Individuals suffering from psychotic disorders have increased comorbidity with chronic organic disorders and reduced life expectancy compared to their healthy peers. Particularly, individuals diagnosed with schizophrenia have a life expectancy 10-20 years shorter than average.1 The main factor contributing to this increased comorbidity and mortality from natural causes is cardiovascular diseases resulting from higher rates of metabolic syndrome (MetS), obesity, diabetes mellitus, sedentary lifestyle, poor diet, and smoking.2 MetS, specifically, is defined by the coexistence of a combination of risk factors such as high blood pressure, high blood glucose levels, excessive fat around the waist, high levels of triglycerides, and low levels of high-density lipoprotein (HDL). These aggravating factors occur more frequently in individuals with psychosis than in control groups from the very onset of symptoms. For example, the prevalence of MetS was found to be 13.2% higher than in the general population in patients who had never taken antipsychotic drugs and presented with first episode psychosis (FEP).3 Similarly, blood pressure, waist circumference, and fasting glucose have been reported to be slightly higher in antipsychotic-naive ultra high risk (UHR) individuals, while lower HDL levels have been demonstrated in FEP adolescents who have never taken medication.4 Moreover, initiating treatment with second-generation antipsychotics is associated with rapid and significant weight gain, depending on the specific drug, within the first three months of treatment.5 This indicates that between 33% and 61% of individuals with FEP experience clinically significant weight gain, defined as an increase of ≥7% of initial body weight within the first 12 weeks of treatment, and certain parameters of MetS progressively deteriorate over the first year of treatment.6,7 The above findings have prompted the implementation of various interventions, both pharmaceutical and non-pharmaceutical, in individuals with FEP, aiming at reducing the burden associated with antipsychotic use, which remains the therapeutic standard despite its side-effect profile. These interventions are extended beyond medication-related adverse effects and target other parameters that increase cardiometabolic risk, such as poor diet, lack of physical activity, tobacco and alcohol use, and inadequate physical care.8 The effectiveness of these interventions varies, but combining them and implementing them in an organized framework with a holistic approach appears to be the optimal choice. In Greece, this type of comprehensive care is delivered through Early Intervention Services (EIP), where the physical health of patients with FEP is prioritized as a core treatment objective. This is achieved through detailed and systematic recording of medical data, monitoring the key parameters in accordance with international guidelines, and collaborating with primary care services. International guidelines suggest best practices for recording and treating MetS, and attempts are now underway to estimate the likelihood of MetS emerging from the early stages of psychosis.9 One example of such best practice guidelines is the "Lester positive cardiometabolic resource" algorithm, which is the version used in the UK by the iphys initiative, summarizing key indicators and target values for young individuals with psychosis.10 Tables of the algorithm list the parameters for lifestyle habits (smoking, diet, activity), obesity (weight, BMI, waist circumference), hypertension, glucose levels, and lipid markers. Baseline measurements for each parameter are categorized into three levels: high risk, medium risk, and a target range to be achieved. In this way and with guidance on recommended monitoring frequency (i.e., blood pressure measured at baseline and every three months thereafter), the tool constitutes a practical resource for assessing physical health problems and planning appropriate interventions. Enhancing the physical health of individuals with FEP requires adopting best practices and providing information and cooperation with primary health care providers within the framework of EIP, as well as with all mental health professionals involved in patient care. Coordinated practice is essential, as physical health outcomes substantially influence both the course of the illness and patients' functional recovery.
Hypnosis combined with cognitive behavioral therapy (CBT-hypnosis) is a type of psychological treatment that focuses on how people think and behave in various mental and medical illnesses. It treats behavioral and emotional issues by tapping into the subconscious mind. Patients who are hypnotized are more open to new ideas and less prone to decline hard ones. The result is that it is simpler to adopt the healthy cognitive patterns and habits that CBT tries to promote. YouTube is a great resource for health-related education that has the power to greatly impact the choices and actions of medical professionals, patients, and their primary caregivers, because they visit the YouTube platform to investigate and obtain guidance regarding CBT-hypnosis. However, unreliable and deceptive information on YouTube could encourage undesirable habits, making patients, primary caregivers, and hypnosis practitioners avoid CBT-hypnosis. Thus, the purpose of this study was to assess the quality and reliability of YouTube videos about CBT-hypnosis as a source of supportive information for practitioners, patients, and their primary caregivers. A total of 354 YouTube videos about CBT-hypnosis were analyzed. The videos' reliability and quality were assessed using the Global Quality Scale and a modified DISCERN tool. The analysis found that the median overall GQS score was 3 (IQR: 2; min-max: 1-5), indicating that the videos had moderate quality and some important information was adequately covered. The modified DISCERN tool yielded a median total score of 3 (IQR: 1; min-max: 0-5), indicating that the videos were moderately reliable and that the information was presented in a balanced and unbiased manner. Most of the included videos came from science and technology sources (academic channels) (57.6%; n = 204). While 42.4% of videos came from non-profits and activism, people and blogs, and others lay in public. As a supportive source of information, YouTube videos about CBT-hypnosis are regarded as being of a moderate level of quality and reliability. Therefore, formal presenters should promote the distribution of good-quality content, which helps to improve the quality of information available on the YouTube platform.
The concept of timing is an interesting way to understand how the body and brain construct the concept of self, but also how self-distortions arise in the case of psychosis. Analysis of temporal representations in psychosis highlights a deficit that includes both the subjective experience of the flow of time, i.e., time perception, and the ability to process temporal information inherent to any perceptual event, i.e., perceptual timing. The representation of the self is stabilized within temporal windows, and thus the self is experienced as continuous in time. Disturbance in the sense of time, in the form of a loss of temporal continuity, has been described by phenomenologists as a central subjective experience of schizophrenia. The positive symptoms of schizophrenia are associated with overestimation of interval timing, i.e., an acceleration of the 'internal clock', while dopamine neurotransmission is likely to regulate the speed of the internal clock. Moreover, findings highlight the importance of interoceptive precision as an aspect of time perception, since accuracy in time perception is related to interoceptive accuracy and vagal activity. Insula contributes significantly to the total awareness of reality. Global emotional moments and meta-representations of the conscious self are created in the anterior insula. In psychosis, the interaction between the default-mode network and the frontoparietal executive network is disrupted by aberrant salience signals from the right anterior insula. Here, we describe the role of the insula as a key hub for the recognition of major aspects of the self, in parallel with the role of interoceptive predictive coding, which reflects the contribution of the insula to the temporality of the self. Based on the above, new insights focus on the development and implementation of rehabilitation strategies that specifically target the temporal deficits observed in psychosis. New therapeutic interventions are based on sensory education and enhancing the multisensory integration of these patients.
The use of illicit substances is a major public health problem. While individuals with substance use problems primarily seek treatment in specialized treatment programs, the role, exposure, and response of private practice psychiatrists to requests for substance use-related problems remain unclear. This study aims to assess private practice psychiatrists' exposure to and response to treatment requests for substance use-related problems, along with examining the requests' characteristics. A cross-sectional online anonymous survey was administered involving private practice psychiatrists in Greece between January and February 2024. A total of 100 private practice psychiatrists responded to the survey (response rate ~10%; 53.0% male, aged 49.5 (SD=9.3) years, with 13.7 (SD=9.9) years of professional experience, and 59.0% with a private office in the Attica/Athens region. Most participants (84.0%) reported exposure to requests for substance use treatment during the last 12 months, with 69.0% of them (58% of the total) accepting to offer of treatment. The most frequently reported categories of substances included cannabis and cocaine/crack. High rates of comorbidity with problematic alcohol use, multiple substance use, and other mental disorders were also reported. Pharmacotherapy and cognitive behavioral therapy were the treatments most commonly used. Factors associated with accepting to offer treatment included past specialized training in addiction (p<0.001), past or current employment in treatment facilities (p=0.002), self-reported expertise in addictions (p=0.017), previous training during specialty in substance use departments (p=0.001), and use of motivational interviewing (p=0.011). Around 70% of participants who did not accept cases believed patients would be better treated in specialized substance use treatment programs. Among all participants, 63.6% were willing to accept future treatment requests⎯significantly higher percentage (93.1%) among those who had accepted similar requests before, compared to those who had not (19.2%, p<0.001). In conclusion, apart from specialized addiction services, a substantial number of private practice psychiatrists in Greece were also exposed to and accepted treatment requests for illicit substance use-related problems, with most frequently encountering requests related to cannabis and cocaine use. Future research should investigate the characteristics of patients treated for illicit substance use-related issues in private settings and the services provided to them.
Borderline personality disorder (BPD) is a severe mental health condition typically identified in adolescence. We aim to investigate the factor structure, internal consistency, item analysis, convergent validity, and diagnostic accuracy of the Greek version of the Borderline Personality Features Scale for Children-11 (BPFSC-11). A sample of 112 early adolescents aged 11 to 14 years was recruited from an outpatient community child and adolescent mental health service. Confirmatory Factor Analysis was used to explore the fit of the unidimensional model to our sample. Reliability was assessed using the omega coefficient, and regression analysis was employed to evaluate convergent validity with the dysregulation profile of psychopathology, as measured by the Youth Self Report (YSR). Item analysis was assessed via Item Response Theory, while criterion validity was evaluated against clinical evaluation using the ROC curve. We found that BPFS-11 did not fit the data well, while a 9-item version provided a good fit (RMSEA = 0.058, CFI = 0.986, TLI = 0.982). Reliability was strong (ω = 0.81). Convergent validity was demonstrated, as adolescents with high scores on the dysregulation profile of the YSR had statistically significantly higher summed scores on the BPFS. The ROC curve analysis suggested high diagnostic accuracy (AUC=0.86). Sensitivity at the optimum cut-off point of 26 was found to be 0.88, while specificity was 0.75. Our study presents evidence for the reliability and validity of the BPFS and provides a cut-off point for its use in outpatient clinical settings to timely identify adolescents with high borderline personality traits.
