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Introduction: Factors that may affect the performance of healthcare professionals performing resuscitation include stress, social profile, fatigue, empathy, and resilience. Interpersonal skills are required for better performance. This study aimed at evaluating the change in empathy and mental resilience in health professionals who have the status of instructor potential achieved after successfully completing a certified training/intervention course and want to develop/certify as course instructors., Methods: Healthcare professionals attended the Generic Instructor Course (GIC), a two-day course training instructor candidates from different training courses. Empathy and the cultivation of mental resilience of adult healthcare professional trainers were measured in order to investigate whether participation in a simulated training process can influence these characteristics of the trainer and how these characteristics interact with the training process. Four measurements were recorded: (i) baseline (before the GIC course), (ii) after the course, (iii) follow-up after one month, and (iv) follow-up after three months., Results: Ninety participants in the GIC course were the study sample. Participants showed statistically higher empathy after participation in the GIC vs. baseline, one-month, and three-month follow-up (p = 0.023). Resilience did not reveal any statistical difference, after the participation in the GIC and follow-up measurements (p = 0.084). For both variables (empathy and resilience), demographics did not have any association with the variables., Conclusions: Besides its primary aim of training and certifying future instructors in resuscitation courses, the GIC also had a positive impact on the participants' empathy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Aretaieio Hospital, National and Kapodistrian University of Athens issued approval 444/07-06-2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Paliatsiou et al.)

Background: Fear of childbirth is a frequent health issue for pregnant women. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a widely used instrument to measure the fear of childbirth during the antenatal period. The aim of the study was to assess the psychometric properties of the W-DEQ (version A) in a sample of Greek pregnant women., Methods: Low-risk pregnant women in the second or third trimester of pregnancy (N = 201) were invited to participate in the study and to complete a booklet of questionnaires including the Greek versions of W-DEQ-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Exploratory (EFA) and confirmatory factor analysis (CFA) was performed., Results: The mean age of participants was 34.2 years (SD = 4.3 years). EFA yielded six factors ("Lack of self-efficacy", "Lack of positive anticipation", "Lack of feeling lonely", "Concerns about delivery and losing control", "Calmness", and "Concern for the child") of 33 items of W-DEQ-A. CFA confirmed the multidimensionality of the instrument. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. All factors were significantly correlated with each other, and convergent validity was demonstrated by a significant association with stress, anxiety, and depression among low-risk pregnant women., Conclusion: The Greek version of W-DEQ-A proved to be a valid and reliable instrument of fear of childbirth among Greek low-risk pregnant women., (© 2024. The Author(s).)

Background: The Traumatic Event Scale (TES) is one of the most often used instruments for the assessment of the Posttraumatic Stress Disorder (PTSD) symptomatology during pregnancy which is linked with adverse effects. The aim of the study was to assess the psychometric properties of the TES (version A) in a sample of Greek pregnant women., Methods: Two hundred one low risk pregnant women in their second or third trimester were invited to participate in the study. Participants completed a number of questionnaires including the Greek versions of TES-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Confirmatory factor analysis (CFA) was conducted in order to test how well the already TES-A five-factor model fits the data from Greece., Results: Participants' average age was 34.2 years (SD = 4.3 years). Through CFA the already five-factor structure of the TES-A (Anticipation of trauma, Intrusion, Avoidance, Resignation, Hyperstimulation) was applied to our sample. All five factors were significantly and positively correlated with each other. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. Relatively convergent validity, all factors of the Greek version of the TES-A were significantly associated with stress, anxiety, depression and coping strategies., Conclusion: The Greek version of TES-A is detected to be a valid and reliable instrument of prenatal Posttraumatic Stress Disorder (PTSD) symptomatology among low-risk Greek pregnant women., (© 2023. The Author(s).)

Maternal perinatal mental disorders (PMD) are associated with developmental and behavioral problems in children, probably mediated by the programming of the hypothalamic-pituitary-adrenal (HPA) axis. Increased cortisol concentrations during the antenatal and perinatal periods have been related to long-term effects on children's behavior and stress response. We aimed to investigate the association of hair cortisol concentrations (HCC) between mothers, with (n = 16) and without PMD (n = 30), and their children, aged between 18 and 48 months. Participants were evaluated with a clinical interview and questionnaires for the Depression Anxiety Stress Scale and the Child Behavior Checklist for ages 1½-5. Maternal and child HCCs were compared between the two groups. Children of the PMD group had increased symptoms of attention deficit hyperactivity disorder. A positive linear association between maternal and child HCC was observed only in the total sample of mother-child dyads and the control group. In the PMD group, children's HCCs were significantly associated with child anxiety/depression symptoms. Aggressive behavior and oppositional/defiant problems correlated significantly with children's own HCCs, and their mother's too. These findings suggest that a chronic dysregulation of maternal and child HPA axis and their associations in the PMD dyads may underlie the linkage among prolonged maternal stress, child behavioral/emotional problems and stress responses.

Literature findings are limited and inconsistent on the relationship between obsessive beliefs and obsessive-compulsive symptoms (OCS) and to our knowledge no data are available in pregnant population. Additionally, an interesting field that has not been adequately studied is the relationship between obsessive-compulsive personality traits and OCS while there are no corresponding studies in perinatal period. The aims of the study were to examine the relationship between OCS presented in pregnancy and obsessive beliefs considered to underlie them as well as their association with obsessive-compulsive personality traits. 30 pregnant women with OCS, regardless of their underlying diagnosis, were recruited from a University Psychiatric Hospital and privately. They completed the Mini International Neuropsychiatric Interview (MINI), the Yale-Brown Obsessive- Compulsive Scale (Y-BOCS), the Dysfunctional Beliefs Questionnaire-44 (OBQ-44), the Leyton Trait Scale and the Hospital Anxiety and Depression Scale (HADS). The main symptoms were aggression (73.3%), contamination (53.3%) obsessions and cleansing/washing (50%), checking (43.3%) compulsions. Pregnant women with obsessive-compulsive personality traits displayed symmetry/exactness obsessions (p=0.020) and cleansing/washing (p=0.011) compulsions as predominant types of OCS and greater severity of compulsions (p=0.049). The results of the logistic regression model suggest that obsessive beliefs of importance/control of thoughts and of responsibility/threat estimation predicted OCS while the belief of perfectionism/certainty did not predict any dimension of OCS. It is noteworthy that most observed relationships between obsessive beliefs and OCS remained even after controlling for variables of anxiety and depression, suggesting that obsessive beliefs have a specific relationship with OCS which is independent of other forms of psychopathology. Depressive symptoms comorbidity increased OCS severity, while in comorbidity with anxiety symptoms no difference in severity of OCS was found. Further research is needed to test our findings in larger and more diverse samples.

To evaluate the effectiveness of a structured education program on lifestyle habits, which is also incorporating teaching on deep breathing, progressive muscle relaxation, and guided visualization, in the control of various components of the climacteric symptomatology in peri- and postmenopausal women. Sixty-one women aged 40-65 years with varying climacteric and stress symptoms were included in this study. Women were randomly assigned to the intervention group (31) or the control group (30). The intervention group followed an 8-week stress management program. The following parameters were assessed at baseline and at the end of the 8-week follow-up period in both groups: climacteric symptoms (Green Climacteric Scale (GCS)), sleep quality (Pittsburg Sleep Quality Index (PSQI)), mood status (Depression-Anxiety-Stress Scale), self-esteem (Rosenberg Self-esteem Scale), and health-related control (health locus of control (HLC)). A mixed-model ANOVA showed significant time × group × GCS interaction (within subjects: F = 23.830, p value<0.001; between subjects: F = 39.078, p value<0.001). With regard to HLC, there was a non-significant between subjects but a significant within-subjects effect (HLC × group × time, F = 3.848, p value = 0.024). Regarding DASS scores, there was a significant between-subjects' effect (F = 10.258, p value = 0.003) but a non-significant within-subjects' effect. With regard to PSQI, the analysis showed significant within-subjects' effects (PSQI × group × time: F = 4.691, p value = 0.003) and non-significant between-subjects' effects (F = 0.022, p = 0.883). Finally, regarding RSS, there was a significant within-subjects' (RSS × group × time, F = 4.183, p value = 0.029) but non-significant between-subjects' effect (F = 1.582, p value = 0.213). Stress management may offer an alternative approach to the management of climacteric symptoms., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Objective: Thyroid dysfunction (overt and subclinical) has been consistently linked to pregnancy adversity and abnormal fetal growth and development. Mood disorders such as anxiety, depression, and obsessive-compulsive disorder (OCD) are frequently diagnosed during pregnancy and at postpartum, and emerging evidence suggests association with impaired offspring neurodevelopment and growth. This study aimed to examine potential associations between thyroid function and mood symptoms during pregnancy and postpartum., Design: This is a prospective study measuring thyroid hormones and assessing mood symptoms by employing specific questionnaires in the same cohort of 93 healthy pregnant women at the 24th (2nd trimester) and 36th (3rd trimester) gestational weeks and at the 1st postpartum week., Methods: Serum thyroid hormones, TSH, anti-TPO, and anti-Tg antibodies were measured at the 24th (2nd trimester) and 36th (3rd trimester) gestational weeks and at the 1st postpartum week. Specific validated questionnaires were employed at the same time-points to assess separately symptoms of anxiety [Generalized Anxiety Disorder Inventory (GADI), Penn State Worry Questionnaire (PSWQ), STAI-State Anxiety inventory (STAI-S), STAI-Trait Anxiety Inventory (STAI-T)], depression [Edinburgh Postnatal Depression Scale (EPDS), Stein's Blues Scale (BLUES), Beck Depression Inventory (BDI)], and obsessive compulsive disorder (OCD) [Yale-Brown Obsessive Compulsive scale (Y-BOCS)]., Results: At the 2nd trimester, GADI score correlated negatively with FT3 ( p < 0.010, r = -0.545) and positively with TSH ( p < 0.050, r = 0.837) concentrations; GADI, PSWQ, EPDS and Y-BOCS scores correlated negatively with FT4 concentrations ( p < 0.010, r = -0.768; p < 0.010, r = -0.384; p < 0.050, r = -0.364; p < 0.010, r = -0.544, respectively). At the 3rd trimester, BLUES score correlated positively with rT3 concentrations ( p = 0.00, r = 0.89); GADI, EPDS, and Y-BOCS scores correlated negatively with FT4 concentrations ( p = 0.001, r = - 0.468; p = 0.036, r = -0.39; p = 0.001, r = -0.625, respectively); GADI, STAI-S, and Y-BOCS scores correlated positively with TSH concentrations ( p = 0.015, r = 0.435; p = 0.024, r = 0.409 p = 0.041, r = 0.389, respectively). At postpartum, PSWQ, STAI-T, EPDS, and BDI scores correlated positively with rT3 concentrations ( p = 0.024, r = 0.478; p = 0.014, r = 0.527; p = 0.046, r = 0.44; p = 0.021, r = 0.556, respectively, Y-BOCS score correlated positively with TSH ( p = 0.045, r = 0.43), and BLUES score correlated positively with anti-TPO antibody concentrations ( p = 0.070, r = 0.586)., Conclusion: The reported findings demonstrate positive associations between low-normal thyroid function at the 2nd and 3rd trimesters of pregnancy and postpartum with anxiety, depression, and OCD scores., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer ST declared a past co-authorship with one of the authors GM to the handling editor., (Copyright © 2021 Konstantakou, Chalarakis, Valsamakis, Sakkas, Vousoura, Gryparis, Sakkas, Papadimitriou, Zervas and Mastorakos.)

Social media platforms have gained ground in the day-to-day life of the vast majority of people globally. Growing evidence suggests that social media overuse can take a pathological form, and users can exhibit behaviors similar to those appearing in several types of addiction. The aim of this study was to validate the Greek version of the Social Media Disorder Scale (SMDS) among young adults. An online survey was conducted among Greek adults, aged 18-29 years old. A total of 251 respondents voluntarily participated. Internal consistency, criterion, and construct validity were examined. Results suggest that the Greek version of SMDS shows good psychometric properties. Internal consistency was above the acceptable margin, with a satisfying Cronbach's α coefficient. Correlations with other addiction-related constructs were found to be moderate. Construct validity of the scale was evaluated with exploratory factor analysis. Exploratory factor analysis resulted in a single factor model, which explained almost half of the total variance. The Greek version of SMDS is a psychometrically sound and valid instrument, which researchers and practitioners can use to assess social media addiction in young adults., (© 2021. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Hoarding disorder is a debilitating condition that results from difficulty or inability to discard possessions and the need to save items and leads to cluttered living space. It impedes normal everyday functioning and causes significant distress and dysfunction. The aim of the current study was to validate the Greek version of the Saving Inventory-Revised (SI-R) in a non-clinical sample of 554 Greek adults. Factor structure and psychometric properties were investigated. Common exploratory (EFA) and confirmatory factor analysis (CFA) were used to explore the factor structure of the data. A three-factor solution was emerged for the Greek SI-R Which appears to cover the clinical dimensions of the phenomenon and consists of clutter, difficulty discarding and acquisition dimensions. This finding is in accordance with the original English version as well as other adaptations of the instrument in other languages. Some items cross loaded but such findings of cross loading items are also reported in related literature. The Greek version of the SI-R exhibits satisfactory internal consistency and good test retest reliability (stability). The current study also aimed to gather evidence towards the convergent and discriminant validity of Greek SI-R. Findings showed no correlation with measurements of different constructs such as anxiety, depression and non-hoarding obsessive compulsive symptoms but also only partial correlation with measurements of relative clinical constructs, such as hoarding items in obsessive compulsive inventories. Current findings suggest that the Greek SI-R can be a useful tool in the detection and evaluation of hoarding symptoms in Greek population.

Introduction: Globally, the total number of people with depression exceeds 300 million, and the incidence rate is 70 % greater in women. The perimenopause is considered to be a time of increased risk for the development of depressive symptoms and major depressive episodes., Aim: The aim of this position statement is to provide a comprehensive model of care for the management of depressive symptoms in perimenopausal and early menopausal women, including diagnosis, treatment and follow-up. The model integrates the care provided by all those involved in the management of mild or moderate depression in midlife women., Materials and Methods: Literature review and consensus of expert opinion., Summary Recommendations: Awareness of depressive symptoms, early detection, standardized diagnostic procedures, personalized treatment and a suitable follow-up schedule need to be integrated into healthcare systems worldwide. Recommended treatment comprises antidepressants, psychosocial therapies and lifestyle changes. Alternative and complementary therapies, although widely used, may help with depression, but a stronger evidence base is needed. Although not approved for this indication, menopausal hormone therapy may improve depressive symptoms in peri- but not in postmenopausal women, especially in those with vasomotor symptoms., (Copyright © 2019. Published by Elsevier B.V.)

Postpartum depression is a debilitating mental disorder with a high prevalence, usually related with a past psychiatric history of major depressive disorder, postpartum depression, bipolar disorder, premenstrual syndrome (PMS), and perinatal depressive symptoms during gestation. However, the existing literature does not sufficiently elucidate the pathophysiology of this clinical entity which appears in such a crucial period of woman's life. This review aims to search the available data regarding the involvement of immunological and autoimmune mechanisms in its onset. A literature review was conducted using web-based search engines provided by PubMed (for Medline database) and Google Scholar. Manuscripts in English and Greek language were included for the period 19902017. Nowadays, a large body of evidence indicates that depressive disorders are accompanied by activated neuro-immune, neuro-oxidative and neuro-nitrosative stress (IO&NS) pathways. However, clinical research regarding the biological mechanisms associated with PPD is a tough challenge as pregnancy and puerperium are periods of adaptive changes in pregnant women by definition. Two of the systems that have been studied as potentially contributing to the onset of PPD are: the activation of the Inflammatory Response System (IRS) and the deregulation of the Hypothalamic-PituitaryAdrenal axis (HPA). Controversial data indicate dysregulation of cytokines and other inflammatory agents in patients with PPD, as well as, a close correlation of immune-inflammatory mechanisms and kynurenine pathway. PPD has been closely associated with autoimmune diseases. It is notable that this entity shares many common traits with autoimmune diseases such as the genetic susceptibility, family history, the high correlation with other autoimmune diseases, clinical exacerbations and remissions, women's superiority in prevalence, and the possible re-occurrence during a future pregnancy. These facts suggest that the typical postpartum flare pattern, and other clinical characteristics, point towards an autoimmune etiology for PPD. There are indications that immune-inflammatory and autoimmune mechanisms may be the key to deciphering the complex pathophysiological pathways associated with the onset of PPD. Clinical studies have been insufficient to make clear the causative correlations of the underlying mechanisms involved. Future research could focus on the immune-inflammatory processes associated with the onset of the disease, as well as on potential biomarkers for an early diagnosis and an effective treatment of PPD.

The aim of the present study was to identify the sexual behavior, attitudes, beliefs, and knowledge on sexually transmitted infections (STIs) focused on human papilloma virus (HPV) in the Greek adolescent population. The participants were 4547 adolescents, a representative sample for Greek territory with a mean age of 17 years. After written permission from Greek ministry of education each student completed a questionnaire with 36 questions. The fields covered were demographic characteristics, sexual life data, and basic knowledge on HPV. In the present study, 43% and 75% of the participants knew about HPV or cervical cancer, while more than 6 out of 10 did not know the association between the 2. More than 60% of the participants could not answer correctly neither about HPV infection and cervical cancer frequency in sexually active women, nor about protection methods against HPV and cervical cancer. This study shows that the low vaccination coverage of the Greek population may be due to lack of information and awareness of the adolescents and their parents. It is our duty to increase our efforts in order to better educate the population and vaccinate the population as early as possible in their reproductive years., Competing Interests: The authors have no conflicts of interest to disclose.

Social changes and developments in medical science prompted mental health professionals to adopt new roles in relation to their self-disclosure practices. The physician-patient relationship has balanced on a different level, promoting the equity and the autonomy of the second. The contemporary patient is better informed, asks more questions and requires more answers. The boundaries between "professional" and "personal" are less strict and patients believe that they have a right to know whether the personal experiences (educational, clinical, research) of their therapists enable them to understand and help them. Although the latest version of the American Psychological Association's Ethics Code (APA, 2002) offers no explicit guidance on therapist self-disclosure, it incorporates an implicit message that therapists can no longer choose non-disclosure without having considered the issue carefully. Non-disclosure is no longer the easy answer, as it may affect adversely the therapeutic relationship and the therapeutic effect. These new circumstances prompted representatives of all psychotherapeutic orientations to reconsider traditional positions on therapist self-disclosure, to adapt to the diverse needs of the patients and the modern requirements of the therapeutic process and to define the framework within which its conduct is not only safe but also effective. This review attempts to describe the concept of therapist self-disclosure and its use and its functions in Cognitive-Behavioral Therapy, following a history of the term in other major therapeutic schools (psychoanalytic, client-centered and systemic). As the focus of any psychotherapy is the patient himself, we added reports of patients' experiences by their therapists' disclosures. Those descriptions reveal clearly not only the benefits of therapist self-disclosure but also the dangers posed by improper use. Finally, we attempt to set a framework in the form of proposals, as these result from existing empirical and theoretical research. As therapists will inevitably be confronted with the issue of self-disclosure in their careers, they will have to make decisions on if, what, when, why, to whom, and how to disclose. These guidelines aspire to be of help to therapists so they can use self-disclosure efficiently and ethically and to minimize potential risks.

Background and Objectives: This study tested the effectiveness of schema therapy (ST) for patients with chronic depression., Methods: Twelve patients with a diagnosis of chronic depression participated. The treatment protocol consisted of 60 sessions, with the first 55 sessions offered weekly and the last five sessions on a biweekly basis. A single case series A-B-C design, with 6 months follow-up was used. Baseline (A) was a wait period of 8 weeks. Baseline was followed by introduction to ST and bonding to therapist (phase B) with individually tailored length of 12-16 sessions, after which further ST was provided (phase C) up to 60 sessions (included the sessions given as introduction). Patients were assessed with Hamilton Rating Scale for Depression three times during baseline, at the end of phase B, then every 12 weeks until the end of treatment and at 6 months follow-up. Secondary outcome measures were the Hamilton Rating Scale for Anxiety and the Young Schema Questionnaire., Results: At the end of treatment 7 patients (approximately 60%) remitted or satisfactorily responded. The mean HRSD dropped from 21.07 during baseline to 9.40 at post-treatment and 10.75 at follow-up. The effects were large and the gains of treatment were maintained at 6-month follow-up. Only one patient dropped out for reasons not related to treatment., Limitations: The lack of control group, the small sample and the lack of a multiple baseline case series., Conclusions: This preliminary study supports the use of ST as an effective treatment for chronic depression., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Many studies have provided important information regarding the anatomy, development and functional organization of the 5-HT system and the alterations in this system that are present within the brain of the suicidal patient. There is also a growing interest in genetic factors associated with suicide, since these may lead to the emergence of personality traits that prove to be long-term predictors of suicidal behaviour. This review will focus on presenting the scientific literature on the role of the serotonergic system in suicidal behaviour as well as dysfunctional attitudes and personality traits associated with the suicidal patient. The association of the serotonin transporter gene, the 5-HT2 receptors and its metabolite 5-hydroxyindoleacetic acid with suicidal behaviour and animal models that may capture the complexity of suicidal behaviour will be discussed. Finally, the relationship between neurobiological models and psychotherapeutic interventions for suicide prevention will be considered with a focus on Schema Therapy (an approach that has shown particular promise in the treatment of suicidal individuals with personality disorders), aiming to invite the reader to integrate some aspects of the neurobiology of human suicidal behaviour into a model of suicide that can be used in a clinical encounter.

Recent studies indicate that the pregnancy rates of mothers with schizophrenia do not differ significantly from those of the general population. Mothers' severe mental illness, combined with poor social support and comorbidity, may significantly affect her parenting capacity. However, the poor quality of parenting by psychotic mothers should not be taken for granted, in advance. Some of them may become excellent parents while other may abuse their children and finally lose custody because of this. The parenting capacity is significantly influenced by the existing insight of patient-parent's disease. Assessing the parenting capacity comprises the measurement of insight and of the risk of child abuse as well. Factors associated with increased risk for child abuse are: (a) active psychiatric symptomatology, (b) history of violent behavior in the past, (c) maternal history of abuse during childhood, (d) dangerous domestic environment, (e) stressful events and poor social support to the mother and (f) unrealistic parental expectations. These factors should be assessed both clinically and by using the appropriate psychometric tools. Tools which have been widely used for this purpose are: (a) "Schedule for Assessment of Insight-SAI", (b) "Childhood Trauma Interview", (c) "Home Observation for the Measurement of the Environment Inventory-HOME" and "Home Screening Questionnaire -HSQ", (d) "Parental Stress Inventory-PSI", "Swedish Parenthood Stress Questionnaire-SPSQ", "Arizona Social Support Inventory" (e) "Parent Opinion Questionnaire-POQ". Interventions to ensure a more adequate parenting capacity should be focused on family planning: mothers with severe mental illness have poor knowledge about reproductive and contraception issues. Their pregnancies are mostly not planned. It is important for the family planning to be tailored according to the specific needs of schizophrenic mothers and to take into account the following issues: (a) the severity and the duration/chronicity of the disease, (b) the onset of the disease in relation to the gestational period, (c) the education of mothers with schizophrenia considering their double patient/mother role. An educational program should train the mother to recognize early signs of the disease, comply with medication, increase her empathy towards the baby and reduce any distorted perceptions about it. The treating, assessing, educating and preventing programs and interventions of mental health services should be continuous and supportive.

Lithium augmentation is one of the best studied strategies for resistant depression. The lithium dosage usually given is around 900 mg/day and plasma level is maintained in the range of 0.5-0.8 mEq/L. However, the administration of lithium in this dosage necessitates monitoring of plasma concentration and increases the risk of toxicity and side effects. Since it has been shown that low lithium levels increase serotonin turnover and enhance serotonin neurotransmission, we thought it of interest to assess the efficacy of low dosage lithium augmentation for patients with resistant depression. Fifty one patients suffering from severe unipolar or bipolar depression who had failed to respond to treatment with venlafaxine 300-375 mg/day were included in the study and treated as outpatients. Patients had previously been exposed to unsuccessful treatment with various antidepressants, mostly SSRIs. After a washout period for previously administered antidepressants of one week, the dosage of venlafaxine was rapidly titrated to 300 or 375 mg/day, corresponding to about 5 mg/kg. The dose remained stable during the next six weeks. Additional antipsychotic medication was allowed to treat psychotic symptoms. Forty seven severely depressed patients who failed to respond to 300-375 mg/day venlafaxine were, in addition, given lithium carbonate in low dosage (300-450 mg/day). The Clinical Global Impression Improvement scale was used as the treatment outcome. A score of 1 or 2 was considered as non-response. All patients gave informed consent to participate in the study. Ratings were performed at baseline and after 1,2 and 5 weeks. Lithium plasma concentration measurements were performed after 1 and 4 weeks. After 5 weeks of augmentation, 51% of the patients were rated as "much" or "very much" improved. Bipolar patients showed a better response than unipolar (64.3% vs 45.5%, p<0.038). Most patients (76%) showed a rapid response (up tp 7 days), and only 2 patients (4.6%) responded after more than 2 weeks The mean lithium plasma level was 0.33±0.09 mEq/L. No significant differences were found in treatment response with regard to sex, family history, psychotic symptomatology and suicidal ideation. No troublesome side effects were reported. Our results show that treatment augmentation with low lithium dosage may be as effective as augmentation with higher dosage, is well tolerated and does not necessitate monitoring of plasma level. Hence, an initial trial of ugmentation at low dosage lithium may be the preferred first choice in non-emergent situations. The low dosage also minimizes the risk of side effects and drug-drug interactions. Prospective controlled studies to confirm our findings are needed as are larger scale comparisons with therapeutic dose lithium augmentation.

Background: The KIDSCREEN-52 is a worldwide instrument for measuring health-related quality of life (HRQoL) in children and adolescents. The aim of this study is to assess reliability and validity of the Greek version of KIDSCREEN., Methods: Questionnaires were collected from a representative nationwide sample of 1,194 adolescents aged from 11 to 17 years. Internal consistency reliability was determined by calculation of the Cronbach α coefficient. A confirmatory factor analysis (CFA) was conducted in order to test the construct validity of the questionnaire. Validity was further examined by investigating the correlation of KIDSCREEN with the Strengths and Difficulties Questionnaire (SDQ) and its association with socioeconomic and health-related factors., Results: Internal consistency reliability was accepted with a Cronbach α above 0.73 for all KIDSCREEN dimensions. CFA showed that the ten-dimensional model fitted the data well (root mean square error of approximation (RMSEA) = 0.048, comparative fit index (CFI) = 0.971 and goodness of fit index (GFI) = 0.965). Correlation coefficients between KIDSCREEN and SDQ dimensions were significant. Adolescents of low socioeconomic status reported lower scores in the majority of KIDSCREEN dimensions. Also, adolescents with chronic health problem had poorer quality of life concerning physical well-being and other dimensions of KIDSCREEN., Conclusions: The Greek version of KIDSCREEN-52 was found to have satisfied psychometric properties and could be suitable for assessing HRQoL in Greek adolescents.

Background and Aims: Caregivers of patients with schizophrenia experience increased levels of psychological distress. This study investigated the impact of caring for patients with chronic schizophrenia on the mental health status of the caregivers and described the relationship between various socio-demographic and clinical characteristics and caregiving psychological distress., Methods: The study was carried out at the Psychiatric Hospital of Athens. The Symptom Check List Revised (SCL-90-R) was administered to 87 caregivers of chronic schizophrenia patients and 90 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was administered to schizophrenia patients in order to assess illness severity., Results: The group of caregivers scored higher on the majority of symptom dimensions of the SCL-90-R than the control group. Clinical features of schizophrenia, i.e. duration of illness and PANSS positive and negative symptoms significantly predicted caregiving psychological distress. Caregivers' and patients' socio-demographic characteristics were not associated with caregivers' distress, with the exception of caregivers' sex: female caregivers experienced significantly higher levels of psychological distress than males., Conclusions: The study suggests that clinical features of schizophrenia influence distress levels in caregivers of patients with chronic schizophrenia. The stronger predictors of distress appear to be female caregiver's gender, duration of illness as well as positive and negative symptomatology.

Objectives: The aim of the present study was to evaluate how sociodemographic parameters, lifestyle indicators and intensity of climacteric symptoms affect the quality of life (QOL) of Greek community dwelling middle-aged women., Study Design: This population survey included 1140 middle-aged women aged 45-65 who represented 1% of the whole female population of this age group in Greece, stratified by residential area., Main Outcome Measures: Participants were asked to complete a questionnaire concerning sociodemographic and anthropometric parameters, medical history, the Utian quality of life (QOL) scale and the Greene climacteric scale rating menopausal symptoms., Results: In the univariate analysis, normal body mass index, married status, higher education, employment, good financial status, physical exercise and a high calcium diet were associated with higher total QOL scores (p-value<0.001). Multivariate regression analysis showed that higher total QOL scores were predicted by being married (separated/divorced/widowed: beta=-3.17, p-value=0.008), by physical exercise (beta=4.84 and beta=4.57 for 1-3h and >3h per week respectively, p-value<0.001) and by a good financial status (beta=7.05, p-value<0.001), while a higher score in the Greene scale resulted in lower total QOL scores (beta=-0.77, p-value<0.001). Women with a better QOL were more health conscious and more probable to have utilized the public health preventive resources., Conclusions: Menopause as a life event has no effect on the QOL of Greek middle-aged women. On the contrary, the presence and intensity of climacteric symptoms have a negative impact on all aspects of QOL. Marital and financial status, as well as physical exercise, are also significant predictors of QOL., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Aim: Postpartum mood disturbances are common among Greek women, with postpartum depression (PPD) being as high as 19%. This study aimed to investigate whether sex steroid hormone levels affect the incidence of postpartum mood disturbances., Materials and Methods: Fifty-seven women were evaluated for postpartum mood disturbances using the Postpartum Blues Questionnaire and the Edinburgh Postnatal Depression Scale on the 1st and 6th week. Serum estradiol, progesterone and testosterone concentrations were measured upon admission for delivery and daily until the fourth postpartum day. We then studied the association between hormone levels and the scores in the two psychometric scales., Results: Testosterone was the only hormone that was marginally associated with psychometric scoring in simple regression analysis. (Postpartum Blues during days 1-4: b = 4.291, 95% C.I. -0.796 to 9.377 and p-value = 0.096). Women with lower testosterone drops had higher scores in Postpartum Blues Questionnaire. This association, however, lost statistical significance in the multivariable analysis after adjusting for pregnancy duration. In multiple regression analysis, only pregnancy duration had the most constant adverse effect on psychometric scores: The shorter the duration of pregnancy, the higher the scores for Postpartum Blues. (r = -0.39, p < 0.01)., Conclusions: Our findings do not indicate an association between the occurrence of postpartum mood disorders and sex steroid hormone levels. Preterm labour may be associated with a higher risk of postpartum mood disturbances.

Background. Esophagogastroduodenoscopy (EGD) and colonoscopy (CS) can evoke anxiety, embarrassment, and discomfort. These concerns can culminate in panic attacks, which may traumatize patients and significantly decrease their compliance to the procedure. The objective of this study was to evaluate the relationship between preendoscopic anxiety and the possibility of a panic attack during an elective gastrointestinal endoscopy (EGE). Methods. The study population comprised of 79 Greek outpatients. The examination was carried out without the use of conscious sedation. Patients' anxiety levels were assessed before the procedure using the Greek version of the Spielberger State-Trait Anxiety Inventory (STAI-Y). Results. Seventy-nine patients were enrolled: 45 EGD and 34 CS. Females had higher state and trait anxiety levels than males (48.14 ± 7.94 versus 44.17 ± 7.43, P < 0.05; and 43.68 ± 6.95 versus 39.86 ± 7.46, P < 0.05). Patients who experienced panic attack had significantly higher levels of both trait and state anxiety, compared to those who were panic-free. There was no significant relationship between panic attacks and sex or type of procedure. Conclusions. Patients who experience panic attacks during endoscopic procedures appear to have significantly higher anxiety levels before the procedure. Administering the STAI questionnaire prior to the endoscopy seems to be a useful screening method for vulnerable patients.

Background: Postpartum mood disturbances are very common with postpartum blues being as high as 44.5% among Greek women. This study aimed to investigate whether thyroid function within the normal range affects the incidence of postpartum mood disturbances., Methods: In a cross-sectional study in the maternity ward of Aretaieion Hospital, 57 Greek women were evaluated for postpartum mood swings by the Maternity Blues Questionnaire and the Edinburgh Postnatal Depression Scale on the first and sixth week postpartum. Serum Free T4, Free T3 and TSH concentrations as well as thyroglobulin and thyroid peroxidase antibodies were measured on admission for delivery and daily until the fourth postpartum day. We examined the association between hormone and antibody levels, and scores in the two scales evaluating postpartum mood disturbances., Results: Prepartum serum FT3 and FT4 correlated negatively with blues scores in the first week postpartum (blues on day 4: with FT3, rho=-0.44, p < or = 0.01; with FT4 rho=-0.36, p < or = 0.01). Women with lower FT3 and FT4 levels belonged to the high scoring group (high scoring group: FT3=1.22 pg/ml, FT4=0.66 ng/dl; low scoring group: FT3=1.64 pg/ml, FT4=0.73 ng/dl). Serum FT3 showed a negative independent correlation with postpartum blues scores in the first postpartum days. No association was found between thyroid antibody levels and mood scores., Conclusion: Our findings indicate an association between the occurrence of postpartum mood disorders and antenatal thyroid function. Within normal limits, lower levels of serum FT3 and FT4 are associated with increased incidence of mood disturbances in the first postpartum week., (Copyright 2009 Elsevier B.V. All rights reserved.)

Background: This case report documents the effectiveness of inositol treatment on a chronic patient with bipolar disorder I and severe psoriasis. Her lithium treatment was discontinued due to psoriasis exacerbation and inositol was administered. The remarked positive effect of inositol was noted on her stable mood during the last 4 years, the absence of psoriatic lesions, which lead to an improved quality of life of the patient., Case Presentation: A 62-year-old female Caucasian patient suffering from bipolar disorder, since the age of 32, presenting manic episodes when without lithium treatment. Lithium treatment caused severe exacerbation of psoriasis and was discontinued while anti-psoriatic treatment had no effect. The last 4 years the patient receives 3 gr per day of inositol alone and her mood has been stabilized while there is also a remarkable improvement on her psoriatic lesions., Conclusion: Taking into consideration the course of her bipolar disorder when lithium was discontinued previously we consider that the 4 years of follow up assessments of this patient as a satisfactory time period for concluding that inositol has been a very effective treatment, replacing lithium, for mood stabilization and psoriasis.

There is growing body of evidence that support an association between stressful life events and an increased risk for Multiple Sclerosis (MS) exacerbations. However, the nature of this relationship remains unclear, because of the lack of agreement about the definition of stress and/or because of research design problems. This article summarizes the psychological and biological mechanisms by which stress may impact MS progression. Findings indicate a number of factors, including stressor chronicity, frequency, severity and type, depression, anxiety, health locus of control, optimism, perceived social support, and coping strategies. Applied implications are discussed, concentrating on the need for multidisciplinary care interventions that target patients' disease symptoms.

Despite the fact that irritability is frequently the main presenting complaint of perimenopausal and postmenopausal women, studies specifically researching irritability in this population are scant. One hundred sixty three (163) peri- and postmenopausal women non-HT users, attending a menopause clinic, were included in this cross-sectional study. The investigation focused on whether the occurrence of inward and outward irritability in menopause is associated with various menopausal parameters, such as vasomotor symptoms, insomnia, menopausal status, hormone levels, and with the presence of chronic disease. Furthermore, we examined the possible association of inward and outward irritability with measures of anxiety and depression. Outward and inward irritability of peri- and postmenopausal women seem to be related to chronic disease, a factor that may be partially influenced by the older age of menopausal women. Outwardly directed irritability is found to be related to FSH and LH levels, independently of specific menopausal symptoms, such as vasomotor symptoms or insomnia. Outward irritability was found to be positively correlated with depressive symptomatology, whereas inward irritability correlated with both anxiety and higher depressive symptomatology.

During the past few years psychiatric research has focused its interest on the disorders of sweating: hyperidrosis and hypoidrosis/anhidrosis. Hyperhydrosis is the most commonly encountered in practice. In this situation, the total amount of sweat produced is greater than needed for thermoregulation. The disorders of sweating receive the research attention of many medical specialties. This trend is attributed to their high prevalence, their relation with many psychiatric disorders, their effects on the quality of life of patients, but also of the new therapeutic approaches that have been developed (the use of botulinum toxin, surgical methods, etc). Balancing among different suggestions for the treatment of hyperhidrosis, the psychiatrist must be thoughtful for the therapeutic approach. The cases of hypohidrosis and anhidrosis are less frequently mentioned, for which patients hardly ever complain. They are characterized by reduced sweating below the amount needed to cool down an elevated body temperature, or even absent sweating. They may constitute an urgent medical situation leading to hyperthermia and death. Overall, disorders in sweating may be caused by pharmaceutical or hormonal causes. Many pharmaceutical and psychotherapeutic methods have been used for treatment. Therefore, we believe it is useful for the clinical psychiatrist to keep in mind the psychiatric and psychological aspects of the disorders of sweating, and their impact on patient diagnosis, course and treatment.

The aim of this study was to study the frequencies of clinical manifestations traditionally associated with the concept of "hysteria", namely conversion, dissociation, and somatization in the emergency room of the Department of Psychiatry in Athens in the late 1990s, in a period of significant social change of the Greek culture towards more Western standards. We used a retrospective chart review of all new emergency room cases in a representative two-year period (1995-1997), replicating the method and the diagnostic classification of a study from our Department published 25 years ago, investigating similar changes in these symptoms in previous periods of change in the Greek social structure. Of 7424 new cases 215 (2.9%) fulfilled criteria for "hysteria", a significant reduction from the original study. Of these 28 were foreign, mostly from non-Western cultural settings. Male to female ratio (1:3) and mean age remained unchanged from the original study. Hysterical fits (pseudoseizures) were significantly less in comparison to the original study. Mental and vegetative conversion (corresponding to dissociative and somatoform disorders, respectively) remained unchanged, mixed conversion increased while changes in somatic conversion (conversion disorder) depended on the nationality of the patients. Over the last quarter century in Athens rates of patients with so called "hysterical symptoms" continue to decrease, as do the most dramatic presentations. These reductions however, are not so great to suggest a disappearance of the syndrome, while increase of the mixed forms suggest that sub-syndromes may have common underlying mechanisms. This may point towards a single disease process with multiple presentations rather than separate diagnostic categories. Culture appears to influence clinical expression of symptoms.

Objective: This study examines the role of an introductory course in cognitive therapy and the relative importance of trainees' characteristics in the selection process for an advanced course in cognitive therapy., Method: The authors assessed the files of all trainees who completed one academic year introductory course in cognitive therapy over the last seven consecutive years (N = 203). The authors examined variables such as previous training, overall involvement during the course, performance, and ability to relate to others, as well as the trainer's evaluations of their performance., Results: Interaction skills in group situations and performance in written assignments were better predictors for admission into the advanced course., Conclusions: Trainees' abilities to learn and to successfully relate to others in group situations are critical for entering an advanced cognitive therapy training course. These findings question the policy of full-scale training in cognitive therapy based merely on the candidates' professional background, stressing instead the merits of an introductory course as an appropriate screening procedure.

Objectives: Neoadjuvant chemotherapy has been used to improve outcome after cystectomy or for selection for bladder preservation in patients with bladder cancer. We have shown encouraging results using docetaxel and cisplatin in patients with advanced urothelial cancer. We are reporting the results of a phase II study using this combination as neoadjuvant treatment in patients with muscle invasive bladder cancer., Methods: Fifty patients were treated with docetaxel and cisplatin at 75 mg/m2 every 3 weeks for 3 cycles prior to cystectomy. Median follow-up was 70.2 months., Results: Chemotherapy was well tolerated. 5-year survival and progression-free survival (PFS) were 51.92% (95% confidence intervals [CI]: 37.76-66.08) and 52.47% (95%CI: 37.99-66.95). Multivariate analysis showed that clinical stage (cT) < or = 3a was associated with improved 5-year survival (86.42% vs. 40.81%, p = 0.027). Forty one patients underwent cystectomy. No tumor was found in 15 cases (36.6%). 5-year survival was 60.34% (95%CI: 52.2-68.48) and PFS was 57.11% (95%CI: 41.29-72.93). Absence of residual tumor was associated with improved 5-year survival (93.33% vs. 40.72%, p = 0.031)., Conclusions: Neoadjuvant chemotherapy with docetaxel and cisplatin is feasible and produced high pathological complete remission rate and excellent outcome in patients with no residual tumor.