Psychometric properties and factor structure of the Greek version of Reflective Functioning Questionnaire.

The ability to mentalize, namely to understand, interpret and effectively communicate the mental state of self and others is considered important in self-organisation and affect regulation. The aim of the present study was to provide data on the validation process of Reflective Functioning Questionnaire (RFQ), a recently developed measure of mentalizing, in order to evaluate its use in research and in clinical practice for Greek populations. A total of 219 participants (102 people with type 1 diabetes and 117 healthy individuals) completed the RFQ. A principal component analysis supported the 2-factor model (RF certainty for mental states and RF uncertainty for mental states) in both samples. Internal consistencies of both subscales were satisfactory (α=0.80 for RF certainty and α=0.79 for RF uncertainty). Relationships with validity measures of psychological distress, empathy and emotional intelligence provided further support for the psychometric properties of the scale. As expected, there were positive associations between the degree of certainty concerning mental states and emotional intelligence (r=0.390, p<0.01), as well as empathy (r=0.292, p<0.01) in general population. Conversely, negative associations were found between the degree of certainty about mental states and psychological distress in the diabetes group (r=-0.470, p<0.01) and in general population (r=0.320, p<0.01). A reverse pattern of associations was observed between the degree of uncertainty about mental states and emotional intelligence (r=-0.265, p<0.01) in general population, as well as psychological distress in both the diabetes group (r=0.590, p<0.01) and in general population (r=0.330, p<0.01). Also, as expected, there were differences across age groups, with older participants reporting a more balanced reflective functioning - with higher certainty levels in the diabetes group (t=-2.133, p>0.05) and the healthy participants (t=-2.738, p>0.05) and lower uncertainty levels in the diabetes group (t=-2.480, p>0.05) and the healthy participants (t=-2.779, p>0.05). The data collected so far support the reliability and validity of the measure that can be used in research to address mentalizing impairments. However, further research is needed to evaluate its consistency thought time with a test-retest analysis, and to evidence its factorial structure with a confirmatory factor analysis. In addition, it is of primary importance to extend the validity testing of RFQ in clinical populations to further support its use in clinical practice.

Alcohol misuse in Greece: a 15-year experience from a specialized outpatient service.

Alcohol use in Greece is traditionally diffused among its population. According to general population surveys, three out of four Greeks aged 12-64 referred to alcohol consumption during the last year and 10% reported at least one episode of alcohol abuse during the last month. Furthermore, the large majority of young people aged 13-18 reported lifetime use of alcohol and 14.8% of them reported more than three episodes of alcohol abuse during the last month. Apparently, cultural factors have influenced the pattern of alcohol consumption and the ensuing alcohol-related problems during the last two decades. The "Athena" Service is an outpatient therapeutic unit for the management of substance misusers and their families. It is a specialized abstinence-oriented service that does not administer substance substitutes; mental health professionals of the service work as a multidisciplinary team. Motivational approaches, individual cognitive-behavioural psychotherapy and family interventions of a systemic orientation are the principal therapeutic techniques applied. Adjunctive medication is prescribed whenever mild to moderate concomitant psychopathology is detected. Support measures such as provisional use of medication, use of antagonistic agents or brief hospitalization can be provided if deemed necessary. No strict time limits are applied regarding treatment duration and discharge from the program. During the period 1998-2013, a total of 1511 individuals with alcohol-related problems addressed the service. The changing pattern of substance misuse over the last fifteen years can be summarized as follows: (a) there is a gradually increasing number of women misusing substances; (b) there is an increasing proportion of young adults reporting multi-substance use with concurrent psychiatric disorders; (c) there is an increasing proportion of young adults regularly using/misusing substances; (d) there is a decreasing proportion of middle-aged individuals presenting with chronic alcohol misuse and dependence, with a long-ago onset and slow development of alcohol-related problems; and (e) the proportion of older age individuals presenting chronic alcohol misuse and dependence with concurrent severe neurological impairments is increasing. Also, detailed information on a sample of 133 individuals who addressed the service for alcohol-related problems during 2012 is given and further discussed. Finally, the need for close monitoring of dangerous alcohol consumption and changing patterns of misuse in times of socio-economic crisis, alongside with an increasing need to provide treatment, is highlighted.

[What place is there for psychotherapy in public psychiatry?]. / Quelle place pour la psychothêrapie dans la psychiatrie publique?

The question of the place of psychotherapy in psychiatric public care is posed in this article. We will address this question first by presenting two clinical and research programmes which were implemented in a clinical psychiatric unit, section Karl Jaspers (Service of General Psychiatry) of the Department of Psychiatry CHUV, in Lausanne with the collaboration of the University Institute of Psychotherapy. The first one puts forward psychodynamic psychotherapy of depressed inpatients; the clinical programme and the research questions on efficacy of this treatment are discussed. The second focuses on the early treatment of patients with Borderline Personality Disorder, in particular in its research question on the effect of the motive-oriented therapeutic relationship in this process. We conclude by underlining the convergences of the two programmes.

[Comparative evaluation of clinical practice guidelines for the treatment of schizophrenia]. / Traitement pharmacologique de la schizophrénie: évaluation comparative de la qualité des recommandations de pratique clinique.

INTRODUCTION: Many clinical practice guidelines (CPG) have been published in reply to the development of the concept of "evidence-based medicine" (EBM) and as a solution to the difficulty of synthesizing and selecting relevant medical literature. Taking into account the expansion of new CPG, the question of choice arises: which CPG to consider in a given clinical situation? It is of primary importance to evaluate the quality of the CPG, but until recently, there has been no standardized tool of evaluation or comparison of the quality of the CPG. An instrument of evaluation of the quality of the CPG, called "AGREE" for appraisal of guidelines for research and evaluation was validated in 2002. AIM OF THE STUDY: The six principal CPG concerning the treatment of schizophrenia are compared with the help of the "AGREE" instrument: (1) "the Agence nationale pour le développement de l'évaluation médicale (ANDEM) recommendations"; (2) "The American Psychiatric Association (APA) practice guideline for the treatment of patients with schizophrenia"; (3) "The quick reference guide of APA practice guideline for the treatment of patients with schizophrenia"; (4) "The schizophrenia patient outcomes research team (PORT) treatment recommendations"; (5) "The Texas medication algorithm project (T-MAP)" and (6) "The expert consensus guideline for the treatment of schizophrenia". RESULTS: The results of our study were then compared with those of a similar investigation published in 2005, structured on 24 CPG tackling the treatment of schizophrenia. The "AGREE" tool was also used by two investigators in their study. In general, the scores of the two studies differed little and the two global evaluations of the CPG converged; however, each of the six CPG is perfectible. DISCUSSION: The rigour of elaboration of the six CPG was in general average. The consideration of the opinion of potential users was incomplete, and an effort made in the presentation of the recommendations would facilitate their clinical use. Moreover, there was little consideration by the authors regarding the applicability of the recommendations. CONCLUSION: Globally, two CPG are considered as strongly recommended: "the quick reference guide of the APA practice guideline for the treatment of patients with schizophrenia" and "the T-MAP".

[Clinical practice guidelines for the treatment of schizophrenia: from theory to practice]. / Recommandations de pratique clinique dans la schizophrénie: de la théorie à la mise en application.

INTRODUCTION: Based on the concept of evidence-based medicine (EBM), the clinical practice guidelines (CPG) occupy an increasingly important place in the field of the treatment of schizophrenia. Although CPGs have been elaborated in a rigorous way, few of them provide the readers with tools for their use in practice. The clinician must therefore create his own method of application. This problem was encountered within the framework of a retrospective study carried out in a rehabilitation unit, where we sought to answer the question concerning the use of the CPG approach in the pharmacological treatment of schizophrenia: "to what degree do doctors, with only indirect knowledge, respect these CPGs?" METHOD: The comparative study between CPG and practical current clinic implied: (1) the choice of a pertinent CPG for the clinical framework studied, (2) the selection of measuring instruments, which allow the quantification of obvious clinical problems approached in the CPG, and (3) the development of a standardized system of comparison to determine the degree of respect of the recommendations. The Expert Consensus Guideline for the treatment of schizophrenia (ECGTS) was selected as the reference. A method of application of the ECGTS is depicted: use of standardized clinical scales; translation of the results of the clinical examination in terms of clinical problems to which the recommendations of the guideline refers; and determination of the degree of respect of the recommendations. RESULTS: In the group of 20 patients included in this study, the recommendations of the ECGTS were totally respected in 65% of the patients, and partially respected in 10%, while in 25% of the patients, they were not respected. COMMENTS: These observations suggest that the clinical approach has to be improved, mainly with regard to the treatment of psychotic and depressive symptoms. This work also showed the limits of the CPG: for example, over half of the patients presented side effects on clinical evaluation, whereas the regulation of their medication respected the recommendations of the ECGTS. CONCLUSION: The future certainly belongs to CPG, which proposes, in addition to the clinical recommendations themselves, a method to check their application in clinical practice.

[Cognitive behavioral treatments of bipolar disorder: current knowledge and perspectives]. / Thérapies comportementales et cognitives du trouble bipolaire: actualités et perspectives.

A significant proportion of patients with bipolar disorder experience relapse, psychosocial impairment and persistent symptoms despite available pharmacotherapy. Prognosis is frequently worsened by poor adhesion to mood stabilizing agents. Cognitive and behavioural therapy (CBT) tends to diminish depressive symptoms, improve treatment adherence and reduce the risk of depressive and manic relapses. CBT effect appears to diminish in patients with a history of over twelve episodes. Most studies exclude patients with comorbid psychiatric disorder, rapid cycling, schizoaffective disorder or patients lacking adherence to mood stabilizing agents. Patients would benefit from development of CBT techniques focusing on the mentioned problems.

The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis.

BACKGROUND: Despite the effectiveness of anti-psychotic pharmacotherapy, residual hallucinations and delusions do not completely resolve in some medicated patients. Additional cognitive behavioral therapy (CBT) seems to improve the management of positive symptoms. Despite promising results, the efficacy of CBT is still unclear. The present study addresses this issue taking into account a number of newly published controlled studies. METHOD: Fourteen studies including 1484 patients, published between 1990 and 2004 were identified and a meta-analysis of their results performed. RESULTS: Compared to other adjunctive measures, CBT showed significant reduction in positive symptoms and there was a higher benefit of CBT for patients suffering an acute psychotic episode versus the chronic condition (effect size of 0.57 vs. 0.27). DISCUSSION: CBT is a promising adjunctive treatment for positive symptoms in schizophrenia spectrum disorders. However, a number of potentially modifying variables have not yet been examined, such as therapeutic alliance and neuropsychological deficits.