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International audience; 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.

Introduction Multiple references to the violent and especially difficult patient have been presented by the international literature. However, there is little literature on the aggressive behaviors of health professionals in their workplaces. The aim of this research is to record and correlate aggression and attachment type data of adult health professionals. Methods The sample includes 192 individuals (43 men and 149 women) health professionals in the private and public sector, aged 20 to 60 years, who were selected by the method of random sampling. The survey was conducted from February 2018 to May 2018. The Greek version of the Aggression Questionnaire and the Greek version of the Revised Experiences in Close Relationships (G-ECR-R) self-report inventory were used and the analysis was performed with the Statistical Package of Social Sciences (SPSS 26) (IBM Corp., Armonk, NY). Results The analysis shows that the dimension of avoidance has a positive correlation with hostility and physical aggression and the dimension of stress has a positive correlation with anger, physical aggression and hostility. It also seems that the stress dimension of the adult attachment contributes significantly positively to the prediction of anger and the stress dimension contributes significantly to the prediction of hostility. The dimension of avoiding adult attachment contributes significantly to the prediction of physical aggression. Conclusions To our knowledge, no studies were found in the literature to examine the relationship between the subscales of aggression and dimensions of attachment. It is important that violence in the workplace is recognized as an underlying occupational risk and not just as a matter of criminal law. Finally, more research is needed to study the phenomenon in order to make it more understandable.

The glucagon-like peptide 1 (GLP-1) receptor (GLP-1R) is a key target for type 2 diabetes (T2D) treatment. Because endocytic trafficking of agonist-bound receptors is one of the most important routes for regulation of receptor signaling, a better understanding of this process may facilitate the development of new T2D therapeutic strategies. Here, we screened 29 proteins with known functions in G protein–coupled receptor trafficking for their role in GLP-1R potentiation of insulin secretion in pancreatic β-cells. We identify five (clathrin, dynamin1, AP2, sorting nexins [SNX] SNX27, and SNX1) that increase and four (huntingtin-interacting protein 1 [HIP1], HIP14, GASP-1, and Nedd4) that decrease insulin secretion from murine insulinoma MIN6B1 cells in response to the GLP-1 analog exendin-4. The roles of HIP1 and the endosomal SNX1 and SNX27 were further characterized in mouse and human β-cell lines and human islets. While HIP1 was required for the coupling of cell surface GLP-1R activation with clathrin-dependent endocytosis, the SNXs were found to control the balance between GLP-1R plasma membrane recycling and lysosomal degradation and, in doing so, determine the overall β-cell incretin responses. We thus identify key modulators of GLP-1R trafficking and signaling that might provide novel targets to enhance insulin secretion in T2D.

OBJECTIVES The Mental Health Continuum-Short Form (MHC-SF), measuring emotional, social, and psychological well-being, has scarcely been validated in clinical populations. We evaluated MHC-SF in 203 patients with affective disorders and 163 nonclinical participants. METHOD Traditional confirmatory factor analysis (CFA), bifactor CFA, three-factor exploratory structural equation modeling (ESEM), and bifactor ESEM models were compared. Convergent/discriminant validity was tested against classic well-being validators and current mood state. RESULTS All three subscales were significantly lower in patients. Test-retest reliability in patients was moderate. Bifactor ESEM fitted data best and displayed full scalar gender and partial scalar invariance across groups. Factor strength indices suggested that MHC-SF is primarily unidimensional, especially in patients. However, subscales differed considerably on size, internal consistency, distinctness, discriminant validity, and temporal stability. CONCLUSIONS MHC-SF was valid and reliable for monitoring well-being in both clinical and nonclinical samples, but further research is needed before safely concluding on its dimensionality.

Contradictory findings have been reported regarding the association between self-esteem and aggression. Most studies have dealt with non-criminal populations. This study aimed to explore the relationship between self-esteem and aggression and investigate possible differences in self-esteem and aggression between female inmates and women without criminal records (non-criminals) in the prefecture of Attica, Greece. One hundred fifty-seven female inmates in the Attica's Korydallos Female Prison and 150 non-criminals from Attica's general population completed the BussPerry Aggression Questionnaire and Rosenberg's Self-esteem Scale between February 2012 and April 2014. Lower self-esteem was associated with higher aggression among women independent of criminality. Self-esteem was lower in inmates (

There is evidence that frequency of suicide attempts of fertile women is related to the menstrual cycle phases, while the influence of hormonal and psychiatric features has been hypothesized. This study aims to explore the distribution and possible differences in clinical characteristics of women who attempted suicide in relation to menstrual cycle. Seventy fertile female psychiatric patients, hospitalized in psychiatric department after a suicide attempt, were studied. Depression was assessed using Beck Depression Inventory, suicide intent with the Suicide Intent Scale, and aggression using the Buss-Perry Aggression Questionnaire. A profile of psychopathology was obtained by using Symptom Check List SCL-90-R. Attempts were more frequent during the last 4 days of luteal phase and during the 4 days of menses, with 59% of attempts to occur during these 8 days. Patterns of number of attempts and cycle phase were similar for subgroups regarding diagnosis, violent/non-violent mode of suicide attempt, and one or repeated attempts. Although attempts were unequally distributed during the cycle, none of the psychiatric features assessed in the present study were related to the higher frequency of attempts during premenstrual/menstrual days, indicating the need to include additional aspects of suicidal behavior in future studies.

The purpose of this study was to investigate overkill in the Greek population from a criminological and victimological point of view and explore possible correlations of the phenomenon with socio-cultural or psychiatric factors. Overall, 158 autopsies of overkill victims were identified throughout the 15-year records of the national forensic laboratories throughout the northern Greek mainland. The pattern that has emerged from the statistical results of the present study on the victims of overkill within the Greek borders was generally in line with global statistics on homicide victims, but also presented differences. The phenomenon correlated more with homicides in the context of mental disorders (within schizophrenia spectrum), other crimes (such as burglary) as well as domestic violence. Overall, males outnumbered females both as victims (approximately threefold) and as perpetrators in overkill homicide cases, but regarding domestic violence, the sad majority of overkill victims stood for females murdered with excessive violence by male relatives. Close female relatives (especially mothers and grandmothers) were also victimized by psychiatrically ill offenders. Female perpetrators tended to attack male individuals with whom they shared a relationship (intimate partners). An important finding was the fact that less than half the offenders' population with major mental disorders were diagnosed at the time of the offense. Overkill victims were found, on average, to be older than average homicide victims, being probably associated with the entailed difference in the physical strength ratio between the victim and the perpetrator.

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. © 2021, The Author(s), under exclusive licence to Springer Nature America, Inc.

Introduction Multiple references to the violent and especially difficult patient have been presented by the international literature. However, there is little literature on the aggressive behaviors of health professionals in their workplaces. The aim of this research is to record and correlate aggression and attachment type data of adult health professionals. Methods The sample includes 192 individuals (43 men and 149 women) health professionals in the private and public sector, aged 20 to 60 years, who were selected by the method of random sampling. The survey was conducted from February 2018 to May 2018. The Greek version of the Aggression Questionnaire and the Greek version of the Revised Experiences in Close Relationships (G-ECR-R) self-report inventory were used and the analysis was performed with the Statistical Package of Social Sciences (SPSS 26) (IBM Corp., Armonk, NY). Results The analysis shows that the dimension of avoidance has a positive correlation with hostility and physical aggression and the dimension of stress has a positive correlation with anger, physical aggression and hostility. It also seems that the stress dimension of the adult attachment contributes significantly positively to the prediction of anger and the stress dimension contributes significantly to the prediction of hostility. The dimension of avoiding adult attachment contributes significantly to the prediction of physical aggression. Conclusions To our knowledge, no studies were found in the literature to examine the relationship between the subscales of aggression and dimensions of attachment. It is important that violence in the workplace is recognized as an underlying occupational risk and not just as a matter of criminal law. Finally, more research is needed to study the phenomenon in order to make it more understandable.

Severe financial crises could influence a country’s suicide trends and characteristics. We aimed to highlight differences among suicide completers before and after the onset of Greece’s serious debt crisis of 2010 based exclusively on forensic data. The sample’s size permitted a further elaboration by means of a time series analysis too. Data were collected from the Piraeus Department of Forensic Medicine for the period 1992–2016. We extracted information on sociodemographic parameters, psychiatric medication and alcohol intake, suicide method, place and month of suicide. The “after crisis onset” group (2011–2016) was significantly older (p = 0.039)—primarily due to differences in the 55–64 age group—, had more frequently used psychiatric medications (p < 0.001), less often alcohol (p = 0.001) and died more frequently by immolation (p = 0.001). These differences were—almost exclusively—due to changes regarding male suicidal behavior. Time series analysis indicates that no strong increasing trend in total (male + female) suicide count can be observed, despite a local increase in 2009–2010. Antidepressant-positive suicides show an increase after 2010, whereas alcohol-positive suicides show a decrease. Future predicted forecasts for antidepressant-positive suicides indicate a decrease (from 5.6 per year in 2018 to 4.3 per year in 2025) whereas an increase is predicted in alcohol-positive suicides (7.7 per year in 2017, 9.36 per year in 2025). Middle-aged men, compared to middle-aged women, presumably found it harder to adjust to economic hardship after the crisis onset. Finally, comparatively more men than women who died by suicide appear to have started and/or complied with psychiatric treatment after 2010. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.

We aimed to examine and compare the attitudes of physicians and law professionals on modern bioethical issues. Euthanasia, physician assisted suicide and abortion were selected for this study, as they underline the conflict between human life as a fundamental value, and the individual's right to self-determination. The demand of euthanasia and physician assisted suicide services reflects each person's right to decide on the way their life will end, while the legalization of abortion determines the individual's right to self-determination. These are complex issues with moral, religious and social implications, and as such tend to divide public opinion. In order to investigate their attitudes, physicians of all specialties, as well as law professionals from all over Greece, were invited to participate in the study. In total, 220 professionals responded to the call and participated in the survey. The professionals involved showed fairly high rates of agreement in all the issues studied, but a significant difference in results was found when the occupation of participants was set as a criterion, with physicians being more negative to euthanasia, physician assisted suicide and abortion than lawyers. Religiousness, age and male sex were negatively correlated with "positive" attitudes towards euthanasia, physician assisted suicide and abortion. Moreover, participants' attitudes towards euthanasia and physician assisted suicide were found to predict their attitudes towards abortion, indicating a single ideological direction of agreement or disagreement, accordingly. Individuals' attitudes and opinions are complicated issues, not easy to be categorized. However, it is of scientific interest to shape a legislative framework that is close to the social consensus, ideological evolution and moral needs. This study tried to pave the way for a modern approach to the issues of euthanasia, physician assisted suicide and abortion.

Introduction: Bipolar disorder (BD) is associated with impairment in cognitive domains such as verbal memory and executive functions. Very few studies have assessed dehydroepiandrosterone sulphate (DHEA-S) in BD and its relation to cognitive functioning despite evidence showing its regulatory effects on glucocorticoid action. The aim of our study was to explore the association of cortisol, DHEA-S, and cortisol to DHEA-S ratio with visuospatial memory and executive functioning in BD. Methods: Cognitive performance of 60 bipolar I patients and 30 healthy subjects was evaluated by using Cambridge Neuropsychological Test Automated Battery tasks targeting visuospatial memory (spatial recognition memory) and executive functions (planning [Stockings of Cambridge; SOC] and attentional set shifting [ID/ED]). Morning serum cortisol and DHEA-S levels were measured in patients. Main effects of cortisol, DHEA-S, and cortisol/DHEA-S ratio for each neurocognitive task were explored in multiple regression analyses correcting for demographic and clinical parameters as well as treatment-related factors (current use of antipsychotic and mood stabilizer medication). Results: Bipolar patients showed poorer performance than healthy subjects in planning and attentional set shifting but not in visuospatial memory. Cortisol to DHEA-S ratio predicted worse performance in planning (SOC). Conclusions: This is the first study to assess memory and executive function in BD in relation to DHEA-S and cortisol to DHEA-S ratio. We report an association of cortisol to DHEA-S ratio with worse performance in planning in bipolar I patients, which warrants further investigation. © 2021 S. Karger AG, Basel. Copyright: All rights reserved.

Background The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. Methods Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ±Â 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. Results The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. Conclusions The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct cores of schizophrenia, the Positive and the Negative, while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition. © 2021 Cambridge University Press. All rights reserved.

The original English language Empathy Quotient (EQ) is a self-reporting questionnaire that measures the construct of empathy in adults of normal intelligence. The EQ is sensitive to gender, and neurodevelopmental disorders. The EQ has been translated to many languages all over the world. The EQ – Greek version may be available through open access from www.autismresearchcentre.com. Aim of the present study was to validate the EQ- Greek version.The study took place in the 1st and 2nd Departments of Psychiatry of the National and Kapodistrian University of Athens (NKUA), “Eginition” and “Attikon” Hospitals respectively, and in the Korydallos Prison Psychiatric Clinic in Athens. Two groups completed the original 60 items version. One group consisted of general population and volunteer students from post graduate training programs (normal control group, N= 127) and the other group of patients recruited from the Adult Neurodevelopmental Disorders Unit of the 1st Department of Psychiatry of NKUA, the outpatients’ clinic of the 2nd Department of Psychiatry of NKUA and the Korydallos Prison Psychiatric Clinic (patient group, N=196). Three versions of the EQ were examined: the EQ-40, EQ-28 and EQ-15. All versions showed very good internal validity: Cronbach’s a value was 0.902, 0.892 and 0.793 respectively. They all showed good test-retest variability: the Intraclass Correlation Coefficient was 0.928, 0.924 and 0.855 respectively. Concurrent validity examined by the correlation analysis with the Interpersonal Reactivity Index (IRI) showed non-significant correlations between the EQ and the IRI. Exploratory Factor Analysis (EFA) indicated a one-factor structure for the three versions. Confirmatory Factor Analysis (CFA) for the one-factor structure showed a good fit for all the three versions. CFA for the three-factor structures (Cognitive Empathy, Emotional Empathy, Social Skills) showed also a good fit for EQ-28 and the EQ-15. When the EQ-40 was used as a measure of empathy in a single dimension in adults, the EQ discriminated the normal control group from the patients’ group. The mean EQ score for the total sample was 35.84 with the lowest scoring being among Autism Spectrum Disorder (ASD) patients. As expected, females scored higher than males (p

We aimed to examine and compare the attitudes of physicians and law professionals on modern bioethical issues. Euthanasia, physician assisted suicide and abortion were selected for this study, as they underline the conflict between human life as a fundamental value, and the individual's right to self-determination. The demand of euthanasia and physician assisted suicide services reflects each person's right to decide on the way their life will end, while the legalization of abortion determines the individual's right to self-determination. These are complex issues with moral, religious and social implications, and as such tend to divide public opinion. In order to investigate their attitudes, physicians of all specialties, as well as law professionals from all over Greece, were invited to participate in the study. In total, 220 professionals responded to the call and participated in the survey. The professionals involved showed fairly high rates of agreement in all the issues studied, but a significant difference in results was found when the occupation of participants was set as a criterion, with physicians being more negative to euthanasia, physician assisted suicide and abortion than lawyers. Religiousness, age and male sex were negatively correlated with "positive" attitudes towards euthanasia, physician assisted suicide and abortion. Moreover, participants' attitudes towards euthanasia and physician assisted suicide were found to predict their attitudes towards abortion, indicating a single ideological direction of agreement or disagreement, accordingly. Individuals' attitudes and opinions are complicated issues, not easy to be categorized. However, it is of scientific interest to shape a legislative framework that is close to the social consensus, ideological evolution and moral needs. This study tried to pave the way for a modern approach to the issues of euthanasia, physician assisted suicide and abortion.

The original English language Empathy Quotient (EQ) is a self-reporting questionnaire that measures the construct of empathy in adults of normal intelligence. The EQ is sensitive to gender, and neurodevelopmental disorders. The EQ has been translated to many languages all over the world. The EQ - Greek version may be available through open access from www.autismresearchcentre.com. Aim of the present study was to validate the EQ- Greek version.The study took place in the 1st and 2nd Departments of Psychiatry of the National and Kapodistrian University of Athens (NKUA), "Eginition" and "Attikon" Hospitals respectively, and in the Korydallos Prison Psychiatric Clinic in Athens. Two groups completed the original 60 items version. One group consisted of general population and volunteer students from post graduate training programs (normal control group, N= 127) and the other group of patients recruited from the Adult Neurodevelopmental Disorders Unit of the 1st Department of Psychiatry of NKUA, the outpatients' clinic of the 2nd Department of Psychiatry of NKUA and the Korydallos Prison Psychiatric Clinic (patient group, N=196). Three versions of the EQ were examined: the EQ-40, EQ-28 and EQ-15. All versions showed very good internal validity: Cronbach's a value was 0.902, 0.892 and 0.793 respectively. They all showed good test-retest variability: the Intraclass Correlation Coefficient was 0.928, 0.924 and 0.855 respectively. Concurrent validity examined by the correlation analysis with the Interpersonal Reactivity Index (IRI) showed non-significant correlations between the EQ and the IRI. Exploratory Factor Analysis (EFA) indicated a one-factor structure for the three versions. Confirmatory Factor Analysis (CFA) for the one-factor structure showed a good fit for all the three versions. CFA for the three-factor structures (Cognitive Empathy, Emotional Empathy, Social Skills) showed also a good fit for EQ-28 and the EQ-15. When the EQ-40 was used as a measure of empathy in a single dimension in adults, the EQ discriminated the normal control group from the patients' group. The mean EQ score for the total sample was 35.84 with the lowest scoring being among Autism Spectrum Disorder (ASD) patients. As expected, females scored higher than males (p

This longitudinal study aimed to investigate the predictive factors of suicidal ideation during the second lockdown in Greece. The respondents presented a 4.32% suicidal ideation in the second lockdown, which did not differ significantly to the initial 4.81%. Anxiety, depression, suicidal ideation during the first lockdown and living with a person with frail health and vulnerable for COVID-19 severe infection emerged as significant risk factors for suicidal ideation during the second lockdown, after controlling for gender, age, and mental health history. Depression was found as the only significant prognostic factor for suicidal ideation incidence of the second lockdown. © 2021

Background: The cerebellum has a crucial role in mood regulation. While cerebellar grey matter (GM) alterations have been previously reported in bipolar disorder (BD), cerebro-cerebellar white matter (WM) connectivity alterations and cerebellar GM profiles have not been characterised in the context of predominant polarity (PP) and onset polarity (OP) subphenotypes of BD patients which is the aim of the present study. Methods: Forty-two euthymic BD patients stratified for PP and OP and 42 healthy controls (HC) were included in this quantitative neuroimaging study to evaluate cerebellar GM patterns and cerebro-cerebellar WM connections. Diffusion tensor tractography was used to characterise afferent and efferent cerebro-cerebellar tract integrity. False discovery rate corrections were applied in post-hoc comparisons. Results: BD patients exhibited higher fractional anisotropy (FA) in fronto-ponto-cerebellar tracts bilaterally compared to HC. Subphenotype-specific FA profiles were identified within the BD cohort. Regarding PP subgroups, we found FA changes in a) left contralateral fronto-ponto-cerebellar tract (depressive-PP > HC) and b) contralateral/ipsilateral fronto-ponto-cerebellar tracts bilaterally (manic-PP > HC). Regarding OP subgroups, we observed FA changes in a) left/right contralateral fronto-ponto-cerebellar tracts (depressive-OP > HC) and b) all fronto-ponto-cerebellar, most parieto-ponto-cerebellar and right contralateral occipito-ponto-cerebellar tracts (manic-OP>HC). In general, greater and more widespread cerebro-cerebellar changes were observed in manic-OP patients than in depressive-OP patients compared to HC. Manic-OP showed higher FA compared to depressive-OP patients in several afferent WM tracts. No GM differences were identified between BD and HC and across BD subgroups. Conclusions: Our findings highlight fronto-ponto-cerebellar connectivity alterations in euthymic BD. Polarity-related subphenotypes have distinctive cerebro-cerebellar WM signatures with potential clinical and pathobiological implications. © 2020 Elsevier Inc.

The aim of this study was to compare the baseline characteristics (demographic, psychiatric-psychopathological and legal) among Greek forensic patients found not guilty by reason of insanity. The first step of this approach being differentiating patients who committed a criminal offense during their first psychotic episode from the ones who did so later in the course of their illness. All patients were hospitalized in the Department of Forensic Psychiatry (DFP) of the Psychiatric Hospital of Thessaloniki (PHT) from January 2015 to January 2020 and were examined in order to be included in the study. The final research sample consisted of 78 patients (70 identifying themselves as males and 8 identifying themselves as females) aged 18 and older, 21 of whom committed a criminal offense during their first psychotic episode (FEP, N = 21) and 57 did so later on in the course of their illness (Course, N = 57). Data were collected from multiple sources and several psychometric tools were used (Mini International Neuropsychiatric Interview-M.I.N·I, Positive And Negative Syndrome Scale-PANSS, Addiction Severity Index-ASI, CAGE Questionnaire, Hostility and Direction of Hostility Questionnaire-HDHQ, Global Assessment of Functioning-GAF and Aggression Questionnaire). Comparing the two groups (FEP vs. Course) we found that patients in FEP were younger, had experienced stressful life events in the last 24 months, committed more serious violent crimes, and more frequently attempted suicide after the crime. Their victims were usually members of their family. The main psychometric disparities between the two groups were found in the “Hostility” score of the Aggression questionnaire, and the items “Criticism of Others” and “Paranoid Hostility” of the HDHQ questionnaire, where patients in FEP scored lower. Patients in FEP scored significantly higher in items P1 (delusions), P4 (excitement), P6 (suspiciousness/persecution) and P7 (hostility) of the PANSS scale. No statistically significant differences were found between the two groups regarding their evaluation with the CAGE, ASI or GAF questionnaires. When comparing the patients' present scores in PANSS scale, the patients in FEP had lower total scores in the Positive and the General Psychopathology subscales. Both groups showed significant improvement during hospitalization in all scales (PANSS & GAF), except for the Negative Subscale of the PANSS scale. Through logistic regression analysis, we found that patients in FEP were younger, more likely to have recently experienced stressful life events and more likely to have assaulted a member of their family. Patients with higher scores in the “Hostility” subscale of the Aggression questionnaire were found to remain at risk for committing a crime during the course of their illness. These findings underline the need to design and develop specialized mental health services in order to identify and treat patients involved in violent crime in a timely and effective manner addressing their multiple needs. © 2021 Elsevier Ltd

Childhood trauma (CT) is correlated with suicidality among patients with bipolar disorder (BD). However, it has not been adequately investigated if a third factor, for instance impulsivity, mediates the effect of CT on suicidality in BD. This study aimed to explore potential mediatory effects of impulsivity in the pathway from CT to suicidality in BD. CT was assessed with the Early Trauma Inventory Self Report-Short Form (ETI-SR-SF), impulsivity with the Barratt Impulsivity Scale-11 (BIS-11) while lifetime suicidality was investigated with the Suicidal Behaviors Questionnaire-Revised (SBQ-R). The effect of childhood trauma on suicidality and impulsivity as well as the effect of impulsivity on suicidality were examined with multiple linear regressions, including gender, age and diagnosis (BD-I, BD-II) as covariates. Structural equation models were built and path analyses were performed (with AMOS 25 software and using bootstrapping in 1000 samples) for the examination of the mediatory role of BIS-11 and its subtypes in the effect of childhood trauma and its subtypes on suicidality. We included 78 BD euthymic patients (60.3% female, 67.9% BD-I). ETI-SR-SF significantly predicted SBQ-R (p=0.004) and BIS-11 (p

The two-year preparation for the National university entrance exams in Greece is one of the most trying periods in a young person's life, physically and emotionally. The present study reports the results from 442 last year senior high school students who completed an online survey (16-30 April 2020) concerning the lockdown impact on their mental health. Overall, the rate of positive screen for depression (PHQ-9 score ≥ 11) significantly increased from 48.5% to 63.8% and of those scoring within severe depression range (PHQ-9 ≥20) from 10% to 27%; for anxiety (GAD-7 score ≥ 11) increased from 23.8% to 49.5% and of those scoring within severe anxiety range (GAD-7≥17) from 3.8% to 20.5%. After taking sex and baseline (one month prior to the lockdown) levels of depression and anxiety into account, the level of lockdown experienced distress was predictive of depression and anxiety levels in time of home confinement, accounting for about 30% of variance in symptoms severity scores. Although our results may be subject to sampling and recall bias, the unexpectedly high rates of anxiety and depression warrant an urgent call to action aiming at mitigating and managing mental health risks of senior high school students in future waves of pandemic. © 2020

The aim of this study was to investigate the prevalence of suicidal ideation in the community as well as the risk and protective factors of suicidal ideation during restriction measures in Greece, after the outbreak of the COVID-19 pandemic. Α web-based anonymous survey was conducted during the first lockdown period. Participants completed the Generalized Anxiety Disorder scale (GAD-2), the Patient Health Questionnaire (PHQ-2), the Systemic Clinical Outcome and Routine Evaluation (SCORE-15), the Connor-Davidson Resilience Scale (CD-RISK-2), and a self-report questionnaire for COVID-19 pandemic-related data. From a total of 5,116 adults included in the study, 5.20% reported suicidal thoughts, 14.17% were potential clinical cases of anxiety, and 26.51% of depression. Participants presented significantly higher suicidal ideation rates during the last two weeks of the lockdown compared to its previous two weeks. Unmarried or divorced marital status, mental health history, poor perceived quality of physical health, impaired family functioning, anxiety and depression symptoms were independently associated with higher odds of suicidal ideation, whereas higher resilience, positive feelings with regard to the lockdown measures, relationship with friends, and faith in a Supreme Being were associated with lower suicidal ideation odds. According to the findings, suicidal ideation prevalence might be considered elevated and its increase during the lockdown period alarming. The risk and protective factors identified in the study offer valuable information for the development of preventive strategies against suicidal ideation, especially in times of crisis. © 2021

The purpose of this study was to investigate overkill in the Greek population from a criminological and victimological point of view and explore possible correlations of the phenomenon with socio-cultural or psychiatric factors. Overall, 158 autopsies of overkill victims were identified throughout the 15-year records of the national forensic laboratories throughout the northern Greek mainland. The pattern that has emerged from the statistical results of the present study on the victims of overkill within the Greek borders was generally in line with global statistics on homicide victims, but also presented differences. The phenomenon correlated more with homicides in the context of mental disorders (within schizophrenia spectrum), other crimes (such as burglary) as well as domestic violence. Overall, males outnumbered females both as victims (approximately threefold) and as perpetrators in overkill homicide cases, but regarding domestic violence, the sad majority of overkill victims stood for females murdered with excessive violence by male relatives. Close female relatives (especially mothers and grandmothers) were also victimized by psychiatrically ill offenders. Female perpetrators tended to attack male individuals with whom they shared a relationship (intimate partners). An important finding was the fact that less than half the offenders’ population with major mental disorders were diagnosed at the time of the offense. Overkill victims were found, on average, to be older than average homicide victims, being probably associated with the entailed difference in the physical strength ratio between the victim and the perpetrator. © 2021 Elsevier Ltd and Faculty of Forensic and Legal Medicine

Childhood trauma (CT) is correlated with suicidality among patients with bipolar disorder (BD). However, it has not been adequately investigated if a third factor, for instance impulsivity, mediates the effect of CT on suicidality in BD. This study aimed to explore potential mediatory effects of impulsivity in the pathway from CT to suicidality in BD. CT was assessed with the Early Trauma Inventory Self Report-Short Form (ETI-SR-SF), impulsivity with the Barratt Impulsivity Scale-11 (BIS-11) while lifetime suicidality was investigated with the Suicidal Behaviors Questionnaire-Revised (SBQ-R). The effect of childhood trauma on suicidality and impulsivity as well as the effect of impulsivity on suicidality were examined with multiple linear regressions, including gender, age and diagnosis (BD-I, BD-II) as covariates. Structural equation models were built and path analyses were performed (with AMOS 25 software and using bootstrapping in 1000 samples) for the examination of the mediatory role of BIS-11 and its subtypes in the effect of childhood trauma and its subtypes on suicidality. We included 78 BD euthymic patients (60.3% female, 67.9% BD-I). ETI-SR-SF significantly predicted SBQ-R (p=0.004) and BIS-11 (p

Bipolar disorder (BD) is a heritable mental illness with complex etiology. We performed a genome-wide association study (GWAS) of 41,917 BD cases and 371,549 controls of European ancestry, which identified 64 associated genomic loci. BD 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 eQTL data implicated 15 genes robustly linked to BD via gene expression, including druggable genes such as HTR6, MCHR1, DCLK3 and FURIN. This GWAS provides the best-powered BD polygenic scores to date, when applied in both European and diverse ancestry samples. Analyses of BD subtypes indicated high but imperfect genetic correlation between BD type I and II and identified additional associated loci. Together, these results advance our understanding of the biological etiology of BD, identify novel therapeutic leads and prioritize genes for functional follow-up studies.