Correlation between depression, anxiety, and polymorphonuclear cells' resilience in ulcerative colitis: the mediating role of heat shock protein 70.

BACKGROUND: To investigate whether anxiety and depression levels are associated with Heat Shock Protein 70 (HSP70) induction in the colon of patients with ulcerative colitis (UC). METHODS: The design was cross-sectional. Clinical activity was assessed by the Rachmilewitz Index (CAI). Three psychometric questionnaires were used: Zung Depression Rating Scale (ZDRS), Spielberg State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS). Colon biopsies were obtained from each affected anatomical site. Severity of inflammation was assessed by eosin/hematoxylin. Constitutive (HSP70c) and inducible (HSP70i) HSP70 expression were immunohistochemically studied. RESULTS: 29 UC patients were enrolled (69% men). Mean age was 46.5 years (SD: 19.5). Inflammation severity was moderate in 17 patients, severe in 6, and mild in 6. The mean number of years since diagnosis was 7.9 (SD: 6.5). The mean CAI was 6.4 (SD: 3.1). In active UC, there was downregulation of HSP70c in inflamed epithelium, without significant HSP70 induction. In 22/29 cases of active cryptitis, polymorphonuclear cells (PMN) clearly expressed HSP70i, with weak, focal positivity in the other 7 cases. Except for the hospital anxiety scale, scores in all psychometric tools were higher in patients with strong HSP70i immunoreactivity in the PMN. Logistic regression showed a strong positive relationship between HSP70i immunoreactivity in the PMN cells and scores in the trait anxiety, ZDRS, and hospital depression scales, (Odds ratios 1.3, 1.3, and 1.5; P = 0.018, 0.023, and 0.038; Wald test, 5.6, 5.2, and 4.3 respectively) and a weaker but significant positive correlation with the CAI (Odds ratio 1.654; P = 0.049; Wald test 3.858). CONCLUSION: HSP70 is induced in PMN cells of UC patients and its induction correlates with depression and anxiety levels.

[The effects of carotid revascularization on mood symptoms and quality of life in patients with high - grade carotid stenosis].

Carotid occlusive disease has been related to ischaemic strokes and cerebral hypoperfusion, thus affecting patients' quality of life, mainly because of cognitive decline and depressive symptoms. Carotid revascularization techniques [carotid endarterectomy (CEA) and carotid artery stenting (CAS)] may, postoperatively, have a positive impact on patients' quality of life and mental condition, though there have been also presented elusive findings and controversial results. The aim of the present study is to evaluate the effect of carotid revascularization (CEA, CAS) on patients' psychological condition and quality of life through a baseline and follow-up examination. We present data of a group of 35 patients (age range:60-80 years, ΜA=70,26-SD=9,05) with severe, left or right, carotid artery stenosis (>75%), presented with or without symptoms, who underwent surgical treatment with CEA or CAS. Baseline and follow-up (6 months post-surgery) evaluation was conducted in order to assess patients' depressive symptoms and quality of life, through completion of the Beck Depression Inventory and WHOQOL-BREF Inventory, respectively. No statistically significant (p < 0,05) effect of the revascularization process on mood or quality of life assessment could be documented for our patients, regardless of the applied technique (CAS or CEA). Our study supports existing evidence that all of the traditional vascular risk factors represent active participants in the inflammatory process, which has also been implicated in the pathophysiology of depression as well as in pathogenesis of atherosclerotic processes. Thus we have to illuminate new links between the two nosological entities, in the crossroads of psychiatry, neurology and angiology, through the pathways of inflammatory reactions and endothelium dysfunctions. Even though the effects of carotid revascularization on patient's mood and quality of life, are often characterized by opposing results, pathophysiological processes of "vascular depression" and "post stroke depression" remain a promising interdisciplinary medical domain, sharing both scientific and clinical interests between the fields of neurosciences and vascular medicine. Our results, regarding the bilateral connection of depression and carotid artery disease, advocate a most probable causality link between atherosclerotic process and depressive symptoms, rather than justifying a direct association between depressive disorders and carotid stenosis and inferred cerebral blood flow reduction per se.

Psychopathological Determinants of Quality of Life in People with Borderline Personality Disorder.

BACKGROUND: Subjective quality of life (SQOL) in people with borderline personality disorder (BPD) is a marker of disease burden; a crucial treatment outcome; an indicator of psychosocial functioning; and a measure of interventions' effectiveness. Given the dearth of consolidated data, the current study examined psychopathological determinants of global and domain-specific SQOL in people with BPD. METHODS: Hierarchical regression models were employed to examine in BPD patients (n = 150) the relationships of the number of BPD diagnostic criteria; the co-occurrence of other personality disorders (PDs); depression; state and trait anxiety; suicidality; self-harming; alcohol and substance use disorders with SQOL indices, namely physical health, psychological health, social relationships, environment, overall QOL and overall health. SQOL was estimated using the WHOQOL-BREF instrument. RESULTS: Co-existing symptomatology such as depression, state and trait anxiety, and personality pathology, namely the co-occurrence of other PDs, exhibited significant associations with global and domain-specific SQOL, albeit depression was the strongest determinant of the most SQOL domains. In contrast, the number of BPD diagnostic criteria and central illness features such as suicidality, self-harming behaviour, and impulsivity manifested through alcohol and substance use did not exhibit significant associations with any SQOL dimension. CONCLUSIONS: Comprehensive assessment of depressive symptoms should be regularly implemented in BPD services to facilitate early detection and treatment, thereby ensuring patients' SQOL. Accordingly, tackling anxiety and other PDs co-occurrence through appropriate interventions can facilitate more effectively SQOL improvement. Our findings can be explained by the hypothesis that co-existing psychopathology such as depression, anxiety and co-occurrence of other PDs in BPD patients represent illness severity indices rather than comorbid disorders, and might fully mediate the effect of BPD traits on SQOL. Future mediation analysis is required to elucidate this hypothesis.

Education in mental health promotion and its impact on the participants' attitudes and perceived mental health.

BACKGROUND: Although the promotion of mental health (MHP) through education and training is widely accepted, there is scarce evidence for its effectiveness in the literature from outcome studies worldwide. The present study aimed to assess the effect of a three-semester MHP educational program on the recipients' opinions towards mental illness and on their own self-assessed health. METHODS: Respondents were 78 attendees who completed the assessment battery at the first (baseline) and the last session (end) of the training course. They were primary care physicians or other professionals, or key community agents, working in the greater Athens area. The course consisted of 44 sessions (4 h each), over a 3-semester period, focusing on the principles and methods of mental health promotion, the main aspects of major psychiatric disorders, and on relevant to health skills. Assessment instruments included the Opinion about Mental Illness (OMI) scale and the General Health Questionnaire (GHQ-28). RESULTS: The mean scores of three OMI factors, that is, social discrimination, social restriction and social integration, and the two GHQ-28 subscales, that is, anxiety/insomnia and social dysfunction, were significantly improved by the end of the training course. CONCLUSIONS: The results of this study provide evidence, with limitations, for the short-term effectiveness of the implemented educational MHP program on an adult group of recipients-key agents in their community. Because interventions for strengthening positive opinions about mental illness and enhancing self-assessed health constitute priority aims of mental health promotion, it would be beneficial to further investigate the sustainability of the observed positive changes. In addition it would be useful to examine (a) the possible interplay between the two outcome measures, that is, the effect of opinions of recipients about mental health on their perceived health, and (b) the applicability of this intervention in individuals with different sociodemographic profiles.

Factor structure and psychometric properties of a new 39-item version of the Criteria for Recovery from Eating Disorders questionnaire (CRED-39).

Eating disorders (ED) are a group of mental disorders, which are quite difficult to treat. In studies on the recovery process of ED, patients' experience is rarely been taken into account. In addition, there seems to be a gap between patients' objective improvement, as assessed by clinicians, and patients' own subjective evaluation of their recovery. Criteria for Recovery from Eating Disorders (CRED) is a questionnaire used to investigate recovery criteria which are considered important from the patients' perspective. The purpose of the present study was to examine the factorial structure of CRED and to evaluate its psychometric properties. A sample of 138 patients in ED treatment were asked to complete the CRED along with the WHO questionnaire on quality of life (WHOQoL-BREF) and the eating disorders questionnaire (EDE-Q). Exploratory factor analysis (EFA) was used to explore the factor structure of the CRED. Internal consistency assessment was based on Cronbach's α. Convergent validity was assessed through correlations of CRED with WHOQoL-BREF and EDE-Q. The EFA led to the removal of 13 items of the original CRED and yielded a conceptually justifiable seven factor model: Body Experience, Psychological Well-being, Social Relationships, Gastrointestinal Symptoms, Bodily Functions, Eating Behaviours, and Compensatory Behaviours. Cronbach's alphas of the total questionnaire and all seven factors ranged from 0.77 to 0.88. Convergent validity to WHOQoL-BREF and EDE-Q total scores and subscales were found to be quite satisfactory. Our analysis has, thus, led us to propose the CRED-39, a 39-item version of the CRED questionnaire, which seems to be a valid and reliable tool in assessing ED patients' own view of their recovery process. CRED-39 can be used in clinical practice to address personal needs and to direct individualised interventions.

Relationship of quality of life, psychopathologic symptoms and ways of coping in Greek nursing staff. / Relación entre calidad de vida, síntomas psicopatológicos y formas de afrontamiento en las enfermeras griegas.

OBJECTIVE: Our aim was to investigate the relationship of quality of life, psychopathological symptoms and ways of coping of nursing staff in two General Hospitals in Greece. METHOD: This was a cross-sectional study of 302 nurses in two General Hospitals in Greece between October and November of 2015. Data collection was performed using three questionnaires: the World Health Organisation Quality Of Life BREF; the Falk Self-Reporting Questionnaire for the detection of possible psychiatric comorbidity, and the Ways of Coping Scale for Stressful Situations. RESULTS: From a sample of 302 nurses, the poorer the mental and physical health of the nursing staff, the more their quality of life was impaired in all dimensions (physical, psychological, social and environmental) (P<.001, P=.047, P=.001). Also, while the scores in coping strategies "positive approach-positive reappraisal", "positive approach-problem solving" and "positive approach (overall)" rose, the score in the General Scale dropped; in other words, the employees' general health improved. CONCLUSION: Coping strategies such as positive approach, improved the nurses' general health. In contrast, their mental health deteriorated when they adopted the wishful thinking/daydream and/or the escape/avoidance strategies. Finally, as their general health worsened, their quality of life was impaired in all dimensions, whereas poor mental health of nurses was associated with lower quality of life in the physical and psychological dimensions.

Quality of life in mentally ill, physically ill and healthy individuals: the validation of the Greek version of the World Health Organization Quality of Life (WHOQOL-100) questionnaire.

OBJECTIVE: The World Health Organization Quality of Life (WHOQOL-100) questionnaire is a generic quality of life (QoL) measurement tool used in various cultural and social settings and across different patient and healthy populations. The present study examines the psychometric properties of the Greek version, with an emphasis on the ability of the instrument to capture QoL differences between mentally ill, physically ill and healthy individuals. METHODS: A total of 425 Caucasian participants were tested, as to form 3 groups: (a) 124 psychiatric patients (schizophrenia n = 87, alcohol abuse/dependence n = 37), (b) 234 patients with physical illness (hypertension n = 139, cancer n = 95), and (c) 67 healthy control individuals. RESULTS: Confirmatory factor analysis was performed indicating that a four-factor model can provide an adequate instrument structure for the participating groups (GFI 0.92). Additionally, internal consistency of the instrument was shown to be acceptable, with Cronbach's alpha values ranging from 0.78 to 0.90 regarding the four -domain model, and from 0.40 to 0.90 regarding the six-domain one. Evidence based on Pearson's r and Independent samples t-test indicated satisfactory test/retest reliability, as well as good convergent validity tested with the General Health Questionnaire (GHQ-28) and the Life Satisfaction Inventory (LSI). Furthermore, using Independent samples t-test and one-way ANOVA, the instrument demonstrated good discriminatory ability between healthy, mentally ill and physically ill participants, as well as within the distinct patient groups of schizophrenic, alcohol dependent, hypertensive and cancer patients. Healthy individuals reported significantly higher QoL, particularly in the physical health domain and in the overall QoL/health facet. Mentally ill participants were distinctively differentiated from physically ill in several domains, with the greatest difference and reduction observed in the social relationships domain and in the overall QoL/health facet. Within the four distinct patient groups, alcohol abuse/dependence patients were found to report the most seriously compromised QoL in most domains, while hypertensive and cancer patients did not report extensive and significant differences at the domain level. However, significant differences between patient groups were observed at the facet level. For example, regarding the physical domain, physically ill participants reported more compromised scores in the pain/discomfort facet, while mentally ill participants in the facets of energy/fatigue, daily living activities and dependence on medication. CONCLUSION: The findings of the study indicate that the Greek version of WHOQOL-100 provided satisfactory psychometric properties supporting its use within general and pathological populations and in the context of national and crosscultural QoL measurement.

Dysregulation and containment in the psychoanalytic psychotherapy of a poorly controlled diabetic patient.

Dysregulation, as a phenomenon of disruption in the psychotherapeutic setting, may be evidenced in the psychoanalytic psychotherapy of diabetic patients presenting poor metabolic and treatment control. In the case of a female patient, violations of the setting via acting out behaviors provided an opportunity for working through and understanding in depth the patient's unconscious attempts to activate traumatic childhood experiences and introduce loss and confusion into the relationship with the psychotherapist. Dysregulation was considered in connection with the patient's pathological containment function, in conflicting part self and object representations, and in relation to traumatic experiences of maternal desertion. Improvement of the patient was identified in her relationships with the psychotherapist, significant others, and the medical health providers, as well as in the overall management of her diabetic treatment.