Psychiatrike = Psychiatriki最新文献

The hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role in regulating dopamine activity in specific brain areas, particularly in the limbic system, as well as in the stress response. The assessment of the HPA axis is important for the research of biological mechanisms leading from stressful experiences to the onset of psychosis. The release of adrenocorticotropic hormone (ACTH) by the anterior pituitary stimulates the production of cortisol and Dehydroepiandrosterone (DHEA) by the adrenal cortex as a response to stress. The co-release of DHEA may act as a protective mechanism against the damaging effects of excessive cortisol activity. We aimed to measure and compare serum DHEA-S, as well as ACTH, cortisol levels, and cortisol/DHEA-S ratio in drug-naïve FEP patients and matched controls. Data were included for 110 subjects (70 men and 40 women), comprising 55 patients and 55 controls. The mean age was 31.3 years (SD 8.7) in patients and 31.4 years (SD 8.9) in controls. Serum DHEA-S was higher in patients compared to controls [0.69 (0.40) versus 0.50 (0.19), respectively]. Serum ACTH was similar between patients and controls [28.0 pg/ml (6.2-73.9) versus 22.4 pg/ml (7.0-70.5), respectively]. Serum cortisol levels and cortisol/DHEA-S ratio were lower in patients [12.6 μg/dl (4.5) and 4.4% (1.3-19.5), respectively] compared to controls [15.4μg/dl (3.7) and 7.0% (2.4-25.5), respectively]. Sub-analysis revealed that in men, serum DHEA-S was similar between male patients and controls [0.53 (0.23) versus 0.48 (0.17), respectively], whereas in women, serum DHEA-S was higher in patients compared to controls [0.97 (0.47) versus 0.55 (0.20), respectively]. ACTH levels were not different in the above subgroups. Serum cortisol in men was lower in patients compared to controls [12.8 μg/dl (4.4) versus 15.9 μg/dl (3.6)]. Additionally, the cortisol/DHEA-S ratio was lower in patients compared to controls in men [4.4% (1.3-19.5) versus 5.8% (2.4-15.4)], as well as in women [4.3% (1.8-15.2) versus 7.9% (4.0-25.5), respectively]. Correlation analysis was performed to examine the association between different psychopathological characteristics in patients and measured hormones. It was found that the PANSS cognitive subscale was positively correlated with DHEA-S in men and the PANSS positive subscale was negatively correlated with DHEA-S in women. In the linear regression analysis, DHEA-S was positively associated with the PANSS cognitive subscale in men.

Eating disorders are mental disorders characterized by disturbed body image and excessive fear of weight gain, leading to disordered eating and weight control behavior. Studies show that early treatment is one of the most important factors in improving the prognosis of these diseases. Nevertheless, a large percentage of patients with eating disorders do not receive treatment or seek treatment until their disorder has progressed. Telepsychiatry promises to expedite treatment times by resolving geographical and cost barriers. However, there are various shortcomings in using telepsychiatry in eating disorders, including its effectiveness in treating patients with eating disorders, difficulty establishing a strong therapeutic relationship, privacy concerns, and security and technological limitations, among others. The purpose of this paper is to review the barriers that limit the usefulness of telepsychiatry in eating disorders. Ultimately, it aims to improve the use of telepsychiatry to better and more safely serve the particular needs of patients with eating disorders. We conducted a systematic review and thematic synthesis using a mixed PRISMA/ ENTREQ methodology, focusing on research that directly or indirectly investigated barriers to the use of telepsychiatry in the treatment of patients with EDs. Fifty-two studies were included, revealing multifaceted challenges in implementing telepsychiatry for patients with EDs. Specific barriers identified include poor therapeutic relationship and poor treatment adherence, clinical limitations (poor therapeutic effect, illness severity, comorbidity, certain eating disorder types are barriers themselves, impersonal care), and technical limitations (program design issues, privacy concerns), as well as negative patient experience. Telepsychiatry shows promise for treating EDs, but it is important to address these barriers in order to reach its full potential. Clinical adaptations, technological improvements, and a person-centered approach are essential to fully realize its potential. Online or hybrid treatment models must be highly personalized and multifaceted and have active therapist involvement, particularly for patients with clinical complexity.

Illness behavior is influenced by subjective, social, and cultural factors and can vary from one person to another and even internally within the same individual depending on the situation and the type of illness he or she needs to deal with. The Illness Attitude Scales (IAS) were designed by Robert Kellner to assess fears, negative beliefs, and attitudes related to hypochondriasis and abnormal behavior in relation to illness, and it is a reliable tool for detecting them as it does not contain items related to symptoms that are characteristic of other psychiatric symptoms. Although the IAS are commonly used, only a few studies have investigated their factor structure, but no common factor solution has been found. The results of these studies differ, ranging from 2 to 5 factor solutions, as well as which items are assigned to the factors. Since factor analysis for the Greek translation has not been previously researched, we analyzed the factor structure in a Greek sample using exploratory factor analysis to reflect cultural nuances in health perceptions and illness behaviors and to enable meaningful comparisons with other populations. A mixed sample of senior medical students of the Athens Medical School (N = 163) completed the psychometric tool before attending the educational clinics. Α percentage of 60.98% were women and 39.02% were men, and the average age of the sample was 23.84 years (SD = 1.67). Data were subjected to Maximum Likelihood Estimation and oblique rotation, which revealed a solution of seven factors: i) Worry about Illness after Pain Sensation, ii) Health Habits, iii) Effects of Symptoms, iv) Hypochondriac Beliefs, v) Thanatophobia, vi) Treatment Experiences, vii) Disease Phobia. The internal consistency of the factors, measured by Cronbach's alpha coefficient, achieved good to acceptable reliability: 0.86, 0.88, 0.68, 0.76, 0.73, 0.65, and 0.81, respectively. The results of the current study, although they cannot be generalized to the general population, provide information on medical students' attitudes towards illness and may pave the way for educational strategies and programs in medical school to improve the detection of negative beliefs and attitudes towards illness in medical students during clinical practice.

Schizophrenia is also manifested in a pattern of impaired speech traditionally considered to reflect thought disorder. This pilot study aimed to investigate the relationship between language impairment and other neurocognitive impairments and psychopathology. The study included 10 patients with schizophrenia (5 males), aged 45.5±12.48 years. They were assessed with the PANSS, scales of disability, and a neuropsychological battery. The experimental condition included four pictures with concrete everyday life content. The statistical analysis included the calculation of Spearman's rho correlation coefficient. Picture description was significantly correlated with the PANSS G. Non-significant but high correlations included the PANSS N, ratings of disability, and the Graphic Sequence test, the Rey figure, and the Stroop test, but there was a lack of correlation with verbal fluency, abstract thinking, and executive function Despite the small study sample, it could be said that the impaired performance in picture description in patients with schizophrenia is not a consequence of disordered thought alone, but also of the existence of a dysfunctional processing of visual information and a problematic translation of it into meaningful mental images.

The present study evaluated the impact of a hybrid Assertive Community Treatment (ACT) model of care on the direct medical costs of treating severe mental illness (SMI) patients in rural Greece. The study aimed to determine whether this model resulted in significant cost differences compared to usual treatment while also assessing its cost-effectiveness based on clinical improvements. A total of 23 patients with SMI and multiple hospitalizations were followed up for 16 months under the hybrid ACT model. Direct medical costs were estimated using previously published Greek data on schizophrenia treatment costs. Cost differences before and after the implementation of the hybrid ACT model were calculated, and cost-effectiveness was assessed using the Incremental Cost-Effectiveness Ratio (ICER), which reflects the cost per unit increase in Global Assessment of Functioning (GAF) scores. There was no statistically significant difference in direct medical costs between usual care (310,029€) and hybrid ACT care (313,896€), with a small cost increase of 3,867€ (p = 0.077). However, hybrid ACT care significantly reduced hospitalizations and length of inpatient stay, leading to an 86.9% reduction in total inpatient days. Clinical improvements were also observed, with GAF scores increasing from 40.43 to 47.26. Cost-effectiveness analysis demonstrated a particularly low ICER of 25.9€ per GAF point gained, suggesting a cost-efficient intervention. In an alternative scenario, the 2024 pricing was estimated with the use of the Consumer Price Index. In this case, the hybrid ACT care appeared to be significantly cost-saving by 25.5%. A rough estimation of indirect costs revealed further cost savings in favor of the hybrid ACT. The hybrid ACT model proved to be cost-effective due to its strong impact on reducing inpatient care and improving patient functioning. These findings align with international studies demonstrating the economic and clinical benefits of community-based mental health care. Future research should focus on larger, multicenter studies to confirm cost-effectiveness and explore the impact on indirect costs, such as caregiver burden and law enforcement involvement. The results support further investment in hybrid ACT services in rural Greece to enhance mental health care delivery in low-resourced settings.

Adolescence (12 to 18 years) represents a critical period of development, wherein attachment undergoes significant changes as individuals navigate new emotional, cognitive, and social challenges and tend to create deeper connections with peers. Αs adolescents seek greater autonomy while simultaneously maintaining bonds with caregivers, attachment studies explore how the attachment system evolves and the factors that have an impact on it. First, we present an overview of several dimensions of attachment in adolescence, like re-organization of internal working models, peer relations, affect regulation, stability, and change of attachment. In addition, we process key points in measures used for attachment in adolescence, self-report and interview-based instruments, reflecting upon the difficulties in capturing the attachment dynamics in this developmental phase. Second, we explore findings about the ways parental state of mind (secure-insecure and unresolved), as well as parental reflective functioning, may influence adolescent attachment via mechanisms of intergenerational transmission. We focus especially on findings from clinical and high-risk samples. Third, we explore the impact that attachment in adolescence has on developmental outcomes and psychopathology. The review focuses on findings from Western culture cross-sectional and longitudinal studies, both on community and clinical samples over the last thirty years (1995-2025). We include studies using only attachment constructs (i.e., excluding parental bonding) and exclude studies on adolescent mothers, adopted adolescents, and case studies. Finally, we reach conclusions in relation to recent developments in the field and future research directions.

For more than half a century, stereotactic neurosurgical procedures have been available in the treatment of patients with severe, debilitating symptoms of treatment-resistant psychiatric conditions such as obsessive-compulsive disorder (OCD). Such surgical interventions include stimulation and lesioning techniques. Capsulotomy is a lesioning procedure targeting the internal capsule. This systematic review aims to explore the safety profile of capsulotomy in the treatment of severe medically-refractory psychiatric illness, focusing on its complications. Methodologically, a literature search was conducted using the terms "psychiatric", "capsulotomy", and "complications" in the PubMed/Medline database until the end of 2022. The search retrieved 41 articles. Following screening for potential suitability, 39 articles relevant to the topic were further analyzed and finally used for this review. No specific assessment tool for risk of bias was used in this study. The vast majority of capsulotomy data in the literature comes from OCD patients, and the main modalities used for this procedure are radiofrequency (RF) ablation, Gamma Knife radiosurgery (GKRS), and magnetic resonance-guided focused ultrasound (MRgFUS). Postoperative complications are usually transient. These include neurological and psychiatric manifestations, cerebrovascular accidents, thromboembolic events, and infections (respiratory, urinary). Common complications are headache, focal edema, and frontal syndrome. Other complications include ataxia, seizures, urinary incontinence, weight gain, and fatigue. Regarding different techniques, urinary incontinence, sleep disorders, fatigue, and disorientation are frequent but transient complications of RF lesioning. Gamma capsulotomy has a risk of adverse radiation effects, such as radiation necrosis, brain edema, and cyst formation. MRgFUS seems to lack many of the inherent risks associated with more invasive treatment modalities. Discussion: Capsulotomy complications, usually transient and self-limited, include neurological and psychiatric manifestations, cerebrovascular accidents, thromboembolic events, and infections. Their occurrence and nature depend on the chosen modality. The principal limitation of this study is the fact that most data come from case reports or case series. As a result, the total number of patients who underwent capsulotomy is limited. Further clinical research is mandatory to improve the safety.

his study aims to assess the quality characteristics of mental health services provided at the General Outpatient Psychiatry Clinic of the 1st Department of Psychiatry at Eginitio Hospital, with the objective of monitoring and improving care. It is a descriptive, cross-sectional study based on clinical records from 1,146 patients. From this total, a stratified random sample of 265 patients was selected and assessed using the Verona Service Satisfaction Scale (VSSS). Among the 1,146 patients, 52% were female. The most represented age group was 50-59 years. Additionally, 56% were unmarried, 47% were unemployed, and 42% lived with their parental family. Psychotic disorders were the most common diagnosis (38%). On average, patients attended three consultations annually, while 26% received more than four sessions per year. Increased visit frequency was significantly associated with both age (p = 0.001) and psychiatric diagnosis (p < 0.001). Regarding satisfaction, 84.2% of patients reported high satisfaction with services. Older age was positively associated with greater satisfaction levels (p < 0.001). Concerning suggestions for service improvement, 28.7% of patients expressed a desire for access to psychotherapy, 25.3% requested more assistance in obtaining social benefits, and 20.8% supported the introduction of home treatment services. These findings align with previous studies in Greece, confirming slightly higher service use by women and a predominance of psychotic spectrum disorders. While the average follow-up interval was 120 days, medically necessary cases were monitored more frequently (30-90 days). Patient satisfaction was generally high, and older individuals tended to report greater contentment. Reported needs for service enhancement centered on increased access to psychotherapeutic and psychosocial interventions, along with the development of home-based care options.

To the Editors, The Maudsley Prescribing Guidelines in Psychiatry have long been regarded as a cornerstone of psychopharmacological practice internationally. In the recently published 15th edition (2025), a notable shift in the positioning of fluoxetine is observed, particularly regarding its use during pregnancy. Fluoxetine is no longer presented as a first-line option without the inclusion of new robust evidence to justify this downgrading.1 Historically, fluoxetine has been recognized as a first-line SSRI due to its well-established efficacy, favorable tolerability, long half-life protecting against withdrawal symptoms, and safer profile in overdose compared to older antidepressants.3,4 In the 15th edition, it is stated that "an association between prenatal SSRI use and congenital heart defects has been reported, with some studies suggesting a higher risk with fluoxetine and paroxetine".1 The only relevant citation is Reefhuis et al (2015),5 which employed Bayesian analysis to reevaluate previous associations. Although a slight increase in risk for specific congenital anomalies (e.g., right ventricular outflow tract obstruction) was identified, the study concludes that the absolute risks are small and that most SSRIs, including fluoxetine, are not significantly associated with specific birth defects. It is important to highlight that this study was already available at the time of the 14th edition (2021),2 where fluoxetine continued to be considered an appropriate and safe choice during pregnancy. This raises concerns about whether the change in tone in the 15th edition reflects genuine new scientific developments or simply evolving clinical preferences. Moreover, current NICE guidelines6,7 do favor sertraline due to a slightly lower observed risk in pregnancy. However, they also emphasize that women benefiting from an existing SSRI treatment should not be advised to switch medications solely because of pregnancy. Notably, fluoxetine remains the only SSRI officially approved for treating moderate to severe depression in adolescents aged 8-18 years.8 While adapting guidelines to evolving prescribing practices is understandable, in authoritative references such as the Maudsley Guidelines, it is crucial to clearly distinguish between evidence-based updates and pragmatic clinical trends. Failure to do so may inadvertently undermine confidence in long-standing, evidence-supported treatments like fluoxetine, ultimately affecting clinical decision-making.