Psychosocial Impact, Perceived Stress Levels and their Learning Effect among the Undergraduate Dental Students during the Transition from Preclinicals to Clinicals: A Questionnaire-based Cross-sectional Study

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• Objective: to specify the frequency and pattern of mental disorders in patients with rheumatoid arthritis (RA) and their association with a number of demographic parameters, stressors, inflammatory activity, duration of RA and its therapy, pain, and concomitant cardiovascular diseases (CVD).Subject and methods. One hundred and sixteen patients with verified RA were examined; 86% were women with a median age of 50 years (range, 41 to 55 years) and a median RA duration of 94.5 months (range, 45 to 228 months). Disease activity was assessed using the DAS 28 scoring system; the Brief Pain Inventory (BPI) was used for pain assessment. CVD was diagnosed by a cardiologist applying echocardiography, Doppler ultrasound, and 24-hour and blood pressure monitoring. Mental disorders were identified by a psychiatrist in accordance with ICD-10, by employing a number of psychiatric and psychological scales.Results. Mental disorders were found in 86% of the patients. There was a preponderance (85%) of anxiety-depressive spectrum disorders (ADSD): depressive episode (37%), including that within recurrent depressive disorder (19%); dysthymia (23%); adjustment disorders (16%); and generalized anxiety disorder (9%). Moderate cognitive impairment was revealed in 52% of the patients with ADSD. Schizophrenia was detected in 1%; 76 % of the RA patients had sleep disorders; 63 and 52% reported a stressful event at the onset of RA or before its exacerbation, respectively. The patients with ADSD did not differ from those without ADSD in age, gender, disease duration and activity, but they had more frequently aseptic bone necroses (ABN), X-ray stage IV, Class III functional insufficiency (FI), higher severity index and HAQ index. The patients with ADSD experienced stronger pain (p < 0.05). They took glucocorticoids for a shorter time (p < 0.05). Basic anti-inflammatory drugs were taken by the patients with and without ADSD at a similar frequency, but the patients with ADSD received methotrexate less often. ADSD was more common in patients with RA and CVD (angina pectoris, atherosclerosis, acute cerebrovascular insufficiency). Conclusion. Mental disorders with a predominance of ADSD are typical of the majority of patients with RA. Stressful events often precede the onset of RA and its exacerbation. The incidence of ADSD does not depend on age, gender, and disease duration and activity, but correlates with joint destructive changes (ABN and X-ray stage IV), pain intensity, FI, severity index and HAQ, less aggressive therapy for RA, and CVD.
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