTP suggest, that cognitive restructuring is not always a useful tool and that stress reducing techniques could be more useful. This hypothesis was tested in the present study.

The authors have not supplied their declaration of competing interest.

Today we lack sufficient evidence to conclude which type of treatment approach that is most efficient when it comes to trauma-affected refugees. That is a problem for both patients and doctors as well as for society. Also there is a lack of studies, which examine the relation between psychosocial resources and treatment efficiency, in order to find reliable predictors of treatment outcome. This study therefore aims to produce new evidence within this field in order to optimise treatment for trauma-affected refugees with complex PTSD.

The study included 207 patients referred to Competence Centre for Transcultural Psychiatry between April 2012 and September 2013. Patients were randomised into one of the two treatment groups: a sertraline group (n = 109) or a venlafaxine group (n = 98). Patients in both groups received the same manual based cognitive behavioural therapy, specially adapted to this group of patients. The trial endpoints were PTSD-and depression symptoms and social functioning, all measured on validated ratings scales. Furthermore the study examined the relation between expected outcome of treatment from a range of predictors and the relation to the treatment results for the individual patient.

Data are presently being analysed and results will be ready for the conference.

The study is among the largest randomised studies ever conducted on pharmacological treatment among traumatised refugees. It is expected to bring forward new knowledge about clinical evaluation and medical treatment of traumatised refugees.

The authors have not supplied their declaration of competing interest.