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The rapid cycling (RC) pattern of a mood disorder is characterized by at least four affective episodes (manic, hypomanic or major depressive) during the last year; different episodes must be demarcated by a switch to an episode of opposite polarity or by a period of remission of at least 2 months. RC is very rare in unipolar patients; its prevalence, however, in bipolar patients is 10-30% with the majority being women (70-90%). Patients with RC usually suffer from bipolar II disorder with onset with a depressive episode. Genetic studies have not convincingly shown that the condition is genetically determined. Major abnormalities of thyroid function have not been shown to be related to RC, but recent studies propose that latent subclinical hypothyroidism might play a role in the acceleration of cycles. Perturbations of the circadian biological and social rhythms might influence the expression of RC. No major effect of the menstrual cycle has been found. Despite the absence of firm empirical data, the possible contribution of the kindling phenomenon on the acceleration of cycles cannot be excluded. Finally, there is evidence that RC can be induced by the use of antidepressant drugs, especially for women.

Disaster research related to earthquakes has almost exclusively dealt with their long-term psychosocial impact; besides, diagnoses were previously based only on DSM criteria. Therefore, it is pertinent to assess stress-related reactions of earthquake victims during the early post-disaster period through the application of ICD-10 criteria. For the first 3 weeks following an earthquake, 102 help-seekers were assessed based on a checklist of sociodemographic variables and a semi-structured interview for the detection of acute stress reaction (ASR) and posttraumatic stress disorder (PTSD) according to ICD-10. Forty-four subjects (43%) fulfilled the ICD-10 criteria for PTSD; all but one of them had suffered ASR. Moreover, among a series of potential predictors for PTSD, ASR was found to be the only significant one; this indicates a definite association between ASR and early development of PTSD. Logistic regression to predict group membership (PTSD/no PTSD) based on specific ASR symptoms showed that accelerated heart rate and feelings of derealization were the only significant predictors for early PTSD. Individuals who fulfill the ICD-10 diagnostic criteria for ASR following an earthquake are at high risk for subsequent occurrence of early PTSD. Increased heart rate and feelings of derealization within the first 48 h after the traumatic event appear to be the principal factors associated with the development of early PTSD. In addition to their potential value for timely prevention and treatment, these findings raise important nosological issues pertaining to the current diagnostic classification of stress-related disorders (ICD-10 versus DSM-IV).

This is the first report of two partners in a folie à deux situation manifesting identical Capgras delusions. It is postulated that the Capgras syndrome developed as a result of interaction between a dominant patient with primarily paranoid psychopathology and a submissive one with primarily organic dysfunction. The submissive "neuro-organic" partner experienced a non-delusional misidentification that acquired a delusional component and developed into the Capgras syndrome as a result of elaboration by the dominant paranoid partner, who subsequently "imposed" the Capgras delusion on the submissive partner. The submissive patient, and, to a lesser extent the dominant patient, had evidence of organic cerebral dysfunction.

Panic disorder was introduced in the standard psychiatric nosology with the publication of the DSM-III in 1980. The myriad of earlier medical and psychiatric names describing anxiety attacks and related conditions were all abandoned, being housed under the term `panic attack and panic disorder.' In this paper, the rationale and the appropriateness of this term are critically examined from a historical perspective. First, a brief historical account of anxiety that comes in the episodic form, and the medical and psychiatric terminology that emerged during the last two centuries regarding this condition, are presented. Next, the origins of the concept of panic as a collective or individual fear reaction are traced from a mythological and historical standpoint, up to its current, almost accidental, introduction into the official psychiatric diagnostic systems. Since the word `panic' has its roots in the Greek god Pan and the unpleasant states inflicted by him, this god is described, as well as St Gilles - also known as St Aegidios, the Athenian - the healing saint for those suffering from panic, horror and phobias. Finally, the current diagnostic features of panic disorder are systematically compared with the corresponding troubles inflicted on people by the mythical god Pan. It is concluded that the introduced term `panic' appropriately and successfully replaced the old ones.

Background: Social anxiety disorder is fairly prevalent among alcohol abusing/dependent subjects. The objective of the present study was to investigate: (a) the incidence of social anxiety symptoms in inpatient alcoholics, (b) the effect of alcohol detoxification on these symptoms, and (c) whether a combined psychotherapeutic/mirtazapine treatment during the post-detoxification phase of alcoholism has a greater impact on the aforementioned symptoms than a non-pharmacological approach. Method: Social anxiety symptoms were assessed through the Liebowitz Social Anxiety Scale (LSAS) following a 4–5-week detoxification period in two groups: group A (n=21) that followed a detoxification protocol of cognitive–behavioral orientation and group B (n=33) that was assigned to mirtazapine in addition to the standard protocol. Concomitant psychopathology was monitored through the HARS and HDRS, and level of functioning through the GAS. Results: A marked reduction of social anxiety symptoms was evidenced in both groups. However, patients on mirtazapine improved significantly more compared to controls. Limitations: A single measure of social anxiety, i.e., the LSAS was used. Also, a longer follow-up period is needed to ascertain remission of social anxiety symptoms. Conclusions: The present study found a rather high incidence of social anxiety symptoms in inpatient alcoholics which subsided following alcohol detoxification; moreover, it provides preliminary evidence that a combined psychotherapeutic/mirtazapine treatment (30–60 mg/daily) has a greater impact on the aforementioned symptoms than non-pharmacological treatment alone.

Zolpidem is a short-acting imidazopyridine hypnotic that is an agonist at the γ-aminobutyric acid A type (GABAA) receptor. It has been suggested that it acts selectively on α1 subunit-containing GABAA benzodiazepine (BZ1) receptors presenting (contrary to classic benzodiazepines) low or no affinity for other subtypes. Therefore, it has been proposed that it lacks the benzodiazepines-like side-effects, having minimal abuse and dependence potential. Nevertheless, there is a considerable number of zolpidem dependence case reports in the literature. We present eight cases of zolpidem abuse and dependence without criminal record, without history of substance abuse (except for one alcohol abuser), with minor psychiatric disorders, who took zolpidem after physicians prescription in order to deal with their insomnia. However, they became zolpidem abusers not craving its sedative, but its anxiolytic and stimulating action, which helped them to cope with everyday activities. It is possible that, in the high doses that our patients used, zolpidem abandons its selectivity for BZ1 receptors and demonstrates all the actions of classic benzodiazepines. Molecular biology, via possible mutations on GABA receptors, may provide some answers as to why our eight patients (who did not differ much from the thousands of insomniacs who use zolpidem) and other zolpidem abusers, raised the dose progressively, and sought something from the drug other than hypnotic action.

This survey investigates psychiatric trainees' attitudes regarding specific educational fields, in order to detect possible divergence from the priorities specified by the European Board of Psychiatry (EBP). It also explores certain factors which influence these attitudes.A structured questionnaire containing 80 randomized educational objectives, which corresponded to 18 basic areas of psychiatric knowledge and competence, was given to 60 psychiatric trainees in 12 psychiatric training institutions in Greece. For the analysis of data, we used descriptive statistics, correlations, and one-way analysis of variance.Despite the variance which existed, the majority of trainees considered nearly all the fields in question as essential for their training, with great priority given to psychopharmacology and biological psychiatry by 91.7% and 91.4% of the trainees, respectively. On the other hand, we found that stage of training, gender, training centre and medical school of graduation played an important role in the formation of the trainees' priorities.The investigation of trainees' attitudes towards educational fields in psychiatry can be very useful in the development of a training plan, and at the same time constitute a valuable index for monitoring the responsiveness of training programmes to the European guidelines for psychiatric training.

Aim of the study was to examine the consistency of the five-factor model of schizophrenic symptoms, assess its validity and evaluate its dimensional factor structure using confirmatory factor (CFA) analysis. A sample of 258 randomly assigned DSM-III R patients with schizophrenic disorders were studied by means of the structured clinical interview for the Greek validated Positive and Negative Syndrome Scale (PANSS) and were rated on its 30 items. Patients' scores were subjected to principal component analysis (PCA) with varimax rotation. Internal consistency for each of the components was determined by the use of Cronbach's alpha. External validity of the model derived was investigated by searching for possible relationships between the components and sociodemographic characteristics with the aid of canonical correlation analysis. Confirmatory factor analysis (CFA) was also performed. Using the scree plot criterion PCA revealed a five-factor model. These factors were interpreted as representing--in a decreasing order of relative importance--the following dimensions of schizophrenic psychopathology: negative, excitement, depression, positive and cognitive impairment. The model was comparable with six previous factor analytic studies. Internal consistency was quite satisfactory whereas external validity was found to be not so powerful. CFA did not show that the proposed model yields an adequate factor structure.

The initiative of the Royal College of Psychiatrists to establish international divisions has created considerable enthusiasm. College members have some common characteristics, mainly their training and success in the Royal College examination. Thus College members share a common approach to the practice of psychiatry as well as some common experiences; it can be argued that they share a common language in psychiatry.

E-mental health refers to the use of telecommunication and information technology in mental health services. In Greece, ordinary telephone communications have been used to provide mental health services, such as a psychiatric crisis intervention line (METB). E-psychiatry is a relatively new approach to delivering psychiatric services through the Internet. We have developed an e-psychiatry Website, Glaucopis-net. The main objective is to provide information on a broad range of psychiatric conditions, such as dementia, depression and anxiety. Email mental health services will be offered as an alternative way of accessing help. Confidentiality issues concerning patient records and personal data will be treated in accordance with Greek legislation. Glaucopis-net will integrate new telecommunication and information services with classical mental health services.

IntroductionPostnatal depression is a serious disorder affecting 10–20% of postpartum women. It has a negative impact on the whole family system and on the child's development.ObjectivesIt is important to identify possible risk factors for PND, due to its frequency and severity. It has been hypothesized that the hormonal fluctuatios of the immediate postpartum period could be a risk factor for the appearance of PND.AimsThis study aimed at inquiring the possible correlation of hormonal parameters in the 1st week postpartum with the appearance of PND.Methods95 postpartum women were recruited, in the process of validating the Greek EPDS. Of them, 40 consented to give blood on the second postpartum day, so that the plasma levels of TSH, T4, T3, FSH, LH, Progesterone, Estradiol, Prolactin and Cortisol were measured. 81/95 women consented to be reassessed at 8 weeks postpartum, and 10/81 were diagnosed with depression, major or minor. Plasma levels of the hormones were correlated with the diagnosis of PND and with the EPDS.ResultsWomen who suffered from PND did not differ from the non-PND subjects in the levels of all measured hormones. There was a statistically significant negative correlation of the levels of prolactin with the EPDS on the second postpartum day (p < 0.001, correlation coefficient -0.56).ConclusionsOur study failed to show a definite correlation of the hormonal levels in the immediate postpartum period with PND. In other studies the role of hormones in the appearance of PND remains as well questionable.

The therapeutic effect of total sleep deprivation (SD) given twice a week, for 4 weeks, was investigated in 16 drug-free patients with major affective disorders. The response was excellent in five patients, satisfactory in three and minimal in eight patients. Six of these patients were treated prophylactically once a week, and four had an excellent response. Additionally, out of five normothymic drug-free patients with affective illness treated prophylactically with SD, without prior therapeutic SD treatment, three had an excellent response. The majority of responders were rapid cycling patients. This method is worth applying to patients resistant to classical treatment.

The basic concept characterising the delusional misidentification syndromes (DMS), particularly the Capgras variety, is the concept of double, or its equivalents. It seems that this concept is prominent in all cultures and this explains the amazing universality of these delusions. Cases of DMS have been reported in practically all parts of the world. In fact, most patients actually mention the word double (or σωσιας, sosie etc.) or refer to transformations (metamorphose, μεταμoρΦωσεις and the like). The preoccupation, and even enchantment, of man with the notion of doubles from time immemorial in all cultures, as reflected in the myths, traditions, literature, beliefs and metaphysical motions, has been dealt with extensively elsewhere (Christodoulou, 1986a).

Although free-thyroxine index is commonly used as a reliable method of thyroid function investigation,1,2 only Rybakowski and Sowinski3 have used this method for the assessment of thyroid function in mania. In depression, determination of free-thyroxine index by four research groups3,6 revealed contradictory results. For these reasons, it was thought that further research in this area would be justified.

Seven patients with the Fregoli syndrome were described. These patients were studied clinically and by routine laboratory tests, electroencephalograms (standard and sleep recordings, sphenoidal electrodes), echoencephalograms, air-encephalograms, brain scanning, and psychological methods (Wechsler, Rey and Benton tests). The following basic conclusions were drawn: All patients were psychotic and in most cases schizophrenia constituted the nosological setting in which the Fregoli syndrome developed. The paranoid element was marked in all cases. All patients were single, young and, with one exception, male. Clinical evidence as well as electroencephalographic, air-ence-phalographic, echoencephalographic, and psychological findings suggest that a strong organic component contributes to the pathogenesis of the Fregoli syndrome.

Two groups of schizophrenic patients with diametrically opposed illness outcomes were compared, 14 months after discharge, with respect to 21 parameters. The first group comprised patients who relapsed and were readmitted into hospital and the second group comprised patients who achieved satisfactory occupational rehabilitation in the community. Satisfactory occupational rehabilitation was positively associated and relapse was negatively associated with the following parameters: compliance to maintenance pharmacotherapy, satisfactory work record, compulsory admission into hospital, living apart from parents or spouse after discharge, illness precipitated by stressful events, longer duration of hospitalization and more advanced age at onset of illness. The authors express the view that awareness of the parameters influencing short-term social outcome might contribute to a more efficient management of schizophrenic patients.

SummaryIn eleven patients with the syndrome of Capgras, the clinical data and the results of electroencephalographic, echoencephalographic, air-encephalographic, psychological and brain-scanning investigations are presented and discussed. All patients were psychotic: six were schizophrenic, four were depressive and one suffered from an organic psychosis. A paranoid element was marked in all cases.The present evidence supports the view that organic factors are important in the pathogenesis of Capgras' syndrome.

In a prospective study, the authors compared 22 delusional and 36 non-delusional depressive patients with respect to demographic and clinical variables, personality, and response to treatment. Delusional depressives had a higher total score than non-delusional depressives on Hamilton's Rating Scale for Depression, as well as a higher score for depressed mood and psychomotor retardation. The type of treatment failed to differentiate the two groups as to outcome at discharge. However, six of the seven delusional depressives who did not respond to tricyclic antidepressants had a full recovery with ECT. The results indicate that delusional depression represents a more severe type of major depression.

In a prospective study the authors compared unipolar psychotic and non-psychotic patients for the presence of delusional ideation in previous episodes. Psychotic patients had a significantly higher frequency of delusions in previous episodes. The type and content of delusional ideas were similar from episode to episode. The results and their implications are discussed.

A mild form of neuroleptic malignant syndrome (NMS) in a schizophrenic patient who was receiving a depot neuroleptic is described and beneficial response to oral diazepam 50 mg daily is reported.

Prophylactic lithium was abruptly discontinued (under double-blind conditions and using placebo) in 18 manic-depressive patients for 15 days. Following lithium withdrawal tremor of hands, polyuria, general muscular weakness, polydipsia and dryness of mouth were significantly reduced. No withdrawal symptoms were noted. Three patients relapsed within 4 days of lithium discontinuation. The questions arising from these findings are discussed and the possibility of a rebound phenomenon produced by lithium is considered.

In an attempt to a) investigate to what extent side-effects attributed to lithium treatment are genuine b) see whether lithium discontinuation produces withdrawal symptoms c) observe the clinical course of the illness after lithium withdraw! and d) investigate the possibility of induction of a rebound phenomenon following lithium discontinuation, 18 patients suffering from recurrent affective disorders (14 women, 4 men, mean age 47.3±14.6, 17 bipolars and one with unipolar depression) were deprived of lithium treatment for 15 days (Christodoulou and Lykouras, 1982).

Early reports suggested that Capgras syndrome is associated with functional psychoses, paranoid schizophrenia or manic-depressive illness and psychodynamic formulations for this phenomenon were reported (Capgras and Reboul-Lachaux, 1923; Courbon and Tusques, 1932). However, recent reports suggest that CNS organic dysfunction may play an important role in the pathogenesis of the delusional misidentification syndromes (Christodoulou, 1976; Prescorn and Reveley, 1978; Wilcox and Waziri, 1983).

The ancient Greek myth of Alcmene’s “innocent” infidelity has apparently provided the original denomination of the syndrome of Capgras, the most frequently encountered delusional misidentification sub-type. Capgras and Reboul-Lachaux (1923)termed this syndrome Illusion des “Sosies” and it was 6 years later that the syndrome acquired the denomination “syndrome de Capgras”, after the distinguished French psychiatrist Joseph Capgras.

Previous studies suggest that patients with either obsessive-compulsive neurosis or hysteria demonstrate a higher incidence of blood phenotype A and a lower incidence of blood phenotype O, as compared to a representative sample of the general population. 1,2 In this article, the results obtained from the investigation of a possible assoication between phobic neurosis and ABO blood types are presented.

SummaryA retrospective study of the records of 17,571 psychiatric patients who attended the out-patients department of Eginition Hospital in Athens during three two-year periods (1948–50, 1958–60 and 1969–71) revealed a statistically significant decrease in the frequency of patients diagnosed as suffering from hysteria, a statistically significant decrease in the relative frequency of patients with hysterical fits and with mental conversion symptoms, and a statistically significant increase in the relative frequency of patients with mixed conversion symptoms. The findings confirm the notion that hysteria is still a ‘woman's disease’, although a statistically significant increase in male participation was noted. The significance of the above findings for the understanding of certain aspects of hysteria is discussed.

In an attempt to interpret previous findings of a higher incidence of blood phenotype A and a lower incidence of blood phenotype O in patients with either obsessive-compulsive neurosis or hysteria, it was hypothesized that phenotype O might be associated with personality traits that render the individual less prone to developing neurotic symptoms. To test the validity of this hypothesis Form A of the Eysenck Personality Inventory was administered to 600 normal individuals and their ABO phenotype was determined. Our results failed to support the above hypothesis, because the blood phenotype of the participants did not differentiate them with respect to their mean neuroticism score. The possibility of an association between ABO blood phenotypes and other, more specific, personality traits, such as hysteroid or obsessional is presently under investigation.