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Aims We aim to systematically document our reflections regarding the establishment of a perinatal-focused Compassion Focused Therapy (CFT) group within an expanding service. It aims to highlight specific outcomes and client experiences resulting from group completion. Methods Synthesizing information from established CFT Group protocols across various National Health Service (NHS) contexts, scholarly investigations, and our CFT training, this study instituted a 10-week perinatal-CFT group intervention. Recruitment targeted individuals already engaged in our services, resulting in the referral and screening of eleven potential participants. Nine eligible individuals provided informed consent, with seven successfully completing the program. Assessments, including the Clinical Outcomes in Routine Evaluation (CORE-10), Postpartum Bonding Questionnaire (PBQ), The Forms of Self-criticizing/Attacking & Self-reassuring Scale (FSCRS), and Maternal Antenatal Attachment Scale (MAAS), were administered pre- and post-group. Quantitative findings were analysed and compared, supplemented by qualitative insights distilled from thematic analyses of feedback forms and post-group reviews with each participant. Results Though we had a small number of participants (n = 4) who completed the pre and post measures and the post group review, we received overall positive feedback for the group intervention. During the post group review and from their feedback forms, participants expressed the value of the group experience and found the discussions and exploration of CFT concepts to be helpful in reflecting on their self-critical thoughts. On the Core-10, there was a reliable and clinically significant change for 75% of participants. Two participants completed the PBQ, and both showed a reliable but not clinically significant change in scores. We had one antenatal client who showed a reliable but not clinically significant change on the MAAS. The FSCRS comprises three scales: Inadequate Self (IS), Reassured Self (RS), and Hated Self (HS). On the IS subscale, a reliable and clinically significant change was observed for 75% of participants. The HS subscale showed a reliable change but lacked clinical significance for 50% of participants. No reliable change was observed in the RS scale for any participant. Conclusion While the study's results are not generalizable due to the small sample size, positive feedback suggests the well-received nature of online perinatal CFT groups. Despite a preliminary evidence base, this paper contributes reflections and experiences, highlighting the potential effectiveness of online CFT groups in the perinatal period. These findings underscore the need for further research and exploration in this promising therapeutic approach.

Abstract. The 5th version of DSM (American Psychiatric Association, 2013) employed a dimensional approach to describe and assess personality disorders, namely, the alternative model of personality disorders (AMPD). So far, AMPD has been translated and validated in many countries. Herein, the results of a series of studies conducted to develop and validate the Greek Personality Psychopathology Inventory (GPPI-5) following the AMPD are reported. Data from more than 1,200 adults were analyzed to examine factor structure. The ESEM approach was applied (1) to examine the proposed personality model, (2) to confirm previous validity studies on AMPD, and (3) to examine the invariance of GPPI-5 across gender. Results successfully replicated the AMPD at both the domain and facet levels. Measurement invariance across gender supported the GPPI-5 structure. Reliability and validity studies were conducted, providing evidence that GPPI-5 is a valid and psychometrically sound measure for assessing personality disorders in clinical and research settings.

Introduction Rates of high expressed emotion (EE) towards patients with schizophrenia have only indirectly been compared between families and community residential facilities, since studies including patients in both settings are unfortunately lacking. High EE rates in staff-patient studies are typically lower than in families, with negligible rates of high emotional overinvolvement (EOI). However, indirect comparisons can suffer from many biases. Objectives This study directly compared patients with schizophrenia living in halfway houses or with their families on the EE of their caregivers, adjusting for patient- and caregiver-related confounders. Methods We included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the EE of the caring staff (N=22 nurses) or parents (N=56), respectively, through Five Minutes Speech Sample interviews. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses, totaling 155 nurse ratings. Each outpatient was rated by one or both parents. Due to the multilevel structure of EE ratings, generalized linear mixed models were fitted. We first adjusted only for differences in patient-related confounders between groups and then added basic caregiver-related demographics. Results Compared to outpatients, inpatients were older (p=0.001), less well educated (p=0.002), had a longer disease duration (p=0.047), more hospitalizations (p=0.012), lower severity of psychotic (p=0.027) and, specifically, negative symptoms (p=0.015), and lower perceived criticism (p=0.001). Nurses were younger (p

BackgroundThis study investigated patient- and caregiver-related predictors of expressed emotion (EE) toward individuals with schizophrenia in families and halfway houses and yet understudied differential effects across settings.MethodsWe included 40 individuals with schizophrenia living with their families (“outpatients”) and 40 “inpatients” in halfway houses and recorded the EE of 56 parents or 22 psychiatric nurses, respectively, through Five Minutes Speech Sample. Each outpatient was rated by one to two parents; each inpatient was rated by two to five nurses. As EE ratings had a multilevel structure, EE predictors were investigated in backward stepwise generalized linear mixed models using the “buildmer” R package. We first fitted models including either caregiver- or patient-related predictors in each setting and finally included both types of predictors. Setting-specific patient-related effects were investigated in interaction analyses. Adjustment for multiple tests identified the most robust associations.ResultsIn multivariate models including either caregiver- or patient-related predictors, nurses’ higher age, shorter work experience and lower inpatients’ negative symptoms robustly predicted higher emotional overinvolvement (EOI). In the final models including both types of predictors, nurses robustly displayed lower EOI (i.e., reduced concern and disengagement) toward inpatients with higher negative symptoms. Several other features were nominally associated with criticism and EOI in each setting. However, no feature robustly predicted criticism in inpatients and criticism/EOI in outpatients after adjustment for multiple tests. In interaction analyses, higher negative symptoms differentially predicted lower EOI in nurses only.ConclusionOur findings suggest setting-specific pathogenetic pathways of EOI and might help customize psychoeducational interventions to staff in halfway houses.

Summary: Background: Pharmacogenomics (PGx) holds promise to revolutionize modern healthcare. Although there are several prospective clinical studies in oncology and cardiology, demonstrating a beneficial effect of PGx-guided treatment in reducing adverse drug reactions, there are very few such studies in psychiatry, none of which spans across all main psychiatric indications, namely schizophrenia, major depressive disorder and bipolar disorder. In this study we aim to investigate the clinical effectiveness of PGx-guided treatment (occurrence of adverse drug reactions, hospitalisations and re-admissions, polypharmacy) and perform a cost analysis of the intervention. Methods: We report our findings from a multicenter, large-scale, prospective study of pre-emptive genome-guided treatment named as PREemptive Pharmacogenomic testing for preventing Adverse drug REactions (PREPARE) in a large cohort of psychiatric patients (n = 1076) suffering from schizophrenia, major depressive disorder and bipolar disorder. Findings: We show that patients with an actionable phenotype belonging to the PGx-guided arm (n = 25) present with 34.1% less adverse drug reactions compared to patients belonging to the control arm (n = 36), 41.2% less hospitalisations (n = 110 in the PGx-guided arm versus n = 187 in the control arm) and 40.5% less re-admissions (n = 19 in the PGx-guided arm versus n = 32 in the control arm), less duration of initial hospitalisations (n = 3305 total days of hospitalisation in the PGx-guided arm from 110 patients, versus n = 6517 in the control arm from 187 patients) and duration of hospitalisation upon readmission (n = 579 total days of hospitalisation upon readmission in the PGx-guided arm, derived from 19 patients, versus n = 928 in the control arm, from 32 patients respectively). It was also shown that in the vast majority of the cases, there was less drug dose administrated per drug in the PGx-guided arm compared to the control arm and less polypharmacy (n = 124 patients prescribed with at least 4 psychiatric drugs in the PGx-guided arm versus n = 143 in the control arm) and smaller average number of co-administered psychiatric drugs (2.19 in the PGx-guided arm versus 2.48 in the control arm. Furthermore, less deaths were reported in the PGx-guided arm (n = 1) compared with the control arm (n = 9). Most importantly, we observed a 48.5% reduction of treatment costs in the PGx-guided arm with a reciprocal slight increase of the quality of life of patients suffering from major depressive disorder (0.935 versus 0.925 QALYs in the PGx-guided and control arm, respectively). Interpretation: While only a small proportion (∼25%) of the entire study sample had an actionable genotype, PGx-guided treatment can have a beneficial effect in psychiatric patients with a reciprocal reduction of treatment costs. Although some of these findings did not remain significant when all patients were considered, our data indicate that genome-guided psychiatric treatment may be successfully integrated in mainstream healthcare. Funding: European Union Horizon 2020.

Bipolar disorder is a heritable mental illness with complex etiology. We performed a genome-wide association study of 41,917 bipolar disorder cases and 371,549 controls of European ancestry, which identified 64 associated genomic loci. Bipolar disorder risk alleles were enriched in genes in synaptic signaling pathways and brain-expressed genes, particularly those with high specificity of expression in neurons of the prefrontal cortex and hippocampus. Significant signal enrichment was found in genes encoding targets of antipsychotics, calcium channel blockers, antiepileptics and anesthetics. Integrating expression quantitative trait locus data implicated 15 genes robustly linked to bipolar disorder via gene expression, encoding druggable targets such as HTR6, MCHR1, DCLK3 and FURIN. Analyses of bipolar disorder subtypes indicated high but imperfect genetic correlation between bipolar disorder type I and II and identified additional associated loci. Together, these results advance our understanding of the biological etiology of bipolar disorder, identify novel therapeutic leads and prioritize genes for functional follow-up studies.

IntroductionImplementation models, frameworks and theories (hereafter tools) provide researchers and clinicians with an approach to understand the processes and mechanisms for the successful implementation of healthcare innovations. Previous research in mental health settings has revealed, that the implementation of coercion reduction programs presents a number of challenges. However, there is a lack of systematized knowledge of whether the advantages of implementation science have been utilized in this field of research. This systematic review aims to gain a better understanding of which tools have been used by studies when implementing programs aiming to reduce formal coercion in mental health settings, and what implementation outcomes they have reported.MethodsA systematic search was conducted using PubMed, CINAHL, PsycINFO, Cochrane, Scopus, and Web of Science. A manual search was used to supplement database searches. Quality appraisal of included studies was undertaken using MMAT—Mixed Methods Appraisal Tool. A descriptive and narrative synthesis was formed based on extracted data. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed in this review.ResultsWe identified 5,295 references after duplicates were removed. Four additional references were found with a manual search. In total eight studies reported in nine papers were included in the review. Coercion reduction programs that were implemented included those that were holistic, and/or used professional judgement, staff training and sensory modulation interventions. Eight different implementation tools were identified from the included studies. None of them reported all eight implementation outcomes sought from the papers. The most frequently reported outcomes were acceptability (4/8 studies) and adaptation (3/8). With regards to implementation costs, no data were provided by any of the studies. The quality of the studies was assessed to be overall quite low.DiscussionSystematic implementation tools are seldom used when efforts are being made to embed interventions to reduce coercive measures in routine mental health care. More high-quality studies are needed in the research area that also involves perspectives of service users and carers. In addition, based on our review, it is unclear what the costs and resources are needed to implement complex interventions with the guidance of an implementation tool.Systematic review registration[Prospero], identifier [CRD42021284959].

Introduction There is evidence that early traumatic experiences may have a negative impact on critical components of psychosocial adjustment, while they may also adversely affect mental health during adulthood. Objectives The aim this study was to investigate the association of early traumatic experiences and in particular sexual abuse with well-being, self-esteem, resilience and close relationships during adulthood. Methods The study included 499 individuals (76.2% women), with a mean age of 24.2 years. Participants completed Early Trauma Inventory-Short form for early traumatic experiences’ assessment, Brief Resilience Scale for resilience evaluation, Mental Health Continuum-Short Form to assess well-being and Experiences in Close Relationships-Revised scale for adult romantic attachment assessment. Results The majority of participants (98.2%) responded positively to at least one statement related to early traumatic experiences while 235 individuals (47.1%) reported that they had experienced sexual abuse. Furthermore, individuals who had experienced sexual abuse displayed lower levels of well-being (p

Introduction Violent behavior has been linked to deficits in social cognition, namely cognitive and affective aspects of empathy. Schizophrenia and antisocial personality disorder have been associated with violence and empathy deficits. Objectives Our main objective is to search for differences in empathy between patients with schizophrenia who have committed a violent offence, patients with schizophrenia with no history of violent offence and patients with antisocial personality disorder. Methods A total sample of Ν=100 participants was divided into four groups: 1) 27 patients with schizophrenia and history of committing a violent offence, 2) 23 patients with schizophrenia with no history of committing a violent offence, 3) 25 participants with antisocial personality disorder and 4) 25 general population participants comprising the control group. Symptoms of schizophrenia were rated using the Positive(P), Negative(N) and General Psychopathology (G) subscales of the Positive and Negative Syndrome Scale (PANSS). Empathy was evaluated using a) The Empathy Quotient (EQ). Theory Of Mind was evaluated using a) The First Order False Belief task, b) The Hinting task, c) The Faux pas Recognition Test and d) The Reading the Mind in the Eyes Test (Revised). Results The four groups differed in PANSS scoring (p

The aim of this study was to assess any seasonal and long-term trends on involuntary admissions. Seasonal pattern and long-term variation were examined statistically and analyzed using Poisson models with robust standard errors, including 1-year period Fourier terms and a linear time term. Maximum (+6.5%) and minimum (−6.1%) within-year values were estimated to occur during mid-June and mid-December, respectively. Estimated long-term trend was more pronounced in the mental and behavioral disorders due to the use of drugs and organic mental disorder diagnoses groups and in the 16–29 and 65+ age groups.

Background: Prisoners are often associated with mental health and substance use disorders. Coercive measures are widely used in prison settings. The objective of this study was to compare inmates' perceptions and satisfaction with telepsychiatry versus face-to-face consultation and the effects of telepsychiatry on the use of coercive measures. The sample consisted of 100 male inmates from various backgrounds who had experienced both approaches of services (face to face and telepsychiatry). Method: The data were obtained through an interview where the individuals completed a Demographic Data Questionnaire, a Participant Satisfaction Questionnaire to assess satisfaction with face-to-face psychiatric services, and a Participant Satisfaction Questionnaire to assess their satisfaction with services offered via telepsychiatry. Additionally, calculations of time spent waiting for a face-to-face psychiatric evaluation and time spent in handcuffs and in confined spaces were made before and after the introduction of telepsychiatry. Results: Statistically significant improvements (all p-values < 0.001) were noted in waiting times, support for relapse prevention, follow up, quality of mental health care, quality of care in the management of psychiatric problems and related medication, behavior of psychiatrists, duration of the assessment, sense of comfort, and confidentiality. Telepsychiatry led to the elimination of time spent in handcuffs and in confined spaces (transport vehicles). Conclusion: According to the results of this study, telepsychiatry is an acceptable method of service delivery in correctional facilities and was associated with a reduction of coercive practices. [ABSTRACT FROM AUTHOR]

A recent special education legislation reform in Greece puts emphasis on the inclusion of pupils with special educational needs into mainstream schools. The purpose of the present study was to investigate knowledge of ASD among 67 mainstream nursery and primary classroom teachers, and evaluate the effectiveness of a half-day ASD awareness seminar in increasing their knowledge of the disorder. A self-report ASD Knowledge Questionnaire (ASD-KQ), developed for the purpose of this study, was used before and after the ASD awareness seminar. The results indicated a significant shift from low to moderate/high level of ASD knowledge among teachers with no previous training in special education and/or autism (58.7%), whereas this shift did not reach significance level in the teacher's group with previous training (16.7%) after the seminar. The present findings have important implications for the development of training programmes of practising teachers.

This study investigated the mental health among 187 final-year-senior-high-school students during the six-months pandemic-related lockdown. Above the thresholds on GAD-7 for severe anxiety (≥17) and PHQ-9 for severe depressive symptoms (≥20) scored 20.3% and 20.7% respectively. Higher levels of experienced lockdown distress and increased conflicts with parents were associated with higher anxiety and depression levels; COVID-related worry was associated only with anxiety, whereas having any family health problem with depression only. Thematic analysis of the open-ended survey item provided a means of gaining students’ perspective regarding the challenges aggravated by the pandemic during the process of preparing for the exams. The findings call to action aiming at mitigating mental health risks of the on-going pandemic on youth's mental health.

AbstractBackground.Adults with attention deficit hyperactivity disorder (ADHD) frequently suffer from sleep problems and report high levels of daytime sleepiness compared to neurotypical controls, which has detrimental effect on quality of life.Methods.We evaluated daytime sleepiness in adults with ADHD compared to neurotypical controls using an observer-rated sleepiness protocol during the Sustained Attention Response Task as well as electroencephalogram (EEG) slowing, a quantitative electroencephalographic measure collected during a short period of wakeful rest.Results.We found that adults with ADHD were significantly sleepier than neurotypical controls during the cognitive task and that this on-task sleepiness contributed to cognitive performance deficits usually attributed to symptoms of ADHD. EEG slowing predicted severity of ADHD symptoms and diagnostic status, and was also related to daytime sleepiness. Frontal EEG slowing as well as increased frontal delta were especially prominent in adults with ADHD. We have validated and adapted an objective observer-rated measure for assessing on-task sleepiness that will contribute to future sleep research in psychology and psychiatry.Conclusions.These findings indicate that the cognitive performance deficits routinely attributed to ADHD and often conceptualized as cognitive endophenotypes of ADHD are largely due to on-task sleepiness and not exclusively due to ADHD symptom severity. Daytime sleepiness plays a major role in cognitive functioning of adults with ADHD.

Abstract Background It remains unclear whether psychotic features increase the risk of completed suicides in unipolar depression. The present systematic review coupled with a meta-analysis attempts to elucidate whether unipolar psychotic major depression (PMD) compared to non-PMD presents higher rates of suicides. Methods A systematic search was conducted in Scopus, PubMed, and “gray literature” for all studies providing data on completed suicides in PMD compared to non-PMD, and the findings were then subjected to meta-analysis. All articles were independently extracted by two authors using predefined data fields. Results Nine studies with 33,873 patients, among them 828 suicides, met our inclusion criteria. PMD compared to non-PMD presented a higher lifetime risk of completed suicides with fixed-effect pooled OR 1.21 (95% CI 1.04–1.40). In a sub-analysis excluding a very large study (weight = 86.62%), and comparing 681 PMD to 2106 non-PMD patients, an even higher pooled OR was found [fixed-effect OR 1.69 (95% CI 1.16–2.45)]. Our meta-analysis may provide evidence that the presence of psychosis increases the risk of suicide in patients suffering from severe depression. The data are inconclusive on the contribution of age, mood congruence, comorbidity, and suicide method on PMD’s suicide risk. The lack of accurate diagnosis at the time of suicide, PMD’s diagnostic instability, and the use of ICD-10 criteria constitute the main study limitations. Conclusions The presence of psychosis in major depression should alert clinicians for the increased risk of completed suicide. Thus, the implementation of an effective treatment both for psychotic depression and patients’ suicidality constitutes a supreme priority.

Abstract Background Personality disorders (PDs) have been associated with both violent crimes and homicides in many studies. The proportion of PDs among prisoners reaches up to 80%. For male prisoners, the most common PD in the literature is antisocial PD. The aim of this study was to investigate the association between PDs and violent crimes/homicides of male prisoners in Greece. Methods A sample of 308 subjects was randomly selected from a population of 1300 male prisoners incarcerated in two Greek prisons, one urban and one rural. The presence of PDs was assessed using the Mini International Neuropsychiatric Interview (MINI) and the Personality Diagnostic Questionnaire-4 (PDQ-4). Using logistic regression models PD types and PD “Clusters” (independent variables) were associated with “violent/non-violent crimes” and “homicides/non homicides” (dependent variables). Results “Cluster A” PDs (Paranoid, Schizoid, and Schizotypal) were diagnosed in 16.2%, “Cluster B” (Antisocial, Borderline, Histrionic, Narcissistic) in 66.9% and “Cluster C” (Obsessive–Compulsive, Dependent, Avoidant) in 2.9% of the studied population. Violent crimes and homicides were found significantly associated with “Cluster A” PDs (p = 0.022, p = 0.020). The odds ratio of committing violent crimes was 2.86 times higher for patients with “Cluster A” PDs than the ones without PDs. In addition, the odds ratio of committing homicides was 4.25 times higher for patients with “Cluster A” PDs. In separate analyses, the commitment of violent crimes as well as homicides, was significantly associated with Schizoid (p = 0.043, p = 0.020) and Schizotypal PD (p = 0.017, p = 0.030). Conclusions The majority of prisoners was found to suffer from a PD, mainly the Antisocial “Cluster B”, but the commitment of violent crimes and homicides was significantly associated only with “Cluster A” PDs and specifically with Schizoid and Schizotypal PD.