The impact of economic crisis on mortality due to mental health illnesses.

BACKGROUND: The financial crisis affected several aspects of health. The aim of this study is to explore the impact of the crisis on mortality of mental illnesses in Greece and the socioeconomic determinants of mortality trends. METHODS: Mortality data of 2000-16 were analyzed and sex-and-age-standardized death rates (SDRs) were calculated. The Average Annual Percent Change (AAPC) before and after the time point of slope change was computed. The crisis impact on SDRs was explored with interrupted time series analyses and standardized rate ratios (SRRs). The correlation of mortality with socioeconomic and healthcare-related variables was investigated with correlation and regression analyses. RESULTS: A significant change in SDR trend was observed after 2012. The AAPC reversed from -2.9% to 94.5%, while the SRR was calculated at 6.1 (5.5-6.7). Income reduction, unemployment rise and health budget cuts were found to be significantly correlated with mortality rise. CONCLUSIONS: Financial crisis had a significant impact on mortality due to mental illnesses, especially in females and elderly. The findings indicate that mortality increase is more driven by socioeconomic and healthcare-related factors that affect access to appropriate healthcare than by morbidity trends. The findings have implications in planning interventions to provide appropriate healthcare to patients living with mental illness.

Liraglutide administration improves hormonal/metabolic profile and reproductive features in women with HAIR-AN syndrome.

SUMMARY: HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance (IR) and Acanthosis Nigricans, constitutes a rare nosologic entity. It is characterized from clinical and biochemical hyperandrogenism accompanied with severe insulin resistance, chronic anovulation and metabolic abnormalities. Literally, HAIR-AN represents an extreme case of polycystic ovary syndrome (PCOS). In everyday practice, the management of HAIR-AN constitutes a therapeutic challenge with the available pharmaceutical agents. Specifically, the degree of IR cannot be significantly ameliorated with metformin administration, whereas oral contraceptives chronic administration is associated with worsening of metabolic profile. Liraglutide and exenatide, in combination with metformin, have been introduced in the management of significantly obese women with PCOS with satisfactory results. Based on this notion, we prescribed liraglutide in five women with HAIR-AN. In all participants a significant improvement regarding the degree of IR, fat depositions, androgen levels and the pattern of menstrual cycle was observed, with minimal weight loss. Furthermore, one woman became pregnant during liraglutide treatment giving birth to a healthy child. Accordingly, we conclude that liraglutide constitutes an effective alternative in the management of women with HAIR-AN. LEARNING POINTS: HAIR-AN management is challenging and classic therapeutic regimens are ineffective. Literally HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance and Acanthosis Nigricans, represents an extreme case of polycystic ovary syndrome. In cases of HAIR-AN, liraglutide constitutes an effective and safe choice.

Overcoming the dichotomy of implementing societal flood risk management while conserving instream fish habitat - A long-term study from a highly modified urban river.

Flood Risk Management (FRM) is often essential to reduce the risk of flooding to properties and infrastructure in urban landscapes, but typically degrades the habitats required by many aquatic animals for foraging, refuge and reproduction. This conflict between flood risk management and biodiversity is driven by conflicting directives, such as the EU Floods and Water Framework Directives, and has led to a requirement for synergistic solutions for FRM that integrate river restoration actions. Unfortunately, ecological monitoring and appraisal of combined FRM and river restoration works is inadequate. This paper uses a case study from the River Don in Northern England to evaluate the effects of the FRM and subsequent river restoration works on instream habitat and the associated fish assemblage over an 8-year period. Flood risk management created a homogeneous channel but did not negatively affect fish species composition or densities, specifically brown trout. Densities of adult brown trout were comparable pre and post-FRM, while densities of juvenile bullhead and brown trout increased dramatically post FRM. River restoration works created a heterogeneous channel but did not significantly improve species composition or brown trout density. Species composition post-river restoration works returned to that similar to pre-FRM over a short-term period, but with improved numbers of juvenile bullhead. Although habitat complexity increased after river restoration works, long-term changes in species composition and densities were marginal, probably because the river reset habitat complexity within the time framework of the study.

The Effects of Antipsychotics on Prolactin Levels and Women's Menstruation.

Introduction. Typical and atypical antipsychotic agent is currently used for treatment in the majority of patients with psychotic disorders. The aim of this review is to assess antipsychotic induced hyperprolactinaemia and the following menstrual dysfunction that affects fertility, quality of life, and therapeutic compliance of women. Method. For this purpose, Medline, PsychInfo, Cochrane library, and Scopus databases were accessed, with a focus on the publication dates between 1954 and 2012. Research of references was also performed and 78 studies were retrieved and used for the needs of this review. Results. A summary of several antipsychotics as well as frequency rates and data on hyperprolactinaemia and menstrual disorders for different agent is presented. Conclusion. Diverse prevalence rates of hyperprolactinaemia and menstrual abnormalities have been found about each medication among different studies. Menstruation plays an important role for women, thus, understanding, careful assessment, and management of hyperprolactinaemia could enhance their lives, especially when dealing with women that suffer from a psychotic disorder.

Depression and atherosclerosis.

The aim of this paper was to examine the interaction between depression and atherosclerosis through a systematic review. A Medline search was performed from 1966 through 2009 using relevant terms such as depression, epidemiology and atherosclerosis. This was supplemented by a thorough manual search using bibliographies of reviews and full articles. The papers were divided and analyzed separately for each vascular bed. Depression is diagnosed usually before atherosclerosis becomes obvious. The contribution of depression in the development of atherosclerosis emerges from various mechanisms, including lack of physical activity, that exist in this illness. Controversies about the etiology and pathogenesis exist. These interactions of all elements and the importance of each one have not been investigated adequately. Repeated objective measurements for atherosclerosis are lacking. There is an association between depression and atherosclerosis, but the strength of this relationship has to be determined. Prospective studies are needed to determine the early and long term effects of their interaction.

Insomnia symptoms among Greek adolescent students with excessive computer use.

BACKGROUND: The aim of the present study is to assess the intensity of computer use and insomnia epidemiology among Greek adolescents, to examine any possible age and gender differences and to investigate whether excessive computer use is a risk factor for developing insomnia symptoms. PATIENTS AND METHODS: Cross-sectional study of a stratified sample of 2195 high school students. Demographic data were recorded and two specific questionnaires were used, the Adolescent Computer Addiction Test (ACAT) and the Athens Insomnia Scale (AIS). RESULTS: Females scored higher than males on insomnia complaints but lower on computer use and addiction. A dosemediated effect of computer use on insomnia complaints was recorded. Computer use had a larger effect size than sex on insomnia complaints. Duration of computer use was longer for those adolescents classified as suffering from insomnia compared to those who were not. CONCLUSIONS: Computer use can be a significant cause of insomnia complaints in an adolescent population regardless of whether the individual is classified as addicted or not.

[The role of immune system in depression].

Although there are many papers which examine the role of immune system in the pathophysiology of depression, it is not clear the relationship between depression and immune system. It seems that inflammation is strongly related with depression. Proinflammatory cytokines play crucial role in thepresence of depression. Administration of proinflammatory cytokines to treat medical diseases induce depressive symptoms in humans. Patients diagnosed with depression tend to have high levels of cytokine activity and impaired immune response, as well as those patients suffering from inflammatory processes. Proinflammatory cytokines interfere with the body's feedback loop to reduce circulating corticosteroids during the stress response. Proinflammatory cytokines may also diminish neurotrophic support and monoamine neurotransmission that can lead to neuronal apoptosis and glial damage. This happens because cytokines cause reduction of the levels of brain derived neurotrophic factor (BDNF), which is the primary neurotrophin of the hippocampus. They also induce the enzyme indoleamine 2,3 dioxygenase (IDO), which breaks down tryptophan, the primary amino acid precursor of serotonin, into kynurenine. Consequently, serotonin is reduced in the brain. Stress, which can precipitate depression, can also promote inflammatory responses through effects on sympathetic and parasympathetic nervous system pathways. The antidepressant drugs reduce the serum levels of proinflammatory cytokines. Interestingly, depressed patients with increased inflammatory biomarkers have been found to be more likely to exhibit treatment resistance, and in several studies, antidepressant therapy has been associated with decreased inflammatory responses. Except from cytokines, there are other factors of immune system which play crucial role in the pathogenesis of depression. These factors include free radicals of oxygen, the balance between ω3and ω6 lipid acids, the increased levels of positive acute phase proteins and the reduction of negative acute phase proteins. The research in the domain of psychoneuroimmunology suggest that targeting proinflammatory cytokines and their signaling pathways might represent a novel strategy to treat depression.

[Validation of adolescent computer addiction test in a greek sample].

The goal of this study is the validation of a reliable research tool for diagnosing computer addiction in adolescents and the description of its particular psychometric properties. 482 students in the city of Trikala, which is Greece's leading city in Internet provision, and 907 students of the city of Larisa took part in this study which was run during the first trimester of 2006. The samples were obtained through randomized stratified sampling for their respective cities. Those students who reported using a personal computer at the time filled in the ACAT (Adolescent Computer Addiction Test), which was modeled after the 20-question Internet Addiction Test. The psychometric tests applied included test-retest reliability, internal consistency and construct validity. Factor analysis revealed four factors which account for 59.15% of total variability of the scale. The ACAT scale was proven to hold excellent test-retest reliability, internal consistency and construct validity. The important role of timely education in new technologies is pointed out. This study is a first attempt in creating and applying a reliable tool in the evaluation of adolescent addiction to personal computers in Greece.

[Internet addiction disorder].

According to recent epidemiological data, 18.9% of the world population are internet users (www. internetworldstats.com). Τhis article attempts to determine the phenomenon of internet addiction disorder and to analyse the concepts of addiction and compulsiveness. The symptoms of internet addiction will be presented; the prevalence and demographic characteristics of internet addicts will be shown. Diagnostic tools developed for internet addiction, most susceptible populations, type of their personalities and integration of internet addiction disorder into the DSM-IV will be investigated in the present article. During the last decade, mental health specialists' research studies on internet addiction have not reached a consensus concerning the name, diagnostic criteria, diagnostic tools or introduction into the DSM-IV system. Nowadays, new technologies have penetrated into everyday life, while their influence is considerably growing, as the number of internet users is increasing. Therefore, it seems important for clinicians to include in their diagnostic interviews with patients questions investigating their relationship with the new technologies, as well as to recognize their impact in their patients' way of living.

Public opinions about mental illness in a Greek area: The influence of socio-demographic factors.

The importance of certain socio-demographic factors, which influence the attitudes and ideas regarding the mentally ill, were investigated in a resident population of a Greek region. An urban and a rural sample of 1,975 inhabitants were selected with an age range between 18 and 65 years. The Greek version of the Opinions about Mental Illness Questionnaire (OMIQ) was used for measuring the attitudes of social discrimination, social restriction, social care, social integration towards the mentally ill and the beliefs for the aetiology of the mental illness. The collected data were statistically analysed with stepwise multiple regression analysis and for the coding of the variables the method of dummy or indicator variables was followed. Educational level, age and place of residence are the main socio-demographic variables on which the OMIQ score depend. The results of this study could lead to the identification of target groups for the organisation of prevention programs aiming at changing public beliefs towards the mentally ill.

Glucose metabolism, insulin secretion and insulin sensitivity in juvenile hemochromatosis. A case report and review of the literature.

Among specific diabetes subtypes secondary to pancreatopathies, hereditary hemochromatosis is an inherited disorder of iron metabolism resulting in excessive iron overload and tissue damage in various organs. We here report the case of a man with the young-onset form of the disease and describe his glycaemic status before and during venesection therapy. A 25-year old man visited our clinic in Athens, Greece, with hypogonadotropic hypogonadism due to hereditary hemochromatosis. Genetic analysis revealed that he was suffering from the juvenile aggressive form and treatment was initiated with frequent phlebotomies in conjunction with androgen substitution. Within 18 months of therapy ferritin level was normalized and hypogonadism was fully restored. Despite severe iron overload, glucose tolerance remained normal during the various stages of the disease, although alterations in both insulin secretion and sensitivity were detected. Present data indicate that in juvenile hemochromatosis, the efficacy of the chelation therapy and probably the chronic interval required to restore normal iron concentration both play important roles in the formation of glucose metabolism characteristics.

Sporadic hypoparathyroidism treated with teriparatide: a case report and literature review.

Herein we describe the case of a 64-year-old woman with hypoparathyroidism diagnosed at the age of 40, after an acute episode of tetany and seizures due to severe hypocalcemia. She was treated for more than 20 years with calcitriol and calcium supplementation but she presented with marked hypercalciuria and recently nephrolithiasis, although serum calcium was maintained at levels below normal range. Provided that any attempt to increase the recommended dose of calcitriol was leading to an exacerbation of hypercalciuria, we decided to enroll an alternative tool in the treatment strategy. In order to avoid further deterioration of renal function she was administered once-daily a subcutaneous (sc) injection of synthetic human parathyroid hormone (PTH 1-34) while doses of calcium and calcitriol were gradually decreased depending on the response of calcium metabolism in serum and urine samples taken periodically. Within two months of administration, PTH (1-34) significantly reduced the level of urine calcium excretion compared with calcitriol therapy and maintained serum calcium in the normal range. The relevant literature is reviewed in light of this alternative therapeutic approach in long-standing hypoparathyroidism, illustrating the potential benefits and the unresolved issues in parathyroid hormone replacement.

Reduced insulin secretion in normoglycaemic patients with beta-thalassaemia major.

AIMS: To assess insulin sensitivity and secretion in the fasting state in regularly transfused patients with beta-thalassaemia major with normal glucose response during an oral glucose tolerance test and to estimate its possible relation to iron overload. METHODS: We measured fasting glucose, insulin and C-peptide levels in 24 patients with beta-thalassaemia major and 18 control subjects matched for age and body mass index. Insulin sensitivity and insulin release index were calculated according to the homeostasis model assessment (HOMA). Correlations with age, body mass index and serum ferritin were also calculated. RESULTS: Fasting glucose levels in patients were increased compared with control subjects (5.5 +/- 0.12 vs. 4.7 +/- 0.13 mmol/l, mean +/- SEM, P < 0.001). Pancreatic B-cell insulin secretion in the fasting state (estimated by SC(HOMA)) was lower in thalassaemic patients (SC(HOMA) 88.5 +/- 11.11 vs. 184.3 +/- 23.72 in control subjects, P < 0.001). Patients were then divided into those with impaired (IFG) and normal (NFG) fasting glucose. SC(HOMA) was higher in the patients with NFG compared with those with IFG patients (110.6 +/- 17.63 vs. 66.3 +/- 10.88, respectively, P < 0.05) but estimated insulin sensitivity (ISI(HOMA)) was similar. Plasma values of C-peptide correlated positively with ferritin (r = 0.42, P = 0.04) and SC(HOMA) (r = 0.45, P = 0.02) and negatively with ISI(HOMA) (r = -0.43, P = 0.03). CONCLUSIONS: These results support the concept that impaired B-cell function, as reflected by a reduction in the insulin secretion index, is present in beta-thalassaemic patients with normoglycaemia before changes in oral glucose tolerance tests are apparent.

The role of luteinizing hormone activity in controlled ovarian stimulation.

The role of LH in the natural menstrual cycle is undisputed. The active participation of LH in both steroidogenesis and ovulation is well established, but its potential effect on oocyte maturation in the issue of assisted reproduction protocols remains a topic of debate. Although several studies have added to our understanding of the specific actions of androgens in human follicular development, some discrepancies persist regarding their role in oocyte atresia. Clinical situations, where LH is either decreased or absent (e.g. in women with hypogonadotrophic hypogonadism or LH-receptor gene mutations), provide important data supporting the necessity for a minimal amount of LH to evoke ovulation. Recent use of GnRH antagonists, which results in profound suppression of LH concentration, in combination with the pharmacological production of recombinant gonadotrophins, has attracted the attention of investigators. Identification of sub-fertilized women, in whom LH administration could be beneficial and should be indicated, is arousing ever more interest. Based on the available data in the literature, the aims of this review are to assess the role of both endogenous and exogenous LH activity in stimulated cycles, and to evaluate the effects of recombinant human LH supplementation on the ovarian hormonal milieu and on the main outcomes of controlled stimulated cycles.

Psychiatric factors in patients with sensitive skin.

The term sensitive skin has been used to describe a clinical phenomenon of skin hyperreactivity induced after exposure to different external factors. The diagnosis is mainly based on patient's self-assessment because of the lack of objective clinical signs of the disease. The aim of this study was to investigate psychiatric factors in patients with sensitive skin and to estimate the possible need for psychological intervention to these patients. Thirty-seven patients with sensitive skin and 38 individuals with nonsensitive skin were studied. The psychometric instruments used were the Symptom Checklist-90 (SCL-90) and the Delusions-Symptoms-States Inventory/states of Anxiety and Depression (DSSI/sAD). Statistically significant differences in subjects with sensitive skin compared to those with nonsensitive skin were observed in the SCL-90 subscales of somatization, phobic anxiety, hostility, interpersonal sensitivity and the DSSI/sAD subscale of anxiety. Our findings suggest that somatization, anxiety, phobic anxiety, hostility and interpersonal sensitivity symptoms may be associated with hypersensitivity of human skin. Psychological factors should be taken into consideration in the treatment of patients with sensitive skin.

Morning levels of fibrinogen in children with sleep-disordered breathing.

Elevated fibrinogen level is a predictor of cardiovascular disease in adults, and it is associated with sleep-disordered breathing. Levels of fibrinogen in adults are affected by other co-existing cardiovascular risk factors, which are not usually present in children. To investigate the association between fibrinogen and sleep-disordered breathing, a case-control study was carried out in children with and without habitual snoring. All snoring children underwent polysomnography. Morning fibrinogen values in 30 children with snoring and an apnoea-hypopnoea index (AHI) > or =5 episodes x h(-1) (median (interquartile range) 318 mg x dL(-1) (290-374)) were similar to values in 61 children with snoring and an AHI <5 episodes x h(-1) (307 (269-346)). Both groups had higher fibrinogen values than those in 23 controls without snoring (271 mg x dL(-1) (244-294)). There was no correlation between fibrinogen values and AHI, respiratory movement/arousal index or haemoglobin desaturation index. In conclusion, fibrinogen values are higher in children with snoring than in controls, but there is no association between these values and polysomnography indices.

Effects of estrogen deprivation due to breast cancer treatment.

Breast cancer is one of the main life-threatening diseases that a woman may have to face during her lifetime. The increasing incidence of breast neoplasia reported over the last few decades has led to widespread screening of women resulting in early diagnosis. One common but challenging question for most doctors, after the surgical excision of the lesion, is determination of the ideal adjuvant therapy for their patients for the achievement of maximum life expectancy with the best quality of life. Since the beginning of the last century, the knowledge that breast cancer arises from hormone-responsive tissues has long made use of hormone-blocking agents in the beneficial treatment of breast neoplasia. The discovery of new molecules with endocrine actions has rendered the use of adjuvant therapy in a tailor-made pattern too complicated, as these agents have a different mode of action, different adverse effects and probably different indications. The aim of the present review is to clarify these issues, analyzing the mechanism of action of available drugs and their actions on specific areas of uncertainty: cognitive function, cardiovascular system, urogenital tract, bone metabolism, weight gain, hot flushes and premature menopause. Regarding the efficacy of adjuvant therapy, there has been particular focus on the multiple hormonal-induced consequences of each regimen in order to provide the clinician with the available data for choosing the ideal therapy for the patient.

Intracerebroventricular administration of atrial natriuretic peptide prevents increase of plasma ADH, aldosterone and corticosterone levels in restrained conscious dehydrated rabbits.

In order to investigate the effects of centrally administered ANP on plasma ADH, aldosterone and corticosterone levels as well as on blood pressure and on heart rate, 20 male New Zealand White (NZW) rabbits were used. Measurements were made on restrained conscious animals one week after the implantation of an indwelling intracerebroventricular (icv) cannula and two indwelling intravascular catheters (intracarotid and intrajugular). Animals were classified into two main groups, those with water available ad libitum ("euhydrated" group) and those who were dehydrated for 24 h ("dehydrated" group) before blood pressure and heart rate recordings and blood sampling for hormonal determination. Each group's individuals were divided into two subgroups of five animals each. Blood samples were collected at 0 min (control) and 30, 60, 90, 120 min following icv administration of 25 microl of either artificial cerebrospinal fluid (aCSF) (subgroups "aCSF") or human (h) ANP (1 microg) in aCSF (25 microl) (subgroups "hANP"). Blood pressure and heart rate were also recorded at the same times. Plasma ADH, aldosterone and corticosterone concentrations were determined using RIA. The results were analysed by analysis of variance (ANOVA). Blood pressure and heart rate values were unaffected by water deprivation or by ANP administration. Mean plasma corticosterone levels at all times (30-120 min) were significantly higher (p<0.001) than those at 0 min time. Plasma corticosterone levels in the "dehydrated+aCSF" group were significantly higher (p<0.05) than in each of the other groups ("dehydrated+hANP", "euhydrated+aCSF", "euhydrated+hANP"). Plasma corticosterone levels in each of those other groups did not differ significantly from one another. Dehydration resulted in a tendency to increase in aldosterone levels (p<0.07), and icv administration of hANP tended (p<0.08) to prevent in the "dehydrated+hANP" experimental group the increase in aldosterone levels observed in the control "dehydrated+aCSF" group from 30 to 120 min. Dehydration resulted in an increase in ADH levels (p<0.0001), and icv administration of hANP prevented (p<0.05) in "dehydrated+hANP" experimental group the increase in ADH levels observed in the control "dehydrated+aCSF" group from 90 to 120 min. The increase of corticosterone and ADH and the tendency towards increase in aldosterone in the control dehydrated groups could possibly be due to the combined stress stimulus of dehydration and restriction in the restrain box. These results indicate that centrally administered ANP, at the concentration achieved in the present study, neither affects blood pressure and heart rate in conscious restrained euhydrated and 24 h-dehydrated NZW rabbits nor decreases the ADH, aldosterone and corticosterone response to dehydration, but does apparently modulate ADH, aldosterone and corticosterone responses to other stimuli in the dehydrated state. In conclusion, the results of this study confirm that brain ANP may have an inhibitory effect on stimulated ADH, aldosterone and corticosterone release.

Hierarchical arrangement of psychiatric symptoms in the context of schizophrenia.

Foulds' model proposing a four-class hierarchical structure of mental illness represents an interesting dimension of psychiatric research and discussion and probably has a significant potential on diagnosis, taxonomy, therapeutics and theory. Psychiatric symptoms were investigated in a group of 244 schizophrenic patients with the purpose of analyzing Foulds and Bedford's notion that psychiatric symptoms are arranged hierarchically. To achieve this the R (recent) version of the Delusions, Symptoms, States, Inventory (DSSI) was administered in the form of a constructed interview to these patients. The hierarchical arrangement of psychiatric symptoms was verified since a great majority of the cases (80.8%) produced symptom patterns conforming to the hierarchy model. However, patients with duration of illness longer than 10 years reported conforming patterns in a lower percentage (77%), whereas 84.6% of those with a duration of illness less than 2 years reported conforming patterns. The non-conforming patterns were those in which integrated delusions were absent in the presence of delusions of disintegration, neurotic symptoms were absent in the presence of integrated delusions, and dysthymic states were absent in the presence of neurotic symptoms.