Eating Disorders (ED), including obesity, with and without Metabolic Syndrome (MetS), are associated with anxiety and depression. Increased levels of cytokines and their consequences on the pathway of kynurenine (KYN), the main metabolite of tryptophan, have been proposed to account for these associations.

To review the evidences suggesting biochemical connections between the Depression and Anxiety Spectrum (DAS), MetS and ED, respectively, focusing on the role of the KYN pathway.

Three PubMed searches of the literature conducted in October 2013 (key words:‘kynurenine’ ‘eating disorders’; ‘kynurenine’ ‘waist circumference’; ‘kynurenine’‘obesity’‘metabolic syndrome’) provided 2, 3 and 7 references, respectively.

The metabolism of L-tryptophan through the KYN pathway depends on the following three factors: 1) NUTRITION; in underweight ED LKYN metabolites (quinolinic acid, kynurenic acid, 5-hydroxyindoleacetic acid) are significantly reduced until the restoration of normal body weight. In overweight and obesity with and without MetS, increased KYN levels and KYN/tryptophan ratio are found, with abdominal fat content as strongest factor for an increase of the KYN/TRP ratio. 2) AGE; KYN/TRP ratios are markedly increased vs. decreased in overweight and obese adults vs. juveniles, respectively. 3) INFLAMMATION; IFN-gamma induces the indoleamine 2,3- dioxygenase (IDO)-catalyzed synthesis of KYN, whose derivatives increase in diabetes (xanturenic acid), psychosis (kynurenic acid), and depression (quinolinic acid).

The KYN pathway may link DAS, MetS and ED explaining the frequent association of DAS to so many different disorders. Further studies are needed in order to understand these complex connections.

Corticosteroids have either somatic and psychiatric side effects. Somatic adverse effects are well described while neuropsychiatric have received less attention. Psychiatric symptoms such as depression, psychosis and especially mania are common side effects of corticotherapy.

Describe a case of a 53-year-old female patient, with no psychiatric history, who developed psychiatric symptoms during the treatment of an acute exacerbation of multiple sclerosis with large parenteral doses of corticosteroids. Three days after the onset of corticotherapy she developed increased energy, elevated mood, increased motor activity, racing thoughts, and diminished need for sleep. She subsequently developed grandiose and persecutory ideation and then feared her grandson was going to die. This lead to her admission to psychiatric unit of our hospital to address these behavioral problems. Her husband noticed that she had become’hyper’ in the past when she received pulse corticosteroid therapy, but the most recent episode was by far the worst.

Revision of the scientific literature through Pubmed, Embase and Psychinfo using search terms including corticosteroids, mania, depression, psychosis and mood.

Prednisone was suspended and Risperidone 2mg was begun for presumed steroid-induced mood disorder, and the patient became calmer and much less guarded over the next 2-3 days. After a week she recovered complete euthymic mood and reverted to normal functioning.

These data suggest that Risperidone is well tolerated and appears to be useful for mood disturbances associated with corticosteroid therapy. Controlled trials seem warranted to confirm these observations.

In this study, it was aimed to evaluation of alexithymia in male patients before open-heart surgery. The correlation between alexithymia and psychopathology was also investigated.

Thirty-two male patients who had cardiovascular disease were enrolled before open-heart surgery. Socio-demographic characteristics and clinical features of the patients were determined. Symptom Checklist-90-Revised (SCL-90-R), Toronto Alexithymia Scale (TAS), Hospital Anxiety and Depression Scale (HADS), State-Trait Anxiety Inventory (STAI) were applied.

The mean age of the patients was 55.20± 11.72 years. The mean scores were 51.71±9.90 for alexithymia, 6.44±3.86 for anxiety, 5.06±3.61 for depression, 38.91±10.21 for state anxiety and 41.22±7.46 for trait anxiety. The positive correlations between Toronto Alexithymia Score and Depression, Interpersonal sensitivity, Hostility, Paranoid Ideation, Psychoticism and Global Severity Index subscales of SCL-90-R were statistically significant. There were no statistically significant correlations between TAS and HADS, and STAI scores.

The most interesting finding was that there is a correlation between alexithymia and paranoid ideation, and psychoticism in these patients. Contrary to expectations, this study did not find a significant correlation between alexithymia and anxiety and depression. Further research should be done to investigate the comparative studies in patients with different diseases at pre-and post-operative period.

The aim of the study was to investigate the influence of agomelatine and venlafaxine on driving skills and on driving performance in an on-road driving test in depressed inpatients.

40 depressed inpatients were randomly assigned to treatment with either agomelatine (n=20) or venlafaxine (n=20). Patients were tested before pharmacologic treatment (t0), and on days 14 (t1) and 28 (t2) with computerized tests and additionally were rated in an on-road driving test on day 28 by a licensed driving instructor. To control for retest effects a group of 20 healthy subjects was examined in the same time schedule.

After two weeks of treatment with agomelatine or venlafaxine patients showed a significant reduction in depressive symptoms, and a distinct improvement in concentration and stress-tolerance. Furthermore, prior discharge to outpatient treatment (day 28), 72.5% of patients were labeled abundantly fit to drive in the on-road driving test, in 22.5% of cases a satisfactory performance was certified and in 5% of our patient sample there were slight concerns with respect to fitness to drive. Patients did not however reach performance level in functional domains of healthy controls. Significant differences between treatment groups could not be observed.

Our results indicate that depressed patients treated with agomelatine or venlafaxine show a better test performance on tasks related to driving skills than do untreated patients Besides, most patients could be rated as fit to drive, on an actual driving test conducted by a licensed driving instructor, prior discharge to outpatient treatment.

Homosexuality and bisexuality have been associated to increased risks of substance use. Affiliation with the gay culture is one of the explanatory models. According to this model, homosexual persons should, compared to heterosexual persons, preferentially use (or at least try) substances which are usual within the gay scene.

To explore the choice of lifetime substance use among heterosexual, bisexual and homosexual men.

The C-SURF study concerns young Swiss male adults who have to go through the mandatory recruitment process at the Swiss army. Data were collected between August 2010 and November 2011. The questionnaire was about the participants’ socioprofessional and family background, their consumption of alcohol, cannabis and other drugs, as well as their personality. The final sample included 5990 males between 17.9 and 31.4 years old (mean=20.01, sd=1.24).

5371 (89.7%) of subjects declared being exclusively attracted by females, 442 (7.4%) by males and females and 62 (1.0%) by males only. A multinominal logistic regression revealed an increased risk of homosexual men to have ever used poppers (OR 1.57), party drugs (Ecstasy, GHB etc.) (OR 2.18) and cannabis (OR 1.34). Homosexual men had an increased risk of lifetime use of poppers (OR 7.29), and cocaine (OR 4.47), and a reduced risk of alcohol use (OR 0.45).

The choice of drugs seems to be influenced partly by sexual affinities. In addition to the affiliation with the gay culture (especially poppers), the minory stress model may help to explain cannabis use among bisexual subjects

To define neural correlates of cognitive dysfunction in major depression and to disentangle the role of cognitive, default mode and limbic networks in emotional and cognitive problems of depressed patients

We will review brain imaging studies of executive function and rumination in depression. We will also describe results of a recent study conducted in healthy volunteers (n=41) using cognitive tasks related to ruminative processes. During fMRI acquisition subjects were asked to read sentences and to engage in an analytical or an experiential self-referential task.

Several studies using executive tasks related cognitive effort in depressed patients with increased activation of the dorsolateral prefrontal cortex. This hyperactivity of lateral prefrontal cortex is associated with abnormal deactivation of medial brain structures such as the medial prefrontal cortex. Consistent with this review, our study in healthy volunteers showed that subjects with High score in rumination showed lower activity in medial brain structures in relation with difficulties to differentiate analytical and experiential self-focus.

Overall these findings support the hypothesis of abnormal interaction in cognitive and default mode network in depression and may help to refine our understanding of how rumination promotes depression through maladaptive self-focus.

Since about 30% of children and adolescents attending primary care and pediatric outpatient departments have psychiatric disorders that cause significant distress and social impairment, the proper functioning of National Health System assumes a determinant role on promoting early detection and intervening in the prevention of mental illnesses which can almost only be done through an efficient matching between primary care and hospital care.

This paper aims to characterize the pediatric population hospitalized sent by their general practitioners to our outpatient clinic, on a level III Pediatric Hospital, evaluating the existence of psychopathology.

Retrospective analyses of 309 cases, at their first appointment on our outpatient clinic from June 2002 to March 2013. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children and adolescents.

During 10 years, 185 male (45,95% 4–10 years; 54,05% 11–17 years) and 124 female (50,0% on each age group) were evaluated. Eighty-four percent of cases, scored for’any psychiatric disorder’. Correlation between parent-reported and self-reported data was found, slightly higher for male gender. Pronounced divergences were found regarding child and adolescents’ perception and their parents, concerning everyday life difficulties and hyperactivity scores, that is also valid for age group and gender. Total scores: emotional symptoms (51,8%), conduct problems (58,3%), hyperactivity score (59,2%).

We observed a positive impact of primary care medicine on referral network since the majority of the evaluated children and adolescents had psychopathology.

The Internet provides adolescents the chance to experience autonomy through the collection of information and contact with peers with whom to share experiences, emotions and thoughts. A misuse of the Internet can occur if a teenager avoids real relationships and surfing the web turns into a psychological defense, in contrast with a healthy mental development.

and Aims The research investigates forms and motivations of misuse of the internet among a group of Italian teenagers. Objective of the work is the hypothesis of a correlation between massive use of internet and behaviours of social retreat.

The research used a questionnaire. The areas of investigation were: school performance, hours of internet surfing, activity on the Internet (social networks, games, information research, gambling online), psychological reasons of the Internet use, behaviours of social retreat. 583 adolescents (45% males and 54% females, mean age 17 years) responded to the questionnaire.

The 6% of adolescents sample responded to always think the Internet even when not on the computer or gets irritated and reacts impulsively if someone bothers him while it is connected. The 5% prefer surfing rather then going out with friends. Hours of internet sulfing and responses of social retreat were correlated.

The social retreat can be one of consequences of the Internet misuse, with difficulties in socializing and use of the Internet as a psychological defense.

Animal research suggests that weight gain may be caused by olanzapine-induced melatonin suppression. We conducted a pilot study of psychiatric patients treated with olanzapine to examine if melatonin was suppressed and if so the dose needed to replace this deficit. The relationship between melatonin and metabolic indices was also examined.

Ten patients with schizophrenia (N=3), schizoaffective disorder (N=3), or bipolar disorder (N=4) completed the study. All patients were male, average age 50.6 years. Patients were treated with olanzapine for 5 weeks, then randomized to either 0.3mg (N=4) or 3mg (N=6) of melatonin supplementation in addition to the olanzapine for another 6 weeks. We obtained baseline, week-6, and week-12 measures of the major metabolite of melatonin in the urine, 6-Sulfatoxymelatonin (aMT6s) adjusted for creatinine excretion. We measures weekly weight, glycemia, cholesterol, and triglycerides.

Olanzapine treatment was associated with a trend toward decreases in melatonin from baseline to week-6 (p=.14). Analysis of a subsample of patients diagnosed with schizoaffective or bipolar disorder showed significant decreases from baseline to week-6 (p=.02). Both supplementation with melatonin by 0.3mg and 3mg increased urinary melatonin levels from week-6 to week-12 (p=.12 and p=.02 respectively). Total cholesterol increased initially but demonstrated a trend for decrease when melatonin was supplemented (p=.10).

Olanzapine appears to be related to melatonin suppression. Melatonin supplementation reverses this suppression and may have the potential to reverse metabolic effects associated with olanzapine. Further studies are needed to examine the metabolic effects of olanzapine with melatonin.

Electroconvulsive therapy (ECT) is a highly effective treatment for major depression with response rates of up to 80%. However, a significant minority does not respond, and no evidence-based guidelines are available for the management of ECT-resistance. Ketamine is an anaesthetic agent with N-methyl-D-aspartate-receptor-antagonist properties, that has a rapid but short-lasting antidepressant effect in treatmentresistant depression.

To present a case of ECT-resistant depression that responded when ketamine anaesthesia was used.

To review the available literature on ECT-resistance and augmentation of ECT.

A case is presented and discussed, followed by a systematic literature review.

We present the case of a 75-year-old woman with severe major depression unresponsive to several adequate treatments with antidepressants, augmentation with antipsychotics, and ECT with anaesthesia using propofol or etomidate. When ketamine was used for anaesthesia, she experienced remission of her condition. She remained well with a continuation of this treatment at a decreasing rate. A literature review revealed that most augmentation strategies for ECT concerned the optimisation of seizures by using of substances that lowered the seizure threshold (e.g. xanthines) or anaesthetics that do not increase the seizure threshold (e.g. remifentanil). Ketamine anaesthesia was shown to speed up response to ECT, but did not increase response rates. However, these studies were not done with ECT-resistant patients. This case suggests that switching to ketamine anaesthesia may be beneficial in these patients.

There are little evidence-based augmentation options for ECT-resistance. This case suggests that ketamine anaesthesia may be efficacious as augmentation in ECT-resistance.

To assess the budget impact of the inclusion of quetiapine vs. aripiprazole or olanzapine on the top of standard bipolar disorder treatment scheme with atypical antipsychotics according to Russian healthcare system.

The 1 year budget impact analysis was conducted. Direct expenses associated with bipolar disorder and resulting follow-up costs were calculated using general tariff agreement of Russian obligatory insurance system and official national statistics. For reference, accepted exchange rate was 1 EUR = 40 RUB.

Quetiapine inclusion into the standard bipolar disorder therapy provided cost saving benefits vs. inclusion of aripiprazole or olanzapine in the bipolar disorder standard therapy scheme. Total healthcare costs of bipolar disorder therapy were approximately 396 539 RUB (9 913 EUR) per patient in quetiapine group, 1 023 089 RUB (25 577 EUR) per patient in aripiprazole group and 557 222 RUB (13 931 EUR) per patient in olanzapine group within one year. Treatment of bipolar disorder using standard therapy with quetiapine inclusion compared to one with aripiprazole or olanzapine leads to cost savings of 626 551 RUB (15 664 EUR) or 160 683 RUB (4 017 EUR) per patient-year, respectively.

The results of budget impact analysis illustrate that including quetiapine into the standard therapy of bipolar disorder in comparison with aripiprazole or olanzapine has potential to reduce Russian healthcare system total costs for bipolar disorder treatment.

There is substantial evidence that patients with schizophrenia present with impaired Theory of Mind (ToM). ToM impairment has been also reported in euthymic bipolar disorder (BD). However, data from direct comparisons of patients with schizophrenia and BD on ToM abilities are limited.

It has been suggested that different aspects of mentalizing processing, such as epistemic and emotional mental representations, i.e. cognitive and affective ToM, must be separately examined.

The aim of the study was to compare ToM ability and both its cognitive and affective components between schizophrenic and euthymic BD patients.

Fifty three BD type I euthymic patients, 54 patients with schizophrenia and 53 healthy controls (HC) completed a multi-facet battery of ToM tasks, including False belief task, Hinting task and Faux Pas Recognition Test (FP). Besides the overall ability to recognize Faux Pas, two specific components of ToM – cognitive and affective – were assessed with FP. The three groups were matched for gender, age and education.

BD and schizophrenia patients showed no impairment in the False belief task. Schizophrenia patients performed significantly lower than HC and BD patients in Hinting task, FP recognition and affective ToM. Both patient groups were impaired in cognitive ToM. However, only BD patients with a history of psychosis performed significantly lower than HC in affective ToM.

In contrast to schizophrenia patients, euthymic BD patients show a specific deficit only in cognitive but not in affective ToM. Further research on the impact of these deficits on social and occupational functioning is warranted.

To estimate the efficiency of the atypical antipsychotics (quetiapine, risperidone, aripiprazole or olanzapine) used to reduce relapses in bipolar disorder, taking into account costs and effectiveness (QALY).

The Russian health care system perspective and a five year temporal horizon have been used. An annual discount rate assumed was of 5%. Taking into account the last literature review on bipolar disorder, four fundamental aspects related with bipolar disorder management were analyzed: relapse rates, inpatient treatment, outpatient treatment and hospitalization rates. The health care direct costs corresponding to the drug acquisition costs have been analyzed together with the costs of inpatient diagnostics, costs of inpatient treatment and costs of hospitality relapses updated with data from Russian health care system.

Quetiapine or risperidone treatment presents the lower total costs (€13 562 and €13 097 respectively) versus the other strategies (aripiprazole = €36 328 and olanzapine = €19 957). Quetiapine presents the higher QALY compared with the alternatives (quetiapine = 3.551, risperidone = 3.534, aripiprazole = 3.528 and olanzapine = 3.525). With these results one can emphasize that quetiapine or risperidone treatment is dominant with the cost-effectiveness ratio (CER) of 3 819 and 3 706, respectively, versus aripiprazole or olanzapine groups (CER 10 297 and 5 662 respectively). The incremental CER (quetiapine vs. risperidone) is €27 322 per QALY.

The results illustrate that quetiapine is dominant versus aripiprazole or olanzapine. Also quetiapine therapy is within willingness to pay threshold in case of risperidone substitution in Russian patients with bipolar disorder