Research findings on Greek forensic patients found not guilty by reason of insanity. A juxtaposition of patients who committed a criminal offense during their first psychotic episode with those who did so later in the course of their illness

The aim of this study was to compare the baseline characteristics (demographic, psychiatric-psychopathological and legal) among Greek forensic patients found not guilty by reason of insanity. The first step of this approach being differentiating patients who committed a criminal offense during their first psychotic episode from the ones who did so later in the course of their illness. All patients were hospitalized in the Department of Forensic Psychiatry (DFP) of the Psychiatric Hospital of Thessaloniki (PHT) from January 2015 to January 2020 and were examined in order to be included in the study. The final research sample consisted of 78 patients (70 identifying themselves as males and 8 identifying themselves as females) aged 18 and older, 21 of whom committed a criminal offense during their first psychotic episode (FEP, N = 21) and 57 did so later on in the course of their illness (Course, N = 57). Data were collected from multiple sources and several psychometric tools were used (Mini International Neuropsychiatric Interview-M.I.N·I, Positive And Negative Syndrome Scale-PANSS, Addiction Severity Index-ASI, CAGE Questionnaire, Hostility and Direction of Hostility Questionnaire-HDHQ, Global Assessment of Functioning-GAF and Aggression Questionnaire). Comparing the two groups (FEP vs. Course) we found that patients in FEP were younger, had experienced stressful life events in the last 24 months, committed more serious violent crimes, and more frequently attempted suicide after the crime. Their victims were usually members of their family. The main psychometric disparities between the two groups were found in the "Hostility" score of the Aggression questionnaire, and the items "Criticism of Others" and "Paranoid Hostility" of the HDHQ questionnaire, where patients in FEP scored lower. Patients in FEP scored significantly higher in items P1 (delusions), P4 (excitement), P6 (suspiciousness/persecution) and P7 (hostility) of the PANSS scale. No statistically significant differences were found between the two groups regarding their evaluation with the CAGE, ASI or GAF questionnaires. When comparing the patients' present scores in PANSS scale, the patients in FEP had lower total scores in the Positive and the General Psychopathology subscales. Both groups showed significant improvement during hospitalization in all scales (PANSS & GAF), except for the Negative Subscale of the PANSS scale. Through logistic regression analysis, we found that patients in FEP were younger, more likely to have recently experienced stressful life events and more likely to have assaulted a member of their family. Patients with higher scores in the "Hostility" subscale of the Aggression questionnaire were found to remain at risk for committing a crime during the course of their illness. These findings underline the need to design and develop specialized mental health services in order to identify and treat patients involved in violent crime in a timely and effective manner addressing their multiple needs.

Early intervention services in Greece: Time to focus on people at high risk

Over the last twenty years, a lot of early intervention services operate worldwide with the aim of offering assistance and promoting the early diagnosis and management, not only of people who experience a first episode of psychosis but also of individuals that are at high risk of developing psychosis. The early intervention services that operate in other countries have been reviewed in correlation with the current status of early intervention services for psychosis in Greece. Early intervention services were first established in Australia, and now hundreds of similar programs exist in Europe, North America and Asia. Furthermore, early intervention services incorporate teams that engage people who have an at risk mental state (ARMS), and are at high risk of developing psychosis. The first clinical service for individuals at high risk for psychosis was established in Melbourne in 1995, and an increasing number of similar services have since emerged worldwide. One of the largest of these is OASIS (Outreach and Support in South London). The first early intervention service was developed during the December 2007, in a rural catchment region of north-western Greece, in Ioannina. After the establishment of Ioannina Early Intervention Service, there was a growing interest of the Greek psychiatric community in the issues of early detection and prevention of psychotic disorders which led to the development of early psychosis units in other regions of Greece, like Athens, Thessaloniki and Patras. However, this field remains neglected in Greece, since in the absence of funding for such early detection services, there are only a few programs that operate mainly on a voluntary basis. Moreover, specialized mental health services for people at high risk for psychosis that have significant clinical benefits and are also cost effective, do not exist in the majority of Greek services. Greece and other countries in a similar condition need to understand the significance of untreated or poorly treated psychotic disorders that affect a lot of young people in late adolescence and early adult life. Focusing on people at high risk of developing psychosis will promote public health and will help not only to prevent the onset of psychotic disorders but to enhance their prognosis as well.

No effect of cognitive performance on post-intervention improvement in emotion recognition

Deficits in emotion perception in patients with first episode of psychosis have been reported by many researchers. Till now, training programs have focused mainly in patients with schizophrenia and not in first psychotic episode (FEP) patients. We used a new intervention for facial affect recognition in a group of 35 FEP patients (26 male). The emotion recognition intervention included coloured pictures of individuals expressing six basic emotions (happiness, sadness, anger, disgust, surprise, fear) and a neutral emotion. The patients were trained to detect changes in facial features, according to the emotion displayed. A comprehensive battery of neuropsychological tests was also administered, measuring attention, memory, working memory, visuospatial ability and executive function by using specific tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). We tried to explore whether cognitive performance can explain the difference noted between the original assessment of emotion recognition and the post-intervention assessment. According to our data, overall cognitive performance did not correlate with post-intervention change in emotion recognition. Specific cognitive domains did not correlate with this change, either. According the above mentioned results, no significant correlation between neuropsychological performance and post-intervention improvement in emotion recognition was noted. This finding may suggest that interventions for emotion recognition may target specific processes that underlie emotion perception and their effect can be independent of general cognitive function.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The Validity of the Distress Thermometer in Greek Colon Cancer Patients

BACKGROUND

Although screening for distress is a crucial part of psycho-social care for cancer patients, there has not been a validation study for this purpose in Greece. The purpose of this study was to evaluate for the first time the psychometric properties of the Greek translation of the Distress Thermometer (DT) and Problem List (PL) in Greek colorectal cancer patients (CRC).

METHODS

Participants were 84 CRC inpatients of the 1st Surgical Propedeutic Department of the Aristotle University of Thessaloniki with a mean age of 70.8±9.5 years. Participants completed the DT, PL and the Hospital Anxiety and -Depression Scale (HADS).

RESULTS

The Cronbach's alpha coefficient in the DT was 0.795. Patients' mean score in the DT was 5.7±2.74, while the mean number of the reported problems in the PL was 18.85±5.50 and the mean total score of the HADS was 15.61±6.95. ROC-analysis supported that a cut-off score of 7 gives the optimal sensitivity and specificity for the DT.

CONCLUSION

The index sample has manifested high levels of distress, which correspond to high need for support and improvement of the patient-provider relationship. This is probably a difficult task, since the Greek healthcare system has minimal experience of providing psycho-oncology care. The present study has indicated that the DT can be reliably used in the Greek clinical setting. Future studies, along with state provision, are essential in order to offer Greek cancer patients state-of-the-art and comprehensive care.

[Manic episode in a patient with Beçhet's disease]

Beçhet's disease (BD) is a chronic, heterogeneous, multisystem disease that affects young males and females around the Mediterranean region, as well as from Far and Middle East. Its etiology is vague with vasculitis being its main pathological feature. International diagnostic criteria have been established and they require the presence of recurrent oral ulcerations plus two of the following: Recurrent genital ulceration, eye lesions, skin lesions and positive pathergy test. A significant number of patients with Beçhet's disease suffers from symptoms from the central nervous system (CNS), while the most common clinical symptoms are pyramidal signs, mental-behavioral changes, hemiparesis and brain stem syndrome. The existence of mental-behavioral changes seems to be one of the most common findings in patients with Neuro-Beçhet (N-BD). These changes seem to be related with memory and attention deficits, and the process of deterioration continues even in attack-free periods, suggesting a continuously active disease process in the CNS. The prevalence of anxiety, depression and general psychiatric symptoms is higher among patients with BD compared to healthy individuals. However, the association between psychiatric symptoms and BD is not clearly understood. On the other hand, syndromes like psychosis or bipolar disorder appear to be less frequent, especially in attack-free periods. We describe the case of a 52-year old woman with Beçhet's disease who developed a single manic episode 13 years after the onset of Beçhet's disease. A 52-year old woman, suffering from Beçhet's disease since the age of 39, developed manic symptoms, namely elevated mood, pressured speech, flight of ideas, distractibility and decreased need for sleep. The above symptoms developed during a period that no other symptoms of Beçhet's disease were present. Moreover there was no other manifestation from the nervous system. A brain MRI was unremarkable, while a brain SPECT study revealed severe hypoperfusion of the left prefrontal cortex. Neuropsychological examination revealed severe disturbance in attention, working memory and learning ability, while her visuaspatial ability and executive functions were well spared. Her symptoms were well controlled after treated with quetiapine 800 mg. The manic episode developed in the absence of any neurological manifestation (Neuro-Beçhet), or other symptom of Beçhet's disease, and was clearly distinguishable from euphoria, disinhibition or irritability that are common in patients with Beçhet's disease. It looks probable that CNS damage caused by the disease constitutes a biological substrate for the development of manic episodes in patients suffering from Beçhet's disease.

Controlled shifting of attention in schizophrenia and bipolar disorder through a dichotic listening paradigm

The dichotic listening (DL) task was developed originally to examine bottom-up or "automatic" information processing. More recently, however, it has been used as a tool in the study of top-down or "controlled" information processing. This has been done by including forced-choice conditions, wherein the examinee is required to focus attention on one or the other ear. It has been widely utilized with patients with schizophrenia, who exhibit rather severe deficits in managing their attention, but not with other patient groups, such as patients with bipolar disorder. In the present study, we examined potential performance similarities in the DL listening task. In total, the sample consisted of 38 patients with schizophrenia, 20 patients with psychotic bipolar disorder and 35 healthy individuals, who performed a DL task with verbal stimuli once at the beginning of their hospitalization and again on the last day before discharge. Our findings indicated that both patient groups showed similarly diminished performance when compared to healthy participants at both times of administration. Symptom improvement between the two evaluations did not significantly influence performance in the DL task. In conclusion, impaired automated and controlled information processing appears to be a common deficit in both schizophrenia and bipolar disorder.

Assessing personality traits by questionnaire: psychometric properties of the Greek version of the Zuckerman-Kuhlman personality questionnaire and correlations with psychopathology and hostility

BACKGROUND

The Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) was developed in an attempt to define the basic factors of personality or temperament. We aimed to assess the factor structure and the psychometric properties of its Greek version and to explore its relation to psychopathological symptoms and hostility features.

METHODS

ZKPQ was translated into Greek using back-translation and was administered to 1,462 participants (475 healthy participants, 619 medical patients, 177 psychiatric patients and 191 opiate addicts). Confirmatory and exploratory factor analyses were performed. Symptoms Distress Check-List (SCL-90R) and Hostility and Direction of Hostility Questionnaire (HDHQ) were administered to test criterion validity.

RESULTS

Five factors were identified, largely corresponding to the original version's respective factors. Retest reliabilities were acceptable (rli's: 0.79-0.89) and internal consistency was adequate for Neuroticism-Anxiety (0.87), Impulsive Sensation Seeking (0.80), Aggression-Hostility (0.77) and Activity (0.72), and lower for Sociability (0.64). Most components were able to discriminate psychiatric patients and opiate addicts from healthy participants. Opiate addicts exhibited higher rates on Impulsive Sensation Seeking compared to healthy participants. Neuroticism-Anxiety (p<0.001) and Impulsive Sensation Seeking (p<0.001) were significantly associated with psychological distress and Aggression-Hostility was the most powerful correlate of Total Hostility (p<0.001), and Neuroticism-Anxiety was the stronger correlate of introverted hostility (p<0.001), further supporting the instrument's concurrent validity.

CONCLUSIONS

Present findings support the applicability of the Greek version of ZKPQ within the Greek population. Future studies could improve its psychometric properties by finding new items, especially for the Sociability scale.

Psychotic symptoms in normal pressure hydrocephalus

Normal Pressure Hydrocephalus due to idiopathic aqueductal stenosis is a chronic abnormal accumulation of cerebrospinal fluid in the cerebral ventricles caused by an obstruction in the Sylvian aqueduct. This leads to a dilatation of the ventricular system and to subsequent damage of the adjacent parenchyma. Although NPH typically presents with the progressive 'triad' of cognitive impairment, gait disturbance and urinary incontinence, it has been described that it rarely manifests in the form of predominant psychotic symptoms. It has been suggested that thought and perceptual disorders could develop secondary to the damage caused by NPH. Although precise anatomical correlates have not yet been established, certain cerebral regions -primarily the frontal cortex, mesencephalic and diencephalic structures of the brain- have been implicated in the pathogenesis of hydrocephalic psychosis. Because frontal lobe lesions are traditionally known to facilitate one's inability to integrate and correct perceptual distortions in the face of contradictory evidence, frontal lobe dysfunction may be integral in delineating the etiology of delusions in NPH. We present the case of a 30-year-old female, admitted involuntarily to our acute psychiatric department because she exhibited aggressive behavior while being in an agitated state with delusions of persecution. Her neurological examination disclosed subtle bradykinesia. Neuropsychological batteries and intelligence testing revealed mild cognitive impairment and a CT scan showed considerable dilatation of the ventricular system due to idiopathic aqueductal stenosis. While a conservative approach was chosen for the treatment of NPH, our patient was initiated on 2nd generation antipsychotics showing marked improvement of her psychiatric symptomatology. The atypical presentation of hydrocephalus in the aforementioned case underlines the necessity to thoroughly investigate the possible presence of an underlying organic factor in those patients who present with predominant psychotic symptoms in association with soft non-localising neurological signs and mild cognitive deficits. Furthermore, our patient's marked improvement indicates that, in cases where the primary cause is treated conservatively, hydrocephalic psychosis could respond to 2nd generation antipsychotics. In light of this case report, we reviewed past and present literature on the matter.

Evaluation of cognitive-analytic therapy (CAT) outcome in patients with panic disorder

Two categories of treatment have been shown to be effective in treating panic disorder with or without agoraphobia. One is pharmacotherapy using antidepressants and benzodiazepinesand the other is psychotherapy. The present study aims at the assessment of the outcome of Cognitive-Analytic Therapy (CAT), a type of brief psychotherapy, in a sample of 128 psychiatricoutpatients with DSM-IV diagnosis of panic disorder, who attended the Mental Health Center of Northwestern District of Thessaloniki. For this purpose, validated instruments for the evaluation,such as the Minnesota Multiphasic Personality Inventory (MMPI), the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI) and the Post-therapy Questionnaire (PtQ), were used.The patients were evaluated in two follow ups, 2 months and 1 year after therapy termination. The results showed that on the 2 month follow up 78 patients showed a statistically significant improvementin comparison to the intake time, in all but two (Mf, Ma) clinical scales of the MMPI, on their sum and on some research scales of the MMPI, on the BDI and on the STAI scores. On the 1-yearfollow-up, according to the results of the MMPI, BDI, STAI and PtQ, the patients maintained the achieved improvement. The above results indicate that CAT is an effective brief psychotherapeuticapproach for patients with panic disorder.

[Neuroleptic malignant syndrome and atypical antipsychotics: two case reports]

Neuroleptic malignant syndrome (NMS) constitutes the most serious adverse effect of antipsychotic medications. Although it was initially described as a complication of conventional neuroleptics, atypical antipsychotic agents are also capable of inducing the syndrome. It has been suggested that atypical antipsychotic-induced NMS may be qualitatively and quantitatively different from the NMS caused by conventional neuroleptics; however, atypical antipsychotics can also be associated with severe forms of NMS. We report two patients who manifested severe NMS in association with atypical antipsychotic agents. Both patients were receiving low antipsychotic doses; moreover, one of the patients had not undergone any recent changes in his antipsychotic regimen. Thus, it is pointed out that vigilance for signs of NMS should not be influenced by antipsychotic type and dose.

[Chronic renal insufficiency after long term lithium treatment]

Lithium is, in the era of evidence-based psychiatry, an efficacious and, simultaneously, cost-effective treatment for bipolar disorder, despite the existence of alternative mood-stabilizers (antiepileptics, atypical antipsychotics). A prerequisite for lithium administration in patients with bipolar disorder is the patient 's cooperation, in order to ensure monitoring of drug plasma levels as well as thyroid and renal function. Lithium-related renal complications include impairment in renal concentrating ability resulting in polyuria, increase of plasma creatinine levels and, more rarely, renal insufficiency. In this paper we present the case of a patient with bipolar disorder, who developed chronic renal insufficiency after 25 years of treatment with lithium.

[First-episode schizophrenia: Pharmacotherapy and psychosocial interventions]

The first episode of schizophrenia is a field of great interest from both clinical and research perspectives. Most clinical and psychosocial deterioration in schizophrenia occurs within the first 5 years of the onset of the illness, suggesting that this is a critical period for treatment initiation. Therefore, early detection and subsequent effective therapeutic intervention are vital for the patient, as they significantly determine the course and the long term outcome of the disease. Pharmacotherapy is the cornerstone of the whole therapeutic approach. Patients with first-episode psychosis are comparatively more treatment responsive than patients with multiple episodes. They need lower doses of antipsychotic medication but at the same time are quite sensitive to side effects mainly to extrapyramidal symptoms and signs. All current guidelines consider second generation antipsychotics as first choice drug for first episode schizophrenics. Data from few double blind randomized clinical trials indicate that the newer agents show equal or even better efficacy than the neuroleptics and to a certain extend fewer side effects, mainly extrapyramidal symptoms. Despite initial symptom reduction, achievement of full remission -particularly if it is defined according to strict criteria- and even more, achievement of full recovery remains unsatisfactory. Predictors of poor short term and long term outcome include male gender, low educational level, "soft" neurological signs, severe positive symptoms at baseline, cognitive deficits at intake, poor premorbid functioning especially during adolescence, prefrontal neuronal dysfunction, extrapyramidal symptoms and tardive dyskinesia early in treatment, long duration of untreated psychosis or untreated illness. Although published guidelines do not make definitive recommendations about the duration of maintenance treatment after the first episode, recent data suggest that 1 or 2 years might not be adequate. Medication adherence is problematic in first episode schizophrenics even within the first six months. Poor adherence is predicted by male gender, younger age, poor insight after discharge, severe positive symptoms at baseline, alcohol and drug abuse, inadequate family involvement, lower occupational status, not positive relationship with the psychiatrist, bad admission experience and medication side effects. Adjunctive psychosocial interventions may be beneficial across a variety of domains and can assist with symptomatic and functional recovery. Cognitive-behavior therapy has shown modest efficacy in reducing symptoms and assisting patients in adjusting to their illness but has shown minimal efficacy in reducing relapse. Some reports support the benefits of family interventions, while there is a paucity of data evaluating group inter ventions. Comprehensive (i.e. multi element) treatment approaches show promise in reducing symptoms and hospital readmissions as well as improving functional outcomes. More randomized controlled trials are needed to evaluate the ef fectiveness of psychosocial interventions, in general, in first-episode psychosis patients.

Psychiatric comorbidity in Greek patients with generalized anxiety disorder

From a total sample of 1,448 psychiatric outpatients, 81 (5.6%) received a diagnosis of generalized anxiety disorder (GAD) according to DSM-III-R criteria. Fifty-three (65%) of them had another Axis I diagnosis, while this percentage increased to 78% (63/81) when lifetime psychiatric diagnoses were recorded. The most frequent comorbid diagnoses were panic disorder, dysthymia, major depression and social phobia. Forty-three (53%) of the GAD patients met the criteria for personality disorder. They manifested obsessive-compulsive, avoidant personality and personalities of cluster C in general significantly more frequently than the rest of the total sample. The presence of a personality disorder was related to a significantly higher score on almost all the Minnesota Multiphasic Personality Inventory clinical and research scales, to a worse level of functioning and to an earlier age of onset of GAD. The results of the present study (1) support previous findings of high rates of comorbidity of clinical syndromes in GAD, (2) indicate that GAD co-occurs frequently with cluster C personality disorders, mainly avoidant and obsessive-compulsive, and (3) that the presence of a concomitant personality disorder is related to severer psychopathology and to a worse level of functioning.

Somatoform disorders: comorbidity with other DSM-III-R psychiatric diagnoses in Greece

From a total sample of 1,448 psychiatric outpatients, 175 (12.1%) received a diagnosis of a somatoform disorder according to DSM-III-R criteria. One hundred twenty-two (70%) of these patients had another current axis I diagnosis, and this rate increased to 79% (139 of 175) when lifetime psychiatric diagnoses were recorded. The most frequent comorbid diagnoses were depressive disorders, i.e., dysthymia and major depression, and then anxiety disorders, mainly panic disorder. One hundred ten (63%) of the somatoform patients met the criteria for a personality disorder, significantly higher than the rate (52%) for the rest of the total sample (n = 1,273), who were used as a control group. The most frequent comorbid personality disorders were histrionic, dependent, and personalities of cluster B in general. Hypochondriasis was the only somatoform disorder that was additionally significantly related to obsessive-compulsive personality disorder. Somatoform patients with a concomitant personality disorder manifested more severe overall psychopathology as measured by the Minnesota Multiphasic Personality Inventory (MMPI) and a worse level of functioning than those without. The results of the present study show that (1) patients with somatoform disorders have a high rate of comorbidity with other clinical syndromes and personality disorders, and (2) the presence of a personality disorder is related to more severe overall psychopathology and a worse level of functioning. All of the above indicate that special attention must be paid to the interaction between somatoform disorders, other clinical syndromes, and personality structure at the level of both clinical and research practice.

Personality disorders in dysthymia and major depression

OBJECTIVE

The purpose of the present study was to investigate the comorbidity of personality disorders in patients with primary dysthymia compared to those with episodic major depression.

METHOD

A total of 177 out-patients with primary dysthymia and 187 outpatients with episodic major depression were administered a structured diagnostic interview for DSM-III-R Axis II disorders. In addition, all of these patients completed the BDI, and those with the appropriate level of education also completed the Minnesota Multiphasic Personality Inventory (MMPI).

RESULTS

A significantly higher proportion of dysthymic patients than patients with major depression met the criteria for a personality disorder, for borderline, histrionic, avoidant, dependent, self-defeating types and for personality disorders of clusters B and C. Further analysis revealed that the above differences were mainly due to the subgroup of patients with 'early-onset dysthymia'. Finally, patients with a personality disorder, both dysthymics and those with major depression, had significantly higher scores on the BDI and on the majority of the MMPI scales compared to those without a personality disorder.

CONCLUSION

The data indicated that (i) dysthymia--mainly that of early onset--is associated with significantly higher personality disorder comorbidity than episodic major depression, and (ii) the presence of a personality disorder is related to more severe overall psychopathology.

Medical students' attitudes toward psychiatry in Greece : an eight-year comparison

This study is a comparative investigation of the attitudes toward psychiatry of two medical student groups who did their undergraduate training in psychiatry in 1985 and 1993. Attitude assessments were carried out by using the Libertarian Mental Health Ideology Scale (LMHIS). The students completed the questionnaire twice, at the beginning and at the end of their clerkship. The LMHIS was also completed by the teaching staff. Both medical student groups showed a significant change in their attitudes toward psychiatry after the end of the training. The change consisted of a shift to a more medical orientation. However, the 1993 group manifested a significantly higher medical orientation both before and after their undergraduate training in psychiatry compared with the 1985 group. Furthermore, the former group's opinions at the end of their education were similar to those of their teaching staff, whereas the 1985 students continued to have a lower medical orientation compared with the teaching staff. These findings indicate that 1) psychiatric education during medical school may significantly mold students' attitudes toward psychiatry and 2) if these medical student groups represent the larger Greek society, then significant changes may be occurring in the Greek society about attitudes toward psychiatry.

Negative symptoms of schizophrenia and the dexamethasone suppression test

The dexamethasone suppression test (DST) was administered to 30 inpatients who met the DSM-III-R criteria for chronic schizophrenia and shared similar environments. Four of them (13%) were DST nonsuppressors. The mean and maximum postdexamethasone cortisol levels were correlated with the patient's score on the scale for the Schedule for the Assessment of Negative Symptoms and with the score on the anergia subscale of the Brief Psychiatric Rating Scale. None of the correlations were statistically significant. Furthermore, the scores on the above scales were not significantly correlated with clinical variables such as duration of illness, number of admissions or length of hospitalization, nor were any significant correlations found between the postdexamethasone cortisol levels and the score on the Beck Depression Inventory. In addition, depressed and nondepressed schizophrenics did not differ regarding the rate of nonsuppression and the postdexamethasone cortisol levels. This study found that: 1) dexamethasone nonsuppression in schizophrenia was not related to the presence of negative symptoms; 2) there was no relationship between negative symptoms and illness variables; and 3) the depressed schizophrenics did not display increased nonsuppression compared with nondepressed schizophrenics.

Greek version of the General Health Questionnaire: accuracy of translation and validity

The purpose of this study was to examine the accuracy of translation and to test the validity of the Greek version of the General Health Questionnaire (GHQ). In the translation study, the English and the Greek versions of the GHQ were administered to a sample of 50 bilingual respondents. The internal consistency, item-by-item and the subject-by-subject analysis have shown that the 2 versions are equivalent and therefore the Greek translation is highly accurate. In the validity study, 100 consecutive patients attending an internal medicine outpatient clinic completed the Greek version of the GHQ-60 and were interviewed independently using the Present State Examination (PSE). The validity of the shorter forms of the questionnaire (GHQ-30 and GHQ-28) was tested by disembedding the relevant items from the larger set. The correlations obtained between the scores of the questionnaire and the PSE ratings, as well as all the validity indices (sensitivity, specificity, positive predictive value, negative predictive value and overall misclassification rate) were quite satisfactory for all the GHQ forms, thus confirming the validity of the questionnaire in its Greek version. The best cut-off points as found by receiver-operating characteristics analysis were 11/12 for the GHQ-60, 5/6 for the GHQ-30 and 4/5 for the GHQ-28. The revised (CGHQ) scoring system for the GHQ-30 has not been proved superior to the conventional scoring method. The above results are discussed in relation to the pertinent literature and especially the studies carried out in similar settings and in countries with similar cultural backgrounds.

Mental health and primary care in ethnic groups Greek Cypriots in London: a preliminary investigation

The psychiatric symptoms of 50 consecutive Greek Cypriot attenders at a primary health care centre in North London were compared with 50 consecutive native English attenders using the 28 item General Health Questionnaire. No differences were identified between the two ethnic groups. However, the less 'acculturated' Greek Cypriot patients manifested a higher level of psychological disturbance.

Psychopathology and personality characteristics of epileptic patients: epilepsy, psychopathology and personality

The psychiatric investigation of a sample of 101 epileptic patients (65 temporal lobe epileptics (TLE) and 36 non-TLE) through various methods of evaluation, showed that only a minority of TLE with DSM-III diagnoses of Organic Brain Syndromes had severe psychopathology and manifested some personality traits. Thus, these patients seem to be differentiated from the rest of epileptics, TLE and non-TLE, who had quite "benign" psychological problems, if at all. It is quite probable that this sub-group of TLE could be the main instigators and perpetrators of the "bad image" of epileptics. The findings are discussed in relation to the pertinent literature and some hypotheses are offered for their explanation.