Ioannis Michopoulos

Neuropsychological and hypothalamic–pituitary-axis function in female patients with melancholic and non-melancholic depression

BackgroundExecutive function deficits in depression implicate involvement of frontal–striatal circuits. However, studies of hypothalamic–pituitary-axis (HPA) function suggest that stress-related brain changes of hippocampus may also implicate prefrontal–hippocampal circuits, which may explain the profile of both executive dysfunction and memory deficits. In this study we examined the performance of patients with major depressive disorder (MDD) on tasks of memory and executive function in relation to melancholic features and to cortisol levels. Our hypothesis was that raised cortisol levels in melancholic patients would correlate with these deficits.MethodForty female MDD patients, 20 having melancholic features (MEL vs. Non-MEL), and 20 sex- age- and education-matched normal controls were investigated using the Cambridge neuropsychological test automated battery (CANTAB), to assess memory (paired associative learning, PAL; short-term recognition memory, SRM) and executive (intradimensional/ extradimensional set-shifting, ID/ED; Stockings of Cambridge, SOC) functions. Plasma and salivary cortisol levels were measured.ResultsThe MDD patients performed worse than controls on PAL and both executive tasks. The MEL group differed from controls on all tests, and differed from the non-MEL only at the ED stage of the ID/ED task. Patient cortisol levels were within the normal range and did not correlate with neuropsychological performance for any group.ConclusionsMDD patients showed neuropsychological deficits on tasks of executive function and memory, supporting the model of frontal-temporal dysfunction. MEL vs. non-MEL performed worse overall and demonstrated a qualitative difference in set shifting, perhaps implicating more extensive prefrontal involvement. Cortisol levels did not correlate with depression severity or the observed deficits.

Cognitive decline and dementia in elderly medical inpatients remain underestimated and underdiagnosed in a recently established university general hospital in Greece

The aim of this study was to report the prevalence of cognitive decline as well as its recognition rates in elderly inpatients in a general hospital in Greece. Two hundred randomly selected patients, 65 years old and over, hospitalized in surgery and internal medicine departments, were assessed for cognitive decline in a period of 12 months by means of structured clinical interview for DSM-IV axis-I disorders, clinical version (SCID-IV), mini-mental state examination (MMSE) and the clock drawing test (CDT). During the next 12 months the liaison calls were evaluated and the two periods were compared. During the first screening period, when psychiatric assessment was performed, 61 patients (30.5%) were diagnosed to present cognitive decline. During the second period, there were only 20 liaison calls from the same departments for patients over 65 years of age, from which 15 patients were found to present cognitive decline. Comparison between the two periods showed significant underestimation of cognitive decline. In the general hospital the cognitive decline of elderly inpatients remains still under-recognized.

Involuntary admission in Greece: A prospective national study of police involvement and client characteristics affecting emergency assessment

Background and aim: Mental health legislation varies considerably from one country to the other. This study aims to describe the characteristics of the individuals who are brought in by the police for psychiatric assessment and the police involvement in this procedure in Greece. Method: Prospective study of the incident books of the police departments throughout Greece concerning involuntary psychiatric admissions. These books were completed by the police officers who brought the individuals for involuntary psychiatric examination. Results: In total, 2,038 involuntary assessments were evaluated and examined in relationship to the demographic characteristics of the examined individuals. The main findings are as follows. Males were more often assessed (69%) at a younger age than females (p < 0.001). The majority of the assessments led to involuntary admission (87.5%). Immigrant status did not lead to increased involuntary commitment. The chance for involuntary admission was greater for younger Greek nationals offering resistance. An unexpected finding is that police officers were unnecessarily present in almost half of the mental health assessments (49.4%). Conclusion: The psychiatrists in Greece who perform mental health assessments under the Greek Mental Health Law admit the majority of individuals. They also accept the presence of a police officer during the assessment more often than expected. This issue needs immediate addressing by means of better training and support of psychiatrists.

Contrasting patterns of deficits in visuospatial memory and executive function in patients with major depression with and without ECT referral

BACKGROUND The pretreatment neuropsychological profile of drug-resistant patients with major depressive disorder (MDD) referred for electroconvulsive therapy (ECT) may differ from that of their drug-respondent MDD counterparts. Such differences could help in identifying distinct MDD subtypes, thus offering insights into the neuropathology underlying differential treatment responses. METHOD Depressed patients with ECT referral (ECTs), depressed patients with no ECT referral (NECTs) and non-psychiatric Controls (matched groups, n=15) were assessed with memory and executive function tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). RESULTS ECTs scored significantly lower than NECTs in the Mini-Mental State Examination (MMSE; p=0.01). NECTs performed worse than Controls in the Paired Associates Learning (PAL) task (p<0.03; Control/NECT p<0.01) and the Spatial Recognition Memory (SRM) task (p<0.05; Controls/NECTs p<0.05); ECTs performed between Controls and NECTs, not differing from either. In the Intra/Extradimensional (IED) set-shifting task, ECTs performed worse that Controls and NECTS (IED: p<0.01; Controls/ECTs p<0.01), particularly in the shift phases, which suggests reduced attentional flexibility. In Stockings of Cambridge (SOC), ECTs abandoned the test early more often than Controls and NECTs (H=11, p<0.01) but ECTs who completed SOC performed comparably to the other two groups. CONCLUSIONS A double dissociation emerged from the comparison of cognitive profiles of ECT and NECT patients. ECTs showed executive deficits, particularly in attentional flexibility, but mild deficits in tests of visuospatial memory. NECTs presented the opposite pattern. This suggests predominantly frontostriatal involvement in ECT versus temporal involvement in NECT depressives.

Topiramate use in alprazolam addiction.

Alprazolam is successful in reducing anxiety but has a high addictive/misuse potential. Topiramate is a novel anticonvulsant which has been used as a mood stabilizer. Other anticonvulsants, such as carbamazepine and valproate, have been used in alcohol and benzodiazepine withdrawal. Topiramate has recently been used in alcohol, cocaine and opiates withdrawal. There has been also one report of topiramate use in midazolam withdrawal. In our case of a patient with reccurent major depressive disorder, subthreshold anxiety disorder and addiction to alprazolam, topiramate appears to be efficient and safe in alprazolam withdrawal.

Sulbutiamine, an ‘innocent’ over the counter drug, interferes with therapeutic outcome of bipolar disorder

A case of a patient with bipolar disorder with a history of hospitalizations and addiction to sulbutiamine is presented. Sulbutiamine is a precursor of thiamine that crosses the blood–brain barrier and is widely available without prescription in most countries or over the internet. Because of this patients need to consume ever increasing quantities of sulbutiamine, his psychiatric care was severely compromised through him defaulting appointments and frequent changes of psychiatrists. This paper reviews the current scientific knowledge about sulbutiamine, and some of the information and claims available on the web about its use and potential. It is argued that doctors need to be aware of the potential misuse of medication available over the counter or on the internet and its potential harmful influence.

Switching Suicide Methods in Order to Achieve Lethality: A Study of Greek Suicide Victims

This article focused on the relation between the method of last attempted suicide and the method used during the subsequent completed suicide. Using the method of psychological autopsy, the authors studied all suicide cases from the Athens Greater Area during a 2-year period. Twenty-four percent of the victims had history of previous suicide attempts. The majority of the suicide attempters switched to a different method (p < 0.001) for their final act. This difference is primarily due to the individuals who had chosen self-poisoning or wrist cutting in their last attempted suicide. Both of these groups switched to hanging or jumping from a height for their final attempt. Individuals who attempted suicide by hanging or jumping became completers using mainly the same methods.

Major depression in elderly medical inpatients in Greece, prevalence and identification.

Background: The aim of this study was to report the prevalence of episodes of DSM-IV major depression, as well as their identification rates, in elderly inpatients in a general hospital in Greece. Methods: 200 selected patients, 65 years old and over, hospitalized in Surgery and Internal Medicine Departments, were assessed for major depression over a period of 12 months (October 2006–November 2007) by means of SCID-I/P, HADS, BDI and GDS-15. During the same period, liaison calls from the same departments were evaluated and findings were compared. Results: When psychiatric screening was performed, 28 patients (14%) were diagnosed as suffering from a major depressive episode. During the same period, there were only 20 liaison calls from the same departments for patients over 65 years old, from which 4 patients were found to be suffering from major depression. Comparison between the two periods showed significant underestimation of depression. All psychometric scales detected depression sufficiently. Conclusions: In general hospital elderly inpatients, depression still remains underestimated. Depression symptom scales could be used as routine tests for screening major depression.

Characteristics of immigrant suicide completers in a sample of suicide victims from Greece

Background: Immigrants have higher rates of suicidal behaviour in comparison to the indigenous population. Aims: To describe the characteristics of foreign nationality suicide completers and search for differences between them and native Greeks. This is the first study focused on immigrant suicide victims in Greece. Methods: Data were collected for all recorded cases of completed suicide for the two-year period November 2007 to October 2009 at the Athens Department of Forensic Medicine, the largest, by far, of its kind in Greece covering approximately 35% of the country’s population. The material was collected using the method of psychological autopsy as well as from the victims’ forensic records. Results: Nearly 10% of Greece’s 11 million population are of foreign nationality. Approximately half of them live in Athens and its suburbs, an area where 35% of Greece’s population lives. In our sample, 15.8% of the suicide victims were of foreign nationality (53 cases): 41 men (77.4%) and 12 women (22.6%). Higher suicide rates were found for citizens of Kuwaiti (9.1%), Somali (6.7%) and Afghan (0.9%) nationality (immigrant communities with very few members); the lower suicide rates were for individuals of Egyptian (0.01%), Ukrainian (0.01%) and Albanian (0.006%) nationality (the Albanian immigrant community is the largest in Greece). In comparison to their Greek counterparts, immigrant victims were younger (mean age 38.7 vs 54.9 years, p < .001) more often unemployed (p = .007) and with a history of alcohol abuse (p < .001). The main suicide method used by immigrants was hanging (p < .001) while for Greeks it was jumping from a height. Conclusions: Individuals who belong to small national communities seem to have the highest risk of dying by suicide. Immigrant suicide victims differ from the indigenous population in several parameters. Our data could help define the most vulnerable of them and apply more effective suicide prevention strategies.

Quetiapine monotherapy in bipolar I disorder: A 1-year stabilization in a woman having undergone bone marrow transplantation

Queatiapine has been used in bipolar mania and most recently in bipolar depression with good results; however, its use in maintenance treatment has not been established yet. A case of a woman suffering from bipolar I disorder who underwent bone marrow transplantation twice because of leukaemia is presented. The use of quetiapine as a monotherapy was efficient and safe and proved to be a good treatment in mood stabilization for 1 year.