RESEARCH PERFORMED BY PROF. THOMAS HYPHANTIS (updated: 2014)

Alcohol and Substance abuse by Greek Adolescents
My research started in 1984, at the Department of Pharmacology, Medical School University of Ioannina, Greece, in collaboration with the Department of Psychiatry, where I earned my doctorate after receiving a scholarship from the Sector of Social Medicine and Mental Health. The research project included a sample of 7904 high school students and indicated that Greek adolescents had already developed, patterns of alcohol and substance use to a significant degree; factors associated to substance abuse were also identified. The results of the study were reported to the relevant institutions, to the National Centre of Social Research and to the media and our presentation received an award at the 17th National Medical Conference.

Neurosciences and Psychopharmacology
During my collaboration with the Department of Pharmacology I had the chance to do research on Psychopharmacology and Neurosciences. Those studies focused initially on the analysis of behavioural patterns as a result of the use of psychostimulants (amphetamine, caffeine, cocaine) investigating mainly whether the behavioural patterns differed depending on the administered substance. The presentation of our work at an International Conference resulted in the invitation by the Editors of the prestigious Neuroscience and Biobehavioral Reviews Journal to submit our work for publication to the journal.
Subsequently I focused on the study of the individual differences at a basic level, investigating the individual differences of animals during their adaptation in a new environment and their responses to psychostimulants. These studies indicated that the animals could be differentiated into “high” and “low responders”, according to their responses mainly in their motor activity. Following the same rationale the research continues focusing currently on the study of these individual differences and their relationship with the dopaminergic reward systems as well as on the relationship of the two phenotypes with the cannabinoid receptors, which may contribute to the development of new medications that can be useful in the management of substance abuse including nicotine.
Our previous findings prompted us to attempt to combine basic with clinical research in Psychosomatic Medicine and to investigate whether potential individual differences among patients were related with the development of symptoms (psychiatric or physical) or with treatment. Our research on the respective human profile (“high” and “low seekers”) indicated that pre-existing individual differences related to the reward system could explain the very important clinical differences between patients with Crohn’s Disease and Ulcerative Colitis regarding their smoking habits, a finding which may contribute to the better management of the patients.
The study of individual differences could be also related with the development of severe psychiatric disorders such as psychosis in conjunction with substance use as well as with the possible individual differences at a genetic level. The research team co-ordinated by the Department of Pharmacology and in collaboration with the newly established Early Intervention in First Episode of Psychosis Service continues the study on the patients with a First Episode of Psychosis aiming to investigate the individual differences at a genetic and a behavioural level.
My collaboration with the Departments of Psychiatry and Pharmacology of the Federal University of Ceara, Fortaleza, Brazil broadened my research in Neurosciences and Psychopharmacology by expanding the research on the use of substances of abuse and on the investigation of new substances for the treatment of severe mental disorders, with encouraging results.

Translation and Validation of Psychometric Questionnaires for use within the Greek Population
My psychodynamically oriented clinical work and research and the need for valid tools for the study of individual differences among the Greek population resulted in the translation into Greek and the validation of three psychometric questionnaires: The Defense Style Questionnaire (DSQ), the Life Style Index – (LSI) (both assessing ego defense mechanisms) and the Zuckerman-Kulman Personality Questionnaire (ZKPQ), which investigates the factors related to the individual differences pertinent to the reward systems (impulsivity – sensation seeking). We used the questionnaires in various research. Recently I was invited by Prof. Aluja, Professor of Psychiatry, University of Lleida, Catalonia, Spain, to participate in the trans-cultural validation of the Zuckerman-Kulman-Aluja Personality Questionnaire.
Furthermore, our research team translated and validated for use in Greek patients with Rheumatologic Disorders, in the context of a doctorate thesis, the widely used Patient Health Questionnaire-9 (PHQ-9), which assesses the degree and severity of depressive symptoms based on the DSM-IV criteria. It is the first validation study of the PHQ-9 for use in rheumatologic patients worldwide. This project is ongoing, aiming to further investigate the validity of the questionnaire in diagnosing depression in patients with epilepsy (in collaboration with the Department of Neurology of the University of Ioannina) and in patients with Diabetes and COPD (in collaboration with the A&E Department of the University Hospital of Ioannina, in the context of the funded project Aristeia). Finally we are currently working on the validation of the Patient Health Questionnaire-15 (PHQ-15).

Psychosomatic Medicine
My research in Psychosomatic Medicine started in 1991 in Athens in collaboration with the Nephrology Department of the Hippokratio General Teaching Hospital and the Gastroenterology Department of the General Hospital of Nicaea, Greece. These studies investigated the indicators of psychiatric morbidity in patients with Inflammatory Bowel Disease, and they were also an initial attempt to investigate the way in which the underlying Ego Defence Mechanisms are associated with various parameters of physical illnesses or with parameters of the treatment such as the choice of the treatment modality in Kidney Failure or the compliance with treatment in patients with Diabetes. These projects resulted in invitations to various gastroenterological conferences, while I was also invited by the Association of Patients with Inflammatory Bowel Disease to give lectures and provide individual and group therapy to its members.
After my appointment at the University of Ioannina as Assistant Professor I continued and further developed my research on Psychosomatic Medicine. My ongoing research that focuses on the relationship between personality, psychiatric disorders and physical illness has resulted so far in interesting findings such as: The burden and the characteristics of Greek families with children with chronic neurological conditions or with neurocardiogenic syncope, the psychological dimensions of genetic endocrinological disorders, the role of psychological factors in the adherence with treatment of patients with glaucoma , as well as the role of personality in the emergence of psychiatric symptoms in multiple sclerosis. The latter project was the topic of two master’s degrees and resulted in invitation to participate in activities of the Society of Friends of Patients with Multiple Sclerosis of Ioannina, Greece giving lectures and providing counselling to patients. These initial research projects facilitated the establishment of productive collaborations with most of the departments of our Hospital, the establishment of our C-L Unit and the development of larger and more focused research projects.

1. «Autoimmune Rheumatic Diseases»
The research on the Autoimmune Rheumatic Diseases which is carried out in collaboration with the Rheumatology Department of the University Hospital of Ioannina focuses on the role of psychological distress, illness perceptions and personality in the outcome of these diseases and also on the investigation of moderators of the outcomes in a large sample of patients with rheumatic diseases. This prospective research project was funded by the Greek Rheumatology Association and in its context 7 master’s degrees and 2 doctorate theses were carried out under my supervision while another thesis is currently in progress. The research on Rheumatic disorders is also part of the funded project Aristeia.

2. «Gastrointestinal Diseases»
The research on Gastrointestinal disorders was conducted in collaboration with 3 departments:
Α. With the Psychiatry Research Group, University of Manchester (Professor Francis Creed and Professor Elspeth Guthrie). We assessed the effectiveness of Psychodynamic Interpersonal Psychotherapy in patients with Irritable Bowel Syndrome with a Randomized Controlled Trial which showed that this particular type of psychotherapy is effective in the improvement of the outcome of the disorder as well as in the improvement of the patient’s interpersonal relationships.
Β. With the Hepato-Gastroenterology Department of our Hospital. In the context of 2 master’s degrees we showed that psychological distress and defence mechanisms contribute to the formation of the Health Related Quality of Life of patients with Inflammatory Bowel Disease.
Γ. With the Department of Pharmacology of the University of Ioannina. So far our research has showed that the related to the ‘reward’ behaviour differentiates Ulcerative Colitis patients from patients with Crohn’s disease, findings which may lead to research on the effectiveness of various treatments for smoking cessation in patients with Crohn’s disease.

3. «Cancer»
In collaboration with the Department of Oncology of the University of Ioannina, we investigate prospectively the factors associated with the risk of developing psychiatric symptoms and the way these factors and personality traits are related to the Quality of Life in patients with Colorectal Cancer , Breast Cancer or Cancer of Unknown Primary Site. In the context of this project a doctorate thesis was defended under my supervision, another one is currently in progress while another one is currently carried out in collaboration with the Faculty of Nursing, University of Manitoba, Winnipeg, Canada, on the information needs and participation in decision making of patients with breast cancer. Initial findings have showed that Greek women with breast cancer adopt a passive approach to treatment decision making.

4. «Nephrology»
Both previous projects in collaboration with the Hippokratio Hospital of the University of Athens, Greece, and more recent projects with the Psychiatry and Pharmacology Departments of the Federal University of Ceara, Fortaleza, Brazil, have contributed to the understanding of the role of personality and defensive profile of patients with kidney failure in the patients’ treatment preferences (haemodialysis or peritoneal dialysis) and also in their Quality of Life.

5. «Postnatal Depression»
This research was carried out in collaboration with the Obstetric Department and the Department of Pharmacology of the Medical School, Ioannina, Greece, in 400 postpartum women, under my leadership and was funded by PENED programme, 2003. The study aimed to investigate the prevalence of postnatal depression and the biological and related to neurotransmitters risk factors as well as psychosocial and related to personality risk factors. A doctorate thesis on this topic was defended under my supervision and currently we are preparing the results for publication.

6. «Psychosomatic Medicine in Children»
This project is conducted in collaboration with the Paediatric and Cardiology Departments of our Hospital and our findings underline the burden and the specific characteristics of Greek families with children with chronic neurological conditions. We also conducted the first study worldwide on the relationship between depressive symptomatology and neurogardiogenic syncope in children, a well established relationship in adults which had not been investigated in paediatric populations. A doctorate thesis is conducted on this topic under my supervision.

My research in Psychosomatic Medicine resulted recently in being invited to participate in the European Association for Somatisation and Medically Unexplained Symptoms (EURASMUS).

Development of New Theories
The re-analysis of the data of the aforementioned studies led to inferences which provide a preliminary but important empirical establishment of hypotheses which may point toward the development of new theories regarding the meaning of the disease or regarding new definitions or new personality traits. My research indicates that autoimmune diseases may be the equivalent of depression (invited oral presentation at the 19th Hellenic Conference of Psychiatry), that ‘somatization’ is not merely present in patients with functional illnesses but also in patients with physical diseases, playing an important role in the outcome and that the ‘Narcissistic Rage’ evoked by a physical illness is a crucial predictive factor of outcome in physical illnesses. Currently in collaboration with the Department of Oncology of our Hospital and the Psychiatry Department of the University of Fortaleza, Ceara, Brazil, we are working on the development of a scale measuring Narcissistic rage in patients with breast cancer.
The recent ongoing projects in collaboration with the Federal University of Ceara, Fortaleza, Brazil and the Faculdade de Biociencias e de Medicina, Pontıficia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil, which include a large sample of 10,000 participants from the general population, investigated the impact of inherent factors of personality (temperaments) and of factors which are formed during the developmental phases of the lifespan (defense mechanisms) in the formation of psychopathology, focusing on the emergence of depressive symptoms. This is an important new finding since it is an empirical base for the study of the interaction of the ‘substrate’ with the ‘environment’, an interaction that may contribute to the development of psychopathology.

Research on Health Services, Social Psychiatry, Community Psychiatry

1. Factors associated with the Frequent Use of Accident and Emergency Departments.
This is the research project “Applying effective and beneficial strategies to reduce unscheduled and urgent visits of patients with chronic physical illnesses to Accident and Emergency Departments” funded by the Ministry of Education and the European Union in the context of the programme ‘ARISTEIA’ (Excellence) which has started in September 2012.
Patients with chronic physical illnesses often seek help out of hours ie in the evening or in weekends. This project aims to understand the need for this unscheduled visits and to assess whether these needs can be reduced with the development of more comprehensive models of scheduled care. The project will investigate the research questions in 3 phases. During Phase 1 we will collect data from approximately 1200 patients with 3 chronic physical diseases: diabetes, rheumatic diseases and COPD in order to define which of these patients seek unscheduled care during 12 months. During Phase 2 we will develop a clinical prediction rule in order to identify patients who frequently seek unscheduled care. We will interview the patients and their families, in an attempt to understand why patients and families/carers seek unscheduled care. During Phase 3 we will introduce a new intervention which will be developed during Phases 1&2 aiming to help patients cope better with their illness. This project’s goal is to prove that the appropriate management of psychological difficulties of patients with chronic physical illinesses may lead to the reduction of the need for unscheduled care in the Greek A&E Departments.

2. Community Mental Health Services
I started my research on the effectiveness of community mental health services in 1989, while being a head psychiatrist in the Mobile Mental Health Unit of Fokis, Greece. In the recent years, as head of the Mobile Unit of the prefectures of Ioannina and Thesprotia, Greece, I continued investigating the effectiveness of these services. A doctorate thesis is currently carried out under my supervision.

3. Prevention
Regarding prevention, I focused on the factors contributing to the burnout syndrome in various groups of health professionals (Hyphantis T. and V. Mavreas: “«Burning-In» – «Burning-Out» In Public: Aspects of the Burnout Process in Community-Based Psychiatric Services”, In: Antoniou, A.-S. and Cooper, C.L. (Eds.), Research Companion to Organizational Health Psychology, Northampton, MA, USA: Edward Elgar, 2005), on factors which increase work-related risks factors of contamination by H. Pylori in the staff of a General Hospital and on the role that the worry of the staff of a General Hospital about the Η1Ν1 infection plays on psychological distress.