Mental illness through the perspective of undergraduate medical students in Greece: a cross-sectional study at Aristotle University of Thessaloniki

Introduction

Numerous studies reveal that mental health-related stigma, stereotypes, and prejudices negatively affect the patients, jeopardizing their health, prognosis, and social opportunities. Healthcare professionals, who are in the first line of combating mental disease, are expected to play a significant role in drastically changing discriminatory and stigmatizing attitudes toward psychiatric patients and in diminishing the existing healthcare and social disparities. In this study, we aimed to explore and highlight the views of Greek medical students-that is of the future physicians-toward mental illness and people suffering from it.

Materials and methods

It is a cross-sectional, observational study, in which 324 undergraduate students from the most populous Greek medical school of the Aristotle University of Thessaloniki, participated online, during the spring semester of 2022. The tools used were the Opinions about Mental Illness Scale (OMI) that assesses one's viewpoints about mental illness, the Social Distance Scale (SDS) that captures the desired degree of social distancing from patients with mental disorders, and the Level of Contact Report (LCR-12) that estimates the level of familiarity with them.

Results

Participants displayed rather positive attitudes regarding the etiology of mental illness, social integration, and discrimination toward psychiatric patients [as evaluated with the respective OMI subscales; Etiology mean score (μ):8.87 ± 4.68, Social Integration (μ):17.79 ± 5.42, Social Discrimination (μ):13.54 ± 11.17], and more clearly favorable opinions concerning the need for social provision or the enactment of restrictive measures [as expressed with the relative OMI subscales; Social Care (μ):22.74 ± 4.56, Social Restriction (μ):13.27 ± 8.98], while claiming to be quite familiar with mental disorders and individuals experiencing them (as assessed with LCR; μ: 8.71 ± 2.16), and relatively willing to interact with them (as measured with SDS; μ:8.95 ± 4.23). Degree of familiarity with mental illness was directly proportional to the desire for contact with patients living with it, while the higher both were, the more improved most of the aforementioned OMI sectors were found to be. Female sex, clinical medical education, previous clinical psychiatric training, and living with or being a person with a mental disorder were the factors that defined a statistically refined profile in many of the aspects above.

Conclusion

Our findings are in accordance with many prior and recent studies, while showing improved opinions compared to those of previous research in Greek student and healthcare population. They are calling for vigilance, rather than complacency, as well as educational and social interventions, in order to enable current and future healthcare professionals to perform their function to its fullest extent. Implications of our results and further research suggestions are included.

Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach

OBJECTIVES

The study examines the clinical determinants of involuntary psychiatric hospitalization. Specifically, it investigates whether distinct clinical profiles of hospitalized patients can be discerned, what other characteristics they are linked with, and which profiles predict involuntary admission.

METHODS

In this cross-sectional multicentre population study, data were collected for 1067 consecutive admissions in all public psychiatric clinics of Thessaloniki, Greece, during 12 months. Through Latent Class Analysis distinct patient clinical profiles were established based on Health of the Nation Outcome Scales ratings. The profiles were then correlated with sociodemographic, other clinical, and treatment-related factors as covariates and admission status as a distal outcome.

RESULTS

Three profiles emerged. The "Disorganized Psychotic Symptoms" profile, combining positive psychotic symptomatology and disorganization, included mainly men, with previous involuntary hospitalizations and poor contact with mental health services and adherence to medication, indicating a deteriorating condition and chronic course. Τhe "Active Psychotic Symptoms" profile included younger persons with positive psychotic symptomatology in the context of normal functioning. The "Depressive Symptoms" profile, characterized by depressed mood coupled with nonaccidental self-injury, included mainly older women in regular contact with mental health professionals and treatment. The first two profiles were associated with involuntary admission and the third with voluntary admission.

CONCLUSIONS

Identifying patient profiles allows the examination of the combined effect of clinical, sociodemographic, and treatment-related characteristics as risk factors for involuntary hospitalization, moving beyond the variable-centered approach mainly adopted to date. The identification of two profiles associated with involuntary admission necessitates the development of interventions tailored to chronic patients and younger persons suffering from psychosis respectively.

Children's anxiety and parenting self-efficacy during the COVID-19-related home confinement

BACKGROUND

The COVID-19 crisis influenced the lives of families and preschoolers, worldwide. School closures and restriction measures introduced distance learning for preschoolers and remote working for parents. Social distancing narrowed opportunities to meet with peers and enjoy leisure activities. Additionally, social and mental services closures limited young children's accessibility to mental, speech and occupational health services. The aim of the current study was to investigate how home confinement during the third wave of the COVID-19 pandemic affected parenting self-efficacy and preschoolers' anxiety.

METHOD

An online survey based on a convenience sample took place on April 2021 to evaluate how home confinement to halt the third wave of COVID-19 pandemic influenced children's anxiety and parenting self-efficacy (PSE). Parents of 146 children (65 girls [44.5%] and 81 boys [55.5%]; aged 2-6 years old) were enrolled and completed a demographics form, the Preschool Anxiety Scale (PAS) and the Tool to Measure Parenting Self-efficacy (TOPSE).

RESULTS

Most of the participants reported that the relationship with their child was positively affected from staying at home. TOPSE mean scores reflected average parenting self-efficacy. PSE was negatively correlated with children's anxiety. COVID-19-related variables 'Parent's vaccine hesitancy' and 'Death of a loved one' had a clear effect on preschoolers' anxiety, whereas the latter also on PSE.

CONCLUSION

Findings highlight the necessity of implementing public health strategies to strengthen families and support parents and their children during the ongoing health crisis.

Primary Sjögren's syndrome presenting with rapidly progressive dementia: a case report

BACKGROUND

Rapidly progressive dementias (RPDs) are dementias that progress subacutely over a time period of weeks to months. Primary Sjögren's syndrome (pSS) is an autoimmune disease that can affect any organ system and may present with a wide range of clinical features that may mimic a plethora of medical conditions and in rare cases may manifest as RPD. We describe a unique case of pSS, in which rapidly progressive dementia (RPD) was the first disease manifestation and the patient's radiological and electroencephalogram findings were compatible with Creutzfeldt-Jakob disease (CJD).

CASE PRESENTATION

Here, we report a 58-year-old woman who presented with cognitive impairment rapidly deteriorating over the last 6 months prior to admission. Brain MRI and EEG were indicative of CJD. However, CSF 14-3-3 and tau/phospho tau ratio were within normal limits and therefore alternative diagnoses were considered. Blood tests were significant for positive antinuclear antibodies, anti-ENA and anti-SSA and a lip biopsy was consistent with pSS. The patient was started on intravenous steroids followed by oral prednisone taper, which prevented further deterioration.

CONCLUSIONS

This rare case expands the spectrum of neurological manifestations in pSS and highlights the importance of considering pSS in the differential diagnosis of RPDs in order to avoid misdiagnosis and provide appropriate treatment in a timely fashion.

Uncertainty, Stress, and Resilience During the COVID-19 Pandemic in Greece

ABSTRACT

The COVID-19 outbreak imposed stress worldwide, as daily routine changed almost overnight, with no time to prepare. A pandemic like this may trigger a chain reaction starting out as surprise, continuing to uncertainty and ending up either in adaptation or in symptoms of fear, anxiety, and/or depression. Resilience on the other hand could lessen anxiety and prove to be a prophylactic coping mechanism against distress. This study explored peritraumatic distress, intolerance of uncertainty (IU), and resilient coping in a sample of 2717 adults who voluntarily and anonymously participated in an online survey conducted in April 2020, in Greece.Results indicated a moderate pandemic-related mental burden and medium resilient coping and designated IU as a significant positive predictor of peritraumatic distress; resilient coping proved to be a significant moderator that alters the strength of the association between IU and distress reactions.

Young adults' coping strategies against loneliness during the COVID-19-related quarantine in Greece

COVID-19 and the related quarantine disrupted young adults' academic and professional life, daily routine and socio-emotional well-being. This cross-sectional study focused on the emotional and behavioural responses of a young adult population during the COVID-19-related quarantine in April 2020, in Greece. The study was conducted through an online survey. A total of 1559 young adults, aged 18-30 years, completed Steele's Social Responsibility Motivation Scale and the De Jong Gierveld Loneliness Scale, and answered questions about compliance with instructions, quarantine-related behaviours and coping strategies. According to the results, participants displayed a relatively high sense of social responsibility (M = 16.09, SD = 2.13) and a trend towards moderate feeling of loneliness (M = 2.65, SD = 1.62); young women reported significantly higher levels of loneliness than men. The majority complied with instructions often (46.4%) or always (44.8%). Significantly more women created a new social media account and used the social media longer than 5 h/day, compared with men. Resorting to religion, practicing sports and sharing thoughts and feelings about COVID-19 with others predicted higher levels of social responsibility; humour, practicing sports and sharing thoughts and feelings about COVID-19 with others predicted lower levels of loneliness. Conclusively, COVID-19 is expected to have a significant psychological impact on young adults. Currently, Greece is going through the second quarantine period. This study raises awareness about loneliness in young adults during the COVID-19-related quarantine and highlights the importance of developing online programmes, attractive to younger people, to nurture adaptive coping strategies against loneliness.

Mental health-related stigma discrimination and prejudices among Greek healthcare professionals

INTRODUCTION

Research shows that mental health-related stigma, stereotypes, and prejudices have a negative impact on the patients themselves as well as on their families and social entourage. Healthcare professionals, whose expertise and professional ethos are historically acknowledged by public opinion, are expected to play a major role in combating discrimination against psychiatric patients. In this study, we aimed to assess the attitudes of Greek healthcare professionals toward mental illness and people suffering from it.

MATERIALS AND METHODS

It is a non-interventional, analytic study, in which 479 health workers from a tertiary hospital in Thessaloniki, Greece, participated. Every single hospital service -except the personnel of the Psychiatric Clinic- was included in our study: from the cleaning service to the administrative staff and the auxiliary staff such as stretcher carriers, food and nutrition services' staff, and social workers, the nursing staff, and finally the attending physicians, taking into consideration that the psychiatric patient, from the moment he/she enters the hospital, consecutively gets in contact with every work grade of the healthcare establishment. Participants' attitudes concerning mental illness have been evaluated using the Opinions about Mental Illness Scale (OMI), the Social Distance Scale (SDS), and the Level of Contact Report (LCR-12).

RESULTS

Despite the high level of familiarity [as evaluated with LCR-12; mean score (μ): 8.82 ± 1.73], the employees displayed a rather poor willingness to interact with psychiatric patients (as measured with SDS; μ:11.68 ± 4.28), and endorsed significant prejudice toward individuals with mental disorders (assessed using OMI subscales; Social Discrimination μ: 22.99 ± 12.08, Social Restriction μ: 17.45 ± 9.07, Social Care μ: 21.04 ± 4.12, Social Integration μ: 16.38 ± 4.68, Etiology μ: 9.80 ± 4.95). Age and education stood out as the main determinants of participants' attitudes, with younger and highly educated participants to have shown a relatively refined profile.

CONCLUSION

These results are not significantly improved compared to those of previous decades in Greek healthcare professionals and call for critical reflection and targeted stigma-reduction efforts.

A systematic review of questionnaires assessing the psychological impact of COVID-19

The COVID-19 pandemic has led to a number of complications in everyday life, greatly affecting public health. Estimating its impact on mental health constitutes a priority issue. The current study aims to summarize the scales that have been specifically developed for this reason and are not adaptations of already existing scales. A comprehensive search was conducted by two reviewers during the period 28/09/2020-30/09-2020 in the following databases: PubMed, ScienceDirect, ScieLo, Mendeley, Google Scholar. A quality appraisal of the identified scales was made by three reviewers using the COSMIN checklist for methodological issues and the Terwee criteria for measurement properties. Our search strategy yielded a total of 855 results. Of these, 832 articles were excluded according to exclusion criteria, 23 were assessed for eligibility and 10 were finally included. These are presented in the text with additional useful information found separately. The identified scales tended to be quite short and examine stress, anxiety or fear. All studies were cross-sectional and the majority was conducted online. Most of them had a good Cronbach value (> 0.80) and adequate fit indices. It is however noted that the evaluation of their quality may be untimely due to relevant lack of data.

A COVID-19 Patient Presenting With Paroxysmal Atrial Fibrillation

The cardiovascular system is influenced in the course of coronavirus disease 2019 (COVID-19); paroxysmal atrial fibrillation (PAF) is not uncommon in hospitalized patients with COVID-19. This is a report of an atypical presentation of a 78-year-old patient who was diagnosed with COVID-19 infection. The patient, in the acute setting, was diagnosed with rapidly deteriorating cardiac failure associated with PAF, respiratory distress, and deteriorating vitals, and was eventually intubated. The mechanisms and preexisting substrates of atrial fibrillation in COVID-19 patients are discussed. A connection between arrhythmia and COVID-19, on the basis of a generalized inflammatory state, is suggested. This particular case adds to the understanding that the occurrence of PAF in COVID-19 patients is consistent with the mechanism of worse outcomes due to systemic inflammation.

Cannabis use in a sample of Aristotle University of Thessaloniki students: a pilot cross-sectional study

BACKGROUND

Cannabis is the most widespread illicit drug among young adults globally. This study aimed to detect the extent of cannabis use in the study population and its impact on users' lives. We hypothesized that early cannabis use would significantly predict later high-risk use.

METHODS

An online cross-sectional study using a self-administered questionnaire was conducted in December 2021, aiming to explore the extent of cannabis use among students and detect changes in behavior and impact on their lives. The results were analyzed statistically and correlated.

RESULTS

Out of the 297 enrolled participants with a mean age of 21.0 ± 2.1 years, 101 (33.9 %) had used cannabis at least once (50 males). The mean age at first cannabis use was 18.5 ± 2.11 years. Over 90 % reported easy access to it. Behavioral changes following use were reported by 41.6 %, but none except one sought help. Age at first cannabis use was negatively correlated with past-month and past-year use. Cannabis use before midday was positively correlated with age on the first try.

DISCUSSION

The prevalence of cannabis use was higher than the European average. Confirming the study's hypothesis, the younger the age at first use, the heavier the past-year and past-month use, which also agrees with previous studies. Cannabis consumption before noon was linked to increased use, and alarmingly, there was reluctance to seek help despite a high proportion of behavioral changes after use.

CONCLUSION

As the legislation on the use of cannabis changes rapidly, and given the increasing popularity of cannabis, there is a need for continued research on how various factors differentially impact its use. HIPPOKRATIA 2021, 25 (4):162-168.

The mediating role of fear of COVID-19 in the relationship between intolerance of uncertainty and depression

OBJECTIVES

Living during the COVID-19 pandemic is characterized by the emergence of great uncertainty surrounding multiple aspects of daily life. This study explored the relationship between intolerance of uncertainty (IU) and depression, as well as the potential mediation effect of COVID-19-related fear.

DESIGN AND METHODS

A cross-sectional study was conducted through an online survey from 10 April until 13 April 2020, three weeks after a national lockdown had been imposed in Greece. The convenience sample used in this study consisted of 2,827 adults. Participants voluntarily provided sociodemographic data and completed the following scales: the Intolerance of Uncertainty Scale (IUS-12), the Fear of COVID-19 Scale (FCV-19S), and the Brief Patient Health Questionnaire (PHQ-9) Depression Scale.

RESULTS

Participants appeared to be moderately depressed [M = 14.75, SD = 4.52]. There was a significant indirect effect of IU to depressive symptoms ((.058), CI (0.051-0.066)). FCV-19S was tested as a mediator in the relationship between IUS-12 (independent variable) and PHQ-9 (dependent variable). Partial mediation of fear of COVID-19 was supported ((.54) (.41) = 13, CI (0.051-0.066), Sobel z-value = 14.93).

CONCLUSIONS

Depressive symptomatology affected study participants at a moderate level. IU was shown to be a significant predictor of depressive symptomatology with higher levels of IU being associated with more severe depressive symptoms. Fear of COVID-19 partially mediated this association. The mediation effect may be explained by the uncertainty around COVID-19-related health issues, which are reflected in the FCV-19S and cause worry and/or anxiety. Uncertainty related with other factors, such as the impact on the economy and education, not assessed by the FCV-19S, may explain part of the relationship between IU and depressive symptoms that is not mediated by FCV-19S.

PRACTITIONER POINTS

Intolerance of uncertainty is related to depressive symptomatology, and fear of COVID-19 explains part of the relation. Fear of COVID-19 indicates worry and anxiety related to health issues. Psychotherapeutic interventions enhancing individuals' capacity to endure uncertainty could be beneficial. Provision of simple and clear information by the authorities should be a priority issue.

COVID-19 vaccine hesitancy in a sample of Greek adults

The ongoing COVID-19 global medical crisis carries a plethora of consequences and various sequelae, of which the most striking is the impact on physical and mental health. After the relaxing of imposed measures in Greece, in May 2020, a cross-sectional web survey based on a convenience sample was conducted exploring the attributions about the COVID-19 pandemic. Respondents were asked to rank their hesitancy to be vaccinated when the COVID-19 vaccine will be available and provided data on gender, age, educational level, professional status, marital status and residential area, as well as a questionnaire exploring COVID-19 attributions.In accordance with relevant studies, the present study confirmed that there is a sizable portion of vaccine-hesitant individuals. Female and less educated participants were more hesitant to get vaccinated. Similar reluctance was identified in participants who strongly believed that the spread of the pandemic is part of a hidden agenda.

Similarities and Differences in the Learning Profiles of Adolescents with SLD and SLI in Mathematics-A Preliminary Analysis

SLI and SLD constitute two independent neurodevelopmental disorders, which frequently cause challenges in the diagnosis process, especially due to their nature. This has caused disagreement among clinicians regarding their recognition as separate or overlapping disorders. The objective of the study was to enlighten the path of valid diagnosis and intervention during adolescence when the two disorders change their manifestation and overlap. Two hundred Greek adolescents (140 boys and 60 girls), 124 already diagnosed with SLD and 76 diagnosed with SLI, 12-16 years old, participated in the study. All participants were assessed in reading, oral and written language and mathematics (mathematical operations and mathematical reasoning) along with IQ testing. In order to determine statistically significant differences, the chi-square test, independent samples t-test, odds ratios and their 95 per cent confidence intervals were implemented. The results revealed that the SLI group presented significantly greater difficulties than SLD in their overall cognitive-mental profile and in most language and mathematical measurements (number concept, executive-procedural part of solving operations and mathematical reasoning). The similarity of the two groups was mainly detected in their deficient metacognitive, metalinguistic and metamnemonic strategies. The research concludes that SLD adolescents managed to overcome their difficulties to a significant degree, while adolescents with SLI still struggle with many learning areas.

A review on the COVID-19-related psychological impact on older adults: vulnerable or not?

BACKGROUND

COVID-19 is a novel event of the twenty-first century. Therefore, contemporary research is required to determine the current pandemic's psychological impact on older populations. Soon after the COVID-19 outbreak, several narrative reviews and guidelines were released to support older adult's psychological wellbeing. However, a lack of data from original studies was reported until May 2020.

AIM

To identify studies published from May 2020 until January 2021 that quantitatively assessed the mental health impact of COVID-19 on older adults using validated psychometric tools.

METHOD

A comprehensive literature search of original research articles was conducted using specific terms. The screening procedure was conducted stepwise.

RESULTS

Among the 18 included studies, cross-sectional online surveys indicated that older adults were less psychologically distressed than younger ones. A longitudinal study revealed that COVID-19 did not have a major impact on loneliness and satisfaction with life. On the contrary, studies comparing pre- with peri-pandemic data revealed that older adults experienced more severe depressive/anxiety/stress symptoms and loneliness during the pandemic. Several studies reported though only subclinical symptoms, as well as low loneliness levels during the pandemic.

CONCLUSIONS

Research studies suggested that older age may buffer against the COVID-19-related impact on mental health. Despite evidence against generalised perceptions of vulnerability, older adults' ability to adapt to adversity may be uneven, depending on cultural, social, economic and other individual factors. Taken together, the impact, moreover the long-term impact of COVID-19, is expected to vary across countries and older subpopulations, and remains to be evaluated by prospective, longitudinal studies.

Clinical Profiles and Socio-Demographic Characteristics of Adults with Specific Learning Disorder in Northern Greece

The manifestation of Specific Learning Disorder (SLD) during adulthood is one of the least examined research areas among the relevant literature. Therefore, the adult population with SLD is considered a "rare" and "unique" population of major scientific interest. The aim of the current study was to investigate, describe, and analyze the clinical, academic, and socio-demographic characteristics, and other everyday functioning life-skills of adults with SLD, in an attempt to shed more light on this limited field of research. The overall sample consisted of 318 adults, who were assessed for possible SLD. The diagnostic procedure included self-report records (clinical interview), psychometric/cognitive, and learning assessments. The main finding of the study was that SLD, even during adulthood, continues to affect the individuals' well-being and functionality in all of their life domains. There is an ongoing struggle of this population to obtain academic qualifications in order to gain vocational rehabilitation, as well as a difficulty to create a family, possibly resulting from their unstable occupational status, their financial insecurity, and the emotional/self-esteem issues they usually encounter, due to their ongoing learning problems. Moreover, the various interpersonal characteristics, the comorbidity issues, and the different developmental backgrounds observed in the clinical, academic, personal, social, and occupational profiles of the participants, highlight the enormous heterogeneity and the continuum that characterizes SLD during adulthood. We conclude that there is an imperative need for further research and the construction of more sufficient tools for the assessment and diagnosis of SLD during adulthood, which will take into account the developmental challenges and milestones in a series of domains, in order to assist this "vulnerable" population with their life struggles.

Psychometric Properties of the Greek Version of FCV-19S

As COVID-19 delivered a devastating blow around Europe, unprecedented mental health issues have arisen. This study outlines the Greek translation and validation of the Fear of COVID-19 Scale (FCV-19S) in the general population. A sample of 3029 Greek-speaking individuals completed the FCV-19S, as part of a large online survey reporting on the aftermath of the coronavirus on the psychological health of Greeks. A total of 2970 participants completed all items without missing values, and their responses were included in the statistical analysis. The confirmatory factor analysis suggested an acceptable model fit. The internal consistency measured by Cronbach's alpha = .87 for the whole scale. All hypothesized correlations were as expected, confirming the construct validity of the scale. The results of the analyses suggest that the psychometric properties of the Greek FCV-19S are sufficient.

Priorities in the Interdisciplinary Approach of Specific Learning Disorders (SLD) in Children with Type I Diabetes Mellitus (T1DM). From Theory to Practice

BACKGROUND

A considerable endeavor had taken place in order to understand the associated challenges for children and adolescents with Specific Learning Disorder (SLD) and Type 1 Diabetes Mellitus (T1DM) but also in order to describe the necessary skills and approaches that the care givers have to develop to assist both children and parents. (1) Aim: The aim of this review is twofold. Firstly, to highlight the T1DM's potential impact on psychological well-being, on cognitive functioning and on school performance in children and adolescents who confront SLD. Secondly, to discuss the necessity of a multidiscipline approach of poor school performance in students with SLD and T1DM, presenting the serious contribution of care providers: (a) parents/carers in the family setting, (b) teachers and psychologists in the school setting and (c) health specialists (pediatricians, nutricians, nurses, child psychiatrists and psychologists) in the medical setting. (2) Methods: In this narrative literature review of 12 selected articles, each one studies a special aspect of approach, during the diagnosis and the treatment of individuals with T1DM and SLD. The review concerns the arising problems and difficulties in the adherence to diagnosis, the management of insulin, the mental and physical wellbeing, the school performance, the cognitive functioning and learning difficulties of patients. We tried to synthesize an interdisciplinary approach that involves collaboration between family, school and medical frame; facilitating children's and adolescents' difficulties management, as well as parent and teacher involvement during the intervention implementation. (3) Results: The main issues of concern were examined through the available literature, as different factors had to be re-examined in the previous studies, regarding the potential impact of T1DM in cognitive and psychological functioning, as well as the effects of the intervention/approach/treatment of children and adolescents with SLD and T1DM. (4) Conclusions: Although T1DM diagnosis and demanding treatment are a heavy burden for children and their families, T1DM may or may not be associated with a variety of academic and psychological outcomes. Despite the variability of the reviewed research design quality, it was clearly defined that the impact of T1DM is not uniform across educational and mental variables. Strengthening the children's physical, psychological and social wellbeing is an especially important factor, as it facilitates the insulin's management as well as the learning difficulties. This is possible by supporting the parental and teacher involvement in the intervention process. This review highlights the need to reduce the distance between theory/research and practice, in some of the proposed areas in this field of knowledge.

School Failure in a Girl with Specific Learning Difficulties, Suffering from Childhood Depression: Interdisciplinary Therapeutic Approach

INTRODUCTION

Recent studies confirm the association of literacy difficulties with higher risk of both childhood behavioral and mental disorders. When co-morbid problems occur, it is likely that each will require separate treatment. The management of major depressive disorder (MDD) for a 9.5 years old girl with specific learning difficulties (SLD), a protracted clinical course, and a family history of affective disorders, was challenging for the interdisciplinary team of our clinic, dealing with learning disabilities.

AIM

The research and examination of the first-onset major depressive disorder (MDD) in a child with specific learning disabilities and its impact on school performance. This case report examines the potential contributory factors, but also the recent evidence on the co-morbidity between literacy difficulties and mental illnesses in children.

METHOD

Reporting a two years follow-up of a 9.5 years old child with SLD suffering from childhood depression.

RESULTS

A 9.5 years old child with no history of affective disorders, but with a family history of first-degree and second-degree relative suffering from childhood-onset, recurrent, bipolar or psychotic depression. The child was assessed by a child psychiatrist during a period of 2 years, with an average of follow-ups between 1 or 2 weeks. The discussion highlights diagnostic and treatment pitfalls, as well as developmental issues. Practical interventions are suggested.

CONCLUSION

A psychiatrically charged familial environment, including a mother suffering from anxiety disorder and behavioral disorder, contribute significantly to the development of depression in early age. An early medical intervention would be the key for successful treatment. The combination of psychotherapy and antidepressants (mostly selective serotonin reuptake inhibitors (SSRIs)) is the suggested therapy for childhood MDD.

Childhood ADHD and Early-Onset Bipolar Disorder Comorbidity: A Case Report

INTRODUCTION

Recent research has highlighted an increased rate of co-morbidity between the neurodevelopmental-behavioral disorder of attention deficit hyperactivity disorder (ADHD) and a variety of psychiatric disorders, such as mood disorders or bipolar disorder (BD). The etiology and clinical course of BD are considered to be determined by both genetic and environmental factors, either aggravating or improving.

AIM

This follow-up study of an adolescent aimed to clarify the co-morbidity between ADHD and BD. We also discuss the controversies surrounding the two diagnoses in younger populations and describe several aspects of concern regarding diagnosis, differential diagnosis, therapeutic planning/intervention, and prognosis.

METHODS

Reporting of a two-year follow-up study of a bipolar 15-year-old female patient with a previous diagnosis of ADHD during childhood.

RESULTS

Despite the occurrence of major risk factors, such as early onset and positive family history, the patient's condition rapidly remitted with medication, without relapse and/or rehospitalization during the following two years, due to the stability of her cooperation, and support of a stable and caring familial environment. Early diagnosis of BD and differential diagnoses of ADHD are considered crucial protective factors leading to an appropriate planning of treatment. In addition, parental involvement and empathic attitude towards the patient supported the latter to cooperate and comply with the treatment, enhancing positive outcomes and stability.

CONCLUSIONS

Research is required into the reliability and validity of diagnostic protocols and criteria for BD in children and adolescents, and also into the development of individualized therapeutic planning.

Mental Health Screening for COVID-19: a Proposed Cutoff Score for the Greek Version of the Fear of COVID-19 Scale (FCV-19S)

The COVID-19 pandemic elicited fear. The Fear of COVID-19 Scale (FCV-19S) is a newly developed self-reported measure, originally developed in Persian to assess COVID-19-related fear. To date, the scale has been translated and validated in 19 other languages, among which Greek. This study, conducted through an online survey, aimed to further explore the validity of the Greek FCV-19S version, as well as to identify appropriate cutoff scores. A total of 538 respondents completed the sociodemographic data sheet, the Generalized Anxiety Disorder 7-item scale, the Short Health Anxiety Inventory, and the Posttraumatic Stress Disorder-8 inventory. According to the results, a cutoff point score of 16.5 or higher revealed a significant predictive power for anxiety, health anxiety, and posttraumatic stress symptoms. Altogether, although the cutoff scores of the Greek FCV-19S version were explored to further evaluate the scale’s validity, they may facilitate discrimination of adults with extreme COVID-19-related fear from those with normal fear reactions.

University students' changes in mental health status and determinants of behavior during the COVID-19 lockdown in Greece

INTRODUCTION

The aim of the study was to investigate mental health in university students in Greece, during lockdown due to COVID-19.

MATERIAL AND METHODS

The data were collected online and anonymously, during lockdown; they included 1104 females (aged 22.08±4,96) and 431 males (aged 22.35±3.11). The analysis included transformation of the data with post-stratification method, descriptive statistics, Chi-square tests, Factorial Analysis of Variance and Relative Risk ratios RESULTS: : The results suggest that during, lockdown major depression was present in 12.43% with 13.46% experiencing severe distress. Risk factors were female sex, history of self-injury, suicidal attempts and following theoretical studies (RR=2-5.71). Conspiracy theories were accepted by 20-68%, with students of theoretical studies manifesting higher rates.

DISCUSSION

The results of the current study confirmed that students are at high risk to develop depression and suicidality in relation to the COVID-19 outbreak. They also identified specific risk factors and pointed to the role of believing in conspiracy theories in copying with stress. They also identified populations with higher prevalence of these beliefs. Further targeted research is necessary as well as targeted intervention in vulnerable groups but concerning mental health as well as the reduction of believing in conspiracy theories.

COVID-19: PTSD symptoms in Greek health care professionals

Objective: The objective of this study was to assess the emergence of posttraumatic stress symptoms (PTSS) in Greek health care professionals during the COVID-19 pandemic. Method: A cross-sectional study was conducted via an online survey from April 10 until April 13, 2020. The survey included sociodemographic questions and the following psychometric tools: the Peritraumatic Distress Inventory, the Posttraumatic Stress Disorder-8 questionnaire, the Brief Patient Health Questionnaire Depression scale, the Athens Insomnia Scale, and 3 questions about negative perceptions of COVID-19. The survey was distributed through social media and comprises part of a larger survey targeting the general population. Altogether, 270 health care professionals responded to the survey. Results: Health care professionals appeared to be moderately stressed from the COVID-19 crisis, with women scoring higher on all clinical scales and the difference between women and men being statistically significant. Criteria for a probable posttraumatic stress disorder diagnosis were met by a total of 16.7% (21.7% of women; 5.1% of men). Negative emotion and threatened or physical tension are positive significant predictors of PTSS. Those suffering with higher levels of PTSS scored positively for insomnia and exhibited significantly higher peritraumatic distress. Conclusion: Health care professionals could benefit by being screened for PTSS and insomnia. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Intolerance of Uncertainty and Loneliness in Older Adults During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic imposed a psychological burden on people worldwide, including fear and anxiety. Older adults are considered more vulnerable during public health emergency crises. Therefore, the aim of the present study was to investigate the psychological response of older adults during the acute phase of the pandemic in Greece.

METHOD

This cross-sectional study was part of a larger three-day online survey. A total of 103 participants over the age of 60 fulfilled inclusion criteria. The survey included sociodemographic questions and six psychometric scales: the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), the Athens Insomnia Scale (AIS), the Intolerance of Uncertainty Scale (IUS-12), and the De Jong Gierveld Loneliness Scale (JGLS).

RESULTS

A significant proportion of the participants reported moderate to severe depressive symptoms (81.6%), moderate to severe anxiety symptoms (84.5%), as well as disrupted sleep (37.9%). Women reported significantly higher levels of COVID-19-related fear, more severe depressive symptoms and sleep disturbances, as well as higher levels of intolerance of uncertainty. Participants living alone showed higher levels of loneliness. Intolerance of uncertainty was shown to modulate levels of loneliness.

CONCLUSIONS

During the quarantine, attention was promptly drawn upon the risks related with older people's loneliness. Studies identifying factors that may contribute to loneliness during a public health emergency facilitate the implementation of supportive interventions. Preparedness to address and manage older people's loneliness may limit this deleterious emotional response during the pandemic, as well as at the post-COVID-19 phase.

Psychological and Behavioral Responses to the COVID-19 Pandemic in Greece

OBJECTIVE

Fear of COVID-19 was associated with more severe depressive and anxiety symptoms. This study aimed to explore COVID-19-related fear, depressive and anxiety symptoms, social responsibility, and behavioral responses during the COVID-19 pandemic in Greece.

METHOD

A cross-sectional study was conducted from April 10 to April 13, 2020. Members of the Greek general population completed anonymously an online survey, distributed through the social media. Among the 3,700 adult respondents, 3,029 fulfilled inclusion criteria. The survey included sociodemographic questions, questions exploring potential risk factors for increased fear of COVID-19, questions about the employment of safety and checking behaviors, and questions about compliance with public health guidelines. In addition, four psychometric scales were used, the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), and Steele's Social Responsibility Motivation scale. Multivariate General Linear Models (GLM) were used to depict significant differences among dependent variables (FCV-19S, PHQ-9, GAD-7) and independent variables (potential risk factors, safety and checking behaviors, compliance with guidelines). The relationship between the FCV-19S total score and influencing factors was quantified by linear regression analysis.

RESULTS

Several participants reported high levels of COVID-19-related fear (35.7%) and moderate to severe depressive symptoms (22.8%), while a significant proportion reported moderate to severe anxiety symptoms (77.4%). Women scored altogether significantly higher than men. Respondents under the age of 30 reported less fear and depressive symptoms and showed the least social responsibility. Based on GLM, a significant other's COVID-19 illness, being on psychiatric medication, employment of safety and checking behaviors, and compliance with guidelines were associated with higher COVID-19-related fear. Linear regression analysis revealed that gender, age, depressive, and anxiety symptoms modified levels of COVID-19-related fear.

CONCLUSIONS

Greater behavioral responses to the pandemic, that is, excessive employment of safety/checking behaviors and greater compliance with guidelines, were shown to amplify fear, potentially due to increased contamination awareness. In addition, female gender, older age, and more severe anxiety symptoms were related with higher COVID-19-related fear. Describing and weighing carefully the psychosocial and behavioral impact of the pandemic will enable the implementation of both supportive and preventive interventions.

Psychopathology, psychosocial factors and sexuality of incarcerated sexual offenders in Greek prison

There are few studies in Greece on sexual offenders. The research aims to contribute knowledge and information related to psychopathology, psychosocial factors and the sexuality of this particular category of convicts for sexual offenses. The search took place in the Greek prison in Grevena, where the largest number of sexual offenders are being held. This is a quantitative study and descriptive and inferential statistical methods were used. The study involved 127 sexual detainees and used the STAI, BDI, EPQ, SCL-90 questionnaires and a special sexual behavior questionnaire. The reliability of the tools was high as the lowest price of Cronbach alpha was equal to 0.733 (STAI) and the highest was 0.975 (SCL-90). The Special Sexual Behavior Questionnaire was 0.877 reliable. RESULTS: The results of the research confirmed the heterogeneity of the population of sexual perpetrators in many categories of data. The importance of some factors such as abuse in childhood, substance use, difficulty in having close relationships, and young delinquent behaviour in the subsequent delinquent evolution of the individual also emerged. Our study did not show particularly high levels of psychopathology except for some elements of anxiety and depression. The results also showed the existence of high transient anxiety, while in the subscales Paranoid Idea and Compulsiveness we had the highest average scores and lower in the subscales Phobic Stress, Aggression and Psychoticism. We had high scores on the scale Neuroticism-Stability and the lowest on the scale Psychoticism-Superego. There were no significant differences between adult and pediatric rapists in terms of differences in stress levels and depression. Sexual perpetrators against minors had higher scores than the dimensions Psychoticism-Superego and Neuroticism-Stability. Minor statistically significant differences in the dimensions Aggression, Anxiety, Paranoid Idea and Neuroticism-Stability were also found. The results show that juvenile delinquency is becoming more serious and violent. Substance users are less likely to sexually abuse a minor. As for the early onset of sexual activity, it appears to be associated with an increased risk of adult rape as well as the fact that the perpetrator's sexual abuse during childhood increases the likelihood that as an adult he or she will harm his or her relatives. In terms of sexual behaviour, incarceration in prison burdened almost all sexual problems of detainees with statistically significant differences in sexual desire and erection problems. There was a universal reduction in the sexual behavior of sexual offenders in prison and a universal reduction in all sexual practices used before imprisonment. Masturbation is the main sexual practice in prison. The main gender of sexual attraction is women despite its significant statistical decline. Statistically, attraction to underage girls has also declined, while homosexual and bisexual tendencies have increased, but there are no statistically significant differences. There was also a significant decrease in the use of pornographic material with adult women and minors, while the use of pornographic material with homosexual content increased. CONCLUSIONS: The investigation of psychopathology, sexual behaviour and those psychosocial factors that characterize and determine the lives of sexual offenders, offers important data and knowledge on which we will rely for the development of therapeutic and preventive programs. Future research on sex offenders should focus on further research on psychopathology and how to think about it, as well as the possibility of using reliable relapse prevention tools to protect society as a whole.

Insomnia during the COVID-19 pandemic in a Greek population

Insomnia is a major health issue associated with great psychological burden. Research of insomnia during a pandemic crisis is limited. The aim of the present study was to explore sleep difficulties during the COVID-19 pandemic in a Greek population. The three-day online survey included questions about sociodemographic characteristics, contact with COVID-19 and COVID-19-related negative attitudes, as well as the Athens Insomnia Scale (AIS), the Intolerance to Uncertainty scale (IUS), the De Jong Gierveld Loneliness scale (JGLS) and the Patient Health Questionnaire-2 (PHQ-2) Depression Scale. Altogether, 2,427 individuals participated in the study (with 2,363 of them providing all basic demographic data). Sleep problems were detected in 37.6% of the participants. Women and people in urban areas were more vulnerable to sleep problems, while younger age showed a non-significant trend. Those uncertain about having themselves, or someone close to them contracted the virus, also demonstrated elevated insomnia scores. Lastly, according to the regression analysis, higher levels of intolerance to uncertainty, COVID-19-related worry, loneliness, as well as more severe depressive symptoms, were all predictive of insomnia. Results may be used for the development of therapeutic strategies and implementation of social policies to support people with sleep difficulties.

Tourette syndrome in an elderly patient

BACKGROUND

Tourette syndrome (TS) is a neurodevelopmental motor disorder. The first diagnosis during adult life involves cases of pre-existing undiagnosed TS.

CASE DESCRIPTION

We present the case of an elderly patient with severe, non-remitted TS, misdiagnosed with "psychoneurosis". The patient was correctly labeled at the age of 82.

CONCLUSION

Despite delays in TS diagnosis, only a few patients remain undiagnosed by the age of 45. Both TS under- and misdiagnosis have an impact on patients' outcomes. HIPPOKRATIA 2019, 23(1): 47-48.

Prevalence of late potentials on signal-averaged ECG in patients with psychiatric disorders

BACKGROUND

Sudden cardiac death (SCD) occurs three times more often in psychiatric patients than in the general population. QRS fragmentation (QRSfr) and signal-averaged electrocardiography (SAECG) are simple, inexpensive, readily available tools for detecting the presence of abnormal depolarization and late potentials (LPs) in these patients, a result of either the underlying disease or treatment.

METHODS

Frequency of LP detection by SAECG and QRSfr was studied in 52 psychiatric patients and compared with 30 healthy (without known structural heart disease or occurrence of ventricular arrhythmia) controls. Patients were then prospectively followed up and incidence of SCD was recorded.

RESULTS

LP prevalence was significantly higher in patients than in controls (16/52-31% vs 2/30-7%, p=0.012), while QRSfr was similar between these two groups (p=0.09). Of the LP presence criteria, the root mean square value at terminal 40msec of the QRS (RMS40) was significantly lower in patients (32μV, SD=19μV, vs 46μV, SD=32μV, p=0.015). Among patients, no differences were noted between the LP positive and negative groups regarding age, sex, number of medications, class of antipsychotics and defined daily doses. Mean follow-up was 46months (SD=11) and during it 3 patients suffered SCD. Although 2 SCD victims had both LPs and QRSfr concurrently present, neither of them, nor their simultaneous presence could definitely account for the events.

CONCLUSIONS

LP prevalence in psychiatric patients was significantly higher than in controls. SAECG performance was feasible in all cases and constitutes a readily available tool for assessing myocardial electrophysiological alterations in this patient group.

Growth and membrane fluidity of food-borne pathogen Listeria monocytogenes in the presence of weak acid preservatives and hydrochloric acid

This study addresses a major issue in microbial food safety, the elucidation of correlations between acid stress and changes in membrane fluidity of the pathogen Listeria monocytogenes. In order to assess the possible role that membrane fluidity changes play in L. monocytogenes tolerance to antimicrobial acids (acetic, lactic, hydrochloric acid at low pH or benzoic acid at neutral pH), the growth of the bacterium and the gel-to-liquid crystalline transition temperature point (T m) of cellular lipids of each adapted culture was measured and compared with unexposed cells. The T m of extracted lipids was measured by differential scanning calorimetry. A trend of increasing T m values but not of equal extent was observed upon acid tolerance for all samples and this increase is not directly proportional to each acid antibacterial action. The smallest increase in T m value was observed in the presence of lactic acid, which presented the highest antibacterial action. In the presence of acids with high antibacterial action such as acetic, hydrochloric acid or low antibacterial action such as benzoic acid, increased T m values were measured. The T m changes of lipids were also correlated with our previous data about fatty acid changes to acid adaptation. The results imply that the fatty acid changes are not the sole adaptation mechanism for decreased membrane fluidity (increased T m). Therefore, this study indicates the importance of conducting an in-depth structural study on how acids commonly used in food systems affect the composition of individual cellular membrane lipid molecules.

Alteration of the phospho- or neutral lipid content and fatty acid composition in Listeria monocytogenes due to acid adaptation mechanisms for hydrochloric, acetic and lactic acids at pH 5.5 or benzoic acid at neutral pH

This study provides a first approach to observe the effects on Listeria monocytogenes of cellular exposure to acid stress at low or neutral pH, notably how phospho- or neutral lipids are involved in this mechanism, besides the fatty acid profile alteration. A thorough investigation of the composition of polar and neutral lipids from L. monocytogenes grown at pH 5.5 in presence of hydrochloric, acetic and lactic acids, or at neutral pH 7.3 in presence of benzoic acid, is described relative to cells grown in acid-free medium. The results showed that only low pH values enhance the antimicrobial activity of an acid. We suggest that, irrespective of pH, the acid adaptation response will lead to a similar alteration in fatty acid composition [decreasing the ratio of branched chain/saturated straight fatty acids of total lipids], mainly originating from the neutral lipid class of adapted cultures. Acid adaptation in L. monocytogenes was correlated with a decrease in total lipid phosphorus and, with the exception of cells adapted to benzoic acid, this change in the amount of phosphorus reflected a higher content of the neutral lipid class. Upon acetic or benzoic acid stress the lipid phosphorus proportion was analysed in the main phospholipids present: cardiolipin, phosphatidylglycerol, phosphoaminolipid and phosphatidylinositol. Interestingly only benzoic acid had a dramatic effect on the relative quantities of these four phospholipids.

Factors affecting hospital length of stay: is substance use disorder one of them? A study in a Greek public psychiatric hospital

Comorbidity of psychiatric disorder and substance use disorder (SUD) is very common. Clinical experience says that comorbidity increases inpatient length of stay. We aimed to discover which factors affect length of stay for inpatients at a psychiatric department in a specialized mental hospital in a Greek urban area, and specifically whether SUD is one of them. All patients admitted over a 12-month period were given the CAGE questionnaire and that part of the EUROPASI questionnaire dealing with substance use. This was followed by a diagnostic interview to establish the final diagnosis in accordance with the DSM-IV criteria. Following this, the patients' characteristics in conjunction with their average length of stay were all evaluated statistically. A total of 313 patients were assessed. Present substance use disorder was identified in 102 individuals (32.6%). The principal substances involved in addiction or abuse were alcohol, cannabis, benzodiazepines, and opiates. Patients differed as to their cooperation with the medication regime. On the other hand, there was no statistical difference regarding the number of hospitalisations. Psychopathology was not found to play a direct role, as no one diagnosis correlated with length of stay. The factors found to affect length of stay in this psychiatric department were the length of time they had been mentally ill and cooperation in taking medication. It appears that SUD is not one of the factors affecting length of stay.

Delusional disorder and alcohol abuse in a patient with Wilson's disease

OBJECTIVE

Wilson's 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.

Psychosocial impacts of infertility on Greek couples

Psychosocial impacts of infertility were investigated in couples undergoing different treatment procedures in our clinic. Couples were interviewed in a semi-structured way by a psychologist or a psychiatrist and responded to three specially structured questionnaires: the Life Events Scale, the Marlowe-Crowne/Taylor Scale and the Side Effect Checklist. The data were analysed in terms of demographic characteristics as well as treatment procedure. The psychosocial, psychosexual and emotional outcomes of their infertility problem and Greek traditional culture laws are discussed. Stress has been identified in both sexes, depression mostly in women, while men showed a tendency towards repressed anxiety and thus a greater risk of psychosomatic illness, a finding supported by their response to the Side Effect Checklist. Women showed a high defensive anxiety and also reported numerous psychosomatic symptoms. These couples seem to have special needs and fears, both general and treatment specific. Very few of our couples would be considered as severely emotionally disturbed. Women seem to have more difficulties in social adjustment. Sexual dysfunction was reported by almost half of our subjects, although this was associated with a degree of deterioration in their marriage. Guilt feelings, particularly connected with previous abortions, seem to be torturing most women. Finally, both partners seem to have psychological problems irrespective of the one in whom the aetiological problem was found. Moreover, traditional rules seem to impose a special burden on people coming from rural areas. Our results strongly support the belief that infertile couples undergoing different treatments need psychological counselling and supportive psychotherapy.