Ioannis Giouzepas

Comorbidity of psychiatric disorders with Internet addiction in a clinical sample: the effect of personality, defense style and psychopathology.

This study aims to contribute to the understanding of underlying causes for the development of Internet Addiction Disorder (IAD) and assess comorbidity with other mental disorders through the analysis of data from a clinical sample of college students who presented for treatment of IAD. The clinical sample of our study has demonstrated a high percentage of comorbidity with Axis I and II disorders, while the temporal precedence of the establishment of those disorders cannot lead to specific conclusions. Half of the sample (25/50) presented with comorbidity of another Axis I disorder and 38% (19/50) with a concurrent Axis II personality disorder. The majority of Axis I disorders (51.85%) were reported before the onset of IAD, 33.3% after the onset while it was unclear in 14.81% of cases. The examination of a path model demonstrated that important contributions to the understanding of this disorder can be made through concepts from the neurobiological, trait personality paradigm, as well as from the psychodynamic defense style paradigm. Comorbid psychopathology can further exacerbate the presentation of IAD through a direct link, regardless of the underlying personality structure. The clinician treating IAD patients should complete a clinical evaluation for comorbid Axis I and II diagnoses since their presence may signify a more serious presentation.

The Relationship Between Personality, Defense Styles, Internet Addiction Disorder, and Psychopathology in College Students

The purpose of this study is to assess any underlying links between personality, defense styles, Internet addiction disorder (IAD), and psychopathology in a college student sample. This is a cross-sectional study of fourth-year Greek Medical students who responded in a comprehensive test battery, which included validated questionnaires on IAD, personality traits, patterns of psychological defense styles, and psychopathology symptoms. A path model that was tested using Partial Least Squares (PLS) methodology showed that the defense styles employed by the students and certain personality traits (Impulsivity, Sensation Seeking, Neuroticism/Anxiety, and Aggression-Hostility) contributed to the prediction of variability in IAD, with IAD in turn predicting variability in overt psychopathology.

Comparison of alternate personality models in psychopathology assessment.

This study assessed the results from the parallel application of two alternate personality models, the Zuckerman-Kuhlman trait model and Bonds Defense Styles, in a sample of 268 Greek medical students (172 women, M age = 22.0 yr., SD = 1.1; 95 men, M age = 22.3 yr., SD = 1.2) in relation to psychopathological symptoms, so as to clarify whether this practice yielded accurate results while avoiding shared variance. Data from both models are cross-checked with canonical correlation analysis to validate whether there was significant conceptual overlap between them that would mean that their parallel use is an ineffective research practice. Following this analysis, factors from both models are utilized to predict variance in sample psychopathology, so as to compare their relative usefulness. Results indicated that the two models did not share a significant amount of variance, while a combination of personality aspects from both models, including Impulsive Sensation-Seeking, Neuroticism-Anxiety, Aggression-Hostility, and Sociability traits and Maladaptive Action, Image Distorting, and Adaptive Action defense styles, predicted high variance in psychopathology symptoms.

742 – Internet addiction and related addictive behaviors in a sample of medical school students

Introduction Internet addiction is a multi-faceted construct which is currently under review for inclusion in the forthcoming fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. In Greece, a specialized outpatient counseling service has been setup by our Psychiatric department in order to provide counseling for any students with related problems. Objectives This survey has been setup in order to facilitate comparisons with those seeking help and validate the research measures used for their assessment. Furthermore, it sheds some light into Internet use from the future health professionals, an area of research that has been neglected. Aims To gather data on student Internet use, social media use, online gaming and gambling, use of online sexual content and any addictive phenomena related to those behaviors. Methods We employed an extensive battery of questionnaires identical to that employed by our counseling service. The battery includes detailed measures of all online behaviors, the SCL-90 psychopathology index, the Defense Styles Questionnaire (DSQ) and the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Results The presentation includes detailed results from the battery of questionnaires including comparisons with the validation samples and previous related research work carried out. Our sample demonstrated an unexpectedly high incidence of psychiatric symptoms and several cases of online addictive behaviors. Conclusions Our results are demonstrating the need for a broader reach out to the target populations since a large number of students may be hesitant to seek help for their online addictions or simply prefer to ignore them.

P-766 - Coexistent mental retardation is a complicating factor in the diagnosis of psychiatric illness. a case study of a mentally impaired OCD patient wrongly diagnosed as schizophrenic

Introduction Mental retardation is a condition characterized by limitations in intellectual and adaptive functioning. Impairments in cognitive and verbal skills may undermine the ability of a patient to clearly express the symptoms of his or her illness. Thus, when a psychiatric disorder coexists, the limited capacity of the individual to describe his or her internal state may lead to an erroneous diagnostic hypothesis. Objectives and method A clinical case was followed and reviewed to illustrate the difficulties concerning the diagnosis of mental illness in patients with lower intelligence. Results A 31 year old male was admitted in our acute psychiatric department with predominant auditory hallucinations. Prior to his admission, based on the assumption that he suffered from paranoid type schizophrenia, the patient had been treated by his private physician with heavy doses of antipsychotic medication, showing no clinical response. During his psychodiagnostic evaluation he underwent intelligence and personality testing, the former indicating mild mental retardation and the latter revealing no signs of psychotic symptoms. Careful clinical interviewing proved that his auditory hallucinations were in fact obsessive thoughts which he could not understand and describe as such due to his limited cognitive skills. Upon these, further investigation revealed typical obsessive compulsive behaviours which led us to a diagnosis of OCD. Following a proper adjustment in his medication and the initiation of psychotherapy, the patient showed marked improvement in his symptomatology. Conclusions Deficits in receptive and expressive language skills in people with mental retardation may obscure the diagnostic indicators of psychiatric disorders. Clinicians should be vigilant to adequatelly explore this area in their standard evaluation and modify the diagnostic assessment accordingly.

P-1040 - The dissociative foundation of hysterical psychosis: a clinical case illustrating janet’s original concept

Introduction Hysterical psychosis has never been part of the standard nomenclature. Janet postulated that a psychosis could be considered hysterical if its dissociative nature could be established. Breuer and Freud emphasized the traumatic origins and oneiroid form of the disorder. Hollender and Hirsch focused mainly on descriptive features: the dramatic onset, the temporal relation to an upsetting event, the short duration and the preponderance of females with histrionic behavior. Objective To demonstrate the traumatic origins and distinct features of hysterical psychosis. Method A clinical case was followed and reviewed. Results A 48-year-old female presented acutely with disorganized behavior, negativism, loosening of associations, delusions of demonic influence and a fluctuating level of consciousness. Symptom onset was temporally related to severe family stressors. A complete medical evaluation ruled out the presence of an underlying organic factor. Dissociative conversion disorder was chosen as our working diagnosis. Rapid clinical response was achieved on low dose paliperidone. After the abatement of symptoms, our patient provided a comprehensive history of her experience, describing an oneiroid state in which she transiently submerged in vivid fantasies based upon past traumatic life events. Pharmacotherapy was gradually withdrawn and psychodynamic psychotherapy was introduced as a means to help her abreact the past traumata and integrate them into a cohesive self. Conclusions This case supports Janets formulation of hysterical psychosis and demonstrates the usefulness of the dissociative component in forming a diagnostic impression and treatment approach. It also underlines the need of distinctly classifying this clinical entity among dissociative disorders.

P03-578 - Factitious disorder case series with predominant psychological signs and symptoms

Introduction Patients with factitious disorder intentionally produce or feign signs of medical or mental disorders. The only apparent objective of this behavior is to assume the role of a patient without an external incentive. The high rate of comorbidity with other psychiatric disorders together with the knowledge that factitious disorder lies on a continuum between somatoform disorders and malingering renders the early detection and diagnosis of cases with feigned psychological signs and symptoms more demanding. Objective and method Poor documentation of factitious disorder with predominant psychological signs and symptoms in the current literature reveals a blind spot in the diagnostic approach. With this in mind three cases were followed and reviewed to illustrate the elusive character of this clinical entity and demonstrate the importance of its early consideration in the differential diagnosis. Results Three patients presented to our acute psychiatric department with an extensive constellation of mood and psychotic symptoms. All patients underwent a thorough neuropsychological and medical evaluation. The diagnosis of factitious disorder was mainly based on their inconclusive mental status examination which could not definitively support the presence of another psychiatric or medical disorder, on the observation that their behavior on the psychiatric unit proved inconsistent with their chief complaints and on the past history from collateral sources which confirmed a pattern of multiple hospitalizations. Conclusions Factitious disorder should be considered in patients with inconsistent psychiatric presentations and negative diagnostic results who are high utilizers of acute care facilities such as the emergency room and inpatient services.

P03-191 - A case of persecutory delusions presenting in a woman with normal pressure hydrocephalus due to idiopathic aqueductal stenosis

Introduction Normal pressure hydrocephalus due to idiopathic aqueductal stenosis is an abnormal accumulation of CSF in the cerebral ventricles caused by an obstruction in the Sylvian aqueduct. Although NPH typically presents with the progressive ‘triad’ of cognitive impairment, gait disturbance and urinary incontinence it has been described that it rarely manifests with predominant psychotic symptoms. Objective and method A clinical case was followed and reviewed to illustrate the psychiatric symptoms in NPH. Results A 32-year-old female was admitted to our acute psychiatric department because she exhibited verbal and physical aggressive behavior while being in an agitated state with persecutory delusions. Symptoms appeared and gradually exacerbated over a 5-year period reaching their climax two weeks before admission. The patients increased body weight and bradykinetic appearance implied the presence of an underlying organic factor. However her endocrinological workup proved normal and her neurological examination revealed no actual focal deficits. An EEG also proved negative for seizure activity and encephalopathy. Neuropsychological batteries showed mild cognitive impairment and a CT scan revealed considerable dilatation of the ventricular system due to idiopathic aqueductal stenosis. While a conservative approach was chosen for the treatment of NPH our patient was initiated on atypical antipsychotics showing marked improvement of her psychiatric symptomatology. Conclusions Patients without a prior psychiatric history who have soft nonlocalising neurological signs and mild cognitive deficits in association with prominent psychotic symptomatology should raise our index of suspicion and prompt the clinician to explore the existence of an organic factor contributing to a behavioral disorder.

Hepatitis C treatment in drug users: an approach in terms of evidence-based medicine

Materials and methods A systematic literature search in PubMed / MEDLINE, was performed. Peer-reviewed journal articles investigating barriers to treatment and therapeutic outcomes were retrieved and critically appraised. Twenty studies identifying issues related to treatment initiation and twenty-six studies presenting therapeutic outcomes were analyzed. Results are summarized and presented in evidence tables. Pooling and further statistical analysis was not justified because of heterogeneity of the identified studies.