Neurobiology of emotional trauma.

An emotional trauma may induce a cascade of neurobiological events that have long-lasting consequences even altered gene expression. Early abuse and neglect can deregulate the child's developing neurobiological system by reducing its resistance to stressful events, leading to later problems of emotional regulation. Children who have been subjected to physical or emotional abuse tend to pay more attention to signs that contain anger and are hypersensitive to threat. Scar hypothesis and the theories of behavioural sensitization or electrophysiological kindling suggest that emotional traumas may leave traces that persist even after remission of depression, and render individuals vulnerable to the onset of new episodes, even under the influence of only moderate psychosocial stress. Unfavorable early social experiences, such as emotional abuse or institutionalization can affect the structure and function of the prefrontal cortex. Exposure to repeated emotional stressors, even in the absence of post-traumatic stress disorder (PTSD) diagnoses, has been shown to produce increased synapse formation and dendritic growth in basolateral amygdala, dendritic retraction in the hippocampus, and anxiety-like behavior against specific triggers, such as phobia of open spaces. During the narration of an emotionally traumatic event, there is activation of the limbic system, the right amygdale, the orbitofrontal cortex and the anterior cingulate gyrus. In addition, there is an activation of the anterior insula, which records the physical impact of negative emotions, and the anterior and medial temporal cortex, which are involved in negative emotions. Neuroimaging studies in PTSD patients have found hypoactivity in the frontal lobe, anterior cingulate and thalamic areas, indicating the effects of PTSD on executive function, attention and cognitive, memorial, and affective and somatosensory integration. One of the most replicated findings in studies involving PTSD patients is the decreased activation of the dorsolateral prefrontal cortex. Studies have also found a negative correlation between the dorsolateral prefrontal cortex and amygdala activation. A recent meta-analysis revealed structural brain abnormalities associated with PTSD and emotional trauma and suggested that global brain volume reductions can distinguish PTSD from major depression. Neuroimaging studies of successful eye movement desensitization and reprocessing (EMDR) treatment have consistently shown that patients exhibited increased frontal lobe activation. Moving beyond diagnostic boundaries, focusing on the causal interplay between specific traumatic processes and using standardized measures, are useful directions for future research in memory, emotion and emotional trauma.

Is psychosis a dysmyelination-related information-processing disorder?

Numerous lines of evidence implicate myelin and oligodendrocyte function as critical processes affecting neuronal connectivity, which is a central abnormality in schizophrenia. Neurodevelopmental models related to dysmyelination have suggested its relation with different schizophrenia-like symptoms. Post-mortem studies in patients with schizophrenia have reported 14-22% reduction in the density and the quantity of oligodendrocytes. Several myelin-related candidate genes have been linked oligodendrocyte and myelin dysfunction with neurocircuitry abnormalities in schizophrenia. A number of myelin gene knockout mice models exhibit schizophrenia-like behaviours, and genomic, especially GWAS, studies identified new schizophrenia loci related to oligodendrocyte genetic polymorphisms. It is known that myelin acts as electrical insulation for the ensheathed axon, which helps to preserve the amplitude and to increase the conduction velocity of the propagating axon potential. A growing body of evidence points towards the involvement of dysmyelination of the prefrontal cortex in the development of the cognitive symptoms of psychosis. Neuroimaging investigations have linked processing speed to brain anatomical connectivity, and have pointed the role of processing speed among the predictors of clinical changes in schizophrenia. The dysmyelination-induced delays in patients with psychosis may cause a discrepancy in sensory feedback mechanisms, which results in prediction error. The myelin abnormalities and the resulting conduction delays vary during the course of the multiple sclerosis and this type of cycles are possibly associated with fluctuations in conduction velocity in psychosis. It is worthy of note that the major histocompatibility complex (MHC) is responsible for the genetic overlap in both multiple sclerosis and schizophrenia. Multiple sclerosis manifests sensory and motor symptoms, and schizophrenia disordered cognition and emotion. Having in mind the interdependent relationship of oligodendrocytes and the axons they myelinate, we could suggest that both multiple sclerosis and schizophrenia may use in central nervous system a common pathway of disordered information-processing. Recent research suggests that adaptive myelination could normalize neuronal electrical excitability, which in turn can modify myelin plasticity, resulting to neural activity and behavior modulation. We may suggest that interventions that preserve white matter integrity or ameliorate white matter disruption may enhance information-processing and functional outcome in psychosis.

Criminality in Greece during the years of financial crisis: 2008-2014.

The link between poverty, unemployment and economic downturns and increases in crime rates has long been the subject of social science study. However, the relationships between these phenomena has not been studied sufficiently and through time in most European countries that suffered, or, like Greece, are still suffering the recent financial crisis. We examined if the recent financial crisis in Greece has coincided with an increase in crime, analyzing crime rates since the start of the financial crisis and over an extensive time period (7 years). Crime statistics were taken from the Greek Police. Repeated measures analyses of variance were performed to reveal potential differences in criminality for the years 2008, 2010, 2012 and 2014. There was a significant increase in global criminality rate per 100,000 residents (Wilks' Lambda=0.32, F (3,11)=7.93, p=0.004). There was a significant increase in illegal gun possession (Wilks' Lambda=0.16, F (3,11)=18.68, p=0.001), fraud (Wilks' Lambda=0.10, F (3,11)=32.35, p=0.001), extortion (Wilks' Lambda=0.38, F (3,11)=4.45, p=0.040), and beggary (Wilks' Lambda=0.33, F (3,11)=6.22, p=0.014). A reversed U shape was found for homicides, thefts and robberies, with rates peaking in 2010 and 2012 before dropping off in 2014. Narcotics and sexual exploitation crime rates remained unchanged. Surprisingly, the incidence of rape decreased (Wilks' Lambda=0.42, F (3,11)=5.14, p=0.018). Our results are in agreement with the results of previous broader studies as well as with criminological theories according to which in times of economic stress an increase in both property crimes and violent crimes is expected. As predicted, an increase in financial crime was observed (e.g. fraud and extortions) as well as petty crime related to financial hardship like beggary. Concerns regarding the escalation of white-collar crimes in times of economic downturns that have been raised in the literature warrant further investigation.

Is impulsivity in part a lithium deficiency state?

Lithium mechanisms of action are related to the function of many enzymes, hormones, vitamins, and growth factors. In humans, lithium treatment has been associated with humoral and structural evidence of neuroprotection, such as increased expression of antiapoptotic genes, inhibition of cellular oxidative stress, synthesis of brain-derived neurotrophic factor, cortical thickening, increased grey matter density, and hippocampal enlargement. Lithium, in pharmacological doses, has been used successfully in treating bipolar disorders, and has been shown to decrease suicidality and violent crime in this situation. The guidelines of major psychiatric association name lithium as a first-line therapy for bipolar disorder. From the other hand, impulsivity is a core feature of bipolar disorder. Increased levels of this dimensional trait are present not only during acute phases of the illness but also during euthymia. Increased impulsivity worsens clinical prognosis of bipolar disorder due to its association with several severity indices, such as substance abuse or dependence, suicidal behavior, and poorer functional outcome. A wide range of intracellular responses may be secondary to the inhibition of glycogen synthase kinase-3 beta (GSK3ß) by lithium, while genetic variability at GSK3ß gene was found to be associated with increased impulsivity in bipolar patients. Although impulsivity has been traditionally linked to dysregulation of serotonergic and dopaminergic systems, some authors have proposed that lithium could reduce impulsivity levels by means of its capacity to regulate the aforementioned neurotransmitter systems. Moreover, lithium in trace amounts, as occurs in drinking water, has been inversely related to suicidal mortality, aggression and homicidal violence. These findings pose the question of whether the prospect of adding lithium to drinking water is realistic, weighing the benefits and potential risks. It seems also that in the competition for survival, those entities that best minimized lithium toxicity and maximized the benefits of lithium action had an edge in the competition to survive and reproduce. Finally, lithium has been reported to increase the volume of the prefrontal cortex and anterior cingulate gyrus. Evidence from both basic and clinical researches support that lithium may decrease impulsivity and may at least partially, exert its antisuicidal effect via reinforcing "top-down brakes" of impulsive action. Considering the research data, we may suggest that even natural lithium level intake can influence impulsivity, a possible core factor that mediate to the manifestation of both suicidality and aggressiveness, or even criminality. Moreover, we may suggest that a lithium deficiency state may precipitate these situations.

[Persistence of psychosis in the population: Τhe cost and the price for humanity].

Schizophrenia is a chronic and highly impairing condition that affects around 1% of the human population. Evolutionary theories lend support for the idea of a continuum approach to the diagnosis of psychosis. Subclinical psychotic-like experiences are relatively common in children and adolescents, occurring in about 17% of youths. The prevalence rate of psychotic symptoms in the general population is up to 8%, which is about ten times higher than the prevalence of diagnosed psychotic disorders. Some scientists have argued that there may be a shared genetic variation between illness and non-clinical psychotic- like symptom expression. The high prevalence of non-clinical psychotic symptoms in the population prompt neuroscientists to re-evaluate these symptoms in the light of evolutionary theory. The schizophrenia impaired physical health and reduced probability of reproduction raises an evolutionary puzzle. How does schizophrenia persist in the population at a stable prevalence rate? The question regarding what processes maintain the persistence of high heritable variation in relatively disadvantageous traits, such as schizotypy, in the general population, remains a universal challenge across the domains of psychiatric and evolutionary genetics. Furthermore, is there any link between the evolutionary persistence of psychosis in the population worldwide and the association of creativity with psychoticlike experiences in the general population? There has been a healthy debate on many hypotheses. One possibility is that schizophrenia remains in the human population because of shared genetic linkages to creativity. During last decade many scientists search the explanation for the evolutionary enigma of the persistence of schizophrenia, and the nature of its relation to creativity, although the notion that there is a heritable aspect of at least some aspects of high ability, including creativity, is going back at least to Francis Galton's book Hereditary genius (1869). Neuroscientists also suggested that schizophrenia may emerge as a by-product of social cognition or that certain types of hallucinations could be viewed as evolutionary by-products of a cognitive system designed to detect threat. Some traits, such as schizotypy, may have an optimal level of expression that is advantageous within the community. However, this trait has adverse consequences for the psychotic person, which becomes, as Sebastian Faulks (2006) suggested, "the price we pay for being what we are".

Steinberg and Durell (1968) revisited: increased rates of First Episode Psychosis following military induction in Greek Army Recruits.

Since the seminal study of Steinbeck and Durell (1968), few epidemiological studies have attempted to replicate whether psychosocial stress precipitates the onset of a first psychotic episode. Our aim was to support or refute the finding of elevated psychosis incidence in the first month of army induction and to examine factors impacting the timing of onset. Data were collected from medical files of 186 army conscripts, hospitalized with a diagnosis of First Episode Psychosis (FEP) between 2005 and 2014 in the Psychiatric Military Hospital in Athens, Greece. FEP rates were at least 4.5 times higher in the first month of military service, compared with any other month. Earlier FEP onset was associated with rural environment at the time of birth, multiple drug use and service away from home. Psychosocial stress precipitates FEP, particularly in those exposed to other risk factors.

[Poor insight and psychosis].

A variety of phenomena might be considered as reflecting impaired insight in psychosis, like failure to recognize signs, symptoms or disease, failure to derive appropriate cognitive representations, despite recognition of the disease, and misattribution of the source or cause of the disease. The unawareness of tardive dyskinesia symptoms in schizophrenic patients points that self-awareness deficits in schizophrenia may be domain specific. Poor insight is an independent phenomenological and a prevalent feature in psychotic disorders in general, and in schizophrenia in particular, but we don't know yet if delusions in schizophrenia are the result of an entirely normal attempt to account for abnormal perceptual experiences or a product of abnormal experience but of normal reasoning. The theoretical approaches regarding impaired insight include the disturbed perceptual input, the impaired linkage between thought and emotion and the breakdown of the process of self-monitoring and error checking. The inability to distinguish between internally and externally generated mental events has been described by the metarepresentation theory. This theory includes the awareness of ones' goals, which leads to disorders of willed action, the awareness of intention, which leads to movement disorders, and the awareness of intentions of others, which leads to paranoid delusions. The theory of metarepresentation implies mainly output mechanisms, like the frontal cortex, while the input mechanism implies posterior brain systems, including the parietal lobe. There are many similarities between the disturbances of awareness seen in schizophrenia and those seen as a result of known neurological impairment. Neuropsychological models of impaired insight typically attribute the disturbance to any of a variety of core deficits in the processing of information. In this respect, lack of insight is on conceptual par with alogia, apraxia or aphasia in reflecting disturbed cognitive processing. In this direction, research have implicated the role of self-monitoring in disorders of awareness and many of the core symptoms of schizophrenia, and has been suggested that these symptoms are the result of a disturbance of a medial frontal system involving anterior hippocampus, cingulated gyrus, supplementary motor area, and dorsolateral prefrontal cortex. Poor insight seems to be something more than a symptom or an epi-phenomenon and its mechanism may constitute a core factor into the psychosis process. Also, poor insight would be involves a common mechanism for many other mental disorders or even it would be an independent and trans-diagnostic factor into the human personality, probably like the dimension of psychotism.

[Online Counselling: The prospect of a therapeutic connection].

Over the last few years, Internet has become an integral part of daily life. An abundant source of information and a principal gateway of communication between individuals, Internet has been continuously gaining considerable ground as a tool of awareness and intervention in the area of public health. With regard to the field of mental health, Internet exhibits a credible potential in facilitating dialogue not only between experts and their beneficiaries but also between stakeholders. Moreover and with regard to various aspects of public concern, it can serve as a circulation portal of educational material between students and teachers. The advent of remote support services dates back in the decade of 1970-1980. In the present time, they consist of informative guides and self-help groups or online counselling. The latter is defined as the process in which both parties, namely the therapist and the client, are involved in an oral or written conciliation through means of an internet connection, videoconferencing, live chat or e-mail exchange. The benefits of this practice - accessibility, relocation, convenience, anonymity, facilitation of face-to-face psychotherapy and low cost - could make online counseling, in specific cases, the treatment of choice. While the usage of the World Wide Web seems promising for the rectification of mental health disorders, there is some debate among experts regarding the ethical aspect of practicing psychotherapy in an interactive digital environment. Issues such as technical expertise and the tackling of related problems, difficulties in the diagnostic process, interchange of verbal and nonverbal cues, crisis management, safeguarding the therapeutic alliance, protection of personal data, age restriction, keeping boundaries in relation to the setting, the time and the dynamics of the therapeutic relationship and, finally, training and supervisory process of online therapist, are some subjects of disagreement. Relevant research reveals the effectiveness of online counseling in decreasing the magnitude of reported symptoms, with a direct positive impact on the improvement of daily functioning and on future relapses. However, the usefulness of developing a therapeutic relationship through internet connection is being criticized by a group of clinicians, with their main arguments revolving around spatiotemporal issues and the reliability of incoming information. Some other researchers correlate the therapeutic alliance concluded in the context of electronic communication with a positive therapeutic effect. The data on the effectiveness of online practice are not sufficient to draw a definite conclusion. In an era of direct and rapid communication, it is imperative to encourage further research, for the determination of optimal conditions with respect to the practice of internet-delivered psychotherapy and the patients' well being as a result of treatment.

Financial crisis and criminality in Greece: 2008 vs 2011.

Α number of previous articles have dealt with the negative impact of the Greek Economic crisis on public health, including significant increases in major depression prevalence and suicide and homicide rates. The mentally ill seem to represent a vulnerable social group, with particular difficulties in this context. The number of compulsory assessments and involuntary admissions was recorded by reviewing patient records in the Department of Psychiatry of the University Hospital of Patras, through years 2006-2013. Compulsory assessments increased from 176 in 2006 to 262 in 2009 and 354 in 2013, representing a 48.86% and 101.13% increase in the first and the fifth year of economic crisis, respectively. The assessments resulted in 160 involuntary admissions in 2006, which escalated to 262 admissions (63.75% rise) in 2013. Even though a rise in involuntary placements could be attributed to other factors as well, it may also partly represent a not so evident side of the Greek economic crisis.

[Virtual reality therapy in anxiety disorders].

During the last decade a number of studies have been conducted in order to examine if virtual reality exposure therapy can be an alternative form of therapy for the treatment of mental disorders and particularly for the treatment of anxiety disorders. Imaginal exposure therapy, which is one of the components of Cognitive Behavioral Therapy, cannot be easily applied to all patients and in cases like those virtual reality can be used as an alternative or a supportive psychotherapeutic technique. Most studies using virtual reality have focused on anxiety disorders, mainly in specific phobias, but some extend to other disorders such as eating disorders, drug dependence, pain control and palliative care and rehabilitation. Main characteristics of virtual reality therapy are: "interaction", "immersion", and "presence". High levels of "immersion" and "presence" are associated with increased response to exposure therapy in virtual environments, as well as better therapeutic outcomes and sustained therapeutic gains. Typical devices that are used in order patient's immersion to be achieved are the Head-Mounted Displays (HMD), which are only for individual use, and the computer automatic virtual environment (CAVE), which is a multiuser. Virtual reality therapy's disadvantages lie in the difficulties that arise due to the demanded specialized technology skills, devices' cost and side effects. Therapists' training is necessary in order for them to be able to manipulate the software and the hardware and to adjust it to each case's needs. Devices' cost is high but as technology continuously improves it constantly decreases. Immersion during virtual reality therapy can induce mild and temporary side effects such as nausea, dizziness or headache. Until today, however, experience shows that virtual reality offers several advantages. Patient's avoidance to be exposed in phobic stimuli is reduced via the use of virtual reality since the patient is exposed to them as many times as he wishes and under the supervision of the therapist. The technique takes place in the therapist's office which ensures confidentiality and privacy. The therapist is able to control unpredicted events that can occur during patient's exposure in real environments. Mainly the therapist can control the intensity of exposure and adapt it to the patient's needs. Virtual reality can be proven particularly useful in some specific psychological states. For instance, patients with post-traumatic stress disorder (PTSD) who prone to avoid the reminders of the traumatic events. Exposure in virtual reality can solve this problem providing to the patient a large number of stimuli that activate the senses causing the necessary physiological and psychological anxiety reactions, regardless of his willingness or ability to recall in his imagination the traumatic event.

Suicide in Greece: 2001-2011.

Since 2008 several European countries have fallen into a financial crisis. This crisis has mainly affected the Greek population. The lower of income and the increase of unemployment as consequences of crisis lead to negative effects on people's mental health. Usually, in periods of economic crisis there is an increase of suicidality of population. The aim of this study is to examine the changes of suicide rates in Greece during the last decade (2001-2011) with particular consideration in the recent period of economic crisis (2008-2011). Data regarding the greek general population and the crude data on suicides were obtained from the Hellenic Statistical Authority (ELSTAT). We assessed the specific suicide rate, i.e. the number of suicide cases per 100.000 inhabitants (SSR) using population data on the 2001 and 2011 census. Yearly and mean total, age and sex-SSR were calculated in five years age groups. There were no suicide cases among children under the age of fifteen. We compared total and male, female SSR during the period before the crisis (2001-2007) and during the crisis (2008-2011). During the decade 2001-2011 a total number of 4133 suicide cases were recorded. There were 3423 (82.8%) male suicides and 710 (17.2%) female suicides. During the decade 2001-2011 total SSR increased by 38.4%. In males increased by 33.1% and in females by 69.6%. In the period before the crisis (2001-2007) total SSR decreased by 3.9%. In males decreased by 8.4% but in females increased by 22.3%. During the period of crisis (2008-2011) total SSR increased by 27.2%. In males increased by 26.9% and in females by 28.5%. There was a statistically significant increase in total SSR during the crisis regarding subjects 50-54 years old (t=3.43, p=0.007) and in total SSR of males (t=2.31, p=0.047) as well as of the males age groups 50-54 (t=3.56, p=0.006), 45-49 (t=2.87, p=0.02), 30-34 (t=2.96, p=0.02). There were no statistically significant differences both in total SSR and in SSR of all age groups of females during the crisis. The most often used method of suicide all the year of this study was by hanging. In absolute count the total suicide cases for the year 2011 in Greece were 477 (SSR=4.22) and the male suicides 393 (SSR=7.02) which are the highest number of suicides observed in Greece during the last decades. Findings suggest an increase in suicide mortality in Greece during the financial crisis. Reorientation of the goals of the national mental health system as well as targeted interventions should be applied in high risk individuals, i.e. unemployed, poor, suffering from mental or/and physical illnesses, in order to prevent or to mitigate the impact of the financial crisis in the greek population.

[Aggressive behavior: theoretical and biological aspects].

The susceptibility to aggression may manifest differently depending on the psychological context in which it occurs. In the context of psychopathy, characterized by a lack of empathy, this may manifest in aggression with criminal acts, which is characteristic of antisocial personality disorder. When the susceptibility is associated with psychotic impairment, aggression may be manifested in highly deviant behavior, like murder or serial killing. While the great majority of persons with schizophrenia do not commit violent acts, clinicians suggest that some schizophrenics may pose a risk in the community, particularly those patients with co-occurring substance abuse diagnoses, those who are noncompliant with prescribed psychiatric treatment, and those with a history of frequent relapses resulting in hospitalization or arrest. Episodic violence and aggression often accompany dementia. When coupled with emotional dysregulation, impulsive aggression often occurs in an interpersonal context, as in borderline personality disorder. However, the most common comorbidity is the substance abuse disorder, which contributes to both the cognitive distortions and disinhibition associated with the substance use. According to the biological data, aggression seems to emerge when the drive of limbic-mediated affective prefrontal response to provocative producing stimuli is insufficiently constrained by inhibition. Thus, excessive reactivity in the amygdale, coupled with inadequate prefrontal regulation, increase the possibility of aggressive behavior. The PET/SPECT studies focusing on schizophrenia have shown reduced activity in fronto-temoral circuitry. The fMRI studies concord with the hypothesis that among violent persons with schizophrenia, those with sociopathetic features and/or substance abuse constitute a highly different subgroup, in which cognitive, neurological and behavioral patterns are more closely associated with the personality traits than schizophrenia. It is known that serotonin facilitates prefrontal inhibition and insufficient serotonergic activity may increase aggression levels. Gabaminergic activity reduce subcortical reactivity, and thus reduced gabaminergic activity may increase aggression. In addition, agonism of 5-HT2A receptor may increase impulsivity levels, while 5-HT2C receptor agonism may decrease it. An imbalance between these receptors with increased serotonergic activity at the 5-HT2A receptor and decreased 5-HT2C receptor sensitivity may increase the possibility of aggression. Fluoxetine may reserve this pattern by increasing presynaptic availability, decreasing 5-HT2A binding and enhancing signal at 5-HT2C receptors. Similarly, atypical antipsychotics, which in parallel with the D2 antagonism have a prominent 5-HT2A receptor antagonism, manifest significant antiaggressive properties. In addition mood stabilizers, affecting glutamatergic/gabaminergic balance, serve to the reduction of impulsive aggression, while lithium manifests positive effect on both suicidality and impulsive aggression.

[Suicide rates and mental health services in Greece].

Some studies have shown that access to mental health services can have an impact on mental health outcomes, including the suicide rates. The aim of the present study was to examine the relationship between regional and prefecture suicide rates (suicides per 100.000 residents) and both the number of primary and mental health-care service providers and the number of mental health infrastructures in Greece. Data were taken mainly from the Hellenic Statistical Authority (EL.STAT.) and the Ministry of Health for the period 2002-2009. Spearman correlations were used to examine the relationship between primary health-care, mental health providers and suicide rates per 100,000 residents at the prefecture, administrative region and geographical region levels. Men showed significantly higher suicide rates than women (U=-7.20, p<0.001). For the period 2002-2009, the highest suicide rate at the prefecture level were in Rethymno (6.99), Rodopi (5.62) and Zakynthos (5.28). For the same period, the highest suicide rates at the geographical level were in Peloponnisos (4.01), Ionian Islands (4.03) and Grete (3.65). Increase in suicide rates (2009 vs 2002-2009) was observed in the following geographical regions of Greece: Crete (4.76 vs 3.65), Thrace (4.45 vs 2.02) Central Greece (3.61 vs 1.39) Aegean Islands (3.03 vs 1.28). The highest correlations between suiciderutes and health services at the geographic regional level were found to be during the period 2007-2009, where suicide rates showed a significant negative correlation with privately practicing psychiatrists (rho=-0.71, p<0.05), privately practicing psychologists (rho=-0.56, p<0.05), pathologists (rho=-0.73, p<0.01), and the number of the official mental health services (psychiatric clinics, day centers, mobile mental health units etc.) (rho=-0.73, p<0.01). In conclusion it was found that at all regional levels, suicide rates were reversely related to the number of primary health-care and mental health service providers, as well as the number of mental health infrastructures in Greece. It should be noted that the running financial crisis in Greece seems to have many effects on quality of life, since the most common effects of an economic crisis are unemployment, spending power cuts,general insecurity and public spending retrenchment, including health related budget cuts. Having in mind the above situation, further analyses are needed to determine the relationship between mental health-care services, suicide rates and other psychosocial indices, in order to provide a strategic plan for a better design of mental health-care policy in Greece.

[Internet use and pathological internet engagement in a sample of college students].

Recent studies indicate multiple consequences of pathologically excessive internet use. This study investigated the correlate of internet usage, with pathological internet engagement. Participants were 514 college students from the University of Athens who completed a questionnaire covering various aspects of internet use, Young's Internet Addiction Test, scales investigating online gambling addiction and cybersexual addiction and scales investigating suicidal ideation and the use of psychoactive substances. We found that the daily Internet use (b=0,38, t=10,38, p<0,001), the use of interactive online games (b=0,21, t=5,15, p<0,001), making acquaintances on the internet (b=0,20, t=5,11, p<0,001) and the participation in online forums (b=0,15, t=3,64, p<0,001) account for 42% of the variance of pathological internet engagement. Subjects at risk for developing pathological internet engagement had significantly higher levels of online gambling addiction, cybersexual addiction, suicidal ideation and alcohol abuse, compared with other groups. Pathological internet engagement, particularly in young people, is a new psychopathological parameter that should be incorporated in the diagnostic and therapeutic horizon of mental health professionals.

[Financial crisis and mental health in Greece].

Several studies indicate an association between economic crises and psychological burden. To investigate the possible impact of the current economic crisis on mental health in Greece, the association between two economic indicators (unemployment and average income) and mental health variables (psychiatric clinic admittance, visits to outpatients' departments and emergency units, suicides, homicides, mortality rates and divorces) was studied. The data were gathered by the Greek Statistical Service and some others were provided by the following hospitals: Eginition Hospital, Psychiatric Hospital of Attica, Athens General Hospital and Evaggelismos Hospital. Simple and multiple regression analyses were performed on the data. There was no significant correlation between the level of unemployment, as well as the average income, and admittance to the psychiatric clinics. A significant correlation was isolated between unemployment and visits to outpatients' department (R2 = 0.40, p = 0.001) and emergency unit (R2 = 0.49, p = 0.0002) of Eginition Hospital. The unemployment rate during the period 1981-2008 was positively associated with the number of homicides (R2 = 0.16, beta = 0.000049, p = 0.03), as well as the number of divorces (R2 = 0.20, beta = 0.005, p = 0.02) during the same period. The average income showed positive association with the visits to both outpatients' department (R2 = 0.55, p < 0.001) and emergency unit (R2 = 0,37, p = 0.004) of Eginition Hospital. However, the data from the 4 hospitals of the study revealed a negative correlation between average income and visits to outpatients' departments (R2 = 0.70, p = 0.02) and emergency units (R2 = 0.90, p < 0.001). Furthermore, a significant negative correlation between the average income and suicide rates (R2 = 0.37, p = 0.007), as well as a positive correlation between the average income and divorce rates (R2 = 0.73, p < 0.001) were found. The findings show several similarities with previous surveys in countries with analogous economic crises, such as the Former Eastern Bloc countries, Asian countries and the USA. Future studies, at a more late stage of the economic crisis, are expected to reveal more reliable associations with mental health. Finally, these findings are expected to inform intervention programmes dealing with prevention or mitigation of the impact of economic crisis on citizens' mental health.

[Financial crisis and mental health].

Most studies investigating the effects of the economic crisis on the quality of life indicate a correlation between unemployment or other economic indexes and the general levels of death rates, depression, and suicide tendencies. The most common effects of an economic crisis are unemployment, spending power cuts, general insecurity and public spending retrenchment, including health related budget cuts. Under conditions of economic crisis, the poor represent a high risk group since they are the first ones to be put at risk. At the same time, due to their pre-existing functionality reduction, individuals already experiencing psychiatric diseases also represent a high risk group, thus creating a vice circle where poverty nurtures psychiatric disorders and vice-versa. For every country in the midst of a recession, protecting high risk target groups is the first priority. In these cases, research showcases that social security networks' reinforcement represents the first strategic priority. Other factors, for instance personality features related to increased vulnerability to psychosocial threat -such as low tolerance to frustration or low self esteem- also play an important role. At the organizational level, one has to research practices and policies that employers use to respond to changing conditions. An economic recession is a chance to revamp essential services toward weaker populations that need to be protected. This translates into a buttressing of the social welfare system while promoting timely interventions. Amongst others, the registration of high risk population groups, the rehabilitation and social inclusion of unemployed individuals and individuals with psychiatric problems, the training of first responders and primary care physicians, the tracing and curing of depression and other usual disorders, as well as an improved access to the psychiatric-health provision system.

Self-injurious behavior among Greek male prisoners: prevalence and risk factors.

BACKGROUND: Self-harm among prisoners is a common phenomenon. This study aims to estimate the prevalence of self-injurious behavior (SIB) among Greek male prisoners, record their motives and determine independent risk factors. METHODS: A self-administered, anonymous questionnaire was administered to 173 male prisoners in the Chalkida prison, Greece. The questionnaire included items on self-harm/SIB, demographic parameters, childhood history, family history, physical and mental disease, lifestyle and smoking habits, alcohol dependence (CAGE questionnaire), illicit substance use, aggression (Buss-Perry Aggression Questionnaire [BPAQ] and Lifetime History of Aggression [LTHA]), impulsivity (Barrat Impulsivity Scale-11) and suicidal ideation (Spectrum of Suicidal Behavior Scale). Univariate nonparametric statistics and multivariate ordinal logistic regression were performed. RESULTS: Of all the participants, 49.4% (95% CI: 41.5-57.3%) disclosed self-harm (direct or indirect). The prevalence of SIB was equal to 34.8% (95% CI: 27.5-42.6%). Most frequently, SIB coexisted with indirect self-harm (80.7%). The most common underlying motives were to obtain emotional release (31.6%) and to release anger (21.1%). At the univariate analysis, SIB was positively associated with a host of closely related factors: low education, physical/sexual abuse in childhood, parental neglect, parental divorce, alcoholism in family, psychiatric condition in family, recidivism, age, sentence already served, impulsivity, aggression, alcohol dependence, self-reported diagnosed psychiatric condition and illicit substance use. Childhood variables were particularly associated with the presence of diagnosed psychiatric condition. At the multivariate analysis, however, only three parameters were proven independent risk factors: self-reported diagnosed psychiatric condition, illicit substance use and aggression (BPAQ scale). CONCLUSION: The prevalence of SIB is particularly high. Psychiatric condition, illicit substance use and aggression seem to be the most meaningful risk factors; childhood events seem only to act indirectly.

Prevalence and risk factors of HIV, hepatitis B and hepatitis C in a forensic population of rapists and child molesters.

The aim of the present study was to assess the prevalence as well as the possible risk factors of HIV, hepatitis B and hepatitis C, in 194 male prisoners who had been convicted for rape (n = 105) or child molestation (n = 89). HBsAg, HBeAg, anti-HBc, anti-HBs, anti-HCV and anti-HIV-1/2 were tested for. The participants also completed a standard sociodemographic questionnaire, indicating possible risk factors, the Barratt Impulsiveness Scale, and the life-time history of aggression. Anti-HIV antibodies were not found in any of the prisoners. HBsAg was found in 25 (13%), anti-HBc in 94 (49%), anti-HBs in 40 (21%) and anti-HCV in 13 (6.5%) subjects. Logistic regression analysis showed that anti-HCV positivity was associated with intravenous drug use (OR 20.7, 95% CI 1.1-4.9, P<0.001), while HBsAg positivity was associated separately with being foreign (OR 4.0, 95% CI 0.2-2.5, P<0.1), as well as with impulsiveness score (OR 1.06, 95% CI 0.01-0.11, P<0.02). The prevalence of HBV and HCV infection in this sex offender sample was highly increased in relation to the general population. Since it has been proved that sex offenders are a high-risk group for reoffending, monitoring their health is a necessary step towards prevention of sexually transmitted diseases being spread.

Narrow and broad definition of mixed-handedness in male psychiatric patients.

Differences in assessment and classification procedures of many mixed-handedness studies have made comparison of findings difficult. In the present study, "narrow" and "broad" definitions of mixed-handedness were investigated using the Annett Handedness Questionnaire in patients with schizophrenia (n=68), panic disorder (n=62), borderline personality disorder (n=35), heroin addiction (n=54), and mental retardation (n=33) in comparison with 944 controls. According to the "narrow" definition of mixed-handedness, an excess of mixed-handedness was observed in patients with borderline personality disorder and mental retardation. An excess of nonmixed-handedness was found in patients with panic disorder. According to the "broad" definition of mixed-handedness, an excess of mixed-handedness was observed in patients with mental retardation, in the total sample of psychiatric patients (n=252), and in the schizophrenic patients. Thus, we can conclude that different mixed-handedness definitions can be associated with different results. Furthermore, we suggest that the neurotic part of the present psychopathology spectrum tends to be related to an excess of normal or nonmixed-handedness, and the psychotic as well as the organic portion is associated with an excess of mixed-handedness, regardless of the definition of mixed-handedness used.