Epidemiology of panic disorder and subthreshold panic symptoms in the Greek general population.

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.

Living with covid-19.

From the beginning of 2020, the alarming news from Italy and the first known cases arrived in Greece, along with travelers from the Holy Land. Spain, France and all other countries followed. From the first week of March, restrictive measures began in Greece and then confinement in order to limit the spread of the pandemic and not drown the National Health System by serious cases. The policy of restrictive measures to stop the pandemic was the internationally accepted response1 and the generalized adherence proved effective, despite the shock and the various reactions from the unprecedented, generalized state of restriction, different scale from epidemics of other times.2-4 In other countries, the loose restrictive measures have cost thousands of deaths. The general restrictive measures, however, have serious consequences for people's mental equilibrium, economy and employment, and for this reason they can only be of limited duration.5 The gradual return to normal life rhythms began gradually from May. But the test of the holiday time and the gradual opening of the tourist season, that is, the open communication of moving populations with limited, random checks for the virus and only local restrictions of the gathering of citizens. We are experiencing now the gradual and severe increase in cases, with an uncertain spreading, with asymptomatic and younger in age likely playing a central role in the spread of the virus, while the fear of a potential large increase in serious cases remains. At the time of this writing, the only means of coping is to maintain and locally strengthen the protective measures, while we gradually realize that these measures came to stay for many more months.6,7 A major problem is that the initial small number of cases favored the underestimation of risk by part of the population, and the serious consequences on people's jobs and lives, along with the deregulation of employment and social security relations legislated in recent months, have provided substantial material to conspiracy theories. We carefully monitor the research on the epidemiological behavior of covid-19 and the clinical data, the discussion on the drugs that make the symptoms milder, the effect of the virus on the CNS and the expected vaccine or vaccines. Our role from the beginning concerned the enormous psychological burden of a global health crisis, with serious consequences on people's working and social lives and equally avoiding the deregulation of the management of our patients and of the units that provide it. At the time of confinement, the telephone contact, familiar to all generations, offered valuable information and support, the lines 10306 and 1110, as well as many local or voluntary help-lines. Telepsychiatry was used more widely - being also an initiative of the Hellenic Psychiatric Association - and seems to have entered impetuously in our work, as well as in education. Its central or complementary role and its safe use are issues that are widely discussed at the moment.8 Protection measures against the virus seriously affect the normal functioning of health and mental health services. The solution should be sought in the urgent operational upgrade, the very necessary reinforcement of the staff and its effective protection from the virus and stress from exposure to danger, which has emerged as important factors for the normal operation of the mental health units.9 The use of telepsychiatry has solved a number of operational problems, but in many cases, it remains complementary, as it cannot replace physical presence in more specific care operations. The need not only to normalize, but to improve the follow up of our patients, the need to strengthen the units that provide basic, community mental health services, is shown by the increase in cases of involuntary hospitalization in the psychiatric hospitals of Athens and Thessaloniki during the last two months. A health crisis that affects almost the entire planet and the working and social life of most is a major social and political problem that concerns all of us,10 while mental health professionals are called to offer their scientific tools for people to face a multifaceted threat and in particular to claim and ensure the continuation of the treatment of our patients and the normal operation of our units.

[European Join Action on Dementia: Dementia Friendly Communities in Greece (DFC), the project "Aeneas"].

The Health Care system has a vital role in improving services and support people with dementia, but it cannot prevent fear and lack of understanding of dementia. Lack of awareness and poor understanding in communities has a major impact on the experience of people with dementia and their caregivers. "Dementia Friendly Communities" is a program of EU as part of the Act on Dementia Joint Action, in order to advance common recommendations for the development of better services for people with dementia, which will improve their quality of life. Ιt has been proposed that within a "Dementia friendly Community, people with dementia will not be marginalized and will be respected by their fellow citizens. The citizens, the public organizations and private sector enterprises cooperate in order to eliminate the obstacles which exclude dementia patients and their caregivers from participating in the life of their community". The Dementia Friendly Communities involve four fields: the environment (places), the citizens (people), the networks and the resources. Based on this model, pilot actions have been developed in Greece (Municipalities of Athens, Byron and Vrilissia), Bulgaria and UK and it is expected to provide important guidelines for the development of Dementia Friendly Communities in EU. In Greece the goal of the Join Action on Dementia was to promote the development of strong alliances within the local communities (municipalities) and the networking of organizations (State, Municipalities, NGOs, enterprises etc) with dementia patients and their caregivers and to educate more people in the municipalities in order to fight stigma and understand dementia.

[The impact of the recent financial crisis on the users' profile of a community mental health unit].

During previous financial crises as well as the recent global financial crisis, a strong impact of the crisis on the population mental health in many countries has been observed. Similarly, in Greece, a series of epidemiological studies pointed out the consequences of the economic crisis on the population mental health. However, there is limited data available, both in Greece and worldwide, regarding the impact of the economic crisis from the perspective of mental health services. The goal of the present study was to examine possible changes on the community mental health during the first years of the Greek financial crisis, as they are reflected on the operation of a community mental health unit with a specific catchment area within Athens (Byron and Kessariani). The demographic, social and clinical characteristics of adult users who were admitted for the first time at ByronKessariani Mental Health Community Center during the years 2008-2013 were analysed. The impact of the financial crisis on the workload of the center was also assessed during the same period. The sample of the study consisted of 1865 adult users and the data was collected with the use of an ad hoc structured questionnaire as well as from the users' case files. No significant differentiation on the number of clients admitted to the center per year after the beginning of the financial crisis was found. However, it is possible that an upper limit has been reached on the center's capacity to admit new clients, i.e. a ceiling effect, as it is shown from the increased number of provided sessions per year as well as from the increase in the mean waiting time for the intake of new patients during the same period. A constant increase in the number of women among the new clients of ByronKessariani Mental Health Community Center was found, but no significant differentiations were detected during the study period. Moreover, the study showed an upward trend in aggressive behavior as a reason for admission, a significant and continuous increase in the rate of unemployed individuals among the new clients, as well as a statistically significant increase in the number of referrals for psychotherapy during the study period. There was also an increase in the number of patients who had psychiatric history, even though they were admitted to Byron-Kessariani Mental Health Community Center for the first time. No significant differentiations were found in the remaining users' demographic and clinical characteristics assessed. Our study showed that during the crisis community mental health services are under pressure due to the increased needs of patients, especially the needs for psychotherapeutic intervention and psychological support. The increased unemployment rates affect the influx of new patients as well as the therapeutic management of many users. Reinforcement of the community mental health service network is an important strategy against the consequences of the crisis on the population mental health.

[Psychosocial rehabilitation and severe mental illness: Factors that influence patients' attendance in a support group].

Psychosocial rehabilitation for people with chronic-severe mental illness mainly aims to social integration by restoring independent functioning in the community, improving quality of life, and addressing risk factors that lead to social disability. Support groups (SG) are usually part of this multilevel mental health process. Given that non-adherence to treatment is a common phenomenon in people with chronic- severe mental illness, the aim of the current study was to identify which factors influence members' attendance in a support group in a vocational training Program of the Psychosocial Rehabilitation Unit of Byron-Kaissariani Community Mental Health Centre. The SG sessions were weekly, with 45-minute duration, opened to any new member of the Program and coordinated by two therapists. Members' demographic and psychiatric data were gathered from the medical records of the Center. Information about SG was obtained from the reports of the sessions. The sample consisted of 18 women, with mean age 38.56 (±6.92) years. Most of them were high school graduates (61.1%), unmarried (83.3%), with low socioeconomic status (55.5%), suffering from a schizophrenic spectrum disorder (61.1%) with a mean duration 15.22 (±8.44) years. Out of 83 sessions in total, twenty-two (26.5%) were in absence of a co-therapist, 11 (13.3%) after a member's entrance or withdrawal and 11 (13.3%) after a session cancellation. Furthermore, an average of four issues was discussed per session, with mental illness (62.7%) and interpersonal relationships (73.5%) being the most popular topics during the sessions. The statistical analysis demonstrated that members' demographic (age, education, marital status, residence, socioeconomic status, working experience) and psychiatric characteristics (diagnosis, illness duration, rehabilitation program experience) were not associated with the attendance rate in the SG. Similarly, the proportion of participants attending the sessions did not seem to be significantly related to the absence of a co-therapist, to a member's entrance or withdrawal and to a session cancellation. In contrast, attendance seemed to be significantly reduced when the topic of a session focused on members' future expectations/goals (having a family, further education, finding a job) (Beta=-0.32, p=0.006). This finding highlights the need for future research in order to incorporate interventions that promote and address future goals and expectations of people with chronic-severe mental illness in psychosocial rehabilitation services.

The impact of unemployment on mental health examined in a community mental health unit during the recent financial crisis in Greece.

Financial crisis has significant impact on the mental health of the population, resulting in increasing incidence of mental disorders and suicides. Specific social and financial factors mediate the effects of financial crisis on mental health, such as poverty, financial difficulties and unemployment. During the recent international financial crisis, studies in many countries have shown that the worsening of various mental health indicators was related to financial difficulties and unemployment. In Greece, which is one of the countries that experienced intense and prolonged economic and social burden due to the recent crisis, the epidemiological findings were similar and the increase of the prevalence of major depression and suicide was excessive. However, the information about the mental health of the population deriving from health services is limited. The aim of this study was to investigate the impact of the crisis on community mental health -more specifically the rates of mental disorders and suicide, as well as the role of unemployment- among the new cases of a community mental health unit. The sample consisted of 1,865 adult users, men and women, who came seeking for help to the Byron-Kessariani Community Mental Health Centre (CMHC) during the years 2008-2013, i.e. the early years of the current crisis. Regarding the rates of the diagnostic categories in the new cases of CMHC per year, no significant differentiation was observed. There was an increase in the proportion of the unemployed individuals in the total sample of new cases during the study, from 9.65% in 2008 to 26.17% in 2013 and a significant association between unemployment and the occurrence of anxiety and depressive disorders, as indicated by the increase in the proportion of unemployed individuals among new cases with disorders of these categories. There was an upward trend in the rate of new patients referred to CMHC after a suicide attempt, which was doubled during the first years of the crisis. There was also an increase in the rate of unemployed individuals among these cases, from 10% in 2008 to 41.7% in 2009, reaching the highest level in 2011 (53.3%). The findings of this study suggest that during economic crisis unemployment plays an important role in the development of anxiety and depressive disorders and is closely related to suicide attempts. Our results were derived from a specific catchment area and therefore they have high ecological validity.

[The psychiatric comorbidity of anorexia nervosa: A comparative study in a population of French and Greek anorexic patients]. / La comorbidité psychiatrique de l'anorexie mentale : une étude comparative chez une population de patients anorexiques français et grecs.

OBJECTIVE: The current study had two objectives: (1) to access the psychiatric comorbidity in axis I and axis II (according to DSM-IV) of anorexia nervosa in a sample of 60 anorexic patients; (2) to compare the features of the psychiatric comorbidity between the two groups of French and Greek anorexic patients who participated in the study, as well as to compare some psychological and behavioral aspects of their anorectic psychopathology. METHOD: Sixty anorexic patients, thirty French and thirty Greek, aged between 18 and 60 years, referred for evaluation and therapy at the unit of eating disorders at the "Institut national Marcel-Rivière of the MGEN" (hôpital de La Verrière, France) and at the unit of eating disorders of the First Department of Psychiatry of EGINITIO University Psychiatric Hospital in Athens (Greece), were accessed with the Eating Attitudes Test-26 (EAT26), Eating Disorder Inventory (EDI), Symptom Checklist-90-Revised (SCL90R), Mini International Neuropsychiatric Interview, Version 5.0.0 and the International Personality Disorder Examination. RESULTS: The comparison between the Greek and French patient populations did not show significant differences in age, socio-educational status, family status and BMI. French patients were hospitalized more regularly than Greek patients (χ2 (1)=6.65, P=0.01) and psychotropic drug therapy was more common in French anorexic patients (χ2 (1)=4.59, P=0.06). The results of the EAT 26 questionnaire in Greek and French patients show an average of 34.93 (±18.54) in total, with no statistically significant difference between the two groups. The results of EDI show a statistically significant difference between the two groups in the subscale 3 (body dissatisfaction) in which the Greeks scored on average at 9.40 and the French at 14.90 (t (58)=3.09, P<0.01). According to the results of the MINI scale, 47% of the patients in our total sample had a restrictive anorexia nervosa and 47% had anorexia nervosa of binge-eating/purging type. The most frequent comorbid disorder was the major depressive episode (40%) and the obsessive compulsive disorder (18.3%). The only statistically significant difference between the two groups was the frequency of the major depressive episode, which appeared statistically higher among the French (χ2 (1)=6.94, P=0.01). According to the results of IPDE, 73.3% of patients in total (76.6% of the French and 70% of the Greeks) showed a personality disorder. The most common personality disorder was borderline personality disorder (40%), followed by obsessive-compulsive personality disorder (26.6%) and avoidant personality disorder (21.7%), with no statistically significant differences between the two groups. DISCUSSION: The profile of anorexic patients who are addressed to the specialized units of eating disorders in both cities (Paris, Athens) had many points in common (demographic parameters, BMI, subtype of anorexia). The results of the EAT-26 and EDI questionnaires did not differ between the two groups, except for the EDI questionnaire subscale 3, which showed body dissatisfaction, where the French had higher scores; this fact underlines the influence of cultural factors on some psychological and behavioral aspects of the psychopathology of the anorexia nervosa. The rates of comorbidity of anorexia nervosa in axis I and axis II found in our study are in agreement with data from various literature reviews and studies in the recent years. The most interesting point of the comorbidity comparison on axis I between the two groups of patients concerns the difference in the frequency of the major depressive episode, for which the results show higher rates in French patients. We can consider that this finding follows the general trend of mood disorder rates in Western countries and we can assume an explanation based on cultural influences. Finally, we can consider that the differences concerning the hospitalization of French patients in a more regular way than Greek patients and the higher rates of psychotropic treatment in French patients reflect the differences in the health systems between the two countries. CONCLUSION: Our study has shown high rates of major depressive episode, as well as personality disorders. There were statistically significant differences in four parameters between our two patient groups, explained by the influence of cultural factors.

[Patients coming back after interruption of care in a community mental health center: Associations with care provision and psychopathological features].

A large number of people with mental health problems do not receive any treatment and in a large number of patients under care the treatment is interrupted. Non-compliance to treatment, observed in many different settings, is a major challenge in providing mental health care. The aim of the present study was to assess the demographic, social and psychological characteristics of the patients coming back for help to community psychiatric services and to shed some light to the reasons of interrupting and coming back. Special emphasis was placed on the possible correlation with specific mental disorders and whether or not the treatment was completed. The survey was carried out at the Byron- Kessariani University Mental Health Center, in a middle-classes catchment area and offering free of charge services. During the years from 2012 to 2016: 346 patients interrupting treatment (PIT) came back, while 1643 new patients were registered. The PIT were assessed with a specific questionnaire consisting of 34 open and closed-ended questions on changes in socio-demographic data, diagnosis, reported causes of discontinuation of care, services provided, important life events, follow-up by other mental health services after interruption of care, medication, and hospitalizations. The data were collected by trainee psychologists through a structured interview lasting 15-30 minutes and also from patients' medical records. Out of the 525 PIT during the study period, we excluded 148 who asked only for a certificate and 31 with many missing values. The final sample consisted of 346 patients and the analysis has focused on 299 PIT falling into one of the following four basic diagnostic categories: (a) schizophrenia and other psychotic disorders (12.7%), (b) mood disorders (41.3%), (c) neurotic and stress-related disorders (22.0%), (d) family and couple problems (10.4%). 64.1% of the PIT considered that they had not completed their previous treatment in the center, 19% attributed the interruption of care to reasons related to the center operation, and 88.4% considered that their demand had been satisfied. The highest rate of patients coming back was observed in the first year (31.7%) and then in four or more years (43.4%) after interruption of care. 32.7% discontinued the medication, 21,4% continued the medication following previous prescription. 47.3% had no follow-up, while 52.7% had been followed-up (36.6% of them by a private psychiatrist and 30.7% by a psychiatrist in a public institution). 45.5% of people with schizophrenia and other psychotic disorders were hospitalized in the meantime. The relationships between diagnosis and follow-up status with unemployment were tested but these associations were not statistically significant. There was greater satisfaction by those who completed treatment, as expected. Reasons for interruption related to the center operation, such as the work shift, the frequent changes in stuff members and the quality of care, are of particular importance.

Psychiatric specialty training in Greece.

The reform and development of psychiatric services require, in addition to financial resources, reserves in specialized human resources. The role of psychiatrists in this process, and at reducing the consequences of mental morbidity is evident. Psychiatrists are required to play a multifaceted role as clinicians, as experts in multidisciplinary team environments and as advisors in the recognition of public needs in mental health issues, as teachers and mentors for students and other health professionals, as researchers in order to enrich our knowledge in the scientific field of psychiatry, and as public health specialists in the development of the mental health services system. This multifaceted role requires the continuous education of modern psychiatrists, but above all a broad, substantial and comprehensive training regime in the initial stage of their professional career, that is to say during specialization. Training in Psychiatry, as indeed has happened in all other medical specialties, has evolved considerably in recent decades, both in the content of education due to scientific advances in the fields of neurobiology, cognitive neuroscience, genetics, psychopharmacology, epidemiology and psychiatric nosology, and also because of advances in the educational process itself. Simple apprenticeship next to an experienced clinician, despite its importance in the clinical training of young psychiatrists, is no longer sufficient to meet the increased demands of the modern role of psychiatrists, resulting in the creation of educational programs defined by setting and pursuing minimum, though comprehensive educational objectives. This development has created the global need to develop organizations intended to supervise training programs. These organizations have various forms worldwide. In the European Union, the competent supervising body for medical specialties is the UEMS (European Union of Medical Specialities) and particularly in the case of the psychiatric specialty, the European Board of Psychiatry. In the US, the supervising bodies are the Accreditation Council on Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology, in the United Kingdom the Royal College of Psychiatrists, in Canada the Royal College of Physicians and Surgeons, etc. In our country, the debate on the need to reform the institutional framework for Psychiatric training has been underway since the mid-90s, with initiatives especially by the Hellenic Psychiatric Association, aiming to raise awareness and concern among psychiatrists while responding to requests from competent central bodies of the state, as well as establishing Panhellenic training programs for psychiatric trainees and continuing education programs. But what is the situation of the educational map in the country today, what would be the objectives, and how might we proceed? These questions we will try to answer in an effort initiated by Hellenic Psychiatric Association (HPA) and the journal "Psychiatriki" with the publication of thematic articles starting by presenting in the next issue of "Psychiatriki"a comparative study of the training in the specialty of psychiatry at two distinct periods of time (2000 and 2014). These time-frames are of great importance, since the first is a period that in retrospect can be considered as wealthier yet missing robust priorities, while the second, at the peak of the economic crisis, constitutes a difficult environment with limited resources. Already in the year 2000, psychiatric residency training in our country had major difficulties due to its outdated framework and its fragmentation. All areas in which training is assessed (clinical experience, theoretical training and training in psychotherapy exhibited inadequacies and limited convergence with European golden standards, in the absence of a plan and the implementation of a national education curriculum. Certain university clinics constituted an important exception, though the bulk of the country's future psychiatrists were lagging behind in educational opportunities. Fifteen years later and under the weight of the consequences of the financial crisis, the institutional framework has not yet changed, and the overall situation seems to have worsened dramatically. Nevertheless, there are positive aspects to be evaluated, reinforced, and utilized in order to minimize the adverse effects of the economic crisis and lay sound foundations for the future. Preparations of a national framework is imperative today more than ever and initiatives to amend the legislation on medical specialties as far as it concerns the field of Psychiatry, could benefit from the evidence, from the willingness of the trainers and trainees concerned, as well as from the elaborated proposals of the Hellenic Psychiatric Association (HPA).

[Group psychoeducational intervention in relatives of patients suffering from schizophrenia].

The present research paper aims at assessing the effectiveness of a psychoeducational intervention in relatives' groups of patients with schizophrenia or schizoaffective disorder. It examines the possible influence of the intervention on family members as well as on the course of the patient illness. Of a total of 131 relatives, 83 consisted the experimental group and 48 the control group. The relatives of the experimental group were divided into 5 groups and attended 18 psychoeducational sessions. Their patients as well s the patients and the relatives of the control group attended no specific intervention and continued their routine care. The psychoeducational intervention included education about the illness, communication skills training and training in problem-solving. It combined educational and psychotherapeutic techniques. The psychometric tools administered were: The Family Burden Scale, The Family Rituals Scale, The General Health Questionnaire GHQ-28, the Center for Epidemiological studies - Depression Scale (CES-D), the Opinions about Mental Illness Scale OMI, two scales concerning the knowledge about the illness, two questionnaires concerning expectations and feedback about the group process and questionnaires regarding sociodemographic characteristics of the sample and information about the illness. The number of hospitalizations of patients (n=91) during the research year was investigated. An interaction between group and measurement was found. While patient hospitalizations of both research groups did not differ significantly at the year before the study with X2=0.54, p=0.46), they differed when measured a year after the intervention, where patients in the intervention group had statistically significant fewer hospitalizations compared to the patients in the control group (x2=4.58, significant at p=0.032). As to the "compliance" in the medication, two statistical tests were conducted, taking into consideration that "compliance" by patients starting with a "very good" one can't be improved, while by those beginning with poor compliance can't be worsened. In the first investigation, which involved patients with possibility of amelioration or deterioration of "compliance", an improvement of patients (n=12) in the intervention group was recorded. This finding is statistically significant (p=0.0005). The second statistical test included all patients who were giving as an initial reply for the 'compliance' any value below "very good". In the intervention group there were 32 patients, 14 of whom showed improved "compliance" during the research year. This change is statistically significant (p=0.0014). The findings verify that the participation of relatives in psychoeducational groups leads to statistically significant improvement in the course of patient illness, as evident by the reduction in hospitalization rates and the improvement in adherence to pharmacotherapy. The study shows that relatives' psychoeducation constitutes a useful tool in improving the course of illness and empowering the family. The widespread implementation of relatives' psychoeducation in Greece is both necessary and challenging.

History of leucotomies in Greece.

In order to present the social, scientific and institutional context which permitted the use of leucotomies in Greece, we have reviewed the Archives of the Medical Associations, the medical literature of the years 1946-56, a reader's dissertation and the memoirs of two psychiatrists. More than 250 leucotomies were done in the two public psychiatric hospitals in Athens from 1947 to 1954, as well as 40 leucotomies in the public psychiatric hospital in Thessaloniki. Although aware of the side effects, psychiatrists justified the use of the procedure. The performance of leucotomies in Greece declined because of reports of the dangers of the operation and its unpredictable outcome for the patients, but mainly because of the encouraging results with psychotropic drugs in the early 1950s.

Pseudologia fantastica à deux: review and case study.

While lying is a diachronic integral part of human interaction, pseudologia fantastica represents probably its psychopathological dimension. There are relatively few reported cases on psychological mechanisms of pathological lying and also on criteria concerning psychopathological development on a ground of lying. A review of literature on possible psychological mechanisms of pseudologia fantastica is presented. Psychopathological qualities are rather controversial, especially whether pathological lying is a conscious act or not. DSM IV-TR recognizes pseudologia fantastica in association with factitious disorder but not as a clinical entity. Diagnostic issues are raised regarding lying, deception, pseudology and its shared dimension. Cases of shared pseudology are rarely reported in literature. Related shared psychopathological phenomena such as pseudologia à deux, folie à deux and mass hysteria are equally examined and compared under the prism of 'mental infection'. Cases of pseudologia fantastica are poorly understood or underecognized and clinicians usually pay minor attention in its psychopathological significance. It remains doubtful, whether pathological lying should be considered as an autonomous clinical entity. The need for research both on phenomenology and pathophysiology is emphasized. In addition to reviewing literature, we also report a case of pseudology à deux in a couple, a female and a male patient. Presented psychopathological manifestations, personality characteristics, psychological and social factors concerning both patients are considered, aiming to determine a sufficient phenomenological analysis. The diagnoses of pseudologia fantastica and folie à deux are discussed and documented. A second axis diagnosis of personality disorder and other diagnostic issues are also considered. A favorable issue of this case, within a follow up of one year, is due to the therapeutic and social potential of a community psychiatry's setting, offering an individual follow up to both partners and a family approach including the ex husband of the female patient and her two minor children. The presented case focuses on a notably rare and controversial form of pathological lying, pseudologia fantastica à deux, and possible underlying mechanisms.

Holy fools: a religious phenomenon of extreme behaviour.

Monks in Byzantine times (330-1453 AD) often expressed their faith with extreme manifestations of behaviour, such as living on a high column (stylites), on a tree (dendrites) or in crowded urban centres of the empire pretending to be fools for Christ's sake. These Holy Fools exposed themselves to the ridicule and the mistreatment of the citizens, being protected, however, by their state of insanity to mock and violate moral codes and social conventions. The official Church barely tolerated these religious attitudes as promoting deviations from standard orthodoxy, and the Quinisext Ecumenical Council (592 AD) judged them as dangerous and formally denounced the phenomenon. The two most famous of them in Byzantium were Symeon of Emesa and Andrew of Constantinople, whose lives constitute unique testimonies to insanity and the simulation thereof. The survival and transplantation of the Holy Fools in Russia, called "yurodivye", where they met widespread acceptance, confirm their appeal in specific geographic areas and their endurance over time. We attempt to approach the symbolism of holy lunacy and to analyse the personality trends of these "eccentric" saints.

Suicidal behaviour in the ancient Greek and Roman world.

OBJECTIVE: We attempt to present and analyze suicidal behaviour in the ancient Greek and Roman world. METHODS: Drawing information from ancient Greek and Latin sources (History, Philosophy, Medicine, Literature, Visual Arts) we aim to point out psychological and social aspects of suicidal behaviour in antiquity. RESULTS: The shocking exposition of suicides reveals the zeitgeist of each era and illustrates the prevailing concepts. Social and legal reactions appear ambivalent, as they can oscillate from acceptance and interpretation of the act to punishment. In the history of these attitudes, we can observe continuities and breaches, reserving a special place in cases of mental disease. The delayed emergence of a generally accepted term for the voluntary exit from life (the term suicidium established during the 17th century), is connected to reactions triggered by the act of suicide than to the frequency and the extent of the phenomenon. CONCLUSIONS: The social environment of the person, who voluntary ends his life usually dictates the behaviour and historical evidence confirms the phenomenon.

Admissions in Dromokaition Psychiatric Hospital of Athens: 1901-1985.

Established in 1887, Dromokaition is the first psychiatric hospital in Athens. Information available for the profile of patients admitted to psychiatric hospitals in Greece, especially for the first half of the 20th century, is very scarce. The aim of the study is to point out the characteristics of patients admitted and the influence of European dominant views on mental diseases in Greek psychiatry. Data for 3014 patients (20% of total number) for the period 1901-1985 were obtained via systematic sampling. The data available were: entry date, gender, age, occupation, brief medical history. The 56 diagnoses have been classified into 9 groups. We have used descriptive statistical methods, two-way associations, odds ratios and cluster analysis, permitting to point out the main characteristics of admitted patients. The preponderance of male admissions in the first decades of the 20th century has been progressively balanced out. About a half of total admissions were schizophrenia-related. The percentage of male patients was significantly higher in personality disorders; for major affective disorders and neuroses the opposite occurs. Progressive paralysis of the insane, a frequent diagnosis in the first decades of the 20th century becomes rare thereafter. In conclusion social changes, major historical events and the evolution of views on psychiatric care have left their traces in the profile of patients admitted.

Evaluation of dangerousness of Greek mental patients.

There is a diachronic interest on the evaluation of the risk of violence by mental patients.Difficulties that have been underlined concern the definition of the term dangerousness and the different methods of approaching it. Accurate risk assessments are particularly important for psychiatric patients, with history of violence, in indoor care. The accuracy of predictions can better determine the patients designated as "at risk" for violence and avoid false designations. The aim of this study was to investigate the probability of patients, from several psychiatric units, to become violent after their discharge and over the next three years. We also investigate the predictive validity and accuracy of the HCR-20 in relation to post-discharge outcomes. Two hundred ninety five (295) psychiatric patients, from several psychiatric units, were assessed with the HCR-20, PCL: SV and GAF scales at discharge (using case file data, interviews with the patients and the clinicians of the units, and also information from the collateral informants) and were monitored for violent episodes over the following three years. The study was conducted in two phases: 1st phase: During the last week before discharge. 2nd phase: Every six months, over the following three years. Both the HCR-20 and PCL: SV scales and their subscales are significant predictors of readmission, suicide attempts and violent behavior. The GAF scale had a low positive correlation with the HCR-20 scale. A number of other variables such as duration of hospitalization, previous violent acts, diagnosis, gender, marital status, socioeconomic status, number of previous hospitalizations, were statistically related with failure of re-integration in the community. The results provide a strong evidence base that the HCR-20 is a good predictor of violent behavior in psychiatric patients, following their discharge from psychiatric wards in Greece, and hence can be used by clinicians in routine clinical practice.

[Depression and anxiety in mothers of children who grow up in an area with industrial pollution].

This study aimed to investigate the effects of chemical pollution with hexavalent chromium on the mental health of mothers with school/pre-school age children, residents of the area of the Asopos basin in Eastern Central Greece. The people of this area have been experiencing great threat regarding their health each and every day, as a result of the well-documented pollution by hexavalent chromium in drinking and ground-water, which is related to the widespread industrial activity, the usage of hexavalent chromium in various processes and the discharges of Cr-bearing wastes. The environmental impact of hexavalent chromium is a controversial issue critical to the protection of groundwater resources, as it affects the soil and the products from local cultivations used in daily food. This condition has been documented scientifically and was published in the mass media as a serious threat to human and animal life in the specific area. Although in Greece serious environmental-technological disasters have occurred during the last decades, there is a lack of studies on the possible consequences, including the psychological impact on the local population. The sample of this study included eighty-eight mothers of young children, residents of the area of Asopos, who were compared with eighty-eight mothers living in a non-polluted area - the area of Kiato in Northern Peloponnese, as a control group. They were assessed by the CES-D scale and the Spielberger State-Trait Anxiety Scale (STAI I-II), which have been standardized for the Greek population. Results indicated that depression and anxiety were significantly correlated with the place of residence [CES-D: t(169,496)=3.45, p=0.001; STAI I-II: A-state: t(174)=10,131, p=0.000; A-trait: t(174)=8,728, p=0.000]. Mothers from the Asopos basin reported more symptoms of depression (Mean=24,14, SD=11,345) than the control group (Mean=18,68, SD=9,625). Similarly, they have scored higher in both subscales of STAI I-II, measuring state and trait anxiety (A-state: Mean=49,66, SD=12,345; A-trait: Mean=46,76, SD=11,458) than the control group (A-state: Mean=32,24, SD=10,383; A-trait: Mean=32,32, SD=10,474). Regarding the anxiety as a personality trait (STAI-II), mothers in Asopos Area reported higher levels of stress that is likely to be associated with the long-term stressful situation of pollution. It could be assumed that mothers from Asopos Area scored higher in both anxiety scales, as a result of the environmental disaster that has been occurred in the area and the high risk that this poses to life. These results confirm relevant literature findings on depression and feelings of anger in regions that have suffered industrial or physical disasters, and suggest that fighting against chemical pollution in Asopos area also needs additional implementation with psychological support to mothers of children growing in the area. Up to date, no psychosocial support has been provided to the residents at the community level. Further research should be carried out in order to measure the impact of chemical pollution on the psychological well-being and health of all members of the local community.

A study of acculturation in psychotic and non-psychotic immigrants living in Athens.

BACKGROUND: Acculturation is the phenomenon that results when a group with one culture comes into continuous contact with a host culture. AIMS: To investigate the correlation between acculturation and psychotic symptomatology in a group of immigrants suffering from psychosis and to explore differences in demographic factors related with the acculturation process between individuals with and without psychosis. METHODS: Sixty-five patients and 317 non-psychotic immigrants were interviewed using the Immigrant Acculturation Scale (IAS) and a structured questionnaire for demographic data. The Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Global Assessment of Functioning (GAF) were also administered to all immigrants suffering from psychosis. RESULTS: Total IAS scores, as well as IAS everyday life scores, were positively correlated with GAF scores. IAS everyday life score in the patient group related with religion, marital status, gender and years in Greece, while in the non-psychosis group it was related with gender and years in Greece. IAS wishful orientation/nostos (the strong desire for one's homeland) related with religion in both groups. The IAS identity in the psychosis group did not show any significant relation with any of the variables, while in the non-patient group, it was related with marital status, gender and years in Greece. Age, duration of residence in Greece and higher adoption of Greek ethnic identity were the variables that differentiated the two groups of immigrants. CONCLUSION: Acculturation in immigrants suffering from psychosis could be seen as a process that does not correlate strongly with the severity of the symptomatology but is probably influenced by different set of factors.

[Ultra-short questionnaires for the detection of depression and anxiety].

Depression and anxiety disorders are the two most common mental health problems seen in the primary care and the general hospital settings. They are both associated with poorer patient functioning, worse quality of life, more frequent utilization of health services, and higher health care costs. However, detection rates of depression and anxiety by non-mental health specialists remain very low, while most of the proposed screening tools are rather not practical and therefore they have not been widely used in practice. Over the last two decades, ultra-short tools including one to three questions have been developed and suggested as case-finding methods and their sensitivity and specificity have been investigated. We reviewed all the ultra-short screening tools for depression and anxiety and the existing evidence on their accuracy in detecting major depression and anxiety disorders. Two simple screening questions for depression, about depressed mood and loss of interest or pleasure in doing things, have been repeatedly applied in primary care settings and found to have satisfactory sensitivity but low specificity. The addition of a third question inquiring if help is needed to the two screening questions for depression improves the specificity, however on the cost of reducing the sensitivity of the method. Screening for depression using only one of these questions alone was found to be less accurate strategy than the two or three question tests. The Patient Health Questionnaire-2 (PHQ-2) includes the same two depression-questions with rating scale answer choices and it was found to be more accurate than the two question test with dichotomous (yes or no) answers. Ultra-short screening strategies for depression in older people were found to have acceptable levels of accuracy, while in patients with cancer the two question tests had higher sensitivity and specificity than in other patient groups. According to the existing data, the Generalized Anxiety Disorder-2 (GAD-2) questionnaire, which includes two questions on "feeling nervous, anxious or on edge" and "not being able to stop or control worrying" appears to have acceptable accuracy in identifying clinically significant anxiety. We concluded that there is sufficient evidence on the suitability of the ultra-short screening instruments for depression and anxiety -especially the PHQ-2, the GAD-2 and their combination, the PHQ-4- for use in epidemiological studies. In primary and secondary care settings, the ultra-short tools can be used only as an initial screening method but diagnosis made by specially-trained clinicians or mental health specialists is warranted for patients who initially screen positive.

[Mental disease in two classical music composers].

A study οn two neglected classical music composers suffering a not syphilitic mental disease, is attempted here, syphilis of the central nervous system being frequent in that time. A brief overview on the psychiatric ailments of many great composers reveals suicide attempts and more or less severe depression following external events. The issue of a possible relationship between mental disease and (musical) creativity can be discussed, as mood swings and a certain tendency to melancholia are frequent features of a talented brain (a fact that can also be detected in their works). The first case presented here is Hans Rott from Austria, the beloved student of Anton Bruckner, who was considered to be at least equal to his famous classmate Gustav Mahler. The great expectations of his teacher and his friends suddenly came to an end, when he suffered a crisis of schizophrenia and was hospitalized in an insane asylum in Lower Austria. The tragic psychiatric adventure of the young musician lasted almost four years. He was diagnosed as a case of "hallucinatory insanity" and "persecution mania" by the medical staff, before dying of tuberculosis, aged only 26, and having completed only one symphony and several smaller works. His name came again on surface only a century after his death, when in 1989 his Symphony in E Major was discovered and premiered with great success, permitting to its creator a posthumous recognition, among Bruckner and Mahler. The second case of mental illness is that of the Armenian Komitas Vardapet. He was an orphan who grew up in theological schools and became a monk and later a priest, though he spent some years in Berlin in order to develop his musical skills. He is considered to be an authority of Armenian ecclesiastic music, introducing polyphony in the Armenian Church's music and collecting numerous traditional songs from all parts of Armenia. In 1915, during the Armenian genocide he was deported, tortured but finally saved, due to interventions of influential friends and politicians. His mental health was destabilized and he spent almost 20 years in psychiatric hospitals in France. He never recovered from a mental disease, whose cause is still debated, as some researchers do not admit its schizophrenic character and consider it as a severe post traumatic syndrome. The issue of a mental disease in relation to artistic creation is discussed, especially concerning biographies and mental diseases of these two gifted but strangely forgotten music composers.