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

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

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

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

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

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

Depression and atherosclerosis.

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

Insomnia symptoms among Greek adolescent students with excessive computer use.

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

[The role of immune system in depression].

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

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

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

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

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

Psychiatric factors in patients with sensitive skin.

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

Hierarchical arrangement of psychiatric symptoms in the context of schizophrenia.

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

Psychiatric symptoms associated with scleroderma.

BACKGROUND: The prevalence of psychiatric symptoms and hostility factors in patients with scleroderma, although a matter of clinical interest, it is rather poorly studied. METHODS: Thirty female patients with scleroderma were investigated. Thirty-three healthy women were used as a comparison group. The applied psychometric instruments were the Hostility and Direction of Hostility Questionnaire (HDHQ), the Delusions Symptoms States Inventory/states of Anxiety and Depression (DSSI/sAD) and the Symptom Check List-90R (SCL-90R). RESULTS: The scleroderma patients reported significantly increased depression and anxiety, somatization, interpersonal sensitivity and obsessive-compulsiveness. Paranoid ideation and psychotic symptoms scores were also increased. On hostility, they presented significantly higher scores predominantly on guilt. CONCLUSIONS: Psychiatric symptomatology in the form of anxiety, depression, obsessive-compulsiveness, somatization and feelings of guilt were reported by the majority of the patients with scleroderma.

Mental symptoms, hostility features and stressful life events in people with cancer.

Hostility features, mental symptoms, and stressful life events were investigated in 100 patients (59 men and 41 women) suffering from cancer. Fifty-seven healthy men (n = 26) and women (n = 31) were used for comparison purposes. The assessment instruments were the Hostility and Direction of Hostility Questionnaire, the Delusions Symptoms States Inventory/states of anxiety and depression and a modified version of the Schedule of Life Experiences. Women patients reported lower scores than healthy women on total hostility, but men patients reported higher scores than healthy men. Introverted hostility was increased in both male and female patients, but due to different patterns: in women due to lower scores on extroverted hostility subscales, especially acting-out hostility, whereas in men due to higher scores on introverted hostility subscales, especially guilt. Female patients, compared with healthy women, reported significantly higher scores on the depressive and anxiety subscales, whereas in the man the differences were not statistically significant even though patients reported higher scores than normals. On the Schedule of Life Experiences, female patients reported statistically significant higher scores than healthy women.

Personality structure disturbances and psychiatric manifestations in primary Sjögren's syndrome.

It has been recently suggested that primary Sjögren's syndrome (SS) patients present with a variety of personality structure disturbances and psychiatric symptoms. To evaluate this finding further, we assessed hostility structure and psychiatric symptoms in 33 Sjögren's syndrome patients and compared the results with those of 33 healthy women, and 41 women with solid malignant tumors. The utilized psychometric instruments were the hostility and direction of hostility questionnaire (HDHQ) and the symptom checklist 90R (SCL-90R). High levels of introverted hostility were reported by SS patients in relation to the other two groups. Cancer and SS patients reported higher scores on anxiety and depressive symptoms compared to the healthy women, but the differences were not significant. In addition, high scores on paranoid ideation, somatization and obsessive compulsive symptoms were found in SS patients compared to the cancer and healthy controls. The results strongly suggest that psychiatric disorders are common in primary SS patients, who may need appropriate therapy.

Neuropsychiatric abnormalities in primary Sjögren's syndrome.

Neuropsychiatric abnormalities were searched for in 52 patients with primary Sjögren's syndrome (SS). 40 patients were evaluated with a detailed neurologic history and physical examination and determination of terminal latencies and nerve conduction velocities of all limbs. Nineteen of them, plus another 12 primary SS patients were evaluated for hostility structure and psychiatric symptoms, using the Hostility and Direction of Hostility Questionnaire (HDHQ) and the Symptoms Check List-90R (SCL-90R) respectively and the results were compared with those of 33 healthy women and 41 cancer patients. Three patients had face numbness and/or hypesthesia indicating trigeminal involvement. Ten had mild sensory or mixed neuropathy of the glove-stocking type. None of our patients volunteered peripheral nervous system (PNS) symptoms nor did we detect central nervous system (CNS) involvement in any of them. One patient with purpura, glomerulonephritis and cryoglobulinemia presented with severe mononeuritis multiplex. High levels of introverted hostility were reported by SS patients in relation to the other two groups. In addition, higher scores on paranoid ideation, somatization and obsessive compulsiveness were found in SS patients compared to the rest but no correlation was found between psychiatric symptomatology and neurologic abnormalities. It is suggested that PNS disease is relatively common and benign in most primary SS patients, psychiatric disorders, sometimes serious, are also common, but CNS involvement must be rather rare.