13 research outputs found
Using ECT in schizophrenia: A review from a clinical perspective
Objectives. Despite the fact that many studies have addressed the use of
ECT in schizophrenia questions on clinical use remain poorly answered
and clinical application is largely based on data originating from
depressed patients. Methods. We review data on the use of ECT in
schizophrenic patients drawn from original studies indicated by a Pubmed
search and referenced in recent and older expert reviews with a specific
focus on four issues: symptom response, technical application,
continuation/maintenance ECT and combination with medication. Results.
Catatonic patients are the most responsive. Positive symptoms such
paranoid delusions and affective symptoms follow. There are indications
that ECT may improve responsivity to medication. No particular technical
features stand out in studies except lengthier courses, but not for
catatonia. Combination with medication appears to be preferable over
either treatment alone and effective combination particularly with
clozapine is supported by data. Use of continuation and maintenance
treatments in responders appears beneficial. Conclusion. Certain
schizophrenic patients may benefit significantly from the use of ECT.
More specific research is required to address particular questions
Association between gestational diabetes and perinatal depressive symptoms: evidence from a Greek cohort study
Aim: The aim of the present study was to assess the association of
gestational diabetes mellitus (GDM) with prenatal and postnatal
depressive symptoms in a sample of pregnant women in Greece. Background:
Earlier research supports a relationship between depression and
diabetes, but only a few studies have examined the relationship between
GDM and perinatal depressive symptomatology. Methods: A total of 117
women in their third trimester of pregnancy participated in the study.
Demographic and obstetric history data were recorded during women’s
third trimester of pregnancy. Depressive symptoms were assessed with the
validated Greek version of the Edinburg Postnatal Depression Scale
(EPDS) at two time points: on the third trimester of pregnancy and on
the first week postpartum. Findings: Prevalence of GDM was 14.5%.
Probable diagnosis of depression occurred for 12% of the sample during
the antenatal assessment and 15.1% in the postpartum assessment. In the
first week postpartum, women with GDM had significantly higher
postpartum (but no antenatal) EPDS scores compared with the non-GDM
cohort. In conclusion, GDM appears to be associated with depressive
symptoms in the first week postpartum. Clinical implications and
recommendations for future research are discussed, emphasizing the
importance of closely monitoring women with GDM who seem more vulnerable
to developing depressive symptomatology during the postnatal period
Psychological Differences Between Greek Artists With and Without History of Major Psychopathology
Investigation of the relationship between creativity and psychopathology
has yielded mixed results with few studies investigating the impact of
psychopathology on creativity among professional artists. To address
this gap, the present study compared 115 living Greek artists, with and
without major psychiatric disorder, using self-report questionnaires
measuring defense styles (DSQ-40), ego boundaries (BQ-18), and early
trauma inventory (ETI-SR-SF). An open-ended exploratory questionnaire
inquired about the effects of their psychological issues, upon their
creative work. Results showed that artists with psychiatric disorder had
thinner ego boundaries, employed more immature defense mechanisms, and
reported higher rates of childhood trauma as well as expressing their
creative endeavor as a “need” rather than “desire” and relied on
their creative work as the sole means of livelihood
The Practice of Electroconvulsive Therapy in Greece
Objective: To describe the practice of electroconvulsive therapy (ECT)
in Greece.
Methods: A survey was conducted during the academic year 2008-2009.
Electroconvulsive therapy use was investigated for 2007. All civilian
institutions providing inpatient care were included. Centers that
provided ECT completed a 57-item questionnaire. Centers that did not
offer ECT completed a 13-item questionnaire.
Results: Fifty-five (82.1%) of 67 institutions responded.
Electroconvulsive therapy was offered in 18 hospitals. Only 2 of 10
university hospitals offered ECT. Overall, 137 patients were treated
with 1271 sessions in 2007. Only 1.47% discontinued treatment owing to
adverse events. There were no deaths. Schizophrenia was the most common
diagnosis (41.3%) among those receiving ECT, followed by major
depression (28.9%), bipolar depression (9.1%), catatonia (4.1%),
suicidal ideation (3.3%), and schizoaffective disorder (2.5%).
Physicians considered major depression (93.8%), catatonia (86.5%),
schizophrenia (56.3%), and mania (50%) the most appropriate
indications. Written informed consent was required in 77.8% of the
institutions, whereas the rest required verbal consent. Bilateral ECT
was the preferred electrode placement (88.9%). Modified ECT was used
exclusively. Propofol was the preferred anesthetic (44.4%), followed by
thiopental (38.9%). Seven (38.9%) of 18 hospitals used a fixed
stimulus dose at first treatment. Five (27.8%) of 18 hospitals used the
half-age method. Continuation/maintenance ECT was used in 33.3% of the
hospitals. Outpatient ECT was seldom used. Lack of training, difficult
access to anesthesiology, billing issues, and stigma were cited as the
main impediments to the practice of ECT.
Conclusions: Electroconvulsive therapy is practiced in moderate numbers
in Greece and almost exclusively on an inpatient basis. Lack of training
and lack of availability of anesthesiologists were cited as the most
common obstacles to providing ECT
Physical Health, Media Use, Stress, and Mental Health in Pregnant Women during the COVID-19 Pandemic
Background: The COVID-19 pandemic has led to significant changes in the care of pregnant women and their fetuses. Emerging data show elevated depression and anxiety symptoms among pregnant women. Aims: The purpose of this article is to investigate the psychological and behavioral impact of the COVID-19 pandemic on pregnant women in Greece during the first national lockdown. Methods: We used a cross-sectional, anonymous survey to collect data in two fetal medicine clinics in the largest urban centers of Greece during the months of April and May 2020. The questionnaire was largely based on the CoRonavIruS Health Impact Survey (CRISIS), and assessed sociodemographic characteristics, general health and obstetric data and COVID-19-related worries and life changes. Mood symptoms, substance use and lifestyle behaviors were assessed at two time points (3 months prior to the pandemic and the 2 weeks before taking the survey), while perceived stress was measured with the perceived stress scale (PSS-14). Results: A total of 308 pregnant women (Mage = 34.72), with a mean gestation of 21.19 weeks participated in the study. Over one-third of the women found COVID-19 restrictions stressful, and their highest COVID-19-related worry was having to be isolated from their baby. Mean PSS-14 score was 21.94, suggesting moderate stress. The strongest predictors of stress were physical and mental health status before COVID-19 and having experienced a stressful life event during their pregnancy. Compared to 3 months before the pandemic, women reported higher scores on mood symptoms (p < 0.001), TV use (p = 0.01) and social media use (p = 0.031) in the last 2 weeks before taking the survey. Conclusion: Our study provides important preliminary evidence of the negative impact of the COVID-19 pandemic and the lockdown on pregnant women’s well-being and functioning
Cardiac Rhythm Management Devices and Electroconvulsive Therapy A Critical Review Apropos of a Depressed Patient With a Pacemaker
Electroconvulsive therapy (ECT) is an effective treatment and, with the
proper risk-minimizing strategies, is relatively safe even in depressed
patients with cardiovascular diseases. Specifically, patients with
cardiac rhythm management devices (CRMDs) require particular attention
because no controlled trials exist to support current empirical
recommendations. We present a depressed patient with a pacemaker
successfully treated with ECT, and we critically review the relevant
literature. Pooled results from 63 patients and 821 ECT sessions showed
that 90% of ECT sessions have been performed on depressed patients with
their pacemakers in sensing mode and rate adaptation, where available,
activated as well. Only 4% of sessions were performed with those
functions disabled, whereas no data was available for 6% of ECT
sessions. Pooled results from case series and reports highlight a
discrepancy between current clinical practice and many guidelines.
Electroconvulsive therapy is probably safe in depressed patients with
asynchronous fixed-rate pacemakers, although there is a risk of
ventricular tachycardia and fibrillation. A larger body of case series
and reports suggests that there might be no need to convert synchronous
demand pacemakers to asynchronous fixed-rate pacing. Regarding patients
with implantable cardioverter defibrillators, antitachycardia treatment
was deactivated during most ECT sessions. In depressed patients with
CRMDs anticholinergics might be best avoided. In all cases, proper ECT
procedures, namely, patient and pacemaker electrical isolation, strict
grounding and adequate muscle relaxation along with interrogation and
monitoring of CRMDs before and after each session should ensure
uncomplicated electroconvulsive treatments
The impact of stressful life events on risk of relapse in women with multiple sclerosis: A prospective study
Purpose - The aim of this study were first to examine the general
relation between stressful life events (SLEs) and clinical relapses in
women with multiple sclerosis (MS) and second, to investigate the
relations of the specific stressor attributes of duration, type, and
severity on MS exacerbations.
Methods - Twenty six ambulating women with relapsing-remitting MS were
followed-up for a mean of 56.3 weeks. Patients documented SLEs weekly in
self report diaries which were then collected at regular pre-scheduled
clinic visits every 4 weeks. SLEs were classified as short-term if they
had subjectively no lasting effect and long-term if they had a
subjectively felt psychological impact that lasted at least 10-14 days
after the event. The sverity of SLEs was determined using the Recent
Life Change Questionnaire.
Results - Experiencing three or more SLEs during a 4-week period, was
associated with a 5-fold increase of MS relapse rate (95% Cl 1.7-16.4.
p=0.003). The presence of at lease one long-term SLE was associated with
three times (95% Cl 1.01-9.13, p<0.05) the rate of MS exacerbation
during the following 4 weeks. There was no significant association
between the severity (95% Cl 0.99-1.01. p>0.05) or the type (x(2) =
7.29. df = 5. P > 0.05) of stressor and the risk for relapse.
Conclusion - Ambulatory women with relapsing-remitting MS who experience
cumulative SLEs may be at a greater risk for relapse. Duration is the
only stress attribute that seems to increase the risk for relapsing in
contrast to stress type and stress severity that were not found to
interact with MS exacerbation. (C) 2008 Elsevier Masson SAS. All rights
reserved
The safety of the electroconvulsive therapy-aripiprazole combination: Four case reports
In clinical practice, a proportion of patients with psychotic or mood
disorders are treated with electroconvulsive therapy (ECT) while
receiving concomitantly antipsychotic and/or other psychotropic agents.
Aripiprazole is a second-generation antipsychotic that seems to have a
favorable side-effect profile. However, to the best of our knowledge,
there are, as yet, no available reports oil the safety of
ECT-aripiprazole combination. We report the cases of 4 female
inpatients-3 suffering from major depression and I from
schizophrenia-who underwent ECT-1 of them twice-while receiving
aripiprazole (10-15 mg/d), as part of their regimen. I it all cases, the
combination was well tolerated and only minimal side effects were
reported
Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation
Background: Erectile dysfunction (ED) and premature ejaculation (PE) are
the two most prevalent sexual disorders among males associated with
significant distress and impairment in quality of life. The aim of this
study was to investigate the prevalence of anxiety and depression
symptoms among patients with primary ED and PE.
Methods: A sample of 57 men (ED = 31; PE = 26) were compared to 25 male
outpatients with anxiety disorder (AD) and 25 healthy controls.
Principal assessment measures included the State-Trait Anxiety Inventory
(STAI) and the Beck Depression Inventory (BDI).
Results: Greater levels of STAI state anxiety were reported among the
ED, PE, and AD groups as compared to healthy controls. In contrast ED
and AD groups scored higher than controls on the STAI trait anxiety and
BDI, but PE scores were not different from healthy controls in both
measures.
Conclusions: The study findings suggest that both primary ED and PE are
conditions associated with significant state anxiety; however, PE
appears to be less associated with trait anxiety and depression compared
to ED, a finding that corroborates the recent acknowledgement of PE as a
more biologically based condition. Limitations and potential clinical
implications are also discussed
Vasomotor and depression symptoms may be associated with different sleep disturbance patterns in postmenopausal women
Objective: This study aims to explore the association of vasomotor
symptoms (VMS) and depression symptoms with different symptoms of
subjective sleep disturbance in postmenopausal women.
Methods: This is a cross-sectional study of 163 postmenopausal women
(not taking hormone therapy) attending a university menopause clinic.
Measures included the Athens Insomnia Scale, Greene Climacteric Scale,
and Symptom Checklist-90-Revised depression subscale. Covariate-adjusted
ordinal logistic regression was used to investigate the association of
VMS and depression with each item of the Athens Insomnia Scale.
Results: Controlling for confounding factors, we found VMS to be
significantly associated with awakenings during the night (odds ratio
[OR], 1.85; P < 0.001), overall quality of sleep (OR, 2.00; P <
0.001), well-being during the day (OR, 1.63; P = 0.008), functioning
capacity during the day (OR, 1.72; P = 0.01), and sleepiness during the
day (OR, 1.66; P = 0.03); whereas we found Symptom Checklist-90-Revised
depression subscale scores to be associated with sleep induction (OR,
2.09; P < 0.001), final awakening earlier than desired (OR, 2.21; P <
0.001), total sleep duration (OR, 1.62; P = 0.01), overall quality of
sleep (OR, 1.64; P = 0.009), well-being during the day (OR, 1.67; P =
0.006), functioning capacity during the day (OR, 1.68; P = 0.01), and
sleepiness during the day (OR, 1.57; P = 0.04).
Conclusions: VMS and depression symptoms are associated with different
patterns of sleep disturbance. Although both symptoms are related to
sleep quality, daytime functioning, and daytime well-being, depression
is uniquely associated with difficulty falling asleep and waking up
earlier than desired, whereas VMS are related to frequent awakenings
during sleep. The findings are limited by the cross-sectional design and
relatively small sample size of the study. Recommendations for future
research are discussed to guide this line of inquiry and to gain a
better understanding of the complex relationship between climacteric and
mood symptoms and their contribution to the development of sleep
disturbances during menopause