Maria Fotiadou

Self-Reported Substance Misuse in Greek Male Prisoners

The aim of this survey was to determine levels and severity of self-reported alcohol and drug misuse and associated physical and mental health problems in Greek male prisoners. The sample consisted of 80 randomly selected convicted and remanded male prisoners in a prison in northern Greece. The Mini International Neuropsychiatric Interview (MINI) was used to assess psychiatric disorders including substance abuse and dependence. All prisoners who participated completed the Alcohol Use Disorders Identification Test (AUDIT). Those who reported daily use of opiates and stimulants completed the Severity of Dependence Scale (SDS). Information was obtained from medical notes about the prisoners’ hepatitis B and HIV status. The MINI identified 27.5% of the prisoners as dependent on opiates, 26.3% on alcohol and 73.8% as cannabis users, while 13.8% were misusing both alcohol and illicit drugs. Severity of dependence was rated, using SDS, as serious for all opiate and stimulant users. In terms of physical health examination of medical records indicated that no prisoner was HIV-positive but 26.5% were hepatitis-B-positive. Of those who had a previous history of substance misuse, 31.2% fulfilled the criteria for depression and 37.5% for antisocial personality disorder. Similarly, 15% of those misusing substances had a previous history of deliberate self-harm and 16% were assessed to have moderate to high suicide risk.

Victimization of the severely mentally ill in Greece: The extent of the problem

Background: In contrast to extensive research on psychiatric patients’ dangerousness, very few studies have examined their victimization. Aim: The aim of our study is to record reported victimization of seriously mentally ill outpatients in Greece and compare them with healthy controls. Method: We interviewed 150 severely mentally ill outpatients and a matched group of healthy controls using a semi-structured interview. This recorded incidents of victimization and perceived discrimination during the previous year. Logistic regression models were used to examine the influence of demographic parameters on both victimization and discrimination. Results: In this study 59.3% of patients and 46.0 % of controls (p = .02) reported being victims of a criminal act at least once and 52.0% of patients and 24.0 % of controls (p < .001) reported experiencing discrimination during the previous year. Patients, in comparison to controls, were more likely to report being victims of any kind of victimization (OR = 1.85, 95% CI = 1.07–3.21), of assault/threat (OR = 4.62, 95% CI = (2.32–9.19) and of discrimination (OR = 3.34, 95% CI = (2.1–5.62). In addition, patients reported experiencing higher distress in assault/threat crime compared to controls (p = .03). Conclusions: Patients with serious mental illness are more likely than the general population to report being victims of criminal acts and experiencing discrimination.

Clinical characteristics and outcomes on discharge of women admitted to a Medium Secure Unit over a 4-year period

There are limited data on women in Medium Secure settings. This study aimed to address this by assessing the characteristics of 45 consecutive admissions to the female ward of a Medium Secure Unit in the United Kingdom over a four-year period. Data on demographics, clinical outcomes and from HONOS-Secure/HONOS and HCR-20 assessments were prospectively collected. Psychiatric diagnoses were recorded using ICD-10 criteria. Data on quality of life from WHO-QoL-BREF surveys were analysed. There was a high proportion of ethnic minorities (57.8%), high rates of childhood and adult abuse and low socioeconomic status. 62.2% of the patients had schizophrenia, 57.8% had multiple diagnoses. The median length of stay at discharge was 465.5 days. There were statistically significant reductions in rates of self-harm and HoNOS-Secure/HoNOS and HCR-20 scores following intervention. Scores on WHO-QoL-BREF compared favourably to a large-scale sample with mental health difficulties. Many characteristics of this sample were comparable to samples from similar populations. However the particularly high proportion of ethnic minorities suggested that the profile of our patients differs from nationwide samples. Intervention by our service was associated with reduced self-harm and improvements in well-defined clinical outcomes and quality of life measures using validated scales.

Greek adolescents in custody: psychological morbidity, family characteristics and minority groups

This study aims to determine the prevalence of psychological problems in a sample of imprisoned male adolescents in Greece, to examine their clinical, demographic and family characteristics and to determine whether adolescents belonging to ethnic minority groups are over-represented in prison. In the study 55 young offenders in two prisons completed the Youth Self-Report and were compared with 154 community control subjects. There was a high incidence of psychological disorder in imprisoned adolescents when compared with the community sample. Illicit drugs were used by 70% of these adolescents. They reported high rates of family and social adversity. Persistent and more serious offending was related to higher rates of psychosocial and family adversity. Ethnic minorities and immigrants were over-represented in the sample. Immigrants reported fewer psychological problems and less disturbed family and social background. Policy-makers need to take into account the mental health needs and cultural background of the adolescents in custody and their families. Consideration needs to be given to the provision of specialist services such as training of social workers and prison staff in identifying psychiatric problems, prison psychiatry and court liaison schemes. Courts should also adopt less punitive approaches when considering disposal of adolescents.

The Italian Version of the Borderline Personality Disorder Severity Index IV: Psychometric Properties, Clinical Usefulness, and Possible Diagnostic Implications

Borderline personality disorder (BPD) has a core embodied in affective and behavioral dysregulations, impulsivity, and relational disturbance. Clinical presentation might be heterogeneous due to a combination of different symptoms listed in the DSM-5. Clinical diagnosis and assessment of the severity of manifestations might be improved through the administration of structured interviews such as the Borderline Personality Disorder Severity Index, 4th edition (BPDSI-IV). The psychometric properties of the Italian version of the BPDSI-IV were examined for the first time in 248 patients affected by BPD and 113 patients affected by bipolar disorder, proving to be a valid and accurate instrument with good internal consistency and high accuracy. The Italian version also demonstrates significant validity in the discrimination between these clinical groups (p < 5001).

Follow-up study of 6.5 years of admissions to a UK female medium secure forensic psychiatry unit

Aims and method We aimed to examine clinical and risk outcomes at follow-up, and reoffending and readmission rates, for a sample of 50 admissions to a female medium secure unit (MSU). Demographic, clinical risk assessment (HCR-20 and HoNOS-Secure) and quality of life data were collected using validated measures for all admissions to a female MSU ward in London, UK, between April 2008 and November 2014. Results All clinical and risk assessment scale scores had improved at follow-up. Quality of life compared favourably to community samples and was good for physical, social and environmental factors and acceptable for psychological health. Twenty-six per cent had at least one readmission, while 17.5% reoffended in the period studied. A longer duration of admission and use of restrictions on discharge was associated with reduced reoffending, but not readmission. Clinical implications Admission is associated with improvement on clinical risk assessment at follow-up. Longer hospital admissions and use of restrictions on discharge may be necessary to prevent reoffending in this group. Declaration of interest None.

Progresses about the Interplay among Clarithromycin, Immune and Central Nervous Systems

Dear Editor, Helicobacter pylori (H. pylori) is spiral in shape with a flagellum, gram-negative, micro aerophilic bacterium which colonizes in the human gastric mucosa and the infection may last for decades. It is thought that the H. pylori infection is the most common bacterial infection and influences approximately 50%–75% of the population worldwide (Lv et al. 2015). It is the main reason for the upper gastrointestinal diseases, including peptic ulcer (gastric and duodenal), chronic gastritis, gastric cancer and gastric mucosal-associated lymphoid tissue lymphoma (Tian et al. 2015). According to the Conference of Maastricht III, the first line of treatment is amoxicillin, omeprazole, and clarithromycin, as triple therapy, for 7 days, which results in an eradication rate of about 80% (75%–98%) (Malfertheiner et al. 2007). Clarithromycin, in particular, is a semi-synthetic macrolide antibiotic indicated for the treatment of many different types of bacterial infections affecting the skin and respiratory system as well as most Mycobacterium avium complex (MAC) bacteria. Beyond proofs of the efficiency of Clarithromycin in the treatment of many major and common infections, there is a Bdark^ aspect to this matter. Some antibiotics, in fact, are reported to stimulate adverse psychiatric effects with an onset within 7 days of initiation and resolution 24–48 h after its interruption (Shah et al. 2012). This phenomenon might be underestimated due to a low clinical incidence but it is being reported in a growing number of cases (Abouesh and Hobbs 1998; Brooks and Hoblyn 2005; Khalili 2014; Lally and Mannion 2013). Known as Antibiomania, it often develops in subjects with no personal or family psychiatric history; age and genetic influences have been excluded, even though some authors suggest a predisposition in elderly. Clarithromycin is among those more commonly associated with psychosis with few reported cases involving amoxicillin (Shah et al. 2012); it has an excellent CSF penetration (Schmidt et al. 1993), but no reports of interaction with central neurotransmitters were found so far in the literature (Shah et al. 2012). A case arrived at our clinical attention might contribute in filling that gap.We documented, for the first time to our knowledge, interactions between Clarithromycin, neurotransmitters and the immunological system. BThe patient had a negative psychiatric history except for two iatrogenic episodes developed during treatment for eradication of Helicobacter Pilory (Clarithromycin 1 g b.i.d + amoxicillin 2 g b.i.d for two weeks at the first episode and one week at the second one). She showed mood symptoms at the first episode and psychotic symptoms at the second. The last administration of Clarithromycin (1 g b.i.d for two days) dated back to a week before her admission to the ER due to low level of consciousness. All the results of clinical examinations as well as laboratory data were within normal limits. Drug abuse screening was negative and blood alcohol concentration was zero. A CT scan of the head was normal. A lumbar puncture was not done. During the Psychiatric * Ester di Giacomo ester.digiacomo@yahoo.com

Pregnancy denial or concealement: A case report highlighting risks and forensic aspects.

The study by Forbes et al. (2015) is important because it draws attention to the victim’s anger response in the course of disaster management. Data drawn from 1017 adult victims of bushfires across 25 communities was tested against three structural equation models. Anger and concurrent stressful life events were found to mediate mental health outcomes, most notably, the development of post-traumatic stress disorder (PTSD). The study did not control for financial compensation. That factor contaminates the mediation of outcomes at many levels (Lock et al., 2012). The authors correctly draw the conclusion that governments and communities should provide social and financial support for victims. However, the anger problem is equally a consequence of the failure of these agencies to provide appropriate disaster relief. They are far from shifting from being the problem to becoming the solution. In the interim, the authors suggest improving diagnostic screening and evidence-based cognitive behavioural therapy (CBT) for anger. The latter might reduce anger. The question is does it also reduce the assertiveness required to combat re-victimisation?