The ITAREPS system (Information Technology Aided Relapse Prevention Program in Schizophrenia) developed in Czech Prague Psychiatric Center, presents a mobile phone-based e-Health solution for weekly remote patient monitoring and disease management in schizophrenia and psychotic disorders in general.

The program provides health professionals with home telemonitoring via a PC-to-phone SMS platform that identifies prodromal symptoms of relapse, to enable early intervention and prevent hospitalizations.

This work presents data on ITAREPS effectiveness obtained from a recent mirror-design follow-up evaluation carried out in Czech Republic and a randomized controlled trial performed in Japan.

A retrospective within-subject mirror-image study was performed to compare inpatient days and inpatient costs for 134 adults with psychotic illness (ICD-10 dg. F 2X.X) before and after at least one-year ITAREPS participation.

The total number of hospitalizations and (inpatient days) decreased significantly from 159 and (6980) in pre-enrolment period to 47 and (3138) post-enrolment respectively (Wilcoxon-signed ranks test, Monte Carlo, exact test, two-tailed, Z = 6.13 /hospitalizations/, p<0.000001 Z = 6.41 /inpatient days/, p<0.01). Methodological weaknesses specific to mirror-image design were controlled by use of resampling method.

Outpatients with schizophrenia were randomized to the ITAREPS (n = 22) or control group (n = 23) and were observed during one- year follow-up (1).

Results Time to rehospitalization was statistically significantly longer in the ITAREPS group than in the control group (Kaplan–Meier survival analysis, 13 p = 0.033 /Fig.3), with a hazard ratio of 0.21 (95% CI 0.04–0.99). The total number of rehospitalization days (Fig. 4) was significantly lower in the ITAREPS group (37 days) compared with the control group (710 days, p = 0.023).

The ITAREPS presents a novel approach towards relapse prevention.

The robust effectiveness of ITAREPS program together with its low start-up and recurrent costs makes it an attractive consideration for long-term treatment in outpatients with schizophrenia and psychotic disorders in general.

Its web-based platform allows for implementation in clinical practice across different health care systems.

This work was supported by grant IGA NT 14387 from Ministry of Health, Czech Republic.

Several studies associated Major Depressive Disorder (MDD) with an increased production of pro-inflammatory cytokines, such as interleukin 6 (IL-6). Serum IL-6 levels were found to be significantly increased in subjects with MDD and with Treatment Resistant Depression (TRD). Moreover, ketamine, a drug with fast-acting antidepressant properties, has proven to reduce IL-6 levels in rat prefrontal cortex and hippocampus. However, despite the clear influence of IL-6 in the pathophysiology of depression and in antidepressant response, studies evaluating the impact of IL-6 functional genetic polymorphisms on treatment response phenotypes are scarce.

We aim to evaluate the role of IL6-174G>C, IL6-6331T>C and IL6R D358A A>C functional polymorphisms in antidepressant treatment phenotypes, specifically remission, relapse and TRD.

We genotyped the referred polymorphisms in a subset of 80 MDD patients followed at Hospital Magalhães Lemos, Portugal, within a period of 18 months.

We found that patients carrying IL6-174 GG genotype are more prone to develop TRD (OR=4.125; 95%CI: [1.151-14.786]; p=0.038). We also observed that patients carrying IL6-6331 TC genotype have a higher risk of relapse (OR=3.988; 95%CI: [1.176-13.516]; p=0.022), and present a lower time to relapse, TC: 26 weeks vs. TT: 45 weeks (p=0.041, Log-rank test). No association was found between IL6R D358A genetic polymorphism and any of treatment phenotypes.

The IL6-174G>C and IL6-6331T>C polymorphisms influence antidepressant treatment response in our subset of MDD patients. These polymorphisms may possibly contribute to the elevated IL-6 levels found in patients with TRD. This research was partially supported by an AstraZeneca Grant

Recent research on depression treatment of cardiac patients indicated that there are depressive subtypes at higher risk for cardiovascular complications and exploring personality types with negative affect may help to identify them.

To explore the association of affective temperaments with cardiac complications in primary hypertensive (HT) outpatients.

Data of 228 HT patients, controlled monthly for hypertension by their GPs, was analysed. TEMPS-A and BDI was applied to measure stable affective temperamental traits and depressive symptoms. ICD-10 diagnosed depression, antidepressant medication and cardiac complications (CC) required acute coronary intervention (acute coronary syndrome or acute myocardial infarction) was checked from patients’ medical records.

Mean age was 64 (SD±14) years and mean duration of hypertension was 14 (SD±7) years. 16 patients out of 228 developed cardiac complications (CC+). Age, gender, systolic blood pressure, BMI, smoking, HDL cholesterol level, years of hypertension, ICD-10 diagnosed depression, BDI point score and family history of cardiovascular diseases (CVD) did not reveal significant differences between those with or without CC. However, serum cholesterol level was significantly lower (U=997, p=0.01) and bigger proportion of three or more CVDs was found (χ2(1)=24.4, p<0.0001) in CC+ patients. Cyclothymic temperament was more prevalent among CC+ group (U=1119, p=0.027) and increased the odds of cardiac complications with 16% (95%CI= 1.047, 1.295) independent of depressive symptoms, diagnosed depression, age, gender and smoking.

Cyclothymic temperament with lability and rapid mood shifts as main characteristics may help to identify hypertensive patients in greater risk of cardiovascular complications irrespective of depression.

Acute stress disorder (ASD) and its predictivity in development of posttraumatic stress disorder (PTSD) has been researched extensively so far. Symptoms of peritraumatic dissociation (PD) has been proven as a predictive factor for PTSD, but recent studies have shown greater need for distinction of peritraumatic versus persistent dissociation.

Symptoms of PD and of persistent dissociation in subjects diagnosed with ASD will be predictive of PTSD symptoms.

To investigate the development of ASD symptoms, symptoms of PD and of persistent dissociation within the first month of traumatic event (initial) and six months later (follow-up) in victims of traffic accidents.

At the moment, 25 subject were included in initial phase, and 18 at follow-up. Subject were interwieved, Mini International Neuropsychiatric Interview, Acute Stress Disorder Structured Interview, Clinician Administered PTSD Scale, The Dissociative Experience Scale, and The Peritraumatic Dissociative Experiences Questionnaire were administered.

10 subjects were diagnosed with PTSD in the follow-up. Preliminary results support for a greater risk for PTSD when dissociative symptoms are present, of PD or persistent dissociation.

Greater distinction of dissociative symptoms in the acute trauma phase should be taken into account when diagnosing ASD. It could be eventually helpfull with identifying individuals at risk for PTSD.

Social representations occupied a place apart in psychology both by the problems it raised and the scale of phenomena with wich it deals.

This survey examined the potential results of Greek's illness's social representations.

To tested the link between social representations of illness and psychopathological behaviours.

A cross-sectional design was performed. 280 healthy individuals (mean age± sd: 40.9±11.5, range:19-65 yrs)participated to the present study from different region of Greece. All the participants completed a) a questionaire for the recording of illness's social representations based on free associations and b) The Symptom Checklist 90-revised (SCL-90R) along with a quaistionnaire concerning socialdemographic characteristics.

Multivariate analysis was performed. No significant differences on social representations were observed in terms of sex, age and marital status. Chronic disease was found to contribute directly in the development of illness representation (F(1)=5.063, p=.025). Thus, GLM analysis was found strong association between illness representations and developing of somatization (p=.013), interpersonal sensitivity (p=.033), depression (p=.005), anxiety (.001), hostility (p=.004), phobic anxiety (p=.005), paranoid ideation (p=.045), and psychoticism (p=.011).

The results of the present study highlighted that social representations are not a quiet thing. But more crucially support the idea of using the development of social representations in terms of therapeutic process.

Depressive disorder occurs in 5-9% of adolescents and it is often associated with chronicity and positive family history. It often persists into adulthood. Depressive symptoms are reported in more than 25% of healthy high school adolescents. Depressive feelings in adolescents require our attention in order to make early recognition possible.

Evaluating frequency and stability of self-reported depressive symptoms in healthy adolescents in 2000 and 2010.

The research was conducted on 408 fourth grade high school students who were 18, during the years of 2000 and 2010. The depressiveness was assessed using the Beck's Depression Inventory (BDI-IA).

Depressive symptoms were found in 59.5% of adolescents (BDI score > 9) during year 2000. In 2010, 18.6% of the examinees had depressive symptoms. The average BDI score in 2000 was 10.23 which is statistically highly relevant (p<0.05) compared to 2010 when the average BDI score was 5.2. Average BDI score was statistically significantly bigger (p<0.05) in female adolescents both in 2000 (women 11.5, men 8.29) and 2010 (women 5.86, men 3.96)

Female adolescents show significantly higher scores on the Beck's scale which could be used in specific prevention. The difference in expressed depression in two adolescent samples requires further research which would include more predisposing and protective factors.

Since April 2004, Government policy in England upholds that clinicians should send copies of their clinical letters to their patients. However, some argue that patients already have the right to access their records under the Data Protection Act, 1998. Others suggest it wiser not to provide a letter in certain circumstances. Little evidence is available examining the factors that impact on and underlie patients’ views in relation to this.

To inform professionals about patients’ views on receiving clinical letters.

To establish the proportion and characteristics of patients who would like to receive clinical letters and to elicit underlying reasons for decisions.

Subjects were randomly sampled from an outpatient clinic and data collected using an 11-item questionnaire, between October 2010 and July 2013.

The majority (60%) of patients wished to receive their clinical letter. Most (62%) favoured wanting to know about treatment primarily. Of those who did not wish to have a copy, greatest concerns were of loss in the post and ‘unnecessary paperwork’ (each 11%). This group of patients were characteristically male, aged 61-80, of asian ethnicity, unmarried and unemployed. Patients with a diagnosis of adult personality and behaviour (ICD-10 F60-69) were most likely to opt to receive their clinical letter.

Although the majority preferred to receive clinical letters, reasons for preferences varied widely. With an increasing drive towards greater transparency in the health service, approaches to enhancing patient involvement will need to be flexible to the individual to enable truly meaningful patient participation.

Non-cardiac chest pain (NCCP) is a common diagnosis among patients visiting an emergency department. 50–90% of patients presenting with chest pain are diagnosed with non-cardiac chest pain. One of the possible causes of NCCP is a psychiatric illness. Previous studies found high prevalence of panic disorder (25%-40%) using structured DSM-IV interviews.

We wanted to review the occurrence of patients with a possible panic disorder in our emergency department. In case of high occurrence further interventions could be warranted.

To examine the frequency of panic disorder diagnosis by emergency physicians in patients with NCCP.

Electronic health records from all patients in the OLVG hospital presenting with cardiac pain at the emergency department with in January 2013 were reviewed in a retrospective cohort study. We substracted the final diagnosis by the emergency physician

In this month 195 patients presented at the emergency department with chest pain. 121 (62%) suffered from non-cardiac chest pain. They were discharged with the following diagnosis: 13 (11%) pulmonal disease, 23 (19%) a musculoskeletal problem, 13 (11%) a gastro-intestinal diagnosis, 4 (3%) drug related, 63 (56%) were described as suffering from atypical chest pain. Only in 5 (4%) a psychologic cause was described as primary diagnosis.

We found a low rate of psychiatric diagnosis by emergency physicians in patients with NCCP compared to previous studies using structured interviews. Interventions are needed to improve the detection of psychiatric symptoms in our emergency department.

Family psychodynamic is closely related to psychological well-being of family members and its impairment affects the family as a whole and a boarder social and organizational structure like family based firms. A significant number of studies on family-business were published but little has been reported on the psychodynamic features of family-business.

The objective is to explore the hidden continuity of the classic themes: family psychodynamic and family dynamics firm. The research aims to identify and to describe psychodynamic characteristics of a family group which held a business through the analyses of some important relational dimensions.

a qualitative and clinical research approach. Sample: voluntary family members of the organization. Instruments: Structured Organizational Interview (SOI) and a rating scale the Group Organizational Scale (GOS). Both were based on previous family studies in a psychodynamic and systemic view. The broader research was approved by a local Ethics Committee and was founded by FAPESP.

The most affected transactional dimensions were communication, conflicts, cohesion, roles, and the quality of leadership within the family organizational group impairing managerial practices. Moreover, important relationship between the family psychodynamic style and the family dynamics firm were found. It also pointed to the validity of the SOI and GOS.

The interview showed a rich material for psychodynamic analysis of family firms. Its rating scale can be included into other future research. This study has major implications for family-business members to understand their own role in their mental health and in the success of a firm.

The study of associated stigma to mental illness has been usually oriented to psychotic disorders. Recently the ASPEN Project has had the objective to study the stigma associated to depressive disorders worldwide. As a part of this study, we present the results of a Spanish sample. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder. Additionally we investigated whether experienced discrimination is related to severity of depression and level of self-esteem.

In a cross-sectional survey, 100 adult outpatients with a diagnosis of major depressive disorder were interviewed with the discrimination and stigma scale (version 12; DISC-12). Severity of depression and self-esteem were measured by the Hamilton-17 questionnaire and the Rosemberg scale respectively. Socio-demographic variables were included.

the life domains where the major proportion of individuals experienced discrimination were: treatment by their family (46%), in marriage or divorce (30%) and been avoided or shunned by people who know their mental health problem (34%). 60% of patients anticipated discrimination avoiding intimate relationships and 67% of them concealed or hid his/her mental health problem from others. Experienced discrimination had a significant association with the severity of depression and with a low level of self-esteem.

Discrimination related to depression acts as a barrier in some fields of social life. Non-disclosure of depression could be a barrier to seeking help. It is important to consider effective actions to prevent stigma and discrimination in the field of depressive disorders. INDIGO-ASPEN Group

There are a number of studies about Quality of Life at Work (QLW). Noteworthy is that few of them focus mental health and show an intervention plan. Psychodynamic work indicates the value of listing to person and psychosomatic indicates the benefits of a body and mental practice like relaxation. Therefore it was developed a QLW project that includes collective interview (psychodynamic work) and relaxation (psychosomatic).

To test the hypothesis that the practitioner would show an increase in coping strategies and a decrease in avoidance strategies.

To identify the relationship between interview, relaxation and how employees deal with stress.

base line with repeated measures. Participants: 10 workers freely enrolled in the project. Measures: a) A questionnaire to identify demographic and health variables; b) The Coping Responses Inventory for Working Settings; c) Collective interview.

final collective interview showed an increase of the experiences of pleasure, and a minimization of the experiences of anguish despite the maintenance of some oppressive organizational features; quantitative results: there was an increase of the Confrontation strategies, especially Positive Revaluation; decrease in the search for external Orientation and in the Avoidance strategies as Resigned acceptance. The findings confirmed the hypothesis that talking sessions and psychosomatic relaxation helps to have a positive and active attitude.

In-depth talking analysis shed light on the psychodynamic of work. The collective interview associate with the relaxation appears as useful tool to help employees to cope with stress, improving their QLW.

The relationship between neuropsychological and overall performance in people with schizophrenia is known. Smoking and stimulant drugs use can improve neuropsychological outcomes, however the existence of drugs use may be a more severe illness marker.

The purpose of this study is to investigate which clinical and epidemiological variables, including stimulant drugs use and smoking, influence on neuropsychological performance in patients with psychosis.

92 patients with different psychosis were assessed with a battery that included SCIP, to assess neuropsychological performance, PANSS, to evaluate psychotalogy, GAF and SIX as global performance measures. We also explore clinic and sociodemographic data. A binary logistic regresion model was applied on scores on the task ‘words’ of the SCIP (memory and learning), dichotomized at the median. The model included: sex, age, onset age, family history, negative scale, positive scale, global psychopatology and PANSS subtypes, estimated premorbid IQ using Barona Index, stimulant drugs use, smoking and funcionality.

The absence of stimulating drugs use and smoking (trials 2 and 3 of SCIP), was associated with better memory and learning in patients with psychosis. Younger age (trials 1-4 and total of words), higher functionality (trials 1,2 and total of words) and premorbid IQ (trials 2 and 4) were also positively associated with better neuropsychological performance.

Stimulant drugs use and smoking could be markers of poorer previous neuropsychological function in psychotic patients. It is necessary to do longitudinal studies evaluating these variables as markers, risk or protective factors of cognitive performance

to identify the relationship among the yoga practice, the health status (HS) and the quality of life (QL) experienced by students.

it was used a base line before the intervention and repeated measures at the end of the program intervention (pre-and post-test). Participants were a 67 students enrolled in the university program. Measures: a) A questionnaire to identify the participants' health status and their quality of life; b) The Yoga Intervention (YI) developed once a week, lasting one hour during two months at the students' place. Statistical results indicated the positive impact of YI over the students' health and their quality of life (QL). In general, there was an important difference in the degree of health status experienced by students at the end of the program. Even if some health problems remain the students have a better control over them. The QL measure also showed an important difference by the end of the intervention. In addition participants reported the importance of the Yoga in their lives, including better school performance.

The quality life intervention plan was tested. We encourage YI for promoting mental health in the university setting.

Joint Hypermobility Syndrome/Ehlers Danlos Syndrome Hypermobility Type (JHS/EDS-HT) is a hereditary connective tissue disorder, mainly characterized by joint hypermobility and instability, widespread chronic pain, and other secondary features. To date, psychiatric disorders have been scarcely investigated in the context of JHS/EDS-HT. Previous studies reported a high rate of panic and other anxiety disorders. No data regarding personality disorders are currently available.

To determine the prevalence of psychiatric comorbidities among patients with JHS/EDS-HT

We conducted a single-centre case-control study, enrolling consecutive JHS/EDS-HT patients and healthy controls. The psychiatric evaluation was based on the Structured Clinical Interview for DSM-IV Axis I and II disorders. Symptom severity was assessed using the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Brief Psychiatric Rating Scale. The Global Assessment of Functioning Scale was used to assess the overall severity of psychological, social, and occupational functioning.

Forty-seven JHS/EDS-HT patients and 45 healthy controls were recruited. Cases had significantly higher mean scores for all the adopted measures, and a 4.3 higher risk of being affected by any psychiatric disorder when compared to controls. In particular, they had a 5.8 higher risk of having a personality disorders, and, specifically, a higher rate of OCPD (10.6%). Conversely, we did not observe a high prevalence of panic disorders, as previously reported.

Patients with JHS/EDS-HT show higher rates of mood and personality disorders (OCPD particularly), while we found low rate of anxiety disorders. The psychiatric evaluation of these patients is strongly recommended.

Post-traumatic Stress Disorder (PTSD) has demonstrated gender-specific prevalence and expressions across the different DSM definitions, since its first introduction in DSM-III. The DSM-5 recently introduced important revisions to PTSD symptomatological criteria. Aim of the present study is to explore whether gender moderates rates of DSM-5 PTSD expression in a non-clinical sample of survivors to a massive earthquake in Italy.

A sample of 450 survivors of the L’Aquila 2009 earthquake, previously investigated for the presence DSM-IV-TR PTSD, was reassessed according to DSM-5 criteria in order to explore gender differences. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR).

Females showed significantly higher DSM-5 PTSD rates and rates of endorsement of almost all DSM-5 PTSD criteria. Significant gender differences emerged in almost half of PTSD symptomatological criteria with women reporting higher rates in almost half of them, while men in only one (a new symptom in DSM-5: reckless or self-destructive behavior). Considering the impact of the three new DSM-5 symptoms on the diagnosis, significant gender differences emerged with these being crucial in almost half of the PTSD diagnoses in males but in about onefourth in females.

This study provides a contribution to the ongoing need for reassessment on how gender moderates rates of expression of particular disorders such as PTSD.

Quality of life (QoL) in patients with Type 2 diabetes mellitus (T2DM) is an important factor in analyzing of effectiveness in medical and other care. Except for physical discomfort resulting from disease symptoms, diabetic patients also bear mental stress.

To investigate quality of life in patients with T2DM in relation to demographic, clinical, psychological, metabolic and anthropometric characteristics.

97 in- and outpatients of both sexes (<65 years) with endocrinologist-diagnosed T2DM, duration ≥5 years, treated with either oral therapy, insulin or both, were included in this cross-sectional study. The Patient Health Questionnaire (PHQ) was employed for assessment of depression. The Scaling of Life Events was performed for assessment of life events in the past year. The Psychological General Well-Being Scale (WBQ) was used to assess QoL. The Problem Areas in Diabetes (PAID) was employed for assessment of T2DM distress. Laboratory and anthropometric measures (Body mass Index, Waist circumference) were also performed. The exclusion criteria were determined.

Patients with presence of life events (p=0.000), metabolic syndrome (p=0,002), and polyneuropathy (p=0.000) had significantly lower WBQ score in relation to these without (Student's t-test). Considerable correlation between WBQ score and level of education (r=0,231; p=0,023), PHQ (r= −0,811, p=0,000) and PAID score (r= −0,611, p=0,000) (Pearson's Correlation) were found.

Lower level of education, depressive symptoms, and higher level of diabetes distress as well as presence of life events, metabolic syndrome and polyneuropathy were associated with worse QoL in T2DM patients.