Eginition Hospital Research Articles

Validation of the Greek version of the Binge Eating Scale in a sample of binge eating disorder patients.

Binge eating disorder (BED), the most prevalent eating disorder, carries significant physical and psychological consequences. Therefore, there is a continuous need to assess binge eating symptomatology and evaluate the effectiveness of various therapeutic interventions. The Binge Eating Scale (BES), which is a self-administered questionnaire, is widely used to assess binge eating in obese people. It examines the person' s experience of binge eating and the emotional, cognitive, and behavioural symptoms associated with it. The purpose of the present study was to translate and adapt BES in Greek, as well as to assess the factorial structure of BES and evaluate its psychometric properties. A sample of 160 participants (90% females) with a mean age of 40.7 years (SD=11.5 years) and a mean body mass index (BMI) 37.5kg/m2 (SD=9.2kg/m2) completed the BES and the Eating Disorder Examination Questionnaire (EDE-Q). An exploratory factor analysis (EFA) was carried out to assess the construct validity of the BES in a sample of patients with BED according to DSM-5 who came for therapy at the Eating Disorders Unit at Eginition Hospital and the day center "Anasa". The two-factor structure fits the data best. Regarding internal consistency, the results were acceptable, with Cronbach' s alpha equal to 0.78. The BES has high significant correlations with the Eating Concern, Weight Concern, and Shape Concern subscales and the Global Score of EDE-Q, but not with the Restrain subscale. Also, BES has correlations with the specific EDE-Q questions about the frequency of objective and subjective binge eating episodes. A high correlation was obtained with the measure of ΒΜΙ too. The Greek version of BES is a valid and reliable scale to evaluate binge eating in a clinical population diagnosed with BED.

No-man land art voices: A quasi-experimental pilot study on the effects of art therapy on psychotic patients of a Psychiatric Day Hospital in Greece

Psychosis is often a debilitating condition that has a dramatic impact on patients' lives. Medication is an integral part of treatment, but the need for complementary therapies has been recognised. One of these is art therapy, the benefits of which have been recognised by many researchers. However, as a relatively new treatment, especially in Greece, it needs to be further investigated if and how it can claim a place among the available therapies in psychosis. The mixed quasi-experimental pilot study aimed to evaluate the effectiveness of art therapy in patients with psychosis. Nine patients with DSM-5 diagnoses of schizophrenia or other mental disorders (bipolar disorder, major depression, anorexia nervosa, mental retardation, obsessive-compulsive disorder) with psychotic symptoms participated in a 9-month art therapy intervention through 15–24 sessions at the day hospital of Eginition Hospital as part of their treatment plan. Assessments were made at baseline and week 23 of the intervention to evaluate the effect of the intervention on reducing psychiatric symptom intensity, improving interpersonal responsiveness/empathy, and functional performance on weighted scale projects. Quantitative research results showed that the art therapy group improved interpersonal responsiveness/empathy and task performance in psychiatric patients, but had no statistically significant effect on reducing the severity of patients' psychiatric symptoms. Limitations and implications for future research are discussed.

Dopamine transporter SPECT imaging in Parkinson's disease and atypical Parkinsonism: a study of 137 patients.

Differential diagnosis between Parkinson's disease (PD) and multiple system atrophy-parkinsonian type (MSA-P), corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP), collectively termed atypical Parkinsonism (AP), is challenging. Dopamine transporter density imaging with Ioflupane I123 (DaTscan) is a marker of presynaptic nigrostriatal dysfunction. The primary aim of this study was to investigate the utility of DaTscan in the differential diagnosis of MSA-P, CBD, and PSP. Patients examined at Eginition Hospital (2011-2021), with available DaTscan data and a diagnosis of probable AP, clinically established PD, as well as a neurological control (NC) group were included. Mean binding specific index (BSI), BSI of the most affected side, asymmetry index, laterality, and caudate/putamen ratio were recorded. Analyses were performed by Kruskal-Wallis and ANCOVA. 137 patients were included (CBD: [Formula: see text]; MSA-P: [Formula: see text]; PSP: [Formula: see text]; PD: [Formula: see text]; NC: [Formula: see text]). There were significant differences when comparing CBS, PSP, and NC vs. all other groups combined. Pairwise between-group comparisons revealed significant differences between PSP and CBD (mean striatum BSI>1.95; sensitivity 74.1%; specificity 85.0%), CBD and MSA-P (mean striatum BSI>2.04; sensitivity 70.4%; specificity 86.7%), and CBD and PD (mean striatum BSI>2.11; sensitivity 66.7%; specificity 100.0%). There were no differences between PSP, MSA-P, and PD. PSP, MSA-P, and PD differed from NC subjects, with 100% specificity and high sensitivity. Differentiation of NC from CBD was suboptimal. CBD patients exhibit relatively mild DaTscan abnormalities. DaTscan may assist in the differentiation of CBD from PSP. DaTscan does not differentiate among PD, MSA-P, and PSP.

Psychometric properties of the Greek version of Affective Lability Scale - Short Form (ALS-18) in a sample of adults with neurodevelopmental disorders.

Affect dysregulation refers to maladaptive patterns of emotional regulation that impair daily life functioning, common in many psychiatric disorders. It is expressed with the form of affective lability, an emotional construct composed of frequent and intense fluctuations in emotion in response to both pleasant and unpleasant events or the interpretations of events. The Affective Lability Scale (ALS) is a widely used self-reporting questionnaire that measures the tendency of emotions to shift from one to another as well as their tendency to oscillate between depression and elation and between depression and anxiety. The original scale had 54 items, but a shorter form of 18-items (ALS-18) was created, with three domains: anxiety-depression shift, depression-elation shift and anger shift. The aim of the present study was to evaluate the psychometric properties of the ALS-18 Greek version. The translation was conducted by two of the authors. The study took place in the 1st Department of Psychiatry of the National and Kapodistrian University of Athens, Eginition hospital. A sample of 108 adults was included in the survey in two groups, neurodevelopmental disorder group (attention deficit hyperactivity disorder or autism spectrum disorder) and controls. They all completed ALS-18, The State - Trait Anxiety Inventory (STAIT), Difficulties in Emotion Regulation Scale (DERS), The Hospital Anxiety and Depression Scale (HADS). The ALS-18 had satisfactory internal consistency; Cronbach's α value was 0.91 for the total scale and 0.89 for Anxiety/Depression, 0.86 for Depression/Elation and 0.85 for Anger. The three-factor structure was replicated in our data. The internal consistency reliability of all the ALS-18 factors in our study could be considered satisfactory with a Cronbach's alpha coefficient of 0.85 or above for all factors. Significantly higher mean values were found for all the subscales, Anxiety/Depression, Depression/Elation and Anger, in NDD subjects as compared to controls, showing good discriminative ability. The ALS factors discriminated well between clinical and non-clinical sample. The present study reveals that the Greek version of ALS-18 presents good psychometric properties, showing good internal consistency reliability as well as concurrent and discriminative validity. It has an elevated score in NDD and thus, our results indicate that affective lability could and maybe should, be a target integrated in therapeutic strategies.

Group psychotherapy for parents of patients with borderline personality disorder: Βasic assumptions and group containing function.

Patients with borderline personality disorders (BPD) have great difficulties with interpersonal relations. Their extreme difficulties with interpersonal relations are illustrated in psychic family interaction. Parents become the recipients of conflicts and patient's aggressive behaviour, while family stress increases due to suicidal tendency, self-injuries and substance abuse. The current report presents the introduction of group psychotherapy for parents of young adult patients with BPD, treated in a special unit of personality disorders at Eginition Hospital. The aim is, through the parallel group therapy of patients and their parents, to establish the conditions of continuing therapy for the patients as well as maintaining therapy outcomes and to construct a facilitating environment where the family's mental pain, anxieties, anger, shame, guilt and sadness can be contained. Clinical material from the first sessions of a 13-member parent group is presented to illustrate the resistances, the primitive defenses and the basic assumptions of dependency and fight-flight developing in therapeutic work with parents. Furthermore, the groups' split and hostile transference communications and the therapists' countertransference reactions are discussed. Τhe containing function of the group is described as a therapeutic process of transformation of the primitive anxieties and projective identifications, which is gradually established through the therapists' elaboration of their countertransference reactions and their tolerance to hostility and confusion. Containment facilitates the establishment of a group culture of empathic understanding for parents' unconscious resistances, denial of the illness and negative projections onto their child and the therapists, so that resistances gradually to be curbed and archaic projections to be transformed. Hence, the group is expected to function as a safe space to allow the manifestation and relief of destruction anxieties, and the expression of unuttered and intolerable emotions. Finally, the group as a mother-object is expected to be internalised as a model of positive parental care, enhancing the empathic and reflective ability of the parents so that they may repeat the parental role in a process of reparation.

TARDBP pathogenic variants in patients with amyotrophic lateral sclerosis, frontotemporal dementia and Alzheimer's disease phenotypes.

Genetic, cerebrospinal fluid and histopathological studies have highlighted the importance of TDP-43 (the protein product of the TARDBP gene) in the pathophysiology of neurodegeneration. Specifically, TDP-43 pathology has been associated with Frontotemporal Dementia (FTD), Amyotrophic Lateral Sclerosis (ALS) and, lately, Alzheimer's Disease (AD). Here we searched for TARDBP pathogenic variants in a cohort of Greek patients with AD, FTD, ALS or FTD/ALS. A total of 192 patients were included in the study. These participants were 1) referred for testing to the Neurology/Neurogenetics Laboratory of the University of Crete, 2) identified through the Cretan Aging Cohort (CAC), 3) referred to the 1st Department of Neurology of the National and Kapodistrian University of Athens at Eginition Hospital, Athens, Greece. Of these, 95 were clinically characterized as AD, 45 as FTD, 44 as ALS and 8 as FTD-ALS. Patients' DNA samples were analyzed through Whole Exome Sequencing (WES). Subsequently, we analyzed WES data for the presence of TARDBP pathogenic variants. All TARDBP pathogenic variants identified were verified by Sanger sequencing. We found three different TARDBP pathogenic variants in five apparently unrelated patients, two of whom had a family history of dementia or ALS. Two of the five patients, an 80-year-old male and a 82-year-old female, members of the CAC, were initially diagnosed as suffering from late-onset AD on the basis of their clinical presentation. Both were found to harbor the p.Ile383Val (c.1147A>G) TARDBP variant. The same variant had been found in another patient, also from Crete, presenting with a combined FTD/ALS phenotype. In addition, in 2 patients with pure ALS, we found the p.Met337Val (c.1009A>G) and the p.Asn352Ser (c.1055A>G) TARDBP pathogenic variants, respectively. Our analyses unraveled five patients with pathogenic TARDBP variants presenting with heterogeneous phenotypes, namely apparent late-onset AD, FTD/ALS and pure ALS phenotypes. Our findings further expand the phenotypic variability of the TARDBP gene variants and draw attention to the possibility that patients diagnosed with possible typical AD could harbor pathogenic TARDBP variants. Furthermore, our study showed that TARDBP pathogenic variants are a rather frequent cause of dementia in the Greek population.

Crisis intervention for serious mental disorders. The example of the First Department of Psychiatry of Athens University

We describe the crisis management and resolution service for serious mental disorders established by the First Department of Psychiatry of the National and Kapodistrian University of Athens. The service is intended to meet patients' needs for adequate management of acute mental crisis without hospitalization, while implementing modern standards in mental care and considering existing restrictions in mental health resources and public expenditure. Last decade we witness an increase in demand for psychiatric beds in Psychiatric clinics of General Hospitals resulting in a drastic increase of auxiliary beds that becomes a serious problem in mental health provision. The shutdown of big psychiatric hospitals in the process of psychiatric reform, accompanied by a delay in the establishment of all the anticipated beds in general hospitals together with overloaded and insufficient network of mental health services in the community are the major determinants. Additionally, fiscal economic crisis of the last decade intensified even more the problem by diminishing funding for the recruitment of new personnel and drastically reducing allocated funding for new and old services. In 2016 we set up a crisis intervention service for serious mental disorders within the operational framework of the emergency psychiatric services of the Department of Psychiatry in Eginition Hospital in Athens. The crisis resolution team is composed by two psychiatrists, a psychiatric nurse, social workers, a psychologist, mental health volunteers, and mental health trainees/students. The patient enters the service through the emergency service when an indication for hospitalization is given by the emergency psychiatrist, followed by the clinical estimation of a member of our team. The therapeutic team convenes twice a week for the new entrants and for follow-up sessions with the participation of the patient and the family members whenever feasible. The rest of the therapeutic interventions take place during the week. The work 'with' the person and not 'to' the person encapsulates the philosophy of the service, which is characterized by a holistic treatment approach aiming to empower the individual strengths and sense of control of the patient for crisis resolution on the basis of a safe therapeutic milieu. Therapeutic interventions include family and supportive members, as well as community interventions. In summation, interventions consist of a) comprehensive evaluation (psychiatric/ physical) and therapeutic plan, b) psychopharmacological treatment, c) psychotherapeutic support for the patient and the family for management of the crisis, d) training for the management of future crises and e) referral to appropriate community services for follow up management and treatment. Treatment lasts approximately 6-8 weeks. Initial data of the evaluation study indicate clinical effectiveness and high levels of satisfaction for patients and family. Conclusively, crisis management and resolution services are feasible even in a time of heavy restrictions in recourses, and anticipated benefits are multiple for the economy, mental health provision, the public health system, patients and relatives alike.

Evidence of advanced parental age linked to sporadic schizophrenia.

Νovel emergence of schizophrenia (SCZ) in its sporadic type has been linked, among many candidate epigenetic factors, with advanced paternal age (PA) and advanced maternal age (MA). The most common hypothesis to the paternal age effect is the increased "de novo mutations" during spermatogenesis, while the maternal age hypothesis, though controversial, is at most based on studies that support higher frequency of perinatal complications. Our sample consisted of 462 subjects with DSM-IV-TR SCZ spectrum disorders from the outpatient unit of Eginition Hospital in Athens, Greece, who were further screened for heritability and were divided in a group of sporadic cases (no reported family history for SCZ related disorders up to 2nd degree relatives) and a group of familial SCZ-spectrum disorder cases (positive reported history for SCZ spectrum). These two groups of patients were compared regarding either paternal or maternal age, while the familial type band was used as a control group. The aim of this retrospective file study was to examine whether advanced parental age may contribute in novel appearance of non-affective psychosis in offspring. Using logistic regression analysis, we found that the risk for the sporadic type, as compared to familial type, showed a significant increase for both advanced MA (OR=4.39, p=0.001) and PA (OR=1.92, p=0.012). After adjusting for confounding effects for the other parent's age and gender, the risk effect for the sporadic type of SCZ remained statistically significant for both advanced MA (OR=4.04, p=0.002) and advanced PA, but with a loss of statistical power (OR=1.72, p=0.049). Few studies have been conducted in Greece concerning the role of parental age in SCZ. Our study is consistent with current literature which indicates that both advanced MA and PA may contribute to an increased risk for emergence of sporadic type of SCZ. Furthermore, it is implied that this risk for the sporadic type as compared to the familial type could be higher for advanced MA than advanced PA. Patients with the sporadic type of SCZ, though clinically indistinguishable from the patients with the familial type of the disorder, may share other pathophysiological underlying mechanisms in which parental age, especially advanced MA, may be a candidate mediator. However, future studies could help clarify the role of both PA and MA in the pathophysiology of the disorder.

The different faces of the p. A53T alpha-synuclein mutation: A screening of Greek patients with parkinsonism and/or dementia

BackgroundThe p. A53T mutation in the alpha-synuclein (SNCA) gene is a rare cause of autosomal dominant Parkinson’s disease (PD). Although generally rare, it is particularly common in the Greek population due to a founder effect. A53T-positive PD patients often develop dementia during disease course and may very rarely present with dementia. MethodsWe screened for the p. A53T SNCA mutation a total of 347 cases of Greek origin with parkinsonism and/or dementia, collected over 15 years at the Neurogenetics Unit, Eginition Hospital, University of Athens. Cases were classified into: “pure parkinsonism”, “pure dementia” and “parkinsonism plus dementia”. ResultsIn total, 4 p. A53T SNCA mutation carriers were identified. All had autosomal dominant family history and early onset. Screening of the “pure parkinsonism” category revealed 2 cases with typical PD. The other two mutation carriers were identified in the “parkinsonism plus dementia” category. One had a diagnosis of PD dementia and the other of behavioral variant frontotemporal dementia. Screening of patients with “pure dementia” failed to identify any further A53T-positive cases. ConclusionsOur results confirm that the p. A53T SNCA mutation is relatively common in Greek patients with PD or PD plus dementia, particularly in cases with early onset and/or autosomal dominant family history.

Exploring the Museum's Images – Exploring My Image (Exploration des images du musée, exploration de mon image)

ABSTRACTIn early 2017, the National Museum of Contemporary Art, Athens (EMST) in collaboration with the First Psychiatric Department of the University of Athens, Eginition Hospital carried out a three-month pilot art psychotherapy program on the museum's premises. The program was held for a closed group of 10 participants, following an open call. During the long-lasting period of economic, political and social crisis that Greece is facing, the two institutions have been collaborating in order to offer participants a space for self-expression, creativity, critical thinking and for reducing anxiety through art making while simultaneously engaging participants with the museum collection.

An Integrated Psychogeriatric Care paradigm in Greece

Backround : Elderly are frequently afflicted by more than one pathological condition and are more vulnerable to dementia and depression, diseases that are of chronic nature and require repeated monitoring. Such patients face the greatest difficulties to gain access to mental health care services. In the context of an integrated care project, the 1st Department of Psychiatry developed a tele-psychogeriatric service, consisting of a tele-psychogeriatric unit (T-psyGU) and a mobile tele-psychogeriatric unit (MT-psyGU) for home care services. The aim of this program was the delivery of diagnostic, therapeutic and educational approaches to demented or depressed patients and their families, that live in remote and underserved areas, through the implementation of new technology in the geriatric mental health care delivery system and to connect health care services provided by different sources. Methods : - Setting: rural and urban underserved areas ( Andros Island) - Staffing: social workers and GP supervised by geriatric psychiatrists based at Eginition Hospital - Intervention: standard protocols to screen, identify and treat depression, dementia and BPSD - Technology: iPad and android technology able to transmit and receive patient’s image and data of psychometric testing. The resulting application is a standalone tool that contains all the pre-existing tests which are useful for the health care professionals visiting a remote patient. Access to Wi-Fi network allows the synchronization of each patient’s data into a central system, accessible to accredited personnel. - Health care services connected: Health care Center, Home care, Social Services, Mobile Psychiatric Unit, Local GP’s - Outcome measures: number of new cases, use of psychotropic drugs, visits to hospitals, suicide prevention, number of health care services connected, follow up visits. - Funding: 2012-2013 Stavros Niarhos Foundation (SNf). From 2013-2015 Andros island Charities Results : During 2012-2015, 198 patients with depression and/or dementia were monitored with more of 889 videoconference appointments. 7 patient admissions were arranged. Compared to previous usual care, the intervention resulted in better recognition of psychiatric symptoms, better use of psychotropic drugs and less use of antipsychotics or sedative–hypnotics, better follow up, fewer visits to tertiary care were recorded and faster resolution of suicidal ideation. Caregivers showed improvement in distress and they expressed their satisfaction about the new service. There were an improvement in connecting Health care services mostly with social services, tertiary health care services and Health center. Conclusions : The successful application of this integrated collaborative service through communication technology in geriatric mental health care offers the opportunity to mental health specialists to reach elderly people in remote areas and to connect different health care services. It seems that, Andros could be a working paradigm of an evolving integrated psychogeriatric care service.

Metacognitive factors in a sample of Greek alcohol dependent patients

IntroductionThe harmful use of alcohol causes a large disease, social and economic burden in societies. Metacognition is a complex concept referring to the cognitive control and regulation of many types of cognitive processes.ObjectivesMetacognitions are considered to be an important factor in the development and continuance of psychological disorders.AimsThe purpose of this study is to examine the probable relations between alcohol abuse and Metacognitions with the Metacognitions Questionaire – 30 (MCQ-30).MethodTwenty-three men and 16 women, aged between 22 and 64 years, inpatients in Eginition Hospital, due to alcohol dependence, completed the Greek-Version of the MCQ-30.ResultsThe mean total scores of alcoholics were higher than the ones of the healthy subjects. Namely, the group of the alcohol abused patients presented a higher score in comparison with the normal group in three of the five metacognitive dimensions. Additionally, alcoholic men outscored alcoholic women in two of the five factors. Specifically, alcoholic men appeared to be less confident about their memory and attention than alcoholic women. Furthermore, alcoholic men, compared to alcoholic women claimed in a significant greater level that worrying helped them to function.ConclusionsThe above findings suggest that metacognitions could play a role in the orientation and maintenance of alcoholic abuse behavior. Moreover, these results may pose the question of whether these metacognitive beliefs could be seen as an indicator of differentiating alcoholic men from women. Overall, further research could provide additional information concerning the relation between Metacognitions and alcoholic dependence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Late onset anorexia nervosa and the role of parental family. Presentation of two cases

Anorexia Nervosa (AN) has traditionally been considered an illness of young individuals and its etiology has been linked with the stress of the transition from childhood to adolescence and adulthood. A recent study reported that 4.6 % of middle aged women were suffering from eating disorder (ED) and an additional 4.8 % displayed subthreshold ED [1]. The literature on late onset EDs is sparse with only a few studies and case reports published in the last decades [2]. However, there are earlier documentations of the appearance of AN in older ages, as shown already back in 1874, in the record of a Lasegue’s patient that was 32 years old at the onset of the disorder [3]. Dally in 1984 [4] described four groups of women that developed ‘‘tardive anorexia’’ related to marriage (in the engagement period, during marriage, within 3 years of pregnancy and during menopause). He considered the first three groups forming a continuum with the adolescent form of anorexia nervosa, characterized of unresolved developmental conflicts, whereas the fourth group was characterized by the loss of will to live, despite the occasional histrionic use of starvation for gain. It has been hypothesized that the perpetuating factors of late life AN include relief from social and domestic responsibilities, control over others and reduced outside involvement [4]. Stressful events prior to the development of ED and comorbid major depression have also been related to late onset AN [2, 4, 5]. It should be noted that some authors report that they did not found any evidence of real late onset AN [6]. It is noteworthy that although the parental’s family role in the development and treatment of AN has been thoroughly investigated [7], the authors that have studied late onset AN have focused more on marriage and the relationship with the husband [4]. The family ties in Greece, as in most Southern European countries, remain strong and expand beyond the core family. It is not uncommon to meet an extended family living in the same block of flats or in great proximity. In these families, the leading role is usually retained by the elder members. Under these circumstances, the issue of autonomy and self-identity in certain occasions remains unresolved even in late age. Can the above conditions contribute to the development of late onset AN? To further discuss this issue we present brief vignettes of two patients. Both patients were treated in a university ED outpatient clinic. They were diagnosed according to DSM-IV TR criteria as suffering from an anorexia nervosa (purging type). Both patients reported fears of gaining weight, distorted body image and low Body Mass Index (BMI) (case 1 lower than 17.5 and case 2 marginally higher than 17.5 but dropped lower than 17.5 after 2 weeks of treatment). The fourth diagnostic criterion could not be utilized as both women were in their menopause. Both women have been extensively investigated, prior to their first appointment in the outpatient clinic, by their physicians (case 2 was also hospitalized) to exclude medical conditions that could cause or contribute to their symptomatology. Except from electrolyte imbalance and gastritis caused by extensive vomiting (case 2) no other medical condition was discovered. F. Gonidakis (&) G. Georgantopoulos G. Konstantakopoulos E. Varsou Eating Disorders Unit, 1st Psychiatric Department, Eginition Hospital, Athens University Medical School, Vas Sofias 74str, 11528 Athens, Greece e-mail: fragoni@yahoo.com

EPA-1275 – Agomelatine as monotherapy in depression

Agomelatine is an melatonergic antidepressant marketed for the treatment of major depressive disorder and has been reported to have a reduced level of sexual side effects as well as discontinuation effects. The present study examined the efficacy of agomelatine in the treatment of symptoms of depression/anxiety in a sample of depressed patients. 110 patients who fulfilled the DSM-IV diagnostic criteria for a major depressive episode treated on an outpatient basis at the Eginition Hospital were assessed with the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale and the Global Assessment Functioning. The questionnaires were administered at the beginning of the medication period and thereafter every week over a 6-week period. Descriptive statistics are used for the presentation of the results. Mean age ± SD of the sample was 52.5 ± 9,3 years. Mean score ± SD on the HDRS, HARS and GAF at the different time points of assessment are shown below. Baseline (1) 1 st week (2) 2 nd week (3) 3 rd week (4) 4 th week (5) 5 th week(6) (mean±SD) (mean±SD) (mean±SD) (mean±SD) (mean±SD) (mean±SD) HDRS 37.2±2.4 32.5±1.8 28.4±2.6 14.4±2.8 6.8±2.6 6.1±1.8 HARS 34.6±7.7 32.3±1.4 27.3±2.5 14.2±2.1 6.4±1.8 6.2±2.1 GAF 45.6±8.2 47.1±2.2 57.7±2.1 72.2±2.1 88.5±2.4 91.1±1.7 Psychopathology significantly subsided by the end of the study period; improvement was marked already from the third week of treatment. The main finding of the present study was that monotherapy with agomelatine had a positive effect on symptoms of depression, anxiety, and global functioning in depressed patients.

Stress management techniques in primary insomnia: a randomized controlled trial

Introduction Background Insomnia is conceived as the subjective complaint of reduced sleep quantity and/or quality. En order for the diagnosis to be made, this complaint must be present quite frequently (at least three times per week) for a considerable period of time (at least for one month). Psychophysiological factors such as stress are often presumed to play a major role in the onset and maintenance of primary insomnia. The treatment should not only focus on ameliorating sleeplessness, it should also address all those factors that cause and maintain insomnia, turning it to a chronic condition. Non-pharmacological treatments, such as stress management techniques can be easily and inexpensively administered in treatment with good results. The aim of this study is to identify the effectiveness of stress management techniques as a treatment in primary insomnia. Materials and methods This is a two-armed parallel group, randomized controlled trial. Primary insomniacs were randomly assigned to undergo either an 8-week CD-based stress management program ( n = 27) (relaxation breathing, progressive muscle relaxation and guided imagery twice a day) or a control condition ( n = 26) both of the groups took information about insomnia and they participate once in a week in consultative meetings for the treatment of insomnia). Self-reported validated measures were used to evaluate insomnia, quality of sleep and symptoms of depression and anxiety at baseline, at the 4th week and at the end of 8 weeks. Also, we measured perceived stress and ”health locus of control” (through scale which is appropriate to identify what it is responsible for the heath problems of an individual) at baseline and at the end of the 8 weeks. Also, free cortisol, as a biological marker of stress, was measured in saliva samples taken three times a day at baseline, at the 4th week and at the end of 8 weeks. Finally, we measured the satisfaction with the stress management program and the compliance with the therapeutic instructions. Results At the end of 8 weeks of the relaxation program, in the intervention group, we noticed decrease in insomnia and improvement on sleep quality. Also, in this group, we found improvements on perceived stress and salivary cortisol, biological marker of stress. As far as symptoms of depression and anxiety are concerned, there was significant decrease at the end of the relaxation program. Finally, there was no change in health locus of control after the practice of stress management techniques. Conclusion The training of patients with primary insomnia in relaxation techniques contributes to decrease in stress and the symptoms of primary insomnia. Simple techniques such as diaphragmatic breathing, progressive muscle relaxation and guided imagery which are easily applicable, may be regarded as effective and low cost non-pharmacological treatment of insomnia. Acknowledgements I would like to thank Dimitrios Dikeos, Associate Professor of Psychiatry at Eginition Hospital for his help to fullfill this study.

Serologic markers for HBV, HCV and HIV in immigrants visiting the Athens' polyclinic of ‘Doctors of the World – Greece’

G. Papadakis , N.A. Okoba , C. Nicolaou , F. Boufidou , A. Ioannidis , S. Bersimis , Doctors of the World e Greece, S. Chatzipanagiotou * Greek Delegation of Doctors of the World, Athens, Greece Department of Medical Biopathology, Eginition Hospital, Medical School, University of Athens, Athens, Greece Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Greece Department of Statistics and Insurance Science, University of Piraeus, Piraeus, Greece

Ocular flutter in essential tremor: clinical course and response to primidone

Essential tremor (ET) is generally regarded as a benign monosymptomatic condition with tremor being the sole neurological manifestation. Structural brain abnormalities are not considered part of the syndrome. Over recent years, however, it has become increasingly clear that a cerebellar pathology might be involved in the disease process [1, 2]. Neuropathological studies associated Purkinje cell loss with ET [3], whereas brain imaging demonstrated in many cases atrophic changes in different lobules of the cerebellum [4]. It should be mentioned, however, that there are also studies which failed to show an association of ET and cerebellar pathology [5]. Reports on clinical cerebellar signs in ET are sparse [1, 6]. Here, we present an ET case exhibiting saccadic intrusions with features of ocular flutter (OF). A 74-year-old woman presented with gradual onset of hand tremor over the last three decades. The tremor worsened with stress or intense physical exercise and improved after ingestion of small amounts of alcohol. Her father had similar symptoms but never sought medical advice. She also complained of dizziness and oscillopsia lasting ‘‘a few seconds’’ many times a day for at least 10 years. On examination, a postural tremor of both hands, more pronounced on the left, was noted. Finger-to-nose test was slightly impaired, but heel–knee–shin was unremarkable. The eyes showed infrequent (1–2/min), rapid, conjugate, horizontal oscillations occurring in bursts, leading to the clinical diagnosis of OF. No other ocular motor abnormalities were noted. Recording of eye movements confirmed the clinical impression, showing bursts of fast phases without intersaccadic intervals (Fig. 1a). Intraburst frequency was 10 Hz, and interburst frequency was 0.5 Hz in a 4-min record. Surface electromyography (EMG) recordings of the wrist extensors revealed a postural tremor frequency of 6–6.5 Hz (Fig. 1c). We put the patient on primidone, slowly titrated up to a daily dose of 375 mg. Upon reexamination 2 months later, hand tremor had virtually disappeared (Fig. 1d), although the patient reported a mild tremor of the left hand during emotional excitement. Interestingly, ocular flutter was also absent both clinically and in a 7-min-long record (Fig. 1b). Importantly, she could not recall any oscillopsias in the last couple of weeks. OF is a pathological form of saccadic intrusions consisting of back-to-back horizontal saccades [7]. It is considered a subtype of opsoclonus, the former being characterized by multidirectional fast phases of varying amplitudes. The pathophysiology of OF and opsoclonus is still controversial. It is assumed that abnormal Purkinje cell activity in the cerebellum leads to reduced inhibition on the fastigial nucleus. This results in enhanced inhibition of brainstem omnipause neurons, which, in turn, renders saccadic burst neurons free to oscillate [8, 9]. Recent modeling, however, is based on a dysfunction of the brainstem saccadic generator while cerebellar abnormalities are believed to be secondary to brainstem oscillations [10]. Nonetheless, available functional neuroimaging data conform to the cerebellar hypothesis of OF genesis [11, 12]. The present case exhibited ocular flutter linked with mild oscillopsia for presumably more than 10 years. Thus, this long period largely rules out causes such as encephalitis or paraneoplastic disease. The fact that both tremor E. Anagnostou (&) E. Kararizou I. Evdokimidis Department of Neurology, Eginition Hospital, University of Athens, Vas. Sophias Avenue 74, 11528 Athens, Greece e-mail: granavan@yahoo.com

The prevalence of heart problems and risk factors in patient with ischemic stroke and their relationship with severity of stroke

The prevalence of heart problems and risk factors in patient with ischemic stroke and their relationship with severity of stroke

Study of the Cochlear Function in Patients with Myotonic Dystrophy Type 1

Objectives: Myotonic Dystrophy type 1 is a progressive autosomal dominant multisystem disorder, the second most common form of muscular dystrophy. The disease is associated with various vestibular, oculomotor, and auditory disorders. The aim of the present study was to undertake a detailed vestibular and audiological evaluation, and specifically to analyze the cochlear function using transiently evoked otoacoustic emissions. Methods: 24 patients with genetically diagnosed myotonic dystrophy type 1 were studied during the past 4 years in Eginition hospital of Athens. Twenty-one normal subjects were used as controls. Testing included pure-tone audiometry, tympanometry, auditory brainstem responses (Abr), transiently evoked otoacoustic emissions, and nystagmography. Results: Tympanograms were normal in most patients. 15 (62.5%) patients had a varying degree of sensorineural hearing loss, with no conductive element. In 9 of them (37.5%), ABR abnormalities were found, such as absence of wave I or increased latencies of waves III and V, compatible with sensorineural hearing loss (5 patients), as well as increased I-III and I-V interpeak latencies, compatible with retrocochlear involvment of the auditory pathways (4 patients). Subclinical cochlear damage was found in all patients, as evidenced by absent otoacoustic emissions or lower otoacoustic emission amplitude. Vestibular hypersthesia was found in 9 patients (37.5%), accompanied by spontaneous nystagmus in 4 of them (15.6%). Conclusions: Audiovestibular abnormalities are quite common in patients with myotonic dystrophy type 1. We have found that subclinical cochlear damage is a common finding of the disease, as concluded from the absence or decrease of otoacoustic emissions in these patients.

Paliperidone-Induced Obsessive Symptoms

Back to table of contents Previous article Next article LettersFull AccessPaliperidone-Induced Obsessive SymptomsThomas Paparrigopoulos, M.D., Elias Tzavellas, M.D., Dimitris Karaiskos, M.D., and Ioannis Liappas, M.D.Thomas PaparrigopoulosSearch for more papers by this author, M.D., Elias TzavellasSearch for more papers by this author, M.D., Dimitris KaraiskosSearch for more papers by this author, M.D., and Ioannis LiappasSearch for more papers by this author, M.D.Published Online:1 Apr 2011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To The Editor: The therapeutic effect of the atypical antipsychotic paliperidone is attributed to a combination of D2 and postsynaptic 5-HT2A receptor antagonism,1 which, in turn, exerts an inhibitory effect on the mesolimbic dopaminergic system.2 Paliperidone also antagonizes α1 and α2-adrenergic and H1-histamine receptors. It is indicated for the treatment of schizophrenia and manic or mixed episodes of bipolar i disorder.1 we report on a patient who benefited in terms of psychotic symptom reduction but developed severe obsessive thoughts.Case ReportA 32-year-old man suffering from paranoid schizophrenia was referred for excessive weight gain attributed to risperidone, resistant to a dietary regimen. The patient had a first episode with auditory hallucinations and persecutory delusions 8 years ago. He had been medicated with risperidone, and symptoms were well-controlled. After an unsuccessful reduction of risperidone, the patient was stabilized on 4 mg/day. A gradual switch to paliperidone 9 mg/day was tried. Positive symptoms, that is, prominent hallucinations or formal thought disorder, were adequately contained, but, after 2 months, the patient complained of uncontrollable, invasive thoughts of harming his parents, which had never been present beforea. The patient recognized the irrational nature of his thoughts, and these produced excessive anxiety that he could not manage. A switch back to risperidone led to full remission of obsessive thoughts in 2 weeks.DiscussionPaliperidone-induced obsessive-compulsive symptoms (OCS) have not been reported. De novo surfacing of OCS by atypical antipsychotics during schizophrenia treatment has been documented in numerous cases.3,4 Pertinent hypotheses have been proposed, such as the following: 1) overt psychosis may mask OCS; 2) obsessions may represent a residual form of psychosis; 3) OCS and psychosis may be two discrete phenomena; and 4) obsessions may be adverse effects of antipsychotic medication.5 Although underlying pathophysiology is not well understood, 5-HT2 receptor antagonism, particularly in the basal ganglia, seems to play a key role in the emergence of OCS in schizophrenic patients. It is noteworthy that, in our case, obsessions had never been previously present, although the patient was on risperidone for 8 years. These symptoms surfaced when paliperidone, an active metabolite of risperidone, was administered, which suggests a potential different mechanism of action in the cortico-striato-thalamic loop. The observation that paliperidone may induce OCS corroborates the key role of the interplay of serotonin and dopamine in their emergence in schizophrenic patients.2 Monitoring of patients on paliperidone is needed because of the possibility of their developing OCS.Athens University Medical School Department of Psychiatry Eginition Hospital Athens, Greece1. Invega (paliperidone) [package insert]. Titusville, NJ: Janssen LP; April 2007Google Scholar2. Kapur S , Remington G : Serotonin-dopamine interaction and its relevance to schizophrenia. Am J Psychiatry 1996; 153:466–476Crossref, Medline, Google Scholar3. Sareen J , Kirshner A , Lander M , et al.: Do antipsychotics ameliorate or exacerbate obsessive-compulsive disorder symptoms? a systematic review. J Affect Disord 2004; 82:167–174Crossref, Medline, Google Scholar4. Lykouras L , Alevizos B , Michalopoulou P , et al.: Obsessive-compulsive symptoms induced by atypical antipsychotics: a review of the reported cases. Prog Neuropsychopharmacol Biol Psychiatry 2003; 27:333–346Crossref, Medline, Google Scholar5. Poyurovsky M , Weizman A , Weizman R : Obsessive-compulsive disorder in schizophrenia: clinical characteristics and treatment. CNS Drugs 2004; 18:989–1010Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByRapid improvement of obsessive-compulsive disorder associated with schizophrenia with cariprazine add-on in a subject under paliperidone long-acting injectionInternational Clinical Psychopharmacology, Vol. 35, No. 2PaliperidoneAmisulpride as Add-on Treatment for Resistant Obsessive-Compulsive DisorderClinical Neuropharmacology, Vol. 38, No. 1Obsessive–Compulsive Disorder27 February 2014 | Journal of Pharmacy Practice, Vol. 27, No. 2Haloperidol augmentation of fluvoxamine in skin picking disorder: a case report26 July 2012 | Journal of Medical Case Reports, Vol. 6, No. 1 Volume 23Issue 2 Spring 2011Pages E46-E46 Metrics PDF download History Published online 1 April 2011 Published in print 1 April 2011