Psychiatrike = Psychiatriki最新文献

{"title":"Βullying's anatomy: How it affects brain structure and function. A systematic review.","authors":"Christodoulos Komiotis, Ioannis Mavridis","doi":"10.22365/jpsych.2025.002","DOIUrl":"10.22365/jpsych.2025.002","url":null,"abstract":"<p><p>Bullying victimization is a common problem among adolescents with many catastrophic sequelae, as it has been associated with psychiatric disorders such as anxiety and depression. Identifying the bullying print on the human brain could be useful in clinical practice, specifically in the secondary prevention of the disorders that are related to it. This review aims to explore the potential bullying-related changes of the human brain from a descriptive and functional anatomic perspective. A literature search was performed using the Pubmed/Medline database, and, following meticulous screening, 16 articles were finally used. Our review included magnetic resonance imaging (MRI) and functional MRI studies, which were focused on gray and white matter structures of the brain. Bullying affects the morphology and function of gray and white matter structures in both victims and perpetrators. Victims seem to have atrophic hyperactive orbitofrontal cortex, hypertrophic hypoactive amygdalae, and increased cortical activation in almost all brain lobes. Bullies, on the other hand, have hyperactive accumbens nuclei. Fundamental nuclei of the limbic system, namely the nucleus accumbens and amygdala, are affected in both victims and perpetrators. Bullying changes the human brain morphologically and functionally, primarily affecting structures of the limbic system. Identifying these changes early could mainly help in the prevention of the expression of psychopathology and thus improve the quality of life of victims and even help bullies to seek medical help.</p>","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":" ","pages":"219-228"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Fear and Coping Strategies during the Pandemic: Insights from Greek health services units.","authors":"Elpida Stratou, Aikaterini Toska, Aikaterini Gamvroula, Stavros Antonopoulos, Athanasios Moulopoulos, Theodora Rigopoulou, Kyriakos Souliotis, Maria Saridi","doi":"10.22365/jpsych.2024.013","DOIUrl":"10.22365/jpsych.2024.013","url":null,"abstract":"<p><p>The aim of this study was to assess the fear caused by the COVID-19 pandemic among health services users in Greece. The study involved 1260 participants from three health services units in the prefecture of Corinthia. The COVID-19 Fear Scale (FCV-19S) and the Coping Orientation to Problems Experienced Inventory (Brief-COPE) were used to assess fear levels. Results showed that females experienced a significantly higher fear of COVID-19 (15.9 compared to 15.4), while the age group of>60 years had the highest mean score (16.6). Individuals in retirement showed a greater fear of COVID-19 (16.8), while health sector employees had lower fear scores (15.1). Chronically ill patients had a higher fear of COVID-19 (16.5 as opposed to 15.5 of healthy persons), while people considering that the COVID-19 pandemic will be dealt with soon presented lower levels of fear compared to those not considering it or being uncertain. According to the Brief-COPE questionnaire, fear of COVID-19 total scores was positively correlated with two of the coping subscales; the emotion-focused and the avoidant-coping. The study's findings can contribute to the identification of fear and coping strategies for the development of targeted interventions and mental health support programs during this global crisis.</p>","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":" ","pages":"244-250"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Link between the mechanism of mitophagy and schizophrenia: A narrative review.","authors":"Nikolaos Statharakos","doi":"10.22365/jpsych.2025.008","DOIUrl":"10.22365/jpsych.2025.008","url":null,"abstract":"<p><p>Despite extensive research, the precise pathophysiology underlying schizophrenia remains unclear, but accumulating evidence suggests that mitochondrial dysfunction and oxidative stress play significant roles in its development. Mitophagy, the selective degradation of damaged or dysfunctional mitochondria, plays a critical role in maintaining cellular homeostasis and is increasingly recognized for its implications in various neuropsychiatric disorders, including schizophrenia. This review examines current knowledge regarding mitophagy and its association with schizophrenia. The literature was searched in PubMed- Medline and Scopus databases, and as a narrative review, the methodology focuses on the comprehensive coverage and synthesis of relevant studies. The hypothesis of the review claims that there is a link between mitophagy and schizophrenia. The terms used in the search query are \"mitophagy\", \"schizophrenia\" with the Boolean variable \"AND\". The relationship between mitophagy and schizophrenia is complex and multifaceted, involving mitochondrial dysfunction, neuroinflammation, and the integrity of oligodendrocytes and microglia. Schizophrenia is associated with dysfunctional mitophagy and elevated oxidative stress. These mechanisms may help to explain overlapping symptoms, particularly cognitive deficits. While the emerging data linking mitophagy and schizophrenia are promising, current research has limitations. Much of the evidence for mitophagy dysfunction in schizophrenia comes from animal models or postmortem studies, which may not fully capture the complexity of the disorder in humans. Moreover, mitophagy is challenging to study in vivo, particularly in the human brain, making it difficult to directly observe mitophagy processes in patients with schizophrenia. Mitophagy and its dysfunction may contribute to the pathophysiology of schizophrenia. Evidence suggests that impaired mitophagy can lead to energy dysregulation, oxidative stress, and neuroinflammation, all of which are implicated in schizophrenia. While more research is needed, the potential link between mitophagy and schizophrenia presents an interesting area for future studies and therapeutic development. Targeting mitophagy could offer new approaches for addressing cognitive and negative symptoms, providing hope for improved treatment outcomes.</p>","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":" ","pages":"229-235"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of attention deficit hyperactivity disorder in individuals with psychoactive substance dependence.","authors":"Spyridoula Giatra, Venetsanos Mavreas","doi":"10.22365/jpsych.2025.010","DOIUrl":"10.22365/jpsych.2025.010","url":null,"abstract":"<p><p>Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental childhood disorder, which in most cases persists into adulthood, causing severe functional impairment. ADHD constitutes an important risk factor for the onset of use and the development of dependence on psychoactive substances. Impulse control disorders, anxiety, mood disorders, and substance abuse are the most common comorbid disorders. The present study aims to estimate the prevalence of ADHD in adult users of psychoactive substances who have attended a treatment program in a special detoxification unit for psychoactive substances. The study concerns the examination of one hundred eighteen psychoactive substance users using the following diagnostic tools: (a) Section 12 of the semi-structured interview SCAN 2.0, which assesses diagnostic criteria of psychoactive substance abuse and dependence. (b) The structured clinical interview CIS-R, which investigates the presence of psychopathological symptoms of \"common mental disorders\". (c) The WURS scale retrospectively probes into ADHD symptoms up to the age of 7. The prevalence of ADHD in the sample of individuals with psychoactive substance use disorders was found to be 38.1%. Analyses were also performed concerning age and the comorbidity of common psychiatric disorders and ADHD. Findings are consistent with the results of other studies. The drug users of psychoactive substances, regardless of the ADHD comorbidity, had an increased prevalence of common psychiatric disorders. The most common comorbidities were other psychoactive substance disorders, anxiety, and depressive disorders. The small number of participants, the exclusive use of one substance by the participants, and the type of unit where the present study was conducted restrict the generalizability of its results.</p>","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":" ","pages":"193-200"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dehydroepiandrosterone sulfate (DHEA-S), cortisol, and adrenocorticotropic hormone (ACTH) levels in drug-naïve, first-episode patients with psychosis.","authors":"Andreas Karampas, Maria Christou, Spirydon Brikos, Giorgos Georgiou, Marios Plakoutsis, Danai-Dimitra Koutsogianni, Stelios Tigas, Petros Petrikis","doi":"10.22365/jpsych.2025.016","DOIUrl":"10.22365/jpsych.2025.016","url":null,"abstract":"<p><p>The hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role in regulating dopamine activity in specific brain areas, particularly in the limbic system, as well as in the stress response. The assessment of the HPA axis is important for the research of biological mechanisms leading from stressful experiences to the onset of psychosis. The release of adrenocorticotropic hormone (ACTH) by the anterior pituitary stimulates the production of cortisol and Dehydroepiandrosterone (DHEA) by the adrenal cortex as a response to stress. The co-release of DHEA may act as a protective mechanism against the damaging effects of excessive cortisol activity. We aimed to measure and compare serum DHEA-S, as well as ACTH, cortisol levels, and cortisol/DHEA-S ratio in drug-naïve FEP patients and matched controls. Data were included for 110 subjects (70 men and 40 women), comprising 55 patients and 55 controls. The mean age was 31.3 years (SD 8.7) in patients and 31.4 years (SD 8.9) in controls. Serum DHEA-S was higher in patients compared to controls [0.69 (0.40) versus 0.50 (0.19), respectively]. Serum ACTH was similar between patients and controls [28.0 pg/ml (6.2-73.9) versus 22.4 pg/ml (7.0-70.5), respectively]. Serum cortisol levels and cortisol/DHEA-S ratio were lower in patients [12.6 μg/dl (4.5) and 4.4% (1.3-19.5), respectively] compared to controls [15.4μg/dl (3.7) and 7.0% (2.4-25.5), respectively]. Sub-analysis revealed that in men, serum DHEA-S was similar between male patients and controls [0.53 (0.23) versus 0.48 (0.17), respectively], whereas in women, serum DHEA-S was higher in patients compared to controls [0.97 (0.47) versus 0.55 (0.20), respectively]. ACTH levels were not different in the above subgroups. Serum cortisol in men was lower in patients compared to controls [12.8 μg/dl (4.4) versus 15.9 μg/dl (3.6)]. Additionally, the cortisol/DHEA-S ratio was lower in patients compared to controls in men [4.4% (1.3-19.5) versus 5.8% (2.4-15.4)], as well as in women [4.3% (1.8-15.2) versus 7.9% (4.0-25.5), respectively]. Correlation analysis was performed to examine the association between different psychopathological characteristics in patients and measured hormones. It was found that the PANSS cognitive subscale was positively correlated with DHEA-S in men and the PANSS positive subscale was negatively correlated with DHEA-S in women. In the linear regression analysis, DHEA-S was positively associated with the PANSS cognitive subscale in men.</p>","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":" ","pages":"183-192"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to the use of telepsychiatry for the treatment of eating disorders: A systematic review and thematic synthesis.","authors":"Melpomeni Eleni Sapouna, Andreas Lappas, Myrto Samara, Vasilios P Bozikas, Nikos Christodoulou","doi":"10.22365/jpsych.2025.007","DOIUrl":"10.22365/jpsych.2025.007","url":null,"abstract":"<p><p>Eating disorders are mental disorders characterized by disturbed body image and excessive fear of weight gain, leading to disordered eating and weight control behavior. Studies show that early treatment is one of the most important factors in improving the prognosis of these diseases. Nevertheless, a large percentage of patients with eating disorders do not receive treatment or seek treatment until their disorder has progressed. Telepsychiatry promises to expedite treatment times by resolving geographical and cost barriers. However, there are various shortcomings in using telepsychiatry in eating disorders, including its effectiveness in treating patients with eating disorders, difficulty establishing a strong therapeutic relationship, privacy concerns, and security and technological limitations, among others. The purpose of this paper is to review the barriers that limit the usefulness of telepsychiatry in eating disorders. Ultimately, it aims to improve the use of telepsychiatry to better and more safely serve the particular needs of patients with eating disorders. We conducted a systematic review and thematic synthesis using a mixed PRISMA/ ENTREQ methodology, focusing on research that directly or indirectly investigated barriers to the use of telepsychiatry in the treatment of patients with EDs. Fifty-two studies were included, revealing multifaceted challenges in implementing telepsychiatry for patients with EDs. Specific barriers identified include poor therapeutic relationship and poor treatment adherence, clinical limitations (poor therapeutic effect, illness severity, comorbidity, certain eating disorder types are barriers themselves, impersonal care), and technical limitations (program design issues, privacy concerns), as well as negative patient experience. Telepsychiatry shows promise for treating EDs, but it is important to address these barriers in order to reach its full potential. Clinical adaptations, technological improvements, and a person-centered approach are essential to fully realize its potential. Online or hybrid treatment models must be highly personalized and multifaceted and have active therapist involvement, particularly for patients with clinical complexity.</p>","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":" ","pages":"236-243"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factor analysis and reliability of the Illness Attitude Scales in senior medical students.","authors":"Charalampos Pischos, Antonios Politis, Petros Sfikakis, Charalampos Papageorgiou","doi":"10.22365/jpsych.2025.004","DOIUrl":"10.22365/jpsych.2025.004","url":null,"abstract":"<p><p>Illness behavior is influenced by subjective, social, and cultural factors and can vary from one person to another and even internally within the same individual depending on the situation and the type of illness he or she needs to deal with. The Illness Attitude Scales (IAS) were designed by Robert Kellner to assess fears, negative beliefs, and attitudes related to hypochondriasis and abnormal behavior in relation to illness, and it is a reliable tool for detecting them as it does not contain items related to symptoms that are characteristic of other psychiatric symptoms. Although the IAS are commonly used, only a few studies have investigated their factor structure, but no common factor solution has been found. The results of these studies differ, ranging from 2 to 5 factor solutions, as well as which items are assigned to the factors. Since factor analysis for the Greek translation has not been previously researched, we analyzed the factor structure in a Greek sample using exploratory factor analysis to reflect cultural nuances in health perceptions and illness behaviors and to enable meaningful comparisons with other populations. A mixed sample of senior medical students of the Athens Medical School (N = 163) completed the psychometric tool before attending the educational clinics. Α percentage of 60.98% were women and 39.02% were men, and the average age of the sample was 23.84 years (SD = 1.67). Data were subjected to Maximum Likelihood Estimation and oblique rotation, which revealed a solution of seven factors: i) Worry about Illness after Pain Sensation, ii) Health Habits, iii) Effects of Symptoms, iv) Hypochondriac Beliefs, v) Thanatophobia, vi) Treatment Experiences, vii) Disease Phobia. The internal consistency of the factors, measured by Cronbach's alpha coefficient, achieved good to acceptable reliability: 0.86, 0.88, 0.68, 0.76, 0.73, 0.65, and 0.81, respectively. The results of the current study, although they cannot be generalized to the general population, provide information on medical students' attitudes towards illness and may pave the way for educational strategies and programs in medical school to improve the detection of negative beliefs and attitudes towards illness in medical students during clinical practice.</p>","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":" ","pages":"210-218"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autism spectrum disorder in adulthood: Diagnostic and training challenges in Greece.","authors":"Katerina Papanikolaou, Artemios Pehlivanidis","doi":"10.22365/jpsych.2025.023","DOIUrl":"10.22365/jpsych.2025.023","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Autism spectrum disorder (ASD) is classified among the neurodevelopmental disorders, which are described in the early chapters of DSM-51 and ICD-11.2 These disorders emerge in childhood, persist across the lifespan, and are characterized by deficits or diversities that affect personal, social, academic, and occupational functioning. Although the two major diagnostic systems have converged in terminology and criteria-with only minor differences in the categorization of co-occurring language and intellectual development disorders-Greece continues to rely on ICD-10, leading to difficulties in the consistent use of terminology among mental health professionals. The global rise in ASD prevalence over recent decades has been widely discussed, largely attributed to broadened diagnostic criteria and increased recognition in groups where autism was previously considered rare, such as women and individuals with milder symptoms. In the United States, current estimates suggest that 1 in 31 children may be diagnosed with ASD.3 In adults, the prevalence is consistently found to be lower. In Greece, the estimated prevalence based on diagnoses recorded by the Diagnostic, Assessment, and Counseling Centers (KEDASY) is 1.15%,4 while no epidemiological data exist for adults. The lifetime cost of care for an individual with autism may exceed 2 million USD.5 The socioeconomic burden in Greece has been exacerbated by the financial crisis, which had a more detrimental impact on families of individuals with autism than the COVID-19 pandemic.6 A critical gap in care has been documented internationally during the transition from adolescence to adulthood. Adults with autism frequently encounter the \"double empathy problem,\" referring to reciprocal difficulties in their communication with neurotypical individuals. This, coupled with the stigma surrounding the diagnosis, often results in misjudgments regarding the abilities and needs of people with autism. Among adults with ASD, depression is the most prevalent and impairing co-occurring psychiatric disorder, often accompanied by anxiety disorders, both of which contribute to marked reductions in functioning, particularly during transitional periods.7-9 For the so-called \"lost generation\" of adults with autism-those with normal intelligence and relatively functional profiles whose diagnosis was missed earlier-an ASD diagnosis may resolve longstanding diagnostic uncertainty and explain treatment resistance in psychiatric disorders. Management of ASD and psychiatric comorbidities requires individualized treatment planning that integrates psychosocial interventions and targeted, when needed, pharmacological strategies. Multidisciplinary collaboration among professionals is essential, while active family involvement is of fundamental importance.10 In the era of precision medicine, its applicability to ASD depends on a comprehensive understanding of genetic, temperamental, and environmental factors, enabling personalized in","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":"36 3","pages":"179-182"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Picture description impairment and neurocognition in schizophrenia: A pilot study.","authors":"Evagelia P Koutra, Sofia Athanasiou, Efstathia Karakosta, Nikitas Arnaoutoglou, Eva-Maria Tsapakis, Konstantinos N Fountoulakis","doi":"10.22365/jpsych.2025.011","DOIUrl":"10.22365/jpsych.2025.011","url":null,"abstract":"<p><p>Schizophrenia is also manifested in a pattern of impaired speech traditionally considered to reflect thought disorder. This pilot study aimed to investigate the relationship between language impairment and other neurocognitive impairments and psychopathology. The study included 10 patients with schizophrenia (5 males), aged 45.5±12.48 years. They were assessed with the PANSS, scales of disability, and a neuropsychological battery. The experimental condition included four pictures with concrete everyday life content. The statistical analysis included the calculation of Spearman's rho correlation coefficient. Picture description was significantly correlated with the PANSS G. Non-significant but high correlations included the PANSS N, ratings of disability, and the Graphic Sequence test, the Rey figure, and the Stroop test, but there was a lack of correlation with verbal fluency, abstract thinking, and executive function Despite the small study sample, it could be said that the impaired performance in picture description in patients with schizophrenia is not a consequence of disordered thought alone, but also of the existence of a dysfunctional processing of visual information and a problematic translation of it into meaningful mental images.</p>","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":" ","pages":"201-209"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Similar cost-better results: the case of the hybrid Assertive Community Treatment model of care for severely mentally ill patients in rural Greece.","authors":"Fotini Tsoli, Ioanna Athina Botsari, Nefeli Menti, Panagiota Kontoudi, Aikaterini Pouliasi, Vaios Peritogiannis","doi":"10.22365/jpsych.2025.022","DOIUrl":"https://doi.org/10.22365/jpsych.2025.022","url":null,"abstract":"<p><p>The present study evaluated the impact of a hybrid Assertive Community Treatment (ACT) model of care on the direct medical costs of treating severe mental illness (SMI) patients in rural Greece. The study aimed to determine whether this model resulted in significant cost differences compared to usual treatment while also assessing its cost-effectiveness based on clinical improvements. A total of 23 patients with SMI and multiple hospitalizations were followed up for 16 months under the hybrid ACT model. Direct medical costs were estimated using previously published Greek data on schizophrenia treatment costs. Cost differences before and after the implementation of the hybrid ACT model were calculated, and cost-effectiveness was assessed using the Incremental Cost-Effectiveness Ratio (ICER), which reflects the cost per unit increase in Global Assessment of Functioning (GAF) scores. There was no statistically significant difference in direct medical costs between usual care (310,029€) and hybrid ACT care (313,896€), with a small cost increase of 3,867€ (p = 0.077). However, hybrid ACT care significantly reduced hospitalizations and length of inpatient stay, leading to an 86.9% reduction in total inpatient days. Clinical improvements were also observed, with GAF scores increasing from 40.43 to 47.26. Cost-effectiveness analysis demonstrated a particularly low ICER of 25.9€ per GAF point gained, suggesting a cost-efficient intervention. In an alternative scenario, the 2024 pricing was estimated with the use of the Consumer Price Index. In this case, the hybrid ACT care appeared to be significantly cost-saving by 25.5%. A rough estimation of indirect costs revealed further cost savings in favor of the hybrid ACT. The hybrid ACT model proved to be cost-effective due to its strong impact on reducing inpatient care and improving patient functioning. These findings align with international studies demonstrating the economic and clinical benefits of community-based mental health care. Future research should focus on larger, multicenter studies to confirm cost-effectiveness and explore the impact on indirect costs, such as caregiver burden and law enforcement involvement. The results support further investment in hybrid ACT services in rural Greece to enhance mental health care delivery in low-resourced settings.</p>","PeriodicalId":20741,"journal":{"name":"Psychiatrike = Psychiatriki","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}