Psychiatrike = Psychiatriki最新文献

"Suffering" patients' wishes concerning hastening their own death by means of euthanasia, raised by personal, psychological, social and other motives, are becoming increasingly common. This raises controversies and marks challenges within both the scientific community and the public. The aim of this study is to investigate physicians' attitudes towards euthanasia and its correlation with their spirituality. The final sample consisted of 93 physicians (64.5% men), whose attitudes on euthanasia who were evaluated using Euthanasia Attitude Scale (EAS) and Daily Spiritual Experience Scale (DSES). Physicians' attitudes correlate with their specialty (p=0.037), years of service (p=0.037), as well as the number of end stage patients they cared for and died within the last 12 months (p=0.016). Oncologists and other physicians with similar specialty, those with longer clinical experience and those who treat more end-stage patients to strongly oppose to the above practices. Spirituality, estimated with Daily Spiritual Experience Scale -DSES, is correlated with a negative attitude toward euthanasia (p<0.001). Finally, a considerable gap in physicians' training regarding the management of end stage patients has been highlighted. Physicians are opposed to euthanasia and they require the acquisition of competencies in end-of-life care in order to fulfill their profession's current and future demands in the domain of palliative care.

Prevalence of dementia or of milder form of cognitive impairment is increasing and a pharmaceutical treatment remains pending. These facts underline the need of identifying modifiable factors and targeted interventions that could reduce the incidence or control disease progression. Physical activity (PA) has been shown to have a beneficial effect on cognitive function, however findings to date remain controversial. The aim of this systematic review is to summarize the most recent data from clinical studies investigating the relationship between cognitive impairment and PA in adults older than 60 years of age. For this purpose, PubMed, Scopus and Google Scholar, search was conducted, and a total of thirty-five studies were selected to review. Eleven studies investigated the effect of PA on individuals without cognitive impairment and seven of them presented some significant improvement, mostly on specific cognitive domains and only one in global cognition. Fourteen studies included populations with mild cognitive impairment (MCI) and twelve of them reported significant improvements in cognitive function. The majority of them presented a beneficial effect on global cognition and executive function. Finally, nine studies investigated interventions on populations with a diagnosis of dementia and only four of them showed any cognitive benefit following their interventions. There was no consistent observed association of a specific type of exercise and greater improvement or improvement in certain domains of cognition nor was there a minimum duration of intervention required for the improvements to take effect. In conclusion, the majority of the latest published literature suggests a protective role of PA on cognitive function. People with MCI seem to benefit the most from PA interventions, benefits in people with normal cognition are more subtle and harder to detect, while findings from studies in people with dementia remain contradictory. As findings are not currently in total agreement, further long-term prospective intervention studies are required in order to elucidate the reasons of this heterogeneity.

We briefly present a case series of six patients hospitalized in the Department of Psychiatry, University General Hospital of Ioannina, between the first (starting March 23, 2020) and the second (starting November 7, 2020) lockdown in Greece who presented with COVID-19 - related delusional ideas. All patients had negative PCR prior to admission and no history of COVID-19 infection.The first three of our cases were admitted during the first lockdown, between March 23 and May 4, one involuntary and the other two voluntary. The first one was diagnosed with acute and transient psychosis (F23 - First Episode Psychosis) and the other two with psychotic depression (F32.3). Three additional patients were admitted voluntary after the end of the first lockdown. One was diagnosed with acute and transient psychosis (F23-First Episode Psychosis) and the other two were relapses of a known psychiatric disorder (Bipolar disorder F31.5 and Psychotic depression F32.3). At follow-up six months after discharge all patients were in remission following antipsychotic medication, among other medicines. These cases reveal that COVID-19 pandemic may have an impact on the delusional content of new or preexisting psychotic disorders during the COVID-19 pandemic.

Theophrastus (381-278 B.C.), was the first to adopt the term character for the description of distinct inner psychological and moral features of an individual. In his classic book 'Characters' in a simple style wording he analyses some of his contemporary individuals. The character "Αναίσθητος" (Anaisthetos) has been translated in English as "The Obtuse Man" and in Modern Greek both as "Αναίσθητος", meaning lack of appreciation and "Βραδύνους", meaning slowness of mind. Theophrastus' description of this particular character is compatible with the co-occurrence in an adult of two Neurodevelopmental Disorders: the Attention-Deficit Hyperactivity Disorder (ADHD) and the Social Pragmatic Communication Disorder (SPCD), according to the 5th Diagnostic and Statistical Manual of Mental Disorders. Ten out of the twelve statements support the possible occurrence of ADHD while five of them the occurrence of SPCD. The description does not justify a diagnosis of an intellectual disability; therefore, we consider that in the Modern Greek vocabulary the original term «Αναίσθητος» ("Anaisthetos"), meaning lack of appreciation, is more accurately corresponding to this particular Theophrastus's character than "Βραδύνους" ("Obtuse"), which indicates the presence of low intellectual capacities. Also the lack of repetitive and restrictive interests and behaviours excludes Autism Spectrum Disorder as a possible diagnosis. Minor psychiatric disorders and traits according to the Peripatic School were attributed to the lack of rational control over appetites and behavior. Accordingly, «Αναίσθητος» is a phenomenological description of a stigmatizing inappropriate social behavior and the only help that might give is in increasing self-awareness. In our contemporary clinical practice, though, the early recognition and appropriate treatment of Neurodevelopmental Disorders in affected individuals, leads to a better clinical care and may diminish stigmatization. The co-existence of these two disorders in a character in such a different historical context reinforces their validity as diagnostic constructs and provides an example of co-occurrence of Neurodevelopmental Disorders.

The COVID-19 outbreak has been accompanied by a massive infodemic: an overabundance of information, some accurate and some not. At this pandemic we have seen a large scale of fake news and misinformation, leading to anti-vaccine, anti-mask, and anti-5G protests.1 Fake news is intentionally misleading and deceptive news that is written and published with the intent to damage an entity or a person. They may contain false, misleading, imposter, manipulated or fabricated content. Much of the discourse on fake news conflates three notions, named "information disorders": (a) Misinformation: false information someone shares without knowing it's untrue, (b) Disinformation: false information that's shared with the intention to harm or mislead, and (c) Malinformation: true information that's used to harm others.2 False beliefs generally arise through the same mechanisms that establish accurate beliefs. People appear to encode all new information as if it were true and later tag the information as being either true or false. Different cognitive, social and affective factors lead people to form or endorse misinformed views. The emotional content of the information shared also affects false-belief formation. An angry mood can boost misinformation sharing, while social exclusion, which is likely to induce a negative mood, can increase susceptibility to conspiratorial content.3 As shown by the Illusory Truth Effect, repeated exposure to an article, whether real or fake, increases people's perceptions of its accuracy. In social media, falsehood seems to diffuse significantly farther, faster, deeper, and more broadly than the truth in all categories of information, and the effects are more pronounced for false political news than for false news about terrorism, natural disasters, and science. Moreover, although prior knowledge of a statement leads people to confirm the statement the next time, they see it (confirmation bias), novelty facilitates decision making since it updates our understanding of the world.4 The fitness value of accurate information seems so obvious, while self-deception seems to threaten such hard-won informational gains. Then, why has not it selected out? The American evolutionary biologist and sociobiologist Robert Trivers5 suggested that although our senses have evolved to give us an exquisitely detailed perception of the outside world, as soon as that information hits our brains, it often becomes biased and distorted, usually without conscious effort. Why should this be so? For Trivers, the evolutionary origins of the human propensity for self-deception lie in the adaptive benefits of deceiving others. An animal becomes a better liar when it believes its own lies, or we deceive ourselves the better to deceive others. Deception in animals is the transmission of misinformation by one animal to another, and natural selection favors deceptive signaling when aggression either confers a great benefit to signalers or imposes a great cost to

In this work 112 studies were reviewed and 21 of them were considered as more reliable and more credible. It is well known that Cognitive-Behavioural Therapy (CBT) is the most valid approach regarding its effectiveness. There are many variations of CBT used in patients with tinnitus, but the most effective appears to be the Cognitive-Behavioural Acceptance and Commitment Therapy. Also, treatment-variations consist in the use of hearing aids, and psycho-education. The Acceptance and Commitment Therapy is a third-generation psychological intervention invented by Steven Hayes in 1986. This therapy also applies to the treatment of many psychological problems, such as depression, anxiety, psychoses and substance use problems, and chronic diseases. The purpose of this therapy is not to reduce symptoms, but to improve health and behaviour changes in order for the patient to accept the inevitable pain involved in his/her condition. There are other forms of therapy that come from the broader spectrum of CBT, such as book-therapy (self-help method), rehabilitation treatment of tinnitus, and the Axiological Model based solely on cognitive psychotherapy inspired by the CBT founder, Aaron Beck. Because the latter treatment is at its first steps, there is no literature yet, and it must be considered as an experimental model. It is also well known that intervention with CBT could significantly reduce the anxiety and stress caused by tinnitus. The CBT technique incorporates many elements used to treat tinnitus, such as self-assessment, applied relaxation, cognitive restructuring, behavioral activation, and positive mental imagery. Finally, it becomes apparent that the tinnitus problem, which is serious for these patients, is increasingly affecting the psychiatric and psychotherapeutic communities.

Sixty years are coming close since the first edition of the book by Goffman on social stigma, and research that connects it with mental illness has produced significant knowledge across different scientific fields, such as psychiatry and social sciences. This paper aims at providing a review of that scientific knowledge published over the last decades, and covers the following topics: a) basic theoretical concepts related to social stigma, such as public stigma, self-stigma, structural stigma and stigma by courtesy, b) representative findings of international empirical studies in regard to public attitudes towards mental illness, c) the measurement of social stigma in mental illness and the development of methodologies, such as scales and vignettes, d) the understanding of social stigma as a mechanism of producing and reproducing social inequalities in a form of symbolic power, e) the psychological and social consequences of social stigma on people' s lives-targets of social stigma, themselves and their families, and, finally, the public campaigns designed and delivered to fight social stigma. Recent advances in the theory of social stigma, as proposed by Pescosolido & Martin, conceptualize social stigma as a dialectic process enacted within a specific socio-historical context of power relations and Link & Phelan give insights of the processes through which social stigma, either implicitly or explicitly, produced and legitimated by institutional practices. International evidence drawn by public surveys on attitudes towards mental illness show that despite the overall negative attitudes, there are some positive changes that are related to people's openness and willingness to share their mental health difficulties with others and to seek professional help. Multi-dimensional and concept specific measures are most appropriate to use. Campaigns designed and delivered to fight stigma in mental illness needs to regenerate their contents and their strategy towards the recovery model communicating to the general public messages of hope and prospect.

Although the relationship of mental health with cardiovascular dysfunction is not a recent finding, scientific data has appeared approximately at the middle of the last century. Firstly, depression was studied as a risk factor for premature death in cases of cardiovascular disease (CVD). Much later, the mechanism of psychosis and schizophrenia in the development of CVD were studied, as it was observed that most premature deaths in schizophrenia were related to cardiovascular disease. This interaction is supported both by epidemiological data and by the associated mechanisms. Inflammation, oxidative and biologic stress, and hormonal and neurotransmitter disorders in coagulation, tissue perfusion, vascular dysfunction and genetic factors get involved in these mental disorders. The combination of these pathophysiological mechanisms and the general risk factors for CVD (sex, age, smoking, systolic blood pressure, body weight, glucose levels) leads, to some extent, to increased rates of comorbidity and mortality. Patients with severe mental disorders are often not monitored and do not receive appropriate treatment for cardiovascular risk factors. In studies of patients with comorbid coronary heart disease and depression, there were signs of cardiovascular dysfunction, including increased heart rate, mainly in stress, QT prolongation and ventricular arrhythmia. At the same time, there is a dose-response relationship between the severity of depression and cardiovascular risk, with the presence of even mild symptoms of untreated depression involving some cardiovascular risk. In addition, improving the symptoms of depression through medication has been associated with increased survival. Moreover, the causes of increased mortality in patients with schizophrenia are similar to those of the general population with metabolic syndrome and diabetes mellitus, while failure to receive antipsychotic medication could lead to obesity, insulin resistance, dyslipidemia and hypertension. These data could be used as a source for future anti-inflammatory therapeutic approaches, but also for the appropriate selection of therapeutic agents, by taking a more holistic view of the patient's comorbidity. The interdisciplinary collaboration and liaison - consultation psychiatry are important factors for the timely prevention, recognition and treatment of potent complications of the cardiovascular system in mentally ill patients. The aim of this review was to present the pathophysiological mechanisms of serious mental disorders, such as depression, bipolar disorder, and schizophrenia that may be related to the development of CVD.

Long-acting injectable antipsychotics (LAIs) hold an important place in the therapeutic management of patients with schizophrenia and other psychoses. They offer advantages, such as knowledge of whether patients follow the medical advice that is given, stable pharmacokinetics and better correlation between the administered dose and the plasma levels of the drug, regular follow-up and reduced risk of overdose. Knowledge of the best way to administer LAIs is important in clinical practice because it maximizes the efficacy of the drug and minimizes the side-effects. This knowledge is facilitated through understanding both the pharmacokinetics and the pharmaceutical forms of these drugs because it provides necessary information concerning their mode of action. Currently in Greece, two first-generation (haloperidol and zuclopenthixol) and four newer LAIs (risperidone, olanzapine, paliperidone and aripiprazole) are in circulation. Their pharmaceutical form facilitates the delayed delivery of the drug during a period of weeks, thus increasing the time interval needed for the drug administration in order to maintain plasma therapeutic concentrations under stable state conditions. This is achieved by creating an extravascular drug reservoir (depot) in the skeletal muscles from which the drug is slowly released into the systemic circulation. The rate of removal of LAIs is regulated by the slow rate of absorption in the site of injection and the phenomenon of their increased half-life is called flip-flop pharmacokinetics. Their rate of absorption from skeletal muscles depends on factors, such as the injection technique, the pharmaceutical form of the drug, the distribution of fat tissue and the blood supply of the muscle. First-generation LAIs are characterized chemically by an esterified drug molecule that is dissolved in oil vehicle. The esterified drug is then hydrolyzed rapidly by plasma esterases allowing the entrance of the drug into the brain. On the contrary, newer LAIs are aqueous- based formulations characterized by various pharmaceutical forms: microspheres (risperidone), pamoic acid crystal (olanzapine), nanocrystals (paliperidone), dry drug- suspension with water (aripiprazole). Among newer drugs, risperidone and aripiprazole must be administered orally concurrently with the LAI for an initial time period. Furthermore, risperidone is the only LAI administered every 2 weeks and 3-monthly paliperidone is the only one administered every 3 months. All the other LAIs (1st generation and atypical) are usually administered every 4 weeks. This paper reviews the pharmacokinetic and pharmaceutical characteristics of these drugs. It also provides information concerning basic elements of LAI pharmacokinetics in order to understand these characteristics better.

Anxiety disorders affect approximately one in six people, causing significant problems in their quality of life and that of their families with a significant percentage of mentally ill people not showing compliance with treatment or not receiving appropriate treatment. Research data therefore reveal the need to develop new and effective interventions that will improve the compliance and therapeutic management of the mentally ill. Because of the recent technological advancement, the field of electronic mental health applications (MHapps) offers unique opportunities which can contribute to self-management of mental health problems and patient compliance, as well as to development of preventive and therapeutic interventions. Mental health applications (MHapps) offer a unique opportunity for expanding availability and quality of treatment of mental health disorders, however few applications have been carefully assessed so far making their effectiveness questionable. The present study investigated the effect of MHapp FiD (Feel-Identity) on anxiety- an innovative electronic prototype application-in a sample of adults over a two-week period. Participants made daily use of the application, based on self-monitoring and self-recording in accordance with the Cognitive Behavioural Therapy protocol, with feedback interventions being fully automated. In order to investigate anxiety levels, the STAI questionnaire (State & Trait Anxiety Inventory) was administered over three different time periods: before the use of MHapp FiD, following the first week after its use, and following the second week after its use. The results between the 3 groups of application usage, showed a statistically significant decrease of the average TRAIT anxiety levels between the 1st and the 3rd administration, i.e., after two weeks of application usage, equal to -3.020 units (Mean Difference = -3.020, p-value = 0.006 <0.01), and a statistically significant drop of the average total anxiety levels, between the administration of the 2nd and the 3rd administration, i.e., over the second week of application usage, equal to -5.388 units (Mean Difference = -5.388, p-value = 0.029 <0.05). Τhere was no statistically significant difference as to the average STATE anxiety levels. The results showed a correlation between the daily use of the FiD application and the reduction of anxiety, providing a promising perspective for dissemination of the application in clinical populations with the addition of more functions and interventions.