Background/objectiveBorderline personality disorder (BPD) is a severe mental health condition typically identified in adolescence. Insecure attachment has been linked to BPD, with adult studies suggesting that reflective functioning might represent a mechanism linking attachment patterns to BPD. However, this interplay remains insufficiently explored in early adolescence—a developmental phase associated with reorganization of attachment and social cognitive function. The aim of this study is to explore the association between attachment styles and borderline personality traits (BPTs) in early adolescence and to test whether reflective functioning explains the association between attachment and borderline traits.MethodsA total of 112 adolescents aged 11–14 years attending a community outpatient child and adolescent mental health service completed the Attachment Questionnaire for Children (AQC), the Reflective Functioning Questionnaire (RFQ) and the Greek modified Borderline Personality Features Scale – Children (BPFS-C). Mediation analysis was conducted using secure attachment as the reference category.ResultsInsecure attachment styles were significantly associated with higher odds of elevated BPTs. Reflective functioning significantly explained a significant amount of variance in the association between ambivalent attachment and high BPTs [OR = 2.92, 95% BCa CI (1.14, 10.17)], whereas avoidant attachment demonstrated a smaller but marginally statistically significant indirect effect through reflective functioning [OR = 1.77, 95% BCa CI (1.00, 3.95)] alongside a strong direct effect [OR = 4.34, 95% BCa CI (1.36, 12.53)].ConclusionsAvoidant and ambivalent attachment appear to be strongly linked to BPTs in early adolescence through partially distinct pathways, highlighting the need for early targeted interventions.

Abstract Background Metabolic syndrome (MetS) has been associated with cognitive decline. Considering its increasing prevalence worldwide, the goal of this study was to evaluate the feasibility and efficacy of a short-term, self-administered computerized cognitive training programme in individuals with metabolic syndrome and low cognitive performances. Methods Thirty six participants, aged 40-72 years (mean age: 57.8 years), were randomly assigned to the cognitive training or the passive control group. The cognitive training component of Long Lasting Memories (LLM) Care was used as an interactive software to enhance participants’ cognitive functions. Up to 24 sessions, each lasting 45 minutes, were self-administered at home twice per week for 3 months. Thorough cognitive assessments with were performed at baseline (randomization), at the end of intervention, and 12 months after baseline. The primary outcome was performance at nine neuropsychological tests, and the secondary outcome was a self-reported questionnaire assessing everyday functional abilities. Primary analyses were performed employing mixed-effect models using the intention-to-treat principle. Results Low adherence was observed in the study, as only 9 participants (50%) completed at least 8 sessions of the cognitive training programme (range 9-24 sessions, median 15 sessions). No statistically significant effect of the cognitive training programme on performance in neuropsychological tests or everyday functioning was found. At the end of the 3-month intervention programme, effect for visual memory enhancement in immediate (β = 1.58, 95% CI = -1.84 to 4.99, Cohen’s d = 0.39) and delayed recall (β = 2.17, 95% CI = -1.68 to 6.01, Cohen’s d = 0.45) was moderate in favour of the intervention group, and at 12-month follow-up, semantic verbal fluency gains for the intervention group were detected (β = 2.78, 95% CI = -0.92 to 6.49, Cohen’s d = 0.70), though with wide confidence intervals. Conclusions Despite some small effects observed in memory and verbal fluency, cognitive training did not yield statistically significant improvements. The observed low adherence and limited benefits on mild cognitive deficits in mostly middle-aged individuals with MetS are likely associated with the self-administered and short-term nature of the computerized intervention. This highlights the need for more intensive and clinician-delivered approaches to enhance engagement. Registry: ClinicalTrials.gov , TRN: NCT05658354 , Registration date: 08 December 2022.

This prospective observational study aimed to estimate the annual service-based incidence of individuals with First Episode Psychosis (FEP) and high-risk states for psychosis presenting to a public Community Mental Health Center within a defined urban catchment area in Northwestern Greece. It offers novel real-world insights into early intervention in psychosis within a resource-constrained, post-crisis health care setting. All individuals aged ≥16 years who presented to the Community Mental Health Center of the University of Ioannina between January 2023 and December 2024 were assessed. Those diagnosed with FEP or identified as being at a high risk for psychosis using the Comprehensive Assessment of At-Risk Mental States were included, while duration of untreated psychosis (DUP) was estimated with the Symptom Onset in Schizophrenia inventory. Among 1115 service users, 51 (4.6%) met criteria for FEP (N = 33) or high-risk states (N = 18), rising to 7.5% among those aged 16–36 years. The annual service-based incidence of FEP was 10.26 per 100,000 in the general population, increasing to 51.62 in individuals aged 16–36 and 63.17 in those aged 16–26. Including high-risk cases, service-based incidence reached 109.71 per 100,000 in the 16–26 age group. Mean DUP was 39.4 weeks but was 7.0 weeks among 80% with DUP < 1 year. Most FEP patients (63.6%) required brief hospitalization, and over half reported family history of mental illness. These findings highlight substantial community caseloads and the need to strengthen early intervention services.

Treatment-resistant schizophrenia affects approximately 30% of schizophrenia patients, and clozapine is the antipsychotic of choice for their treatment. Despite its effectiveness, clozapine is considerably under-prescribed for the aforementioned patients' group, probably due to its severe side effects. Measurement of plasma concentrations of clozapine and its active metabolite, norclozapine, in plasma could help clinicians to monitor compliance to treatment and reduce the possibility of severe side effects. Such measurements are currently not included in routine clinical practice, although clozapine plasma concentrations seem to be influenced by many different factors and do not usually reflect the prescribed dose. The aim of the present study was to measure clozapine and norclozapine plasma concentrations and their ratio in a group of early psychosis, treatment-resistant, schizophrenia patients and to investigate possible associations among the prescribed clozapine daily dose and socio- demographic variables. Thirty-eight patients were included in the study, and 342 blood samples were collected. Clozapine and norclozapine plasma concentration measurements were performed by UHPLC-MS/MS. Mixed-effects linear regression models were performed to associate blood clozapine and norclozapine levels and their ratio to clozapine dose. The median clozapine dose, clozapine, norclozapine plasma concentrations, and their ratio at first and last measurement were as follows: 400mg/day (IQR = 350mg/day to 500mg/day) and 425mg/day (IQR = 350mg/day to 600mg/day), 335 ng/ml (IQR = 191 ng/ml to 427 ng/ml) and 389 ng/ml (IQR = 276 ng/ml to 523 ng/ml), 129 ng/ml (IQR = 62 ng/ml to 218 ng/ml) and 135 ng/ml (IQR = 82 ng/ml to 209 ng/ml), 2.5 (IQR = 1.6 to 4.8) and 2.9 (IQR = 1.7 to 4.4). An increase of clozapine dose by 50mg/day was associated with higher blood clozapine and norclozapine levels but with lower clozapine/norclozapine ratio. Clozapine dose was positively associated with blood clozapine and norclozapine levels and negatively with the clozapine/norclozapine ratio.

Purpose The treatment of mental disorders has shifted from inpatient wards to community-based settings in recent years, but some patients may still have to be admitted to inpatient wards, sometimes involuntarily. It is important to maintain the length of hospital stay (LoS) as short as possible while still providing adequate care. The present study aimed to explore the factors associated with the LoS in involuntarily admitted psychiatric patients.Methods A ten-year retrospective chart review of 332 patients admitted involuntarily to the inpatient psychiatric ward of the General University Hospital of Ioannina, Northwestern Greece, between 2008 and 2017 was conducted.Results The mean LoS was 23.8 (SD = 33.7) days and was relatively stable over the years. Longer-stay hospitalization was associated with schizophrenia-spectrum disorder diagnosis, previous hospitalizations and the use of mechanical restraint, whereas patients in residential care experienced significantly longer LoS (52.6 days) than those living with a caregiver (23.5 days) or alone (19.4 days). Older age at disease onset was associated with shorter LoS, whereas no statistically significant differences were observed with regard to gender.Conclusion While some of our findings were in line with recent findings from other countries, others could not be replicated. It seems that multiple factors influence LoS and the identification of these factors could help clinicians and policy makers to design more targeted and cost-effective interventions. The optimization of LoS in involuntary admissions could improve patients' outcomes and lead to more efficient use of resources.

Developmental language disorder (DLD) has a great impact on language skills as well as on a wide range of functioning areas, such as social and school functioning. In the present study, we aim to explore the Health-Related Quality of Life (HRQoL) of preschool children with DLD, compared to children with no language difficulties, using a self and proxy report method. A total of 230 parents of preschool children with DLD and 146 parents of children without language difficulties completed the Pediatric Quality of Life Inventory (PedsQLTM) 4.0 Generic Core Module and the Strengths and Difficulties Questionnaire (SDQ). Additionally, 71 children with DLD and 55 peers without DLD completed the self-reported PedsQLTM module. The parents of kindergarten children (5–6 years old) with DLD reported that their kids experience worse social and school functioning compared to the control group. In addition, the children with DLD self-reported lower physical and social functioning. The parents of children with DLD reported that their children experience higher hyperactivity/inattention problems than the parents of the control group. Kindergarten children with DLD have a poorer HRQoL compared to their peers, as perceived by themselves and their parents. Moreover, children with DLD present with higher hyperactivity and inattention symptoms. Health professionals working with children who have DLD need to consider not only the language difficulties but also the children’s wellbeing and symptoms of hyperactivity and inattention.

ImportanceTest accuracy studies often use small datasets to simultaneously select an optimal cutoff score that maximizes test accuracy and generate accuracy estimates.ObjectiveTo evaluate the degree to which using data-driven methods to simultaneously select an optimal Patient Health Questionnaire-9 (PHQ-9) cutoff score and estimate accuracy yields (1) optimal cutoff scores that differ from the population-level optimal cutoff score and (2) biased accuracy estimates.Design, Setting, and ParticipantsThis study used cross-sectional data from an existing individual participant data meta-analysis (IPDMA) database on PHQ-9 screening accuracy to represent a hypothetical population. Studies in the IPDMA database compared participant PHQ-9 scores with a major depression classification. From the IPDMA population, 1000 studies of 100, 200, 500, and 1000 participants each were resampled.Main Outcomes and MeasuresFor the full IPDMA population and each simulated study, an optimal cutoff score was selected by maximizing the Youden index. Accuracy estimates for optimal cutoff scores in simulated studies were compared with accuracy in the full population.ResultsThe IPDMA database included 100 primary studies with 44 503 participants (4541 [10%] cases of major depression). The population-level optimal cutoff score was 8 or higher. Optimal cutoff scores in simulated studies ranged from 2 or higher to 21 or higher in samples of 100 participants and 5 or higher to 11 or higher in samples of 1000 participants. The percentage of simulated studies that identified the true optimal cutoff score of 8 or higher was 17% for samples of 100 participants and 33% for samples of 1000 participants. Compared with estimates for a cutoff score of 8 or higher in the population, sensitivity was overestimated by 6.4 (95% CI, 5.7-7.1) percentage points in samples of 100 participants, 4.9 (95% CI, 4.3-5.5) percentage points in samples of 200 participants, 2.2 (95% CI, 1.8-2.6) percentage points in samples of 500 participants, and 1.8 (95% CI, 1.5-2.1) percentage points in samples of 1000 participants. Specificity was within 1 percentage point across sample sizes.Conclusions and RelevanceThis study of cross-sectional data found that optimal cutoff scores and accuracy estimates differed substantially from population values when data-driven methods were used to simultaneously identify an optimal cutoff score and estimate accuracy. Users of diagnostic accuracy evidence should evaluate studies of accuracy with caution and ensure that cutoff score recommendations are based on adequately powered research or well-conducted meta-analyses.

Diabetes and dyslipidemia are common in patients with psychosis and may be related to adverse effects of antipsychotic medications.Metabolic disturbances in first-episode patients with psychosis are common, even prior to any antipsychotic treatment, and antipsychotic medications are implicated in the development of metabolic syndrome, at least in the long run.We therefore aimed to follow a group of drug-naïve, first-episode patients with psychosis at different time points (baseline, six months, and 36 months after the initiation of antipsychotic treatment) in order to evaluate the progression of metabolic abnormalities after antipsychotic therapy and the time-course of their onset.We assessed glucose and lipid metabolism during the fasted state in 54 drug-naïve patients with first-episode psychosis (FEP) before the initiation of any antipsychotic treatment and compared them with matched controls.The same parameters were assessed in the patient group (n=54) after six months of antipsychotic treatment and in a subgroup of patients (n=39) after three years of continuous and stable treatment in comparison to baseline.Measurements were obtained for fasting serum concentrations of total cholesterol, triglycerides, high density lipoprotein (HDL), glucose, insulin, connecting peptide (C-peptide), homeostatic model assessment index (HOMA-IR), glycated hemoglobin (HbA1c) and body mass index (BMI).Insulin, C-peptide, triglyceride levels, and HOMA-IR index were significantly higher compared to controls.Total cholesterol, triglyceride levels and BMI, increased significantly in the patient group after six months of antipsychotic treatment.After three years of continuous antipsychotic treatment, we found statistically significant increases in fasting glucose, insulin, total cholesterol, triglyceride levels, HbA1c, HOMA-IR index, and BMI compared to baseline.In conclusion, FEP patients developed significant increases in BMI and serum lipid levels as soon as six months after antipsychotic treatment.These metabolic abnormalities persisted following 36 months of treatment and in addition, increases in fasting glucose, insulin, HbA1c and HOMA -IR were observed compared to baseline.

Background: Parenting a child with Autism Spectrum Disorder (ASD) may lead to emotional distress. However, it has been recognized that it can also be accompanied with positive experiences that may conduce parents to posttraumatic growth (PTG). Few studies have investigated the factors that may be associated with growth. The present study aimed to assess the role of maternal perceptions, coping strategies and depressive symptoms to PTG.Method: In this cross-sectional study, 123 mothers of ASD offspring completed self-reported questionnaires to assess posttraumatic growth (PTGI); coping strategies (Beta rief-COPE); perceptions about ASD (B-IPQ) and depressive symptoms (PHQ-9). Hierarchical regression analysis was used to assess their independent associations.Results: A significant proportion of mothers (56.1%) reported moderate to high growth levels (PTGI >= 63). Nearly half of the mothers (46.3%) reported clinically significant depressive symptoms. Engagement (b = 0.361), cognitive reframing (b = 0.214), personal control (b = 0.200) and depressive symptoms (b = -0.232) were independently and significantly associated with PTG.Conclusions: Mothers of children with ASD may experience moderate to high PTG. Engagement, cognitive reframing, personal control and depressive symptoms were significant predictors of growth level. Interventions aiming to support mothers to potentiate their personal control over ASD, to use adaptive coping strategies and to reduce distress may facilitate their growth.

Language disorders are associated with difficulties in various aspects of life, such as academic and social functioning, resulting in impaired health-related quality of life (HRQoL). Most studies use a parent proxy method to assess HRQoL. Since HRQoL refers to the subjective experience of an individual, it is necessary to assess children’s perspectives along with their mothers’. The aim of the current study is to explore HRQoL rating agreement between children and their mothers, since the literature on other conditions suggests that discrepancies seem to reflect their different perspectives. Thus, 53 Greek-speaking children diagnosed with DLD attending kindergarten and their mothers completed, respectively, self-report and parent proxy PedsQLTM questionnaires. Mothers reported significantly better HRQoL than their children with developmental language disorder (DLD) in all HRQoL domains (p < 0.001). Poor agreement was revealed after comparing the scores from both responders, both in abstract domains, such as emotional functioning, as well as in more observable ones, such as physical health (ICC ranged from −0.05 to 0.07). Bland–Altman plots also showed poor agreement on HRQoL. Our results expand on the already known, from other conditions, importance of evaluating children’s subjective experience of their HRQoL in kindergarten children with DLD. A multi-informant approach is ideal, and clinicians should prioritize children’s view about their lives even when they are kindergarten-age. This approach could inform interventions focusing not only on language skills but also on other areas where it is necessary, depending on the child’s subjective experience combined with the maternal perspective.

Background: Stroke has been associated with compromised patient outcomes, such as a decreased quality of life. We aimed in the present study to evaluate the health-related quality of life (HRQ.L) of hospitalized Greek stroke patients during the sub-acute rehabilitation period and assess the effect of demographic and clinical characteristics mediated by depressive symptom severity on HRQ.L. Methods: In a prospective study, a cohort of adult patients hospitalized in the sub-acute phase of their first stroke episode were assessed in the Rehabilitation Clinic of the University Hospital of Ioannina in Greece. Patients' functional status, depressive symptom severity, and HRQ.L were evaluated twice, using the Patient Health Questionnaire 9 (PHQ-9), the Barthel Index (BI), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), respectively. All patients received physical, occupational, and speech therapy during their rehabilitation. Results: Fifty consecutive adult stroke patients were enrolled. We detected a statistically significant (p <0.001) improvement in WHOQOL-BREF, especially in the "psychological health" and "environment" domains, BI, and PHQ-9 scores, between the initial and follow-up assessments. Mediation analysis revealed that baseline disability had both a significant direct (estimate =0.014, p <0.001) and indirect (estimate =0.010, p <0.001, PHQ-9 as mediator) effect on the total HRQoL score. Gender and stroke localization had significant direct effects on HRQoL total (estimate =-0.432, p =0.009, and estimate =0.395, p =0.031, respectively), while PHQ-9 mediation was insignificant. Antidepressant medications and stroke type did not play a substantial role in HRQoL. Conclusion: By the end of the subacute rehabilitation phase, patients' HRQoL, functionality and depression severity improved. Additionally, baseline functionality, stroke localization, and gender directly or indirectly (mediated by initial depression severity) affected HRQoL, with male patients and patients with stroke non-involving the frontal lobe/basal ganglia showing a better HRQoL by the end of rehabilitation.

Parents of children with developmental disabilities experience more stress compared to those of typically developing children; therefore, measuring parental stress may help clinicians to address it. The Parental Stress Scale (PSS) is a self-rceport measure in the public domain that assesses stress related to child rearing. The present study tested the psychometric properties of the Greek version of the PSS in 204 parents (mean age: 39.4 ± 5.7, 124 mothers and 80 fathers) of kindergarten children diagnosed with Developmental Language Disorder (DLD) after a clinical assessment. Confirmatory factor analysis (CFA) was used to confirm the original four-factor structure. The results showed that the original four-factor structure (parental rewards, parental stressors, lack of control and parental satisfaction) is valid in this specific Greek population. The reliability was high (ω = 0.78) and there were weak correlations (r = −0.372, r = −0.337, r = −0.236), yet of statistical significance (p < 0.001), with similar psychological constructs (quality of life, emotional functioning and worries). Our data confirmed that the PSS is a reliable and valid tool to measure parental stress in parents of children with DLD. Greek clinicians (mental health professionals, speech-language pathologists) can evaluate parental stress and design early interventions targeting specific stress aspects, along with core language interventions for the children.

Introduction A significant proportion of pregnant women and women in the early postpartum period suffer from mental health problems. The COVID-19 pandemic represents a unique stressor during this period and many studies across the world have shown elevated rates of postpartum depression (PPD). Methods In this multicenter two-phase observational prospective cohort study, we aim to assess the prevalence of anxiety prior to labor (Generalized Anxiety Disorder-7), as well as PPD at 6–8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Results Of the 330 women analyzed, 13.2% reported symptoms of depression using EPDS cut-off score ≥13. High antenatal levels of anxiety (24.8% scored ≥10 in GAD-7) were documented. A significant proportion of postpartum women reported a decrease in willingness to attend antenatal education courses (36%) and fewer antenatal visits to their obstetrician (34%) due to pandemic. Higher antenatal anxiety increased the odds of being depressed at 6–8 weeks postpartum (EPDS ≥13). Conclusions Compared to reported prevalence of PPD from previous studies before the COVID-19 era in Greece, we did not find elevated rates during the first wave of the pandemic. High anxiety levels were observed indicating that there is a need for close monitoring in pregnancy during the pandemic and anxiety screening to identify women who need support in the pandemic era. A well-planned maternity program should be employed by all the associated care providers to maintain the proper antenatal care adjusted to the pandemic strains as well as a follow-up after labor.

We briefly present a case series of six patients hospitalized in the Department of Psychiatry, University General Hospital of Ioannina, between the first (starting March 23, 2020) and the second (starting November 7, 2020) lockdown in Greece who presented with COVID-19 - related delusional ideas. All patients had negative PCR prior to admission and no history of COVID-19 infection.The first three of our cases were admitted during the first lockdown, between March 23 and May 4, one involuntary and the other two voluntary. The first one was diagnosed with acute and transient psychosis (F23 - First Episode Psychosis) and the other two with psychotic depression (F32.3). Three additional patients were admitted voluntary after the end of the first lockdown. One was diagnosed with acute and transient psychosis (F23-First Episode Psychosis) and the other two were relapses of a known psychiatric disorder (Bipolar disorder F31.5 and Psychotic depression F32.3). At follow-up six months after discharge all patients were in remission following antipsychotic medication, among other medicines. These cases reveal that COVID-19 pandemic may have an impact on the delusional content of new or preexisting psychotic disorders during the COVID-19 pandemic.

BACKGROUND:Involuntary psychiatric admissions are a widely used practice despite ethical concerns about coercion. There are particular concerns that vulnerable groups, such as single, unemployed or racial minorities, may be more subjected to such practices. AIM:We aimed to investigate the social patterns of involuntary psychiatric admissions from 2008 to 2017 at University General Hospital in Ioannina, Greece. METHOD:We retrospectively assessed inpatient records from 2008 to 2017 of patients admitted to the Department of Psychiatry of the Ioannina University General Hospital, Northwestern Greece. Alternative patients of alternative years were selected for inclusion; this yielded 332 patients involuntarily admitted, corresponding to 28.5% of total involuntary psychiatric admissions. RESULTS:Over the 10-year period, the overall numbers of annual involuntary psychiatric admissions remained relatively stable, as did the length of hospital stay (mean = 23.8 days). The most common disorder upon admission was schizophrenia spectrum disorders, accounting for approximately two-thirds of all admissions, followed by mood disorders (about 20%). There was evidence that people who lacked social support or experienced financial hardship were more greatly represented among those admitted: 70.2% of admitted patients were single and 64.8% were unemployed. Most patients had been admitted to the psychiatric ward in the past (64.2%). CONCLUSION:Our study indicates potentially worrisome evidence that patients who are in vulnerable positions are at elevated likelihood of being involuntarily admitted to psychiatric wards. Future research is needed to evaluate the socio-demographic patterning of involuntary admissions in other European countries.

Background: Upon the onset of a debilitating rapidly evolving condition (such as cancer or a rapidly progressing myopathy, neuropathy, respiratory disease, or a severe traumatic injury), individuals have limited time to find a new home or make radical structural modifications in their residence. How the affected patients can continue sharing the same house with their families, while meeting their own special requirements, is thus rising as a critical issue. Household and daily routine rearrangements, either temporary or permanent, may be necessary, to ameliorate the life of patients with impairments, lasting for months or even years. Objectives: Interior design may provide a highly efficient ?living? palliation for debilitating medical conditions directly at patients' home-site. Methods: Research of relevant literature, using keywords ?debilitating conditions,? ?home care,? ?end of life care,? ?care of advanced cancer patients,? ?care of patients with mental disorders,? ?home care of covid-19 affected patients,? and ?care of patients with degenerative illnesses.? Results: We found that patients and their relatives may not be aware of the probable interior design solutions to their daily life challenges, imposed by a disease-related impairment. In parallel, interior design experts may equally be unaware of these issues, as well as of who needs the available solutions. Similarly, medical and architectural sciences are not connected, eventually failing to meet patients' everyday needs. Conclusions: Interior architecture and health scientists are called to cooperate, aiming to provide a highly efficient and meaningful support to patients and families affected by unforeseen debilitating medical conditions.

The study aims to assess the predictive values of certain psychological factors on the quality of life in patients with Head and Neck Cancer after radiotherapy. The authors conclude that the identification and the understanding of the depressive symptoms of patients, their beliefs about their illness as well as their coping strategies may provide the basis for timely implementation of appropriate intervention that may improve the quality of life in patients.

Introduction People with schizophrenia are considered to be within the most stigmatized social groups. Accurate and efficient detection of stigma and its correlates is essential in patients with psychosis. Objectives The purpose of this study was to assess illness insight, stigma, social anxiety and quality of life in patients with a first episode of psychosis and their possible correlations Methods The sample of this study consisted of 90 patients with a first episode of psychosis that fulfilled inclusion and exclusion criteria. Tools used for the purpose of this study were Schedule for the assessment of insight-Expanded version, Internalized Stigma for Mental Illness Scale, World Health Organization Quality of Life Assessment - Greek version, Liebowitz Social Anxiety Scale - Greek version. Data were collected and analyzed with SPSS v26. Results The study group had good insight (SAI-E score: 20.33±4.449), medium to high stigma values (ISMI score 50.93±7.854), a good enough quality of life (WHOQOL-BREF score: 86.08±10.010) and low levels of social anxiety (LSAS-Gr Fear score: 3.26±8.653; Anxiety score: 2,93±7,596). The results of this study show significant at the 0.01 level 2-tailed correlations as such: (i) a positive and significant relationship between ISMI and LSAS-Gr, (ii) a negative and significant relationship between ISMI and WHOQOL-BREF, and (iii) a negative and moderate relationship between WHOQOL-BREF and LSAS-Gr. Conclusions We report medium to high stigma levels, good insight and a good enough quality of life in a sample of first-episode patients with psychosis. Disclosure No significant relationships.

Researchers increasingly use meta-analysis to synthesize the results of several studies in order to estimate a common effect. When the outcome variable is continuous, standard meta-analytic approaches assume that the primary studies report the sample mean and standard deviation of the outcome. However, when the outcome is skewed, authors sometimes summarize the data by reporting the sample median and one or both of (i) the minimum and maximum values and (ii) the first and third quartiles, but do not report the mean or standard deviation. To include these studies in meta-analysis, several methods have been developed to estimate the sample mean and standard deviation from the reported summary data. A major limitation of these widely used methods is that they assume that the outcome distribution is normal, which is unlikely to be tenable for studies reporting medians. We propose two novel approaches to estimate the sample mean and standard deviation when data are suspected to be non-normal. Our simulation results and empirical assessments show that the proposed methods often perform better than the existing methods when applied to non-normal data.