Conceptual controversies regarding the terms Gender and Sex.

I have been following lately the debate that has emerged in the Greek and International literature regarding the terms "sex" and "gender". Traditionally, the term sex refers to the assignment of gender at birth by the obstetrician or the midwife, based on the external genitalia. They declared the sex of the newly born baby as male or female, without any other graduation. Therefore, the term sex is a nonflexible categorical concept. It is quite difficult to comprehend the sense of "a little bit male" or "a little bit female", as it is not possible to comprehend the sense of "a little bit pregnant". At the preface of the DSM-5, the American Psychiatric Association presents its intention to propose the new dimensional classification of psychiatric symptoms, based on the rationale that the present categorical system does not apply to clinical and research needs.1 In that case, it would be difficult (if not impossible), to achieve the graduation of the term "sex", which refers to the biological definition. Therefore, in my opinion, there is a trend to bring back the term "gender", where a graduation is feasible, and dimensions can be applied. The term gender contains the social definition of reproductive behavior, which can be detached from the reproductive role per se. The term "gender" was recalled in 1955 by the well-known author J. Money, in order to indicate the social effect on the development of the behavior of "sex", and therefore he used at the beginning the term G-I/R, which refers to Gender Identity Role.2 The short term "gender", that derived from the abovementioned term, came up the recent years and was widely used, putting aside the clearly biologic, non-flexible term "sex".3 The term "gender" spread in the literature, especially when it was adopted by the women rights' movement (feminism), in order to highlight the "socially constructed" differences between the two sexes. The term "gender" has given ground to the proposal of several graduations of sexual behavior. Zucker et al at in a recent article report ten different gender behaviors such as agender, gender nonconforming, gender neutral, gender variant, gender queer, gender dysphoria, gender fluid, bigender, nonbinary, transgender.4 Several of these identities overlap considerably. In the Greek language, the use of the terms gender and sex (male, female) may lead to confusion, since they are attributed by the same term «φύλο¼. Additionally, the use of the term "gender" in Greek as «Î³Î­νος¼ may also lead to misunderstandings and misconceptions, as it happened lately with the law regarding the name change in the identification card (ID) of people with gender dysphoria. Actually, the latter term refers to masculinity or femininity, as these are configured by the social background. In my opinion, in the Greek language it would be better to use the term "gender" referring to its social delineation, meaning "social sex", social sex identity. The term "gender dysphoria" could be attributed as «Î´υσφορία γένους¼, in order to distance itself from the dysphoria caused by dysplasias of genitalia which are refered to in the literature as "intersexual disorders" and could be referred to as "disorders of the development of genitalia".

Factor structure and psychometric properties of the Greek version of Saving Inventory-Revised (SI-R) in a non-clinical sample.

Hoarding disorder is a debilitating condition that results from difficulty or inability to discard possessions and the need to save items and leads to cluttered living space. It impedes normal everyday functioning and causes significant distress and dysfunction. The aim of the current study was to validate the Greek version of the Saving Inventory-Revised (SI-R) in a non-clinical sample of 554 Greek adults. Factor structure and psychometric properties were investigated. Common exploratory (EFA) and confirmatory factor analysis (CFA) were used to explore the factor structure of the data. A three-factor solution was emerged for the Greek SI-R Which appears to cover the clinical dimensions of the phenomenon and consists of clutter, difficulty discarding and acquisition dimensions. This finding is in accordance with the original English version as well as other adaptations of the instrument in other languages. Some items cross loaded but such findings of cross loading items are also reported in related literature. The Greek version of the SI-R exhibits satisfactory internal consistency and good test retest reliability (stability). The current study also aimed to gather evidence towards the convergent and discriminant validity of Greek SI-R. Findings showed no correlation with measurements of different constructs such as anxiety, depression and non-hoarding obsessive compulsive symptoms but also only partial correlation with measurements of relative clinical constructs, such as hoarding items in obsessive compulsive inventories. Current findings suggest that the Greek SI-R can be a useful tool in the detection and evaluation of hoarding symptoms in Greek population.

Zolpidem related persistent genital arousal disorder: An interesting case.

The present paper is describing a case of persistent genital arousal disorder that developed to a 55-year-old woman, shortly after the initiation of zolpidem. Persistent genital arousal disorder (PGAD) is a clinical entity that appears with a relatively low frequency in women, and is characterized by persistent or recurrent, unwanted and bothersome feelings of genital arousal, which often do not resolve with orgasm and are not associated with sexual desire (sexual interest, thoughts or fantasies). Women who experience PGAD often have feelings of shame, guilt and distress. Although its exact etiology remains unclear, various etiological factors have been proposed, central or peripheral, which may be psychological, vascular, dietary, pharmacological or neurological. Additionally, its presence has been associated to restless legs syndrome and overactive bladder syndrome. Likewise, multiple therapeutic interventions have been proposed and tried in patients with PGAD, either pharmacological (SSRIs, SNRIs, antiandrogens, benzodiazepines, antipsychotics, anticonvulsive agents) or other (ECT, physiotherapy, psychotherapy, nerve stimulation). Zolpidem is a nonbenzodiazepine indirect GABA A receptor agonist, which has lately been used as a therapeutic agent for PGAD in some cases. Nevertheless, in our patient, receiving zolpidem for insomnia seemed to be timely connected to the onset of PGAD symptomatology. The aim of the present paper is to highlight the need for more research into the possible factors that may contribute to PGAD.

Assessment of the Greek worry-related metacognitions: the Greek version of the Metacognitions Questionnaire (MCQ-30).

The Metacognitions Questionnaire-30 (MCQ-30), developed by Wells and Cartwright-Hatton (2004), represents a multidimensional measure of metacognitive factors considered to be important in the metacognitive model of psychological disorders. The primary aim of the present study was to examine internal consistency, test-retest reliability, convergent validity and the factor structure of the Greek version of the MCQ-30. Moreover, we investigated the associations of the extracted factors with trait anxiety in a Greek sample. The study sample consisted of 547 non-clinical participants (213 males and 334 females). All participants completed the Greek version of the MCQ-30. A subsample of 157 participants also completed the Trait Anxiety subscale of the State -Trait Anxiety Inventory and the Meta-worry subscale of the Anxious Thought Inventory. Thirty participants were retested with the MCQ-30 over a retest interval ranging from three to five weeks. The results confirmed the dimensionality of the MCQ-30 and five factors were extracted consistent with the original English version: (1) positive beliefs about worry, (2) negative beliefs about worry concerning uncontrollability and danger, (3) cognitive confidence, (4) beliefs about the need to control thoughts and the negative consequences of not controlling them, and (5) cognitive selfconsciousness. The MCQ-30 showed high levels of internal consistency and test-retest reliability. The correlation between MCQ-30 total score and AnTI-MW was strong, indicating high level of convergent validity. Moreover, all correlations between MCQ-30 total and subscale scores and STAI-T were significant apart from the correlation between 'cognitive confidence' and trait anxiety. The Greek sample scored higher in the MCQ-30 and its subscales than the English sample in the original study. Women scored significantly higher than men in the overall MCQ-30 and the "uncontrollability and danger" and "need to control thoughts" subscales, whereas no significant differences between genders had been found in the original study. The assumption that the differences in score levels and the gender effect might reflect cultural differences warrants further investigation. The findings of the present study indicate that the Greek version of the MCQ-30 is a comprehensible and psychometrically adequate instrument, as well as a reliable tool in assessing a range of dimensions of worry-related metacognitions in the Greek population. The Greek version of this scale facilitates crosscultural research in metacognition and wider testing of the metacognitive approach to emotional vulnerability, psychological disturbances and mental disorders.

The impact of HPV diagnosis on women's sexual and mental health: preliminary findings.

PURPOSE OF INVESTIGATION: The objective of the present study was to demonstrate the impact of HPV diagnosis on sexual function and mental health of Greek women. METHODS: The study population included 51 patients who proceeded to the gynecological outpatient clinic of "Aretaieion" Hospital, Athens, during 2008-2009. The participants were asked to complete a questionnaire regarding demographic characteristics, knowledge on HPV, gynecological and sexual history, as well as questions regarding their mental and sexual health after the diagnosis. RESULTS: Mean age of the participants was 36 years and mean age of their first Pap smear test was 24.4 years. Mean age of HPV diagnosis was 34 years and mean number of sexual partners was four. Regarding mental health, the majority experienced anxiety after the HPV diagnosis as well as fear regarding their health in the future. Nearly half of the women experienced guilt and anger and some of them distress, shame, diminution of self-esteem and stigmatization. Diminution in the level of sexual interest and desire and decrease in sexual intercourse frequency were quite often reported. CONCLUSION: Except for the important physical impact of HPV infection, its diagnosis seems to trigger several negative feelings and reduce sexual desire.

Administration of citalopram before ECT: seizure duration and hormone responses.

From theoretical and clinical perspectives, it is important to know if selected serotonin-reuptake inhibitors (SSRIs), often administered concurrently with electroconvulsive therapy (ECT), modify seizure duration. In a study with a double-blind, cross-over design, the authors evaluated the effect of citalopram, the most selective SSRI available, on the length of electrically induced seizures and on hormone secretion during ECT. Ten depressed women were given either 20 mg citalopram or placebo orally 2 hours before the third and fourth ECT sessions. Seizure duration was assessed by the cuff technique and from electroencephalographic recordings, whereas blood for prolactin, thyrotropin, and cortisol assessment was sampled before ECT and 5, 10, 20, 30, 40, and 60 minutes after ECT. No adverse effects after the administration of citalopram were recorded. The length of seizures was not statistically different in the citalopram (29.3+/-8.4 seconds) and placebo sessions (28.2+/-9.4 seconds). Neither pre-ECT plasma hormone levels measured 2 hours after citalopram or placebo administration nor the patterns of ECT-induced hormone secretions differed between the two drug and placebo conditions. The lack of effect of citalopram on hormones in this study may be a result of possible deficiencies of the monoaminergic (i.e., serotoninergic) systems in depression. Although safety and efficacy issues were not fully addressed by coadministering citalopram for the long term and throughout the course of ECT, these findings support the view that challenges the typical clinical practice of discontinuing SSRIs before ECT.

Neuroleptic-induced catatonia or a mild form of neuroleptic malignant syndrome?

Neuroleptic-induced catatonia (NIC) and milder neuroleptic malignant syndrome (NMS) share parkinsonian features, catatonic symptoms, mild fever, and have been described in patients receiving antipsychotic agents. We report the case of a patient with a schizophreniform disorder and a mild mental retardation who developed a condition which can be diagnosed either as NIC or as a mild form of NMS and has been treated successfully with a combination of amantadine (600 mg/day) and diazepam (30 mg/day). The overlapping between NIC and mild NMS cases might lead to an overestimation of the incidence of current NMS and reinforces the view of the existence of a 'neuroleptic toxicity spectrum'.

Psychiatric case identification in two Athenian communities: estimation of the probable prevalence.

A two stage cross sectional survey on the prevalence of psychiatric disorders was conducted in a sample of 1,574 adults, residents of two boroughs in the greater Athens area. In this paper we examine the value of the first stage self report symptom screening scales (CES-D and Langner) for case finding, by comparing it to five psychiatric case identification criteria, proven to be highly reliable, after the completion of an inter-rater reliability study. A higher proportion of mentally impaired respondents was found with the criterion of screening scale cut off scores than the cases found by the application of the five case identification criteria. The practical significance of establishing case finding reliable criteria is apparent for the purpose of epidemiologic research e.g. the problem of false positive and negative cases, the completion of the second stage of diagnostic interviews and for the planning of outreach programs, identifying and helping high risk individuals.

Epidemic faintness: a psychophysiological investigation.

A psychophysiological assessment was carried out in 16 telephone operators, who fainted during an epidemic, and in 16 control subjects. Heart rate, skin conductance level, number of spontaneous fluctuations and pulse volume were measured at rest and during periods of auditory and visual stimulation. All subjects completed rating scales on anxiety, depression, anxiety experienced during experimental procedure and personality inventories. Analysis of data support the notion that the fainting episodes represent a form of transitory anxiety attacks in response to environmental stress and are not related either to hysteria or to anxiety state.

Obsessive-compulsive neurosis, anancastic symptomatology and ABO blood types.

Determinations of ABO blood types was carried out in 38 patients with obsessive-compulsive neurosis, 48 schizophrenics with anancastic symptomatology, 31 depressives with anancastic symptomatology, 260 schizophrenics free of anancastic symptomatology and 65 depressives free of anancastic symptomatology. Results were compared with a representative sample of the general population. The findings of the present study provide evidence of an association between obsessive-compulsive neurosis and phenotype A, whilst a similar association between ABO blood types and anancastic symptomatology occurring in the course of psychotic disorders was not found. The significance of these findings is discussed with regard to current diagnostic and aetiological issues in obsessive-compulsive neurosis.