Panagiota Goulia

Disability Status, Disease Parameters, Defense Styles, and Ego Strength Associated with Psychiatric Complications of Multiple Sclerosis

Objective: The aim of the present study was to identify disease parameters, defensive styles and ego strength measurements associated with various forms of psychiatric complications in patients with multiple sclerosis (MS). Methods: Seventy-nine patients with MS participated in the study and 158 healthy subjects matched for age and sex served as controls. A wide range of clinical information was collected and the following self-report instruments were used: General Health Questionnaire, Symptom Distress Check List, Defense Style Questionnaire, MMPI Ego Strength Scale and Hostility and Direction of Hostility Questionnaire. Results: The odds of being assessed with a psychiatric diagnosis upon interview were 6.7 times greater among patients compared to controls and 9.3 times greater among patients with recent-onset MS compared to patients with long-term disease. Psychiatric complications of MS were closely associated with age of the disease onset and the degree of disability due to MS. Additionally, higher rates of introverted hostility, adoption of maladaptive ego defenses and weakened ego strength were also closely associated with several forms of psychological distress, especially depressive symptoms. Conclusions: MS patients experience elevated symptoms of psychological distress, especially depressive symptoms, which are most closely associated with disease parameters. However, the crucial role of various personality traits such as ego defenses and hostility features in the psychiatric symptom formation also appear to contribute to the development of depressive symptoms. Clinicians involved in the clinical management of patients with MS should identify and modify treatment if these specific personality markers that indicate the exhaustion of the patients resources to cope with the physical and psychological stress of the illness are present.

Comparison of health-related quality of life and associated psychological factors between younger and older patients with established rheumatic disorders

Objectives: To compare health-related quality of life (HRQOL) between younger and older patients with established rheumatic disorders and to assess the relative impact of a number of psychosocial parameters on HRQOL. Methods: In a cross-sectional study of 320 patients (245 < 65 and 75 ≥ 65 years old, response rate: 74.9%) with various rheumatic disorders (rheumatoid arthritis, 168; systemic lupus, 56; scleroderma, 56; and Sjogrens syndrome, 40) attending a follow-up clinic, HRQOL was assessed by the WHOQOL-BREF. Functional limitations (Health Assessment Questionnaire), psychological distress (Symptom Distress Checklist-90-R), defense mechanisms (Defense Style Questionnaire and Life Style Index), sense of coherence, and interpersonal difficulties (Inventory of Interpersonal Problems-40) were also assessed. Results: Older patients presented more impaired physical HRQOL (p = 0.018) and social relationships HRQOL (p = 0.041) independent of disease type, education, and pain. Functional limitations were more prominent in the older group (p = 0.030). Pain, functional limitations, and psychological distress were independently associated with physical HRQOL in both groups. Psychological distress was the only common independent correlate of social relationships HRQOL. Personality factors were significant correlates of physical and social relationships HRQOLs only in the younger group, while the impact of pain in physical HRQOL was greater for younger than older patients, as shown by a moderator analysis. Conclusion: Older patients with rheumatic diseases experience more impaired HRQOL than the younger ones, and the management and prevention of functional limitations and psychological distress should be a priority, since they are strongly associated with HRQOL. Pain also warrants attention in all age groups, but especially in younger patients. Personality factors impact on HRQOL in younger patients, and this might be relevant to psychological interventions.

Does psychological distress vary between younger and older adults in health and disease

OBJECTIVE The effect of age on psychological distress remains controversial and it is unclear how a chronic medical illness influences this association. We aimed to compare the level of psychological distress between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with individuals without long-term conditions are made. METHODS In 519 individuals without chronic medical conditions and 949 patients with established severe chronic medical illnesses, we compared psychological distress (GHQ-28 and SCL-90R) between younger (<65, N=1040) and older (≥65, N=428) participants after controlling for gender, marital status, education and primary diagnosis in multiple logistic regression models. RESULTS Among the healthy participants, a greater proportion of older individuals presented mild/moderate psychological distress (p=.026), predominantly depressive and somatization symptoms. Among the medical patients, both age groups presented elevated levels of psychological distress, but a greater proportion of younger patients had severe psychological distress (p=.016), predominantly depressive, anxiety and hostility symptoms. Younger patients reported similarly high levels of somatization symptoms compared to older patients. The odds of being assessed with severe psychological distress were significantly greater for younger individuals with physical illnesses, independently of gender, marital status, education and primary diagnosis. CONCLUSIONS Medical patients from both age groups had significant psychological distress symptoms scores. Younger patients with chronic medical illnesses were more vulnerable to severe psychological distress, including symptoms of anxiety, depression, hostility and somatization. Therefore, clinicians should direct efforts to recognize these symptoms in order to prevent further functional impairment.

The association of illness perceptions with depressive symptoms and general psychological distress in parents of an offspring with autism spectrum disorder

BACKGROUND Raising a child with an autism spectrum disorder (ASD) is a severe stressor and parents often present high levels of depression. Depression is associated with illness perceptions but this association has not been studied in parents of ASD offspring. OBJECTIVE We aimed to assess the prevalence of psychological distress symptoms and their associations with illness perceptions in parents with an ASD offspring. METHODS In 111 parents of ASD offspring we assessed depressive symptoms (PHQ-9), illness perceptions (B-IPQ) and general psychological distress (GHQ-28). Multiple linear and logistic regressions were used to assess their independent associations. RESULTS The prevalence of parental clinically significant depressive symptoms was 34.2%, while 55% presented clinically significant levels of general psychological distress. Younger parents and those with lower financial resources had greater psychological distress and more severe depressive symptoms. Parents felt that the condition impacted their lives and believed it would be chronic. Their beliefs about the consequences and the chronicity of the disorder were significant independent correlates of their psychological distress and depressive symptoms severity. CONCLUSIONS These findings indicate that a remarkable proportion of parents with an ASD offspring present clinically significant depressive symptoms, which were associated with illness perceptions relevant to the consequences and the chronicity of the disorder. Our data encourage psychotherapeutic interventions aiming to support parents to deal with the consequences and chronicity of their offsprings disorder, in order to reduce parental psychological distress.

Assessing Ego Defense Mechanisms by Questionnaire: Psychometric Properties and Psychopathological Correlates of the Greek Version of the Plutchik's Life Style Index

The Life Style Index (LSI; Plutchik, Kellerman, & Conte, 1979) was designed to assess defense mechanisms, assuming that their use is related to specific affective states and diagnostic concepts. We aimed to assess the psychometric properties of its Greek version and its relation to psychopathological symptoms. The LSI was back-translated into Greek and was administered to 1,261 participants. Six factors were identified, 5 of them largely corresponding to the original versions defenses (compensation, denial, projection, reaction formation, and repression). The sixth factor, named regressive emotionality, included mainly the original scales regression and displacement factors. Test–retest reliabilities, internal consistencies, and construct validity were quite satisfactory. Most defenses were able to discriminate psychiatric patients from healthy participants and were associated with specific psychopathological symptoms in a theoretically expected mode, further supporting the validity of the Greek version. Our findings suggest that the LSI, based on both psychoevolutionary and psychoanalytic theory, can provide a solid ground for assessing ego defense mechanisms.

Delirium, a 'confusing' condition in general hospitals: The experience of a Consultation-Liaison Psychiatry Unit in Greece.

Background/aims: A plethora of studies showed that delirium is common in hospitalized populations. We aimed to examine the characteristics of delirium patients referred to our Consultation–Liaison Psychiatry Unit (CLPU). Methods: Our CLPU database was used to obtain data of all referred patients admitted to our hospital and diagnosed with delirium. All referred nondelirious patients served as controls. Results: During one year, 483 patients were referred to the CLPU. Ninety-three (19.3%) were diagnosed with delirium. Delirious patients were older than nondelirious patients (P < 0.001), with 76.3% aged over 70 years. The majority of the referrals came from surgical specialties. Common etiological factors were fluid and electrolyte imbalance (29%), fractures (28%) and infections (24%), but laboratory tests for the investigation of the etiology prior to the consultation had been performed in only 12 patients (12.9%). The syndrome resulted in prolonged hospitalization and greater use of CLPU services. Conclusions: Referrals for delirium are frequent in CLPUs in Greece. Although delirium is common, it remains a ‘confusing’ condition for health practitioners. The under-diagnosis of delirium, the prolonged hospitalization and the time that the CLPU dedicated to these patients underlines the role of the CLPU psychiatrists in the management of the syndrome.

Narcissistic rage: The Achilles’ heel of the patient with chronic physical illness

Based on the psychoanalytic reading of Homer’s Iliad whose principal theme is “Achilles’ rage” (the semi-mortal hero invulnerable in all of his body except for his heel, hence “Achilles’ heel” has come to mean a person’s principal weakness), we aimed to assess whether “narcissistic rage” has an impact on several psychosocial variables in patients with severe physical illness across time. In 878 patients with cancer, rheumatological diseases, multiple sclerosis, inflammatory bowel disease, and glaucoma, we assessed psychological distress (SCL-90 and GHQ-28), quality of life (WHOQOL-BREF), interpersonal difficulties (IIP-40), hostility (HDHQ), and defense styles (DSQ). Narcissistic rage comprised DSQ “omnipotence” and HDHQ “extraverted hostility”. Hierarchical multiple regressions analyses were performed. We showed that, in patients with disease duration less than one year, narcissistic rage had a minor impact on psychosocial variables studied, indicating that the rage was rather part of a “normal” mourning process. On the contrary, in patients with longer disease duration, increased rates of narcissistic rage had a great impact on all outcome variables, and the opposite was true for patients with low rates of narcissistic rage, indicating that narcissistic rage constitutes actually an “Achilles’ Heel” for patients with long-term physical illness. These findings may have important clinical implications.