Validation of the greek version of the Young Schema Questionnaire-Short Form 3: Internal consistency reliability and validity.

Schema therapy (ST) is an integrative therapy, which combines elements of cognitive behavior therapy, attachment theory, object relations theory and emotional-focused models. Schema therapy is an effective treatment for patients with personality disorders and other chronic psychological disorders. Early Maladaptive Schemas (EMSs) are a main concept in schema theory referring to self-defeating, core themes or patterns. They develop as a result of traumatic or toxic childhood experiences and the frustration of the core emotional needs in childhood. To date 18 EMSs have been identified and grouped into five higher order structures, known as domains. For the evaluation of the EMSs, Young developed a self-report inventory, the Young Schema Questionnaire (YSQ). There are two forms of the YSQ, the Young Schema Questionnaire - Long Form 3 (YSQ-L3) a 232-item inventory and the Young Schema Questionnaire - Short form 3 (YSQ-S3), a 90-item inventory, which is a subset of the Long form. The aim of this study was to validate the Greek Version of the YSQ-S3. A non-clinical sample of 1,236 undergraduate students completed the YSQ-S3 and 124 patients with Axis-I, Axis II or comorbid diagnosis, completed the YSQ-L3. Moreover, both samples completed the second part of the Adults Self Report (ASR). Internal consistency reliability, discriminative, convergent and predictive validity were examined. The internal consistency reliability of the schema factors was satisfactory with a Cronbach's alpha coefficient of 0.70 or above, for all factors in both student's and clinical sample. The effect sizes were high for most of the scales, regarding the differences between clinical and non-clinical sample. Emotional Deprivation, Vulnerability to harm or Illness, Subjugation, Social Isolation/Alienation and Defectiveness/Shame had the highest effect sizes in the clinical sample and in the non-clinical sample according to whether they had ever visited a mental health specialist. This may suggest that these EMSs are more sensitive and useful markers of psychological problems. In addition, patients with Axis II pathology scored significantly higher on Emotional Deprivation, Abandonment, Mistrust/Abuse, Social Isolation/Alienation compared to patients with only Axis I pathology. This finding is consistent with Schema theory, as these EMSs are associated with earlier in life traumatic experiences and insecure attachment and lie in the core of personality pathology. YSQ-S3 factors were significantly correlated with all ASR dimension and linear regression analysis showed that certain EMSs could predict Depressive and Anxiety problems. In total, the greek version of the YSQ-S3 showed good reliability and validity.

[Electroconvulsive therapy: 80 years of use in psychiatry].

Electroconvulsive therapy (ECT) is the oldest among the early biological treatments introduced in psychiatry, and the only one still in use. In this paper we attempt a brief presentation of ECT usage over the last 80 years, since it was originally introduced. It is a safe, well-tolerated, and highly effective treatment option for major psychiatric disorders, such as mood disorders and schizophrenia, especially when there is an acute exacerbation of psychotic symptoms or if catatonic symptoms are prominent. ECT has also been used successfully for the treatment of Parkinson's disease, delirium, neuroleptic malignant syndrome, autism and agitation and depression in demented patients. There are no absolute contraindications. However, it is considered a high risk procedure for patients with increased intracranial pressure, recent myocardial infarction, recent cerebral hemorrhage or stroke, vascular aneurysm, retinal detachment and pheocromocytoma. Modern genetic and neuroimaging techniques have helped clarify possible mechanisms of action of ECT, but much remains unknown. Improvement of this method through a number of technical advancements has contributed in the reduction of side effects. Thus, modified ECT is currently considered as an effective and safe form of treatment even in vulnerable populations such as the geriatric patients, the adolescents and the pregnant patients. The mortality rate is very low, comparable to that of a minor anesthetic procedure. The most common adverse events are headache, nausea, myalgias and postictal delirium while the most severe are the cardiovascular side effects. Of note, the cognitive side effects especially amnesia, although transient, has been the focus of skepticism against the treatment. Major psychiatric disorders are chronic, recurring disorders. The relapse rate after a successful course of ECT without any intervention is extremely high. Pharmacotherapy or continuation ECT reduces equally the relapse rate up to 40%. Continuation and maintenance ECT, in combination with pharmacotherapy, have been successfully used in preventing relapse and recurrence. Gradual tapering off acute ECT treatments and individualized continuation and maintenance ECT treatments based on the needs of each patient seems the optimum clinical practice. Conclusively, despite impressive new developments in pharmacotherapy and in biological non pharmacological treatments ECT remains a valuable, irreplaceable treatment option for debilitating, resistant major psychiatric disorders.

The impact of depression and cardiophobia on quality of life in patients with essential hypertension.

Patients with chronic conditions like hypertension may experience many negative emotions which endorse the development of anxiety and depression symptomatology, thus they increase their risk for poor quality of life. Several studies have shown an association between symptoms of psychological distress and hypertension. In this study we aimed to quantify the link between depression, cardiophobia and quality of life in hypertensive patients. A cross-sectional design was employed. A sample of 197 hypertensive patients (89 men-108 women, mean age 53 years, SD=12 ranged 25-78) from a university outpatient hypertension clinic in Greece participated. Ninety-four (47.7%) of the participants suffered from essential grade I hypertension; 68 (34.5%) were grade II; 16 (8.1%) were categorized as grade III, while only 11 (5.6%) patients were recorded as normotensives with high normal values. The questionnaires included: (a) question for the recording of social-demographic characteristics and clinical features, (b) The Short Form (SF-36) Health Survey, (c) The Beck Depression Inventory -I, and (d) The Cardiac Anxiety Questionnaire. There were no significant differences between the two genders with exception of marital status (p=0.010), dyslipidemia (p=0.050), grade of hypertension (p=0.014), cardiac left ventricular hypertrophy (p=0.004), renal failure (p=0.043) and stroke (p=0.024). Lower levels of quality of life and higher levels of depression and cardiophobia were observed compared to the general population. There were no significant differences on psychological measures between the two sexes (p>0.05). Cardiophobia was positively related to depressive symptomatology (r=0.533, p=0.000) while negatively to both physical and mental health summary measures of SF-36 health survey (r=-0.467, p=0.000 r=-0.537, p=0.000 respectively). Multiple linear regression models found that for psychical health depression and cardiac anxiety, avoidance activities had an influence on levels of quality of life in hypertensive patients, after controlling for age and other socio-demographic variables and clinical characteristics (Beta=-0.133, p=0.007, Beta=-0.364 p=0.000 and Beta=-0.167 p=0.006, respectively). For mental component summary depression and cardiophobia, heart focused attention had also impact on mental health in hypertensives (Beta=-0.438, p=0.016, Beta=-0.564, p=0.000 and Beta=-0.223, p=0.037, respectively) after adjustments. Heart focused anxiety symptoms-as avoidance activities and/or attention and monitoring cardiac activity, are related to hypertensive patients' present deteriorated depressive symptoms and levels of quality of life. Both depressive symptomatology and heart focused anxiety may be a mechanism partly responsible for hypertensive patients' present impaired levels of quality of life.

[Representations of mental illness in the Greek Press: 2001 vs 2011].

The media seem to have played a prominent role in shaping the contemporary social image of people with mental illness, by perpetuating the stigma attached to it. Worldwide, a vast amount of research findings converge to the stigmatizing representation of people with mental illness by the media, with reference to the dominant stereotype of violence. The present study aims to explore the representations of mental illness in the Greek Press using a quantitative and qualitative approach. Potential changes in the media portrayal of mental illness during the last decade are also being examined: findings are compared to those of a previous research that took place in 2001, following the same methodology. The sample consisted of press articles referring to mental illness, that were indexed daily from the Greek newspapers during the period July-November 2011. The items were categorized into thematic categories and further analyzed taking in account the use of stigmatizing vocabulary, the reproduction of common myths concerning mental illness, the overall valence of each article (stigmatizing, neutral or anti-stigmatizing) towards people with mental illness, as well as the contextual implications conveyed in the use of psychiatric terms as a metaphor. The largest thematic category that emerged from the sample was that referring to the repercussions of the economic crisis to mental health, followed by the category of articles where psychiatric terms are used as a metaphor. The comparisons made between 2001 and 2011 revealed an improved representation of mental illness in terms of stigma, especially regarding schizophrenia. The public expression of stigma has decreased, with fewer stigmatizing articles and notably more neutral in valence articles. The findings of this study suggest a decline of the media propensity for emotionally charged descriptions and a shift towards objective journalism regarding mental illness. This is most likely to be attributed to the anti-stigma campaigns, targeting media workers, that have been implemented during the last decade in Greece. Nevertheless, the public expression of stigma remains present by taking more subtle forms. Such examples are demonstrated by the semantic context of articles in which psychiatric terms are used as a metaphor, or by the recurrent reference of (unspecified) mental illness on the occasion of violent crime.

Homocysteine, cortisol, diabetes mellitus, and psychopathology.

OBJECTIVE: This study investigates the association of homocysteine and cortisol with psychological factors in type 2 diabetic patients. METHOD: Homocysteine, cortisol, and psychological variables were analyzed from 131 diabetic patients. Psychological factors were assessed with the Eysenck Personality Questionnaire (EPQ), Hostility and Direction of Hostility Questionnaire (HDHQ), the Symptom Checklist 90-R (SCL 90-R), the Zung Self-Rating Depression Scale (ZDRS), and the Maudsley O-C Inventory Questionnaire (MOCI). Blood samples were taken by measuring homocysteine and cortisol in both subgroups during the initial phase of the study (T0). One year later (T1), the uncontrolled diabetic patients were reevaluated with the use of the same psychometric instruments and with an identical blood analysis. RESULTS: The relation of psychoticism and homocysteine is positive among controlled diabetic patients (P value = 0.006 < 0.05) and negative among uncontrolled ones (P value = 0.137). Higher values of cortisol correspond to lower scores on extraversion subscale (r(p) = -0.223, P value = 0.010). Controlled diabetic patients showed a statistically significant negative relationship between homocysteine and the act-out hostility subscale (r(sp) = -0.247, P = 0.023). There is a statistically significant relationship between homocysteine and somatization (r(sp) = -0.220, P = 0.043). CONCLUSIONS: These findings support the notion that homocysteine and cortisol are related to trait and state psychological factors in patients with diabetes mellitus type 2.

Myocarditis after administration of clozapine.

OBJECTIVE: Clozapine is an atypical antpsychotic medication with established efficacy in patients diagnosed of resistant schizophrenia. However, clozapine has multiple side effects. Cardiac complications such as myocarditis and cardiomyopathy have always been related with treatment with clozapine. METHODS: A 42 year old Caucasian male, with history of schizophrenia developed a acute myocarditis after commencement of clozapine. RESULTS: The patient recovered with intensive medical support. The symptoms occurred approximately 20 days after starting clozapine. CONCLUSIONS: Myocarditis is an ingreasingly recognized complication associated with clozapine. Use of clozapine must be based on a balance of its risks and benefits on an individual basis which for the most part defines its use in treatment refractory schizophrenia. Appropriate monitoring of adverse events is an essential part of the clinical usage of clozapine and should be charted for at least two years.

Assessment of the Greek worry-related metacognitions: the Greek version of the Metacognitions Questionnaire (MCQ-30).

The Metacognitions Questionnaire-30 (MCQ-30), developed by Wells and Cartwright-Hatton (2004), represents a multidimensional measure of metacognitive factors considered to be important in the metacognitive model of psychological disorders. The primary aim of the present study was to examine internal consistency, test-retest reliability, convergent validity and the factor structure of the Greek version of the MCQ-30. Moreover, we investigated the associations of the extracted factors with trait anxiety in a Greek sample. The study sample consisted of 547 non-clinical participants (213 males and 334 females). All participants completed the Greek version of the MCQ-30. A subsample of 157 participants also completed the Trait Anxiety subscale of the State -Trait Anxiety Inventory and the Meta-worry subscale of the Anxious Thought Inventory. Thirty participants were retested with the MCQ-30 over a retest interval ranging from three to five weeks. The results confirmed the dimensionality of the MCQ-30 and five factors were extracted consistent with the original English version: (1) positive beliefs about worry, (2) negative beliefs about worry concerning uncontrollability and danger, (3) cognitive confidence, (4) beliefs about the need to control thoughts and the negative consequences of not controlling them, and (5) cognitive selfconsciousness. The MCQ-30 showed high levels of internal consistency and test-retest reliability. The correlation between MCQ-30 total score and AnTI-MW was strong, indicating high level of convergent validity. Moreover, all correlations between MCQ-30 total and subscale scores and STAI-T were significant apart from the correlation between 'cognitive confidence' and trait anxiety. The Greek sample scored higher in the MCQ-30 and its subscales than the English sample in the original study. Women scored significantly higher than men in the overall MCQ-30 and the "uncontrollability and danger" and "need to control thoughts" subscales, whereas no significant differences between genders had been found in the original study. The assumption that the differences in score levels and the gender effect might reflect cultural differences warrants further investigation. The findings of the present study indicate that the Greek version of the MCQ-30 is a comprehensible and psychometrically adequate instrument, as well as a reliable tool in assessing a range of dimensions of worry-related metacognitions in the Greek population. The Greek version of this scale facilitates crosscultural research in metacognition and wider testing of the metacognitive approach to emotional vulnerability, psychological disturbances and mental disorders.

Psychological but not vasomotor symptoms are associated with temperament and character traits.

OBJECTIVE: Recent evidence suggests that climacteric symptoms may be intensified by specific temperament and personality traits in postmenopausal women. In this study we investigate Cloninger's model of personality in relation to menopausal symptoms. METHODS: One-hundred and seventy peri- and postmenopausal women consecutively recruited from a menopause clinic of an academic hospital completed the Cloninger's Temperament and Character Inventory (TCI-140) which measures four dimensions of temperament: Harm avoidance, Novelty seeking, Reward dependence and Persistence, as well as three dimensions of character: Self-directedness, Cooperativeness, and Self-transcendence. Menopausal somatic, vasomotor and psychological symptoms were also assessed using the Greene Climacteric Scale. RESULTS: In comparison to the norms of the Greek general population, postmenopausal women presented lower scores in Novelty seeking and Reward dependence and higher scores in Persistence, Self-directedness, Cooperativeness and Self-transcendence. Higher harm avoidance (the inclination to avoid potential punishment, be shy and fearful of uncertainty) significantly correlated with anxiety and depressive symptoms while lower Self-directedness (the ability to have the willpower to adapt to or overcome any changes) correlated with depressive symptoms only. By multivariate regression analysis, higher Harm avoidance and lower Self-directedness were independently associated with the presence of depressive symptoms. No significant associations were observed between TCI-140 traits and somatic or vasomotor symptoms. CONCLUSIONS: Our findings indicate that most temperament and character traits according to Cloninger's model in peri- and postmenopausal women varied significantly as compared to the general population. Among several traits, high Harm avoidance and low Self-directedness were most strongly associated with psychological climacteric distress but not with somatic and vasomotor symptoms.

[Depression and anxiety in mothers of children who grow up in an area with industrial pollution].

This study aimed to investigate the effects of chemical pollution with hexavalent chromium on the mental health of mothers with school/pre-school age children, residents of the area of the Asopos basin in Eastern Central Greece. The people of this area have been experiencing great threat regarding their health each and every day, as a result of the well-documented pollution by hexavalent chromium in drinking and ground-water, which is related to the widespread industrial activity, the usage of hexavalent chromium in various processes and the discharges of Cr-bearing wastes. The environmental impact of hexavalent chromium is a controversial issue critical to the protection of groundwater resources, as it affects the soil and the products from local cultivations used in daily food. This condition has been documented scientifically and was published in the mass media as a serious threat to human and animal life in the specific area. Although in Greece serious environmental-technological disasters have occurred during the last decades, there is a lack of studies on the possible consequences, including the psychological impact on the local population. The sample of this study included eighty-eight mothers of young children, residents of the area of Asopos, who were compared with eighty-eight mothers living in a non-polluted area - the area of Kiato in Northern Peloponnese, as a control group. They were assessed by the CES-D scale and the Spielberger State-Trait Anxiety Scale (STAI I-II), which have been standardized for the Greek population. Results indicated that depression and anxiety were significantly correlated with the place of residence [CES-D: t(169,496)=3.45, p=0.001; STAI I-II: A-state: t(174)=10,131, p=0.000; A-trait: t(174)=8,728, p=0.000]. Mothers from the Asopos basin reported more symptoms of depression (Mean=24,14, SD=11,345) than the control group (Mean=18,68, SD=9,625). Similarly, they have scored higher in both subscales of STAI I-II, measuring state and trait anxiety (A-state: Mean=49,66, SD=12,345; A-trait: Mean=46,76, SD=11,458) than the control group (A-state: Mean=32,24, SD=10,383; A-trait: Mean=32,32, SD=10,474). Regarding the anxiety as a personality trait (STAI-II), mothers in Asopos Area reported higher levels of stress that is likely to be associated with the long-term stressful situation of pollution. It could be assumed that mothers from Asopos Area scored higher in both anxiety scales, as a result of the environmental disaster that has been occurred in the area and the high risk that this poses to life. These results confirm relevant literature findings on depression and feelings of anger in regions that have suffered industrial or physical disasters, and suggest that fighting against chemical pollution in Asopos area also needs additional implementation with psychological support to mothers of children growing in the area. Up to date, no psychosocial support has been provided to the residents at the community level. Further research should be carried out in order to measure the impact of chemical pollution on the psychological well-being and health of all members of the local community.

Oxytocin and diabetes mellitus: a strong biochemical relation. Review.

Oxytocin (OXT) is a neurohypophysial hormone which is synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. OXT is currently attracting considerable attention because it has been discovered that it regulates various functions of behavior especially in the context of social interactions. OXT is a key component in bone formation, glycemia, male sexuality, cardiac differentiation and pregnancy and thus it is important to be further explored. The authors review various aspects of gestational diabetes, including definition, screening, diagnostic procedures, complications, clinical evaluation, indications of delivery and neonatal aspects. Not only the relation among diabetes mellitus, oxytocin and neurophysiology concerning erectile dysfunction, but also the role of OXT in the activity of arginine and vasopressin is investigated. It is imperative to develop technological and experimental methods that will be able to reveal the oxytocin and its potential.

A study of acculturation in psychotic and non-psychotic immigrants living in Athens.

BACKGROUND: Acculturation is the phenomenon that results when a group with one culture comes into continuous contact with a host culture. AIMS: To investigate the correlation between acculturation and psychotic symptomatology in a group of immigrants suffering from psychosis and to explore differences in demographic factors related with the acculturation process between individuals with and without psychosis. METHODS: Sixty-five patients and 317 non-psychotic immigrants were interviewed using the Immigrant Acculturation Scale (IAS) and a structured questionnaire for demographic data. The Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Global Assessment of Functioning (GAF) were also administered to all immigrants suffering from psychosis. RESULTS: Total IAS scores, as well as IAS everyday life scores, were positively correlated with GAF scores. IAS everyday life score in the patient group related with religion, marital status, gender and years in Greece, while in the non-psychosis group it was related with gender and years in Greece. IAS wishful orientation/nostos (the strong desire for one's homeland) related with religion in both groups. The IAS identity in the psychosis group did not show any significant relation with any of the variables, while in the non-patient group, it was related with marital status, gender and years in Greece. Age, duration of residence in Greece and higher adoption of Greek ethnic identity were the variables that differentiated the two groups of immigrants. CONCLUSION: Acculturation in immigrants suffering from psychosis could be seen as a process that does not correlate strongly with the severity of the symptomatology but is probably influenced by different set of factors.

Oxytocin and psychological factors affecting type 2 diabetes mellitus.

BACKGROUND: The aim of this study was to investigate the association of oxytocin with trait and state psychological factors in type 2 diabetic patients. METHODS: OXT and psychological variables were analyzed from 86 controlled diabetic patients (glycosylated haemoglobin A1c (HbA1c) < 7%) from 45 uncontrolled diabetic patients (HbA1c ≥ 7). Psychological characteristics were assessed with the Eysenck Personality Questionnaire (EPQ), while state psychological characteristics were measured with the Symptom Checklist 90-R (SCL 90-R). Blood samples were taken for measuring oxytocin in both subgroups during the initial phase of the study. One year later, the uncontrolled diabetic patients were reevaluated with the use of the same psychometric instruments. RESULTS: During the first evaluation of the uncontrolled diabetic patients, a statistically significant positive relationship between the levels of OXT and psychoticism in EPQ rating scale (P < 0.013) was observed. For controlled diabetic patients, a statistically significant negative relationship between oxytocin and somatization (P < 0.030), as well as obsessive-compulsive scores (P < 0.047) in SCL-90 rating scale, was observed. During the second assessment, the values of OXT decreased when the patients managed to control their metabolic profile. CONCLUSIONS: The OXT is in association with psychoticism, somatization, and obsessionality may be implicated in T2DM.

[Studies of psychopathology of homeless individuals in European countries].

Most research on the homeless is coming from the US, where the prevalence of mental disorders concerning this population was pointed out. The surveys for the homeless in European countries focus on the mental state and community care of the homeless very early, since the 1980's. Homelessness is gradually developing in these countries, while in the countries of North America the phenomenon is much older. The prevalence of mental disorders in European countries is higher in the homeless population, with rates of 58% -100% compared with the general population. In countries like Germany, Spain, Holland, France, Switzerland, where the phenomenon of homelessness has been studied, one of the most striking features was the high prevalence of substance abuse disorders, emotional disorders, while small percentages were reported for psychotic disorders. The prevalence of alcohol abuse was very high in Germany, perhaps because it is easily accessible and less expensive than in other countries. Limited use by homeless of relevant health services was also very common in this country. The same observation was also recorded in Spain, France and the Netherlands. High rates in these countries was reported for comorbidity, most often concerning the combination of substance abuse disorder and emotional disorders. Another interesting finding in the European countries is the high prevalence of depressive and anxiety disorders and the low prevalence of schizophrenia and antisocial personality disorder. The low prevalence of schizophrenia and antisocial personality disorder is in contrast with studies from North America according to some authors who compared their samples with samples of homeless people in Los Angeles. The level of abuse of illegal substances was also found high in countries such as England. In Spain affective disorders was reported to be very high among the homeless population. The homeless population faces many complex mental health problems compared with those of the general population. What is a source of concern is that these problems are not adequately faced either by mental health services and rehabilitation programs, or the social services for the homeless. It is recommended that these services have to achieve integration in therapeutic and organizational level, in order to better meet the needs of this complex and heterogeneous population.

[Use of informatics technology in psychiatry].

Computer technology dominates our daily lives and has become an integral professional tool in medical practice and by extension, in psychiatry as well. The widespread use of internet technology has taken place with unprecedented speed in the history of human civilization, spreading in a few decades to all countries of the world, offering novel possibilities for transmitting information, and leading to the globalization of knowledge. However, the speed with which computer technology is becoming a part of our lives is accompanied by difficulties in integration. The continued evolution of applications often leads to the impression that to be modern and efficient we have to run continuously after developments, dedicating time and effort that we cannot often afford. At the same time, its widespread use alters the needs of our patients, and our efficiency is constantly judged in a globalized environment which, while offering new possibilities, also has new demands. The initial impression that computer technology is simply a tool that can facilitate the work of those who are willing and able to use it has been replaced by the perception that the practice of medicine, in both clinical and academic level, requires sufficient knowledge of modern technology and the development of relevant skills for ongoing training and following innovative applications. The result of this assumption is the introduction of technology courses in the curricula of medical schools in the country. This article offers a brief description of the uses of information technology in psychiatry. In particular, e-mail is one of the most popular Internet services and there is internationally an increasing pressure from the public to be able to contact their doctor by e-mail. Furthermore, almost all psychiatric journals now have a digital electronic edition, thus increasing the volume of articles published, the ease of accessing the required information, and ultimately the reduction of the time it takes a psychiatrist to come to possess a specialized field of knowledge. The Internet also enables psychiatrists, while being at their residence and from their offices and homes in remote areas of a country, or from developing countries to be able to take part relatively easily in continuing medical education programs that are under development in advanced educational centers, eliminating in this way the barrier of distance. Furthermore, telemedicine allows access in health-care to people living in geographically isolated areas with poor medical facilities. The electronic filing systems on the other hand, are also expected in the near future to provide the essential foundation of sharing and managing information material in health care. Apart from the uses of technology in the practice of psychiatry, technology has many uses in Psychiatric Education, providing valuable assistance to both trainees and trainers. Today the educational community has at its disposal a range of devices, operating systems, and web applications useful in medical education. For example, we can mention the existence of technological tools for educational administration and management, evaluation of educational work, tools for creating educational content, and learning outside the confines of the classroom. Developments arising from the use of technology are rapid, and its use brings new applications that have the potential to alter the framework of practicing medicine. However, in many cases, these applications do not go along with the guidelines and principles available to doctors in order to practice their profession in a manner not inconsistent with moral imperatives. The challenge of this new environment is to establish guidelines consistent with the principles of medical ethics.

Aggressive behaviour in schizophrenic patients after abrupt treatment discontinuation.

OBJECTIVE: This retrospective study examined the demographic, clinical and pharmacological factors associated with aggressive behaviour after abrupt discontinuation of medication in schizophrenic patients. METHOD: The study reports on a survey of 402 schizophrenic patients, who had abruptly discontinued their medication and had been involuntarily hospitalized to Psychiatric Hospital of Attika. The survey utilized the Discontinuation-Emergent Signs and Symptoms Checklist (DESS) to assess the signs and symptoms that patients exhibited (Rosenbaum et al., Biol Psychiatry 1998;44:77), as well the Aggression Scale (Delgado-Escueta et al., New England J Med 1981;305:711) to estimate the aggressive behaviour. Demographic and clinical variables as well as variables related to pharmacological treatment have been also investigated. RESULTS: Analyses revealed that the presence of aggressive behaviour after abrupt drug discontinuation was associated positively with previous history of aggression, male gender , abrupt discontinuation of anticholinergics, delusions, nervousness or anxiety, elevated mood, irritability and negatively with negative symptoms. These predictors can correctly classify 76.3% of patients with aggressive behaviour and 64.0% of patients without aggressive behaviour. CONCLUSION: These findings suggest that abrupt discontinuation of medication in schizophrenic patients may lead to aggressive behaviour, being connected at least in the acute phase with particular demographic, clinical and pharmacological parameters.

[Neurocognitive function in clinically stable patients with schizophrenia or bipolar disorder and normal controls].

There is a substantial body of evidence suggesting that cognitive deficits in schizophrenia (SΖ) and bipolar disorder (BD) persist after the subsidence of active symptoms. However, it is unclear whether the cognitive deficits observed in patients with BD are quantitatively or qualitatively similar to those in SΖ patients. The aim of the study was to assess and compare the cognitive functioning of patients with clinically stable SZ and BD. To the best of our knowledge, this is the first study including a comparison of the Theory of Mind between patients with SZ and BD. General intelligence, attention, speed of processing, working memory, verbal memory and learning, visuospatial ability, executive functions and ToM were assessed in 21 patients with SZ in remission, 23 euthymic BD type I patients, and 27 healthy controls (HC), using WAIS-Vocabulary, Block design, and Digit span, Babcock Story Recall Test, Rey Auditory Verbal Learning Test, Stroop Word-Colour Test, Wisconsin Card Sorting Test, Trail Making Test, and Faux Pas Recognition Test. The three groups were matched for gender, age and education. The SZ and BD groups were also matched in terms of illness duration and the age of the onset of the illness. To be enrolled in the study patients should have been clinically stable for 3 months, operationalized as no change in total Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale (<8), and Young Mania Rating Scale (<6). One-way ANOVA with post hoc Bonferroni corrections was used for the between groups comparisons. Both BD and SC patients were significantly impaired in general intellectual ability, verbal memory and learning, and executive functions compared to HC. Patients with SZ performed significantly worse than patients with BD on verbal memory tasks, whereas BD group did not have significant lower score than SZ in any task. SZ patients performed worse than HC group on attention, processing speed and immediate memory tests, while BD patients on visuospatial ability and working memory. Both SZ and BD groups did not differ from HC regarding Theory of Mind. Our results indicate that stable SZ and euthymic BD exhibit similar profiles of cognitive impairment, consistently with previous studies suggesting that the differences are related to the extent and degree of impairments, rather than being qualitative. Finally, our findings offer support to the hypothesis that the Theory of Mind does not represent a trait marker of schizophrenia or bipolar disorder.

The oncologic conceptions of the great clinician, phtisiologist, pathologist and statistician Gaspard-Laurent Bayle (1774-1816).

Gaspard-Laurent Bayle was a 19th century eminent clinician, pathologist, phthisiologist and statistician that deserves our attention. His very advanced oncologic conceptions rank him among the all-time great pioneers of oncology.

Fatigue in female patients with major depression: the effect of comorbid anxiety disorders.

Several studies have investigated fatigue in the general population, in primary care facilities as well as in patients with fatigue-related physical diseases, but only marginally in patients with Major Depressive Disorder (MDD). Therefore, the investigation of correlates of depression-related fatigue is highly warranted and expected to facilitate the implementation of effective fatigue-specific treatment strategies. Depressed patients often suffer from comorbid anxiety disorders (CADs) or subthreshold anxiety symptoms. This study aimed to investigate the independent correlation of the severity of fatigue in female patients with MDD with the presence, number and type of CADs. We studied 70 consecutive female MDD patients (48.6% inpatients), aged 23-65 years (mean 48.2±10.6 years), currently in a Major Depressive Episode [17-item Hamilton Depression Rating Scale (HDRS) score≥17] and free of other fatigue-associated conditions. Diagnostic assessments were made with the short structured DSM-IV-based MINI version 5.0.0. Reported fatigue was assessed with the 14-item Chalder Fatigue Questionnaire (FQ). Correlations between the FQ score and age, inpatient status, HDRS score, presence and number of CADs were calculated. Then, stepwise multiple regression analyses were performed, with the FQ score as the dependent variable,so as to isolate independent predictors of the severity of fatigue. 92.9% of patients had clinically significant fatigue. 62.9% were suffering from at least one CAD (38.6% met criteria for one CAD,21.4% for two and 2.9% for three). 51.4% were diagnosed with generalized anxiety disorder (GAD),25.7% with panic disorder and/or agoraphobia (PD/AP), 17.1% with social anxiety disorder and 7.1%with obsessive-compulsive disorder. The FQ score was significantly correlated with the HDRS score(r=0.406, p<0.001), the presence of any CAD(s) (rho=0.4, p=0.001), the number of CADs (rho=0.393,p=0.001), the presence of GAD (rho=0.421, p<0.001) and the presence of PD/AP (rho=0.252, p=0.035).In multiple regression analyses, the presence and number of CADs and the presence of comorbid GAD turned out as significant independent predictors of the FQ score along with the HDRS score.The severity of fatigue in female MDD patients is independently correlated with the presence and number of CADs and, in specific, comorbid GAD. Our findings imply that: (1) this effect might in part account for greater impairment/disability and adverse prognosis for MDD with CADs; (2) high levels of fatigue, putatively clustering with anxiety symptoms, may be a marker of severity and anxiety disorders comorbidity for MDD and may define an "anxious-fatigued" subtype/phenotype in this population; (3) medications and psychotherapies for the management of severe depression-related fatigue should also target CADs.

The Nobel Prize laureate - father of anaphylaxis Charles-Robert Richet (1850-1935) and his anticancerous serum.

Professor of physiology Charles-Robert Richet, winner of the Nobel Prize in 1913, is best known for his work on anaphylaxis. However, with his collaborator Jules Héricourt studied the effects of antibody treatment and made the very first attempts to fight cancer with serotherapy. Being versatile, Richet contributed in neurology, psychology and was also a poet, playwrighter, pacifist and pioneer in aviation.

Seasonality, suicidality and melatonin.

Seasonality of suicidal behavior has been investigated regarding both neurobiological and climatic factors, as well as psychopathological and social aspects. Most of the studies detectedpeaks in late spring and troughs in the winter. Several lines of evidence evaluated the role of extended periods of light associated with probability of suicides whereas others summarize the alterations of melatonin excretion and its seasonal variation along with seasonaldistribution of psychiatric disorders. The purpose of this paper is to provide an overview of studies attempted to reach an explanatory model of underlying pathophysiology of melatonin in thepathogenesis of seasonal variation in suicidality. There is argument on the interconnection between suicide rates and weather factors. However, an inverse pattern of melatonin levels and the seasonalpeak in suicides was observed. These findings suggest that sunlight exposure along with a wide spectrum of other factors may explain the aetiopathogenesis of suicidal behavior.