Psychiatrike = Psychiatriki最新文献

Involuntary psychiatric hospitalization is a contested issue in mental health care provision. Despite indications of very high rates of involuntary hospitalizations in Greece, no valid national statistical data has been collected. After reviewing current research on involuntary hospitalizations in Greece, the paper introduces the Study of Involuntary Hospitalizations in Greece (MANE), a multi-centre national study of the rates, process, determinants and outcome of involuntary hospitalizations, conducted in the regions of Attica, Thessaloniki and Alexandroupolis, from 2017 to 2020, and presents some preliminary comparative findings regarding the rates and process of involuntary hospitalizations. There is a major difference in the rates of involuntary hospitalizations between Alexandroupolis (around 25%) and Athens and Thessaloniki (over 50%), that is possibly related to the sectorized organization of mental health services in Alexandroupolis and to the benefits of not covering a metropolitan urban area. There is a significantly larger percentage of involuntary admissions that end in involuntary hospitalization in Attica and Thessaloniki compared to Alexandroupolis. Reversely, of those accessing the emergency departments voluntarily, almost everyone is admitted in Athens, while large percentages are not admitted in Thessaloniki and in Alexandroupolis. A significantly higher percentage of patients were formally referred upon discharge in Alexandroupolis compared to Athens and Thessaloniki. This may be due to increased continuity of care in Alexandroupolis and that might explain the low rates of involuntary hospitalization there. Finally, re-hospitalization rates were very high in all the study centers, demonstrating the revolving-door phenomenon, especially for voluntary hospitalizations. The MANE project came to address the gap in national recording of involuntary hospitalizations, by implementing, for the first time, a coordinated monitoring of involuntary hospitalizations in three regions of the country with different characteristics, so that a picture of involuntary hospitalizations can be drawn at national level. The project contributes to raising awareness of this issue at the level of national health policy and to formulating strategic goals to address the problem of violation of human rights and to promote mental health democracy in Greece.

Literature findings have suggested that psychological factors, including anxiety, depression and somatic symptom disorder (SSD), are predictors of poor outcomes in individuals with chronic low back pain (CLBP). The aim of this study was to examine the correlations between anxiety, depression and SSD with pain, disability and health-related quality of life (HRQoL) in Greek CLBP patients. Ninety-two participants with CLBP recruited using random systematic sampling from an outpatient physiotherapy department, who completed a battery of paper-and-pencil questionnaires included items on demographic characteristics, as well the Numerical Pain Rating Scale (NPRS) for pain, the Rolland-Morris Disability Questionnaire for disability (RMDQ), the EuroQoL 5-dimension 5-level (EQ-5D-5L) for health status, the Somatic Symptom Scale-8 (SSS-8) for SSD, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression. A Mann-Whitney test and a Kruskall-Wallis test were used for the comparison of continuous variables between two groups and among more than two groups, respectively. Moreover, Spearman correlations coefficients were used to explore the association between subjects' demographics, SSS-8, HADS-Anxiety, HADS-Depression, NPS, RMDQ and EQ-5D-5L indices. Predictors of health status, pain and disability were assessed using multiple regression analyses, whereas the level of statistical significance was set at p<0.05. The response rate was 94.6% (87 participants, 55 of whom were women) and the mean age of the sample was 59.6 years (SD=15.1). A tendency of weak negative associations was noted between scores of SSD, anxiety and depression with EQ-5D-5L indices, whereas only a weak positive correlation was found between levels of SSD with pain and disability. After examining in a multiple regression analysis, only SSD emerged as prognostic factor of poor HRQoL, greater levels of pain and disability. In conclusion, the elevated scores of SSD significantly predict worse HRQoL, intense pain and severe disability in Greek CLBP patients. Further research is needed to test our findings in larger and more representative samples of the Greek general population.

In philosophy, intentionality involves directedness, aboutness, or reference of mental states. It seems to have intense connections with mental representation, consciousness, as well as evolutionary selected functions. Naturalizing intentionality, in terms of tracking or functional roles, is one of the most important goals in philosophy of mind. Such what-matters models would be useful, employing a combination of the principles of intentionality and causality. For example, the brain contains a seeking system that is responsible for its capacity of having an instinct-like urge towards something or towards wanting. Reward circuits are linked with emotional learning, reward seeking, reward learning, as well as with the homeostatic system and the hedonic system. We may suggest that such brain systems reflect components of a broad intentional system, whereas non-linear dynamics can explain the complex behavior of such chaotic or fuzzy systems. Historically, the cusp catastrophe model has been used to predict health behaviors. It can explain why relatively small changes in a parameter can result in catastrophic changes in the state of a system. If distal risk is low, then proximal risk will be linearly related to psychopathology. If distal risk is high, then proximal risk is nonlinearly related to a severe psychopathology and small changes in proximal risk predict a sudden lapse. The phase of hysteresis can explain how a network stays active long after the events in the external field that triggered its activation have waned. It seems that in psychotic patients there is a failure of intentionality, due to the inappropriateness of an intentional object or connection, or due to the absence of an intentional object altogether. In psychosis, these failures seem to occur through a non-linear and multifactor fluctuating pattern of intentionality. The ultimate goal is to provide a better understanding of relapse. The sudden collapse can be explained by an already fragile intentional system rather than by a novel stressor. The catastrophe model may help individuals remove themselves from a hysteresis cycle, and strategies for sustainable management of such cases should focus on maintaining resilience. Focusing on disruptions of intentionality can deepen and enrich our understanding of radical disturbances involved in different psychopathologies, including psychosis.

Pandemics precipitate feelings of discomfort and anxiety in healthcare professionals. This study investigates the prevalence of anxiety and depression among public primary health care professionals (PHCPs) in Greece, along with the demographic risk factors, during the second wave of the COVID-19 pandemic, in order to address work exhaustion and protect frontline professionals' psycho-emotional balance. This cross-sectional study was conducted from June 2021 to August 2021, using an online questionnaire (demographic data, GAD-7, PHQ-9). Eligible participants (medical, nursing, allied professionals) were PHCPs employed in Greek public PHC facilities. Analysis involved descriptive statistics to present sociodemographic characteristics, participants' experience with COVID-19, anxiety and depression levels. Univariate analysis was performed to evaluate the association between sociodemographic factors and the anxiety and depression levels, and multivariable logistic regression was used to investigate the presence of predictive factors for anxiety and depression. In total, 236 PHCPs participated in the study, with a mean age of 46 (SD 9.3) years and a mean professional experience of 14.71 (SD 9.2) years. Most participants were women (71.4%) and the majority were General Practitioners (38.9%) and Nurses (35.2%). Anxiety (33.1% mild, 29.9% moderate/ severe) and depression (33.9% mild, 25.9% moderate/ severe) were prevalent among PHCPs. The female gender is the most important predictor of anxiety manifestations (OR:3.50, 95%CI:1.39-10.7; p=0.014). Participants older than 50 years have a lower risk of both anxiety (OR=0.46, 95%CI:0.20-0.99; p=0.049) and depression (OR=0.48, 95%CI:0.23-0.95; p=0.039). PHCPs working in rural facilities have a lower risk of anxiety (OR:0.34, 95%CI:0.137-0.80; p=0.016). Previous infection with SARS-CoV-2 was not associated either with anxiety (p=0.087) or with depression (p=0.056). Notably, having a friend, relative, or coworker who was hospitalized for COVID-19 or died from it, was not associated with the presence of anxiety or depressive symptoms. Additionally, living with someone in a high-risk group for severe SARS-CoV-2, living with children or being at high risk for severe COVID-19 was not associated with higher GAD-7 and PHQ-9 scores. Findings indicate concerning levels of psychological distress among PHCPs. Early recognition of emotional discomfort in PHCPs and the prompt intervention could reinforce PHCPs' resilience against the pandemic.

Low back pain is a relatively common health problem which afflicts many adults, and its prevalence increases with age. Several studies have indicated that psychosocial factors are of importance in low back pain. The aim of this study was to carry out a systematic review of the efficacy of psychoeducation in managing low back pain from evidence provided by randomised controlled trials. The inclusion criteria for studies included in this systematic review were randomised controlled trials; patients with low back pain, with or without sciatica; the inclusion of a psychoeducation (treatment) arm; and age of patients ≥ 17 years. Data extraction revealed the heterogeneous nature of the psychoeducational interventions. Accordingly, it was deemed inappropriate to carry out a formal meta-analysis. Ultimately, nine studies, corresponding to 10 publications, were included in the systematic review. When possible, group contrast mean difference effect sizes were calculated for the studies. Overall, favourable outcomes associated with personalised telephone coaching, while unfavourable outcomes were associated with both Transtheoretical Model-based counselling and motivational enhancement treatment. Other forms of one-to-one counselling were associated with intermediate outcomes. Psychoeducation via personalised telephone coaching was particularly associated with reduced low back pain, reduced daily living disability, improved function and improved recovery expectation. On the basis of this review, the following suggestions are made relating to the design and publication of future studies of the efficacy of psychoeducation in the management of low back pain. First, it would be good to use an experimental design which blinds both the patients and the assessors to group status. Second, it is recommended that all the relevant outcome data from a study are published, either in the corresponding paper or in an on-line supplement. Third, it is important to ensure that the intervention and control groups are matched at baseline. Clearly, baseline group differences can emerge following random allocation of patients into two groups. It may be useful, therefore, to carry out all baseline assessments immediately prior to the randomisation process; an independent assessor could then examine the degree of matching at baseline before the rest of the study proceeds. It is also important that sufficiently large sample sizes be recruited.

The Psychiatric Hospital of Corfu was founded in 1838 by the (British) Ionian State and was joined in Greek territory in 1864. It was the unique psychiatric hospital in Greece, until the establishment of Dromokaition Hospital of Athens, in 1887. In its long history many of the patients' admissions had a local character, mainly from Corfu, the Ionian Islands, and later from Western Greece. Until the 1950s, we can follow efforts to improve buildings and patient care, but we note also long hospitalizations of men and women and high death rates. It had been an isolated institution until it joined the National Health System in 1983. It closed its doors in 2006, after a long reform process started in 1986. In its place today there is a network of community psychiatric care and rehabilitation units. Based on the medical and social hospital's books data, this paper focuses on the time of appearance and eventually withdrawal of the main diagnoses. 15844 admissions were recorded from 1838 to 2000. We note the time of first description of a diagnosis in European and Greek literature. In the 19th century, the wide diagnosis of dementia also included cases of chronic schizophrenia of our days. The diagnoses of lipomania (from 1855 to 1888), monomania (from 1845 to 1885), and degeneration insanity (from 1902 to 1952) depended on the scientific audience of these theories. Schizophrenia, as expected, was the leading one diagnosis, from 1915. Dementia praecox (πρωτογόνος άνοια in Greek) and precocious dementia were present from 1862 to 1945. Throughout the history of this institution, a large number of cases of mania and melancholia were also observed. Since 1859, the intermittent or cyclic nature of these two symptoms has been recorded, as well as since 1916, Kraepelin's manic-depressive insanity. From 1950, with the use of antibiotics, general paralysis (syphilis of the CNS) will disappear. The presence of many other diagnoses is discussed. From the end of the 19th century, the concept of widely used psychosis has gradually replaced insanity and phrenitis. From the 1940's, we also observe the use of "syndrome" in order also to describe clinical pictures of psychosis and affective disorders. This use of syndrome is probably related to the will of the medical directors of a freer use of diagnoses, compared to those included in the known nosography criteria. The homogenization of diagnoses in Greece was essentially accomplished by introducing ICD-10 in 1990s.

Type 1 Diabetes mellitus (T1DM) is a chronic, multifactorial metabolic disease that requires constant medical care. T1DM is the result of an irreversible destruction of pancreatic β-cells, inevitably leading individuals to chronic exogenous insulin dependence. The prevalence of depression among T1DM is common and affects both the progression and management of the disease. The aim of this study is to present the depressive symptoms in people with T1DM who apply and those who do not apply the insulin pump therapy method and to highlight differences in terms of gender and age. The literature review was conducted using the databases PubMed, Science-Direct and Scopus. The inclusion criteria were the following: the studies had to be conducted in T1DM patients, study depressive symptomatology, the number of participants in the studies to be more than 70 people and to be in English. Initially, 464 articles were retrieved and 11 articles met the requirements for inclusion in the systematic review. The results of the systematic review, excluding paediatric patients with T1DM, showed that patients who apply the insulin pump therapy method were more likely to have higher prevalence and intensity of depressive symptoms, compared to users of multiple daily injections. Respectively, increased depressive symptoms in women with T1DM were presented, regardless of the method of treatment. Factors that mediate this difference in depressive symptoms are the sense of freedom and flexibility in lifestyle, fewer dietary restrictions, the sense of constant "bonding" and social stigma. Finally, mental health professionals should frequently evaluate the depressive symptoms of the T1DM patients, as it has a direct impact on the development and management of the disease.

Early life stressors display a high universal prevalence and constitute a major public health problem with two thirds of youth being exposed to potentially traumatic experiences by the age of 17. Traumatic stress exposure during critical periods of development may have essential and long-lasting effects on the physical and mental health of individuals and represents a developmental risk factor mediating risk for disease. Early-life stress (ELS) and childhood trauma (CT) can both have an impact on sensitive neuronal brain networks involved in stress reactions, and could exert a programming effect on glucocorticoid signaling leading to chronic hyper- or hypo-activation of the stress system. In addition, alterations in emotional and autonomic reactivity, circadian rhythm disruption, functional and structural changes in the brain, as well as immune and metabolic dysregulation have been lately identified as important risk factors for a chronically impaired homeostatic balance after ELS/CT. Furthermore, human genetic background and epigenetic modifications through stress-related gene expression could interact with these alterations and explain inter-individual variation in vulnerability or resilience to stress. This narrative review presents relevant evidence from mainly human research on the most acknowledged neurobiological allostatic pathways exerting enduring adverse effects of ELS/CT even decades later. Future studies should prospectively investigate potential confounders, their temporal sequence and combined effects at the biological level, while considering the potentially delayed time-frame for the expression of their effects. Finally, screening strategies for ELS/CT and trauma need to be improved. Information about ELS/CT history and the number of adverse experiences could help to better identify the individual risk for disease development, predict individual treatment response and design prevention strategies to reduce the negative effects of ELS/CT.

We were pleased to read Pehlivanidis and Papanikolaou's article1 and see that more colleagues are recognizing Theophrastus' text as the first description of Attention Deficit Hyperactivity Disorder (ADHD).2 We agree with the authors' perspective that Theophrastus' description may suggest the presence of more than one neurodevelopmental disorder. In fact, Theophrastus' description aligns with the shared clinical symptoms and underlying neurodevelopmental mechanisms of ADHD and Social Pragmatic Communication Disorder (SPCD). It is fascinating that a description from over 2000 years ago already presented prototypical individual transdiagnostic aspects that are compatible with a modern biological view of psychiatry. Indeed, it is not unexpected that heritable traits with clear biological underpinnings should have been perceived since the dawn of medicine. A significant leap forward in the development of this field came a few decades ago when Clements (1966)3 published a NIH-sponsored project entitled 'Minimal Brain Dysfunction in Children.' This seminal work prepared the terrain for the ongoing understanding of the grouping of signs, symptoms, and biological factors observed across various neurodevelopmental disorders. This grouping can be present in different spectrums, proportions, and nuances, including children and adults with some impairments that are not solely explained by their cognitive abilities. Thus, the characterization of 'The Obtuse Man' by Theophrastus could be considered a prototypical case of this more integrated and less fragmented view of what we call neurodevelopmental disorders.

Over the past decades mental health services around the world are faced with a high number of patients with borderline personality disorder (BPD) which has resulted in a particular emphasis on research for specialist treatments for this class of disorders. At least 5 psychotherapeutic models are based on evidence from clinical trials that support their effectiveness. In this review we present the latest research evidence as well as a summary of the basic characteristics of Transference-Focused Psychotherapy and Mentalization Based Treatment, which are not yet widely used in Greece. The two modalities originate from the psychoanalytic tradition and they have various points of convergence and divergence with regards to their structure (individual, group, combined) the role of the therapist and their use of basic theoretical concepts (eg. attachment, aggression). Their descriptive presentation in the form of a treatment manual and the standardisation of their training model, makes them accessible for training therapists and allows their introduction in psychiatric training programmes. We present a clinical case as an example of the application of the two approaches, along with the clinical and research paradigm originating from DeanCross Personality Disorder Service in London and the Centre for Understanding Personality Disorder, in order to compare the basic theoretical and technical characteristics of the two therapeutic modalities in view of their unique application within one outpatient service in the community. DeanCross provides a mixed MBT model (group, individual) with psychiatric input, which has been updated by the introduction of TFP in individual and group formats. Our review aligns with the international current that does not regard the two models in competition with each other; instead, we present a successful paradigm of their compatibility and mutual enrichment. The successful introduction of these therapies in the British public healthcare system, which is similar in its characteristics to the Greek national health system, is an encouraging prognostic factor when it comes to the applicability of these models in the Greek paradigm. It is a necessary prerequisite that clinical and theoretical knowledge of services that care for populations with a high prevalence of BPD is updated, and the current review makes a contribution in this direction.