Background: Sleep disturbances are an important symptom dimension of post-traumatic-stress-disord... more Background: Sleep disturbances are an important symptom dimension of post-traumatic-stress-disorder (PTSD). There is no meta-analytic evidence examining the effects of all types of pharmacotherapy on sleep outcomes among patients with PTSD. Methods: Medline/Embase/PsychInfo/CENTRAL/clinicaltrials.gov/ICTRP, reference lists of published reviews and all included studies were searched for Randomised Controlled Trials (RCTs) examining any pharmacotherapy vs. placebo or any other drug among patients with PTSD. Primary outcomes: total sleep time, nightmares, sleep quality. Secondary outcomes: sleep onset latency, number of nocturnal awakenings, time spent awake following sleep onset, dropouts due to sleep-related adverse-effects, insomnia/somnolence/vivid-dreams as adverse-effects. Pairwise and network meta-analyses were performed. Results: 99 RCTs with 10,481 participants were included. Prazosin may be the most effective treatment for insomnia (SMD = 0.88, 95%CI = [-1.22;-0.54], nightmares (SMD = 0.44, 95%CI = [-0.84;-0.04]) and poor sleep quality (SMD = 0.55, 95%CI = [-1.01;-0.10]). Evidence is scarce and indicates lack of efficacy for SSRIs, Mirtazapine, z-drugs and benzodiazepines, which are widely used in daily practice. Risperidone and Quetiapine carry a high risk of causing somnolence without having a clear therapeutic benefit. Hydroxyzine, Trazodone, Nabilone, Paroxetine and MDMA-assisted psychotherapy may be promising options, but more research is needed. Conclusions: Underpowered individual comparisons and very-low to moderate confidence in effect estimates hinder the generalisability of the results. More RCTs, specifically reporting on sleep-related outcomes, are urgently needed.
Background Physical activity and exercise have been suggested as effective interventions for the ... more Background Physical activity and exercise have been suggested as effective interventions for the prevention and management of mild cognitive impairment (MCI) and dementia, but there are no international guidelines. Objectives To create a set of evidence- and expert consensus-based prevention and management recommendations regarding physical activity (any bodily movement produced by skeletal muscles that results in energy expenditure) and exercise (a subset of physical activity that is planned, structured, repetitive), applicable to a range of individuals from healthy older adults to those with MCI/dementia. Methods Guideline content was developed with input from several scientific and lay representatives’ societies. A systematic search across multidisciplinary databases was carried out until October 2021. Recommendations for prevention and management were developed according to the GRADE and complemented by consensus statements from the expert panels. Recommendations Physical activi...
: Antidepressants are a commonly used, easily accessible, and overall safe treatment option for p... more : Antidepressants are a commonly used, easily accessible, and overall safe treatment option for post-traumatic stress disorder (PTSD). The present review aims to evaluate the efficacy and safety of antidepressants in treating sleep disturbances in patients with PTSD. PubMed and the Cochrane Li- brary were searched (July 2022) for systematic reviews and meta-analyses on the treatment of PTSD. Moreover, PubMed and ClinicalTrials.gov were searched for individual trials investigating the antidepressant treatment of PTSD (up to September 2022), and reference lists of all relevant identi- fied studies were screened. Sleep-related outcomes, i.e., total sleep time, sleep quality, dreams/ nightmares, insomnia, and somnolence, were extracted independently by at least two reviewers. Meta- analytic evaluations were performed wherever possible. 39 randomised controlled trials (RCTs) were identified; data from pooled analyses, reviews, and observational studies were used for antidepressants with a weak evidence base or when their findings were deemed important. Overall, scarce data exist on the effects of antidepressants on sleep outcomes among patients with PTSD. Some evidence may support the use of amitriptyline, nefazodone, paroxetine, and sertraline for improving sleep in patients with PTSD. Τhere was a meta-analytical trend indicating improvement of nightmares with fluoxetine, less insomnia with amitriptyline and more with brofaromine, as well as more somnolence with paroxe- tine vs. placebo, respectively. However, data from more than 1 RCT with a considerable number of pa- tients were only available for paroxetine. Evidence is insufficient to draw safe conclusions. More and better-designed RCTs, with consistent reporting of sleep-related outcomes, are needed.
The glymphatic system is responsible for the clearance of the potentially harmful metabolic waste... more The glymphatic system is responsible for the clearance of the potentially harmful metabolic waste of the Central Nervous System. The prevalent theory is that the cerebrospinal fluid (CSF) circulates in the perivascular space (PVS) and through the astrocytes' aquaporin-4 channels (AQ-4), and it is then drained by the lymphatic vessels after mixing with interstitial fluid (ISF). However, there is little evidence supporting this hypothesis. A deeper understanding of the physiology of the glymphatic system could transform the way we understand neuropathology and our approach to treating neurological and neuropsychiatric disorders. In this review, we introduce a new conceptual framework for the functionality of the glymphatic system, offering new directions for future research. We propose that CSF and ISF exchange flow depends on arterial pulsation, respiration, posture and sleep. PVS changes due to disrupted cerebral autoregulation, alternations of intrathoracic pressure, venous flo...
Objective: To establish whether there is a significant change in suicidality risk following psych... more Objective: To establish whether there is a significant change in suicidality risk following psychiatric assessment for commencement of isotretinoin and identify factors that underpin any potential risk change. Method: Retrospective cohort study. Suicidality risk was defined as a combination of the following: (i) actual/intended self-harm and/or attempted/completed suicide, and (ii) increased service utilisation associated with suicidal ideation/behaviour. All patients referred to Psychiatry for assessment prior to commencement of isotretinoin between 2014 and 2019 were examined. Inclusion criteria: >16 years of age, assessed for commencement of isotretinoin, complete clinical records. Data were collected by reviewing the Electronic Patient Records. Fifty-seven patients were eligible. We employed descriptive statistics, parametric/non-parametric/normality tests and logistic regression analysis, using socio-demographic and clinical characteristics as independent parameters, and sui...
Objective: To establish whether there is a significant change in suicidality risk following psych... more Objective: To establish whether there is a significant change in suicidality risk following psychiatric assessment for commencement of isotretinoin and identify factors that underpin any potential risk change. Method: Retrospective cohort study. Suicidality risk was defined as a combination of the following: (i) actual/intended self-harm and/or attempted/completed suicide, and (ii) increased service utilisation associated with suicidal ideation/behaviour. All patients referred to Psychiatry for assessment prior to commencement of isotretinoin between 2014 and 2019 were examined. Inclusion criteria: >16 years of age, assessed for commencement of isotretinoin, complete clinical records. Data were collected by reviewing the Electronic Patient Records. Fifty-seven patients were eligible. We employed descriptive statistics, parametric/non-parametric/normality tests and logistic regression analysis, using socio-demographic and clinical characteristics as independent parameters, and sui...
The current system of mental health care in Greece was created in accordance with the European Un... more The current system of mental health care in Greece was created in accordance with the European Union and other international principles for mental health care provisions. Whereas Greece has been reforming its system of mental healthcare since at least the 80s, the main recent Greek effort has been Psychargos, a programme which began in 2000 and is still in effect. During the last two decades the Greek mental health system has been gradually shifting to a community-based system of care. Various different services with unique, yet intertwined, responsibilities have been introduced. The Greek system of mental health care still faces challenges, and the mental health reform is on-going. Future goals should be to improve the current framework of care, improve access to care by establishing fit-for-purpose community mental health services across the country, enhance multidisciplinary collaboration and patient involvement, integrate community mental health care with physical and social car...
The current system of mental health care in Greece was created in accordance with the European Un... more The current system of mental health care in Greece was created in accordance with the European Union and other international principles for mental health care provisions. Whereas Greece has been reforming its system of mental healthcare since at least the 80s, the main recent Greek effort has been Psychargos, a programme which began in 2000 and is still in effect. During the last two decades the Greek mental health system has been gradually shifting to a community-based system of care. Various different services with unique, yet intertwined, responsibilities have been introduced. The Greek system of mental health care still faces challenges, and the mental health reform is on-going. Future goals should be to improve the current framework of care, improve access to care by establishing fit-for-purpose community mental health services across the country, enhance multidisciplinary collaboration and patient involvement, integrate community mental health care with physical and social car...
BAckgROUnd: The present study assessed the immediate respiratory effects of water-pipe smoking (W... more BAckgROUnd: The present study assessed the immediate respiratory effects of water-pipe smoking (WPS) specifically focusing on tidal breathing examining Impulse Oscillometry (IOS), Control of Breathing (CoB) and exhaled CO (eCO) among young healthy adults. MethOdS: A cross-over study design with sample size of 50 young healthy smokers was used. All measurements were taken immediately pre and post a Control and Experimental session. Repeated analysis of variance (ANOVA) and log-transformations were used for comparisons between pre-post and sessions. Significance was set to p<0.05. ReSUltS: During the Experimental session, TI/TE, TI/Ttot (p<0.001), P0.1 (p=0.005) and P0.1/(VT/TI) (p=0.021) increased significantly while TE/Ttot decreased (p=0.003) post WPS. IOS parameters Ζ5, R5, R10, R20 and fdr all increased significantly immediately post WPS (p<0.001) as did eCO and COHb (p<0.001). cOnclUSiOn: A 30-minute session of WPS altered respiratory mechanics expressed by the incre...
Psychiatric manifestations are common in patients with Wilson&#39;s Disease(WD), and they are... more Psychiatric manifestations are common in patients with Wilson&#39;s Disease(WD), and they are usually correlated with neurological symptoms. However, psychotic presentation without neurological symptoms has rarely been reported. We present a case of WD involving a 34-year-old gentleman who was diagnosed at the age of 22, but due to lack of medication for approximately 5 months was admitted in a psychiatric ward with delusional thoughts of grandeur and persecution, echopraxia and echolalia. No neurological impairment, ophthalmic manifestations or liver abnormalities were identified. Through this report, we aim to discuss the pathophysiology and the treatment of psychosis in WD, and its association with neurological, liver and ophthalmic manifestations.
Background: Sleep disturbances are an important symptom dimension of post-traumatic-stress-disord... more Background: Sleep disturbances are an important symptom dimension of post-traumatic-stress-disorder (PTSD). There is no meta-analytic evidence examining the effects of all types of pharmacotherapy on sleep outcomes among patients with PTSD. Methods: Medline/Embase/PsychInfo/CENTRAL/clinicaltrials.gov/ICTRP, reference lists of published reviews and all included studies were searched for Randomised Controlled Trials (RCTs) examining any pharmacotherapy vs. placebo or any other drug among patients with PTSD. Primary outcomes: total sleep time, nightmares, sleep quality. Secondary outcomes: sleep onset latency, number of nocturnal awakenings, time spent awake following sleep onset, dropouts due to sleep-related adverse-effects, insomnia/somnolence/vivid-dreams as adverse-effects. Pairwise and network meta-analyses were performed. Results: 99 RCTs with 10,481 participants were included. Prazosin may be the most effective treatment for insomnia (SMD = 0.88, 95%CI = [-1.22;-0.54], nightmares (SMD = 0.44, 95%CI = [-0.84;-0.04]) and poor sleep quality (SMD = 0.55, 95%CI = [-1.01;-0.10]). Evidence is scarce and indicates lack of efficacy for SSRIs, Mirtazapine, z-drugs and benzodiazepines, which are widely used in daily practice. Risperidone and Quetiapine carry a high risk of causing somnolence without having a clear therapeutic benefit. Hydroxyzine, Trazodone, Nabilone, Paroxetine and MDMA-assisted psychotherapy may be promising options, but more research is needed. Conclusions: Underpowered individual comparisons and very-low to moderate confidence in effect estimates hinder the generalisability of the results. More RCTs, specifically reporting on sleep-related outcomes, are urgently needed.
Background Physical activity and exercise have been suggested as effective interventions for the ... more Background Physical activity and exercise have been suggested as effective interventions for the prevention and management of mild cognitive impairment (MCI) and dementia, but there are no international guidelines. Objectives To create a set of evidence- and expert consensus-based prevention and management recommendations regarding physical activity (any bodily movement produced by skeletal muscles that results in energy expenditure) and exercise (a subset of physical activity that is planned, structured, repetitive), applicable to a range of individuals from healthy older adults to those with MCI/dementia. Methods Guideline content was developed with input from several scientific and lay representatives’ societies. A systematic search across multidisciplinary databases was carried out until October 2021. Recommendations for prevention and management were developed according to the GRADE and complemented by consensus statements from the expert panels. Recommendations Physical activi...
: Antidepressants are a commonly used, easily accessible, and overall safe treatment option for p... more : Antidepressants are a commonly used, easily accessible, and overall safe treatment option for post-traumatic stress disorder (PTSD). The present review aims to evaluate the efficacy and safety of antidepressants in treating sleep disturbances in patients with PTSD. PubMed and the Cochrane Li- brary were searched (July 2022) for systematic reviews and meta-analyses on the treatment of PTSD. Moreover, PubMed and ClinicalTrials.gov were searched for individual trials investigating the antidepressant treatment of PTSD (up to September 2022), and reference lists of all relevant identi- fied studies were screened. Sleep-related outcomes, i.e., total sleep time, sleep quality, dreams/ nightmares, insomnia, and somnolence, were extracted independently by at least two reviewers. Meta- analytic evaluations were performed wherever possible. 39 randomised controlled trials (RCTs) were identified; data from pooled analyses, reviews, and observational studies were used for antidepressants with a weak evidence base or when their findings were deemed important. Overall, scarce data exist on the effects of antidepressants on sleep outcomes among patients with PTSD. Some evidence may support the use of amitriptyline, nefazodone, paroxetine, and sertraline for improving sleep in patients with PTSD. Τhere was a meta-analytical trend indicating improvement of nightmares with fluoxetine, less insomnia with amitriptyline and more with brofaromine, as well as more somnolence with paroxe- tine vs. placebo, respectively. However, data from more than 1 RCT with a considerable number of pa- tients were only available for paroxetine. Evidence is insufficient to draw safe conclusions. More and better-designed RCTs, with consistent reporting of sleep-related outcomes, are needed.
The glymphatic system is responsible for the clearance of the potentially harmful metabolic waste... more The glymphatic system is responsible for the clearance of the potentially harmful metabolic waste of the Central Nervous System. The prevalent theory is that the cerebrospinal fluid (CSF) circulates in the perivascular space (PVS) and through the astrocytes' aquaporin-4 channels (AQ-4), and it is then drained by the lymphatic vessels after mixing with interstitial fluid (ISF). However, there is little evidence supporting this hypothesis. A deeper understanding of the physiology of the glymphatic system could transform the way we understand neuropathology and our approach to treating neurological and neuropsychiatric disorders. In this review, we introduce a new conceptual framework for the functionality of the glymphatic system, offering new directions for future research. We propose that CSF and ISF exchange flow depends on arterial pulsation, respiration, posture and sleep. PVS changes due to disrupted cerebral autoregulation, alternations of intrathoracic pressure, venous flo...
Objective: To establish whether there is a significant change in suicidality risk following psych... more Objective: To establish whether there is a significant change in suicidality risk following psychiatric assessment for commencement of isotretinoin and identify factors that underpin any potential risk change. Method: Retrospective cohort study. Suicidality risk was defined as a combination of the following: (i) actual/intended self-harm and/or attempted/completed suicide, and (ii) increased service utilisation associated with suicidal ideation/behaviour. All patients referred to Psychiatry for assessment prior to commencement of isotretinoin between 2014 and 2019 were examined. Inclusion criteria: >16 years of age, assessed for commencement of isotretinoin, complete clinical records. Data were collected by reviewing the Electronic Patient Records. Fifty-seven patients were eligible. We employed descriptive statistics, parametric/non-parametric/normality tests and logistic regression analysis, using socio-demographic and clinical characteristics as independent parameters, and sui...
Objective: To establish whether there is a significant change in suicidality risk following psych... more Objective: To establish whether there is a significant change in suicidality risk following psychiatric assessment for commencement of isotretinoin and identify factors that underpin any potential risk change. Method: Retrospective cohort study. Suicidality risk was defined as a combination of the following: (i) actual/intended self-harm and/or attempted/completed suicide, and (ii) increased service utilisation associated with suicidal ideation/behaviour. All patients referred to Psychiatry for assessment prior to commencement of isotretinoin between 2014 and 2019 were examined. Inclusion criteria: >16 years of age, assessed for commencement of isotretinoin, complete clinical records. Data were collected by reviewing the Electronic Patient Records. Fifty-seven patients were eligible. We employed descriptive statistics, parametric/non-parametric/normality tests and logistic regression analysis, using socio-demographic and clinical characteristics as independent parameters, and sui...
The current system of mental health care in Greece was created in accordance with the European Un... more The current system of mental health care in Greece was created in accordance with the European Union and other international principles for mental health care provisions. Whereas Greece has been reforming its system of mental healthcare since at least the 80s, the main recent Greek effort has been Psychargos, a programme which began in 2000 and is still in effect. During the last two decades the Greek mental health system has been gradually shifting to a community-based system of care. Various different services with unique, yet intertwined, responsibilities have been introduced. The Greek system of mental health care still faces challenges, and the mental health reform is on-going. Future goals should be to improve the current framework of care, improve access to care by establishing fit-for-purpose community mental health services across the country, enhance multidisciplinary collaboration and patient involvement, integrate community mental health care with physical and social car...
The current system of mental health care in Greece was created in accordance with the European Un... more The current system of mental health care in Greece was created in accordance with the European Union and other international principles for mental health care provisions. Whereas Greece has been reforming its system of mental healthcare since at least the 80s, the main recent Greek effort has been Psychargos, a programme which began in 2000 and is still in effect. During the last two decades the Greek mental health system has been gradually shifting to a community-based system of care. Various different services with unique, yet intertwined, responsibilities have been introduced. The Greek system of mental health care still faces challenges, and the mental health reform is on-going. Future goals should be to improve the current framework of care, improve access to care by establishing fit-for-purpose community mental health services across the country, enhance multidisciplinary collaboration and patient involvement, integrate community mental health care with physical and social car...
BAckgROUnd: The present study assessed the immediate respiratory effects of water-pipe smoking (W... more BAckgROUnd: The present study assessed the immediate respiratory effects of water-pipe smoking (WPS) specifically focusing on tidal breathing examining Impulse Oscillometry (IOS), Control of Breathing (CoB) and exhaled CO (eCO) among young healthy adults. MethOdS: A cross-over study design with sample size of 50 young healthy smokers was used. All measurements were taken immediately pre and post a Control and Experimental session. Repeated analysis of variance (ANOVA) and log-transformations were used for comparisons between pre-post and sessions. Significance was set to p<0.05. ReSUltS: During the Experimental session, TI/TE, TI/Ttot (p<0.001), P0.1 (p=0.005) and P0.1/(VT/TI) (p=0.021) increased significantly while TE/Ttot decreased (p=0.003) post WPS. IOS parameters Ζ5, R5, R10, R20 and fdr all increased significantly immediately post WPS (p<0.001) as did eCO and COHb (p<0.001). cOnclUSiOn: A 30-minute session of WPS altered respiratory mechanics expressed by the incre...
Psychiatric manifestations are common in patients with Wilson&#39;s Disease(WD), and they are... more Psychiatric manifestations are common in patients with Wilson&#39;s Disease(WD), and they are usually correlated with neurological symptoms. However, psychotic presentation without neurological symptoms has rarely been reported. We present a case of WD involving a 34-year-old gentleman who was diagnosed at the age of 22, but due to lack of medication for approximately 5 months was admitted in a psychiatric ward with delusional thoughts of grandeur and persecution, echopraxia and echolalia. No neurological impairment, ophthalmic manifestations or liver abnormalities were identified. Through this report, we aim to discuss the pathophysiology and the treatment of psychosis in WD, and its association with neurological, liver and ophthalmic manifestations.
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