Internal structure and psychometric properties of Diabetes Distress Scale for Type 1 Diabetes.

Diabetes-related distress (DD) refers to the worries and concerns about the nature and complications of Type 1 diabetes (T1D) and the frustration with the burdens of its management. Research suggests that sources of DD among people with T1D differ from those among Type 2. Many adults with T1D experience difficulties that are often unrecognised, unaddressed and mismanaged. The Diabetes Distress Scale for Type 1 diabetes (T1-DDS), is a newly developed instrument that is used to identify the specific sources of DD, exclusively for adults with T1D. The aim of the study was to examine the factorial structure of T1-DDS in Greek population and to evaluate its psychometric properties for use in research and clinical practice. A sample of 102 adults with type 1 diabetes, aged 38.85 (±10.08) years, females 63%, BMI 21.45 (±5.84) kg/m2, diabetes duration 21.35 (±13.73) years, HbA1c 7.5% (±1.2;58 mmol/mol) completed the translated T1-DDS. Exploratory factor analysis (EFA) and confirmatory (CFA) factor analysis were used to investigate the factor structure of the scale. Reliability was explored by internal consistency. Convergent validity was assessed through correlations with measures of psychological distress and diabetes status variables. Differential validity was assessed on the basis of known-group comparisons, with expected differences in distress for gender and age. Confirmatory factor analysis provided a low fit for the 7-factor model. Exploratory factor analysis supported a conceptually justifiable 5-factor model in the Greek sample. Internal consistencies of all five factors ranged from α=0.76 to 0.89. As expected, all factors were correlated with psychological distress [(r=0.510, p<0.01) for the total scale]. Management distress was positively correlated with HbA1c (r=0.397, p<0.01) and BMI (r=0.296, p<0.01), and Family/Friends distress was negatively correlated with duration of diabetes (r=-0.298, p<0.01). Further analyses showed that men exhibited higher score in relations to the social context of diabetes management (t=2.164, p<0.05 for Negative Social Perceptions), (t=2.572, p<0.05 for Family/Friends distress), and younger participants reported significantly higher distress in relation to reactions from friends and family (t=2.106, p<0.05). The Greek version of T1-DDS is a valid and reliable measure of diabetes-related distress that can be used in clinical practice to address personal needs and direct targeted interventions.

Psychometric properties and factor structure of the Greek version of Reflective Functioning Questionnaire.

The ability to mentalize, namely to understand, interpret and effectively communicate the mental state of self and others is considered important in self-organisation and affect regulation. The aim of the present study was to provide data on the validation process of Reflective Functioning Questionnaire (RFQ), a recently developed measure of mentalizing, in order to evaluate its use in research and in clinical practice for Greek populations. A total of 219 participants (102 people with type 1 diabetes and 117 healthy individuals) completed the RFQ. A principal component analysis supported the 2-factor model (RF certainty for mental states and RF uncertainty for mental states) in both samples. Internal consistencies of both subscales were satisfactory (α=0.80 for RF certainty and α=0.79 for RF uncertainty). Relationships with validity measures of psychological distress, empathy and emotional intelligence provided further support for the psychometric properties of the scale. As expected, there were positive associations between the degree of certainty concerning mental states and emotional intelligence (r=0.390, p<0.01), as well as empathy (r=0.292, p<0.01) in general population. Conversely, negative associations were found between the degree of certainty about mental states and psychological distress in the diabetes group (r=-0.470, p<0.01) and in general population (r=0.320, p<0.01). A reverse pattern of associations was observed between the degree of uncertainty about mental states and emotional intelligence (r=-0.265, p<0.01) in general population, as well as psychological distress in both the diabetes group (r=0.590, p<0.01) and in general population (r=0.330, p<0.01). Also, as expected, there were differences across age groups, with older participants reporting a more balanced reflective functioning - with higher certainty levels in the diabetes group (t=-2.133, p>0.05) and the healthy participants (t=-2.738, p>0.05) and lower uncertainty levels in the diabetes group (t=-2.480, p>0.05) and the healthy participants (t=-2.779, p>0.05). The data collected so far support the reliability and validity of the measure that can be used in research to address mentalizing impairments. However, further research is needed to evaluate its consistency thought time with a test-retest analysis, and to evidence its factorial structure with a confirmatory factor analysis. In addition, it is of primary importance to extend the validity testing of RFQ in clinical populations to further support its use in clinical practice.

Prevalence of women's worries, anxiety, and depression during pregnancy in a public hospital setting in Greece.

Many studies have examined the prevalence and risk factors of postnatal depression. However, only a few studies have explored the prevalence of anxiety and depressive symptoms in pregnancy. The aim of this study was to investigate the prevalence of worries, antenatal anxiety (AA), and antenatal depression (AD). The sample of this study consisted of 163 pregnant women with gestational age from 11 to 26 weeks. Worries were measured with Cambridge Worry Scale (CWS), anxiety was measured with State-Trait Anxiety Inventory (STAI), and depression was measured with Center for Epidemiologic Studies-Depression scale (CES-D). Depressive symptoms were found in 32.7% of the participants and 44.4% had STAI scores indicating anxiety symptoms of clinical significance. The mean score for total CWS was 26 (SD = 12.3). It is noteworthy that the most important worries in the study sample were "the possibility of something going wrong with the baby", "giving birth", and "financial problems". The prevalence of antenatal anxiety and depression identified in this study is of concern. Screening for antenatal anxiety and depressive symptoms with validated instruments is crucial.

Sexual delusion in a case of vaginal aplasia after surgical operation for neovagina.

The Mayer-Rokitansky-Kuster-Hauser (MRKH) is a syndrome of unknown etiology characterized by congenital aplasia of the uterus and the upper part (2/3) of the vagina in women showing normal development of secondary sexual characteristics. We report the case of a patient with vaginal aplasia and schizophrenia presenting with sexual delusion. To the authors' knowledge this is the first case to provide evidence of coexistence between MRKH and sexual delusion in a schizophrenic patient. The core of the patient's delirium was that she was having sexual intercourse with an eminent person through the big toe of her right foot. We approached this case using a neurological and a psychodynamic hypothesis. The neurological hypothesis suggests that the "deactivation" of the patient's genitalia led to an expansion of the adjacent big toe cortical area. The psychodynamic hypothesis supports that the sexual function and pleasure was partially expelled from the body image and was stored in a non sexual part of the body (i.e., big toe). Clinicians should be aware of this association and offer patients with MRKH psychological or/and psychiatric evaluation.

Psychometric properties and factor structure of the Fertility Problem Inventory in a sample of infertile women undergoing fertility treatment.

OBJECTIVE: to examine the psychometric properties of the Fertility Problem Inventory (FPI) originally developed by Newton et al. (1999); as there are no data concerning the factorial structure of the FPI, a special focus is placed on construct validity through factor analysis. SETTING: public hospital in Athens, Greece. DESIGN: a cross-sectional study. PARTICIPANTS: 108 women undergoing fertility treatment with in-vitro fertilisation. METHODS: the FPI was 'forward-backward' translated from English to Greek. The translated instrument was then administered to a set of infertile women for pilot testing. Principal axis factoring with promax rotation was used to test the factor structure of the FPI. Measures of anxiety State Trait Anxiety Inventory, depression (Center for Epidemiologic Studies--Depression Scale) and mood states Profile of Mood States were used to assess the convergent validity of the FPI. Cronbach's α was used to measure internal consistency of the FPI scales. FINDINGS: exploratory factor analysis suggested four factors. The majority of relationship and sexual concern items grouped into one solid factor, named 'spousal concern'. The original scales of social concern, need for parenthood and rejection of childfree lifestyle were reproduced after rearranging nine cross-loading items. Construct validity was confirmed by computing correlations between the derived FPI scales and conceptually similar constructions of anxiety, depression and mood states. Internal consistency reliability was satisfactory. CONCLUSION: the FPI was found to have a relatively stable factor structure and satisfactory reliability, and convergent and discriminant validity. The FPI may enable researchers and clinicians to apply a reliable measure that focuses on various/many dimensions of infertility-related stress.

What kind of care and support do infertile women undergoing fertility treatment in Greece expect? A questionnaire survey.

The aim of this study was to identify infertile women's expectations and perceived importance of professional psychosocial services and to identify the predictors of their expectations. The study included 404 infertile women. Most women sought more medical information and more emotional support than what was offered, mainly by the hospital staff. Less than half the women rated psychosocial services as important. The main predictors of the importance of ratings were high fertility-related stress, low provision of social support, low social class and male infertility factor. A provision for information regarding the medical and psychosocial aspects of infertility should be included in routine care in fertility clinics. Although it seems possible to meet the emotional and psychosocial needs of less distressed women through information and support, it is necessary to offer professional psychosocial services to more distressed women.

Alexithymia is positively associated with the outcome of in vitro fertilization (IVF) treatment.

The goal was to examine prospectively the relation of psychological factors to the outcome after in vitro fertilization (IVF) in a sample of Greek women. Previous studies investigating the relation of IVF outcome to anxiety and depression have yielded contradictory results; other psychological dimensions have not been studied. 81 women who followed an IVF program during a 6-mo. period were prospectively evaluated. Demographic and gynecological data were assessed and women completed questionnaires measuring anxiety, depression, narcissistic traits, over-dependency, self-esteem, hostility, and alexithymia. Multiple logistic regression analysis showed that successful IVF outcome correlated with more alexithymic characteristics and younger age. Correlation between alexithymia and successful IVF outcome is demonstrated. This might be explained by the "operational" nature of IVF techniques, to which alexithymic individuals would respond better.

On the therapist's reverie and containing function.

Containment and interpretation are two inseparable aspects of the psychoanalytic technique. This is better understood by Bion's clinical metaphors of "container-contained" relationship and the capacity for reverie. Bion, continuing and expanding Klein's concept of projective identification, has transposed this from what happens to an infant to what happens in the link between mother and infant; until now he laid emphasis on the mother's (or therapist's) ability to contain the primitive anxieties which the infant (or the patient) experiences. He described three types of links--love, hate, and knowledge-- and proposed two metaphors which laid the foundation of a new and efficient frame of reference of the analytic process and technique, namely, the container-contained relationship and the reverie. Two clinical vignettes will illustrate the pivotal function of the therapist's reverie within the therapist-patient interaction. In the first case, a dead (internal) object of the patient was contained in the context of the session, enabling the patient to contain and sustain the psychic pain and her self-destructive tendencies; the second case stresses how the therapist's reverie, during a silence, revealed a bad part of the patient's self, which was lost through projective identification.

The efficacy of a psychiatric halfway house: a study of hospital recidivism and global outcome measure.

The authors investigated the post-halfway house outcome of a sample of 41 former residents of the halfway house of the Department of Psychiatry, Athens University. Two criteria were used: hospital recidivism and global ratings of outcome (which was assessed on the basis of three parameters: rehospitalization, employment and independent living). Mean duration from the time of departure was 32 months (range: 8-52 months). Within this period good outcome and non-recidivism were related with compliance to pharmacotherapy. Most recidivists also had a shorter stay in the halfway house and cases with successful outcome tended to be evaluated higher on the "Behaviour in Halfway House Scale" at the end of the residency.

An investigation of hostile and alexithymic characteristics in breast cancer patients.

Two measures of personality characteristics, the Personality Deviance Scale and the Toronto Alexithymia Scale, were administered to a total sample of 448 women and a subsample of 100 women, respectively, attending two breast-screening centers in Athens. The relative risk of breast cancer between women with low denigratory attitudes towards others and women with high scores in this scale was 2.31. Statistically significant relations were not noted between the mean scores of alexithymia factors and breast cancer diagnosis. Our findings point to the conclusion that breast cancer patients can be distinguished from healthy women on the basis of their cognitive activity, characterized by rare denigratory thoughts.

Study of the patients' difficulties in ending brief psychoanalytic psychotherapy.

Brief psychotherapy implies a limitation of the time needed, which should meet both the patient's acceptance and the therapist's awareness. However, some patients have difficulties in ending therapy. The material of this study consists of 27 patients. Of these patients, 5 dropped out in the termination phase, while for another 8 it became apparent a little before or after the final phase that psychotherapy would have to be continued. The results of the statistical analysis--factor analysis and analysis of variance for the investigation of therapists' difficulties, and discriminant analysis to assess differences concerning the suitability of patients for brief psychotherapy--showed that: (1) the less a therapist feels self-confident, the more likely his/her patient is to break off therapy at the termination point, and (2) the suitability score, determined during evaluation, emerges as the main differentiating parameter of the three groups (dropouts, continuers, completers).

Attempted suicide by jumping: clinical and social features.

A group of 46 persons who had attempted suicide by jumping was compared on clinical and social-demographic parameters with another group of 214 persons who had attempted suicide by drug overdose. The differential characteristics of persons attempting suicide by jumping are the following: more often men, of a more advanced age, married or widowed, more often suffering from major psychopathology (that is affective psychosis-depressive type or schizophrenia), and quite frequently having a serious somatic illness.

Multiple neuroendocrinological responses in borderline personality disorder patients.

Male patients suffering from borderline personality disorder (n = 13), major depression (n = 13) or schizophrenia (n = 13) were investigated on several psychopathological (HDRS, BPRS) and neuroendocrinological (DST and TSH, PRL, GH responses to TRH) parameters. Comparisons were made between the borderline group and the other groups of patients. Borderline patients differed from schizophrenics psychopathologically (BPRS) and neuroendocrinologically (DST). Also, borderline patients differed from major depressives in the HDRS, but behaved like them concerning DST. Our findings support the hypothesis that there are neuroendocrinological similarities between borderline personality disorder and major depressive patients, especially on the hypothalamo-pituitary-adrenal axis.

Social and resource factors related to the utilization of emergency psychiatric services in the Athens area.

Emergency Psychiatric Service of the Department of Psychiatry at the University of Athens is the only referral service for the emergency psychiatric cases coming from the Athens greater area. During 1981 2,169 patients used the Service. The relations of socio-demographic and resource factors of the 26 districts of the greater area of Athens to a Standardized Psychiatric Emergencies Index (S.P.E.I.) are investigated in the study. Unemployment, education, profession, distance from the service, psychiatric coverage and involuntary incoming were considered as independent variables and S.P.E.I. for 1981 as a dependent variable. Multiple regression analysis showed that the only factor significantly correlated with the emergency use of the psychiatric service is the distance from the Facility.

Countertransference responses in short-term dynamic psychotherapy.

The concept of countertransference is used in a broader sense (Heimann, Kernberg) or a more restricted one (Reich, Dewald) in the psychoanalytic literature. All authors generally agree that it is of great importance 'to have countertransference under conscious awareness and control' (Singer and Luborsky). Our study stresses the importance of the countertransference phenomenon in the context of short-term dynamic psychotherapy (STDP). Three clinical examples were selected to illustrate only the specific issues of this study. Psychotherapies were carried out in the Psychotherapy Unit of the Psychiatric Clinic, Athens University. Therapists were residents in psychiatry and were supervised by psychiatrists with a formal psychoanalytic training and experience. Taking into account the therapeutic processes, three kinds of countertransference responses were discerned: (a) those connected with the patient's transference pattern; (b) those linked with the therapist's character structure, and (c) those manifested in specific stages of STDP, especially during the termination phase.

Early dropouts in brief dynamic psychotherapy.

Brief dynamic psychotherapy at the Psychiatric Clinic of Athens University follows the approach of Malan and Sifneos and the selection criteria proposed by Davanloo. The early dropout phenomenon was studied in 24 therapies, in relation to variables included in the selection criteria. The statistical analysis was based on discriminant analysis. A high final score, early transference confrontation, circumscribed problem of the patient, high motivation for treatment and existence of crisis were strongly associated with continuation of brief psychotherapy.

Dysthymic distress and hostile personality characteristics in Greek student nurses: a comparative study.

A comparative evaluation of anxiety, depression and personality deviances of student nurses was attempted, using Foulds' 'Scale of anxiety and depression and personality deviance' on Greek student nurses and on controls from other schools. It was found that: Greek student nurses scored higher in depression than student teachers and the Greek women sample, Greek student nurses scored higher in intropunitiveness than the Greek women sample, but there was no difference between student nurses and the control groups in all the personality deviances, and The younger the students, the higher their scores in anxiety and depression. Our findings support the hypothesis that dysthymic distress in Greek student nurses is associated with stresses of their training.