Health Related Quality of Life and Cardiovascular Risk Factors.

Cardiovascular diseases (CVD) is associated with deteriorating of quality of life (QOL) and exercise capacity (EC) but less is known on how EC interplays with QOL. The present study explores the relationship between quality of life and cardiovascular risk factors in people who present in cardiology clinics. A total of 153 adult presentations completed the SF-36 Health Survey and provided data for hypertension, diabetes mellitus, smoking, obesity, hyperlipidemia and history of coronary heart disease. Physical capacity was assessed by treadmill test. were correlated with the scores of the psychometric questionnaires. Participants with longer duration on treadmill exercise score higher on the scale of physical functioning. The study found that treadmill exercise intensity and duration were associated with improved scores in dimensions of the physical component summary and the physical functioning of SF-36, respectively. The presence of cardiovascular risk factors is related to a decreased quality of life. Patients with cardiovascular diseases should undergo particularly detailed analysis of the quality of life along with specific mental factors such as depersonalization and posttraumatic stress disorder.

Sexual expression and the COVID-19 pandemic: The future of sexual intimacy after the COVID-19 pandemic.

Humans, as social beings, rely on interaction in order to survive and "flourish". By nature, they are "weak" and when in solitary, their freedom is jeopardized. Connecting with others, intimacy, physical contact, and the sense of belonging are core needs, and once recognized as such, they ultimately serve one's freedom. In this context, social interaction serves as a fundamental factor for survival. The creation of bonds improves one's position in the evolutionary process, and paves the way towards the ultimate "goal" of existence. The COVID-19 pandemic and the measures to control its spread have disrupted every aspect of human activity. Social, academic, cultural, business, and economic activities have been drastically modified.1 The conscious experience of the threat of life has been a ubiquitous "dramatic reminder of human vulnerability". The environment became unintelligible, death was "present" at all times. People tried to find a new meaning of life and discover a new sense of self-worth. The triggered vulnerability, the isolation from friends and relatives that to date validated one's self-esteem, the unprecedented obstacles with respect to career goals, and unexpected job losses affected the global view of things.1 The restrictive measures and the resulting urgent vaccination created "dystopian" conditions, under which deriving pleasure became a luxury. Scientific data have shown that social distancing has led to high levels of psychological distress. Primary research conducted during the social restrictions as well as subsequent meta-analytical studies have revealed increased irritability, emotional instability, and ultimately an increase in emotional and anxiety disorders' prevalence.2 Undoubtedly, mental and sexual health share a strong and bidirectional relationship.3 International health organizations emphasize the positive impact of a healthy sexual life on psychological well-being. Sexual well-being can serve - along with other factors - as a protective measure against the development of psychopathology, while stable sexual activity acts as a safeguard for well-being in general. The negative relationship between psychological symptoms and sexual gratification has been repeatedly documented by research, highlighting the impact of anxiety on sexual desire, arousal, and overall satisfaction with sexual life.4 Given this relationship and the increased emotional vulnerability during the pandemic, one might wonder how this reciprocal path has been affected. Physical intimacy, one of the basic expressions of the connection between partners, could not remain unaffected. During the first year of the pandemic and the restrictive measures, it became difficult for partners to meet. Due to the measures and discouragement of gatherings, a strong fear of infection gradually developed and avoidance behaviors emerged. In some countries, there were recommendations for physical-sexual interactions' limitation, and use of masks in intimate situations.5 The end result of these circumstances was that one in three individuals demonstrated such fear that they completely avoided engaging in sexual contact with the person they desired, even in cases they cohabited.6 The anxiety and reduced quality of life seemed to affect sexual function, especially aspects related to sexual desire and arousal. The fear and anxiety caused by the constant threat to life deprived individuals of the ability to derive satisfaction from intimate relationships, guiding sexual expression towards a safer "self-centered" orientation. As a result, self-gratification through masturbation increased for both single individuals as well as for stable, cohabiting partners.7 On the other hand, the newly formed living conditions served as a "vehicle' in an attempt to search for new paths towards pleasure. People, as in every past crisis, needed to "reinvent" themselves in order to adapt. Given that every sexual contact is a multi-sensory experience as well as a means of psychological discharge, they searched for or even created new paths that led to sexual release. The concept of "virtual sexuality" emerged even more strongly than it did before the pandemic. The pre-existing use of digital sexual content, which priorly simply facilitated individual sexual practices, took another form. The use of interactive technologies allowed people to create and share - in most cases for the first time - their personal erotic content.8 The internet emerged as an effective substitute for the discharge of sexual desire for people not in a stable romantic relationship, while for those with a stable partner in some cases facilitated their relationships, but for most of them prolonged behaviors of fear and avoidance of intimacy. The human need for connection, love, flirting, and sexual expression cannot be eliminated. The questions that arise whether the changes that have occurred are permanent, whether the need for real-life, physical contact has decreased, and whether the ways through which people connect with others have been permanently modified. It is possible that sexual intimacy is now conceptualized and experienced as something different, and perhaps the pandemic is a causal factor and a strong catalyst for a predetermined change of course with respect to close relationships. In any case, the clinical significance of the dynamic interaction between sexual factors and psychological well-being must be understood in depth. As mental health professionals, we must take into account the altered or new aspects of sexual expression, and with scientific rigor and respect for human nature, we should keep highlighting the unbreakable bond between sexuality and quality of life. We must recognize the timeless human need for intimacy and meaningful, stable connections, irrespective of threatening factors and uncertainty caused by conditions such as the recent pandemic.

Psychiatric Disorders and Obesity in Childhood and Adolescence-A Systematic Review of Cross-Sectional Studies.

Obesity and psychiatric disorders have high prevalence and are both considered major health problems. Within the last decades, the rates of obesity have risen over 6%, while the prevalence of psychiatric disorders is over 12% for children and adolescents. The aim of this study was to systematically review the evidence regarding the relation of obesity and psychiatric disorders in childhood and adolescence. This review, based on the PRISMA guidelines, included cross-sectional studies published within the last decade, pertaining to the relation between psychiatric disorders and obesity in children and adolescents up to the age of 19 years. Studies on eating disorders were excluded. A total of 14 studies of 23,442 children and adolescents that investigated the relation of obesity with anxiety, mood disorders, and psychosis were included in this systematic review. Nine of the included studies reported a significant relationship between the psychiatric disorder under investigation and obesity. Understanding the nexus between obesity and psychiatric disorders in children and adolescents is of great importance, given the alarming increase in both conditions in youth. Such findings could facilitate the development and implementation of targeted interventions.

Exploring the adult sexual wellbeing and behavior during the COVID-19 pandemic. A systematic review and meta-analysis.

Implemented social distancing measures may have forestalled the spread of COVID-19, yet they suppressed the natural human need for contact. The aim of this systematic review was to explore the impact of the COVID-19 pandemic on adult sexual wellbeing and sexual behavior. An extensive search in Pubmed, Scopus, and PsycInfo databases based on PRISMA guidelines was conducted. After applying specific eligibility criteria, screening resulted in 38 studies. Results were drawn from 31,911 subjects and outlined the negative effect of the pandemic in sexual frequency, function, satisfaction, and the behavioral changes regarding masturbation and internet-based practices. Meta-analyses of the drawn data on 1,343 female, and 1,372 male subjects quantified the degree of sexual function change during the COVID-19 pandemic vs. prior the pandemic. A random effects model revealed the significant negative impact of the pandemic on female sexual function (SMD: 0.76, 95% CI:0.74 to 1.59), while no significant change was found for the males (SMD: 0.25, 95% Cl: -0.03 to 0.52). Significant heterogeneity was identified across included studies (p < 0.00001, I2 = 97%, I2 = 90% for females and males, respectively). As part of the global health, sexual wellbeing should be on the focus of clinicians and researchers.

Obsessive-compulsive symptoms in pregnancy: Their relationship with obsessive beliefs and obsessive-compulsive personality traits.

Literature findings are limited and inconsistent on the relationship between obsessive beliefs and obsessive-compulsive symptoms (OCS) and to our knowledge no data are available in pregnant population. Additionally, an interesting field that has not been adequately studied is the relationship between obsessive-compulsive personality traits and OCS while there are no corresponding studies in perinatal period. The aims of the study were to examine the relationship between OCS presented in pregnancy and obsessive beliefs considered to underlie them as well as their association with obsessive-compulsive personality traits. 30 pregnant women with OCS, regardless of their underlying diagnosis, were recruited from a University Psychiatric Hospital and privately. They completed the Mini International Neuropsychiatric Interview (MINI), the Yale-Brown Obsessive- Compulsive Scale (Y-BOCS), the Dysfunctional Beliefs Questionnaire-44 (OBQ-44), the Leyton Trait Scale and the Hospital Anxiety and Depression Scale (HADS). The main symptoms were aggression (73.3%), contamination (53.3%) obsessions and cleansing/washing (50%), checking (43.3%) compulsions. Pregnant women with obsessive-compulsive personality traits displayed symmetry/exactness obsessions (p=0.020) and cleansing/washing (p=0.011) compulsions as predominant types of OCS and greater severity of compulsions (p=0.049). The results of the logistic regression model suggest that obsessive beliefs of importance/control of thoughts and of responsibility/threat estimation predicted OCS while the belief of perfectionism/certainty did not predict any dimension of OCS. It is noteworthy that most observed relationships between obsessive beliefs and OCS remained even after controlling for variables of anxiety and depression, suggesting that obsessive beliefs have a specific relationship with OCS which is independent of other forms of psychopathology. Depressive symptoms comorbidity increased OCS severity, while in comorbidity with anxiety symptoms no difference in severity of OCS was found. Further research is needed to test our findings in larger and more diverse samples.

The Impact of Social Distancing Measures Due to COVID-19 Pandemic on Sexual Function and Relationship Quality of Couples in Greece.

INTRODUCTION: Recent studies have reported that the quarantine imposed in several countries around the world due to Covid-19 affected the sexual function and relationship quality. On the March 23, 2020 the Greek government imposed a national quarantine to contain the spread of the pandemic. The impact of such conditions on sexual function and relationship quality of couples is unknown. AIM: To investigate sexual function and relationship quality of couples during the quarantine. METHODS: An online anonymous survey was conducted one month post-impose of the quarantine, between the April 21 and the May 3, 2020. Adult respondents in a relationship completed a questionnaire including sociodemographic characteristics, structured inquiries regarding sexual activity and quality of relationship, anxiety level, and mood during the quarantine, as well as the IIEF and FSFI indices. OUTCOMES: Sexual function was assessed using the Greek versions of the FSFI and IIEF for females and males respectively. Sexual activity using 5 statements regarding frequency of sexual thoughts, masturbation, and intercourse, quality of intercourse and general estimation of the level of sexual function. Participants graded their level of agreement. Relationship quality was assessed using 5 questions regarding communication, company, understanding, tension and general estimation of companionship. Participants graded their level of agreement. Two additional statements were used in order to evaluate mood and the level of anxiety. RESULTS: A sum of 299 adult heterosexual participants in a relationship participated. Little or no negative impact on sexual function was reported. Increased anxiety and deficient mood were reported only for those with no access to their partner. Being in a steady relationship and living with their partner, but only for couples without children, resulted in satisfaction by sexual activity and enhanced emotional security. CONCLUSION: Sexual function and relationship quality appeared as not affected by the quarantine and by the measures of social distancing. Sotiropoulou P, Ferenidou F, Owens D, et al. The Impact of Social Distancing Measures Due to COVID-19 Pandemic on Sexual Function and Relationship Quality of Couples in Greece. Sex Med 2021;9:100364.

Exploring the Effects of Problematic Internet Use on Adolescent Sleep: A Systematic Review.

Adolescent suse internet via several devices to gather information or communicate. Sleep, as a key factor of adolescents' development, contributes to their physical and mental health. Over the past decades insufficient sleep among adolescents has been wide spread, and one of its attributing factors is the increased availability of technology. This review aims to investigate the body of evidence regarding the impact of problematic internet use on adolescent sleep. Extensive search of databases was performed according to PRISMA guidelines for studies published within the last decade, regarding subjects aged 10-19. The final step of the search yielded 12 original studies. The quality of extracted data was evaluated with the AXIS tool, in order to estimate the risk of bias. All studies showed a negative correlation between adolescent sleep and problematic internet use. It was found to affect sleep quality and quantity and provoke insomnia symptoms. Interestingly, adolescent's sex, parental educational level, type of family and use for leisure or academic reasons appeared as affecting factors of the problematic internet use-sleep relationship. Problematic internet use has several effects on adolescents' sleep. Results of relevant studies should be embedded in educational interventions addressed to adolescents as well as parents, to eliminate the negative outcomes of problematic internet use on sleep and adolescence's health in general.

Validation of the Greek Version of Hedonic, Eudaimonic, and Extrinsic Motives for Activities (HEEMA) Instrument.

Hedonia and eudaimonia are motivating forces through which individuals pursue well-being. The latter is a multidimensional concept, while hedonia and eudaimonia, both of which are realized through the reward system of the brain, are known to influence each other. Researchers have shown that specific extrinsic values (e.g., material wealth, power over other people, etc.) are associated with a sense of "good life" and may influence both hedonia and eudaimonia. The HEEMA (Hedonic, Eudaimonic, and Extrinsic Motives for Activities) scale was developed to evaluate all three ways of seeking well-being, hedonia, eudaimonia, and extrinsic values, in both a healthy and unhealthy fashion. The purpose of this study was to assess the psychometric properties of the HEEMA scale in a sample of 225 Greek individuals. Participants filled the HEEMA, SWLS, MLQ, Self-Esteem questionnaire, DASS-21, MHC-SF, and Big Five Inventory, anonymously. Reliability and validity indices of the scales were satisfactory (Cronbach's α were 0.734, 0.811, and 0.843 for the hedonic, eudaimonic, and extrinsic motives subscales, respectively). Indicatively, the study showed a positive correlation between aspects of well-being and positive emotions, satisfaction with life, sense of meaning and purpose, as well as with specific personality traits, while negative correlations were found between eudaimonic orientation and depression.

Validation of the Greek Version of Social Media Disorder Scale.

Social media platforms have gained ground in the day-to-day life of the vast majority of people globally. Growing evidence suggests that social media overuse can take a pathological form, and users can exhibit behaviors similar to those appearing in several types of addiction. The aim of this study was to validate the Greek version of the Social Media Disorder Scale (SMDS) among young adults. An online survey was conducted among Greek adults, aged 18-29 years old. A total of 251 respondents voluntarily participated. Internal consistency, criterion, and construct validity were examined. Results suggest that the Greek version of SMDS shows good psychometric properties. Internal consistency was above the acceptable margin, with a satisfying Cronbach's α coefficient. Correlations with other addiction-related constructs were found to be moderate. Construct validity of the scale was evaluated with exploratory factor analysis. Exploratory factor analysis resulted in a single factor model, which explained almost half of the total variance. The Greek version of SMDS is a psychometrically sound and valid instrument, which researchers and practitioners can use to assess social media addiction in young adults.

Hair cortisol concentrations in mental disorders: A systematic review.

OBJECTIVE: Research on HPA axis dysregulation has been associated with vulnerability to, or perseverence of, several mental disorders. Hoever, measurements of cortisol levels in blood, saliva and/or urine have yielded variable results. Nevertheless, cortisol analysis in scalp hair appears to be a consistent tool for measurement of long-term exposure to stress. This article provides a systematic review of studies exploring hair cortisol concentrations in patients with mental disorders in comparison with healthy controls. METHODS: This review was conducted according to PRISMA guidelines. The electronic databases of PubMed/Medline, Web of Science and Scopus were searched for relevant articles, using a specific syntax. RESULTS: A total of 582 articles were identified, of which 22 were finally included. Patients with depression show a general trend for higher hair cortisol concentrations (HCC) than controls, whereas patients with PTSD tend to demonstrate lower HCC. Very little is known about other mental disorders, including suicidality and drug abuse. The divergence of samples included and the timing of cortisol sampling, seem to play a key role in the discrepancies of the results. Correlations of HCC with self-reported measures of stress were found, at best, inconclusive. CONCLUSIONS: Further research should attempt to describe specific cortisol profiles for each psychiatric disorder and HCC could contribute in evaluating therapy outcomes and predicting relapses. Obtaining information on HCC in different stages of psychiatric disorders in association with pertinent clinical variables, might help in forging a neuroendocrine model for clinical staging of mental disorders.

Low hair cortisol concentrations in obsessive compulsive disorder: A cross-sectional study.

Recent findings have highlighted the association between changes in the activity of the HPA axis, primarily its end-hormone, cortisol and OCD. However, to date, cortisol levels of OCD patients have been assessed mainly in body fluids, such as serum, saliva or urine, frequently leading to ambiguous results because of their inherent lack of stability. The aim of this study was to investigate time-integrated levels of stress exposure in 32 OCD patients and 32 sex and age-matched healthy controls by measuring endogenous cortisol in hair segments reflecting the last 3 months preceding hair collection. Psychometric parameters, including BDI, FQ, STAI, PSS and ECQ-R, were obtained in all participants; Y-BOCS was performed in the OCD patients. The OCD patients exhibited significantly higher scores in all psychometric instruments administered and lower hair cortisol concentrations than the healthy controls (p = 0.001, r = 0.41). No significant correlations were found between the HCC and the Y-BOCS total scores. After having sorted OCD patients into subtypes, according to the nature of their symptomatology, the "washers/cleaners" category showed the lowest HCC (compared to the "checking/harming", "ordering/symmetry" and "sexual/religious obsessions" categories). The novel finding of chronic low cortisol secretion in OCD patients could be attributed to a possible down-regulation of the HPA axis, as an adaptive response to chronic stress exposure. Given that the OCD subtypes reflect the great heterogeneity in the OCD spectrum, studies with larger samples should extend the investigation of HCC in patients with distinctive symptomatology, so as to develop a basis for better neuroendocrine profiling and understanding of the pathophysiology of OCD. Further work is needed in exploring HPA axis' activity over the natural course and treatments of the disorder.

Psychometric Properties, Factor Structure, and Evidence for Measurement Invariance in the Greek Version of the Disgust Scale-Revised (DS-R).

The Disgust Scale has been designed to measure disgust propensity-the individual ease in experiencing disgust. The present study aimed to explore the validity, reliability, the factor structure, and the measurement invariance of the Greek version of the Disgust Scale-Revised (DS-R). A sample of 754 healthy participants completed the Greek version of the DS-R. A subset (n = 363) also completed the revised Symptom checked list and the Eysenck Personality Questionnaire, in order to examine the concurrent validity. Exploratory and Confirmatory factor analyses in different subsets were used to examine the factor structure. Multiple indicators-multiple causes model (MIMIC) models were used to assess the measurement invariance across gender and age. Demographic influences were assessed using t-tests, ANOVA, and Pearson's correlations. Exploratory factor analysis concluded to two and three factor models, with a factor structure similar to the ones proposed in the literature. Confirmatory factor analysis and bi-factor analysis provided evidence in favor of the three-factor solution. Measurement invariance test revealed differences in six items across gender, and three items across age. The psychometric properties of the factors were satisfactory. Demographic influences on the responses were present, especially with respect to gender. The Greek version of the DS-R demonstrated satisfactory psychometric properties, making it suitable for use for the Greek population.

Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation.

BACKGROUND: Erectile dysfunction (ED) and premature ejaculation (PE) are the two most prevalent sexual disorders among males associated with significant distress and impairment in quality of life. The aim of this study was to investigate the prevalence of anxiety and depression symptoms among patients with primary ED and PE. METHODS: A sample of 57 men (ED = 31; PE = 26) were compared to 25 male outpatients with anxiety disorder (AD) and 25 healthy controls. Principal assessment measures included the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI). RESULTS: Greater levels of STAI state anxiety were reported among the ED, PE, and AD groups as compared to healthy controls. In contrast ED and AD groups scored higher than controls on the STAI trait anxiety and BDI, but PE scores were not different from healthy controls in both measures. CONCLUSIONS: The study findings suggest that both primary ED and PE are conditions associated with significant state anxiety; however, PE appears to be less associated with trait anxiety and depression compared to ED, a finding that corroborates the recent acknowledgement of PE as a more biologically based condition. Limitations and potential clinical implications are also discussed.

Pregabalin augmentation in treatment-resistant obsessive-compulsive disorder.

The therapeutic limitations of mainstay psychopharmacological treatments of obsessive-compulsive disorder (OCD) warrant the clinical testing of further add-on agents to improve patients' clinical symptoms. One such agent might be pregabalin, which has been found efficacious in other anxiety disorders. We report on the findings of a small, 8-week open-label trial of adjunctive pregabalin with a 4-week follow-up in 10 OCD patients resistant or only partial responders to a combination of serotonin reuptake inhibitors with atypical antipsychotics. Adjunctive pregabalin at 225-675 mg/d was well tolerated and led to patients' substantial improvement in their OCD symptoms, as reflected in their scores on the Yale-Brown Obsessive Compulsive Scale. Despite the several limitations of the study, its results suggest that adjunctive pregabalin might be a safe and efficacious new augmentation agent in the treatment of drug-resistant OCD. We hypothesize that pregabalin's mechanism of action in OCD might consist in its inhibition of glutamatergic neurotransmission.

Catatonia as a risk factor for the development of neuroleptic malignant syndrome: report of a case following treatment with clozapine.

Catatonia is characterized by the predominance of psychomotor abnormalities and shares many clinical, biological and treatment response features with the neuroleptic malignant syndrome (NMS), a rare adverse reaction to psychoactive medications. It has been advocated that the two conditions should be placed along the same spectrum of disorders. A case of a 49-year-old woman, who developed NMS while on low dose clozapine soon after recovering from catatonia, is presented. The potential relationship between catatonia and NMS is discussed in the light of the existing literature, and attention is drawn to the risk for clozapine-induced NMS in catatonic patients.

Amisulpride-induced hyperprolactinemia is reversible following discontinuation.

BACKGROUND: Although amisulpride is considered to be a prolactin-raising atypical antipsychotic drug, a limited number of studies have documented the extent of its prolactin-elevating properties. In the present study the effect of amisulpride on plasma levels of prolactin and the reversibility of this untoward side effect were investigated. METHODS: 17 patients with various diagnoses received amisulpride (50-800 mg/day) or a combination of amisulpride plus other medication as needed. Plasma prolactin was determined 26.7+/-9.4 days (range: 13-50 days) after initiation of treatment and in 3 cases after a much longer period, and 14-51 days following its withdrawal. RESULTS: All patients on amisulpride had hyperprolactinemia (mean+/-S.D. prolactin levels: 62.5+/-33.0 ng/ml) with females exhibiting considerably higher prolactin levels than males. Following amisulpride discontinuation prolactin levels were significantly (p<000) reduced (mean+/-S.D. prolactin levels: 12.3+/-6.7 ng/ml). No significant correlation was detected between prolactin levels and either amisulpride dosage or duration of administration. CONCLUSION: Amisulpride has a pronounced prolactin-elevating effect which appears to be independent of dosage and duration of administration. Hyperprolactinemia rapidly reverses following amisulpride discontinuation.