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The present study aims to investigate the course of psychological symptoms through chemotherapy in a sample of primary caregivers of patients with cancer and to examine all possible correlations between psychological distress and demographic characteristics. In this prospective study, 112 primary family caregivers of cancer patients were evaluated. Symptom checklist 90 revised (SCL-90-R) was administered to assess their pathological symptoms, the Hospital Anxiety and Depression Scale (HADS) to assess depression and anxiety. There was an evaluation at the beginning of chemotherapy and a second at the end of the patients’ intravenous chemotherapy treatment (EOT). A total of 112 primary caregivers were initially enrolled in the study, and 99 (88.4%) completed it. Caregivers’ psychopathology was low to moderate at both points of time (baseline and EOT). However, a considerable decrease in the Global Severity Index (GSI) emerged over time. At EOT, participants reported statistically significant decreases in five aspects of SCL 90, namely Depression, phobic anxiety, obsessive–compulsive symptoms, somatization, and psychoticism. A notable finding was that female caregivers were significantly more distressed, especially when providing care to a male recipient.

Τhe COVID-19 pandemic has mental health implications for both healthcare workforces and general population, particularly in regions heavily hit by the crisis. Τhe study aimed (i) to investigate anxiety- and depression severity differences between staff of a COVID-19 treatment unit (N = 84) and a hospital without such a unit (N = 55) in comparison to participants of a convenience general population online survey (N = 240) and (ii) to explore relations between such symptoms and hospital staff reaction to COVID-19 in a low COVID-19 burden setting. Anxiety was studied with the Generalized Anxiety Disorder 7-Item in hospital workforces and with the Hospital Anxiety Depression Scale (HADS) in online survey participants. Depression symptoms were assessed with the Patient Health Questionnaire-9 in hospital employees and the HADS in the online survey sample. Symptoms were classified as absent/minimal, borderline abnormal or indicating clinical caseness. Staff reaction to COVID-19 was tapped with a 9-item-questionnaire and the 22-item Impact of Event Scale-revised (IES-R). Proper tests for differences and stepwise ordered logistic regression models were employed. Anxiety- and depression severity was higher in hospital workforces than in online survey participants (P < 0.05). Anxiety was more severe in frontline- compared to backstage employees (P < 0.001) was inversely correlated with age (P = 0.011) and positively with avoidance (P = 0.028). Both anxiety and depression symptoms related to intrusion symptoms (P < 0.001). Regarding the relatively long data collection period, an inverse association between crisis duration and depression symptoms was detected (P = 0.025). These observations point to the urgent need for distress-mitigating interventions for hospital workforces even in low COVID-19 burden settings.

Major depressive disorder (MDD) is a chronic, severe psychiatric illness with an incidence of 3% worldwide. MDD patients have a significantly impaired quality of life and reduced life expectancy compared to unaffected individuals, the latter being largely accounted for by an increased incidence of suicide and cardiovascular disorders. The premature mortality observed in MDD has been considered a signature of accelerated aging, a hypothesis supported by data showing altered functioning and morphology of several brain regions that are typically present in the aging population. Telomere shortening is a hallmark of cellular aging, and as such several studies explored the involvement of disrupted telomere dynamics in MDD, reporting contrasting findings. In the current study, we measured leukocyte telomere length (LTL) in a sample of 54 MDD patients and 47 non-psychiatric controls characterized for response to antidepressant treatment. After correcting for age, sex, and body mass index, we showed significantly reduced LTL in affected individuals compared to controls (beta = -.22, p = .02). There was no difference in LTL between treatment resistant or responsive MDD patients. Moreover, we observed no correlation between lifetime exposure to antidepressants and LTL. Our study showed that MDD patients have shorter telomeres compared to controls, supporting the hypothesis of accelerated aging in this disorder. However, LTL seemed not to be influenced by antidepressant treatment or to correlate with clinical response to these antidepressants. Further investigations in larger samples and possibly with longitudinal design are warranted to elucidate the role of altered telomere dynamics in MDD.

Recent research has fueled a debate concerning the role of nicotine in the emergence of schizophrenia. The three main hypotheses are: (a) the self-medication effect, (b) the causal relationship hypothesis, or (c) the shared diathesis hypothesis. To explore this role, the study of nicotine consumption during the initial prodromal phase of schizophrenia offers important opportunities. In the present work, 10 relevant studies are reviewed, out of 727 retrieved citations, in order to address questions regarding the prevalence of smoking in the prodromal period, the time of smoking initiation, existing patterns of tobacco use in relation with the escalation of prodromal symptoms into first psychotic episode, and potential differences in symptomatology between smokers and nonsmokers. Even though there was considerable heterogeneity among studies, relevant findings are discussed. Prevalence of nicotine use during the prodromal period was reported to be 16.6-46%. Tobacco use was found to be taken up most often before or during the prodromal period of schizophrenia. Even though a protective role of smoking has been reported by one study, other studies report an increased risk for psychosis, with hazard ratios 2.77 (95% CI: 2.34-3.43) and 2.21 (95% CI: 1.11-4.42) for female and male heavy smokers (11-20 and >20 cigarettes/day), respectively. In a different study, the risk of onset was associated with the progressive use of cannabis and tobacco prior to onset, particularly with rapid escalation to the highest levels of use. Also, nicotine use in ultra high risk (UHR) for developing psychosis subjects is associated with elevated cognitive performance, namely better processing speed, visual learning, and spatial working memory. As a conclusion, it appears that evidence accumulates supporting a possible etiologic role of smoking, in the emergence of schizophrenia along with diverse effects on patients' symptomatology, already demonstrable at the prodromal phase. Future research employing better-defined criteria should further explore the patterns of use and effects of nicotine during the schizophrenia prodrome.

Compulsory admissions represent a significant proportion of psychiatric hospitalizations. A wide variation seems to exist internationally regarding legal frameworks, administrative procedures, detention rates and clinical practice. The aim of the present study is to describe qualitative and quantitative features of compulsory admissions in a large administrative area in southwest Greece, in order to identify targets for future research and possible remediation. Involuntary assessments and admissions in the Department of Psychiatry of the University Hospital of Patras were retrospectively assessed, during a 12-month period, for demographic features and data regarding legal procedures. Diagnoses following compulsory first assessment and at discharge were recorded for the patients who were admitted in our department. During the period of observation, 218 compulsory assessments were made, corresponding to 190 patients and resulting in 183 compulsory admissions. Thirty five cases (16.1%) were assessed as not justifying hospitalization and corresponded mainly to the diagnoses of alcohol and/or substance abuse or dependence. Involuntary hospitalizations represented 44.9% of all psychiatric admissions in our department. Diagnosis at first assessment was most frequently psychosis (68.4%). Diagnoses at discharge were most often schizophrenia (52.8%) and bipolar disorder (21.3%). A history of multiple hospitalizations (>5) was observed in 17 (15.8%) patients, whereas 46 patients (42.6%) were hospitalized for the first time, and 13 (11.7%) exhibited their first psychotic episode. Of the 108 patients who were admitted in our department, 88 (81.5%) declared that they did not wish to attend the court hearing, 7 (6.5%) were not able to attend due to severe health condition, and only 13 (12.0%) actually presented in court. Concluding, current situation regarding legal procedures, involuntary admissions and mental health care in Greece is rather far from satisfying. Future directions should include the systematic recording of mental health care parameters, such as compulsory hospitalizations, as well as efforts to improve these parameters and the existing legal framework and procedures.

Cost- and time-effective markers of Alzheimer's disease (AD), reliable and feasible at the population level are urgently needed. Soluble amyloid-β protein precursor β (sAβPPβ) in plasma has attracted scientific attention as a potential AD biomarker candidate. Here we report that plasma sAβPPβ levels in patients with AD dementia and typical for AD cerebrospinal fluid (CSF) biomarker profiles (N = 33) are significantly lower (p

IntroductionCOVID-19 pandemic and lockdown has brought a serious impact on physical and mental health.ObjectivesThe purpose of the present study was to estimate the impact of the first lockdown in Greece, on both quality of life and anxiety levels in different occupational groups.MethodsA cross-sectional on- line survey was conducted from 20th of April to 4th of May 2020. A 24-item anonymous questionnaire was administered to collect basic demographic and socioeconomic data. The 5-item WHO Well-Being Index (WHO-5, 0-100%, cut-off 52%) and the Generalized Anxiety Disorder Assessment (GAD-7) tools were used to assess well-being and anxiety, respectively. Statistical analysis was performed with SPSS for Windows v.24.0 Statistical Package.ResultsA total of 575 participated in the study, 62.8% females, 48.5% aged between 40 to 59 years. 32.5% were employed in education sector, 32.5% in health sector and 20.3% as season workers in tourism sector. Males showed slightly higher levels of wellbeing (52.1 vs. 47.3, p=0.023) and lower levels of anxiety (7.1 vs. 8.2, p=0.023) compared to females. Factors associated with higher wellbeing and lower anxiety were higher education and income level, optimism, taking less protection measures, and being seasonal worker. Furthermore, participants with comorbidities and symptoms like headache, musculoskeletal pain, as well as feeling depressed or stressed revealed lower wellbeing and higher anxiety scores.ConclusionsOur study revealed an overall poor wellbeing and mild to moderate levels of anxiety during the lockdown. Actions should be taken to address and to prevent its serious impact on mental health.DisclosureNo significant relationships.

IntroductionChildren with traumatic brain injury (TBI) are at risk for post-traumatic stress disorder (PTSD). The vast majority of TBI are of mild severity (MTBI), however, they may develop persistent neurophysiological symptoms.ObjectivesThe purpose of this study was to investigate the incidence of PTSD in children with MTBI in Western Greece.MethodsA one-year prospective study was conducted at the Children Hospital of Patras. A total of 175 children aged 6-14 years screened for risk of PTSD at one-week and one-month post-injury, completing the Child Trauma Screening Questionnaire (CTSQ). The Children’s Revised Impact of Event Scale (CRIES 13) was administered to the parents, to inquire their assessment of PTSD in the children. Statistical analysis was performed with IBM SPSS v.22.0ResultsThere were 59 (33.7%) children (27.2% boys, 45.9% girls) whose screen result was at risk. At the rescreening one-month postinjury, 9.9% were still at risk. Parents assessed presence of PTSD in 19% of their children at one-week and in 3.9% at one-month post-injury. There was a positive correlation between parenting and child reporting on symptoms of PTSD in children. However, 23.4% mistakenly estimated their children did not experience stress while in fact they did and 24.2% mistakenly estimated the contrary.ConclusionsThe findings revealed the risk of PTSD even in mild TBI, justifying thus the screening to identify these children for intervention strategies. On the other hand, the rescreening demonstrated that not all at-risk children required intervention, since a natural remission in PTSD symptoms was observed one-month post-injury.

Rapid hormonal changes during pregnancy as well as psycho-social stressors accompanying parenthood have often been associated with peripartum mood episodes in women with bipolar disorder or with not yet clinically expressed bipolar diathesis. Yet, little is known about the correlation of peripartum onset of bipolar disorder in men. We present the case of a man with bipolar disorder with peripartum onset and subsequent episodes following the peripartum initiation of the disease, as well as the association of the couvade syndrome, as a pathological response to a man due to hormonal shifts observed in males cohabiting with a pregnant female. The patient had his first depressive episode during the peripartum period of his spouse, followed by two mixed episodes with psychotic features that leaded to his compulsory psychiatric evaluation and subsequent hospitalization and the diagnosis of Bipolar Disorder I. There is a well-known correlation between the peripartum period and mood disturbances to the point of inducing full blown episodes, suggesting of a bipolar disorder initiation or mood episodes relapsing in female patients already diagnosed with bipolar disorder. Due to the patient's psychological disturbances and the phenomenology of his symptoms, mainly concerning the psychotic features accompanying his episodes, we discuss the possible underlying biological correlates as a triggering mechanism, that might overlap the manifestation of the Couvade Syndrome as well as the initiation or relapse of Bipolar Disorder in males. It seems that males are not less influenced by hormonal and psycho-social factors posed upon them during the peripartum period of their cohabiting female spouse.

The established biomarkers of Alzheimer's disease (AD) require invasive endeavours or presuppose sophisticated technical equipment. Consequently, new biomarkers are needed. Here, we report that plasma levels of soluble amyloid precursor protein β (sAPPβ), a protein of the initial phase of the amyloid cascade, were significantly lower in patients with symptomatic AD (21 with mild cognitive impairment due to AD and 44 with AD dementia) with AD-typical cerebral hypometabolic pattern compared with 27 cognitively healthy elderly individuals without preclinical AD. These findings yield further evidence for the potential of sAPPβ in plasma as an AD biomarker candidate.

OBJECTIVES Tardive dystonia is a serious extrapyramidal side effect emerging after long-term treatment with antipsychotics, frequently with a deteriorating course, and unsatisfactory treatment. Presently, clozapine is used for the cotreatment of tardive dystonia and psychosis, at the cost of serious side effects. Apart from clozapine, there have been case reports describing positive effects of quetiapine on dystonic symptoms. Aim of the present study was to demonstrate the ameliorating effects of quetiapine on dystonic symptoms, in a sample of patients suffering from antipsychotic-induced tardive dystonia. METHODS Quetiapine was administered to 16 consecutively enrolled stabilized patients with psychotic or mood disorders and tardive dystonia, replacing the "offending drugs," over a 3-month cross-tapering period. Target dose of quetiapine was set according to the defined daily dose of the received antipsychotic(s) at baseline, as reviewed by the World Health Organization Center of Drug Statistics Methodology, aiming at both maintenance of psychosis control and reduction of dystonic symptoms. RESULTS Patients were found to have significant positive results in amelioration of dystonia (P < 0.001) over a 1-year period, without loss of antipsychotic efficacy. Reduction of dystonic symptoms with the use of quetiapine could be considered comparable with the positive effects of clozapine, with the additional advantage of relatively lacking serious side effects. CONCLUSIONS Quetiapine may represent a valuable therapeutic choice for the treatment of tardive dystonia.

Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11th version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.

The cerebrospinal fluid (CSF) levels of β-amyloid 42, total tau, and phosphorylated tau 181 are supposed to be all continuously abnormal in dementia due to Alzheimer's disease (AD), being the most advanced disease stage. The aim of the present study, which included a monocentric and a multicentric sample (N = 119 and 178, respectively), was to investigate the degree of CSF biomarker agreement and interrelation in AD dementia. Based on previously published cut-off values, biomarker values were categorized as positive or negative for AD (dichotomization strategy) and as either positive, negative, or borderline (trichotomization strategy). The statistical analyses relied on distance correlation analysis and kappa (k) statistics. Poor agreement (k

Negative consequences of the obesity epidemic include decreased physical, psychological, and sexual health. Bariatric surgery is a well-tolerated and effective treatment for morbid obesity. This study aimed to determine the effect of bariatric surgery on health-related quality of life (HRQOL) and sexual functioning and to identify potential predictors of this effect.Eighty morbidly obese patients (50 women) completed the study. HRQOL was measured using the Short Form 36 questionnaire (SF-36). Sexual functioning was assessed using the Female Sexual Functioning Index (FSFI) and the International Index of Erectile Function (IIEF). All participants were evaluated four times as follows: presurgery (T1), 1 month (T2), 6 months (T3), and 1 year (T4) after surgery.Body mass index (BMI) significantly decreased over time (p 0.001). Apart from male orgasm, all sexual functioning components as well as all SF-36 sub-scales improved between T1 and T4. The maximum improvement was observed between T2 and T3. Baseline HRQOL scores correlated with postoperative improvement in all HRQOL components. BMI improvement was correlated with improvement in role physical, bodily pain, and mental health scores. Baseline total sexual satisfaction score independently predicted total satisfaction improvement in both genders.The present findings indicate that bariatric surgery represents an effective obesity treatment, leading to significant BMI reduction and improvement in HRQOL and sexual functioning, especially in the first 6 months postoperatively.

Personality disorders in the premorbid period of schizophrenia and particularly in relation to age of onset and sex, seem to be a rather under-researched area. In the present study, 88 patients with paranoid schizophrenia were examined, regarding demographic characteristics and premorbid personality disorder traits, in order to investigate for differences in the premorbid period of the disease, in relation to age of onset and sex. Age cutoff points were set at

Background According to new diagnostic guidelines for Alzheimer’s disease (AD), biomarkers enable estimation of the individual likelihood of underlying AD pathophysiology and the associated risk of progression to AD dementia for patients with mild cognitive impairment (MCI). Nonetheless, how conflicting biomarker constellations affect the progression risk is still elusive. The present study explored the impact of different cerebrospinal fluid (CSF) biomarker constellations on the progression risk of MCI patients. Methods A multicentre cohort of 469 patients with MCI and available CSF biomarker results and clinical follow-up data was considered. Biomarker values were categorized as positive for AD, negative or borderline. Progression risk differences between patients with different constellations of total Tau (t-Tau), phosphorylated Tau at threonine 181 (p-Tau) and amyloid-beta 1–42 (Aβ42) were studied. Group comparison analyses and Cox regression models were employed. Results Patients with all biomarkers positive for AD (N = 145) had the highest hazard for progression to dementia due to AD, whilst patients with no positive biomarkers (N = 111) had the lowest. The risk of patients with only abnormal p-Tau and/or t-Tau (N = 49) or with positive Aβ42 in combination with positive t-Tau or p-Tau (N = 119) is significantly lower than that of patients with all biomarkers positive. Conclusions The risk of progression to dementia due to AD differs between patients with different CSF biomarker constellations.

Multiple sclerosis is a chronic demyelinating disease affecting one million people worldwide, with a significant burden of psychiatric comorbidity. Depression is the commonest psychiatric manifestation but still remains largely underdiagnosed and undertreated. The present work reviews current knowledge on diagnosis, assessment, and somatic and psychotherapeutic treatment interventions for depression in adult and pediatric populations of patients with multiple sclerosis.

Background A wide spectrum of prodromal symptoms has been reported, but their association with the severity of the active phase psychopathology in relationship to sex is unknown. Method Seventy-three (47 male) Diganostic and Statistical Manual (DSM) schizophrenia patients were subjected to the structured clinical interview for Positive and Negative Syndrome Scale (PANSS). Prodromal symptoms were recorded retrospectively after psychotic phase had subsided. Results Thirty-eight prodromal symptoms were identified. All symptoms appeared in both sexes. However, there was a significantly greater frequency of 3 symptoms (odd beliefs/magical thinking, over elaborate speech, hyperacusia) in female patients and of 2 symptoms (marked peculiar behavior, aggressiveness) in male patients. In the female patients, 9 symptoms were associated with an increased risk for severe total and components of the PANSS psychopathology in the psychotic phase; 2 symptoms were associated with a mild negative subscale psychopathology. In the male patients, 6 symptoms were associated with the severity of the PANSS psychopathology; 5 carried an increase risk for severe and 1 was associated with mild psychopathology. Also, the risk for severe PANSS positive, general, and total psychopathology increased with the increasing number of total and less specific symptoms in the female but not in the male patients. Conclusions Sex differences in schizophrenia are extended into the prepsychotic stage. Also, the presence of certain prodromal symptoms, different in men and women, and the number of symptoms in female patients are associated with the severity of the psychotic phase psychopathology. Evaluation of early therapeutic interventions in prodromal phase should consider sex and spectrum of prodromal symptoms.

Background: Schizophrenic patients commonly suffer from sleep disorders which are associated with acute disease severity, worsening prognoses and a poorer quality of life. Research is attempting to disentangle the complex interplay between schizophrenia and sleep disturbances by focusing not only on demographic and clinical characteristics, but also on the identification of genetic factors. Methods: Here, we performed a systematic literature review on the topic of genetic variations in sleep-disordered schizophrenic patients in an attempt to identify high quality investigations reporting scientifically sound and clinically useful data. For this purpose, we conducted a thorough search of PubMed, ScienceDirect and GoogleScholar databases, according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol. Results: Our search yielded 11 eligible studies. Certain genetic variations were reported to be associated with schizophrenia-related sleep disorders. Antipsychotic-induced restless legs syndrome was linked to polymorphisms located on CLOCK, BTBD9, GNB3, and TH genes, clozapine-induced somnolence was correlated with polymorphisms of HNMT gene, while insomnia was associated with variants of the MTNR1 gene. Conclusions: There are significant genetic associations between schizophrenia and co-morbid sleep disorders, implicating the circadian system, dopamine and histamine metabolism and signal transduction pathways.

Multiple sclerosis (MS) is a major inflammatory and demyelinating disease of the central nervous system. Although a significant incidence and prevalence of psychological disorders in MS has been reported there is limited data on the prevalence of personality disorders (PD) in these patients. Recent findings indicate the need for early diagnosis and treatment of PD in MS patients in the interests of prognosis, conformity to treatment and patient's quality of life improvement. This article summarizes existing evidence on prevalence, types and diagnostic criteria of PD in MS, clinical manifestations of personality pathology or changes in MS patients, and instruments currently used for diagnosis and assessment of PD in this group of patients. Underlying mechanisms suggested as causes of personality changes in MS patients are also discussed. The article reviews therapeutic strategies, including pharmacotherapy and psychotherapy interventions and emphasizes the need for a multidisciplinary approach to patient's treatment.

Objective – To prospectively detect significant transient F wave abnormalities obtained after exercise in patients with peripheral arterial disease (PAD) and to assess the potential diagnostic sensitivity of dynamic F wave study in such a context. Patients and methods – A series of 40 electrical stimuli were delivered to the peroneal and the posterior tibial nerves of 25 patients with PAD in order to obtain F waves at rest and post-exercise. The following variables were estimated and the obtained pre- and post-exercise data were compared: F persistence, F wave latency, amplitude, duration and F chronodispersion. For each nerve studied, the minimum, average and maximum values were calculated. Conventional electrophysiological data were also collected pre- and post-exercise and the data obtained were also compared. Twenty-five healthy age-, gender- and height-matched individuals served as controls. Results – No evidence of conventional nerve conduction abnormalities was recorded either pre- or post-exercise in the group of patients. As regards the peroneal nerve, the significantly reduced F wave persistence (P = 0.007) and maximum F wave amplitude post- as opposed to pre-exercise (P = 0.05)- were the main findings to emerge. The average (P = 0.017) and the minimum duration (P = 0.005) of tibial F waves were also significantly increased post- compared with pre-exercise. Insignificant differences were observed between pre- and post-exercise neurophysiological and F wave values in the group of controls. Conclusion – Given the observed absence of conventional neurophysiological abnormalities, the detection of dynamic F wave changes supports the view of an increased diagnostic sensitivity of this method in patients with mild PAD.

The current prospective study sought to trace the incidence and severity of oxaliplatin-induced peripheral neuropathy (OXLIPN) and to determine its clinical and electrophysiological pattern.Twenty-five adult patients scheduled to be treated with 12 courses of the oxaliplatin-based regimen, FOLFOX-4, for metastatic colon cancer participated in this study. Patients were clinically and electrophysiologically monitored at baseline and followed-up during chemotherapy. The severity of OXLIPN was summarized by means of a modified Total Neuropathy Score (TNS).Evidence of OXLIPN was disclosed in 16 of the 25 patients (64%). The mean TNS values for patients manifesting some grade of OXLIPN were 13.9 +/- 5.8 (range 7-28). All longitudinal comparisons concerning the motor conduction parameters failed to reach significance. By contrast, comparisons of the median changes at baseline and each of the follow-up studies revealed significant decrease in all sensory action potentials examined.Our results indicate that the majority of patients treated with the FOLFOX-4 regimen would manifest an axonal, predominately sensory peripheral neuropathy, of mild to moderate severity.

The current setting tested the hypothesis that advanced age would be strongly associated with increased incidence and severity of chemotherapy-induced peripheral neuropathy (CIPN). We prospectively studied 35 cancer patients treated with paclitaxel or cisplatin-based regimens for lung or breast cancer. All patients underwent a detailed clinical and electrophysiological evaluation for screening of CIPN at baseline, at the third, the sixth course of chemotherapy and up to 3 months after its cessation. Means of a modified Peripheral Neuropathy (PNP) score summarized the results of the clinical and electrophysiological study. Patients were divided according to their age in two groups (mean age difference, p=0.000) to those younger than 65 years (group I, n=18) and those older or equal than 65 years (group II, n=17). According to the clinical, neurological and electrophysiological variables of each patient, the incidence and severity of CIPN was determined and then compared between groups. The incidence of neurotoxicity was similar (p=0.869) between group I (9/18 patients, 50%) and group II (8/17 patients, 52.9%). Likewise, according to the mean PNP scores, the severity of CIPN was similar between age groups (p=0.897). The between-age-groups comparison of electrophysiological data revealed no significant differences in any of the motor or sensory conduction parameters examined. Our study indicates that elderly cancer patients do not have greater risk of CIPN, whilst advanced age was not associated with worst severity of CIPN.

IntroductionPostpartum depression (PPD) is a serious mental health condition. Untreated PPD places the mother and infant at risk and is associated with significant long-term effects on child development and behavior.ObjectivesAppropriate screening for and prompt recognition and treatment of depression after the birth of a child are essential for maternal and child well-being.AimsThe purpose of the present study was to estimate the prevalence of PPD in the first 5 days after the birth of a neonate and to investigate associations with several risk factors.MethodsA cross-sectional study was conducted among 150 mothers, in a public obstetric hospital in Nicosia, Cyprus. A questionnaire was administered including socio-demographic characteristics. The Greek version of the Edinburgh postnatal depression scale (EPDS), a 10–item questionnaire to identifying women who are at risk of PPD, was used to estimate depression among the participants.ResultsAccording to EPDS, 42% of the mothers screened positive for risk of developing PPD. Higher risk was observed in very young mothers (ConclusionThe study reveals a high prevalence of PPD and identifies various risk factors associated with developing PPD. The use of maternal depression screening programs such as the EPDS may help to recognize an elevated risk of postpartum depression and to ensure a healthier mother-child relationship.

IntroductionFrontotemporal dementia (FTD) encompasses a group of clinical features that include personality and behavior changes (disinhibition, social isolation, antisocial behavior, compulsion) and executive dysfunction (poor planning, loss of judgment and loss of insight). These features may lead to an incorrect diagnosis of a primary psychiatric disorder.ObjectivesTo emphasize the difficulties in making a clinical distinction between early frontotemporal dementia and other psychiatric diseases.MethodsWe describe 11 patients who suffered from FTD, while initially had diagnosed with primary psychiatric disorders. The correct diagnosis was achieved by psychiatric and neuropsychological evaluations (WAIS SCALE, ACE-R, MMSE), neuroimaging studies (MRI 7/11, SPECT 8/11) and applying the international consensus criteria for FTD.ResultsAll patients (5 males and 6 females) were initially diagnosed with psychiatric disorders: schizophrenia (2/11), bipolar disorders (4/11), depression (5/11), schizoaffective disorder (1/11), somatization disorder (1/11), personality disorders (2/11), malingering (1/11), alcohol dependence (1/11), while 5 patients had more than one diagnosis. The age of onset varied from 19 to 53 years old. Final diagnosis of FTD was delayed on average 6,5 years from the onset of symptoms.ConclusionClinicians should be familiar with the clinical entity of FTD and its difficult distinction from other psychiatric disorders. A possible hospitalization of a patient with FTD in a psychiatric department and the social impact that it brings may be avoided. On the other hand, the proper care of FTD patients (pharmacological and psychosocial) improves the quality of life of patients and their caregivers.Disclosure of interestThe authors have not supplied their declaration of competing interest.

There is an increased frequency of smoking among patients with schizophrenia. However, it is unknown whether the smoking behavior of the patients is similar in all schizophrenia subtypes, as well as which is the relationship between smoking initiation and disease onset. Four hundred six patients with DSM-IV schizophrenia were interviewed to determine the smoking status in relationship to gender and schizophrenic subtype, and to other factors that could affect or be affected by smoking. The frequency of smoking among patients (58%) was significantly greater than in subjects from the general population (42%) (P = .000005). Male patients smoked significantly more frequently (70%) than the corresponding control subjects (50%) (P = .000006), whereas the difference failed to reach significance between female patients (41%) and control subjects (32%). Among male patients, the number of smokers was significantly greater than in the controls in the paranoid (77%), undifferentiated (72%), and residual (78%) subtypes, whereas there was no significant difference in the disorganized (44%) and catatonic (22%) subtypes. The findings show that the frequency of smoking in schizophrenia patients increases with increasing positive symptoms and decreases with increasing negative symptoms. Male and female smoking patients consumed approximately 10 cigarettes per day more than the corresponding control subjects (P < .000001). In 86% of the patients, smoking initiation occurred before the disease onset. Among patients who smoked, smoking initiation and disease onset occurred at age 18.7 ± 4.4 and 24.1 ± 6.1 years, respectively (P < .000001). It appears that smoking in schizophrenia is influenced by gender and subtype. However, the nature of this association remains uncertain because in the vast majority of the patients smoking initiation occurs earlier than the disease onset.

Wolfram syndrome, a rare autosomal recessive neurodegenerative disorder, was originally described as a combination of familial juvenile-onset diabetes mellitus and optic atrophy. It was later demonstrated that Wolfram syndrome patients were highly prone to psychiatric disorders. Mutations in exon 8 of the Wolfram syndrome gene account for 88% of the patients with Wolfram syndrome. To examine whether the gene responsible for causing Wolfram syndrome is involved in psychiatric disorders, we screened exon 8 of the Wolfram syndrome gene for mutations in 119 patients with schizophrenia, one patient with schizoaffective disorder, 12 patients with bipolar disorder and 15 patients with major depression, using sequence analysis. In Wolfram syndrome patients, this gene has been shown to have primarily nonsense or frameshift mutations, which would result in a premature truncation of the protein. None of the psychiatric patients screened in this study carried these types of mutations. We identified, however, 24 new variations whose significance remains to be determined.

We report two patients who developed persistent oculogyric crisis, obsessional thoughts and psychiatric symptoms after prolonged treatment with typical and atypical antipsychotics. Both our patients did not improve after withdrawal of these antipsychotics, but rather after quetiapine was administered.

Venous thromboembolism has been associated with antipsychotic drugs, but the underlying mechanisms are largely unknown. Hypotheses that have been made include body weight gain, sedation, enhanced platelet aggregation, increased levels of antiphospholipid antibodies, hyperhomocysteinemia, whereas hyperprolactinemia has recently attracted attention as a potential contributing factor. The highest risk has been demonstrated for clozapine, olanzapine, and low-potency first-generation antipsychotics; however, presently there is no data for amisulpride. In the present paper we describe a case of pulmonary embolism in a female bipolar patient, receiving treatment with amisulpride, aripiprazole, and paroxetine. Although a contribution of aripiprazole and paroxetine cannot completely be ruled out, the most probable factor underlying the thromboembolic event seems to be hyperprolactinemia, which was caused by amisulpride treatment. Increased plasma levels of prolactin should probably be taken into account during the monitoring of antipsychotic treatment as well as in future research concerning venous thromboembolism in psychiatric settings.

The psychiatric records of a 7-year period were searched for cases with seasonal mood disorders. Among 358 cases with a mood disorder there were 41 patients with 3 or more admissions, 4 of which were demonstrating a seasonal pattern. It was found that the depressive or manic episodes of these patients were anniversary reactions associated with intense traumatic experiences in childhood, adolescence or adulthood. The seasonal pattern of the depressive episodes fulfilled the DSM-IV diagnostic criteria. The time and sometimes the place of the traumatic event acted as triggers eliciting the clinical symptoms. This study showed that anniversary reactions may constitute a subgroup of seasonal mood disorders manifesting both depressive and manic episodes, which are precipitated primarily by psychological factors rather than climatic conditions.

Introduction. Frontotemporal dementia is a disorder of complex etiology, with genetic components contributing to the disease. The aim of this report is to describe a young patient suffering from frontotemporal dementia, misdiagnosed as schizophrenia, related to a genetic defect on chromosome 1.Case Presentation. A 29-year-old female patient, previously diagnosed as having schizophrenia, was hospitalized with severe behavioural disturbances. She demonstrated severe sexual disinhibition, hyperphagia, lack of motivation, apathy, psychotic symptoms, suicidal thoughts, and cognitive deterioration. Focal atrophy of frontal and anterior temporal structures bilaterally was found on brain MRI, as well as bifrontal hypo perfusion of the brain on SPECT scan. The diagnosis of frontotemporal dementia was made clinically, according to Lund and Manchester groups and Neary diagnostic criteria. Chromosomal analysis was conducted and revealed decrease in length of heterochromatin on the long arm of chromosome 1 (46, XX, 1qh-). Parental karyotypes were normal.Discussion. Frontotemporal dementia, and particularly early-onset cases, can be often misdiagnosed as schizophrenia, with negative impact on case management. Genetic testing could be an aid to the correct diagnosis, which is crucial for optimal patient care.

Young and late onset patients with paranoid schizophrenia were compared, regarding the initial prodromal and active phases of the disorder, in order to examine the influence of age of onset on the prodromal and active phase symptomatology of the disease.We examined 88 consecutively hospitalized patients with paranoid schizophrenia. Age cutoff points were set at30 years of age for the young, and ≥35 years of age for the late onset group. Diagnoses were made prospectively, using the Structured Clinical Interview for DSM-IV-Patient Edition for Axis I disorders (SCID-P). Type and severity of psychopathology in the active phase were assessed by applying the Structured Clinical Interview for Positive and Negative Syndrome Scale (PANSS). Patients were retrospectively examined regarding their initial prodromal symptoms by applying the Structured Clinical Interview for DSM-III-R Patient Edition and clinical interviewing for additional symptoms. Comparisons were performed by applying the two-tailed Wilcoxon rank-sum and the chi-square statistical tests.The young onset group was characterized by significantly more negative prodromal symptoms, and heavier negative symptomatology in the active phase, than the late onset group. Differences were more prominently shown in male patients.Older age of onset of paranoid schizophrenia appears to be related to a less severe form of the disease, characterized by less severity of negative symptomatology, already demonstrated in the prodromal phase of the disorder.

Background/Aims: The diagnostic accuracy of the German version of the revised Addenbrooke’s Cognitive Examination (ACE-R) in identifying mild cognitive impairment (MCI), mild dementia in Alzheimer’s disease (AD) and mild dementia in frontotemporal lobar degeneration (FTLD) in comparison with the conventional Mini Mental State Examination (MMSE) was assessed. Methods: The study encompasses 76 cognitively healthy elderly individuals, 75 patients with MCI, 56 with AD and 22 with FTLD. ACE-R and MMSE were validated against an expert diagnosis based on a comprehensive diagnostic procedure. Statistical analysis was performed using the receiver operating characteristic method and regression analyses. Results: The optimal cut-off score for the ACE-R for detecting MCI, AD, and FTLD was 86/87, 82/83 and 83/84, respectively. ACE-R was superior to MMSE only in the detection of patients with FTLD [area under the curve (AUC): 0.97 vs. 0.92], whilst the accuracy of the two instruments did not differ in identifying MCI and AD. The ratio of the scores of the memory ACE-R subtest to verbal fluency subtest contributed significantly to the discrimination between AD and FTLD (optimal cut-off score: 2.30/2.31, AUC: 0.77), whereas the MMSE and ACE-R total scores did not. Conclusion: The German ACE-R is superior to the most commonly employed MMSE in detecting mild dementia in FTLD and in the differential diagnosis between AD and FTLD. Thus it might serve as a valuable instrument as part of a comprehensive diagnostic workup in specialist centres/clinics contributing to the diagnosis and differential diagnosis of the cause of dementia.

Background Both retrospective and prospective studies have identified a broad spectrum of "prodromal" symptoms, but their relationship to those of frank psychosis remains largely unexplored. Method In 73 successive hospitalized patients with schizophrenia in the first or second psychotic episode and with duration of illness 3 years or less from the onset of psychosis, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I diagnoses were made. In addition, within the first 5 days from the psychotic episode's onset, symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). Results Stepwise regression analyses showed that 8 prodromal symptoms carried an increased risk for high total PANSS and the components of the PANSS scores, independently of sex; 1 symptom was associated with mild psychopathology. However, the categories of negative- and positive-disorganization prodromal symptoms were not associated with the corresponding PANSS components. Similar findings were observed in the nonparanoid patients, whereas in the paranoid, only 2 nonspecific symptoms were associated with high PANSS psychopathology. In addition, there were significant associations between number of prodromal symptoms and total PANSS and the subscales positive and general scores in the patients with the nonparanoid subtypes, but there were not such associations in those with the paranoid. Conclusions Several prodromal symptoms, as well as the number of symptoms, are associated with the severity of the psychopathology of frank psychosis. In the nonparanoid subtypes there is a continuance in the transition from the prepsychotic to the psychotic stage, whereas in the paranoid, the transition appears to be disrupted.

Background and Purpose: Myoclonus-dystonia (MD) is a rare movement disorder characterized by myoclonic jerks, dystonia and a variety of psychiatric symptoms. Neuroimaging and electrophysiologic studies have not been able to detect any specific central nervous system abnormality. We report for the first time a well-characterized case with MD and abnormal brain perfusion imaging using single photon emission computed tomography (SPECT) with 99mTc-ethyl cysteinate dimer (ECD). A review of the literature on the phenotypic and pathogenetic considerations for MD is also presented. Methods: To better define the functional regional central nervous system involvement in MD, we conducted a brain perfusion SPECT with 99mTc-ECD in a patient diagnosed with typical disease. Results: Analysis of the SPECT data revealed significantly reduced regional cerebral blood flow (rCBF) in both temporal lobes (left > right and medial > lateral). Reduced rCBF was also observed in both frontal lobes and the right caudate nucleus. Conclusions: Our findings of reduced frontotemporal and striatal rCBF in the absence of other neuroimaging and electrophysiologic findings correlate well with the clinical manifestations in our patient and suggest possible functional/metabolic involvement of these areas in the etiopathogenesis of MD.

We conducted a randomized, open-label, controlled trial to assess the efficacy of oxcarbazepine for prophylaxis against oxaliplatin-induced peripheral neuropathy (OxIN). Thirty-two patients with colon cancer received 12 courses of the FOLFOX-4 regimen and were randomly assigned to receive oxcarbazepine (600 mg BID) or chemotherapy without oxcarbazepine. The incidence of OxIN was strikingly decreased in patients receiving oxcarbazepine (31.2% vs 75%). Oxcarbazepine may prevent OxIN symptoms. Further larger placebo-controlled trials are warranted to confirm our results.

The authors sought to identify factors associated with poor compliance with driving restrictions due to a diagnosis of epilepsy. They compared the demographic and clinical characteristics of 60 patients with epilepsy who, despite the authors' recommendation, continued to drive, with those of 60 age- and sex-matched epileptic patients who refrained from driving. The results showed that patients with epilepsy do not comply with driving restrictions, mainly for employment-related reasons.

The authors retrospectively reviewed all neurologic records of an emergency unit from 1999 to 2003 to identify a potential association between lunar phases and seizure occurrence. Overall 859 patients admitted for seizure occurrence were divided into the four quarters of the synodic month according to moon phases. A significant clustering of seizures around the full moon period was observed, supporting the ancient belief of periodic increased seizure frequency during full-moon days.

The authors present a case of paroxetine-induced rabbit syndrome in a 65-year-old white woman. To their knowledge, this is the first report in the literature describing rabbit syndrome induced by the administration of a selective serotonin reuptake inhibitor-specifically, paroxetine in combination with perphenazine and amitriptyline.

The initial prodromal symptoms in schizophrenia were studied in 100 DSM-diagnosed patients and 100 controls. The median number of symptoms in the patients and the controls was 8 (range 2-13) and 0 (range 0-5), respectively. Patients developed symptoms indicating social, occupational, and affective dysfunction, whereas the controls' symptoms included magical content and disturbance in mood. There were significant differences in the frequency of several symptoms appearing in the subtypes. Initial prodromal symptoms were classified into negative, positive-prepsychotic, and positive-disorganization categories. Patients with the disorganized subtype were more likely to have had negative symptoms in the prodromal state, and patients with the paranoid subtype were more likely to have had positive symptoms in the prodromal state. Observation of the course of symptoms from the prodromal to the psychotic state revealed that 58 percent of the symptoms showed increased intensity, 21 percent remained unchanged, 5 percent decreased, 3 percent evolved into other affective difficulties, 9 percent progressed into delusions, 1 percent progressed into hallucinations, and 3 percent disappeared. The Global Assessment of Functioning Scale showed that functioning is differentially affected among the subtypes even in the prodromal phase. These findings provide a better understanding of the initial prodromal state of schizophrenia, the signs and symptoms that best define it, and their prognostic significance.

Introduction Sleep problems are common in older people and often associated with mood disorders, such as anxiety or depression. Aims The present study examined the association between sleep disturbances in older adults and frequency of depressed mood and other aggravating factors. Methods The sample consisted of 139 subjects, aged >65 years, members of day care center for older people (KAPI) in the municipality of Tripolis, Greece. Geriatric Depression Scale (GDS-15) was applied, to screen the elderly for depression. Athens Insomnia Scale (AIS), a self-assessment psychometric instrument, was used to quantify sleep difficulty. Statistics was processed with SPSS 17.0. Results 56.8% of older people reported inadequate sleep, based on AIS. According to GDS-15, 53.3% of the studied population screened positive for depressive symptoms (43.2% moderate, 10.1% severe). In 79 persons who reported insomnia, 70.9% and 17.7% observed moderate and severe depression respectively, applying the GDS-15. Sleep disorders were more frequent in women (67.7% vs 48.1%, p=0.02), in not married, including divorced and widowed, (85.2% vs 44.7%, p=0.004) and in subjects without children (91.7% vs 53.2%, p=0.25). Insomnia was common in elderly with chronic diseases compared to elderly without co-morbidity (65.8% vs 9.1%, p Conclusions Sleep disorders between the elderly of this study are common and strongly associated with depression. Determining the causality of the sleep disturbance could help to treat insomnia in the elderly and improve overall their health.

The authors report 2 patients with schizophrenia who developed focal tardive dystonia secondary to treatment with atypical antipsychotics (risperidone, olanzapine). When quetiapine was gradually introduced and other antipsychotics were discontinued, these patients experienced remarkable and sustained improvement of their dystonic symptoms, without loss of psychotic symptom control. The mechanism by which quetiapine may improve tardive dystonia caused by other atypical antipsychotics is unclear. Due to its receptor and pharmacologic profile, quetiapine is the atypical antipsychotic that is most similar to clozapine (without its hematologic side effects), which leads the authors to consider it for the treatment of tardive movement disorders.

Introduction Premenstrual dysphoric disorder is a premenstrual syndrome comprising physical and psychic symptoms. Bipolar disorders, particularly “soft” forms, share symptoms such as depressive mood, irritability or mood reactivity with premenstrual dysphoric disorder, posing challenges on differential diagnosis. In the present work a case of a woman suffering from cyclothymia is reported, with mood episodes confined in the luteal phase of the menstrual cycle. Methods Case Report. Results A 42-year-old married Caucasian woman is presented, suffering from mood disorder episodes lasting for 10-12 days each, during the luteal phase of the menstrual cycle, and remitting after the beginning of her menses. The mood episodes occurred since the age of 20, in almost every menstrual cycle. The patient described hypomanic symptoms during the first 4-5 days of the luteal phase, reporting irritable mood, pressured speech, increased libido as well as vividness of her perceptions and excessive goal-directed activity. The hypomanic symptoms were followed by irritable and depressive mood, fatigue, hypersomnia, tearfulness, decreased self-esteem and pessimism, lasting for another 6-7 days. The patient also reported migraine and binge-eating episodes during each depressive phase. A full range of examinations, including blood and hormonal tests, yielded normal results. Lamotrigine was titrated at 200 mg/day, with subsequent amelioration of symptoms. Conclusions The exact relationship between premenstrual dysphoric disorder and other disturbances, which either coexist, or deteriorate premenstrually, or even synchronize with the menstrual cycle, has not been elucidated yet. Studies aiming at a better understanding of this relationship could aid at accurate diagnosis and treatment.

We describe the case of a patient who, after a traumatic experience at the age of 12, had a series of anniversary depressive episodes at 16, 17, 18 and 19 years of age, followed by a series of anniversary manic episodes at the ages of 21, 23, 24, 25 and 26 years. All of these episodes occurred almost always a few days before or after the date of the accident and only when the patient was residing in his home town, the place of the traumatic event. The case fulfills the DSM-III-R criteria for seasonal mood disorder, but differs from previously described cases in that: (a) both depressive and manic episodes developed at the same time of the year, and (b) the illness was precipitated by psychosocial factors rather than climatic conditions.

Background It is well established that cytokines signal the brain and serve as mediators between immune and nerve cells. Recent research findings have led to speculation that the neuroimmunologic consequences of cytokine levels might be involved in the pathogenesis of depression. Although TNF-a is required for normal immune responses, its overexpression has severe pathological consequences. The present study was undertaken to determine whether TNF-a secretion levels before and after mitogenic stimulation differ between depressed patients and matched healthy controls during clinical improvement.