Difference in symptom profile between generalized anxiety disorder and anxiety secondary to hyperthyroidism.

OBJECTIVE: The differential diagnosis between subclinical hyperthyroidism and Generalized Anxiety Disorder (GAD) is often a difficult problem to solve without laboratory examination. The aim of this pilot study was to assess whether there are differences in the symptom profile between these two disorders. METHODS: Fifty patients took part in the study: Twenty-five were hyperthyroid patients, and twenty-five were GAD patients. The diagnosis was based on the TSH values and the DSM-IV criteria, respectively. The Hamilton Anxiety Scale (HAS) and the list of fifty-one symptoms produced by the detailed expansion of HAS items were used to quantify the anxiety symptomatology. The differences in the frequencies between the two diagnostic groups were calculated at each categorical response for every item of both scales. Forward Stepwise Discriminant Function Analysis was performed twice using HAS items and the fifty-one-list items. RESULTS: The symptoms of anxiety in subclinical hyperthyroidism were not identical to those of GAD. Four Hyperthyroid/Anxiety Indices (HAI I-IV) were developed. These indices reach optimum classification of patients (3 of them reach 100% sensitivity and specificity). CONCLUSION: The results of the current study suggest that it is possible to differentiate between GAD and subclinical cases of hyperthyroidism by the careful study of clinical symptomatology. This may be of particular help in isolated areas without laboratory support, but replication of the indices in other samples is indicated.

Changes in pupil reaction to light in melancholic patients.

The aim of the current study was to compare the pupil reaction to light in depressed patients and normal control subjects. Seven depressed patients with melancholic features according to DSM-IV criteria and 14 age- and gender-matched control subjects took part in the study. All were free of any medication for at least 2 weeks. All were aged between 25 and 50 years. An optical method was used to assess the pupil reaction to a single flash. Depressed patients manifested shorter latency for constriction than control subjects, and a marginal difference in the total work produced by acetylcholine. The results of the current study support the theory that there is a norepinephrine hypoactivity in melancholic depression, with less affected acetylcholine activity.

The validation of the short form of the Geriatric Depression Scale (GDS) in Greece.

The Geriatric Depression Scale-15 (GDS-15) is a short, 15-item instrument specifically designed to assess depression in geriatric populations. Its items require a yes/no response. The Geriatric Depression Scale was first introduced by Yesavage et al. in 1983, and the short form (GDS-15) was developed by Sheikh and Yesavage in 1986. The aim of the current study was the standardization of the GDS-15 for use in Greece. Subjects were divided into Group A: 168 control subjects, and Group B: 103 patients suffering from clinically diagnosed depression. All were over 65 years of age. A score of 6/7 on the GDS-15 was found to be the best cut-off point for diagnosing depression in an elderly Greek population, with Sensitivity = 92.23 and Specificity = 95.24. GDS-15 manifests high internal consistency with Cronbach's alpha = 0.94, and all items seem to be equivalent. Factor Analysis of the GDS-15 revealed 4 factors: a cognitive (thought content), an affective, a functional, and a factor that reflects helplessness and fear for the future. The two diagnostic groups differed on all 4 factors scores at p-value <0.001.

Burnout in nursing staff: is there a relationship between depression and burnout?

OBJECTIVE: There is evidence that burnout may be a clinical entity with pathological stress reaction features related to the inability in finding pleasure from work. The purpose of this study was to investigate the relationship between burnout and depression. METHODS: The study took place in the general hospital AHEPA of Thessaloniki. All members of the nursing staff (in total 368 subjects) took part. The protocol was self-reported and anonymous, in order to obtain as valid data as possible and included the Maslach Burnout Inventory (MBI) to assess the level of burnout, the Eysenck Personality Questionnaire (EPQ) to assess personality traits, and the Zung Self-Rating Depression Scale to assess depressive symptomatology. RESULTS: The analysis revealed a weak but significant relationship between burnout and depression. CONCLUSIONS: Depression is a pervasive disorder that affects almost every aspect of the patient's life. On the contrary, burnout is, by definition, a syndrome restricted to the patient's professional environment. However, it seems that there may be two distinct types of burnout syndromes, of which the one comprising the majority of nurses has little or no common features with depression. The second type consists of individuals with a predisposition to develop burnout. The latter is characterized by more severe symptomatology, phenotypic similarity to depression and presumably common etiological mechanisms.

Comparison of the diagnosis of melancholic and atypical features according to DSM-IV and somatic syndrome according to ICD-10 in patients suffering from major depression.

While melancholic (according to DSM) or somatic syndrome (according to ICD) has strong historical roots and substantial empirical verification, the concept of atypical features is relatively new and not sufficiently studied. The aim of the current study was to investigate the reliability of these diagnostic subcategories in patients suffering from major depression in Greece. Forty patients (eight males and 32 females) aged 19-60 years (mean 39.3, sd 12.2) suffering from major depression according to DSM-IV criteria were studied. SCAN v.2.0 was used to assess symptomatology. The presence of each criterion according to DSM-IV and ICD-10 was registered. Frequency tables were developed and factor and cluster analysis were performed. The results of the analysis suggest the existence of three syndromes which roughly reflect the melancholic and atypical but also propose a third, which can be considered as an 'undifferentiated' syndrome. The DSM demand that the existence of melancholic features be excluded first and then that diagnosis of atypical features be made was confirmed.

The concept of mental disorder in Greek cinema.

Mental patients in Greek society have never been considered as 'sacred', but on the contrary as handicapped, and cinema largely reflects these concepts. A total of 30 films that appeared to deal with mental disorder in a direct or indirect way have been reviewed. The identification of each mental disorder was made according to DSM-IV criteria. Five of these cases were presented as having a factitious disorder, seven were psychotic and two had dissociative (hysterical) disorders. The remaining eight cases related to personality disorder or character deviance. In two cases diagnosis was impossible. The image of mental disorder is consistent with psychiatric nosology, and disorders with 'dramatic' or 'impressive' manifestation of symptomatology are chosen. No real solutions, proposals or ideology on mental illness emerge.

Changing patterns of attempted suicide in Greece: clinicoepidemiological and psychodynamic data.

Greece is known to have one of the lowest rates of both completed and attempted suicides. Yet during the last three decades the pattern of suicide attempts has shown some differentiations, which point to possible changes in family structure and social behavior, bringing the pattern closer to that of western countries. While in 1971-72 the ratio of male to female attempters was 1:4.6, in 1994-96 it was 1:2.3 - the mean age rose from early to middle adulthood - more married people attempted suicide than before - more attempters took alcohol before the act etc. There are, nevertheless, many steady features, e.g. the low rates of attempters in old age (above 65 years: 7.9% of the total), the methods used, the type of preceding stressful life events (more financial than emotional in males), no drug abuse etc. Since the low rates of suicide attempts in Greece have been attributed to cultural parameters and the close bonds in the family, psychodynamic studies were also carried out, which showed that adolescent attempters preserve the ability for outward aggression and their self-destructive act is due to other than intrapsychic factors (usually social and relational problems).

Exercise renal rehabilitation program: psychosocial effects.

The aim of this study was to assess the psychosocial effects of exercise training on hemodialysis (HD) patients. Thirty-one uremic patients, aged 50.6+/-11.6 years, on maintenance HD were studied. Twenty patients were selected at random for a 6-month exercise renal rehabilitation program (ERRP) consisting of 3 weekly sessions of exercise training. The other 11 patients were assigned to sedentary control status. A formal psychosocial assessment, which included affective (Beck Depression Inventory, BDI), quality of life (Quality of Life Index, QLI) and personality (Eysenck Personality Questionnaire, EPQ) parameters, was performed with validated questionnaires at the beginning and the end of the ERRP. After training significant improvement occurred in physical capacity (VO2max increased from 16.8+/-6.2 to 23.2+/-7.6 ml/kg/min, p < 0.05). Although the level of depression did not differ betwen the 2 groups at pretesting, the ERRP group showed a decrease in their self-report of depression (decrease in BDI score value, from 21.0+/-10.4 to 13.7+/-9.5, p < 0.05) after the training program. From the relationship between the baseline levels of BDI depression and changes in VO2max in the ERRP group it was suggested that the most severely depressed patients got the greatest beneficial effects from exercise training. Moreover, trained patients demonstrated an improvement in QLI (from 6.3+/-1.5 to 9.0+/-0.9, p < 0.05). This improvement was found to be dependent on the participation in ERRP, the effects of the training and the improvement in the depression. All the above functional and psychosocial parameters remained unchanged in the controls. The results demonstrate that ERRP is an effective emotional therapeutic method for HD patients and improves their quality of life.

Short-term psychoanalytic psychotherapy with obsessive preadolescents.

The phenomenological and psychodynamic differences between obsessive preadolescents and obsessive adults are pointed out. Case material shows how an effective therapeutic alliance on psychoanalytic lines can be established quite early with preadolescents. The therapy can be shortened mainly by opening up sexual subjects connected with the onset of puberty, and by working through the guilt engendered by the ambivalent relations this age group has with its parents.

Burnout in nursing staff: a clinical syndrome rather than a psychological reaction?

The aim of this study was to investigate the relationship between the development of burnout in the nursing staff and traits of personality, as well as sociodemographic and professional characteristics. Maslach Burnout Inventory and Eysenck Personality Questionnaire were used to evaluate all the members of the nursing staff of General Hospital AHEPA. Data on sociodemographic and professional characteristics of the staff were gathered as well. The analysis showed that there is a complex interaction of the measured characteristics of the sample that leads to the development of burnout. The model of burnout development is not only nonlinear, that is, different variables play a different role in each level of burnout development, but also points to a discontinuity between 'normal' attitude towards work and true burnout. This suggests the possibility that burnout is a true clinical syndrome with neurotic features rather than a magnification of normal tiredness from work.

Psychiatric and psychosocial status of elderly patients undergoing dialysis.

We investigated the psychiatric and psychosocial status of 31 elderly (age > 65 years) end-stage renal disease patients undergoing hemodialysis (HD) (17 patients) and continuous ambulatory peritoneal dialysis (CAPD) (14 patients). There was no difference between the two groups in terms of age (67.3 +/- 2.3 and 68.5 +/- 4.3 in HD and CAPD groups, respectively), duration of dialysis treatment, and biochemical profile. The psychiatric and psychosocial status of the patients was assessed using the standardized psychiatric interview (SPI), Hamilton's depression scale (HRS-D), and a questionnaire for the evaluation of the psychosocial impact of the method of treatment. Sixteen of 31 patients presented with psychiatric morbidity (9 mild, 5 moderate, 2 severe). However, there was no significant relationship between psychiatric morbidity and method of dialysis (HD or CAPD). The mean values of SPI (21.47 +/- 16.38 and 17.14 +/- 13) and HRS-D (20.91 +/- 17.33 and 15.41 +/- 13.13) scores for the HD and CAPD groups, respectively, did not differ significantly. The analysis of the results of the questionnaire regarding the impact of the method of treatment on psychosocial status indicated that the HD patients felt that their lives were more dependent on factors that they could not influence (i.e., the dialysis equipment, etc.). Our findings suggest that the psychiatric status of elderly patients undergoing chronic dialysis treatment is not affected by the method of treatment, a factor that should be taken into consideration when deciding the proper dialysis treatment for these patients.

Adolescents' mental health and the Greek family: preventive aspects.

Preventive mental health measures can be properly planned only if the various factors leading to the adolescent's personality structure are extensively investigated. Starting with the specific attitudes of a couple towards genetic counselling, the disadvantages of urbanization and of the dissolution of the traditional extended family are discussed with regard to their effect on the younger members. Data are produced concerning the child-rearing practices of Greek in comparison to American parents and their effect on the adolescent's emotional life. Extreme dependence on the family, pressure for school achievements, lack of sexual education, etc. are characteristic of the stresses a Greek adolescent undergoes. Socio-cultural conditions, like immigration, adoption, etc. are shown to have a different psychological effect on an adolescent in Greece than in America. Specific stresses regarding the adolescent's future, like preparing for university entrance examinations, are discussed and preventive measures are proposed.

Somatic manifestations of depressive patients in different psychiatric settings.

The diagnostic and prognostic significance of somatic manifestations in various depressive conditions is discussed with special reference to the somatic complaints in masked depression. The experience presented is based on 788 depressive patients studied in three different psychiatric services of a Greek rural district--an inpatient, an outpatient and a mobile unit service. Headache was found to be on top of the symptom checklist in both outpatient and mobile unit population. Musculoskeletal complaints and dizziness had also a high incidence and to a lesser degree gastrointestinal, cardiovascular and genitourinary symptoms. Though the incidence of all other somatic complaints increased with age and was higher in inpatients, headache was a prominent symptom in younger patients, too, and in outpatients, proving to be also an early diagnostic phenomenon for an underlying depression. The mental health mobile unit saw the greatest percentage of neurotic depressives, who also presented the highest incidence of headache (62.63%). The efficacy of that service for tracing such cases and the need for cooperation with the primary health care for better preventive measures are stressed.

Psychotherapeutic possibilities in a rural community mental health center in Greece.

The psychotherapeutic possibilities were explored in an experimental community mental health center covering a rural, secluded district in Greece. Cultural difficulties and visualization of the therapist as a protective figure produced some initial resistances, while somatization was common. Various psychotherapeutic approaches, including a mobile unit's intervention in the villages, were organized to cover the countryside's needs.

Prevention of psychiatric disturbances following gynaecologic operations.

The emotional complications following gynaecologic operations are investigated in an effort to search for their causes and find ways of prevention. A study of the authors in women after hysterectomy compared to a control group showed a great percentage of reactive depression, 6-12 months following the operation. Based on the findings concerning family attitudes, sexual misconceptions and body image changes, certain preventive measures are proposed: pre-operatively, proper psychological approach of the woman, investigation of the special individual and family attitudes and problems, provision of accurate information about the nature of the operation, and post-operatively adequate psychotherapeutic support.