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Investigating predictors of well-being in type 2 diabetes mellitus patients: the role of undiagnosed depression. 调查 2 型糖尿病患者幸福感的预测因素:未确诊抑郁症的作用。
Q3 Medicine Pub Date : 2023-12-29 Epub Date: 2022-11-11 DOI: 10.22365/jpsych.2022.093
Anastasia Antoniou, Alexios Sotiropoulos, Efstathios Skliros, Athanasios Raptis, Rossetos Gournellis, Emmanouil Rizos, Nikolaos Smyrnis, Panagiotis Ferentinos

Type 2 diabetes mellitus (T2DM) is a common metabolic disorder with various medical and psychological adverse effects. Well-being in patients with T2DM is often compromised. The aim of the present study was to investigate clinicodemographic predictors of well-being in patients with T2DM with no known psychiatric history and explore the mediatory role of undiagnosed anxiety and depression. We recruited 175 outpatients with T2DM (54.3% males, aged 34-79 (mean 59.9) years) followed-up at the Diabetes Center of the General Hospital of Nikaia-Peiraeus in Athens. Patients included had no severe diabetes-related complications or known psychiatric history. Well-being was measured with the Mental Health Continuum Short-Form (MHC-SF), a novel 14-item tool measuring the emotional (EWB), social (SWB) and psychological (PWB) dimensions of well-being, as well as a total score of well-being (WBT). Hospital Anxiety and Depression Scale (HADS) was used for screening for undiagnosed anxiety (HADS-A) and depression (HADS-D). Patients' demographics, Body Mass Index (BMI), glycemic control (HbA1c), T2DM duration, comorbid hypertension or dyslipidemia and type of antidiabetic medication were investigated as predictors of well-being or its dimensions in stepwise linear regression models, also including or excluding HADS-A and HADS-D. Mediational effects of HADS-A and HADS-D were explored in structural equation models through path analyses. Results showed that 21.1% of participants had comorbid depression (HADS-D≥11) and 5.1% comorbid anxiety disorder (HADS-A≥11). In the models without HADS, higher WBT as well as EWB and PWB were significantly predicted by lower HbA1c (all p=0.001) and lower BMI (p=0.015, 0.019 and 0.030, respectively). After being included in the model, HADS-A and HADS-D significantly predicted WBT and every dimension of well-being, but the effects of HbA1c and BMI were no longer statistically significant. In path analyses, the indirect effects of HbA1c and BMI on well-being via HADS-D were statistically significant, while the direct and indirect effects via HADS-A were not. Therefore, the effects of HbA1c and BMI on EWB, PWB and WBT were completely mediated by HADS-D. Concludingly, this is the first study using MHC-SF to measure well-being in patients with T2DM. High levels of undiagnosed depression were recorded, in agreement with other studies. Depression was predicted by HbA1c and BMI and finally predicted well-being. Undiagnosed depression fully explained the effects of HbA1c and BMI on well-being. The interplay of glycemic control and positive mental health should be further investigated.

2 型糖尿病(T2DM)是一种常见的代谢性疾病,对医疗和心理有各种不利影响。T2DM 患者的幸福感往往受到损害。本研究旨在调查无已知精神病史的 T2DM 患者幸福感的临床人口学预测因素,并探讨未确诊的焦虑症和抑郁症的中介作用。我们在雅典 Nikaia-Peiraeus 综合医院糖尿病中心招募了 175 名门诊 T2DM 患者(54.3% 为男性,年龄在 34-79 岁(平均 59.9 岁)之间)进行随访。所纳入的患者均无严重的糖尿病相关并发症或已知的精神病史。幸福感采用心理健康连续简表(MHC-SF)进行测量,这是一种包含 14 个项目的新型工具,用于测量幸福感的情感(EWB)、社交(SWB)和心理(PWB)维度,以及幸福感总分(WBT)。医院焦虑和抑郁量表(HADS)用于筛查未确诊的焦虑(HADS-A)和抑郁(HADS-D)。在逐步线性回归模型中,将患者的人口统计学特征、体重指数(BMI)、血糖控制情况(HbA1c)、T2DM持续时间、合并高血压或血脂异常以及抗糖尿病药物类型作为幸福感或其维度的预测因素进行了研究,其中也包括或排除了HADS-A和HADS-D。通过路径分析,在结构方程模型中探讨了 HADS-A 和 HADS-D 的中介效应。结果显示,21.1%的参与者合并有抑郁症(HADS-D≥11),5.1%的参与者合并有焦虑症(HADS-A≥11)。在不包含 HADS 的模型中,较低的 HbA1c(均 p=0.001)和较低的 BMI(分别 p=0.015、0.019 和 0.030)可显著预测较高的 WBT 以及 EWB 和 PWB。将 HADS-A 和 HADS-D 纳入模型后,可显著预测 WBT 和幸福感的每个维度,但 HbA1c 和 BMI 的影响不再具有统计学意义。在路径分析中,HbA1c 和 BMI 通过 HADS-D 对幸福感的间接影响具有统计学意义,而通过 HADS-A 的直接和间接影响则不具有统计学意义。因此,HbA1c 和 BMI 对 EWB、PWB 和 WBT 的影响完全由 HADS-D 介导。总之,这是第一项使用 MHC-SF 测量 T2DM 患者幸福感的研究。未确诊的抑郁症患者人数较多,这与其他研究结果一致。抑郁可由 HbA1c 和 BMI 预测,并最终预测幸福感。未确诊抑郁症完全解释了 HbA1c 和 BMI 对幸福感的影响。血糖控制与积极的心理健康之间的相互作用应得到进一步研究。
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引用次数: 0
Dimensionality and psychometric properties of the Greek version of the Τype 1 Diabetes Stigma Assessment Scale (DSAS-1-Gr). 希腊语版 1 型糖尿病耻辱感评估量表(DSAS-1-Gr)的维度和心理测量特性。
Q3 Medicine Pub Date : 2023-12-29 Epub Date: 2023-11-24 DOI: 10.22365/jpsych.2022.097
Emmanouil S Benioudakis, Argyroula Kalaitzaki, Eleni Karlafti, Maria-Alexandra Kalpou, Christos Savopoulos, Triantafyllos Didangelos

Type 1 Diabetes Mellitus (T1D) is one of the most common chronic diseases affecting children and adolescents. The daily management of T1D requires continuous insulin therapy, as well as the inevitable adjustment of daily activities according to glycaemic control, both of which may result in experiencing T1D related stigma. A significant proportion of people with T1D have been shown to experience social discrimination and stigma, which can lead to emotional distress and act as a barrier to help-seeking behavior. This study presents the psychometric properties of the Greek translation of the Diabetes Stigma Assessment Scale-1 (DSAS-1), which assesses self-perceived stigma in people with T1D. A sample of 105 adults with T1D, mostly females (70.5%), with a mean age of 34.3 years (±11.1), and mean disease duration of 19.4 years (±10.5), completed the translated in Greek DSAS-1 (DSAS-1-Gr). Exploratory and confirmatory factor analyses were used to investigate the construct validity of the scale. In line with the original version, the results of the present study supported the three-factor model of the scale 'identity concerns', 'different treatment', 'blame and judgment'. The internal consistency indices (Cronbach alpha) of the three subscales were above α=.80 and .88 for the whole scale. Moderate correlations were found between the DSAS-1-Gr and the Diabetes Distress scale for type 1 Diabetes (T1-DDS), the Rosenberg self-esteem scale, and the DASS-21 subscales (depression, anxiety, and stress), which is indicative of convergent validity. DSAS-1-Gr correlated negatively with the diabetes duration (in years), which was indicative of discriminant validity. Finally, females presented higher total DSAS-1-Gr score than males. DSAS-1-Gr is a valid and reliable tool to be used in clinical practice to assess stigma in Greek people with T1D.

1 型糖尿病(T1D)是影响儿童和青少年的最常见慢性疾病之一。T1D 的日常管理需要持续的胰岛素治疗,并不可避免地要根据血糖控制情况调整日常活动,这两者都可能导致患者遭受与 T1D 相关的耻辱。研究表明,相当一部分 T1D 患者会遭受社会歧视和污名化,这可能会导致患者情绪低落,并成为他们寻求帮助的障碍。本研究介绍了希腊语翻译的糖尿病耻辱感评估量表-1(DSAS-1)的心理测量特性,该量表用于评估 T1D 患者的自我耻辱感。105名患有T1D的成人完成了希腊语翻译的DSAS-1(DSAS-1-Gr),其中大部分为女性(70.5%),平均年龄为34.3岁(±11.1)岁,平均病程为19.4年(±10.5)年。为研究量表的结构效度,我们采用了探索性和确认性因子分析。与原始版本一致,本研究的结果支持量表的三因素模型 "身份关注"、"不同待遇"、"指责和评判"。三个分量表的内部一致性指数(Cronbach alpha)均在 α=.80 以上,整个量表的内部一致性指数为 0.88。DSAS-1-Gr与1型糖尿病压力量表(T1-DDS)、罗森伯格自尊量表和DASS-21分量表(抑郁、焦虑和压力)之间存在适度的相关性,这表明其具有趋同效度。DSAS-1-Gr与糖尿病病程(以年为单位)呈负相关,这表明了判别效度。最后,女性的 DSAS-1-Gr 总分高于男性。DSAS-1-Gr是一种有效、可靠的工具,可用于临床实践,评估希腊T1D患者的耻辱感。
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引用次数: 1
Outcome in patients with religious delusions. 宗教妄想症患者的疗效
Q3 Medicine Pub Date : 2023-12-29 Epub Date: 2023-05-12 DOI: 10.22365/jpsych.2023.012
Vera Rössler, Philipp Sand

We read with interest the recent report on the definition, diagnosis, and clinical implications of religious delusions (RD).1 In our sample of 929 delusional schizophrenia patients who had been admitted to two psychiatric hospitals in Germany between 2010 and 2014, 138 patients (15%) reported RD. In 569 cases, information on religious affiliation was available. Patients with religious affiliation did not differ from patients without religious affiliation in the frequency of RD [χ2(1,569)= 0.02, p= 0.885]. Furthermore, patients with RD did not differ from patients with other types of delusion (OD) in the duration of hospitalisation [t(924)= -0.39, p= 0.695], or the number of hospitalisations [t(927)= -0.92, p= 0.358]. Additionally, in 185 cases, information on Clinical Global Impressions (CGI) and Global Assessment of Functioning (GAF) was available at the beginning and end of the hospital stay. By CGI-scores, no difference was seen in morbidity of subjects with RD relative to subjects with OD on admission [t(183)= -0.78, p= 0.437] and discharge t(183)= -1.10, p= .273 . Likewise, GAF-scores on admission did not differ in these groups [t(183)= 1.50, p= 0.135]. However, a trend was noted for lower GAF-scores on discharge in subjects with RD [t(183)= 1.91, p= .057, d= 0.39, CI 95% (-0.12-0.78)]. While RD have often been associated with a poorer prognosis in schizophrenia,2,3 we argue that this need not apply to all domains. Mohr et al4 reported that patients with RD were less likely to maintain psychiatric treatment, but did not have a more severe clinical status than patients with OD. Iyassu et al5 found higher levels of positive, but also lower levels of negative symptoms in patients with RD compared to patients with OD. Groups did not differ in terms of length of illness or level of medication. Siddle et al6 reported higher symptom scores in patients with RD at their first presentation, but a similar response to treatment when compared to patients with OD after 4 weeks of treatment. Furthermore, Ellersgaard et al7 iindicated that first-episode psychosis patients with RD at baseline were more likely to be non-delusional at follow-ups conducted after years 1, 2 and 5 when compared to patients with OD at baseline. We conclude that RD may thus interfere with short-term clinical outcome. With regard to long-term effects more favourable observations exist8 and the interplay of psychotic delusions with non-psychotic beliefs still warrants further research.

我们饶有兴趣地阅读了最近关于宗教妄想症(RD)的定义、诊断和临床影响的报告。1 在我们对 2010 年至 2014 年期间入住德国两家精神病院的 929 例妄想型精神分裂症患者进行的抽样调查中,有 138 例患者(15%)报告了宗教妄想症。569例患者提供了宗教信仰信息。有宗教信仰的患者与无宗教信仰的患者在 RD 频率上没有差异 [χ2(1,569)= 0.02, p= 0.885]。此外,在住院时间[t(924)= -0.39,p= 0.695]或住院次数[t(927)= -0.92,p= 0.358]方面,RD 患者与其他类型的妄想症(OD)患者没有差异。此外,有 185 例患者在住院开始和结束时提供了临床总体印象(CGI)和总体功能评估(GAF)的信息。根据 CGI 评分,入院时 RD 患者的发病率与出院时 OD 患者的发病率没有差异 [t(183)= -0.78,p= 0.437] ,出院时 t(183)= -1.10, p= .273 。同样,这两组患者入院时的 GAF 分数也没有差异 [t(183)= 1.50,p= 0.135]。然而,RD 患者出院时的 GAF 分数有降低趋势[t(183)= 1.91,p= .057,d= 0.39,CI 95% (-0.12-0.78)]。虽然 RD 通常与精神分裂症患者较差的预后有关,2,3 但我们认为这并不适用于所有领域。Mohr 等人4 报告说,RD 患者维持精神治疗的可能性较低,但其临床状况并不比 OD 患者严重。Iyassu 等人5 发现,与 OD 患者相比,RD 患者的阳性症状水平较高,但阴性症状水平也较低。两组患者在患病时间和用药水平上没有差异。Siddle 等人6 报告称,RD 患者首次发病时的症状评分较高,但治疗 4 周后与 OD 患者的治疗反应相似。此外,Ellersgaard 等人7 指出,与基线时患有妄想症的患者相比,基线时患有妄想症的首发精神病患者在 1、2 和 5 年后的随访中更有可能不再妄想。我们的结论是,RD 因此可能会干扰短期临床结果。至于长期效果,我们的观察结果更为乐观8 ,而精神病性妄想与非精神病性信念之间的相互作用仍值得进一步研究。
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引用次数: 0
The impact of the COVID-19 pandemic on children and young people. COVID-19大流行对儿童和年轻人的影响。
Q3 Medicine Pub Date : 2023-12-29 Epub Date: 2023-11-14 DOI: 10.22365/jpsych.2023.024
Konstantina Magklara, Marinos Kyriakopoulos

In March 2020, the World Health Organization declared the spread of COVID-19 as a global pandemic, and youth worldwide were suddenly confronted with unprecedented consequences. The first line of concern was related to the direct effect of SARS-CoV-2 viral infection. While severe physical health symptomatology including death following infection was found to be less common in children than in adults,1 long-COVID has been identified in the pediatric population with the most prevalent manifestations involving mood symptoms, sleep difficulties, and fatigue.2 Secondly, the measures against COVID-19 carried their own set of risks. Many governments imposed national lockdowns, schools closed, remote learning started operating and social distancing measures prevented families from visiting public places or meeting people from other households. Isolation, disruption of everyday routines, and a sharp and dramatic decrease in physical activity and social interaction levels became the new reality experienced by children and adolescents of all age groups.3 Cross-sectional community studies on children and adolescents conducted early in the course of the pandemic indicated elevated levels of loneliness, anxiety, and behavioral problems in youth samples, even during the initial phases of the outbreak.4 Systematic reviews of mainly cross-sectional studies that followed indicated a significant rise in clinically significant anxiety and depression symptoms among children and adolescents compared to pre-pandemic levels5 and high prevalence estimates for depression, anxiety, posttraumatic stress symptomatology, and sleep disorders.6 A recent systematic review that included data from 55,000 children and adolescents from many countries of the world (mean age 11.3 years) reported that anxiety (range = 1.8–49.5%), depression (range = 2.2– 63.8%), irritability (range = 16.7–73.2%) and anger (range = 30.0–51.3%) were frequently reported by children and adolescents during the pandemic.7However, the experience of the pandemic was not homogenous among all youth. Possible risk factors included the presence of mental health problems before the pandemic, excessive exposure to media, and high COVID-19 caseload in the community, while the presence of any kind of family routines and good parent-child communication were identified as protective factors.7 Females and older adolescents were also reported to be at greater risk for adverse mental health outcomes. In most countries, the spread of the infection, on one hand, and the enforcement of lockdowns and other containment measures, on the other, have put health care under tremendous pressure, leaving families with children with mental health disorders with minimal or inadequate support. Nevertheless, differences were also observed within the group of children with psychiatric or developmental disorders diagnosed before the pandemic. Numerous studies that have investigated the impact of the COVID-19 pandemic and related cont

2020年3月,世界卫生组织宣布COVID-19为全球大流行,全球青年突然面临前所未有的后果。第一行关注与SARS-CoV-2病毒感染的直接影响有关。虽然发现感染后死亡等严重身体健康症状在儿童中比在成人中更少见(Chua等人,2021年),但在儿科人群中发现了长covid,其最普遍的表现包括情绪症状、睡眠困难和疲劳(Lopez-Leon等人,2022年)。第二,新冠肺炎防控措施也存在一定风险。许多国家的政府实施了全国封锁,学校关闭,远程教育开始运作,社会距离措施阻止家庭前往公共场所或与其他家庭的人会面。孤立、日常生活中断、身体活动和社会互动水平急剧下降成为所有年龄组儿童和青少年所经历的新现实(Wang et al ., 2020)。在大流行早期对儿童和青少年进行的横断面社区研究表明,即使在疫情暴发的初始阶段,青少年样本中的孤独感、焦虑和行为问题水平也会升高(Zhou et al ., 2020)。随后对主要是横断面研究的系统回顾表明,与大流行前相比,儿童和青少年的临床显著焦虑和抑郁症状显著增加(拉辛等人,2021年),抑郁、焦虑、创伤后应激症状和睡眠障碍的患病率估计很高(Ma等人,2021年)。最近一项包括来自世界许多国家(平均年龄11.3岁)的55,000名儿童和青少年数据的系统评价报告称,大流行期间儿童和青少年经常报告焦虑(范围= 1.8-49.5%)、抑郁(范围= 2.2-63.8%)、易怒(范围= 16.7-73.2%)和愤怒(范围= 30.0-51.3%)(Panchal et al, 2023)。然而,并非所有青年对这一流行病的经历都一样。可能的风险因素包括大流行前存在心理健康问题、过度接触媒体以及社区中COVID-19病例量高,而任何类型的家庭惯例和良好的亲子沟通被认为是一个保护因素(Panchal等,2023)。据报告,女性和年龄较大的青少年出现不良心理健康结果的风险更大。在大多数国家,一方面是感染的传播,另一方面是封锁和其他遏制措施的实施,这给卫生保健带来了巨大压力,使有精神健康障碍儿童的家庭得到的支持很少或不足。然而,在大流行之前诊断出患有精神或发育障碍的儿童群体中也观察到差异。许多研究调查了COVID-19大流行和相关遏制措施对患有自闭症谱系障碍的儿童和青少年的影响,报告称,儿童和青少年的父母压力显著增加,焦虑、易怒、多动、刻板行为和其他行为问题水平也很高(milia - milea et al, 2023)。对神经发育障碍问题的进一步研究表明,COVID-19大流行对患有注意力缺陷/多动障碍(ADHD)的儿童产生了不成比例的不利影响,最近的一项荟萃分析指出,全球ADHD症状有所增加(Rogers et al, 2023)。最后,关于流行病期间青少年自杀率可能大幅上升的早期关切,随后相关研究得出了相互矛盾的结果。但总体而言,据报告,在大流行期间,与以前一样,儿童和青少年的自杀意念率高于自杀行为和自杀事件率(Bersia等人,2023年)。在希腊青年中也发现了与上述类似的精神健康问题。在大流行的早期阶段,三分之一(35.1%)的父母报告说,他们孩子的心理健康受到了很大影响(Magklara等人,2023年),而一项对高三学生的研究发现,在封锁期间,严重抑郁和焦虑的比例显著增加(Giannopoulou等人,2020年)。在来自全国不同地区的已有精神健康问题的儿童和青少年中,在大流行发病前后的情绪状态得分没有变化,而他们的一些日常行为在封锁期间恶化,例如睡眠减少或户外活动时间减少(Magklara et al ., 2022)。 这些与COVID-19大流行及其遏制措施的影响有关的研究结果应指导对受其影响的儿童和青少年的后续行动,并为大流行后时代有效的卫生战略和政策的设计提供信息,旨在预防和减轻进一步的心理健康危机。
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引用次数: 0
Depression in medical students during the COVID-19 lockdown in Greece. 希腊新冠肺炎封锁期间医学生的抑郁症。
Q3 Medicine Pub Date : 2023-12-29 Epub Date: 2023-09-29 DOI: 10.22365/jpsych.2023.023
Mariana Styliari, Michaella Alexandrou, Georgia Polychronidou, Garyfallia Poulakou, Vana Sypsa, Konstantinos Ν Fountoulakis

The COVID-19 pandemic has caused a mental health crisis. The purpose of this study was to estimate the prevalence of depression in medical students in Greece during a nationwide lockdown. The secondary aims were to assess the association of depression with socio-demographic factors and students' attitudes regarding the quality of their studies. The data was gathered anonymously through a self-administered online questionnaire between January 11 and 27, 2021. The CES-D scale was used to measure depression rates. Multiple logistic regression was used to identify factors independently associated with depression. Analyses were conducted using Stata version 16.0 and the IBM® SPSS® software. In total, 978 sixth- and fifth-year medical students participated; their mean age was 23.2 years and 65.6% were females. The prevalence of clinical depression was 21.3% (95% CI: 18.7%, 24.0%), whereas 17.9% (95% CI: 15.5%, 20.4%) experienced severe distress. Depression was more prevalent in females (25.4% vs 13.1% in males, p<0.001). Approximately half (53.4%) of the participants reported a change in plans regarding their medical career due to the pandemic and 16.9% expressed a decreased willingness to practice medicine. Factors independently associated with depression were female gender, living alone or with housemates at high risk for COVID-19, being anxious about becoming infected with SARS-CoV-2, studying in one of the three largest medical schools, negatively evaluating the adjustment of the teaching personnel to online teaching and the university's response to the pandemic. The findings of this study report depression in one out of five medical students during the COVID-19 pandemic, highlighting the need to protect the most vulnerable medical students during a pandemic. Medical students must be able to seek professional mental health services, even in the era of a pandemic. Universities should increase accessibility to support services and provide a student-centered approach in their strategies, as the pandemic has placed a spotlight on an existing phenomenon.

新冠肺炎大流行造成了精神健康危机。这项研究的目的是估计希腊全国封锁期间医学生的抑郁症患病率。次要目的是评估抑郁症与社会人口因素和学生对学习质量的态度之间的关系。这些数据是在2021年1月11日至27日期间通过自行管理的在线问卷匿名收集的。CES-D量表用于测量抑郁率。多元逻辑回归用于确定与抑郁症独立相关的因素。使用Stata 16.0版和IBM®SPSS®软件进行分析。总共有978名六年级和五年级的医学生参加了活动;平均年龄23.2岁,女性占65.6%。临床抑郁症的患病率为21.3%(95%可信区间:18.7%,24.0%),而17.9%(95%置信区间:15.5%,20.4%)经历了严重的痛苦。抑郁症在女性中更为普遍(25.4%vs13.1%,p
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引用次数: 0
Early maladaptive schemas and symptoms of psychopathology in children in residential care. 寄宿儿童的早期适应不良模式和精神病症状。
Q3 Medicine Pub Date : 2023-12-29 Epub Date: 2023-02-10 DOI: 10.22365/jpsych.2023.007
George Tsouvelas, Michaila Chondrokouki, Xenia Antoniou, George Nikolaidis

According to schema theory, early maladaptive schemas (EMS) contribute to the onset and development of psychopathology. Given that research on EMS in children is limited, the contribution of the present study is that it investigates the role of EMS in psychopathology in children living in residential care. Participants of the present study were children who lived in residential care and were referred for assessment to the Day Center "The House of the Child" run by the Organisation "The Smile of the Child". The study sample comprised of 75 children (35 boys, 40 girls), mean age 12.7 years old. The Greek version of the Achenbach Child Behavior Checklist was completed by the child's caregiver, whereas the Greek version of the Schema Questionnaire for Children was administered to children. The research questions were explored by implementing both variable-focused (multiple regression) as well as person-focused (cluster analysis) techniques. The Confirmatory Factor Analysis conducted in the Schema Questionnaire for Children showed acceptable goodness of fit indices. The Vulnerability schema was found to be the highest scoring schema. Social isolation was a strong predictor for most indicators of psychopathology (internalizing and externalizing). Strong predictor for the Symptoms of Withdrawal, Anxiety/Depression, Social Problems and Thought Problems was the EMS of Failure. Hierarchical cluster analysis on schemas revealed two strong clusters, one with low scores and one with high scores in most EMS. In the cluster with high levels of EMS, Emotional deprivation, Failure, Defectiveness, Social isolation and Abandonment showed the highest scores. In this cluster, children presented statistically significant burdened indicators in externalizing psychopathology. Our hypotheses that EMS and, especially, schemas related to the domains of Disconnection/Rejection and Impaired Autonomy/Performance would be predictive indicators of psychopathology were confirmed. Cluster analysis confirmed the above findings and highlighted the role of schemas Emotional deprivation and Defectiveness in the emergence of psychopathology symptoms. The results of the current study highlight the importance of assessing EMS in children who live in residential care and could inform the development of appropriate intervention programs in this population to prevent the establishment of psychopathology.

根据图式理论,早期适应不良图式(EMS)会导致精神病理学的发生和发展。鉴于对儿童早期适应不良图式的研究有限,本研究的贡献在于调查了早期适应不良图式在寄宿儿童心理病理学中的作用。本研究的参与者是寄宿儿童,他们被转介到 "儿童的微笑 "组织开办的日间中心 "儿童之家 "接受评估。研究样本包括 75 名儿童(35 名男孩,40 名女孩),平均年龄为 12.7 岁。希腊语版的阿亨巴赫儿童行为检查表由儿童的看护人填写,而希腊语版的儿童模式问卷则由儿童填写。对研究问题的探讨同时采用了以变量为中心(多元回归)和以人为中心(聚类分析)的技术。对儿童模式问卷进行的确认性因素分析表明,拟合指数是可以接受的。脆弱性模式是得分最高的模式。社会隔离对大多数精神病理学指标(内化和外化)都有很强的预测作用。对 "退缩症状"、"焦虑/抑郁"、"社交问题 "和 "思想问题 "有较强预测作用的是 "失败感"。对图式进行的层次聚类分析显示出两个强大的聚类,一个是在大多数 EMS 中得分较低的聚类,另一个是得分较高的聚类。在 EMS 分值较高的聚类中,情感缺失、失败、缺陷、社会孤立和被遗弃的得分最高。在这个群组中,儿童的外化心理病理学指标在统计学上有显著的负担。我们的假设得到了证实,即 EMS,尤其是与 "断绝/拒绝 "和 "自主/表现受损 "领域相关的模式,将是心理病理学的预测指标。聚类分析证实了上述发现,并强调了情感剥夺和缺陷模式在精神病理学症状出现过程中的作用。本研究的结果凸显了对寄宿儿童进行情绪管理系统评估的重要性,并可为制定针对该群体的适当干预计划提供信息,以防止其产生心理病理学。
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引用次数: 1
The impact of meteorological factors on involuntary admission in Attica, Greece. 气象因素对希腊阿提卡非自愿入院的影响。
Q3 Medicine Pub Date : 2023-12-29 Epub Date: 2023-05-12 DOI: 10.22365/jpsych.2023.011
Ioannis Rizavas, Rossetos Gournellis, Nikos Pantazis, Fotios Chatzinikolaou, Phoebe Douzenis, Vasiliki Efstathiou, Kostas Lagouvardos, Athanasios Douzenis

Few studies in the literature have examined the effect of meteorological factors, especially temperature, on psychiatric hospitalization and even less on their association with involuntary admission. This study aimed to investigate the potential association of meteorological factors with the involuntary psychiatric hospitalization in the region of Attica, Greece. The research was conducted at the Psychiatric Hospital of Attica "Dafni". This was a retrospective time series study of 8 consecutive years of data (2010 to 2017) and included 6887 involuntarily hospitalized patients. Data on daily meteorological parameters were provided from the National Observatory of Athens. Statistical analysis was based on Poisson or negative binomial regression models with adjusted standard errors. Analyses were initially based on univariable models for each meteorological factor separately. All meteorological factors were taken into account through factor analysis and then, through cluster analysis, an objective grouping of days with similar weather type was performed. The resulting types of days were examined for their effect on the daily number of involuntary hospitalizations. Increases in maximum temperature, in average wind speed and in minimum atmospheric pressure values were associated with an increase in the average number of involuntary hospitalizations per day. Increase of the maximum temperature above 23 °C at lag 6 days before admission did not affect significantly the frequency of involuntary hospitalizations. Low temperature and average relative humidity above 60% levels had a protective effect. The predominant day type at lag 1 to 5 days before admission showed the strongest correlation with the daily number of involuntary hospitalizations. The cold season day type, with lower temperatures and a small diurnal temperature range, northerly winds of moderate speed, high atmospheric pressure and almost no precipitation, was associated with the lowest frequency of involuntary hospitalizations, whereas the warm season day type, with low daily temperature and small daily temperature range during the warm season, high values of relative humidity and daily precipitation, moderate wind speed/gust and atmospheric pressure, was associated with the highest. As climate change increases the frequency of extreme weather events, it is necessary to develop a different organizational and administrative culture of mental health services.

很少有文献研究气象因素(尤其是气温)对精神病住院治疗的影响,更少研究气象因素与非自愿住院治疗的关系。本研究旨在调查希腊阿提卡地区气象因素与非自愿精神病住院的潜在关联。研究在阿提卡 "达夫尼 "精神病院进行。这是一项连续 8 年(2010 年至 2017 年)数据的回顾性时间序列研究,包括 6887 名非自愿住院患者。每日气象参数数据由雅典国家天文台提供。统计分析基于泊松或负二项回归模型,并调整了标准误差。分析最初基于单变量模型,对每个气象因素分别进行分析。通过因子分析将所有气象因素考虑在内,然后通过聚类分析对天气类型相似的日子进行客观分组。由此得出的天数类型对每天非自愿住院人数的影响进行了研究。最高气温、平均风速和最低气压值的增加与每天非自愿住院的平均人数增加有关。入院前 6 天最高气温升至 23 ° C 以上对非自愿住院次数没有明显影响。低温和平均相对湿度高于 60% 有保护作用。入院前 1 至 5 天的主要日型与每日非自愿住院次数的相关性最强。寒冷季节日型的气温较低,昼夜温差较小,吹中等风速的偏北风,大气压较高,几乎没有降水,与非自愿住院次数最少相关;而温暖季节日型的气温较低,温暖季节的昼夜温差较小,相对湿度和日降水量值较高,吹中等风速/恶心风,大气压较高,与非自愿住院次数最多相关。由于气候变化增加了极端天气事件发生的频率,因此有必要发展不同的心理健康服务组织和管理文化。
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引用次数: 0
Stigma and discrimination among persons with mental illness in a tertiary care medical institution in Southern India. 印度南部一家三级医疗机构中精神病患者的耻辱感和歧视。
Q3 Medicine Pub Date : 2023-12-29 Epub Date: 2023-05-12 DOI: 10.22365/jpsych.2023.013
Shashwath Sathyanath M, Sachin Beesanahalli Shanmukhappa, Anil Kakunje, Santanu Nath, Mohanchandran Varikara Veetil

The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Stigma and discrimination are major barriers to seeking treatment for persons with mental illness (PMI). Stigma reduction strategies are thus crucial, and for this, there needs to be an understanding of the various factors associated with them. The current study intended to assess stigma and discrimination in PMI visiting the department of psychiatry in a teaching hospital in Southern India and their association with various clinical and sociodemographic factors in them. The index study was a descriptive cross-sectional study involving consenting adults who presented to the department of psychiatry with mental disorders from August 2013 to January 2014. Socio-demographic and clinical data were collected using a semi-structured proforma, and the Discrimination and Stigma Scale (DISC-12) was used to assess discrimination and stigma. Most of PMI suffered from bipolar disorder, followed by depression, schizophrenia, and other disorders, such as obsessive-compulsive disorder, somatoform disorder, and substance use disorder. Discrimination was experienced by 56% of them and 46% had stigmatizing experiences. Both discrimination and stigma were found to be significantly associated with their age, gender, education, occupation, place of residence, and illness duration. While PMI suffering from depression experienced the highest discrimination, those with schizophrenia faced the stronger stigma. Binary logistic regression revealed depression, family history of psychiatric illness, age of less than 45 years, and rural locality of residence to be the significant determinants of discrimination and stigma. The study thus found that stigma and discrimination were associated with multiple social, demographic, and clinical factors in PMI. A rights-based approach to PMI is the need of the hour to tackle stigma and discrimination, which is already included in recent Indian acts and statutes. Implementation of these approaches is the need of the hour.

自 1990 年以来,精神障碍在印度疾病总负担中所占比例几乎翻了一番。污名化和歧视是精神病患者寻求治疗的主要障碍。因此,减少污名化的策略至关重要,为此需要了解与之相关的各种因素。本研究旨在评估在印度南部一家教学医院精神病科就诊的精神病患者所遭受的羞辱和歧视,以及这些羞辱和歧视与他们的各种临床和社会人口因素之间的关联。指标研究是一项描述性横断面研究,涉及 2013 年 8 月至 2014 年 1 月期间因精神障碍到精神科就诊的成年人。研究采用半结构化问卷收集社会人口学和临床数据,并使用歧视和成见量表(DISC-12)评估歧视和成见。大多数躁郁症患者患有躁郁症,其次是抑郁症、精神分裂症和其他疾病,如强迫症、躯体形式障碍和药物使用障碍。其中 56% 的人遭受过歧视,46% 的人遭受过侮辱。研究发现,歧视和鄙视都与患者的年龄、性别、教育程度、职业、居住地和患病时间长短密切相关。患有抑郁症的 PMI 遭受的歧视最多,而患有精神分裂症的 PMI 遭受的耻辱感更强。二元逻辑回归显示,抑郁症、精神病家族史、年龄小于 45 岁和居住地为农村是歧视和成见的重要决定因素。因此,研究发现,在 PMI 中,成见和歧视与多种社会、人口和临床因素相关。对 PMI 采取基于权利的方法是解决污名化和歧视问题的当务之急,这已被纳入印度近期的法案和法规中。实施这些方法是当务之急。
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引用次数: 0
The impact of COVID-19 pandemic on elderly with neurocognitive disorders. 新冠肺炎大流行对患有神经认知障碍的老年人的影响。
Q3 Medicine Pub Date : 2023-10-12 Epub Date: 2023-07-14 DOI: 10.22365/jpsych.2023.018
Maria Basta, Eleni Skourti

Since the COVID-19 pandemic outburst, numerous studies have reported on the holistic approach of the disease, which has negative consequences on physical and mental health as well as short- and long-term effects on cognition, independently of age. The context of the pandemic brought significant demands on public health systems, leading to restrictive measures against coronavirus expansion (quarantines, physical distancing policies, etc.). Such measures are reported to increase perceived loneliness and helplessness and may exacerbate feelings of emotional distress.1 Elderly diagnosed with neurocognitive disorders, i.e., mild cognitive impairment (MCI) or dementia, may present multifaceted cognitive deficits accompanied by neuropsychiatric symptoms, medical comorbidities, and high mortality rates. Furthermore, elderly with MCI/dementia are more vulnerable to SARS-COV-2 infection and disease complications due to decreased compliance with protective measures and multimorbidity. Simultaneously, limited access to health care services, distancing from their loved ones, abrupt changes in their daily routines or cancellation of daycare programs may make them more susceptible to pandemic secondary effects. According to the World Health Organization about 55 million people live with dementia globally. Dementia diagnosis was reported as an independent risk factor for increased mortality rate among the elderly infected with SARS-COV-2.2 Cross-sectional studies conducted all over Europe reported increased cognitive deterioration rate in patients with MCI and dementia during lockdown compared to the pre-lockdown period, as well as among dementia patients infected with COVID-19 compared to those not infected.3 Exacerbation of pre-existing sleep/appetite dysregulation and aberrant motor behavior, worsened symptoms of apathy, depression, and agitation, a rise in delirium episodes and disease-related falls and onset of behavioral symptoms during quarantine occurred.4 Also, patients living alone expressed excessive worrying and an overall decline in well-being. However, results from a large cohort study conducted in England failed to distinguish COVID-19 effects on dementia patients' psychological state between 2018 and 2020, possibly due to the small number of dementia patients recruited and disease severity.5 Among the Greek elderly, dementia prevalence rates range between 5-10.8% and 32.4% for MCI incidence.6,7 Only a few studies have investigated the impact of COVID-19 quarantine on mental and psychological health of the Greek elderly diagnosed with cognitive disorders. A longitudinal study was conducted between 2018 and 2020 including a rather large number of elderly people with MCI or Alzheimer's disease (AD). The authors compared the objectively assessed deterioration difference pre- and during the quarantine in terms of cognition, behavior and function level. They concluded that no significant quarantine-related changes were detected in cognition betwe

自新冠肺炎疫情爆发以来,许多研究报告了该疾病的整体治疗方法,这对身心健康产生了负面影响,并对认知产生了短期和长期影响,与年龄无关。疫情背景对公共卫生系统提出了重大要求,导致对冠状病毒传播采取了限制性措施(隔离、保持身体距离政策等)。据报道,这些措施会增加孤独感和无助感,并可能加剧情绪困扰。1被诊断为神经认知障碍的老年人,即。,轻度认知障碍(MCI)或痴呆,可能表现出多方面的认知缺陷,并伴有神经精神症状、医学合并症和高死亡率。此外,由于对保护措施的依从性降低和多发病,患有MCI/痴呆症的老年人更容易感染严重急性呼吸系统综合征冠状病毒2型和疾病并发症。与此同时,获得医疗服务的机会有限、与亲人保持距离、日常生活的突然改变或日托项目的取消可能会使他们更容易受到疫情的次要影响。根据世界卫生组织的数据,全球约有5500万人患有痴呆症。据报道,痴呆症诊断是感染严重急性呼吸系统综合征冠状病毒的老年人死亡率增加的一个独立风险因素。2欧洲各地进行的横断面研究报告称,与封锁前相比,封锁期间MCI和痴呆症患者的认知恶化率增加,以及与未感染者相比,感染新冠肺炎的痴呆症患者。3先前存在的睡眠/食欲失调和异常运动行为加重,冷漠、抑郁和烦躁症状恶化,谵妄发作和疾病相关跌倒增多,隔离期间出现行为症状。4此外,独居患者表现出过度担忧和整体幸福感下降。然而,2018年至2020年间,在英格兰进行的一项大型队列研究的结果未能区分新冠肺炎对痴呆症患者心理状态的影响,这可能是由于招募的痴呆症患者数量少和疾病严重程度。5在希腊老年人中,MCI发病率在5-10.8%至32.4%之间。6,7只有少数研究调查了新冠肺炎隔离对被诊断患有认知障碍的希腊老年人的心理和心理健康的影响。2018年至2020年间进行了一项纵向研究,包括大量患有MCI或阿尔茨海默病(AD)的老年人。作者比较了隔离前和隔离期间在认知、行为和功能水平方面客观评估的恶化差异。他们得出的结论是,尽管不能排除行为和心理恶化间接影响AD患者认知和功能下降的可能性,但在三个时间点之间,没有检测到与隔离相关的认知显著变化。8在第一个隔离期(即2020年2月至5月)进行的一项横断面研究中,根据MCI或痴呆症老年人护理人员提供的主观信息,检查了日常生活的关键方面(情绪、身体健康、沟通)以及对禁闭政策的遵守情况。根据他们的发现,作者报告称,MCI和痴呆症患者表现出显著的整体下降,而痴呆症患者在神经精神症状(冷漠、情绪变化、精神运动焦虑)、过度担忧、,9为了尽量减少与流行病相关的隔离对患有神经认知障碍的老年人可能产生的有害影响,实施了远程医疗。神经心理学在线测试、临床结果的系统监测(对药物治疗的依从性)和动机干预(如体育活动计划)通过用户友好的应用程序和电话咨询提供。10然而,获得和熟悉技术的机会有限,认知缺陷的严重性,以及人口因素(即低教育和社会经济地位),可能在当前人口中产生有限的积极结果。总之,神经认知障碍和疫情的综合影响超过了医疗系统的需求,在某些情况下带来了难以克服的挑战。为了最大限度地减少未来类似情况的负面影响,应关注以下方向:以患者为导向,对临床过程进行系统监测的整体方案,未来认知能力下降,必要时及时进行精神/神经心理学干预。 对护理人员和护理人员进行专门培训,重点是将自我卫生措施纳入患者的日常生活。患者熟悉用于认知增强程序和诊断/监测目的的在线工具。
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引用次数: 0
GReek Anaesthesiologists's Burnout EPidemic within the COVID-19 pandemic (GRABEP study); a multicenter study on burn out prevalence among Greek anesthesiologists and association with personality traits. GReek麻醉师在新冠肺炎大流行中的精疲力竭EPidmic(GRABEP研究);一项关于希腊麻醉师精疲力竭患病率及其与人格特征关系的多中心研究。
Q3 Medicine Pub Date : 2023-10-12 Epub Date: 2023-05-12 DOI: 10.22365/jpsych.2023.010
Maria P Ntalouka, Agathi Karakosta, Diamanto Aretha, Alexandra Papaioannou, Vasileia Nyktari, Pelagia Chloropoulou, Eleni Koraki, Efstathia Pistioli, Paraskevi K Matsota, Petros Tzimas, Eleni M Arnaoutoglou

COVID-19 pandemic resulted in an unprecedented crisis with extreme distress for the frontline physicians and increased risk of developing burnout. Burnout has a negative impact on patients and physicians, posing a substantial risk in patient safety, quality of care and physicians' overall wellbeing. We evaluated burnout prevalence and possible predisposing factors among anaesthesiologists in the COVID-19 referral university/tertiary hospitals in Greece. In this multicenter, cross-sectional study we have included anaesthesiologists, involved in the care of patients with COVID-19, during the fourth peak of the pandemic (11/2021), in the 7 referral hospitals in Greece. The validated Maslach Burnout Inventory (MBI) and Eysenck Personality Questionnaire (EPQ) were used. The response rate was 98% (116/118). More than half of the respondents were females (67.83%, median age 46 years). The overall Cronbach's alpha for MBI and EPQ was 0.894 and 0.877, respectively. The majority (67.24%) of anaesthesiologists were assessed as "high risk for burnout" and 21.55% were diagnosed with burnout syndrome. Almost half participants experienced high levels of all three dimensions of burnout; high emotional exhaustion (46.09%), high depersonalization (49.57%) and high levels of low personal accomplishment (43.49%). Multivariate logistic analysis revealed that neuroticism was an independent factor predicting "high risk for burnout" as well as burnout syndrome, whereas the "Lie scale" of EPQ exhibited a protective effect against burnout. Burnout prevalence in Greek anaesthesiologists working in COVID-19 referral hospitals during the fourth peak of the pandemic was high. Neuroticism was predictive of both "high risk for burnout" and "burnout syndrome".

新冠肺炎大流行导致了一场前所未有的危机,给一线医生带来了极大的痛苦,并增加了职业倦怠的风险。倦怠对患者和医生产生了负面影响,对患者安全、护理质量和医生的整体健康构成了巨大风险。我们评估了希腊新冠肺炎转诊大学/三级医院麻醉师的职业倦怠患病率和可能的诱因。在这项多中心、横断面研究中,我们纳入了参与新冠肺炎患者护理的麻醉师,他们在疫情的第四个高峰期(2021年11月)在希腊的7家转诊医院。采用经验证的Maslach倦怠量表(MBI)和艾森克个性问卷(EPQ)。有效率为98%(116/118)。超过一半的受访者是女性(67.83%,中位年龄46岁)。MBI和EPQ的总体Cronbachα分别为0.894和0.877。大多数(67.24%)麻醉师被评估为“倦怠的高风险”,21.55%被诊断为倦怠综合征。近一半的参与者经历了高水平的三个维度的倦怠;多因素logistic分析显示,神经质是预测“高倦怠风险”和倦怠综合征的独立因素,而EPQ的“谎言量表”对倦怠具有保护作用。在大流行的第四个高峰期间,在新冠肺炎转诊医院工作的希腊麻醉师的精疲力竭率很高。神经质可预测“高倦怠风险”和“倦怠综合征”。
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Psychiatrike = Psychiatriki
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