Outcome of Voluntary vs Involuntary Admissions in Greece over 2 years after Discharge: A Cohort Study in the Psychiatric Hospital of Attica "Dafni".

The increasing rates of involuntary hospitalization constitute a major ethical issue in psychiatric practice. The present cohort study endeavours to investigate the relationship between patients' legal status (involuntary vs voluntary) and the outcome of their hospitalization, over 2 years after discharge. All individuals admitted in the 3rd Psychiatric Department of the Psychiatric Hospital of Attica during February 2015-February 2017 took part in the study. 64.7% of patients were compulsory admitted. Findings indicate a statistically significant improvement in global functioning and symptomatology levels from admission to discharge for all treated patients, independently of their legal status. However, readmission rates over 2 years after discharge were high (34.8% vs. 21.9% in voluntary and involuntary patients, respectively). In conclusion, psychiatric admission, irrespectively of legal status leads to clinical improvement.

Effectiveness of two formulations of oral olanzapine in patients with schizophrenia or bipolar disorder in a natural setting: results from a 1-year European observational study.

OBJECTIVE: This study aims to assess the proportion of patients with schizophrenia or bipolar disorder who discontinued treatment with one of two oral formulations of olanzapine within 12 months in outpatient settings in Germany, Greece, and France. METHODS: This 1-year, prospective, observational study included patients who had recently initiated treatment with olanzapine-coated tablets (OC) or the orodispersible (OD) formulation. Primary endpoint was olanzapine discontinuation for any reason. Clinical and functional status were also evaluated. RESULTS: Out of 927 enrolled patients, 903 were included in the analyses (612 patients with schizophrenia, 291 with bipolar disorder). Within 12 months, 46 of 903 patients discontinued olanzapine. Most (95%) patients remained on olanzapine for 12 months with similar rates for patients with either diagnosis (94.5% for schizophrenia, 94.9% for bipolar disorder) and for both formulations (93.7% with OC, 95.3% with OD). The only factor significantly associated with time to discontinuation was baseline disease severity. Patients with more severe disease at baseline had a lower discontinuation risk. There were significant improvements in functioning and well-being and non-significant improvements in therapeutic alliance and compliance. CONCLUSIONS: No significant difference was seen between discontinuation rates of the two formulations. Higher baseline severity was associated with a lower discontinuation rate.

Factors associated with caregiver psychological distress in chronic schizophrenia.

BACKGROUND AND AIMS: Caregivers of patients with schizophrenia experience increased levels of psychological distress. This study investigated the impact of caring for patients with chronic schizophrenia on the mental health status of the caregivers and described the relationship between various socio-demographic and clinical characteristics and caregiving psychological distress. METHODS: The study was carried out at the Psychiatric Hospital of Athens. The Symptom Check List Revised (SCL-90-R) was administered to 87 caregivers of chronic schizophrenia patients and 90 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was administered to schizophrenia patients in order to assess illness severity. RESULTS: The group of caregivers scored higher on the majority of symptom dimensions of the SCL-90-R than the control group. Clinical features of schizophrenia, i.e. duration of illness and PANSS positive and negative symptoms significantly predicted caregiving psychological distress. Caregivers' and patients' socio-demographic characteristics were not associated with caregivers' distress, with the exception of caregivers' sex: female caregivers experienced significantly higher levels of psychological distress than males. CONCLUSIONS: The study suggests that clinical features of schizophrenia influence distress levels in caregivers of patients with chronic schizophrenia. The stronger predictors of distress appear to be female caregiver's gender, duration of illness as well as positive and negative symptomatology.

Increased plasma levels of 8-iso-PGF2alpha and IL-6 in an elderly population with depression.

Oxidative damage and immune-inflammatory activation have been suggested to play a role in depression. The purpose of the study was to investigate possible associations and interactions of these pathophysiological mechanisms in geriatric depression by determining the levels of plasma 8-iso-prostaglandin F(2alpha) (8-iso-PGF(2alpha)) and interleukin-6 (IL-6) in elderly depressed individuals. Subjects over 60 years of age with depression and controls were randomly selected from a population in the community after screening with the Geriatric Depression Scale. Plasma concentrations of 8-iso-PGF2alpha and IL-6 were measured in both groups. Depressed patients had significantly higher mean (+/-S.D.) 8-iso-PGF2alpha levels compared to healthy controls (245.01+/-179.92 pg/ml vs 97.64+/-42.72 pg/ml, respectively). Similarly, the same groups demonstrated significantly elevated IL-6 levels compared with controls (58.73+/-39.90 pg/ml vs 15.41+/-9.27 pg/ml). This study indicates an association between increased levels of plasma 8-iso-PGF2alpha and IL-6 with depressive symptomatology in elderly individuals and indicates the necessity for further investigation, possibly within the framework of an integrated involvement of oxidative damage and inflammation in the pathophysiology of depression in the elderly.

Greek police officers' attitudes towards the mentally ill.

The deinstitutionalization of the mentally ill and their shift into the community lead the police to play an important role in the management of acute psychiatric states. This study examines the attitudes of the Greek police towards the mentally ill, and the problems that arise during the transfer of mentally ill people to psychiatric emergency departments. Results highlight policemen misperceptions, and the difficulties encountered during transport procedures, which may be attributed to insufficient knowledge about mental illness and lack of training, respectively. Furthermore, this article discusses the need for police educational intervention, and the formation of specialized teams to improve the handling of mentally ill in crisis situations.

Correlation of folate, vitamin B12 and homocysteine plasma levels with depression in an elderly Greek population.

BACKGROUND: Alterations in folate, vitamin B12 and homocysteine plasma levels have been associated with aging, neuronal development and depressive symptomatology. Nevertheless, the associations are not strong enough to suggest the use of these parameters in every day practice for diagnostic or therapeutic purposes. OBJECTIVES: The aim of the study was to investigate the relationship between plasma folate, vitamin B12 and homocysteine in depressive states in the elderly. METHODS: Community-dwelling, elderly individuals over 60 years of age were screened with the Geriatric Depression Scale. The study population was divided into two groups: (a) 33 subjects with depression and (b) 33 healthy controls. All participants were clinically evaluated and completed a questionnaire for socio-demographic and clinical data. Measurements of folate, vitamin B12 and homocysteine were estimated in all blood samples and results were statistically evaluated at p<0.05 level of significance. RESULTS: No statistical significance emerged for the socio-demographic data between the two groups. Chronic diseases such as stroke, hypercholesterolemia, hypertension and diabetes also did not differ between the depression and control group. Group (a) had significantly lower levels of folate and vitamin B12 than group (b). Homocysteine was significantly higher in depressed individuals than in controls. CONCLUSION: Lower levels of plasma folate and/or vitamin B12, and higher levels of plasma homocysteine are associated with depression in elderly individuals.

Characterization of the lipid profile in dementia and depression in the elderly.

The purpose of the study was to examine the association of plasma lipid concentrations with changes in cognitive function and depressive states in elderly Greek individuals. The study population consisted of 3 groups: A) 37 subjects with dementia, B) 33 subjects with depression, and C) 33 controls. All individuals were screened with the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and an evaluation of their psychiatric state. Lipid profile was assessed in all subjects, and the results were statistically evaluated at P < .05 level of significance. Groups A and B had significantly lower levels of total plasma cholesterol and HDL cholesterol than group C (P < .01). Triglyceride levels did not differ significantly between groups A and C, although they were significantly higher in group B. The results of this study suggest that an association does exist between the plasma concentration of cholesterol and HDL-C and depression and/or cognitive impairment. Further studies are required to explore the significance of these observations and establish if lipid levels could serve as markers for diagnostic and therapeutic purposes.

Association of cognitive impairment with plasma levels of folate, vitamin B12 and homocysteine in the elderly.

BACKGROUND: Alterations in folate, vitamin B12 and homocysteine plasma levels have been associated with aging, neuronal development and cognitive impairment. The aim of this study was to investigate the relationship between plasma folate, vitamin B12 and homocysteine and cognitive function in the elderly. PATIENTS AND METHODS: Elderly individuals over 60 years of age living in the community, were screened with the Mini-Mental State Examination. The study population was divided into two groups: (a) 37 subjects with dementia; and (b) 33 healthy controls. Blood samples were analyzed with the use of ELISA, and the results were statistically evaluated at p < 0.05 level of significance. RESULTS: Group a had significantly lower levels of folate and vitamin B12 than group b. Homocysteine was significantly higher in demented individuals than in controls (p < 0.01). CONCLUSION: Lower levels of plasma folate and/or vitamin B12 and higher levels of plasma homocysteine are associated with cognitive impairment in elderly individuals.

Panic Attack during Elective Gastrointestinal Endoscopy.

Background. Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) can evoke anxiety, embarrassment, and discomfort. These concerns can culminate in panic attacks, which may traumatize patients and significantly decrease their compliance to the procedure. The objective of this study was to evaluate the relationship between preendoscopic anxiety and the possibility of a panic attack during an elective gastrointestinal endoscopy (EGE). Methods. The study population comprised of 79 Greek outpatients. The examination was carried out without the use of conscious sedation. Patients' anxiety levels were assessed before the procedure using the Greek version of the Spielberger State-Trait Anxiety Inventory (STAI-Y). Results. Seventy-nine patients were enrolled: 45 EGD and 34 CS. Females had higher state and trait anxiety levels than males (48.14 ± 7.94 versus 44.17 ± 7.43, P < 0.05; and 43.68 ± 6.95 versus 39.86 ± 7.46, P < 0.05). Patients who experienced panic attack had significantly higher levels of both trait and state anxiety, compared to those who were panic-free. There was no significant relationship between panic attacks and sex or type of procedure. Conclusions. Patients who experience panic attacks during endoscopic procedures appear to have significantly higher anxiety levels before the procedure. Administering the STAI questionnaire prior to the endoscopy seems to be a useful screening method for vulnerable patients.