Athanasios Douzenis

Alexithymia, anxiety and depression in patients with psoriasis: a case–control study

BackgroundAlexithymia, the difficulty in describing or recognizing emotions, has been associated with various psychosomatic pathologies including psoriasis. The aim of this study was to examine the prevalence of alexithymia and its association with anxiety and depression in patients with psoriasis compared with healthy participants, while taking into consideration demographic and clinical variables.MethodsOne hundred and eight psoriatic patients and 100 healthy participants from the general population completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale (HADS). The severity of patients’ psoriasis was clinically assessed using the Psoriasis Area and Severity Index (PASI).ResultsPsoriatic patients had higher levels of alexithymia compared with healthy participants. While a rather high rate of psoriatic patients presented anxiety and depression as defined by the HADS, the differences that were found in comparison with the control group were not significant. Neither alexithymia nor its dimensions, difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally oriented thinking (EOT), were associated with gender or psoriasis severity. Age was associated only with EOT, which was independent of depression and anxiety. Higher anxiety and depression were connected with higher alexithymia and DIF, while higher anxiety with higher DDF as well.ConclusionsThe alexithymia prevalence was higher in psoriatic patients than that in healthy participants, while it was positively correlated with anxiety and depression. Difficulty in identifying feelings was connected with both anxiety and depression, whereas difficulty in describing them was only with anxiety. Finally, externally oriented thinking was predicted only from age.

Transfers to psychiatry through the consultation-liaison psychiatry service: 11 years of experience

BackgroundThere are only a few reports on issues related to patient transfer from medical and surgical departments to the psychiatric ward by the consultation-liaison psychiatry service, although it is a common practice. Here, we present a study assessing the factors that influence such transfers.MethodWe examined the demographic and clinical backgrounds of a group of patients transferred from internal medicine and surgery to the psychiatric ward over an 11-year period. A comparison was made of this data with data obtained from a group of non-transferred patients, also seen by the same consultation-liaison psychiatry service.ResultsAccording to our findings, the typical transferred patient, either female or male, is single, divorced or widowed, lives alone, belongs to a lower socioeconomic class, presents initially with (on the whole) a disturbed and disruptive behaviour, has had a recent suicide attempt with persistent suicidal ideas, suffers from a mood disorder (mainly depressive and dysthymic disorders), has a prior psychiatric history as well as a prior psychiatric inpatient treatment, and a positive diagnosis on axis II of the five axis system used for mental health diagnosis.ConclusionThe transfer of a patient to the psychiatric ward is a decision depending on multiple factors. Medical diagnoses do not seem to play a major role in the transfer to the psychiatric ward. From the psychiatric diagnosis, depressive and dysthymic disorders are the most common in the transferred population, whilst the transfer is influenced by social factors regarding the patient, the patients behaviour, the conditions in the ward she/he is treated in and any recent occurrence(s) that increase the anxiety of the staff.

A case-control validation of Type D personality in Greek patients with stable coronary heart disease.

BackgroundType D personality has been associated with a variety of emotional and social difficulties as well as with poor prognosis in patients with established coronary heart disease (CHD). We examined the psychometric properties and validity of the Type D Scale-14 (DS14) and the prevalence of Type D personality among Greek patients with CHD while taking into account demographic; clinical, such as diabetes mellitus, hypertension, and hypercholesterolemia; as well as psychological variables such as depression, anxiety, and psychological stress.MethodsNinety-six patients with stable coronary heart disease and 80 healthy participants from the general population completed the Greek version of the DS14 and the Hospital Anxiety and Depression Scale (HADS).ResultsCronbachs α coefficient for the negative affectivity (NA) and social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88 and 0.76 for the control group, respectively. Internal-structural validity was assessed by a factor analysis (two-factor solution), and the factor structure of the original DS14 was replicated. Using the standardized cutoff point of NA ≥10 and SI ≥10, instead of the median scores, in order to have compatible results with the majority of studies, the prevalence of Type D personality was 51% for the CHD patients and 13% for the control group. Higher NA and SI were connected with higher anxiety, depression, and total psychological stress. Finally, more patients with CHD and Type D personality than those without were diagnosed with type 2 diabetes; however, no differences were observed in hypertension or hypercholesterolemia.ConclusionsThese results indicate that the Type D construct is reliable and valid in a Greek population. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in people from the general population. The DS14 subscales were positively correlated with higher anxiety, depression, and total psychological stress. Regarding other CHD risk factors, only diabetes mellitus was found more frequently in CHD patients with Type D personality.

Involuntary admission: The case of anorexia nervosa

Involuntary treatment of psychiatric disorders has always been controversial; this is especially true for eating disorders. Patients with anorexia nervosa of life threatening severity frequently refuse psychiatric hospitalization. Ambivalence toward treatment is characteristic of eating disorders and patients are often admitted to inpatient programs under pressure from family and doctors. In this article, we report research on the positive or negative impact of involuntary admission in the treatment of eating disorders, its application and effectiveness as well as the adverse consequences of coercive treatment in eating disorders. A literature review was done. From a total of 134 publications which were retrieved from the literature search, 50 studies were directly relevant to the scope of this review and fulfilled all inclusion criteria. There are trends and arguments for both sides; for and against involuntary treatment in anorexia nervosa. The scientific literature so far is inconclusive, although in the short term, involuntary hospitalization has benefits. This review has also shown that involuntary hospitalization can have adverse long-term consequences for the patient-therapist allegiance. We conclude that in some cases, involuntary treatment can save lives of young patients with anorexia nervosa; however, in other cases, it can break the psychotherapeutic relationship and make the patient abandon treatment. It is the clinician who has to decide for whom and when to approve involuntary treatment or not.

Abduction of Children by Their Parents: A Psychopathological Approach to the Problem in Mixed-Ethnicity Marriages

Aim: Child abduction by one parent and their transport to a foreign country is increasing worldwide but has not received adequate scientific interest. When inter-marital relationships reach the point of break-up and divorce, one of the parents abducts his/her child/children. Method: Records of forty seven (47) cases of inter family abduction that took place in 2007 in Greece were obtained. The majority of cases concerned relocation of children in a foreign country. A special inventory was developed for data collection. This consisted of three distinctive parts, for the father, the mother, or the abducted child. Results: Results showed that a typical abductive mother is of non Greek nationality, more likely of having psychiatric symptoms, without indication of substance abuse and no signs of violent behavior. Abductive fathers are of Greek nationality, less likely of having psychiatric symptoms, no substance abuse, and tend to exhibit violent behavior. Legal resolution of these cases and repatriation takes very long adding to the child and family’s distress. Conclusions: Child abduction is associated with cases of dissolved marriages. Domestic violence is frequent. Child abduction cases takes on average 3.5 years to be

Clinical and treatment-related predictors of cognition in bipolar disorder: focus on visual paired associative learning

Bipolar disorder (BD) is associated with impairment in cognitive domains such as verbal memory and executive functions. However, visual paired associative learning (PAL) has been far less researched. Neurocognitive dysfunction in BD patients has been related to several clinical factors, but data on the effect of medication are relatively scarce and inconsistent. The aim of our study was to explore the effect of clinical and treatment-related parameters on executive functions and visual memory/learning, including PAL, in BD. Cognitive performance of 60 bipolar I patients and 30 healthy subjects was evaluated by using CANTAB battery tasks targeting spatial recognition memory, PAL and executive functions (set shifting, planning, inhibitory control). Bipolar patients showed poorer performance in PAL, set shifting, planning and inhibitory control than healthy subjects; however, only differences in PAL and planning survived correction for multiple comparisons. Number of previous manic episodes and illness duration predicted worse performance in set shifting and PAL, respectively, whereas current treatment with valproate predicted better performance in PAL. This is one of the first studies to assess clinical and treatment-related predictors of PAL in BD. We report a possibly beneficial effect of valproate on PAL, which warrants further investigation.

Islam, mental health and law: a general overview

Islam is the dominant religion in about 56 countries around the globe, and has more than 1.2 billion followers. Islam represents a holistic way of life, and according to a large proportion of its followers, the Islamic law or Shari’ah should prevail over secular law and should be implemented as state law. The etymological root of the word Shari’ah can be traced back to the harsh life in the desert and it means “pathway to be followed” or “path to the water hole,” since the water was the basic element and preserver of life. At the dawn of its historical course and at its moral and ethical core, Islam introduced many interesting and innovative beliefs concerning the mentally ill. Islam underlines the moral necessity for the protection and care of the vulnerable individuals, as dictated by God himself. On the other hand, beliefs about “possession” and stigmatization influence the peoples’ attitude against and apprehension of mental disorders. This strange admixture is reflected upon the status of the mental health services and corresponding legislation found in the different countries of the Islamic world.

Differences between elderly voluntary and involuntary admitted psychiatric patients in Greece.

BACKGROUND Involuntary psychiatric admission is a controversial issue with legislation varying from country to country. Research on elderly individuals being involuntary admitted has been limited. This study aims first at assessing whether elderly involuntary admitted patients (IAPs) differ with regard to demographic, psychopathological, and behavioral characteristics from voluntary admitted psychiatric patients (VAPs) and second to assess whether the former group should be treated in a different (special) way. METHODS Forty IAPs were compared to 39 VAPs with regard to sociodemographic data, DSM-IV diagnosis, as well as behavioral issues recorded by the Patient-Staff Conflict Checklist - Shift Report (PSCC-SR). All patients were aged 60 years and over and were admitted in the psychiatric departments of four general hospitals in Athens. The study period lasted 12 months. RESULTS VAPs were more likely to be suffering from mood disorders, while IAPs presented higher rates of delirium. From the 20 items of the PSCC-SR, differences were found only in two: IAPs presented more aggressive behavior during the first few days of admission whereas VAPs had committed recent suicide attempt just before admission. CONCLUSION From the clinical point of view, IAPs presented with delirium and more aggressive behavior, whereas, the VAPs presented with higher rates of mood disorder and suicidality. However, from the medicolegal point of view, our findings lend support to the argument of either setting a limited time frame for involuntary admission in elderly patients, and/or allowing for elderly individuals with acute organic conditions to be treated against their will.

Sertindole in the treatment of tardive dyskinesia in a patient with genetically abnormal dopamine D3 receptors

Tardive dyskinesia (TD) is a hyperkinetic abnormal involuntary movement disorder induced mostly by conventional antipsychotics possibly through a mechanism of a chronic blocking of striatal D2 and D3 receptors. In addition, patients suffering from schizophrenia with genetically abnormal D2 and D3 receptors were found to present an even greater likelihood towards the emergence of TD (1). TD’s treatment options include switching from a typical to an atypical antipsychotic (2–4). We present a case of a 47-year-old male with schizophrenia who developed TD after chronic administration of haloperidol and risperidone, and his TD and psychotic symptoms were substantially ameliorated by sertindole administration. Mr A, a 47-year-old unmarried male was referred to our department complaining of mild anxiety and severe tremor. He was diagnosed on the basis of Structured Clinical Interview for DSM-IV Axis I (SCID-I/P) as suffering from DSM-IV schizophrenia of paranoid type with onset of his disorder at the age of 32. The patient had been taking haloperidol from the onset of his disorder with doses ranging from 20 to 30 mg. During the previous 9 months risperidone was added to his medication regimen. Thus his daily medication at referral consisted of 30 mg of haloperidol, 9 mg of risperidone and 6 mg of biperiden. His total Positive and Negative Syndrome Scale (PANSS) score was 21. In addition, he had extra-pyramidal symptoms: tremor, cogwheel rigidity as well as a severe syndrome of TD consisted of abnormal movements of the jaw, lips, mouth and the upper extremities (Abnormal Involuntary Movement Scale – AIMS: 28). The onset of his TD was 2 years before his referral and the onset of extra-pyramidal symptoms followed immediately risperidone administration. The patient underwent a comprehensive physical, neurological and laboratory work-up as well as brain computed tomography which did not reveal any additional abnormalities. He was genotyped and found to be DRD3ser-gly heterozygous, whereas, no polymorphisms in 5-HT2C receptor gene area were found. Haloperidol, risperidone and biperiden gradually discontinued in order to control his extra-pyramidal and TD symptoms, and the patient had administrated quetiapine titrated up to 800 mg/day. Six weeks later, his extra-pyramidal symptoms were totally eliminated (AIMS: 11). Although TD symptoms were not remitted, his daily dose of quetiapine was kept unchanged because of the stabilization of his mental state. Four months later he severely relapsed manifesting positive and negative symptoms (PANSS: 51). He was admitted to our department and quetiapine titrated up to 1200 mg/day. Two weeks later, there was no improvement in his psychotic symptoms and there was also a worsening in TD symptoms (PANSS: 50, AIMS: 19). Quetiapine was gradually discontinued and he had been administrated clozapine titrated up to 125 mgday within 14 days. However, 3 days later his white blood cell count fell to 1.700/mm3 and his neutrophil count to 870/mm3. Thus, the treatment with clozapine was suspended. Sertindole was initiated with a dose of 4 mg/day and gradually titrated up to 16 mg/day within 2 weeks. There was no prolongation of QTc on the ECGs (Q − T = 340 ms). His mental state improved progressively, and 2 weeks later, his psychotic and TD symptoms were ameliorated (PANSS score: 39, AIMS score: 8). After an 8-week-hospitalization the patient was discharged and his medication remained unchanged. The assessment of his TD symptoms revealed further improvement (PANSS: 29, AIMS: 0). Mr A has been followed-up monthly and within a year his level of improvement of both psychotic and TD symptoms was wholly preserved (PANSS: 28, .AIMS score: 0). In our case, haloperidol is considered to have played a causative role in the development of TD. Our patient was genotyped and he was found to be DRD3ser-gly heterozygous, a finding associated with an increased likelihood towards emergence of TD in patients suffering from schizophrenia or schizoaffective disorder (5). Following TD’s treatment guidelines (2,3), the patient had been switched to atypical antipsychotics. However, quetiapine failed to remit both the psychotic and TD symptoms, and clozapine induced severe hematological side effects. Sertindole is a new atypical antipsychotic characterized by a high affinity of serotoninergic 5-HT2 receptors and high selectivity for dopaminergic D2 receptors in the mesolimbic region. Sertindole is also well tolerated and there is evidence that it presents a favourable extra-pryramidal symptoms profile (6–8). We consider that the specific action of sertindole (low D2 –D3 occupancy) on dopaminergic system in the striatum on the genetically abnormal DRD3 receptors may have led to down regulation and desensitization of them and thus to a remission of TD symptoms. To the best of our knowledge, this is the first case study which suggests that sertindole as a monotherapy might be beneficial in the treatment of TD in patients who have genetically abnormal D3 receptors. Although sertindole is not a first-line treatment option in schizophrenia because of the QTc prolongation, its beneficial effect in TD appears promising. More controlled clinico-pharmacogenetic studies including adequate number of patients suffering from TD and schizophrenia are warranted to establish sertindole’s propertities in the TD symptoms.

Acute retropharyngeal abscess in a patient with anorexia nervosa

Retropharyngeal abscess (RA) is an unusual and severe condition especially among adult patients. It is characterized by a collection of pus in the tissues behind the pharynx, accompanied by difficulty in swallowing, sore throat, fever and pain. The high mortality rate of retropharyngeal abscess is due to its association with among others, mediastinitis. Unlike children, adults’ abscesses due to nasal or pharyngeal infection are rare. Usually, adults with RA have a history of intraoral procedures, trauma, dental infections or penetrating foreign bodies (fish bones, chicken bones, pen refill) [1]. RA is a very rare condition in adults with eating disorders. We present a case of a woman suffering from anorexia nervosa (AN), who developed an acute RA while she was hospitalized. The novelty of our case is the unusual mechanism that caused the RA: self-injury with a plastic spoon used to induce vomit.