Engineered mucoperiosteal scaffold for cleft palate regeneration towards the non-immunogenic transplantation.

Cleft lip and palate (CL/P) is the most prevalent craniofacial birth defect in humans. None of the surgical procedures currently used for CL/P repair lead to definitive correction of hard palate bone interruption. Advances in tissue engineering and regenerative medicine aim to develop new strategies to restore palatal bone interruption by using tissue or organ-decellularized bioscaffolds seeded with host cells. Aim of this study was to set up a new natural scaffold deriving from a decellularized porcine mucoperiosteum, engineered by an innovative micro-perforation procedure based on Quantum Molecular Resonance (QMR) and then subjected to in vitro recellularization with human bone marrow-derived mesenchymal stem cells (hBM-MSCs). Our results demonstrated the efficiency of decellularization treatment gaining a natural, non-immunogenic scaffold with preserved collagen microenvironment that displays a favorable support to hMSC engraftment, spreading and differentiation. Ultrastructural analysis showed that the micro-perforation procedure preserved the collagen mesh, increasing the osteoinductive potential for mesenchymal precursor cells. In conclusion, we developed a novel tissue engineering protocol to obtain a non-immunogenic mucoperiosteal scaffold suitable for allogenic transplantation and CL/P repair. The innovative micro-perforation procedure improving hMSC osteogenic differentiation potentially impacts for enhanced palatal bone regeneration leading to future clinical applications in humans.

Attitudes of psychology students to depression and its treatment: Implications for clinical practice.

Stigma and mental health literacy affect access to and quality of treatment of major depression. Though mental health professionals seem better able to recognize major depression than the general public, they often hold similarly stigmatizing attitudes towards people suffering from the disorder. These attitudes are shaped jointly by the public stigma attached to mental illnesses as well as by the content and delivery of mental health professionals' undergraduate training. In line with this, the present study aimed to explore psychology students' ability to recognize major depression, their attitudes towards the disorder, and their views surrounding helpfulness of various interventions. A random sample of 167 undergraduate students was recruited from the psychology department of one public university in Athens. During one university hour, students were administered a vignette describing a woman fulfilling the DSM-IV criteria for major depression. A self-report questionnaire exploring students' recognition abilities, attitudes to depression and views on the helpfulness of various treatment modes was also administered. In total, 80.2% of students correctly recognized major depression from the vignette. Concerning their attitudes, students were unsure about the illness and ambivalent towards the person who suffers from it. With regard to available treatments for depression, students considered discussion with a friend to be the most helpful intervention. Counseling, cognitive behavioural therapy and psychoanalysis were also viewed in a positive light. On the contrary, antidepressants were not deemed helpful by most students. Finally, recognition of as well as attitudes towards depression and its treatments seemed to improve during the second year of undergraduate study; however they remained unchanged thereafter. Consistent with these, psychology students seem to have only a rudimentary knowledge on depression, that cannot not be qualified as mental health literacy. The core misconception espoused pertains to the view that major depression is not a medical illness; a finding which can also be interpreted in light of the lingering controversy on the medicalization of normal sadness and human predicament. The clinical implications of these findings are substantial. Mental health professionals-educators should reflect on their own beliefs and attitudes towards depression, as they may convey stigmatizing messages to their students and thus perpetuate the stigmatization of the illness. Concomitantly, psychology students' attitudes to depression and its treatment might render them incapable of understanding their patients, responding to their needs and providing them with appropriate help, while they may hinder their effective collaboration with psychiatrists.

Experimental effect of ozone upon the microbial flora of commercially produced dairy fermented products.

Ozone was used to control spoilage microorganisms during the manufacturing of dairy products. Ozone stream was applied onto the surface of freshly filled yoghurt cups just before storage for curd development in order to prevent cross contamination from spoilage airborne microorganisms. Accordingly, brine solution was bubbled with ozone for various periods of time and used for ripening of white (feta type) cheese. Both products were subjected to a continuous monitoring of microbial load and also tested for their sensorial properties. In ozonated yoghurt samples there was a reduction in mould counts of approximately 0.6Logcfu/g (25.1%) by the end of the monitoring period in relation to the control samples. In white cheese ripened with ozonated brine (1.3mg/L O3, NaCl 5%) it seems that ozone treatment during the two months of observation reduced some of the mould load but without offering any advantages over the use of traditional brine (NaCl 7%). However, some sensorial alterations were observed, probably due to the organic load in the brine which deactivates ozone in early stages of application. It is concluded that, if the factors of time and concentration of ozone are configured properly, ozonation could be a promising approach safeguarding the production of some dairy products.

Bipolar disorder and self-stigma: A comparison with schizophrenia.

AIM: Even though numerous studies have focused on the effects of self-stigma on patients with schizophrenia, little is known about self-stigma of patients with bipolar disorder (BD). In this study, a self-administered scale of self-stigmatising attitudes of patients with BD and schizophrenia was used to explore these attitudes, examine the potential differences between the two groups and study the factors that influence stigma within groups. METHODS: Self-stigma of 120 patients with schizophrenia and BD was assessed with the Self-stigma Questionnaire (SSQ) and the Stigma Inventory for Mental Illness (SIMI). Presence of clinical symptoms, overall functioning and level of self-esteem were also evaluated. RESULTS: Self-stigma is present in both groups but differs in its intensity. Patients with BD experience self-stigma in a lesser degree without affecting their social life or overall functioning. Patients with schizophrenia adopt more intense self-stigmatising attitudes leading to social exclusion and lower level of overall functioning. LIMITATIONS: The results are limited by the small sample size, whereas the inclusion of other questionnaires would broaden our insight to self-stigma. CONCLUSIONS: Self-stigma has a direct effect on overall functioning of patients with BD and schizophrenia tampering the clinical outcome of therapeutic interventions. Therefore, it should be incorporated in every treatment plan and be addressed as a clinical symptom of the mental illness.

[Comparative study of the operation of two day's Hospitals in Athens].

The present paper describes the preparation for the commencement of services by the University Mental Health Research Institute (UMHRI) Day Hospital and Eginition Day Hospital whose operation (in 1977) signifies the beginning of the Psychiatric Reform in our country. The two units' functional characteristics and the type of offered services are mentioned. Psychotherapeutic, biological and sociotherapeutic approaches are practiced on a daily basis within a framework of Therapeutic Community services. Moreover, relations, similarities and differences among the two day hospitals are pointed out. Special mention is given to the problems and difficulties that these two units faced upon their commencement, which took place at different time periods, set 32 years apart. The lack of legislative framework with regards to the operation of Day Hospitals, the bureaucratic obstacles and the skepticism towards the new treatment approach of patients, were the basic obstacles that had to be overcome in order for the first Day Hospital to become operational in 1977. Licensing and funding were the main obstacles that the creation of UMHRI's Day Hospital faced, although these two units had already been established. Emphasis was placed on the staff's training, which mainly consisted of young professionals and at the social environment's and all those services' (health-care, community etc) attitude, in the specific catchment area (6th Mental Health Sector). The study of patients' characteristics hospitalized in Eginition's Day Hospital throughout its first year of operation (1977-1978) and of patients hospitalized at UMHRI's Day Hospital, also at its first year of operation (2009-2010), showed, among other things, that in both cases, the number of hospitalized male patients is larger than the number of female patients. This constitutes an exception compared to other countries, whereby female patients outnumber male patients in Day Hospitals. Especially at UMHRI's Day Hospital, the number of men is twice the number of women and three times the number of women in the subgroup of patients with schizophrenia. In addition, at Eginition Day Hospital, the men- women ratio is 3:2 in the total number of hospitalized patients and 2:1 in the schizophrenia subgroup. The comparison between the hospitalized patients in Eginition Day Ηospital and UMHRI. Day Hospital brought out the following differences: inpatients at UMHRI's day Hospital were more often older, (x²= 29.52, p=0.0001), unemployed (x²=14.65, p=0.0001) and used public means of transportation more rarely (x²=7.38, p=0.005). No other differences were found in the rest of the sociodemographic variables such as education, marital status, insurance agency, living conditions, traveling time to the day Hospital, referral source, diagnosis of schizophrenia, past hospitalizations. To conclude, it is worth mentioning that the Day Hospital is in a position to treat patients with active psychotic symptomatology, preventing thus their hospitalization on a 24 hour basis.

[Economic crisis and mental health: effects on the prevalence of common mental disorders].

Economic crises have been found to bring adverse repercussions on physical and mental health internationally through various pathways. Research corroborates a link between financial distress and common mental disorders. In this context, the University Mental Health Research Institute conducted epidemiological nationwide surveys in an endeavour to gauge the impact of the ongoing financial crisis on the mental health of the Greek population. The purpose of the present analysis pertains to investigating changes in the prevalence of common mental disorders in the population as a whole as well as in various population sub-groups between years 2009 and 2011. In addition, the association of financial strain with common mental disorders was also explored. For investigating the particular research objectives, two cross-sectional surveys following the same methodology were conducted. A random and representative sample of 2192 respondents in 2009 and 2256 respondents in 2011 took part in telephone interviews. Generalized anxiety disorder and major depression were assessed with the germane modules of Structured Clinical Interview, while financial difficulties with the Index of Personal Economic Distress (IPED), an original scale developed for the purposes of the particular surveys. All measures displayed good psychometric properties. Between the two years, a noteworthy, albeit non-significant, increase in one-prevalence of major depression was documented. On the other hand, the prevalence of generalized anxiety disorder remained largely unchanged. Statistically significant differences in the prevalence of both disorders were reported for particular population subgroups, with married persons and employed people emerging as the most afflicted individuals. Regarding financial distress, it was found to bear a statistically significant association with major depression but not with generalized anxiety disorder. For mitigating the mental health effects of the crisis on the general population, study findings underline the necessity of implementing targeted interventions, tailored to the needs and difficulties of each population sub-group.

[Depression telephone helpline: help seeking during the financial crisis].

Mental health telephone help-lines usually play a significant role in mental health services system. Their importance is substantiated during periods of financial crisis, where the mental health of the population is gravely inflicted. Media reports have documented a large increase in calls made to mental health telephone help-lines around the world as a corollary to the global economic crisis; however, a systematic investigation of this observation is still lacking. In this context, the present study endeavours to fill this gap in the literature, while it adds strength to the handful of studies which have empirically supported the impact of the financial crisis on mental health in Greece. Data were extracted from information gleaned during the calls made to the Depression Telephone Helpline of the Greek University Mental Health Research Institute. The information entailed the reason for calling, the socio-demographic and clinical profile of the person with mental health problems, his/her previous and current contacts with mental health professionals and the treatment he/she might be receiving. The results showed a steep increase in calls with direct or indirect reference to the economic crisis during the first half of 2010 and onwards. The callers who referred to the economic crisis manifested depressive symptomatology of clinical significance to a greater degree than callers who made no such reference. The latter exhibited increased levels of distress and agitation as well as drug/alcohol misuse. Concomitantly, a higher frequency of depressive symptomatology was discerned among the unemployed, whereas employed people were found to experience anxiety symptoms to a higher degree. The impact of the financial crisis on the mental health of the Greek population has been considerable, underscoring in this way the importance of mental health help-lines as emotional buffers and as guides for timely and appropriate service use in response to the emerging mental health problems.

Fighting psychiatric stigma in the classroom: the impact of an educational intervention on secondary school students' attitudes to schizophrenia.

BACKGROUND: Adolescents constitute an appealing target group for fighting stigma and discrimination surrounding mental illness, since it is during this developmental period that adult attitudes about mental illness are formed and consolidated. AIM: The aim of the present study was twofold, to explore adolescents' beliefs and attitudes to schizophrenia and to evaluate the effectiveness of an anti-stigma intervention in altering them. METHODS: A total of 616 high school students participated in the study, divided into a control condition and an anti-stigma intervention group. Data were collected at three time points: before the intervention, upon its completion and at a 12-month follow-up. RESULTS: Baseline measurements indicated that students espoused certain stereotypical beliefs about patients with schizophrenia and were reluctant to interact with them on some occasions. Upon completion of the intervention, positive changes were recorded in students' beliefs, attitudes and desired social distance; however, only the changes in beliefs and attitudes were maintained after one year. CONCLUSION: For anti-stigma interventions to be effective, they should be continuously delivered to students throughout the school years and allow for an interaction between students and patients. Health promotion programmes might be an appropriate context for incorporating such interventions.

Schizophrenia-related RGS4 gene variations specifically disrupt prefrontal control of saccadic eye movements.

BACKGROUND: The gene encoding the regulator of G-protein signaling subtype 4 (RGS4), located on chromosome 1q23-3, has been proposed as a possible susceptibility gene for schizophrenia and has been specifically linked to prefrontal cortical structural and functional integrity. METHOD: The effects of four core single nucleotide polymorphisms (SNPs) within the RGS4 gene on oculomotor parameters in a battery of oculomotor tasks (saccade, antisaccade, smooth eye pursuit, fixation) were investigated in a sample of 2243 young male military conscripts. RESULTS: The risk allele of RGS4SNP18 was found to be associated with two variables of antisaccade performance, increased error rate and variation in the correct antisaccade latency. By contrast, the same allele and also the risk allele of RGS4SNP4 led to an improvement in smooth eye pursuit performance (increased gain). Structural equation modeling confirmed that the combined gene variation of RGS4SNP4 and RGS4SNP18 was a significant predictor of antisaccade but not smooth eye pursuit performance. CONCLUSIONS: These results provide evidence for a specific effect of schizophrenia-related RGS4 genotype variations to prefrontal dysfunction measured by oculomotor indices of performance in normal individuals, further validating the hypothesis that RGS4 is related to prefrontal dysfunction in schizophrenia.

Microbial ecology of the watery ecosystems of Evros river in North Eastern Greece and its influence upon the cultivated soil ecosystem.

The aim of the present study was to evaluate the microbial ecosystem of cultivated soils along the Evros river in NE Greece. Evros river together with its derivative rivers constitute the capital source of life and sustainable development of the area. Along this riverside watery ecosystem systematic agro-cultures were developed such as wheat, corn and vegetable cultures. The evaluation of the ecosystem microbial charge was conducted in both axes which are the watery ecosystem and the riverside cultivated soil area. Considerable discrimination of water quality was observed when considering chemical and microbiological parameters of the Evros river ecosystem. Ardas river possesses a better water quality than Evros and Erythropotamos, which is mainly due to the higher quantities that these two rivers accumulate from industrial, farming and urban residues leading to higher degree of pollution. An increased microbial pollution was recorded in two of the three rivers monitored and a direct relation in microbial and chemical charging between water and cultivated-soil ecosystems was observed. The protection of these ecosystems with appropriate cultivated practices and control of human and animal activities will define the homeostasis of the environmental area.

Occurrence of Clostridium perfringens from different cultivated soils.

The occurrence of Clostridium perfringens was estimated in 750 samples originated from a variety of soils bearing various bulb crops: Brawnica oderacea (vegetable), Olea europaea, Daucus carota (carote), Solanum tuberosum (potato), Phaseolus vulgaris (green haricot), Beta vulgaris var. rapaceum (beetroot), Cucurbita pepo (squash), Allium cepa (onion), Cucumis sativus (cucumber) and Capsicum annum (pepper). All isolated strains were tested for their antimicrobial activities to amoxicillin, penicillin G, kanamycin, tetracycline, streptomycin, erythromycin, chloramphenicol and metronidazole. When considering the type of the bulb production, it was observed increased number of C. perfringens spore densities in the most undersurface bulb soils. Moreover, C. perfringens spore are likely to occur in particularly large numbers in soil contaminated by fecal matter. Additionally, there is a close relationship between the spore amount and nature of organic content. Presence of C. perfringens was associated with acidic soil. Most of our strains showed resistance to the studied antibiotics applied usually for human and veterinary care. A systematic monitoring of the cultivated soil ecosystems must include bacteriological parameters together with chemical indices of organic pollution in order to obtain information adequate for assessing their overall quality.

[Social Distance Scale: Greek adaptation and psychometric properties].

Literature on stigma refers to social distance as the most widely used index of attitudes towards mental illness and it involves the desire to avoid contact with patients with psychiatric disorders in social contexts of varied intimacy. Social distance scales have been utilized in more than 100 studies internationally, including those that have been conducted under the auspices of the Global Programme against Stigma and Discrimination Because of Schizophrenia run by the World Psychiatric Association (WPA). The Greek site broadened the scale that was used in the WPA pilot studies in order to adjust and validate it in Greece. The extended version consisted of 14 items enquiring about social encounters of varied intimacy with a patient with schizophrenia and were rated on a 5-point Likert scale. Face to face interviews were conducted on a random and representative sample of the Greek general population. The results showed that the scale displayed good reliability and validity, with the principal component analysis revealing 3 underlying factors and thus providing evidence for the multifaceted nature of social distance. The first factor describes stable social relations of moderate intimacy with long duration and consistency in contact; the second factor concerns more close relations which necessitate feelings of trust and a sense of security during the contact with the patient; and the third factor aggregates items describing transient relations of limited intimacy. The investigation of associations between socio-demographic variables and the three factors of the scale constitutes the next step in this process of standardization and validation of the scale in Greece.

Compulsory hospitalisation and optimal mental health care: A European perspective and the example of Greece.

Countries offering good psychiatric care which respects their clients' dignity and human rights can be expected to reflect this fact in their official health statistics. Given that European data on compulsory hospitalisation are currently inadequate, we propose that all Member States should collect at least a basic set of figures for calculating the rates or quotas of compulsory admissions and the rate of legally indefensible detentions; this will allow us to examine both the actual cost of freedom lost as well as the extent to which national mental health laws are delivered as prescribed. As shown here by the example of Greece, there is an urgent need to focus on possible infringements on the rights of the mentally ill, because Member States can nοt be compelled to accept international monitoring or to observe minimum standards of mental health care.

Occupational abilities and performance scale--reliability-validity assessment factor analysis.

BACKGROUND: This article presents a study of the Occupational Abilities and Performance Scale (OAPS), developed for administration to schizophrenic patients. The reliability and validity of the OAPS has been evaluated. METHOD: A total of 174 schizophrenic patients who participated in the Psychosocial and Vocational Rehabilitation Unit (PVRU) of the University Mental Health Research Institute (UMHRI) in Athens were assessed. The OAPS is conducted at entry and after 18 months, when the client has completed training. RESULTS: The results of the reliability analysis showed very good internal consistency, with high split-half reliability as well as test-retest reliability and inter-rater agreement. The scale was also found to have good predictive validity, as well as concurrent validity. Finally, factor analysis with principal components extraction method was performed in order to assess the construct validity of the scale. CONCLUSIONS: The results of factor analysis supported the conclusion of good reliability and validity of the OAPS and revealed the existence of five components, each correlated with a set of the original items.

Suicide in cyprus 1988-1999.

Suicide is a universally observed human behavior related to bio-psychological, social and cultural factors. The aim of the present study was to examine suicide in Cyprus, an island that has known many civilizations and cultures. All completed suicide cases in the Christian population of Cyprus during the years 1988-1999 were included in the study and they were analyzed according to age, gender, reported reasons for suicide and suicide methods. The main results indicate that: 1. The mean age-standardized suicide rate is the lowest in Europe, in males (3.08/100,000) and also in females (1.05/100,000). 2. Mean suicide rates increase significantly with age in males only. 3. Female suicide rates are highest in the 15-24 age group. 4. Statistically significant rising trends of male and female suicide rates in the all-ages group. 5. Suicide methods were mostly violent. Among males, the most common methods were poisoning, firearms-explosives, and hanging, while in females, jumping, hanging and poisoning. 6. Mental disorders, physical illness, interpersonal and financial problems were the main reported reasons for suicide. The epidemiological characteristics of suicide in Cyprus might be attributed to a combined effect of social and cultural factors and probably reflect influences from countries to which Cyprus is ethnically, historically or geographically related.

Early adolescent cannabis exposure and positive and negative dimensions of psychosis.

AIMS: To investigate the effect of exposure to cannabis early in adolescence on subclinical positive and negative symptoms of psychosis. DESIGN: Cross-sectional survey in the context of an ongoing cohort study. SETTING: Government-supported general population cohort study. PARTICIPANTS: A total of 3500 representative 19-year olds in Greece. MEASUREMENTS: Subjects filled in the 40-item Community Assessment of Psychic Experiences, measuring subclinical positive (paranoia, hallucinations, grandiosity, first-rank symptoms) and negative psychosis dimensions and depression. Drug use was also reported on. FINDINGS: Use of cannabis was associated positively with both positive and negative dimensions of psychosis, independent of each other, and of depression. An association between cannabis and depression disappeared after adjustment for the negative psychosis dimensions. First use of cannabis below age 16 years was associated with a much stronger effect than first use after age 15 years, independent of life-time frequency of use. The association between cannabis and psychosis was not influenced by the distress associated with the experiences, indicating that self-medication may be an unlikely explanation for the entire association between cannabis and psychosis. CONCLUSIONS: These results add credence to the hypothesis that cannabis contributes to the population level of expression of psychosis. In particular, exposure early in adolescence may increase the risk for the subclinical positive and negative dimensions of psychosis, but not for depression.

Is the excess risk of psychosis-like experiences in urban areas attributable to altered cognitive development?

BACKGROUND: Rates of psychotic disorder and related attenuated psychotic experiences are higher in urban areas. We examined to what degree differences between urban and rural areas could be attributed to differences in cognitive development. METHOD: Scores on the nine subscales of the schizotypal personality questionnaire (SPQ) as well as IQ and specific neuropsychological functions of memory and attention were assessed in a representative sample of 943 young army conscripts from the 49 counties of Greece. RESULTS: Young men from urban areas had higher scores on the SPQ subscale Odd beliefs/magical thinking (OR = 1.99, 95% CI: 1.42, 2.78), but lower scores on Excessive social anxiety (OR = 0.63, 95 % CI: 0.49, 0.81) and No close friends (OR = 0.42, 95% CI: 0.29, 0.62). Adjustment for demographic factors, IQ and specific neuropsychological functions did not change the results. When the lower scores on Excessive social anxiety and No close friends were taken into account, the differences on the Odd beliefs/magical thinking subscale became even more pronounced (OR = 2.33, 95% CI: 1.56, 3.49). CONCLUSIONS: Young men from urban areas are socially more competent, but display higher levels of positive psychotic experiences, which are not mediated by lower IQ or higher levels of neuropsychological impairment.

Active eye fixation performance in 940 young men: effects of IQ, schizotypy, anxiety and depression.

A total of 940 young men performed a task in which they actively maintained fixation for 50 s in three conditions: a). on a visual target, b). on a visual target while distracting targets appeared briefly on the periphery and c). with no visual target present. The same individuals completed psychometric evaluation tests measuring IQ, schizotypy and current state-dependent psychopathology. The proportion of fixation time decreased and saccade frequency increased in condition b compared wih condition a, and sequentially in condition c compared with condition b. A trend towards a decrease in proportion of fixation time and increase in saccade frequency was found as the subjects maintained fixation during the task and this time-dependent deterioration of performance was again most pronounced in condition c, less so in condition b and absent in condition a. Psychometric test scores were significantly correlated with fixation performance in the population. Worse performance in all three fixation conditions was observed for individuals with lower IQ scores. A deterioration of fixation performance with time in condition b was correlated with disorganization characteristics of schizotypy, suggesting that these individuals had difficulty maintaining active fixation in the presence of increased inhibitory load. A connection of such a difficulty with the frontal lobes and their role in the control of voluntary inhibitory functions is discussed.

Effects of direction on saccadic performance in relation to lateral preferences.

A sample of 676 healthy young males performed visually guided saccades and antisaccades and completed the Porac-Coren questionnaire measuring lateral preferences. There was no difference in mean latency between rightward versus leftward saccades or for saccades executed in the left versus right hemispace. There was also no right/left asymmetry for individuals with left or right dominance as assessed by the lateral preferences questionnaire. The same results were observed for the latency of antisaccades and for the error rate in the antisaccade task. Finally, we did not confirm any substantial subpopulation of individuals with idiosyncratic left/right latency asymmetries that persisted both in the saccade and antisaccade task. These results suggest that neither latency nor antisaccade error rate are good indicators of lateral preferences in these tasks. Other oculomotor tasks might be more sensitive to hemifield differences, or cerebral hemispheric asymmetry is not present at the level of cortical organization of saccades and antisaccades.

Self-esteem, social adjustment and suicidality in affective disorders.

Self-esteem (SE) and social adjustment (SA) are often impaired during the course of affective disorders; this impairment is associated with suicidal behaviour. The aim of the present study was to investigate SE and SA in unipolar or bipolar patients in relation to demographic and clinical characteristics, especially the presence of suicidality (ideation and/or attempt). Forty-four patients, 28 bipolar and 16 unipolar, in remission for at least 3 months, and 50 healthy individuals were examined through a structured clinical interview. SE and SA were assessed by the Rosenberg self-esteem scale and the social adjustment scale, respectively. The results have shown that bipolar patients did not differ from controls in terms of SE, while unipolar patients had lower SE than bipolars and controls. No significant differences in the mean SA scores were found between the three groups. Suicidality during depression was associated only in bipolar patients with lower SE at remission; similar but not as pronounced was the association of suicidality with SA. It is concluded that low SE lasting into remission seems to be related to the expression of suicidality during depressive episodes of bipolar patients, while no similar pattern is evident in unipolar patients.