The objective of this study was to investigate the levels of tau protein in neurosyphilis. Total ... more The objective of this study was to investigate the levels of tau protein in neurosyphilis. Total tau protein in the cerebrospinal fluid of 12 patients with neurosyphilis, 17 with syphilis without nervous system involvement, 14 controls, and 14 patients with Alzheimer disease of comparable age were analyzed. Double-sandwich enzyme-linked immunosorbent assay was used for measurements. Increased levels of cerebrospinal fluid total tau were observed in neurosyphilis (median [25th-75th percentile]: 349 pg/mL [312-429]) and in Alzheimer disease (543 [441-1017]) as compared with the controls (189 [106-220]) and syphilis without nervous system involvement (190 [160-223]). Using a cutoff level of 300 pg/mL, increased tau discriminated cases of neurosyphilis from syphilis without nervous system involvement with a sensitivity and specificity of 83% and 94%, respectively. These results indicate that increased total tau may be useful in the discrimination of neurosyphilis from syphilis without n...
Objectives: To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease... more Objectives: To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease. Clinical Presentation and Intervention: A 56-year-old man initially presented with a 6-month duration of a continuous, diffuse headache of mild to moderate and sometimes of severe intensity. A CT of the brain was normal. Neurological examination was normal, including absence of symptoms and signs of meningismus. During the last 2 months, an intermittent eye pain, redness, and gradual loss of vision in both eyes was detected and subsequently he had tinnitus, malaise, nausea and mild meningismus. He was diagnosed as having VKH disease. Ophthalmologic examination revealed high intraocular pressure, requiring trabeculectomy with surgical iridectomy. The patient is now being treated with systemic steroids. Conclusion: VKH disease may initially present as sustained headache, without specific ophthalmologic symptoms and it should be considered in the differential diagnosis in patients with at...
To assess anxiety induced by a planned cataract surgery and to evaluate the correlations of rated... more To assess anxiety induced by a planned cataract surgery and to evaluate the correlations of rated anxiety and depression with optical acuity pre- and postoperatively, 278 patients ages 65 years or older were tested. Patients were divided into two groups: first-eye and second-eye cataract surgery. Anxiety and depression were evaluated using the Hamilton's Rating Scales for Anxiety and Depression, respectively. Pre-operatively, first-eye patients showed significantly higher anxiety than second-eye patients ( F1,251 =75.39, p .05). Postoperatively, anxiety and depression in patients without any improvement in their vision were rated significantly higher than in those presenting improved visual acuity after surgery ( F1,251 =566.17 and 300.25, respectively, p
There is growing body of evidence that support an association between stressful life events and a... more There is growing body of evidence that support an association between stressful life events and an increased risk for Multiple Sclerosis (MS) exacerbations. However, the nature of this relationship remains unclear, because of the lack of agreement about the definition of stress and/or because of research design problems. This article summarizes the psychological and biological mechanisms by which stress may impact MS progression. Findings indicate a number of factors, including stressor chronicity, frequency, severity and type, depression, anxiety, health locus of control, optimism, perceived social support, and coping strategies. Applied implications are discussed, concentrating on the need for multidisciplinary care interventions that target patients' disease symptoms.
The aim of this study was to evaluate the safety and efficacy of vardenafil in outpatients with c... more The aim of this study was to evaluate the safety and efficacy of vardenafil in outpatients with chronic schizophrenia and erectile dysfunction and to investigate any effect on quality of life in this population. In this 12-week, open-label, flexible-dose study, 25 outpatients with chronic schizophrenia (DSM-IV criteria) and erectile dysfunction received vardenafil 10 mg as needed (at a maximum of 1 dose per day) with the option to maintain current dose or to titrate to 5 mg or 20 mg at 4 and 8 weeks. Assessment was performed with the International Index of Erectile Function (IIEF) at base line and at weeks 4, 8, and 12. The Quality of Life Scale (QLS) was administered at baseline and at week 12. The study was carried out at the Psychiatric Hospital of Athens, Greece, between October 2005 and November 2006. Vardenafil produced a statistically significant improvement in all IIEF domains [erectile function (p < .001), orgasmic function (p < .05), sexual desire (p < .05), intercourse satisfaction (p < .01), and overall satisfaction (p < .001)] and QLS (p < .003). Results were similar for the intention-to-treat (N = 25) and completer (N = 21, 84%) groups. Adverse events were infrequent and decreased in incidence over the course of the study. Vardenafil was generally well tolerated and highly effective in outpatients with chronic schizophrenia and erectile dysfunction. The response to vardenafil was not influenced by certain patient characteristics, such as erectile dysfunction severity or serum prolactin levels. Improvement in sexual function was correlated with improvement in the quality of life.
PurposeThe aims of this study were first, to examine the general relation between stressful life ... more PurposeThe aims 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.MethodsTwenty 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 severity of SLEs was determined using the Recent Life Change Questionnaire.ResultsExperiencing three or more SLEs, during a 4-week period, was associated with a 5-fold increase of MS relapse rate (95% CI 1.7–16.4, p = 0.003). The presence of at least one lon...
Objective Self-reported stressful life events and infections have been associated with relapses i... more Objective Self-reported stressful life events and infections have been associated with relapses in multiple sclerosis. Also, anxiety has been reported to influence other diseases of unpredictable course. To study relation of self-reported stressful life events, levels of anxiety, and episodes of infection, with relapses of the disease in women with multiple sclerosis. Methods This is a one-year prospective study. Thirty seven women with multiple sclerosis were regularly seen every four weeks, for one year. They were keeping diaries of events they considered stressful. These events were ranked according to the Holmes and Rahe Social Readjustment Rating Scale. Their anxiety levels were assessed with the Hamilton rating scale for anxiety. Relapses and episodes of infection were verified at additional visits. Results were studied using a survival analysis model adapted for several recurrent events. Results A total of 291 stressful events, 37 episodes of infection, and 48 relapses, were registered. High level of anxiety were stongly related to the number and the severity of reported stressful events during the preceding period and with the advent of a relapse in the following period (Hamilton score greater than 18 is associated with 4.2 times the rate of relapsing and three or more reported stressful events with 5.7 times the rate of relapsing). Conclusions Anxiety and self-reported stressful events may in fact be two measures of the same underlying emotional factor, which plays an important role on the course of the disease, in addition to episodes of infection.
Aim of the report was the study of the clinical features of neurosyphilis in the last 40 years (1... more Aim of the report was the study of the clinical features of neurosyphilis in the last 40 years (1965-2005). The investigation was based on the retrospective review of patients with neurosyphilis hospitalized in our hospital from 1965 to 2005 (period A: 1965-1984 and B: 1985-2005). Eighty one patients with neurosyphilis were studied. Typical forms represent 68.6% of cases of neurosyphilis in period A. In period B, 85.7% of the cases are presented with atypical clinical patterns. Typical forms of the disease were no longer common, while atypical and masked clinical patterns prevailed. Neuropsychiatric symptoms were the most common manifestations of the disease.
Delusional disorder, somatic type (DDST) is a rare psychiatric disorder and the treatment is most... more Delusional disorder, somatic type (DDST) is a rare psychiatric disorder and the treatment is mostly based on observations, due to the lack of well-organized studies. Initially, antipsychotics and especially pimozide were considered to be the pharmacological approach of choice but, subsequently, tryciclic anti-depressants and selective serotonin re-uptake inhibitors (SSRIs) were also suggested to be effective, implicating the serotonergic system in the pathophysiology of the disorder. We present the case of a female with DDST, who responded to aripiprazole-mirtazapine combination, a finding that is in accordance with the initial approach of this disorder as a part of the schizophrenic spectrum, but also supports the hypothesis of serotonin dysfunction in DDST.
Journal of Geriatric Psychiatry and Neurology, 2007
The purpose of the study was to examine the association of plasma lipid concentrations with chang... more The purpose of the study was to examine the association of plasma lipid concentrations with changes in cognitive function and depressive states in elderly Greek individuals. The study population consisted of 3 groups: A) 37 subjects with dementia, B) 33 subjects with depression, and C) 33 controls. All individuals were screened with the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and an evaluation of their psychiatric state. Lipid profile was assessed in all subjects, and the results were statistically evaluated at P < .05 level of significance. Groups A and B had significantly lower levels of total plasma cholesterol and HDL cholesterol than group C (P < .01). Triglyceride levels did not differ significantly between groups A and C, although they were significantly higher in group B. The results of this study suggest that an association does exist between the plasma concentration of cholesterol and HDL-C and depression and/or cognitive impairment. Further studies are required to explore the significance of these observations and establish if lipid levels could serve as markers for diagnostic and therapeutic purposes.
The objective of this study was to investigate the levels of tau protein in neurosyphilis. Total ... more The objective of this study was to investigate the levels of tau protein in neurosyphilis. Total tau protein in the cerebrospinal fluid of 12 patients with neurosyphilis, 17 with syphilis without nervous system involvement, 14 controls, and 14 patients with Alzheimer disease of comparable age were analyzed. Double-sandwich enzyme-linked immunosorbent assay was used for measurements. Increased levels of cerebrospinal fluid total tau were observed in neurosyphilis (median [25th-75th percentile]: 349 pg/mL [312-429]) and in Alzheimer disease (543 [441-1017]) as compared with the controls (189 [106-220]) and syphilis without nervous system involvement (190 [160-223]). Using a cutoff level of 300 pg/mL, increased tau discriminated cases of neurosyphilis from syphilis without nervous system involvement with a sensitivity and specificity of 83% and 94%, respectively. These results indicate that increased total tau may be useful in the discrimination of neurosyphilis from syphilis without n...
Objectives: To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease... more Objectives: To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease. Clinical Presentation and Intervention: A 56-year-old man initially presented with a 6-month duration of a continuous, diffuse headache of mild to moderate and sometimes of severe intensity. A CT of the brain was normal. Neurological examination was normal, including absence of symptoms and signs of meningismus. During the last 2 months, an intermittent eye pain, redness, and gradual loss of vision in both eyes was detected and subsequently he had tinnitus, malaise, nausea and mild meningismus. He was diagnosed as having VKH disease. Ophthalmologic examination revealed high intraocular pressure, requiring trabeculectomy with surgical iridectomy. The patient is now being treated with systemic steroids. Conclusion: VKH disease may initially present as sustained headache, without specific ophthalmologic symptoms and it should be considered in the differential diagnosis in patients with at...
To assess anxiety induced by a planned cataract surgery and to evaluate the correlations of rated... more To assess anxiety induced by a planned cataract surgery and to evaluate the correlations of rated anxiety and depression with optical acuity pre- and postoperatively, 278 patients ages 65 years or older were tested. Patients were divided into two groups: first-eye and second-eye cataract surgery. Anxiety and depression were evaluated using the Hamilton's Rating Scales for Anxiety and Depression, respectively. Pre-operatively, first-eye patients showed significantly higher anxiety than second-eye patients ( F1,251 =75.39, p .05). Postoperatively, anxiety and depression in patients without any improvement in their vision were rated significantly higher than in those presenting improved visual acuity after surgery ( F1,251 =566.17 and 300.25, respectively, p
There is growing body of evidence that support an association between stressful life events and a... more There is growing body of evidence that support an association between stressful life events and an increased risk for Multiple Sclerosis (MS) exacerbations. However, the nature of this relationship remains unclear, because of the lack of agreement about the definition of stress and/or because of research design problems. This article summarizes the psychological and biological mechanisms by which stress may impact MS progression. Findings indicate a number of factors, including stressor chronicity, frequency, severity and type, depression, anxiety, health locus of control, optimism, perceived social support, and coping strategies. Applied implications are discussed, concentrating on the need for multidisciplinary care interventions that target patients' disease symptoms.
The aim of this study was to evaluate the safety and efficacy of vardenafil in outpatients with c... more The aim of this study was to evaluate the safety and efficacy of vardenafil in outpatients with chronic schizophrenia and erectile dysfunction and to investigate any effect on quality of life in this population. In this 12-week, open-label, flexible-dose study, 25 outpatients with chronic schizophrenia (DSM-IV criteria) and erectile dysfunction received vardenafil 10 mg as needed (at a maximum of 1 dose per day) with the option to maintain current dose or to titrate to 5 mg or 20 mg at 4 and 8 weeks. Assessment was performed with the International Index of Erectile Function (IIEF) at base line and at weeks 4, 8, and 12. The Quality of Life Scale (QLS) was administered at baseline and at week 12. The study was carried out at the Psychiatric Hospital of Athens, Greece, between October 2005 and November 2006. Vardenafil produced a statistically significant improvement in all IIEF domains [erectile function (p < .001), orgasmic function (p < .05), sexual desire (p < .05), intercourse satisfaction (p < .01), and overall satisfaction (p < .001)] and QLS (p < .003). Results were similar for the intention-to-treat (N = 25) and completer (N = 21, 84%) groups. Adverse events were infrequent and decreased in incidence over the course of the study. Vardenafil was generally well tolerated and highly effective in outpatients with chronic schizophrenia and erectile dysfunction. The response to vardenafil was not influenced by certain patient characteristics, such as erectile dysfunction severity or serum prolactin levels. Improvement in sexual function was correlated with improvement in the quality of life.
PurposeThe aims of this study were first, to examine the general relation between stressful life ... more PurposeThe aims 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.MethodsTwenty 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 severity of SLEs was determined using the Recent Life Change Questionnaire.ResultsExperiencing three or more SLEs, during a 4-week period, was associated with a 5-fold increase of MS relapse rate (95% CI 1.7–16.4, p = 0.003). The presence of at least one lon...
Objective Self-reported stressful life events and infections have been associated with relapses i... more Objective Self-reported stressful life events and infections have been associated with relapses in multiple sclerosis. Also, anxiety has been reported to influence other diseases of unpredictable course. To study relation of self-reported stressful life events, levels of anxiety, and episodes of infection, with relapses of the disease in women with multiple sclerosis. Methods This is a one-year prospective study. Thirty seven women with multiple sclerosis were regularly seen every four weeks, for one year. They were keeping diaries of events they considered stressful. These events were ranked according to the Holmes and Rahe Social Readjustment Rating Scale. Their anxiety levels were assessed with the Hamilton rating scale for anxiety. Relapses and episodes of infection were verified at additional visits. Results were studied using a survival analysis model adapted for several recurrent events. Results A total of 291 stressful events, 37 episodes of infection, and 48 relapses, were registered. High level of anxiety were stongly related to the number and the severity of reported stressful events during the preceding period and with the advent of a relapse in the following period (Hamilton score greater than 18 is associated with 4.2 times the rate of relapsing and three or more reported stressful events with 5.7 times the rate of relapsing). Conclusions Anxiety and self-reported stressful events may in fact be two measures of the same underlying emotional factor, which plays an important role on the course of the disease, in addition to episodes of infection.
Aim of the report was the study of the clinical features of neurosyphilis in the last 40 years (1... more Aim of the report was the study of the clinical features of neurosyphilis in the last 40 years (1965-2005). The investigation was based on the retrospective review of patients with neurosyphilis hospitalized in our hospital from 1965 to 2005 (period A: 1965-1984 and B: 1985-2005). Eighty one patients with neurosyphilis were studied. Typical forms represent 68.6% of cases of neurosyphilis in period A. In period B, 85.7% of the cases are presented with atypical clinical patterns. Typical forms of the disease were no longer common, while atypical and masked clinical patterns prevailed. Neuropsychiatric symptoms were the most common manifestations of the disease.
Delusional disorder, somatic type (DDST) is a rare psychiatric disorder and the treatment is most... more Delusional disorder, somatic type (DDST) is a rare psychiatric disorder and the treatment is mostly based on observations, due to the lack of well-organized studies. Initially, antipsychotics and especially pimozide were considered to be the pharmacological approach of choice but, subsequently, tryciclic anti-depressants and selective serotonin re-uptake inhibitors (SSRIs) were also suggested to be effective, implicating the serotonergic system in the pathophysiology of the disorder. We present the case of a female with DDST, who responded to aripiprazole-mirtazapine combination, a finding that is in accordance with the initial approach of this disorder as a part of the schizophrenic spectrum, but also supports the hypothesis of serotonin dysfunction in DDST.
Journal of Geriatric Psychiatry and Neurology, 2007
The purpose of the study was to examine the association of plasma lipid concentrations with chang... more The purpose of the study was to examine the association of plasma lipid concentrations with changes in cognitive function and depressive states in elderly Greek individuals. The study population consisted of 3 groups: A) 37 subjects with dementia, B) 33 subjects with depression, and C) 33 controls. All individuals were screened with the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and an evaluation of their psychiatric state. Lipid profile was assessed in all subjects, and the results were statistically evaluated at P < .05 level of significance. Groups A and B had significantly lower levels of total plasma cholesterol and HDL cholesterol than group C (P < .01). Triglyceride levels did not differ significantly between groups A and C, although they were significantly higher in group B. The results of this study suggest that an association does exist between the plasma concentration of cholesterol and HDL-C and depression and/or cognitive impairment. Further studies are required to explore the significance of these observations and establish if lipid levels could serve as markers for diagnostic and therapeutic purposes.
Uploads
Papers by CHARALAMPOS Mitsonis