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Objective The current article is aimed at identifying the best practice for counseling around depression in community and outpatient pharmacies, resulting in a draft guideline, proposing key steps and an algorithm for integration of community pharmacists into care for patients with depression. Methods A literature review was performed followed by a detailed analysis, for the purpose of creation a short draft document used as a basis for creation of a guideline for pharmaceutical care for patients with depression. The technological scheme PRISMA flow diagram was applied. The paper is based on current knowledge, taking into consideration already published articles, guidelines, and recommendations about pharmaceutical care for patients with depression, giving a basis for further studies. Results This paper includes two main sections: 1) depression – a short description of the main symptoms, risk factors and pharmacotherapy guidelines available in Bulgaria important for the purposes of ensuring qualitative community-based pharmaceutical care; and 2) the pharmacists’ role in providing high-quality care – the main aspects of pharmaceutical care for patients with depression with specific examples. Conclusion The involvement of pharmacists in supporting depressive patients is crucial taking into account the specific characteristics of the pharmacological treatment: delayed onset of clinical results, risks in case of sudden pharmacotherapy abruption without physician consultation, multiple adverse drug reactions and drug–drug, drug–food and drug–alcohol interactions, etc. The current article could also be used as an initial document for creating a methodological guideline for providing pharmaceutical care services for patients with depression.

Въведение: Шизофрения и афективни разстройства са тежки психични заболявания с редица неблагоприятни последици за засегнатите, техните семейства и обществото. Цел: Анализ на разходите, ефективността и стойностната ефективност при лечение на шизофрения и афективни разстройства в реалната клинична практика. Материали и методи: Изследвани са 117 пациенти с шизофрения и афективни разстройства, постъпващи за болнично лечение в УМБАЛ „Александровска“, и техни близки и са проследени 12 месеца по-късно. Използвани са въпросници за оценка на използваните ресурси (CSSRI-EU), психопатологията (PANSS), функционирането (PSP), качеството на живот (MANSA) и бремето на неформалните грижи (BAS). Изследвани са разходите (от две перспективи: на здравната система и на обществото) и ефективността (като промяна в клиничните показатели). Проведен е анализ разход-ефективност с помощта на диаграми разход-ефективност и криви на приемливата рентабилност. Резултати: Шизофрения и афективни разстройства имат висока социална цена, като разходите от перспективата на обществото достигат респективно до 1737 лв./м. и 1072 лв./м. Само 20% от разходите са медицински. Ефективността е между 70 и 90% в зависимост от избора на клиничен измерител. Лечението на шизофрения и афективни разстройства в реалната клинична практика е ефективно и стойностно-ефективно при ниски нива на готовност за заплащане. Заключение: Инвестиране в психично-здравни грижи трябва да се възприема като устойчива инвестиция., Background: Schizophrenia and affective disorders are disabling mental illnesses with a range of negative consequences for the individuals, their families, and the society. Purpose: To analyze the cost, effectiveness, and cost-effectiveness of treating individuals with schizophrenia and affective disorders in the real clinical practice Materials and methods: 117 individuals with schizophrenia and affective disorder admitted for inpatient treatment at Alexandrovska University Hospital in Sofia, Bulgaria and their primary caregivers were recruited for the study and followed up after 12 months. Instruments were used to evaluate resource utilization (CSSRI-EU), psychopathology (PANSS), functioning (PSP), quality of life (MANSA) and caregiver’s burden (BAS). Costs were evaluated from healthcare and societal perspectives. Effectiveness was measured as the change in the clinical outcomes. Cost-effectiveness analysis was performed using cost-effectiveness planes and cost-effectiveness acceptability curves. Results: Schizophrenia and affective disorders have high societal costs, reaching up to 1737 and 1032 BGN per month respectively. The medical costs are only 20% of the total costs. The effectiveness varies from 70 to 90% depending on the chosen outcome. The treatment is cost-effective at low levels of willingness to pay. Conclusion: Investment in mental healthcare for should be viewed as a sustainable investment.

Activated leukocyte cell adhesion molecule (ALCAM, CD166) is a cell adhesion molecule of the immunoglobulin superfamily and has been implicated in diverse pathophysiological processes including T cell activation, leukocyte trafficking, and (lymph)angiogenesis. However, exploring the therapeutic potential of ALCAM blockade in immune-mediated inflammatory disorders has been difficult due to the lack of antibodies with blocking activity toward murine ALCAM. In this study, we identified and characterized a monoclonal antibody with high affinity and specificity for murine ALCAM. This antibody reduced in vitro T cell activation induced by antigen-presenting dendritic cells (DCs) as well as (trans)migration of murine DCs across lymphatic endothelial monolayers. Moreover, it reduced emigration of DCs from in vitro-cultured human skin biopsies. Similarly, antibody-based blockade of ALCAM reduced (lymph)angiogenic processes in vitro and decreased developmental lymphangiogenesis in vivo to levels observed in ALCAM-deficient mice. Since corneal allograft rejection is an important medical condition that also involves (lymph)angiogenesis, DC migration and T cell activation, we investigated the therapeutic potential of ALCAM blockade in murine corneal disease. Blocking ALCAM lead to DC retention in corneas and effectively prevented corneal allograft rejection. Considering that we also detected ALCAM expression in human corneal DCs and lymphatics, our findings identify ALCAM as a potential novel therapeutic target in human corneal allograft rejection., Frontiers in Immunology, 10, ISSN:1664-3224

Schnitzler syndrome is a rare autoinflammatory disease, which is defined by the presence of two major criteria: chronic urticaria and monoclonal immunoglobulin M (IgM) or immunoglobulin G gammopathy, in combination with at least two additional minor criteria: recurrent fever, leukocytosis and/or elevated C-reactive protein (CRP), objective signs of abnormal bone remodelling and a neutrophilic infiltrate in skin biopsy. We report on a 68-year-old female patient with a 10-year medical history of chronic urticaria, recurrent fever, severe arthralgia and increased CRP. Over the years, multiple diagnostic investigations were performed without conclusive findings, and therapeutic attempts with anti-histamines and several immunosuppressive agents had failed. The decision to initiate monotherapy with interleukin-1 (IL-1) receptor antagonist was based on immunohistochemical detection of the abundance of IL-1β positive cells in the patient's skin biopsy. After starting treatment with anakinra, disappearance of symptoms could be observed within 24 h. Discontinuation of the treatment resulted in a rapid relapse of the symptoms. Finally, already after the initiation of therapy with anakinra, the suspected diagnosis of Schnitzler syndrome could be confirmed by detection of IgM-gammopathy that was initially absent.

Background and Aims:Recent data from the literature show insufficiency of the information from training programmes in Psychiatry around Europe (1).Methods:Bulgarian Training Programme in Psychiatry (BTPP) was compared to the Training Requirements for the Speciality of Psychiatry (UEMS, 2017/08).Results:Our training programme generally complies with the UEMS recommendations with several exceptions, mainly concerning psychotherapy and supervision. While UEMS recommends u201cProgrammes to include... at least 120 hours of theoretical teaching and 100 hours of supervision of which at least 50 hours should be individualu201d, in the BTPP the words u201cpsychotherapyu201d and u201cpsychological treatmentu201d were mentioned only in the following statements: 1. u201cThe programme aims to prepare specialist with.... specific range of psychotherapeutic ... approachesu201d; 2. u201cThe programme covers the following subjects: ... psychotherapeutic interventions ...u201d. 3. u201cTheoretical education, organized for 15 weeks with 2 hours per week ... each covering one of the following topics ...psychological treatment...u201d (i.e. only 30 hours of theoretical teaching). The only mentioning of supervision is: u201cTraining is performed.... and includes clinical work under supervision...u201d and u201cThe programme aims to prepare a specialist who... is able to use and perform supervisionu201d. The words u201cSupervisoru201d and u201cChief of Psychotherapy Trainingu201d are not even mentioned, with no one assigned to perform the corresponding responsibilities.Conclusions:Further harmonization of the BTPP with focus on psychotherapy and supervision is needed. This is among the aims of the newly founded Bulgarian Young Psychiatristsu2019 Association.1 .Mayer S. et al., 2014. EPA guidance on post-graduate psychiatric training in Europe. Eur Psy 29, 101 u2013 106.