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Major depressive episodes (MDEs) show diverse cortisol level alterations. Heterogeneity in symptom profiles, symptom severity and cortisol specimens may explain these heterogeneous results. Less severely ill out-patients with a non-melancholic MDE (NM-MDE) may have a variation in the rhythm of cortisol secretion rather than in its concentration.
Cortisol measures were taken (a) over a short-term period (12 h) by measuring daily salivary output using the area under the curve with respect to the ground (AUCg) and (b) over a long-term period (3 months) in hair. Additionally, cortisol reactivity measures in saliva – the cortisol awakening response and the 30 min delta cortisol secretion after awakening (DELTA) – were investigated in 19 patients with a melancholic MDE (M-MDE) and 52 with a NM-MDE, and in 40 matched controls who were recruited from the UK and Chile. Depression severity scores were correlated with different cortisol measures.
The NM-MDE group showed a decreased AUCg in comparison with controls (P = 0.02), but normal cortisol reactivity and long-term cortisol levels. The M-MDE group did not exhibit any significant cortisol alterations nor an association with depression severity scores. Higher Hamilton Rating Scale for Depression score was linked with decreased hair cortisol concentration (HCC, P = 0.05) and higher DELTA (P = 0.04) in NM-MDEs, whereas decreased HCC was the sole alteration associated with out-patients with severe M-MDEs.
The contrasting short- and long-term cortisol output results are compatible with an alteration in the rhythm of cortisol secretion in NM-MDEs. This alteration may consist of large and/or intense episodes of hypercortisolaemia in moderate NM-MDEs and frequent, but brief and sharp early-morning DELTAs in its severe form. These changes may reflect the effects of environmental factors or episodes of nocturnal hypercortisolaemia that were not measured by the short-term samples used in this study.
The purpose of this study was to show any possible differences in relation to the degree of improvement between two groups of patients with borderline personality disorder. The patients of the first group exhibited self-inflicted injury in the past while the second one didn't.
50 patients took part in the study. 13 of them reported self- inflicted injury (group A) while the rest 37 didn't (group B).
All the patients followed a psychotherapeutic program based on a Kernberg model for borderline personality disorders. 10 of them received medication in addition to psychotherapy.
Several variables were examined: sex, age, medication and outcome of treatment.
From the results we noted that:
76% of the patients of group A showed a great or sufficient improvement while from group B, 78,4%.
Also, the patients of the group A who received psychotherapy and some medication and showed great or sufficient improvement were 23%, while those without any medication 53,8%.
In the group B those who received psychotherapy and medicine and showed great or sufficient improvement were 66,7%, while the others without medication 80,6%.
From the results, it seems that the outcome of the treatment, overall, regardless of which of the two therapies for both groups, didn't show any significant difference.
The noted differences between those patients who received only psychotherapy and those who received psychotherapy and medication could be attributed to the fact that the condition of the patients in the first group was more severe than the others.
We reported that the non-specific 5HT agonist m-chlorophenylpiperazine (mCPP) and the SSRI fluoxetine (FLX) both cause acute persistence increases in the rewarded alternation (RA) model of OCD. Chronic pretreatment with either substance or their combined subclinical doses protects from this ‘pathogenic’ effect, so mCPP and fluoxetine exhibit cross-tolerance and synergy.
Using specific 5HT2A and 5HT2C receptor antagonists we investigated whether these receptors participate in a common mechanism of action mediating the acute mCPP/fluoxetine effect in our model.
Naïve, male Wistars were used. Drugs used (intraperitoneally): FLX (10mg/kg), mCPP (2.5mg/kg), M100907 (5HT2A antagonist, 0.03mg/kg), SB242084 (5HT2C antagonist, 0.5mg/kg), vehicle. Experiments included a drug-free training/baseline phase in T-maze RA (group-matching for spontaneous persistence: SP).
Experiment 1: Effects of M100907, SB242084, vehicle were assessed on 3 matched low SP and 3 high SP groups.
Experiment 2: the acute effect of FLX, mCPP and saline were examined on RA in 3 SP-matched groups.
Experiment 3: Effects of Vehicle+FLX, M100900+FLX, SB242084+FLX and Vehicle were examined on RA, in 4 SP-matched groups.
Experiment 4: Correspondingly for mCPP.
Experiment 1: Neither M100907 nor SB242084 affected high or low SP.
Experiment 2 replicated the pathogenic effects of FLX/mCPP.
Experiment 3: Neither M100907 nor SB242084 affected the pathogenic effect of FLX.
Experiment 4: in contrast, SB242084 (but not M100907) significantly reduced the pathogenic mCPP effect.
The acute pathogenic action of mCPP, but not of FLX, involves 5HT2C but not 5HT2A receptors. the similar acute action of mCPP and FLX on persistence cannot be attributed to 5HT2 mediation.
Although postpartum depression (PPD) is a common condition, it often goes undiagnosed and untreated, with devastating consequences for the woman's ability to perform daily activities, to bond with her infant and to relate to the infant's father. Leptin, a protein synthesised in the adipose tissue and involved in regulation of food intake and energy expenditure has been related to depressive disorders, but studies report conflicting results. The aim of this study was to evaluate the association between serum leptin levels at the time of delivery and the subsequent development of postpartum depression in women, using data from a population-based cohort of delivering women in Uppsala, Sweden. Three hundred and sixty five women from which serum was obtained at the time of delivery filled out at least one of three pre-coded questionnaires containing the Edinbourgh Scale for Postnatal Depression (EPDS) five days, six weeks and six months after delivery. Crude mean leptin levels did not significantly differ between cases of PPD and controls. Using linear regression analysis and adjusting for maternal age, body-mass index, smoking, interleukin-6 levels, duration of gestation, gender and birth weight of the newborn, the EPDS scores at five days, six weeks and six months after delivery were negatively correlated with leptin levels at delivery (p< 0.05). Serum leptin levels at delivery were found to be negatively correlated with self reported depression during the first six months after delivery.
In the rewarded alternation model of obsessive compulsive disorder (OCD), the serotonin agonist m-chlorophenylpiperazine (mCPP) increases persistent behaviour, while chronic pretreatment with selective serotonin reuptake inhibitor (SSRI-fluoxetine) but not benzodiazepine or desipramine abolishes mCPP effects. However, we noted that acute SSRI administration also causes transient persistence increases, counteracted by mCPP pretreatment.
a. further explores the apparent cross-tolerance between fluoxetine and mCPP and
b. extends the model by investigating its sensitivity to dopaminergic manipulations (D2,3 agonism - quinpirole).
In both experiments, baseline and drug testing was carried out under daily T-maze alternation training.
Matched group (n=8) pairs of rats received one of the following 20-day pretreatments (daily intraperitoneal administration):
2. low-dose fluoxetine (2.5mg/kg),
3. low-dose mCPP (0.5mg/kg) or
4. combined fluoxetine+mCPP.
One group per pretreatment then received a 4-day challenge with high-dose fluoxetine (10mg/kg), the other with high-dose mCPP (2.5mg/kg).
One group (n=12) of rats received 20-day treatment with saline, another with quinpirole (0.5 mg/kg).
Saline and low-dose mCPP- or fluoxetine-pretreated animals showed significant persistence increases under both challenges, while combined low-dose fluoxetine+mCPP pretreatment afforded full protection from either challenge.
Quinpirole significantly increased directional persistence after 13 administration days.
These results establish the sensitivity of the rewarded alternation OCD model to D2,3receptor activation, thereby extending its profile of pharmacological isomorphism with OCD. Furthermore, they suggest a common mechanism of action of an SSRI and a serotonin agonist in the control of directional persistence.
Stress is a key feature of many aetiological models of psychosis and there is considerable empirical evidence implicating stress in the development of psychosis. This paper investigates the role of psychosocial stress in the onset of psychosis by examining the relationship between current and lifetime exposure to traumatic experiences and psychosocial stressors, HPA axis function, and psychopathology in people at high risk of developing psychosis.
Sixty ‘high risk’ (HR) participants were compared with 50 healthy control (HC) participants on measures of exposure to psychosocial stressors. Subgroups of HR and HC participants which provided saliva samples were compared regarding measures of HPA axis function.
HR participants were exposed to greater levels of psychosocial stress than HC participants. Specifically, HR participants were more likely to have been separated from their parents (p = .003), report severe parental antipathy (p = .011), and have been bullied while growing up (p = .024). HR participants experienced greater levels of perceived stress than HC participants (p = .001) and were more likely to have had a negative life event in the previous 6 months (p < .001). Positive correlations were found between current stress and number of life events and attenuated psychotic symptoms (r = .585, p < .001, and r = .384, p = < .001, respectively) in the HR participants.
This study shows that people at high risk of developing psychosis experience greater levels of psychosocial stress than matched healthy control participants throughout the lifetime, from early childhood to the present day, and that current stress is strongly associated with psychotic symptomatology.
The Mental Health Center of Peristeri was established in 1990 and has gradually developed a range of clinical and therapeutic responses of psychoanalytic orientation. These responses are targeted on the treatment of disorders of DSM-IV Axis I and II and bear an educational, therapeutic and research character. Concerning duration, we follow Gabbard's definition that sets a minimum standard of six months as a condition for regarding psychotherapy as a long-term one. Our work is based primarily on a transference-focused model, as it is defined by Kernberg. The theoretical equipment of our intervention consists mainly of object-relations theory and contemporary Kleinian technique for adult psychotherapy, as well as the theoretical models of post-Kleinian authors, such as Joseph, Ogden and others (Racher, Meltzer and Ferro). Generally, irrespective of the specific psychoanalytic theory adopted (Freud, Klein, Bion, Winnicott), we assume that psychic life is for the most part unconscious. As a result, transference represents the primary source for understanding the patient, while counter-transference provides unique information on patient's intrapsychic life and, generally, on what the patient “places” to others. The main goal of this study is the description of a psychoanalytic intervention model that “absorbs” contemporary psychoanalytic theories, without being technically vague, and responds to a broad spectrum of pathology related to personality dysfunction.
There is evidence of an abnormal antioxidant defence system in schizophrenia. No such evidence exists for bipolar disorder.
To compare plasma antioxidant levels between patients with a relapse of schizophrenia or bipolar disorder (manic episode).
The serum levels of uric acid and bilirubin were assessed in 160 patients with schizophrenia and 41 patients with bipolar disorder, consecutively admitted in an acute psychiatric ward during a 2-year period.
Uric acid plasma levels were lower in patients with schizophrenia compared to bipolar patients (p=0.024), after adjusting for age. This difference was observed in male patients, while no significant difference was noted in females. The two groups did not significantly differ in plasma bilirubin concentrations. In patients with schizophrenia, uric acid concentrations positively correlated with bilirubin levels (Spearman rho=0.205, p=0.012), while no correlation between these two antioxidants was found in bipolar patients.
Our findings suggest that acutely admitted patients with schizophrenia have lower plasma uric acid levels, but do not differ in bilirubin levels compared to bipolar patients.
About two decades ago, “Open Care Centers for Aged Citizens” have been established in Greece. These facilities consider as members everyone older than 65 years and provide social opportunities, entertainment, activities, education and work on artistic objects, as well as basic first degree health care by visitors physicians.
We performed an investigation with Geriatric Depression Scale (GDS 15 and 4) among the members of two such centers in order to examine the probable prevalence of depression in this population. Our sample consisted of 51 persons (38 females and 13 males) with average age 72±5.7 years. Besides the GDS we examined parameters as: marital status, education, known organic (somatic) or mental health problems.
From our results we mention that 23.5% of all (7 females and 5 males) were scored in GDS-15 over 5 and were referred for further psychiatric evaluation about the existence of depression. Only one of them was already diagnosed as depressive before our investigation.
Given that the population of these centers is generally considered as “healthy, active and functional” in comparison with other people of the same age, the above found percentage indicates that we must focus our attention on aged people trying to find out early indications of mental health problems and especially depression.
Schizophrenia and bipolar disorder are both associated with increased levels of serum lipids compared to healthy controls. However, it is not clear whether patients with schizophrenia differ from bipolar patients in terms of serum lipid concentrations and hyperlipidemia rates.
The serum lipid levels of 160 patients with schizophrenia and 41 patients with bipolar disorder (manic episode), consecutively admitted in an acute psychiatric ward during a 2-year period, were assessed.
There was no significant difference in serum cholesterol, high-density lipoproteins, low-density lipoproteins or triglycerides levels between the two groups of patients, after controlling for age. A considerable rate of schizophrenia patients demonstrated high cholesterol levels (>200mg/dl; 45.6%), whereas 15.6% of them had elevated triglyceride levels (>150 mg/dl). In bipolar patients, the rates for both
hypercholesterolemia and hypertriglyceridemia were 29.3%. The above rates did not differ significantly between the two groups of patients.
Acutely hospitalized patients with schizophrenia and bipolar disorder did not differ in serum lipid concentrations and hyperlipidemia rates.
In this research communication we describe an innovative protocol that combines three pairs of primers, two from the literature and one designed in our laboratory, for application in triplex-PCR on somatic cell DNA to enable identification of the species origin (cow, sheep, goat) of cheeses and yogurts with a detection limit of 0.1%. Mislabeling was detected in 15 out of 40 cheeses and in 18 out of 40 yogurts tested. The suggested procedure is a quick and reliable tool for identifying the animal origin of cheeses and yogurts and it can be used to certify product reliability on the domestic and international market. Additionally, in combination with a serological test it can offer a reliable tool for detecting the presence of cow's whey.
To investigate seroprevalence rates of hepatitis B (HBV) and hepatitis C (HCV) virus in an acute psychiatric ward in , Greece.
289 (168 male and 121 female) consecutively admitted psychiatric patients were recruited during a two-year period. Their mean age was 42,5 years (SD:13.8). The most common diagnoses at discharge were schizophrenia or schizoaffective disorder (60%) and mood disorders (24%). Data from patient's charts with respect to HBV and HCV status, liver functions, demographic characteristics, psychiatric history and hospitalization were collected.
59 patients (20.4%) were positive for HBV. 23 patients (8%) had a history of hepatitis C infection. 10 patients (3.5%) were positive for both HBV and HCV. Patients positive for HBV were older (p=0.022) than those without such a diagnosis, but did not differ in terms of the duration of their psychiatric illness. The seroprevalence of HBV was lower in Greek compared with immigrant patients (p=0.02). Substance abuse was associated with testing positive for HCV (p<0.001) but not for HBV. There was no difference in the duration of hospitalization between psychiatric patients testing positive or negative for HBV and HCV.
More than one in four psychiatric patients hospitalized in an acute psychiatric ward were positive for HBV or HCV. The implications of this finding for the psychiatric care of patients with mental disorders in acute psychiatric settings need to be taken into account.
Postpartum depression (PPD), with a prevalence of about 10-15% in developed countries, has a major impact on both mother and child. Personality traits, mainly neuroticism, have been associated with affective disorders and in particular postpartum depression.
To examine if neuroticism is associated with depressive symptoms in pregnancy and post-partum, controlling for possible confounding factors.
Since September 2009, all pregnant women in Uppsala, Sweden have been asked to participate in BASIC study, which is a population based, prospective study on mental health during pregnancy and post-partum. Women filled in the Swedish Scales of Personality (SSP), as well as the Edinburg Postnatal Depression Scale (EPDS) in pregnancy week 32. EPDS was also administered 6 weeks and 6 months postpartum. A factor analysis of SSP traits was conducted in our material and the three factor structure comprising neuroticism, aggressiveness and sensation seeking was confirmed. The association between personality traits and depressive symptoms was examined using binary logistic regression. High levels of neuroticism, aggressiveness and sensation seeking were defined as the highest quartile of each factor.
High levels of neuroticism were strongly associated with depressive symptoms during pregnancy as well as at 6 weeks and 6 months post-partum, while aggressiveness and sensation seeking were not. After controlling for confounding factors, such as previous history of depression, employment, education, partner support and breastfeeding, neuroticism remained a significant predictor for depressive symptoms, at all three time-points.
Neuroticism is an independent strong predictor of depressive symptoms during pregnancy and the postpartum period.
Suicide seasonality with a peak incidence in spring or early summer has been consistently reported. Although a quite robust finding this spring peak of suicides is poorly understood. The effect of climate parameters such as sunlight, temperature, humidity etc. on hormones and neurotransmitters such as serotonin has been hypothesized to explain the seasonal variation in suicide.
To examine the amplitude of suicide seasonality in relation to sunlight duration and serotonergic medication.
By using Swedish Registers we gathered information including forensic data on antidepressive medication for 11,845 suicides during 1992 to 2003. Moreover, data for sunlight duration for the same period for all Swedish counties was obtained from the Swedish Meteorological and Hydrological Institute. The presence of suicide seasonality was estimated with a Poisson regression variant, in three groups, as defined by tertiles of sunlight duration.
In regions with low sunlight duration no statistically significant seasonality pattern was found for men independently of medication. In regions with middle or high sunlight duration an increased amplitude of seasonality was observed among men treated with SSRIs in a dose dependent pattern. Such a pattern was not observed among suicide victims on other antidepressant medication or those without an antidepressant. Women on the other hand showed a seasonal variation in suicide only in regions with low sunlight duration.
Suicide seasonality amplitude increases with higher sunlight duration especially in men treated with SSRIs. In women, the highest suicide seasonality was observed in regions with the lowest sunshine duration.
Anorexia Nervosa (AN) is a serious psychiatric disorder associated with high mortality.
To examine mortality patterns in patients with anorexia nervosa and psychiatric comorbidity.
6009 women who received in-patient treatment for AN between 1973-2003 were followed up retrospectively using Swedish registers. SMR were calculated on the basis of 74 523 person-years for natural causes of death and 80 388 personyears for unnatural causes of death. SMR was calculated for the group as a whole but also for patients with comorbid inpatient-treated psychiatric disorders, defined by respective ICD-codes from the Swedish patient discharge register.
Nearly half of the patients (44.9%) received in-patient treatment for a psychiatric disorder other than AN during the follow-up time. The overall SMR for anorexia nervosa with psychiatric comorbidity was 6.5 (95% CI: 5.2–7.9) for natural causes and 17.6 (95% CI:14.3–21.4) for unnatural causes of death. Comorbid psychiatric disorders yielded very high SMR for unnatural causes of death. The highest SMR for natural causes was estimated for anorexia nervosa with comorbid alcohol use disorder (16.8; 95% CI: 11.7–23.3).
Anorexia nervosa is a disorder with high mortality for natural and unnatural causes of death, especially when psychiatric comorbidity is involved. To correctly diagnose psychiatric comorbidity, particularly alcohol use disorder, and initiate early treatment could be a way to decrease mortality.
Several investigations have shown the influence of environmental factors, i.e. seismic activity on human health. However, no studies have focused on the effect of earthquakes on mental health. Crete is located within a rectangular region at the boundaries of Eurasian and African tectonic plates with high seismicity.
To investigate the effect of seismic activity on mental health.
To explore possible association between seismic activity and rates of hospital admissions of psychotic patients.
We compared the seismic activity (EQs with magnitude M>2) in a geographical area of Crete, and admissions to the Psychiatric Inpatient Unit/ University General Hospital of Heraklion, Crete during the years 2008–2010.
Our analysis showed (1) a very low rate of admissions of psychotic patients suffering from acute psychotic disorders, during the period with several great (M>6.4) and middle (4.5< M< 6.4) magnitude period earthquakes (EQs), (2) an increasing trend of admissions of acute psychotic disorders during a period with increasing number of relatively small EQs(r=0.667; p< 0.001), (3) a correlation between the number of total monthly admissions and the number of M>2 EQs.
It appears that strong EQs have a protective effect on the relapse of major psychiatric disorders, whereas small EQs are associated with an increasing number of relapses. We hypothesized that the beneficial/adverse effects are related to anomalous electric fields/Extra Low Frequency (ELF)-Ultra Low Frequency (ULF) emissions.