Frequency of sexual dysfunction in outpatients with severe mental illness in Greece

INTRODUCTION: Patients with psychosis can develop sexual dysfunction, which may be related to the disease itself, psychosocial factors, somatic comorbidities, and the use of psychotropic medication. OBJECTIVE: We aimed to investigate the type and frequency of sexual dysfunction in patients diagnosed with schizophrenia or bipolar disorder in order to assess the side effects of antipsychotics in sexual function. METHODS: This is a multicenter, cross-sectional study, involving patients diagnosed with schizophrenia (79.3%) or bipolar disorder (20.7%) treated in the Department of Psychiatry and Community Mental Health Centers from November 2018 to December 2019. Patients were enrolled in the study after signed informed consent. Demographic and clinical data were collected from patients through a semi-structured interview. The Antipsychotics and Sexual Functioning Questionnaire (ASFQ) was administered to assess sexual function. RESULTS: A total of 87 outpatients on antipsychotics were recruited in the study. The mean age was 43.6 years, while the mean duration of the disease was 16.9 years. Overall, only 9.1% of patients spontaneously reported sexual dysfunction. Patients treated with oral first-generation antipsychotics had more difficulties in achieving orgasm and decreased erection capacity. In contrast, patients treated with oral second-generation antipsychotics had decreased ejaculation capacity. Patients on antipsychotic combination therapy were associated with higher rates of sexual anhedonia. DISCUSSION: These results suggest that sexual dysfunction is a side effect of antipsychotic treatment, which was spontaneously rarely reported by patients. It seems essential to obtain a psychosexual clinical history before initiating antipsychotic treatment to evaluate following changes and adopt an individualized strategy to manage sexual dysfunction induced by antipsychotics

Predictors of successful move-on to more independent accommodation amongst users of the community mental health rehabilitation team: A prospective cohort study in inner London

Purpose: In England, community mental health rehabilitation teams play a major role in supporting people with complex mental health needs to progress from inpatient to community settings and from more to less supported accommodation. We aimed to conduct the first study to investigate longitudinal outcomes for users of a community rehabilitation team and identify service user characteristics associated with successful progress along the rehabilitation pathway. / Methods: We used routinely collected clinical outcome data relating to all 193 users of a community rehabilitation team in inner London, transferred to the team between June 2013 and May 2018, with a cut-off data-collection date of 20th June 2019. We estimated the proportion who moved on to more independent accommodation successfully, with no breakdown in the placement. We conducted multivariable Cox proportional hazard regression to investigate associations between service user characteristics at transfer and successful move-on. / Results: Overall, 43/193 (23%) service users achieved successful move-on during a median follow-up of 51 months (IQR 32–63). This was more likely for those who were residing in more highly supported accommodation (HR 3.90; 95% CI 2.01–7.54) and those who had better functioning (HR 1.04, 95% CI 1.02–1.06) at transfer, while those with a serious physical health condition were less likely to achieve successful move-on (HR 0.44, 95% CI 0.21–0.95). / Conclusion: Most supported accommodation services aim to offer time-limited support, but most service users do not progress successfully to more independent accommodation within 4 years. Investment in interventions that improve functioning and physical health may facilitate successful move-on

Translation and Validation of the Greek Version of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ)

Introduction Sexual dysfunction in patients with psychoses may be associated with the psychiatric illness itself (negative symptoms, such as apathy, and avolition), comorbid somatic health, psychosocial factors (stigmatization, discrimination), and the use of psychotropic drugs. In Greece, research into the study of antipsychotic-induced sexual dysfunction is not sufficient. Aim This study was conducted to translate and validate the Greek version of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ) in a sample of patients receiving antipsychotic treatment. Methods A “forward-backward translation” method was applied. A pilot study was conducted with 15 outpatients with schizophrenia and bipolar disorder under antipsychotics treatment. Patients also completed the “Subjects’ Response to Antipsychotics (SRA)” questionnaire in order to assess the validity of the ASFQ. The ASFQ and the SRA questionnaire were completed twice within 2 weeks. Main outcome measures Reliability (internal consistency and test-retest) and validity were assessed. Results The Greek translation of ASFQ was reliable, with excellent internal consistency (Cronbach's a = 0.90 for men and 0.95 for women in both measurements). In addition, the Spearman correlation coefficient was 1 (P< .001) in all Likert-type questions in both assessments. Finally, Spearman correlation coefficients between ASFQ and SRA were moderately positive to strongly positive (between 0.25 and 1) in both assessments, demonstrating moderate to high validity. Conclusions The Greek version of the ASFQ has proved to be a reliable and valid clinical instrument, hence it can be used in further studies in the Greek population. Angelaki M, Galanis P, Igoumenou A, et al. Translation and Validation of the Greek Version of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ). J Sex Med 2021;9:100334

Use of risk assessment instruments to predict violence in forensic psychiatric hospitals: a systematic review and meta-analysis

Background and Aims: Violent behaviour by forensic psychiatric inpatients is common. We aimed to systematically review the performance of structured risk assessment tools for violence in these settings. Methods: The nine most commonly used violence risk assessment instruments used in psychiatric hospitals were examined. A systematic search of five databases (CINAHL, Embase, Global Health, PsycINFO and PubMed) was conducted to identify studies examining the predictive accuracy of these tools in forensic psychiatric inpatient settings. Risk assessment instruments were separated into those designed for imminent (within 24 hours) violence prediction and those designed for longer-term prediction. A range of accuracy measures and descriptive variables were extracted. A quality assessment was performed for each eligible study using the QUADAS-2. Summary performance measures (sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio, and area under the curve value) and HSROC curves were produced. In addition, meta-regression analyses investigated study and sample effects on tool performance. Results: Fifty-two eligible publications were identified, of which 43 provided information on tool accuracy in the form of AUC statistics. These provided data on 78 individual samples, with information on 6,840 patients. Of these, 35 samples (3,306 patients from 19 publications) provided data on all performance measures. The median AUC value for the wider group of 78 samples was higher for imminent tools (AUC 0.83; IQR: 0.71-0.85) compared with longer-term tools (AUC 0.68; IQR: 0.62-0.75). Other performance measures indicated variable accuracy for imminent and longer-term tools. Meta-regression indicated that no study or sample-related characteristics were associated with between-study differences in AUCs. Interpretation: The performance of current tools in predicting risk of violence beyond the first few days is variable, and the selection of which tool to use in clinical practice should consider accuracy estimates. For more imminent violence, however, there is evidence in support of brief scalable assessment tools

Prison vs. hospital for offenders with psychosis; effects on reoffending

With research showing a high prevalence of psychosis in prisons, its effective management is essential for clinical and criminal outcomes. In a matched sample of released prisoners and discharged patients with psychosis (124 pairs) we investigated whether group participation (prison vs. hospital) affected the likelihood of reoffending as well as time to reoffending. Statistical analysis was completed using multilevel logistic regression and multilevel survival analysis. We found that prison cases were more likely to commit any offence within a given period of time (1, 2 or 3 years). Moreover, at any particular time 3 times as many patients with psychosis released from prisons reoffended proportionally to their matched controls discharged from hospitals (HR = 2.92, 95% CI = 1.99, 4.29, P < 0.001). In conclusion, release from prison carries higher risk of a future offending and reduced time to reoffending among offenders with psychosis. Notwithstanding limitations inherent in observational study designs, we advocate that in addition to clinical need and the humanitarian argument, offenders with psychosis should be treated in secure hospitals to reduce future recidivism

Psychiatric disorders and criminal history in male prisoners in Greece

Objectives: Τo explore the psychopathology of the Greek male prisoner population and the relationship between psychiatric disorders and the criminal history of the subjects. Methods: The Iowa Structured Psychiatric Interview and the Personality Disorders Questionnaire were administered. The prevalence of the most common mental disorders was analyzed separately and in relation to the criminal history. SPSS was used for the statistical analysis. Results A total of 495 male prisoners were interviewed. Overall, 223 (45.06%) were diagnosed with a psychiatric disorder. Non-violent crimes were the most prevalent reason for imprisonment (40.7%). One-third (30.3%) of the sample was convicted with drug-related crimes, and 28.0% with violent crimes. Discussion: The prevalence of mental disorders in Greek prisoners was higher than in the general population. Personality disorder was the most common type of mental disorder and the only psychiatric diagnosis related to violent crime. This highlights the need for screening for mental disorders and the need for therapeutic provision within the prison setting

Faces and Facets:Variability of Emotion Recognition in Psychopathy Reflect its Affective and Antisocial Features

Psychopathy consists of a constellation of affective-interpersonal features including lack of empathy, callousness, manipulativeness and interpersonal charm, impulsiveness and irresponsibility. Despite its theoretical and predictive value in forensic contexts, the relationships between the psychometric dimensions of psychopathy, including its antisocial features, and the construct’s neuropsychological characteristics remain uncertain. In this study, 685 personality-disordered prisoners with histories of serious violent or sexual offenses were assessed for psychopathy before completing a computerized and well-validated assessment of the ability to recognize emotional expressions in the face. Prisoners with more of the affective features of psychopathy, and prisoners with more of its antisocial manifestations, showed relatively poor recognition accuracy of fearfulness and disgust. These relationships were independent and modest but were still evident following correction for demographic features (e.g., ethnicity and socioeconomic status), mental illness (e.g., substance and alcohol misuse), personality disorders (other than antisocial personality disorder) and treatment status. By contrast, the associations between these dimensions of psychopathy and emotion recognition were diminished by controlling for cognitive ability. These findings demonstrate that variability in the ability of high-risk personality-disordered prisoners to recognize emotional expressions in the face—in particular, fear and disgust—reflects both the affective and antisocial aspects of psychopathy, and is moderated by cognitive ability. (PsycINFO Database Record (c) 2017 APA, all rights reserved

Improving the home environment of people living with mental illness in the community

People living with mental illness (PLWMI) discharged from wards often move to inadequate homes, with poor conditions affecting their health and leading to re-hospitalisations. Despite research on psychiatric wards and the central role of the built environment (BE) to deinstitutionalisation and social reintegration, little is known about the BE after the discharge from the psychiatric ward and how PLWMI’s living conditions affect their health, including clinical outcomes, wellbeing, and social reintegration. This cross-disciplinary research brings healthcare architects, clinicians and psychologists, aiming to highlight the importance of the BE as an integral part of a comprehensive rehabilitation plan. The research is examining the home environment needs of post-hospitalised PLWMI in independent living accommodation in the community, to prevent relapse and encourage psychosocial reintegration. Methodology includes a systematic review on the needs of PLWMI related to their home BE and the development of a checklist for evaluating the home BE to support PLWMI. To validate the checklist we employ site visits to recently discharged PLWM living in the community to perform the checklist and conduct semi-structured interviews. The research is underpinned by the SCP model theoretical model of environmental provision. By adopting this cross-disciplinary approach, this research is addressing the issue from a 360 perspective, both from the built environment and psycho-social aspect. Findings comprise improvements for the living conditions and support the psychosocial re-integration of PLWMI into the community, targeting social services and government policies on housing and facility conditions for social care, strengthen social workers' skills to assess premises in an informed way and evaluate living conditions, especially in reaction to the environment. This research project supports that psychosocially supportive environments promote independence for PLWMI. The project findings and validated checklist could be used to inform policy makers, urban planners and housing providers, enabling them to make more informed decisions and develop policies and design guidelines that prioritise the needs of PLWMI. This will help create more supportive and inclusive home BEs, to improve community integration and improved health and well-being. Lastly, benefits PLWMI, carers, health authorities, and health and social policies

Palliative embolization arteries or veins for a recurrent pelvic chondrosarcoma

Chondrosarcoma is a malignant bone tumor characterized by the formation of cartilage structures of varying degrees of ma-turity. They account for approximately 20 % of malignant skele-tal tumors. Chondrosarcoma most often affects the pelvis (iliac bone), the proximal femur and humerus, ribs. The chondrosar-coma of the pelvis has a low response to chemo- and radiation therapy, so they are usually resected by standard hemipelvec-tomy. New surgical reconstructive techniques allow surgeons to perform major reconstructions, thereby improving patients' quality of life. Clinical case: male, 64 years old, with complains of the left thigh pain for 6 months. The patient was made a com-prehensive examination \u2014 standard X-rays, MRI and CT scan of the pelvis, biopsy of the pathological formation. Diagnosis: chondrosarcoma II clinical group, stage IIB. Primary sur-gery \u2014 wide-field excision and reconstruction with a massive bone allograft was performed and bipolar hip replacement. Two major local recurrences were detected in 3 years. Due to inef-ficiency of chemo- and radiation therapy, refusal of the patient from amputation, high degree of tumor vascularization, arterial embolization was applied. A selective study of both the medial and lateral femoral arteries was performed using a uroangio-graphic contrast medium. The achievement of complete devas-cularization of the greatest lesion was confirmed angiographi-cally. After 20 days due to partial revascularization, re-emboli-zation of the lateral circular femoral artery was made. The final embolization of all arterial branches that fed the tumor was performed after 3 months with acrylic (n-butyl 2-cyanoacrylate) glue for larger-sized vessels and microparticles of polyvinyl al-cohol (150\u2013 250 \u3bcm) for the smallest branches. Conclusion: em-bolization can be effectively used as a palliative treatment for highly vascularized pelvic chondrosarcoma. Key words: chond-rosarcoma, pelvis, embolization, palliative, polyvinyl alcohol microparticles