Cinema constitutes an artistic presentation of the spectrum of human emotions and offers a number of examples of artistic vision of posttraumatic stress disorder (PTSD). Cinema of the Russian director, Andriei Tarkovsky, alludes to the complexity of human psycho through poetic narration and cinematography. Particularly, Tarkovsky makes reference to such topics as trauma, depression, melancholy, and madness.

The aim of this study is to analyze Tarkovsky’s film “Ivan’s Childhood” from the perspective of psychiatry and psychology with the special attention to the topic of PTSD.

We identified elements of trauma and PTSD in line with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Furthermore, we analyzed manifestations of trauma in “Ivan’s Childhood” according to the trauma complex in Jungian perspective.

The main protagonist of the movie, Ivan, is treated as an archetype of a person exposed to trauma. The traumatic circumstance is the war in which he lost his loved ones. “Ivan’s Childhood” is a poetic presentation of this boy’s struggling to overcome his fears and his personal fight for dignity. Tarkovsky accomplishes it through a series of poetic images in which the director demonstrates flashbacks from Ivan’s life. Based on comparisons to Jung’s model of generic complexes, it is possible to define Ivan’s trauma complex as a set of psychological processes that are archaic and typical, i.e., “archetypal.”

“Ivan’s Childhood” is a moving portrait of a destroyed childhood and subsequent trauma as well as coping mechanisms such as rebellion, alienation, and transference.

Usually, Plato is not considered a philosopher that comprehensively treated the matter of suicide. By studying Plato’s work (especially Crito, Phaedo, the Republic and the Laws), we observe that Plato was concerned with the problem of suicide and that he gave an elaborate answer regarding the problem of suicide, laws against its practice as well as exceptions from them, customs and punishments.

This paper, in the light of a trial to overcome the monistic approaches of the matter of suicide, proposes the modest but fundamental goal to point out the resemblance between Plato’s position (especially from the Laws and the Republic) regarding the matter of suicide and the nowadays reasons invoked by the patients requesting assisted suicide.

Looking at the patients from the United States of America which requested assisted suicide, by analyzing the available annual reports (at the time of writing this abstract, only 6 out of 9 states that have a legal status that permits assisted suicide are publishing annual reports regarding the patients and their assisted suicide requests), we compare them with Plato’s attitude towards suicide.

We observe that the most invoked reasons (concerns and underlying illnesses), by the patients wich request assisted suicide, are also the cases in which Plato permitted suicide.

This comparison and insight into Plato’s philosophy does not resolve any particular issues of the medical praxis but is binging out the utility of a multidisciplinary, especially philosophical and ethical, approach to the practice of assisted suicide.

Definitions of health in different branches of medicine are one of the key paradigms in medical sciences. Nowadays, there are two distinct definitions of sexual health and mental health. The definition of sexual health, as well as sexual rights, was proposed by the World Health Organization (WHO, 2006), and the definition of mental health was published in World Psychiatry (Galderisi et al, 2015).

The analysis and comparison of these two definitions: mental health and sexual health are two main objectives of this study.

The analysis was carried out in three areas: logic, philosophical aspects (values) and the impact of other disciplines.

The definition of sexual health reveals a eudaimonistic approach, whereas the definition of mental health is based on a holistic paradigm. Regarding the main principles in the definition of sexual heath, one can identify the following values: well-being, pleasure, safety, sexual rights – compared to harmony, empathy, coping skills, universal values in the definition of mental health. Sexual rights are a constitutive part of sexual health. There is no comparative element in the definition of mental health (e.g. the rights of mentally disabled persons).

These two definitions can have different effects on the prophylaxis and therapy of patients. It all depends on the specific context of care (sexology or psychiatry). Sometimes universal values matter and sometimes not. This is contradictory. Consistency is needed between definitions and practices.

Recently, several studies have implicated the social context during a traumatic experience in susceptibility to, and severity of, post-traumatic stress disorder (PTSD). Although the precise mechanisms through which the social context affects the development of PTSD are unknown, it has been suggested that the neuropeptides oxytocin and β-endorphin may play a key role in this dynamic through their effects on both the locus coeruleus and the mesocortical and mesolimbic dopamine systems.

This experiment aims to identify in how far a formal social position, endowed by a recognised authority, modulates the stress response in cadets at the Czech military academy during a highly stressful training exercise.

As part of survival training, 40 cadets partake in a simulation of an avalanche. Although the maximum duration of the experience (being buried under snow) is 15 minutes, most cadets do not last longer than a few minutes with a significant portion requesting termination after a matter of seconds. During the experience, participants are fitted with a heart-rate and heart-rate variability monitor and tested before and after for pain resilience (a common proxy measure for β-endorphin). Participants are randomly allocated to have their individual scores or the average of their collective scores (in small groups of 5) incorporated in their final evaluation of the exercise.

Not all data has been collected yet.

We expect to see a difference in resilience (measured in duration) between the two groups which is mirrored in the afore mentioned biomarkers.

Refugees and asylum seekers have often been exposed to multiple or complex traumas and are known to have a high rate of trauma-related disorders. Different therapeutic approaches have been used to treat this group with varying success. Narrative Exposure Therapy (NET) is one promising intervention for refugees and asylum seekers that are suffering from post-traumatic stress-disorder (PTSD). NET is a treatment given individually or in small groups in typically 12 sessions or less. In NET, memories are reorganized through a process involving imaginary exposure to trauma.

To review the literature on NET for refugees and asylum seekers suffering from PTSD.

The data bases PubMed, Medline, PsycInfo and Web of Science were searched using a selection of search terms, including ‘Narrative therapy’, ‘refugees’ and ‘stress disorders, post-traumatic’. The identified relevant articles were qualitatively assessed and effect sizes were compared. Methodological quality was assessed according to the GRADE-criteria.

Thirteen studies were assessed with a total study population of 745. Nine of the included studies were RCTs. Overall, the studies found medium to very high effects of NET. The quality of the studies varied from very low to high. More studies of NET for refugees and asylum seekers are needed, and in particular studies reporting long-term outcomes.

The review suggests that NET shows promise as a method for the treatment of PTSD in refugees and asylum seekers. However, the review is based on relatively few studies and more studies of long-term outcomes are particularly needed.

Previous research indicates that traumatized individuals with post-traumatic stress disorder (PTSD) symptoms may show alterations in interpersonal distance regulation that are not evident in traumatized individuals without PTSD symptoms. However, the underlying mechanisms of these alterations are yet to be investigated. Moreover, it is not clear whether altered interpersonal distance regulation is correlated with trauma-related psychopathology.

The current study investigated behavioral and neurophysiological markers of interpersonal distance regulation as predictors of PTSD and anxiety in traumatized firefighters.

Twenty-four active-duty firefighters (M = 30.58, SD = 3.62) completed an experimental task that measures comfortable interpersonal distance. During the task, event-related potentials were recorded to assess attentional processing as reflected in the P1 and N1 components. Trauma-related psychopathology was assessed using the Clinician-Administered PTSD Scale and the state version of the State-Trait Anxiety Inventory.

Participants who did not choose a closer distance towards friends as compared to strangers experienced greater anxiety post-trauma. On a neurophysiological level, participants who showed attentional avoidance towards strangers reported more PTSD symptoms. By contrast, participants who showed hypervigilant attention towards strangers reported greater anxiety.

The results demonstrate associations between interpersonal distance regulation and psychopathology after trauma, shedding light on the underlying processes of interpersonal distance regulation in anxiety and PTSD. Future studies should re-investigate these associations in a larger sample and explore potential implications for the prevention and treatment of trauma-related psychopathology.

Transgenerational transmission of trauma (TTT) describes the residual ‘presence of the past’ through generations. This phenomenon has an established evidence base with Holocaust survivors (HS) and their offspring, who are hypothesised to be at a greater risk of psychiatric conditions. This advanced literature review explores the relationship between Post Traumatic Stress Disorder (PTSD) in survivors and mental health conditions (MHC) in survivor’s offspring.

The objective is to review the literature, looking for evidence of TTT and exploring the mechanisms of action of such phenomenon.

An advanced search was performed in three databases; Medline, Ovid PsycInfo and the Yehuda Schwarzbaum Online library using the following search terms; (Post Traumatic Stress Disorder OR PTSD) AND (Holocaust OR Shoah) AND (Offspring OR Children)’. 190 articles were identified and a following 163 were excluded. 26 studies were reviewed.

Parental PTSD is circumstantially influential in parenting and attachment quality. Unfavourable attachments in offspring are associated with psychiatric conditions. Furthermore, poor health behaviour can be transmitted; for example, poor diet is an independent risk factor for depression. Psychopathology may pass intergenerationally; parental PTSD increases the risk of developing PTSD in response to one’s trauma. Parental PTSD can also result in impaired cortisol function and epigenetic changes.

PTSD in HS is an important risk factor for development of MHC in offspring. However, this does not mean all offspring develop MHC. The variability in offspring proneness to psychiatric conditions may reflect specific vulnerabilities. Further research is pertinent for an understanding of TTT. The poster will discuss clinical value.

Students often suffer from stress, anxiety and depression (Saleh et al., 2019). However, research on PTSD is scarce among this population.

We therefore wanted to explore the presence of PTSD and other psychopathological and psychological variables in this population.

We recruited 70 students -150 still planned- (22 years old, 70% women, 84.3% in the third year undergraduate) who filled out questionnaires at the university, after ethic committee’s approval.

31.2% show PCL-5 scores in favor of a PTSD. The most frequently mentioned traumatic events (direct exposure) are physical assaults (49.3%), transport accidents (29.4%) and unwanted sexual experiences (23.2%). According to the Mann-Withney U test, if they do not differ from students without PTSD in the number of traumatic events encountered (LEC 5 ns), they show more stress, anxiety and depression (p <.02), more dissociative symptoms (p <.04), less social support available (p = .048), a gap between the importance given to studies as a value and action directed towards this value (p = .002), idem for leisure activities (p =.035), and more rumination (p <.001) and more experiential avoidance (p <. 001). These two latter appear to be powerful processes involved in PTSD, as the PCL5 score is 37% explained by avoidance and rumination, according to linear regression.

These preliminary results tend to show that PTSD should be investigated in students and seems to be linked to higher emotional difficulties, lower academic and social involvement. Rumination and avoidance could be an important therapeutic target.

Psychiatric staff could be exposed to various types of violence that might have potential consequences on their psychological balance.

To detect post-traumatic stress disorder (PTSD). To assess the professional quality of life among psychiatric hospital workers.

A descriptive cross-sectional study was conducted in the psychiatric department of the Hedi Chaker University Hospital in Sfax. The questionnaire study had three major components: the baseline participant characteristics,the post-traumatic stress disorder Checklist (PCL-5) for which a total symptom severity score cutoff of 38 was recommended as the cutoff for a positive screening test and the Professional Quality of Life Scale (ProQOL).

Thirty-one participants completed the questionnaire. The sex-ratio was 0.93. The mean age was 41.5 years. All participants were exposed to physical or verbal assault. Physical aggression was the most traumatic behavior reported by 39.3% of psychiatric professionals. A feeling of insecurity when performing professional tasks was reported by 93.3% of participants. Among participants, 41.9% expressed the desire to change workplace. The mean score on the PCL-5 was 21.6 ± 15.35. Five participants (16.7%) had a PCL-5 score ≥ 38. The Compassion Satisfaction mean score was 37.48 ± 5.64. The burnout mean score was 26.41 ± 7.3 and the mean score at the secondary traumatic stress scale was 27 ±6.7.

PTSD could result from stressful events encountered in the course of managing patients in mental health departments. Attention to post-traumatic event interventions may be useful both to reduce the rate of PTSD and to improve the professional quality of life among psychiatric staff.

Family caregivers of psychotic patients are exposed to violence and stress. However, associated psychological outcomes are poorly characterized in this population.

The aim of this study was to clarify the relationship between violence directed towards caregivers of patients with psychosis and developing post-traumatic stress disorder (PTSD).

Participants were family caregivers of psychotic patients (n=95). They completed a questionnaire assessing sociodemographic characteristics. Sociodemographic and clinical data of patients were collected from medical records. We used the perceptions of prevalence of aggression scale (POPAS) to measure the frequency and severity of aggression directed at the respondent in the past and the Impact of Event Scale-Revised (IES-R) to evaluate PTSD.

A rate of 75.8% of caregivers reported experiencing moderate to severe levels of aggression. Decreased contact with patient (p=0.00), male gender (p=0.00), older age (p=0.00) and parent relationship (p=0.01) of caregivers, diagnosis of schizophrenia or schizoaffective disorder (p=0,00) and poor adherence to treatment (p=0,00) in affected relatives were associated with experiences of moderate–severe aggression. More than a half of caregivers (54.7%) reported potentially significant levels of PTSD which correlated with the level of aggression (p=0.00).

Our findings suggest that a large proportion of family caregivers of patient-initiated violence in psychosis reported experiencing a great distress and a high level of PTSD symptomatology. So, more attention should be paid to the support needs of caregivers who are faced with potentially life threatening aggressive behaviour by psychotic family members.

An association can be found between patient with psychosis and perpetrating acts of violence. So, the caregiving role can impact negatively on psychosis carer psychological health and wellbeing.

The aim of this study was to identify the factors associated with post-traumatic stress disorder (PTSD) in family caregivers of psychotic patients following exposure to aggression.

This cross-sectional study was carried out involving 95 family caregivers of psychotic patients followed in psychiatry. Data were gathered from caregivers about their experiences in providing care. Sociodemographic and clinical data of patients were collected from medical records.We used the perceptions of prevalence of aggression scale (POPAS) to measure the frequency and severity of aggression directed at the respondent in the past and the Impact of Event Scale-Revised (IES-R) to evaluate PTSD.

The caregivers were male in 51.6% and with low educational level in 46.3% of cases. A rate of 75.8% of caregivers reported experiencing moderate to severe levels of aggression. More than a half of caregivers (54.7%) reported potentially significant levels of PTSD. Decreased contact with patient (p=0.01), male gender (p=0.00), older age (p=0.00), living far from patient (p=0.00), parent relationship of caregivers (p=0.00), diagnosis of schizophrenia or schizoaffective disorder (p=0.00) and poor adherence to treatment (p=0.00) in affected relatives were associated with the presence of PTSD following exposure to moderate to severe aggression.

These findings highlight the need for interventions to promote family psychoeducation and to provide psychosocial support for caregivers of patients in order to prevent the traumatic impact of violence on them.

Children with traumatic brain injury (TBI) are at risk for post-traumatic stress disorder (PTSD). The vast majority of TBI are of mild severity (MTBI), however, they may develop persistent neurophysiological symptoms.

The purpose of this study was to investigate the incidence of PTSD in children with MTBI in Western Greece.

A one-year prospective study was conducted at the Children Hospital of Patras. A total of 175 children aged 6-14 years screened for risk of PTSD at one-week and one-month post-injury, completing the Child Trauma Screening Questionnaire (CTSQ). The Children’s Revised Impact of Event Scale (CRIES 13) was administered to the parents, to inquire their assessment of PTSD in the children. Statistical analysis was performed with IBM SPSS v.22.0

There were 59 (33.7%) children (27.2% boys, 45.9% girls) whose screen result was at risk. At the rescreening one-month postinjury, 9.9% were still at risk. Parents assessed presence of PTSD in 19% of their children at one-week and in 3.9% at one-month post-injury. There was a positive correlation between parenting and child reporting on symptoms of PTSD in children. However, 23.4% mistakenly estimated their children did not experience stress while in fact they did and 24.2% mistakenly estimated the contrary.

The findings revealed the risk of PTSD even in mild TBI, justifying thus the screening to identify these children for intervention strategies. On the other hand, the rescreening demonstrated that not all at-risk children required intervention, since a natural remission in PTSD symptoms was observed one-month post-injury.

Posttraumatic stress disorder (PTSD) is common in survivors of acute life-threatening illness, but little is known about the burden of PTSD in survivors of stroke attack.

This study estimated the prevalence of PTSD in post-stroke in the elderly and to look for the factors which are correlated with it.

Participants were outpatients of Psychiatry B department in Hedi chaker University Hospital Center in Tunisia, over the age of 65, hospitalized in psychiatry for a major depressive episode, recruted between 2000 and 2015. The data was collected using a pre-established sheet containing socio-demographic information, the clinical and evolutionary characteristics of the depressive episode and the therapeutic data concerning the depressive episode.

30 patients were included in this study with an average age (69 Y) and sex ratio (0.66). More than half (53.3%, 16 patients) had a history of chronic somatic disease. The average length of hospitalization was 26 days. The most frequent reason for hospitalization is sadness of mood (43.3%) with cognitive impairment as the predominant clinical symptomatology (40%). 93.3% of the population received as treatment an antidepressant mainly Fluoxetine (50%).

clinicians should be mindful that PTSD can be a devastating mental health condition and should consider screening for PTSD in stroke survivors.

Pregnancy and delivery are considered to be an important transition stage in a woman’s life. Although this experience is emotionally rich, it varies from one person to another and each woman goes through it in her own way.

discuss the psychiatric outcomes after a childbirth with somatic complications.

case report

Mrs X is a 32 years old woman, she has no particular history of illness until she gave birth to her son. He is now three and a half years old and he is an outpatient at the child and teen psychiatry department in a Tunisian hospital. After her delivery, Mrs X had several physical and psychological complications. She was hospitalized in the cardiology department for cardiomyopathy of Meadows for three weeks among it one week in the medical reanimation ward because she needed respiratory assistance. Furthermore, she suffered of left femoral head’s necrosis for which she was operated, and a total hip prosthesis replacement was done. Psychologically, Mrs X. presented a postpartum depression which resolved in its own after 9 months. Ever Since the childbirth, the patient presents symptoms concording with post-traumatic stress disorder and symptoms that may be linked to a specific phobia (fear of birthchild or tokophobia).

In addition to the usual health care provided to women during pregnancy and after childbirth, looking for mental health disturbances and eventually referring them for psychiatric assessment is important specially for women who have experienced traumatic events during the pregnancy or the delivery

No significant relationships.

Spousal abuse (SA) against women, by its frequency and its consequences on the health of the victims, is a public health issue. For this reason, the role of the physician is essential not only in the care of victims but also in the screening of psychological repercussions.

To study the risk factors associated with the development of post-traumatic stress disorder(PTSD) in women victims of spousal abuse(SA).

Descriptive and analytical cross-sectional study conducted at the National Health Fund of Sfax(CNSS)on 110 women who consulted during the months of October and November2019.The sociodemographic and clinical characteristics of the consultants were collected using a pre established form.We used a 10-item scale,the “Women’s Experience with Battering Scale” (WEBS),to screen women for SA.PTSD was assessed using a PCLS scale(17 items).

(SA)was estimated at 57.3% in our population.The average WEBS score among abused women was 30.92.The prevalence of PTSD in abused women was 63.5% and the average PCLS score was 48.8.The somatic(p=0.049)and psychiatric(p=0.005)histories in the women who had experienced(SA) were related to the development of PTSD.The PCLS score was significantly associated with the WEBS score(p<.0001 and r=.76).The type of violence experienced (physical, psychological, sexual and material) was correlated with the development of PTSD;(p were respectively: <.0001; <.001; 0.02; <.0001).Similarly, repeated violence was strongly related to it(p<0.001).

It seems clear that the(SA)experienced by the women had a psychological impact through the development of PTSD.In addition,several other risk factors inherent to women can be incriminated in this disorder for which systematic screening remains a necessity in order to allow an apdate care.

No significant relationships.

Post-traumatic stress disorder (PTSD) is often a chronic condition, despite the existence of evidence-based treatment options. Psychotherapy is the designated first line treatment for PTSD, although high rates of psychiatric and medical comorbidity are observed among patients who have undergone treatment. The psychoactive properties of psychedelics may be of particular interest within a substance-assisted psychotherapy approach, offering new treatment opportunities for this debilitating disorder.

Review current evidence, therapeutic context, and possible mechanisms of action of different types of psychedelics in the treatment of PTSD.

Literature review using Medline database.

3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy appears to be a potentially safe, effective, and durable treatment for individuals with treatment-refractory PTSD. Based on a small number of studies, ketamine administration appears to result in temporary symptom relief and may, in combination with psychotherapy, lead to lasting reductions in PTSD symptoms. Although these have not yet been investigated in controlled studies, it is known that psilocybin and LSD induce psychoactive effects that could as well contribute to the psychotherapeutic treatment of PTSD.

The use of psychedelic compounds within a substance-assisted psychotherapy framework offers a novel method for pharmacotherapy-psychotherapy integration, although there is still much to learn from both a clinical and neurobiological perspective. It is necessary to generate more data regarding the safety and efficacy of psychedelics, in addition to research on cost-effectiveness, its use in mental health care infrastructure and also regarding the training of specialized therapists.

This study wants to identify elements that could be informative in diagnosis and prognosis process of all those subjects who, following traumatic experiences, may develop PTSD, or even show signs of a more general and pervasive adaptation disorder, allowing a more precise damage assessment.

In this perspective, the analysis of the Rorschach test according to the comprehensive system of Exner, reading Structural Summary and the analysis of the constellations, allows to make interesting inferences, in all the descriptive areas associated with the key variables as regards not only the cognitive area (Processing >> Mediation >> Ideation) but also the affective and relational area (Interpersonal Perception >> Self-Perception >> Controll >> Affect), so as to have a picture of the functioning of these subjects and, to be able to plan a more functional therapeutic plan.

It is based on a sample of 29 subjects, 20 women and 9 men with an average age of about 35 years (54-14 years), who came to the attention of the clinic, at the request of the reference psychiatrist for diagnostic personality assessment. All subjects complained of various kinds of discomfort, affective-relational difficulties and anxious-depressive symptoms.

The results that emerged, in line with the initial hypotheses, converge in describing a personality style, not very resilient that could suffer in overcoming difficulties and in the search for new equilibrium.

It’s emphasized how the weight of a traumatic event like abuse can evolve into an adaptation disorder,strongly affecting the functionality of the subjects and their social integration.

Currently available psychotherapies and psychotropic drugs for post-traumatic stress disorder (PTSD) are poorly effective in a substantial proportion of patients. Dopaminergic dysfunction plays a prominent role in the pathophysiology of PTSD: intrusions, avoidance symptoms, anhedonia and emotional numbing. Dopamine reuptake inhibitors can be studied as novel drugs in PTSD treatment.

Explore methylphenidate as a promising drug in PTSD treatment.

Case report presentation based on the review of clinical notes and non-systematic review of the PTSD therapeutics state-of-the-art.

A 72-year-old Portuguese male, a veteran of the Angolan War, sought medical attention four years ago after the death of his brother, which had happened three years before the consultation. The clinical picture consisted of re-experiencing the war and the loss of his brother, flash-backs, nightmares, irritability, a fear of losing control, inner dialogues with occasional intra-psychic voices, emotional numbing with the impossibility of developing loving relationships with his relatives, feelings of unreality, an episode of dissociative fugue and complaints of episodic forgetfulness and time warp. He was diagnosed with PTSD with dissociative symptoms, based on DSM 5 clinical criteria. He was initially treated with SNRIs and risperidone, with little improvement. A year ago, he suffered a flare-up, with suicidal ideation. He was prescribed methylphenidate 36 mg, with progressive improvement, persisting mild PTSD residual symptoms.

There is enough evidence of the dopamine involvement in PTSD, although research on dopaminergic drugs is scarce. Methylphenidate may be promising in the treatment of at least some individuals that haven’t responded to current psychological and medical interventions.

A psychotic episode may be sufficiently traumatic to induce symptoms of post-traumatic stress disorder (PTSD), which could impact outcomes in first-episode psychosis (FEP). Yet, post-traumatic stress disorder is often left untreated and undiagnosed in the presence of psychosis.

To conduct a short review of literature on the prevalence and impact of PTSD after FEP.

We performed a literature search on PUBMED, using the query: “Stress Disorders, Post-Traumatic” [Mesh] AND “first episode” AND “psychosis”. We focused on data from systematic reviews, clinical trials and meta-analysis published on last 10 years, either in English or Portuguese.

Approximately one in two people experience PTSD symptoms and one in three experience full PTSD, following a FEP. Prevalence may be higher in affective psychosis, inpatient samples and patients previously suffering from depression and anxiety. PTSD Symptom Scale – Self-Report (PSS-SR) can be a useful screening instrument, but there is no established evidence-based intervention for PTSD in people with FEP. Coercive intervention such as involuntary hospitalization, seclusion, restraint or being forced to take medication, as well as being around sick or anxious patients, can be upsetting and traumatizing.

Our data showed high rates of psychosis-related PTSD. To prevent PTSD, conditions of hospitalization should be optimized and the use of coercive treatments should be limited. Subjects with recent-onset psychosis should be screened for PTSD symptoms. Evidence-based interventions to treat PTSD symptoms in the context of FEP are needed to address this burden and improve outcomes.

Major depressive disorder (MDD) constitutes the leading cause of disability worldwide. Although efficacious antidepressant pharmacotherapies exist for MDD, only about 40-60% of the patients respond to initial treatment. However, there is still a lack of robustly established and applicable biomarkers for antidepressant response in everyday clinical practice.

This study targets the assessment of the vasopressin (AVP) surrogate marker Copeptin (CoP), as a potential peripheral hypothalamic-level biomarker of antidepressant treatment response in MDD.

We measured baseline and dynamic levels of plasma CoP along with plasma ACTH and cortisol (CORT) in drug-naive outpatients with MDD before and after overnight manipulation of the hypothalamic-pituitary-adrenal (HPA) axis [i.e., stimulation (metyrapone) and suppression (dexamethasone)] on three consecutive days and their association with treatment response to 4 weeks of escitalopram treatment.

Our findings suggest significantly higher baseline and post-metyrapone plasma CoP levels in future non-responders, a statistically significant invert association between baseline CoP levels and probability of treatment response and a potential baseline plasma CoP cut-off level of above 2.9 pmol/L for future non-response screening. Baseline and dynamic plasma ACTH and CORT levels showed no association with treatment response.

This pilot study provide first evidence in humans that CoP may represent a novel, clinically easily applicable, endocrine biomarker of antidepressant response, based on a single-measurement, cut-off level. These findings, underline the role of the vasopressinergic system in the pathophysiology of MDD and may represent a significant new tool in the clinical and biological phenotyping of MDD enhancing individual-tailored therapies.