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BackgroundMajor depressive disorder (MDD) is a public health burden that creates a strain not only on individuals, but also on the economy. Treatment-resistant depression in the course of major depressive disorder represents a clinically challenging condition that is defined as insufficient response to two or more antidepressant trails with antidepressants of the same or different classes that were administered at adequate daily doses for at least 4 weeks.Objective/HypothesisTo develop a treatment guideline for Treatment Resistant Depression (TRD).MethodologyExperts in the field gathered and reviewed the available evidence about the subject. Then, a series of meetings were held to create recommendations that can be utilized by Egyptian psychiatrists.ResultsThe guidelines provide recommendations in various clinical settings. It evaluates different situations, such as patients at risk of resistance, those with resistance and recommends strategies to resolve the clinical case.ConclusionThe consensus guidelines will improve the outcomes of patients, as they provide recommendations across various domains that are of concern for the practicing psychiatrist.

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Objectives:to find an association between substance use and risky sexual behavior and to find association between personality traits and risky sexual behavior among substance users.Subjects and Methods:The study was applied on 100 subjects classified into 2 groups: cases and control groups. Group 1(cases) 50 substance dependence patients are chosen sequentially from the addiction department of the psychiatry and addiction hospital in kasr-alainy and group 2 (controls) included 50 normal individuals, matched for age, sex and socioeconomic status. All participants are men, range from 18 to 40 years, were taking substances for at least 6 months, and all of them could read and write. Those with a comorbid axis I diagnosis were excluded from the study. Both groups were subjected to a full psychiatric sheet, sex risk subscale of risk assessment battery (RAB), and the Eysenck personality questionnaire (EPQ). Addiction severity index is applied on cases, urine sampling was done using urine drug screening strips and a laboratory test was done for HIV and hepatitis C virus detection.Results:no statistically significant difference between the 2 groups regards age, education, employment and social status. The most prevalent substance is Tramadol (96%) followed by Cannabis (72%) and Herion (58 %). Hepatitis C virus is detected in (16 %) of cases, non of them have HIV infection. There were statistically significant difference in extroversion and neuroticism between cases and controls. There were a statistically significant difference between cases and controls in the sex risk subscale of RAB.There was a significant correlation between psychotocism and criminality subscales of (EPQ) and the sex risk subscale of RAB.