Miltos Livaditis

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.

Olfaction-associated quality of life in chronic rhinosinusitis: Adaptation and validation of an olfaction-specific questionnaire†

To detect validity and reliability of the Questionnaire of Olfactory Disorders (QOD) compared to other quality‐of‐life (QoL) questionnaires, to explore its ability to reflect olfaction‐related QoL changes, and to investigate age‐ and gender‐related effects of olfactory changes on QOD results.

Sleep architecture in stroke and relation to outcome.

The aim of this study was to investigate sleep architecture in stroke patients, and correlate possible disturbances with the topography, severity and outcome of stroke and the presence of sleep-disordered breathing (SDB). In total, 62 acute stroke patients and 16 age- and gender-matched hospitalised controls underwent polysomnographic studies. Sleep architecture was analysed according to the topography of lesion, severity (National Institutes of Health Stroke Scale) and outcome (Barthel Index) of stroke. We found that sleep architecture is disturbed in stroke patients, regardless of SDB. Stroke patients (without SDB) have reductions in total sleep time and sleep efficiency, reduced stage II and slow wave sleep, increased wakefulness during sleep and increased sleep latency. Rapid eye movement (REM) sleep is reduced when SDB is also present. REM sleep is relatively preserved in cerebellar strokes, as opposed to other topographies. Sleep stages I and REM are negatively associated with stroke severity, and the latency to REM sleep is positively correlated with a good outcome. Sleep architecture is impaired in stroke patients (with fragmentation, increased wakefulness and reduced slow wave sleep), and this correlates with severity and outcome. Sleep disturbances should be investigated and addressed in these patients. Further studies are needed to confirm these findings and assess the clinical and therapeutic implications.

Olfactory dysfunction and asthma as risk factors for poor quality of life in upper airway diseases.

Background The study of olfaction/quality of life (QoL) interaction has not been adequately discussed and remains to be further explored. Determination of clinical predictors for poor QoL may support consultation of respective patients. This study explores QoL of patients with olfactory dysfunction and evaluates associated clinical risk factors for QoL prediction. Methods One hundred eight patients suffering from chronic rhinosinusitis (CRS) and allergic rhinitis (AR) and 30 healthy subjects were studied. Olfactory function was evaluated using objective olfactory test. All patients completed six validated questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits [QOD]) and for assessing psychological state (Zung Anxiety Scale [ZAS], State-Trait Anxiety Inventory, Zung Depression Scale, and Beck Depression Inventory [BDI]) or a generic one (Short Form 36). Results Significantly poorer QoL and more severe anxiety and depression symptoms were observed in anosmic (all p < 0.001) and hyposmic patients compared with controls. Anosmic patients presented significantly worse results compared with hyposmic and normosmic patients. However, higher scores were observed in hyposmic compared with normosmic patients only in the QOD, ZAS, and BDI scale. Patients with CRS presented significantly poorer QoL than patients with AR only. The presence of nasal polyps or concomitant AR in patients with CRS did not show any differentiation in the results. Asthma was associated with significantly worse scores in all the psychometric questionnaires. Conclusion Olfactory dysfunction was found to decrease QoL among patients. Anosmia, CRS disease, and asthma as clinical predictors were proved to be independently correlated with QoL, anxiety, and depression levels.

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.

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.

Collective Trauma Transmission and Traumatic Reactions Among Descendants of Armenian Refugees

Background: It has been suggested, mainly by case reports, that the collective trauma generated by mass calamities may be transmitted to, and have long-lasting effects on, new generations. Aims: To investigate the psychological impact on contemporary Armenians of traumatic events suffered by Armenians during the period 1914—1918. Methods: A descriptive, cross-sectional study investigating demographic and cultural characteristics of a population of 689 people of Armenian origin, residents of Greece and Cyprus. Subjects were recruited during a range of Armenian cultural, athletic or charitable events. The participants completed a version of the Post-Traumatic Stress Disorder (PTSD) (Self-Rating) Scale and a questionnaire including ad hoc questions regarding their relationship to the Armenian community, their attitudes and their source of information about the 1914—1918 events. Results: Over a third (35.7%) of participants presented at least sub-clinical forms of such reactions during long periods of their lives. Women, older people, participants with a close relative lost during the events and those with strong connections to the Armenian community were more vulnerable. Conclusion: The results are indicative of a long-lasting (though gradually fading) cross-generational traumatizing effect of the discussed events. Clinicians having to deal with patients belonging to cultural or ethnic groups that suffered persecutions in the past should take into account the probable effects caused by a trauma-transmission mechanism.

Improvement of olfactory function for quality of life recovery

To explore quality of life (QoL) improvement after treatment of patients with chronic olfactory disorders; and to correlate QoL with olfactory rehabilitation and evaluate olfactory improvement values over which QoL outcomes are significantly recovered.

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.