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To study the functional organization of the cerebral hemispheres in patients with bipolar psychosis using a verbal dichotic listening test for pairs of digits 26 patients were tested twice, during the acute expression of manic phase and after recovery. The patient group during the manic phase did not support the expected right-ear advantage of normal subjects on verbal dichotic tests but showed a statistically significant left-ear advantage, which shifted after recovery toward the typical normal asymmetry. Comparing patients during the manic phase and after recovery showed that the left-ear advantage as well as the shift in right-ear advantage after recovery was due to the reduction of left-ear performance. From the over-all neuropsy-chological findings for these patients mania may be hypothesized to be characterized by overactivation of the right hemisphere. This phaenomenon seems associated with acuteness of the symptoms of the psychotic disorder.

Introduction: Childhood trauma (CT) has been recognized as a risk factor for psychosis. Among the pathways implicated in the CT-psychosis association, attributional biases (ABs) hold a prominent position. ABs disrupt reality testing, thus laying a conducive ground for the emergence of paranoid symptoms. Paranoid patients have been theorized to externalize the causality of negative life events (externalizing bias; EB), mainly by blaming other people (personalizing bias; PB), in an attempt to maintain their self-esteem. Objectives: We sought to investigate the presence and intercorrelations of CT and ABs in a group of patients with schizophreniaspectrum psychosis (SSP). Methods: We compared 63 SSP inpatients to a healthy control group (HC) on measures of CT and attributional style. CT was assessed with the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), and attributional style with the Internal, Personal and Situational Attributions Questionnaire (IPSAQ). Results: SSP inpatients displayed higher levels of CT (X2 (1, N = 124) = 34.5, p < .001) and PB (U = 1309, p = .002) than HCs. EB was not detected in the SSP group. Within the SSP group, PB was negatively correlated to the severity of maternal antipathy (rs = - 0.380, p = .002) and neglect (rs = - 0.300, p = .017). Conclusions: SSP inpatients do not favor external attributions for negative events. However, when they do externalize causality for negative events, they tend to personalize the blame. If PB serves the purpose of preserving an intact self-image in paranoid patients, negative maternal rearing behaviors appear to reduce this defensive capacity. [ABSTRACT FROM AUTHOR]

Introduction: Among the environmental factors recognized to convey an increased risk for psychosis, childhood trauma (CT) holds a prominent position. CT is a generic term encompassing experiences of sexual, physical and emotional abuse, and neglect during childhood and adolescence. Due to the fact that CT in adult patients with psychosis has been mainly assessed through retrospective reports, concerns have been raised about the reliability and validity of these data. Objectives: We sought to explore the short-term reliability of retrospective CT reports in a group of patients with schizophrenia-spectrum psychosis (SSP). Methods: We assessed 63 SSP patients on two different early adversity self-report measures to establish concurrent validity by confirming the similarity of CT ratings; and on two separate occasions (T1: inpatient status; T2: outpatient status, three months after initial testing) to establish test-retest reliability by confirming the temporal stability of abuse and neglect reporting. Early adversity was measured with the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), and the Parental Bonding Instrument (PBI). Results: High concurrent validity was detected between CECA.Q antipathy scales and PBI care and protection scales; and between CECA.Q neglect scales and PBI care scales. High test-retest reliability was confirmed for all CECA.Q and PBI scales. Conclusions: Our findings indicate that retrospective CT reports are a reasonably reliable and valid means of assessing early experiences of abuse and neglect in SSP patients. However, additional provisions are required for corroborating these reports through other sources and removing the effect of confounding variables, such as caveats of autobiographical memory, desirability bias and psychopathology. [ABSTRACT FROM AUTHOR]

Abstract Introduction The current study aimed to assess the reliability, validity and psychometric properties of the Greek translation of the Zung Depression Rating Scale (ZDRS). 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. In 20 of them (12 patients and 8 comparison subjects) the instrument was re-applied 1–2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. Statistical Analysis included ANOVA, the Pearson Product Moment Correlation Coefficient, Principal Components Analysis and Discriminant Function Analysis and the calculation of Cronbach's alpha (α) Results Both Sensitivity and specificity exceed 90.00 at 44/45, Chronbach's alpha for the total scale was equal to 0.09, suggesting that the scale covers a broad spectrum of symptoms. Factor analysis revealed five factors (anxiety-depression, thought content, gastrenterological symptoms, irritability and social-interpersonal functioning). The test-retest reliability was satisfactory (Pearson's R between 0.92). Conclusion The ZDRS-Greek translation is both reliable and valid and is suitable for clinical and research use with satisfactory properties. Its properties are similar to those reported in the international literature, although the literature is limited. However one should always have in mind the limitations inherent in the use of self-report scales.

Abstract Introduction The aim of the current study was to assess the reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies- Depression Scale (CES-D). Methods 40 depressed patients 29.65 ± 9.38 years old, and 120 normal controls 27.23 ± 10.62 years old entered the study. In 20 of them (12 patients and 8 controls) the instrument was re-applied 1-2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. Statistical Analysis included ANOVA, the Pearson Product Moment Correlation Coefficient, Principal Components Analysis and Discriminant Function Analysis and the calculation of Cronbach's alpha (α) Results Both Sensitivity and specificity exceed 90.00 at 23/24, Chronbach's alpha for the total scale was equal to 0.95. Factor analysis revealed three factors (positive affect, irritability and interpersonal relationships, depressed affect and somatic complains). The test-retest reliability was satisfactory (Pearson's R between 0.45 and 0.95 for individual items and 0.71 for total score). Conclusion The Greek translation of the CES-D scale is both reliable and valid and is suitable for clinical and research use with satisfactory properties. Its properties are similar to those reported in the international literature. However one should always have in mind the limitations inherent in the use of self-report scales.

Background: Auditory processing disorders involve deficits in the processing of information in the auditory domain that are not due to higher order language, cognitive or other related factors. Purpose: To evaluate the possibility of structural brain abnormalities in preterm children manifesting as auditory processing disorders. Research Design : A case report of a young girl, preterm at birth, with language difficulties, learning problems at school, and additional listening problems. Results: A diagnosis of a central auditory processing disorder was made on the basis of severe deficits in three nonspeech temporal tests (the frequency and duration pattern and the random gap detection tests). Her brain MRI revealed large porencephalic cysts and thinning of the corpus callosum. Conclusions: The observed auditory deficits would be compatible with a pressure effect of the cysts at a brainstem or higher level for the random gap detection test, and with the thinning of the corpus callosum for the pattern tests, the latter requiring interhemispheric transfer of information. The case highlights that preterm children with learning difficulties may suffer from an auditory processing disorder, in the presence of structural brain abnormalities that are due to birth and neonatal complications. [ABSTRACT FROM AUTHOR]

It is indicated that auditory perception deficits are present in schizophrenia and related to formal thought disorder. The purpose of the present study was to investigate the association of auditory deficits with cognitive impairment in schizophrenia. An experimental group of 50 schizophrenia patients completed a battery of auditory processing evaluation and a neuropsychological battery of tests. Correlations between neuropsychological battery scores and auditory processing scores were examined. Cognitive impairment was correlated with auditory processing deficits in schizophrenia patients. All neuropsychological test scores were significantly correlated with at least one auditory processing test score. Our findings support the coexistence of auditory processing disorder, severe cognitive impairment, and formal thought disorder in a subgroup of schizophrenia patients. This may have important implications in schizophrenia research, as well as in early diagnosis and nonpharmacological treatment of the disorder.

Childhood trauma (CT) refers to severe early life adversities, especially experiences of parental abuse and neglect. Patients with schizophrenia spectrum psychosis (SSP) report higher CT rates than the general population. As CT assessment in SSP samples has been mainly conducted retrospectively through adult recollections of childhood adverse events, reservations about the reliability and validity of these reports have arisen. We sought to explore the short-term reliability of retrospective CT reports in sixty-three patients with SSP, by assessing the concurrent validity and test-retest reliability of the data. Two CT self-report measures, the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and the Parental Bonding Instrument (PBI) were employed for this task. High concurrent validity was detected between CECA.Q antipathy scales and PBI care and overprotection scales; and between CECA.Q neglect scales and PBI care scales. High test-retest reliability was confirmed for all CECA.Q and PBI scales. Our findings indicate that retrospective CT self-report measures are a reliable means of assessing early life adversities in SSP. However, further provisions should be taken to increase the reliability of retrospective reports, especially corroboration of the events through other sources and removal of latent confounders, such as psychopathology, memory fallacies and social desirability biases.

Background: COVID-19 is a novel event of the twenty-first century. Therefore, contemporary research is required to determine the current pandemic's psychological impact on older populations. Soon after the COVID-19 outbreak, several narrative reviews and guidelines were released to support older adult's psychological wellbeing. However, a lack of data from original studies was reported until May 2020., Aim: To identify studies published from May 2020 until January 2021 that quantitatively assessed the mental health impact of COVID-19 on older adults using validated psychometric tools., Method: A comprehensive literature search of original research articles was conducted using specific terms. The screening procedure was conducted stepwise., Results: Among the 18 included studies, cross-sectional online surveys indicated that older adults were less psychologically distressed than younger ones. A longitudinal study revealed that COVID-19 did not have a major impact on loneliness and satisfaction with life. On the contrary, studies comparing pre- with peri-pandemic data revealed that older adults experienced more severe depressive/anxiety/stress symptoms and loneliness during the pandemic. Several studies reported though only subclinical symptoms, as well as low loneliness levels during the pandemic., Conclusions: Research studies suggested that older age may buffer against the COVID-19-related impact on mental health. Despite evidence against generalised perceptions of vulnerability, older adults' ability to adapt to adversity may be uneven, depending on cultural, social, economic and other individual factors. Taken together, the impact, moreover the long-term impact of COVID-19, is expected to vary across countries and older subpopulations, and remains to be evaluated by prospective, longitudinal studies.

Competing Interests: Declaration of competing interest The authors have no conflicts of interest, including relevant financial interests, activities, relationships and affiliations, relevant to this article to disclose.

The present study investigates the presence of Auditory Processing Disorder (APD) in schizophrenia and its association with symptomatology, especially Formal Thought Disorder (FTD). 50 patients with schizophrenia and 25 matched healthy controls completed a battery of three auditory processing tests. Positive and Negative Syndrome Scale (PANSS) and Thought, Language and Communication (TLC) scale were used to assess clinical symptoms. The patient group was divided into two subgroups, according to FTD severity. Auditory processing performance of the control group and the patient group was evaluated. Correlations between auditory processing scores and TLC scores, as well as auditory processing scores and PANSS scores were examined. Most of the patients, especially those with FTD, had auditory deficits that can be classified as APD. Patients showed impaired performance compared to controls in all tests. Total severity and specific factors of FTD, as well as other clinical symptoms and symptom categories were correlated with auditory processing performance. We provided evidence that APD may be present in schizophrenia and that FTD, as well as other clinical symptoms are associated with auditory processing deficits. There are important clinical implications for non-pharmacological interventions and early diagnosis of schizophrenia., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Childhood trauma (CT) is a comprehensive concept encompassing experiences of sexual, physical, and emotional abuse, and neglect during childhood and adolescence. Patients with schizophrenia-spectrum psychosis (SSP) display higher rates of CT than healthy controls. Among the potential mediators of this association, insecure attachment has gained attention and empirical validation. The present study aimed to extend existing knowledge on this field by exploring the role of the two attachment dimensions, attachment anxiety and attachment avoidance, in the CT-SSP association. A clinical sample of 63 SSP inpatients was compared to a healthy control group on CT and attachment style measures. Correlations between CT, attachment dimensions and psychopathology were sought. Mediation analyses were also performed to examine whether attachment anxiety and/or attachment avoidance mediated the CT-SSP association. Patients displayed higher rates of CT and insecure attachment than controls. Attachment anxiety and severity of Mother Antipathy were linked to severity of hallucinations. Attachment anxiety was recognized as the sole mediator of the CT-SSP association. Our findings suggest that individuals with severe CT and increased attachment anxiety represent a risk population warranting early clinical attention, regular monitoring and tailored therapeutic interventions aimed at reducing the psychological impact of trauma., (Copyright © 2019. Published by Elsevier B.V.)

Empathy is the epicenter of the theoretical and clinical interest of many different scientific domains, constituting a common term in different fields as these of psychology, psychiatry, clinical psychopathology, neuroscience, psychotherapy and psychoanalysis. Studying the phenomenon of empathy requires distinguishing the empathy as a method of observation of psychological phenomena from the empathy as a component of the therapy of psychopathological phenomena. In this case, beyond the empathic understanding, the optimum responsiveness of the therapist is included. Empathy means sharing the psychological and emotional state of another as if you were able to sense one's private world. This emotional sharing is a temporary situation and concerns the quality but not the quantity of the emotional experience. The modern scientists of neurobiology and neurobehavior distinguish three types of empathy: the emotional, the cognitive and motivational which help the interpersonal relations occurring in complex groups of society where the transgenerational relationships between parents and offspring are essential for the survival of species. Jaspers introduces, already by the beginning of the 20th century in his monumental work ''General Psychopathology'', the notion of empathy as an interpretative and a diagnostic tool in psychiatry and psychopathology. Meanwhile psychoanalysis, mainly during its early course, was not impressed by this term. The answer to this seems to be that the term empathy is related to the intersubjectivity and the interpersonal relationship, fields that were not really attractive at this point of time for the psychoanalytical theory which during the period of the founder of the psychoanalysis was initially mainly focused on the "intrapsychic" field. However, during the course of time and chiefly with the contribution of Kohut and Greenson, the importance of the concept of empathy is emphasized in the clinical psychoanalysis and efforts are made regarding the clarification of the nature and the psychological mechanisms that operate in this complex intuitive (feeling the other through the interpersonal communication) form of knowledge. The quality of the relationship between the therapist and the patient (therapeutic alliance) plays a fundamental role in the positive outcome in any form of psychotherapy. Empathic understanding plays an important role in the quality of the therapeutic relationship. In the field of general psychiatry, the focus of research for the role of empathy and the potential of its application, has been until today limited. The lack of a model for the application of empathy in psychiatric and psychotherapeutic practice is an important challenge for the training of the new psychiatrists.

During the last decades, a considerable number of studies about auditory processing deficits in schizophrenia have been published, some of them using the term of Auditory Processing Disorder (APD). Due to heterogeneous methodology and inconsistent results concrete conclusions may not be straightforward. We focused on studies that used at least one behavioral test for the assessment of auditory processing in schizophrenia, in order to identify new evidence on auditory processing deficits in schizophrenia, and to consider fields for future research. 28 studies met inclusion criteria and are presented in this review. The articles were divided into three groups, those that implemented a test battery approach, those that used only Dichotic Listening (DL), those that used DL along with imaging or electrophysiology techniques. Most of the studies that implemented a test battery showed significant performance differences between patients and controls. This indicates APD presence. Due to the limited number of studies implementing a test battery, this is not conclusive. The majority of all studies that used a DL task showed that patients' performance or laterality was significantly lower than that of controls. Age, duration of illness, total and specific positive symptoms seem to affect significantly DL performance and auditory laterality. The results support the existence of various schizophrenia subgroups that differ in their auditory processing performance, and also have structural and functional specificities. Further research in the field is needed, especially studies that implement a test battery, and studies that examine possible correlations between clinical variables and auditory processing deficits., (© 2018 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

The term "Cotard's syndrome" is used to describe a number of clinical features, mostly hypochondriac and nihilistic delusions, the most characteristic of which are the ideas "I am dead" and "my internal organs do not exist". Besides, anxious and depressed mood, delusions of damnation, possession and immortality, suicidal and self-mutilating behavior are included. The first description of the syndrome was made in 1880 by Cotard, who presented the case of a female patient in a lecture. He originally named it "hypochondriac delusion", and some years later "delusion of negations", while it was named "Cotard delusion" after his death. In international literature, the terms "nihilistic delusion" and "Cotard's syndrome" prevailed over "delusion of negations" and "Cotard delusion". In the present study we report the case of a 59 year-old woman, who was admitted to our department after a suicide attempt, and who showed symptoms of Cotard's syndrome for about two years, namely depressed mood, hypochondriac and nihilistic delusions, delusions of immortality and damnation, suicidal ideation, severe psychomotor retardation, diminished motivation and tendency to stay in bed. She never took the medication she was prescribed, and at times she refused to eat. During her hospitalization, there was performed a full blood panel and medical imaging, that showed chronic ischemic infarctions, periventricular leukoencephalopathy and diffuse cerebral atrophy in MRI. All the other test results were normal. She was administered treatment with haloperidol, mirtazapine and venlafaxine. Gradually, her psychomotor ability, motivation and mood improved, she didn't express suicidal ideation, her delusions were less intense and she was able to question them, but they weren't eliminated. She was discharged in improved condition, after 44 days. Cotard's syndrome isn't mentioned in the current classification systems (ICD-10, DSM-5). In literature though, it has been divided into three types, according to the clinical symptoms: psychotic depression, Cotard type I, and Cotard type II, and three stages have been proposed: germination stage, blooming stage and chronic stage. It has been associated with various medical conditions, such as cerebral infractions, frontotemporal atrophy, epilepsy, encephalitis, brain tumors, traumatic brain injury. Furthermore, it has been associated with psychiatric conditions, such as mental retardation, postpartum depression, depersonalization disorder, catatonia, Capgras syndrome, Fregoli syndrome, Odysseus syndrome, koro syndrome. Several reports about successful pharmacological treatments have been published, both monotherapies with antidepressants, antipsychotics or lithium, and by antidepressant and antipsychotic combination treatments. The most reported successful treatment strategy for Cotard's syndrome is electroconvulsive therapy (ECT), administration of which should follow current treatment guidelines of the underlying conditions.

Purpose: The scope of this study was to trace central auditory processing issues in patients with first-episode psychosis using a psychoacoustic test battery approach., Method: Patients (n = 17) and volunteer control subjects (n = 17) with no personal or family history of schizophrenia were included in the study on the basis of normal hearing sensitivity. The authors implemented a central auditory processing battery consisting of monaural and binaural tests with verbal and nonverbal stimuli., Results: Perceptual deficits in both nonverbal and verbal auditory stimuli are reported in this study, with temporal central auditory processing deficits and a mean left-ear advantage documented in the patient group., Conclusion: This study points to the possibility of the existence of central auditory processing deficits in first-episode psychosis leading to schizophrenia. Audiologists should be aware of the psychiatric research pointing to enhanced verbal memory as a result of auditory training, linking bottom-up remediation with top-down improvement.

One of the widely used tests to evaluate functional asymmetry of cerebral hemispheres is the dichotic listening test with the usually prevailing right ear advantage. The current study aims at assessing hemispheric laterality in an adult sample of individuals with dyslexia, with auditory processing disorder (APD), and adults experiencing comorbidity of the two mentioned disorders against a control group with normal hearing and absence of learning disabilities. Results exhibit a right hemispheric dominance for the control and APD group, a left hemispheric dominance for the group diagnosed with both dyslexia and APD, and absence of dominance for the dyslexia group. Assessment of laterality was repeatable and produced stable results, indicating a true deficit. A component of auditory processing, specifically the auditory performance in competing acoustic signals, seems to be deficient in all three groups, and laterality of hemispheric functions influenced at least for auditory-language stimuli in the two of the three groups, one being adults with dyslexia and the other being adults with comorbidity of dyslexia and APD.

Aim: The current study aims to assess: (a) the prevalence of auditory processing in a population of children reporting learning difficulties, (b) the correlation of APD diagnosis with age, the intelligence coefficient (IQ) and with the presence of a specific learning disability such as dyslexia and (c) to evaluate the reliability of each auditory processing test used in this study in identifying APD., Method: We evaluated one hundred and twenty-seven consecutive children referred to the academic tertiary LD Clinic of the Psychiatric Department by means of a psychoacoustic mainly non-verbal test battery., Results: APD was found to be present in 43.3% and co-existing with developmental dyslexia in 25% of cases. The diagnosis of APD correlated with age in that children with APD were younger by 2 years than those without a diagnosis of APD. The diagnosis of APD did not correlate with IQ or with the diagnosis of dyslexia., Interpretation: High prevalence of APD in the targeted group of children suspected of Learning Disabilities sets the grounds for a possible benefit in screening for the disorder.

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.

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.

The present study aimed to investigate the relationship between stressful life events and depression. Ninety major depressive patients, aged 36.57 +/- 12.02 years, and 121 matched controls, aged 27.11 +/- 10.59 years, took part in the study. The life change units (LCU) according to Rahe et al. were used for the quantification of life events. The results suggested that males reported significantly more life events than females. Atypical males differed from all other gender-by-type groups, while no other differences emerged. LCU correlated with melancholic indices but did not correlate with anxiety or functioning. The results suggest that subgroups of depressive patients are characterized by the presence of stressful life events. Male atypical patients reported the highest load of life events. The question that arises is whether this finding is valid or whether these patients (who have higher personality psychopathology and interpersonal rejection sensitivity) tend to over-report life events.

Objective: Recent data indicate significant clinical, biological, and treatment response overlap between eating and bipolar disorders, especially when soft symptoms of either spectrum disorders are considered. The aim of the present analyses is to evaluate the lifetime prevalence of bulimia nervosa (BN) in patients with atypical depression (AD) and to delineate any demographic, clinical, personality or temperamental factors that may characterize this subgroup., Method: We examined in a semi-structured format 107 consecutive patients who met DSM-IV criteria for major depressive episode with atypical features and we separated them into two groups according to the co-occurring criteria for BN. They were further evaluated on the basis of the Atypical Depression Diagnostic Scale (ADDS), the Hopkins Symptoms Check-list (HSCL 90), and the Hamilton Rating Scale for Depression (HRSD), coupled with its modified form for reverse vegetative features, as well as Axis I and II comorbidity and temperamental dispositions., Results: Seventeen (17.8%) percent of AD met the DSM-IV criteria for Bulimia Nervosa (BN+). These patients, compared with those who did not meet criteria for BN (BN-), were indistinguishable on all demographic and most psychopathologic and clinical features (including bipolar I and II), but were significantly higher in lifetime comorbidity for Narcissistic, Histrionic, Borderline and Dependent personality disorders as well as that for Cyclothymic temperament. BN+ also scored higher on the ADDS items of reactivity of mood and interpersonal sensitivity., Limitations: Correlational clinical study in which doctors could not be entirely blind to the variables under investigation., Conclusions: Cyclothymic temperament and related mood reactivity and interpersonal sensitivity may account for much of the relationship between AD and BN. Narcissistic, histrionic and borderline traits, too, seem to be related to the presence of a cyclothymic disposition. The data overall, in particular the cyclothymic reactivity in the absence of differences in BP-I and II, all support the hypothesis that places BN in the "ultra-soft" bipolar realm.

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.

Introduction: The development of treatment guidelines emerged as an important element so as to standardize treatment and to provide clinicians with algorithms, which would be able to carry research findings to the everyday clinical practice., Material and Method: The MEDLINE was searched with the combination of each one of the key words 'mania', 'manic', 'bipolar', 'manic-depression', 'manic-depressive' with 'treatment guidelines'., Results: The search was updated until March 1st, 2004 and returned 224 articles. Twenty-seven papers concerning the publication of treatment algorithms were traced., Discussion: Despite supposedly being evidence-based, guidelines for the treatment of bipolar disorder vary significantly across committees or working groups. Overall, however, at the first stage of the mania/hypomania algorithm, monotherapy with lithium, divalproex sodium or olanzapine is generally recommended. At latter stages combination therapy is strongly recommended. It is clearly stated that in bipolar depression antidepressants should be used only in combination with antimanic agents in order to avoid switching of phases. During the maintenance phase all patients should receive antimanic agents, while some may need the addition of antidepressants. The most recent guidelines emphasize the use of atypical antipsychotics for mania and lamotrigine for depression. The main problem with guidelines is that they are rapidly outdated and that the evidence base relies mainly on registration monotherapy trials that hardly reflect treatment in routine clinical conditions., Conclusion: Treatment guidelines may be useful to avoid non-evidence-based treatment decisions, but they are quickly out-of-date and may not fully apply to the clinical setting. The more recent guidelines point the value of atypical antipsychotics, lithium, and valproate in the treatment of mania; the role of lithium, lamotrigine, and olanzapine as options for maintenance therapy; and the scarcity of options for the treatment of bipolar depression. Psychoeducation is also supported by most guidelines as an adjunctive treatment.

BACKGROUND: Difficulty in speech understanding in the presence of background noise or competing auditory signals is typically present in central auditory processing disorders. These disorders may be diagnosed in Alzheimer's disease as a result of degeneration in the central auditory system. In addition perception and processing of speech may be affected. MATERIAL AND METHODS: A MEDLINE research was conducted in order to answer the question whether there is a central auditory processing disorder involved in Alzheimer's disease. A second question to be investigated was what, if any is the connection, between central auditory processing disorders and speech deterioration?Articles were retrieved from the Medline to find relevance of Alzheimer's dis ease with central auditory processing disorders, they summed up to 34. Twelve papers were studied that contained testing for CAPD through psychoacoustic investigation. An additional search using the keywords 'speech production' and 'AD' produced a result of 33 articles, of them 14 are thoroughly discussed in this review as they have references concerning CAPD. The rest do not contain any relavent information on the central auditory system. RESULTS: Psychoacoustic tests reveal significantly lower scores in patients with Alzheimer's disease compared with normal subjects. Tests concerning sound localization and perception of tones as well as phoneme discrimination and tonal memory reveal deficits in Alzheimer's disease. Central auditory processing disorders may exist several years before the onset of clinical diagnosis of Alzheimer's disease. Segmental characteristics of speech are normal. Deficits exist concerning the supra-segmental components of speech. CONCLUSIONS: Central auditory processing disorders have been found in many cases when patients with Alzheimer's disease are tested. They may present as an early manifestation of Alzheimer's disease, preceding the disease by a minimum of 5 and a maximum of 10 years. During these years changes in the central auditory system, starting in the temporal lobe, may produce deficits in speech processing and production as hearing and speech are highly connected human functions. Another theory may be that spread of degeneration of the central nervous system has as a consequence, speech deterioration. Further research and central auditory processing disorders testing in the elderly population are needed to validate one theory over the other.

BACKGROUND: The older population increases all over the world and so also does the number of older psychiatric patients, which manifest certain specific and unique characteristics. The aim of this article is to provide a comprehensive review of the international literature on unipolar depression with onset at old age. METHODS: The authors reviewed several pages and books relevent to the subject but did not search the entire literature because of it's overwhelming size. They chose to review those considered most significant. RESULTS: The prevalence of major depression is estimated to be 2% in the general population over 65 years of age. The clinical picture of geriatric depression differs in many aspects from depression in younger patients. It is not yet clear whether it also varies across cultures and different socio-economic backgrounds. Biological data suggest that it is associated with an increased severity of subcortical vascular disease and greater impairment of cognitive performance. Many authors consider the existence of a somatic disorder to be related to the presence of depression in late life, even constituting a negative prognostic factor for the outcome of depression. Most studies support the opinion that geriatric depression carries a poorer prognosis than depression in younger patients. The therapeutic intervention includes pharmacotherapy, mainly with antidepressants, which is of established value and psychotherapy which is not equally validated. CONCLUSION: A significant number of questions regarding the assessment and treatment of geriatric depression remain unanswered, empirical data are limited, and further research is necessary.

The definition and phenomenological features of 'burnout' and its eventual relationship with depression and other clinical conditions are reviewed. Work is an indispensable way to make a decent and meaningful way of living, but can also be a source of stress for a variety of reasons. Feelings of inadequate control over one's work, frustrated hopes and expectations and the feeling of losing of life's meaning, seem to be independent causes of burnout, a term that describes a condition of professional exhaustion. It is not synonymous with 'job stress', 'fatigue', 'alienation' or 'depression'. Burnout is more common than generally believed and may affect every aspect of the individual's functioning, have a deleterious effect on interpersonal and family relationships and lead to a negative attitude towards life in general. Empirical research suggests that burnout and depression are separate entities, although they may share several 'qualitative' characteristics, especially in the more severe forms of burnout, and in vulnerable individuals, low levels of satisfaction derived from their everyday work. These final issues need further clarification and should be the focus of future clinical research.

Introduction: The aim of the current study was to assess the reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies- Depression Scale (CES-D)., Methods: 40 depressed patients 29.65 +/- 9.38 years old, and 120 normal controls 27.23 +/- 10.62 years old entered the study. In 20 of them (12 patients and 8 controls) the instrument was re-applied 1-2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. Statistical Analysis included ANOVA, the Pearson Product Moment Correlation Coefficient, Principal Components Analysis and Discriminant Function Analysis and the calculation of Cronbach's alpha (alpha), Results: Both Sensitivity and specificity exceed 90.00 at 23/24, Chronbach's alpha for the total scale was equal to 0.95. Factor analysis revealed three factors (positive affect, irritability and interpersonal relationships, depressed affect and somatic complains). The test-retest reliability was satisfactory (Pearson's R between 0.45 and 0.95 for individual items and 0.71 for total score)., Conclusion: The Greek translation of the CES-D scale is both reliable and valid and is suitable for clinical and research use with satisfactory properties. Its properties are similar to those reported in the international literature. However one should always have in mind the limitations inherent in the use of self-report scales.

Introduction: The current study aimed to assess the reliability, validity and psychometric properties of the Greek translation of the Zung Depression Rating Scale (ZDRS)., 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. In 20 of them (12 patients and 8 comparison subjects) the instrument was re-applied 1-2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. Statistical Analysis included ANOVA, the Pearson Product Moment Correlation Coefficient, Principal Components Analysis and Discriminant Function Analysis and the calculation of Cronbach's alpha (alpha), Results: Both Sensitivity and specificity exceed 90.00 at 44/45, Chronbach's alpha for the total scale was equal to 0.09, suggesting that the scale covers a broad spectrum of symptoms. Factor analysis revealed five factors (anxiety-depression, thought content, gastrenterological symptoms, irritability and social-interpersonal functioning). The test-retest reliability was satisfactory (Pearson's R between 0.92)., Conclusion: The ZDRS-Greek translation is both reliable and valid and is suitable for clinical and research use with satisfactory properties. Its properties are similar to those reported in the international literature, although the literature is limited. However one should always have in mind the limitations inherent in the use of self-report scales.