Stavroula Sokolaki

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.

Development of a standardized scoring method for the Graphic Sequence Test suitable for use in psychiatric populations.

Although the graphic version of the Alternating Sequences Test which was introduced by Luria exists for years little has been done to standardize it. The aim of the current study was to develop a novel and detailed standardized method of administration and scoring. The study sample included 93 normal control subjects (53 women and 40 men) aged 35.87±12.62 and 127 patients suffering from schizophrenia (54 women and 73 men) aged 34.07±9.83. The psychometric assessment included the Positive and Negative Symptoms Scale the Young Mania Rating Scale, and the Montgomery-Asberg Depression Rating Scale. A scoring method was developed and was based on the frequencies of responses of healthy controls. Cronbach α and test-retest and interrater reliability were very good. Two indices and 6 subscales of the Standardized Graphic Sequence Test were eventually developed. The Standardized Graphic Sequence Test seems to be a reliable, valid, and sensitive to change instrument based on Lurias graphic sequence test. The great advantage of this instrument is the fact that it is paper and pencil, easily administered and little time consuming. Further research is necessary to test its usefulness as a neuropsychologic test.

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.

Comparison of body fat in patients with schizophrenia and normal controls

Materials and methods The study sample included 105 patients suffering from schizophrenia (44 females−41.91% and 61 males− 58.09%) aged 36.25±10.03 (range 19-69) and 156 normal control subjects (65 females−41.66% and 91 males− 58.34%) aged 36.03±11.33 (range 19-68). Clinical diagnosis was made according to DSM-IV-TR criteria. Height, weight, waist circumference and number of cigarettes smoked daily were recorded. Duration of illness was calculated based on records concerning the age of first onset of psychotic symptoms. Body Surface Area (BSA) and Body Mass Index (BMI) were calculated as well as % body fat, with the use of LifeWiseTM Body Fat Analyzers No 631525. Results The ANOVA results suggested a significant main effect regarding diagnosis and gender as well as for their interaction. Scheffe post hoc test demonstrated significant differences between patients and controls regarding body weight (women only, p=0.002), waist circumference (men p=0.002, women p<0.0001), BMI (women only, p<0.001), BSA (women only, p<0.01) and % body fat (women only, p=0.033), with patients being more obese. The patients also smoked more cigarettes daily (men p=0.002, women p=0.016)

Advances in the treatment of geriatric depression

Late-life depression is a rather difficult and complicated issue. Although there have been significant advances in our knowledge in this area, a large number of questions still remain unanswered. The aim of this review is a critical presentation of the current evidence for treatment of depression in the elderly. We summarize the evidence for the effectiveness and safety of a range of proposed treatments, including pharmacological, psychological and alternative therapies and lifestyle changes. The treatments with best evidence of effectiveness are antidepressant pharmacotherapy, electroconvulsive therapy, cognitive–behavioral therapy, psychodynamic psychotherapy, reminiscence therapy, problem-solving therapy and exercise. Implications for future research are discussed.

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.

Psychological impact of perinatal bereavement in different cultures

Conclusions Social factors and cultural parameters involving with the tragic event play a major role in the mourning processes. Religion and personal beliefs influence the bereavement period and have a catalytic impact on the psychological situation of the couple, relatives and the medical environment. References 1. Herbert M P: Perinatal bereavement in its cultural context. Death Studies 1998, 22:61-78. 2. Leon I: The psychoanalytic conceptualization of perinatal loss: A multidimensional model. American Journal of Psychiatry 1992, 149:1464-1472. 3. Uren T H, Wastell C A: Attachment and meaning-making in perinatal bereavement. Death Studies 2002, 26:279-308. from International Society on Brain and Behaviour: 3rd International Congress on Brain and Behaviour Thessaloniki, Greece. 28 November – 2 December 2007