George N. Christodoulou - Academia.edu (original) (raw)

Chapters in Books by George N. Christodoulou

Chapter in JM Mezzich, M Botbel, G Christadoulou, R Cloninger and I Salloum (eds): Person Centered Psychiatry, Springer Verlag, 2017

The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.

Papers by George N. Christodoulou

Journal of Sex & Marital Therapy, 2003

The aim of the present study was to assess androgen plasma levels and biogenic amine metabolites ... more The aim of the present study was to assess androgen plasma levels and biogenic amine metabolites in a sex-offender group as well as to investigate the relationship between the biological findings and the impulsive, aggressive, and suicidal profile of the offenders. Fifty-seven males convicted for rape and 25 normal males comprised the study sample. We found that although both testosterone levels and aggression-impulsivity scores were higher in the group of rapists, testosterone levels were not associated with the aggression and impulsivity scores. Nevertheless, aggression-impulsivity scores were clearly associated with luteinizing hormone levels. This association may indicate a hyperactive hypothalamic-pituitary-gonadal axis, possibly the result of a reduced serotonergic activity.

Springer eBooks, 2016

The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.

Annals of general hospital psychiatry, Jan 17, 2003

BACKGROUND: The aim of this paper is to describe a case of severe neuroleptic-induced tardive tor... more BACKGROUND: The aim of this paper is to describe a case of severe neuroleptic-induced tardive torticollis successfully treated with a combination of clozapine, clonazepam and botulinum toxin-A. CASE REPORT: The patient, a 30-year old man with a seven-year history of delusional disorder experienced severe right torticollis with painful tightness of the neck and elevation of the shoulder. At this time he was receiving haloperidol 20 mg, trifluoperazine 5 mg, zuclopenthixol 20 mg and biperidine 4 mg daily. The combination therapy with clozapine and clonazepam and the long-term use of botulinum toxin-A resulted in a complete remission of dystonic movements. CONCLUSIONS: The present observations provide evidence indicating that this combination therapy may be of benefit in patients with severe neuroleptic-induced tardive torticollis.

Certain studies on measures related to central neurotransmitter activity have demonstrated that i... more Certain studies on measures related to central neurotransmitter activity have demonstrated that in delusional (psychotic) depression there is a dopaminergic dysregulation which distinguishes it from non-psychotic depression. A neuroendocrinologic method to check the degree of DA receptor responsivity is by measuring the prolactin responses to acute intramuscular administration of haloperidol. We studied this possibility by applying the haloperidol test in seven delusional and ten non-delusional depressed patients. All patients met DSM-IV criteria for a major depressive episode, single or recurrent, with or without psychotic features. After a three-week washout period, 5 mg of haloperidol were injected i.m. and blood samples were taken at 0, 30, 60, 90 and 120 minutes. In both trials, significant time effects were observed (elevated prolactin levels, F = 11.36, P = 0.000). However, the prolactin responses to haloperidol did not differ significantly between the two patient groups (F = 0.12, P = 0.97). These data do not show a difference in D 2 receptor responsivity, at least at the hypothalamus-pituitary level, between psychotic and non-psychotic depression.

European Psychiatry, 1998

American Journal of Psychiatry, 2001

Risperidone-Induced Retrograde Ejaculation TO THE EDITOR: Schizophrenic patients treated with ant... more Risperidone-Induced Retrograde Ejaculation TO THE EDITOR: Schizophrenic patients treated with antipsychotic drugs may suffer from a variety of sexually disabling side effects that can affect all domains of sexual activity. The most common such adverse effects in men are erectile dysfunction and retrograde ejaculation (1). Retrograde ejaculation has been mostly reported in association with typical antipsychotics, especially thioridazine (1); among the atypical antipsychotics, to our knowledge, only clozapine has been reported to cause retrograde ejaculation (2). We describe a schizophrenic patient with risperidone-induced ejaculatory failure that was compatible with retrograde ejaculation, both clinically and in the laboratory. Mr. A was a 37-year-old man who was married with three children and who met DSM-IV criteria for paranoid schizophrenia. He was physically healthy, had no apparent concomitant general medical condition, and had never experienced ejaculatory problems. He had his first overt psychotic episode at age 29 and was successfully treated with perphenazine, 32 mg/day, without any major adverse effects. He was admitted to our psychiatric inpatient ward after a second psychotic exacerbation of the disorder and after being drug free for about 6 years. On admission, treatment with risperidone was initiated; the dose was increased to 4 mg/day by 1-mg/day increments and thereafter remained constant. On days 6, 9, and 14 after the initiation of risperidone treatment, Mr. A engaged in sexual intercourse with his wife, after which he reported having ejaculatory difficulties compatible with retrograde ejaculation. A condom was used during all encounters. He reported a complete failure to emit semen but a normal desire, erection, and sense of orgasm. Postcoital urine was collected after days 9 and 14, and semen was evident on evaluation of the samples on both occasions. A reduction of Mr. A's risperidone dose to 3 mg/day was associated with partial restoration of anterograde ejaculation.

Psychiatry Research, 2015

Therapeutic interventions in chronic mental illness face the important challenge to pursuit the q... more Therapeutic interventions in chronic mental illness face the important challenge to pursuit the quality of life (QOL) of patients. Insight into chronic mental illness, though a prerequisite for treatment adherence and a positive therapeutic outcome, has shown adverse associations with subjective QOL. This study aims to explore the contribution of psychopathological symptoms on the ambiguous role of insight on QOL. Seventy-two outpatients with schizophrenia spectrum disorders were assessed using the positive and negative syndrome scale, the scale to assess unawareness of mental disorder, and the WHOQOL-100 instrument for the assessment of quality of life. Insight was found to associate inversely with quality of life. Among psychopathological symptoms, depressive symptoms were the strongest negative contributor on QOL. Mediation analysis revealed that the effects of awareness of the consequences of illness on QOL were largely mediated by depressive symptoms (full mediation for the effect on physical and psychological domain and partial mediation for the effect on independence and environment domain of the QOL). Our results suggest that the inverse relationship between insight and subjective quality of life is partially mediated by depressive symptoms. We discuss theoretical and therapeutic implications of the findings, in conjunction with similar recent research data.

The International Journal of Neuropsychopharmacology, 2004

European Neuropsychopharmacology, 2000

Background: The neuroleptic malignant syndrome is a rare but serious condition mainly associated ... more Background: The neuroleptic malignant syndrome is a rare but serious condition mainly associated with antipsychotic medication. There are controversies as to whether "classical" forms of neuroleptic malignant syndrome can occur in patients given atypical antipsychotics. The serotonin syndrome is caused by drug-induced excess of intrasynaptic 5-hydroxytryptamine. The possible relationship between neuroleptic malignant syndrome and serotonin syndrome is at present in the focus of scientific interest. Methods: This retrospective phenomenological study aims to examine the seventeen reported olanzapine-induced neuroleptic malignant syndrome cases under the light of possible overlap between neuroleptic malignant syndrome and serotonin syndrome clinical features. Results: The serotonin syndrome clinical features most often reported in cases initially diagnosed as neuroleptic malignant syndrome are: fever (82%), mental status changes (82%) and diaphoresis (47%). Three out of the ten classical serotonin syndrome clinical features were concurrently observed in eleven (65%) patients and four clinical features were observed in seven (41%) patients. Conclusion: The results of this study show that the clinical symptoms of olanzapine-induced neuroleptic malignant syndrome and serotonin syndrome are overlapping suggesting similarities in underlying pathophysiological mechanisms.

Annals of General Hospital Psychiatry, 2003

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2004

Schizophrenia has been associated with a high rate of suicide. This study investigates the preval... more Schizophrenia has been associated with a high rate of suicide. This study investigates the prevalence of suicidal ideation in a population of inpatients with acute schizophrenia, together with the clinical parameters associated with suicidal thoughts. We assessed 93 schizophrenia patients. We matched subjects for age and sex and compared subjects with and without suicidal thoughts. We performed stepwise multiple regression analysis to assess the association between specific clinical symptoms and suicidal ideation. Of the patients, 20.4% reported suicidal thoughts during the last 15 days. Severity of depressive symptoms, motor retardation, guilt feelings, pathological guilt, and self-depreciation predicted the patients' suicidal ideation. Suicidal thoughts are frequent among inpatients with acute schizophrenia. Prevention of suicidal behaviour should include helping patients improve their self-esteem and reducing depression and guilt feelings.

Person Centered Psychiatry, 2016

The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.

European Archives of …, 2000

Aim of the study was to examine the consistency of the five-factor model of schizophrenic symptom... more Aim of the study was to examine the consistency of the five-factor model of schizophrenic symptoms, assess its validity and evaluate its dimensional factor structure using confirmatory factor (CFA) analysis. A sample of 258 randomly assigned DSM-III R patients with schizophrenic disorders were studied by means of the structured clinical interview for the Greek validated Positive and Negative Syndrome Scale (PANSS) and were rated on its 30 items. Patients' scores were subjected to principal component analysis (PCA) with varimax rotation. Internal consistency for each of the components was determined by the use of Cronbach's alpha. External validity of the model derived was investigated by searching for possible relationships between the components and sociodemographic characteristics with the aid of canonical correlation analysis. Confirmatory factor analysis (CFA) was also performed. Using the scree plot criterion PCA revealed a five-factor model. These factors were interpreted as representing-in a decreasing order of relative importance-the following dimensions of schizophrenic psychopathology: negative, excitement, depression, positive and cognitive impairment. The model was comparable with six previous factor analytic studies. Internal consistency was quite satisfactory whereas external validity was found to be not so powerful. CFA did not show that the proposed model yields an adequate factor structure.

Psychiatry and Clinical Neurosciences, 2009

A fifty-six-year-old married man presented with a continuous illness of nearly two years duration... more A fifty-six-year-old married man presented with a continuous illness of nearly two years duration of a psychotic nature. He first presented to our hospital in June 2006 with four months history of sleep disturbances, being preoccupied, hallucinatory behavior and persecutory ...

Annals of general …, 2006

Background: The aim of the current study is to investigate the relationship between physical anhe... more Background: The aim of the current study is to investigate the relationship between physical anhedonia and psychopathological parameters, pharmacological parameters or motor side-effects in a sample of inpatients with schizophrenia in an acute episode of their illness.

The British Journal of …, 2004

Background Patients with psychosis have activation of the hypothalamic-pituitary-adrenal (HPA) ax... more Background Patients with psychosis have activation of the hypothalamic-pituitary-adrenal (HPA) axis during the acute phase of the psychosis. Whether this has any morphological consequences for the pituitary gland is currently unknown. Aims To examine pituitary volume variation in people at different stages of psychotic disorder. Method Pituitary volume was measured using 1.5 mm, coronal magnetic resonance images in 24 people with first-episode psychosis, 51 with established schizophrenia and 59 healthy controls. Results Compared with the control group, the people with first-episode psychosis had pituitary volumes that were 10% larger, whereas those with established schizophrenia had pituitary volumes that were 17% smaller. In both of the groups with psychosis, there was no difference in pituitary volume between those receiving typical antipsychotic drugs and those receiving atypical antipsychotics. Conclusions The first episode of a psychosis is associated with a larger pituitary volume, which we suggest is due to activation of the HPA axis. The smaller pituitary volume in the group with established schizophrenia could be the consequence of repeated episodes of HPA axis hyperactivity.

European Psychiatry, 1998

European Psychiatry, 2000

Certain studies on measures related to central neurotransmitter activity have demonstrated that i... more Certain studies on measures related to central neurotransmitter activity have demonstrated that in delusional (psychotic) depression there is a dopaminergic dysregulation which distinguishes it from non-psychotic depression. A neuroendocrinologic method to check the degree of DA receptor responsivity is by measuring the prolactin responses to acute intramuscular administration of haloperidol. We studied this possibility by applying the haloperidol test in seven delusional and ten non-delusional depressed patients. All patients met DSM-IV criteria for a major depressive episode, single or recurrent, with or without psychotic features. After a three-week washout period, 5 mg of haloperidol were injected i.m. and blood samples were taken at 0, 30, 60, 90 and 120 minutes. In both trials, significant time effects were observed (elevated prolactin levels, F = 11.36, P = 0.000). However, the prolactin responses to haloperidol did not differ significantly between the two patient groups (F =...

European Psychiatry, 2000

Certain studies on measures related to central neurotransmitter activity have demonstrated that i... more Certain studies on measures related to central neurotransmitter activity have demonstrated that in delusional (psychotic) depression there is a dopaminergic dysregulation which distinguishes it from non-psychotic depression. A neuroendocrinologic method to check the degree of DA receptor responsivity is by measuring the prolactin responses to acute intramuscular administration of haloperidol. We studied this possibility by applying the haloperidol test in seven delusional and ten non-delusional depressed patients. All patients met DSM-IV criteria for a major depressive episode, single or recurrent, with or without psychotic features. After a three-week washout period, 5 mg of haloperidol were injected i.m. and blood samples were taken at 0, 30, 60, 90 and 120 minutes. In both trials, significant time effects were observed (elevated prolactin levels, F = 11.36, P = 0.000). However, the prolactin responses to haloperidol did not differ significantly between the two patient groups (F =...

Chapter in JM Mezzich, M Botbel, G Christadoulou, R Cloninger and I Salloum (eds): Person Centered Psychiatry, Springer Verlag, 2017

The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.

Journal of Sex & Marital Therapy, 2003

The aim of the present study was to assess androgen plasma levels and biogenic amine metabolites ... more The aim of the present study was to assess androgen plasma levels and biogenic amine metabolites in a sex-offender group as well as to investigate the relationship between the biological findings and the impulsive, aggressive, and suicidal profile of the offenders. Fifty-seven males convicted for rape and 25 normal males comprised the study sample. We found that although both testosterone levels and aggression-impulsivity scores were higher in the group of rapists, testosterone levels were not associated with the aggression and impulsivity scores. Nevertheless, aggression-impulsivity scores were clearly associated with luteinizing hormone levels. This association may indicate a hyperactive hypothalamic-pituitary-gonadal axis, possibly the result of a reduced serotonergic activity.

Springer eBooks, 2016

The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.

Annals of general hospital psychiatry, Jan 17, 2003

BACKGROUND: The aim of this paper is to describe a case of severe neuroleptic-induced tardive tor... more BACKGROUND: The aim of this paper is to describe a case of severe neuroleptic-induced tardive torticollis successfully treated with a combination of clozapine, clonazepam and botulinum toxin-A. CASE REPORT: The patient, a 30-year old man with a seven-year history of delusional disorder experienced severe right torticollis with painful tightness of the neck and elevation of the shoulder. At this time he was receiving haloperidol 20 mg, trifluoperazine 5 mg, zuclopenthixol 20 mg and biperidine 4 mg daily. The combination therapy with clozapine and clonazepam and the long-term use of botulinum toxin-A resulted in a complete remission of dystonic movements. CONCLUSIONS: The present observations provide evidence indicating that this combination therapy may be of benefit in patients with severe neuroleptic-induced tardive torticollis.

Certain studies on measures related to central neurotransmitter activity have demonstrated that i... more Certain studies on measures related to central neurotransmitter activity have demonstrated that in delusional (psychotic) depression there is a dopaminergic dysregulation which distinguishes it from non-psychotic depression. A neuroendocrinologic method to check the degree of DA receptor responsivity is by measuring the prolactin responses to acute intramuscular administration of haloperidol. We studied this possibility by applying the haloperidol test in seven delusional and ten non-delusional depressed patients. All patients met DSM-IV criteria for a major depressive episode, single or recurrent, with or without psychotic features. After a three-week washout period, 5 mg of haloperidol were injected i.m. and blood samples were taken at 0, 30, 60, 90 and 120 minutes. In both trials, significant time effects were observed (elevated prolactin levels, F = 11.36, P = 0.000). However, the prolactin responses to haloperidol did not differ significantly between the two patient groups (F = 0.12, P = 0.97). These data do not show a difference in D 2 receptor responsivity, at least at the hypothalamus-pituitary level, between psychotic and non-psychotic depression.

European Psychiatry, 1998

American Journal of Psychiatry, 2001

Risperidone-Induced Retrograde Ejaculation TO THE EDITOR: Schizophrenic patients treated with ant... more Risperidone-Induced Retrograde Ejaculation TO THE EDITOR: Schizophrenic patients treated with antipsychotic drugs may suffer from a variety of sexually disabling side effects that can affect all domains of sexual activity. The most common such adverse effects in men are erectile dysfunction and retrograde ejaculation (1). Retrograde ejaculation has been mostly reported in association with typical antipsychotics, especially thioridazine (1); among the atypical antipsychotics, to our knowledge, only clozapine has been reported to cause retrograde ejaculation (2). We describe a schizophrenic patient with risperidone-induced ejaculatory failure that was compatible with retrograde ejaculation, both clinically and in the laboratory. Mr. A was a 37-year-old man who was married with three children and who met DSM-IV criteria for paranoid schizophrenia. He was physically healthy, had no apparent concomitant general medical condition, and had never experienced ejaculatory problems. He had his first overt psychotic episode at age 29 and was successfully treated with perphenazine, 32 mg/day, without any major adverse effects. He was admitted to our psychiatric inpatient ward after a second psychotic exacerbation of the disorder and after being drug free for about 6 years. On admission, treatment with risperidone was initiated; the dose was increased to 4 mg/day by 1-mg/day increments and thereafter remained constant. On days 6, 9, and 14 after the initiation of risperidone treatment, Mr. A engaged in sexual intercourse with his wife, after which he reported having ejaculatory difficulties compatible with retrograde ejaculation. A condom was used during all encounters. He reported a complete failure to emit semen but a normal desire, erection, and sense of orgasm. Postcoital urine was collected after days 9 and 14, and semen was evident on evaluation of the samples on both occasions. A reduction of Mr. A's risperidone dose to 3 mg/day was associated with partial restoration of anterograde ejaculation.

Psychiatry Research, 2015

Therapeutic interventions in chronic mental illness face the important challenge to pursuit the q... more Therapeutic interventions in chronic mental illness face the important challenge to pursuit the quality of life (QOL) of patients. Insight into chronic mental illness, though a prerequisite for treatment adherence and a positive therapeutic outcome, has shown adverse associations with subjective QOL. This study aims to explore the contribution of psychopathological symptoms on the ambiguous role of insight on QOL. Seventy-two outpatients with schizophrenia spectrum disorders were assessed using the positive and negative syndrome scale, the scale to assess unawareness of mental disorder, and the WHOQOL-100 instrument for the assessment of quality of life. Insight was found to associate inversely with quality of life. Among psychopathological symptoms, depressive symptoms were the strongest negative contributor on QOL. Mediation analysis revealed that the effects of awareness of the consequences of illness on QOL were largely mediated by depressive symptoms (full mediation for the effect on physical and psychological domain and partial mediation for the effect on independence and environment domain of the QOL). Our results suggest that the inverse relationship between insight and subjective quality of life is partially mediated by depressive symptoms. We discuss theoretical and therapeutic implications of the findings, in conjunction with similar recent research data.

The International Journal of Neuropsychopharmacology, 2004

European Neuropsychopharmacology, 2000

Background: The neuroleptic malignant syndrome is a rare but serious condition mainly associated ... more Background: The neuroleptic malignant syndrome is a rare but serious condition mainly associated with antipsychotic medication. There are controversies as to whether "classical" forms of neuroleptic malignant syndrome can occur in patients given atypical antipsychotics. The serotonin syndrome is caused by drug-induced excess of intrasynaptic 5-hydroxytryptamine. The possible relationship between neuroleptic malignant syndrome and serotonin syndrome is at present in the focus of scientific interest. Methods: This retrospective phenomenological study aims to examine the seventeen reported olanzapine-induced neuroleptic malignant syndrome cases under the light of possible overlap between neuroleptic malignant syndrome and serotonin syndrome clinical features. Results: The serotonin syndrome clinical features most often reported in cases initially diagnosed as neuroleptic malignant syndrome are: fever (82%), mental status changes (82%) and diaphoresis (47%). Three out of the ten classical serotonin syndrome clinical features were concurrently observed in eleven (65%) patients and four clinical features were observed in seven (41%) patients. Conclusion: The results of this study show that the clinical symptoms of olanzapine-induced neuroleptic malignant syndrome and serotonin syndrome are overlapping suggesting similarities in underlying pathophysiological mechanisms.

Annals of General Hospital Psychiatry, 2003

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2004

Schizophrenia has been associated with a high rate of suicide. This study investigates the preval... more Schizophrenia has been associated with a high rate of suicide. This study investigates the prevalence of suicidal ideation in a population of inpatients with acute schizophrenia, together with the clinical parameters associated with suicidal thoughts. We assessed 93 schizophrenia patients. We matched subjects for age and sex and compared subjects with and without suicidal thoughts. We performed stepwise multiple regression analysis to assess the association between specific clinical symptoms and suicidal ideation. Of the patients, 20.4% reported suicidal thoughts during the last 15 days. Severity of depressive symptoms, motor retardation, guilt feelings, pathological guilt, and self-depreciation predicted the patients' suicidal ideation. Suicidal thoughts are frequent among inpatients with acute schizophrenia. Prevention of suicidal behaviour should include helping patients improve their self-esteem and reducing depression and guilt feelings.

Person Centered Psychiatry, 2016

The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric pra... more The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.

European Archives of …, 2000

Aim of the study was to examine the consistency of the five-factor model of schizophrenic symptom... more Aim of the study was to examine the consistency of the five-factor model of schizophrenic symptoms, assess its validity and evaluate its dimensional factor structure using confirmatory factor (CFA) analysis. A sample of 258 randomly assigned DSM-III R patients with schizophrenic disorders were studied by means of the structured clinical interview for the Greek validated Positive and Negative Syndrome Scale (PANSS) and were rated on its 30 items. Patients' scores were subjected to principal component analysis (PCA) with varimax rotation. Internal consistency for each of the components was determined by the use of Cronbach's alpha. External validity of the model derived was investigated by searching for possible relationships between the components and sociodemographic characteristics with the aid of canonical correlation analysis. Confirmatory factor analysis (CFA) was also performed. Using the scree plot criterion PCA revealed a five-factor model. These factors were interpreted as representing-in a decreasing order of relative importance-the following dimensions of schizophrenic psychopathology: negative, excitement, depression, positive and cognitive impairment. The model was comparable with six previous factor analytic studies. Internal consistency was quite satisfactory whereas external validity was found to be not so powerful. CFA did not show that the proposed model yields an adequate factor structure.

Psychiatry and Clinical Neurosciences, 2009

A fifty-six-year-old married man presented with a continuous illness of nearly two years duration... more A fifty-six-year-old married man presented with a continuous illness of nearly two years duration of a psychotic nature. He first presented to our hospital in June 2006 with four months history of sleep disturbances, being preoccupied, hallucinatory behavior and persecutory ...

Annals of general …, 2006

Background: The aim of the current study is to investigate the relationship between physical anhe... more Background: The aim of the current study is to investigate the relationship between physical anhedonia and psychopathological parameters, pharmacological parameters or motor side-effects in a sample of inpatients with schizophrenia in an acute episode of their illness.

The British Journal of …, 2004

Background Patients with psychosis have activation of the hypothalamic-pituitary-adrenal (HPA) ax... more Background Patients with psychosis have activation of the hypothalamic-pituitary-adrenal (HPA) axis during the acute phase of the psychosis. Whether this has any morphological consequences for the pituitary gland is currently unknown. Aims To examine pituitary volume variation in people at different stages of psychotic disorder. Method Pituitary volume was measured using 1.5 mm, coronal magnetic resonance images in 24 people with first-episode psychosis, 51 with established schizophrenia and 59 healthy controls. Results Compared with the control group, the people with first-episode psychosis had pituitary volumes that were 10% larger, whereas those with established schizophrenia had pituitary volumes that were 17% smaller. In both of the groups with psychosis, there was no difference in pituitary volume between those receiving typical antipsychotic drugs and those receiving atypical antipsychotics. Conclusions The first episode of a psychosis is associated with a larger pituitary volume, which we suggest is due to activation of the HPA axis. The smaller pituitary volume in the group with established schizophrenia could be the consequence of repeated episodes of HPA axis hyperactivity.

European Psychiatry, 1998

European Psychiatry, 2000

Certain studies on measures related to central neurotransmitter activity have demonstrated that i... more Certain studies on measures related to central neurotransmitter activity have demonstrated that in delusional (psychotic) depression there is a dopaminergic dysregulation which distinguishes it from non-psychotic depression. A neuroendocrinologic method to check the degree of DA receptor responsivity is by measuring the prolactin responses to acute intramuscular administration of haloperidol. We studied this possibility by applying the haloperidol test in seven delusional and ten non-delusional depressed patients. All patients met DSM-IV criteria for a major depressive episode, single or recurrent, with or without psychotic features. After a three-week washout period, 5 mg of haloperidol were injected i.m. and blood samples were taken at 0, 30, 60, 90 and 120 minutes. In both trials, significant time effects were observed (elevated prolactin levels, F = 11.36, P = 0.000). However, the prolactin responses to haloperidol did not differ significantly between the two patient groups (F =...

European Psychiatry, 2000

Certain studies on measures related to central neurotransmitter activity have demonstrated that i... more Certain studies on measures related to central neurotransmitter activity have demonstrated that in delusional (psychotic) depression there is a dopaminergic dysregulation which distinguishes it from non-psychotic depression. A neuroendocrinologic method to check the degree of DA receptor responsivity is by measuring the prolactin responses to acute intramuscular administration of haloperidol. We studied this possibility by applying the haloperidol test in seven delusional and ten non-delusional depressed patients. All patients met DSM-IV criteria for a major depressive episode, single or recurrent, with or without psychotic features. After a three-week washout period, 5 mg of haloperidol were injected i.m. and blood samples were taken at 0, 30, 60, 90 and 120 minutes. In both trials, significant time effects were observed (elevated prolactin levels, F = 11.36, P = 0.000). However, the prolactin responses to haloperidol did not differ significantly between the two patient groups (F =...