The NICE guidelines recommend for mild major depression a range of low-intensity psychosocial intervention of proven effectiveness, as Interpersonal Counselling, and a stepped-care approach.

To assess feasibility and effectiveness of Interpersonal Psychotherapy interventions for the treatment of depression in a consolidated Collaborative Stepped Care Model between primary care and mental health specialists.

103 patients were referred by their PCPs to the Consultation-Liaison Service of Bologna and Modena. Of them, 78 were included in the study and administered self-report instruments and interview, including screening depression, anxiety and daily functioning. Patients were asked to choose one of the available treatment: 1) Interpersonal Counseling (IPC) 6-8 weekly meetings for 30 minutes; 2) IPC for Depression in Primary Care 3 sessions of 50 minutes; 3) a guided self-help intervention. Follow-up were planned at 1, 3 and 6 months. Both patients and PCPs provided a feedback about intervention’s satisfactions.

At the baseline, 39.4% of the patients presented a minor depression/major depression mild and the large majority (75.0%) of them chose IPC, while none of them chose the guided self-help intervention. At follow ups the mean PHQ-9 significantly decreased compared to the baseline (p<0.001); daily functioning increased (WSAS: p<0.001) and anxiety traits improved (STAI: p<0.001). Patient’s general satisfaction with the service received was high (GSQ: 85.9±15.0) as well as PCPs, 62.7% of them expressed high satisfaction for the intervention.

The study emphasised that IPC is an effective and feasible treatment very well suited to the primary care setting for an optimal management of depression.

COVID-19 pandemic and lockdown greatly impact on mental health, especially on individuals with pre-existing psychiatric conditions.

To explore the prevalence of specific psychiatric symptoms across a sample of patients with Eating Disorder (ED), compared to a group of healthy controls (HC), during the lockdown period in Italy, and to assess whether patients’ symptoms improved, persisted or worsened with the easing of the lockdown measures.

Study 1: 59 ED patients and 43 HC were recruited and completed, at the beginning of May 2020(t0), an online survey including: the Depression, Anxiety and Stress Scale – 21 items (DASS-21), the Impact of Event Scale-Revised (IES-R), the Perceived Stress Scale (PSS), and few ad-hoc questions extracted from the Eating Disorder Examination Questionnaire (EDE-Q). Study 2: 40 ED patients from Study 1 completed the same survey two months after t0 (t1).

Study 1: ED patients scored significantly higher than HC at the DASS-21 (Total Score and subscales), the IES-R (Total Score and subscales) and the PSS. Moreover, they showed higher distress specifically related to food and their body. Study 2: at t1, levels of stress, anxiety and depression were not different than at t0, but symptoms related to post-traumatic stress disorder (PTSD) improved, together with patients’ reported level of psychological wellbeing and specific ED symptomatology.

During lockdown, ED patients presented significantly higher levels of stress, anxiety, depression, PTSD-related symptoms, and ED-related symptoms than HC. With the easing of lockdown, PTSD-related and ED-related symptoms ameliorated, but high levels of stress, anxiety and depression persisted.

No significant relationships.

Many children with autism spectrum disorder (ASD) experience high levels of anxiety. However, inconsistencies between parent and child reports may complicate the assessment of anxiety in this population.

The aim of this study is to investigate discrepancies between parent and self-reported anxiety among children with high functioning ASD.

Children aged between 8 and16 years with high functioning ASD, followed in the outpatient unite of child psychiatry at the University Hospital of Monastir, Tunisia and their parents, were invited to complete the Arabic version of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD). The ASC-ASD is a 24-item questionnaire with six sub-scales, designed specifically for the assessment of anxiety symptomatology in children with ASD. A total score of ≥ 20 indicate significant levels of anxiety.

We recruited 66 children and their parents. The mean age was 10 years old. High rates of anxiety were found: children’s reports revealed that 70% of them present anxiety and 60 % were coated anxious by parent’s reports. Performance Anxiety, Uncertainty and Social Anxiety were the most frequent types of anxiety reported by both parents and children. We did not find a significant difference between the parents and children rating of anxiety except for the apprehension subscale.

This is one of the first studies to compare between parent and self-reported anxiety among children with ASD using an autism-specific measure of anxiety. No discrepancies have been found between parents and children report, however others studies are needed to investigate discrepancies in children with severe ASD.

Prescribing antidepressants in the treatment of bipolar depression remains highly controversial due to the inconsistency between routine clinical practice and the results of controlled trials.

To assess the validity of antidepressants use in bipolar depression from the point of view of evidence-based medicine.

Database search (Scopus and MEDLINE) followed by analysis of studies concerning the efficacy and safety of antidepressants in the bipolar depression treatment.

The search found 23 studies. There was a high degree of inconsistency in the results, apparently related to the methodology. Only two studies compared the effectiveness of antidepressants in monotherapy with placebo. No differences were found in the study with 740 participants but in the study with 70 participants with type 2 bipolar disorder antidepressants were found to be more effective than placebo. Nevertheless, both studies had significant methodological issues. In 6 studies comparing the effectiveness of the combination of antidepressants with mood stabilizers against the combination of mood stabilizers with placebo, only the effectiveness of fluoxetine in combination with olanzapine was confirmed, other antidepressants were ineffective. At the same time, studies where antidepressants were compared with each other in combination with mood stabilizers revealed a significant clinical response to therapy. Risk of the treatment emergency adverse events were relatively low for SSRI.

Despite the contradictory literature data, the use of antidepressants in bipolar depression is justified from the point of view of evidence-based medicine for certain groups of patients with taking into account risk factors.

Declines in mental health among youth in the COVID-19 pandemic have been observed, yet longitudinal studies on how housing may impact these declines are lacking.

Our aim was to determine whether changes in mental health among Danish youth were dependent on their housing conditions.

Young participants from the Danish National Birth Cohort, who had responded to an online questionnaire at 18 years of age, and later during the initial national Danish lockdown, were included. Associations between housing conditions (direct access to outdoor spaces, urbanicity, household density, and household composition) and changes in mental health (mental well-being, quality of life (QoL) and loneliness) were examined in multivariate linear and logistic regression analyses.

We included 7455 participants. Greater decreases in mental well-being were observed for youth with no access to direct outdoor spaces and those living in denser households (mean difference -0.83 [95 % CI -1.19, -0.48], -0.30 [-0.43, -0.18], respectively). Onset of low mental well-being was associated with no access and living alone (odds ratios (OR) 1.68 [1.15, 2.47] and OR 1.47 [1.05, 2.07], respectively). Household density was negatively associated with QoL (mean difference -0.21 [-0.30, -0.12]). Youth living alone experienced more loneliness (OR 2.12 [95 % CI 1.59, 2.82]).

How youth’s mental health changed from before to during lockdown was associated with housing conditions. Among the Danish youth in our study, greater decreases in mental health during lockdown were observed among youth without access to outdoor spaces, living alone, or living in denser households.

No significant relationships.

Neuropsychiatric drugs account for 16% of drugs that can lead to hepatotoxicity and psychiatric patients can have multiple comorbidities that can increase the incidence of liver disorders such as alcoholism, drug abuse and polymedication. The continuous use of atypical antipsychotic drugs (AAD) has raised questions over their tolerability over endocrine, metabolic and cardiovascular systems. They are also associated with mild elevation of aminotransferases and occasionally cause idiosyncratic liver injury with varying phenotypes. Hepatotoxicity is defined based on biological parameters such as elevation of alkaline phosphatase enzyme, SGPT, SGOT and GGT or clinical abnormalities (jaundice and hepatitis).

This work reviewed the current available evidence on the hepatic damage produced by AAD.

Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: atypical antipsychotic drugs; hepatotoxicity; hepatic; Olanzapine; Clozapine; Risperidone; Aripiprazol; Paliperidone.

Atypical Antipsychotic Drugs are generally well tolerated and hepatic alterations are in general very low or rare. The cases published were observed with Clozapine, Olanzapine and Risperidone. Atypical Antipsychotic drugs have a better profile than Chlorpromazine.

In conclusion, the hepatic injury generally occurs within the first weeks of treatment and is usually reversible with drug withdrawal. Hepatic check-ups may be relevant, especially in the beginning of treatment.

No significant relationships.

The psychological effects of using any method of contraception are not hidden from anyone but in different methods, they have different effects.

We aim to investigate the different psychological effects of common contraceptive methods in women.

A search conducted by keywords “contraception”, “psychological effects” and “women” in PubMed, Science Direct, Scopus and Clinical Key and Google Scholar search engine. Finally, data from 12 articles were used for this review study.

The positive and negative psychological effects were slightly different in consumers. The effect of OC and IUD and sterilization on sex life compared to condoms was reported to be positive and in menstrual experiences, OC consumers reported higher satisfaction than other methods, in particular, IUD. The regret in using sterilization was higher than in other methods. Psychopathological disorders and psychological disorders developed while using these methods should be differentiated. Negative psychological effects of women using contraceptive methods are often due to their mental background to a mother’s role and fertility and the conflict that exists in these methods with their mental image. Also, cooperation and understanding of spouses on the acceptance of these methods and their positive or negative impact has been reported to be very effective.

Before providing any method of contraception, it is recommended to provide comprehensive counseling on each method and follow up with women while consuming to reduce these symptoms and improving their effectiveness.

No significant relationships.

In March 2020,World Health Organization characterized the COVID-19 outbreak as pandemic. This new health situation has created an anxiety-provoking climate among health professionals

To provide risks associated with the exposure of caregivers to COVID-19 for their mental health by studying the prevalence and predictors of post-traumatic stress disorder, anxiety and depression.

Our study was descriptive and analytical cross-sectional, carried out with healthcare in different hospitals in Tunisia, between 13 May until 20 June 2020. An online survey was sent to caregivers. mental health was assessed using 3 scales: PCL-5:measure the symptoms of post-traumatic stress disorder HADS :screen for anxiety and depression. PSQI:see the existence of a disturbance in sleep quality

125 caregivers participated in the survey. The average age was 32 years. The participants were predominantly female (72.8%), married (48%), and had at least one child (39.2%). 28.7% of participants had increased their consumption of coffee, especially anxious people (p = 0.001). Anxiety was retained in 44% and depression in 47.2%. Anxiety was significantly related to sex with (p = 0.039) and affects more women. The consumers of coffee developed more anxiety (p = 0.034) and depression (p = 0.026). 42.4% of participants had presented post-traumatic stress disorder. Three parameters were correlated with post-traumatic stress disorder: young age, having children and fewer years of professional experience. 62.4% of caregivers had a bad quality of sleep

This health crisis had a major impact on the mental health of our heroes. So, we should provide for them with the necessary support.

Treatment of accompanying somatic disorders in patients with schizophrenia is a crucial issue, as those people die about 25 years earlier, compared with the general population. Moreover, premature death in this group of patients is more often caused by comorbidities than by suicide. It is worth emphasizing that cardiovascular disease itself in people with schizophrenia accounts for as much as 23% of causes of death, followed by suicides and drug toxicity. The paper presents a description of a 65-year-old patient diagnosed with schizophrenia, alcohol addiction, metabolic syndrome, and cardiac arrhythmia.

To determine the impact of cooperation between medical specialists and a psychiatric patient on the treatment effect.

A case of a patient treated in a day ward is described. A literature search was made in the PubMed database.

A patient after exacerbations of mental illness, often preceded by a return to alcohol use, tends to discontinue both psychiatric drugs and those prescribed for somatic diseases. Due to the diagnosed atrial fibrillation, sudden discontinuation of cardiac medications significantly increases the risk of life-threatening somatic complications, including stroke.

Diagnostic and therapeutic management in the treatment of psychiatric and somatic diseases with concurrent addiction to psychoactive substances requires interdisciplinary cooperation of medical specialists with the patient to achieve a successful outcome. Summarizing, in treatment, we must always look at the patient as a whole. Aside from caring for the mental state, the physical condition along with the possibility of cooperation on the part of the patient remains essential.

No significant relationships.

Neural stem/progenitor cells derived from olfactory neuroepithelium (hereafter OE-NS/PCs) are emerging as a viable proxy and a valuable tool for translational studies on severe mental illnesses (SMI). In this respect, the use of OE-NS/PCs as a surrogate cellular model of schizophrenia (SZ) has enabled insights into cell signaling and cell cycle dynamics in this disease.

We explored whether mitochondrial dysfunction, which has been already associated with SZ, may have a role in the altered proliferation pattern previously observed in OE-NS/PCs of SZ patients.

OE-NS/PCs were collected from 20 patients and 20 healthy controls (Hcs) by nasal brushing, cultured in proper medium and expanded. Fresh OE-NS/PCs at passage 3 of both groups underwent BrdU proliferation assays or were frozen for later use. Mitochondrial ATP production was measured in both fresh and thawed OE-NS/PCs by using the ATPlite Luminescence Assay kit.

Fresh OE-NS/PCs of patients grew at a higher rate than those of HCs (M-W U=0; p<0.001), whereas the proliferation of thawed OE-NS/PCs of both groups exhibited an opposed pattern (at passage 6, p=0.002). Mitochondrial ATP production was significantly lower in OE-NS/PCs of patients than in those of HCs (M-W U=0; p=0.02), regardless of freeze-thaw conditions (M-W U=6; p=0.77).

Mitochondrial ATP production is negatively affected in OE-NS/PCs of SZ patients as compared to those of HCs. This evidence does not differ in fresh OE-NS/PCs and OE-NS/PCs undergoing freeze-thaw cycles, which instead perturb the proliferation pattern of SZ OE-NS/PCs.

Several evidence recognizes Brain Derived Neurotrophic Factor (BDNF) as a promising biomarker in the pathophysiology of psychiatric disorders, including Obsessive-Compulsive Disorder (OCD), considering the involvement of epigenetic regulation in BDNF altered expression.

This study aims to investigate, in a sample of OCD patients, the epigenetic modulation in terms of levels of methylation and hydroxymethylation on the BDNF gene exon I promoter.

Fifty OCD patients, recruited from Psychiatry Unit 2, Sacco University Hospital in Milan and fifty healthy controls, comparable by age and gender. Saliva samples were collected by oral swab and epigenetic analysis were performed at the University of Teramo. Statistical analyses were performed with t test with Bonferroni correction.

Data analysis showed a significant decrease in 5-methyl cytosine levels (5mC) (mean OCD: 1.221%; mean CTRL: 1.784%; p < 0.001) and a significant increase in 5-Hydroxy-methyl cytosine levels (5hmC) (mean OCD: 1.018%; mean CTRL: 0.527% p< 0.0001) in BDNF gene exon I promoter of OCD patients compared to controls. Regarding 5mC of site 3 and 5hmC of site 1 and 2 of the exon I promoter CpG islands, no statistical significance was found.

Present results showed significant differences in epigenetic modulation of BDNF gene, which might not be univocally interpreted. They could represent an intrinsic OCD characteristic or the effect of antidepressant drugs, assumed by all recruited patients. Further studies, comparing OCD subjects in treatment vs drug-free, are necessary to define BDNF epigenetic modulation role and its possible use as biomarker in the characterization of OCD.

No significant relationships.

When depression is comorbid with tuberculosis, it will lead to decreased quality of life, lack of adherence to anti-Tb drugs, progression to MDRTB and will end in death with mortality from the disease.

We aimed to study the association of Tuberculosis and depressive disorders in children aged 7-18 years compared to non-tuberculosis diseases and their correlation. We hypothesized that depression will be significantly more common in patients with tuberculosis than in non-TB patients, who served as a control.

A prospective observational case-type study for a period of 2 years, 2018-2020. The patients included in the study are patients diagnosed and treated in the Child Pneumology Department of the Pneumoftiziology Hospital “Sfantul Spiridon” Galati and in the TB Dispensaries in Galati County divided into the study group consisting of patients diagnosed with Tuberculosis and the control group of patients without a diagnosis of Tuberculosis or other previous chronic disease. For the diagnosis of depression in the case of the two groups, we used the CDI questionnaire (Depression Inventory for children).

Out of 100 children with TB, 68% had depression compared to the control group, which showed that only 9% had depression.

Depression can affect all parts of a child’s life, including behavior, appetite, energy levels, sleep patterns, relationships, and academic performance. We observe a wide range of symptoms in the group of children with tuberculosis compared to the control group.

We present the case of a 19-year-old female patient treated in our hospital due to an outburst of persistent vomiting. The patient had a diagnosis of Cyclic Vomiting Syndrome (CVS), a year before the diagnosis the patient had been labeled as a somatizer and admitted into the department of psychiatry. Given her psychiatric record and the fact that CVS is a rare diagnosis we were consulted on arrival.

CVS is an infrequent disorder of unknown etiology which shares similarities with migraine headaches. It is characterized by episodes of vomiting followed by periods of remission without active symptomatology with no organic pathology to account for the symptoms. Epistemic injustice (EI) is defined by Miranda Fricker as “a damage done to someone in their capacity as a knower”. She defined two forms of EI: testimonial and hermeneutical injustice.

A case report is presented alongside a review of the relevant literature regarding CVS and epistemic injustice.

On arrival at the emergency department she tried explaining her condition, but her testimony was disregarded on the basis of her psychiatric record. It was only after the on-call psychiatrist explained the condition when she received the appropriate abortive treatment, after which she was admitted to the internal medicine department where she was followed by the liaison psychiatrist.

CVS is a disabling disease still unknown to most clinicians in spite of the increasing quality evidence about its identification and treatment. The case highlight how cases of newly identified disease can suffer from testimonial and hermeneutical injustice.

The uncertainty of contemporary social contexts fosters suspiciousness and anaclitic anxieties. In the context of interpersonal relationships this manifests in cognitive distortions and magical thinking, specially in the vulnerable populations.

To study the ability of understanding social causality and its relation to magical thinking and ambiguity intolerance in schizophrenia and controls.

Participants were 40 inpatients with paranoid schizophrenia and 40 controls. Understanding of social causality was measured by corresponding SCORS-S scale for Thematic Apperception Test, Magical thinking was measured by SPQ-74 and intolerance to ambiguity by the New Tolerance-Intolerance to ambiguity questionnaires.

The understanding of social causality was less developed in schizophrenia group (mean values 2.28 and 3.28, p<.001). They manifest omissions of psychological aspects, logical faults and inconsistencies in depicting social relationships. Magical thinking was higher in clinical group (4.32 and 2.33, p<0.001). Two measures were significantly (p<0.05) correlated in both groups. Regression analysis indicates that 37.7% of variance of dependent variable ‘understanding of social causality’ (R2=0,377) was predicted by ‘magical thinking’ (-0,398, p<0,001) and ‘tolerance to ambiguity’ (0,412, p<0,001). The overal level of tolerance of ambiguity was higher in control group (52.2 and 61.0, p<0.002).

Tolerance of ambiguity, being more characteristic for normal population, underlies the understanding of social causality. In contrast, the intolerance to interpersonal ambiguity is related to increment of anxiety, failures in cognitive elaboration of interpersonal relationships and leads to superstition and illogical beliefs. This relationship has a heuristic value for understanding what is happening to vulnerable individuals in the context of current COVID pandemic.

Storytelling could be considered as one of the ecological way to study the pragmatic function of speech in schizophrenia. It demands the ability to create narrative (text) that would be appropriate to particular context. Neuropsychological basis of text-context relation impairment in schizophrenia needs clarification.

To study neuropsychological correlates of pragmatic text-context impairment revealed during storytelling in patients with schizophrenia.

Participants were 14 inpatients with schizophrenia and 18 students without mental disorders. Neuropsychological functioning was measured in both groups according to Luria’s method. Pragmatics assessed by storytelling on images which simultaneously depicts some narrative that should be correctly decoded and after expressed to investigator. The images were taken from Luria’s neuropsychological album and Bidstrup’s drawings.

Stories of patients with schizophrenia were different from control stories in two ways. Some patients produced stories which predominantly characterized by incompleteness that don’t give an opportunity to understand their narratives as connected whole because of its lacunarity. In other cases, stories predominantly characterized by distortion of the storyline which became not realistic and don’t match with the original picture. Incompleteness errors primarily correlates with neuropsychological dysfunction of left frontal lobe (p<0,001). Distortion errors also mainly correlates with dysfunction of frontal lobes (p<0,01), but qualitative analysis reveals right hemisphere involvement.

Impairment of the pragmatic function of speech during storytelling in schizophrenia could manifest itself in at least two different ways. Preliminary results show that it could be connected with different neuropsychological mechanisms and worth considered with left-right frontal lobes opposition.

The reported study was funded by RFBR, project number 20-013-00772

Neurofibromatosis type 2 (NF2) is a rare disorder associated with significant morbidity such as hearing loss that can lead to many psychiatric disorders.

Describe the psychiatric symptoms associated to NF2.

We report the case of a patient admitted to the locked unit of the psychiatric ward for agitation and persecutory delusion and diagnosed with NF2. The data was collected from the patient’s medical file. A review of the literature was performed by selecting articles from PubMed using ‘Psychosis acoustic neuromas’ and ‘Psychosis neurofibromatosis 2’ as key words.

This is the case of a 21-year-old patient who was admitted for behavioral disorders. Our patient had a medical history of a one-sided deafness treated with a hearing prosthesis. He was also followed irregularly by a free-lance psychiatrist. The start of trouble dated back to 3 years marked by behavioral disorders such as fugue, agitation, irritability and sleep disorder. The symptoms worsen in the last 3 months with appearance of hostility and delusion of persecution towards his mother. The patient declines to eat the food that his mother cooked for him and threatened her with a knife. The clinical overview includes delirium, clastic agitation strikes, emotional lability, cerebral ataxia and conjunctival hyperemia. Brain scanner showed an association of bilateral acoustic neuromas, cavernous and intraventricular meningioma. These clinical and radiological signs met the diagnosis for NF2 according to the consensus conference of the National Institute of Health in Bethesda (USA 1988).

The psychiatric symptoms reported in acoustic neuroma patients are usually described as transient.

General-population studies investigating the biological correlates of anhedonia/amotivation might be informative for treatment breakthroughs for a number of clinical conditions. Reduced gut-microbial diversity might lead to an anhedonic/amotivational syndrome (“sickness behaviour”). However, how gut-microbial diversity contribute to this clinical phenotype is a key gap in knowledge. We hypothesised the endocannabinoid system would be at play.

We tested the hypothesis that the endocannabinoid system mediates the association between gut-microbial diversity and anhedonia/amotivation

Secondary data analysis on 786 volunteer twins (TwinsUK). Measures of gut-microbiome, faecal endocannabinoid metabolites, and anhedonia/amotivation were collected over five years. To test our hypothesis we used a multilevel mediation model using alpha diversity as predictor, faecal levels of the endocannabinoid palmitoylethanolamide (PEA) as mediator, and anhedonia/amotivation as outcome. Analyses were adjusted for obesity, diet, antidepressants, and sociodemographic covariates.

Mean age was 65.2±7.6; 27% were obese and 4.7% were on antidepressants. Alpha diversity was significantly associated with anhedonia/amotivation (β=-0.37; 95%CI: -0.71 to -0.03; P=0.03). Faecal PEA levels mediated this association: the indirect effect was significant (β=-0.13; 95%CI: -0.24 to -0.01; P=0.03), as was the total effect (β=-0.38; 95%CI: -0.72 to -0.04; P=0.03). The direct effect of alpha diversity on anhedonia/amotivation was attenuated fully

We provided the first evidence showing that the association between gut-microbial features and anhedonia/amotivation is mediated by the endocannabinoid system. These findings shed light on a new therapeutic target in an area of unmet clinical need.

No significant relationships.

Metabolic syndrome (MS) is an often co-occurring condition that occurs during antipsychotic therapy and impairs social functioning

We tried to conduct a self - evaluation of social adaptation in patients with schizophrenia and MS

We examined 150 patients with schizophrenia receiving antipsychotic therapy at the clinics of Mental Health Research Institute. The study was supported by a grant from the Russian Science Foundation 18-15-00011. The IDF criteria were used to diagnose metabolic syndrome. We used «The social adaptation self - evaluation scale» (SASS).

63 patients (42%) had MS and 87 patients (58%) did not. In the subgroup of patients with MS, 59 people (93.65%) had disabilities or were unemployed, in the group without MS - 82 (94.26%) patients. There were no statistically significant differences between the groups (p ≥ 0.05). In the patients with schizophrenia and concomitant MS, the median SSAS scores was 35 [29; 39], which corresponds mainly to a high level of self - evaluation of social adaptation. At the same time, in patients with schizophrenia and without MS, on the contrary, the self - evaluation of social adaptation was 30 [23; 38] points (p = 0.03914). Perhaps this is due to the great attention from relatives and doctors of general somatic practice and the primary medical network in connection with the risk of developing severe somatic pathology.

Patients with MS can give a higher assessment of social adaptation, despite a objectively low social status.

No significant relationships.

Electroconvulsive therapy (ECT) is considered a gold-standart treatment of severe and treatment-resistant depression. Lack of response to ECT often causes distress in psychiatrists regarding the next therapeutic decisions.

To present a case report of a patient with psychotic depression with partial response to ECT.

Clinical interviews and review of literature using the Pubmed platform.

The authors present a case of a 60 year-old woman admitted for severe depressive episode with psychotic symptoms. Due to lack of response to multiple antidepressive and antipsychotic treatments, 15 sessions of ECT were performed with improvement of behavioral and psychotic symptoms. However, endogenous depressive symptoms with functional impairment persisted. It was then initiated Bupropion 300mg/day resulting in vast improvements on drive, energy and activity levels with restored functionality. Previously to ECT, Bupropion was not considered a valid option due to the psychomotor restlessness that was present. This case exposes the limitations of ECT and the therapeutic conundrums that arise when there is partial response. The symptoms expressed in the patient after ECT course correlate with deficits in noradrenergic and dopaminergic pathways that are involved in endogenous depression. The use of Bupropion, with its effect on noradrenaline and dopamine receptors, may offer a therapeutic lifeline in these cases.

ECT still stands as a gold-standart for severe depressive disorder, especially when several psychopharmacological therapies have failed. In cases of partial response to ECT, the neurobiological correlates of clinical presentation can guide the therapeutic management towards improved outcomes.

No significant relationships.

There is a high degree of comorbidity between serious mental illness (SMI) and substance use disorders (SUD) and cardiovascular disorders. Other life-style related disorders are also common in patients with SMI and SUD. Consequently, comorbidity with somatic diseases contributes to a dramatic reduction in life-expectancy for these patient groups. Physical training has been shown to have positive effects also for mental health, but there has been little systematic use of physical training as part of the treatment for patients suffering from SMI and SUD in Norwegian health care.

To present a new project on physical training for patients suffering from SMI and SUD.

We briefly describe a project in a major Norwegian hospital, where physical exercise will be offered as part of the treatment for patients suffering from SMI and SUD.

The Division for Substance Use and Mental Health now offers an exercise room for inpatients at the main clinic in Tromsø, Norway. The exercise room contains various equipment including treadmills and equipment for strength training. This facility has recently been made available and is currently being used by a selection of patients. A study of user experiences is forthcoming and a systematic study of effects of physical exercise for patients suffering from SMI and SUD is being planned.

Physical exercise has been shown to have positive effects also on mental health. In one major Norwegian hospital, facilities are now offered for inpatients suffering from SMI or SUD. The effects of physical exercise on patients with SMI and SUD will be examined.

No significant relationships.