A pilot study of resilience and severity of depressive symptoms in patients with psoriasis.

Background: Patients with psoriasis show an increased prevalence of depressive symptoms that worsen disease outcomes. This study investigated the effect of resilience and other sociodemographic/clinical variables on depressive symptoms' severity in patients with psoriasis. Methods: This study included 58 psoriasis patients consecutively enrolled during the 14 months of the study. We evaluated psoriasis severity using the Psoriasis Area and Severity Index, Body Surface Area, and Physician Global Assessment. The psychometric assessment included the Resilience Scale and the Beck Depression Inventory-II (BDI-II). We divided participants into two subgroups based on the optimal BDI-II cut-off score (Group A: BDI-II ≤17; Group B: BDI-II >17). A stepwise regression analysis explored whether the variation in the BDI-II score could be predicted by a linear combination of sociodemographic and clinical variables. Results: Psoriasis patients with more severe depressive symptoms (Group B patients) showed lower resilience levels than Group A patients (p <0.001). Moreover, depressive symptoms correlated only with resilience levels (p <0.001), with a negative correlation. The stepwise regression analysis revealed that resilience explained 37.1 % of the variance in BDI-II scores, whereas resilience, gender, and comorbidity with other physical illnesses combined explained 51.3 % of the variance. Conclusion: Resilience may alleviate depressive symptoms in psoriasis patients. This study underscores the importance of resilience-building interventions for these patients. HIPPOKRATIA 2022, 26 (4):131-137.

Gastrostomy as a Preemptive Measure after Pancreatoduodenectomy against Delayed Gastric Emptying: A Small Case Series and a Review of the Literature.

Delayed gastric emptying (DGE) is a common (20-30%) postoperative complication following pancreatoduodenectomy (PD) (Parmar et al., 2013). Various causes and preemptive measures have been suggested to decrease the occurrence of DGE. We added a simple step in the procedure of 26 consecutive pancreatic head resections, which seems to alleviate DGE and has never been highlighted before.

The Jamaican Haemophilia Registry: Describing the burden of disease.

INTRODUCTION: Jamaica has an estimated 200 persons with haemophilia (PWH), who face significant constraints in access to specialized haemophilia care, including access to clotting factor concentrates. AIM: The aim of this paper is to establish the current burden of disease in PWH in Jamaica. METHODS: PWH were enrolled through the University Hospital of the West Indies, Jamaica. The impact of haemophilia was assessed using a comprehensive battery of heath outcome measures that included the following: laboratory, clinical information and validated outcome measures of joint structure and function, activity, and health-related quality of life (HRQoL) to provide a health profile of the Jamaican haemophilia population. RESULTS: In all, 45 PWH were registered (mean age: 29, range: 0.17-69 years), including 13 children (<18 years of age) and 32 adults. In this sample, 41 had haemophilia A (30 severe) and 4 had haemophilia B (3 severe); 10 patients with haemophilia A were inhibitor positive. The results indicate that adults with haemophilia in Jamaica have significant joint damage: mean Haemophilia Joint Health Score (HJHS) = 42.1 (SD = 17.3); moderate activity levels - mean Haemophilia Activities List (HAL) score = 64.8 (SD = 17.8); and low HRQoL scores - mean Haemo-QoL-A score = 62.3 (SD = 19.4). Results for children are also reported but should be interpreted with caution due to the small sample size. CONCLUSIONS: There is a very high burden of disease in PWH in Jamaica. The health profiles reported in this paper are an essential first step in advocating for a multidisciplinary Comprehensive Care Program for assessment and care of PWH in Jamaica.

Internet addiction and psychopathology in a community before and during an economic crisis.

Background. Internet addiction disorder (IAD) is a novel concept under scrutiny for a definite inclusion in the psychiatric taxonomy, after showing correlations with overt expressions of psychopathology. This study aims to assist the scientific dialogue concerning IAD while presenting comparative data on adolescent psychopathology before and during a major economic crisis that has affected Greece from 2010 onwards. Methods. This is a cross-sectional study of a high school student population, aged 12-18, on IAD which follows-up a 2006 survey, and is carried out 5 years later at the same school classes. A comparison on psychopathological symptoms between the two samples is carried out to confirm any underlying correlations with IAD while providing some first insight on any effects of the economic crisis on adolescent psyche. Results. Results indicate that Internet addiction is increased in this population paralleling the increase in Internet availability at home. Adolescents affected with IAD present with more psychopathological symptoms. A comparison between the 2006 and 2011 samples reveals lower rates of general psychopathology but similar burden of reported symptoms. Conclusions. Those findings are discussed in the framework of adolescent coping to adversity, individual reactions to major crises, as well as the general debate regarding the value of IAD as a distinct diagnosis. The effects of the economic crisis may have triggered an adaptive response in the adolescent population although IAD as a distinct nosological entity is clearly linked to more symptoms of overt psychopathology. Directions are offered for further research in countries affected by crises.

[The Life Style Index: correlations with psychological distress and hostility].

The Life Style Index (LSI) was designed to assess defense mechanisms, assuming that their use is related to specific emotional states and diagnostic concepts. Aiming to further investigate the psychometric properties of the Greek version of the LSI, the aim of the present study was to investigate the relationship of specific defense mechanisms with dimensions of psychological distress and hostility features in three different populations. The sample comprised 1261 adults (410 healthy participants, 723 medical patients and 128 psychiatric patients). Along with defense mechanisms (LSI), Psychological Distress (General Health Questionnaire, GHQ-28) and Hostility features (Hostility and Direction of Hostility Questionnaire, HDHQ) were also assessed. The results showed that increased psychological distress is related with increased use of all defenses except Denial, with which psychological distress is negatively associated. Regression is constantly related with psychological distress and differentiates psychiatric patients from the other groups of participants, while Compensation and Reaction Formation are related to depressive symptomatology. In medical patients, Repression was found to increase the physical dimension of psychological distress and the social dysfunction. On the contrary,Denial was negatively associated with these dimensions of psychological distress. In the psychiatric patient and healthy participant samples, Projection plays the most detrimental role. Regarding hostility and direction of hostility, those who were found to introvert their hostility presented with higher scores in Denial, indicating that they possibly 'deny' their hostility, and the degree of the Denial was found to be negatively associated with the degree of Introverted Hostility. Those who directed their hostility towards the others, presented with higher rates of Projection, while neither Denial nor Reaction Formation seemed sufficient enough to temper the degree of Extroverted Hostility. In conclusion,the present results strengthen further the validity of the Greek version of the LSI and provide additional evidence about the relation of defence mechanisms with dimensions of psychological distress and the direction of hostility in different populations, indicating that the empirical assessment of defense mechanisms can contribute significantly in the study of the factors that mediate or moderate the course or the outcome of medical or psychiatric disorders.

The changing face of hepatitis in boys with haemophilia associated with increased prevalence of obesity.

Hepatitis in children with haemophilia was historically most often associated with transfusion-transmitted infections. However, with the use of recombinant clotting factor concentrates, acquisition of such infections has now become rare. We studied the profile of hepatitis in North-American children with haemophilia in the modern era of safe blood products and excess childhood obesity. A total of 173 boys (<18 years) registered in the Pediatric Comprehensive Care Haemophilia Program were included in this retrospective study. Hospital records were reviewed for baseline data, serial height and weight measurements and serial alanine aminotransferase (ALT) levels. A body mass index (BMI) ranking was available for 170 boys, of whom 25 (14.7%, 95% CI 9.7-20.9%) were obese. The rate of obesity was higher in severe haemophilic boys. Compared with the general childhood population, the rate of obesity trended towards being higher in young haemophilic boys (2-5 years), but was similar in other age groups. A persistently high ALT (≥80 U L(-1) ) was documented in 5 boys and was associated with obesity. Three boys had clinical and imaging studies compatible with non-alcoholic fatty liver disease (NAFLD). Overweight and obesity are common among haemophilic boys, especially those who are younger and with severe disease. In this large group of haemophilic boys, chronic viral hepatitis was rare and NAFLD was a more common cause of liver disease. Overweight and obese haemophilic boys should be evaluated for NAFLD and interventional programmes should be designed to reduce the potential complications associated with obesity.

Insomnia symptoms among Greek adolescent students with excessive computer use.

BACKGROUND: The aim of the present study is to assess the intensity of computer use and insomnia epidemiology among Greek adolescents, to examine any possible age and gender differences and to investigate whether excessive computer use is a risk factor for developing insomnia symptoms. PATIENTS AND METHODS: Cross-sectional study of a stratified sample of 2195 high school students. Demographic data were recorded and two specific questionnaires were used, the Adolescent Computer Addiction Test (ACAT) and the Athens Insomnia Scale (AIS). RESULTS: Females scored higher than males on insomnia complaints but lower on computer use and addiction. A dosemediated effect of computer use on insomnia complaints was recorded. Computer use had a larger effect size than sex on insomnia complaints. Duration of computer use was longer for those adolescents classified as suffering from insomnia compared to those who were not. CONCLUSIONS: Computer use can be a significant cause of insomnia complaints in an adolescent population regardless of whether the individual is classified as addicted or not.

[Validation of adolescent computer addiction test in a greek sample].

The goal of this study is the validation of a reliable research tool for diagnosing computer addiction in adolescents and the description of its particular psychometric properties. 482 students in the city of Trikala, which is Greece's leading city in Internet provision, and 907 students of the city of Larisa took part in this study which was run during the first trimester of 2006. The samples were obtained through randomized stratified sampling for their respective cities. Those students who reported using a personal computer at the time filled in the ACAT (Adolescent Computer Addiction Test), which was modeled after the 20-question Internet Addiction Test. The psychometric tests applied included test-retest reliability, internal consistency and construct validity. Factor analysis revealed four factors which account for 59.15% of total variability of the scale. The ACAT scale was proven to hold excellent test-retest reliability, internal consistency and construct validity. The important role of timely education in new technologies is pointed out. This study is a first attempt in creating and applying a reliable tool in the evaluation of adolescent addiction to personal computers in Greece.

Intracranial bleeding in haemophilia beyond the neonatal period--the role of CT imaging in suspected intracranial bleeding.

We conducted a review of a single institutional experience of patients with haemophilia presenting with suspected intracranial haemorrhage (ICH) who underwent computed tomographic (CT) neuro-imaging. We found that over a 9-year period (1996-2004) 43 patients with haemophilia presented 73 times with suspected ICH: 10 presented multiple times (range: 2-9 times). The median age at presentation was 3.5 years (range: 0.5-17). Preceding trauma occurred in most (62/73; 85%) episodes. ICH was confirmed in 11 of the 73 (16%) episodes in eight patients. Patients with severe haemophilia accounted for a disproportionate number of episodes of suspected (60/73; 82%) and of confirmed ICH (10/11; 91%). All ICH occurred in patients not on prophylaxis; five occurred in three inhibitor-positive patients. Altered consciousness at presentation was present in 10/11 (91%) cases of confirmed ICH but only in 5/62 (8%) (ICH-negative) episodes. The positive and negative predictive values of altered consciousness to predict/rule out an ICH was 67% and 98%, respectively. The following were associated with an increased risk of presenting with suspected ICH and of having a confirmed ICH: (i) having severe haemophilia; (ii) not being on prophylaxis; (iii) having an inhibitor; and (iv) presenting with an altered level of consciousness. Patients without any of these features may not need to undergo CT imaging when presenting with suspected ICH. Ideally a prospective study to evaluate this hypothesis should be conducted.