Prodromou, Maria

Background:Dual diagnosis is a special case of psychiatric comorbidity in which the drug dependent patient also qualifies for other than dependence co-occurring mental health disorder. This old term is still maintained in bibliography in order to underline the difficulties in treating these patients. Dual diagnosis was found to negatively affect prognosis in patients with drug dependence. Nowadays, the treatment model for dual diagnosis has transformed its focus, from treating each disorder in independent setting to providing integrating care in one setting. The aim of this study was to explore whether dual diagnosis is related with worse prognosis than simple drug dependence, even when integrative care is provided. Methods: Fourty-five consecutive patients (30 males, mean age 27.5 ± 6.7, 15 females, mean age 26.4 ± 4.1), 16 of them were dually diagnosed, were admitted to a therapeutic community inspired, abstinence oriented, relapse prevention and rehabilitation program. Integrative care was provided in the sense that both diagnoses were managed by the same multidisciplinary team. Retention in the treatment was used as the endpoint for comparisons. Results: By using time-to-event analysis differences revealed in time to relapse between the group of dually diagnosed and the group with drug-dependence only. (Log Rank Mantel-Cox test shown Chi-Square: 4.52, df=1, p<.05). Univariate and multivariate Cox-regression analysis was conducted and did not show any significant effects of gender, age, multiple-drug dependence, on time to relapse. Conclusion: This study adds evidence to the fact that drug dependent patients with a comorbid mental health disorder show worse prognosis. Treating these dually diagnosed populations according to the integrative care model seems to have advantages in comparison to the previous model of treating each disorder in independent settings, namely a relapse prevention and rehabilitation program and an inpatient or outpatient mental health clinic. Despite these advantages, our findings underline the fact that dual diagnosis is still characterised by a higher relapse rate, even when treatment is provided according to a modern, integrative care model.

Introduction: The acquisition of patients' satisfaction is a definitive factor for the right function of the healthcare system and for that healthcare professionals should recognize and satisfy the needs that arise. Disease contributes an extra burden to patient, that creates insecurity for his/her future, and consequently stress, and in some cases even depression. Purpose: The purpose of this paper was to investigate patients with acute or chronic cardiological disease satisfaction levels with the provided health care in relation to their stress and depression levels. Material and Method: The sample consisted of 153 patients with acute or chronic cardiological disease hospitalised in General Hospital "ppokrateio" of Athens and it was collected during the period 07/2016 to 10/2016. Data collection was performed using the "Hospital Anxiety and Depression Scale (HADS)", as well as the Kristjandottir's questionnaire, modified and adjusted to the hospitalised patients’ needs. Significance level was set at 5%. All statistical analyses were performed using the SPSS statistical package version 22 and the t-test, anova, and Pearson correlation tests were used. Results: Most of the participants (62.1%) were men. 47.7% were experiencing normal stress levels, 19,0% low levels, 20,9% medium levels and 12,4% high stress levels. Depression levels were 49.7%, 17.0%, 20.9% and 21.4%, respectively. There were found positive correlations among satisfaction dimentions, (p<0.001), and negative correlations between them and stress (p=0.002), or depression (p<0.001) levels. Men experienced higher stress (p=0.029) and depression (p=0.050) levels, and, as well as older patients, (p<0.001), lonely patients (p=0.006 and p=0.004 respectively), patients whose children were over 25 years old, (p<0.001), patients of first or second grade education background (p<0.001), and patients with another health problem (p=0.026 and p=0.004 respectively). Older patients stated that they received less support (p=0.008), security (p=0,001), and overall satisfaction (p=0,030). The unmarried, divorced and widowed felt less secure (p=0,027), while primary and secondary education level patients had lower satisfaction levels (p=0.024). The same group had less support, (p=0.005), felt less secure, (p=0.002), and had lower overall score at the satisfaction scale (p=0.040). Pensioners, patients occupied with the household and unemployed patients received less support (p=0.036). Conclusions: The satisfaction of hospitalised patients’ needs seems to be directly related to stress and depression's intensity. Moreover, the satisfaction of their needs is affected by socio-demographic factors, as well as clinical ones.