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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.

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.

IntroductionDepression is fast becoming a major public health problem with a very high prevalence rate in the 65 and over age group.ObjectivesThe aim of the present study was to estimate the prevalence of depression in Greeks and Cypriots older adults.MethodsA cross-sectional study was conducted among the 445 participants, 239 members of three day care centers for older people, in the municipality of Patras, West-Greece and 206 older adults (110 in the community, 65 in outpatient clinics, 31 in nursing homes) in Cyprus, aged > 60 years. A questionnaire was administered including socio-demographic characteristics. Depression was assessed using the Greek version of Geriatric Depression Scale (GDS-15).ResultsThe overall prevalence of depression according to GDS-15 was 33% (28% moderate, 5% severe type). Depressive symptoms were more frequent in women (41,6% vs. 28,3%, P < 0,001), in not married (43,0% vs. 29,3%, P < 0,001), in elderly with chronic diseases (36,8% vs. 25,0%, P = 0,007), in older people dwellers of urban areas compared to rural (36,3% vs. 26,4%, P = 0,028) and in ages between 70 to 80 years old (38,7% vs. 31,6%, P = 0,038). Moreover, higher prevalence of depression was measured in Greeks compared to Cypriots (44,3% vs. 20,6%, P < 0,001). In a univariate analysis, the following variables were significantly associated with depression: female gender (P < 0,001), co-morbidity (P = 0,004), higher age group (P = 0,018), place of living (P = 0,022) and Greek nationality (P < 0,001).ConclusionsHigh prevalence and several risk factors are strongly associated with depression, whereas Greeks are in higher danger of developing depressive symptoms in late life, than Cypriots.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAthena possesses a special place among the Greek Gods, as she was born from her father, according to an extreme patriarchal model with a marked depreciation of the maternal role. Zeus had swallowed and absorbed the mother of Athena, Mites, because of an oracle that if Mites gave birth to a boy, the boy would take his throne. When the time comes, Zeus commands Hephaestus to cleave his forehead with an axe, and then Athena leaps fully armed and shouting her cry of war, in front of the astonished Gods. The next moment she puts her weapons down, as a token of obedience and devotion. The exceptionally close bond between father and daughter is evident through their uniquely confidential relationship. The ancient myth is paralleled, from a psychodynamic aspect, with the case of a narcissistic patient receiving psychodynamic psychotherapy.MethodsCase report.ResultsA case of a woman with narcissistic personality features and depressive symptoms is described, presenting with the complaints of withdrawal, self-depreciation, passivity, and agoraphobia. Psychodynamic factors defining her pathology are her narcissistic and sexualized relationship with her father, whereas the relationship with her mother has been depreciated. The patient experiences an intrapsychic conflict of reciprocal idealization, against her anger and fear for her father, resulting in the symptoms of agoraphobia and passivity.ConclusionLike Athena, who puts her weapons down, the patient resigns from her will for autonomy and moves to a passive position, as a result of her entrapment in her idealized relationship with the father.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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.

Anxiety disorders have a great impact in a patient's environment. Organizing this environment through Caregiving Social Networks (CSNs) offers an important assistance to a patient's treatment and improves the quality of life of its members. The medical practice of anxiety disorders' treatment is presented, based on which the CSN is established. An abstract structure and indicative roles for the CSN's players are further illustrated which may vary depending on several factors. Finally, a case scenario is provided, showing that a CSN is adequate to support patients with anxiety disorders. CSNs offer important advantages not only to the treatment itself, but both to the patients and their environment.

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 The past few decades have been marked by an everincreasing awareness of bioethical issues among the scientific community and general public. Informed consent is a question of central importance in contemporary medical ethics, and clinical practice is inconceivable without considering the issues it raises. The determination of psychiatric patient's capacity to understand the risks and benefits of participation in clinical research trials remains an important and controversial issue among psychiatric research community. The purpose of this study is to summarize and critically present the challenges and moral parameters arising from the assessments of the ability of individuals with impaired cognitive function to give informed consent for clinical research enrollment.

Informed consent is a question of central importance in contemporary medical ethics, and clinical practice is inconceivable without considering the issues it raises. Although it is often vigorously argued that consent, informed or otherwise, is a recent phenomenon and that no sources testify to its existence before the 20th century, it is difficult to accept that a process for regulating the common and fundamental parameters in the relationship between doctor and patient and the planning of treatment had not concerned previous eras. A review of the Registers of the Islamic Court of Candia (Heraklion) in Crete, a series of records that touches on, among other things, matters of medical interest, reveals that the concept of informed consent was not only known during a period that stretched from the mid-17th to the early 19th century, but it was concerned with the same principles that prevail or have been a point of contention today. An extension of this study into other periods may thus provide contemporary researchers with material and information valuable in the discussion of today's bioethical issues.

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.

Introduction Depression is the most common mental health problem in late life. Objectives To estimate the prevalence of depression in the elderly and to investigate associations with risk factors. Methods A cross-sectional study was conducted among the members of four day care centers for older people (KAPI), three in the municipality of Patras, West-Greece and in one KAPI in the municipality of Tripolis, Peloponnese-Greece. A total of 378 individuals took part in the study. A questionnaire was developed to collect basic demographic data. Moreover, to all participants the Greek validated version of the Geriatric Depression Scale (GDS-15) was applied, to screen for depressive symptoms. Results According to GDS-15, 48.1% of the studied population screened positive for depressive symptoms (38.6 % moderate, 9.5% severe). In 139 members of KAPI of Tripolis, depressive symptoms were more frequent in women than in men (62.9% vs 45.5%, p=0.012), in not married (85.6% vs 38.9%, p>0.001), in participants without children (91.7% vs 49.2%, p>0.001), in subjects suffering from insomnia (88.6% vs 6.7%. p>0.001), in participants with low monthly income (63.7% vs 25.8%, p>0.001) and in older adults with co-morbidity (62.4% vs 4.5%, p>0.001). In 239 members of KAPI of Patras, depression were more frequent in women (54.6% vs 37.4%, p=0.027), in not married (55.6% vs 38.9%, p=0.038), in subjects living alone (62% vs 38.1%, p=0.003) and in elderly with co-morbidity (50.8% vs 27.5%, p=0.02). Conclusions The present study reveals high prevalence and several risk factors for developing depression in the specific population of the elderly.

Objective: The objective of this study was to estimate the prevalence and probable under-diagnosis of depressive symptoms in elderly of an urban and semi-urban area in Greece. Materials and Methods: A cross-sectional study was conducted among the members of 4 days care centers for older people (KAPI), three in the municipality of Patras, West-Greece, and in one in Tripolis, Peloponnese, Greece. A total of 378 individuals took part in the study, aged >60 years. A questionnaire was developed to collect basic demographic data, including three questions from the European Health Interview Survey, regarding self-reported or by a physician-diagnosed depression. Moreover, to all participants the Greek validated version of the Geriatric Depression Scale-15 (GDS-15) was applied, to screen for depressive symptoms. Results: According to GDS-15, 48.1% of the studied population screened positive for depressive symptoms (38.6% moderate, 9.5% severe), whereas having ever been affected with chronic depression reported 19.0% by themselves. In 162 members of KAPI of Patras and in 106 of Tripolis, who never reported have been affected by depression and depressive symptoms were observed in 27.7% and 44.7%, respectively. In 28 individuals from Patras, who reported not to know if they have depression and in 10 from Tripolis, depressive symptoms were observed in 60.7% and 90%, respectively, applying the GDS-15. Conclusion: Except the high prevalence, the present study reveals a remarkable under-detection of depressive symptoms in older adults. Various interventions in primary care are necessary so as to increase detection rates of depression among the elderly.

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.

Objective The objective of this study is to identify early patients who are at-risk for major depression (MD) induced by interferon-α (IFN-α) and evaluate the response of depressive symptoms to antidepressants. Methods Thirty-six consecutive patients were treated with IFN-α. Psychiatric evaluations were performed prior to, and at 1 and 2 months after onset of therapy and upon completion of the study. Diagnoses were made according to DSM-IV criteria, and the severity of depressive symptoms was determined by the Hamilton Depression Rating Scale score (HDRSS). Results Of the 36 patients studied, 7 (19%) had MD before IFN-α treatment, 6 of which manifested a worsening of the depressive symptomatology during treatment. Of the remaining 29 patients, 9 (31%) developed MD during treatment. The median time required for the appearance or worsening of the depressive symptoms was 15 days (range 7–25). The median HDRSS before IFN-α in the 36 patients was 3 (range 1–20), whereas after 1 month of therapy, it was 10 (range 1–24; P =.000004). There was a strong positive correlation in the HDRSS before and 1 month after the initiation of treatment ( r =.863). Of the 14 patients with a HDRSS of 1–2 before IFN-α treatment, only 1 (7%) developed MD, whereas of the 15 patients with a score >3, 8 (53%) developed MD. Antidepressants resulted in a decrease of the HDRSS to the IFN-α pretreatment values. Conclusion One third of those treated with IFN-α developed MD. The HDRSS before treatment reveals the high- and low-risk patients for developing MD. Psychiatric evaluation should be performed prior to IFN-α treatment.

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 Depression is the most common mental health problem among older people, posing a critical impact on their well-being and the quality of life. Aims To estimate the prevalence and under diagnosis of depression in elderly, and to investigate the association with various factors. Methods Data on 239 members of “day care centres for older people” in the municipality of Patras, W-Greece, were recorded, including questions regarding self-reported and/or diagnosed depression (EHIS). Furthermore, the Greek version of the Geriatric Depression Scale (GDS-15) was applied. The scores of GDS were compared to the corresponding EHIS answers and associated to various basic parameters. Results The results of GDS indicated 45% having depression (36% moderate, 9% severe). Having ever been affected with chronic depression reported 49 (20.5%), out of them 34 (66.7%) were diagnosed by physician. In detail, out of the 162 (67.8%) subjects reporting never have been affected by depression, 37 (22.8) and 8 (4.9%) screened positive for moderate and severe depression, respectively. In 27 individuals who reported not to know if they have depression, 16 revealed depressive symptoms using the GDS. Depression is more frequent in women, in not married, including divorced and widowed, in subjects living alone at home (62% vs 38.1%, p = 0.003), and in elderly with chronic diseases (50.8% vs 27.5%, p = 0.02). Conclusions High prevalence of depressive symptoms in elderly population is evident, but rarely recognized. The systematic use of short GDS versions in primary care may increase detection rates of depression among the elderly.

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.