Thomas Hyphantis

Although the prevalence of a mental disorder, in general, in patients with diabetes mellitus is regarded to be comparable to the general population, an increased prevalence of depressive disorders, often comorbid with anxiety, has been reported in patients with diabetes mellitus. The co-occurrence of depression in diabetes is attributed to a variety of factors, including the psychological and psychosocial impact of the disease, a potential common genetic susceptibility and common pathophysiological abnormalities involving neuroimmunological and neuroendocrinical pathways, as well as microvascular brain lesions due to diabetes mellitus. However, issues concerning pathogenesis and causality of this high co-occurrence are not fully determined yet. Still, the presence of depression in patients with diabetes mellitus is of vast importance, as it is usually associated with poor disease control, adverse health outcomes and quality of life impairment. This article aims to provide a comprehensive review of epidemiological findings, clinical considerations and management strategies concerning depression in patients with diabetes mellitus.

ABSTRACTThis research was planned to assess the predictive power of dimensions and facets of the Zuckerman–Kuhlman–Aluja Personality Questionnaire in relation to the Millon Clinical Multiaxial Inventory III 10 personality disorder (PD) scales in healthy subjects. The sample was composed of 529 subjects from the general population. The average age was 44.51 (standard deviation: 18.27; range 18–85) for men and 43.94 (standard deviation: 18.01; range 18–83) for women. Five factors emerged from principal component analyses. Alpha reliabilities were acceptable for the two questionnaires. Neuroticism correlated with most PD scales. Aggressiveness and sensation seeking correlated with antisocial PD; extraversion (negative) and neuroticism (positive) correlated with several PDs such as avoidant and dependent. The facets presented a similar pattern of correlations with the PD dimensions with different values and statistical power. Sensation seeking and aggression facets were strongly related...

Background: To aid in the differentiation of individuals with major depressive disorder (MDD) from healthy controls, numerous peripheral biomarkers have been proposed. To date, no comprehensive evaluation of the existence of bias favoring the publication of significant results or inflating effect sizes has been conducted. Methods: Here, we performed a comprehensive review of meta-analyses of peripheral nongenetic biomarkers that could discriminate individuals with MDD from nondepressed controls. PubMed/MEDLINE, EMBASE, and PsycINFO databases were searched through April 10, 2015. Results: From 15 references, we obtained 31 eligible meta-analyses evaluating biomarkers in MDD (21,201 cases and 78,363 controls). Twenty meta-analyses reported statistically significant effect size estimates. Heterogeneity was high (I2 ≥50%) in 29 meta-analyses. We plausibly assumed that the true effect size for a meta-analysis would equal the one of its largest study. A significant summary effect size estimate was observed for 20 biomarkers. We observed an excess of statistically significant studies in 21 meta-analyses. The summary effect size of the meta-analysis was higher than the effect of its largest study in 25 meta-analyses, while 11 meta-analyses had evidence of small-study effects. Conclusions: Our findings suggest that there is an excess of studies with statistically significant results in the literature of peripheral biomarkers for MDD. The selective publication of ‘positive studies' and the selective reporting of outcomes are possible mechanisms. Effect size estimates of meta-analyses may be inflated in this literature.

A diagnosis of colorectal cancer (CRC) and its long-term treatment may lead to significant psychological distress and impaired health-related quality of life (HRQoL) for a significant proportion of patients. We searched the PubMed/MEDLINE electronic database for available literature on the associations between personality characteristics, depression, psychological distress and HRQoL in CRC. Additional references were identified through the citation tracking of the included articles. Recent evidence indicates that Type-D (distressed) personality may predict distress among CRC patients. Additionally, other personality traits, such as specific ego defense mechanisms, influence the coping responses and HRQoL. Although the presence of a stoma has been linked to the development of depressive symptoms and impairment in HRQoL in CRC patients, more prospective studies are necessary to confirm these associations. Sense of coherence (SOC) has both a moderating and mediating effect on health (especially mental health and HRQoL), and preliminary data indicate that SOC may be an independent predictor of CRC survival. The interplay between personality variables during the elaboration of "the impaired role" is complex, and the assessment of personality traits may be incorporated into a comprehensive psychosomatic evaluation of CRC patients. More well-designed prospective investigations are necessary to establish the contributory role of personality dimensions for the development of and protection from distress and impairment in the HRQoL of CRC patients, which could eventually lead to the development of psychosocial interventions that are personalized to this patient population (for example, manual-based psychotherapies).

IntroductionObesity is a serious health issue, associated with significant medical and psychosocial co-morbidity. Bariatric surgery is a promising treatment modality however, few studies have so far investigated its impact on patients’ sexuality.AimsThe present study's aim was to determine bariatric surgery's effect on female patients’ Body Mass Index (BMI), psychological and sexual functioning.Methods59 obese female patients, scheduled to undergo weight loss operation, completed the study. Psychological functioning was measured by the Hospital Anxiety and Depression Scale (HADS), while sexual functioning was assessed by the Female Sexual Functioning Index (FSFI). All participants were evaluated in two consecutive time intervals, one week before surgery (T1) and one year after (T2).ResultsStatistical analysis revealed a significant reduction in BMI (p < 0.001) and depression (p < 0.001) scores, a significant improvement in sexual desire (p = 0.005), arousal (p = 0.001), lubrication (p = 0.003), satisfaction (p = 0.012) and total sexual function (p = 0.003) and a decrease in the levels of pain during intercourse (p = 0.014) postoperatively.Postoperative total sexual functioning was correlated with baseline BMI (p = 0.030) and BMI decrease (p = 0.037).ConclusionsBariatric surgery appears as an effective way to control weight and improve psychological and sexual functioning in female obese patients. Patients, who ceased to be obese postoperatively, reported the greatest level of sexual improvement, indicating that obesity treatment should focus on BMI normalization.

Two recent studies conducted in the US and in France found an unexpectedly high prevalence of a positive screen for bipolar disorder (BD) in primary care (PC). There are few studies of the prevalence of BD in PC and no information exists on the epidemiology of BD in Brazilian PC services. This study investigated the prevalence and correlates of a positive screen for BD among patients attending three Brazilian PC centers. This cross-sectional survey recruited a systematic sample of 720 patients between 18 and 70 years of age who were seeking primary care treatment. Study measures included the Mood Disorder Questionnaire, the Center for Epidemiologic Studies Depression Scale, the World Health Organization Quality of Life instrument-Abbreviated version, the Functional Comorbidity Index, the Functioning Assessment Short Test, data on past mental health care, service utilization and a review of medical records for coded diagnosis. The prevalence of receiving positive screen for BD was 7.6% (n=55; 95% CI: 5.6-9.5%), but only 2 (3.6%) were recognized by general practitioners. A positive screen for BD was associated with significant depressive symptoms (CES-D score ≥16; 70.9%) and more general medical conditions, along with higher primary care utilization. Patients who screened positive for BD reported worse health-related quality of life as well as impaired functioning, compared to those who screened negative. Co-morbid mental disorders were not assessed. The cross-sectional design prevents firm cause-effect inferences. The prevalence of a positive screening for BD is high, clinically significant and under-recognized in Brazilian PC settings.

IntroductionTreatment resistant schizophrenia (TRS) affects at least 15-20% of newly diagnosed patients with schizophrenia. Clozapine treatment for this sub-group of patients should be considered immediately after the failure in response to two antipsychotics (usually risperidone and olanzapine) received in adequate doses and time. Immune changes have been reported in first episode patients with psychosis, although results from various studies remain inconclusive. Very few studies have investigated so far cytokine and adipokine changes in TRS.ObjectivesTo measure Interleukin-4 (IL-4), Tumor Growth Factor-β2 (TGF-β2), adiponectin and resistin in a sample of forty first-episode patients with psychosis (FEP) who proved to be treatment resistant (TRS),after treatment with two atypical antipsychotics ( olanzapine and risperidone) and after clozapine treatment.MethodsSerum levels of adiponectin, resistin, IL-4 and TGF-β2 were measured by enzyme linked immunosorbent assay (ELISA) before an...

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...

IntroductionImpaired response to stress and a pathological activation of the hypothalamic-pituitary-adrenal axis have been implicated in the pathophysiology of schizophreniaObjectivesTo measure serum ACTH, cortisol and DEHA-S levels in drug-naïve, first-episode patients with psychosis.MethodsResults are reported as mean (standard deviation, range). Paired t-test or Wilcoxon signed rank test were performed for group comparisons. The level of significance was set at p-value<0.05. Statistical analysis was performed with Stata 15.1.ResultsData were included for 110 subjects (70 men, 40 women); 55 patients and 55 controls matched for age and sex. Mean age was 31.3 years (8.7, 18-48) in patients and 31.4 years (8.9, 17-49) in controls. Serum cortisol and Cortisol/DHEA-S ratio were statistically significantly lower in patients [12.6μg/dl (4.5, 3.5-24.5) and 5.3 (3.6, 1.3-19.5), respectively] compared to controls [15.5 μg/dl (4.9, 4.2-30.1) and 8 (4.7, 1.1-25.5), respectively] (p-value=0...

Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. Objective: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. Methods: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. Results: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structure...

a chronic physical illness or a financial crisis) with depression. Thus, we aimed to test whether the presence of depression in people with 1 or 2 co-occurring LTCs is influenced by the 5-HTTLPR polymorphism and whether resilience mediates this relationship, in the context of the current Greek financial crisis. The sample comprised 446 participants. These included 318 patients with at least 1 of 3 LTCs: rheumatological disorders ( n = 167), type-II diabetes mellitus ( n = 85), and chronic pulmonary obstructive disease ( n = 25), or a combination of 2 conditions ( n = 41), who attended specialty clinics or the emergency department (response rate: 86.2%) between September 2015 and March 2016, and 128 people without LTCs recruited from the hospital staff (response rate: 64.5%). The study was approved by the ethics committee of the Ioannina University Hospital (617/17-09-2015). Signed informed consent was obtained from all participants. Sociodemographic variables, disease parameters, and history of depression were collected. Participants were also asked to define the perceived degree of the negative impact of the current recession upon their social and financial status on a 1–9 Likert-type scale (not at all to very much). Depressive symptom severity was assessed using the validated Greek version of the Patient Health Questionnaire-9 (PHQ-9) which, at an optimum threshold of 10, has 81.2% sensitivity and 86.8% specificity in diagnosing depression among Greek medical patients [2] . Resilience was assessed using the Greek version of the Wagnild and Young 14-item Resilience Scale (RS14) [9] . DNA was isolated from whole blood samples and amplified with polymerase chain reaction (PCR), and the PCR products were separated by electrophoresis in a 3% agarose gel. Two allele variants were identified based on PCR fragment sizes: long (L, 530 bp) and short (S, 426 bp). The sample was split into 3 groups based on 5-HTTLPR genotypes: L/L ( n = 148, 33.2% of the sample, 47.3% males), L/S ( n = 226, 50.7% of sample, 42.5% males), and S/S ( n = 72, 16.2% of sample, 48.6% males). Genotype and allele frequencies (L: 0.58, S: 0.42) were in Hardy-Weinberg equilibrium (χ 2 (1) = 0.78, p > 0.05) and in agreement with previous findings [7] . There were no significant differences in genotype frequencies across gender, age, marital status, education, health/disease, number of LTCs, disease duration, or across disease type. PHQ-9 scores were significantly correlated with age, sex, education, marital status, disease duration, history of depression, and perceived impact of recession, and these variables were included as covariates. RS-14 scores were significantly correlated with PHQ-9 scores ( r = –0.315, p < 0.001) and the number of LTCs ( r = –0.108, p = 0.023) but not with perceived impact of recession ( r = 0.050, p = 0.294). To investigate interactive effects, an interaction term (RS-14 × number of LTCs) was produced. The odds of being assessed with probable depression (PHQ-9 ≥ 10) were examined with hierarchical binary logistic regressions separately for L/L and S-carriers ( Table 1 ). Thirteen patients with 2 LTCs (33.3%) and 67 with 1 LTC (25.2%) were identified with probable depression (PHQ-9 ≥ 10) The financial crisis that has afflicted Greece since 2008 has adversely affected the physical and mental health of the population, with reports pointing to a rise in the prevalence of depression from 3.3% prior to the crisis to 12.3% in 2013 [1] , while in people with rheumatological disorders the prevalence of depression was found to be 25.4% [2] . The stress-diathesis model of depression postulates that individuals exhibit different vulnerability to depression once challenged with varying levels of stress [3] . In psychosomatic practice, when the cumulative exposure to stressors exceeds coping resources, allostatic overload ensues, which may precipitate disease states or otherwise aggravate existing somatic and mental disorders [4] . Evidence indicates that gene-environment interactions and epigenetic mechanisms may influence resilience to stress [5] . Therefore, genetic factors may influence resilience to stress in patients with physical long-term conditions (LTCs) in the context of a financial crisis. Evidence indicates that 5-HTTLPR, a polymorphism in the promoter region of SLC6A4, the gene that encodes for the serotonin transporter (5-HTT), could moderate the association between stress and depression [6] . The S (“short”) 5-HTTLPR allele that encodes for a less functional serotonin transporter appears to be associated with increased sensitivity to stress, and may confer a higher predisposition to developing depressive episodes as a result of exposure to stressors [6, 7] , although a recent meta-analysis provided conflicting evidence [8] . Resilience refers to a dynamic process that moderates the negative effects of stress and promotes adaptation, optimism, and acceptance [9] . Although a small number of studies have shown a link…

ABSTRACT Objectives Symptoms of psychological distress and illness perceptions influence outcomes in rheumatologic patients. We aimed to assess the prevalence of psychological distress symptoms and illness perceptions in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) and to test whether the association between psychological variables and health-related quality of life (HRQoL) was similar in the two forms of arthritis. Methods In 83 PsA and 199 RA patients we used the Patient Health Questionnaire (PHQ-9), the Symptom Check-List (SCL-90-R) and the Brief Illness Perception Questionnaire (B-IPQ) to assess psychological variables and the World Health Organization Quality of Life Instrument - Short-Form (WHOQOL-BREF) to assess physical HRQoL. Hierarchical regression models were built to test their independent contribution to Physical HRQoL after adjusting for demographic variables and disease parameters. Results The prevalence of major depressive disorder as indicated by a PHQ-9 score ≥10 was 21.7% in PsA, 25.1% in RA, and 36.7% in those PsA patients with polyarthritis. After adjustment for severity of disease and pain, anxiety (b=-0.28) and concern about bodily symptoms attributed to the illness (b=-0.33) were independent correlates of physical HRQoL in PsA. In RA, depression (b=-0.29) and concern about the consequences of the arthritis (b=-0.27) were independent correlates of physical HRQoL. Conclusions These findings suggest that psychological factors are important correlates of HRQoL in PsA, as well as in RA. Attention to patients’ anxiety and their concern about numerous bodily symptoms attributed to the illness may enable rheumatologists to identify and manage treatable aspects of HRQoL in PsA. Disclosure of Interest None Declared

The Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) was developed in an attempt to define the basic factors of personality or temperament. We aimed to assess the factor structure and the psychometric properties of its Greek version and to explore its relation to psychopathological symptoms and hostility features. ZKPQ was translated into Greek using back-translation and was administered to 1,462 participants (475 healthy participants, 619 medical patients, 177 psychiatric patients and 191 opiate addicts). Confirmatory and exploratory factor analyses were performed. Symptoms Distress Check-List (SCL-90R) and Hostility and Direction of Hostility Questionnaire (HDHQ) were administered to test criterion validity. Five factors were identified, largely corresponding to the original version's respective factors. Retest reliabilities were acceptable (rli's: 0.79-0.89) and internal consistency was adequate for Neuroticism-Anxiety (0.87), Impulsive Sensation Seeking (0.80), Aggress...

We aimed to assess the defensive profile of primary Sjögren's syndrome (SS) patients and to investigate the independent associations of psychological distress and personality variables with health-related quality of life (HRQOL). In 40 primary SS patients we assessed psychological distress (SCL-90-R), ego defense mechanisms (Defense Style Questionnaire), hostility features (HDHQ) and HRQOL (WHOQOL-BREF). Fifty-six patients with Systemic Lupus Erythematosous (SLE) and 80 healthy participants matched for age and sex served as controls. Primary SS patients presented higher rates of general psychological distress compared to SLE and healthy participants. Symptoms of somatisation were more prominent in SS than SLE or healthy controls. SS patients presented less use of humour defense and more help-rejecting complains and delusional guilt hostility, compared to controls. Primary SS patients' HRQOL was more impaired than healthy participants and comparable to SLE. Psychological dist...

associated with physical health-related quality of life in rheumatologic disorders T. Hyphantis , K. Kotsis , N. Tsifetaki , F. Creed , A.A. Drosos , A.F. Carvalho , P.V. Voulgari b a Department of Psychiatry, Medical School, University of Ioannina, Greece, b Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Greece, c Psychiatry Research Group, Medical School, University of Manchester, Manchester, United Kingdom, d Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil

Objective: A five year prospective study of 43 patients with Inflammatory Bowel Disease (IBD), 33 with Ulcerative Colitis and 10 with Crohn#39s Disease, was conducted with the purpose to investigate the role of psychosocial factors on the course and outcome of the disease. Methods: Sociodemographic data were collected and the participants were given four psychometric instruments: the Hostility and Direction of Hostility Questionnaire (HDHQ), the Spieberger#39s trait anxiety (STAI-t), the Spieberger#39s state anxiety (STAI-s) and the Center of Epidemiological Studies-Depression Scale (CES-D). After the lapse of five years the patients were allocated to three groups according to the degree of severity of their illness (improvement, stability, deterioration).nbsp Results: Patients with IBD, whose condition was evaluated as deteriorated at the end of the follow-up, had initially given much higher scores on the HDHQ subscale of Paranoid Hostility than those with improvement. Patients who...

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 dis...

The use of antidepressants in combination is common practice following non-response to single antidepressant agents. Nevertheless, the scientific literature lacks preclinical studies regarding the combined administration of antidepressants across multiple behavioral measures including, but not limited to, cognition. Hence, we aimed to determine the effects of paroxetine (PAR), venlafaxine (VEN) and bupropion (BUP) alone or combined (PAR + BUP or VEN + BUP) on spatial and affective memory tasks to advance the knowledge about the combined use of antidepressants in cognition. Adult rats received daily injections (15 days) of PAR (20 mg/kg, ip), VEN (20 mg/kg, ip), BUP (20 mg/kg, ip) alone or combined and were submitted to behavioral measures of spatial memory (radial-arm maze - RAM), aversive memory (passive avoidance - PA), open field (OF) and forced swimming (FST) tests. In the RAM, VEN or VEN + BUP impaired learning, while short-term memory (STM) was impaired by PAR, BUP and their c...

The aim of the study was to assess the effectiveness of specially designed, empathy training for medical undergraduates, based on the principles of Person-Centered Approach.Within the context of the humanistic person-centered patient care, the experiential, 60-hour “Empathize with me, Doctor!” training program contains theory, personal development and skills development. Role plays, experiential exercises, self-awareness exercises, active listening practice and conduction of a person-centered interview constituted the training.Forty-two medical undergraduates (66% females; 29% fourth year of study, 40% fifth, 31% sixth) from the University of Ioannina in Greece applied and all of them completed the empathy training. Forty-five medical students comprised a similar according to age and year of studies control group.The Jefferson Scale of Physician Empathy (JSPE) was used to assess the empathic performance, and Cohen’s d to assess the practical importance of any statistical difference....

Suicidal risk is often unrecognized in emergency department (ED). We aimed to assess its prevalence in patients with long-term conditions (LTCs) attending an ED and to test whether gender differences influence suicidal risk assessment, using the diagnostic accuracy properties of the Risk Assessment Suicidality Scale (RASS). The RASS was administered to 349 patients with diabetes, COPD and rheumatic diseases visiting an ED. The MINI interview was used as the criterion standard. ROC curve analysis was performed to determine the optimal RASS cutpoint for suicidal risk separately for males and females. Somatic (PHQ-15) and depressive (PHQ-9) symptoms were also assessed and factors associated with suicidal risk across gender were determined in hierarchical regression models. The prevalence of suicidal risk according to the MINI was 22.9%; 16.6% of patients were at low, 5.1% at moderate, and 0.9% at high risk. At an optimal cutpoint of 270, RASS had 81.3% sensitivity and 81.8% specificity. The optimal RASS cutpoint for females (340) was double the cutpoint for males (175). Somatic symptom burden was associated with suicidal risk in both sexes but it became non-significant after depressive symptoms were taken into account; suicidal risk was also associated with history of depression in females and lower income in males. There is a high prevalence of suicidal risk in patients with LTCs attending the ED. As the optimal RASS cutpoint for females was double the cutpoint for males, clinicians should bear in mind gender differences when assessing for suicidal risk in the ED.

Several personality models are known for being replicable across cultures, such as the Five–Factor Model (FFM) or Eysenck's Psychoticism–Extraversion–Neuroticism (PEN) model, and are for this reason considered universal. The aim of the current study was to evaluate the cross–cultural replicability of the recently revised Alternative FFM (AFFM). A total of 15 048 participants from 23 cultures completed the Zuckerman–Kuhlman–Aluja Personality Questionnaire (ZKA–PQ) aimed at assessing personality according to this revised AFFM. Internal consistencies, gender differences and correlations with age were similar across cultures for all five factors and facet scales. The AFFM structure was very similar across samples and can be considered as highly replicable with total congruence coefficients ranging from .94 to .99. Measurement invariance across cultures was assessed using multi–group confirmatory factor analyses, and each higher–order personality factor did reach configural and metri...