Areti C. Spyropoulou

Schema therapy for patients with chronic depression: a single case series study

BACKGROUND AND OBJECTIVES This study tested the effectiveness of schema therapy (ST) for patients with chronic depression. METHODS Twelve patients with a diagnosis of chronic depression participated. The treatment protocol consisted of 60 sessions, with the first 55 sessions offered weekly and the last five sessions on a biweekly basis. A single case series A-B-C design, with 6 months follow-up was used. Baseline (A) was a wait period of 8 weeks. Baseline was followed by introduction to ST and bonding to therapist (phase B) with individually tailored length of 12-16 sessions, after which further ST was provided (phase C) up to 60 sessions (included the sessions given as introduction). Patients were assessed with Hamilton Rating Scale for Depression three times during baseline, at the end of phase B, then every 12 weeks until the end of treatment and at 6 months follow-up. Secondary outcome measures were the Hamilton Rating Scale for Anxiety and the Young Schema Questionnaire. RESULTS At the end of treatment 7 patients (approximately 60%) remitted or satisfactorily responded. The mean HRSD dropped from 21.07 during baseline to 9.40 at post-treatment and 10.75 at follow-up. The effects were large and the gains of treatment were maintained at 6-month follow-up. Only one patient dropped out for reasons not related to treatment. LIMITATIONS The lack of control group, the small sample and the lack of a multiple baseline case series. CONCLUSIONS This preliminary study supports the use of ST as an effective treatment for chronic depression.

Additive effect of depressed mood and vasomotor symptoms on postmenopausal insomnia.

Objective:The aim of this study was to investigate the role of vasomotor and mood symptoms on insomnia in postmenopausal women. Methods:One hundred sixty-three postmenopausal women, not receiving hormone therapy, attending a menopause clinic at the University of Athens, Greece, were included in this cross-sectional study. Climacteric symptoms were assessed by Greenes scale, whereas psychological morbidity was measured by Zung Self-Assessment Depression Scale, Symptom Checklist-90-R, and Athens Insomnia Scale. Results:Vasomotor symptoms were significantly associated with insomnia (P = 0.001). When depressive symptomatology was added to the logistic regression analysis, the predictive ability of the model was significantly improved as defined by the increase in the log likelihood (P < 0.001) and the increase in the area under the receiver operating characteristic curve. Conclusions:Insomnia in postmenopausal women attending a menopause clinic is related both to the effects of vasomotor symptoms and depressive symptomatology. Mood symptoms seem to affect sleep independently of vasomotor symptoms, suggesting that depression should be carefully assessed and treated in postmenopausal women with insomnia.

Comorbid attention-deficit/hyperactivity disorder in adult psychiatric outpatients with depressive or anxiety disorders

Abstract Background. There are very few studies reporting on the prevalence and the contribution of not previously diagnosed ADHD in the clinical picture of other psychiatric disorders. The aim of our study is to determine the prevalence and clinical correlates of comorbid attention deficit/hyperactivity disorder (ADHD) in adult psychiatric outpatients with depressive or anxiety disorders. Methods. During a 6-month period, 114 outpatients with depressive or anxiety disorders were evaluated for ADHD diagnosis. Assessment included interviews with both patient and relatives/friends and the use of a daily diary. Moreover, the patients completed the self-report scales Beck Depression Inventory (BDI), Spielbergers Anxiety Inventory (STAI), and the Symptom Checklist-90-R Rating Scale (SCL-90-R). Results. A total of 22 out of 114 patients (19.3%) received an ADHD diagnosis for the first time in their life. Comorbid ADHD compared to non ADHD patients scored significantly higher (p < 0.05) for depression (BDI), state and trait anxiety (STAI) and in the following SCL-90-R factors: Positive Symptoms Distressing Index, Positive Symptoms Index, Somatization, Obsessive Compulsive, Depression, Anxiety, and Hostility. Conclusions. ADHD might go unrecognized among psychiatric outpatients. Patients with depressive or anxiety disorder reporting more severe symptomatology should be carefully screened for possible comorbid adult ADHD.

Quality of life and psychological symptoms in Greek postmenopausal women: association with hormone therapy.

Quality of life (QoL) in menopause is influenced by many parameters, including vasomotor symptoms, psychological status and culture. The aim of the present study was to examine the association of hormone therapy (HT) with QoL and psychological symptoms in Greek postmenopausal women. The study assessed 216 postmenopausal women (mean age 54.5 years) attending a university menopause clinic in Greece. Fifty-three were users of HT and 163 were not. QoL was evaluated by the Utian Quality of Life Scale (UQOL) and psychological symptoms were assessed by the Symptom Checklist-90-R (SCL-90-R). Women on HT were younger and more educated than women not using HT. Adjusting the analysis for the womens characteristics, HT users had better total UQOL scores than non-users (p < 0.05). Marital status and education had independent effects on QoL, with married and more educated women scoring higher (p < 0.05). Assessment of psychological symptomatology, after adjustment for sociodemographic variables across the different dimensions, revealed that HT users had better SCL-90-R scores than non-users for obsessionality, interpersonal sensitivity and for the general index (p < 0.05). Concluding, even though the impact of sociodemographic and lifestyle variables must be factored into the assessment of QoL, HT use is independently related to an improvement in the total score and in most domains of QoL, and has a significant positive effect on many aspects of psychological well-being in Greek postmenopausal women.

Vasomotor and depression symptoms may be associated with different sleep disturbance patterns in postmenopausal women.

Objective:This study aims to explore the association of vasomotor symptoms (VMS) and depression symptoms with different symptoms of subjective sleep disturbance in postmenopausal women. Methods:This is a cross-sectional study of 163 postmenopausal women (not taking hormone therapy) attending a university menopause clinic. Measures included the Athens Insomnia Scale, Greene Climacteric Scale, and Symptom Checklist-90—Revised depression subscale. Covariate-adjusted ordinal logistic regression was used to investigate the association of VMS and depression with each item of the Athens Insomnia Scale. Results:Controlling for confounding factors, we found VMS to be significantly associated with awakenings during the night (odds ratio [OR], 1.85; P < 0.001), overall quality of sleep (OR, 2.00; P < 0.001), well-being during the day (OR, 1.63; P = 0.008), functioning capacity during the day (OR, 1.72; P = 0.01), and sleepiness during the day (OR, 1.66; P = 0.03); whereas we found Symptom Checklist-90—Revised depression subscale scores to be associated with sleep induction (OR, 2.09; P < 0.001), final awakening earlier than desired (OR, 2.21; P < 0.001), total sleep duration (OR, 1.62; P = 0.01), overall quality of sleep (OR, 1.64; P = 0.009), well-being during the day (OR, 1.67; P = 0.006), functioning capacity during the day (OR, 1.68; P = 0.01), and sleepiness during the day (OR, 1.57; P = 0.04). Conclusions:VMS and depression symptoms are associated with different patterns of sleep disturbance. Although both symptoms are related to sleep quality, daytime functioning, and daytime well-being, depression is uniquely associated with difficulty falling asleep and waking up earlier than desired, whereas VMS are related to frequent awakenings during sleep. The findings are limited by the cross-sectional design and relatively small sample size of the study. Recommendations for future research are discussed to guide this line of inquiry and to gain a better understanding of the complex relationship between climacteric and mood symptoms and their contribution to the development of sleep disturbances during menopause.

Limited Depressive and Anxiety Symptoms Late in Pregnancy Are Not Related to Neonatal Outcomes.

Background: Prior studies have reported inconsistent findings regarding the link between antenatal depressive and anxiety symptomatology, with neonatal outcomes. Objectives: The aim of the present study was to assess the possible association of prenatal depressive and anxiety symptoms, in the third trimester of pregnancy, with perinatal outcomes (birth weight of the newborn, Apgar score and the newborn’s admission in neonatal intensive care unit) in a sample of pregnant women, in Greece. Patients and Methods: A total of 117 women from Athens, during the 32nd to 35th week of pregnancy, participated in the study. Demographic and obstetric history data, as well as neonatal outcomes, were recorded. Three self-administered psychometric scales (Beck depression inventory (BDI), Edinburg postnatal depression scale (EPDS) and beck anxiety inventory (BAI)) were used to evaluate in detail the prenatal depressive and anxiety symptoms. Descriptive statistics, Spearman’s Rho coefficients, Mann-Whitney U and Kruskal-Wallis testes were applied to analyze the data. Results: On the basis of BDI, 81.1% of the sample showed minimal, 15.4% mild, 2.6% moderate and 0.9% severe depressive symptoms, respectively. Furthermore, 80.3% of the participants, scored on EPDS below the cut-off point for a likely diagnosis of depression. According to BAI scale, 43.6% showed minimal, 42.7% women mild, 10.3% moderate and 3.4% severe anxiety symptoms. No statistically significant correlations were found between depressive and anxiety symptoms and neonatal outcomes (birth weight, Apgar score and admission in neonatal intensive care unit). Conclusions: Limited levels of prenatal depressive and anxiety symptoms do not seem to be associated with neonatal outcomes. In clinical practice, pregnant women, who suffer from low levels of prenatal depressive and anxiety symptoms, may be reassured, in respect of the adverse outcomes of these mood symptoms on the neonate.

Birth order and memories of traumatic and family experiences in Greek patients with borderline personality disorder versus patients with other personality disorders

The purpose of this study was to assess the possible effect of recalled traumatic experiences, perceived parental rearing styles, and family parameters on the occurrence of borderline personality disorder (BPD) versus other personality disorders (other-PDs). A total of 88 adult outpatients with personality disorders completed the Traumatic Antecedents Questionnaire and the Egna Minnen av Barndoms Uppfostran, which measures perceptions regarding parental rearing. Results indicated that incidence of traumatic childhood experiences was higher among those in the BPD group compared to those in the other-PD group. Firstborns were less likely to carry a diagnosis of BPD over other-PDs. Also, significantly more BPD compared to other-PD patients reported being the fathers favorite child over siblings. Results suggest that traumatic experiences, birth order, and family interactions in the presence of siblings seem to differentially affect the formation of borderline diagnosis compared to other-PDs. Limitations and clinical implications of the study are discussed in detail.

Association between gestational diabetes and perinatal depressive symptoms: evidence from a Greek cohort study

Aim The aim of the present study was to assess the association of gestational diabetes mellitus (GDM) with prenatal and postnatal depressive symptoms in a sample of pregnant women in Greece. BACKGROUND Earlier research supports a relationship between depression and diabetes, but only a few studies have examined the relationship between GDM and perinatal depressive symptomatology. METHODS A total of 117 women in their third trimester of pregnancy participated in the study. Demographic and obstetric history data were recorded during womens third trimester of pregnancy. Depressive symptoms were assessed with the validated Greek version of the Edinburg Postnatal Depression Scale (EPDS) at two time points: on the third trimester of pregnancy and on the first week postpartum. Findings Prevalence of GDM was 14.5%. Probable diagnosis of depression occurred for 12% of the sample during the antenatal assessment and 15.1% in the postpartum assessment. In the first week postpartum, women with GDM had significantly higher postpartum (but no antenatal) EPDS scores compared with the non-GDM cohort. In conclusion, GDM appears to be associated with depressive symptoms in the first week postpartum. Clinical implications and recommendations for future research are discussed, emphasizing the importance of closely monitoring women with GDM who seem more vulnerable to developing depressive symptomatology during the postnatal period.

Amisulpride monotherapy in a patient with clozapine-resistant schizophrenia.

To the Editor: C lozapine is most often the drug of choice for patients with treatmentresistant schizophrenia. In clozapineresistant patients, polypharmacy is widely used, although no firm evidence exists for any effective augmentation strategy. In the following case, we describe the satisfactory response to amisulpride monotherapy of a patientwith long-lasting clozapine-resistant schizophrenia. Mr A, a 34-year-old patient, has had disorganized schizophrenia since the age of 14 years, and he has been hospitalized 15 times. Because of his history of unresponsiveness to various antipsychotics (both typical and atypical) and to the combination with antidepressants and antiepileptics, he was administered clozapine. Clozapine was administered at an adequate dose (500 mg/d) and with good compliance, for a period of 4 years. Clozapine has been efficacious for the positive schizophrenia symptoms, but negative symptoms were intensified, and the patient’s overall functioning deteriorated. During his last hospitalization, the patient experienced a monthlong exacerbation of psychotic symptoms, characterized by extremely disorganized behavior, psychomotor agitation, delusions of persecution, auditory hallucinations, and thoughts of self-harming. Cytochrome P450 (CYP) pharmacogenetic testing indicated that the patient was a CYP 3A5 poor metabolizer and a CYP 2D6 intermediate metabolizer. Taken into consideration, the poor pharmacological history and to avoid first-pass metabolism, amisulprideVan antipsychotic whose clearance is largely due to urinary excretionV was initiated. Clozapine was gradually discontinued, and the patient was set on 1200 mg of amisulpride monotherapy. Therapeutic response to amisulpride was clinically evaluated as excellent and was further confirmed by Positive and Negative Syndrome Scale ratings that dropped from an initial measurement of 125 to 42 at discharge, a total of 3 months since admission. This significant improvement persisted during the 2-month outpatient follow-up. To our knowledge, this report is unique in the sense that clozapine in this treatment-resistant case of schizophrenia was totally replaced by amisulpride. The most acknowledged clinical practice for treating clozapine-resistant patients with schizophrenia is the enhancement of clozapine by the addition of other antipsychotics (typical, atypical, and amisulpride). The good response of this case to monotherapy with amisulpride against the background of previous unsuccessful antipsychotic treatments could be partially related to its preponderant renal metabolic route and the Batypical[ atypical properties of amisulpride. Amisulpride’s high and selective affinity for dopamine D2/D3 receptors, lack of affinity for serotonin receptors, activity against phencyclidine, and a mesolimbic preference may give amisulpride its unique properties possibly related to the excellent response that was shown in our case.