“Empathize with me, Doctor!” Medical Undergraduates Training Project: Development, Application, Six-months Follow-up

The aim of the study was to assess the effectiveness of specially designed, empathy training for medical undergraduates, based on the principles of Person-Centered Approach.Within the context of the humanistic person-centered patient care, the experiential, 60-hour “Empathize with me, Doctor!” training program contains theory, personal development and skills development. Role plays, experiential exercises, self-awareness exercises, active listening practice and conduction of a person-centered interview constituted the training.Forty-two medical undergraduates (66% females; 29% fourth year of study, 40% fifth, 31% sixth) from the University of Ioannina in Greece applied and all of them completed the empathy training. Forty-five medical students comprised a similar according to age and year of studies control group.The Jefferson Scale of Physician Empathy (JSPE) was used to assess the empathic performance, and Cohen’s d to assess the practical importance of any statistical difference.The JSPE mean score (and standard deviation) before, after and six months follow-up was 109.3(12.7), 121.1(9.0), 121.1(9.5), respectively. The before–after and before–follow-up difference was highly significant (CI95%, p<0.001 in both cases), and of great practical importance (d=1.072, d=1.052, respectively), while no decrease was observed six-months later (CI 95%, p=0.999, d<0.001). Control group reached a JSPE 108.7(10.5), similar to intervention group before training (CI95%, p=0.832), and highly different and important compared to after (CI 95%p<0.001; d=1.268) and follow-up (CI 95%, p<0.001; d=1.238) intervention scores.The “Empathize with me, Doctor!” improved significantly and importantly medical undergraduates’ empathic performance, which was maintained intact for at least six months

Treatment implications of predominant polarity and the polarity index: a comprehensive review.

Background: Bipolar disorder (BD) is a serious and recurring condition that affects approximately 2.4% of the global population. About half of BD sufferers have an illness course characterized by either a manic or a depressive predominance. This predominant polarity in BD may be differentially associated with several clinical correlates. The concept of a polarity index (PI) has been recently proposed as an index of the antimanic versus antidepressive efficacy of various maintenance treatments for BD. Notwithstanding its potential clinical utility, predominant polarity was not included in the DSM-5 as a BD course specifier. Methods: Here we searched computerized databases for original clinical studies on the role of predominant polarity for selection of and response to pharmacological treatments for BD. Furthermore, we systematically searched the Pubmed database for maintenance randomized controlled trials (RCTs) for BD to determine the PI of the various pharmacological agents for BD. Results: We found support from naturalistic studies that bipolar patients with a predominantly depressive polarity are more likely to be treated with an antidepressive stabilization package, while BD patients with a manic-predominant polarity are more frequently treated with an antimanic stabilization package. Furthermore, predominantly manic BD patients received therapeutic regimens with a higher mean PI. The calculated PI varied from 0.4 (for lamotrigine) to 12.1 (for aripiprazole). Conclusions: This review supports the clinical relevance of predominant polarity as a course specifier for BD. Future studies should investigate the role of baseline, predominant polarity as an outcome predictor of BD maintenance RCTs. Keywords

The Greek-Orthodox version of the Brief Religious Coping (B-RCOPE) instrument: psychometric properties in three samples and associations with mental disorders, suicidality, illness perceptions, and quality of life

Background: The B-RCOPE is a brief measure assessing religious coping. We aimed to assess the psychometric properties of its Greek version in people with and without long-term conditions (LTCs). Associations between religious coping and mental illness, suicidality, illness perceptions, and quality of life were also investigated. Methods: The B-RCOPE was administered to 351 patients with diabetes, chronic pulmonary obstructive disease (COPD), and rheumatic diseases attending either the emergency department (N = 74) or specialty clinics (N = 302) and 127 people without LTCs. Diagnosis of mental disorders was established by the MINI. Associations with depressive symptom severity (PHQ-9), suicidal risk (RASS), illness perceptions (B-IPQ), and health-related quality of life (WHOQOL-BREF) were also investigated. Results: The Greek version of B-RCOPE showed a coherent two-dimensional factor structure with remarkable stability across the three samples corresponding to the positive (PRC) and negative (NRC) religious coping dimensions. Cronbach’s alphas were 0.91–0.96 and 0.77–0.92 for the PRC and NRC dimensions, respectively. Furthermore, NRC was associated with poorer mental health, greater depressive symptom severity and suicidality, and impaired HRQoL. In patients with LTCs, PRC correlated with lower perceived illness timeline, while NRC was associated with greater perceived illness consequences, lower perceived treatment control, greater illness concern, and lower illness comprehensibility. Conclusions: These findings indicate that the Greek-Orthodox B-RCOPE version may reliably assess religious coping. In addition, negative religious coping (i.e., religious struggle) is associated with adverse illness perceptions, and thus may detrimentally impact adaptation to medical illness. These findings deserve replication in prospective studies

Depression in Cancer: the many biobehavioural pathways driving tumor progression

Major Depressive Disorder (MDD) is common among cancer patients, with prevalence rates up to four-times higher than the general population. Depression confers worse outcomes, including non-adherence to treatment and increased mortality in the oncology setting. Advances in the understanding of neurobiological underpinnings of depression have revealed shared biobehavioral mechanisms may contribute to cancer progression. Moreover, psychosocial stressors in cancer promote: (1) inflammation and oxidative/nitrosative stress; (2) a decreased immunosurveillance; and (3) a dysfunctional activation of the autonomic nervous system and of the hypothalamic-pituitary-adrenal axis. Consequently, the prompt recognition of depression among patients with cancer who may benefit of treatment strategies targeting depressive symptoms, cognitive dysfunction, fatigue and sleep disturbances, is a public health priority. Moreover, behavioral strategies aiming at reducing psychological distress and depressive symptoms, including addressing unhealthy diet and life-style choices, as well as physical inactivity and sleep dysfunction, may represent important strategies not only to treat depression, but also to improve wider cancer-related outcomes. Herein, we provide a comprehensive review of the intertwined biobehavioural pathways linking depression to cancer progression. In addition, the clinical implications of these findings are critically reviewed

Relationship of suicide rates with climate and economic variables in Europe during 2000-2012

The derived models explained 62.4 % of the variability of male suicidal rates. Economic variables alone explained 26.9 % and climate variables 37.6 %. For females, the respective figures were 41.7, 11.5 and 28.1 %. Male suicides correlated with high unemployment rate in the frame of high growth rate and high inflation and low GDP per capita, while female suicides correlated negatively with inflation. Both male and female suicides correlated with low temperature. Data from 29 European countries covering the years 2000-2012 and concerning male and female standardized suicidal rates (according to WHO), economic variables (according World Bank) and climate variables were gathered. The statistical analysis included cluster and principal component analysis and categorical regression. It is well known that suicidal rates vary considerably among European countries and the reasons for this are unknown, although several theories have been proposed. The effect of economic variables has been extensively studied but not that of climate. The current study reports that the climatic effect (cold climate) is stronger than the economic one, but both are present. It seems that in Europe suicidality follows the climate/temperature cline which interestingly is not from south to north but from south to north-east. This raises concerns that climate change could lead to an increase in suicide rates. The current study is essentially the first successful attempt to explain the differences across countries in Europe; however, it is an observational analysis based on aggregate data and thus there is a lack of control for confounders. RESULTS METHODS BACKGROUND DISCUSSIO

Psychosocial Factors Affecting the Course of Inflammatory Bowel Disease

Objective: A five year prospective study of 43 patients with Inflammatory Bowel Disease (IBD), 33 with Ulcerative Colitis and 10 with Crohn#39s Disease, was conducted with the purpose to investigate the role of psychosocial factors on the course and outcome of the disease. Methods: Sociodemographic data were collected and the participants were given four psychometric instruments: the Hostility and Direction of Hostility Questionnaire (HDHQ), the Spieberger#39s trait anxiety (STAI-t), the Spieberger#39s state anxiety (STAI-s) and the Center of Epidemiological Studies-Depression Scale (CES-D). After the lapse of five years the patients were allocated to three groups according to the degree of severity of their illness (improvement, stability, deterioration).nbsp Results: Patients with IBD, whose condition was evaluated as deteriorated at the end of the follow-up, had initially given much higher scores on the HDHQ subscale of Paranoid Hostility than those with improvement. Patients whose course of illness showed a deterioration, had given significantly higher scores on CES-D scale, on the initial examination. Married patients who showed improvement had a significantly longer duration of marriage than the rest. Older age at the beginning of the disease was significantly related to the improvement of symptomatology than younger age. Conclusions: Paranoid Hostility and Depressive Symptoms are predictors of more severe course of illness. Married patients with longer duration of marriage had better prognosis. Older patients had better prognosis than younger ones.nbs