B.J. Havaki-Kontaxaki
National and Kapodistrian University of Athens
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Featured researches published by B.J. Havaki-Kontaxaki.
Clinical Neuropharmacology | 2006
B.J. Havaki-Kontaxaki; P. Ferentinos; V.P. Kontaxakis; Konstantinos G. Paplos; Constantin R. Soldatos
Objective: The aim of this article is to critically review all published studies regarding the efficacy and safety of the concurrent administration of clozapine (CLZ) and electroconvulsive therapy (ECT) in CLZ-resistant schizophrenic or schizoaffective patients. Method: A MEDLINE search from January 1980 to July 2005 was conducted. Results: One open-label trial and 6 case studies were located, comprising 21 schizophrenic and 1 schizo affective patients (12 men and10 women) with a mean age of 41.9 years. The duration and dosage of CLZ monotherapy before ECT were reported at least 12 weeks and 300 mg/d, respectively, in 10 patients (45.4%). Plasma CLZ levels before ECT were assessed in 12 patients (54.5%), in which only 7 (31.8%) were reported to be higher than 350 ng/mL. The CLZ dosage during ECT ranged from 200 to 900 mg/d (mean, 518.2 ± 203.3 mg/d). The number of ECT sessions ranged from 2 to 20 (mean, 11.5 ± 5.4). Application of electrodes was unilateral in 7 patients, bilateral in 10 patients, and mixed in 2 patients. Sixteen patients (72.7%) showed marked improvement whereas 6 patients (27.3%) had moderate, minimal, or no improvement. No predictors of outcome could be isolated. Side effects reported by 5 patients (22.7%) were nausea, tachycardia, hypertension, memory problems, and confusion. Ten patients (45.4%) relapsed during follow-up. Substantial improvement persisted beyond 4 months in only 5 patients (22.7%). Conclusion: Preliminary evidence exists for the safety and short-term efficacy of the concurrent administration of CLZ and ECT in CLZ-resistant schizophrenic or schizoaffective patients.
European Psychiatry | 2000
V.P. Kontaxakis; B.J. Havaki-Kontaxaki; S.S. Stamouli; Maria Margariti; C.T Collias; George Christodoulou
Several scales have been used to diagnose and evaluate depression in schizophrenia. However, the association between different depression scales and between depression scales and negative symptoms has not been studied adequately. Sixty-four consecutively admitted schizophrenic patients to Eginition Hospital, Department of Psychiatry, Athens, were assessed on the following scales: the Calgary Depression Scale for Schizophrenia (CDSS), the Hamilton Depression Rating Scale (HDRS), the Expanded Brief Psychiatric Rating Scale-Depression subscale (EBPRS-D), the Positive and Negative Syndrome Scale-Depression subscale (PANSS-D) and the Negative Symptoms subscale (PANSS-N). The depression scales were found to be highly intercorrelated with the exception of the comparison between the EBPRS-D and the PANSS-D. Out of the four depression scales studied, only CDSS and EBPRS-D can discriminate between depression and a PANSS-Negative Symptoms subscale score or negative item scores.
Progress in Neuro-psychopharmacology & Biological Psychiatry | 2002
V.P. Kontaxakis; B.J. Havaki-Kontaxaki; S.S. Stamouli; George Christodoulou
Although atypical antipsychotics have generally a decreased risk of neurotoxicity, there are reports regarding various neurotoxic or idiosyncratic reactions including neuroleptic malignant syndrome (NMS). The authors present here the toxic interaction between risperidone (RIS) and clozapine (CLZ) in a first-episode schizophrenic patient. A 20-year-old man suffering from first-episode schizophrenia--catatonic subtype, developed a neurotoxic syndrome, which has been characterized as a mild form of NMS, after CLZ (100 mg/day) was added to a regimen of RIS (16 mg/day). The NMS symptomatology subsided only by drug discontinuation and supportive care. Later, CLZ monotherapy restarted without further complications. This case report shows that neurotoxic syndromes, even NMS, may occur during combination therapy with RIS and CLZ.
Annals of General Psychiatry | 2006
V.P. Kontaxakis; C.T. Kollias; B.J. Havaki-Kontaxaki; Maria Margariti; S.S. Stamouli; Eleni Petridou; George Christodoulou
BackgroundThe aim of the current study is to investigate the relationship between physical anhedonia and psychopathological parameters, pharmacological parameters or motor side-effects in a sample of inpatients with schizophrenia in an acute episode of their illness.MethodEighty one patients with schizophrenia, consecutively admitted, with an acute episode of their illness, at the Eginition Hospital, Department of Psychiatry, University of Athens, during a one-year period were investigated regarding possible relationships between physical anhedonia, social-demographic data and clinical parameters as well as motor side-effects, induced by antipsychotic agents. All patients were assessed using the Chapman Revised Physical Anhedonia Scale (RPAS), the Positive and Negative Syndrome Scale (PANSS), the Rating Scale for Extrapyramidal Side-Effects (EPSE), the Barnes Akathisia Rating Scale (BARS) and the Abnormal Involuntary Movement Scale (AIMS). Simple cross tabulations were initially employed. Subsequently, multiple regression analysis was performed.ResultsBoth positive and negative symptoms were associated with physical anhedonia. A positive association between physical anhedonia and the non-paranoid sub-category of schizophrenia was also proved.ConclusionAccording to these results, it seems that in the acute phase of schizophrenia, physical anhedonia may be a contributing factor to patients psychopathology.
Psychiatry Research-neuroimaging | 2000
V.P. Kontaxakis; B.J. Havaki-Kontaxaki; Maria Margariti; S.S. Stamouli; C.T. Kollias; Elias Angelopoulos; George Christodoulou
The aim of this study was to evaluate the reliability and validity, as well as the specificity, of the Greek version of the Calgary Depression Scale for Schizophrenia (CDSS). Schizophrenic inpatients consecutively admitted at the Eginition Hospital, University of Athens, were included in the study. Patients were assessed on admission using the CDSS, the Hamilton Depression Rating Scale (HDRS), the Positive and Negative Syndrome Scale (PANSS), the Rating Scale for Extrapyramidal Side Effects (RSESE), the Rating Scale for Drug-Induced Akathisia (RSDIA) and the Abnormal Involuntary Movement Scale (AIMS). The CDSS was found to have a high inter-rater reliability, as well as test-retest reliability or split-half reliability. The internal consistency of the CDSS was good (a=0.87). There were positive correlations between the CDSS and the HDRS, or the depression cluster of the PANSS. The mean score on the CDSS showed no significant correlations with that of the PANSS negative subscale (r=0.123); a negative but not significant correlation with that of the PANSS positive subscale (r=-0.036); a weak correlation with that of the PANSS general psychopathology subscale (r=0.218); and no significant correlations with that of the RSESE (r=0.197), the RSDIA (r=0.160) or the AIMS (r=0.031). Our results give further support to the reliability, the validity, and the specificity of the CDSS.
Psychopathology | 2008
C.T. Kollias; V.P. Kontaxakis; B.J. Havaki-Kontaxaki; S.S. Stamouli; Maria Margariti; Eleni Petridou
Background/Aims: Researchers have shown interest in the association between anhedonia and depression in schizophrenia. The aim of the current study was to investigate the relationship between physical and social anhedonia with depression in a sample of inpatients with schizophrenia in the acute phase of their illness. Methods: Sixty-two patients with acute schizophrenia consecutively admitted at the Eginition Hospital, Department of Psychiatry, University of Athens were assessed using the revised Physical Anhedonia Scale, the revised Social Anhedonia Scale and the Calgary Depression Scale for Schizophrenia. Results: The Calgary Depression Scale for Schizophrenia score correlated with both physical anhedonia and social anhedonia ratings. The revised Social Anhedonia Scale score significantly correlated to self-depreciation, guilty ideas of reference, pathological guilt, early wakening, suicidality and observed depression. The revised Physical Anhedonia Scale score significantly correlated with depressive mood, self-depreciation, pathological guilt and observed depression. Self-depreciation, pathological guilt and observed depression were correlated with both social and physical anhedonia. Conclusion: Depression in schizophrenia and anhedonia may overlap, and it could therefore be difficult to clinically differentiate them, especially in acute schizophrenia patients.
Clinical Neuropharmacology | 2005
V.P. Kontaxakis; P. Ferentinos; B.J. Havaki-Kontaxaki; Konstantinos G. Paplos; Dimitris K. Roukas; George Christodoulou
Approximately 40%-70% of neuroleptic-resistant schizophrenic patients are nonresponders even to clozapine. Several clozapine augmentation strategies have come into clinical practice, although often without evidence-based support. This study aims to critically review all the reported case studies regarding the efficacy and safety of adjunctive agents in clozapine-resistant schizophrenic or schizoaffective patients. All published case studies examining the efficacy and safety of adjunctive agents in clozapine-resistant schizophrenic patients were searched for in the MEDLINE database from January 1980 to February 2004. Case studies regarding ECT as a clozapine augmentation strategy were not included in our study. All the included papers were critically reviewed and examined against a set of clinical and pharmacological parameters, outcome measures, and reported side effects. Fifteen case studies regarding the efficacy and safety of sulpiride, risperidone, olanzapine, lithium, lamotrigine, fluvoxamine, and bromocriptine as clozapine adjuncts were found. A total of 33 schizophrenic or schizoaffective patients were included. Of the 15 studies, 8 were associated with risperidone. The duration and dosage of previous clozapine monotherapy was adequate for 16 patients. Plasma clozapine level was assessed for only 7 patients. Outcome measures were used for only 11 patients. The outcome was positive in 13 studies. Combined treatments were generally well tolerated, and side effects never resulted in discontinuation of treatment. Most case studies favor the use of risperidone as an adjunctive agent in clozapine-resistant schizophrenic or schizoaffective patients. However, small numbers of patients and other methodological shortcomings limit the impact of evidence provided.
Progress in Neuro-psychopharmacology & Biological Psychiatry | 2002
V.P. Kontaxakis; B.J. Havaki-Kontaxaki; Nikolaos G Christodoulou; Konstantinos G. Paplos
Neuroleptic malignant syndrome (NMS) is an uncommon but serious idiosyncratic reaction associated with antipsychotic medication. The purpose of this study was to reveal and analyze the clinical characteristics of the reported cases of NMS in patients given the novel antipsychotic olanzapine. A MEDLINE search related to olanzapine-induced NMS cases reported in the international literature was conducted. All cases were critically reviewed and examined against three different sets of NMS diagnostic criteria (DSM-IV, Addonizio, Levenson). The authors identified 17 cases of possible NMS associated with olanzapine. Ten of the reported NMS cases were definitely NMS meeting all three sets of criteria and three cases were probable NMS meeting two sets of criteria. Most of the patients exhibited a full-blown NMS. There were four definite NMS cases associated with olanzapine monotherapy. Three of them had concurrent serious physical illnesses and one had a previous NMS episode. Olanzapine can cause NMS, mainly in susceptible or predisposed patients.
Psychopathology | 2007
P. Ferentinos; V.P. Kontaxakis; B.J. Havaki-Kontaxaki; Konstantinos G. Paplos; Constantin R. Soldatos
instruments such as the Medical Outcomes Study Short-Form 36 (SF-36), the General Health Questionnaire (GHQ), the Symptom Distress Checklist (SCL-90) and the Profile of Mood States (POMS). Specific fatigue instruments were used in only 10 studies to assess fatigue in patients with major depression [3–12] and in 1 study including 13 patients with dysthymia [13] . A total of 694 patients suffering from major depression (n = 681) or dysthymia (n = 13) were included. Of these studies, 6 were trials concerning the efficacy of modafinil as an adjunctive treatment in major depression [6, 8–12] . The fatigue instruments used were: Fatigue Severity Scale (FSS) in 7 studies [4–6, 8–10, 12] , Brief Fatigue Inventory (BFI) in 2 [7, 12] , Fatigue Questionnaire (FQ) in 1 [3] , Fatigue Assessment Instrument (FAI) in 1 [13] and Fatigue Scale Inventory (FSI) in 1 study [11] . FSS was the instrument most often used to assess fatigue severity in depressed patients. Validation data were provided in only 1 study using FAI to assess fatigue in a group of 13 patients with dysthymia [13] . There were no studies presenting standardisation data for any fatigue instrument in patients with major depression. In conclusion fatigue in patients with depression is understudied. Fatigue inFatigue is a frequent, albeit non-specific symptom encountered in various clinical settings. It is considered as a core symptom of major depression and the main residual symptom persisting after treatment interventions [1, 2] . Although fatigue is difficult to define and conceptualise, various self-report fatigue measures have been used to assess its severity and/or prevalence, especially in patients with physical diseases. We sought to review the specific instruments used to measure fatigue in depressed patients without co-morbid fatiguing diseases and to search for fatigue measures standardised for depressed patients. We searched the MEDLINE, EMBASE and PsycINFO databases for papers published from January 1980 to December 2005, studying fatigue in patients with major depression and/or dysthymia without co-morbid physical diseases associated with fatigue. The identified papers were screened for the fatigue measures used and critically reviewed. The key words used were: ‘major depression’, ‘dysthymia’, ‘fatigue’, ‘scale’, ‘measure’ and ‘instrument’. In the majority of studies found, fatigue was indirectly and briefly assessed by means of specific items or subscales of broader general health or psychopathology instruments. These included generic Received: November 28, 2005 Accepted aftrer revision: February 13, 2006 Published online: January 11, 2007
Annals of General Hospital Psychiatry | 2003
B.J. Havaki-Kontaxaki; V.P. Kontaxakis; Maria Margariti; Konstantinos G. Paplos; George Christodoulou
BackgroundThe aim of this paper is to describe a case of severe neuroleptic-induced tardive torticollis successfully treated with a combination of clozapine, clonazepam and botulinum toxin-A.Case ReportThe patient, a 30-year old man with a seven-year history of delusional disorder experienced severe right torticollis with painful tightness of the neck and elevation of the shoulder. At this time he was receiving haloperidol 20 mg, trifluoperazine 5 mg, zuclopenthixol 20 mg and biperidine 4 mg daily. The combination therapy with clozapine and clonazepam and the long-term use of botulinum toxin-A resulted in a complete remission of dystonic movements.ConclusionsThe present observations provide evidence indicating that this combination therapy may be of benefit in patients with severe neuroleptic-induced tardive torticollis.