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“Sleep apnoea and visceral adiposity in middle-aged male and female subjects.” Ilia Kritikou, Maria Basta, Rafel Tappouni, Slobodanha Pejovic, Julio Fernandez-Mendoza, Racha Nazir, Michelle L. Shaffer, Duanping Liao, Edward O. Bixler, George P. Chrousos and Alexandros N. Vgontzas. Eur Respir J 20...more
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OBJECTIVE To examine the relationship between insomnia symptoms and metabolic syndrome in patients with severe psychiatric disorders. METHODS We conducted a cross-sectional study including 272 inpatients (mean age: 34.06 ± 11.52 years,... more
OBJECTIVE To examine the relationship between insomnia symptoms and metabolic syndrome in patients with severe psychiatric disorders. METHODS We conducted a cross-sectional study including 272 inpatients (mean age: 34.06 ± 11.52 years, 67.3% males) with severe psychiatric disorders consecutively admitted in Shantou University Mental Health Center Inpatient Department. All patients underwent a psychiatric evaluation. Insomnia symptoms were assessed by the Pittsburgh Sleep Quality Index (PSQI) and defined present if PSQI>7. The diagnosis of metabolic syndrome was defined using the new International Diabetes Federation definition based on clinical and laboratory evaluation. RESULTS Among the 272 patients, 94 (34.6%) presented insomnia symptoms. Overall, patients with insomnia symptoms had significantly higher percentage of metabolic syndrome (23.4% vs. 12.4%, p = 0.019) and hypertriglyceridemia (30.9% vs. 19.1%, p = 0.029), and marginally significantly higher levels of fasting insulin (58.75 ± 37.22 pmol/L vs. 51.72 ± 34.09 pmol/L, p = 0.050), homeostasis model assessment of insulin resistance (1.83 ± 1.31 vs. 1.62 ± 1.25, p = 0.055) and percentage of insulin resistance (55.3% vs. 44.4%, p = 0.086) compared to those without insomnia symptoms. Multiple logistic regressions showed that patients with insomnia symptoms had significantly higher odds for metabolic syndrome [odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.25-7.14], central obesity (OR = 3.02, 95% CI = 1.18-7.76), hypertriglyceridemia (OR = 2.46, 95% CI = 1.28-4.76) and marginally significantly higher odds for insulin resistance (OR = 1.68, 95% CI = 0.93-3.02) after controlling for potential confounders. CONCLUSIONS Within severely mentally ill patients, insomnia symptoms are associated with metabolic syndrome and insulin resistance. It appears that insomnia symptoms are independent clinical indicators of underlying metabolic syndrome in patients with severe psychiatric disorders.
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Introduction Deinstitutionalization in Crete, as part of the psychiatric reform, resulted in the closure of the only psychiatric hospital of the island in 2006. Objectives To explore the trends of yearly involuntary admissions in the... more
Introduction Deinstitutionalization in Crete, as part of the psychiatric reform, resulted in the closure of the only psychiatric hospital of the island in 2006. Objectives To explore the trends of yearly involuntary admissions in the Psychiatric Department of the University Hospital of Crete (PD/UHC) (2008-2011), the only inpatient public unit to receive involuntary admissions in a region of 400,000 residents, and the profile of the patients admitted. Aims To find possible associations between the closure of the Psychiatric Hospital in Crete and the number of involuntary admissions. Methods We examined the records of total and involuntary admissions in PD/UHC between 2008–2011. In a subset of 400 inpatients admitted between Nov/2011 and Aug/2012, sociodemographic/psychopathology parameters were also examined. Statistical analysis was conducted with chi-square and regression analysis models. Results Yearly involuntary admissions have increased by 245% during a period of 4 years, with the number of total admissions having increased by 22%. Within the subset of patients admitted during the last year, involuntary admissions account for the 47% of total admissions. Mean age of patients was 41.3 ± 1.38 years. Chi-square tests showed that male gender, aggression and positive psychotic symptoms at admission, absence of spouse/children are associated with involuntary admissions. Multivariate analysis revealed significant correlations for male gender and aggression. Conclusion Deinstitutionalization, i.e. closure of the only psychiatric hospital in Crete, has resulted in a significant and marked increase of involuntary admissions, a fact that also reflects the lack of community services and infrastructure.
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Introduction: Twenty percent of psychiatric inpatients have co-morbid substance abuse/dependence and their management is challening. Objectives: To investigate co-morbidity and patterns of substance use among inpatients in a general... more
Introduction: Twenty percent of psychiatric inpatients have co-morbid substance abuse/dependence and their management is challening. Objectives: To investigate co-morbidity and patterns of substance use among inpatients in a general psychiatric unit. Aim: To examine specific patterns and risk factors associated with substances/alcohol in psychiatric inpatients. Methods: Participants included 487 inpatients consecutively admitted to the Psychiatric Unit, University Hospital of Crete between Nov 2011- Jun 2013. Data were analyzed using the Pearson's chi-square test and multiple regression. Results: Our sample, mean age 42.7±14.5yrs, consisted of 57.9% males, whereas 51.9% were admitted involuntarily. In addition, 60.3% were unemployed, 24.3% had a spouse and 38.1% had no previous psychiatric hospitalizations. Furthermore, 354 (72.8%) used no substances, while 16.1% used alcohol, 12.3% cannabis, 3.8% opioids, 2.5% cocaine, and 5.5% anxiolytics. Mean age of those abusing alcohol was 41.8yrs, cannabis 34.1yrs, opioids and cocaine 31.6yrs and anxiolytics 36.9yrs. In patients with Major Depression, alcohol (21.1%) and anxiolytics (9.8%) were the most prevalent, whereas, in patients with psychotic disorders and bipolar disorders, alcohol (9.8% and 5.8% respectively) and cannabis (11.9% and 15.2%) were the most frequent. Unemployment, and involuntary admission weren’t significant risk factors for alcohol/substance use. Conclusions: Substance/alcohol abuse/dependence is present in 1/3 of our psychiatric population with alcohol, cannabis and anxiolytics the most commonly used. Alcohol was more frequent in older patients with depression, whereas cannabis was more frequent in younger patients with psychotic/bipolar disorder. Development of dual diagnosis centers, very scarce in Greece, are needed for the management of psychiatric patients with substance co-morbidity.
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Introduction To systematically examine the association between sleep duration and metabolic syndrome (Mets) risk in cross-sectional and prospective cohort studies. Methods Data were collected from 36 cross-sectional and 9 longitudinal... more
Introduction To systematically examine the association between sleep duration and metabolic syndrome (Mets) risk in cross-sectional and prospective cohort studies. Methods Data were collected from 36 cross-sectional and 9 longitudinal studies with a total of 164799 MetS subjects and 430895 controls. Odds ratios (ORs) for MetS in cross-sectional studies and risk ratios (RRs) for incident MetS were calculated through meta-analyses of adjusted data from individual studies. Subgroup analyses were performed to investigate the association between MetS and the duration of short-and-long sleep. Results Short sleep duration was significantly associated with increased prevalent MetS (OR= 1.11, 95% CI =1.05-1.18) and incident MetS (RR= 1.28, 95% CI =1.07-1.53,) in cross-sectional and longitudinal studies, respectively. Furthermore, long sleep duration was significantly associated with increased prevalent MetS in cross-sectional studies (OR= 1.14, 95% CI =1.05-1.23), rather than incident MetS (RR= 1.16, 95% CI =0.95-1.41) in longitudinal studies. Interestingly, the association between long sleep and prevalent MetS was found in sleep duration defined by 24-hour sleep (including naps) rather than nighttime sleep. In cross-sectional studies, pooled odds for MetS were 1.36 (95% CI=1.04-1.78, I2=83.3%) in ≤ 5 hours, 1.09 (95% CI=1.02-1.16, I2=67.8%) in ≤6 hours, 1.01 (95% CI=0.93-1.10, I2=24.9%) in <7 hours, 1.11 (95% CI=1.02-1.21, I2=67.0%) in ≥9 hours and 1.31 (95% CI=1.22-1.40, I2=0%) in ≥10 hours, respectively. The association of short sleep and MetS was stronger in young and middle age adults, but lost in adults age >60 years. Conclusion Our findings suggest 1) a “U-shape” relationship between sleep duration and MetS in cross-sectional studies and 2) association between short sleep duration, but not long sleep duration with incident MetS. Future studies should shed light on the underlying mechanisms related to the association between sleep duration and MetS and examine if normalizing sleep duration reduces MetS risk in the general population. Support This study was supported by National Natural Science Foundation of China (No. 81600068 & 81970087), the Young Elite Scientists Sponsorship Program by CAST (No. YESS20160072), Medical Science Foundation of Guangdong Provence (A2018296) and Grant for Key Disciplinary Project of Clinical Medicine under the Guangdong High-level University Development Program.
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Genetic, cerebrospinal fluid and histopathological studies have highlighted the importance of TDP‐43 (the protein product of the TARDBP gene) in the pathophysiology of neurodegeneration. Specifically, TDP‐43 pathology has been associated... more
Genetic, cerebrospinal fluid and histopathological studies have highlighted the importance of TDP‐43 (the protein product of the TARDBP gene) in the pathophysiology of neurodegeneration. Specifically, TDP‐43 pathology has been associated with Frontotemporal Dementia (FTD), Amyotrophic Lateral Sclerosis (ALS) and, lately, Alzheimer’s Disease (AD). Here we searched for TARDBP pathogenic variants in a cohort of Greek patients with AD, FTD, ALS or FTD/ALS.
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Background: Apolipoprotein E gene (APOE) ɛ4 allele increases the risk for Alzheimer’s disease (AD). Furthermore, among patients with cognitive impairment, longer sleep duration is associated with worse cognitive performance. To date,... more
Background: Apolipoprotein E gene (APOE) ɛ4 allele increases the risk for Alzheimer’s disease (AD). Furthermore, among patients with cognitive impairment, longer sleep duration is associated with worse cognitive performance. To date, literature examining the associations between APOE ɛ4 allele and objective sleep duration is limited. Objective: Our aim was to assess the association between APOE ɛ4 and objective sleep duration, among patients with mild cognitive impairment (MCI) and AD. A sub-sample of 89 patients with AD (n = 49) and MCI (n = 40) were recruited from a large, population-based cohort of 3,140 elders (>60 years) residing on Crete, Greece. Methods: All participants underwent medical history/physical examination, extensive neuropsychiatric and neuropsychological evaluation, 3-day 24 h actigraphy and APOE ɛ4 allele genotyping. Comparisons of sleep duration variables between APOE ɛ4 allele carriers and non-carriers were assessed using ANCOVA, controlling for confounders...
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Background Evidence suggests that the outbreak of the coronavirus disease 2019 (COVID-19) and the prevention/control measures for COVID-19 may cause insomnia during the acute phase of COVID-19 pandemic in China. However, it is unclear... more
Background Evidence suggests that the outbreak of the coronavirus disease 2019 (COVID-19) and the prevention/control measures for COVID-19 may cause insomnia during the acute phase of COVID-19 pandemic in China. However, it is unclear whether insomnia sustains during the later phases of the pandemic. Methods We searched PubMed/Medline, EMBASE, PsycINFO and China National Knowledge Infrastructure from the 27th December 2019 to the 2nd February 2021. As early stage studies on COVID-19 pandemic in China were defined as those conducted prior to April 1st, 2020, while late stage studies were those conducted after April 1st, 2020. Results A total of 98 studies with 193,889 participants were included. The pooled prevalence of insomnia symptoms among all populations was 39.1%; the pooled prevalence of insomnia symptoms during the early and late stages of COVID-19 in China were 37.0% (95% CI 34.1-39.9%) and 41.8% (95% CI 33.6-50.0%), respectively. Importantly, there was no significant difference regarding the prevalence of insomnia symptoms between the early and late stages of COVID-19. Meta-regression showed that healthcare workers, COVID-19 patients, patients with chronic medical conditions and patients with mental disorders had a higher prevalence of insomnia symptoms compared to the general population. This association remained significant in healthcare workers and patients with chronic medical conditions after adjusting for age, gender, areas of high or low prevalence of COVID-19 cases, anxiety and depression. Conclusions Over one third of our sample presented insomnia symptoms during the early stage of COVID-19 pandemic in China. Interestingly, prevalence of insomnia symptoms sustained high during the late stage of the pandemic despite the control of the disease and the amelioration of its adverse effects. Our findings suggest that insomnia symptoms related to COVID-19 appear to persist of over time.
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Introduction: Research focused on the intrafamilial environment of people experiencing their first episode of psychosis (FEP) is limited. Objectives: To investigate possible differences in family environment between FEP patients, chronic... more
Introduction: Research focused on the intrafamilial environment of people experiencing their first episode of psychosis (FEP) is limited. Objectives: To investigate possible differences in family environment between FEP patients, chronic psychotic patients and healthy controls. Aims: To compare family variables between relatives of FEP patients, chronic patients and healthy controls. Methods: Family cohesion and flexibility (FACES-IV) and psychological well-being (GHQ-28) were evaluated in relatives of 50 FEP patients, 50 chronic patients and 50 controls, whereas expressed emotion (FQ) and family burden (FBS) were assessed between the two clinical groups. Results: Multivariable linear regression analysis adjusted for several confounding variables revealed statistically significant differences in the total ratio for family cohesion and flexibility between the three groups indicating poorer family functioning for chronic families as compared to FEP families (β coefficient −0.47, 95% CI: −0.77, −0.18) and lower scores for FEP families as compared to controls (β coefficient −0.59, 95% CI: −0.81, −0.37). Chronic families scored significantly higher in critical comments (β coefficient 7.17, 95% CI: 3.45, 10.89), and reported higher subjective (β coefficient 2.85, 95% CI: 0.69, 5.01) and objective burden (β coefficient 8.25, 95% CI: 4.67, 11.84) as compared to FEP families. Non-significant differences were found in psychological well-being between FEP and chronic families, whereas FEP families reported higher levels of psychological distress as compared to controls. Conclusions: Having a family member with a major psychiatric disorder is a general stressor for families and family interventions should be considered to minimize disruption to family life.
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Introduction The influential role of family in the outcome of chronic mental illness is well documented; however there has been relatively little research on the intrafamilial relationships of people experiencing their first episode of... more
Introduction The influential role of family in the outcome of chronic mental illness is well documented; however there has been relatively little research on the intrafamilial relationships of people experiencing their first episode of psychosis (FEP). Objectives To investigate possible differences in family environment between FEP and chronic patients with schizophrenia and bipolar disorder. Aims To compare family measures between relatives of FEP and chronic psychotic patients. Methods Family functioning (FACES-IV), expressed emotion (FQ), family burden (FBS) and psychological well being (GHQ- 28) were assessed in relatives of 30 FEP and 30 chronic patients. Results Multivariable linear regression models adjusted for confounders revealed that relatives of chronic patients scored significantly lower in balanced cohesion (β coefficient -4.27, 95% CI: -08.03, -1.71) and balanced flexibility (β coefficient -4.01, 95% CI: -6.91, -1.10), as well as communication (β coefficient -6.61, 95% CI: -11.70, -1.50) and satisfaction scales (β coefficient -7.32, 95% CI: -13.23, -1.41). Relatives caring for a chronic patient had significantly higher scores in critical comments (β coefficient 7.81, 95% CI: 3.95, 11.68) and emotional overinvolvement (β coefficient 3.70, 95% CI: 0.24, 7.16). They, also, reported higher objective (β coefficient 12.23, 95% CI: 3.76, 20.71) and subjective (β coefficient 2.79, 95% CI: 0.45, 5.14) burden, as well as poorer psychological well being (β coefficient 12.23, 95% CI: 3.76, 20.71). Conclusions These findings suggest that chronicity adversely affects patients’ family. Early intervention strategies are needed to reduce family burden which in turn may adversely affect the course of the patient’s illness.
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ObjectivesCognitive impairment is known to have a significant impact on the quality of life of individuals and their caregivers, yet it is often underdiagnosed. The objective of this study is to assess the extent of cognitive impairment... more
ObjectivesCognitive impairment is known to have a significant impact on the quality of life of individuals and their caregivers, yet it is often underdiagnosed. The objective of this study is to assess the extent of cognitive impairment among elders visiting primary healthcare (PHC) practice settings, to explore associated risk factors and discuss current care challenges for PHC providers.DesignA cross-sectional study was conducted between March 2013 and May 2014.SettingFourteen PHC units located in rural and urban areas of the Heraklion district in Crete, Greece.ParticipantsConsecutive visitors aged at least 60 years attending selected PHC practices.Primary and secondary outcome measuresThe Mini-Mental State Examination (MMSE) was used to indicate cognitive status. Associations of low MMSE scores (≤23/24, adjusted for education level) with 12 socio-demographic factors, comorbidities and lifestyle factors were assessed.ResultsA total of 3140 PHC patients met inclusion criteria (43.2...
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Introduction Previous cross-sectional studies have shown that insomnia symptoms and objective short sleep are associated with disease severity in patients with Mild Cognitive Impairment (MCI) and Dementia. Our aim was to examine the... more
Introduction Previous cross-sectional studies have shown that insomnia symptoms and objective short sleep are associated with disease severity in patients with Mild Cognitive Impairment (MCI) and Dementia. Our aim was to examine the longitudinal associations between sleep quality/quantity with cognitive progression in non-demented community-dwelling elderly. Methods A sub-sample of 105 participants (77.5% females) from a large population-based cohort in Crete, Greece of 3,140 older adults (>60 years; baseline) were followed up 8 years later (follow-up). All participants underwent neuropsychiatric/neuropsychological evaluation on both phases. At baseline, subjective sleep complaints and objective sleep variables based on 3-day 24 hour actigraphy were assessed. The impact of baseline objective sleep characteristics and/or insomnia (as defined by at least two subjective sleep complaints) on cognitive progression was assessed with univariate and multivariate models controlling for co...
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BackgroundEvidence-based information is essential to delivering effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities... more
BackgroundEvidence-based information is essential to delivering effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a comprehensive analysis of scientific evidence on child and adolescent mental health in Greece.MethodsThis systematic review encompasses three research topics related to the mental health of children and adolescents in Greece: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality was ascertained using validated tools. This review was registered in protocols.io [68583].Ou...
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Identifying modifiable factors that may predict long-term cognitive decline in the elderly with adequate daily functionality is critical. Such factors may include poor sleep quality and quantity, sleep-related breathing disorders,... more
Identifying modifiable factors that may predict long-term cognitive decline in the elderly with adequate daily functionality is critical. Such factors may include poor sleep quality and quantity, sleep-related breathing disorders, inflammatory cytokines and stress hormones, as well as mental health problems. This work reports the methodology and descriptive characteristics of a long-term, multidisciplinary study on modifiable risk factors for cognitive status progression, focusing on the 7-year follow-up. Participants were recruited from a large community-dwelling cohort residing in Crete, Greece (CAC; Cretan Aging Cohort). Baseline assessments were conducted in 2013–2014 (Phase I and II, circa 6-month time interval) and follow-up in 2020–2022 (Phase III). In total, 151 individuals completed the Phase III evaluation. Of those, 71 were cognitively non-impaired (CNI group) in Phase II and 80 had been diagnosed with mild cognitive impairment (MCI). In addition to sociodemographic, life...
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STUDY OBJECTIVES The insomnia with objective short sleep duration (ISS) phenotype, is associated with increased risk for adverse health outcomes, physiological hyperarousal, and a blunted response to Cognitive-Behavioral Treatment for... more
STUDY OBJECTIVES The insomnia with objective short sleep duration (ISS) phenotype, is associated with increased risk for adverse health outcomes, physiological hyperarousal, and a blunted response to Cognitive-Behavioral Treatment for Insomnia (CBT-I). Whether ISS responds better to pharmacological compared to CBT-I has not been examined. METHODS Participants included 15 chronic insomniacs (86.7% female) 45.3 ± 8.1 years old. Eight patients were randomized to CBT-I and seven to trazodone. Patients were examined with two weeks actigraphy, salivary cortisol, and the insomnia severity index (ISI) at three time points (pre-treatment, 3-month post-treatment, and 6-month follow-up). Mixed between-within subjects analysis of variance and univariate analysis of covariance were conducted to assess the impact of trazodone and CBT-I on patients' total sleep time (TST), salivary cortisol, and ISI scores across three time points. RESULTS Trazodone, but not CBT-I, significantly lengthened TST (when measured with actigraphy) both at post-treatment (51.01 versus -11.73 minutes; p = 0.051, Cohen's d = 1.383) and at follow-up (50.35 versus -7.56 minutes; p = 0.012, Cohen's d = 1.725) respectively. Additionally, trazodone, but not CBT-I, had a clinically meaningful decrease in salivary cortisol from pre-treatment to post-treatment (-36.07% versus -11.70%; Cohen's d = 0.793) and to follow-up (-21.37% versus -5.79%; Cohen's d = 0.284) respectively. Finally, there were no differences on ISI scores between trazodone and CBT-I groups. CONCLUSIONS The current preliminary, open-label, randomized trial suggests that trazodone, but not CBT-I, significantly improves objective sleep duration and reduces HPA axis activation, suggesting a differential treatment response in the ISS phenotype. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Identifier: NCT01348542.
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Several epidemiologic, longitudinal studies have reported that short sleep duration is a risk factor for the incidence of obesity. However, the vast majority of these studies used self-reported measures of sleep duration and did not... more
Several epidemiologic, longitudinal studies have reported that short sleep duration is a risk factor for the incidence of obesity. However, the vast majority of these studies used self-reported measures of sleep duration and did not examine the role of objective short sleep duration, subjective sleep disturbances and emotional stress. Longitudinal, population-based study. We studied a random sample of 815 non-obese adults from the Penn State Cohort in the sleep laboratory for one night using polysomnography (PSG) and followed them up for a mean of 7.5 years. Subjective and objective measures of sleep as well as emotional stress were obtained at baseline. Obesity was defined as a body mass index (BMI) ≥30 kg/ m(-2). The incidence of obesity was 15% and it was significantly higher in women and in individuals who reported sleep disturbances, shorter sleep duration and higher emotional stress. Significant mediating effects showed that individuals with subjective sleep disturbances who d...
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Research Interests: Magnetic Resonance Imaging, Treatment Outcome, Medicine, Humans, Cerebellum, and 12 moreHypertension, Male, Clinical Sciences, Adult, Parietal Lobe, Encephalopathy, Angiotensin Converting Enzyme Inhibitors, Occipital Lobe, Calcium Channel Blockers, Brain stem, Magnetic resonance image, and Antihypertensive agents
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Introduction We have previously shown that although sleep duration is similar between cognitively non-impaired (CNI) elders and patients with Mild Cognitive Impairment (MCI), long sleep duration is associated with disease severity in... more
Introduction We have previously shown that although sleep duration is similar between cognitively non-impaired (CNI) elders and patients with Mild Cognitive Impairment (MCI), long sleep duration is associated with disease severity in patients with multi-domain MCI and Dementia. Our aim was to examine the associations between sleep duration and cognitive status in subjects with CNI and MCI followed 8 years later. Methods A sub-sample of 110 participants (77.3% females) were recruited from a large population-based cohort in Crete, Greece of 3,140 older adults (>60 years). Participants with an initial diagnosis of CNI (n=57) and MCI (n=53) (mean age at baseline=72.7 years [SD=6.8]) were followed-up 8 years later (mean age at follow up=80.5 years [SD=6.7]). All participants underwent neuropsychiatric/neuropsychological evaluation (baseline & follow-up) and a 7-day 24h actigraphy (follow-up). Sleep duration measured as night Total Sleep Time (TST) at follow-up was compared between the...
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IntroductionMajor depressive disorder (MDD) is the third leading cause of disease burden, accounting for 4.3% of the global burden of disease. Personality traits, as described in the Five-Factor Model, are consistently associated with... more
IntroductionMajor depressive disorder (MDD) is the third leading cause of disease burden, accounting for 4.3% of the global burden of disease. Personality traits, as described in the Five-Factor Model, are consistently associated with individual’s well-being and mental health. Early Maladaptive Schemas (EMS) are self-perpetuating dysfunctional cognitive structures that have been linked with psychological health and play a significant role in developing and maintaining psychological distress. Both personality traits and EMS have been extensively studied as contributors to MDD symptoms.ObjectivesTo our knowledge, very few studies have attempted to link personality to EMS in clinical samples. The present study aimed to investigate the association between EMS with personality traits of Five-Factor Model in a clinical sample of patients with MDD in Crete, Greece.MethodsTwo hundred and two patients with a clinical diagnosis of MDD (81.7% females, aged 47.75±14.06 years) participated in th...
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Mobile mental health units (MMHUs) have been proposed as an effective model to serve the mental health needs of remote underserved areas. In 2013, the Department of Psychiatry, University of Crete, started a pilot MMHU to cover the needs... more
Mobile mental health units (MMHUs) have been proposed as an effective model to serve the mental health needs of remote underserved areas. In 2013, the Department of Psychiatry, University of Crete, started a pilot MMHU to cover the needs of remote rural areas of the Heraklion Prefecture. The main objectives were early detection, prevention and therapy of patients with severe psychiatric disorders, without access to regular psychiatric care. In addition to regular visits to primary care health centers, a community support network was established. During this 10-year period, the MMHU has evaluated 3343 patients and performed 19,935 visits. The most frequent diagnoses are depression and anxiety (52.7%) whereas psychosis and bipolar disorders are the third (12.7%) and fifth most frequent diagnoses (4.7%). Half of the patients with depression/anxiety were older than 65 years and one third were living alone. Furthermore, the first visit with the MMHU of severely mentally ill was about 15 ...
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Introduction Both trazodone and cognitive-behavioral treatment of insomnia (CBT-I) are widely used to treat patients with chronic insomnia. Animal studies have shown that trazodone increases slow wave sleep (i.e., increased EEG delta... more
Introduction Both trazodone and cognitive-behavioral treatment of insomnia (CBT-I) are widely used to treat patients with chronic insomnia. Animal studies have shown that trazodone increases slow wave sleep (i.e., increased EEG delta power). However, no study to date has compared the long term effects of trazodone vs. CBT-I on spectral EEG activity during sleep in humans. Methods We addressed this question in a sample of 19 middle-aged men and women who received either trazodone (n=8) or CBT-I (n=11) treatment for 9 months. We examined delta (0.39-3.91 Hz), theta (4.30-7.81 Hz), alpha (8.20-11.72 Hz), sigma (12.11-14.84 Hz), beta (15.23-35.16 Hz) and gamma (35.55-49.61 Hz) relative power during NREM sleep after 3-month and 9-month of treatment. Results Compared to CBT-I, trazodone significantly increased relative delta power (p=0.05) and decreased relative sigma (p=0.004) and beta (p=0.05) power during NREM sleep across 9-month treatment. Furthermore, compared to CBT-I, trazodone si...
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Introduction Previous research reports an inverse U-curve association between subjective sleep duration and cognition in elderly, while findings on objective sleep duration are inconsistent. Only one study found weak association between... more
Introduction Previous research reports an inverse U-curve association between subjective sleep duration and cognition in elderly, while findings on objective sleep duration are inconsistent. Only one study found weak association between objective short sleep duration and cognition, mainly driven by demented elders. Our aim was to examine the non-linear associations between objective sleep duration and cognitive performance among community-dwelling patients with dementia. Methods A sub-sample of 46 patients with mild-to-moderate dementia(AD) [mean age: 80.3 (SD=5.6) years, 40% males] and 85 cognitively intact controls(NI) [mean age: 73.0 (SD=7.4) years, 37% males], were recruited from a large, population-based cohort [Cretan Aging Cohort] in the island of Crete, Greece of 3,140 older adults (≥60yrs). All participants underwent medical history/physical examination, extensive neuropsychiatric and neuropsychological evaluation, and 3-day 24-h actigraphy. Comparisons between AD and NI pa...