An "Awakener" Patient Suffering From Treatment-Resistant Depression Following Adjunctive Cariprazine.

This report presents a case of particular interest in terms of course and therapeutic outcomes, concerning a patient suffering from treatment-resistant depression in whom adjunctive cariprazine to medication brought about an immediate overall improvement in symptomatology. Informed written consent was obtained from the subject for publication of the case.

The Effect of Socioeconomic Factors on Maternal Perinatal Depressive Symptoms and the Contribution of Group Prenatal Support as a Preventive Measure.

Background: The European and Greek financial turmoil that began in 2007 has had adverse health consequences. Stillbirth, low birth weight, infant mortality, and maternal suicide have all increased. The purpose of this study was to evaluate whether socioeconomic factors contribute to postpartum blues, and whether psychoprophylaxis with group prenatal education and support may have a beneficial effect. Materials and Methods: The sample study comprised 414 pregnant women equally divided into psychoprophylaxis or standard care. There were six psychoprophylaxis sessions, with two each week lasting 2 hours each in groups of five people at the urban health center of Larissa, Greece. A questionnaire was used for data collection, including (1) closed-type questions about sociodemographic characteristics, and medical and obstetric history; (2) the Hamilton Depression Scale; (3) a Blues Questionnaire; (4) the Holmes and Rahe stressful life events scale; and (5) a scale of effects of the economic crisis. Differences between the two groups and within the groups at different time points were assessed by two-way repeated measures ANOVA tests. Results: Maternity blues scores, depression scores at all time points, life stress event score, and financial difficulty score were all significantly related to each other in both groups at all time points (p < 0.01). The correlation between financial difficulties and depression/maternity blues disappeared after delivery in the intervention group. Financial difficulties, depression, and psychoprophylaxis sessions emerged as independent prognostic factors of maternity blues score, the group variable being most significantly associated with maternal blues. Conclusion: Although financial status as well as depression continued to play a role, the deterrent contribution of psychoprophylaxis was the most important parameter in the final maternity blues prognostic model. The results of our study show a potential for prevention and suggest interesting hypotheses for future interventions.

Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte Ratio and Systemic Immune-Inflammatory Index in Different States of Bipolar Disorder.

The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammatory (SII) index, which provide a simple, rapid, inexpensive method to measure the level of inflammation, have been examined as potential inflammatory biomarkers of bipolar disorder (BD) in several studies. We conducted a case-control study recruiting 180 BD patients and 407 healthy controls. BD patients who met the inclusion criteria and were hospitalized due to BD at the psychiatry clinic of the University General Hospital of Larisa, Greece, until September 2021 were included in the study. Among them, 111 patients experienced a manic episode and 69 patients experienced a depressive episode. Data including a complete blood count were retrieved from their first admission to the hospital. Bipolar patients had a higher NLR, MLR and SII index compared to healthy controls when they were experiencing a manic episode (p < 0.001) and a depressive episode (p < 0.001). MLR was increased with large effect size only in patients expressing manic episodes. Neutrophils and NLR had the highest area under the curve with a cutoff of 4.38 and 2.15 in the ROC curve, respectively. Gender-related differences were mainly observed in the SII index, with males who were expressing manic episodes and females expressing depressive episodes having an increased index compared to healthy controls. The NLR, MLR and SII index were significantly higher in patients with BD than in healthy controls, which implies a higher grade of inflammation in BD patients.

Smoking Patterns and Anxiety Factors Among Women Expressing Perinatal Depression.

Background: Relationships among perinatal depression occurring a number of weeks before and after childbirth and smoking have been identified. Depression may lead to the inability to abstain from smoking during pregnancy. Objectives: This study aims to determine factors affecting smoking during pregnancy revealing potential relationships between depression and smoking patterns during and after pregnancy. Methods: A total of 206 mothers participated in the study. Data were collected through self-reporting as respondents were asked to answer questionnaires during the 12th week of pregnancy, during the 30th week of pregnancy, after childbirth, and during the period after pregnancy. Relationships between smoking behavior, sociodemographic variables, and feelings of perinatal depression were examined using chi-square test and binary logistic regression analysis. A follow-up investigation has been conducted after 2 years revealing the percentage of women returning to their smoking habits. Results: Smokers before (B = 0.568; p = 0.026) and during pregnancy (B = 1.238; p = 0.009) were more likely to express depression before childbirth. Average daily cigarette consumption before (B = 1.110; p = 0.001) and during pregnancy (B = 1.167; p = 0.002) was associated with depression during pregnancy. Women who smoked during pregnancy reported significantly more depressive symptoms after pregnancy (B = 1.757; p = 0.005) compared with nonsmokers and smokers who abstained during pregnancy. Average daily cigarette consumption during pregnancy (B = 1.402; p = 0.002) affects the expression of depression after pregnancy. Women who smoked before pregnancy (B = 0.568; p = 0.025) and their average daily cigarette consumption before pregnancy (B = 1.465; p = 0.025) were highly associated with the inability to abstain from smoking during pregnancy. However, the knowledge of risks of maternal smoking during pregnancy (B = -1.110; p = 0.001) and medical consult on abstaining (B = -1.238; p = 0.009) reinforced the maternal attempt to quit smoking. The follow-up investigation revealed an elevated amount of women returning to previous smoking patterns. Discussion: Perinatal depression is associated with smoking patterns during pregnancy. Assessment of depression and smoking is needed throughout perinatal period to support the health of women.

Sugars, Alcohol, and Caffeine Intake From Drinks Among Outpatients With Mental Health Disorders in Greece: A Pilot Study.

Background and aim Excessive intake of sugars and energy from drinks has been postulated to increase the risk of obesity, which may in turn be associated with mental health disorders. In addition, excessive intakes of alcohol and caffeine may co-occur with psychiatric disorders. The purpose of the present pilot study was to estimate energy, sugar, caffeine, and alcohol intakes through the consumption of drinks in patients with schizophrenia and affective disorders and assess potential differences in drink consumption between the two disorders. Methodology The current study included 89 outpatients with schizophrenia (n = 36) and affective disorders (n = 53) attending the psychiatric clinic of the University General Hospital of Larissa (UGHL) in Greece. In addition to anthropometric measurements, the patients were asked to complete a specific, previously validated questionnaire on the frequency of drink consumption in order to estimate sugar, caffeine, and alcohol intakes. Results The participants had a mean body mass index (BMI) of 28.9 ± 5.6 kg/m2 without significant differences between the two types of mental disorders. Similarly, the mean waist circumference (102.6 ± 15.7 cm) and mean body fat percentage (32.9% ± 10.8%) were above the recommended values. The total energy intake from drinks was more than a third of the estimated daily energy requirements. Although there was no significant difference in the mean daily caffeine intake, those with affective disorders had a significantly higher intake of sugars from drinks (median (Mdn) = 80.0 (interquartile range (IQR) = 89.8) g/day) and alcohol (Mdn = 45.6 (IQR = 31.1) g/day), compared to those with schizophrenia (Mdn = 60.0 (IQR = 45.4) g/day and Mdn = 24.9 (IQR = 19.8) g/day, respectively). Conclusions Considering the link between high sugar and alcohol intake with excess body weight and mental health, these preliminary data are of particular concern and point to the need for better dietary counseling in order to improve the dietary behaviors of these patients.

Evaluation of memory performance in patients with brain disorders following rTMS treatment. A systematic review.

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) is being used as a non-invasive, non-pharmacological treatment with emerging clinical applications. The objective of this systematic review is to assess the possible rTMS effect on memory performance in patients suffering from central nervous system diseases. METHODS: PubMed, Google Scholar, Science Direct and Cochrane Library were searched through April 2021 for rTMS clinical trials in neuropsychiatric conditions, assessing pre-post treatment patients' memory performance with neuropsychological measures. RESULTS: One hundred and four clinical studies were included for evaluation. Overall, a large number of reports were detected with a positive outcome of patients' memory performance, concerning primarily the working memory, whereas there were also inconsistent results. In particular, considerable results were observed in patients with mild cognitive impairment and early stage Alzheimer's disease. CONCLUSIONS: Despite the variability of reports and the limited ability to generalize our findings, this review offers further evidence regarding the possible use of rTMS as a memory enhancement tool. SIGNIFICANCE: The study provides an updated and broad review in the field and highlights the need for more adequate studies, focusing on treatment procedure characteristics, follow-up and maintenance options of this approach.

Geography of hospital admissions for multiple sclerosis in Greece.

BACKGROUND: Multiple sclerosis (MS) is the 2nd most common, disability causing neurological disorder in young adults, known for its differences in prevalence according to geographical position. Data on MS epidemiology is lacking in Greece. In this study, we aimed to examine the pattern of MS related hospital admissions in Greece and analyze their spatial distribution. Data for hospital admissions due to MS was obtained from the Hellenic Statistical Authority (ELSTAT) database and they were available from 1999 to 2012. METHODS: We used the proportional hospitalization ratio (PHR) which was age and sex adjusted according to hospitalizations of Greek population, in order to calculate the ratio between hospitalizations in each regional unit (RU) and hospitalizations of national population. PHR was calculated for each RU, which is categorized as level 3 based on the Nomenclature of Territorial Units for Statistics (NUTS level 3). The classification of MS was based on International Classification of Diseases, Ninth Revision (ICD-9), code 340. Descriptive analysis was conducted to understand the epidemiological characteristics and time series analysis was used to investigate the trend of annual PHR's values during the study period. Global spatial autocorrelation analysis was conducted to assess spatial homogeneity of MS across the country. Moreover, local spatial autocorrelation analysis was performed using the LISA statistic to detect any potential clusters of similar values. Finally, multiple linear regression was conducted to examine correlations between PHR and latitude. RESULTS: Over the 14-year period the number of hospitalizations increased while the proportion of hospitalizations remained higher for females compared to males, as well as for the 25-44 year age group. RUs that appeared to be most affected included Evros with a sex- and age- adjusted PHR of 2.00 (95%CI: 1.89-2.10), Larisa with a PHR of 1.74 (95%CI: 1.67-1.81) and Chios with a PHR of 1.77 (95%CI: 1.60-1.95). The least affected RU was Arkadia with a PHR of 0.29 (95%CI: 0.24-0.36). CONCLUSION: In this study we present a rise in hospital admissions related to MS over a 14-year period, possibly indicating a parallel rise in incidence. A combinational analysis of the number of hospitalizations along with incidence studies could be further performed to be used to design public health interventions.

Evaluating Mediterranean diet adherence in university student populations: Does this dietary pattern affect students' academic performance and mental health?

Adherence to a healthy diet such as Mediterranean Diet (MD) may exert beneficial effects in university students, promoting their academic performance and quality of life, as well as their mental and physical health status. In this aspect, the present study aimed to critically analyze the current epidemiological evidence concerning MD adherence of university students' populations. PubMed database was comprehensively searched, using relative keywords. Students' dietary habits are moving away from MD guidelines towards unhealthy eating patterns, especially for those living away from home and even for students with a Mediterranean country origin. Most of the available studies have documented that poorer students' health status was associated with lower MD adherence. Higher MD adherence was correlated with lower depression risk, while higher perceived stress score with lower fruit and vegetables intake. The access of students to information and knowledge provided by courses and lectures did not effectively enhance their compliance to MD. Alarmingly enough, the majority of students, even from medical and nutritional university departments, showed inadequate knowledge on healthy eating habits. Due to the influence of diet on the quality of life and the mental and physical health of students, it is crucial to redirect research focus on this important aspect.

Assessing hostility in patients with chronic obstructive pulmonary disease (COPD).

COPD is a disease that can adversely affect patients' psychology. The purpose of this study is to investigate whether COPD patients feel increased hostility, and if hostility is associated with socio-economic factors. A cross-sectional study was conducted in 203 COPD patients in primary health care services in Greece, using the hostility and direction of hostility questionnaire HDHQ. Patient demographics, smoking habits, body mass index (BMI) and disease grade were also recorded. The results showed significant differences between males and females, with women exhibiting higher hostility (p = 0.004). Age correlates negatively with hostility, with younger patients showing higher values. Patients who continue to smoke (p = 0.005), and those in a very poor financial situation, have a much higher level of hostility. Regarding family status, married patients show the least hostility. In patients with very severe COPD and those with low education (p = 0.035) there is a high level of self-criticism. In conclusion, patients with COPD, still smokers, single, low-income and low-educated, especially female patients, have a higher risk of developing hostility. These findings suggest a need for further research in order to clarify the complexity of the different risk factors.

Burnout Evaluation and Potential Predictors in a Greek Cohort of Mental Health Nurses.

BACKGROUND: Job burnout is one of the most serious occupational health hazards, especially, among mental health nurses. It has been attributed among others to staff shortages, health service changes, poor morale and insufficient employee participation in decision-making. AIM: The aim of this study was to measure burnout among mental health nurses, investigate relations between burnout and organizational factors and examine potential predictors of nurses' burnout. Specifically, this study aimed to investigate whether role conflict, role ambiguity, organizational commitment and subsequent job satisfaction could predict each of the three dimensions of burnout. DESIGN/METHODOLOGY/APPROACH: During current cross sectional, the survey was administered to 232 mental health nurses, employed in four private psychiatric clinics in the region of Larissa, Thessaly, Greece in May 2015. Our findings were based on the responses to 78 usable questionnaires. Different statistical analyses, such as correlation analyses, regression analyses and analyses of variance were performed in order to explore possible relations. FINDINGS: High emotional exhaustion (EE) accounted for 53.8% of the sample, while high depersonalization (DP) and high personal accomplishment (PA) accounted for 24.4% and 25.6%, respectively. The best predictors of burnout were found to be role conflict, satisfaction with workload, satisfaction with training, role ambiguity, satisfaction with pay and presence of serious family issues. PRACTICAL IMPLICATIONS: These findings have implications for organizational and individual interventions, indicating that mental health nurses' burnout could be reduced, or even prevented by team building strategies, training, application of operation management, clear instructions and psychological support.

Investigation of factors associated with health-related quality of life and psychological distress in vitiligo.

BACKGROUND AND OBJECTIVES: Skin diseases distort the body image with possible negative effects on the quality of life and psychosocial health of patients. While vitiligo does not affect the physical well-being, it may be psychologically distressing. The present study was based on the hypothesis that particular factors might be critical regarding the adjustment to the disease. PATIENTS AND METHODS: We investigated the vitiligo-related quality of life and psychological distress of 216 patients diagnosed with the disease in relation to demographic factors, disease components, and personality traits. For this purpose, we administered the self-completed questionnaires Dermatological Quality of Life Index, General Health Questionnaire, Eysenck Personality Inventory, and Rosenberg Self-Esteem Scale. RESULTS: Statistical analysis revealed a significant positive correlation between patients' distress and health-related quality of life. Moreover, the impact of vitiligo on the quality of life was significantly associated with disease variables as well as personality traits and gender. On the other hand, psychological distress was significantly associated with personality traits and gender, but not with disease components. CONCLUSIONS: Our results indicate that the psychosocial adjustment to the disease is mainly influenced by subjective factors. This observation could imply the need for targeted support interventions in the treatment of vitiligo.

Do patients with Alzheimer's disease draw like young children? An exploratory study.

BACKGROUND: Previous studies have shown that AD patients present a stepwise regression to their cognitive functioning from a mature adult to that of an infant. OBJECTIVES: The present study aimed to compare Alzheimer's disease (AD) patients' and 4-10 year old children's drawing performance, taking into account that drawing is currently considered as a cognitive process and that AD manifests a severe cognitive impairment. METHODS: The sample consisted of 10 AD patients and 10 adult controls, as well as of 40 children, divided into 4 age groups (4-, 6-, 8-, and 10-years old). Participants were asked to draw from memory (a) six simple objects, (b) a man, and (c) a tree behind a house. RESULTS: Analysis showed an improvement with age in children's drawing performance, while controls' drawing scores were similar to those obtained by older children. On the contrary, drawing performance of AD patients significantly decreased into levels under that of the 4-year old children in drawing errors, or under that of the 8-year old children in drawing a man task and partial occlusion task. CONCLUSIONS: The observed regression in AD patients' drawing performance is discussed in relation to the cognitive deficits accompanying the disease.

Alexithymia components in excessive internet users: a multi-factorial analysis.

The increasing use of computers and the internet - especially among young people - apart from its positive effects, sometimes leads to excessive and pathological use. The present study examined the relationship among the excessive use of the internet by university students, the alexithymia components and sociodemographic factors associated with internet users and their online activities. 515 university students from the University of Thessaly participated in the study. Participants anonymously completed: a) the Internet Addiction Test (IAT), b) the Toronto Alexithymia Test (TAS 20) and c) a questionnaire covering various aspects of internet use and demographic characteristics of internet users. Excessive use of the internet among Greek university students was studied within a multi-factorial context and was associated with the alexithymia and demographic factors in nonlinear correlations, forming thus a personalized emotional and demographic profile of the excessive internet users.

Psychological distress, personality traits and functional disability in patients with osteonecrosis of the femoral head.

BACKGROUND: The aim of the present study was to investigate personality traits, psychological distress and functional disability in patients with non-traumatic osteonecrosis of the femoral head (ONFH). METHODS: Sixty-seven patients participated in the study, 48 males and 19 females. The mean age was 37.6 years (SD: 10.92, range: 15 - 61). Seventy-five healthy individuals, age and sex matched, served as controls. Socio-demographic information and clinical data were collected. The following instruments were used: the General Health Questionnaire (GHQ-28), the Defence Style Questionnaire (DSQ) and the World Health Organization Disability Assessment Schedule II (WHO-DAS II). RESULTS: Patients suffering from ONFH presented higher scores at the GHQ-28 compared to healthy controls (P < 0.001). Duration of disease (P < 0.047) and age (P < 0.023) were the main factors associated with psychological distress (P < 0.003). Personality traits such as image distorting (P < 0.025) and self-sacrificing (P < 0.029) were identified in patients with ONFH compared to healthy controls. Functional disability was associated with high scores at GHQ-28 scale (P < 0.001). The "adaptive personality structure", as measured by DSQ was negatively associated with functional impairment (P < 0.022). CONCLUSIONS: Patients with ONFH more commonly present symptoms of psychological distress associated with distinct functional clinical parameters. The present study also reveals the role of personality traits. Further investigation could specify the possible influence of psychopathology and personality traits or coping strategies on the course of disease.

Depression in patients with cardiovascular disease.

It has been widely suggested that depression negatively affects patients with cardiovascular disease. There are several pathophysiological mechanisms as well as behavioral processes linking depression and cardiac events. Improvements in nursing and medical care have prolonged survival of this patient population; however, this beneficial outcome has led to increased prevalence of depression. Since mortality rates in chronic heart failure patients remain extremely high, it might be as equally important to screen for depression and there are several valid and reliable screening tools that healthcare personnel could easily employ to identify patients at greater risk. Consultation should be provided by a multidisciplinary team, consisting of cardiologists, psychiatrists, and hospital or community nurses so as to carefully plan, execute, and evaluate medical intervention and implement lifestyle changes. We aim to systematically review the existing knowledge regarding current definitions, prognostic implications, pathophysiological mechanisms, and current and future treatment options in patients with depression and cardiovascular disease, specifically those with heart failure.

Systemic immune aberrations in Alzheimer's disease patients.

The role of chronic inflammation in the pathogenesis of Alzheimer's disease (AD) has been implied in a plethora of studies. The objective of the present study was to evaluate the immune alterations and the immunological markers in patients suffering from AD. IL-1alpha, IL-2, IL-6, IL-8, IL-10, TNF-alpha cytokine and helper/inducer (CD4), suppressor/cytotoxic (CD8) T lymphocyte levels were investigated in patients with various degrees of cognitive impairment (mild-moderate and severe stage), as well as in age-matched non demented controls. Cytokines were measured using the ELISA immunoassay method and lymphocytes using flow cytometry. Results showed a significant TNF-alpha increase in patients of severe stage serum compared to controls as well as a significant decrease of CD4 lymphocyte subpopulation levels in patients of severe stage compared to those of mild-moderate stage patients and controls. No significant differences were observed on IL-1alpha, IL-2, IL-6, IL-8, IL-10 cytokine levels and on CD8, CD4/CD8 lymphocyte subpopulations levels between patients and controls neither between mild moderate and severe stage patients. CD4 lymphocyte subpopulation and cytokine IL-2 were revealed as having a significant relationship (positive and negative respectively) with the MMSE score of patients. Data suggest the existence of detectable changes of peripheral immune system in AD.