To assess and compare the quality of life in HIV patients with and without depression.

100 HIV positive subjects were interviewed in a case control study. Subjects were interviewed by a psychiatrist to diagnose depression and HAM-D was used to rate the severity of depression. HAT-QOL was employed to assess Health related Quality of Life in these patients.

50 HIV patients were diagnosed to be depressed. 23% were mildly depressed, 19% were moderately depressed, 7% were severely depressed and 1% was very severely depressed. Mean QOL scores in depressed HIV patients were found to be significantly lower than that in non-depressed patients in all 9 dimensions.

HIV itself impairs QOL in HIV patients. Depression further worsens the QOL in these patients. Diagnosing depression in this set of HIV patients is the first step towards improving their Quality of Life.

The mean oral methadone dosage is reported to be 60-100 mg per day (Vazquez 2006).

We measured methadone oral dosages in three methadone clinics in Paris (Espace Murger, Marmottan, Horizons). The number of patients evaluated was 197. They were all at the steady state of methadone treatment. The influence of sex, center, age and retention in the program on prescribed oral dosage was tested with khi2 and spearman tests.

The mean dosage was 52 mg/d (+/- 28). The mean retention in the methadone program was more than three years. The dose range was [5-130]. The dosage was not different according to sex (p= 0,388), retention (p = 0,744), and age (p = 0,144). But the dosages were statistically different according to the center: 60 mg/d in Horizons (N = 37), 54 mg/d in Murger (N = 104), and 44 mg/d in Marmottan (N = 56) (p = 0,022).

This study confirms the great variability of methadone oral dosages in France, with a center-effect. Dosages that were found are still lower than what is found in other countries [5-350 mg/j] (Eap 2000). Other variability factors are to be considered: clinical, pharmacokinetic and pharmaco-dynamic factors.

[1]. Vazquez V, Gury C, Laqueille X. Méthadone : de la pharmacocinétique à la pharmacologie clinique. L'Encéphale 2006 ; 32 : 478-86

[2]. Eap CP, Bourquin M, Martin JL, et al. Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment. Drug and Alcohol Dependence 2000 :61,47–54

To compare the tolerability and efficacy of escitalopram and duloxetine in the treatment of patients with major depressive disorder over 8 weeks.

Data from two randomised, multi-centre, double blind studies in specialist1 or psychiatric and general practice settings were pooled and analysed for all patients and for severely depressed patients (baseline MADRS at least 30). The primary efficacy measure in both studies was the MADRS total score.

Patients were randomised to either escitalopram (10-20mg/day) (n=280) or duloxetine (60mg/day) (n=284). Escitalopram was statistically significantly superior to duloxetine with respect to mean change from baseline in MADRS total score at Weeks 1, 2, 4, and 8 (LOCF). The mean treatment difference at Week 8 was 2.6 points (p<0.01). For severely depressed patients, a mean treatment difference at Week 8 of 3.7 points (p<0.01) was seen. Response to treatment at Week 8 was statistically significantly greater for patients treated with escitalopram, as was remission when defined as MADRS<=10 or 12. The percentage of escitalopram-treated patients that withdrew (12.9%, n=36) was significantly (p<0.001) less than in the duloxetine group (24.3%, n=69). Significantly fewer (p<0.001) escitalopram-treated patients withdrew due to adverse events (4.6%, n=13) than from the duloxetine group (12.7%, n=36).

Escitalopram showed advantages in efficacy and tolerability compared to duloxetine in the acute treatment of patients with major depression. There were additional benefits for escitalopram-treated patients with severe depression.

This study evaluated the efficacy and tolerability of escitalopram and duloxetine in the treatment of major depressive disorder (MDD).

Patients were randomised to 24 weeks of double-blind treatment with fixed doses of escitalopram (20mg) (n=144) or duloxetine (60mg) (n=151). The primary analysis of efficacy was an ANCOVA of change from baseline to endpoint (Week 24) in MADRS total score (last observation carried forward).

At Week 8, the mean change from baseline in total MADRS score was -19.5 for escitalopram-treated patients (n=143) and -17.4 for duloxetine-treated patients (n=151), a difference of 2.1 points (p<0.05). At Week 8, the proportion of responders (at least 50% decrease in MADRS) was 69% (escitalopram) and 58% (duloxetine) (p<0.05) and remission (MADRS<=12) rates were 56% (escitalopram) and 48% (duloxetine) (NS). For the primary endpoint, the mean change from baseline in total MADRS score at Week 24 was -23.4 for escitalopram-treated patients and -21.7 for duloxetine-treated patients, a difference of 1.7 points (p=0.055, one-sided). The difference in mean change from baseline in MADRS total score favoured escitalopram at Weeks 1, 2, 4, 8, 12, and 16 (p<0.05). The overall withdrawal rates were 22% (escitalopram) and 26% (duloxetine) (NS). The withdrawal rate due to adverse events was lower for escitalopram (9%) compared to duloxetine (17%) (p<0.05) and significantly more patients treated with duloxetine reported insomnia (12.6% versus 4.9%) and constipation (8.6% versus 2.8%).

Escitalopram was superior to duloxetine in acute treatment, and at least as efficacious and better tolerated in long-term treatment of MDD.

We designed a prospective study to determine if an association exists between alexithymia, leptin levels and hopelessness in patients with major depressive disorder, before and after treatment.

The study included 170 patients suffering from major depressive disorder, and they were divided into 2 groups: 100 subjects with alexithymia (MDD-A) & 70 subjects without alexithymia (MDD-nonA). All patients received 12 weeks of fluoxetine treatment.

After 12 weeks treatment, the MDD-nonA group had a significant increase in leptin levels compared with the MDD-A group (25.7% vs 9.5%). In addition, there was a significant decrease in hopelessness level in the MDD-nonA group compared with the MDD-A group (35.0 % vs 17.6 %). At the index week and follow-up week, the MDD-A group showed significantly higher scores of alexithymia, Beck depressive index (BDI), and hopelessness than the MDD-nonA group; the MDD-A group had significantly lower levels of leptin than the MDD-nonA group. The correlation coefficients between alexithymia and BDI, between alexithymia and hopelessness, and between alexithymia and leptin levels were not statistically significant. However, the correlation coefficients among BDI, hopelessness, and leptin levels were significant.

Our findings supported the premise that alexithymia, decreased leptin levels, BDI, and hopelessness are related and that both decreased leptin levels and hopelessness are strongly associated with severity of depression . These findings further reveal that alexithymia and depression are distinct constructs.

to assess the role of social and psychological factors in manifestation of depression and anxiety, to estimate the prevalence of depression and anxiety symptoms among students.

students of Universities in Lithuania participate in survey: they are assessed with HADS, Beck Depression Inventory and the Symptoms of Anxiety-Depression index containing four symptoms of anxiety (tension, restlessness) and depression (feeling blue, hopelessness). The population includes students aged 20 – 22 years. We are assessing students in the first and four years from the various universities. Demographic, environmental data, psychological and social factors are associated with manifestation of depression and anxiety symptoms.

results show, that the prevalence of depressive and anxiety symptoms is rather high. The HADS scale performed better in detecting depressive and anxiety disorders. Patients with anxiety and depressive disorders had adverse social and psychological factors, as financial problems, lack of support from parents, workload, personality features. Personal psychiatric history is related to depression.

These findings underline the importance of screening of depressive and anxiety disorders in young people – students of Universities. Preventive mental health programs should be developed and implemented.

There is a dearth of epidemiological research on psychosis. Most of the published literature is either at a national scale, or compares urban and rural areas. Little is known about how psychosis rates vary within urban areas. Variation in rates would have implications for the aetiology of psychosis

We conducted a retrospective audit of the caseloads of the four Community Mental Health Teams (CMHTs) in Luton,UK. Caseloads were categorised by diagnoses recorded in the medical notes, and by patient age. We performed a descriptive analysis of the levels of psychosis in each CMHT, considered against multiple population parameters including deprivation and ethnicity as recorded in the 2001 UK census.

Areas with high indices of deprivation, and a large ethnic minority and migrant population, were found to have higher rates of psychosis. There was considerable overlap between areas with large ethnic minority and migrant populations, and areas of high deprivation. We were unable to disentangle this confounder in our audit.

Our findings are consistent with, and build on, the MRC Aetiology & Ethnicity of Schizophrenia & Other Psychoses (AESOP) study which showed variation in psychosis between three urban centers. The increased rates of psychosis observed in areas with large migrant and ethnic minority populations, and in areas of high deprivation, has implications for the planning of local services, and in further understanding the role of environmental factors in the aetiology of psychosis. There is a need for further prospective epidemiological studies at this geographical scale.

As depression and anxiety can have profound negative effects on the functional status, quality of life, duration of hospitalization and even medical out come of cancer patients, therefore evaluation and treatment of these disorders are important.

This was a descriptive study to assess the prevalence of anxiety and depression in cancer patients hospitalized at Isfahan Sayyed-o-shohada hospital. A total of 173 hospitalized patients were entolled. The Beck Depression Inventory (BDI) and Zung Self- rating Anxiety Scale (ZSAS) were applied to measure depression and anxiety respectively. Data were analyzed using chi-squar test running SPSS-ll soft-ware.

Prevalence of anxiety and depression was found to be 18.5% and 32.9% respectively. Anxiety had a higher Prevalence among women (P< 0.05). Patients in the age group of 50 – 65 years old had the highest rate of anxiety (P < 0.05). Age or gender had no correlation with depression. Type of malignancy, duration of treatment and treatment method were not correlated with prevalence of depression and anxiety.

Considering the relatively high prevalence of anxiety and depression among cancer patients, careful attention must be paid toward diagnosis and treatment of these morbidities.

Psychiatric morbidity among Afghan refugees in Iran, especially those who are resettled in camps has been poorly studied. This study was done to determine the prevalence of mental health problems and the associated effective demographic factors.

Cross-sectional survey of 321 resettled Afghan refugees who were at least 15 years old. A version of the General Health Questionnaire (GHQ-28) in Persian was administered. Data were analyzed using univariate analysis and logistic regression.

Social dysfunction with 80.1% and depression with 22.1% had the highest and lowest prevalence. 48.9% had psychosomatic problem, and 39.3% of them had anxiety. Regarding each person that had at least one mental health disorder as unhealthy, 88.5% of the studied population had mental health problem. Being a man, living with more than eight persons in the same home, and being ten or under ten years at the migration time were statistically significantly associated with higher levels of social dysfunction. Having psychosomatic problem was associated with unemployment, being born in Iran, being ten or less than ten years at the migration time, and having no entertaining programs. Having 1-3 children, living with more than eight persons in the same home, and positive history of chronic disease were statistically significantly associated with higher levels of anxiety. Moreover, having no entertaining programs, and family members' death during migration were associated with higher levels of depression.

Mental health problems related to immigration and living in camps, were common among Afghan refugees resettled in Bushehr refugee camp.

Eating Disorders are strongly associated with psychological distress. We examined this association for anorectic and bulimic symptoms and obesity.

Cross sectional study of 2263 adolescents aged 15-18 years-old from 10 schools in Northwestern Greece. Subjects were screened using the 12-item general health questionnaire (GHQ-12). 873 subjects were selected for the second stage interview with the revised Clinical Interview Schedule (CIS-R) and asked for eating and dieting practices. Odds ratios adjusted for age and sex were computed for the association between eating disorder symptoms and scores on the CIS-R.

Eating disorder symptoms are prevalent among adolescents (Anorectic symptoms=15.8% ♀/♂=30/1, Bulimic symptoms=9.3% ♀/♂=2/1, Binge Eating symptoms=10.2% ♀/♂=1/1) and they are strongly associated with high psychological distress (CIS-R score≥18). The Odds Ratio (OR) of having a high score on the CIS-R for subjects with anorectic symptoms compared to healthy subjects was 3.7 (95% Confidence Intervals 2.1 – 6.5). For bulimia the OR was 12.9 (4.7 – 35.4) and for binge eating the OR was 7.2 (2.4 – 21.4). Obesity was not associated with higher psychological distress but it was found to influence satisfaction with body image and self reported physical health.

The prevalence of eating-related symptoms defines a risk-population, much larger than the clinical significantly cases of eating disorders. The “eating related disorders” should be considered in a continuum in the one side of which lie obesity and on the other anorexia/bulimia nervosa, connected with the pre-morbid situations of Anorectic/bulimic symptomatology.

“The research Project is co-funded by the European Union - European Social Fund (ESF) & National Sources, in the framework of the program "Pythagoras II" of the "Operational Program for Education and Initial Vocational Training" of the 3rd Community Support Framework of the Hellenic Ministry of Education.”

To test the hypothesis that Anorectic and Bulimic symptoms in adolescence are associated with smoking, substance use, unhealthy nutrition and increased physical exercise.

Cross sectional study of 2263 adolescents aged 15-18 years-old from 10 schools in Northwestern , Greece. Subjects were screened using the 12-item general health questionnaire (GHQ-12). 873 subjects were selected for the second stage interview with the revised Clinical Interview Schedule (CIS-R) and asked for eating and dieting practices. Odds ratios adjusted for age and sex were computed for the association between eating disorder symptoms and scores on the CIS-R.

Bulimic but not anorectic symptoms were positively associated with weekly consumption of Sweets, Hams and Crisps (Odds ratios [OR] from 1.57 to 2.02, p<0.05) and increased alcohol consumption (OR=1.81, 95% Confidence Intervals: 1.23 - 2.67). Moderate to vigorous physical activity was negatively associated with symptoms (OR=0.31, 95% CI: 0.13-0.72). Both Anorectic and Bulimic Symptoms were not associated with weekly consumption of fruits-vegetables and nicotine or cannabis use.

These findings support the hypotheses that bulimic symptoms are correlated more than anorectic symptoms with bad nutrition habits and sedentary behavior. Neither the anorectics nor the bulimics used smoking as a weight-restriction strategy. Alcohol use but not other substances seem to be more prevalent among bulimic adolescents.

“The research Project is co-funded by the European Union - European Social Fund (ESF) & National Sources, in the framework of the program "Pythagoras II" of the "Operational Program for Education and Initial Vocational Training" of the 3rd Community Support Framework of the Hellenic Ministry of Education.”

Few studies have looked at the very long-term outcome of individuals with autism who were diagnosed in childhood. A longitudinal, prospective, community-based follow-up study of adults who had received the diagnosis of autism (classic and atypical) in childhood was conducted with the purpose of investigating diagnostic categories, outcome, symptoms, and symptom patterns. The present study is a follow-up study of 120 individuals with autism diagnosed in childhood 13-22 years after original diagnosis.

Diagnostic Interview for Social and Communicative Disorders (DISCO-10), Vineland Adaptive Behaviour Scales (VABS), Global Assessment of Functioning scale (GAF), outcome criteria and neuropsychiatric examination.

Eighty-five percent of both the classic and atypical autism groups now received the diagnosis of classical autism when re-examined. Overall outcome was poor in 78% of cases. Only four individuals were independent albeit leading fairly isolated lives. Childhood IQ-level was positively correlated with better adult outcome. In the majority of cases symptoms typical of the childhood period were still present in adulthood, but some clusters of behaviour (particularly hyperactivity) were much less prevalent than they had been in the past.

Children with autism as diagnosed in the 1960s, 1970s, and 1980s may have an even worse psychosocial outcome than previously believed.

Many mentally distressed individuals seek emergency department (ED) care in the US, but the extent and correlates of significant mental health problems in such patients is unknown.

All patients aged 18-60 presenting to an inner-city midwestern US ED April 2006-March 2007 were approached to participate in brief health screening. Exclusions were serious trauma preventing interview, unable to provide informed consent, pregnancy, acute suicidality, or presenting for psychiatric evaluation. Consenting patients completed a short web-tablet screen, including SF-12 for mental and physical health status, recent substance use and DSM-IV diagnoses of substance use disorders.

The lowest 25% on the SF-12 Mental Health Component were assigned to “poor mental health functioning” (PMHF). 5641 patients participated (58% female, 57% African-American). In bivariate analysis, the PMHF group was significantly more likely to be unmarried, female, use cocaine and marijuana, and binge drink in the past year, and have DSM-IV substance use disorders. Multiple logistic regression found that being female (OR=1.8), older (OR=1.01), not being married (OR=1.2) and DSM-IV alcohol abuse and dependence (OR=1.7, 2.4), cocaine abuse and dependence (OR=1.9, 2.0), and marijuana dependence (OR=1.7) were all independent predictors of PMHF. In a separate model, use of cocaine (OR=2.7) and marijuana (OR=1.7) but not use of alcohol, were independent predictors of PMHF as well as gender, age, and marital status.

Therefore PMHF in ED patients is strongly associated with recent substance use. ED clinicians should regularly ascertain both mental health status and substance use and refer for additional services where appropriate.

Significant life expectancy increase in HIV-positive patients undergoing antiretroviral therapy (HAART) has motivated inquiries into their quality of life.

To describe quality of life and reliability of WHO's Quality of Life Instrument ((WHOQOL HIV BREF) in depressed or non-depressed HIV/AIDS outpatients in a specialized facility in Rio de Janeiro.

Sectional study in 33 depressed (D) and 70 non-depressed (ND) HIV patients classified using Composite International Diagnostic Interview (CIDI10), Hamilton's depression scale, viral load, CD4 and demographic data. Means of all six WHOQOL HIV BREF domains were compared by the Student t test. Inter-interviewer reliability was evaluated by intraclass correlation coefficient (CCI) with CI of 95%.

The sample comprised mostly of male (62.2%), single (42.9%) AIDS patients (51%), who considered themselves ill (66.3%) and were on HAART (78%). Reliability was excellent, varying from CCI 0.95 (0.93-0.97) for the environmental domain to CCI 0.99 (0.98-0.99) for psychological, level of independence and spiritual domains. Means for all domains in depressed patients (D) were lower than those seen in non-depressed patients (ND) (p<0.005): physical domain 11.0 (D) and 15.3(ND); psychological domain 10.1(D) and 14.7(ND); level of independence domain 10.8(D) and 14.1(ND); social relationship domain 11.9(D) and 15.2(ND); environmental domain 11.9(D) and 15.1(ND); spiritual domain 11.5(D) and 15.5(ND).

WHOQOL HIV BREF's showed excellent reliability and its six domains discriminated several quality of life aspects in depressed and non-depressed HIV/AIDS's patients. Depressed patients have a worst perception of their quality of life for all WHOQOL HIV BREF's domains.

This paper describes the use of mental health data from a centralized regional intake and access tracking system for regional mental health and psychiatry services and provincial data to describe mental disorder as a function of regional population density. Population-based utilization results are compared to available epidemiological data. Implications for existing and future service models are examined.

Diagnoses from annual data collected in the regional CAMHP information system from 2002-2007 (n = 25,000 registrants) was used. Estimates of population calculated from the regional census were used to denominate the utilization diagnostic data. Cumulative and annual density results were represented graphically and using GIS mapping techniques.

The rate of publicly funded service provision to unique individuals in the catchment area (9/1000) is much lower than the expected rates of debilitating mental disorder in the base population (30/1000). Modeling the costs of service provision shows that two evidence-based forms of service delivery could dramatically improve access and capacity of mental health services within the catchment.

The results point to the need to develop novel evidence-based service delivery models so that the basic mental health needs of the population are met. Two such models are discussed.

To calculate the prevalence of mental disorders (anxiety, depression and psychosis) in the immigrant population compared to autochtonous population in primary care, exploring the predictive value of socioeconomic and demographic factors in the outcome.

In a cross-sectional, prevalence study, a sample of 200 immigrants and 200 autochtonous individuals attending primary care were evaluated with the Mini International Neuropsychiatric Inventory, the Goldberg Anxiety and Depression Scale, the General Health Questionnaire, and a demographic information sheet.

Immigrants showed higher levels of psychopathology relative to autochtonous patients for most mental disorders. Socioeconomic and demographic factors, particularly those related to the immigrant's living and work condition were positively correlated with psychopathology. Rates of some mental disorders in the immigrant group exceed the expected levels to the extent that the findings may be spurious.

Immigrants are at greater risk for developing a mental disorder, however this would in part appear to be a result of socioeconomic and demographic factors. It may be the case that the elevated rates of immigrant psychopathology may in part be a function of error due to the lack of cultural equivalence of the instruments employed. Further study is required to clarify these points.

The relationship between immigration and the secondary development of psychopathology remains unclear. Studies have raised contradictory findings, although it generally found that migrants face a higher level of stress than general population. This stress consists of different factors, of which “perceived discrimination” would appear to be the most significant. Clinical experience indicates that there may be an association between the intensity of stress related to perceived discrimination and mental disorders, of which anxiety and affective disorders are the most frequent. This study evaluates the relationship between perceived discrimination and anxiety and affective disorders.

The data was drawn from a multicentric, observational, cross-sectional study comparing psychopathology in migrants relative to the autochthonous population attending primary care health centres in Catalonia (Spain). 150 individuals from each cohort were evaluated with the MINI international Neuropsychiatric Interview and the Perceived Discrimination subscale of the Barcelona Immigration Stress Scale. A first step compared scores on anxiety and affective disorders between the two groups. In the second step, multivariate analyses were carried out to determine if perceived discrimination and sociodemographic factors were correlated with the presence of anxiety and affective disorders.

Immigrant patients were found to have higher levels of both anxiety and affective disorders relative to the autochthonous population. Perceived discrimination was predictive of psychopathology, and also moderated the impact of certain sociodemographic characteristics such as legal status.

The metabolic syndrome is associated with an increased cardiovascular comorbidity and mortality. Many epidemiological studies prove an increased prevalence of the metabolic syndrome among psychiatric patients compared to the general population.

In this on-going naturalistic observational study carried out in an inpatient treatment setting we as yet surveyed the parameters of the metabolic syndrome in 188 psychiatric patients at admission and at discharge. According to the NCEP definition at least three of the five following criteria have to be fulfilled for diagnosing the metabolic syndrome: visceral adipositas (waist circumference: male > 102 cm; female > 88 cm), diabetes mellitus (fasting glucose > 110 mg/dl), arterial hypertonia (≥130 mmHg systol., ≥ 85 mmHg diastol.), elevated triglycerides (≥ 150 mg/dl), reduced HDL cholesterol (male< 40 mg/dl; female< 50 mg/dl).

At discharge we found significantly more patients with visceral adipositas (p=0.0001) and elevated triglycerides (p=0.014) compared to the time of admission. A significantly higher percentage of female in comparison to male patients were diagnosed a metabolic syndrome. Higher age was associated with a higher prevalence of the metabolic syndrome (p=0.001, N=186).

Our results demonstrate a deterioration of parameters of the metabolic syndrome in the course of an inpatient treatment. As visceral adipositas constitutes an essential risk factor for metabolic and cardiovascular diseases, an uncomplicated and easily manageable measurement of visceral body fat percentage would be desirable. In a pilot study we are evaluating the informative value of visceral body fat percentage as measured by a body composition analyzer.