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The current coronavirus pandemic (COVID-19) has led mental health systems to uncertainty regarding safe continuation of clozapine monitoring protocols. Clozapine is without doubt the only antipsychotic available with repeatedly proven efficacy in treatment resistant schizophrenia.1 Replacing clozapine with an alternative antipsychotic in patients stabilized with clozapine can potentially lead to higher risk of relapse or exacerbation of severity of illness.1 Clozapine, as already known, has a number of side effects, some of which can be serious, thus patients receiving clozapine require ongoing scheduled monitoring. Side effects of clozapine include neutropenia or agranulocytosis, myocarditis, fever, hypersalivation, weight gain and constipation. These side effects can be detected and treated when recognized on time decreasing the possibility of serious consequences making the implementation of an ongoing treatment monitoring protocol for patients on clozapine mandatory.2 Since it was advised for all mental health providers in most countries worldwide to limit non-urgent hospital visits and procedures to reduce the risk of contamination a challenge arose for patients' ability to access health care facilities for their routine clozapine monitoring. Nevertheless, the majority of Mental Health Care Authorities decided to ensure access for all patients on clozapine to their routine monitoring protocol.3,4 To date, no data exist on any potential relationship between antipsychotic use and the risk of contamination with SARS-CoV-2 or the development of severe symptoms of the infection. The literature suggests that patients receiving antipsychotics, especially clozapine, have an increased risk of developing pneumonia, leading to the assumption that patients receiving clozapine are at higher risk to develop COVID-19. 1 Balancing the importance of monitoring continuation against the increased risk for COVID-19, an International Consensus Statement was recently published addressing a monitoring protocol with reduced visits. The Consensus suggested reduced hematologic monitoring frequency of every 3 months with a prescription of 90 days clozapine supply (if safe). The above applies to patients receiving clozapine for at least one year without neutropenia. Τhe risk of neutropenia after 12 months of clozapine treatment falls significantly.4 Based on the above it is suggested to all clozapine clinics to implement a guidance monitoring protocol for all patients on clozapine to ensure safety during the pandemic. Besides hematological monitoring that requires physical contact with healthcare workers it is significant to implement a telemedicine appointment in frequent intervals to monitor symptoms of infection, symptoms of cardiovascular diseases and constipation. Patient should also be advised to regularly monitor one's blood pressure and pulses and ideally be educated on how by a member of the staff. If a patient is detected with any symptoms related to the above an emergency appointment for evaluation should be planned. Overall, since both the consequences and the duration of the pandemic are unknown, mental health services must work jointly to implement a clozapine monitoring plan to ensure safe continuation in such a vulnerable population.

The idea of a network of small devices that would be able to connect each other, appeared in the early 80s. In a prophetic article, Mark Weiser,1 described such a connection, that it is now known under the term of Internet of Things (IoT). In a broadest sense, the term IoT encompasses everything connected to the internet, but it is increasingly being used to define objects that "talk" to each other, creating a network from simple sensors to smartphones and wearables connected. During the recent years this network of communicating devices has been combined with other technological achievements, and particularly with the Virtual Reality (VR)2 and the Artificial Intelligence (AI).3 The emerge of COVID-19 pandemic in 2019, resulted to the poor response and healthcare failures of many countries globally.4 One of the main reasons for such a failure, was the inability of accurate data collection from different sources. Apparently, it was the first time, humanity realized the need for massive amounts of heterogeneous data to be collected, interpreted, and shared. Amid the ongoing COVID-19 pandemic, several innovators and public authorities are looking to leverage IoT tools to reduce the burden on the healthcare systems.5 Mental health is one of the areas that seems to benefit the most of such technologies. A significant decrease of the total amount of ER visits and a dramatic increase of internet access from the patients and care givers along to the development of applications for mental health issues, followed the outbreak of SARS-CoV-2.6 Such technologies proved to be efficient to help mentally ill patients and pioneer the path in the future. Probably the most obvious use of these emerged technologies is the improvement of the telehealth options. Patients who suffer from mental illness face significant problems towards the continuity of care during the crisis.7 Nonetheless, they usually have other health problems, that deprive them from an equitable health care provision. Improved telehealth platforms can give them a single point access to address all their problems. The use of electronic health records can reduce the fragmentary health services and improve the outcome.8 However, this is only the beginning. The COVID-19 crisis and the subsequent social isolation, to reduce both the contamination and the spread of the disease, highlighted the necessity for providing accurate and secure diagnoses and treatments from a safe distance. Virtual reality combined with IoT and AI technologies seem to be a reliable alternative to the classic physical and mental examination and treatment in many areas of mental and neurological diseases.2 These novel techniques can spot the early signs and detect mental illnesses with high accuracy. However, caution and more work are required to bridge the space between these recently thrived technologies and mental health care.7 It is worth mentioning, that internet-oriented health care procedures can also help to reduce the gaps caused by the stigma of mental illness. For example, the development of AI chatbots (an application used to chat directly with a human) can alleviate the fears of judgment of the help seeking persons and provide the professionals with a supplemental support toward improved services to their patients.9 A final remark for conclusion. Humanity is more and more depended to the "intelligent" machines. However, we must not forget that we humans are responsible to set the rules of such co-existence.

Socio-demographic and clinical characteristics of adults under compulsory psychiatric treatment, have not been reported adequately in Southern European countries. We investigated the socio-demographic and clinical characteristics of adults with psychotic symptomatology who were involuntarily treated in the acute Mental Health Services in Cyprus. A descriptive cross-sectional study was applied. Data collection (December 2016 to February 2018) achieved via a structured questionnaire including demographic and clinical variables. Census sampling was applied in Cyprus referral center for compulsory psychiatric treatment. The sample included 406 individuals (262 males, 144 females). Approximately 86.2% were single, 77.6% were unemployed, and 24.9% held a bachelor's degree. The most frequent clinical diagnosis was schizophrenia or a relevant psychotic disorder (86.4%). The most frequent admission cause was non-adherence to pharmacotherapy along with disorganized behavior (agitation and/or self-care deficit, and/or aggressive behavior, and/or suicidal behavior) (53.6%). Moreover, 70.7% of the sample reported a positive personal history of mental health problems, while 42.1% reported a positive family history of mental health disorders. Half of the participants (52%) were previously involuntarily admitted for compulsory treatment. Adjusted associations of readmission status were reported with Cypriot ethnicity (OR: 4.40, 95%CI: 2.58–7.50), primary education only (OR: 3.70, 95%CI: 1.64–8.37), readmission due to disorganized behavior along with non-adherence to pharmacotherapy (OR: 10.84, 95%CI: 2.69–43.72), as well as along with substance use (OR: 6.39, 95%CI: 1.52–26.82). Readmission was almost five times more likely to occur due to suicidal behavior (OR: 5.01, 95%CI: 1.09–22.99) compared to disorganized behavior not otherwise specified. Additionally, those with a diagnosis of schizophrenia were more than 12 times more frequently readmitted for compulsory treatment compared to other diagnoses (OR 12.15, 95%CI: 1.04–142). Moreover, the participants with higher secondary education had 54.6% less odds to be involuntarily re-admitted compared to Bachelor degree holders (OR 0.442, 95%CI: 0.24–0.79). A high percentage of involuntary treatment was noted due to non-adherence to pharmacotherapy and substance use. Re-evaluation of the effectiveness of relevant community interventions is suggested, as well as implementation of structured educational programs on therapy adherence during psychiatric hospitalization. © Copyright © 2021 Kaikoushi, Middleton, Chatzittofis, Bella, Alevizopoulos and Karanikola.

With the percentage of mental health disorders on the rise and the cost for their treatment reaching astounding proportions, research in their treatment has also become quite extensive. Individuals suffering from the effects of their disorder constituting them incapable at various levels to lead a normal life, the need for a more effective treatment has been well established. We have focused on anxiety disorders specifically, which have mainly fear as their common denominator, and using this we decided to look into the role of the clinician in live ET sessions so as to examine whether this role can be replicated in a VRET simulation with similar or better outcomes for the patient, i.e. a more effective treatment. Our hypothesis was tested in an outpatient setting with patients being separated into two groups. We examined whether the presence of a virtual guided master using participant modeling in a virtual environment was as effective or more effective than the Standard ET method. Our VR system is based on the Full Body Immersive Virtual Reality System with Motion Recognition Camera created by Jacob Kritikos. The outcomes were gathered via the Session Rating Scale by Miller which led to the conclusion that participant modeling within a VRET approach can lead to a better treatment quality. © 2021, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.

Τhe severity and variation of depressive symptoms (DS), among psychotic individuals under involuntary hospitalization is unclear. We investigated the socio-demographic and clinical characteristics of psychotic adults with DS involuntarily hospitalized for compulsory treatment in Cyprus. We also evaluated the psychometric properties (internal consistency, known-group and discriminant validity) of the HDRS-17 and HAM-A for the assessment of depressive and anxiety symptoms, respectively. A descriptive correlational study with cross-sectional comparisons was applied. Data on demographics, cognitive functioning (MoCA scale), depressive (HDRS-17 scale), anxiety (HAM-A scale) and psychotic (PANSS scale) symptoms were collected (December 2016 -February 2018). Following informed consent, the sample included 406 patients. Among them, 21 males and 23 females reported DS (HDRS-17 total score ≥8). The latter were mainly Greek-Cypriots (61.4%), 45-65 years old (38.6%), single (77.3%), unemployed (72.7%), mainly admitted due to aggressiveness towards others (47.7%), most frequently diagnosed with a bipolar disorder (59.1%). The mean score (M) in the HDRS-17 was 30.72 (scale range: 8-50; Standard Deviation [SD]: 10.42). The highest mean score (M) per item was in the variables "Suicide behavior"'(M:3.09; SD:1.09) and "Depressive mood" (M=2.95; SD=1.07). The DS group (HDRS-17 score≥8) reported higher PANSS positive symptoms subscale score (t-test, p=0.003) and HAM-A total score (t-test, p=0.05) compared to the non-DS group (HDRS-17 score

Clozapine is an atypical antipsychotic used for the treatment of resistant schizophrenia, exhibiting significant advantages over other antipsychotic agents. Clozapine efficacy is well established in people diagnosed with schizophrenia via reducing both positive and negative symptoms. Also, is associated with a low risk of extrapyramidal side effects compared to other antipsychotics. Despite the above, clozapine is an unpopular therapeutic option for patients not previously responded to other antipsychotics, because of adverse side effects, such as hyper-salivation and weight gain or critical side effects, i.e., risk for developing neutropenia and agranulocytosis and the need for a systematic and vigilant patients' monitoring, causing discomfort to them and increased expenses to the healthcare system. The aim of the present article is to describe (a) the development of a "clozapine treatment monitoring protocol", and (b) the monitoring process applied at the Department of Psychiatry of Aghioi Anargyroi Cancer Hospital in patients under clozapine treatment. For the protocol development a systematic review of the existing literature was conducted. An advanced search in Medline, CINAHL, Scopus and Google Scholar was conducted, as well as at the National Organization of Greece for Medicines database, with the following key- words: "clozapine", "clozapine protocol", "clozapine monitoring", "clozapine guidelines". Based on this procedure, the Victorian Consensus View protocol applied in Australia was evaluated as the most appropriate since it encompasses: (a) monitoring of multiple systems based on a holistic healthcare approach towards patients, and (b) Intense cardiovascular functioning monitoring, highly relevant to the Greek population due to increased incidence of myocarditis. Overall, the necessary interventions prior and after clozapine treatment initiation are, monitoring of heamatological and cardiovascular function and related side effects, metabolic monitoring and related side effects, monitoring of metabolic adverse effects, gastrointestinal and neurological adverse effects, hepatic function monitoring and related side effects. Clozapine treatment monitoring protocol applied at special settings, e.g., Clozapine Clinics, is highly beneficial, since the risk of neutropenia, agronulocytosis is minimized, while suicidal behavior and substance use are reduced along with risky health behaviors, i.e., nicotine use and sedentary lifestyle. The current protocol may be applied by mental healthcare professionals aiming to empower individuals with schizophrenia through promoting their independency and quality of life.

Virtual Reality has already been proven as a useful supplementary treatment tool for anxiety disorders. However, no specific technological importance has been given so far on how to apply Virtual Reality with a way that properly stimulates the phobic stimulus and provide the necessary means for lifelike experience. Thanks to technological advancements, there is now a variety of hardware that can help enhance stronger emotions generated by Virtual Reality systems. This study aims to evaluate the feeling of presence during different hardware setups of Virtual Reality Exposure Therapy, and, particularly how the user’s interaction with those setups can affects their sense of presence during the virtual simulation. An acrophobic virtual scenario is used as a case study by 20 phobic individuals and the Witmer–Singer presence questionnaire was used for presence evaluation by the users of the system. Statistical analysis on their answers revealed that the proposed full body Motion Recognition Cameras system generates a better feeling of presence compared to the Hand Controllers system. This is thanks to the Motion Recognition Cameras, which track and allow display of the user’s entire body within the virtual environment. Thus, the users are enabled to interact and confront the anxiety-provoking stimulus as in real world. Further studies are recommended, in which the proposed system could be used in Virtual Reality Exposure Therapy trials with acrophobic patients and other anxiety disorders as well, since the proposed system can provide natural interaction in various simulated environments. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Objective: Providing informed, consent requires patients’ Decision-Making Capacity for treatment. We evaluated the Decision Making Capacity of outpatients diagnosed with schizophrenia and schizoaffective disorder on treatment with Long Acting Injectable Antipsychotic medication. Method: This is a retrospective, cross-sectional, correlational study conducted at two Depot Clinics in Athens, Greece. Participants included 65 outpatients diagnosed with schizophrenia and schizoaffective disorder on treatment with Long Acting Injectable Antipsychotics. Results: Over half of the participants showed poor understanding of the information given regarding their disease and treatment (Understanding subscale), however > 70% seemed to comprehend the relevance of this information to their medical condition (Appreciation subscale). Moreover, half of the participants reported adequate reasoning ability (Reasoning subscale), whilst patients who gained > 7% of their body weight scored statistically significantly higher in the subscales of Understanding and Appreciation. Conclusion: Our results suggest that there is a proportion of patients with significantly diminished Decision Making Capacity, hence a full assessment is recommended in order to track them down. Further research is needed to better interpret the association between antipsychotic induced weight gain and Decision Making Capacity in patients suffering from schizophrenia or schizoaffective disorder. © 2017 Elsevier Inc.

The use of physical and mechanical restraints in mental health services in Greece arise many ethical and practical issues. The justification of the use of such procedures is rather controversial and subjective to scientific debate. The practice of restraint puts both patients and staff at risk for injury and death. Moreover, restraints can be traumatic even when they do not result in any physical injury to the patient. The types of the physical adverse events include dehydration, suffocation, circulation disturbances, skin problems, loss of strength and mobility, incontinence, etc. Research studies regarding the use of restraints are limited, although individual, professional, and social impact is extensive. Worldwide many associations involving patients, care givers and patient rights authorities have disapproved such techniques as inhumane and against recent scientific evidence. Nevertheless, the methods are being used for highly agitated and violent patients in mental health hospitals in order to protect the patients and others towards physical harms. Verbal de-escalation strategies should be attempted prior to the use of any form of restraint. Although there are no strict guidelines in Greece for the use of the least restrictive and effective treatment for an agitated and/or violent patient there are certain occasions that restraints cannot be avoided. Physical, chemical and mechanical restraints should never be used for the sake of convenience or punishment. The healthcare professionals understand and follow proper procedures when restraining a patient to ensure safety and dignity of the person. Failure to follow guidelines is subjective to legal actions by the patient, the family and the independent mental health authorities. Restraining comes in many forms, like chemical, physical and mechanical. Clinical judgment must be applied to determine the necessity of any restrictive decision. Consultant psychiatrists, mental health nurses and ward staff are involved to the initial assessment, the level of restriction, the procedure of restraints, the follow-up and the reassessment of the level of safety, due to the guidelines and the wide range of complication concerns. Further to the clear public, medical and operational concerns for the restraints, these procedures are expensive for the mental health services. In our study we estimated the costs of the procedures per patient, excluding the medication costs. According to our data each mechanical restraint costs at least € 57.28 and each seclusion € 47.16 respectively for up to 2 hours of duration and increase according to the prolongation of the restraint procedures.

A 43-year-old psychiatric patient was transferred in coma and hypercapnic respiratory failure at the emergency department. He was intubated for airway protection and transferred to the Intensive Care Unit (ICU). Abdominal X-ray revealed a radiopaque mass; a pharmacobezoar was suspected and confirmed by gastroscopy; one large in the stomach fundus and a smaller one in the pylorus. Gastric lavage through the gastroscope and administration of gastro-kinetic drugs and laxatives were able to dilute the bezoars. Tablets retrieved from the stomach identified as methadone and toxicological tests of the gastric fluid confirmed the presence of methadone as the only organic chemical compound. The patient was extubated on the 7th day and released from the ICU on the 10th day under psychiatric consultation having normal vital signs. Methadone gastric bezoar may lead to persistent intoxication, respiratory failure, and coma requiring ICU care. Diagnosis may be difficult and a high index of suspicion is needed. © 2017 Indian Journal of Critical Care Medicine | Published by Wolters Kluwer - Medknow.

Objectives Τo explore the psychopathology of the Greek male prisoner population and the relationship between psychiatric disorders and the criminal history of the subjects. Methods The Iowa Structured Psychiatric Interview and the Personality Disorders Questionnaire were administered. The prevalence of the most common mental disorders was analyzed separately and in relation to the criminal history. SPSS was used for the statistical analysis. Results A total of 495 male prisoners were interviewed. Overall, 223 (45.06%) were diagnosed with a psychiatric disorder. Non-violent crimes were the most prevalent reason for imprisonment (40.7%). One-third (30.3%) of the sample was convicted with drug-related crimes, and 28.0% with violent crimes. Discussion The prevalence of mental disorders in Greek prisoners was higher than in the general population. Personality disorder was the most common type of mental disorder and the only psychiatric diagnosis related to violent crime. This highlights the need for screening for mental disorders and the need for therapeutic provision within the prison setting. © 2016 Elsevier Ltd

Alcohol exposure is related to increased susceptibility to infections. We investigated the effect of acute exposure to alcohol on pro- and anti-inflammatory cytokine production in an ex-vivo model of whole blood stimulation with lipopolysacharide (LPS). Ten ml of whole blood were taken from 24 healthy volunteers (all men) aged 36.5 ± 1.4 years. Each sample was transferred into two tubes, without and with EDTA as anticoagulant, under sterile conditions. We had 14 groups: the control group in which whole blood was incubated without any other intervention, the LPS group in which whole blood was stimulated with LPS alone, and 12 alcohol groups with (6 groups) and without LPS stimulation (6 groups) using six different doses of alcohol (5, 12.5, 25, 50, 100 and 200mM). LPS (500pg) was added after pretreatment with alcohol for 10 minutes. Blood samples were diluted 1:10 in RPMI 1640 culture medium (100μl whole blood added in 900μl RPMI 1640), and then alcohol solution and LPS were added according to the study protocol for incubation period of 4 hours at 37°C. Cell culture supernatants were isolated with centrifugation at 1,800rpm, for 5 min at room temperature and stored at -70°C until measurements. Cytokine levels were determined in culture supernatant with the ELISA method. Alcohol had no effect on cytokine production when incubated with whole blood alone. TNF-α IL-6 and IL-10 significantly increased after LPS stimulation. Alcohol had no effect on IL-6 production after LPS challenge but significantly decreased TNF-α and IL-10 production in the presence of LPS challenge at 25mM to 200mM in a dose dependent manner. Conclusively TNF-α and IL-10 were significantly decreased after alcohol exposure in a dose depended manner in a model of whole blood stimulation with LPS exvivo expressing both suppression of pro- and anti-inflammatory response. © 2015 Gavala A, et al.

The aim of this study was to investigate the prevalence of secondary traumatic stress/compassion fatigue (STS/CF), burnout (BO) and compassion satisfaction (CS) in psychiatric nurses, and their risk factors. The Professional Quality of Life Scale (ProQOL R-IV) and a demographic and work related characteristics questionnaire were distributed to 174 psychiatric nurses in 12 public hospitals in Greece. The majority of participants were at the high risk category for STS/CF (44.8%) and BO (49.4%), while only 8.1% of nurses expressed high potential for CS. Awareness of the factors associated with STS may help nurses to prevent or offset the development of this condition. © 2015 Elsevier Inc.

Objectives: The aim of this study was to investigate whether depressive symptoms are related to the risk factors for sudden death in patients with hypertrophic cardiomyopathy (HCM). Design: 121 patients diagnosed as having HCM were assessed for depressive symptomatology using the Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale (CES-D) and followed up for a period of 2 years. For the interview, the authors used the Structured Clinical Interview for DSM-III/DSM-III-R. A multidimensional longitudinal study was carried out with both somatic and psychological symptoms and signs taken into consideration. SPSS was used for the statistical analysis. Results: (1) Patients with HCM are more depressed than the general population. (2) There is no positive correlation between the occurrence of depressive symptoms and the risk factors for sudden death in patients with HCM. (3) Patients at high risk for sudden death are not more depressed than the others. (4) Time from diagnosis of the cardiac disease is not related to the presence and severity of depressive symptoms. Conclusions: Patients with HCM are more depressed than the general population. The authors suggest that depressive symptoms and risk factors for sudden death in these patients are not related. It is important to screen for mood disorders in this patient population in order to provide an early diagnosis and treatment of the psychiatric disease.

Background and Objectives: The purpose of the present study was to develop an attitudinal schedule, the Attitudes to Severe Mental Illness (ASMI) scale, which synthesizes elements from different conceptual frameworks of the field, while addressing gaps on the existing literature on stigma measurement. Methods: A national representative sample of 2039 adults from the general population was interviewed by telephone. Results: Factor analysis revealed 4 factors to underlie the data, namely "stereotyping" "optimism", "coping" and "understanding", which explained 67% of total variance. The instrument's face and predictive validity were also supported, while its internal consistency and test -retest reliability were found to be high for the overall scale and its factors. Conclusions: Consistent with these, the ASMI scale emerges as a valid and reliable tool for the assessment of attitudes towards severe mental illness, while it opens new directions for advancing scientific understanding of the topic.

Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed to treat depression and a broad range of other comorbidities. The increased use of SSRIs in patients with various comorbidities treated with different drugs engenders the risk of pharmacokinetic drug interactions via cytochrome P450 (CYP450) enzymes inhibition. In the present review, we provide an overview of documented clinically significant drug interactions between SSRIs and other drugs co-prescribed in psychiatric patients for the same or other diseases. We further discuss the significance of drug interactions in the era of pharmacogenomics to underline the need for using information on both genotype and drug interactions towards implementing better clinical outcomes through personalized medicine. © 2012 by Walter de Gruyter Berlin Boston 2012.

Sildenafil (SDL) is a phosphodiesterase type 5 inhibitor and it is approved for the treatment of erectile dysfunction and pulmonary hypertension. SDL is extensively metabolized to its pharmacologically active metabolite, desmethyl-sildenafil (DSDL). A sensitive and specific GC/MS method for the determination of SDL and DSDL in whole blood was developed and validated to support therapeutic drug monitoring of SDL patients. The combination of solid-phase extraction with derivatization using BSTFA with 1% TMCS in acetonitrile efficiently reduced matrix effect and improved sensitivity of the method. In this assay, protriptyline was used as internal standard for both analytes. The LODs were 1.50 and 5.00 ng/mL for SDL and DSDL, respectively, whereas the respective LOQs were 5.00 and 15.0 ng/mL. The calibration curves were linear up to 500.0 ng/mL (SDL: R2 0.992, DSDL: R2 0.990). Absolute recovery values for both analytes ranged from 83.1 to 93.2%. Within-and between-batch accuracy was less than 11.8 and 10.2%, respectively, whereas within-and between-batch precision was less than 8.1 and 10.8%, correspondingly. The developed method is suitable for the determination of SDL and DSDL concentrations in blood samples obtained from patients under Viagra® treatment, for pharmacokinetic studies or for the investigation of related forensic cases. © 2011 WILEY-VCH Verlag GmbH &Co. KGaA, Weinheim.

The purpose of the present study was to investigate the association of opinions towards seeking psychiatric help with the duration of untreated mental disorders in a sectorized Athens area, served by a Community Mental Health Centre. The sample consisted of 134 individuals who had sought help from health or mental health non sectorized services prior to their visit to the Centre (group A) and 156 individuals whose visit to the Center was their first ever contact with a mental health service (group B). Opinions were assessed by the "Attitudes Toward Seeking Professional Psychological Help scale. Both groups were selected from a total of 1,008 individuals who had visited the Centre in four consecutive years. The duration of untreated mental disorders was found to be shorter in group A compared to group B. Males and females of both groups, who had visited the Centre in a time period shorter than 12 months since the onset of their psychopathology, expressed more positive views towards help-seeking, compared to their counterparts with longer duration of untreated mental disorder. The variables of gender (females), age at symptom onset (younger) and education (higher) predicted a shorter duration without psychiatric treatment and more positive views about the necessity of help-seeking. More severe type of diagnoses was associated with shorter durations before accessing care. Our findings underline that mental health awareness programs are clearly required in order to strengthen the early recognition of the need for help- seeking. The development of liaison and outreach activities could also prevent prolonged delays in psychiatric treatment. © 2011 Springer Science+Business Media, LLC.

Three methods of esophagoscopy are available until now: Sedated conventional endoscopy, unsedated ultrathin endoscopy, and esophageal capsule endoscopy. The three methods carry comparable diagnostic accuracy and different complication rates. Although all of them have been found well accepted from patients, no comparative study comprising the three techniques has been published. The aim of this study was to compare the three methods of esophagoscopy regarding tolerability, satisfaction, and acceptance. Twenty patients with large esophageal varices and 10 with gastroesophageal reflux disease were prospectively included. All patients underwent consecutively sedated conventional endoscopy, unsedated ultrathin endoscopy, and esophageal capsule endoscopy. After each procedure, patients completed a seven-item questionnaire. The total positive attitude of patients toward all methods was high. However, statistical analysis revealed the following differences in favor of esophageal capsule endoscopy: (i) total positive attitude has been found higher (χ2 = 18.2, df = 2, P = 0.00), (ii) less patients felt pain (χ 2 = 6.9, df = 2, P = 0.03) and discomfort (κ 2 =22.1, df =2, P =0.00), (iii) less patients experienced difficulty (χ2 = 13.7, df = 2, P = 0.01), and (iv) more patients were willing to undergo esophageal capsule endoscopy in the future (χ2 = 12.1, df = 2, P = 0.002). Esophageal capsule endoscopy was characterized by a more positive general attitude and caused less pain and discomfort. Sedated conventional endoscopy has been found more difficult. More patients would repeat esophageal capsule endoscopy in the future. Patients' total position for all three available techniques for esophageal endoscopy was excellent and renders the observed advantage of esophageal capsule endoscopy over both sedated conventional and unsedated ultrathin endoscopy a statistical finding without a real clinical benefit. © 2009 International Society for Diseases of the Esophagus.

The toxicity of different substances was studied on the protozoan Tetrahymena pyriformis, using as an endpoint the DNA content of the macronucleus. Substances from various chemical classes were administered to the Tetrahymena cultures and then the DNA content of the protozoan macronuclei was measured by means of Image Analysis System. The increase in the DNA content of the nuclei is indicative of the stimulation of the mitotic process. Since mitogenic stimuli can substantially alter susceptibility to chemical carcinogenesis, the results of such experiments, which are cheap and easy to run, may contribute to the investigation of the toxic action of several substances on cellular level. © 2008 Elsevier Ltd. All rights reserved.