G. Kaprinis

Morning and Evening Plasma Melatonin and Dexamethasone Suppression Test in Patients with Nonseasonal Major Depressive Disorder from Northern Greece (Latitude 40–41.5°)

Introduction: The present study aimed to search for correlations between melatonin (MT) levels and the dexamethasone suppression test (DST) and clinical variables. Methods: Fifty depressed patients aged 21–60 years took part in the study. The Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and the International Personality Disorders Examination were used for diagnosis. Psychometric assessment included the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale, the General Assessment of Funtioning Scale, the Newcastle scales and the Diagnostic Melancholia Scale. The DST and 9.00 and 23.00 h MT values were assessed. Statistical analysis included Student’s t test, Pearson product moment correlation coefficient and forward stepwise multiple linear regression analysis. Results: Melancholic patients had lower 23.00 h MT values in comparison to the rest of the patients and the atypical and ‘undifferentiated’ patients. Conclusion: The current study shows that low MT values were closely related to melancholic depression. Distinct quality of mood, psychomotor agitation or retardation and anorexia or weight loss seemed to be responsible for this relationship.

Delusional disorder and alcohol abuse in a patient with Wilson's disease

OBJECTIVE Wilsons disease (WD) or hepatolenticular degeneration is a rare disorder of copper metabolism that results in copper deposition in brain, liver, kidneys and the cornea. Due to the copper deposits in the brain, neurological and psychiatric symptoms may appear. The psychiatric manifestations may vary from mood disorders, behavioral and personality disorders to cognitive impairment, while psychotic symptoms are rarely reported. The objective of this report was to present an unusual case of WD presenting with nonpersecutory delusional disorder and alcohol abuse in the absence of neurological signs. CASE SUMMARY A 34-year-old male patient, without any previous psychiatric or alcohol abuse history, presented with delusions of jealousy and alcohol abuse when he discontinued his treatment for WD. Although the patient had no previous symptoms or neurological signs, he was receiving treatment for WD for 3 years, after being diagnosed with the disease during family precautionary examination, since his brother developed symptomatic WD. The patient started combined pharmacotherapy, and after 3 months of follow-up the psychiatric manifestations were controlled sufficiently. CONCLUSIONS Although WD is rarely associated with alcohol abuse and delusions of jealousy, this disease should be taken into account in the differential diagnosis of these psychiatric manifestations.

Reliability and cultural applicability of the Greek version of the International Personality Disorders Examination.

BackgroundThe International Personality Disorders Examination (IPDE) constitutes the proposal of the WHO for the reliable diagnosis of personality disorders (PD). The IPDE assesses pathological personality and is compatible both with DSM-IV and ICD-10 diagnosis. However it is important to test the reliability and cultural applicability of different IPDE translations.MethodsThirty-one patients (12 male and 19 female) aged 35.25 ± 11.08 years, took part in the study. Three examiners applied the interview (23 interviews of two and 8 interviews of 3 examiners, that is 47 pairs of interviews and 70 single interviews). The phi coefficient was used to test categorical diagnosis agreement and the Pearson Product Moment correlation coefficient to test agreement concerning the number of criteria met.ResultsTranslation and back-translation did not reveal specific problems. Results suggested that reliability of the Greek translation is good. However, socio-cultural factors (family coherence, work environment etc) could affect the application of some of the IPDE items in Greece. The diagnosis of any PD was highly reliable with phi >0.92. However, diagnosis of non-specfic PD was not reliable at all (phi close to 0) suggesting that this is a true residual category. Dianosis of specific PDs were highly reliable with the exception of schizoid PD. Diagnosis of antisocial and Borderline PDs were perfectly reliable with phi equal to 1.00.ConclusionsThe Greek translation of the IPDE is a reliable instrument for the assessment of personality disorder but cultural variation may limit its applicability in international comparisons.

Functional recovery results from the risperidone long-acting injectable versus quetiapine relapse prevention trial (ConstaTRE)

Objective ConstaTRE is an open-label, randomised, controlled, relapse prevention trial in patients with stable schizophrenia or schizoaffective disorder switched to risperidone long-acting injectable (RLAI) or oral quetiapine, and was designed to test the hypothesis that injectable antipsychotic treatment with risperidone would be more effective than oral therapy with quetiapine. Here we report the functional recovery results from the ConstaTRE trial. Methods Clinically stable adults previously treated with oral risperidone, olanzapine, or oral first-generation antipsychotics were randomised to RLAI or quetiapine for 24 months. Functional recovery was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS) and two quality-of-life (QoL) measures [Medical Outcomes Survey Short Form-12 (SF-12) and Schizophrenia Quality-of-Life Scale Revision 4 (SQLS-R4)]. Results A total of 666 patients were randomised and treated with RLAI (n = 329) or quetiapine (n = 337). Relapse occurred in 16.5% RLAI and 31.3% quetiapine patients. Significant improvements in SOFAS, SF-12, and SQLS-R4 scores were observed from baseline to month 24 with both RLAI and quetiapine. At months 6, and 12, and endpoint, improvement in SOFAS score was significantly greater for RLAI than quetiapine (p < 0.05). Conclusions Among patients with stable schizophrenia or schizoaffective disorder, the likelihood of functional recovery appears to be higher in those switching to RLAI than to quetiapine, although improvements in functional status and QoL were observed with both treatments.

Status epilepticus in a patient treated with olanzapine and mirtazapine.

OBJECTIVE Few cases of seizures associated with olanzapine therapy and even fewer with mirtazapine have been published, most of them in patients with confounding risk factors. Our objective was to report a case of Status epilepticus in a patient receiving olanzapine and mirtazapine, with no previous history of seizure and no confirmed underlying cause for seizure. CASE SUMMARY A 48-year-old white, psychotic woman developed generalized tonic-clonic seizures that progressed to Status epilepticus during hospitalization. 4 days before the incident, mirtazapine (30 mg) was added to the treatment, while 2 days before the incident, the treatment switched from quetiapine to olanzapine, and mirtazapine was increased to 60 mg. No other toxic, metabolic, electrolyte or anatomic abnormality was identified. After discontinuation of olanzapine, the patient remained seizure-free. CONCLUSION To our knowledge, this is the second reported case of Status epilepticus that has been associated with the use of olanzapine, while only one report of seizures, but none of Status epilepticus connected to mirtazapine is found in the literature. Although olanzapine has infrequently been associated with epileptogenic risk, it should be used cautiously especially when concomitant medication or other predisposing factors exist.

Investigation of the comorbidity of psychiatric disorder and substance use disorder among inpatients of a public psychiatric hospital in an urban area in Greece

Background: Τhe prevalence of comorbidity is high among outpatients in rehabilitation centres and in psychiatric clinics. Aims: To investigate the level and type of comorbid psychiatric disorder and substance use disorder among inpatients of a psychiatric clinic in a public psychiatric hospital in an urban area in Greece, and to distinguish the characteristics of the dual diagnosis population, in order to help develop specialised services. Method: All patients admitted over a 12-month period were given the CAGE questionnaire and part of the EUROPASI questionnaire addressing substance use. This was followed by a diagnostic interview to establish the final diagnosis in accordance with the DSM-IV criteria. Results: A total of 313 patients were assessed. Present substance use disorder was identified in 102 individuals (32.6%), and involved one substance in 70 cases (68.6%) and more than one in 32 cases (31.4%). The principal substances involved in addiction or abuse were alcohol, cannabis, benzodiazepines and...

Assessment of cognitive function with MMSE in chronic schizophrenic inpatients

A large number of chronic patients with serious mental disorder are hospitalized in the private sector, either because the public sector is not able to hospitalize them for long periods, or because a private clinic might be closer to the patients habitat so that the relatives may have the possibility to visit them more often. In the frame of the Psychiatric Reform, the private sector has developed and adapted, in the direction of new data of benefits of Psychiatric care. However, the interaction of the chronicity of the disease with prolonged or life hospitalization has unknown effects on cognitive function. The aim of this project was to study if and how much the cognitive function of schizophrenic patients can be influenced by the long term of hospitalisation.

Ability of picture naming in chronic schizophrenics

Background The purpose of this research was the study of the abilities of picture perception and naming in two different groups of schizophrenics, according to their place of living. Subjects: Forty-two chronic schizophrenics participated in this study (21 male, 21 female). Twenty-two of them were living in alternative residences, while the other twenty were institutionalized. The two groups did not differ in the years of schooling and the years of their commitment in institution. Their age ranged between 30 and 81 years and all the patients fulfilled the criteria a) of schizophrenia, according to ICD-10 and b) those of chronicity.

Transcultural issues about death fantasies and beliefs

Our data comes from 32 interviews occurring during aone-year period with Greek patients who were seen within24 hours of a suicide attempt and after admission at thecasualty department of a Greek general hospital. At theend of the assessment the patient was asked to give a sui-cidal fantasy and speak about his thoughts and believesaround death.

Inadvertent hospitalization - association between diagnosis and age

Conclusions The severe psychotic incidents of the schizophrenic range are the most common cause of inadvertent hospitalization and follow the incidents of bipolar disorder, while in the ages of 31–40 most inadvertent hospitalizations take place. from International Society on Brain and Behaviour: 3rd International Congress on Brain and Behaviour Thessaloniki, Greece. 28 November – 2 December 2007