Measuring authoritarianism in a Greek health care setting.

Few studies have investigated the level of authoritarianism in the area of health. Staff with authoritarian personality may put in danger the quality of health services, especially towards stigmatized groups, such as the mentally ill and HIV positive people or the minority ethnic communities. Authoritarianism Scale (AS) by P. Heaven, is an instrument focusing on the multi-faced nature of authoritarianism and authoritarian behaviors. The aim of this study is to assess the psychometric properties of the Greek Authoritarianism Scale (AS) and to explore authoritarian attitudes of people employed in health services, in Greece. Initially, 600 individuals (health employees and medical students) were enrolled and completed AS. Additionally, 33 postgraduate students completed AS twice, in an interval of 30 days. In order to assess the psychometric properties of AS explanatory factor analysis was performed, which resulted in a 20-items scale and revealed five (5) factors: "Leadership", "Verbal hostility", "Military way of thinking", "Fear-Suspiciousness", "Achievement Motivation". Cronbach's alpha value overall was satisfactory (0.79), while values for every factor separately ranged from 0.55 to 0.76 showing moderate to satisfactory reliability. AS's test-retest reliability was high: ICC showed high to excellent agreement of AS total and factor scores between the two time points. Women and older people were less authoritarian while youngers, students and staff with primary education showed more authoritarianism. Psychiatric staff presents the lowest AS total score comparing to the other specialties. Significant differences in all categories of the sample arose in "Achievement Motivation". Greek version of AS, as evaluated in a Greek health staff sample, revealed interesting differences among participated subgroups and had overall satisfactory reliability. The influence of Authoritarianism on the major issues of our days, such as immigration flows, social and financial crisis, leads to the need of the existence of reliable measures of its assessment.

Association of maternal depression with children's attention deficit hyperactivity disorder.

Family problems are considered to be the main risk factor leading to the development of behavi oural problems during childhood and adolescence as well. A well documented fact in the current literature is that psychopathology of any kind in parents may influence behaviour, personality and appearance of psychopathology in their children. The permanent interaction between children's psychopathology or any kind of developmental disorder on one hand and parental psychopathology on the other, is considered to be one of the most important fields of research during the last decades. The aim of the present study was to review research concerning the relationship between maternal depressive disorder and children's attention deficit hyperactivity disorder (ADHD) among members of the same family, the influence that each disorder has in the appearance and development of the other, and the way that the mother-child relationship is influenced by both. We conducted an electronic search through PubMed to detect articles concerning the association of maternal depressive disorder and children's ADHD among the members of the same family published in English from January 1980 to December 2015. The choice was strictly limited to articles concerning exclusively emotional disorders in mothers and ADHD in their children. This process concluded with the electronic research of bibliographic citations of the identified articles, or related articles, in order to locate additional sources. Considering as a fact the interaction between this developmental disorder, ADHD, and mother's psychological profile which is maternal depression for the present research, we report the following: among the 27 articles found, 24 concerned the influence of the mother's depression to the child's ADHD, and the remaining 3 concerned their genetic association. There were important limitations found as well. Despite the fact that all the studies included a control group, many of them did have a follow-up and were short-term studies. Their results were mostly heterogenous and therefore their meta-analysis proved impossible. There was evidence concerning the association between the two disorders as both maternal depressive disorder and children's ADHD influence each other through multiple psychosocial and biological factors. Nevertheless, more data is needed from well structured, homogenous studies, especially in the field of genetics, in order to document this association.

[Greek students' attitudes towards mental disorders].

Attitudes and beliefs of the population regarding the mentally ill have been universally subject of many researches. Research of different groups' opinion for mental disorders has given remarkable findings that assist in the right design of psychiatric services. Objective of this thesis is to study the attitude of students towards mental illness. In particular, it intends to study the differences derived from the age, gender, place of birth, kind of studies, year of study, duration of stay at the place of studies and the existence of mental disorders in the student's family. Data were collected from 536 students randomly selected from Universities and Technological Institutions both in Athens and Thessaloniki. In general, the participants are being divided based on the subject of their studies in undergraduates of human sciences, exact sciences, social and health sciences. The short version of the scale "Community Attitudes Toward the Mentality III" (CAMI) was used, which consists of 26 questions sorted to four subscales (domination scale, humanism scale, social exclusion scale and the scale measuring the community beliefs regarding the care of mentally ill), along with a special questionnaire in order to collect social and demographic data. Students' attitudes towards mental illness are influenced by demographic factors, the department they are studying at and the year of study. Female gender (p=0.000), personal contact with mentally ill (p=0.012), studying in Universities (p=0.031) and especially social sciences (p=0.009) are associated with positive attitudes. On the contrary, less years of studying are associated with negative attitudes whereas older students appear to score less in the Domination Scale (p=0.000). It is significant that the place of birth (p=0,335) and the duration of stay at the place of studies (r=0.735) did not show any association with the variables studied in this research. However these results cannot be compared with older researches since there are not sufficient findings. Women tend to show more humanitarian attitude towards the mentally ill in comparison to men, emphasizing the role the community plays in their support reinforcing their reintegration in the community verifying the results of research conducted in Greece and other countries. Furthermore, students who have previously been in contact with mentally ill tend to have more favorable attitude and understanding towards them. The findings concerning the age and the years of studying highlight the imperative need of exploring thoroughly the knowledge regarding the attitudes towards mental illness.

Validity of the Greek Eating Disorder Examination Questionnaire 6.0 (EDE-Q-6.0) among Greek adolescents.

The aim of this study is to examine the validity of the Greek version of the Eating Disorder Examination Questionnaire 6.0 (EDE-Q-6.0) in a sample of adolescent pupils. EDE-Q is a self- report instrument that assesses attitudes and behaviors related to Eating Disorders (EDs). A two-stage identification protocol has been applied to the 16 schools that agreed to participate in the present study. Initially, 2058 adolescents, in class under the supervision of one research assistant and one teacher, completed a Questionnaire on socio-demographic data, the Greek EDE-Q-6.0 and the Greek Eating Attitudes Test (EAT-26) while their weight and height were measured. Six-hundred and twenty six participants, who had scores on EAT-26≥20 and/or were underweight or overweight, were considered as "possible-cases" while the remaining 1432 pupils of the sample were thought as "non-possible cases". At the second stage, parents of 66 of the participants identified as possible-cases as well as parents of 72 participants from 358 controls randomly selected from the sample of "non-possible cases" agreed that their children would be examined by means of Best Estimate Diagnostic Procedure. Participants meeting DSM-IV-TR Eating Disorders criteria were identified. Receiver Operating Characteristics (ROC) analysis was applied to reveal EDE-Q's criterion validity. The kappa statistic test was used as measure of agreement between categorical variables at EDE-Q and at interview (the presence of objective binge eating episode, of self-induced vomiting, the use of laxatives and of excessive exercise). The Discriminant and Convergent validity were assessed using the non-parametric Mann-Whitney U test and by means of the Spearman's correlation coefficient, respectively. Nineteen cases of EDs were identified [one case of Anorexia Nervosa (AN), 13 cases of Eating Disorder Not Otherwise Specified (EDNOS), 5 cases of Binge Eating Disorder (BED)]. At the cut off point of 2.6125 on the EDE-Q's global scale the instrument screens with a sensitivity (Se) of 89.5% and a specificity (Sp) of 73.1%, a Positive Predictive Value (PPV) of 34.7% and a Negative Predictive Value (NPV) of 97.8% The same analyses for both sexes revealed a cut-off point of 2.612 for females and of 3.125 for males on the global EDE-Q-6.0 score (Se=84.62%, Sp=73.33% for females and Se=83.33%, Sp= 84.09% for males), yielding a PPV and a NPV of 35.5% and of 96.5% for females and 41.7% and 97.4% for males, respectively. A very low agreement level, between EDE-Q and interview, was observed regarding the presence of objective bulimic episodes (OBEs) [k=0.191 (SE=0.057)] and the unhealthy weight control behaviors [k=0.295 (SE=0.073)]. Positive correlations were found between EAT-26 and EDE-Q-6.0 for both global scale and subscales (rho=0.50-0.57). The results suggest that EDE-Q-6.0, when using its global score, appears to be a proper screening tool for assessing the core psychopathology of eating disorders in community samples in two-stage screening studies since it distinguishes very well the cases from the non-cases. However, the assessment of the presence and frequency of pathological behaviours which characterize EDs appears to be problematic since adolescents, especially the younger ones, misunderstood terms like large amount of food and loss of control or misinterpret the motivation for excessive exercise. Therefore, marked discrepancies were observed between pathological behaviors self-reported at questionnaire and those detected at interview. We may assume that giving participants more information regarding the definition of these concepts may increase the accuracy with which the participants report these behaviors.

[Standardization of the Greek version of Zung's Self-rating Anxiety Scale (SAS)].

Self-rating Anxiety Scale (SAS), introduced by Zung, has been widely used in research and in clinical practice for the detection of anxiety. The present study aims at standardizing the Greek version of SAS. SAS consists of 20 items rated on a 1-4 likert type scale. The total SAS score may vary from 20 (no anxiety at all) to 80 (severe anxiety). Two hundred and fifty four participants (114 male and 140 female), psychiatric patients, physically ill and general population individuals, aged 45.40±11.35 years, completed the following: (a) a demographic characteristics' questionnaire, (b) the SAS Greek version, (c) the Spielberg's Modified Greek State-Trait Anxiety Scale (STAI-Gr.-X) and (d) the Zung Depression Rating Scale (ZDRS). Seventy six participants answered the SAS twice within a 12th-day median period of time. The following parameters were calculated: (a) internal consistency of the SAS in terms of Cronbach's α co-efficient, (b) its test-retest reliability in terms of the Intraclass Correlation Coefficient (ICC) and (c) its concurrent and convergent validities through its score's Spearman's rho correlations with both the state and trait subscales of STAI-Gr X and the ZDRS. In addition, in order to evaluate SAS' discriminant validity, the scale's scores of the three groups of participants (psychiatric patients, physically ill and general population individuals) were compared among each other, in terms of Kruskall Wallis and Mann Whitney U tests. SAS Cronbach's alpha equals 0.897 while ICC regarding its test-retest reliability equals 0.913. Spearman's rho concerning validity: (a) when SAS is compared to STAI-Gr.-X (state), equals it 0.767, (b) when SAS is compared to STAI-Gr. X (trait), it equals 0.802 and (c) when SAS is compared to ZDRS, it equals 0.835. The mentally ill scored significantly higher in SAS compared to both the healthy and the general population. In conclusion, the SAS Greek version presents very satisfactory psychometric properties regarding its reliability and validity as well.

[What can qualia be? The monistic views].

Phenomenal properties, also named qualia (that is, the qualities of human experiences, e.g. the senses of red, of salt, of pain, qua senses) create a hard problem for philosophy. It is claimed that phenomenal properties are radically different to the physical ones: they are intrinsic (their essence is totally confined within the limits of their existence), they depend on mind, they are accessible only privately, by introspection and they are infallible, in the sense that the experience of a quale is identical to its existence. On the contrary, physical properties are dispositional (their essence is defined through their causal consequences), they exist independently of mind, they are accessible to public observation and are liable to verification or falsification. The faculty of philosophy, named philosophy of mind, is systematically interested in qualia. In the present paper some of the main monistic philosophical approaches to qualia are discussed. The main common characteristic of monistic views is that (contrary to dualistic views) they purport that: two radically different substances cannot exist, side by side, within the same world (our world). Thus, there are either physical properties, or phenomenal properties, but not both. The monistic theories, supporting that in our world there are only physical properties, or properties totally reducible into physical ones, are named physicalism (or according to a more traditional nomination, materialism). On the other hand, monistic theories maintaining that all existing properties are phenomenal, or properties reducible into phenomenal ones, are named phenomenalism. The main arguments for physicalism are: (a) the scientific principle of the causal closure of the universe (every event has one physical cause), (b) the dependence of every well-studied mental phenomenon, from a physical phenomenal, such as the function of the neural system. Dualists counterattack physicalism with mental experiments (such as, the experiments concerning philosophical zombies) in order to demonstrate that qualia are irreducible entities. The main physicalistic options are eliminativism, the theories of identity, functionalism and representationalism. The main argument for phenomenalism is that physical properties and physical knowledge of them, as well, are reducible into and derived from experiences. On the other hand, opponents of phenomenalism retort that our world comprises spatiotemporal parts inaccessible to experience (f.e. the microworld of atomic physics, the world before the appearance of intelligent beings). Yet, some phenomenalists claim that phenomenal properties can be either real (experienced) or potentially real (what one would experience if one could observe this or that spatiotemporal part of the world). According to a third, agnosticistic opinion, named mysterianism, the human mind lacks the capacity of bridging the explanatory gap between physical and phenomenal identities. Many opponents of this theory claim the historically proved ability of human mind to find solutions for difficult problems of our world through scientific knowledge and based on it natural philosophy.

Sociodemographic and clinical characteristics of Roma and non-Roma psychiatric outpatients in Greece.

OBJECTIVE: Differences in psychiatric symptoms are often reported between minority and majority groups. The aim of this study was to compare Roma psychiatric outpatients who are Greek citizens living in Thrace (Greece) with outpatients belonging to the 'majority Greek group' with respect to socio-demographic characteristics, psychopathological symptoms and psychiatric diagnoses. DESIGN: A sample of 122 Roma and 132 majority Greek patients visiting the Outpatient Psychiatric Clinic at the University General Hospital of Alexandroupolis, Greece, were examined with the Structured Clinical Interview for DSM III-R (SCID-I), the International Personality Disorder Examination (IPDE) and the Derogatis Psychiatric Rating Scale (DPRS). Only those with a psychiatric diagnosis were retained in the analyses. The two groups of patients were compared in relation to their socio-demographic characteristics, their diagnoses and their scores on the DPRS symptom dimensions. RESULTS: In comparison to the majority group, Roma patients were younger, more often women, less educated, married, parents of more children, without social security coverage; The Roma group had higher scores on many DPRS symptom dimensions such as somatisation, hostility, sleep disturbance, phobic anxiety, psychoticism, psychomotor retardation, hysterical behaviour and abjection-disinterest. In addition, Roma women presented psychotic and bipolar disorders less often than the majority group women. Symptoms did not differ by ethnic group for those seeking medical certification. CONCLUSION: Roma patients face serious social problems and show greater levels of symptoms than the majority group. The limitations of this include that the sample was not representative of the general psychiatric patient population and language, as well as other cultural and educational barriers, might have obscured important aspects of the Roma people's psychopathology.

Group psychosocial interventions for adults with schizophrenia and bipolar illness: the evidence base in the light of publications between 1986 and 2006.

AIM: The treatment of major mental disorders usually combines medical and psychosocial interventions. The present study reviews research pertaining to the efficacy of group psychosocial interventions for people with psychotic illness. METHOD: An electronic search was conducted through Medline and PsychINFO to identify articles relevant to group therapy for people with schizophrenia and bipolar affective disorder. Articles published in the English language, between January 1986 and May 2006, were considered. Studies were included if they had a control group and at least 20 participants. The search resulted in 23 articles concerning patients with schizophrenia and five concerning patients with bipolar affective disorder. RESULTS AND CONCLUSION: The therapeutic approach in the majority of the studies was along the lines of cognitive behaviour therapy and psychoeducation. All studies reported improvement in at least one parameter. Most of them report improvement in skills and overall functioning.

[Psychotherapeutic interventions in stereotypies].

Stereotypies belong to the psychomotor disorders and they are found in many different disorders. This article refers to the international literature about the psychotherapeutic interventions in stereotypies and reviews the psychotherapeutic techniques that are already being used for these disorders. This study refers to four kinds of psychotherapeutic treatment: (a) Behavioral therapy, (b) Milieu therapy which can be combined successfully with an occupational therapy, (c) Family therapy and (d) Supportive or cognitive or dynamic psychotherapy. The method used for finding the articles for this review was the web research. The articles found were 44 in total, but only 25 were studied extensively since they were absolutely relative to the subject of this review. 12 of these articles were case studies, 7 theoretical papers and 5 of them were reviews. The last one was a research epidemiological study. According to most of the articles, behavioral therapy is considered to be the most effective psychotherapeutic treatment for attenuating stereotypies and relies on techniques like systematic desensitization, environmental enrichment, positive reinforcement of alternative behaviors and negative reinforcement of the "problematic" behaviors. The milieu therapy, combined with occupational therapy, endeavours to shape an appropriate environment where the patient can recover. Family therapy focuses on fully informing the relatives about the nature of stereotypies. Supportive psychotherapy focuses on the current problems in the patient's life. The cognitive psychotherapy tries to fix the dysfunctional thoughts of the patients. Finally, the dynamic psychotherapy is focused on the restoration or reinforcement of the patient's defensive mechanisms. It should be noted that there is a lack of systematic research in the field of stereotypies in general and, especially, regarding psychotherapeutic interventions.

[Intellectual representations and brain].

The present paper aims at presenting and discussing a naturalistic version of the representational- computational theory of mind (r-c.t.m.). In this paper the term "mind" refers to any complex system whose outputs (behaviours) are characterized by reasonability and intentionality. According to the r-c.t.m., the human brain is a mind continuously creating and containing representations of objects in two forms: image - like and proposition - like representations. Brain representations per se, may be largely distributed functional webs of neurons; each web, as a whole, is either in a state of activation or in a certain degree of readiness for activation. The brain representations are constantly composed from simpler ones, via the recursive engagement of a finite number of programs, either innate or created through learning mechanisms. Concerning proposition - like representations there may be programs that classify the representations of linguistic objects (i.e. words, phrases) into lexical or syntactical categories and combine them according to grammatical patterns. In the present text, some indices (psychological, neuroscientific, from the domain of linguistics and artificial intelligence) are presented that are supportive of the r-c.t.m.; furthermore some weak points of this theory are discussed along with some alternative views concerning the representational activity of the brain.

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.

Prevalence of mental disorders and deliberate self-harm in Greek male prisoners.

The aim of this survey was to determine the prevalence of current and lifetime mental disorder and deliberate self-harm among male prisoners in Greece. The subjects were 80 randomly selected remanded and sentenced prisoners in a Greek prison. They were assessed for mental disorder including suicidality and substance misuse using the Mini International Neuropsychiatric Interview (MINI). We also collected information regarding contact with psychiatric services, previous deliberate self-harm as well as physical health and conducted a brief assessment of their intellectual functioning. Mental disorder was diagnosed in 63 (78.7%) prisoners. The main diagnoses were: anxiety disorder, 30 (37.5%); major depression, 22 (27.5%); antisocial personality disorder, 30 (37.5%); alcohol dependence, 21 (26.3%) and opiate dependence 22 (27.5%) and schizophrenic or bipolar disorder 9 (11.2%). Deliberate self-harm prior to and during imprisonment was reported by 15% and 2.5% of prisoners, respectively, and 12 prisoners (15%) had IQ below 75. This survey identified a significant level of need for specialist mental health services in prison. Further studies are required to assess the specific needs of those patients who are too unwell to remain in prison, the need for specific treatments for substance misuse and improved assessment/treatment of common psychiatric disorders.

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). CONCLUSION: 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.

Sociodemographic and psychological characteristics associated with smoking among Greek medical students.

This study aims to investigate associations between sociodemographic and psychological characteristics and smoking among Greek medical students. The students studied were separated into four groups: non-smokers and occasional, regular and heavy smokers. The students completed a battery of inventories and checklists. Immigrant students, users of other psychoactive substances, students more prone to minor delinquency and students with high scores on activity level, approach to new situations, sociability and novelty seeking showed higher smoking rates. A better understanding of these differences could be useful for the planning of antismoking policy.