Drugs for mental illnesses in ancient greek medicine.

Drugs with psychedelic, hypnotic, narcotic, analgesic, suppressive, euphoric and stimulating effects were used in various ways during the ancient times. We can classify drug use in ancient times into two main categories. On the one hand, ancient physicians prescribed drugs based on their pharmaceutical-therapeutic actions. On the other hand, people not pertaining to medicine and not relating to its accurate implementation often abused drugs to achieve an euphoric state of mind, either for personal gratification or as an indispensable element of religion and mythology. Ancient Greek medical literature contains ample prescriptions and recipes indicating that plants were the essential components of drugs. Pedanius Dioscorides dedicated his lifetime's work to the synthesis of ancient drugs. One can find a plethora of information concerning the production methods and the plants used in drugs for the treatment of psychiatric diseases. These were herbs like black and white hellebore, mandrake, hyoscyamus (henbane), Papaver somniferum (also known as opium poppy), Strychnos, Frankincense-tree and dorycnium. The preparation of narcotics included the addition of other elements, mainly wine, to the opus of plants or to their extracts. Drugs were produced via methods of dehumidification/desiccation, grinding, squeezing or boiling of the plants' roots with a formation of a juice, oil or mush extract. In addition, drugs could also be inhaled if burnt. Many physicians of antiquity, such as Hippocrates, Galen, Ctesias and Aretaeus of Cappadocia, all refer to many of these aforementioned drugs analyzing the different symptoms which they could address, and the risks accompanying their use. Physicians of antiquity used drugs for the treatment of somatic, as well as psychiatric disorders. Most of these drugs affected the central nervous system. Taking advantage of their analgesic properties, physicians used them for the management of severe and chronic painful conditions. The hypnotic effects of some drugs were desirable in order to be used as anesthetics for surgical operations and cauterization. Drug use was also established in the initial treatment of epilepsy and seizures, regardless of their cause. Public rituals and mythology were the two main contexts in which drug use flourished, outside the realms of medicine. The psychotropic and especially the hallucinatory effects of drugs caused the person under their influence to lose control, rendering him incapable of governing his actions and thoughts. These consciousness-altering medications were frequently the central focus of mythology. In this case, one would dictate and give orders to another person, which under any other circumstances would not be carried out. This led to the formation of the concept of the magic potion. Theophrastus frequently referred to magic potions.

[Psychosomatic disorders in ancient Greek medicine].

The concept of psychosomatic disorders, as defined by modern medicine, was difficult to be perceived by the ancient Greek physicians. Two main reasons contributed to this. One was that physicians in Greek antiquity had formed the idea that the mental illnesses that were recognized at that time, namely mania, melancholy, frenzy, caros, lethargy, apoplexy, but even epilepsy, was the result of a disturbance of the essential elements of the body, the balance of them contributed to the preservation of health. Thus, depending on the school of medical thought of each physician in antiquity, mental and corporal illnesses were the result of various disorders such as the dyscrasia of humors for the physicians of the Dogmatic school that followed the Hippocratic principles or the disorder of the qualitative characteristics of the humor and the pneuma (air), as the physicians of the Pneumatic School considered, but also of the stenosis or the expansion of the pores as the physicians of the Methodic school thought. Although there was the perception that the diseases were the result of various combinations of the previous theories, as concluded by the physicians who constituted the Eclectic school. The second reason was that ancient physicians could not perceive the autonomy of man's psychic world as an element of human nature in which emotional distress and irrational mental processing of stimuli from the social, cultural and natural environment of the individual would be aggravating to the challenge of mental imbalance. Nevertheless, many physicians such as physicians who wrote various work of Corpus Hippocraticum, Soranus of Ephesus (1st - 2nd c. AD) Galen (1st - 2nd c. AD), Aretaeus of Cappadocia (1st - 2nd or 4th c. AD) and Caelius Aurelianus (5th c. AD) did not forget to describe in their works psychosomatic disorders as they are defined by modern medicine. In their works there are the observations about intense sweating, tremor, eating disorders, hysteria and even death as a result of an intense and long psychological unrest. These corporal symptoms, although were onset due to a psychological unequilibrium they could not been listed by the ancient Greek physicians in any of the mental diseases as they were defined in antiquity. The psychological disturbance which could provoke the above corporal disorders arose by various phobias, shame, sorrow, anger, envy, excessive drinks and food, excessive sexual desire, passion for gambling and anxiety of everyday life.

Psychiatry trainees' attitudes towards euthanasia and physician-assisted suicide.

We investigated the attitudes towards Euthanasia (EUT) and Physician-Assisted Suicide (PAS) in a sample of Greek Psychiatry trainees (PT), (n=120, mean age 32.01±0.21, male 60.0%) and compared these to those of medical trainees of other specialties (OMT), i.e. internal medicine, surgery, intensive care (n=154, mean age 32.97±1.17, male 57.1%). Most of the responders were for the acceptance of EUT and PAS under some circumstances. More often PT answer "never" in the question regarding the permission to withdraw life-sustaining medical treatment to hasten death, if that requested by a terminally ill patient (p<0.001) and also more often answer "never" to the question regarding the permission to hasten the death of a patient if that is requested by family members (p<0.01). On the other hand OMT were more often for the acceptance of EUT (p<0.001) and more often expressed a positive view in the case allowing PAS in patients with incurable-terminal illness and low expected quality of life (p<0.001). According to the results of this study there is a need for special education of PT on end of life decisions. Also, it is important for educators to have understanding the views of the trainees since soon in the future, the new generation of physicians will have to make end of life decisions.

Homosexuality according to ancient Greek physicians.

Homosexuality and pedophilia in ancient Greece greatly concerned many researchers who were mainly interested in highlighting the social aspect of this phenomenon in ancient Greek society. An important source on the subject was the paintings of a man and his lover in attic black and red figured pottery, up to the end of the 5th century BC. Another main source was the information that derived from the texts of ancient Greek literature, especially poetry. Homosexuality was not only referring to relationships between males, but it was also manifested in lesbian love. It is believed that in the Homeric world homosexuality was not favored. In Greek society of the archaic period, the restriction of women at home, the satisfaction of sexual needs with courtesans, the marriage for the purpose of maintaining and managing the property, put women aside, marginalizing them in terms of social life, impeding the cultivation of emotional relationships between sexes. At the same time, in the society of those times, the aristocratic ideal, the constant communication of men during military training and the war, the male nudity in sports and the promotion of beauty and bravery in athletic contests, as well as the gatherings and the entertainment of men at the symposia, created a suitable substrate in which male homosexuality could develop. In this context, pedophile relationships were developed mainly during the archaic period, as recorded on vase paintings, where a mature man developed a special relationship with a teenager of the same social class. The mature man had the role of mentor for the juvenile, he would look after him and cover his living expenses and education cost. In this relationship, exhibiting predominantly the social dimension of an initiation process and introduction to adult life, the erotic homosexual intercourse could find a place to flourish. The above-mentioned relationship could not last forever, given that this would later transform into an emotional connection of friendship and trust. Besides, the constant homosexual relationships and male prostitution were considered to be reprehensible behaviors. Regarding the lesbian love, the main example was Sappho and her poems that praised love between women. Nevertheless, the relationship with the girls in the poems is considered to be similar to that Socrates had with his students, an intense personal relationship which would not involve sexual love and could probably be a platonic love. Ancient Greek physicians used their methodological tools in order to interpret homosexuality as a mental disease, but ancient medical dogmas such as the theory of humors, stereopathology and their variations could not offer an explanation for homosexuality.

Dreams in ancient Greek Medicine.

Dreams preoccupied the Greek and Roman world in antiquity, therefore they had a prominent role in social, philosophical, religious, historical and political life of those times. They were considered as omens and prophetic signs of future events in private and public life, and that was particularly accentuated when elements of actions which took place in the plot of dreams were associated directly or indirectly with real events. This is why it was important to use them in divination, and helped the growth of superstition and folklore believes. Medicine as a science and an anthropocentric art, could not ignore the importance of dreams, having in mind their popularity in antiquity. In ancient Greek medicine dreams can be divided into two basic categories. In the first one -which is related to religious medicine-dreams experienced by religionists are classified, when resorted to great religious sanctuaries such as those of Asclepius (Asclepieia) and Amphiaraos (Amfiaraeia). These dreams were the essential element for healing in this form of religious medicine, because after pilgrims underwent purifications they went to sleep in a special dwelling of the sanctuaries called "enkoimeterion" (Greek: the place to sleep) so that the healing god would come to their dreams either to cure them or to suggest treatment. In ancient Greek literature there are many reports of these experiences, but if there may be phenomena of self-suggestion, or they could be characterized as propaganda messages from the priesthood of each sanctuary for advertising purposes. The other category concerns the references about dreams found in ancient Greek medical literature, where one can find the attempts of ancient Greek physicians to interpret these dreams in a rational way as sings either of a corporal disease or of psychological distress. This second category will be the object of our study. Despite the different ways followed by each ancient Greek physician in order to explain dreams, their common intention was to give a rational answer for the creation and content of dreams setting aside any supernatural beliefs. In addition they tried to explain in a scientific way the correlation that could have emerged between the story that took place in dreams and the events that happened in everyday life. Nevertheless, ancient Greek physicians focused especially on nightmares, which were associated with physical problems. For those physicians these nightmares included information about the corporal disease of the patient, which had a reflection in the dream, and they could help them to diagnose the problem in order to restore balance of the body.

Financial crisis and criminality in Greece: 2008 vs 2011.

Α number of previous articles have dealt with the negative impact of the Greek Economic crisis on public health, including significant increases in major depression prevalence and suicide and homicide rates. The mentally ill seem to represent a vulnerable social group, with particular difficulties in this context. The number of compulsory assessments and involuntary admissions was recorded by reviewing patient records in the Department of Psychiatry of the University Hospital of Patras, through years 2006-2013. Compulsory assessments increased from 176 in 2006 to 262 in 2009 and 354 in 2013, representing a 48.86% and 101.13% increase in the first and the fifth year of economic crisis, respectively. The assessments resulted in 160 involuntary admissions in 2006, which escalated to 262 admissions (63.75% rise) in 2013. Even though a rise in involuntary placements could be attributed to other factors as well, it may also partly represent a not so evident side of the Greek economic crisis.

Suicide in ancient Greece.

The theme of suicide appears several times in ancient Greek literature. However, each such reference acquires special significance depending on the field from which it originates. Most of the information found in mythology, but the suicide in a mythological tale, although in terms of motivation and mental situation of heroes may be in imitation of similar incidents of real life, in fact is linked with the principles of the ancient Greek religion. In ancient drama and mainly in tragedies suicide conduces to the tragic hypostasis of the heroes and to the evolution of the plot and also is a tool in order to be presented the ideas of poets for the relations of the gods, the relation among gods and men and the relation among the men. In ancient Greek philosophy there were the deniers of suicide, who were more concerned about the impact of suicide on society and also these who accepted it, recognizing the right of the individual to put an end to his life, in order to avoid personal misfortunes. Real suicides will be found mostly from historical sources, but most of them concern leading figures of the ancient world. Closer to the problem of suicide in the everyday life of antiquity are ancient Greek medicines, who studied the phenomenon more general without references to specific incidents. Doctors did not approve in principal the suicide and dealt with it as insane behavior in the development of the mental diseases, of melancholia and mania. They considered that the discrepancy of humors in the organ of logic in the human body will cause malfunction, which will lead to the absurdity and consequently to suicide, either due to excessive concentration of black bile in melancholia or due to yellow bile in mania. They believed that greater risk to commit suicide had women, young people and the elderly. As therapy they used the drugs of their time with the intention to induce calm and repression in the ill person, therefore they mainly used mandragora. In general, we would say that there were many reasons to suicide someone in antiquity. Very important factor was to avoid captivity and the consequent overcrowding of indignity, especially for politicians and military leaders. Also intention in these circumstances was to avoid torture and the disgrace of rape. Strong grief is another reason, as in case of death of family members. The erotic disappointment had place in ancient suicides, which concerned both men and women, while there were also suicide for financial reasons. Especially for the elderly, the despair of the anility in conjunction with physical illness and cachexia, were important factors for these people to decide thee suicidal. Finally, the methods of suicide fitted their epoch, but bear resemblance to those of the modern time. Poisoning was very common to both men and women but equally popular in both sexes was also the hanging. It was not unusual to fall from a high in order to reach the death, while stabbing a sword in the body for self killing was widespread in men and soldiers.

Cognitive impairments and psychopathological parameters in patients of the schizophrenic spectrum.

Cognitive impairment is a core feature of schizophrenia and it is considered by many researchers as one of the dimensional components of the disorder. Cognitive dysfunction occurs in 85% of schizophrenic patients and it is negatively associated with the outcome of the disorder, the psychosocial functioning of the patients, and non-compliance with treatment. Many different cognitive domains are impaired in schizophrenia, such as attention, memory, executive functions and speech. Nowadays, it is argued that apart from clinical heterogeneity of schizophrenia, there is probable heterogeneity in the accompanying neurocognitive dysfunction. Recent studies for cognitive dysfunction in schizophrenia employ computerized assessment batteries of cognitive tests, designed to assess specific cognitive impairments. Computerized cognitive testing permits for more detailed data collection (e.g. precise timing scores of responses), eliminates researcher's measurement errors and bias, assists the manipulation of data collected, and improves reliability of measurements through standardized data collection methods. The aims of the present study are: the comparison of cognitive performance of our sample of patients and that of healthy controls, on different specific cognitive tests, and the testing for possible association between patients' psychopathological symptoms and specific cognitive impairments, using the Cogtest computerized cognitive assessment battery. 71 male inpatients diagnosed with schizophrenia or other psychotic spectrum disorders (mean = 30.23 ± 7.71 years of age), admitted in a psychiatric unit of the First Department of Psychiatry, Athens University Medical School, Eginition Hospital (continuous admissions) were studied. Patients were excluded from the study if they suffered from severe neurological conditions, severe visual or hearing impairment, mental retardation, or if they abused alcohol or drugs. The patients' diagnoses were based on the semi-structured diagnostic interview "Diagnostic Interview for Psychosis" (DIP) and were clinically confirmed by two independent expert psychiatrists, according to the criteria of DSM-IVTM. Our healthy control group consisted of 20 healthy male participants (mean = 31.65 ± 5.90 years of age), who met the same inclusion criteria for the study as the patient group, as well as the same exclusion criteria from the study, having no history of psychiatric disorders. All statistical analyses were conducted using the statistical package SPSS.17. According to our results, healthy controls cognitively outperform our patient sample in all cognitive tests, with the differences between performances being statistically significant. Results concerning the association between psychotic symptoms and cognitive deficits of our patients indicated that hallucinations, highly organized delusions, persecutory delusions, agitation, catatonia and inappropriate affect did not associate with any subtype of cognitive deficit. Blunted affect associated significantly with response inhibition ("GoNoGo test", p = 0.007), and poor speech associated significantly with declarative memory of faces ("FMT test", p = 0.002). Moreover, psychomotor ability (non-dominant hand) associated significantly with generalized delusions ("TST test", p = 0.033), and with constricted affect ("TST test", p = 0.026). Furthermore, there was a tendency towards significance association between persecutory delusions and executive function ("CPT test", p = 0.053), inappropriate affect and declarative face memory ("FMT test", p = 0.056), and psychomotor ability and poor speech (p = 0.086).

Suicide in the Byzantine Empire.

Studying the suicide in the Byzantine Empire is difficult due to the limited number of references to it. Their number is greater in the early years of the Empire, mainly because of the persecution of Christians and gradually decreases. The attitude of the Church also gradually hardens, as well as the law. The law was strictly followed to the West, but as far as the Eastern Empire is concerned there are no references of punishment, confiscation of property or vandalism of dead bodies mentioned. Avoiding public humiliation after a public crime or a military defeat, religious redemption, emotional disturbance and debts, are the main cause of suicide. There are some references of mass suicides, while women suicides are relatively fewer, if the early Christian years are excluded. Suicide is more acceptable to the pagans because of their lifestyle. The therapeutic approach comes mainly through the treatment of depression. Aretaeus and Galen cite some ways to deal with the disturbance in the internal balance of black bile. Their view echoes through the centuries and the subsequent doctors embrace it. At least after the 9th century, more importance is given to the patient's bliss. Gemistus Pletho tried to revive the Platonic view of suicide shortly before the end of the Empire. The Church forbids Christian burial and troubled soul hovers in an intangible journey.

Attitudes on euthanasia and physician-assisted suicide among medical students in Athens.

Attitudes towards assisted death activities among medical students, the future health gatekeepers, are scarce and controversial. The aims of this study were to explore attitudes on euthanasia and physician-assisted suicide among final year medical students in Athens, to investigate potential differences in attitudes between male and female medical students and to review worldwide attitudes of medical students regarding assisted death activities. A 20- item questionnaire was used. The total number of participants was 251 (mean age 24.7±1.8 years). 52.0% and 69.7% of the respondents were for the acceptance of euthanasia and physician-assisted suicide, respectively. Women's attitudes were more often influenced by religious convictions as well as by the fact that there is a risk that physician-assisted suicide might be misused with certain disadvantaged groups. On the other hand, men more often believed that a request for physician-assisted suicide from a terminally ill patient is prima-facie evidence of a mental disorder, usually depression. Concerning attitudes towards euthanasia among medical students in various countries there are contradictory results. In USA, the Netherlands, Hungary and Switzerland most of the students supported euthanasia and physician-assisted suicide. However, in many other countries such as Norway, Sweden, Yugoslavia, Italy, Germany, Sudan, Malaysia and Puerto Rico most students expressed negative positions regarding euthanasia and physician assisted suicide.

["Continuum" and "Spectrum" hypotheses of depressive disorders].

Nowadays, the acceptance of depressive disorders as distinct entities in a categorical system with clearly defined diagnostic criteria has been considered by many researchers to be dysfunctional and stringent. An increasing number of patients with mild depressive symptomatology and dysfunction, who do not satisfy specific diagnostic criteria, seek help in primary care settings. Many questions arise in relation to whether contemporary categories of depressive disorders categories adequately reflect the broad spectrum of depressive disorders occurring in the general population. Contemporary classification-categorization systems are based on the development of diagnostic categories using a "threshold" that defines the subjective dimensional depressive spectrum. However, the so-called categorical or "threshold" diagnostic system of depressive disorders is nowadays open to skepticism. According to the "continuum" hypothesis, depressive disorders extend from normality up to exceptionally disturbed symptomatology (i.e. major depression) and behaviour (i.e. suicidality). Moreover, the "spectrum" of depressive disorders includes a variety of signs and symptoms, extending from the core depressive symptoms to temperament characteristics. These symptoms and/or signs could manifest during a depressive episode, between depressive episodes, or even in the absence of depressive episodes. Many researchers argue that subthreshold (subsyndromal) depressive symptoms may be prodromal or residual manifestations of depressive episodes, or may represent early stages of the continuum of major depressive disorders. The continuum and the spectrum hypotheses of depression could be especially beneficial to the development of primary care prevention programms. However, various concerns have been expressed in relation to the depressive continuum and spectrum hypotheses. Such arguments include the decrease of the reliability and validity of the depression diagnosis, as well as the need for introduction of new subgroup categories of depressive disorders, based on special symptoms (i.e. typical or atypical depression). The lack of specific psychometric instruments measuring subthreshold symptoms should also be considered. The above hypotheses of depressive disorders require further theoretical elaboration and confirmation by systematic research studies.