Hypothalamus-pituitary-adrenal (HPA) axis parameters and neurocognitive evaluation in patients with bipolar disorder.

Bipolar disorder is associated with neurocognitive impairment but the etiology of such impairment remains largely unknown. The present study aimed at investigating the performance of bipolar patients in various neuropsychological tasks within the framework of HPA axis hyperactivity model and also the impact of disease characteristics on neuropsychological functioning. Cognitive performance of 60 bipolar-I patients and 30 healthy controls was evaluated by using tasks from the CANTAB battery targeting visual memory, executive function and inhibitory control. Current symptoms were evaluated via administration of the Hamilton Depression Rating Scale (HAMD) and Young Mania Rating Scale (YMRS) whereas assessment of functioning was performed with the Global Assessment of Functioning (GAF). Basal cortisol levels were determined and all patients were administered the Dexamethasone Suppression Test (DST). Statistically significant differences between patients and controls were found in visuo-spatial associative learning and memory, planning, attentional set shifting and inhibitory control. Worse performance in visuospatial associative memory correlated with longer duration of illness and higher levels of basal cortisol. Poorer attentional set shifting was related to higher number of manic episodes. We found no relationship of neurocognitive measures with DST suppression status, current symptom severity or history of psychosis. The results of our study confirm the presence of cognitive deficits in bipolar disorder and provide evidence on the relation of cortisol with neuropsychological functioning, especially visuo-spatial associative memory. Moreover, we have found that number of previous manic episodes and duration of illness is associated with worse cognitive performance. It is known that neurocognitive deficits are evident in many patients with bipolar disorder. These deficits are often a cause of considerable distress and can lead to impairment of psychosocial and occupational functioning. The role of HPA axis needs to be further examined in bipolar disorder. Nevertheless, the identification of factors affecting neurocognitive functioning, like basal cortisol and number of manic episodes, may contribute to the implementation of more appropriate prevention strategies.

Psychometric properties of WHOQOL-BREF in clinical and health Greek populations: incorporating new culture-relevant items.

Τhe present study examines main psychometric properties of the World Health Organisation (WHO) quality of life (QoL) instrument, the WHOQOL-BREF with the inclusion of four national items. Participants were 425 adult native Greek speaking, grouped into patients with physical disorders, psychiatric disorders and healthy individuals. Participants were administered WHOQOL-BREF and 23 national items, the General Health Questionnaire (GHQ-28) and the Life Satisfaction Index (LSI). Confirmatory factor analysis produced acceptable fit values for the original model of 26 items within the four WHOQOL domains: physical health, psychological health, social relationships and environment. Testing for the fit of national items within this model, the results indicated four new items with the most satisfactory fit indices and were thus included forming a 30-items version. The national items refer to: (a) nutrition, (b) satisfaction with work (both loaded in the physical health domain), (c) home life and (d) social life (both loaded in the social relationships domain). Statistical tests were applied to the 26- and 30-items versions producing satisfactory results, with the 30-items version showing slightly better values. Furthermore, results on the 30-items version included: (a) internal consistency, which was found satisfactory, with alpha values ranging from α=0.67-0.81, while the inclusion of new items produced higher alpha values in physical health and social relationships domains, (b) construct validity with good item-domain correlations, as well as strong correlations between domain scores, (c) convergent validity, which was very satisfactory, showing good correlations with GHQ-28 and LSI, (d) discriminant validity, showing instrument's ability to detect QoL differences between healthy and unhealthy participants, and between physically ill and psychiatric patients, and (e) test-retest reliability, with ICC scores in excess of 0.80 obtaining for all domains. The WHOQOL-BREF Greek version was found to perform well with sick and healthy participants, demonstrating satisfactory psychometric properties. Use of the instrument may be recommended for clinical and general populations, for service or intervention evaluation, as well as for cross-cultural clinical trials.

Time-frequency analysis methods to quantify the time-varying microstructure of sleep EEG spindles: possibility for dementia biomarkers?

The time-varying microstructure of sleep EEG spindles may have clinical significance in dementia studies and can be quantified with a number of techniques. In this paper, real and simulated sleep spindles were regarded as AM/FM signals modeled by six parameters that define the instantaneous envelope (IE) and instantaneous frequency (IF) waveforms for a sleep spindle. These parameters were estimated using four different methods, namely the Hilbert transform (HT), complex demodulation (CD), matching pursuit (MP) and wavelet transform (WT). The average error in estimating these parameters was lowest for HT, higher but still less than 10% for CD and MP, and highest (greater than 10%) for WT. The signal distortion induced by the use of a given method was greatest in the case of HT and MP. These two techniques would necessitate the removal of about 0.4s from the spindle data, which is an important limitation for the case of spindles with duration less than 1s. Although the CD method may lead to a higher error than HT and MP, it requires a removal of only about 0.23s of data. An application of this sleep spindle parameterization via the CD method is proposed, in search of efficient EEG-based biomarkers in dementia. Preliminary results indicate that the proposed parameterization may be promising, since it can quantify specific differences in IE and IF characteristics between sleep spindles from dementia subjects and those from aged controls.

Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: investigating differences in early and later years of current treatment.

BACKGROUND: The study examines differences regarding quality of life (QoL), mental health and illness beliefs between in-centre haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD/PD) patients. Differences are examined between patients who recently commenced treatment compared to patients on long term treatment. METHODS: 144 End-Stage Renal Disease (ESRD) patients were recruited from three treatment units, of which 135 provided full data on the variables studied. Patients consisted of: a) 77 in-centre haemodialysis (HD) and 58 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, all currently being treated by dialysis for varied length of time. Patients were compared for differences after being grouped into those who recently commenced treatment (< 4 years) and those on long term treatment (> 4 years). Next, cases were selected as to form two equivalent groups of HD and CAPD/PD patients in terms of length of treatment and sociodemographic variables. The groups consisted of: a) 41 in-centre haemodialysis (HD) and b) 48 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, fitting the selection criteria of recent commencement of treatment and similar sociodemographic characteristics. Patient-reported assessments included: WHOQOL-BREF, GHQ-28 and the MHLC, which is a health locus of control inventory. RESULTS: Differences in mean scores were mainly observed in the HD patients with > 4 years of treatment, providing lower mean scores in the QoL domains of physical health, social relationships and environment, as well as in overall mental health. Differences in CAPD/PD groups, between those in early and those in later years of treatment, were not found to be large and significant. Concerning the analysis on equivalent groups derived from selection of cases, HD patients indicated significantly lower mean scores in the QoL domain of environment and higher scores in the GHQ-28 subscales of anxiety/insomnia and severe depression, indicating more symptoms in these areas of mental health. With regards to illness beliefs, HD patients who recently commenced treatment provided higher mean scores in the dimension of internal health locus of control, while CAPD/PD patients on long term treatment indicated higher mean scores in the dimension of chance. Regarding differences in health beliefs between equivalent groups of HD and CAPD/PD patients, HD patients focused more on the dimension of internal health locus of control. CONCLUSION: The results provide evidence that patients in HD treatment modality, particularly those with many years of treatment, were experiencing a more compromised QoL in comparison to CAPD/PD patients.

Sleep position and laterality of benign paroxysmal positional vertigo.

OBJECTIVE: The aim of this study was to investigate the frequency of posterior semicircular canal benign paroxysmal positional vertigo in each ear, and to assess the association between the ear affected by benign paroxysmal positional vertigo and the head-lying side during sleep onset. Based on a previous study which used objective methods to prove the preference of the elderly for the right head-lying side during sleep, we hypothesised that a predominance of the same head-lying side in benign paroxysmal positional vertigo patients may affect the pathophysiology of otoconia displacement. STUDY DESIGN: We conducted a prospective study of out-patients with posterior semicircular canal benign paroxysmal positional vertigo, confirmed by a positive Dix-Hallpike test. METHODS: One hundred and forty-two patients with posterior semicircular canal benign paroxysmal positional vertigo were interviewed about their past medical history, focusing on factors predisposing to benign paroxysmal positional vertigo. All patients included in the study were able to define a predominant, favourite head-lying side, right or left, during sleep onset. RESULTS: The Dix-Hallpike test was found to be positive on the right side in 82 patients and positive on the left side in 54; six patients were found to be positive bilaterally. During sleep onset, 97 patients habitually laid their head on the right side and the remaining 45 laid their head on the left. The association between the affected ear and the head-lying side during sleep onset was statistically significant (p < 0.001). CONCLUSIONS: Our study found a predominance of right-sided benign paroxysmal positional vertigo, a subjective preference amongst patients for a right head-lying position during sleep onset, and an association between the ear affected by benign paroxysmal positional vertigo and the preferred head-lying side during sleep onset. The clinical and therapeutical implications of this observation are discussed.

[A study of irritability in menopausal women].

Despite the fact that irritability is frequently the main presenting complaint of perimenopausal and postmenopausal women, studies specifically researching irritability in this population are scant. One hundred sixty three (163) peri- and postmenopausal women non-HT users, attending a menopause clinic, were included in this cross-sectional study. The investigation focused on whether the occurrence of inward and outward irritability in menopause is associated with various menopausal parameters, such as vasomotor symptoms, insomnia, menopausal status, hormone levels, and with the presence of chronic disease. Furthermore, we examined the possible association of inward and outward irritability with measures of anxiety and depression. Outward and inward irritability of peri- and postmenopausal women seem to be related to chronic disease, a factor that may be partially influenced by the older age of menopausal women. Outwardly directed irritability is found to be related to FSH and LH levels, independently of specific menopausal symptoms, such as vasomotor symptoms or insomnia. Outward irritability was found to be positively correlated with depressive symptomatology, whereas inward irritability correlated with both anxiety and higher depressive symptomatology.

[Habits and problems of sleep in adolescent students].

The evaluation of sleep habits and sleep related problems in high school adolescent students in the Athens area and the assessment of these problems' relation to demographic and other variables was investigated by the Athens Insomnia Scale - 5 item version (AIS-5), which was administered to 713 adolescent Senior High School students in the Greater Athens Area. Data such as age, sex, school records, and time spent per week in school-related and extracurricular activities were collected. The sample's mean sleep duration was 7,5 hours, mean bedtime 12:20 am and wake-up time 7:15 am. Total sleep time was not affected by gender, but was influenced by time spent in various activities. Sleep complaints were related to delayed sleep, onset latency and insufficient total duration of sleep. Girls complained more than boys, while correlations showed that students with lower academic per formance and those in second grade were more likely to have higher AIS-5 scores. The results show that sleep time of high school students is dependent on practical matters such as school schedule and other activities, while sleep complaints are related to female gender, bad school performance as well as to the second grade. The difference between actual sleep time and sleep complaints should be considered when studying the sleep of adolescents.

Potential dementia biomarkers based on the time-varying microstructure of sleep EEG spindles.

The time-varying microstructure of sleep EEG spindles may have clinical significance in dementia studies. In this work, the sleep spindle is modeled as an AM-FM signal and parameterized in terms of six parameters, three quantifying the instantaneous envelope (IE) and three quantifying the instantaneous frequency (IF) of the spindle model. The IE and IF waveforms of sleep spindles from patients with dementia and normal controls were estimated using the time-frequency technique of Complex Demodulation (CD). Sinusoidal curve-fitting using a matching pursuit (MP) approach was applied to the IE and IF waveforms for the estimation of the six model parameters. Specific differences were found in sleep spindle instantaneous frequency dynamics between spindles from dementia subjects and spindles from controls.

Sublingual use of olanzapine in combination with alprazolam to treat agitation in a terminally ill patient receiving parenteral nutrition.

This paper reports the case of a 64-year-old man who was receiving parenteral nutrition after repeated operations due to stomach cancer. Olanzapine (orally disintegrating tablets) in combination with alprazolam was used successfully to relieve this terminally ill patient's anxiety and tension improving his relationship with his physicians and his daily life.

Detecting changes in quality of life and psychiatric symptomatology following an in-patient detoxification programme for alcohol-dependent individuals: the use of WHOQOL-100.

The present study examines quality of life (QoL) and psychiatric symptomatology prior to and upon completion of a 5-week in-patient detoxification programme with the aim to identify any changes produced following clinical intervention. A group of 46 alcohol-dependent individuals, who were consecutively admitted for detoxification in the Psychiatric Hospital of the University of Athens, were clinically-assessed at admission and just before discharge with DSM-IV, CIDI-WHO and with the Hamilton Depression and Anxiety Scales (HDRS, HARS) and the Global Assessment Scale (GAS) for depression, anxiety and overall functioning, respectively. In addition, the patients were invited to complete the World Health Organization Quality of Life WHOQOL-100 instrument. Differences between admission and discharge scores were examined using related sample t-tests. Correlations between the WHOQOL-100 scores and clinically-assessed symptomatology measures were performed. Regression analysis was conducted to investigate the correlation of clinical and socio-demographic variables with patient overall QoL. The results indicate that QoL scores increased at discharge in 16 out of the 24 WHOQOL-100 facets. In addition, patient-assessed status of health was significantly improved. Improvement was also observed in the symptomatology scales rated by the clinician, providing evidence for lower levels of depression, anxiety and a higher level of functioning. Moderate correlations were found between WHOQOL-100 domains and psychiatric symptomatology scales. Significant WHOQOL-100 gains at discharge and clinically-assessed improvement in the HDRS, HARS and GAS, provide evidence of the WHOQOL-100 instrument's sensitivity to changes in clinical condition. The WHOQOL-100 measurement may be suitable for detecting QoL deficits or therapeutic gains in alcohol-dependent patients and may prove useful to mental health professionals for treatment planning.

Set shifting deficits in melancholic vs. non-melancholic depression: preliminary findings.

Twenty-two patients with major depressive disorder, 11 of them with melancholic features, and 11 controls were investigated with CANTAB subtests focusing in visual memory/learning and executive functions. Melancholic patients performed worse than the other groups in all tasks and manifested a significant impairment in set shifting. The results are discussed in association with prefrontal dysfunction.

Hip dysplasia following a case of olanzapine exposed pregnancy: a questionable association.

This is a case report of a 33 year old woman with a history of psychosis, who presented to the women's mental health clinic for consultation at the 12(th) week of gestation, having already received olanzapine throughout the first trimester. She was followed from that point on at our clinic and remained on small doses of olanzapine for the rest of her pregnancy, which was uncomplicated. She gave birth to a healthy female, which at the age of three months was diagnosed with developmental dysplasia of the hip and subsequently received appropriate treatment with favorable outcome. The possibility of the association of this congenital dysplasia with the use of olanzapine during pregnancy is further discussed in this paper.

Switching to amisulpride monotherapy for treatment-resistant schizophrenia.

The objective of this study was to assess switching to amisulpride (AMS) in treatment-resistant schizophrenia. Seven male subjects were switched to AMS and followed for 8 weeks. PANSS scores improved from 123 to 66 over this period. We conclude that AMS is of interest in the treatment of refractory schizophrenia.

Modeling the time-varying microstructure of simulated sleep EEG spindles using time-frequency analysis methods.

The time-varying microstructure of sleep spindles may have clinical significance and can be quantified and modeled with a number of techniques. In this paper, sleep spindles were regarded as AM-FM signals modeled by six parameters. The instantaneous envelope (IE) and instantaneous frequency (IF) waveforms were estimated using four different methods, namely Hilbert Transform (HT), Complex Demodulation (CD), Wavelet Transform (WT) and Matching Pursuit (MP). The six model parameters were subsequently estimated from the IE and IF waveforms. The average error, taking into account the error for each model parameter, was lowest for HT, higher but still less than 10% for CD and MP, and highest (greater than 10%) for WT, for three different spindle model examples. The amount of distortion induced by the use of a given method is also important; distortion was the greatest (0.4 sec) in the case of HT. Therefore, in the case of real spindles, one could utilize CD and MP and, if the spindle duration is more than 1 sec, HT as well.

Identifying Differences in the P600 Component of ERP-Signals between OCD Patients and Controls Employing a PNN-based Majority Vote Classification Scheme.

In the present study an attempt was made to focus in the differences between Obsessive-Compulsive Disorder (OCD) patients and healthy controls, as reflected by the P600 component of event-related potential (ERP) signals, to locate brain areas that may be related to Working Memory (WM) deficits. Neuropsychological research has yielded contradicting results regarding WM in OCD. Eighteen patients with OCD symptomatology and 20 normal controls (age and sex matched) were subjected to a computerized version of the digit span Wechsler test. EEG activity was recorded from 15 scalp electrodes (leads). A dedicated computer software was developed to read the ERP signals and to calculate features related to the ERP P600 component (500-800 ms). Nineteen features were generated, from each ERP-signal and each lead, and were employed in the design of the Probabilistic Neural Network (PNN) classifier. Highest single-lead precision (86.8%) was found at the Fp2 and C6 leads. When the output from all single-lead PNN classifiers fed a Majority Vote Engine (MVE), the system classified correctly all subjects, providing a powerful classification scheme. Findings indicated that OCD patients differed from normal controls at the prefrontal and temporo-central brain regions.

Protracted acute stress reaction following an earthquake.

OBJECTIVE: To verify the official criteria of ICD-10 diagnosis of acute stress reaction (ASR) among earthquake victims. METHOD: Data on psychosocial variables and the diagnosis of ASR were collected from 91 subjects. RESULTS: The diagnosis of ASR was made in 70% of the sample. However, the restrictive duration criterion (i.e. symptoms not exceeding the first 48 h) was fulfilled only in 10%; in the remaining 60% the symptoms lasted for about another week. Thus, 60% of the sample constituted a group with protracted ASR (PASR) and 40% a group without it (n-PASR). Medical history was more frequent among PASR than n-PASR; PASR showed higher anxiety levels (both pre- and post-disaster) than n-PASR; finally, the persistence of ASR related positively to the fear of death at the time of the earthquake and pre-disaster anxiety levels. CONCLUSION: As in the vast majority of earthquake victims the ASR is protracted beyond 48 h, a revision of ICD-10 guidelines should be considered.

Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria.

OBJECTIVES: To describe and validate the Athens Insomnia Scale (AIS). METHODS: The AIS is a self-assessment psychometric instrument designed for quantifying sleep difficulty based on the ICD-10 criteria. It consists of eight items: the first five pertain to sleep induction, awakenings during the night, final awakening, total sleep duration, and sleep quality; while the last three refer to well-being, functioning capacity, and sleepiness during the day. Either the entire eight-item scale (AIS-8) or the brief five-item version (AIS-5), which contains only the first five items, can be utilized. The validation of the AIS was based on its administration to 299 subjects: 105 primary insomniacs, 144 psychiatric patients and 50 non-patient controls. RESULTS: Regarding internal consistency, for both versions of the scale, the Cronbach's alpha was around 0. 90 and the mean item-total correlation coefficient was about 0.70. Moreover, in the factor analysis, the scale emerged as a sole component. The test-retest reliability correlation coefficient was found almost 0.90 at a 1-week interval. As far as external validity is concerned, the correlations of the AIS-8 and AIS-5 with the Sleep Problems Scale were 0.90 and 0.85, respectively. CONCLUSION: The high measures of consistency, reliability, and validity of the AIS make it an invaluable tool in sleep research and clinical practice.

Sleep spindle incidence dynamics: a pilot study based on a Markovian analysis.

Results are reported, based on 5 healthy subjects, concerning patterns in the dynamics of the sequential arrangement of spindles in human stage 2 sleep. Specifically, the conditional probability of incidence of successive spindle lengths and successive inter-spindle intervals is investigated. The results show that successive spindle lengths may be statistically independent. However, their distribution (histogram) may be similar for two different stage 2 periods, one in the first third and another in the second third of the night sleep record. In contrast to the finding about spindle lengths, results show that successive inter-spindle intervals may not be statistically independent. Furthermore, the overall dynamics of the sequential arrangement of inter-spindle intervals may be similar for the two sleep periods. These findings are discussed in the context of the "sleep maintenance" role of spindles.