[Mental health locus of control in refugees with clinically established psychopathology].

The present study attempts to examine the mental health locus of control (LOC) of refugees with clinically diagnosed psychopathology and to examine the possible association of LOC with the presentation of the psychopathology. LOC refers to the degree to which a person attributes what happens in their life to themselves or to external factors. It draws its theoretical background from Rotter's theory of social learning. External LOC has been linked to psychopathology in anxiety disorders (AD), depression and post-traumatic stress disorder (PTSD), of which migrants are primarily at risk in comparison to the indigenous population. This is a descriptive cross-sectional study. The study involved 40 refugees who were referred to the psychiatric office, by the psychologists of a non-governmental organization, due to clinically established psychopathology. In the first session, the Patient Health Questionnaire-9 (PHQ-9) and the Harvard Trauma Questionnaire-5 (HTQ5) were administered, according to the score of which the psychologists' referral diagnoses were confirmed. To assess the LOC the Multidimensional Health Locus of Control Questionnaire (MHLC) was administered, which measures LOC in self, significant others, and luck. The questionnaires were administered in English, Farsi, and Lingala. We translated the MHLC questionnaire to Lingala for the needs of the present study and the validity of the translation was ensured using back-translation, from English to Lingala and from Lingala back to English by different translators to control the identification of the English texts. Refugees scored lower on self and higher on significant others and chance. Correlations between LOC and the presentation of psychopathology were sought. A negative correlation was found between the severity of depression and the score on self on the MHLC, a finding that has also been demonstrated in other studies. The intensity of depression was positively correlated with the score of MHLC on luck. There was also a positive correlation between the intensity of the symptoms of PTSD and the score of MHLC to luck, in our sample. The present study highlights the Multidimensional Health Locus of Control Questionnaire as a remarkable and useful tool in the assessment of refugees with psychopathology in Greece.

Cognitive changes in health locus of control attributions after behavioral analysis in patients with panic disorder and/or agoraphobia.

Patients with Panic Disorder and / or Agoraphobia (PD +/- Ag) attribute their mental health more to external factors and less to internal, while after behavior treatment (BT) their external attributions decrease and internal attributions increase. We examined whether these cognitive changes observed at the end of BT, begin earlier. Forty patients with PD +/- Ag were assessed on the Multidimensional Health Locus of Control Scale, before and after the diagnostic and psychoeducational sessions that precede the clinical implementation of BT. Decreased health attributions to significant others (t = 4.22, p < 0.01), and an increase trend to self (t = -0.78, p = 0.43) were observed, which are compatible with the active role patients need to adopt in the clinical application of BT.

Differentiation of 2 Obsessive-Compulsive Disorder Subgroups with Regard to Demographic and Phenomenological Characteristics Combining Multiple Correspondence and Latent Class Analysis.

INTRODUCTION: Classic factor analysis of obsessive-compulsive disorder (OCD) dimensions and attempts to identify valid subgroups have not yet produced definitive conclusions. OBJECTIVE AND METHODS: This study aims to examine possible homogeneous subgrouping of demographic and phenomenological characteristics in 134 treatment-seeking OCD patients. A combination of multiple correspondence analysis (MCA) and latent class analysis (LCA) was used. RESULTS: MCA showed 2 distinct subgroups of OCD patients and LCA confirmed this result by a two-class solution. Both analyses demonstrated (a) a clear subgroup of female patients with washing compulsions, obsessions related to contamination, and late age of onset and (b) a subgroup comprised mostly of male patients with earlier onset of OCD, checking rituals, and doubts or aggressive obsessions. Mental, ordering, hoarding compulsions, religious, or sexual obsessions and images appeared exclusively in this subgroup. CONCLUSIONS: Using 2 different analytic methods, we confirmed at least 2 subgroups in a clinical sample of Greek OCD patients. Future research combining dimensional and latent approaches could facilitate our understanding of the heterogeneous phenotype of OCD.

Manualized single-session behavior treatment with self-help manual for panic disorder with or without agoraphobia.

Objective: We examined the clinical feasibility and utility of a single behavior treatment session, with 11 patients with Panic Disorder with or without Agoraphobia (PD+/-AG). Patients used an individualized, exposure based, homework manual, derived from their behavioral analysis. Treatment was implemented in an outpatient behavior treatment unit. Method: Patients presented with moderate to severe anxiety, avoidance behavior, functional impairment and depressive symptoms. Treatment was evaluated with a double-baseline case series/pre-post design with four follow-ups. Results: There was a significant and steady improvement in all self-rated outcome measures and participants were satisfied with the services provided. Nine out of 11 patients (82%) were free of PD+/-AG at 3 months and all patients at 1-year follow-up. The absence of a control group, the small sample and lack of blind assessments, limit the validity of the study. Conclusions: These case studies provide empirical evidence in support of both the feasibility and utility of a single-session behavior treatment (SSBT) plus self-help implemented in a public mental health unit. Further research with a control group is needed to assess the efficacy of the intervention in routine clinical practice.

Treatment engagement in the early phase of cognitive-behavior therapy for panic disorder: A grounded theory analysis of patient experience.

Exposure-based cognitive-behavior therapy (EBCBT) is the treatment of choice for panic disorder (PD). However, little is known about early treatment processes that facilitate retention in treatment and positive outcomes of PD treatment. We studied the development of early treatment process with semi-structured individual in-depth interviews with 12 patients with PD, conducted post session 3. Grounded theory was used to analyze the transcripts. The development of early treatment process was captured by four thematic categories: approaching the problem, easing in and opening up, building trust and bonding, and making sense of panic. The developmental scheme culminated to the core category: Jointly Engaging in PD Therapy versus Awaiting Relief, capturing early engagement or disengagement from PD therapy respectively. The emergent core category was cross-validated against distal treatment outcome. Emergent processes can be replicated and incorporated in early treatment procedures of EBCBT for PD. Clinical practice recommendations are discussed.

Earthquake-related psychological distress and associated factors 4 years after the Parnitha earthquake in Greece.

Exposure to earthquakes has been associated with psychological distress and in particular the development of post-traumatic stress disorder (PTSD). Earthquake-related psychological distress can be longstanding. The present study involved 157 Greek survivors of the 1999 Parnitha earthquake assessed approximately 4 years after the earthquake. Assessments were based on the Traumatic Stress Symptom Checklist (TSSC). Using stringent calibrations for the estimation of symptom presence 25% of the survivors endorsed at least 5 and 12% at least 10 TSSC symptoms. Approximately 22% of the survivors reported subjective distress and 15% impaired adjustment due to their symptoms. Intensity of fear during the earthquake and participation in rescue operations related to greater post-earthquake psychological distress. The results suggest that the psychological consequences of earthquakes can be serious and long-standing even when the magnitude of the earthquake is moderate. Psychological treatments that have been proven to reduce fear and PTSD symptoms need to be made available to the survivors. Such treatments may also increase the survivors' psychological preparedness and emotional resilience in view of future earthquakes.