Εργασίες

Ierodiakonou – Benou I., Karamanavis D., Markantonakis P., Iakovides A., Kaprinis G. Ανακοίνωση: World Congress 2009 of the World Federation for Mental Health “Working together for Mental Health”, 2-6 September, 2009. Athens, Abstracts Issue, p. 127, O146 Δημοσίευση: Psychiatriki2009, V.20, (suppl.1):S144-S150 Psychoanalytic psychotherapy together with general medical care can significantly help cancer patients, cope with the suffering associated with the illness group psychotherapy especially addresses the need for a more integrated care of cancer patients within hospitals, which pay attention to the medical anguish as well as psychical distress caused by the disease. The aim was to investigate the possibilities and difficulties presented by operating group-psychotherapy within an oncology department, looking into dynamics arose in the patients, the medical staff and the nurses and clarify issues of technique- transference and counter transference-emerging in the patients- therapist relationship during the course of the therapy. Method: A women’s group, consisted of 8 cancer patients, meeting once a week, for 90 minutes session, during a two years period (2007-2009) has been studied. The group was operating in the oncology department of the University General Hospital “AHEPA”, Thessaloniki, Greece as a Liaison-Consultation Psychiatric department in the same hospital. Results: The difficulties of setting a group within a clearly medical department presenting resistances and defences in the medical and nursing stuff is presented The impact of cancer on hospital relationships and the question of telling the truth is also discussed. During group psychotherapy feelings of despair, hopelessness, helplessness for oneself, anxiety and depression with concern for the family and disappointment, anger and rage towards the doctor are apparent. Issues on transference and counter transference are vital for the understanding of the intragroup dynamics, while defences like denial, omnipotence, acting out and projection along with feelings of guilt, anger and traumatic experiences are expressed from both the patients and the therapist Conclusion: Group psychotherapy can have a great impact and be of considerable help for cancer patients and can act as a catalyst for the medical and nursing staff in an Oncology Department in a General Hospital.

Fountoulakis K., Iacovides A., Kleanthous S., Samolis St., Gougoulias K., Kaprinis G., Bech P. Ανακοίνωση: World Congress2009of the World Federation for Mental Health “Working together for Mental Health”, 2-6 September, 2009. Athens Δημοσίευση: BMC Psychiatry 2003, 3:21 Background: The aim of the current study was to assess the reliability, validity and the psychometric properties of the Greek translation of the Symptoms Rating Scale For Depression and Anxiety. The scale consists of 42 items and permits the calculation of the scores of the Beck Depression Inventory (BDI)-21, the BDI 13, the Melancholia Subscale, the Asthenia Subscale, the Anxiety Subscale and the Mania Subscale. Methods: 29 depressed patients 30.48 ± 9.83 years old, and 120 normal controls 27.45 ± 10.85 years old entered the study. In 20 of them (8 patients and 12 controls) the instrument was reapplied 1–2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. CES-D and ZDRS were used for cross-validation purposes. The Statistical Analysis included ANOVA, the Spearman Correlation Coefficient, Principal Components Analysis and the calculation of Cronbachs alpha. Results: The optimal cut-off points were: BDI-21: 14/15, BDI-13: 7/8, Melancholia: 8/9, Asthenia: 9/10, Anxiety: 10/11. Chronbachs alpha ranged between 0.86 and 0.92 for individual scales. Only the Mania subscale had very low alpha (0.12). The test-retest reliability was excellent for all scales with Spearmans Rho between 0.79 and 0.91. Conclusions: The Greek translation of the SRSDA and the scales that consist it are both reliable and valid and are suitable for clinical and research use with satisfactory properties. Their properties are close to those reported in the international literature. However one should always have in mind the limitations inherent in the use of self-report scales.

Fountoulakis K., Fotiou F., Iacovides A., Kaprinis G. Ανακοίνωση: World Congress2009of the World Federation for Mental Health “Working together for Mental Health”, 2-6 September, 2009. Athens Δημοσίευση: Annals of General Psychiatry 2005, 4:7 Background The aim of the current study was to identify a possible locus of dysfunction in the visual system of depressed patients. Materials and Methods Fifty Major Depressive patients aged 21–60 years and 15 age-matched controls took part in the study. The diagnosis was obtained with the SCAN v 2.0. The psychometric assessment included the HDRS, the HAS, the Newcastle Scales, the Diagnostic Melancholia Scale and the GAF scale. Flash Electroretinogram and Electrooculogram were performed in all subjects. The statistical analysis included ANCOVA, Students t-test and Pearson Product Moment Correlation Coefficient were used. Results The Electro-oculographic findings suggested that all subtypes of depressed patients had lower dark trough and light peak values in comparison to controls (p < 0.001), while Arden ratios were within normal range. Electroretinographic recordings did not reveal any differences between patients and controls or between subtypes of depression. Discussion The findings of the current study provide empirical data in order to assist in the understanding of the international literature and to explain the mechanism of action of therapies like sleep deprivation and light therapy.

Iliadou V., Kaprinis S., Kandylis D., Kaprinis G. Δημοσίευση: International Journal of Audiology2010, (suppl.49):S247-S252 One of the widely used tests to evaluate functional asymme­try of cerebral hemispheres is the dichotic listening test with the usually prevailing right ear advantage. The current study aims at assessing hemispheric laterality in an adult sample of individuals with dyslexia, with auditory processing disorder (APD), and adults experiencing comorbidity of the two men­tioned disorders against a control group with normal hearing and absence of learning disabilities. Results exhibit a right hemispheric dominance for the control and APD group, a left hemispheric dominance for the group diagnosed with both dyslexia and APD, and absence of dominance for the dys­lexia group. Assessment of laterality was repeatable and pro­duced stable results, indicating a true deficit. A component of auditory processing, specifically the auditory performance in competing acoustic signals, seems to be deficient in all three groups, and laterality of hemispheric functions influenced at least for auditory-language stimuli in the two of the three groups, one being adults with dyslexia and the other being adults with comorbidity of dyslexia and APD.

Fountoulakis K., Grunze H., Panagiotidis P., Kaprinis G. Δημοσίευση: Journal of Affective Disorders2008, 109(1-2): 21-34. This article attempts to summarize the current status of our knowledge and practice in the acute treatment and prophylaxis of bipolar depression. For prophylactic treatment, our knowledge about lithium firmly supports its usefulness against bipolar depression and its specific effectiveness for suicidal prevention. Valproic acid and carbamazepine could be effective, too, while lamotrigine which seems to be preferably effective against depression but not mania. The FDA has approved the olanzapine–fluoxetine combination and quetiapine monotherapy for the treatment of acute bipolar depression. The usefulness of antidepressants in bipolar depression is controversial both for acute and prophylactic treatment; guidelines suggest their cautious use and always in combination with an antimanic and mood stabilizer agent, because in some patients they may induce switching to mania or hypomania, mixed episodes and rapid cycling. Data on psychosocial intervention are restricted to the maintenance phase. Electroconvulsive therapy and transcranial magnetic stimulation are additional options for refractory patients. Bipolar depression seems to be a more difficult condition to treat than mania. Most patients need complex combination treatment although the published evidence on this type of treatment is limited.

Xafenias A., Diakogiannis I., Iacovides A., Fokas K., Kaprinis G. Ανακοίνωση: 2nd European Conference on Schizophrenia Research: From Research to Practice, 21-23 September 2009. Berlin Δημοσίευση: Am J Addict.2008, 17(5): 447-51. Comorbidity of psychiatric disorder and substance use disorder (SUD) is very common. Clinical experience says that comorbidity increases inpatient length of stay. We aimed to discover which factors affect length of stay for inpatients at a psychiatric department in a specialized mental hospital in a Greek urban area, and specifically whether SUD is one of them. All patients admitted over a 12-month period were given the CAGE questionnaire and that part of the EUROPASI questionnaire dealing with substance use. This was followed by a diagnostic interview to establish the final diagnosis in accordance with the DSM-IV criteria. Following this, the patients characteristics in conjunction with their average length of stay were all evaluated statistically. A total of 313 patients were assessed. Present substance use disorder was identified in 102 individuals (32.6%). The principal substances involved in addiction or abuse were alcohol, cannabis, benzodiazepines, and opiates. Patients differed as to their cooperation with the medication regime. On the other hand, there was no statistical difference regarding the number of hospitalisations. Psychopathology was not found to play a direct role, as no one diagnosis correlated with length of stay. The factors found to affect length of stay in this psychiatric department were the length of time they had been mentally ill and cooperation in taking medication. It appears that SUD is not one of the factors affecting length of stay.

Kouidi E., Karagiannis V, Grekas D., Iakovides A., Kaprinis G., Tourkantonis A., Deligiannis A. Ανακοίνωση: World Congress2009of the World Federation for Mental Health “Working together for Mental Health”, 2-6 September, 2009. Athens Δημοσίευση: European Journal of Cardiovascular Prevention & Rehabilitation 2010, 17(2):160-7 BACKGROUND: Functional limitations, altered cardiac autonomic activity, and psychological distress are known disorders in chronic hemodialysis (HD) patients, relating to increased morbidity and mortality. The aim of this study was to examine the influence of an exercise training program on emotional parameters and heart rate variability (HRV) indices, as well as to determine whether emotional stress contributes to autonomic dysfunction in these patients. METHODS: Forty-four HD patients were randomly assigned into group A (24 patients, aged 46.3+/-11.2 years), who participated in a 1-year intradialytic exercise training program and group B (20 patients, aged 45.8+/-10.8 years), who were used as controls. At baseline and a year after, measures of HRV were obtained for the estimation of standard deviation of RR intervals, the mean square successive differences, percentage of RR intervals differing by more than 50 ms from the preceding RR interval (pNN50), and low to high frequency components. Emotional parameters (Beck Depression Inventory - BDI and Hospital Anxiety and Depression Scale - HADS) were also assessed by validated questionnaires. Moreover, all patients performed a spiroergometric study for the estimation of VO2peak. RESULTS: At baseline, all measurements were similar in the two groups and remained almost unchanged after a year in group B. After a year of training, VO2peak increased from 16.79+/-5.24 to 22.33+/-4.90 ml/kg per min (PCONCLUSION: Cardiac autonomic modulation seemed to be sensitive to the experience of persistent depression in HD patients. Significantly, exercise training reduced emotional distress and concomitantly improved HRV.

Panagiotidis P., Kaprinis G.,, Iacovides A., Fountoulakis K. Ανακοίνωση: 2nd European Conference on Schizophrenia Research: From Research to Practice, 21-23 September2009. Berlin Δημοσίευση: Psychiatrie 2013, 24(4), p.p. 272-287 Though the pathobiology of schizophrenia can be examined in multiple levels, the organic notion of brain disease suggests that neurological features will be present. One straightforward, inexpensive method of investigating brain dysfunction in schizophrenia is thought the bedside assessment of neurological abnormalities with a standard neurological examination. Neurological abnormalities are traditionally classified as "hard signs" (impairments in basic motor, sensory, and reflex behaviors, which do not appear to be affected in schizophrenia) and "soft signs", which refer to more complex phenomena such as abnormalities in motor control, integrative sensory function, sensorimotor integration, and cerebral laterality. Additionally, neurological soft signs (NSS) are minor motor and sensory abnormalities that are considered to be normal in the course of early development but abnormal when elicited in later life or persist beyond childhood. Soft signs also, have no definitive localizing significance but are indicative of subtle brain dysfunction. Most authors believe that they are a reflection not only of deficient integration between the sensory and motor systems, but also of dysfunctional neuronal circuits linking subcortical brain structures such as the basal ganglia, the brain stem, and the limbic system. Throughout the last four decades, studies have consistently shown that NSS are more frequently present in patients with schizophrenia than in normal subjects and non-psychotic psychiatric patients. However, the functional relevance of NSS remains unclear and their specificity has often been challenged, even though there is indication for a relative specificity with regard to diagnosis, or symptomatology. Many studies have considered soft signs as categorical variables thus hampering the evaluation of fluctuation with symptomatology and/or treatment, whereas other studies included insufficient number of assessed signs, or lacked a comprehensive assessment of extrapyramidal symptomatology. Factors such as sex, age or family history of schizophrenia, are said to influence the performance of neurological examination, whereas relative few studies have provided longitudinal follow-up data on neurological soft signs in a sufficient number of patients, in order to address a possible deterioration of neurological functions. Finally, one additional difficulty when analyzing the NSS literature lies in the diversity of symptoms that are evaluated in the studies and/or non-standardized procedures or scoring. We will review some basic issues concerning recurrent difficulties in the measurement and definition of soft signs, as well as controversies on the significance of these signs with respect to clinical subtyping of schizophrenia, and social and demographic variables.

Malliakas P., Moustakas E., Kandylis D., Kaprinis G., Antoniou I. Ανακοίνωση: 2nd European Conference on Schizophrenia Research: From Research to Practice, 21-23 September2009. Berlin, P-08-007 Δημοσίευση: Eur Arch Psychiatry Clin Neurosci 2009, 259, (suppl.1):S3-S105 Objective: The disturbances of prosody in schizophrenia are signifi­cant because apart from the profound understanding of the brain’s organization and function, there are stray indications that (1) they may be an early definite diagnostic or differential diagnostic sign, (2) they may indicate different reasons that contribute to the appearance of this disorder. The aim of this study is to describe the impairment of prosody abilities in a group of chronic residual schizophrenic patients during the phase of illness stability. Method: To quantify the emotion and the speech intonation of 30 chronic schizophrenics (15 males, 15 females) we study the duration, energy, pitch (Fundamental Frequency, F0) contour’s value, rippling and slope of a speech signal in comparison with an homogeneous group of full healthy subjects. All the examinees were given to read loudly two kinds of written texts, one lecture and one poem. The readings were recorded digitally in a personal computer as waveform files. Afterwards, the signals were analyzed and compared statistically between the healthy and patient subjects of the same sex. Results: The male healthy subjects read 25-34% faster, speak 99% louder, have a mean value of F0 25-30% higher, F0 rippling 11-12% higher and F0 slope 36-38% higher than the male patient subjects. Similarly, the female healthy subjects read 46-56% faster, speak 47- 53% louder, have a mean value of F0 23-25% higher, F0 rippling 16- 19% higher and F0 slope 36-39% higher than the female patient subjects. Conclusion: The clinical observations that the residual schizophrenia appears slowness in day speech and prosody disturbance have been estimated quantitatively. The estimation revealed significant differ­ences between the prosody of the two target groups. The results were obtained using a new software which was constructed for a live assessment of prosody characteristics

Δημουλάς Κ., Καπρίνης Γ., Καράβατος Α., Διακογιάννη-Ταρλατζή Ε., Παπαδημητρίου Θ., Δημουλάς Ε., Μακρή Αικ., Μηταλούλη Ά., Κανταράκη Σ., Παπαναστασίου Μ. Ανακοίνωση: 6ο Πανελλήνιο Συνέδριο Ψυχιατρικής στο Γενικό Νοσοκομείο, 3-5 Φεβρουαρίου2011. Θεσσαλονίκη, Πρακτικά συνεδρίου Ρ17 Σκοπός τής έρευνας ήταν η διερεύνηση της ικανότητας των ψυχωσικών να αναγνωρίζουν συναισθηματικές εκφράσεις στο πρόσωπο των άλλων. Έλαβαν μέρος 133 (81 άντρες και 52 γυναίκες) σχιζοφρενείς και 165 (61 άντρες και 104 γυναίκες) υγιή άτομα ως ομάδα ελέγχου, μέσης μόρφωσης, 22-25 ετών. Η δοκιμασία που χρησιμοποιήθηκε ήταν η σειρά των Ekman και Friesen 65 διαφανειών τού προσώπου, με ένα ή περισσότερα από τα παγκοσμίως αναγνωρισμένα συναισθήματα (ευτυχία, λύπη, φόβο, θυμό, έκπληξη, αηδία και περιφρόνηση), με προβολή των σε δύο φάσεις, με την ίδια σειρά, για 10"-5" και 25"-10", αντίστοιχα, για κάθε διαφάνεια, σημειώνοντας, στην πρώτη (μόνο) ένα συναισθηματικό όρο και στη δεύτερη (μόνο) ένα βαθμό (για όλα τα συναισθήματα), από το 0 (για ανυπαρξία συναισθήματος) μέχρι το 8 (για έντονη έκφραση συναισθήματος). Με βάση τη συμφωνία των σημασιοδοτικών κρίσεων των υποκειμένων με το λεξικό, που σχηματίστηκε από το 20 και πλέον % των ατόμων μέσα στην ίδια ομάδα που αποδέχτηκαν την ίδια συναισθηματική σημασιοδότηση ως το συγκεκριμένο συναίσθημα της κάθε διαφάνειας, αξιολογήθηκε η συχνότητα και η ένταση των συναισθημάτων που αναγνωρίστηκαν και αυτών που πήραν τον υψηλότερο βαθμό ανάμεσά τους (αναγνωρισιμότητα). Διαπιστώθηκε, ότι, στην προσπάθεια αυτή, η ολική μορφή του προσώπου κατακερματίζεται, λόγω πληροφοριακής υπερφόρτωσης, συνεπαγόμενης κόπωση, που εξισώνεται με άγχος. Περαιτέρω βιβλιογραφική συλλογιστική έδειξε ότι, στην κατάσταση άγχους, στην οποία, περιέρχονταν οι σχιζοφρενείς ίσως εγγράφουν διασπασμένο το πρόσωπο των θεραπευτών, που, αδυνατώντας να του δώσουν συνεκτική μορφή, δυσκολεύονται να αντιληφθούν, ακόμα και όταν πρόκειται για γνωστό προσωπικό, ότι πρόκειται για απέναντι τους γνωστά πρόσωπα που τους φροντίζουν.