Pseudocyesis as a healing mechanism for psychological trauma

Pseudocyesis, a rare condition characterized by clinical signs and symptoms of pregnancy except for the actual existence of a fetus, is a somatic symptom disorder associated with a variety of biological, psychological and social factors. The present report aims to present the case of a 45-year old patient with pseudocyesis from a psychodynamic perspective. According to a psychodynamic perspective and based on patient’s history, pseudocyesis functioned as a mental healing mechanismfor the trauma of long-standing infertility, the trauma of eight unsuccessful and painful in vitro fertilization attempts and above all, the trauma of finally giving birth to a non-healthy child

Mental illness through the perspective of undergraduate medical students in Greece: a cross-sectional study at Aristotle University of Thessaloniki

IntroductionNumerous studies reveal that mental health-related stigma, stereotypes, and prejudices negatively affect the patients, jeopardizing their health, prognosis, and social opportunities. Healthcare professionals, who are in the first line of combating mental disease, are expected to play a significant role in drastically changing discriminatory and stigmatizing attitudes toward psychiatric patients and in diminishing the existing healthcare and social disparities. In this study, we aimed to explore and highlight the views of Greek medical students—that is of the future physicians—toward mental illness and people suffering from it.Materials and methodsIt is a cross-sectional, observational study, in which 324 undergraduate students from the most populous Greek medical school of the Aristotle University of Thessaloniki, participated online, during the spring semester of 2022. The tools used were the Opinions about Mental Illness Scale (OMI) that assesses one’s viewpoints about mental illness, the Social Distance Scale (SDS) that captures the desired degree of social distancing from patients with mental disorders, and the Level of Contact Report (LCR-12) that estimates the level of familiarity with them.ResultsParticipants displayed rather positive attitudes regarding the etiology of mental illness, social integration, and discrimination toward psychiatric patients [as evaluated with the respective OMI subscales; Etiology mean score (μ):8.87 ± 4.68, Social Integration (μ):17.79 ± 5.42, Social Discrimination (μ):13.54 ± 11.17], and more clearly favorable opinions concerning the need for social provision or the enactment of restrictive measures [as expressed with the relative OMI subscales; Social Care (μ):22.74 ± 4.56, Social Restriction (μ):13.27 ± 8.98], while claiming to be quite familiar with mental disorders and individuals experiencing them (as assessed with LCR; μ: 8.71 ± 2.16), and relatively willing to interact with them (as measured with SDS; μ:8.95 ± 4.23). Degree of familiarity with mental illness was directly proportional to the desire for contact with patients living with it, while the higher both were, the more improved most of the aforementioned OMI sectors were found to be. Female sex, clinical medical education, previous clinical psychiatric training, and living with or being a person with a mental disorder were the factors that defined a statistically refined profile in many of the aspects above.ConclusionOur findings are in accordance with many prior and recent studies, while showing improved opinions compared to those of previous research in Greek student and healthcare population. They are calling for vigilance, rather than complacency, as well as educational and social interventions, in order to enable current and future healthcare professionals to perform their function to its fullest extent. Implications of our results and further research suggestions are included

Potentially inappropriate medication use in older adults with mild-moderate Alzheimer's disease:Prevalence and associations with adverse events

Aim: Potentially inappropriate medication (PIM) use is prevalent in older adults and is associated with adverse events, hospitalisation and mortality. We assessed the patterns and associations of PIM use in older adults with mild-to-moderate Alzheimer's Disease (AD), who may represent a particularly vulnerable group. Design: Analysis of data from NILVad, an 18-month Randomised Control Trial of Nilvadapine in mild-to-moderate AD. The v2 STOPP criteria were applied in duplicate to identify PIM use. Associations between PIM use and adverse events/unscheduled healthcare visits in addition to the associations between PIM use and AD progression were evaluated. Setting and Participants: 448 older adults with mild-to-moderate AD from 23 centres in nine European countries. Results: Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) were prescribed a PIM with 30.1% being prescribed 2+ PIMs. The most frequent PIMs were (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% N = 50/448), and (iii) Proton-Pump Inhibitors (PPIs) without appropriate indication (10.7% N = 48/448). Increasing number of PIMs was associated with a greater risk of adverse events (IRR 1.17, 1.13-1.19, P < 0.001), serious adverse events (IRR 1.27; 1.17-1.37, P < 0.001), unscheduled hospitalisations (IRR 1.16, 1.03-1.30, P = 0.016) and GP visits (IRR 1.22, 1.15-1.28, P < 0.001). PIM use was not associated with dementia progression. Conclusions and Implications: PIM use is highly prevalent in mild-to-moderate AD and is associated with adverse events and unscheduled healthcare utilisation. Further attention to de-prescribing in this vulnerable group is warranted

Staging of Schizophrenia with the Use of PANSS: An International Multi-Center Study

Introduction: A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method.Methods: Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed.Results: Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients.Discussion: This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.<br /

Διερεύνηση της άνοιας τύπου Alzheimer μέσω της νευροψυχολογικής δοκιμασίας S.I.B. (Severe Impairment Battery)

The assessment of cognitive change in Alzheimer disease (AD) has been focus of a great deal of research attention in recent years. Neuropsychological assessment, along with clinical examination, provides a reliable and valid evaluation of the degree of cognitive decline in dementia. Whereas a great deal is now known about the cognitive deficits and the evolution of the early AD, not much is known about patients with severe cognitive deterioration, in part because of the limited sensitivity of the available tests. Assessment of the later stages of cognitive impairment is veryimportant in geriatrics. The aim of this study was to assess patients with early, moderate and severe Alzheimer disease by means of the Severe Impairment Battery (SIB), and Mini Mental State Examination (MMSE). Forty-two patients with early, moderate and severe AD and met the criteria of the DSM-IV for AD, were assessed with the SIB which was translated into Greek language and MMSE. Additionally 23 patients who has not AD were assessed with the same neuropsychological tests. All patients were assessed two times. The mean score on the SIB in AD patients was 129,9±1,9 and in patients with no dementia was 89,3±26,8 Subgroups of patients with the most severe degree of dementia (MMSE scores 11 - 0) showed significant differences in their scores on the SIB. All cognitive domains showed a significant deterioration across the three severity groups as determined by the MMSE scores. Our study indicates that SIB is useful for the neuropsychological evaluation of severely demented patients. It is also useful for detection of the remaining cognitive functions in severely stages of AD.Η άνοια τύπου Alzheimer είναι το συχνότερο ανοϊκό σύνδρομο και χαρακτηρίζεται από σταδιακή έκπτωση των γνωστικών λειτουργιών, η εκτίμηση της σοβαρότητας της οποίας σχετίζεται με τις γνωστικές και νευροπαθολογικές εκδηλώσεις της, ενώ οι επιπρόσθετες διαταραχές συμπεριφοράς και τα νευρολογικά συμπτώματα που εμφανίζει, απαιτούν ολοκληρωμένη εκτίμηση και συνολική αντιμετώπιση. Μεγάλος αριθμός νευροψυχολογικών δοκιμασιών που διερευνούν τις ανώτερες ψυχικές λειτουργίες σε σχέση με τις εγκεφαλικές δομές, έδειξαν ότι οι ασθενείς με ΝΑπαρουσιάζουν διαταραχή σε μεγάλο εύρος των γνωστικών λειτουργιών τους ενώ έχουν τη δυνατότητα να διαχωρίζουν αποτελεσματικά τις γνωστικές μεταβολές που είναι συνέπειες της προχωρημένης ηλικίας, από αυτές που οφείλονται στη ΝΑ. Οι νευροψυχολογικές αυτές δοκιμασίες μπορούν να καθορίσουν τα γνωστικά ελλείμματα που συνοδεύουν τη ΝΑ και να επισημάνουν τις διαταραχές στις γνωστικές λειτουργίες καθώς και τα χαρακτηριστικά τους που παρατηρούνται στα πρώιμα στάδια της νόσου. Η Severe Impairment Battery (SIB) είναι από τις πρώτες δοκιμασίες που δημιουργήθηκε για την αξιολόγηση ασθενών με βαρεία άνοια, οι οποίοι δεν μπορούν να ολοκληρώσουν τις συμβατικές νευροψυχολογικές δοκιμασίες. Η παρούσα μελέτη είχε σκοπό τη διερεύνηση των βαρέως ανοϊκών ασθενών που εμφανίζουν πιθανή νόσο Alzheimer με τη Ελληνική προσαρμογή της νευροψυχολογικής δοκιμασίας Severe Impairment Battery (Δοκιμασία Βαρείας Νοητικής Διαταραχής). Για το σκοπό αυτό εξετάστηκαν δύο ομάδες ασθενών. Η ομάδα Alzheimer (ομάδα Α) αποτελούνταν από 42 ασθενείς οι οποίοι ελέγχθηκαν με την κλίμακα κλινικής αξιολόγησης της άνοιας (Clinical Dementia Rating, CDR), την κλίμακα ισχαιμίας Hachinski για την εκτίμηση της αγγειακής επιβάρυνσης ενώ, σύμφωνα με τα κριτήρια κατά DSM-IV και κατά NINCDS-ADRDA, παρουσίαζαν πιθανή άνοια τύπου Alzheimer. Την ομάδα ελέγχου (ομάδα Ε) αποτελούσαν 23 μάρτυρες οι οποίοι δεν πληρούσαν τα κριτήρια άνοιας σύμφωνα με τις παραπάνω δοκιμασίες και δεν παρουσίαζαν νευρολογική ή ψυχιατρική συμπτωματολογία. Οι ασθενείς και των δύο ομάδων είχαν παρόμοια ηλικία και αναλογία φύλου ενώ οι διαφορές των ετών εκπαίδευσης τους ήταν ασήμαντες. Όλοι οι ασθενείς είχαν πρόσφατη νευροαπεικονιστική εξέταση η οποία απέκλειε άλλου τύπου παθολογία του ΚΝΣ που να δικαιολογεί την υφιστάμενη νοητική διαταραχή. Επιπρόσθετες παρακλινικές εξετάσεις έγιναν όπου κρίθηκε απαραίτητο σύμφωνα με τα ευρήματα από την κλινική εξέταση. Όλοι οι ασθενείς υποβλήθηκαν στη δοκιμασία Mini Mental State Examination (MMSE) και στη δοκιμασία Severe Impairment Battery (SIB) ενώοι εξετάσεις επαναλήφθηκαν μετά μεσοδιάστημα μίας περίπου εβδομάδας και σε κάθε ασθενή καταγράφηκε η βαθμολογία των παραπάνω δοκιμασιών σε κάθε εξέταση. Η μέση τιμή της MMSE και της SIB της ομάδας Α ήταν σημαντικά μικρότερη απ' αυτή της ομάδας Ε, ενώ δεν υπήρχαν διαφορές στις τιμές της ίδιας ομάδας μεταξύ της πρώτης και δεύτερης εξέτασης. Οι ασθενείς της ομάδας Α χωρίστηκαν σε τρεις κατηγορίες βαρύτητας με τη MMSE (24 - 18, 17 - 12, 11 - 0) και οι μέσες τιμές της SIB συγκρίθηκαν τόσο με την ομάδα Ε όσο και μεταξύ των κατηγοριών βαρύτητας. Η σύγκριση των τιμών των ομάδων έδειξε σημαντική ελάττωση και στις τρεις κατηγορίες βαρύτητας της ομάδας Α σε σχέση με την ομάδα Ε, ενώ η μικρότερη τιμή SIB καταγράφηκε στη κατηγορία με MMSE 11-0. Οι τιμές της SIΒ σε σχέση με τις τιμές της MMSE για κάθε ασθενή δεν έδειξαν σημαντική συσχέτιση στις ομάδες με MMSE 17 - 12 και 11 - 0. Η σύγκριση των τιμών στις υποκατηγορίες της SIB (προσανατολισμός, προσοχή, γλωσσική ικανότητα, ευπραξία, οπτικοχωρική ικανότητα, μνήμη, κατασκευαστική ικανότητα, κατεύθυνση προσοχής και κοινωνικότητα) έδειξαν πολύ σημαντική ελάττωση σε σχέση με την ομάδα Ε και μεταξύ των κατηγοριών βαρύτητας με μικρότερη την τιμή της κατηγορίας με MMSE 11-0. Συμπερασματικά, σύμφωνα με τα αποτελέσματα της μελέτης μας, η Δοκιμασία Βαρείας Νοητικής Διαταραχής (SIΒ) μπορεί να διαχωρίσει το σύνολο των ανοϊκών ασθενών με πιθανή νόσο Alzheimer από αυτούς που δεν παρουσιάζουν νοητικές διαταραχές. Η αξιοπιστία της δοκιμασίας είναι μεγάλη, παρουσιάζοντας τις ίδιες τιμές σε διαδοχικές μετρήσεις και μπορεί να διακρίνει τις επιμέρους εναπομείνασες λειτουργίες κυρίως στους βαρέως ανοϊκούς ασθενείς. Οι κύριες λειτουργίες που διατηρούνται έως και τα σοβαρότερα στάδια της ΝΑ φαίνεται να είναι κυρίως η κατεύθυνση της προσοχής, στοιχεία γλωσσικής ικανότητας και σημαντικός βαθμός κοινωνικότητας. Επειδή η Δοκιμασία Βαρείας Νοητικής Διαταραχής (SIB) είναι σύντομη, απλή στην εφαρμογή της, έχει υψηλή αξιοπιστία και μπορεί να διακρίνει με κατανοητό τρόπο τις εναπομείνασες ικανότητες σε βαρέως πάσχοντες ανοϊκούς ασθενείς με πιθανή νόσο Alzheimer, πιστεύουμε ότι είναι μια χρήσιμη δοκιμασία τόσο για την εκτίμηση των θεραπευτικών παρεμβάσεων όσο και για την αξιολόγηση της πορείας της νόσου

Prediction of dysnatremias in critically ill patients based on the law of conservation of mass. Comparison of existing formulae.

BACKGROUND:We aimed to examine the predictive value of a novel mathematical formula based on the law of conservation of mass in calculating sodium changes in intensive care unit patients and compare its performance with previously published formulae. METHODS:178 patients were enrolled from 01/2010 to 10/2013. Plasma and urine were collected in two consecutive 8-hour intervals and the sodium was measured. The predicted sodium concentration was calculated based on previous equations and our formula. The two 8-hour period (epoch 1 and 2) results were compared. Variability of predicted values among the measured range of serum sodium levels were provided by Bland-Altman plots with bias and precision statistics. Comparison of the results was performed with the statistical model of the Percentage Similarity. RESULTS:47.19% patients had dysnatremias. The bias ± SD with 95% limits of agreement for sodium levels were -1.395±3.491 for epoch 1 and -1.623 ±11.1 for epoch 2 period. Bland-Altman analysis for the epoch 1 study period had the following results: -0.8079±3.447 for Adrogué-Madias, 0.56±9.687 for Barsoum-Levine, 0.1412±3.824 for EFWC and 0.294±4.789 for Kurtz-Nguyen formula. The mean similarity, SD and coefficient variation for the methods compared with the measured sodium are: 99.56%, 3.873, 3.89% epoch 1, 99.56%, 1.255, 1.26% for epoch 2, 99.77%, 1.245, 1.26% for Adrogue-Madias, 100.1%, 1.337, 1.34% for Barsoum-Levine, 100.1%, 1.704, 1.7% for Nguyen, 100.1%, 1.370, 1.37% for ECFW formula. CONCLUSIONS:The law of conservation of mass can be successfully applied for the prediction of sodium changes in critically ill patients

Development and validation of the Greek severe impairment battery

Most neuropsychological batteries, especially those most often used, are unsuitable for the assessment of patients with severe dementia. The Severe Impairment Battery (SIB) was developed for the evaluation of preserved cognitive functions in these patients. The aim of this study was to formulate a Greek version of the SIB and to conduct a first assessment of its use of patients with mild, moderate, or severe Alzheimer's disease (AD), compared to the Mini-Mental State Examination (MMSE). A convenience sample of 42 dementia patients according to DSM-IV-TR criteria and 23 healthy participants was selected. Patients were assessed twice using a Greek translation of the SIB and the Greek version of MMSE. Patients were divided into three severity groups based on grouped by Clinical Dementia Rating (CDR) score and the SIB and MMSE scores were compared. The validity of the SIB was confirmed by evaluating the correlation coefficients between the SIB and Greek-MMSE, grouped by CDR, which were found to be significant. Cronbach's α for the total SIB score and each subscale score showed high significance, and the item-total correlation for each subscale was also acceptable. The test-retest correlation for the total SIB score and subscale scores were significant. The total SIB score and subscale scores were examined according to CDR. The Greek SIB is reliable and valid in differentiating patients with moderate or severe dementia, whereas MMSE loses sensitivity due to a floor and ceiling effect

Assess of Combinations of Non-Pharmacological Interventions for the Reduction of Irritability in Patients with Dementia and their Caregivers: A Cross-Over RCT

Introduction: Dementia is a very common disorder that affects people over 65 years old all over the world. Apart from the cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) are a crucial matter in dementia, because they affect up to 90% of the patients during the course of their illness. Irritability has been found to be a common BPSD and one of the most distressing behaviors for the caregivers. The aim of the current study was to explore the efficacy of a combination of non-pharmacological interventions to treat irritability. Methods: Sixty patients with different types and stages of dementia with irritability were participated in a cross-over RCT. Three non-pharmacological interventions were used; (a) Validation Therapy (VT)/Psycho-educational program, (b) Aromatherapy/massage and (c) Music Therapy (MT). The study assessed the three non-pharmacological interventions in order to find the most effective combination of the interventions. This study did not compare pharmacological and non-pharmacological treatments. The interventions lasted for five days. There was no drop-out rate. All patients were assessed at baseline using Mini Mental State of Examination (MMSE), Addenbrooke&rsquo;s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for symptoms in dementia (FRSSD), and Neuropsychiatric Inventory (NPI) (sub questions for irritability). Only NPI used for the assessment after each intervention. The analyses used categorical variables, Wilcoxon signed-rank test, Chi-square test and z value score. Results: The most effective combination of non-pharmacological interventions was Aromatherapy/massage (p = 0.003)-VT plus Psycho-educational program (p = 0.014) plus MT (p = 0.018). The same combination was the most effective for the caregivers&rsquo; burden, too (p = 0.026). Conclusions: The above combination of non-pharmacological interventions can reduce irritability in patients with dementia and caregivers&rsquo; burden

Non-Pharmacological Interventions for Wandering/Aberrant Motor Behaviour in Patients with Dementia

Background: Aberrant motor behaviour or wandering refers to aimless movement without a specific purpose. Wandering is common in patients with dementia and leads to early institutionalization and caregivers&rsquo; burden. Non-pharmacological interventions should be also considered as a first-line solution for the wandering because current pharmacological treatment has serious side-effects. Methods: A cross-over randomised controlled trial (RCT) with 60 participants of all stages and different types of dementia was conducted in Greece. The sample was randomly assigned in 6 different groups of 10 participants each. Every intervention lasted for 5 days, and there were 2 days as a wash-out period. There was no drop-out rate. The measurements used were the Mini Mental State Examination (MMSE), Addenbrooke&rsquo;s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for Symptoms in Dementia (FRSSD), and Neuropsychiatric Inventory (NPI). The interventions that were evaluated were reminiscence therapy (RT), music therapy (MT), and physical exercise (PE). Results: NPI scores were reduced in the group receiving PE (p = 0.006). When MT (p = 0.018) follows PE, wandering symptoms are reduced further. RT should follow MT in order to reduce wandering more (p = 0.034). The same combination was effective for the caregivers&rsquo; burden as well; PE (p = 0.004), MT (p = 0.036), RT (p = 0.039). Conclusions: An effective combination that can reduce wandering symptoms in all stages and types of dementia was found: The best order was PH-MT-RT. The same combination in the same order reduced caregivers&rsquo; burden