Maria Samakouri

Health service staff’s attitudes towards patients with mental illness

IntroductionStereotypes and prejudices against patients with mental illness are widespread in many societies. The aim of the present study is to investigate such attitudes among the staff and medical students, including employees and trainees, in a general university hospital.MethodSix hundred individuals (361 employees, 231 students) completed the following questionnaires: Level of Contact Report (LCR), Authoritarianism Scale (AS), and Opinion about Mental Illness (OMI), a scale yielding five factors (social discrimination, social restriction, social care, social integration, and aetiology). Multivariate linear regression models were applied in order to search for the simultaneous effect of many variables on the scores of OMI factors.ResultsAn important part of the sample held negative attitudes especially concerning social discrimination and restriction of the patients. Women, older and less educated staff, nursing staff, and people scoring higher on authoritarianism were more prejudiced. Higher scores on familiarity were associated with less negative attitudes.ConclusionThe results indicate the need to develop sensitisation and training programs considering mental health topics among health service employees.

HIV infection and depression

Major depression is highly prevalent among HIV‐positive patients (HIVpp). The prevalence of depression ranges between 18% and 81%, depending on the population studied and the methodology of the study. The etiology of depression in HIVpp is likely determined by: (i) biological factors (alterations in the white matter structure, hypothalamic–pituitary–thyroid dysfunction, Tat‐protein‐induced depressive behavior); (ii) psychosocial factors (HIV stigma, occupational disability, body image changes, isolation and debilitation); (iii) history or comorbidity of psychiatric illness; and (iv) the perinatal period in HIVpp women. Symptomatology of depression differs between HIVpp and HIV‐negative patients (HIVnp). Depression may also alter the function of lymphocytes in HIVpp and decrease natural killer cell activity, contributing to the increased mortality in these patients. Selective serotonin re‐uptake inhibitors are considered the first‐line treatment. Treatment of depression can improve quality of life and lead to a better prognosis of HIV infection.

The Association of Bipolar Spectrum Disorders and Borderline Personality Disorder

Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) are two different entities sharing a variety of common features in a number of fields and, thus, presenting difficulties in their differential diagnosis. The aim of the review is to identify similarities and differences between BD and BPD concerning the symptomatology, causes, course and treatment of the two disorders. A systematic electronic search of Pubmed (Medline) was conducted in order to identify all relevant scientific articles published between 1990 and 2010. The main common clinical features of BD and BPD are affective instability and impulsivity, which, however, present with quality differences in each disorder. In the field of neuroanatomy, BD and BPD demonstrate similarities such as alterations in the limbic system, as well as specific differences, such as the increase in size of the amygdala in BD and the decrease in BPD. Both disorders appear to have a significant percentage of heritability, but environmental factors seem to hold an important role in BPD, in particular. Both BD and BPD are affected by alterations in the dopaminergic and serotonergic system. Fuctionability and prognosis are slightly worse for BPD. Concerning medication treatment, antidepressants are considered effective in BPD, whereas mood stabilizers are the main treatment of choice in BD. The effectiveness of a variety of psychotherapeutic methods is still under research for both disorders. Despite the similarities and differences already being traced in clinical and biological fields, the relationship of the two disorders has not yet been thoroughly defined.

Gender differences, family and psychological factors affecting school performance in Greek secondary school students

High rates of school failure have been reported for secondary school students, with boys presenting more schooling difficulties. The aim of this study was to investigate the association between school performance and family and psychological factors. A sample of 1315 male and female secondary school students was recruited from 54 classes randomly selected out of a total of 534 classes in the Greek region of East Macedonia and Thrace. School performance was measured dichotomously according to the final school results (pass or fail). Family and sociodemographic data were collected and psychological problems were measured using the Youth Self Report (YSR). Male gender, low socioeconomic status, low parental education and parental separation were all positively associated with school failure. Those who failed scored higher on the YSR problem scales than those who passed, and boys were more affected by adverse circumstances than girls. The results indicate that students, especially boys, with psychological problems and those coming from families of low socioeconomic and educational status are at high risk of school failure.

Psychological vulnerability differences in students--carriers or not of the serotonin transporter promoter allele S: effect of adverse experiences.

To study the effect of the serotonin transporting gene L/S polymorphism on several psychological characteristics in a group of Greek University students.

Cross-Cultural Approach of Postpartum Depression: Manifestation, Practices Applied, Risk Factors and Therapeutic Interventions

It is a well known fact that postpartum depression (PPD) is a global phenomenon that women may experience, regardless of cultural identity and beliefs. This literature review presents the cultural beliefs and postnatal practices around the world, in each continent and people’s origins, looking through the extent to which they contribute positively or negatively to the onset of the disease. 106 articles were used in this research, through a systematic electronic search of Pubmed (Medline) and Scopus. Comparison is also made between the prevalence, the risk factors and the different ways of appearance of the disease around the world and among immigrants. Finally, the initiatives and interventions made so far by the governments and institutions with a view to prevent and address this global problem are presented. The results showed (a) that different cultures share the same risk factors towards the disease (b) significant differences in the prevalence of the disease among both Western and non Western cultures and between the cultures themselves (c) more tendencies for somatization of depressive symptoms in non—Western cultures, (d) different postnatal practices between cultures, which are not always effective (e) the more non-West a culture is, the less interventions concern on mental health; the same phenomenon is observed on populations burdened by immigration. The beliefs held by culture should be taken seriously in detecting of PPD, as well as the assessment of the needs of women who have recently given birth.

Interpersonal Support Evaluation List (ISEL)--college version: validation and application in a Greek sample.

Objectives: a) To validate the Interpersonal Support Evaluation List (ISEL) - college version in a Greek population sample and b) To test the hypothesis that students scoring high on the ISEL present stronger resistance to stressful experiences and fewer psychological or physical problems. Design: Rating scale assessment and analytical cross-sectional study. Method: The ISEL was translated into Greek and then back-translated into English. A random sample of 145 students of the Faculty of Medicine completed: a) the translated version of the ISEL, b) the Symptom Check List 90-R (SCL-90-R), c) the Scale of Stressful Life Events (SSLE) and d) a questionnaire about physical health problems. Comparisons were conducted between the scores on the ISEL and the scores on the other measures. Correlations were also calculated between the scores on the Global Severity Index (GSI) of the SCL-90-R and SSLE, separately for students with high, fair and low social support, in order to assess the protective role of social support. The test-retest reliability and the internal consistency of the ISEL were also investigated. Results: The students with a lower score in social support reported more psychological and somatic symptoms. The students with a higher score in social support were protected against the harmful effect of stressful events. The ISEL presents good internal consistency (Cronbach’s alpha: 0.452-0.752) and test-retest reliability (intraclass correlation coefficients (ICC): 0.631-0.847). Conclusions: The ISEL is a valid and reliable instrument for measuring social support among Greek students. A higher score on the ISEL is correlated with a significant stress-buffering effect.

Self-Reported Substance Misuse in Greek Male Prisoners

The aim of this survey was to determine levels and severity of self-reported alcohol and drug misuse and associated physical and mental health problems in Greek male prisoners. The sample consisted of 80 randomly selected convicted and remanded male prisoners in a prison in northern Greece. The Mini International Neuropsychiatric Interview (MINI) was used to assess psychiatric disorders including substance abuse and dependence. All prisoners who participated completed the Alcohol Use Disorders Identification Test (AUDIT). Those who reported daily use of opiates and stimulants completed the Severity of Dependence Scale (SDS). Information was obtained from medical notes about the prisoners’ hepatitis B and HIV status. The MINI identified 27.5% of the prisoners as dependent on opiates, 26.3% on alcohol and 73.8% as cannabis users, while 13.8% were misusing both alcohol and illicit drugs. Severity of dependence was rated, using SDS, as serious for all opiate and stimulant users. In terms of physical health examination of medical records indicated that no prisoner was HIV-positive but 26.5% were hepatitis-B-positive. Of those who had a previous history of substance misuse, 31.2% fulfilled the criteria for depression and 37.5% for antisocial personality disorder. Similarly, 15% of those misusing substances had a previous history of deliberate self-harm and 16% were assessed to have moderate to high suicide risk.

Mental health problems in the elderly in residential care in Greece—A pilot study

The aim of this study is to examine the mental health problems of older adults living in a residential home in a Greek rural area. A sample of 40 residents was compared with 40 matched controls attending a community open care centre for the elderly (OCCE). The following measures were used: Mini International Neuropsychiatric Interview (MINI), Geriatric Depression Screening Scale (GDSS), and the Mini Mental State Examination (MMSE). The group of the residents had a lower educational level and presented with a higher prevalence of depression and suicidality. Suicidal ideation was not significantly correlated to any of the examined independent social or psychological factors and was persistent during a period of two years follow-up. It is possible that, especially in rural areas, admission in the institution is per se a traumatic event precipitating suicidality. The issues of effective psychological care for older adults in residential care are discussed.

Psychological problems in Christian and Moslem primary care patients in Greece

Objective: Psychiatric problems are often expressed through, or coexist with, somatic symptoms. Cultural factors may influence this association. This study aims to 1) estimate the prevalence of mental health problems in a sample of primary care attendees in a rural area of Greece, and 2) investigate the differences in psychiatric symptomatology among patients from different religious/cultural backgrounds. Method: Over a three-month period, 300 consecutive adult patients (Christians and Moslems) at the rural Primary Care Health Centre of Iasmos in Thrace, Greece, were assessed with the 28-item General Health Questionnaire. Results: The probable prevalence of mental health problems was estimated at 32 percent. Only for a small minority of the patients (3.3 percent) psychological problems were the presenting complaint. Moslems scored significantly higher than Christians in the somatic complaints subscale (p < 0.001). Conclusions: Mental health problems are common in primary care although they rarely constitute a reason for consultation. Sociocultural background may affect the presentation of psychological distress. Primary health care staff have a significant role in identifying hidden psychiatric morbidity.