Exploring the Effects of Major Depressive Disorder on Daily Occupations and the Impact of Psychotherapy: A Literature Review

Major depressive disorder (MDD) is a prevalent psychological mood disorder that can disrupt one's functioning and result in decreased engagement in daily activities. Psychotherapy, in different approaches, is a common approach for individuals experiencing MDD. Nevertheless, a literature review of the research supporting the effectiveness of psychotherapeutic interventions in patients with MDD-impacted areas of their daily occupations, such as back to work, cognitive deficits, and well-being, has not been conducted. A literature review was carried out to evaluate the effectiveness of psychotherapy on daily occupations for individuals diagnosed with MDD. Due to variations in study design and outcome measures, a best evidence synthesis was carried out instead of a meta-analysis. Forty-one identified articles were fully assessed in total. These studies were conducted in various countries so that a global approach could be considered comprehensive. The findings showed strong evidence supporting the effectiveness of psychotherapy on return-to-work interventions in improving depressive symptoms. There was limited evidence for the effectiveness of psychotherapy on lifestyle interventions in reducing anxiety and suicidal ideation, as well as limited evidence for enhancing work participation. Notably, there were no studies evaluating individualized client-centered psychotherapy interactions with occupations, revealing a research gap. Challenges such as incomplete reporting within studies and study heterogeneity prevented a meta-analysis. While the overall evidence base for the effectiveness of psychotherapy for MDD in treating functionality is limited, the findings provide strong support for the efficacy of occupational therapy return-to-work interventions. This is particularly important given the economic costs associated with mental health issues and work-related absences. Further research is required to strengthen the existing evidence base.

Does the orientation of the styloid process cause Eagle Syndrome? An anatomical study of the styloid process in 72 Greek skulls

<b>Introduction:</b> Patients often suffer from an elongated styloid process. This clinical entity is well known and is described as Eagle syndrome. The presence of this anatomical variation is not always associated with symptoms. However, there is a strong correlation between the elongated styloid process and Eagle syndrome </br></br> <b>Aim:</b> This study aims to calculate the incidence of elongated styloid processes in the Greek population, to analyze the morphometric characteristics of styloid processes, and to compare these among sexes. </br></br> <b>Material and methods:</b> This is a single-center retrospective study. All skulls were donated to the Department of Anatomy, the Ari-stotle University of Thessaloniki from January 2013 to May 2019 for research purposes. A styloid process longer than 30 mm was considered elongated. We used Welch’s t-test for the statistical analysis of the data. </br></br> <b>Results:</b> The prevalence of elongated styloid processes was 35%. The average diameter was 3.32 mm and the average total length was 25.02 mm. There was no statistically significant difference between male and female skulls, though the female styloid processes were slightly longer and the male ones were slightly wider. Symmetry was recorded in 31% of skulls. Average axial angle was 650 but in 4% of cases it was less than 20⁰. </br></br> <b>Conclusions:</b> The elongated styloid process is not a rare entity. Eagle syndrome should always be considered in the differential diagnosis when patients report chronic sore throat. Our anatomical findings add a new dimension to the etiopathogenesis of Eagle syndrome.

Association of Tortuous Common Carotid Artery with Abnormal Distribution of the Ansa Cervicalis: A Case Report

In the current study, we display a rare association of an aberrant innervation of the sternocleidomastoid muscle by the ansa cervicalis (AC) with a tortuous common carotid artery (TCCA). In specific, in a male cadaver we observed on the right side of the cervical region, a nerval branch of remarkable size originating from the most distal part of the AC's superior root and after piercing the superior belly of the omohyoid muscle innervated the distal portion of the sternocleidomastoid muscle. Furthermore, we noticed a tortuous course of the initial part of the right common carotid artery. We discuss the surgical significance of the awareness of AC's variations during neurotisation of the recurrent laryngeal nerve in cases of its damage, as well as the importance of aberrant innervation of the sternocleidomastoid muscle by AC for the preservation of muscle's functionality after accessory nerve's damage. Furthermore, we highlight the fact, that the knowledge of the relatively uncommon variant, such as TCCA is crucial for the physician in order to proceed more effectively in differential diagnosis of a palpable mass of the anterior cervical region or deal with symptoms such as dyspnea, dysphagia or symptoms of cerebrovascular insufficiency.

[The implementation of the law 4509/2017 in the Forensic Department of the Psychiatric Hospital of Thessaloniki]

According to the Explanatory Memorandum of the law 4509/2017, a significant change is being made to the current institutional framework of Articles 69 and 70 of the ECHR concerning the penal treatment of mentally ill offenders, in order to ensure a high level of treatment for perpetrators with mental or intellectual disorder. In application of the law, it was examined in court the abolishment, maintenance or replacement of the treatment measure of 47 patients from the Department of Forensic Psychiatry in Thessaloniki. The results were compared with the previous status quo. In 22 cases, abolishment was ordered for the patients to be discharged and return to their parent's home or to Psychosocial Rehabilitation Units. In 11 of them, their stay was in direct violation of the law due to exceeding the cap as defined by the severity of the offense. However, 7 patients remain voluntarily in the Department, as no beds are available in reintegration structures. 13 patients who have committed homicide remain with the psychiatrist's agreement beyond the overrunning the ten years of treatment due to the severity of the disease or the risk for violent behavior. The Public Prosecutor has provided solutions in many cases and has appointed lawyers for all patients as prescribed by law. However, the judiciary remains cautious and the trend towards exhaustion of the limits is clear, despite the fact that their fears are not confirmed by international bibliographic data. The application of N 4509/2017 attempts to change the landscape for this particular group of patients and allows visions for de-institutionalization, elimination of the stigma and personalized treatment, despite any ambiguities or potential problems that may arise. However, as the predominant social viewpoint, shown by the media, treats the mentally ill as dangerous, any positive changes are doomed to fail. In addition, it is necessary to develop psychiatric services for the treatment of patients which will not only treat psychotic symptoms but also antisocial and aggressive behavior in general.

Iulius Casserius, a relatively underestimated anatomist: his contributions to brain's anatomy

Iulius Casserius is to be remembered for his excellent contributions in Anatomy and especially in Neuroanatomy. His persistent and meticulous scientific anatomical work resulted in the first record of the arterial circle of the brain 37 years before the comprehensive description by Thomas Willis. Casserius' great interest in the human brain led him to the discovery of plenty anatomical structures before their official documentation. Casserius was an excellent teacher and anatomist of a humble origin, who managed to be distinguished among other famous physicians of his era.

Neural Loop by the Median Nerve's Roots Associated with Multiple Neurovascular Anomalies: A Cadaver-based Case Report with Clinical Aspects

The existence of a combination of neural and vascular variations in the axilla and arm region are relatively common. In the current case study, an association of a neural loop by the roots of the left median nerve along with an ipsilateral proximal division of the brachial artery in the upper arm and bilateral communications between the median and musculocutaneous nerves is documented. The morphological features of these abnormalities, along with the clinical implications induced during nerve blocks and surgical interventions in the region, are discussed as well.

Congenital Synostosis of Cervical Vertebrae: An Osteological Study and Review of the Literature

Introduction

The possible appearance of congenital fusion of the second cervical vertebra with adjacent cervical vertebrae, along with its epidemiology, embryological development, and clinical manifestations, was the aim of the current study.

Methods

The osteological material of 93 dried second cervical vertebrae of both sexes were examined in order to identify the likely presence of congenital fusion with the neighboring vertebrae.

Results

Among 93 axes, we identified one case of a congenitally fused second cervical vertebrae with the third and fourth cervical vertebrae, which accounted for a frequency of 1.08%. There was an incomplete fusion of the vertebral bodies and almost complete fusion of the laminae and facet joints.

Conclusion

The knowledge of such rare vertebral synostosis is crucial for the neurosurgeon, orthopedist, and physician dealing with the cervical spine, as well as the anesthetist when performing procedures, such as endotracheal intubation.

Correlation of the Hallux Sesamoids' Orientation with Various Anatomical Parameters in Patients with Hallux Valgus Deformity

Introduction An awareness of the anatomical parameters of the foot such as the position and orientation of the sesamoid bones can be of great value for the etiology and diagnostic approach to patients with hallux valgus (HV). The purpose of this study was to evaluate the basic anatomical features and measurements related to the characteristics of HV in cadaveric material. Materials and methods The study sample included 12 cadaveric limbs with HV and 10 cadaveric limbs without HV as a control group. We measured the HV angle (HVA), the first to second intermetatarsal angle (IMA), and the first to fifth IMAs of all samples. We also recorded the shape of the first metatarsal head and the position/orientation of the sesamoid bones. Results The mean values of the HVA (p = 0.000), the first to second IMA (p = 0.000), and the first to fifth IMA (p = 0.000) differed between the HV and non-HV group. The position of the sesamoid ossicles between the HV and the non-HV group was statistically significant (p = 0.001). While we noted the round shape of the first metatarsal head was predominant in HV samples, we found no statistically significant difference in the first metatarsal head shape between the test and control groups. Conclusion The HVA, the first to second IMA, the first to fifth IMA, and the orientation of the sesamoid ossicles differed significantly between cadaveric samples with HV and those without HV.

Costoclavicular Joint: An Osteological Study on Clavicles with Clinical Relevance

Introduction The current study aims to detect the incidence of occurrence of a morphological variant of the impression for the costoclavicular ligament, that is a faceted apophysis of the clavicle which participates in the formation of an aberrant joint, the so-called costoclavicular joint. Methods A material of 208 dry clavicles, 107 of right and 101 of left side derived from an osteological collection, was examined in order to detect the likely presence of facet apophysis at the clavicular area of impression for the costoclavicular ligament. Results We observed three cases of oval-shaped faceted apophysis, thus an incidence of 1.44%, two in right clavicles and one in left clavicle. Conclusion The awareness of such a rare joint, thus the costoclavicular joint, is important for the physician, since such a joint may be mistaken for occupying space lesion, induce pain when it is osteoarthritic and decrease the costoclavicular space leading to difficulties in subclavian vein catheterization.

The Anatomist James Douglas (1675-1742): His Life and Scientific Work

James Douglas (1675-1742) is considered one of the most important anatomists of the eighteenth century; he introduced meticulous and scientific methods for studying human anatomy. He is known for the “pouch of Douglas,” but his contribution is much more important. He deepened our knowledge of the anatomy of the peritoneum, located new muscles, and evolved the already recorded knowledge in a way that it could be implemented in surgery. Furthermore, he was such a famous obstetrician that even the Pope of his era admired him for his charisma.

A Left-sided Azygos Vein in a Cadaver: Anatomical and Surgical Considerations

Despite the wide-spread knowledge among anatomists and surgeons that the azygos vein lies on the right side of the vertebral column, various scientific works have been conducted which suggest the existence of left-sided azygos veins. The displacement of the vessel seems to be related with aging, due to crossover veins and the development of osteophytes on the thoracic vertebrae. The current case report confirms the variation of the azygos vein’s course, highlights the awareness of the relatively unusual left-sided location of the azygos vein for the surgeon of the region, and underlines the clinical significance of such knowledge to the modern internist-radiologist, general surgeon and thoracic surgeon, as well.

Myocardial bridge over the left anterior descending coronary artery: A case report and review of the literature

Myocardial bridging (MB) is considered as a topic of high interest since its occurrence in different studies is statistically significant, and the clinical manifestations of this phenomenon are complicated with cardiovascular diseases. Whether the MB participates in heart diseases and has a decisive effect to life-threatening situations is still under research, and many studies have been conducted to clarify the abovementioned question. A case report with a MB on the left anterior descending coronary artery is presented in the current study, and a review of the literature is provided as well. Cardiologists as well thoracic surgeons and radiologists should bear in their mind the potential presence of such variant during interpretation of angiographies and multidetector-computed tomography.

Accessory coracobrachialis muscle with two bellies and abnormal insertion - case report

OBJECTIVE

In the current study a brief review is presented of the coracobrachialis muscle's morphological variability, action, embryological development and clinical significance.

CASE REPORT

We report a case of a left-sided coracobrachialis muscle consisting of two bellies. The deep belly inserts into the usual site in the middle area of the anteromedial aspect of the left humerus, whereas the superficial belly inserts through a muscular slip into the brachial fascia and the medial intermuscular septum, forming a musculo-aponeurotic tunnel in the middle region of the left arm, for the passage of the median nerve, brachial artery and veins, medial antebrachial cutaneous nerve and ulnar nerve.

CONCLUSION

Awareness of such a muscle variant should be kept in mind by physicians and surgeons during interpretation of neural and vascular disorders of the upper limb, since such a variant may potentially lead to entrapment neuropathy and/or vascular compression, predisposing to neurovascular disorders, as well as during preparation of that muscle in cases of utilizing it as a graft in reconstruction of defects.

Unusual Origin of a Double Upper Subscapular Nerve from the Suprascapular Nerve and the Posterior Division of the Upper Trunk of the Brachial Plexus: A Case Report

A double upper subscapular nerve on the right side was detected in a male cadaver, with the proximal one arising from the suprascapular nerve and the distal one from the posterior division of the upper trunk of the brachial plexus. Both of them penetrated and supplied the uppermost portion of the right subscapularis muscle. That anatomic variation was associated with a median nerve formed by two lateral roots. The origin and pattern of the upper subscapular nerve displays high variability, however the presented combination of the variable origin of a double upper subscapular nerve has rarely been described in the literature. The knowledge of such an anatomic variation is essential for the surgeon operating in the region especially in instances of brachial plexus' repair after any traumatic injury. Moreover, the awareness of the precise origin and topography of these nerves is important for the physician attempting to block these nerves or utilizing these nerves as grafts for neurotization of adjacent damaged nerves of the brachial plexus.

Correlation between Manchester Grading Scale and American Orthopaedic Foot and Ankle Society Score in Patients with Hallux Valgus

OBJECTIVE

To evaluate the correlation between the Manchester Grading Scale and the American Orthopaedic Foot and Ankle Society (AOFAS) score in patients with a hallux valgus deformity.

SUBJECTS AND METHODS

The study sample included 181 feet of 122 patients with hallux valgus and 424 feet of 212 individuals without hallux valgus deformity as the control group. The severity of hallux valgus, utilizing a relative nonmetric scale, the Manchester Grading Scale, and the metric AOFAS score, was determined for all individuals in the hallux valgus and control groups. SPSS version 18 (Chicago, Ill., USA) was used for data analysis.

RESULTS

According to the Manchester Grading Scale, the 424 feet of the normal group were classified as 'no deformity'. In the hallux valgus group, 85 feet were classified as 'mild deformity', 67 as 'moderate deformity' and 29 as 'severe deformity'. The AOFAS total score in the control group was 99.14. In the hallux valgus group, patients with mild or moderate deformity had total scores of 86.20 and 68.19, respectively. For those with severe hallux valgus, the total score was 44.69 and the differences were statistically significant (p = 0.000). Using the Pearson correlation, strong negative correlations were found between the AOFAS score and the hallux valgus angle (HVA; r = -0.899, p = 0.000). Strong negative correlations were demonstrated between the AOFAS score and the first intermetatarsal angle (IMA) as well (r = -0.748, p = 0.000).

CONCLUSIONS

The AOFAS score was negatively associated with the Manchester Grading Scale, HVA and first IMA. As the severity of hallux valgus increased, the AOFAS score seemed to decrease.

Relationship between pedographic analysis and the Manchester scale in hallux valgus

OBJECTIVE

The aim of this study was to evaluate the correlation between the Manchester scale and foot pressure distribution in patients with hallux valgus deformity.

METHODS

The study included 152 feet of 87 patients with hallux valgus and a control group of 391 feet of 241 individuals without hallux valgus deformity. The severity of hallux valgus was determined using the Manchester scale grading system. Plantar loading patterns in 10 foot areas were determined for all participants.

RESULTS

According to the Manchester scale, 72% of the participants had no, 12.9% mild, 10.7% moderate and 4.4% severe deformity. The Manchester scale grade was highly correlated with both hallux valgus angle and first intermetatarsal angle (p=0.00). Significant differences between the four grades were present for mean pressure under the hallux and the first and second metatarsal heads only (p=0.00). The load distribution under these areas was higher as the hallux valgus progressed from mild to more severe. In all groups, the highest pressure was observed under the second metatarsal head.

CONCLUSION

The Manchester scale was strongly associated with both the hallux valgus angle and the first intermetatarsal angle. The progression from mild to moderate and severe deformation is associated with peak pressure raise at the hallux, first and second metatarsal heads. The Manchester scale appears to be a useful tool to provide information for the degree of deformity and the pressure under painful foot areas.

Uterine artery embolization for treatment of symptomatic fibroids; a single institution experience

BACKGROUND

Uterine fibroids are the most common reproductive tract tumours in females. Uterine artery embolization (UAE) is a fertility-sparing procedure for treatment of symptomatic fibroids. We evaluated the efficacy and safety of UAE in the treatment of 118 patients with symptomatic uterine fibroids in a single Academic Centre in the West of Ireland to determine whether fibroid and uterine size affect clinical outcomes and complications.

METHODS

This was a retrospective cohort of 118 patients who underwent UAE for treatment of symptomatic fibroids between November 2006 and August 2011. Diagnosis of fibroids in symptomatic patients was established by magnetic resonance imaging (MRI) and/or transabdominal ultrasonography (US). Three different embolic agents were used. All patients had at least one follow-up using MRI, at three and/or 12 months. A non-validated questionnaire was used to report patient satisfaction with regards to symptoms improvement on a yes-or-no basis.

RESULTS

Mean fibroid volume, uterine size and dominant fibroid size were significantly reduced at three months and one year follow-up (p = 0.00) and that was tallied with symptoms improvement (p < 0.05). Overall patient satisfaction at three months was 84% falling to 75.9% by 12 months (all p < 0.05). Few complications were reported (2.5%). No significant difference was observed in safety or efficacy for different embolic agents.

CONCLUSION

The study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids. Hippokratia 2014; 18 (3): 258-261.

Morphological study of the calcaneofibular ligament in cadavers

The aim of the present study was to investigate the anatomical and morphological characteristics and the maximum elongation of the calcaneofibular ligament (CFL) in cadavers. In a sample of 72 cadaveric lower limbs the mean values of length, width, thickness, and angle with the sagittal plane were recorded for the CFL. The mean ligament's length was 31.8 mm, and the mean width and thickness were 4.4 mm and 1.5 mm respectively. The mean angle with the sagittal plane was 51.11°. In 72.2% of the lower limbs studied, the ligament presented one band, while 22.2% and 5.6% of them were two-banded and three-banded respectively. A common origin with the anterior talofibular ligament (TFL) was found in 24 of the feet (33%). There were also 4 cases in which the anterior TFL was absent. Finally, we measured the maximal elongation of the ligament during extreme inversion and simultaneous dorsal flexion and found it to be 2.88 mm on average. We noticed and statistically verified that women presented a greater elongation compared to men. A precise knowledge of the origin, insertion, direction, and morphology of CFL is critical for ligament injuries in ankle sprains and during ankle reconstruction. Ligament elasticity plays an important role in the range of ankle motion and ligament shearing. Male and female ankle joints differ in several anthropometric characteristics and thus the genre differences in ligament elongation are of great interest.

Signs and symptoms of temporomandibular joint disorders related to the degree of mouth opening and hearing loss

Background

The temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD) have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss.

Methods

The study involved 464 healthy Greek university students (156 men and 308 women) with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests.

Results

The overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 < 0.05). The number of aural symptoms was associated to the TMD severity (p-value 0.0001 < 0.05) as well as maximum mouth opening (p-value 0.004 < 0.05). Audiometry showed that moderate and severe TMD was associated with hearing loss of median and low tones respectively (p-value 0.0001 < 0.05). TMJ pain (p-value 0.0001 < 0.05), TMJ ankylosis (p-value 0.0001 < 0.05), bruxism (p-value 0.0001 < 0.05) and ear itching (p-value 0.0001 < 0.05) were also found to be statistically different between TMD and non-TMD subjects.

Conclusions

TMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.

Clinical study of the factors affecting radioulnar deviation of the wrist joint

Background

The radioulnar carpal joint is critical for hand and wrist function. Radioulnar deviation indicates distal radioulnar joint flexibility and reflects the structure and function of the carpal bones, ulna, radius and ligaments. The present study examined whether radioulnar deviation is affected by gender, manual labor, playing a musical instrument, playing sport, handedness, previous fracture or prior inflammation. The study used clinical findings based on anatomical landmarks

Methods

The ulnar, radial and total deviations for both left and right hands were measured in 300 subjects (157 men and 143 women) of mean age 21.7 years. Measurements were made with the forearm in a fixed pronated position using a novel specially designed goniometer. The gender of each subject was recorded, and information on playing of sport, playing a musical instrument, manual labor, handedness, and history of fracture or inflammation was sought. Data were analyzed using a multifactor ANOVA test.

Results

No statistically significant difference (p-value > 0.05) was found between those comparing groups except the total deviation of athletes' left hand versus the total deviation of non athletes' left hand (p-value 0.041 < 0.05) and the radial deviation of manual workers' left hand and non manual workers' left hand (p-value 0.002 < 0.05).

Conclusions

This study was based on clinical findings using anatomical landmarks. We found that manual workers and athletes showed greater left hand flexibility. This suggests that activities that place chronic stress on the radiocarpal joint can independently affect radioulnar deviation.