Christos Mantas

Levetiracetam in tardive dyskinesia: an open label study.

Levetiracetam (LEV), a novel antiepileptic drug, has demonstrated antidyskinetic effect in preclinical animal models of Parkinsons disease (PD) and in one open label study in PD patients with levodopa‐induced dyskinesia. The acute antidyskinetic effects of LEV in patients with tardive dyskinesia were evaluated in an open label study. Eight patients received oral LEV (1,000 mg/day) for 1 month and blinded evaluations were performed at baseline and at the end of the treatment period. A significant reduction of the abnormal movements was recorded while psychiatric symptoms did not worsen and the adverse event profile was benign. LEV may be efficacious for the treatment of tardive dyskinesia and deserves further clinical testing.

Defense mechanisms in inflammatory bowel disease.

BackgroundAlthough psychiatric disturbances and personality features are possibly involved in inflammatory bowel disease, little attention has been given to the potential role of defense mechanisms in the formation, course, or prognosis of the disease. The purpose of the present study was to determine whether certain defense styles and ego mechanisms of defense are associated with inflammatory bowel disease, including both ulcerative colitis and Crohn’s disease.MethodsSeventy-six consecutive unselected outpatients participated in the study. The sample consisted of 39 patients with Crohn’s disease, 33 with ulcerative colitis, and 4 with an intermediate form of inflammatory bowel disease. The Symptom Distress Checklist (SCL-90-R), Defense Style Questionnaire (DSQ), and Hostility and Direction of Hostility Questionnaire (HDHQ) were used.ResultsCrohn’s disease patients presented a more immature defensive profile than ulcerative colitis patients, using a “maladaptive action” style, as well as “consumption” and “pseudo-altruism” defense mechanisms more often. These differences were statistically significant and they were independent of age, sex, educational level, disease extension, and pharmacologic treatment. A significant positive correlation was also found between disease activity and defensive profiles in both ulcerative colitis and Crohn’s disease patients. In contrast, there was no statistically significant difference between ulcerative colitis and Crohn’s disease patients in terms of psychiatric symptoms.ConclusionsCrohn’s disease patients presented a different and more immature defensive profile than patients with ulcerative colitis. In addition, the more psychologically mature inflammatory bowel disease patients had lower rates of relapses and surgical operations, providing evidence that these aspects of personality are likely to influence the patients’ adaptation to the disease.

BDNF serum concentrations in first psychotic episode drug-naïve schizophrenic patients: Associations with personality and BDNF Val66Met polymorphism

AIMS To investigate the relationship among brain derived neurotrophic factor (BDNF) serum concentrations, BDNF Val66Met polymorphism and personality profile in drug-naïve schizophrenic patients with first-episode psychosis (FEP) and healthy participants. MAIN METHODS This cross-sectional study included fifty FEP patients and fifty healthy participants who served as controls. To study their personality profile the standardized Greek version of the Alternative Five-Factor Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) was administered. Serum BDNF levels were measured and genotyping of BDNF Val66Met polymorphism was performed in patients and healthy subjects. KEY FINDINGS FEP patients presented lower BDNF serum concentrations (P=0.002) and higher scores in ZKPQ Neuroticism (P=0.001) and Aggression-Hostility (P=0.002) scales while lower scores in the ZKPQ Sociability scale (P<0.001) than healthy participants. Multivariate analysis revealed that the odds of being assessed with FEP were 0.4 times lower in those with higher BDNF values (P<0.001) and 1.8 times greater in those with higher Neuroticism scores (P<0.001). There were no significant differences with respect to the Val66Met polymorphism between patients and healthy participants. SIGNIFICANCE Reduced BDNF serum concentrations along with higher Neuroticism scores might be associated with FEP. A complex interplay between BDNF serum concentrations, personality traits, BDNF Val66Met polymorphism, and psychotic symptomatology has been arisen but further investigation is needed to better clarify the observed associations.

Personality correlates of adherence to type 2 diabetes regimens

“Adherence” is a broad concept that is preferably used in diabetes care in place of “compliance,” since patients are more autonomous today in defining and following medical treatments than ever before [1]. Although important to control blood glucose levels, adherence to diabetes management programs appears to be poor [2-4]. Research has shown some links between poor glycaemic control and personality factors in type 2 diabetes patients. High levels of blood glucose were associated with high levels of altruism and low levels of neuroticism, including

Disability Status, Disease Parameters, Defense Styles, and Ego Strength Associated with Psychiatric Complications of Multiple Sclerosis

Objective: The aim of the present study was to identify disease parameters, defensive styles and ego strength measurements associated with various forms of psychiatric complications in patients with multiple sclerosis (MS). Methods: Seventy-nine patients with MS participated in the study and 158 healthy subjects matched for age and sex served as controls. A wide range of clinical information was collected and the following self-report instruments were used: General Health Questionnaire, Symptom Distress Check List, Defense Style Questionnaire, MMPI Ego Strength Scale and Hostility and Direction of Hostility Questionnaire. Results: The odds of being assessed with a psychiatric diagnosis upon interview were 6.7 times greater among patients compared to controls and 9.3 times greater among patients with recent-onset MS compared to patients with long-term disease. Psychiatric complications of MS were closely associated with age of the disease onset and the degree of disability due to MS. Additionally, higher rates of introverted hostility, adoption of maladaptive ego defenses and weakened ego strength were also closely associated with several forms of psychological distress, especially depressive symptoms. Conclusions: MS patients experience elevated symptoms of psychological distress, especially depressive symptoms, which are most closely associated with disease parameters. However, the crucial role of various personality traits such as ego defenses and hostility features in the psychiatric symptom formation also appear to contribute to the development of depressive symptoms. Clinicians involved in the clinical management of patients with MS should identify and modify treatment if these specific personality markers that indicate the exhaustion of the patients resources to cope with the physical and psychological stress of the illness are present.

Does psychological distress vary between younger and older adults in health and disease

OBJECTIVE The effect of age on psychological distress remains controversial and it is unclear how a chronic medical illness influences this association. We aimed to compare the level of psychological distress between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with individuals without long-term conditions are made. METHODS In 519 individuals without chronic medical conditions and 949 patients with established severe chronic medical illnesses, we compared psychological distress (GHQ-28 and SCL-90R) between younger (<65, N=1040) and older (≥65, N=428) participants after controlling for gender, marital status, education and primary diagnosis in multiple logistic regression models. RESULTS Among the healthy participants, a greater proportion of older individuals presented mild/moderate psychological distress (p=.026), predominantly depressive and somatization symptoms. Among the medical patients, both age groups presented elevated levels of psychological distress, but a greater proportion of younger patients had severe psychological distress (p=.016), predominantly depressive, anxiety and hostility symptoms. Younger patients reported similarly high levels of somatization symptoms compared to older patients. The odds of being assessed with severe psychological distress were significantly greater for younger individuals with physical illnesses, independently of gender, marital status, education and primary diagnosis. CONCLUSIONS Medical patients from both age groups had significant psychological distress symptoms scores. Younger patients with chronic medical illnesses were more vulnerable to severe psychological distress, including symptoms of anxiety, depression, hostility and somatization. Therefore, clinicians should direct efforts to recognize these symptoms in order to prevent further functional impairment.

The contribution of a mobile mental health unit to the promotion of primary mental health in rural areas in Greece: a 2-year follow-up.

During the 2 years of the mobile mental-health units operation in Northwestern Greece, the referrals increased rapidly with 29.4% of patients never having received mental-health care before, while hospitalizations and relapses reduced significantly, indicating that community-oriented programs can contribute greatly to successfully addressing the needs of patients in remote rural areas.

HSP70 polymorphisms in first psychotic episode drug-naïve schizophrenic patients

AIMS The aim of this study is to investigate differences in HSPA8 polymorphisms between first-episode psychotic (FEP) schizophrenic patients and healthy participants after adjustment for temperamental personality traits. MAIN METHODS This study included fifty drug-naive schizophrenic patients with an FEP and fifty healthy participants who served as controls. Genotyping of HSPA8 polymorphisms was performed in patients and healthy subjects as well. Personality characteristics were assessed using the standardized Greek version of the Alternative Five-Factor Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). KEY FINDINGS Our results showed that FEP patients presented a polymorphism differentiation related to the HSPA8 gene (rs1136141), and a higher frequency of T carriers compared to healthy controls was observed. The HSP8A polymorphism and the levels of Neuroticism as measured by the Alternative Five-Factor ZKPQ were the variables most closely and independently associated with FEP in multiple logistic regression analysis, and the odds of being assessed with a FEP was 2.8 times greater in T carriers compared to non-carriers. SIGNIFICANCE Present findings indicate a role of HSP8A in FEP and underline the importance of including personality traits in the study of the factors associated with the development of schizophrenia.

Establishing and operating an early intervention service for psychosis in a defined catchment area of northwestern Greece within the context of the local mental health network.

Aim: The study aims to present briefly the development of an early intervention service (EIS) for psychosis in a rural catchment area of north‐western Greece within the context of the local mental health network, its structure and procedures, and the results of its operation 2 years after its establishment.

Delirium, a 'confusing' condition in general hospitals: The experience of a Consultation-Liaison Psychiatry Unit in Greece.

Background/aims: A plethora of studies showed that delirium is common in hospitalized populations. We aimed to examine the characteristics of delirium patients referred to our Consultation–Liaison Psychiatry Unit (CLPU). Methods: Our CLPU database was used to obtain data of all referred patients admitted to our hospital and diagnosed with delirium. All referred nondelirious patients served as controls. Results: During one year, 483 patients were referred to the CLPU. Ninety-three (19.3%) were diagnosed with delirium. Delirious patients were older than nondelirious patients (P < 0.001), with 76.3% aged over 70 years. The majority of the referrals came from surgical specialties. Common etiological factors were fluid and electrolyte imbalance (29%), fractures (28%) and infections (24%), but laboratory tests for the investigation of the etiology prior to the consultation had been performed in only 12 patients (12.9%). The syndrome resulted in prolonged hospitalization and greater use of CLPU services. Conclusions: Referrals for delirium are frequent in CLPUs in Greece. Although delirium is common, it remains a ‘confusing’ condition for health practitioners. The under-diagnosis of delirium, the prolonged hospitalization and the time that the CLPU dedicated to these patients underlines the role of the CLPU psychiatrists in the management of the syndrome.