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Introduction: Classic factor analysis of obsessive-compulsive disorder (OCD) dimensions and attempts to identify valid subgroups have not yet produced definitive conclusions. Objective and Methods: This study aims to examine possible homogeneous subgrouping of demographic and phenomenological characteristics in 134 treatment-seeking OCD patients. A combination of multiple correspondence analysis (MCA) and latent class analysis (LCA) was used. Results: MCA showed 2 distinct subgroups of OCD patients and LCA confirmed this result by a two-class solution. Both analyses demonstrated (a) a clear subgroup of female patients with washing compulsions, obsessions related to contamination, and late age of onset and (b) a subgroup comprised mostly of male patients with earlier onset of OCD, checking rituals, and doubts or aggressive obsessions. Mental, ordering, hoarding compulsions, religious, or sexual obsessions and images appeared exclusively in this subgroup. Conclusions: Using 2 different analytic methods, we confirmed at least 2 subgroups in a clinical sample of Greek OCD patients. Future research combining dimensional and latent approaches could facilitate our understanding of the heterogeneous phenotype of OCD.

BACKGROUND AND AIMS Chronic kidney disease (CKD) is considered as a high-stress disease for patients, because of severe morbidity, chronicity and its life-long treatment often requiring dedicated family care. Caregivers’ burden is considered a multidimensional bio-psychosocial reaction of great importance both for caregivers’ and CKD patients’ Quality of Life (QoL). Kidney transplantation (KT) has been shown to improve patient's QoL, however the effect of KT on family's burden in comparison with dialysis has not been sufficiently studied. Aim of this cross-sectional, multicentre, observational study was to estimate and compare the QoL and burden between family caregivers of dialysis patients versus KT recipients (KTRs). METHOD We included 138 caregivers of dialysis patients and 33 of KTRs. We assessed caregivers’ QoL with SF-36 questionnaire and bio-psychosocial burden with Zarit Burden Interview scale (ZBI). RESULTS Mean age of caregivers did not differ between the two groups (56y dialysis versus 58y KTRs). The majority of KTRs (57.6%) and dialysis patients’ caregivers (68.1%) were women of whom 73% and 52% were spouses, respectively. Educational level and financial status did not differ between the two groups of caregivers. The results of the SF-36 and ZBI are comparatively presented in the Table 1. Dialysis patients’ caregivers had worse QoL compared with KTRs caregivers. There was a statistically significant difference in general health, bodily pain and social functioning role among KTRs versus dialysis caregivers. Dialysis caregivers showed a significantly higher burden in 3 sub-dimensions of ZBI (personal strain, role strain, relational deprivation) compared with KTRs caregivers. Moreover, the burden of KTRs caregivers found to be inverse correlated with educational level (P = 0.01), while in dialysis caregivers, older age, female gender and low income were directly associated with burden (P CONCLUSION The caregivers of dialysis patients showed worse QoL and significantly higher burden compared with KTRs caregivers. Further studies of larger size will probably shed light to the potential benefits of ΚΤ in patients’ caregivers and families. Currently, implementation of programs for psychological support in high burdened caregivers of kidney disease patients’ could be of help.

Panic disorder (PD) is a common anxiety disorder with severe social and health consequences in the lives of individuals who suffer from it. General population studies that attempt to measure the prevalence of this disorder across the world suggest that a 1.7% to 4.7 % of adults and adolescents suffer from Panic Disorder. In Greece, research analyzing the abovementioned matters is limited, and previous studies were put forward in small samples. The aim of the present study was to describe the prevalence and sociodemographic associations of panic disorder (PD) and related subthreshold panic symptoms in the general population of Greece and to appraise the comorbidity, use of services and impact on quality of life of these syndromes. This was a secondary analysis of the 2009-2010 psychiatric morbidity survey carried out in a representative sample of the Greek general population (4894 participants living in private households, 18-70 years, response rate 54%). Psychiatric disorders were assessed with the computerized version of the revised Clinical Interview Schedule (CIS-R). Quality of life was assessed with the EuroQoL EQ-5D generic instrument. The utilization of health services was examined by making relevant questions. Finally, direct questions were used to assess sociodemographic and socioeconomic factors According to our findings, 1.87% of the participants (95% confidence interval [CI]: 1.50-2.26%) met criteria for PD and 1.61% met criteria for subclinical PD (95% CI: 1.26-1.96%). There was a clear female preponderance for both PD (p=0.001) and Sub-PD (p=0.01). In addition, 3.48% of the participants reported having experienced panic attacks during the past week (95% confidence interval [CI]: 2.98-4.01%). PD or subclinical PD was independently associated with a limited number of sociodemographic and socioeconomic variables especially after the adjusted analysis. Both panic related conditions involved significant reductions in quality of life and elevated utilization of health services for both medical and psychological reasons in comparison to healthy participants. In conclusion, PD and subclinical panic symptoms were common in the general Greek population with substantial comorbidity and impaired quality of life. The observed use of the general and psychological health services among adults with panic symptoms and its temporal and economic consequences calls for more efficient diagnostic and treatment policies.

Aim: Sex differences have long been reported in schizophrenia leading to the hypothesis that sex hormones may be implicated in the pathophysiology of the disorder. We assessed gonadal hormones during the fasted state in drug-naive patients with psychosis.Method: Fasting serum concentrations of follicular-stimulating hormone (FSH) and luteinizing hormone (LH), testosterone, free-testosterone, Sex Hormone Binding Globulin (SHBG) and oestradiol (E2) were compared between a group of 55 newly diagnosed, drug-naive, first-episode men with psychosis and a group of 55 healthy controls, matched for age, smoking status and BMI. Testosterone, free-testosterone and SHBG were compared between a group of 32 drug-naive, first-episode females with psychosis and a group of 32 healthy controls matched for age, smoking status and BMI.Results: Testosterone and free-testosterone levels were significantly lower in the patients' group and SHBG levels significantly higher in the patients' group compared to those in healthy controls. The two female groups had similar values in the hormones which were measured.Conclusion: Our findings provide evidence of lower testosterone and free-testosterone levels and increased SHBG levels in drug-naive, first-episode males with psychosis.KEY POINTSReduced testosterone and free-testosterone levels in drug-naive, first-episode males with psychosis.Increased SHBG levels in drug-naive first-episode males with psychosis.No difference in FSH, LH and E2 levels between drug-naive first episode males with psychosis and controls.No difference in testosterone, free-testosterone and SHBG levels between drug-naive, first-episode women with psychosis and controls.

There is increasing evidence that adiponectin, resistin and leptin may be implicated in the pathophysiology of neuropsychiatric disorders, including schizophrenia. The results of the studies so far remain controversial. Our aim was to compare serum adiponectin, leptin and resistin levels between drug-naïve, first -episode patients with psychosis and healthy controls and in the same group of patients after six weeks of antipsychotic treatment.Forty first-episode patients with psychosis and 40 matched controls were included in the study. Serum levels of adiponectin, resistin and leptin were measured by enzyme linked immunosorbent assay (ELISA) in both groups. In the patient group, the same adipokines were also measured six weeks after the initiation of antipsychotic treatment.Log-transformed serum levels of adiponectin (mean difference = 1.68, 95% confidence interval [CI] = 1.30 to 2.06, U = 157, p 0.0001), resistin (0.48, 95% CI = 0.36 to 0.59, t = 8.00, p 0.0001) and leptin (0.66, 95% CI = 0.52 to 0.80, U = 160, p 0.0001) were significantly higher to the patient group compared to controls. Leptin levels were significantly decreased in the patient group six weeks after the initiation of antipsychotic treatment (mean change = -0.40, 95% CI = -0.59 to -0.21, W = 666; p 0.0001) while those of adiponectin and resistin levels did not change significantly.In our study we found higher levels of adiponectin, leptin and resistin in drug-naïve, first-episode patients with normal Body Mass Index (BMI) compared to controls. After six weeks of antipsychotic treatment, there was no change in adiponectin and resistin levels, while leptin levels were reduced compared to baseline.

The most widely used screening instrument for alcohol use disorders (AUD) is the Alcohol Use Disorders Identification Test (AUDIT) which, although initially developed for use in primary care, is increasingly used in general population studies. Previous studies that have assessed the screening properties and the factorial structure of AUDIT were mostly based on clinical samples and did not take into consideration the possible differences in AUDIT factorial properties between subgroups according to age, sex and mental health status. Aim of the current study was to explore the distribution of AUDIT and AUDIT-Consumption (AUDIT-C) scores and the factorial structure of AUDIT in subgroups of participants according to sex, age and the presence of mental health disorder. Descriptive statistics and Exploratory/Confirmatory Factor Analysis of AUDIT were extracted in a general population representative sample of 4,894 Greek participants. Different cut-offs are suggested in order to screen 10% of the population with the highest severity of AUD into the aforementioned subgroups. Generally, a cut-off between 10-12 at AUDIT score is suggested for screening the 10% with the highest severity of alcohol use problems in subgroups of frequent alcohol consumers (e.g. younger males) and a cut-off between 4-5 would screen the 5% with the highest severity of alcohol use problems in subgroups of low alcohol-consumers (e.g. older women). A cut-off of 3 in AUDIT-C score is suggested for screening 25% of individuals with the heaviest alcohol consumption. The traditional three-factor model does not explain better the factorial structure of AUDIT compared to the 2-factors model. The AUDIT is a reliable instrument for assessing AUD and heavy alcohol consumption in the Greek general population. Age, sex and the presence of mental health disorders should be taken into consideration when selecting cut-offs for screening purposes in non-clinical samples.

Objective: We examined the clinical feasibility and utility of a single behavior treatment session, with 11 patients with Panic Disorder with or without Agoraphobia (PD+/-AG). Patients used an indi...

Objective: We aimed to describe the epidemiology of obsessive-compulsive disorder (OCD) and related subthreshold symptoms in the general population of Greece and to assess the comorbidity, use of health services and impact on quality of life of these syndromes in the general population. Methods: This was a secondary analysis of the 2009-2010 general population Greek psychiatric morbidity survey (4902 participants living in private households, response rate 54%). Psychiatric disorders were assessed with the revised Clinical Interview Schedule (CIS-R). Quality of life was assessed with the EuroQoL EQ-5D. Results: 1.69% of the participants (95% confidence interval [CI]: 1.33%-2.05%) met criteria for current OCD while 2.79% met criteria for subthreshold obsessive-compulsive symptoms (95%CI: 2.33%-3.26%). In the adjusted analysis few sociodemographic associations remained statistically significant. Although the full-blown syndrome was more severe in terms of comorbidity and quality of life our results showed that even subthreshold obsessive-compulsive symptoms were associated with significant comorbidity and reductions in quality of life. Use of mental health services was small. Conclusions: OCD is an under-treated public health problem that needs more attention in Greece and elsewhere. Provision of specialised mental health services should be a priority for publicly funded national health systems. Keypoints OCD is common in the general population of Greece with few sociodemographic associations apart from subjective financial difficulties. The comorbidity pattern of the full-blown syndrome versus the subthreshold obsessive-compulsive symptoms is similar and differs in magnitude in the expected way. Quality of life in OCD is greatly reduced especially when there is chronicity and/or comorbidity with depression. Use of services is limited but comorbidity with depression may increase the chances of consultation with a mental health professional.

The objective of this study is to explore the association between maternal somatic anxiety in pregnancy and hyperactivity symptoms and ADHD diagnosis in children. Data from the Avon Longitudinal Study of Parents and Children cohort were used to examine the association between somatic anxiety symptoms in pregnancy measured with five items of the Crown-Crisp Experiential Index, ADHD diagnosis in children at 7.5 and 15 years (obtained with the Development and Well-Being Assessment-DAWBA) and hyperactivity at 4 and 16 years (measured with the Strengths and Difficulties Questionnaire hyperactivity subscale-SDQ). Maternal somatic anxiety was associated with ADHD diagnosis at age 7.5 [crude OR = 1.87 (95% CI = 1.21–2.91)], adjusted model [OR = 1.57 (95% CI = 0.99–2.48)]. There was no evidence of association with ADHD at 15: crude OR = 2.27 (95% CI = 0.90–5.71), adjusted OR = 1.65 (95% CI = 0.63–4.35). An association was found at 4 and 16 with the SDQ hyperactivity subscale: crude OR at 4: 1.70 (95% CI =1.37–2.11), adjusted OR = 1.34 (95% CI = 1.07–1.69); crude OR at 16: 1.95 (95% CI = 1.47–2.58), adjusted OR = 1.62 (95% CI = 1.21–2.17).Thus, there was evidence for an association between maternal somatic anxiety in pregnancy and increased hyperactivity symptoms (SDQ) at 4 and 16. There was no association with ADHD diagnosis.

Clinical Decision Support Systems (CDSS) could play a prominent role in preventing Adverse Drug Reactions (ADRs) especially when integrated in larger healthcare systems (e.g. Electronic Health Record – EHR systems, Hospital Management Systems – HMS, e-Prescription systems etc.). This poster presents an approach to model Therapeutic Prescription Protocols (TPPs) via the Business Process Management Notation (BPMN), as part of the e-Prescription CDSS developed in the context of the PrescIT project.

Clinical Decision Support Systems (CDSS) could play a prominent role in preventing Adverse Drug Reactions (ADRs) especially when integrated in larger healthcare systems (e.g. Electronic Health Record - EHR systems, Hospital Management Systems - HMS, e-Prescription systems etc.). This poster presents an approach to model Therapeutic Prescription Protocols (TPPs) via the Business Process Management Notation (BPMN), as part of the e-Prescription CDSS developed in the context of the PrescIT project.

Objective. The COVID-19 epidemic has shown a more benign course in Greece possibly due to the early lockdown measures. Mental health consequences of the lockdown however are unknown. In addition, illness perceptions and relevant strategies to cope with the stress of the epidemic may have played a role in complying with the restrictions. We conducted a survey of the Greek population with the aim to investigate the prevalence of anxiety and depression during the lockdown, the emotional impact of the epidemic, and the effect of coping strategies and illness perceptions in mental health. Methods. Adult persons were invited during the peak of the lockdown period through social media. Depressive and anxiety symptoms were assessed with the PHQ-9 and GAD-2 scales, respectively. Coping strategies were assessed with selected items of the Brief COPE questionnaire, while illness beliefs were assessed with items from the revised Illness Perception Questionnaire (IPQ-R). Results. A total of 3379 individuals took part. A strong emotional impact of the epidemic was more often in women and in those with severe financial difficulties. Levels of depressive and anxiety symptoms were high but similar to past assessments. Participants showed high levels of personal control and used more often positive strategies to cope with the stress of the epidemic. Depressive symptoms were higher in the younger, in students, in those with a stronger emotional impact, in those isolated due to symptoms, and those overexposed to media for COVID-19-related news. Lower levels of depression were seen in those using positive coping strategies and showing high levels of personal and treatment control. Conclusions. The study shows that certain psychological and social determinants were associated with increased depressive symptoms during the lockdown warranting the development of public health guidelines to mitigate the effects of the epidemic to the mental health of the population.

Background. Country-level epidemiological data about alcohol-related problems is useful for planning prevention and treatment services. Heavy Alcohol Consumption (HAC) and Alcohol Use Disorder (AUD) are two syndromes of alcohol-related problems that have been recognized worldwide. Study of the epidemiological determinants of HAC and AUD in different sociocultural contexts could inform hypotheses about the etiology or the consequences of alcohol-related problems. Objectives. We assessed the prevalence and associations of HAC and AUD with sociodemographic variables adjusting for common mental disorders in a representative sample of the general population of Greece (N=4894 participants). The period of data collection just preceded the emergence of the financial crisis in Greece. Results. The majority of the population did not report HAC, AUD or abstinence from alcohol. HAC was reported by 12.7% (95% CI: 11.8–13.6) of the population while 3.1% (95% CI: 2.7–3.6) met criteria for AUD. Younger age, divorce, lower educational level, living in an urban area, physical health problems, and smoking were associated with a higher prevalence of both conditions. Presence of severe financial difficulties and never married family status were associated with a higher prevalence of HAC but not AUD. HAC was associated with nonspecific psychiatric morbidity while AUD was associated with more specific psychiatric disorders. Conclusion/Importance. Both alcohol-related problems are frequent in the general population and have common and distinct determinants. The comparison between the findings of our study and those of similar studies during or after the period of financial austerity in Greece, would offer the opportunity to assess the possible effects of changes in the economical context in the determinants of alcohol-related problems.

An increasing body of evidence suggests that antipsychotic medication can cause immunological changes that could be attributed to the amelioration of psychotic symptoms or the metabolic side effects of the drugs. So far, the results of the studies remain controversial. Our aim was to compare the levels of interleukin (IL) IL-2, IL-6 and transforming growth factor-β2 (TGF-β2) in drug-naive, first-episode patients with psychosis before and after six weeks of antipsychotic medication. Thirty-nine first-episode patients with psychosis were enrolled in the study. Serum levels of IL-2, IL-6 and TGF-β2 were measured by enzyme linked immunosorbent assay (ELISA) before and six weeks after the initiation of antipsychotics. In addition, clinical psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS) before and after treatment. Serum levels of IL-2 were significantly increased six weeks after the initiation of antipsychotic treatment ( p 0.001 ) while TGF-β2 levels were decreased ( p 0.001 ). IL-6 levels were overall increased ( p 0.004 ), but this occurred in a non-linear way. These findings, although preliminary, provide further evidence that antipsychotic treatment in patients with psychosis may be correlated with immunological changes but further research is needed.

Background. The aim of the current study was to examine the prevalence and associations of hazardous alcohol use with sociodemographic variables and its comorbidity with depression and other common mental disorders in a sample of Greek adolescents between 16 and 18 year old. Methods. We recruited 2431 adolescents attending 25 senior high schools in Greece. We assessed depressive and anxiety disorders using the computerized version of a fully-structured psychiatric interview (the revised Clinical Interview Schedule / CIS-R). Alcohol use was assessed using questions taken from a previous WHO school survey. Results. Approximately one-third of adolescents (overall: 30.7%, boys: 39.2%, girls: 21.9%, p<0.001) consumed alcohol on a weekly basis. The experience of excessive consumption, leading to drunkenness at least two or more times in their lifetime, was reported by 15.39% of the adolescents (19.42% for the boys and 11.24% for the girls, p<0.001). Frequent alcohol consumption and drunkenness were strongly associated with the presence of depression, all other anxiety disorders except panic disorder, current smoking, and lifetime cannabis use, lower school performance, bad or fair relationship with parents, and increased health services use. Conclusion. Alcohol use is highly prevalent among Greek adolescents. Special attention for the development of more focused preventive strategies should be paid to adolescents suffering from depression or other common mental disorders.

Background: Several studies that have examined the full range of alcohol consumption have pointed to a possible non-linear association between alcohol use and the common mental disorders. Most of these studies are cross sectional and assessed psychiatric morbidity using non-specific instruments. Our aim was to investigate the longitudinal association between varying levels of alcohol consumption at baseline and the new-onset of depression and generalized anxiety disorder (GAD), in a large international primary care sample.Methods: The sample consisted of 3201 primary care attenders from 14 countries in the context of WHO Collaborative Study of Psychological Problems in General Health Care. Alcohol use at baseline was assessed using AUDIT and the mental disorders were assessed with the Composite International Diagnostic Interview.Results: Light to moderate alcohol consumption at baseline was associated with a lower incidence of depression and GAD compared to abstinence while excessive alcohol consumption was associated with a higher incidence of depression but not GAD. This non-linear association was not substantially affected after adjustment for a range of possible confounding variables.Conclusion: Any causal interpretation of this association is difficult in the context of an observational study and further combined and consistent evidence from different sources is needed.

Hyperprolactinaemia as a side effect of dopamine receptor blockers is common in patients with schizophrenia and other psychotic disorders and may lead to amenorrhoea, galactorrhoea, hypogonadism, subfertility and osteoporosis. The aim of our study was to determine whether hyperprolactinaemia occurs also in patients with schizophrenia and other psychotic disorders prior to any antipsychotic treatment.Serum prolactin, thyroid-stimulating hormone (TSH), triiodothyronine (T3), free tetraiodothyronine (FT4) and cortisol levels were measured in 40 newly diagnosed, drug naïve, patients with schizophrenia and other psychotic disorders and in 40 age and gender matched healthy subjects.The median prolactin value was 12.5 ng/ml (range: 2-38 ng/ml) for patients and 8.6 ng/ml (range: 4-17.6 ng/ml) for healthy subjects (p = 0.011). Patients had lower levels of T3 compared to healthy controls (mean: 1.08 ng/ml, SD: 0.16 vs. 1.18 ng/ml, 0.18, respectively; p = 0.008). Serum TSH, FT4 and cortisol levels were similar between the two groups. Multiple regression analysis revealed that the difference in serum prolactin values was independent of thyroid function (TSH, FT4, T3) and serum cortisol levels.A higher serum prolactin level was found in drug naïve, newly diagnosed patients with schizophrenia and other psychotic disorders compared to healthy controls, prior to starting any antipsychotic treatment.

BackgroundObsessive–compulsive disorder (OCD) is a relatively common and disabling condition.ObjectivesTo determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents and adults.Data sourcesWe searched the Cochrane Collaboration Depression, Anxiety and Neurosis Trials Registers, which includes trials from routine searches of all the major databases. Searches were conducted from inception to 31 December 2014.Review methodsWe undertook a systematic review and network meta-analysis (NMA) of the clinical effectiveness and acceptability of available treatments. Outcomes for effectiveness included mean differences in the total scores of the Yale–Brown Obsessive–Compulsive Scale or its children’s version and total dropouts for acceptability. For the cost-effectiveness analysis, we developed a probabilistic model informed by the results of the NMA. All analyses were performed using OpenBUGS version 3.2.3 (members of OpenBUGS Project Management Group; seewww.openbugs.net).ResultsWe included 86 randomised controlled trials (RCTs) in our systematic review. In the NMA we included 71 RCTs (54 in adults and 17 in children and adolescents) for effectiveness and 71 for acceptability (53 in adults and 18 in children and adolescents), comprising 7643 and 7942 randomised patients available for analysis, respectively. In general, the studies were of medium quality. The results of the NMA showed that in adults all selective serotonin reuptake inhibitors (SSRIs) and clomipramine had greater effects than drug placebo. There were no differences between SSRIs, and a trend for clomipramine to be more effective did not reach statistical significance. All active psychological therapies had greater effects than drug placebo. Behavioural therapy (BT) and cognitive therapy (CT) had greater effects than psychological placebo, but cognitive–behavioural therapy (CBT) did not. BT and CT, but not CBT, had greater effects than medications, but there are considerable uncertainty and methodological limitations that should be taken into account. In children and adolescents, CBT and BT had greater effects than drug placebo, but differences compared with psychological placebo did not reach statistical significance. SSRIs as a class showed a trend for superiority over drug placebo, but the difference did not reach statistical significance. However, the superiority of some individual drugs (fluoxetine, sertraline) was marginally statistically significant. Regarding acceptability, all interventions except clomipramine had good tolerability. In adults, CT and BT had the highest probability of being most cost-effective at conventional National Institute for Health and Care Excellence thresholds. In children and adolescents, CBT or CBT combined with a SSRI were more likely to be cost-effective. The results are uncertain and sensitive to assumptions about treatment effect and the exclusion of trials at high risk of bias.LimitationsThe majority of psychological trials included patients who were taking medications. There were few studies in children and adolescents.ConclusionsIn adults, psychological interventions, clomipramine, SSRIs or combinations of these are all effective, whereas in children and adolescents, psychological interventions, either as monotherapy or combined with specific SSRIs, were more likely to be effective. Future RCTs should improve their design, in particular for psychotherapy or combined interventions.Study registrationThe study is registered as PROSPERO CRD42012002441.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

Summary Background Several interventions are available for management of obsessive-compulsive disorder in adults, but few studies have compared their relative efficacy in a single analysis. We aimed to simultaneously compare all available treatments using both direct and indirect data. Methods In this systematic review and network meta-analysis, we searched the two controlled trials registers maintained by the Cochrane Collaboration Common Mental Disorders group for trials published up to Feb 16, 2016. We selected randomised controlled trials in which an active psychotherapeutic or pharmacological intervention had been used in adults with obsessive-compulsive disorder. We allowed all comorbidities except for schizophrenia or bipolar disorder. We excluded studies that focused exclusively on treatment-resistant patient populations defined within the same study. We extracted data from published reports. The primary outcome was symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale. We report mean differences with 95% credible intervals compared with placebo. This study is registered with PROSPERO, number CRD42012002441. Findings We identified 1480 articles in our search and included 53 articles (54 trials; 6652 participants) in the network meta-analysis. Behavioural therapy (mean difference −14·48 [95% credible interval −18·61 to −10·23]; 11 trials and 287 patients), cognitive therapy (−13·36 [–18·40 to −8·21]; six trials and 172 patients), behavioural therapy and clomipramine (−12·97 [–19·18 to −6·74]; one trial and 31 patients), cognitive behavioural therapy and fluvoxamine (−7·50 [–13·89 to −1·17]; one trial and six patients), cognitive behavioural therapy (−5·37 [–9·10 to −1·63]; nine trials and 231 patients), clomipramine (−4·72 [–6·85 to −2·60]; 13 trials and 831 patients), and all SSRIs (class effect −3·49 [95% credible interval −5·12 to −1·81]; 37 trials and 3158 patients) had greater effects than did drug placebo. Clomipramine was not better than were SSRIs (−1·23 [–3·41 to 0·94]). Psychotherapeutic interventions had a greater effect than did medications, but a serious limitation was that most psychotherapeutic trials included patients who were taking stable doses of antidepressants (12 [80%] of the 15 psychotherapy trials explicitly allowed antidepressants). Interpretation A range of interventions is effective in the management of obsessive-compulsive disorder, but considerable uncertainty and limitations exist regarding their relative efficacy. Taking all the evidence into account, the combination of psychotherapeutic and psychopharmacological interventions is likely to be more effective than are psychotherapeutic interventions alone, at least in severe obsessive-compulsive disorder. Funding National Institute for Health Research.

Objective: To evaluate impact of WHO checklist compliance on risk-adjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. Background: There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. Methods: Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. Results: Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affect mortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio = 0.57, 95% confidence interval: 0.37–0.87, P < 0.01). Calculated population-attributable fractions showed that 14% (95% confidence interval: 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. Conclusions: Checklist implementation was associated with reduced case-mix-adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care.

Objective: To determine whether psychosocial factors moderate the relationship between surgical complications and quality of life (QoL). Background: Patients who experience surgical complications have significantly worse postoperative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear whether they affect QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients postoperatively. Methods: This is a longitudinal cohort study; data were collected pre-op, 1 month post-op, 4 months post-op, and 12 months post-op. A total of 785 patients undergoing major elective gastrointestinal, vascular, or cardiothoracic surgery who were recruited from 28 National Health Service sites in England and Scotland took part in the study. Results: Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (P < 0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL. Conclusions: Surgical complications alongside other sociodemographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies before surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow-up procedures.

The purpose of the present study was to investigate the burden and depression in spouses of patients with chronic kidney disease (CKD). The interrelation between burden and depression in family caregivers has been pointed out by previous researches in several chronic diseases and researchers agree that they clearly go together and one cannot talk about one without considering the other. More particularly, in the present study, the caregiver burden, the depression, anxiety, and also health-related quality of life and demographic factors of spouses of patients with CKD were examined, using self-report questionnaires. Participants were 50 spouses of patients with CKD, 29 of whom were dialysis dependent and 21 were not dialysis dependent. Group differences were examined for participants. Results confirm the interrelation between caregiver burden and depression in spouses. The increased perceived burden related to higher levels of depression. Low levels of caregiver burden, depression, anxiety, and satisfactory quality of life were found in spouses, with no differences between them relevant to whether the patients were dialysis dependent or not. All the above parameters interrelated. Implications for the findings and future research directions are discussed.

An increasing body of evidence suggests that immunological changes may play a role in schizophrenia but the results of the studies are controversial and little is known about the presence of those changes at the onset of the disease. Our aim is to compare the levels of interleukin (IL) IL-2, IL-6, IL-10, IL-17 and transforming growth factor -β2 (TGF-β2) between drug-naïve-first episode patients with psychosis and healthy controls matched for age, sex, BMI and smoking.Thirty-nine drug-naïve-first episode patients with psychosis and 39 healthy individuals (control group) were enrolled in the study. Serum levels of IL-2, IL-6, IL-10, IL-17 and TGF-β2 were measured by enzyme linked immunosorbent assay (ELISA).Serum IL-2 and IL-6 levels were significantly higher in the drug-naïve patients with psychosis group (p0.022 and p0.002 respectively) compared to healthy controls. No differences were found between the two groups in the levels of IL-10, IL-17. The levels of TGF-β2 did not differ significantly between the two groups.The serum levels of IL-2 and IL-6 are increased in first episode drug-naïve patients with psychosis compared to healthy controls. An inflammatory response mediated by IL-2 and IL-6 may play a role in schizophrenia.

Ikonomou M., Skapinakis P., Balafa O., Eleftheroudi M., Damigos D., Siamopoulos K.C. (2015). The impact of socioeconomic factors on quality of life of patients with chronic kidney disease in Greece. Journal of Renal Care xx(xx), 1–8. SUMMARY Background:Quality of Life (QoL) is oftenpoor in people undergoing dialysis and this sometimes contributes to the highrate of morbidity and mortality. The aim of our study is to assess the QoL of patients on haemodialysis in Greece and discuss the socio-demographic factors that affect QoL in this period of financial crisis. Design/Patients: Patients with CKD not on dialysis, plus those undergoing Haemodialysis (HD) and Peritoneal Dialysis (PD) were invited to complete the SF-36 questionnaire electronically, supervised by a trained nurse. Patients were asked about their marital status, education level and monthly household income. Additionally, patients were requested to comment on their subjective financial difficulties. Results: A total of 172 patients wereenrolled inthe study, 39ofthemwereundergoingPD, 90onHDand 43had CKD. Among those with CKD, on HD and PD, 9.3%, 17.8% and 23.1%, respectively, had ‘some/a lot’ difficulties in copying with financial problems. The physical component summary score was significant lower in HD, while the summary score of the mental componentshowednodifferencesbetweenthegroups.Inmultiplelinearregressionanalysis,ageanddialysishadsignificantly negative correlations with physical functioning scores. Those who were divorced or widowed tended to perform worse in physicalscorescomparedwiththosewhoweremarried.Mentalscoreswereaffectedonlybycopingwithfinancialdifficulties. Conclusions:In generalterms, peoplewithCKD patients presentwithapoorQoL. Apart fromtheburdenof the renaldisease per se, social and economic factors (divorce, financial difficulties) seem to aggravate their status, especially in this period of financial crisis.

Depression in dementia is known to deteriorate patients' cognitive function and Quality of Life and to increase the burden of care. Although detecting depression in dementia is crucial, there is no gold standard for its screening and diagnosis. We examined the psychometric properties of 3 different scales in detecting depression in dementia. Results will be useful as community services for dementia in the country are developing and the need for reliable detection of depression in dementia patients is urgent. Our sample consisted of 136 Greek dementia patients who consulted a memory clinic. For the diagnosis of depression, DSM-IV criteria for major depression and 3 different depression measures were used: a self-assessment scale (Geriatric Depression Scale; GDS), a caregiver assessment scale (Neuropsychiatric Inventory-Depression; NPI-D) and a clinician rated scale (Cornell Scale for Depression in Dementia; CSDD). For the evaluation of the screening performance of the three depression scales receiver operating characteristic curve (ROC) analysis was applied. The DSMIV criteria served as the gold standard method for the diagnosis of major depression. CSDD showed the best psychometric properties for the diagnosis of depression in dementia. The ROC curve analysis revealed that among the three measures, the CSDD had the wider AUC (0.919), second in the width of the AUC was the GDS (0.871), and last was the NPI-D (0.812). The prevalence of depression ranged from 18.4% according to DSM-IV criteria to 42.6% using the NPI-D. Using the GDS (cut off point: 7/8) and the CSDD (cut off point: 6/7), depression was present in 26.9% and 33.1% of the patients, respectively. Correlations between scales used were significant (r from 0.432 to 0.660; p

The aim of this study was to examine the epidemiology, comorbidity and use of health services of obsessive-compulsive disorder (OCD) and subclinical obsessive-compulsive symptoms in late adolescence.A total of 2427 adolescents attending senior high schools in Greece were selected for a detailed psychiatric interview using the revised clinical interview schedule (CIS-R). Use of alcohol, nicotine and cannabis, and several socio-demographic and socio-economic variables were also assessed.The prevalence of OCD was 1.39% (95% confidence interval [CI]: 1.05-1.84) while that of subclinical obsessive-compulsive symptoms was 2.77% (2.22-3.45). There was a female preponderance for subclinical symptoms. Financial difficulties of the family was the only socio-demographic variable that was significantly associated with OCD but not with subclinical symptoms. The pattern of comorbidity was similar for both conditions but milder in the subclinical form. About one in three reported use of general health services and one in ten use of psychiatric services.OCD and subclinical obsessive-compulsive symptoms were relatively common. Comorbidity with other psychiatric disorders and use of substances was considerable even in subclinical status, but use of specialised health services was small. Clinical and research implications are discussed.

Summary Objective To investigate whether the h index (a bibliometric tool which is increasingly used to assess and appraise an individual's research performance) could be improved to better measure the academic performance and citation profile for individual healthcare researchers. Design Cohort study. Setting Faculty of Medicine, Imperial College London, UK. Participants Publication lists from 1 January 2000 until 31 December 2009 for 501 academic healthcare researchers from the Faculty of Medicine. Main outcome measures The h index for each researcher was calculated over a nine-year period. The citation count for each researcher was differentiated into high ( h2 upper), core ( h2 centre) and low ( h2 lower) visibility areas. Segmented regression model (sRM) was used to statistically estimate number of high visibility publications (sRM value). Validity of the h index and other proposed adjuncts were analysed against academic rank and conventional bibliometric indicators. Results Construct validity was demonstrated for h index, h2 upper, h2 centre, h2 lower and sRM value (all P < 0.05). Convergent validity of the h index and sRM value was shown by significant correlations with total number of publications ( r =0.89 and 0.86 respectively, PConclusions This study supports the construct validity of the h index as a measure of healthcare researcher academic rank. It also identifies the assessment value of our developed indices of h2 upper, h2 centre, h2 lower and sRM. These can be applied in combination with the h index to provide additional objective evidence to appraise the performance and impact of an academic healthcare researcher.

Insulin-like growth factor 1 (IGF-1) plays an important role in neurogenesis and synaptogenesis and may be implicated in schizophrenia, although data so far have been inconclusive. The aim of our study was to compare levels of IGF-1 in drug-naive patients with a first episode of schizophrenia and related disorders with matched healthy controls. Forty drug naive first-episode patients with schizophrenia and related disorders and forty healthy subjects matched for age, gender, body mass index (BMI) and smoking status were enrolled in the study. Serum levels of IGF-1 for each sample were measured in duplicate by the enzyme-linked immunosorbent assay (ELISA) method using human IGF-1. The median IGF-1 levels were significantly higher in drug-naive patients with psychosis compared to healthy controls (109.66 ng/ml vs. 86.96 ng/ml, respectively p =0.039). Multiple regression analysis revealed that differences in serum IGF-1 values were independent of glucose metabolism (fasting glucose, fasting insulin, insulin resistance) and cortisol. These results show that IGF-1 may be implicated in the pathophysiology of psychosis but confirmation is needed from other studies.

The provision of mental health services is a field that is linked more and more with issues concerning the quality of care, its evaluation as well as its quality assurance. Linking evaluation and quality of care to mental health is directly related to the shift towards a community-oriented service system. In this chapter, we will analyse concepts related to the public mental health system in Greece, quoting contemporary literature and linking it with the main concerns of psychiatric reform and the function of a community-oriented mental health system. Following this, we will present the clinical approach with the administrative-management approach relative to the evaluation and record the basic requirements for the proper collection and use of clinical information in the health systems. Finally, we will refer to the obstacles in the implementation of evaluation in the Greek mental health system with one implementation example and will underline the significance of evaluation for the protection of the users of mental health services as the direct beneficiaries of the provided services, as well as the parties involved in mental healthcare.

BackgroundIt has been argued that sleep disturbances are a risk factor for depression but previous longitudinal studies have had limitations and not addressed alternative explanations. The aim of this study was to examine the longitudinal association between sleep disturbances and depressive symptoms in a nationally representative sample.MethodData from the 18-month follow-up of the UK National Psychiatric Morbidity survey were used (n = 2406). Sleep disturbances, depressive and other psychiatric symptoms (fatigue, concentration problems, irritability, anxiety and pain symptoms) were assessed using the Revised Clinical Interview Schedule (CIS-R). The bidirectional association between symptoms was investigated with logistic regression analyses and path analysis.ResultsSleep disturbances and depressive symptoms were correlated with each other cross-sectionally (r = 0.52, p ConclusionsPrevious studies may have overestimated the importance of sleep disturbances as an independent risk factor of depression. The strong cross-sectional association is compatible with sleep disturbances being either a prodromal or a residual symptom of depression and this may have implications for recognition and treatment of depression.

ObjectiveThe epidemiology of panic disorder has not been investigated in the past in the UK using a nationally representative sample of the population. The aim of the present paper was to examine the epidemiology, comorbidity and functional impairment of subthreshold panic and panic disorder with or without agoraphobia.MethodWe used data from the 2000 Office for National Statistics Psychiatric Morbidity survey (N = 8580). Panic disorder and agoraphobia were assessed with the Revised Clinical Interview Schedule (CIS-R).ResultThe prevalence of panic disorder with or without agoraphobia was 1.70% (95% confidence interval: 1.41–2.03%). Subthreshold panic was more common. Economic inactivity was consistently associated with all syndromes. The comorbidity pattern of the panic syndromes and the associated functional impairment show that panic-related conditions are important public health problems, even in subthreshold status.ConclusionsThe findings show that efforts to reduce the disability associated with psychiatric disorders should include detection and management of panic disorder.

Several studies in the past have examined whether the hierarchical structure of anxiety and depressive symptoms can explain the high comorbidity between them but more studies are needed from other settings and with different methods. The present study aimed to examine the structure of common anxiety and depressive symptoms in adolescents 16-18 years old attending secondary schools using the Greek version of the revised Clinical Interview Schedule (CIS-R), a fully structured psychiatric interview. A total of 2431 adolescents were interviewed with the computerized version of the CIS-R. The hierarchical structure of 12 depressive and anxiety symptoms was examined with confirmatory factor analytical methods. Four alternative models of increasing complexity were tested. The best-fitting model included three first-order factors, representing the dimensions of anxiety, depression and non-specific distress respectively. A model with a higher-order factor representing the broader internalizing dimension was less supported by the data. The findings of this and other studies should be taken into account in future classifications of psychiatric disorders and may have clinical practical implications.

BACKGROUND: Metabolic syndrome [MetS] is a chronic, progressive and multi-complex health problem that can trigger physical, emotional and psychosocial problems. The aim of this study is to investigate the association between MetS and health-related quality of life (HRQoL) as well as depressive and anxiety disorders. METHODS: New consecutive patients who attended an outpatient lipid clinic for evaluation for MetS were eligible for inclusion in the study. The MetS was defined according to the new definition of International Diabetes Federation (IDF). The Medical Outcomes Study, Short Form-36 (SF-36) was used to assess HRQoL. Anxiety and depressive symptoms were assessed by a validated Greek version of the Hospital Anxiety and Depression Scale (HADS). RESULTS: Three hundred and fifty-nine subjects were involved of whom 206 [57.4%] met the diagnostic criteria for the MetS (cases) and 153 [42.6%] were free of MetS criteria (comparator group). MetS was associated with lower scores of all subscales of the SF-36 except of bodily pain. The physical component summary score of SF-36 was independently associated with gender (beta=2.41, P=.01), married or living together (beta=5.18, P=.001) and satisfactory household income (beta=5.77, P

Which facets of social capital affect mental health in rural settings? This study explores the association between different aspects of social capital and psychiatric morbidity in rural communities of the Greek North Aegean islands. A large number of individual and community characteristics that may influence psychiatric morbidity are concurrently examined in multilevel models to account for the clustering of individuals within rural settings. The current findings indicate that psychiatric morbidity is, to a large extent, clustered within rural communities. Individuals' perceived divisions in the community, i.e., political party preference, landholdings, low social support networks, and lack of perceived solidarity, are associated with psychiatric morbidity according to theoretical expectation. At the community level, this risk is lower in villages with over 250 residents, where there are youth clubs or a common threat, for instance, property crime. © 2010 Wiley Periodicals, Inc.

Evidence-based practice has become increasingly important in all aspects of medicine. The availability and variety of diagnostic tests in cardiovascular practice are increasing rapidly and are therefore under scrutiny in the literature. Diagnostic meta-analysis is used to summarise and combine results from multiple studies. The analytical techniques for diagnostic meta-analysis differ from other meta-analyses because the measures of diagnostic accuracy (sensitivity and specificity) are unique to diagnostics. However, the benchmark for diagnostic meta-analysis techniques continues to move forward, making interpretation and application of the results difficult for clinicians. This article explains the terminology of the current standards in diagnostic meta-analysis, and outlines the principles of applying these results to clinical practice. Int J Cardiol

The impact of cigarette smoking on progression of atherosclerosis in patients with known cardiovascular disease suggests a strong need for effective cessation interventions in this group. This letter compares and discusses smoking cessation outcomes following behavioural smoking cessation interventions versus usual care in hospitalised cardiovascular patients using meta-analysis of randomised controlled peer-reviewed publications. It particularly focuses on the impact of intensity and duration of intervention on outcome. Int J Cardiol

Background: The use of anticonvulsant drugs for the prevention of migraine in children and adolescents has been supported in the past. Aims: To evaluate the available evidence for the efficacy and safety of anticonvulsants; drugs in the prevention of migraine attacks in children and adolescents. Methods: Studies were selected through a comprehensive literature search. We included all types of study designs (controlled and uncontrolled) due to the limited evidence. Monthly migraine frequency was used as the primary outcome measure in most of the studies. Studies were classified into levels of evidence according to their design. Results: Fourteen studies were included with a total of 939 patients. Topiramate (4 randomized controlled trials [RCT], two uncontrolled trials), sodium valproate/divalproex sodium (two RCTs, one uncontrolled trial, two retrospective chart reviews) levetiracetam and zonisamide (both only uncontrolled Studies) are the anticonvulsants that have been reported in the literature. The findings show that valproate is not different from placebo and topiramate may not be different but further randomized trials are needed. All drugs were well tolerated in this age group with no serious events reported. Conclusions: The use of anticonvulsants in the prevention of migraine in children and adolescents is not adequately supported by methodologically sound RCTs. More research is needed in the future to establish the efficacy and safety of specific agents. (C) 2008 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved. European Journal of Pain

Aim. To conduct a systematic review of longitudinal studies that examined the association between childhood socioeconomic status (SES) and illegal drug use in later life. Design and Methods. Systematic search with an agreed list of search items was used to identify all longitudinal population-based studies that examined the association between childhood SES and later drug use. These included MEDLINE (1966–2005), EMBASE (1990–2005), CINAHL (1982–2005) and PsychInfo (1806–2005), and specialist databases of the Lindesmith Library, Drugscope and Addiction Abstracts. Foreign-language papers were included. Abstracts were screened independently by two reviewers. If there was disagreement to accept or reject the abstract, then a third reviewer acted as arbiter. Data were extracted by one of the authors. Results. Eleven relevant papers were identified (two birth cohorts and nine papers on school-aged cohorts). There was consistent evidence to support an association between lower childhood SES and later drug use, primarily cannabis use. However, few studies examined cannabis dependence, and studies of more problematic forms of drug use gave contradictory results. Discussion and Conclusions. We found consistent, though weak, evidence to support the assumption that childhood disadvantage is associated with later cannabis use. Further research is needed to clarify this issue and to inform future policies and public health messages. [Daniel JZ, Hickman M, MacLeod J, Wiles N, Lingford-Hughes A, Farrell M, Araya R, Skapinakis P, Haynes J, Lewis G. Is socioeconomic status in early life associated with drug use? A systematic review of the evidence. Drug Alcohol Rev 2009;28:142–153]