Mental illness through the perspective of undergraduate medical students in Greece: a cross-sectional study at Aristotle University of Thessaloniki.

Introduction: Numerous studies reveal that mental health-related stigma, stereotypes, and prejudices negatively affect the patients, jeopardizing their health, prognosis, and social opportunities. Healthcare professionals, who are in the first line of combating mental disease, are expected to play a significant role in drastically changing discriminatory and stigmatizing attitudes toward psychiatric patients and in diminishing the existing healthcare and social disparities. In this study, we aimed to explore and highlight the views of Greek medical students-that is of the future physicians-toward mental illness and people suffering from it. Materials and methods: It is a cross-sectional, observational study, in which 324 undergraduate students from the most populous Greek medical school of the Aristotle University of Thessaloniki, participated online, during the spring semester of 2022. The tools used were the Opinions about Mental Illness Scale (OMI) that assesses one's viewpoints about mental illness, the Social Distance Scale (SDS) that captures the desired degree of social distancing from patients with mental disorders, and the Level of Contact Report (LCR-12) that estimates the level of familiarity with them. Results: Participants displayed rather positive attitudes regarding the etiology of mental illness, social integration, and discrimination toward psychiatric patients [as evaluated with the respective OMI subscales; Etiology mean score (µ):8.87 ± 4.68, Social Integration (µ):17.79 ± 5.42, Social Discrimination (µ):13.54 ± 11.17], and more clearly favorable opinions concerning the need for social provision or the enactment of restrictive measures [as expressed with the relative OMI subscales; Social Care (µ):22.74 ± 4.56, Social Restriction (µ):13.27 ± 8.98], while claiming to be quite familiar with mental disorders and individuals experiencing them (as assessed with LCR; µ: 8.71 ± 2.16), and relatively willing to interact with them (as measured with SDS; µ:8.95 ± 4.23). Degree of familiarity with mental illness was directly proportional to the desire for contact with patients living with it, while the higher both were, the more improved most of the aforementioned OMI sectors were found to be. Female sex, clinical medical education, previous clinical psychiatric training, and living with or being a person with a mental disorder were the factors that defined a statistically refined profile in many of the aspects above. Conclusion: Our findings are in accordance with many prior and recent studies, while showing improved opinions compared to those of previous research in Greek student and healthcare population. They are calling for vigilance, rather than complacency, as well as educational and social interventions, in order to enable current and future healthcare professionals to perform their function to its fullest extent. Implications of our results and further research suggestions are included.

Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach.

OBJECTIVES: The study examines the clinical determinants of involuntary psychiatric hospitalization. Specifically, it investigates whether distinct clinical profiles of hospitalized patients can be discerned, what other characteristics they are linked with, and which profiles predict involuntary admission. METHODS: In this cross-sectional multicentre population study, data were collected for 1067 consecutive admissions in all public psychiatric clinics of Thessaloniki, Greece, during 12 months. Through Latent Class Analysis distinct patient clinical profiles were established based on Health of the Nation Outcome Scales ratings. The profiles were then correlated with sociodemographic, other clinical, and treatment-related factors as covariates and admission status as a distal outcome. RESULTS: Three profiles emerged. The "Disorganized Psychotic Symptoms" profile, combining positive psychotic symptomatology and disorganization, included mainly men, with previous involuntary hospitalizations and poor contact with mental health services and adherence to medication, indicating a deteriorating condition and chronic course. Τhe "Active Psychotic Symptoms" profile included younger persons with positive psychotic symptomatology in the context of normal functioning. The "Depressive Symptoms" profile, characterized by depressed mood coupled with nonaccidental self-injury, included mainly older women in regular contact with mental health professionals and treatment. The first two profiles were associated with involuntary admission and the third with voluntary admission. CONCLUSIONS: Identifying patient profiles allows the examination of the combined effect of clinical, sociodemographic, and treatment-related characteristics as risk factors for involuntary hospitalization, moving beyond the variable-centered approach mainly adopted to date. The identification of two profiles associated with involuntary admission necessitates the development of interventions tailored to chronic patients and younger persons suffering from psychosis respectively.

Mental health-related stigma discrimination and prejudices among Greek healthcare professionals.

Introduction: Research shows that mental health-related stigma, stereotypes, and prejudices have a negative impact on the patients themselves as well as on their families and social entourage. Healthcare professionals, whose expertise and professional ethos are historically acknowledged by public opinion, are expected to play a major role in combating discrimination against psychiatric patients. In this study, we aimed to assess the attitudes of Greek healthcare professionals toward mental illness and people suffering from it. Materials and methods: It is a non-interventional, analytic study, in which 479 health workers from a tertiary hospital in Thessaloniki, Greece, participated. Every single hospital service -except the personnel of the Psychiatric Clinic- was included in our study: from the cleaning service to the administrative staff and the auxiliary staff such as stretcher carriers, food and nutrition services' staff, and social workers, the nursing staff, and finally the attending physicians, taking into consideration that the psychiatric patient, from the moment he/she enters the hospital, consecutively gets in contact with every work grade of the healthcare establishment. Participants' attitudes concerning mental illness have been evaluated using the Opinions about Mental Illness Scale (OMI), the Social Distance Scale (SDS), and the Level of Contact Report (LCR-12). Results: Despite the high level of familiarity [as evaluated with LCR-12; mean score (µ): 8.82 ± 1.73], the employees displayed a rather poor willingness to interact with psychiatric patients (as measured with SDS; µ:11.68 ± 4.28), and endorsed significant prejudice toward individuals with mental disorders (assessed using OMI subscales; Social Discrimination µ: 22.99 ± 12.08, Social Restriction µ: 17.45 ± 9.07, Social Care µ: 21.04 ± 4.12, Social Integration µ: 16.38 ± 4.68, Etiology µ: 9.80 ± 4.95). Age and education stood out as the main determinants of participants' attitudes, with younger and highly educated participants to have shown a relatively refined profile. Conclusion: These results are not significantly improved compared to those of previous decades in Greek healthcare professionals and call for critical reflection and targeted stigma-reduction efforts.

Children's anxiety and parenting self-efficacy during the COVID-19-related home confinement.

BACKGROUND: The COVID-19 crisis influenced the lives of families and preschoolers, worldwide. School closures and restriction measures introduced distance learning for preschoolers and remote working for parents. Social distancing narrowed opportunities to meet with peers and enjoy leisure activities. Additionally, social and mental services closures limited young children's accessibility to mental, speech and occupational health services. The aim of the current study was to investigate how home confinement during the third wave of the COVID-19 pandemic affected parenting self-efficacy and preschoolers' anxiety. METHOD: An online survey based on a convenience sample took place on April 2021 to evaluate how home confinement to halt the third wave of COVID-19 pandemic influenced children's anxiety and parenting self-efficacy (PSE). Parents of 146 children (65 girls [44.5%] and 81 boys [55.5%]; aged 2-6 years old) were enrolled and completed a demographics form, the Preschool Anxiety Scale (PAS) and the Tool to Measure Parenting Self-efficacy (TOPSE). RESULTS: Most of the participants reported that the relationship with their child was positively affected from staying at home. TOPSE mean scores reflected average parenting self-efficacy. PSE was negatively correlated with children's anxiety. COVID-19-related variables 'Parent's vaccine hesitancy' and 'Death of a loved one' had a clear effect on preschoolers' anxiety, whereas the latter also on PSE. CONCLUSION: Findings highlight the necessity of implementing public health strategies to strengthen families and support parents and their children during the ongoing health crisis.

Primary Sjögren's Syndrome Presenting with Rapidly Progressive Dementia: A Case Report.

BACKGROUND: Rapidly progressive dementias (RPDs) are dementias that progress subacutely over a time period of weeks to months. Primary Sjögren's syndrome (pSS) is an autoimmune disease that can affect any organ system and may present with a wide range of clinical features that may mimic a plethora of medical conditions and, in rare cases, may manifest as RPD. We describe a unique case of pSS, in which rapidly progressive dementia (RPD) was the first disease manifestation, and the patient's radiological and electroencephalogram findings were compatible with Creutzfeldt- Jakob disease (CJD). CASE PRESENTATION: Here, we report a 58-year-old woman who presented with cognitive impairment rapidly deteriorating over the last 6 months prior to admission. Brain MRI and EEG were indicative of CJD. However, CSF 14-3-3 and tau/phospho tau ratio were within normal limits and therefore alternative diagnoses were considered. Blood tests were significant for positive antinuclear antibodies, anti-ENA, and anti-SSA and a lip biopsy was consistent with pSS. The patient was started on intravenous steroids followed by oral prednisone taper, which prevented further deterioration. CONCLUSION: This rare case expands the spectrum of neurological manifestations in pSS and highlights the importance of considering pSS in the differential diagnosis of RPDs in order to avoid misdiagnosis and provide appropriate treatment in a timely fashion.

Uncertainty, Stress, and Resilience During the COVID-19 Pandemic in Greece.

ABSTRACT: The COVID-19 outbreak imposed stress worldwide, as daily routine changed almost overnight, with no time to prepare. A pandemic like this may trigger a chain reaction starting out as surprise, continuing to uncertainty and ending up either in adaptation or in symptoms of fear, anxiety, and/or depression. Resilience on the other hand could lessen anxiety and prove to be a prophylactic coping mechanism against distress. This study explored peritraumatic distress, intolerance of uncertainty (IU), and resilient coping in a sample of 2717 adults who voluntarily and anonymously participated in an online survey conducted in April 2020, in Greece.Results indicated a moderate pandemic-related mental burden and medium resilient coping and designated IU as a significant positive predictor of peritraumatic distress; resilient coping proved to be a significant moderator that alters the strength of the association between IU and distress reactions.

Young adults' coping strategies against loneliness during the COVID-19-related quarantine in Greece.

COVID-19 and the related quarantine disrupted young adults' academic and professional life, daily routine and socio-emotional well-being. This cross-sectional study focused on the emotional and behavioural responses of a young adult population during the COVID-19-related quarantine in April 2020, in Greece. The study was conducted through an online survey. A total of 1559 young adults, aged 18-30 years, completed Steele's Social Responsibility Motivation Scale and the De Jong Gierveld Loneliness Scale, and answered questions about compliance with instructions, quarantine-related behaviours and coping strategies. According to the results, participants displayed a relatively high sense of social responsibility (M = 16.09, SD = 2.13) and a trend towards moderate feeling of loneliness (M = 2.65, SD = 1.62); young women reported significantly higher levels of loneliness than men. The majority complied with instructions often (46.4%) or always (44.8%). Significantly more women created a new social media account and used the social media longer than 5 h/day, compared with men. Resorting to religion, practicing sports and sharing thoughts and feelings about COVID-19 with others predicted higher levels of social responsibility; humour, practicing sports and sharing thoughts and feelings about COVID-19 with others predicted lower levels of loneliness. Conclusively, COVID-19 is expected to have a significant psychological impact on young adults. Currently, Greece is going through the second quarantine period. This study raises awareness about loneliness in young adults during the COVID-19-related quarantine and highlights the importance of developing online programmes, attractive to younger people, to nurture adaptive coping strategies against loneliness.

Young adulthood is a critical developmental period, related with significant changes in life roles. COVID-19 disrupted young adults' academic and professional life, daily routine and socio-emotional well-being. This cross-sectional study investigated social responsibility, compliance with health guidelines, loneliness, coping strategies and quarantine-related behaviours in a sample of 1559 young adults, aged 18−30 years, during the first COVID-19-related quarantine in April 2020, in Greece. According to the results, participants displayed a relatively high sense of social responsibility and complied often/always with guidelines. A trend towards moderate feeling of loneliness was observed; young women reported significantly higher levels of loneliness than men. Significantly more women created a new social media account, and used the social media for longer hours, compared with men. Humour, practicing sports and sharing thoughts and feelings about COVID-19 with others predicted lower levels of loneliness. Currently, Greece is going through the second COVID-19-related quarantine, which has no foreseeable end. This study raises awareness about loneliness in young adults, a negative emotional state that should not be overlooked during this novel public health crisis. The COVID-19 pandemic offers the opportunity to develop online programmes nurturing adaptive coping strategies to reduce loneliness in young adults.

A COVID-19 Patient Presenting With Paroxysmal Atrial Fibrillation.

The cardiovascular system is influenced in the course of coronavirus disease 2019 (COVID-19); paroxysmal atrial fibrillation (PAF) is not uncommon in hospitalized patients with COVID-19. This is a report of an atypical presentation of a 78-year-old patient who was diagnosed with COVID-19 infection. The patient, in the acute setting, was diagnosed with rapidly deteriorating cardiac failure associated with PAF, respiratory distress, and deteriorating vitals, and was eventually intubated. The mechanisms and preexisting substrates of atrial fibrillation in COVID-19 patients are discussed. A connection between arrhythmia and COVID-19, on the basis of a generalized inflammatory state, is suggested. This particular case adds to the understanding that the occurrence of PAF in COVID-19 patients is consistent with the mechanism of worse outcomes due to systemic inflammation.

A systematic review of questionnaires assessing the psychological impact of COVID-19.

The COVID-19 pandemic has led to a number of complications in everyday life, greatly affecting public health. Estimating its impact on mental health constitutes a priority issue. The current study aims to summarize the scales that have been specifically developed for this reason and are not adaptations of already existing scales. A comprehensive search was conducted by two reviewers during the period 28/09/2020-30/09-2020 in the following databases: PubMed, ScienceDirect, ScieLo, Mendeley, Google Scholar. A quality appraisal of the identified scales was made by three reviewers using the COSMIN checklist for methodological issues and the Terwee criteria for measurement properties. Our search strategy yielded a total of 855 results. Of these, 832 articles were excluded according to exclusion criteria, 23 were assessed for eligibility and 10 were finally included. These are presented in the text with additional useful information found separately. The identified scales tended to be quite short and examine stress, anxiety or fear. All studies were cross-sectional and the majority was conducted online. Most of them had a good Cronbach value (> 0.80) and adequate fit indices. It is however noted that the evaluation of their quality may be untimely due to relevant lack of data.

Similarities and Differences in the Learning Profiles of Adolescents with SLD and SLI in Mathematics-A Preliminary Analysis.

SLI and SLD constitute two independent neurodevelopmental disorders, which frequently cause challenges in the diagnosis process, especially due to their nature. This has caused disagreement among clinicians regarding their recognition as separate or overlapping disorders. The objective of the study was to enlighten the path of valid diagnosis and intervention during adolescence when the two disorders change their manifestation and overlap. Two hundred Greek adolescents (140 boys and 60 girls), 124 already diagnosed with SLD and 76 diagnosed with SLI, 12-16 years old, participated in the study. All participants were assessed in reading, oral and written language and mathematics (mathematical operations and mathematical reasoning) along with IQ testing. In order to determine statistically significant differences, the chi-square test, independent samples t-test, odds ratios and their 95 per cent confidence intervals were implemented. The results revealed that the SLI group presented significantly greater difficulties than SLD in their overall cognitive-mental profile and in most language and mathematical measurements (number concept, executive-procedural part of solving operations and mathematical reasoning). The similarity of the two groups was mainly detected in their deficient metacognitive, metalinguistic and metamnemonic strategies. The research concludes that SLD adolescents managed to overcome their difficulties to a significant degree, while adolescents with SLI still struggle with many learning areas.

Clinical Profiles and Socio-Demographic Characteristics of Adults with Specific Learning Disorder in Northern Greece.

The manifestation of Specific Learning Disorder (SLD) during adulthood is one of the least examined research areas among the relevant literature. Therefore, the adult population with SLD is considered a "rare" and "unique" population of major scientific interest. The aim of the current study was to investigate, describe, and analyze the clinical, academic, and socio-demographic characteristics, and other everyday functioning life-skills of adults with SLD, in an attempt to shed more light on this limited field of research. The overall sample consisted of 318 adults, who were assessed for possible SLD. The diagnostic procedure included self-report records (clinical interview), psychometric/cognitive, and learning assessments. The main finding of the study was that SLD, even during adulthood, continues to affect the individuals' well-being and functionality in all of their life domains. There is an ongoing struggle of this population to obtain academic qualifications in order to gain vocational rehabilitation, as well as a difficulty to create a family, possibly resulting from their unstable occupational status, their financial insecurity, and the emotional/self-esteem issues they usually encounter, due to their ongoing learning problems. Moreover, the various interpersonal characteristics, the comorbidity issues, and the different developmental backgrounds observed in the clinical, academic, personal, social, and occupational profiles of the participants, highlight the enormous heterogeneity and the continuum that characterizes SLD during adulthood. We conclude that there is an imperative need for further research and the construction of more sufficient tools for the assessment and diagnosis of SLD during adulthood, which will take into account the developmental challenges and milestones in a series of domains, in order to assist this "vulnerable" population with their life struggles.

A review on the COVID-19-related psychological impact on older adults: vulnerable or not?

BACKGROUND: COVID-19 is a novel event of the twenty-first century. Therefore, contemporary research is required to determine the current pandemic's psychological impact on older populations. Soon after the COVID-19 outbreak, several narrative reviews and guidelines were released to support older adult's psychological wellbeing. However, a lack of data from original studies was reported until May 2020. AIM: To identify studies published from May 2020 until January 2021 that quantitatively assessed the mental health impact of COVID-19 on older adults using validated psychometric tools. METHOD: A comprehensive literature search of original research articles was conducted using specific terms. The screening procedure was conducted stepwise. RESULTS: Among the 18 included studies, cross-sectional online surveys indicated that older adults were less psychologically distressed than younger ones. A longitudinal study revealed that COVID-19 did not have a major impact on loneliness and satisfaction with life. On the contrary, studies comparing pre- with peri-pandemic data revealed that older adults experienced more severe depressive/anxiety/stress symptoms and loneliness during the pandemic. Several studies reported though only subclinical symptoms, as well as low loneliness levels during the pandemic. CONCLUSIONS: Research studies suggested that older age may buffer against the COVID-19-related impact on mental health. Despite evidence against generalised perceptions of vulnerability, older adults' ability to adapt to adversity may be uneven, depending on cultural, social, economic and other individual factors. Taken together, the impact, moreover the long-term impact of COVID-19, is expected to vary across countries and older subpopulations, and remains to be evaluated by prospective, longitudinal studies.

The mediating role of fear of COVID-19 in the relationship between intolerance of uncertainty and depression.

OBJECTIVES: Living during the COVID-19 pandemic is characterized by the emergence of great uncertainty surrounding multiple aspects of daily life. This study explored the relationship between intolerance of uncertainty (IU) and depression, as well as the potential mediation effect of COVID-19-related fear. DESIGN AND METHODS: A cross-sectional study was conducted through an online survey from 10 April until 13 April 2020, three weeks after a national lockdown had been imposed in Greece. The convenience sample used in this study consisted of 2,827 adults. Participants voluntarily provided sociodemographic data and completed the following scales: the Intolerance of Uncertainty Scale (IUS-12), the Fear of COVID-19 Scale (FCV-19S), and the Brief Patient Health Questionnaire (PHQ-9) Depression Scale. RESULTS: Participants appeared to be moderately depressed [M = 14.75, SD = 4.52]. There was a significant indirect effect of IU to depressive symptoms ((.058), CI (0.051-0.066)). FCV-19S was tested as a mediator in the relationship between IUS-12 (independent variable) and PHQ-9 (dependent variable). Partial mediation of fear of COVID-19 was supported ((.54) (.41) = 13, CI (0.051-0.066), Sobel z-value = 14.93). CONCLUSIONS: Depressive symptomatology affected study participants at a moderate level. IU was shown to be a significant predictor of depressive symptomatology with higher levels of IU being associated with more severe depressive symptoms. Fear of COVID-19 partially mediated this association. The mediation effect may be explained by the uncertainty around COVID-19-related health issues, which are reflected in the FCV-19S and cause worry and/or anxiety. Uncertainty related with other factors, such as the impact on the economy and education, not assessed by the FCV-19S, may explain part of the relationship between IU and depressive symptoms that is not mediated by FCV-19S. PRACTITIONER POINTS: Intolerance of uncertainty is related to depressive symptomatology, and fear of COVID-19 explains part of the relation. Fear of COVID-19 indicates worry and anxiety related to health issues. Psychotherapeutic interventions enhancing individuals' capacity to endure uncertainty could be beneficial. Provision of simple and clear information by the authorities should be a priority issue.

Improvement of Medical Students' Empathy Levels After an Intensive Experiential Training on Empathy Skills.

Background: EMPATHY IN HEALTHCARE is an intensive 20-hour experiential training program based on mediation techniques and specialized healthcare role-play for clinicians and medical students. It is hypothesized that the training will improve empathy via the intensive experiential techniques implemented. Methods: A total of 50 medical students (25 males/25 females) took the course voluntarily. Empathy was measured using the Jefferson Scale of Empathy-Medical Students Version (JSE-S) (Greek version), before and after the 20-hour training, along with a 6-month follow-up. Gender, age, preferred medical specialty and baseline empathy score were explored as possible moderator variables of the training effect. Results: Empathy increased after training, with a mean JSE-S score improvement of 11.25 points (±8.848) (P < .001). After 6 months, the mean JSE-S score maintained a difference of 6.514 points (±12.912) (P < .005). No differences were recorded with regard to gender, age group or medical specialty for the pooled data. Women in the 22-24 year-old age group had a 5-point mean difference (P = .05), and higher post-training scores than men. Lower initial scorers were the ones that mostly improved, with a 3-fold mean score difference from the higher scorers regardless of gender (P < .001), while also showing a smaller drop in empathy levels 6 months after the training compared to the higher scorers. Conclusion: Intensive experiential training can improve empathy in a clinical setting. EMPATHY IN HEALTHCARE is a successful training program in improving empathy in medical students, as measured by the JSE-S. A score of 110 and below could be used for selecting medical student candidates who will benefit most from empathy training.

Priorities in the Interdisciplinary Approach of Specific Learning Disorders (SLD) in Children with Type I Diabetes Mellitus (T1DM). From Theory to Practice.

BACKGROUND: A considerable endeavor had taken place in order to understand the associated challenges for children and adolescents with Specific Learning Disorder (SLD) and Type 1 Diabetes Mellitus (T1DM) but also in order to describe the necessary skills and approaches that the care givers have to develop to assist both children and parents. (1) Aim: The aim of this review is twofold. Firstly, to highlight the T1DM's potential impact on psychological well-being, on cognitive functioning and on school performance in children and adolescents who confront SLD. Secondly, to discuss the necessity of a multidiscipline approach of poor school performance in students with SLD and T1DM, presenting the serious contribution of care providers: (a) parents/carers in the family setting, (b) teachers and psychologists in the school setting and (c) health specialists (pediatricians, nutricians, nurses, child psychiatrists and psychologists) in the medical setting. (2) Methods: In this narrative literature review of 12 selected articles, each one studies a special aspect of approach, during the diagnosis and the treatment of individuals with T1DM and SLD. The review concerns the arising problems and difficulties in the adherence to diagnosis, the management of insulin, the mental and physical wellbeing, the school performance, the cognitive functioning and learning difficulties of patients. We tried to synthesize an interdisciplinary approach that involves collaboration between family, school and medical frame; facilitating children's and adolescents' difficulties management, as well as parent and teacher involvement during the intervention implementation. (3) Results: The main issues of concern were examined through the available literature, as different factors had to be re-examined in the previous studies, regarding the potential impact of T1DM in cognitive and psychological functioning, as well as the effects of the intervention/approach/treatment of children and adolescents with SLD and T1DM. (4) Conclusions: Although T1DM diagnosis and demanding treatment are a heavy burden for children and their families, T1DM may or may not be associated with a variety of academic and psychological outcomes. Despite the variability of the reviewed research design quality, it was clearly defined that the impact of T1DM is not uniform across educational and mental variables. Strengthening the children's physical, psychological and social wellbeing is an especially important factor, as it facilitates the insulin's management as well as the learning difficulties. This is possible by supporting the parental and teacher involvement in the intervention process. This review highlights the need to reduce the distance between theory/research and practice, in some of the proposed areas in this field of knowledge.

School Failure in a Girl with Specific Learning Difficulties, Suffering from Childhood Depression: Interdisciplinary Therapeutic Approach.

INTRODUCTION: Recent studies confirm the association of literacy difficulties with higher risk of both childhood behavioral and mental disorders. When co-morbid problems occur, it is likely that each will require separate treatment. The management of major depressive disorder (MDD) for a 9.5 years old girl with specific learning difficulties (SLD), a protracted clinical course, and a family history of affective disorders, was challenging for the interdisciplinary team of our clinic, dealing with learning disabilities. AIM: The research and examination of the first-onset major depressive disorder (MDD) in a child with specific learning disabilities and its impact on school performance. This case report examines the potential contributory factors, but also the recent evidence on the co-morbidity between literacy difficulties and mental illnesses in children. METHOD: Reporting a two years follow-up of a 9.5 years old child with SLD suffering from childhood depression. RESULTS: A 9.5 years old child with no history of affective disorders, but with a family history of first-degree and second-degree relative suffering from childhood-onset, recurrent, bipolar or psychotic depression. The child was assessed by a child psychiatrist during a period of 2 years, with an average of follow-ups between 1 or 2 weeks. The discussion highlights diagnostic and treatment pitfalls, as well as developmental issues. Practical interventions are suggested. CONCLUSION: A psychiatrically charged familial environment, including a mother suffering from anxiety disorder and behavioral disorder, contribute significantly to the development of depression in early age. An early medical intervention would be the key for successful treatment. The combination of psychotherapy and antidepressants (mostly selective serotonin reuptake inhibitors (SSRIs)) is the suggested therapy for childhood MDD.

Childhood ADHD and Early-Onset Bipolar Disorder Comorbidity: A Case Report.

INTRODUCTION: Recent research has highlighted an increased rate of co-morbidity between the neurodevelopmental-behavioral disorder of attention deficit hyperactivity disorder (ADHD) and a variety of psychiatric disorders, such as mood disorders or bipolar disorder (BD). The etiology and clinical course of BD are considered to be determined by both genetic and environmental factors, either aggravating or improving. AIM: This follow-up study of an adolescent aimed to clarify the co-morbidity between ADHD and BD. We also discuss the controversies surrounding the two diagnoses in younger populations and describe several aspects of concern regarding diagnosis, differential diagnosis, therapeutic planning/intervention, and prognosis. METHODS: Reporting of a two-year follow-up study of a bipolar 15-year-old female patient with a previous diagnosis of ADHD during childhood. RESULTS: Despite the occurrence of major risk factors, such as early onset and positive family history, the patient's condition rapidly remitted with medication, without relapse and/or rehospitalization during the following two years, due to the stability of her cooperation, and support of a stable and caring familial environment. Early diagnosis of BD and differential diagnoses of ADHD are considered crucial protective factors leading to an appropriate planning of treatment. In addition, parental involvement and empathic attitude towards the patient supported the latter to cooperate and comply with the treatment, enhancing positive outcomes and stability. CONCLUSIONS: Research is required into the reliability and validity of diagnostic protocols and criteria for BD in children and adolescents, and also into the development of individualized therapeutic planning.

Psychological and Behavioral Responses to the COVID-19 Pandemic in Greece.

OBJECTIVE: Fear of COVID-19 was associated with more severe depressive and anxiety symptoms. This study aimed to explore COVID-19-related fear, depressive and anxiety symptoms, social responsibility, and behavioral responses during the COVID-19 pandemic in Greece. METHOD: A cross-sectional study was conducted from April 10 to April 13, 2020. Members of the Greek general population completed anonymously an online survey, distributed through the social media. Among the 3,700 adult respondents, 3,029 fulfilled inclusion criteria. The survey included sociodemographic questions, questions exploring potential risk factors for increased fear of COVID-19, questions about the employment of safety and checking behaviors, and questions about compliance with public health guidelines. In addition, four psychometric scales were used, the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), and Steele's Social Responsibility Motivation scale. Multivariate General Linear Models (GLM) were used to depict significant differences among dependent variables (FCV-19S, PHQ-9, GAD-7) and independent variables (potential risk factors, safety and checking behaviors, compliance with guidelines). The relationship between the FCV-19S total score and influencing factors was quantified by linear regression analysis. RESULTS: Several participants reported high levels of COVID-19-related fear (35.7%) and moderate to severe depressive symptoms (22.8%), while a significant proportion reported moderate to severe anxiety symptoms (77.4%). Women scored altogether significantly higher than men. Respondents under the age of 30 reported less fear and depressive symptoms and showed the least social responsibility. Based on GLM, a significant other's COVID-19 illness, being on psychiatric medication, employment of safety and checking behaviors, and compliance with guidelines were associated with higher COVID-19-related fear. Linear regression analysis revealed that gender, age, depressive, and anxiety symptoms modified levels of COVID-19-related fear. CONCLUSIONS: Greater behavioral responses to the pandemic, that is, excessive employment of safety/checking behaviors and greater compliance with guidelines, were shown to amplify fear, potentially due to increased contamination awareness. In addition, female gender, older age, and more severe anxiety symptoms were related with higher COVID-19-related fear. Describing and weighing carefully the psychosocial and behavioral impact of the pandemic will enable the implementation of both supportive and preventive interventions.

Intolerance of Uncertainty and Loneliness in Older Adults During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic imposed a psychological burden on people worldwide, including fear and anxiety. Older adults are considered more vulnerable during public health emergency crises. Therefore, the aim of the present study was to investigate the psychological response of older adults during the acute phase of the pandemic in Greece. METHOD: This cross-sectional study was part of a larger three-day online survey. A total of 103 participants over the age of 60 fulfilled inclusion criteria. The survey included sociodemographic questions and six psychometric scales: the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), the Athens Insomnia Scale (AIS), the Intolerance of Uncertainty Scale (IUS-12), and the De Jong Gierveld Loneliness Scale (JGLS). RESULTS: A significant proportion of the participants reported moderate to severe depressive symptoms (81.6%), moderate to severe anxiety symptoms (84.5%), as well as disrupted sleep (37.9%). Women reported significantly higher levels of COVID-19-related fear, more severe depressive symptoms and sleep disturbances, as well as higher levels of intolerance of uncertainty. Participants living alone showed higher levels of loneliness. Intolerance of uncertainty was shown to modulate levels of loneliness. CONCLUSIONS: During the quarantine, attention was promptly drawn upon the risks related with older people's loneliness. Studies identifying factors that may contribute to loneliness during a public health emergency facilitate the implementation of supportive interventions. Preparedness to address and manage older people's loneliness may limit this deleterious emotional response during the pandemic, as well as at the post-COVID-19 phase.