Much discussion has occurred about the idea that different antipsychotics can be combined in order to reduce the dose and the side effect profile of each one. Present Guidelines do not support this approach.

We decided to carry out a literature review to establish the evidence which supports this approach.

We carried out a literature search using Google Scholar and Pubmed databases.

Clozapine augmentation with another antipsychotic, usually sulpiride, amisulpride or aripiprazole, has been most studied. Many studies focus on efficacy rather than side effect profile.

A number of short studies and case reports, often with the use of Aripiprazole as the augmenting medication,

suggest that combinations of antipsychotics can reduce side effect profile; larger studies are beginning to emerge.

Some of these studies do not demonstrate greater efficacy for the combination, and in these, the combination use can only be justified on the basis of improvement of side effect profile.

What can be done pragmatically in clinical trials is to compare the effect of a combination with that of each medication separately, or in some cases with placebo. Efficacy of the combination needs to be balanced against side effect profile.

Before this approach can be recommended in guidelines, it is necessary that more trials of larger samples need to be carried out.

The Humanitarian Assistance Programmes UK & Ireland (HAP) work in partnership with mental health professionals in Bosnia-Herzegovina (BH), the country affected by war 1992-1995, providing knowledge and expertise in the treatment of trauma, and specifically in the use of EMDR (eye movement desensitisation and reprocessing). In this way we aim to build a body of qualified and experienced professionals who can establish and sustain their own EMDR training and professional associations in BH.

Authors described educational process considering the history of idea and its realization through training levels and process of supervision which was provided from the Humanitarian Assistance Program (HAP) of UK &Ireland with non profit, humanitarian approach in sharing skills of EMDR to mental health therapists in BH.

The trainers from HAP UK & Ireland completed two EMDR trainings in Tuzla than in Sarajevo for 50 recruited trainees from different BH health institutions from different cities and entities in BH. To be accredited EMDR therapists all trainees are obliged to practice EMDR therapy with clients under the supervision process of HAP UK&Ireland supervisors. Supervision is organized via Skype Internet technology. Up today three trainees completed their supervision successfly and became European Accredited EMDR Psychoitherapists.

Two training of Bosnia-Herzegovina mental health workers to effectively use EMDR with enthusiastic help of EMDR trainers from HAP UK&Ireland resulted with foundation of Bosnia-Herzegovina EMDR Association. The next training is organized in Sarajevo again in 2013-2014 and it will increase psychotherapy capacities in postwar BH.

5-HTTLPR (serotonin transporter linked polymorphic region) has long (l) and short (s) allelic variations. The s allele is linked to depression, anxiety, and slower response to selective serotonin reuptake inhibitors (SSRI). Both depression and SSRI's are associated with bone loss and fractures. We explored the relationship between the 5-HTTLPR and bone loss.

IRB-approved retrospective chart review of adult psychiatric patients during a 10-year period with both 5-HTTLPR genotype and bone mineral density (BMD) assessment (hip and spine BMD stratified by age, Z-scores < 50, T-scores ≥50 years). Age, gender, and BMD scores were compared between the 5-HTTLPR categories of s allele (l/s and s/s genotypes) versus l/l genotype using one-way ANOVA.

Of 3016 with 5-HTTLPR genotyping, 239 had BMD, with 157 (66%) s allele and 82 (34%) l/l genotypes. Among men and women < 50 years, s allele had lower Z-scores in the hip (−0.6628/n=43 vs −0.1306/n=36, p=0.012) and spine (−0.9762/n=42 vs -0.1000/n=41, p=0.0019) than l/l. There were no differences in T-scores between the s allele and l/l genotypes for men and women ≥50 years. Gender analysis (n=198 women, n=41 men) showed women with s allele had lower Z-scores in the hip (−0.68182/n=33 vs −0.08788/n=33, p=0.0146) and spine (−1.0250/n=32 vs − 0.0586/n=29, p=0.0020) than the l/l genotype.

The s allele is associated with lower bone density at the hip and spine in younger adults, particularly in younger women. Our results suggest 5-HTTLPR variants may mediate serotonin effects on bone in a gender-specific or hormonal/ menopausal-dependent interaction.

Above 60 years, prevalence rates of neuropsychiatric disorders double with every 5.1 years of age (from 0.7% at 60-65 years to 23.6% for those aged 85 or older). As aged people are dramatically increasing in Portugal, a Country under a serious financial crisis, it is important to understand whether health services are being used appropriately.

to characterize the use of health services among the elderly, as part of the implementation of the 10/66-Dementia Research Group Population-based Research Protocol in Portugal.

A cross-sectional survey was implemented of all residents aged 65 or more in a semi-rural area in Southern Portugal. Core evaluation included a cognitive module and the Geriatric Mental State-AGECAT (GDS). A structured questionnaire assessed the use of services, including health care providers (public, private), inpatient episodes, medication and costs.

703 participants were evaluated. Almost half of the participants (48,9%) were in contact with public primary care facilities, but only 22,5% had a contact with a hospital service. In both settings, nurses and other non-doctor professionals were rarely involved (6,4%) as principal care providers. 11,8% had at least one contact with a private doctor. Inpatient episodes in the last 3 months were very infrequent (3%). The National Health Service covered most costs.

Previous research strongly suggests that health services are not provided equitably to people with mental disorders, namely the elderly. Reliable and cross-culturally comparable information about patterns of care may guide the implementation of adequate management in this area in Portugal.

of this paper is to establish what kind of influence may have regularity of Namazs’ performing on mental stability and health of adolescents, in order that how these may have influenced on preventing of their social excluding.

The sample was consisted from 240 mentally and physically healthy secondary school adolescents of both genders, of age 15–18 years, equal in regard of school achievements, conduct, family structure and level of exposure to psychosocial distress. Participants were assessed in regard of regularity and frequency of prayer performing. Personality profile was assessed with Freiburg questionnaire of personality. Statistical analysis was done in SPSS 10.00 program; we used Pearson's correlation test (r).

indicated that regularity of prayer performing and earlier acquired basic instruction about prayer was in positive correlation with mental stability during adolescence, particularly among boys.

Performing of Namazs engages physical, mental and spiritual potentials of personality on individual and also on social plan; so it helps that developmental potentials direct to the way of forming emotionally more stabile person and in that way these will diminish risk of appearance of different forms of unadjusted behavior, in other words these preventing social excluding of young people.

Multiple neurotrophic factors, including vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF)-2, nerve growth factor (NGF) and insulin-like growth factor(IGF)-1, have been shown to play important roles in the pathophysiology of mood disorders. However, insufficient clinical data supporting the importance of these neurotrophic factors in mood disorders, especially manic episode, have made inconclusive to make a connection between these factors and the disorder.

This study intended to investigate possible peripheral biomarkers in serum of manic episode of bipolar disorder.

We aimed to investigate whether or not serum levels of VEGF, FGF-2, NGF and IGF-1 varied in manic state.

Serum levels of VEGF, FGF-2, NGF and IGF-1 were examined in 70 drug-naïve patients with manic episode of bipolar disorder (BM) as well as 50 healthy controls, using an ELISA method.

The mean serum levels of VEGF, FGF-2, NGF and IGF-1 were 168.13±225.61pg/ml, 279.09±378.62pg/ml, 61.38±171.67pg/ml and 162.01±72.00ng/ml in BM patients, and 140.80±143.71pg/ml, 275.46±235.29pg/ml, 36.34±15.14pg/ml and 138.90±80.11ng/ml in healthy controls, respectively. Serum levels of FGF-2, NGF and IGF-1 in patients were significantly higher than those in healthy controls (Z=−2.896, P=0.004; Z=− 2.050, P=0.040; Z=−2.188, P=0.029; respectively), although there was no statistical difference in the serum levels of VEGF between two groups (Z=-0.468, P=0.639). Moreover, serum levels of NGF in patients correlated with the duration of disorder (rs=−0.241, P=0.044).

The increase in serum levels of FGF-2, NGF and IGF-1 in manic state may reflect a neuroprotective role for these factors, and these factors may be considered biological markers for manic episode.

In Brazil, the public health system is universal and regionalized. Currently, it is being restructured starting from the primary care system.

In Rio de Janeiro there is a lack of children and adolescents mental health professionals, and there is a deficient system to attend the demand, without integration between health and educational systems and insufficient and inadequate psychology, pedagogy, speech therapy, occupational therapy and medical care.

The city of Rio de Janeiro is divided in 10 Programmatic Areas (PA). The Child and Adolescent psychiatry of Piquet Carneiro Policlinic (PPC)/ UERJ covers, amongst three more units, the PA 2.2 of 371.120 habitants, amid those, 74.257 are under 15 years old (IBGE, 2010).

Analyze the Child and Adolescent Psychiatric demand in PPC/ UERJ in 2013, arising from the primary care system.

A sample of 50 patients that were evaluated in this policlinic referred from the primary care system were attended and directed through consultations. Those evaluations were made by psychiatrists and reports and counter-referrals were fulfilled. The patients in need of psychiatric care are being accompanied.

Out of the 50 patients, we analyzed gender, age, diagnosis, familial background, social-economical background, educational achievement and prescribed drugs.

Among the analyzed patients, we found that the majority of the cases regard learning disabilities and family issues that could have better prognosis with an integrated and multidisciplinary care.

The existing units covering Child and Adolescent Mental Health in the referred PA are not enough to provide the necessary care.

The benefits of Tai-chi on relaxation, mental focus, motor coordination, balance, and stress reduction may help improve symptoms control and physical functioning in schizophrenic patients. The study aims at evaluating the effects of Tai-chi and developing this mind-body exercise in residential care of schizophrenia in long term.

The RCT included a pilot trial and an on-going 3-arm main study. A pilot trial with 30 participants randomly allocated into a 12-session (6-week) Tai-chi program and control group was conducted. Gross motor coordination, negative symptoms and functional disabilities were assessed at baseline, 1 week and 6 weeks post-intervention. Recruitment of 150 participants for the main study was conducted at the same hostel. They were randomly allocated into Tai-chi group, exercise group and wait-list control group. The study is still in progress and will be reported in the presentation.

For the pilot trial, participants in the control group showed marked deteriorations in the above areas throughout the study period. Tai-chi showed a protective effect from deteriorations in gross motor coordination (Z=-2.28; p=.023), and interpersonal functioning which could be sustainable for 6 weeks after the program (Z=(2.56; p=.01). Preliminary results of the main study will be presented in the conference.

The pilot trial demonstrated the positive effects of Tai-chi on promoting movement coordination and alleviating functional disabilities. The group exercise format encourages socialization and interpersonal functioning. Tai-chi emphasizes movement rhythm and inner calmness which may further help symptoms control. The main study will confirm the results of the pilot trial.

There are no effective programs on return-to-work (RTW) despite an increase of stress related disorders. We developed an original rehabilitation program,’Ultra-short daily briefings care (USDBC)’. USDBC is based on a key concept of European Framework for Psychosocial Risk Management (PRIMA-EF; WHO, 2008) that provides the good practice guidelines at the workplace. We carried out USDBC at the worksite of Panasonic Healthcare Co., Ltd. to determine whether USDBC facilitates RTW.

To develop and establish the appropriate intervention that reduces depressive severity of sick-listed employees.

The aim of the study was to determine whether USDBC strengthen the sense of coherence (SOC; Antonovsky, 1985).

We compared two groups in a cross-sectional study design: 16 depressed RTW employees (USDBC group) vs. 121 healthy employees (control group) (Fig.1). USDBC group was received the instant face-to-face rehabilitation program in every workday (Fig.2). The primary outcome was the ability to cope with stress, measured by self-reported 13-items SOC scale for Japanese (Yamazaki, 1999).

In the USDBC group, significant changes were observed between baseline and measurement point in SOC score (40.3 vs. 54.4; 95% CI (20.6 to (7.5), whereas in the control group, no significant changes were observed (58.3 vs. 57.9; 95% CI (0.1 to 0.9) (Table.1).

The study suggests that USDBC strengthen the depressed employees’ SOC.

Fig. 1

Participant now climt

Flow diagram showing the selection of USDBC group and control group

Fig. 2

Intervention with USDBC

Depressive employees behave according to this flow in every workday.

Table 1

Subjects’ characteristics and SOC.

Data from the American National Comorbidity Survey Replication (Martin et al., 2013; JAMA Psychiatry) - a nationally represented mental health survey - provides evidence that current diagnostic criteria for depression in men may be incomplete.

To conduct and present findings of a systematic review of the biological, psychological and social depression research literature relating to men.

(1) To provide a comprehensive summary of current knowledge about the expression of depression in men; (2) To examine the accuracy of current diagnostic criteria for identifying depression in men.

The PRISMA statement was used to guide a multiple database search in February and July 2012 and June 2013. Search terms included: ‘men’, ‘depression’, ‘signs’ or ‘symptoms’, ‘gender’, and ‘sex differences’. Initial database searches together with forward and backward searches found 15,966 studies that were assessed for eligibility. Thirty studies met selection criteria and were included in the review.

The review challenges findings that are commonly reported in the depression literature. The majority of studies in the review did not find significant differences between males and females in global depression rates, but instead, found significant differences between males and females in specific depressive symptoms that are expressed. Depressed men commonly reported alternative symptoms, including social withdrawal, functional impairment and sexual disturbance, together with maladaptive coping mechanisms.

Current diagnostic criteria may not accurately identify depression in men. Targeted research needs to further clarify which symptoms are required to accurately detect depression in men.

Despite the significant prevalence of adolescent depression, little is known about the neuroanatomical basis of this disorder. Functional dysregulation in frontolimbic circuitry has been suggested as a key neural correlate of adult and adolescent depression impeding emotional regulation. However, less is known about whether this dysregulation is overlaid on impaired white matter microstructure. Guided by neuroimaging findings, we test the a priori hypotheses that adolescent depression is associated with alterations in white matter microstructure in the 1) uncinate fasciculus (UF) 2) cingulum bundles, and 3) fibers linking subgenual anterior cingulate cortex (sgACC) and amygdala.

Diffusion tensor magnetic resonance imaging (DTI) data were obtained on 52 un-medicated adolescents with major depressive disorder and 42 matched controls. We calculated fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD) for bilateral UF, cingulum, and sgACC-amygdala fibers using probabilistic tractography. We also completed a voxelwise comparison of depressed and control participants using tract-based spatial statistics (TBSS).

Depressed adolescents had significantly lower FA and higher RD in bilateral UF and right sgACC-amygdala tracts. TBSS results additionally revealed lower FA values in the white matter associated with the limbic-cortical-striatal-thalamic circuit, corpus callosum, and anterior and superior corona radiata.

Adolescent depression is associated with reduced white matter integrity in emotion regulatory networks, which may underlie the functional differences in frontolimbic circuitry often observed in adolescent depression. We offer evidence that poor myelination of the white matter tracts supporting emotion regulation may contribute to the etiology of early-onset depression.

A previous 40-week, randomised, double-blind placebo-controlled core study [comprising of dose confirmation (9-week), real-life dose optimisation (5-week) and maintenance of effect phases (6-month)] reported the safety of MPH-LA in the treatment of adult ADHD. Here, we report the long-term safety from the extension phase (6-month) of this core study.

During the extension phase, patients initiated treatment with MPH-LA 20 mg/day; up-titrated to an optimal dose of 40, 60 or 80 mg/day in increments of 20 mg/week. Safety was analysed from baseline of maintenance of effect phase (core study); and from baseline of extension phase to end of extension phase. Adverse events (AEs) and serious adverse events (SAEs) were reported.

Incidence of AEs occurring anytime starting from baseline of the maintenance of effect phase (core study) until the end of extension phase was 80.5%. The incidence of AEs occurring in the extension phase period was 69.8% (Table). Incidence of serious AEs (SAEs) reported during both periods were similar (0.7%). Most common AEs were nasopharyngitis, headache, decreased appetite, dry mouth and nausea. No deaths were reported. No new or unexpected results were observed for laboratory findings, vital signs or ECGs. None of the patients had QT, QTcB or QTcF ≥500ms during the study.

Long-term treatment with MPH-LA in adult ADHD patients was well-tolerated.

Table: Number (%) of patients with most frequent AEs and SAEs

The safety profile of MPH-LA in the paediatric population has been well studied. However, there are very limited studies reporting safety of MPH-LA in adults. We present the safety profile of MPH-LA in adults and from a pooled analysis in children.

Data from 3 multiple-dose, double-blind, placebo-controlled studies of 7-12 weeks duration in children with ADHD; MPH-LA (10-80mg/d) (n=314) & placebo (n=318) (aged 6-12 yrs in 2 studies &13-17 yrs in one study) were pooled for this analysis. In addition, data from 722 adult patients, 18-60 yrs of age with ADHD receiving MPH-LA 40-80 mg/d (n=542) or placebo (n=180) from double-blind dose confirmation phase of 9-week duration from one study was included in the analysis.

Common adverse events (AEs) reported by both adult and paediatric ADHD patients were decreased appetite, headache, nasopharyngitis, nausea, and insomnia (Table). Incidence of serious AEs (SAEs) was low with MPH-LA in both adults (0.7%) and children (0.6%) compared with placebo group (1.1% in adults and 0.3% in children).

Our findings show that safety profile of MPH-LA in adults is similar to that observed in the paediatric population.

Table

Adverse events (>5%) by preferred term in multiple dose, placebo-controlled studies In adult and paedlatrlc ADHD patients

alcohol abuse induce neuroadaptive alters of benzodiazepine receptors (BDR) that modulate GABAAR, mediation of GABA and activity of dopaminergic neurons in brain regions, associated with reward function in the brain that serve alcohol addictions.

properties of BDR’central’ (CBR) and’peripheral’ (PBR) types were studied in synaptosomal and mitochondrial membranes from different brain areas of alcohol abused patients and non-alcoholic persons (early postmortem material, less 5 hours after death) by radioreceptor assay with using selective ligands: [3H]flunitrazepam and [3H]PK-11195.

comparative study of kinetic parameters (affinity and capacity) of [3H]flunitrazepam and [3H]PK-11195 binding with synaptosomal and mitochondrial membranes in autopsy samples from different areas of human brain was showed that affinity of BDR was decreased: CBR – in 1,2 times in prefrontal cortex and n.caudatus, less – in cerebella cortex; PBR – in 2,1 times in n.caudatus, 1,3 times – in prefrontal cortex and cerebella cortex in patients with alcohol addiction.

Capacity of BDR was increased in different areas of human's brain under influence of alcohol abuse. More alters of CBR appeared in prefrontal cortex (179%) and cerebella cortex (176%), less – in n.caudatus (145%); PBR – in n.caudatus (262%); and cerebella cortex (205%), and less in prefrontal cortex (123%).

These results showed that alcohol addiction induce more alterations in PBR (mitochondrial) than CBR (synaptic) that agree with maintaining function of glial cells in CNS under influence of different toxic factors.

our findings suggest hypothesis of difference in response BDR from various brain areas on alcohol influence.

Research data indicate that many dermatological conditions may be related to stress and emotion dysregulation. Increased attention has recently been given also to mindfulness, the ability of attending present experiences in both a non-evaluative and accepting way. In fact, dispositional mindfulness and mindfulness-based interventions have found to influence rates of skin clearance in patients with psoriasis, while reducing pain, and improving the quality of life (QoL).

The main aim of the current study was to test differences in the mindfulness ability of individuals affected by psoriasis vs. in absence of any chronic skin condition. Additionally, we also aimed at investigating the link between mindfulness and QoL.

Participants were 42 patients with psoriasis and 42 healthy controls. All completed the Five Facets Mindfulness Questionnaire (FFMQ;a self-report measuring five aspects of mindfulness, i.e., Observe, Describe, Act with Awareness, Nonjudge, and Nonreact), and the Dermatology Life Quality Index (DLQI;a self-report assessing the impact of dermatological diseases on the QoL). The two groups were fairly well balanced in terms of gender and age (all p>.05).

When compared to the healthy controls, the patients with psoriasis overall showed lower mindfulness scores, although most of the results were only marginally significant. The strongest difference was observed for the Nonjudge mindfulness facet,t(82)=1.97,p=.05,d=.43. No correlation between DLQI and FFMQ was observed.

This study provides further support for the link between psoriasis and mindfulness, but fails to demonstrate an association between mindfulness and QoL. Accordingly, psoriasis treatment might benefit from a multidisciplinary approach that includes, but is not limited to mindfulness techniques.