Πλήρες Τεύχος - Ελληνική Ψυχιατρική Εταιρεία

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ΨΥΧΙΑΤΡΙΚΗΤριμηνιαία έκδοση της Ελληνικής Ψυχιατρικής ΕταιρείαςΠΕΡΙΕΧΟΜΕΝΑΆρθρο σύνταξηςΣύνδρομο κινδύνου για ψύχωση: Φαρμακολογικές παρεμβάσειςΓ. Γαρύφαλλος, Γ. Λαυρεντιάδης, Ι. Γκιουζέπας ...............................................................................................................................277Ειδικά άρθραΕξελίξεις και προοπτικές στην ψυχική υγεία: Υπάρχει προκατάληψη για την ψυχιατρική;R. Montenegro .......................................................................................................................................................................................283Stress και προσωπικότηταD. Lecic-Tosevski, O. Vukovic, J. Stepanovic ....................................................................................................................................290Προβλήματα σχετικά με τον καθορισμό της αποτελεσματικότηταςκαι της δραστικότητας των αντικαταθλιπτικών φαρμάκωνH.J. Möller, K.N. Fountoulakis ............................................................................................................................................................298ΑνασκόπησηΑγχώδεις διαταραχές και παχυσαρκίαΛ. Λύκουρας, Ι. Μιχόπουλος ................................................................................................................................................................307Ερευνητικές εργασίεςΧρήση ψυχοτρόπων φαρμάκων σε νοσηλευόμενα παιδιά και εφήβουςM. Pejovic-Milovancevic, V. Miletic, S. Popovic-Deusic, S. Draganic-Gajic, D. Lecic-Tosevski, V. Marotic ..........................314Η κόπωση σε γυναίκες ασθενείς με μείζονα κατάθλιψη:H επίδραση των συννοσηρών αγχωδών διαταραχώνΠ. Φερεντίνος, Β.Π. Κονταξάκης, Μ.Ι. Χαβάκη-Κονταξάκη, Δ. Δικαίος, Γ.Ν. Παπαδημητρίου, Λ. Λύκουρας .....................320Ψυχικός πόνος και κίνδυνος αυτοκτονίας: Εφαρμογή της ελληνικής εκδοχής των κλιμάκωνΨυχικού Πόνου και Ανοχής στον Ψυχικό ΠόνοA. Σουμάνη, Δ. Δαμίγος, Π. Ουλής, Β. Μασδράκης, Β. Μαυρέας, Γ.Ν. Παπαδημητρίου, Δ. Πλουμπίδης,Γ. Κωνσταντακόπουλος ........................................................................................................................................................................330Προσεχείς επιστημονικές εκδηλώσεις ...............................................................................................................................341Οδηγίες για τους συγγραφείς.................................................................................................................................................. 344
PSYCHIATRIKI 22 (4), 2011 277Psychosis risk syndrome:Pharmacological interventionsEditorialΆρθρο ΣύνταξηςPsychiatriki 2011, 22:277–282The potential benefits of providing effective treatment for young people at psychosis risk syndrome (PRS)–known variably as ultra high risk (UHR)– of developing a psychotic disorder has been recognized only the lastdecade. Interventions on this phase, which can be divided to psychosocial and pharmacological, aim to reducesymptom severity, as well as to delay or even to fully prevent the onset of psychosis.There are few published studies to date that have studied the use of medications in PRS. As antipsychoticsare helpful in the treatment and relapse prevention for psychosis, these drugs have been tried for thePRS individuals. According to the first published study, a randomized controlled trial (RCT), UHR subjectsreceiving Cognitive Behavior Therapy (CBT) and a low dose of risperidone for 6 months, manifested significantlylower rate of transition to psychosis (9.7%) compared to UHR subjects receiving supportive psychotherapy(36%). However, in subsequent follow ups (f.u.), 6 months and 3–4 years later, this significantdifference had been disappeared. 1 Another RCT double blind study, comparing olanzapine to placebo,reached similar results 2 while two open label studies found significant improvement on both severalsymptom dimensions and functioning at the end of 8 and 12 weeks of treatment with aripiprazole andamisulpride correspondingly. 3 Furthermore, a naturalistic multisite study reported that antipsychotics improvepositive attenuated symptoms and disorganized behavior in PRS subjects but did not influencenegative and general symptoms, while antidepressants did not decline symptom severity. 4 Finally, accordingto the latest published RCT double blind study, 5 UHR individuals who received cognitive therapyplus a low dose of risperidone or cognitive therapy plus placebo or supportive psychotherapy plus placebofor 6 months, did not manifest any difference both in symptom improvement and conversion rateto psychosis.In summary, from all the above studies, one can assume that intervention with antipsychotic medicationin PRS subjects may delay conversion to psychosis and improve symptoms, especially positive symptoms,during the active phase of treatment, but there is no evidence of long lasting effects after therapy termination.There are a number of reasons against the use of antipsychotics in PRS individuals. First of all there are potentiallyserious side effects associated with all antipsychotic drugs such as extrapyramidal symptoms, metabolicsyndrome, sexual dysfunction etc. In addition, many UHR subjects, as they have strange experiences, areconcerned that they are going "mad". The prescription of drugs with indications for schizophrenia and otherpsychotic disorders increases the distress and make them feel stigmatized, especially if it occurs without informationabout potential benefits. Finally, of concern is recent evidence that long term use of antipsychotics,
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