Current antidepressants are clinically effective only after several weeks of administration. Because our previous studies indicated that both acute and sustained stimulation of serotonin4 (5-HT4) receptors facilitate central 5-HT activity, we assessed the ability of 5-HT4 agonists to induce antidepressant-like effects in the rat brain within a short (3 days) time-frame.

We found that 5-HT4 agonists reduce immobility in the Forced Swimming Test, displaying an antidepressant potential. Moreover, a 3-day regimen with such compounds modify rat brain parameters considered as key markers of antidepressant action, but observed only after 2-3 week treatments with classical molecules: desensitization of 5-HT1A autoreceptors, increased tonus on hippocampal postsynaptic 5-HT1A receptors, enhanced phosphorylation of the CREB protein and neurogenesis in the hippocampus. A 3-day regimen with the 5-HT4 agonist RS 67333 was also sufficient to reduce both the hyperlocomotion induced by olfactory bulbectomy, and the diminution of sucrose intake consecutive to a chronic mild stress. Moreover, the concomitant administration of a 5-HT4 receptor agonists with a classical antidepressant (SSRI) potentiated the amplitude of these effects, without altering the rapidity of action of the former.

These findings point out 5-HT4 receptor agonists as a putative new class of antidepressants, with a rapid onset of action.

In term of efficacy and onset of action, current antidepressant drugs still suffer from important drawbacks. Hence, we recently assessed whether the pharmacological blockade of serotonin 7 receptors [5-hydroxytryptamine (5-HT7) receptors] can produce a faster and safer antidepressant response than fluoxetine (Prozac®), the most prescribed antidepressant.

In rats, we showed that SB-269970, a selective 5-HT7 receptor antagonist, exerts an effective antidepressant-like effect as assessed in the forced swim test. Moreover, we revealed in vivo that 5-HT7 receptors negatively regulate the firing activity of dorsal raphe 5-HT neurons and become desensitised after a chronic treatment with fluoxetine. In contrast to fluoxetine, a one-week treatment with SB-269970 did not decrease 5-HT neuronal firing activity but desensitized 5-HT autoreceptors, enhanced the hippocampal cellular proliferation rate and counteracted the anxious/depressive-like behaviour that present the olfactory bulbectomized rat model. Finally, early life treatment with fluoxetine, but not with SB-269970, induced anxious/depressive-like behaviours in adulthood.

These results indicated that the 5-HT7 receptor participates in both mood regulation and the antidepressant effect of SSRIs, and that 5-HT7 receptor antagonists may represent a new class of antidepressant drugs with safer and faster therapeutic action.

Many researches conducted in antidepressant therapeutics aimed to obtain a reduction of the delay of action of the drugs. Until now, neither antidepressant per se, nor potentialization strategies (5HT1A agonists), have obtained some significant results. Deep Brain Stimulation (DBS) techniques used in resistant and severe depressive patients have shown a rapid improvement of several patients from the first week of treatment. In that sense, mechanism of action of DBS could represent a model for improving the duration of action of antidepressant.

Comparison of data extracted from clinical trials using antidepressants and those obtained from brain electro stimulation techniques.

The current data do not allow to conclude to a faster action of DBS technique in depression. However, results obtained from randomized control trials will provide some more powerful data.

a better comprehension of the mechanism of action of DBS is crucial for the improvement of the action rapidity of new antidepressants.

5-HT2C receptors are well known to be involved in anxiety, but their implication in stress-induced changes of 5-HT transmission remained to be investigated. We thus assess the behavioral and neurochemical effects of 5-HT2C receptor activation in naïve and stressed mice, and after chronic paroxetine known to exert anxiolytic effects in humans.

The effects of the preferential 5-HT2C agonists m-chlorophenylpiperazine (mCPP) and RO60-0175, the selective 5-HT2C receptor antagonist SB242,084 and restraint-stress on anxiety-like behavior in mice were assessed using the social interaction test, while the neurochemical effects of these treatments on 5-HT turnover (5-HIAA/5-HT ratio) and extracellular 5-HT were determined using HPLC and microdialysis. Both mCPP and restraint-stress increased anxiety-like behavior in the social interaction test, and these effects were blocked by pretreatment with SB242,084. Restraint-stress increased 5-HT turnover in various brain areas, and this effect could be prevented by the 5-HT2C receptor agonist RO60-0175. Acute administration of SB242,084 potentiated the stress-induced increase in 5-HT turnover and blocked the inhibitory effect of RO60-0175. Microdialysis studies in frontal cortex revealed that RO60-0175 has an inhibitory effect on the stress-induced increase in extracellular 5-HT levels, but not on basal 5-HT levels. Chronic paroxetine prevented the anxiogenic effect of mCPP and prevented the inhibitory effect of RO60-0175 on restraint-stress-induced increase in 5-HT turnover.

These data strongly suggest that 5-HT2C receptor activation mediates the anxiogenic effect of stress. In addition, the anxiolytic action of long term treatment with SSRIs might be causally related to a clear-cut 5-HT2C receptor desensitization.

Höschl C, Kozeny J. Predicting academic performance of medical students: The first three years. Am. J. Psychiatry 1997;154(6): 87-92 Höschl C. Pathways of Integrated Medical Curriculum. Surg Radiol Anat. 2007;29(6):423

For the last dozen years, there has been a reduction of candidates for specialization in Psychiatry. Furthermore, we receive complaints from the units where they work as young psychiatrists after training. Although, five years ago the examination-selection to this specialisation became a federal contest which prioritises grades obtained during their medical studies, this does not alone account for this development.

The authors teach in the Faculty of Medicine, but are also involved in the selection process, and in the process of accompanying candidates as they master Psychiatry. Based on their experiences and meetings with colleagues in other universities, they formulate hypotheses to explain this phenomenon.

In addition to the reduction of numbers of candidates for specialisation, the complaints regard their competences in three domains: Pharmacotherapies, Psychoterapies, and their leadership style which is qualified as authoritarian.

We believe DSM II and subsequent versions had important effects on how psychiatry is taught. While trying to free the DSM from the influence of Psychoanalysis and not wanting to reduce training to merely learning statistical diagnostics and pharmacotherapeutic guidelines, training in Psychiatry has become «a little of everything and nothing precise». The result of this lack of content is young psychiatrists, lacking in self confidence and not sure enough of their references to establish a leadership style other than authoritarian.

During medical studies, we need to reinforce the courses of physio-pharmaco-therapy, Psychotherapy, and comparative psychopathologie and add training in team management.

Optimal mental health care for Lesbian, Gay, Bisexual, and Transgender (LGBT) populations requires access to both competent prevention and treatment mental health services.

This paper will explore the barriers for LGBT people to accessing adequate and sensitive mental health care in Europe and the potential for the improvement of mental health services.

This paper will draw from an investigation on access to health care for lesbians in Germany, which triangulated qualitative und quantitative methods to study self-perceived barriers to culturally sensitive and appropriate care. The debate about LGBT mental health in the last few years will be illustrated by examples from several European countries and differences between countries will be highlighted.

LGBT people encounter numerous specific barriers to accessing mental health services, such as the lack of geographically and financially accessible providers who offer culturally sensitive, non-discriminatory care. Providers often lack specific knowledge, appropriate intervention strategies and general psychosocial skills to adequately serve LGBT clients. The findings show that these factors negatively shape the experiences of LGBT clients with the health care system.

Several countries have started initiatives to improve the quality of services for LGBT clients and their access to optimal mental health care.

Strategies and actions on all levels of the health care system - from public health policy making to the individual provider - are required to address access barriers and to establish equal and universal access for LGBT populations.

In this workshop, Dr. Nakajima will discuss position statements that the American Psychiatric Association (APA) has taken concerning gay and lesbian issues and mental health.

A review of position statements by the American Psychiatric Association and European psychiatric organizations about gay and lesbian mental health issues.

The APA was the first psychiatric organization to delete homosexuality as a mental illness from its nosology, DSM-II back in 1973. When homosexuality was deleted the APA also passed a resolution affirming the civil rights of gay men and lesbians. These position statements in 1973 were the first of a long number of positions statements that the APA has taken concerning mental health issues for gay men and lesbians. In 1987 the APA voted against keeping egodystonic homosexuality in DSM-III R and currently there is no diagnoses related to homosexuality in DSM-IV. The APA has also taken position statement concerning adoption and co-parenting of same-sex couples as well as discrimination of gay and lesbians in the US military. In the past few years the APA has developed position statements against therapies to change sexual orientation, which is sometimes referred to as “conversion or reparative therapy,” and in support of same sex marriage. Some European psychiatric associations including Norway's and the United Kingdom's have followed the APA in passing position statements against conversion therapies.

We will discuss the importance of Psychiatric Organizations to make formal position statements to advance the mental well being of lesbians and gay men.

The objective of implementing a cost effective analysis on four arms of a schools based mental health intervention is to find the most cost effective way of detecting suicidal ideation among young people with the ultimate aim of preventing suicide. These interventions are as follows; a professional screening of young people, a question persuade and refer programme, an awareness programme and a poster campaign.

Cost data on the four arms of the mental health intervention is collected using costing questionnaires. Each cost relating to the interventions is recorded. The main focus is on direct costs, primarily derived from the personnel costs associated with the health professionals involved. A cost effective analysis will be carried out. This means that the costs of each intervention will be measured against the health outcomes of each intervention and a cost effectiveness ratio is calculated.

The interventions are currently being undertaken and therefore the costs have not been collected yet. However, instruments have been designed to aid in the collation of the costs. Once the interventions are completed, the costs and the number of young people reporting, and being treated, for suicide ideation is recorded. Preliminary results are expected shortly thereafter.

It is expected that the four schools based mental health interventions will detect cases of suicide ideation among young people. The exact numbers are as yet unknown.

For Major Depression, current guidelines recommend treatment durations of 3-8 weeks until optimisation in case of insufficient outcome. Many retrospective studies indicate that improvement (HAMD-17 decrease ≥20%) occurs usually within 10-14 days and that non-improvement after 14 days of treatment is highly predictive for poor clinical outcome.

In level 1 of the EMC trial, non-improvers after 14 days of antidepressant treatment will be randomised to “early medication change” (EMC) strategy or treatment according to current guidelines (TAU). EMC schedules treatment optimisations on day 15 and day 29 in case of non-improvement. TAU schedules a medication change after 28 days in case of non-response (HAMD-17 decrease < 50%). Both interventions will last 42 days. In levels 2 and 3, EMC strategies will be compared with TAU strategies in improvers on day 14, who experience a stagnation of improvement during the course of treatment. The EMC trial is a multi-centre, multi-step, randomised controlled trial investigating for the first time prospectively, whether non-improvers after 14 days of antidepressant treatment with EMC are more likely to attain remission on treatment day 56 compared to patients with TAU. The trial is funded by the German Federal Ministry of Education and Research (BMBF), will be conducted in cooperation with the BMBF supported Interdisciplinary Centre for Clinical Trials (IZKS) Mainz and at six trial sites in Germany.

If the EMC strategy leads to significantly more remitters, consecutive revision of guidelines, clinical practice and research settings for the treatment of MD can be expected.