[Greek students' attitudes towards mental disorders].

Attitudes and beliefs of the population regarding the mentally ill have been universally subject of many researches. Research of different groups' opinion for mental disorders has given remarkable findings that assist in the right design of psychiatric services. Objective of this thesis is to study the attitude of students towards mental illness. In particular, it intends to study the differences derived from the age, gender, place of birth, kind of studies, year of study, duration of stay at the place of studies and the existence of mental disorders in the student's family. Data were collected from 536 students randomly selected from Universities and Technological Institutions both in Athens and Thessaloniki. In general, the participants are being divided based on the subject of their studies in undergraduates of human sciences, exact sciences, social and health sciences. The short version of the scale "Community Attitudes Toward the Mentality III" (CAMI) was used, which consists of 26 questions sorted to four subscales (domination scale, humanism scale, social exclusion scale and the scale measuring the community beliefs regarding the care of mentally ill), along with a special questionnaire in order to collect social and demographic data. Students' attitudes towards mental illness are influenced by demographic factors, the department they are studying at and the year of study. Female gender (p=0.000), personal contact with mentally ill (p=0.012), studying in Universities (p=0.031) and especially social sciences (p=0.009) are associated with positive attitudes. On the contrary, less years of studying are associated with negative attitudes whereas older students appear to score less in the Domination Scale (p=0.000). It is significant that the place of birth (p=0,335) and the duration of stay at the place of studies (r=0.735) did not show any association with the variables studied in this research. However these results cannot be compared with older researches since there are not sufficient findings. Women tend to show more humanitarian attitude towards the mentally ill in comparison to men, emphasizing the role the community plays in their support reinforcing their reintegration in the community verifying the results of research conducted in Greece and other countries. Furthermore, students who have previously been in contact with mentally ill tend to have more favorable attitude and understanding towards them. The findings concerning the age and the years of studying highlight the imperative need of exploring thoroughly the knowledge regarding the attitudes towards mental illness.

[Forensic psychiatry and Islamic law].

Islam is the second most popular monotheistic religion in the world. Its followers, the Muslims, are about 1.2 billion people and are the majority in 56 countries around the globe. Islam is an holistic way and model of life and its rules, according to a large proportion of Muslims, should have more power than the laws deriving from any secular authority. This means that the divine laws, as depicted from Islam's holy scripts, should be the laws of the land. In the strict Islamic states, as Saudi Arabia, the Islamic law or the Shari'ah prevails. Shari'ah means the path, the road each faithful Muslim should follow according to the rules of God. The Islamic views on mental health have some interesting characteristics: on the one hand, the moral necessity for the protection and care of the vulnerable individuals is very strong, but on the other hand superstitions and stigmatization influence the peoples' attitude against mental health patients. At the beginning of its historical course, Islamic world was a pioneer concerning mental health care. Unfortunately, as time passed by, we have observed considerable regression. In our days mental health services provided in most of the Islamic states cannot be considered adequate according to modern Western standards. The same course characterizes the Forensic Psychiatric services and the relevant legislation in the Islamic world.

Mental health law in Greece.

Like all European countries, Greece has developed its national legislation based on the principles of equality and the right of representation, but there is no separate, specific mental health law in Greece. This paper describes the law for involuntary psychiatric admission. The law concerning criminal and civil responsibility and the law relating to individuals with addictions committing drug-related crimes are also outlined.

Suicidal behaviour in the ancient Greek and Roman world.

OBJECTIVE: We attempt to present and analyze suicidal behaviour in the ancient Greek and Roman world. METHODS: Drawing information from ancient Greek and Latin sources (History, Philosophy, Medicine, Literature, Visual Arts) we aim to point out psychological and social aspects of suicidal behaviour in antiquity. RESULTS: The shocking exposition of suicides reveals the zeitgeist of each era and illustrates the prevailing concepts. Social and legal reactions appear ambivalent, as they can oscillate from acceptance and interpretation of the act to punishment. In the history of these attitudes, we can observe continuities and breaches, reserving a special place in cases of mental disease. The delayed emergence of a generally accepted term for the voluntary exit from life (the term suicidium established during the 17th century), is connected to reactions triggered by the act of suicide than to the frequency and the extent of the phenomenon. CONCLUSIONS: The social environment of the person, who voluntary ends his life usually dictates the behaviour and historical evidence confirms the phenomenon.

Suicide and seasonality.

OBJECTIVE: Seasonal variation of deaths by suicide offers an important pathway in the study of possible suicide determinants of suicide and consequently suicide prevention. METHOD: We conducted a review of the literature on suicide seasonality, assessing articles published between 1979 and 2009. RESULTS: The majority of the studies confirm a peak in spring, mainly for men, older individuals, and violent methods of suicide. A secondary peak during autumn is observed. There is no common seasonality pattern for suicide methods. However, there are also certain studies that did not confirm seasonal variation. Inconsistent results with reduced, unchanged, and even increased suicide seasonality have been reported. Aspects on the association between seasonality and suicides are discussed. Except sex, age, and method of suicide, other parameters were taken into account to find more specific characteristics of seasonality in suicides as well. The influence of clinical, bioclimatic, sociodemographic as well as biological factors seems to affect the seasonal variation. CONCLUSION: Studies from both the Northern and the Southern hemisphere report a seasonal pattern for suicides. These studies are not only an important source of epidemiological data for suicides but also represent a global effort to uncover hidden parameters of this self-destructive behaviour.

[Psychotherapeutic interventions in stereotypies].

Stereotypies belong to the psychomotor disorders and they are found in many different disorders. This article refers to the international literature about the psychotherapeutic interventions in stereotypies and reviews the psychotherapeutic techniques that are already being used for these disorders. This study refers to four kinds of psychotherapeutic treatment: (a) Behavioral therapy, (b) Milieu therapy which can be combined successfully with an occupational therapy, (c) Family therapy and (d) Supportive or cognitive or dynamic psychotherapy. The method used for finding the articles for this review was the web research. The articles found were 44 in total, but only 25 were studied extensively since they were absolutely relative to the subject of this review. 12 of these articles were case studies, 7 theoretical papers and 5 of them were reviews. The last one was a research epidemiological study. According to most of the articles, behavioral therapy is considered to be the most effective psychotherapeutic treatment for attenuating stereotypies and relies on techniques like systematic desensitization, environmental enrichment, positive reinforcement of alternative behaviors and negative reinforcement of the "problematic" behaviors. The milieu therapy, combined with occupational therapy, endeavours to shape an appropriate environment where the patient can recover. Family therapy focuses on fully informing the relatives about the nature of stereotypies. Supportive psychotherapy focuses on the current problems in the patient's life. The cognitive psychotherapy tries to fix the dysfunctional thoughts of the patients. Finally, the dynamic psychotherapy is focused on the restoration or reinforcement of the patient's defensive mechanisms. It should be noted that there is a lack of systematic research in the field of stereotypies in general and, especially, regarding psychotherapeutic interventions.

[A volumetric study of brain structures in subtypes of depression].

The aim of this study is to compare the volumes of hippocampus, amygdala and subgenual prefrontal cortex among patients with melancholic depression, patients with psychotic depression and normal controls. Thirty nine patients with a diagnosis of major depression (22 with melancholic and 17 with psychotic subtype) and 18 normal controls were included in the study. Hippocampal, amygdala, anterior and posterior subgenual cortex volumes were measured by manual tracings on magnetic resonance volumetric images and compared across the 3 groups. We identified larger amygdala volumes and smaller left anterior subgenual cortex volumes in both patient groups compared to controls. There were no differences in hippocampal, right anterior and posterior subgenual cortex volumes across the 3 groups. In conclusion, melancholic and psychotic depression were not differentiated regarding the volumes of the hippocampus, the amygdala, and anterior and posterior subgenual cortex, even though amygdala volumes and left anterior subgenual cortex volume of both patient groups were differentiated compared to controls.

[Behavioral and psychological symptoms of dementia and their management].

The decline in cognitive function is a core feature of dementias. However, other symptoms of the disease are also crucial. These symptoms are the behavioral and psychological manifestations of dementia and include symptoms such as delusions, hallucinations, delusional misindentification syndromes (DMS), illusions, anxiety, aggression, depression, personality changes, disinhibition-impulsivity, violation of social and moral norms, changes in dietary or eating behavior and repetitive behaviors. Delusions, hallucinations, anxiety, depression and aggression are highly prevalent in Alzheimer's disease, vascular dementia and dementia with Lewy bodies, whereas symptoms that include severe disturbance of behavior are highly prevalent in frontotemporal dementias. Psychotic symptoms are associated with subcortical disturbances mainly of the limbic system. Patients with depression present greater loss of noradrenergic cells in the locus coeruleus and loss of serotonergic nuclei of dorsal raphe. Furthermore, disturbances of behavior are associated with frontal lobe dysfunction. Atypical antipsychotics is the first treatment option for delusions, hallucinations, misidentifications, anxiety and aggression. Furthermore, antidepressants may be useful for moderate or severe depression as well as for disinhibition-impulsivity, aggression, changes in dietary or eating behavior and repetitive behaviors. Cholinesterase inhibitors may also improve apathy, anxiety, disinhibition, aberrant behavior, mood disorders and hallucinations. Moreover, non-pharmacological methods alone or in combination with psychotropic drugs may also improve patient's symptomatology.

Association of serum BDNF levels with hippocampal volumes in first psychotic episode drug-naive schizophrenic patients.

Evidence suggests that hippocampal volumetric abnormalities are present in first-episode schizophrenia. The hippocampus contains the highest brain levels of neurotrophic factors, which are major determinants of neuronal plasticity. Brain-derived neurotrophic factor (BDNF) influences neuronal survival, differentiation, synaptogenesis, and maintenance and is also correlated with neuronal activation in the hippocampus. BDNF is also involved in the development and modulation of dopaminergic-related systems. Alterations of serum BDNF levels have been shown in a number of studies with first episode patients with schizophrenia, probably reflecting an association between BDNF and the pathogenesis of the disorder. In the present study we investigated the correlation between serum BDNF levels and hippocampal volumes in a sample of first episode drug-naïve patients with schizophrenia (FEP) and healthy control subjects. We found that hippocampal volume (HV) was decreased in FEP patients. Corrected right HV of FEP patients were significantly smaller compared to corrected right HVs of healthy subjects. The serum BDNF levels in the sample of FEP patients was significantly reduced compared to the healthy subjects. A significant positive association was found between serum BDNF and the corrected right HV in the group of patients such that the smaller the HV, the more reduced the serum BDNF levels. (Pearson r=0.452, p=0.045). Our findings indicate that low serum BDNF levels are associated with reduction in HV at the onset of schizophrenia and may further support the theory of a neuroprogressive-neurotoxic reaction associated with the onset of psychosis.

Prolactin and cortisol responses to acute intravenous clomipramine challenge in patients with mania, depression and healthy controls: evidence for reduced serotonergic responsivity.

Serotonergic dysregulation has been shown to be involved in the pathophysiology of unipolar and bipolar depression. Neuroendocrine challenge tests have been extensively used to investigate serotonin functioning in the brain. Although the role of serotonin has received a great deal of attention using neuroendocrine challenge paradigms, little effort has been made to explore the role of serotonin in mania. We assessed serotonergic neuroendocrine responsivity in patients with depression (n = 22), mania (n = 11) and 15 healthy controls by measuring the prolactin (PRL) and cortisol responses to i.v. clomipramine (CMI) and searched for possible differences among the groups. Blunted PRL responses to CMI in manic and depressed patients compared to healthy controls were found. The response to CMI disclosed similar results for the 2 patient groups. No significant differences were found among the 3 subject groups in the cortisol response to CMI. The blunted PRL responses to CMI in patients with mania and depression suggest that serotonergic functioning in mania and depression is similarly impaired, at least at the level of hypothalamus-hypophysis.

Fatigue in female patients with major depression: the effect of comorbid anxiety disorders.

Several studies have investigated fatigue in the general population, in primary care facilities as well as in patients with fatigue-related physical diseases, but only marginally in patients with Major Depressive Disorder (MDD). Therefore, the investigation of correlates of depression-related fatigue is highly warranted and expected to facilitate the implementation of effective fatigue-specific treatment strategies. Depressed patients often suffer from comorbid anxiety disorders (CADs) or subthreshold anxiety symptoms. This study aimed to investigate the independent correlation of the severity of fatigue in female patients with MDD with the presence, number and type of CADs. We studied 70 consecutive female MDD patients (48.6% inpatients), aged 23-65 years (mean 48.2±10.6 years), currently in a Major Depressive Episode [17-item Hamilton Depression Rating Scale (HDRS) score≥17] and free of other fatigue-associated conditions. Diagnostic assessments were made with the short structured DSM-IV-based MINI version 5.0.0. Reported fatigue was assessed with the 14-item Chalder Fatigue Questionnaire (FQ). Correlations between the FQ score and age, inpatient status, HDRS score, presence and number of CADs were calculated. Then, stepwise multiple regression analyses were performed, with the FQ score as the dependent variable,so as to isolate independent predictors of the severity of fatigue. 92.9% of patients had clinically significant fatigue. 62.9% were suffering from at least one CAD (38.6% met criteria for one CAD,21.4% for two and 2.9% for three). 51.4% were diagnosed with generalized anxiety disorder (GAD),25.7% with panic disorder and/or agoraphobia (PD/AP), 17.1% with social anxiety disorder and 7.1%with obsessive-compulsive disorder. The FQ score was significantly correlated with the HDRS score(r=0.406, p<0.001), the presence of any CAD(s) (rho=0.4, p=0.001), the number of CADs (rho=0.393,p=0.001), the presence of GAD (rho=0.421, p<0.001) and the presence of PD/AP (rho=0.252, p=0.035).In multiple regression analyses, the presence and number of CADs and the presence of comorbid GAD turned out as significant independent predictors of the FQ score along with the HDRS score.The severity of fatigue in female MDD patients is independently correlated with the presence and number of CADs and, in specific, comorbid GAD. Our findings imply that: (1) this effect might in part account for greater impairment/disability and adverse prognosis for MDD with CADs; (2) high levels of fatigue, putatively clustering with anxiety symptoms, may be a marker of severity and anxiety disorders comorbidity for MDD and may define an "anxious-fatigued" subtype/phenotype in this population; (3) medications and psychotherapies for the management of severe depression-related fatigue should also target CADs.

Anxiety disorders and obesity.

Anxiety disorders are the most prevalent mental disorders in developed countries. On the other hand, obesity is recognized to be one of the greatest public health problems worldwide.The connection between body weight and mental disorders remains an open issue. Low body weight has been studied enough (anorexia nervosa is a typical example) but high body weight has not been addressed sufficiently. It is known that obesity has been related with depression. Although moderate level of evidence exists for a positive association between obesity and anxiety disorders, the exact association between these two conditions is not clear yet.The studies about this subject are quite few and they follow different methodology. Furthermore,anxiety disorders share some common elements such as anxiety, avoidance and chronicity, but they also present a great deal of differences in phenomenology, neurobiology, treatment response and prognosis. This factor makes general conclusions difficult to be drawn. Obesity has been associated with anxiety disorders as following: most of the studies show a positive relationship with panic disorder, mainly in women, with specific phobia and social phobia. Some authors have found a relationship with generalised anxiety disorder but a negative relationship has been also reported.Only few studies have found association between obesity and agoraphobia, panic attacks and posttraumatic stress disorder. There has not been reported a relationship between obesity and obsessive-compulsive disorder. The causal relationship from obesity to anxiety disorders and vice versa is still under investigation. Pharmacological factors used for obesity treatment, such as rimonabant,were associated with depression and anxiety. Questions still remain regarding the role of obesity severity and subtypes of anxiety disorders. Besides, it is well known that in the morbidly obese patients before undergoing surgical treatment, unusual prevalence of psychopathology, namely depression and anxiety disorders, is observed. Anxiety is also a common trait in personality disorders.There is no single personality type characteristic of the morbidly obese, they differ from the general population as their self-esteem and impulse control is lower. Obese patients present with passive-dependent and passive-aggressive personality traits, as well as a trend for somatization and problem denial. Their thinking is usually dichotomous and catastrophic. Obese patients also show low cooperativeness and fail to see the self as autonomous and integrated. When trying to participate in society roles they are subject to prejudice and discrimination and should be treated with concern to help alleviate their feelings of rejection and guilt.

Association of serum brain-derived neurotrophic factor and duration of untreated psychosis in first-episode patients with schizophrenia.

BACKGROUND/AIMS: The brain-derived neurotrophic factor (BDNF) levels in serum and the central nervous system are altered in patients with schizophrenia, suggesting that changes in the expression of BDNF might contribute to the disease pathophysiology. Long duration of untreated psychosis (DUP) has been associated with poorer prognosis in patients with schizophrenia. Such a relationship of untreated psychosis to outcome may indicate a neurodegenerative process and may have important implications for understanding the pathophysiology of schizophrenia. METHODS: In this study, we investigated the association between serum BDNF levels and DUP in a sample of drug-naïve patients in their first episode of schizophrenia (FEP). We investigated serum BDNF levels in a sample of 37 drug-naïve FEP patients and 21 matched healthy subjects. RESULTS: The serum BDNF level in the sample of FEP was significantly reduced compared to the healthy subjects (18.87 +/- 8.23 vs. 29.2 +/- 7.73 ng/ml, t = 4.76, d.f. = 57, p = 0.01). A negative correlation was found between serum BDNF levels and DUP in the group of patients (r = -0.346, p = 0.036). CONCLUSIONS: Our findings indicate that low serum BDNF levels at the onset of schizophrenia were associated with a long DUP and this could reflect an acute neurodegenerative reaction during the untreated phase of psychosis.

Hospital anxiety and depression scale. A quantitative analysis in medical outpatients, psychiatric outpatients and normal subjects.

Depressive and anxiety symptomatology represent the most common psychiatric manifestations that complicate the management and prognosis of patients with somatic disorders. The Hospital Anxiety and Depression Scale (HADS) is a reliable, valid andpractical screening tool for identifying and quantifying anxiety and/or depression in non-psychiatric out patients. The aim of the present study was to compare the psychometric properties of the HADS among internal medicine outpatients, psychiatric outpatients and the generalpopulation. The present study involved 264 subjects: 95 internal medicine outpatients, 79 psychiatric outpatients and 90 normal controls. Psychiatric outpatients were diagnosed according to DSMIV-TR and inclusion criteria required the absence of any psychotic or organic psychiatric disorder. Patients with depressive disorders were divided in 3 groups: major depression, dysthymic disorderand adjustment disorder with mixed anxiety and depressed mood. All patients were administered the following psychometric tools: HADS, BDI and STAI. Subjects of the control group were administeredonly HADS. In all psychometric scales the psychiatric group presented significantly greater values than the internal medicine and the control group. In turn, the internal medicine group scoredsignificantly higher than the control group. Within the psychiatric outpatient group significantly higher HADS and HADS-D scores were observed in the major depression group followed by the dysthymicdisorder and the adjustment disorder with mixed anxiety and depressed mood group. HADS may be capable of identifying anxiety and depressive symptoms between psychiatric outpatients, internal medicine outpatients and subjects in the general population. In addition, the HADS-D subscaledifferentiates the main depressive disorders.

Signs of striatal dopamine transporter density increase in association with improvement of tardive dyskinesia in a patient with schizophrenia, as demonstrated by a DAT scan.

The imaging of the dopamine transporter could demonstrate the implication of dopaminergic pathway in the appearance of tardive dyskinesia. We report a case with psychotic and tardive dyskinesia symptoms. A DAT scan showed decreased dopamine transporter uptake in the area of brain's basal gaglia. A trial with quetiapine improved both psychotic and TD symptoms while a second DAT scan showed improvement status. We conclude that increased dopamine transporter uptake seemed to associate with the improvement of TD.

Seasonality of violent suicides in the Athens greater area.

The aim of the study was to ascertain suicide seasonality in the Greek population and to associate this seasonal variation with age, sex, and suicide method. Studying seasonality can be of help in establishing a public health policy, related with suicide prevention. This is an epidemiologic study based on forensic evidence. We studied the deaths caused by self-injury (trauma), namely deaths by violent suicide (not self-poisoning). Statistically significant suicide seasonality was established with a peak in May. This seasonal variation is attributed mainly to males. As for the method, suicide by hanging peaks in June and by shooting in April. It was also observed that seasonality for individuals above the age of 45 peaks in early May.

Association of serum BDNF and val66met polymorphism of the brain-derived neurotrophic factor in a sample of first psychotic episode patients.

Polymorphisms in the brain-derived neurotrophic factor (BDNF) gene have been indicated to be associated with schizophrenia. Previous studies have suggested that val66met polymorphism may increase the risk for schizophrenia, although other studies have not confirmed this association. Decreased BDNF levels in the brain and the serum of patients with psychotic disorders have been reported in first episode psychotic (FEP) patients. In our study we investigated the potential genetic association of this polymorphism with schizophrenia in a sample of 38 FEP patients with schizophrenia compared with a sample of 21 normal controls. Furthermore, we assessed serum BDNF levels and investigated whether there was an association between this polymorphism and alterations of serum BDNF levels between the investigated groups. There was a significant difference in genotyped frequencies between cases and controls (p=0.030). The homozygous carriers Met/Met were over-represented in the schizophrenia group (13/31, 41.9%), compared to controls (2/19, 10.5%). The serum BDNF levels in the sample of FEP patients was significantly reduced compared to controls (18.87±8.23 ng/mL vs 29.2±7.73ng/mL, U=140, p=0.0). No association was found between alterations of serum BDNF levels and Val66Met polymorphism in the group of patients (p=0.198). Negative correlations were shown between serum BDNF levels of the patients and the PANSS Negative subscale scores (p=0.015). There was found no significant difference between genotypes and memory scores in the sample of patients. Our findings indicate that serum BDNF levels at the onset of schizophrenia and BDNF Val66Met variant may be susceptibility risk factors for schizophrenia.

Neuropsychological relationships in paranoid schizophrenia with and without delusional misidentification syndromes. A comparative study.

Delusional misidentification syndromes (DMSs) and schizophrenia are strongly associated, since the former occur predominantly in the context of paranoid schizophrenia. However, the possible underlying neuropsychological relationships between DMSs and paranoid schizophrenia have not been thoroughly investigated. The aim of the present study was to investigate whether DMSs in paranoid schizophrenia are associated with a distinct neuropsychological substrate indicative of differential bilateral frontal and right hemisphere dysfunction. We compared two matched groups of paranoid schizophrenic patients with (N=22) and without (N=22) DMS(s) on a battery of neuropsychological tests assessing mainly frontal and right hemisphere functions. No statistically significant differences were detected between the two groups. Our findings are indicative of a bilateral frontal and right hemisphere dysfunction of equal severity in both DMS and non-DMS patients with paranoid schizophrenia.