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Highlights • Adolescents facing national entrance university exams experience high levels of depressive and anxiety symptoms. • Anxiety and depressive symptoms increased during the COVID-19 lockdown. • Distress experienced during the lockdown predicts the severity of anxiety and depression symptoms. • Targeted interventions are imperative to address the needs of young people in future waves of pandemic., The two-year preparation for the National university entrance exams in Greece is one of the most trying periods in a young person's life, physically and emotionally. The present study reports the results from 442 last year senior high school students who completed an online survey (16-30 April 2020) concerning the lockdown impact on their mental health. Overall, the rate of positive screen for depression (PHQ-9 score ≥ 11) significantly increased from 48.5% to 63.8% and of those scoring within severe depression range (PHQ-9 ≥20) from 10% to 27%; for anxiety (GAD-7 score ≥ 11) increased from 23.8% to 49.5% and of those scoring within severe anxiety range (GAD-7≥17) from 3.8% to 20.5%. After taking sex and baseline (one month prior to the lockdown) levels of depression and anxiety into account, the level of lockdown experienced distress was predictive of depression and anxiety levels in time of home confinement, accounting for about 30% of variance in symptoms severity scores. Although our results may be subject to sampling and recall bias, the unexpectedly high rates of anxiety and depression warrant an urgent call to action aiming at mitigating and managing mental health risks of senior high school students in future waves of pandemic.

Research on how children with neurodevelopmental disorders perceive, process, and interpret visual illusions (VIs) has been extensively focused on children with autism spectrum disorder providing controversial findings. In this study, we investigated the patterns of vulnerability to a wide set of VIs comprising 23 standard text book VIs and their variations in a clinical sample of children with neurodevelopmental disorders compared to typically developing children (TD). A total of 176 children, aged between 4.6 and 13.8 years old, were distributed into four groups: high-functioning autism (HFA; N = 23), attention-deficit/hyperactivity disorder (ADHD; N = 42), specific learning disorder (SLD; N = 70), and TD (N = 41). Regression models, adjusted for sex, age, and non-verbal IQ, showed that HFA was associated with greater responses accuracy than TD children to the full battery of VIs, to the cognitive illusions, to the distortions, and to both geometrical illusions of size/shape (cognitive distortions) and lightness contrast effects (physical distortions). The susceptibility of ADHD children was found attenuated for illusory contours and greater for paradoxical illusions in comparison with TD children. No significant differences were shown between the SLD group and the TD children. Our findings, which were adjusted for the same duration of visual working memory across groups, showed that there is a potential specific tendency of HFA children to failure of processing visual information in context. Contrarily, children with ADHD showed in general normal global processing such as children diagnosed with SLD.

There is evidence that children with neurodevelopmental disorders may exhibit atypical responses to stress and alterations in concentrations and diurnal secretion of stress hormones. We assessed diurnal profiles and stress responses of salivary cortisol and alpha-amylase (sAA) in children with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and specific learning disorder (SLD) compared to typically developing children (TD). A total of 157 children of both sexes, aged between 6 and 12 years old, took part in the study distributed into four groups: ADHD (N = 34), ASD (N = 56), SLD (N = 43) and TD (N = 24). Salivary samples were collected at three time points during a day, as well as before and 5 min after an academic performance test and a moral cognition task. ADHD children had lower evening and diurnal sAA levels, adjusted for age. Also, ASD children showed lower diurnal sAA secretion, adjusted for age. The mean percentage change for salivary cortisol and sAA after both tests did not differ between the groups. In conclusion, we demonstrated alterations in diurnal autonomic functioning in children with ADHD and ASD, while hypothalamic-pituitary-adrenal axis functioning did not differ between the clinical and the comparison groups.

A recent special education legislation reform in Greece puts emphasis on the inclusion of pupils with special educational needs into mainstream schools. The purpose of the present study was to investigate knowledge of ASD among 67 mainstream nursery and primary classroom teachers, and evaluate the effectiveness of a half-day ASD awareness seminar in increasing their knowledge of the disorder. A self-report ASD Knowledge Questionnaire (ASD-KQ), developed for the purpose of this study, was used before and after the ASD awareness seminar. The results indicated a significant shift from low to moderate/high level of ASD knowledge among teachers with no previous training in special education and/or autism (58.7%), whereas this shift did not reach significance level in the teacher’s group with previous training (16.7%) after the seminar. The present findings have important implications for the development of training programmes of practising teachers.

Background: Psoriasis is a chronic, inflammatory, relapsing skin disease that has a psychosocial impact on the patients' life. Objective: This study aimed to investigate psychopathology in patients with psoriasis based on a valid psychometric instrument, as well as on the relationship between psychopathology and alexithymia. Methods: 108 patients with psoriasis were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R) and alexithymia with the Toronto Alexithymia Scale (TAS-20). Disease severity was clinically assessed using the Psoriasis Area and Severity Index. Results: As regards the psychopathological dimensions, female patients presented with statistically significant higher somatization, depression, anxiety, phobic anxiety, and psychoticism than males. Patients with alexithymia presented with statistically significant higher somatization, interpersonal sensitivity, anxiety, and phobic anxiety than non-alexithymic patients. Alexithymia positively correlated with somatization (r = 0.26, p < 0.01), interpersonal sensitivity (r = 0.24, p < 0.05), depression (r = 0.27, p < 0.01), anxiety (r = 0.26, p < 0.01), and phobic anxiety (r = 0.26, p < 0.01). In addition, alexithymia also contributed to the prediction of these conditions. Study Limitations: A larger study sample could yield safer generalized results. Nevertheless, to the best of our knowledge, this was the first study to investigate various psychopathological dimensions in patients with psoriasis. Conclusions: Our study results indicate that alexithymia and female sex were associated with several psychopathological dimensions in patients with psoriasis. It may be suggested that alexithymia constitutes an important factor in the development of mental disorders among patients with psoriasis.

This study aimed to examine the psychometric properties of Beck Hopelessness Scale (BHS) in Greek patients with a recent suicide attempt, the predictive ability of BHS especially in terms of age and the possible effect of the financial crisis on hopelessness as it has been identified as a significant suicide risk factor. The study included a total of 510 individuals, citizens of Athens, Greece. Three hundred and forty individuals (170 attempted suicide patients, and 170 -age and gender- matched healthy individuals used as controls) completed BHS before the financial crisis onset (from 2009 to 2010). A sample of 170 healthy individuals also completed the BHS after the financial crisis onset (from 2013 to 2014), when the impact of the austerity measures was being felt by the Greek society. The Greek BHS version demonstrated good psychometric properties and a sufficient degree of internal consistency. Attempted suicide patients (M = 9) presented higher hopelessness than the controls (M = 3). The patients' age positively correlated with hopelessness (r

Background: Hidradenitis suppurativa (HS) is a long-term skin disorder associated with high levels of psychological distress and significant life impact. Objective: To evaluate the quality of life, depression, anxiety, loneliness, and self-esteem in patients with HS. Methods: Ninety-four patients with HS were enrolled in the study. The quality of life, depression, anxiety, loneliness, and self-esteem of the patients were assessed using the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), the UCLA Loneliness Scale (UCLA-Version 3), and the Rosenberg Self-Esteem Scale (RSES), respectively. Results: The DLQI mean score was 11.43 ± 6.61 in patients with HS. The patients with HS presented statistically significantly higher anxiety (6.41 ± 3.31 vs. 5.00 ± 1.59, p < 0.001), depression (5.45 ± 2.79 vs. 4.16 ± 1.54, p < 0.001), and loneliness and social isolation scores (42.86 ± 8.63 vs. 35.57 ± 6.17, p < 0.001) and lower self-esteem scores (18.91 ± 1.79 vs. 19.77 ± 2.53, p = 0.008) than the healthy controls. Conclusions: HS is a distressing, recurrent disease that impairs quality of life. We can suggest services that allow an integrated approach, which includes psychosocial support, offering the patients relief from isolation and an opportunity to share common experiences.

Zusammenfassung Hintergrund Die Alopezie ist eine haufige dermatologische Erkrankung mit zumeist kosmetischen Folgen, jedoch einem wesentlichen psychologischen und psychosozialen Einfluss. Ziel Vergleichende Erhebung des Einflusses einer vernarbenden und einer nicht-vernarbenden Alopezie auf die Lebensqualitat und verschiedene psychologische Bereiche bei erwachsenen Griechinnen. Patientinnen und Methoden Vierundvierzig Frauen im Alter zwischen 18 und 70 Jahren mit vernarbender (n = 19) oder nicht-vernarbender (n = 25) Alopezie wurden eingeschlossen. Bei allen Patientinnen wurden der Dermatologische Lebensqualitatsindex (Dermatology Life Quality Index, DLQI), die Hospital Anxiety and Depression Scale (HADS), die Rosenberg Self-esteem Scale (RSES) und die UCLA Loneliness Scale (UCLA-LS) erhoben. Ergebnisse Frauen mit vernarbender Alopezie hatten hohere DLQI-, HADS- und UCLA-LS-Werte und niedrigere RSES-Werte im Vergleich zu Frauen mit nicht-vernarbender Alopezie. Statistisch signifikante Unterschiede zwischen den Gruppen bestanden bei DLQI (p = 0,0067), HADS (p = 0,0008) und den HADS-Angst (HADS-A) (p < 0,05) sowie HADS-Depression (HADS-D) (p < 0,01) – Subskalen. Schlussfolgerungen Bei vernarbender Alopezie ist die psychologische Belastung der Patientinnen schwerer und die Lebensqualitat starker eingeschrankt als bei nicht-vernarbender Alopezie, was wahrscheinlich die schlechtere Prognose der vernarbenden Alopezie widerspiegelt.

Summary Background Alopecia is a common dermatological condition with mostly cosmetic consequences that, nevertheless, has significant psychological and psychosocial impact. Objective To assess the impact of alopecia on quality of life and certain psychological domains and to compare it between scarring and non-scarring alopecia in Greek adult women. Patients and methods Forty-four women, aged 18–70 years, with scarring (n = 19) or non-scarring alopecia (n = 25) were recruited. All patients were evaluated by Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-esteem Scale (RSES) and UCLA Loneliness Scale (UCLA-LS). Results Women with scarring alopecia had higher scores in DLQI, HADS and UCLA- LS and lower scores in RSES, compared to women with non-scarring alopecia. A statistically significant difference between the two groups was documented for DLQI (p = 0.0067), HADS (p = 0.0008), and HADS-Anxiety (HADS-A) (p < 0.05) and HADS-Depression (HADS-D) (p < 0.01) subscales. Conclusions The psychological burden is heavier and quality of life is more severely impaired among women with scarring alopecia compared with non-scarring alopecia, probably depicting the poorer prognosis of the former.

Attention deficit hyperactivity disorder (ADHD) is a neurobiological disorder, which affects about 5.2% of school-aged children worldwide. Children with ADHD present teachers with a special challenge, since they interfere with teaching process and do not respond to typical classroom management techniques. In order to meet this challenge teachers must have accurate, up-to-date, information about the disorder so that they can respond to the needs of the student with ADHD. Studies that have examined teachers' beliefs and knowledge relating to ADHD highlighted the need for providing training to increase Greek teachers' knowledge and understanding of the disorder. Thus, the aims of the present study were: (a) to develop and evaluate brief ADHD training seminar for teachers; and (b) to investigate whether the training format (half-day versus two-day seminar) would have a differential effect on teachers' knowledge about ADHD. A total of 143 teachers formed the two sample groups; Group 1 (n=68) attended a half-day training (5 hours), and Group 2 (n=75) a two-day training (18 hours). Seminar topics included: (a) gaining basic knowledge about the symptoms, causes and natural history of ADHD, (b) understanding the key underlying cognitive deficits of the disorder and their impact on learning and behavior, (c) implementation of specific learning strategies for children with ADHD, (d) benefits and limitations of existing treatment approaches including the pharmacological treatment, and (e) available instruments for teachers that could inform their decision to refer the student to CAMHS for an assessment. A self-report ADHD Knowledge Questionnaire (ADHD-KQ), which covers four domains (clinical presentation, causes, cognitive deficits, interventions) was developed for the purpose of the present study, and was administered pre- and post-seminar. Teachers were generally knowledgeable about clinical presentation of ADHD, with more than 80% of the sample responding correctly to items pertaining to core symptoms. The internal consistency of the total ADHD-KQ scale measured by Cronbach's alpha coefficient was found to be good (0.89). The alpha coefficients for the sub-scales were acceptable (0.70 for the Symptoms/Diagnosis sub-scale, 0.73 for the Cognitive Deficits sub-scale, and 0.75 for the Intervention sub-scale), except for the Causes sub-scale, which was poor (0.59). In addition, each of the sub-scales showed a significant correlation with the total scales score (range r=0.66 to r=0.79), and there also was significant correlation between the four sub-scales (range r=0.39 to r=0.45). As expected, gaps in knowledge were identified, particularly in the area of causes, pharmacological treatment and cognitive deficits associated with ADHD. The results, using paired samples t tests, showed a highly significant increase in ADHD-KQ total and all sub-scale scores in both groups (p

Background: Bullous pemphigoid (BP) is a chronic, autoimmune blistering skin disease that affects patients' daily life and psychosocial well-being. Objective: The aim of the study was to evaluate the quality of life, anxiety, depression and loneliness in BP patients. Methods: Fifty-seven BP patients and fifty-seven healthy controls were recruited for the study. The quality of life of each patient was assessed using the Dermatology Life Quality Index (DLQI) scale. Moreover, they were evaluated for anxiety and depression according to the Hospital Anxiety Depression Scale (HADS-scale), while loneliness was measured through the Loneliness Scale-Version 3 (UCLA) scale. Results: The mean DLQI score was 9.45±3.34. Statistically significant differences on the HADS total scale and in HADS-depression subscale (p=0.015 and p=0.002, respectively) were documented. No statistically significant difference was found between the two groups on the HADS-anxiety subscale. Furthermore, significantly higher scores were recorded on the UCLA Scale compared with healthy volunteers (p=0.003). Conclusion: BP had a significant impact on quality of life and the psychological status of patients, probably due to the appearance of unattractive lesions on the skin, functional problems and disease chronicity.

Alopecia is a common dermatological condition with mostly cosmetic consequences that, nevertheless, has significant psychological and psychosocial impact.To assess the impact of alopecia on quality of life and certain psychological domains and to compare it between scarring and non-scarring alopecia in Greek adult women.Forty-four women, aged 18-70 years, with scarring (n = 19) or non-scarring alopecia (n = 25) were recruited. All patients were evaluated by Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-esteem Scale (RSES) and UCLA Loneliness Scale (UCLA-LS).Women with scarring alopecia had higher scores in DLQI, HADS and UCLA- LS and lower scores in RSES, compared to women with non-scarring alopecia. A statistically significant difference between the two groups was documented for DLQI (p = 0.0067), HADS (p = 0.0008), and HADS-Anxiety (HADS-A) (p0.05) and HADS-Depression (HADS-D) (p0.01) subscales.The psychological burden is heavier and quality of life is more severely impaired among women with scarring alopecia compared with non-scarring alopecia, probably depicting the poorer prognosis of the former.

Background: Alexithymia, the difficulty in describing or recognizing emotions, has been associated with various psychosomatic pathologies including psoriasis. The aim of this study was to examine the prevalence of alexithymia and its association with anxiety and depression in patients with psoriasis compared with healthy participants, while taking into consideration demographic and clinical variables. Methods: One hundred and eight psoriatic patients and 100 healthy participants from the general population completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale (HADS). The severity of patients’ psoriasis was clinically assessed using the Psoriasis Area and Severity Index (PASI). Results: Psoriatic patients had higher levels of alexithymia compared with healthy participants. While a rather high rate of psoriatic patients presented anxiety and depression as defined by the HADS, the differences that were found in comparison with the control group were not significant. Neither alexithymia nor its dimensions, difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally oriented thinking (EOT), were associated with gender or psoriasis severity. Age was associated only with EOT, which was independent of depression and anxiety. Higher anxiety and depression were connected with higher alexithymia and DIF, while higher anxiety with higher DDF as well. Conclusions: The alexithymia prevalence was higher in psoriatic patients than that in healthy participants, while it was positively correlated with anxiety and depression. Difficulty in identifying feelings was connected with both anxiety and depression, whereas difficulty in describing them was only with anxiety. Finally, externally oriented thinking was predicted only from age.

BackgroundType D personality has been associated with a variety of emotional and social difficulties as well as with poor prognosis in patients with established coronary heart disease (CHD). We examined the psychometric properties and validity of the Type D Scale-14 (DS14) and the prevalence of Type D personality among Greek patients with CHD while taking into account demographic; clinical, such as diabetes mellitus, hypertension, and hypercholesterolemia; as well as psychological variables such as depression, anxiety, and psychological stress.MethodsNinety-six patients with stable coronary heart disease and 80 healthy participants from the general population completed the Greek version of the DS14 and the Hospital Anxiety and Depression Scale (HADS).ResultsCronbach's α coefficient for the negative affectivity (NA) and social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88 and 0.76 for the control group, respectively. Internal-structural validity was assessed by a factor analysis (two-factor solution), and the factor structure of the original DS14 was replicated. Using the standardized cutoff point of NA ≥10 and SI ≥10, instead of the median scores, in order to have compatible results with the majority of studies, the prevalence of Type D personality was 51% for the CHD patients and 13% for the control group. Higher NA and SI were connected with higher anxiety, depression, and total psychological stress. Finally, more patients with CHD and Type D personality than those without were diagnosed with type 2 diabetes; however, no differences were observed in hypertension or hypercholesterolemia.ConclusionsThese results indicate that the Type D construct is reliable and valid in a Greek population. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in people from the general population. The DS14 subscales were positively correlated with higher anxiety, depression, and total psychological stress. Regarding other CHD risk factors, only diabetes mellitus was found more frequently in CHD patients with Type D personality.Keywords: Coronary heart disease, Type D personality, DS14, Validity, HADS

IntroductionChronic prostatitis has been long considered a psychosomatic illness. We have previously studied alexithymic and obsessive-compulsive features in chronic prostatitis patients.AimsTo evaluate introverted, extroverted and total hostility in patients with chronic prostatitis.MethodsPatients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated with the Hostility and Direction of Hostility Questionnaire (HDHQ), a questionnaire with 5 subscales designed to assess total hostility or punitiveness and direction of hostility. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.Results82 patients (median age 37.5 yrs old; IQR 30-45.5 yrs) were evaluated. According to the NIH Prostatitis Classification patients were categorized as type II: 45.1%, IIIa: 9.7%, IIIb: 39%, IV: 2.4%. Median CPSI score was 19.5 (IQR: 14.5-24.3). Median introverted, extroverted and total hostility scores were 3 (IQR: 2-6), 9 (IQR: 7-13) and 13 (IQR: 9-18) respectively. Results from the Extroverted Hostility HDHQ subscale correlated (r squared = −0.25, p = 0.024) with subscales of the TAS (Toronto Alexithymia Scale). These results were independent of CPSI scores.ConclusionsChronic prostatitis patients’ total hostility scores are similar to those of the general population reported by other studies. However, chronic prostatiitis patients show more outward directed hostility. The relationship between TAS subscale scores and measures of extroverted hostility needs further elucidation. Patients with chronic prostatitis are potentially at risk for psychiatric disturbances and thus may need psychiatric counseling and therapy.

ObjectiveChronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet. The present study aims to assess alexithymia, hypochondriasis and obsessive-compulsive symptoms in patients with chronic prostatitis.MethodsPatients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated for the presence of alexithymia, hypochondriasis and obsessive compulsive symptoms using respectively the following psychometric tools: Toronto Alexithymia Scale (TAS), Whiteley Index (WI) and Leyton Obsessional Inventory (LOI). Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.Results57 patients (median age 40 yrs old; IQR 32-51.5 yrs) have been evaluated so far. Median CPSI score was 18 (IQR: 13-24). Median TAS score was 44 (39-57), median LOI score was 13 (10-15) and median WI score was 28 (22-38). An abnormal LOI score indicative of obsessive-compulsive features was noted in 58% of patients and an abnormal WI score indicative of hypochondriacal beliefs in 45%. CPSI strongly correlated with TAS score (r=0.57, p=0.007).ConclusionHigh rates of alexithymia, obsessive compulsive symptoms and hypochondriasis are present in chronic prostatitis patients. Alexithymic features were strongly correlated with quality of life measures such as the CPSI. These findings necessitate further elucidation and suggest that patients with chronic prostatitis may need psychiatric counseling and therapy.

Background:Chronic prostatitis has been long considered a psychosomatic illness, however the psychological profile of patients suffering from it, has not been fully elucidated yet.Methods:Patients diagnosed with chronic prostatitis at a tertiary care ID clinic are evaluated for the presence of alexithymia, with the use of the Toronto Alexithymia Scale, as part of a prospective cohort. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category. Association of psychiatric symptoms with prostatitis category was performed.Results:Preliminary results are reported for 30 patients (median age 43 years old; IQR= 36-52). According to the NIH Prostatitis Classification System patients were categorized as type II : 48.2%, type IIIa: 6.9 %, type IIIb: 38%, type IV: 6.9%. Median CPSI score was 16 (IQR: 11-25). Abnormal TAS score was noted in 72% of the population. Specifically, 90% had high scores in external orientation of emotions, 25% in identification of emotions and 38% showed reduced expression of emotions. It is of notice, that mean TAS scores were significantly higher in type IIIa prostatitis cases (p=0.002, ANOVA).Conclusions:High rates of alexithymia were noted in prostatitis subjects especially in type IIIa cases. These findings need further prospective evaluation.