Rossetos Gournellis

Olanzapine and obsessive-compulsive symptoms

Clozapine and risperidone have been implicated in the development of obsessive-compulsive symptoms. We present three cases in which olanzapine caused a significant exacerbation of obsessive-compulsive symptoms in schizophrenia (two cases) and obsessive-compulsive disorder (one case).

Psychotic (delusional) major depression in the elderly and suicidal behaviour

BACKGROUND It has been established that depressed patients manifest a higher risk of committing suicide. The role of delusional experiences accompanying depressive symptomatology as a risk factor for suicidal behaviour has been investigated but the results are inconsistent. METHOD In the present study, 40 elderly depressed inpatients with psychotic features (DSM-IV criteria) were compared to 64 elderly depressed patients without such features in terms of suicide attempts. RESULTS The results of univariate and multivariate analyses were negative: Psychotic and nonpsychotic depressed patients did not differ with respect to attempted suicide. CONCLUSION The results of the present study support the notion that psychotic features do not increase the risk for the elderly depressed patients to attempt suicide.

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.

Manic symptoms induced by olanzapine

We present the case of a never medicated patient with a diagnosis of DSM-IV paranoid schizophrenia in which olanzapine therapy induced manic symptoms. The latter remitted after drug discontinuation.

Dimensional approach to delusions in psychotic depression in the elderly: factor structure and clinical correlates.

The present study attempted to investigate the clinically important broader dimensions of clinical characteristics of delusions, through multivariate analysis, in a pure sample of elderly unipolar delusional depressives as well as to test their external validity against a set of demographic, anamnestic and psychopathological validators.

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.

A Case of Autophagia: A Man Who Was Mutilating His Fingers by Biting Them

Self-mutilating behaviors could be minor and benign, but more severe cases are usually associated with psychiatric disorders or with acquired nervous system lesions and could be life-threatening. The patient was a 66-year-old man who had been mutilating his fingers for 6 years. This behavior started as serious nail biting and continued as severe finger mutilation (by biting), resulting in loss of the terminal phalanges of all fingers in both hands. On admission, he complained only about insomnia. The electromyography showed severe peripheral nerve damage in both hands and feet caused by severe diabetic neuropathy. Cognitive decline was not established (Mini Mental State Examination score, 28), although the computed tomographic scan revealed serious brain atrophy. He was given a diagnosis of impulse control disorder not otherwise specified. His impulsive biting improved markedly when low doses of haloperidol (1.5 mg/day) were added to fluoxetine (80 mg/day). In our patients case, self-mutilating behavior was associated with severe diabetic neuropathy, impulsivity, and social isolation. The administration of a combination of an antipsychotic and an antidepressant proved to be beneficial.

Depression in the elderly

Depression is highly prevalent in elderly individuals. The overall prevalence of major depressive disorder in the community in persons 65 years old or older has been calculated as about 1,3-4%, of dysthymic disorder 2%, of minor depressive disorder 4-13% and of depressive symptoms about 8-16%. The prevalence of various types of depression in primary care, inpatients settings and in long-term-care is higher. Depression in the elderly is more frequent in women and widowers, in individuals who are isolated, institutionalized as well as in those facing stressful events and being economically impoverished. Moreover, low volumes of frontostriatal structures and hyperintensities in subcortical structures have been reported in depressed elderly. Thus, psychological adversity may trigger depression to already biologically or genetically vulnerable persons. Depression frequently affects patients with chronic physical illnesses and cognitive impairment. It causes suffering, disability and dependence, it increases drug consumption and it worsens the outcome of physical illnesses and the patients quality of life. Depression also increases mortality, suicidality and family burden as well. Clinical features unique to depressed elderly are not included in the current DSM IV and ICD 10 criteria. However, depressed elderly often manifest an inhibition to express their sadness and they frequently tend to somatize their complaints. These features of late-life depression may lead inexperienced clinician to miss the diagnosis. Antidepressant medication of an SSRI or an SNRI is considered as treatment of choice. Lastly, psychosocial interventions could be helpful, mainly when they adjunct to other treatments of a comprehensive management of late-life depression. from International Society on Brain and Behaviour: 3rd International Congress on Brain and Behaviour Thessaloniki, Greece. 28 November – 2 December 2007