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Pross B, Strube W, Papazova I, Güler D, Häckert J, Keeser D, Padberg F, Siamouli M, Falkai P, Hasan A. Anodal transcranial direct current stimulation sustainably increases
EEG
alpha activity in patients with schizophrenia. Neuropsychopharmacol Rep 2022; 42:323-332. [PMID: 35716122 PMCID: PMC9515721 DOI: 10.1002/npr2.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/20/2022] Open
Abstract
Aims Transcranial direct current stimulation (tDCS) applied to the prefrontal cortex has been frequently used to elicit behavioral changes in patients with schizophrenia. However, the interaction between prefrontal tDCS and electrophysiological changes remains largely uncharted. The present study aimed to investigate cortical electrophysiological changes induced by tDCS in frontal areas by means of repeated electroencephalography (EEG) in patients with schizophrenia. Methods In total, 20 patients with schizophrenia received 13 minutes of anodal tDCS (1 mA) applied to the left dorsolateral prefrontal cortex (DLPFC). Repeated resting EEG was recorded before (once) and following (at five follow‐up time‐bins) tDCS to trace post‐tDCS effects. We used sLORETA for source reconstruction to preserve the localization of brain signals with a low variance and to analyze frequency changes. Results We observed significant changes after the stimulation in areas highly connected with the stimulated DLPFC areas. The alpha 1 (8.5‐10.0 Hz) activity showed a highly significant, long‐lasting, increase for up to 1 hour after the stimulation in the postcentral gyrus (Brodmann area 2, 3, and 40). Significant yet unstable changes were also seen in the alpha‐2 frequency band precentral at 10 minutes, in the beta‐1 frequency band occipital at 20 minutes, and in the beta‐3 frequency band temporal at 40 minutes. Conclusion We were able to show that anodal tDCS can induce stable EEG changes in patients with schizophrenia. The results underline the potential of tDCS to induce long‐lasting neurophysiological changes in patients with schizophrenia showing the possibility to induce brain excitability changes in this population.
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Affiliation(s)
- Benjamin Pross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty University of Augsburg, BKH Augsburg Augsburg Germany
- Department of Psychiatry and Psychotherapy LMU University Hospital Munich Germany
| | - Wolfgang Strube
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty University of Augsburg, BKH Augsburg Augsburg Germany
| | - Irina Papazova
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty University of Augsburg, BKH Augsburg Augsburg Germany
| | - Duygu Güler
- Department of Psychiatry and Psychotherapy LMU University Hospital Munich Germany
| | - Jan Häckert
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty University of Augsburg, BKH Augsburg Augsburg Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy LMU University Hospital Munich Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy LMU University Hospital Munich Germany
| | - Melina Siamouli
- 3rd Department of Psychiatry, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy LMU University Hospital Munich Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty University of Augsburg, BKH Augsburg Augsburg Germany
- Department of Psychiatry and Psychotherapy LMU University Hospital Munich Germany
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Fountoulakis KN, Gonda X, Siamouli M, Panagiotidis P, Moutou K, Nimatoudis I, Kasper S. A case-control study of paternal and maternal age as risk factors in mood disorders. Int J Psychiatry Clin Pract 2019; 23:90-98. [PMID: 30880518 DOI: 10.1080/13651501.2018.1519079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Advanced parental age might constitute a risk factor for various disorders. We tested whether this concerns also mood disorder patients. Methods: The study included 314 subjects (42 bipolar-BD patients; 21 manics and 21 depressives, 68 unipolar-UD, and 204 normal controls-NC). Analysis of Covariance (ANCOVA) and the calculation of the Relative Risk (RR) and the Odds Ratio (OR) were used for the analysis. Results: Paternal age differed between NC and UD patients (29.42 ± 6.07 vs. 32.12 ± 5.54; p = .01) and manics (29.42 ± 6.07 vs. 35.00 ± 5.75; p = .001) and maternal age between NC and manics (25.46 ± 4.52 vs. 31.43 ± 4.75; p < .001) and manic and UD (31.43 ± 4.75 vs. 26.75 ± 6.03; p = .002). The RR and OR values suggested that advanced parental age constitutes a risk factor for the development of mood disorders. Conclusions: In a non-dose dependent and gender-independent, advanced parental age constitutes a risk factor for the development of BD with index episode of mania (probably manic predominant polarity); only advanced paternal age constitutes a risk factor for the development of UD and BD with index episode of depression (probably depressive predominant polarity). This is the first study suggesting differential effect of advanced parental age depending on predominant polarity of BD.
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Affiliation(s)
- Konstantinos N Fountoulakis
- a 3rd Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Xenia Gonda
- b Department of Psychiatry and Psychotherapy , Semmelweis University , Budapest , Hungary
| | - Melina Siamouli
- a 3rd Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Panagiotis Panagiotidis
- a 3rd Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | | | - Ioannis Nimatoudis
- a 3rd Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Siegfried Kasper
- d Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien , Vienna , Austria
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Fountoulakis KN, Gonda X, Siamouli M, Panagiotidis P, Moutou K, Nimatoudis I, Kasper S. Paternal and maternal age as risk factors for schizophrenia: a case-control study. Int J Psychiatry Clin Pract 2018; 22:170-176. [PMID: 29069946 DOI: 10.1080/13651501.2017.1391292] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Advanced parental age might constitute a generic risk factor for mental and somatic disorders. The current study tested whether this concerns also patients with schizophrenia. METHODS A total of 231 schizophrenic, 56 other severe mental disorders patients and 204 controls were diagnosed according to DSM-IV-TR. Data were tested with ANOVA models including relative risk and odds ratios. RESULTS Patients with schizophrenia manifested higher paternal (32.55 ± 6.35 vs. 29.42 ± 6.07, p < .001) and maternal age (27.66 ± 5.57 vs. 25.46 ± 4.52, p < .001). Patients with other mental disorders had higher paternal (33.29 ± 8.35; p = .001) but not maternal age (26.69 ± 5.89; p = .296) compared to controls. There was no difference between the two patient groups concerning either paternal or maternal age (p > .05). There seems to be a higher risk for the development of schizophrenia in offspring with paternal age above 25 years and maternal age above 22 years at delivery. CONCLUSIONS The current study provides further support for the suggestion that advanced paternal age constitutes a risk factor (in a non-dose dependent and gender-independent way) for the development of schizophrenia but also for other mental disorders. In contrast, advanced maternal age characterises schizophrenia specifically. The higher risk is evident after 25 years of paternal and 22 years of maternal age, respectively.
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Affiliation(s)
- Konstantinos N Fountoulakis
- a Third Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Xenia Gonda
- b Department of Psychiatry and Psychotherapy , Semmelweis University , Budapest , Hungary.,c MTA-SE Neuropsychopharmacology and Neurochemistry Research Group , Hungarian Academy of Sciences, Semmelweis University , Budapest , Hungary
| | - Melina Siamouli
- a Third Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Panagiotis Panagiotidis
- a Third Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | | | - Ioannis Nimatoudis
- a Third Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Siegfried Kasper
- e Universitätsklinik für Psychiatrie und Psychotherapie , Medizinische Universität , Vienna , Austria
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N. Fountoulakis K, Popovic D, Mosheva M, Siamouli M, Moutou K, Gonda X. MOOD SYMPTOMS IN STABILIZED PATIENTS WITH SCHIZOPHRENIA: A BIPOLAR TYPE WITH PREDOMINANT PSYCHOTIC FEATURES? Psychiat Danub 2017. [DOI: 10.24869/psyd.2017.148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fountoulakis KN, Gonda X, Siamouli M, Moutou K, Nitsa Z, Leonard BE, Kasper S. Higher than recommended dosages of antipsychotics in male patients with schizophrenia are associated with increased depression but no major neurocognitive side effects: Results of a cross-sectional pilot naturalistic study. Prog Neuropsychopharmacol Biol Psychiatry 2017; 75:113-119. [PMID: 28137432 DOI: 10.1016/j.pnpbp.2017.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/27/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The current small pilot naturalistic cross-sectional study assesses whether higher dosages of antipsychotics are related to a satisfactory outcome concerning symptoms of schizophrenia but also to a worse outcome in terms of adverse events and neurocognitive function. MATERIAL AND METHODS 41 male stabilized hospitalized schizophrenic patients were assessed by PANSS, Calgary Depression Rating Scale, UKU and Simpson-Angus Scale and a battery of neurocognitive tests. Medication and dosage was prescribed according to clinical judgement of the therapist. RESULTS Clinical variables and adverse events did not differ between patients in the recommended vs high dosage groups. Higher dosage correlated with depressive symptoms but there was no correlation with neurocognitive measures except for impaired concentration. DISCUSSION Results suggest that it is possible to achieve a good clinical response in refractory patients by exceeding recommended antipsychotic dosages at the price of depression and possible mild isolated concentration deficits but not other neurocognitive or extrapyramidal adverse events. Currently clinicians prefer first-generation antipsychotics when high dosages are prescribed, but considering the more favorable adverse effects profile of newer agents, it is important to study higher dosages of these agents and to test whether they should be preferably given when high dosages are necessary.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, University Hospital AHEPA, 1 Kyriakidi Street, 54636 Thessaloniki, Greece.
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Kútvölgyi út 4, 1125 Budapest, Hungary; Department of Pharmacodyamics, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary.
| | - Melina Siamouli
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, University Hospital AHEPA, 1 Kyriakidi Street, 54636 Thessaloniki, Greece.
| | - Katerina Moutou
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, University Hospital AHEPA, 1 Kyriakidi Street, 54636 Thessaloniki, Greece.
| | - Zoe Nitsa
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, University Hospital AHEPA, 1 Kyriakidi Street, 54636 Thessaloniki, Greece.
| | - Brian E Leonard
- National University of Ireland, Galway, University Road, Galway, Ireland.
| | - Siegfried Kasper
- Universitätsklinik für Psychiatrie und Psychotherapie Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Dragioti E, Wiklund T, Siamouli M, Moutou K, Fountoulakis KN. Could PANSS be a useful tool in the determining of the stages of schizophrenia? A clinically operational approach. J Psychiatr Res 2017; 86:66-72. [PMID: 27940386 DOI: 10.1016/j.jpsychires.2016.11.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/31/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022]
Abstract
Staging in schizophrenia might be an important approach for the better treatment and rehabilitation of patients. The purpose of this study was to empirically devise a staging approach in a sample of stabilized patients with schizophrenia. One hundred and seventy patients aged ≥18 years (mean = 40.7, SD = 11.6) diagnosed by DSM-5 criteria were evaluated with the Positive and Negative Syndrome Scale (PANSS). Principal components analysis (PCA) with varimax rotation was used. The model was examined in the total sample and separately across a hypothesized stage of illness based on three age groups and between the two sexes. The PCA revealed a six factor structure for the total sample: 1) Negative, 2) Positive, 3) Depression and anxiety, 4) Excitement and Hostility, 5) Neurocognition and 6) Disorganization. The separate PCAs by stage of illness and sex revealed different patterns and quality of symptomatology. The Negative and Positive factors were stable across all examined groups. The models corresponding to different stages differed mainly in terms of neurocognition and disorganization and their interplay. Catatonic features appear more prominent in males while in females neurocognition takes two forms; one with disorganization and one with stereotype thinking with delusions. This study suggests that the three arbitrary defined stages of illness (on the basis of age) seem to reflect a progress from a preserved insight and more coherent mental functioning to disorganization and eventually neurocognitive impairment. Sexes differ in terms of the relationship of psychotic features with neurocognition. These results might have significant research and clinical implications.
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Affiliation(s)
- Elena Dragioti
- Pain and Rehabilitation Centre, and Rehabilitation Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Tobias Wiklund
- Pain and Rehabilitation Centre, and Rehabilitation Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Melina Siamouli
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Moutou
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Fountoulakis KN, Rozsa S, Siamouli M, Moutou K, Pantoula E, Cloninger CR. Standardization and normative data of the Greek version of the temperament and character inventory (TCI). Ann Gen Psychiatry 2015; 14:28. [PMID: 26396587 PMCID: PMC4578673 DOI: 10.1186/s12991-015-0067-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/11/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Robert Cloninger's psychobiological model of temperament and character is a dimensional approach to personality assessment and gave birth to the temperament and character inventory (TCI). The aim of the present report is to examine the psychometric properties of the Greek version of the TCI, and to replicate its postulated structure and provide preliminary normative data for the Greek population. METHODS The study sample included 734 subjects from the general Greek population (436 females; 59.4 % and 298 males; 40.6 %). Their mean age was 40.80 ± 11.48 years (range 25-67 years). The mean age for females was 39.43 ± 10.87 years (range 25-65 years), while the mean age for males was 42.82 ± 12.06 years (range 25-67 years). Descriptive statistics tables concerning age, gender and occupational status distribution in the sample were created. The analysis included the calculation of Cronbach's alpha, factor analysis with promax rotation and the calculation of Pearson correlation coefficients between the subscales scores. Analysis of Covariance with age as covariate and t test and Cohen's d as post hoc tests was used to search for differences in subscales scores between males and females. RESULTS The overall psychometric properties of the Greek version of the TCI proved to be satisfactory, with acceptable consistencies of the subscales. The factor analysis of temperament identified four factors which together explained 58.56 % of total variance, while the factor analysis of the three-factor solution of the character explained 52.24 % of total variance. The TCI scales correlate significantly but weakly between each other and with age. DISCUSSION The Greek version of the TCI exhibits psychometric properties similar to its original English counterpart and to other national translations and it is suitable for use in research and clinical practice.
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Affiliation(s)
| | - Sandor Rozsa
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Melina Siamouli
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, Thessalonikis, Greece
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Fountoulakis KN, Siamouli M, Magiria M, Pantoula E, Moutou K, Kemeridou M, Mavridou E, Panagiotidis P, Loli E, Batsiari E, Preti A, Tondo L, Gonda X, Rihmer Z, Akiskal K, Akiskal H. Standardization of the TEMPS-A in the Greek general population. J Affect Disord 2014; 158:19-29. [PMID: 24655761 DOI: 10.1016/j.jad.2013.12.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/21/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The current study evaluates the reliability and factor-structure replicability of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in its Greek Version. METHODS The TEMPS-A was administered to a convenient sample of 734 subjects from the general Greek population (436 females; 59.4% and 298 males; 40.6%). Their mean age was 40.80±11.48 years (range 25-67 years). The analysis included the calculation of Chronbach's alpha, the calculation of the threshold to define dominant temperaments (+2 standard deviations or 95th percentile), confirmatory factor analysis and the calculation of Pearson correlation coefficients between the temperament scales scores. Analysis of Covariance with age as covariate and post-hoc t-test was used to search for differences in temperament scores between males and females. Also a table of percentile values corresponding to a raw score was created. RESULTS Internal consistency was excellent for the various temperaments (0.72-0.88). The factor analysis confirmed the five factor solution as the best factor solution. All TEMPS items were included in the final version of the scale in the Greek language. LIMITATIONS The study sample included subjects from the general population, but it is a convenient and not representative sample. Although the authors tried to select them on the basis of being mentally healthy and without a psychiatric history, there is always a degree of uncertainty. There is also always the possibility some of them to manifest a mental disorder in the future, thus being currently in a premorbid state. CONCLUSION The Greek version of the TEMPS-A, has good internal consistency and factor structure similar to what was found in other translations. Overall our results are in accord with the literature and in line with theoretical considerations as well as with empirical evidence.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Pylaia, Thessaloniki 55535, Greece.
| | - Melina Siamouli
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Pylaia, Thessaloniki 55535, Greece
| | - Matina Magiria
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Pylaia, Thessaloniki 55535, Greece
| | | | | | | | | | | | - Efimia Loli
- Resident in Psychiatry, Mental Health Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Antonio Preti
- Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Italy; Centro Medico Genneruxi, Cagliari, Italy
| | - Leonardo Tondo
- Mood Center Lucio Bini, Cagliari and Rome, Italy; McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Xenia Gonda
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Zoltan Rihmer
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Kareen Akiskal
- International Mood Disorders Center, University of California at San Diego, CA, USA
| | - Hagop Akiskal
- International Mood Disorders Center, University of California at San Diego, CA, USA
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Abstract
During the last decade a number of meta-analytic studies have been published and they triggered a debate on the true clinical usefulness of antidepressants. The current article comments on problems within the randomized controlled trials design, the study samples, the psychometric scales, the methods of meta-analysis, the interpretation of the results, and the reporting of conflicts of interest. Although the meta-analyses published so far agree that medication works in severe depression, they question its efficacy in mild cases. However, several methodological issues should be clarified before conclusions are definite. Different methods give different results and similar results seem to entertain a variety of interpretations. In the future it is important to address all of these problems, and to improve methodology on the basis of clinically informed choices. Otherwise, meta-analysis risks alienation from clinical reality and thus risks becoming the 21(st) century psychoanalysis.
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Fountoulakis KN, Siamouli M, Moysidou S, Pantoula E, Moutou K, Panagiotidis P, Kemeridou M, Mavridou E, Loli E, Batsiari E, Preti A, Tondo L, Gonda X, Mobayed N, Akiskal K, Akiskal H, Costa P, McCrae R. Standardization of the NEO-PI-3 in the Greek general population. Ann Gen Psychiatry 2014; 13:36. [PMID: 25505930 PMCID: PMC4263201 DOI: 10.1186/s12991-014-0036-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The revised NEO Personality Inventory (NEO-PI-3) includes 240 items corresponding to the Big Five personality traits (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience) and subordinate dimensions (facets). It is suitable for use with adolescents and adults (12 years or older). The aim of the current study was to validate the Greek translation of the NEO-PI-3 in the general Greek population. MATERIAL AND METHODS The study sample included 734 subjects from the general Greek population of whom 59.4% were females and 40.6% males aged 40.80 ± 11.48. The NEO-PI-3 was translated into Greek and back-translated into English, and the accuracy of the translation was confirmed and established. The statistical analysis included descriptive statistics, confirmatory factorial analysis (CFA), the calculation of Cronbach's alpha, and the calculation of Pearson product-moment correlations. Sociodemographics groups were compared by ANOVA. RESULTS Most facets had Cronbach's alpha above 0.60. Confirmatory factor analysis showed acceptable loading of the facets on their own hypothesized factors and very good estimations of Cronbach's alphas for the hypothesized factors, so it was partially supportive of the five-factor structure of the NEO-PI-3.The factors extracted with Procrustes rotation analysis can be considered reasonably homologous to the factors of the American normative sample. Correlations between dimensions were as expected and similar to those reported in the literature. DISCUSSION The literature suggests that overall, the psychometric properties of NEO-PI-3 scales have been found to generalize across ages, cultures, and methods of measurement. In accord with this, the results of the current study confirm the reliability of the Greek translation and adaptation of the NEO-PI-3. The inventory has comparable psychometric properties in its Greek version in comparison to the original and other national translations, and it is suitable for clinical as well as research use.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Melina Siamouli
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefania Moysidou
- Research associate Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleonora Pantoula
- Research associate Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Moutou
- Research associate Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Marina Kemeridou
- Research associate Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Mavridou
- Research associate Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efimia Loli
- Mental Health Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Antonio Preti
- Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Italy, and Centro Medico Genneruxi, Cagliari, Italy
| | - Leonardo Tondo
- Mood Center LucioBini, Cagliari and Rome, Italy ; McLean Hospital, Harvard Medical School, Boston, USA
| | - Xenia Gonda
- Department of Clinical and Theoretical Mental Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Nisreen Mobayed
- Department of Psychiatry, University of California, San Diego, California USA
| | | | - Hagop Akiskal
- International Mood Center, University of California, San Diego, CA USA
| | - Paul Costa
- Laboratory of Behavioral Neuroscience Biomedical Research Center, Baltimore, MD USA
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Fountoulakis KN, Veroniki AA, Siamouli M, Möller HJ. No role for initial severity on the efficacy of antidepressants: results of a multi-meta-analysis. Ann Gen Psychiatry 2013; 12:26. [PMID: 23941527 PMCID: PMC3751863 DOI: 10.1186/1744-859x-12-26] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/08/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION During the last decade, a number of meta-analyses questioned the clinically relevant efficacy of antidepressants. Part of the debate concerned the method used in each of these meta-analyses as well as the quality of the data set. MATERIALS AND METHODS The Kirsch data set was analysed with a number of different methods, and eight key questions were tackled. We fit random effects models in both Bayesian and frequentist statistical frameworks using raw mean difference and standardised mean difference scales. We also compare between-study heterogeneity estimates and produce treatment rank probabilities for all antidepressants. The role of the initial severity is further examined using meta-regression methods. RESULTS The results suggest that antidepressants have a standardised effect size equal to 0.34 which is lower but comparable to the effect of antipsychotics in schizophrenia and acute mania. The raw HDRS difference from placebo is 2.82 with the value of 3 included in the confidence interval (2.21-3.44). No role of initial severity was found after partially controlling for the effect of structural (mathematical) coupling. Although data are not definite, even after controlling for baseline severity, there is a strong possibility that venlafaxine is superior to fluoxetine, with the other two agents positioned in the middle. The decrease in the difference between the agent and placebo in more recent studies in comparison to older ones is attributed to baseline severity alone. DISCUSSION The results reported here conclude the debate on the efficacy of antidepressants and suggest that antidepressants are clearly superior to placebo. They also suggest that baseline severity cannot be utilized to dictate whether the treatment should include medication or not. Suggestions like this, proposed by guidelines or institutions (e.g. the NICE), should be considered mistaken.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6, Odysseos str (1st Parodos Ampelonon str,), Pylaia, Thessaloniki 55535, Greece.
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Fountoulakis KN, Savopoulos C, Siamouli M, Zaggelidou E, Mageiria S, Iacovides A, Hatzitolios AI. Trends in suicidality amid the economic crisis in Greece. Eur Arch Psychiatry Clin Neurosci 2013; 263:441-4. [PMID: 23223905 DOI: 10.1007/s00406-012-0385-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 11/15/2012] [Indexed: 11/30/2022]
Abstract
For the decade 2000-2010, suicidal rates appear to be both low and stable in Greece and unrelated to the socioeconomic environment. It is highly possible that the recent crisis caused a significant increase in dysphoria, stress, depression and maybe suicidal ideation in the general population, but completed suicides do not seem to have increased so far. Measures are needed to make sure there will be no increase in completed suicides in the near future, since historically, periods of socioeconomic instability might be related to increased suicidality. Community interventions reduce stigma and enhance help-seeking. However, only those including the creation of social support networks are essential in the fight against suicidality.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Gonda X, Fountoulakis KN, Csukly G, Dome P, Sarchiapone M, Laszik A, Bedi K, Juhasz G, Siamouli M, Rudisch T, Molnar E, Pap D, Bagdy G, Rihmer Z. Star-crossed? The association of the 5-HTTLPR s allele with season of birth in a healthy female population, and possible consequences for temperament, depression and suicide. J Affect Disord 2012; 143:75-83. [PMID: 22840619 DOI: 10.1016/j.jad.2012.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/29/2012] [Accepted: 05/29/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Birth season has well-known effects on neuropsychiatric disorders, and may also influence genotype distribution by possibly influencing chance of conception via parental idiosyncratic conception patterns or survival of foetuses or infants. The 5-HTTLPR is associated with phenomena including affective temperaments or suicide which are also associated with birth season. Our aim was to investigate the association of 5-HTTLPR genotype and birth season in a healthy female population. METHODS Birth date and 5-HTTLPR genotype was determined for 327 psychiatrically healthy women. The association between presence of s allele and time of birth was analysed using generalized linear models. RESULTS A significant association between s allele frequency and time of birth was detected. S allele carrier frequency was marginally significantly higher in July borns and significantly lower in autumn borns. LIMITATIONS We investigated an adult sample so genotype frequency data do not reflect birth frequencies. Our sample consisted exclusively of females. CONCLUSIONS There is no clear explanation for the observed association, although idiosyncratic parental conception patterns, the association of 5-HTTLPR with sudden infant/intrauterine death, or other s allele-mediated behaviours may play a role. Our results are strikingly parallel with earlier data reporting a higher risk of completed suicide in July borns, and higher scores of July borns and lower scores of autumn borns on certain affective temperament scales, both of which are also associated with the s allele of 5-HTTLPR. Thus our results may add to the growing body of evidence regarding the etiological background of affective disorders.
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Affiliation(s)
- Xenia Gonda
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary.
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Fountoulakis KN, Siamouli M, Grammatikopoulos IA, Koupidis SA, Siapera M, Theodorakis PN. Economic crisis-related increased suicidality in Greece and Italy: a premature overinterpretation. J Epidemiol Community Health 2012; 67:379-80. [PMID: 23213113 DOI: 10.1136/jech-2012-201902] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Fountoulakis KN, Pantoula E, Siamouli M, Moutou K, Gonda X, Rihmer Z, Iacovides A, Akiskal H. Development of the Risk Assessment Suicidality Scale (RASS): a population-based study. J Affect Disord 2012; 138:449-57. [PMID: 22301115 DOI: 10.1016/j.jad.2011.12.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 12/11/2011] [Accepted: 12/29/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide and suicide attempts are significant and costly public health problems. In order to prevent suicidal and other self-injurious behaviors, research on the multiple factors involved in these behaviors with comprehensive and user-friendly instruments is necessary. The aim of the current study was to construct a self-report instrument with emphasis on items describing suicide-related behavior itself rather than strongly related clinical features on the basis of a general population study. METHODS Twelve items comprising a new scale were applied to 734 subjects from the general population (40.6% males and 59.4% females) aged 40.8±11.5 along with the STAI and the CES-D. RESULTS The scoring method was developed on the basis of frequency table of responses to the individual scale items. The factor analysis returned 3 factors explaining 59.19% of total variance (Intention, Life, and History). The Cronbach's alpha was 0.85 for the Intention, 0.69 for the Life and 0.52 for the History subscale. LIMITATION The findings need replication in clinical and epidemiologic studies. CONCLUSION The RASS is a reliable and valid instrument which might prove valuable in the assessment of suicidal risk in the general population as well as in mental patients.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 55535 Pylaia, Thessaloniki, Greece.
| | - Melina Siamouli
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 55535 Pylaia, Thessaloniki, Greece
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Fountoulakis KN, Siamouli M, Magiria S, Panagiotidis PT, Kantartzis S, Terzoglou VA, Oral T. A standardized scoring method for the copy of cube test, developed to be suitable for use in psychiatric populations. Ann Gen Psychiatry 2011; 10:19. [PMID: 21745404 PMCID: PMC3154184 DOI: 10.1186/1744-859x-10-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 07/11/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although the 'copy of cube test', a version of which is included in the Short Test of Mental Status (STMS), has existed for years, little has been done to standardize it in detail. The aim of the current study was to develop a novel and detailed standardized method of administration and scoring this test. METHODS The study sample included 93 healthy 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 years. The psychometric assessment included the Positive and Negative Symptoms Scale (PANSS) the Young Mania Rating Scale (YMRS), and the Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS A scoring method was developed based on the frequencies of responses of healthy controls. Cronbach's α was equal to 0.75 and inter-rater reliability was 0.90. Three indices and five subscales of the Standardized Copy of the Cube Test (SCCT) were eventually developed. They included the Deficit Index (DcI), which includes the Missing Elements (ME) Mirror Image (M) subscales, the Deformation Index (DfI) which includes the Deformation (D) and the Rotation (R) subscales and the Closing-In Index (CiI). DISCUSSION The SCCT seems to be a reliable, valid and sensitive to change instrument for the testing of psychiatric patients. The great advantage of this instrument is the fact that it only requires paper and a pencil, and is this easily administered and brief. Further research is necessary to test its usefulness as a neuropsychological test.
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Fountoulakis KN, Siamouli M, Panagiotidis PT, Magiria S, Kantartzis S, Terzoglou VA, Oral T. The standardised copy of pentagons test. Ann Gen Psychiatry 2011; 10:13. [PMID: 21481250 PMCID: PMC3080354 DOI: 10.1186/1744-859x-10-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 04/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 'double-diamond copy' task is a simple paper and pencil test part of the Bender-Gestalt Test and the Mini Mental State Examination (MMSE). Although it is a widely used test, its method of scoring is crude and its psychometric properties are not adequately known. The aim of the present study was to develop a sensitive and reliable method of administration and scoring. METHODS 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. RESULTS The scoring method was based on the frequencies of responses of healthy controls and proved to be relatively reliable with Cronbach's α equal to 0.61, test-retest correlation coefficient equal to 0.41 and inter-rater reliability equal to 0.52. The factor analysis produced two indices and six subscales of the Standardised Copy of Pentagons Test (SCPT). The total score as well as most of the individual items and subscales distinguished between controls and patients. The discriminant function correctly classified 63.44% of controls and 75.59% of patients. DISCUSSION The SCPT seems to be a satisfactory, reliable and valid instrument, which is easy to administer, suitable for use in non-organic psychiatric patients and demands minimal time. Further research is necessary to test its psychometric properties and its usefulness and applications as a neuropsychological test.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Fountoulakis KN, Pantoula E, Siamouli M, Moutou K, Gonda X, Rihmer Z, Iacovides A, Akiskal H. [Development of the Risk Assessment Suicidality Scale (RASS): a population-based study]. Psychiatriki 2011; 22:132-147. [PMID: 21888186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Suicide and suicide attempts are significant and costly public health problems. In order to prevent suicidal and other self-injurious behavior, research on the multiple factors involved in these behaviors with comprehensive and user-friendly instruments is necessary. The aim of the current study was to construct a self-report instrument with emphasis on the items which describe suicide-related behavior itself rather than strongly related clinical features on the basis of a general population study. Twelve items comprising a new scale were applied to 734 subjects from the general population (40.6% males and 59.4% females) aged 40.8 +/- 11.5, along with the STAI and the CES-D. The scoring method was developed on the basis of frequency table of responses to the individual scale items. The factor analysis returned 3 factors explaining 59.19% of total variance (Intention, Life, and History). The Cronbach's alpha was 0.85 for the Intention, 0.69 for the Life and 0.52 for the History subscale. The RASS is a reliable and valid instrument which might prove valuable in the assessment of suicidal risk in the general population as well as in mental patients.
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Fountoulakis KN, Siamouli M, Panagiotidis P, Magiria S, Kantartzis S, Papastergiou N, Shoretsanitis G, Pantoula E, Moutou K, Kouidi E, Deres S. Obesity and smoking in patients with schizophrenia and normal controls: a case-control study. Psychiatry Res 2010; 176:13-6. [PMID: 20079934 DOI: 10.1016/j.psychres.2008.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 04/07/2008] [Accepted: 11/30/2008] [Indexed: 10/19/2022]
Abstract
Cardiovascular risk factors, especially obesity and smoking are highly prevalent in patients with schizophrenia. Central obesity and the metabolic syndrome are conditions mostly attributed to the use of antipsychotic medication and lifestyle habits, and they constitute a significant health concern. Our study sample included 105 patients suffering from schizophrenia aged 36.25+/-10.03 and 156 normal control subjects aged 36.03+/-11.33. All patients were in- or out-patients of a private hospital. 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 LifeWise Body Fat Analyzers No 63-1525. The results of analysis of variance suggested a significant main effect regarding diagnosis and sex as well as for their interaction. There were significant differences between patients and controls regarding body weight, waist circumference, BMI, BSA and % body fat, with patients, especially females, being more obese than controls. The results of the present study corroborate the increased prevalence of obesity in schizophrenia. The interpretation of this finding remains unclear.
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Rosa AR, Fountoulakis K, Siamouli M, Gonda X, Vieta E. Is anticonvulsant treatment of mania a class effect? Data from randomized clinical trials. CNS Neurosci Ther 2009; 17:167-77. [PMID: 20015083 DOI: 10.1111/j.1755-5949.2009.00089.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Our aim was to evaluate the efficacy and tolerability of anticonvulsant agents for the treatment of acute bipolar mania and ascertain if their effects on mania are a "class" effect. We conducted a systematic review of randomized controlled trials (RCTs) with placebo or active comparator, in acute bipolar mania in order to summarize available data on anticonvulsant treatment of mania/mixed episodes. We searched (PubMed/MEDLINE) with the combination of the words "acute mania" and "clinical trials" with each one of the following words: "anticonvulsants/antiepileptics,""valproic/valproate/divalproex,""carbamazepine,""oxcarbazepine,""lamotrigine,""gabapentin,""topiramate,""phenytoin,""zonisamide,""retigabine,""pregabalin,""tiagabine,""levetiracetam,""licarbazepine,""felbamate," and "vigabatrin." Original articles were found until November 1, 2008. Data from 35 randomized clinical trials suggested that not all anticonvulsants are efficacious for the treatment of acute mania. Valproate showed greater efficacy in reducing manic symptoms, with response rates around 50% compared to a placebo effect of 20-30%. It appears to have a more robust antimanic effect than lithium in rapid cycling and mixed episodes. As valproate, the antimanic effects of carbamazepine have been demonstrated. Evidences did not support the efficacy of the gabapentin, topiramate as well as lamotrigine as monotherapy in acute mania and mixed episodes. Oxcarbazepine data are inconclusive and data regarding other anticonvulsants are not available. Anticonvulsants are not a class when treating mania. While valproate and carbamazepine are significantly more effective than placebo, gabapentin, topiramate, and lamotrigine are not. However, some anticonvulsants may be efficacious in treating some psychiatric comorbidities that are commonly associated to bipolar illness.
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Affiliation(s)
- A R Rosa
- Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Fountoulakis KN, Gonda X, Siamouli M, Rihmer Z. Psychotherapeutic intervention and suicide risk reduction in bipolar disorder: a review of the evidence. J Affect Disord 2009; 113:21-9. [PMID: 18676024 DOI: 10.1016/j.jad.2008.06.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 06/20/2008] [Accepted: 06/20/2008] [Indexed: 01/25/2023]
Abstract
BACKGROUND 25-50% of bipolar patients attempt suicide at least once in their lifetime and completed suicide in this population is about 1% annually, about 60 times the rate of the general population. Psychotherapy may be an effective adjunctive option in preventing suicide in bipolar patients. It has been suggested that interpersonal, cognitive and behavioural techniques may be effective in controlling mood shifts, increasing compliance with pharmacotherapy, and maintaining morale in the face of therapeutic adversity and incomplete response. The aim of our study was to systematically review the literature concerning the efficacy of psychosocial interventions in reducing the risk for attempting or committing suicide. METHODS We searched MEDLINE with the combination of the key words 'psychotherapy' or 'psychoeducation' or 'cognitive therapy' or 'behavio(u)ral therapy', 'cognitive-behavio(u)ral' or 'family therapy' or 'social rhythm' or 'rhythm' with 'suicide' and 'bipolar', limited to English language papers published between 1990 and January 2008. Papers were selected based on the criterium that they provided definite data on the role of psychotherapy in suicide prevention, and specifically in bipolar disorder. RESULTS Our search returned 481 references, of which 17 were selected based on the above criteria. The selected papers were classified according to the area of suicide prevention they were dealing with as 1. Psychosocial and demographic factors, 2. Psychological profile and 3. Efficacy of psychotherapies. DISCUSSION Our paper summarizes specific features and correlates of suicide in bipolar patients and possible targets of psychosocial intervention in the prevention of suicide in bipolar patients. Although studies researching the effect of psychosocial interventions on suicidal behaviour are virtually non-existent, hard data concerning the effectiveness of psychosocial interventions in bipolar disorder are emerging, but still suffer from methodological drawbacks.
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Siamouli M, Moutou K, Pantoula E, Magiria S, Chatzivasileiou I, Arapidis K, Chatzivasileiou A, Deres S, Fountoulakis KN. Preliminary data concerning the reliability and psychometric properties of the Greek translation of the 20-item Subjective Well-Being Under Neuroleptic Treatment Scale (SWN-20). Ann Gen Psychiatry 2009; 8:3. [PMID: 19159480 PMCID: PMC2651143 DOI: 10.1186/1744-859x-8-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 01/21/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 20-item Subjective Well-Being Under Neuroleptic Treatment Scale (SWN-20) is a self-report scale developed in order to assess the well-being of patients receiving antipsychotic medication independent of the improvement in their psychotic symptoms. The current study reports on the reliability and the psychometric properties of the Greek translation of the SWN-20. METHODS A total of 100 inpatients or outpatients with schizophrenia (79 males and 21 females, aged 42.6 +/- 11.35 years old) from 3 different facilities were assessed with the Positive and Negative Symptoms Scale (PANSS), the Calgary Depression Scale and the Simpson-Angus Scale, and completed the SWN-20. The statistical analysis included the calculation of Pearson product moment correlation coefficient, the Cronbach alpha and factor analysis with Varimax normalised rotation. RESULTS The SWN-20 had an alpha value equal to 0.79 and all the items were equal. The factor analysis revealed the presence of seven factors explaining 66% of total variance. The correlation matrix revealed a moderate relationship of the SWN-20 and its factors with the PANSS-Negative (PANSS-N), PANSS-General Psychopathology (PANSS-G), the Simpson-Angus and the Calgary scales, and no relationship to age, education and income class. DISCUSSION The Greek translation of the SWN-20 is reliable, with psychometric properties close to the original scale.
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Triantafyllou N, Evangelopoulos ME, Kimiskidis VK, Kararizou E, Boufidou F, Fountoulakis KN, Siamouli M, Nikolaou C, Sfagos C, Vlaikidis N, Vassilopoulos D. Increased plasma homocysteine levels in patients with multiple sclerosis and depression. Ann Gen Psychiatry 2008; 7:17. [PMID: 18782433 PMCID: PMC2553073 DOI: 10.1186/1744-859x-7-17] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 09/09/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to assess the plasma levels of homocysteine in patients with multiple sclerosis (MS) and to investigate whether an association with depression exists. METHODS Plasma homocysteine (Hcy), vitamin B12 and plasma folate were measured in 65 moderately disabled patients with relapsing/remitting MS (RR-MS) and 60 healthy controls. All subjects were assessed with the Beck Depression Inventory (BDI). RESULTS Hcy levels were significantly increased in MS patients compared to controls (13.5 +/- 4.7 mumol/l vs 8.5 +/- 3.1, p < 0.001). A significant correlation was found between Hcy levels and BDI scores (Pearson r = 0.3025, p < 0.05). Plasma Hcy was not related to Extended Disability Status Scale (EDSS) score, age, disease duration or vitamin B12 and folate. CONCLUSION Moderately disabled MS patients with elevated Hcy levels are particularly prone to develop depressive symptomatology. Further study is warranted in order to elucidate the prognostic and therapeutic implications of this novel finding.
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Fountoulakis KN, Siamouli M, Panagiotidis P, Magiria S, Kantartzis S, Iacovides A, Kaprinis GS. Ultra short manic-like episodes after antidepressant augmentation with modafinil. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:891-2. [PMID: 18068287 DOI: 10.1016/j.pnpbp.2007.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 10/24/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
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Fountoulakis KN, Siamouli M, Magiria S, Kaprinis G. Late-life depression, religiosity, cerebrovascular disease, cognitive impairment and attitudes towards death in the elderly: Interpreting the data. Med Hypotheses 2008; 70:493-6. [PMID: 17825997 DOI: 10.1016/j.mehy.2007.01.093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 01/11/2007] [Indexed: 10/22/2022]
Abstract
Geriatric depression is considered to be a major health problem in the elderly. Passing the age, the speed of mental process is decreasing and personality obtains more mature functioning (better coping) while most of its traits remain stable. Empirical studies have shown that fear of death is most prominent during midlife and not late-life. Neuroimaging studies led to the "vascular depression" hypothesis. Depression was found to be a strong predictive factor leading to stroke, while religiosity seemed to be a 'protective' factor. A possible interpretation of these reports could consider late-life depression to be an early symptomatology of an undergoing vascular disease. Religiosity could be interpreted as absence of depression, and therefore, mainly as absence of vascular lesions. The above have profound implications in the understanding of late-life depression and to the therapeutic design, especially in the primary care setting.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 546 36 Thessaloniki, Greece.
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Fountoulakis KN, Vieta E, Siamouli M, Valenti M, Magiria S, Oral T, Fresno D, Giannakopoulos P, Kaprinis GS. Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder. Ann Gen Psychiatry 2007; 6:27. [PMID: 17925035 PMCID: PMC2089060 DOI: 10.1186/1744-859x-6-27] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 10/09/2007] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Manic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment. METHODS This article summarizes the current status of our knowledge and practice of its treatment. RESULTS It is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling. CONCLUSION The first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule.
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Siamouli M, Magiria S, Panagiotidis P, Spyridi S, Sokolaki S, Fountoulakis KN, Kaprinis G. Advances in the treatment of geriatric depression. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/1745509x.3.4.495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Melina Siamouli
- Aristotle University of Thessaloniki, 3rd Department of Psychiatry, Greece
| | - Stamatia Magiria
- Aristotle University of Thessaloniki, 3rd Department of Psychiatry, Greece
| | | | - Styliani Spyridi
- Aristotle University of Thessaloniki, 3rd Department of Psychiatry, Greece
| | - Stavroula Sokolaki
- Aristotle University of Thessaloniki, 3rd Department of Psychiatry, Greece
| | | | - George Kaprinis
- Aristotle University of Thessaloniki, 3rd Department of Psychiatry, Greece
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Panagiotidis PT, Fountoulakis KN, Siamouli M, Magiria S, Iacovides A, Kaprinis G. Risperidone-induced sialorrhea responsive to biperiden treatment. Schizophr Res 2007; 93:410-1. [PMID: 17462863 DOI: 10.1016/j.schres.2007.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Revised: 03/07/2007] [Accepted: 03/08/2007] [Indexed: 11/21/2022]
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Fountoulakis KN, Bech P, Panagiotidis P, Siamouli M, Kantartzis S, Papadopoulou A, Papadopoulou M, Kaprinis S, Kourila E, Iacovides A, St Kaprinis G. Comparison of depressive indices: reliability, validity, relationship to anxiety and personality and the role of age and life events. J Affect Disord 2007; 97:187-95. [PMID: 16844229 DOI: 10.1016/j.jad.2006.06.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 06/06/2006] [Accepted: 06/15/2006] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although a great number of depressive scales were developed during the last decades, there are only a few studies that compare them in terms of reliability and validity. The current study aimed to compare the properties of some of the most popular of these scales. MATERIALS AND METHODS The study sample included 40 depressed patients 29.65+/-9.38 years old, and 120 normal comparison subjects 27.23+/-10.62 years old. The clinical diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0. The scales compared were the CES-D, ZDRS, BDI-I, and the KSQ. The STAI, the Life Change Scale (Holms and Rahe), and the EPQ were also administered. The analysis included the comparison of psychometric properties and the use of Pearson correlation coefficient and factor analysis. RESULTS The results suggested that no scale was clearly superior to the others. All scales correlated to anxiety measurements, sociodemographic variables, personality dimensions and non-specific indices. The results reported here include an appendix with algorithms that help transforming one scale score into other scales scores. These algorithms can be useful for comparison purposes in meta-analytic studies. DISCUSSION The comparison of several depressive scales provided no impressive results on the superiority or inferiority of a specific scale in comparison to the others.
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Abstract
The involvement of the thyroid gland and thyroid hormones is generally believed to be important in the aetiopathogenesis of major depression. Major support comes from studies in which alterations in components of the hypothalamic-pituitary-thyroid (HPT) axis have been documented in patients with primary depression. However, screening thyroid tests are often routine and add little to the diagnostic evaluation. Overt thyroid disease is rare among depressed inpatients. The finding that depression often co-exists with autoimmune subclinical thyroiditis suggests that depression may cause alterations in the immune system, or that in fact it could be an autoimmune disorder itself. The outcome of treatment and the course of depression may be related to thyroid status as well. Augmentation of antidepressant therapy with the co-administration of thyroid hormones (mainly T3) is a well-documented treatment option for refractory depressed patients. Review of the literature suggests that there are no conclusive data on the role of thyroid function in depression. It is clear that depression is not characterised by an overt thyroid dysfunction, but it is also clear that a subgroup of depressed patients may manifest subtle thyroid abnormalities, or an activation of an autoimmune process. There is a strong possibility that the presence of a subtle thyroid dysfunction is a negative prognostic factor for depression and may demand specific therapeutic intervention.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Laboratory of Psychophysiology, 3rd Department of Psychiatry, Aristotle University of Thessaloniki, University Hospital AHEPA, Greece.
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Fountoulakis KN, Panagiotidis P, Siamouli M, Kantartzis S, Mavridis T, Iacovides A, Kaprinis G. Amisulpride-induced tardive dyskinesia. Schizophr Res 2006; 88:232-4. [PMID: 16963229 DOI: 10.1016/j.schres.2006.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Revised: 07/26/2006] [Accepted: 08/01/2006] [Indexed: 10/24/2022]
Abstract
Tardive dyskinesia (TD) is a movement disorder that develops during the course of long-term treatment with neuroleptic agents and is characterized primarily by choreiform and athetotic movements. We report the case of a 34-year-old man suffering from schizophrenia, disorganized type. He received amisulpride (400 mg daily) and the result was much improvement. 20 months later, he was presented with TD, which resolved almost completely after change of treatment to 1200 mg quetiapine without any relapsing. To our knowledge, his is the first case report in the literature of tardive dyskinesia induced by amisulpride.
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Fountoulakis KN, Kantartzis S, Siamouli M, Panagiotidis P, Kaprinis SG, Kourila E, Lacovides A, Kaprinis GS. Beneficial effect of long-acting injectable risperidone on the neurocognitive deficit of a schizophrenic patient: a case report. Int J Clin Pharmacol Ther 2006; 44:589-92. [PMID: 17176626 DOI: 10.5414/cpp44589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 37-year-old female patient suffering from schizophrenia, disorganized type. Adherence to treatment was always a major problem. During the last 2 years the patient was disorganized and was refusing treatment. Since the patient was already receiving a very high (double) dose per os, it was decided to administer two 50 ml ampoules of long-acting, injectable risperidone plus 5 mg of haloperidol per os daily. After 80 days of treatment, all positive, negative and even neurocognitive symptoms improved markedly. Extrapyramidal side effects did not appear at any stage of treatment. The most impressive neurocognitive improvement concerned the clock drawing test, which was in parallel with her improvement in both the positive and negative symptoms of the PANSS.
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Affiliation(s)
- K N Fountoulakis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, Greece.
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Fountoulakis KN, Iacovides A, Siamouli M, Koumaris V, Kaprinis GS. Successful treatment of anorexia with a combination of high-dose olanzapine, fluoxetine and mirtazapine. Int J Clin Pharmacol Ther 2006; 44:452-3. [PMID: 16995335 DOI: 10.5414/cpp44452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Fountoulakis KN, Siamouli M, Kantartzis S, Panagiotidis P, Iacovides A, Kaprinis GS. Acute dystonia with low-dosage aripiprazole in Tourette's disorder. Ann Pharmacother 2006; 40:775-7. [PMID: 16569800 DOI: 10.1345/aph.1g331] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report a case of an acute dystonic episode in a patient with Tourette's disorder (TD) treated with the partial dopamine agonist aripiprazole. CASE SUMMARY An 18-year-old male with TD was prescribed aripiprazole 10 mg orally daily, which produced a significant improvement in his symptoms. However, after 3 days of treatment, he experienced an acute episode of dystonia with facial muscle spasm, oculogyric crisis, and torticolis. All symptoms resolved after a single intramuscular injection of biperidine 5 mg. The Naranjo probability scale indicated that the adverse events were probably caused by aripiprazole. DISCUSSION To our knowledge, as of this writing, this is the first report concerning an aripiprazole-induced dystonic episode in an adult, and it is especially notable because it occurred at low dosage. Aripiprazole is a dopamine partial agonist and a serotonin(2A) antagonist with a favorable adverse effect profile. Short-term clinical trials reported a very low incidence of extrapyramidal symptoms, with akathisia being the most common, although there have been reports of severe extrapyramidal symptoms in a 3-year-old child and in an adolescent with a previous history of such symptoms. CONCLUSIONS Acute dystonic phenomena may be caused by aripiprazole, although the drug's suggested mode of action largely precludes them.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Laboratory of Psychophysiology, Third Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Fountoulakis KN, Siamouli M, Fotiou F, Kaprinis GS. Lateralization of pupillary light reflex parameters. Comment on the paper: Bär KJ, Boettger MK, Till S, Dolicek J, Sauer H. Clin Neurophysiol 2005;116:790–798. Clin Neurophysiol 2005; 116:2505; author reply 2505-6. [PMID: 16120483 DOI: 10.1016/j.clinph.2005.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Accepted: 06/08/2005] [Indexed: 11/17/2022]
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