George Garyfallos

Comorbidity of obsessive-compulsive disorder with obsessive-compulsive personality disorder: Does it imply a specific subtype of obsessive-compulsive disorder?

The present study examined whether the comorbidity of obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD) constitute a specific subtype of OCD. The study sample consisted of 146 consecutive outpatients with a DSM-IV diagnosis of OCD. Diagnoses were established using MINI, IPDE, YBOCS and YBOCS-SC. OCD patients with comorbid OCPD were compared with OCD patients without OCPD on various sociodemographic and clinical variables. Almost one third of the OCD subjects met criteria for comorbid OCPD. OCD+OCPD patients had a significantly earlier age at onset of initial OC symptoms, earlier age at onset of OCD and more obsessions and compulsions than pure obsessions compared to the patients with OCDOCPD. OCD+OCPD patients also had a higher rate of comorbidity with avoidant personality disorder and showed more impairment in global functioning. There were not differences between the two sub-groups on severity of OCD symptoms and also on type of OCD onset. Our results indicate that the comorbidity of OCD with OCPD is associated with a number of specific clinical characteristics of OCD. These findings in conjunction with of current clinical, family and genetic studies provide some initial evidence that OCD comorbid with OCPD constitute a specific subtype of OCD.

Sex differences in neuropsychological functioning among schizophrenia patients

Objectives: Evidence from the literature addressing sex differences in cognition in schizophrenia remains equivocal, with some researchers suggesting that male schizophrenia patients are more impaired than female subjects, while others report no significant sex differences in cognitive functioning. The aim of the present study was to investigate whether the differential pattern of cognitive performance observed in healthy men and women is preserved in male and female schizophrenia patients. Method: Ninety-six schizophrenia patients (56 men) were compared with 62 age- and gender-ratio matched healthy controls (31 men), on a battery of neuropsychological tests that assessed basic cognitive abilities: attention, working memory, abstraction, inhibition, fluency, verbal learning and memory, visual memory, visuospatial skills, and psychomotor speed. Results: As a group, schizophrenia patients were significantly impaired in each of the cognitive domains assessed, with the exception of psychomotor speed. The effect of sex was significant for verbal learning and memory, wherein women outperformed men. No significant group × sex interactions were found in any cognitive domains, indicating that the female advantage typically observed in verbal learning and memory remained the same in the schizophrenia patients. Conclusion: The degree of cognitive impairment is the same for male and female schizophrenia patients. Those sex differences found among the patients were typical of the healthy population as well. Therefore, differential decrements in basic cognitive domains do not appear to account for the favourable course of schizophrenia in women relative to men.

Medical Students’ Attitudes Toward Psychiatry in Greece

This study is a comparative investigation of the attitudes toward psychiatry of two medical student groups who did their undergraduate training in psychiatry in 1985 and 1993. Attitude assessments were carried out by using the Libertarian Mental Health Ideology Scale (LMHIS). The students completed the questionnaire twice, at the beginning and at the end of their clerkship. The LMHIS was also completed by the teaching staff. Both medical student groups showed a significant change in their attitudes toward psychiatry after the end of the training. The change consisted of a shift to a more medical orientation. However, the 1993 group manifested a significantly higher medical orientation both before and after their undergraduate training in psychiatry compared with the 1985 group. Furthermore, the former group’s opinions at the end of their education were similar to those of their teaching staff, whereas the 1985 students continued to have a lower medical orientation compared with the teaching staff. These findings indicate that 1) psychiatric education during medical school may significantly mold students’ attitudes toward psychiatry and 2) if these medical student groups represent the larger Greek society, then significant changes may be occurring in the Greek society about attitudes toward psychiatry.

The Role of Cortisol in First Episode of Psychosis: A Systematic Review

The stress diathesis hypothesis is currently one of the prevailing models of etiology of psychotic disorders. Cortisol is the most researched stress hormone; yet its role in first episode psychosis (FEP) was only recently investigated. The aim of the present study is to systematically review the evidence on the potential role of cortisol in FEP. Higher cortisol levels in blood samples have been consistently replicated, whereas saliva studies measuring baseline cortisol levels have exhibited divergent results. Moreover, longitudinal studies have revealed a cortisol upregulation in FEP with a subsequent decrease induced by antipsychotic treatment. The evidence suggests a role for cortisol in psychosis, although the association of cortisol with psychopathological symptoms is currently non-specific. Future research should focus on more pure diagnostic entities, clearly defined stages of the disorder and refined methods of hormonal measurement.

Emotion perception in obsessive-compulsive disorder.

The purpose of the present study was to investigate the ability to perceive facial and vocal affect in a group of patients with obsessive-compulsive disorder (OCD) and to explore the specific emotions that might be troublesome for them. Participants were 25 patients with OCD and 25 healthy controls, matched for age, education, and gender. They were assessed with computerized tests of affect perception using visual faces [Kinneys Affect Matching Test (KAMT)], visual everyday scenarios [Fanties Cartoon Test (FCT)], and prosody [Affective Prosody Test (APT)], as well as a facial recognition test [Kinneys Identity Matching Test (KIMT)]. Severity of OCD symptoms in the patient group was measured with the Yale-Brown Obsessive Compulsive Scale. Patients with OCD were not impaired in the perception of emotion, in either the visual [still photographs (KAMT) or sketches of everyday scenarios (FCT)] or the vocal (APT) modality, as compared with age-, sex-, and education-matched healthy individuals. Moreover, patients with OCD did not differ from healthy individuals in discriminating facial identity (KIMT). With regard to each emotion type separately, patients performed equally well as healthy individuals in all the emotions examined. Emotion processing of both facial expressions and prosody does not appear to be deficient in patients with OCD (JINS, 2009, 15, 148-153).

Factor structure of the Greek translation of the Scale for the Assessment of Thought, Language and Communication

Objective: The Scale for the Assessment of Thought, Language and Communication (TLC) is a widely used instrument for the assessment of formal thought disorder. TLC disorders were initially conceptualized as having only two underlying dimensions, a negative and a positive one. But studies of the factorial structure of the TLC have not provided confirmation for the positive-versus-negative distinction. The aim of the present study was to assess the factorial structure of the Greek translation of the TLC. Method: Subjects were 103 patients (69 male, 34 female) with psychotic disorders randomly recruited from both inpatient and outpatient facilities. The TLC was assessed by two raters based on a 20 min clinical interview. Results: Principal component analysis with varimax rotation yielded a three-factor structure; the three factors consisted off items reflecting (i) disorganization of speech; (ii) peculiarities of speech; and (iii) verbosity. The disorganization factor could be further divided into two dimensions reflecting disturbances in the flow of ideas and in the structure of speech. Conclusion: The investigation of the factorial structure of the Greek translation of the TLC scale found no support for the positive-versus-negative distinction of TLC disorders. Three factors (disorganization, speech peculiarities, and verbal productivity) were found to underlie the variance of the scale.

Humor appreciation in remitted patients with bipolar disorder.

The purpose of the present study was to investigate humor appreciation in a group of remitted patients with bipolar disorder. We examined 19 patients (8 men) with bipolar disorder I, currently remitted, and 22 (9 men) healthy controls, matched on age, education, and gender, on a computerized test comprising captionless cartoons, the Penns Humor Appreciation Test (PHAT). Residual manic symptoms were evaluated with the Young Mania Rating Scale and residual depressive symptoms with the Montgomery-Asberg Depression Rating Scale. Patients with bipolar disorder performed worse than the healthy group on the PHAT, but this difference was not statistically significant. Performance on the PHAT did not significantly correlate with age of onset and duration of illness, or with residual manic or depressive symptoms measured by Young Mania Rating Scale and Montgomery-Asberg Depression Rating Scale, respectively. Humor appreciation, based on captionless cartoons, in bipolar disorder does not seem to be deficient at least during remission, suggesting that this high-order cognitive function may not be considered a trait deficit of the disorder.

Emotional perception and theory of mind in first episode psychosis: The role of obsessive–compulsive symptomatology

The aim of the present study was to investigate the effects of comorbid obsessive-compulsive symptoms on emotional perception and theory of mind (ToM) in patients with first-episode psychosis. Participants were 65 patients with non-affective first episode psychosis (FEP) and 47 healthy controls. The patient group was divided into two subgroups, those with (FEP+; n=38) and those without obsessive-compulsive symptomatology (FEP-; n=27). Emotion perception and ToM were assessed with the Perception of Social Inference Test. Severity of psychotic and obsessive-compulsive symptoms was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), respectively. Deficits in emotion recognition and theory of mind were confirmed in patients with non-affective first-episode psychosis compared to healthy controls. In patients, comorbidity with obsessive-compulsive symptoms was associated with worse performance on certain aspects of social cognition (ToM 2nd order) compared to FEP- patients. Our findings of impaired emotion perception and ToM in patients with first-episode psychosis support the hypothesis that deficits are already present at illness onset. Presence of OCS appears to have further deleterious effects on social cognition, suggesting that these patients may belong to a schizo-obsessive subtype of schizophrenia characterized by more extensive neurobiological impairment.

Evidence for increased immune mobilization in First Episode Psychosis compared with the prodromal stage in males

The aim of the study was to gauge both the immune and neuroendocrine function in Ultra High Risk for psychosis (UHR) subjects and compare them with a cohort presenting with First Episode Psychosis (FEP). We recruited two groups, the first group consisted of 12 UHR males and the second of 25 males with FEP. We measured serum cortisol levels at 08:00, 12:00, 18:00 with their Area Under Curve with respect to the ground (AUCg) and the increase (AUCi) and we measured serum cytokines levels, Interleukin-1a, IL-1a, IL-2, IL-4,IL-5,IL-6,IL-8, IL-10,IL-12, IL-17a, Tumor Necrosis Factor-a (TNF-a), Interferon-γ (IFN-γ). Dexamethasone Suppression Test (DST) was also performed . The results suggest higher levels of both pro-inflammatory (TNF-a, IL-2, IL-12, IFN-γ) and anti-inflammatory (IL-10) cytokines in the FEP group compared with the UHR counterparts. Regarding the HPA axis function, the prodromal subjects showed a trend for higher AUCg and AUCi change/decrease cortisol levels. On the contrary, the DST results did not differ between the groups. No significant associations were demonstrated within each group among cytokines, cortisol and psychopathology. The findings favor a hypothesis of a relatively increased mobilization of both the pro- and anti-inflammatory cytokine networks, in FEP compared with that of UHR subjects.

Tardive Nocturnal Akathisia Due to Clozapine Treatment

In the following case report we present a 43-year-old male patient diagnosed with schizophrenia, paranoid type, who exhibited nocturnal tardive akathisia or pseydoakathisia approximately one year after being treated with clozapine 300 mg per day. Because of the low occurrence of akathisia due to clozapine, the episodes of restlessness were at first considered as a sign of worsening of the patients psychopathology. Since the patient was resistant to other antipsychotic agents, clozapine was reinitiated. A week later, the patient once again exhibited episodes of restlessness. This time, the episodes were diagnosed as akathisia and the patient was treated with biperidene and lorazepam, while he had already been on propanolol for cardiovascular reasons. The episodes continued without any change in frequency or severity. Therefore, treatment with clozapine was discontinued and the patient was started on a new regimen with ziprasidone. Three days later, the episodes that caused distress to the patient resolved. Thus, it is possible that apart from episodes of acute akathisia, episodes of tardive akathisia or pseydoakathisia can also occur in patients treated with atypical antipsychotics.