[Development and implementation of clozapine protocol in patients with schizophrenia in Greece].

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.

[Perceptions regarding pharmacotherapy and effective treatment disease in people diagnosed with bipolar disorder].

Bipolar disorder (BD) encompasses neuro-cognitive disturbances leading to psychological and social consequences affecting the quality of life of those suffering from it. However, the number of studies on the lived experience of people with BD about the treatment provided is relatively scant. The aim of this study is to investigate the lived experience of people with BD, focused on their perceptions and meanings about the treatment provided for their disorder. A qualitative, phenomenological design was applied. Following informed consent, thirteen people agreed to participate in the study, according to purposeful sampling and thematic saturation. Data collection was achieved through individual, semistructural interviews with open-ended questions, of a 30 minutes to an hour. The rigor of the analysis was validated according to Munhall's and van Manen's criteria. With regard to the main themes emerged, those revolved mainly around the social stigmatization following psychotropic medication. Further, the participants described anguish, fear and insecurity about the winding road nature of the disease, a condition that seemed to be worsened mainly due to discontinuation of medication, or alterations of the therapeutic schema. Interestingly, some of the participants described medication as a nutrient ingredient that kept them alive, thus revealing the importance they attached to psychotropic medication. Participants highlighted the importance of psychotropic medication, along with psychotherapy and personal effort, as well as education on topics related to psychopathology and treatment interventions for BD. Control over the clinical outcome of the disorder and self-management of the symptoms seem to be the ultimate need of people suffering from BD, with a core association to the effective medication and psycho-education. Based on that, interventions aiming to patients' education in self-management skills are suggested. Furthermore, interventions towards the sensitization of the community on the biological aspects of mental disorders are proposed, tackling issues as stigma and medication concerns.

[Restraints in Greek mental health services: Ethics, practice and costs].

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 study comparing tolerability, satisfaction and acceptance of three different techniques for esophageal endoscopy: sedated conventional, unsedated peroral ultra thin, and esophageal capsule.

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 (chi(2)= 18.2, df = 2, P= 0.00), (ii) less patients felt pain (chi(2)= 6.9, df = 2, P= 0.03) and discomfort (chi(2)= 22.1, df = 2, P= 0.00), (iii) less patients experienced difficulty (chi(2)= 13.7, df = 2, P= 0.01), and (iv) more patients were willing to undergo esophageal capsule endoscopy in the future (chi(2)= 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.

DNA content of Tetrahymena pyriformis as a biomarker for different toxic agents.

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.