Psychiatrike = Psychiatriki最新文献

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.

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.

Depression is a common issue among patients with chronic viral hepatitis. Living with chronic hepatitis can create chronic stress, which is a known risk factor for developing or exacerbating depression. This stress can be related to concerns about health, the effectiveness of treatment, and the social implications of the illness. Neuropsychological scales and assessments can objectively measure the severity of depression and other mental health issues in these patients. The presence of depression was studied in 233 patients with chronic viral hepatitis, who were treated in the Infectious Disease Hospital of Shymkent and the Regional Hepatology Centre of Shymkent in the period from March 2021 to January 2022. All patients were examined using the Hamilton Depression Rating Scale (HDRS) to identify the presence of depression. Of the 233 patients with chronic viral hepatitis, 38.3% had mild depressive disorder, 2.7% of patients had scores indicating moderate depressive disorder, and 2.7% of patients were found to have major depressive disorder. Multivariate analysis showed that older age, the form of chronic viral hepatitis, higher viral load, and female gender were most strongly associated with depression. Depression is a common manifestation in patients with chronic viral hepatitis and can lead to cognitive impairments such as difficulties with concentration, memory problems, and decreased executive function. In the context of chronic hepatitis, which may already affect liver function and metabolic processes, untreated depression can exacerbate these cognitive deficits.

Chronic dermatophytosis, a persistent fungal infection lasting over six months, is a significant public health concern. The study examines the psychosocial well-being, psychological distress, and financial burden experienced by patients with chronic and recurrent dermatophytosis. A hospital-based cross-sectional design was employed, enrolling 316 patients from a tertiary care dermatology outpatient department in South India over six months. Participants completed questionnaires of quality of life (Dermatology Life Quality Index, DLQI), financial burden (Financial Burden and Worry questionnaire, FBW), and psychological distress (Hospital Anxiety and Depression Scale, HADS). Findings revealed a substantial impact on the quality of life, with 71.6% of participants reporting a very large effect as per DLQI scores. Factors such as itching, embarrassment, and daily routine disturbances were significantly associated with higher DLQI scores. Financial challenges were prominent, with 56.6% of participants delaying treatment due to financial constraints and 30.7% reducing overall expenses. The economic burden was further evident as 26.2% used savings, 12.9% borrowed money, and 16.1% reduced essential healthcare spending for other family members. Psychological distress was significant, with 31.6% and 29.7% of participants showing abnormal anxiety and depression scores, respectively, on HADS. A strong positive correlation was observed between DLQI scores, anxiety, and depression, highlighting the interdependence between disease severity and mental health. This study underscores the need for a holistic approach to managing chronic dermatophytosis, addressing not only medical but also psychosocial and financial aspects. Integrating affordable treatment options, public health awareness campaigns, and psychological counselling can significantly alleviate the burden on affected individuals. These findings provide critical insights for clinicians and policymakers to design comprehensive care strategies aimed at improving patient outcomes and quality of life.

Hypnosis is an externally induced alteration in consciousness as a result of suggestion. Hypnotherapy, also called clinical hypnosis, is the use of hypnosis as psychological treatment, either brief or long-term psychotherapy, for alleviating pain, inducing habit modification, and treating a range of physical and mental health problems, such as psychosomatic diseases, mood and anxiety disorders, and personality or behavior disorders. In the present article, the method for therapeutic hypnosis is presented, mainly based on the first author's experience. The method involves muscle relaxation, suggestion, and sensory deprivation, which lead the hypnotized individual to become detached from the environment, allowing them to establish a connection ("rapport"), meaning they have direct contact only with the hypnologist and receive instructions without any external influences. The method used by the first author is that of "rapid" induction of catalepsy, which starts with instructions to remain still with closed eyes. The hypnologist then takes hold of the person's limbs and moves them, stimulating the kinesthetic system responsible for the proprioceptive sense of position in space, thus leading to entering the hypnotic state. Personal characteristics that are associated with the degree of hypnotizability are also presented, as well as the levels of hypnotic state depth, potential complications of hypnosis, and its contraindications, which mainly include psychosis, especially schizophrenia with delusions of influence, and the presence of prominent histrionic personality characteristics. Use of alcohol or illegal substances is not a contraindication; it is, however, noted that, in their presence, the therapeutic effect of hypnosis is uncertain in the absence of other appropriate measures and suitable therapeutic interventions. The effects of hypnosis on the electroencephalogram (EEG) are indicative that the hypnotic state is distinct both from sleep and from full wakefulness. During hypnotic catalepsy, the EEG is characterized (compared to baseline) by an increase in delta rhythm power and an increase in the amplitude and index of theta rhythm, mainly in the temporal leads of both hemispheres. Additionally, there is significant asymmetry between the right and left hemispheres. It must be noted that hypnosis is just the tool through which hypnotherapy is applied. The latter should be only performed by clinicians, psychiatrists, or psychologists trained in psychotherapy, ensuring, thus, the therapeutic value of advice that is given to patients during the period of hypnotic suggestion.

Exposure to childhood trauma experiences shows a high prevalence worldwide, with approximately two-thirds of the general population reporting traumatic experiences during childhood. The valid psychometric assessment of childhood trauma experience represents, however, a significant challenge in clinical research and practice. The Childhood Trauma Questionnaire - Short Form (CTQ-SF) embodies the most valid and internationally widely used tool for the retrospective assessment of traumatic experiences during childhood to date. The purpose of this study was the Greek translation of the questionnaire and its validation in both a general and clinical population. Participants completed electronically the Greek translation of the CTQ-SF, the Early Trauma Questionnaire (ETI-SR-SF), the Trauma Symptom Checklist (TSC-40), the Positive and Negative Affect Scale (PANAS- SF), the Well-Being Index (WHO-5) and the Patient Health Questionnaire (PHQ-4) to examine psychometric properties of the questionnaire (e.g., internal consistency, concurrent, convergent and divergent validity), but also to investigate the relationship between childhood trauma exposure and psychological well-being and symptoms of anxiety and depression. The total study sample (TS) consisted of 722 adults (606 women), of which 155 declared the existence of a psychiatric diagnosis (PD) and 567 constituted the general population (GP) sample. The most common trauma types reported were emotional abuse (29.1%), emotional neglect (23.7%), and physical abuse (24.6%). The CTQ-SF questionnaire showed high levels of internal consistency based on the Cronbach α coefficient (TS = 0.92, PD = 0.92, GP = 0.92), high concurrent and convergent validity and satisfactory convergent validity. In addition, self-reported childhood trauma was highly positively correlated to negative affect and anxiety and depression symptoms, as well as negatively to psychological well-being. Our results confirm that the Greek Version of Childhood Trauma Questionnaire (CTQ-SF) is a reliable and valid tool that can be used for the retrospective assessment of traumatic childhood experiences both in the general and in the clinical adult Greek population.

The COVID-19 pandemic, which rapidly spread worldwide in early 2020, has affected the daily lives of parents and their children in various ways. This study assessed the overall mental health status and stress experienced by parents during the COVID-19 pandemic and the differences between parents of children with special educational needs and parents of typically developing children. Additionally, we explored potential demographic factors that may influence these experiences. In this cross-sectional study, data were collected through questionnaires completed by a sample of 205 parents (103 of children with typical development attending regular mainstream schools and 102 of children with special educational needs attending special education schools) from February to April 2021. Participants completed the Perceived Stress Scale (PSS-10), the short form of the Profile of Mood States (POMS-S), and a demographic questionnaire. Our findings confirmed that parents of children attending special education schools reported higher levels of anxiety, reduced coping abilities, and poorer overall emotional well-being during the pandemic compared to parents of children attending regular schools. The type of educational setting that children attended was identified through multivariate analyses as the only factor consistently influencing all psychometric outcomes. Factors influencing anxiety levels included gender, older age, and family status, while family status and unemployment negatively impacted coping abilities. Taken together, the pandemic appears to have had a greater impact on the mental health of parents of children with special education needs compared to parents of children attending regular schools, highlighting the need for increased psychosocial support within this population group.

Cerebellum, along with it' s role in coordinating motor functions, exercises a significant regulatory influence in fields of cognitive and affective functions. Therefore, studying the effect of cerebrovascular atherosclerotic pathology on mood and cognition should not be limited to stenotic dysfunctions of carotid arteries, but also extend its methodological framework to the consideration of the integrity of vertebrobasilar system (VBS), cerebellar perfusion and posterior cerebral circulation in general, as it has not been yet sufficiently addressed whether VBS insufficiency is associated with deterioration of patients' mental and emotional status and quality of life (QoL). Vertebrobasilar circulatory dysfunction has been pointed out, since decades, as a cause of progressive memory impairment and dementia, due to multiple infarcts in cerebral areas which are topographically critical for mental and emotional functions. Indicative of the pathophysiological and anatomic-functional association of VBS with these neuro-psychiatric domains are cerebellar cognitive-affective syndrome (CCAS) and crossed cerebello-cerebral diaschisis (CCCD). Mental and psychiatric components of CCAS, along with ataxic motor disability, constitute the conceptual hypothesis of "dysmetry of thought", while diagnostic significance of mental dysfunctions and psychopathological manifestations, in terms of symptoms preceding motor impairments that ascribe cerebellar malfunction in the epicenter of their pathophysiology, such as cerebellar ataxias, in which, early recognition of CCAS may facilitate therapeutic interventions aimed at improving QoL, reveal that cerebellar pathology, either of degenerative etiology or vascular substrate on the ground of vertebrobasilar insufficiency (VBI) or other surgical conditions of the posterior fossa, is associated with deterioration of patients' QoL which is related to significant impairments in their cognitive functions with (co)manifested emotional disorders. Studies in animal models also support these conclusions. Since VBI is responsible for a wide range of psychiatric and neurological symptoms, new findings concurred with current indications advocating that, without consideration of VBS disorders, it is impossible to clarify the connection of cerebral perfusion dysfunctions to neurocognitive deficits. The inclusion of cerebellar perfusion disorders in scientific research and clinical approaches to cognitive and affective disorders that may occur in patients with cerebrovascular lesions constitutes a paradigm of best clinical practices implementation and interdisciplinary convergence of neurosciences and vascular medicine.

The aim of this study is to present the data from the psychiatric evaluation and treatment of passengers of the passenger train of the accident of Tempi in central Greece (28/2/2023) who were assessed and treated at the Trauma and Stress Disorders Unit of the Outpatient Clinic of the 3rd Department of Psychiatry, Aristotle University of Thessaloniki, at the University Hospital AHEPA. The material included two populations. The first was the total population of passengers on the passenger train (N=352). The second population was a subset of the first and consisted of those passengers who presented for diagnosis and follow-up (N=41). Frequency and percentage tables were generated, the Risk Ratio (RR) was calculated, and t-test and chi-square tests were used. Concerning the total of passengers on the train, it was estimated that 20-59 people would develop PTSD. The Trauma and Stress Disorders Unit of the 3rd Department of Psychiatry assessed and followed a total of 41 passengers, 18 males (43.90% aged 28.83±10.83 years) and 23 females (56.10% aged 32.87±14.16 years) with 34 (82.92%) of them developing PTSD, representing 2/3 of the expected PTSD cases after the accident. There was no significant effect of gender, physical injury or general psychiatric history on help-seeking, but there was an effect of proximity to the impact (wagon) and history of psychosis. The treatment included antidepressants (63.14%) and group psychotherapy (48.78%), with 58.54% showing significant improvement, and 7.32% deterioration. Males showed an overall increased likelihood of showing improvement (RR=1.53). Physical injury increased the likelihood of females not showing improvement (RR=2.44) while it did not affect men at all (RR=1.02). The findings of the present study are generally in agreement with the literature in terms of incidence and response to treatment, as well as concerning the role of gender, physical injury, and proximity to the event. An important finding was that males responded more to treatment and that physical injury adversely affected the outcome of females but not males, and this point should be considered as a novel contribution of the present study to the literature.