Konstantinos Bonotis

Rheumatic diseases (RDs) significantly impact patients' physical, psychological, and social well-being, yet psychological dimensions remain inadequately addressed in routine clinical practice. In this commentary, we examine psychological manifestations and mental health comorbidities in RDs, such as systemic lupus erythematosus, systemic sclerosis, Sjögren's disease, vasculitis, rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, axial spondyloarthritis, osteoarthritis, and fibromyalgia. Patients demonstrate high rates of depression (up to 90% lifetime prevalence), anxiety (18-65%), sleep disturbances (19-90%), chronic fatigue (31-89%), and alexithymia (25-59%). The prevalence of anxiety and depression is nearly double in RDs compared to the general population, whereas health-related quality of life is inferior to that in chronic conditions. These manifestations are bidirectionally linked to disease activity, pain intensity, and functional impairment. We propose the utilization of psychorheumatology, integrating psychological assessment, targeted interventions, and coordinated care between rheumatologists and mental health professionals.

This study aims to evaluate perceived social support (SS) in inpatients with mental disorders, its association with sociodemographic and clinical characteristics, and its impact on hospitalization patterns, highlighting the importance of evaluating and enhancing SS. This hospital-based study, using a cross-sectional design, was conducted at the Psychiatric Clinic of University Hospital Larissa, Greece and included 280 consecutive admitted patients. SS was assessed with short form social support questionnaire SSQ-6, and sociodemographic and clinical characteristics were examined along with possibility of reentry during a 32-month period. Most respondents reported low SS levels, with significant differences in SS quantity across diagnostic categories. Sociodemographic factors, including age, work status, housing conditions, medical insurance and the number of cohabitants, were significantly associated with both SS quantity and satisfaction. Clinical factors, including diagnosis, illness duration and prior admissions also showed significant associations with both dimensions of SS. Multivariate analysis identified increasing age, urbanicity, homelessness, retirement, and unemployment as independent risk factors for lower SS quantity, while cohabitation and affective disorder diagnoses were protective factors. Regarding SS satisfaction, homelessness, retirement, and prolonged illness duration, emerged as risk factors, while medical adherence was protective. Notably, SS quantity was marginally negatively associated with involuntary type of admission. Low SS significantly increased the likelihood of readmission during the 32- month follow-up period. The study highlights the critical role of assessing and enhancing SS in hospitalized patients with mental disorders. Sociodemographic and clinical factors significantly influence SS, with poor SS contributing to a higher risk of involuntary admission and increased readmission likelihood.

This article has been corrected to disclose a financial relationship between the author, Konstantinos Bonotis, and Recordati, a pharmaceutical company which manufactures cariprazine. Konstantinos Bonotis served as an advisory board member for Recordati in December, 2022. As a result, an honorarium was awarded to the University of Thessaly's Research Committee.

Objectives The aim of study was to evaluate the quality of life (QOL) across different diagnostic categories in inpatients with severe mental illness (SMI) and examine its associations with sociodemographic, illness-related characteristics, and perceived social support. Methods A cross-sectional study was conducted. A total of 280 patients, consecutively admitted, were recruited in the Adult Psychiatric Department of the University Hospital Larissa, Larisa, Greece. QOL and social support were measured using the World Health Organization Quality of Life - BREF (WHOQOL-BREF) and the Social Support Questionnaire - Short Form (SSQ-6) scales, along with sociodemographic and clinical data. Results The social relationships domain of the WHOQOL-BREF received the lowest score across all diagnoses. Significant differences in QOL were noted based on the type of admission, though not by diagnosis. Women reported significantly worse physical (-0.90, p=0.019), mental (-1.02, p=0.020), and overall QOL (-1.09, p=0.035) compared to men. Age was significantly associated with environmental (-0.03, p=0.016) and overall QOL (-0.05, p=0.014). Homelessness was linked to poorer QOL in social (-2.42, p=0.040) and environmental domains (-2.16, p=0.020). Urbanicity (1.09, p=0.041) and retirement (-1.48, p=0.031) were also significant factors for global QOL. Social support satisfaction had a significant positive association with the social relationship dimension (0.06, p=0.022), while the support network had a marginal effect (0.05, p=0.080). Outpatient monitoring was significantly associated with the mental health dimension (-0.94, p=0.032). Multiple regression analyses indicated that gender, marital status, age, work status, number of cohabitants, type of residence, and social support were significantly associated with global and specific QOL dimensions. Conclusions This study explores the QOL in inpatients with SMI, admitted both involuntarily and voluntarily, emphasizing the impact of sociodemographic, clinical factors, and perceived social support. Key predictors of QOL include female gender, homelessness, retirement, and perceived social support. Routine QOL assessments combined with gender- specific and social support interventions are essential for improving patient outcome.

This report presents a case of particular interest in terms of course and therapeutic outcomes, concerning a patient suffering from treatment-resistant depression in whom adjunctive cariprazine to medication brought about an immediate overall improvement in symptomatology. Informed written consent was obtained from the subject for publication of the case.

The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammatory (SII) index, which provide a simple, rapid, inexpensive method to measure the level of inflammation, have been examined as potential inflammatory biomarkers of bipolar disorder (BD) in several studies. We conducted a case-control study recruiting 180 BD patients and 407 healthy controls. BD patients who met the inclusion criteria and were hospitalized due to BD at the psychiatry clinic of the University General Hospital of Larisa, Greece, until September 2021 were included in the study. Among them, 111 patients experienced a manic episode and 69 patients experienced a depressive episode. Data including a complete blood count were retrieved from their first admission to the hospital. Bipolar patients had a higher NLR, MLR and SII index compared to healthy controls when they were experiencing a manic episode (p < 0.001) and a depressive episode (p < 0.001). MLR was increased with large effect size only in patients expressing manic episodes. Neutrophils and NLR had the highest area under the curve with a cutoff of 4.38 and 2.15 in the ROC curve, respectively. Gender-related differences were mainly observed in the SII index, with males who were expressing manic episodes and females expressing depressive episodes having an increased index compared to healthy controls. The NLR, MLR and SII index were significantly higher in patients with BD than in healthy controls, which implies a higher grade of inflammation in BD patients.

The present study is a Dance Movement Psychotherapy (DMP) pilot intervention designed to address the psychological challenges faced by Greek breast cancer patients, after surgery and around radiotherapy treatment. It was designed as a 12 weeks’ project, involving patients of diverse age and educational level, mostly living in rural areas. The personality and psychopathology inventory Symptoms’ Check List-90 (SCL-90), the therapist’s records and video self-observation were used in a mixed method approach. Thirteen subjects initiated the study, but they were gradually reduced and only four completed it. Statistical analysis was performed using SPSS-25 addressing this fact. Positive results of qualitative interpretation of the therapist’s data and SCL-90, as well as changes in movement patterns and self-perception evaluated via video self-observation, showed that the intervention was beneficial for the patients who completed it. However, the fact that not all the participants were able to finish the program, implies that although DMT intervention at an early stage can help some patients deal with strong emotions, careful evaluation of eligible individuals should precede. Besides the patients’ medical condition, demographic and personality characteristics should be considered in the design of future similar studies.

Background: The primary goal of this study is to estimate the pattern of hospital discharges throughout Greece due to mental disorders between 1999 and 2012. Methods: Data for discharges were obtained from the Hellenic Statistical Authority. A sex- and age-adjusted proportional hospitalization ratio (PHR) was used to estimate the ratio between the hospitalizations in each prefecture and the overall hospitalizations. Additionally, age-adjusted admission rates and hospitalization days were calculated for each sex. Descriptive and time series analysis were conducted to understand the epidemiological characteristics and to investigate the trend of annual PHR, respectively. Correlation between disorders and sociodemographic characteristics was also tested. Global and local spatial analysis was conducted to assess the spatial homogeneity of disorders and to detect any clusters of similar values. Results: More males (55%) were hospitalized. Schizophrenic and other psychoses were stated as the primary diagnosis of discharges (54.3%) for mental disorders, contributing to the highest annual mean number of hospitalization-days for male (296.9) and female patients (341.0). Most patients were out of the workforce, and most patients with drug dependence (74.5%) and schizophrenia and other psychoses (55.9%) remained unmarried. Higher PHRs were discovered in the north, while schizophrenic and other psychoses (R = 0.492), affective psychoses (R = 0.534), senile and presenile organic psychotic conditions (R = 0.543) were correlated with alcohol consumption (p < 0.001). Conclusions: The study provides evidence of geographical variation of discharges due to mental disorders and a significant association between disorders and alcohol consumption, marriage status and absence of the workforce.

Excessive intake of sugars and energy from drinks has been postulated to increase the risk of obesity, which may in turn be associated with mental health disorders. In addition, excessive intakes of alcohol and caffeine may co-occur with psychiatric disorders. The purpose of the present pilot study was to estimate energy, sugar, caffeine, and alcohol intakes through the consumption of drinks in patients with schizophrenia and affective disorders and assess potential differences in drink consumption between the two disorders. The current study included 89 outpatients with schizophrenia (n = 36) and affective disorders (n = 53) attending the psychiatric clinic of the University General Hospital of Larissa (UGHL) in Greece. In addition to anthropometric measurements, the patients were asked to complete a specific, previously validated questionnaire on the frequency of drink consumption in order to estimate sugar, caffeine, and alcohol intakes. The participants had a mean body mass index (BMI) of 28.9 ± 5.6 kg/m2 without significant differences between the two types of mental disorders. Similarly, the mean waist circumference (102.6 ± 15.7 cm) and mean body fat percentage (32.9% ± 10.8%) were above the recommended values. The total energy intake from drinks was more than a third of the estimated daily energy requirements. Although there was no significant difference in the mean daily caffeine intake, those with affective disorders had a significantly higher intake of sugars from drinks (median (Mdn) = 80.0 (interquartile range (IQR) = 89.8) g/day) and alcohol (Mdn = 45.6 (IQR = 31.1) g/day), compared to those with schizophrenia (Mdn = 60.0 (IQR = 45.4) g/day and Mdn = 24.9 (IQR = 19.8) g/day, respectively). Considering the link between high sugar and alcohol intake with excess body weight and mental health, these preliminary data are of particular concern and point to the need for better dietary counseling in order to improve the dietary behaviors of these patients.