Publications by authors named "Andrea Pozza"

63 Publications

Non-intimate Relationships and Psychopathic Interpersonal and Affective Deficits as Risk Factors for Criminal Career: A Comparison Between Sex Offenders and Other Offenders.

Front Psychol 2021 24;12:600370. Epub 2021 Aug 24.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.

Sex-offenders are at risk of criminal recidivism. For the treatment to be truly effective, it must be individualized. For this purpose, an accurate assessment should focus on criminological, psychological, and psychopathological features. The present study compared sex offenders with other offenders on historical experiences (i.e., problems with violence, anti-social behaviors, problems with personal relationships, problems with substance use, traumatic experiences, and parenting style). In addition, given the association between life events and psychopathy, we explored whether the relation between life events and crime type (sexual crime vs. other types of crime) might be moderated by psychopathy traits (interpersonal and affective deficits and antisocial behavior). Eighty-eight sex offenders (76% of whom child molesters) and 102 other offenders were included. The Historical, Clinical and Risk Management - 20 item Version 3 (HCR-20V3) and Psychopathy Checklist-Revised (PCL-R) were administered. The scores of the HCR-20V3 Historical scale items were computed to assess life events. The scores of the PCL-R factors, F1 Interpersonal affective deficits and F2 Antisocial behavior, were recorded. The presence of a history of problems with non-intimate relationships was the only significant risk factor for sexual crime compared with other crimes. Interpersonal and affective deficits provided an increased likelihood of being sex offenders as compared with other offenders when problems with non-intimate relationships were possibly/partially or certainly present.
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http://dx.doi.org/10.3389/fpsyg.2021.600370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8421521PMC
August 2021

DSM-5 personality trait facets amongst child molesters: an exploratory comparison with other types of offenders.

BMC Psychol 2021 Aug 6;9(1):117. Epub 2021 Aug 6.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Mario Bracci 16, 53100, Siena, Italy.

Background: DSM-5 provided a dimensional model of personality disorders which may be more clinically informative for the assessment and management of prisoners than a categorical one, as diagnoses of personality disorders alone cannot explain the type of violence. The role of DSM-5 personality facets is however understudied in child molesters, and no study compared these clinical features between individuals who have committed sex crime against children and those who have committed other types of crime. The present study compared DSM-5 personality trait facets between prisoners who had committed sex crime against children, prisoners who had committed property crime (i.e., robbery, fraud) and those who had committed crime against the person (i.e., homicide, assault or violence not implying a sexual element). A further aim was to explore which facets were associated with sex crime against children as compared with the other types of crime, controlling for socio-demographics (age, gender), psychiatric comorbidity (presence of any psychiatric diagnoses) and general psychopathy traits.

Methods: One hundred sixty-seven prisoners participated (91 had committed sex crime against children, 25 property crime, and 51 committed a crime against the person) and completed the Personality Inventory for the DSM-5 and the Psychopathy Checklist-Revised.

Results: Prisoners who had committed sex crime against children reported higher Restricted Affectivity traits than those who had committed property crime and crime against the person and higher Irresponsibility traits than those who had committed property crime. The results of a multinomial logistic regression analysis showed that on the one hand being a man, having a higher age, and the presence of a psychiatric comorbidity were more likely to be related to sex crime than property crime, on the other hand higher Irresponsibility personality traits, being a man, and the presence of a psychiatric comorbidity were more likely to be related to sex crime against children than crime against the person.

Conclusions: The Irresponsibility facet might be specific to child molesters and can differentiate this group from offenders who have committed other crime types. This facet might be considered a key target of a tailored assessment and treatment planning during clinical practice with child molesters.
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http://dx.doi.org/10.1186/s40359-021-00619-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349104PMC
August 2021

Compulsive Hoarding Symptoms and the Role of Mindfulness Skills During Social Distancing for the COVID-19 Pandemic: An Exploratory Survey.

Front Psychiatry 2021 14;12:634454. Epub 2021 Jun 14.

Department of Health Sciences, University of Florence, Florence, Italy.

People reporting compulsive hoarding symptoms (CHS) have lower mindfulness skills than those without such symptoms. Mindfulness skills can have the role of a protective buffer against stressful periods. The quarantine imposed to contain the COVID-19 spread had a negative impact on daily habits and healthy behaviors (including social interactions). An increased attachment to objects might be one of the under-recognized psychological consequences of these difficult times, yet no study focused on CHS. Through an online survey in men who were on quarantine during the pandemic, this exploratory survey examined the prevalence of men reporting CHS during this period and explored the role of mindfulness skills on CHS controlling for anxious-depressive/stress symptoms. Forty-three men from the general population completed the Obsessive Compulsive Inventory-Revised (OCI-R), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) and Depression Anxiety Stress Scales-21 (DASS-21). Twenty-eight percent reported CHS. No differences on the scores of the questionnaires emerged between men with and without CHS, except on CAMS-R Attention scores. In a logistic regression analysis lower CAMS-R Attention scores predicted CHS (β = -0.34, = 0.03). This is the first, yet preliminary investigation on CHS during quarantine. The prevalence of CHS appears higher than the rates (4%) reported in the last years before the COVID-19 outbreak. Perhaps people showed more intense hoarding tendencies during quarantine/social distancing, and this pattern should be monitored. Larger samples, longitudinal designs and clinician-rated instruments are needed to support or not our findings.
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http://dx.doi.org/10.3389/fpsyt.2021.634454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236584PMC
June 2021

Lifetime evolution of ADHD treatment.

J Neural Transm (Vienna) 2021 Jul 15;128(7):1085-1098. Epub 2021 May 15.

Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, Pisa, Italy.

Attention-deficit hyperactivity disorder (ADHD), has been traditionally considered a neurodevelopmental disorder affecting children and adolescents characterized by inattention, hyperactivity, disruptive behavior, and impulsivity. Although still debated, it is evident that ADHD is also present in adulthood, but this diagnosis is rarely carried out, mainly for the frequent comorbidity with other psychiatric and/or substance abuse disorders. Given the need to shed more light on the pharmacological treatment of ADHD, we performed a naturalistic review to review and comment on the available literature of ADHD treatment across the lifespan. Indeed, stimulants are endowed of a prompt efficacy and safety, whilst non-stimulants, although requiring some weeks to be fully effective, are useful when a substance abuse history is detected. In any case, the pharmacological management of ADHD appears to be still largely influenced by the individual experience of the clinicians. Further longitudinal studies with a careful and detailed characterization of participants across different phases of the lifespan are also required to provide relevant confirmations (or denials) regarding pharmacological treatments amongst the different age groups.
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http://dx.doi.org/10.1007/s00702-021-02336-wDOI Listing
July 2021

Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder.

Psychiatry Res 2021 06 31;300:113916. Epub 2021 Mar 31.

University of Siena, Department of Medical Sciences, Surgery and Neurosciences, Italy.

Mourning is a coping-with-loss stage that prevents grief from becoming pathologic, i.e., complicated grief (CG) syndrome and persistent complex bereavement disorder (PCBD), recently included in international classification systems. During the COVID-19 pandemic, to contain virus spread, several countries adopted/adopt the prohibition of mourning rituals (funeral ceremonies/visiting to cemeteries), so that people were/are unable to give their hospitalized relatives the latest goodbye. Such measures can lead vulnerable individuals to develop CG and PCBD. We critically discuss literature-based risk factors for and protective resources against the onset of these conditions since the start of the pandemic and analyze prevention strategies to inform public health programs.
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http://dx.doi.org/10.1016/j.psychres.2021.113916DOI Listing
June 2021

Is Mindfulness-Based Stress Reduction Effective for People with Hypertension? A Systematic Review and Meta-Analysis of 30 Years of Evidence.

Int J Environ Res Public Health 2021 03 11;18(6). Epub 2021 Mar 11.

Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56126 Pisa, Italy.

: Hypertension is among the most important risk factors for cardiovascular diseases, which are considered high mortality risk medical conditions. To date, several studies have reported positive effects of mindfulness-based stress reduction (MBSR) interventions on physical and psychological well-being in other medical conditions, but no meta-analysis on MBSR programs for hypertension has been conducted. Objectives: The objective of this study was to determine the effectiveness of MBSR programs for hypertension. : A systematic review and meta-analysis of randomized controlled trials examining the effects of MBSR on systolic and diastolic blood pressure (BP), anxiety, depression, and perceived stress in people with hypertension or pre-hypertension was conducted. The PubMed/MEDLINE and PsycINFO databases were searched in November 2020 to identify relevant studies. : Six studies were included. The comparison of MBSR versus control conditions on diastolic BP was associated with a statistically significant mean effect size favoring MBSR over control conditions ( = -2.029; 95% confidence interval (CI): -3.676 to -0.383, = 0.016, = 6; 22 effect sizes overall), without evidence of heterogeneity ( = 0.000%). The comparison of MBSR versus control conditions on systolic BP was associated with a mean effect size which was statistically significant only at a marginal level ( = -3.894; 95% CI: -7.736-0.053, = 0.047, = 6; 22 effect sizes overall), without evidence of high heterogeneity ( = 20.772%). The higher the proportion of participants on antihypertensive medications was, the larger the effects of MBSR were on systolic BP ( = -0.750, = -2.73, = 0.003). : MBSR seems to be a promising intervention, particularly effective on the reduction of diastolic BP. More well-conducted trials are required.
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http://dx.doi.org/10.3390/ijerph18062882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000213PMC
March 2021

Obsessive-Compulsive Personality Disorder Co-occurring in Individuals with Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis.

Harv Rev Psychiatry 2021 Mar-Apr 01;29(2):95-107

From the Department of Medical Sciences, Surgery and Neurosciences, University of Siena (Dr. Pozza and Profs. Ferretti and Coluccia); University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry (Prof. Starcevic); Emergency and Urgency Department, Azienda USL Toscana Sud Est (Dr. Pedani); Oncological Immunotherapy Unit (Dr. Crispino), Postoperative Intensive Care Unit (Dr. Governi), Interventional Radiology Unit (Dr. Luchi), and Cardiology Unit (Dr. Gallorini), Santa Maria alle Scotte University Hospital of Siena; SU/UCT MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University (Prof. Lochner).

Learning Objectives: After participating in this activity, learners should be better able to:• Assess the rates of co-occurring obsessive-compulsive personality disorder (OCPD) in patients with obsessive-compulsive disorder (OCD)• Identify characteristics related to OCD with co-occurring OCPD.

Abstract: The current literature discloses discrepant findings regarding the rates of co-occurring obsessive-compulsive personality disorder (OCPD) in patients with obsessive-compulsive disorder (OCD). In addition, it is not clear which characteristics are related specifically to OCD with co-occurring OCPD. We conducted the first systematic review and meta-analysis of the studies of the prevalence of OCPD in patients with OCD. We also investigated potential moderators of the prevalence, including OCD severity, age of onset of OCD, sex, current age, methodological quality, and publication date of the studies. Electronic databases and gray literature were searched by two independent reviewers. A PRISMA systematic review with a random-effect meta-analysis was conducted. Thirty-four studies were included. A significant mean effect size of 0.25 without publication bias indicated that OCPD was present in 25% of patients with OCD, suggesting that the two conditions are distinct clinical entities. This prevalence was higher than the rates found in the literature for any other personality disorders among OCD patients. OCPD that occurs in the context of OCD was more likely to be present in males and to be characterized by a later age of onset of OCD, older age at assessment, and less severe OCD symptoms. Clinicians should consider these findings when assessing and planning treatment of OCD with co-occurring OCPD.
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http://dx.doi.org/10.1097/HRP.0000000000000287DOI Listing
March 2021

A Pilot Study of Gender Differences in Sexual Arousal of Patients With OCD: The Moderator Roles of Attachment and Contamination Symptoms.

Front Psychiatry 2020 10;11:609989. Epub 2021 Feb 10.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.

Sexual arousal is often impaired in patients with obsessive-compulsive disorder (OCD). However, little is known about the factors related to this impairment: no study focused on the role of gender-based effects of attachment styles and contamination symptoms. The Dual Control Model assumes three processes driving sexual arousal: sexual excitation (SE), sexual inhibition (SI) due to threat of performance failure, and SI due to threat of performance consequences (e.g., getting contaminated with sexually transmitted diseases). In a group of OCD patients, we hypothesized that (a) women report lower SE and higher SI than men; (b) patients with insecure (both anxious and avoidant) attachment styles show lower SE and higher SI; (c) attachment styles moderate the relation between gender and sexual arousal (respectively, for women, higher attachment anxiety, and for men higher attachment avoidance were related to impaired sexual arousal (higher SE and SI) controlling for OCD severity); and (d) contamination symptoms moderate the relation between gender and sexual impairment (women with contamination symptoms show impaired sexual arousal). Seventy-two OCD patients (37.50% women) completed the Obsessive-Compulsive Inventory-Revised, Attachment Styles Questionnaire and Sexual Inhibition/Sexual Excitation Scales. In contrast with our hypotheses, women reported higher SE and lower SI due to threat of performance consequences than men. Patients with higher attachment avoidance (discomfort with intimacy) but also confidence in self and others had higher SE. Women with attachment avoidance (i.e., discomfort with intimacy) had lower SE, while women with attachment anxiety (i.e., preoccupations with relationships) had higher SI due to negative performance consequences. Women with contamination symptoms had higher SI due to performance failure but lower SI due to performance consequences. The present preliminary findings suggest that sexual arousal impairment should be evaluated during the assessment of OCD patients, and gender-based effects of attachment styles and contamination symptoms should be considered during personalized treatment planning.
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http://dx.doi.org/10.3389/fpsyt.2020.609989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902707PMC
February 2021

Internalized psychopathology dimensions in middle childhood: Cross-sectional and temporal associations.

J Anxiety Disord 2020 12 4;76:102300. Epub 2020 Sep 4.

Department of Health Sciences, University of Florence, Florence, Italy.

Background: Anxiety, depression, and obsessive-compulsive symptoms often onset during middle childhood and are major causes of disability in young individuals. A better understanding of how these symptoms are linked and unfold over time is important to develop valid etiological models and effective prevention and treatment.

Methods: In the present study, 950 community children (8-14 years) reported on a broad range of internalised symptoms at three time points over the course of a year. First, factor analysis was used to examine the overarching dimensions of these symptoms. Second, network analysis was used to examine unique cross-sectional associations among these empirically supported symptom dimensions. Last, longitudinal structural equation models (SEMs) were used to examine temporal associations among the symptom dimensions.

Results: Six broad symptom dimensions fitted the self-report data well at all time points. These dimensions were conceptualized as depression, general anxiety, situational fears, compulsivity, intrusive thoughts, and somatic anxiety. Network analysis showed that these dimensions formed a highly interconnected network with general anxiety and somatic anxiety being most central (i.e., most strongly associated with other dimensions) at all time points. Longitudinal SEMs supported the central role played by general anxiety in the temporal associations among these dimensions.

Conclusions: Overarching expressions of internalized psychopathology are highly interconnected in middle childhood with possible central roles played by general and somatic anxiety. Interventions aimed at a general proneness for anxiety may be warranted in preventing and treating internalizing symptoms in middle childhood.
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http://dx.doi.org/10.1016/j.janxdis.2020.102300DOI Listing
December 2020

Anxiety sensitivity dimensions in young individuals with at-risk-mental states.

Res Psychother 2020 May 20;23(1):431. Epub 2020 May 20.

Department of Health Sciences, University of Florence, Florence, Italy.

Anxiety Sensitivity (AS) is a transdiagnostic risk factor involved in the development and maintenance of different psychopathological conditions including anxiety disorders and psychosis. It consists of Physical Concerns (., the belief that palpitations lead to a cardiac arrest), Social Concerns (the belief that observable anxiety reactions will elicit social rejection), and Cognitive Concerns (the belief that cognitive difficulties lead to mental incapacitation). No study investigated whether specific AS dimensions are related to At-Risk Mental States (ARMS). This study compared AS dimensions between young individuals with ARMS, patients after a recently occurred First-Episode Psychosis (FEP) and matched community controls. Based on models of ARMS and previous evidence, it was hypothesized that ARMS individuals have higher physical, social and cognitive concerns than FEP patients and controls. Thirty individuals with ARMS and 30 with FEP and 30 controls recruited from the general population completed the Anxiety Sensitivity Index-3 (ASI-3) and Penn State Worry Questionnaire. ARMS and FEP individuals had higher scores than controls on ASI-3 Cognitive Concerns [ = 11.48, <.001]. Individuals with ARMS had higher ASI-3 Physical Concerns scores than FEP patients [ = 5.10, <.01] and at a marginal significance level than controls. No between-group difference was found on Social Concerns. Higher ASI-3 Physical Concerns scores [ = -.324, Wald's = 8.29, < .01] and psychiatric comorbidities [ = -2.726, Wald's = 9.33, < .01] were significantly related to ARMS than FEP. Higher ASI-3 Social Concerns scores were related to FEP, despite at a marginal significance level [ =.213, Wald's = 3.79, = .052]. Interventions for AS Cognitive/Physical Concerns could be incorporated in the treatment of ARMS. A replication of the findings is required. Future longitudinal studies should examine whether Cognitive Concerns predict development of FEP in ARMS to improve early detection and prevention strategies.
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http://dx.doi.org/10.4081/ripppo.2020.431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451320PMC
May 2020

The role of disgust propensity and sensitivity on sexual excitations and inhibition in obsessive-compulsive disorder.

Res Psychother 2019 Dec 20;22(3):409. Epub 2019 Dec 20.

Department of Health Sciences, University of Florence, Florence.

Sexuality is understudied in Obsessive-Compulsive Disorder (OCD). According to the Dual Control Model, low sexual excitation (SE) and high sexual inhibition (SI) are indicative of a higher probability of experiencing a sexual dysfunction. The present study investigated SE and SI in OCD patients compared with controls. It was hypothesized that OCD patients report lower SE and higher SI than controls. Given their potential role as inhibitors of sexual response, it was hypothesized that in the OCD group higher disgust propensity/sensitivity, contamination/washing symptoms, unacceptable thoughts, and obsessive beliefs predicted lower SE, higher SI due to Threat of Performance Failure, and higher SI due to Threat of Performance Consequences. Seventy-two OCD patients and 72 controls matched on gender/age completed the Disgust Propensity and Sensitivity Scale-Revised, Obsessive Beliefs Questionnaire-46, Obsessive Compulsive Inventory- Revised, and Sexual Inhibition/Sexual Excitation Scales. OCD patients had higher SE, SI due to Threat of Performance Failure, and SI due to Threat of Performance Consequences than controls. In the OCD group, higher disgust sensitivity, SI due to Threat of Performance Consequences, and perfectionism predicted higher SI due to Threat of Performance Failure. Higher SI due to Threat of Performance Failure and contamination/washing symptoms predicted higher SI due to Threat of Performance Consequences. These findings highlight the presence of sexual difficulties in OCD patients, particularly a higher SE and SI. The latter is especially relevant in those patients with higher disgust sensitivity, contamination/washing symptoms and perfectionism. Psychotherapists should assess and target sexuality during clinicalpractice with OCD patients.
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http://dx.doi.org/10.4081/ripppo.2019.409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451344PMC
December 2019

Convergence between clinician-rated and patient-reported PTSD symptoms in a specialized outpatient service: The moderator role of gender.

Perspect Psychiatr Care 2021 Apr 27;57(2):761-769. Epub 2020 Aug 27.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.

Purpose: Posttraumatic stress disorder (PTSD) includes different symptoms: re-experiencing, avoidance of reminders and numbing, and hyperarousal. Although questionnaires are widely used, clinician-administered interviews provide a more comprehensive exploration of symptoms. Few studies examined the convergence between clinician-rated and patient-reported general severity and symptoms, with mixed findings. We explored the association between clinician-rated and patient-reported general severity and symptoms and the moderator role of gender in PTSD patients referred to a specialized outpatient service.

Design And Methods: The Clinician-Administered PTSD Scale and Davidson Trauma Scale were administered to 56 patients.

Findings: Patients classified by clinicians as with higher avoidance/numbing symptoms and women classified with higher hyperarousal symptoms reported higher general severity.

Practice Implications: The assessment of the patients reporting high severity should focus on hyperarousal, particularly for women.
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http://dx.doi.org/10.1111/ppc.12611DOI Listing
April 2021

Quality of life and infertility stress in homologous and heterologous medically assisted reproduction: The role of common and specific psychopathological traits.

Perspect Psychiatr Care 2021 Apr 10;57(2):717-725. Epub 2020 Aug 10.

Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy.

Purpose: This study compared the quality of life/stress between individuals undergoing homologous and heterologous medically assisted reproduction (MAR) and explored the role of psychopathological traits.

Design And Methods: Two hundred and twenty-six participants in homologous (52.2%) and heterologous MAR (47.8%) completed Symptom Checklist 90-R, Fertility Problem Inventory, and Fertility Quality of Life.

Findings: The homologous group showed higher depressive/anxious and obsessive-compulsive traits, hostility and interpersonal detachment, and worse quality of life/stress than the heterologous one. In the homologous pathway, those with higher interpersonal detachment showed worse quality of life, in the heterologous one those with greater paranoid traits had greater stress.

Practice Implications: Psychiatric nursing support should focus on interpersonal detachment in homologous and paranoid traits in heterologous MAR.
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http://dx.doi.org/10.1111/ppc.12603DOI Listing
April 2021

Sexual response in obsessive-compulsive disorder: the role of obsessive beliefs.

CNS Spectr 2020 Jul 15:1-10. Epub 2020 Jul 15.

Department of Health Sciences, University of Florence, Florence, Italy.

Background.: Sexual response in obsessive-compulsive disorder (OCD) research and practice is overlooked. According to the Dual Control Model, satisfactory sexual response is based upon a balance of sexual excitation and inhibition. The assessment of sexual response in OCD may have clinical implications, such as the integration of sex therapy in psychotherapeutic intervention. The present study was aimed at comparing sexual excitation and inhibition levels between OCD patients and matched control subjects, and investigating whether obsessive beliefs might predict sexual excitation/inhibition.

Methods.: Seventy-two OCD patients (mean age ± standard deviation [SD]: 34.50 ± 10.39 years) and 72 matched control subjects (mean age ± SD: 34.25 ± 10.18) were included (62.50% men and 37.50% women in both groups). The Obsessive Compulsive Inventory-Revised (OCI-R), the Obsessive Beliefs Questionnaire-46 (OBQ-46), and the Sexual Inhibition/Sexual Excitation Scales (SIS/SES) were administered.

Results.: Patients with OCD showed significantly higher levels of sexual excitation, inhibition due to threat of performance failure, and inhibition due to threat of performance consequences than the controls. In addition, the patients with more severe symptoms showed lower excitation than those with less severe symptoms, and those with higher perfectionism had stronger inhibition due to threat of performance failure than those with lower perfectionism.

Conclusions.: This is the first study exploring sexual response in OCD according to the Dual Control Model. Sexual response is an impaired quality of life outcome in OCD that should be assessed in routine clinical practice. These findings support the importance of addressing specific obsessive beliefs to improve sexuality in OCD patients.
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http://dx.doi.org/10.1017/S1092852920001649DOI Listing
July 2020

Negative Air Ions in Neuropsychiatric Disorders.

Curr Med Chem 2021 ;28(13):2521-2539

Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy.

Background: Air ions (AIs) are clusters of ionized particles present in the atmosphere, carrying an electrical charge of negative or positive polarity. Past speculations suggested that exposure to positive air ions may be harmful, while exposure to negative air ions (NAIs) may be associated with beneficial health effects. Increasing attention has been directed towards investigating the potential effect of NAIs on human brain activities since initial observations of their beneficial effects on some cognitive processes and mood.

Aims: Given the paucity and scattered literature, our paper aims to review the available studies on potential positive effects of NAIs exposure on cognitive performances and depression.

Discussion: The review of the literature seems to confirm the effects of NAIs on several brain functions. Indeed, a significant association between NAIs exposure and both well-being and high cognitive performances has been described. Furthermore, exposure to high concentrations of NAIs could be related to the improvement of depressive symptoms.

Conclusion: A growing evidence of data, although not yet conclusive, would suggest that NAIs might improve cognitive processes. These findings require specific and urgent controlled trials adopting systems based on AIs release to possibly prevent and treat cognitive dysfunctions present in a broad range of neuropsychiatric conditions.
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http://dx.doi.org/10.2174/0929867327666200630104550DOI Listing
June 2021

Evaluation of the Health Education Impact Questionnaire (heiQ), a Self-Management Skill Assessment Tool, in Italian Chronic Patients.

Psychol Res Behav Manag 2020 19;13:459-471. Epub 2020 May 19.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.

Background: The Health Education Impact Questionnaire (heiQ) aims to evaluate eight self-management skills in people with chronic conditions. Knowledge about the relations between these self-management skills and different quality of life (QoL) outcomes has received little attention. It is also important to provide further evidence on its properties in non-English healthcare contexts, as the questionnaire is being used in cross-cultural research. Furthermore, in the Italian healthcare context, the relationship between the medical staff and the patients remains asymmetrical, with the latter having the role of passive recipients of medical prescriptions and services. The current study provided further evidence about the psychometric properties of the heiQ among Italian people with chronic conditions, specifically by assessing the factor structure, reliability, convergent/divergent and criterion validity (ie, the specific contribution of each of the self-management skills to QoL outcomes).

Methods: Two hundred ninety-nine individuals with a chronic condition (mean age = 61.4 years, 50% females) completed the heiQ and the Medical Outcomes Study-Short Form (MOS SF-36). Confirmatory factor analyses, Composite Reliability Indices (CRI), bivariate correlations and linear regression analyses were computed.

Results: A model with 8 correlated factors showed good fit, in a similar way to previous studies. CRI values were acceptable to good for all the subscales. Associations between some of the heiQ subscales and some of the MOS SF-36 subscales supported criterion validity. In particular, it was confirmed by the moderate associations between the constructive attitudes and approaches subscale and the MOS SF-36 vitality and perceived mental health and by the moderate correlations between the health directed activities subscale and the MOS SF-36 Vitality. In linear regressions, higher emotional distress predicted higher physical and mental QoL, while higher mental QoL was also associated with stronger constructive attitudes and approaches.

Conclusion: The heiQ has robust properties across translations and it can also be used routinely in Italian healthcare contexts. The evidence that all the other self-management skills did not predict either physical or mental QoL could suggest that the self-management model of chronic diseases is still not sufficiently developed in the Italian context, where patients are passive recipients of medical instructions.
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http://dx.doi.org/10.2147/PRBM.S245063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246315PMC
May 2020

What is the impact of pharmacotherapy on psychotherapy for obsessive-compulsive disorder?

Expert Opin Pharmacother 2020 10 16;21(14):1651-1654. Epub 2020 Jun 16.

Department of Biotechnology, Chemistry and Pharmacy, University of Siena , Siena, Italy.

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http://dx.doi.org/10.1080/14656566.2020.1775814DOI Listing
October 2020

The impact of the COVID-19 pandemic on patients with OCD: Effects of contamination symptoms and remission state before the quarantine in a preliminary naturalistic study.

Psychiatry Res 2020 09 9;291:113213. Epub 2020 Jun 9.

Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Infant-Maternal Science, Section of Psychiatry, University of Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

The containment measures implemented to reduce the progression of the COVID-19 pandemic can increase the risk of serious mental disorders, including obsessive-compulsive disorder (OCD). The general fear of getting infected and the importance given to personal hygiene, may have a negative impact on this clinical population. In a group of patients with OCD who had completed an evidence-based therapeutic path for OCD before the quarantine, this study evaluated the changes on OCD symptoms during the quarantine and investigated the effects of contamination symptoms and remission state before the quarantine on OCD symptom worsening during the quarantine. The Yale-Brown Obsessive Compulsive (Y-BOCS) Severity score, administered before the quarantine, was re-administered after six weeks since the beginning of the complete lockdown. A significant increase in obsession and compulsion severity emerged. Remission status on OCD symptoms and having contamination symptoms before the quarantine were significantly associated with more elevated OCD symptom worsening during the quarantine. To our knowledge, this is the first study which assessed OCD symptoms at the COVID-19 time. Our results support the need to improve relapse prevention during the period of social restrictions and develop alternative strategies such as online consultations and digital psychiatric management.
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http://dx.doi.org/10.1016/j.psychres.2020.113213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280119PMC
September 2020

The psychosocial impact of COVID-19 pandemic in Italy: A lesson for mental health prevention in the first severely hit European country.

Psychol Trauma 2020 Jul 11;12(5):531-533. Epub 2020 Jun 11.

Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine.

Italy was the first European country severely hit by the COVID-19 pandemic. While the containment measures were relatively effective in the acute phase, the current postemergency phase addressing the long-term psychosocial consequences is the key challenge for our healthcare system, where the importance of mental health prevention is not sufficiently recognized. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/tra0000687DOI Listing
July 2020

Post-traumatic Stress Disorder in Prisoners' Offspring: A Systematic Review and Meta-analysis.

Clin Pract Epidemiol Ment Health 2020 1;16:36-45. Epub 2020 Apr 1.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.

Background: Parental incarceration can produce serious effects on the offspring's mental health. The presence of Post-Traumatic Stress Disorder (PTSD) in prisoners' offspring is understudied and the few literature data showed heterogeneous evidence, with some studies suggesting that about 25% of prisoners' offspring have PTSD and other reporting much lower prevalence rates around 2-3%. There is no systematic review and meta-analysis about PTSD in prisoners' offspring.

Objectives: The present systematic review and meta-analysis aimed to provide a first quantitative synthesis of the prevalence of the PTSD diagnosis in prisoners' offspring. Moderator variables of the effect sizes were assessed, including offspring's and parents' gender, offspring's generational cohort (children/adolescents versus adults), reasons for parental incarceration (political/war versus crime), and country type (Western versus Non-Western countries).

Methods: A systematic review and a meta-analysis were conducted according to the PRISMA guidelines. Studies were included if they assessed the presence of a PTSD diagnosis in child, adolescent or adult offspring of prisoners through a diagnostic classification system, a clinician-administered interview or a self-report questionnaire, if they reported data necessary to calculate the effect sizes or the authors were available to provide them. Studies might have been based upon any design except review, single-case, case series, and case reports. Outcomes might have been measured at any time after parental incarceration. Parental imprisonment was defined as any kind of custodial confinement of a parent by the criminal justice system, including being held as a prisoner of war or for political reasons.Independent reviewers searched published/unpublished studies through electronic databases and additional sources and extracted the data. A random-effect meta-analysis was carried out by calculating the effect sizes as event rates. Heterogeneity was examined by the and the statistics. Moderators were assessed through meta-regressions.

Results: Six studies (2512 participants) were included. Fifteen percent of prisoners' offspring had PTSD, as shown by a significant mean effect size of 0.14 without evidence of publication bias (: 0.081 - 0.249, < 0.001). There were no significant differences on the mean effect sizes between the studies on adults and those on children/adolescents [ = 0.00, = .999], between the studies on parents incarcerated for political/war reasons and those for crime [ = 0.00, = .979], and between the studies conducted in Western and non-Western countries [ = 0.854, = .355]. While offspring's gender was not related to the effect sizes [ = -0.01, : -0.02 - 0.02, = .452], parents' gender was significantly and positively associated with the effect sizes suggesting that in studies with higher percentages of incarcerated mothers, the prevalence of offspring's PTSD was higher [ = 0.01, : 0.0 - 0.01, = .019].

Conclusion: PTSD is a serious mental health condition among prisoners' offspring, particularly when mothers are incarcerated. The present findings point out the importance of thorough assessment and timely intervention/prevention strategies implemented by professionals of mental health settings and detention systems. The cross-sectional design of the studies does not allow causal conclusions to be drawn about the effect of parental incarceration as a risk factor for PTSD. Other variables related to parental incarceration may explain these findings. This limitation points out the importance of further longitudinal research.
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http://dx.doi.org/10.2174/1745017902016010036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254824PMC
April 2020

Online Romance Scams: Relational Dynamics and Psychological Characteristics of the Victims and Scammers. A Scoping Review.

Clin Pract Epidemiol Ment Health 2020 26;16:24-35. Epub 2020 Mar 26.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.

Background: Digital communication technologies can overcome physical, social and psychological barriers in building romantic relationships. Online romance scams are a modern form of fraud that has spread in Western societies along with the development of social media and dating apps. Through a fictitious Internet profile, the scammer develops a romantic relationship with the victim for 6-8 months, building a deep emotional bond to extort economic resources in a manipulative dynamic. There are two notable features: on the one hand, the double trauma of losing money and a relationship, on the other, the victim's shame upon discovery of the scam, an aspect that might lead to underestimation of the number of cases.

Objectives: This paper presents a scoping review of the quantitative and qualitative evidence on this issue, focusing on epidemiological aspects, relational dynamics, and the psychological characteristics of victims and scammers.

Methods: A literature scoping review was conducted using electronic databases and descriptors. Studies were included if they had analyzed the phenomenon in any population or the relationship dynamics characterizing it through whatsoever typology of design. Scoping reviews are a form of knowledge synthesis, which incorporates a range of study designs and wide eligibility criteria to comprehensively summarize evidence with the aim of informing practice, programs, and policy and providing direction to future research priorities.

Results: Twelve studies were included. Sixty-three percent of social media users and 3% of the general population report having been a victim at least once. Some psychological variables appear to be associated with the risk of being scammed, such as female gender, middle-age, higher levels of neuroticism, tendencies to the romantic idealization of affective relations, sensation seeking, impulsiveness and susceptibility to addiction. We analyse literature limitations and future directions.

Conclusion: Since this emerging phenomenon is still largely unrecognized, understanding the psychological characteristics of victims and scammers will allow at-risk personality profiles to be identified and prevention/intervention strategies to be developed.
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http://dx.doi.org/10.2174/1745017902016010024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254823PMC
March 2020

Cognitive behavioural therapy for help-seeking adolescents and young adults with at-risk-mental state: Effects on subclinical positive symptoms.

Early Interv Psychiatry 2021 Jun 26;15(3):513-524. Epub 2020 May 26.

Department of Health Sciences, University of Florence, Florence, Italy.

Aim: Cognitive behavioural therapy (CBT) is effective for at-risk-mental state (ARMS) in reducing/delaying transition to psychosis. However, previous systematic reviews pointed out the small number of trials as a limitation and suggested that additional outcomes should be evaluated, not only prevention of first psychosis episode. No study assessed the CBT effects on subclinical psychotic symptoms. The present study investigated the effects of CBT on the transition risk (primary outcome), and on overall remission from ARMS and severity of subclinical symptoms, that is, unusual content of thought, non-bizarre ideas, perceptual abnormalities, disorganized speech (secondary outcome).

Methods: CBT consisted of 30 individual weekly sessions over 7 months. Fifty-eight participants with ARMS detected by the Comprehensive Assessment of At-Risk-Mental States were randomized to CBT or control condition.

Results: Respectively in the CBT and control groups, 1 (3.40%) and 5 (26.31%) participants at post-treatment and 3 (10.30%) and 8 (42.10%) at follow-up made transition with a difference between the two groups, despite at borderline significance. At post-treatment and follow-up, respectively, the number of participants recovered from ARMS was significantly higher in CBT (76.92% and 61.53%) than in control (10.52% and 15.80%). Participants in the control group reported lower reductions on all the subclinical symptoms over time as compared with those in CBT.

Conclusions: This is the first study assessing CBT on subclinical positive symptoms in ARMS. CBT seems to be a tailored approach able to produce short- and long-term benefits on this outcome.
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http://dx.doi.org/10.1111/eip.12974DOI Listing
June 2021

Sexual Arousal in Obsessive-Compulsive Disorder With and Without Contamination/Washing Symptoms: A Moderating Role of Disgust Sensitivity.

J Nerv Ment Dis 2020 09;208(9):694-700

Department of Health Sciences, University of Florence, Florence, Italy.

Different findings would indicate that obsessive-compulsive disorder (OCD), a common psychiatric condition, might significantly impair intimate relationships and sexual well-being. The aim of the present study was to ascertain whether OCD outpatients with contamination/washing symptoms experience a lower sexual arousal than those experiencing other symptoms. In addition, we explored whether a higher disgust propensity/sensitivity might moderate the relation between contamination/washing symptoms and impaired sexual arousal. A total of 72 outpatients (27 with contamination/washing symptoms and 45 with other obsessive-compulsive symptoms) were selected for this study and assessed by a battery of specific rating scales. The results highlighted how OCD patients with contamination/washing symptoms and higher disgust sensitivity showed an increased propensity to inhibition due to threat of sexual performance failure and consequences. It may be speculated that the disgust sensitivity may be a mechanism involved in the impairment of this well-being domain. In conclusion, these findings suggest that the sexual wellbeing should be evaluated during routine clinical evaluation of OCD patients.
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http://dx.doi.org/10.1097/NMD.0000000000001184DOI Listing
September 2020

Obsessive-compulsive symptoms and their links to depression and anxiety in clinic- and community-based pediatric samples: A network analysis.

J Affect Disord 2020 06 16;271:9-18. Epub 2020 Apr 16.

Baylor College of Medicine, Houston, TX, United States.

Background: Symptoms of depression and anxiety are common in children with obsessive-compulsive disorder (OCD) and associated with more severe OCD, greater impairment, and worse treatment outcome. Beyond twin studies showing that genetic factors contribute to the high co-occurrence, few studies have examined how OCD, depression, and anxiety are linked in youth, and current studies often fail to account for OCD and anxiety heterogeneity.

Methods: Network analysis was used to investigate how OCD were linked to depression and anxiety in multinational youth diagnosed with OCD (total n = 419) and in school-recruited, community-based samples of youth (total n = 2 991).

Results: Initial results aligned with earlier work showing that severity of obsession-related symptoms are important in linking OCD to depression in youth with OCD. However, when symptom content of OCD (e.g., washing, ordering) was fully taken into account and when measures of anxiety were included, specific OCD symptom dimensions (primarily obsessing and doubting/checking) were linked to specific anxiety dimensions (primarily panic and generalized anxiety) which in turn were linked to depression. These results were replicated in three separate community-based samples from Chile, Italy, and Spain using different measures of anxiety and depression.

Limitations: Cross-sectional data were analyzed which precludes causal inference. Self-report measures were used.

Conclusions: Youth with OCD with symptoms related to doubting/checking and obsessing should be carefully assessed for symptoms of panic and generalized anxiety. Non-responders to standard OCD treatment may benefit from interventions targeting panic and generalized anxiety, but more research is needed to test this hypothesis.
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http://dx.doi.org/10.1016/j.jad.2020.03.090DOI Listing
June 2020

Italian validation of the health education impact questionnaire (heiQ) in people with chronic conditions.

Health Qual Life Outcomes 2020 Mar 30;18(1):89. Epub 2020 Mar 30.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci, 16 53100, Siena, Italy.

Background: The health education impact Questionnaire (heiQ) measures eight self-management skills in people with chronic conditions. It seems to be important to provide cross-cultural evidence on its properties in non-English healthcare contexts. The present study assessed the psychometric properties of the heiQ in Italian adults with chronic conditions.

Methods: Two hundred ninety-nine individuals with a chronic condition (mean age = 61.4 years, 50.16% females) completed the heiQ and the Medical Outcomes Study-Short Form (SF-36). Confirmatory factor analyses, Composite Reliability Indices, and bivariate correlations were performed.

Results: Structural validity based on 8 correlated factors with good fit was in line with previous research. Concurrent validity was confirmed, as shown by moderate associations between the scores on the Constructive attitudes and approaches, Self-monitoring and insight, Health directed activities, Social integration and support, and Emotional distress subscales and the scores on SF-36 Physical functioning, General health perceptions, Vitality, Social functioning, Perceived mental health and Role limitations due to physical and emotional problems subscales.

Conclusions: The Italian heiQ has strong properties and it can be used routinely also in the Italian healthcare services.
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http://dx.doi.org/10.1186/s12955-020-01329-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106648PMC
March 2020

Early maladaptive schemas as common and specific predictors of skin picking subtypes.

BMC Psychol 2020 Mar 19;8(1):27. Epub 2020 Mar 19.

Department of Health Sciences, University of Florence, via di San Salvi 12 - Building 26, 50135, Florence, Italy.

Background: Three distinct subtypes of Skin Picking (SP) have been identified in previous research: Focused, Automatic and Mixed. Early Maladaptive Schemas (EMS) were not investigated across the subtypes. Understanding which EMS are associated with the subtypes might suggest the evaluation of Schema Therapy for SP and guide clinicians using it according to subtypes. The current study explored the relationship between EMS and SP subtypes in community adults.

Methods: Five hundred ninety-six adults [mean age = 35.23 years, 66% females] self-reporting SP behaviours completed the Milwaukee Inventory for Dimensions of Adult Skin Picking and the Young Schema Questionnaire-Long form third version (YSQ-L3).

Results: Higher Dependence/Incompetence EMS was a common predictor of both Focused and Automatic subtypes, while lower Emotional Deprivation EMS and younger age predicted all three subtypes. Higher Approval/Recognition Seeking, Mistrust/Abuse and Failure to Achieve were specific predictors of Automatic, Focused and Mixed subtypes, respectively. Lower Social Isolation/Alienation and Enmeshment/Undeveloped Self were specific predictors of Focused subtype. Male gender was a specific predictor of Mixed subtype.

Conclusions: The assessment and psychological treatment of individuals with SP behaviour may focus on specific EMS. Future longitudinal studies using clinical samples may clarify this association.
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http://dx.doi.org/10.1186/s40359-020-0392-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081682PMC
March 2020

Impact of thumb osteoarthritis on pain, function, and quality of life: a comparative study between erosive and non-erosive hand osteoarthritis.

Clin Rheumatol 2020 Jul 22;39(7):2195-2206. Epub 2020 Feb 22.

Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, Viale Bracci 1, 53100, Siena, Italy.

Objective: The study was aimed to compare the impact of thumb base osteoarthritis (TBOA) on pain, function, and quality of life in patients with erosive or non-erosive hand osteoarthritis (HOA).

Methods: This observational retrospective study included 232 patients: 64 with erosive HOA (EHOA) and concomitant TBOA, 36 with isolated EHOA, 97 with non-erosive HOA (non-EHOA) and TBOA, and 35 with isolated non-EHOA. Hand pain by a visual analogue scale (VAS), Functional Index for Hand Osteoarthritis (FIHOA) score, Health Assessment Questionnaire (HAQ), the Medical Outcomes Study 36-Item Short Form (SF-36), and the possible correlations between VAS and FIHOA with radiological score were assessed.

Results: No differences were found between EHOA with TBOA and isolated EHOA in VAS and FIHOA scores; opposite, there was a significant difference in VAS (p < 0.01) and FIHOA (p < 0.001) between subjects with non-EHOA and TBOA and patients with only non-EHOA. VAS and FIHOA values resulted slightly higher in patients with EHOA and TBOA vs non-EHOA and TBOA; they were significantly more elevated in EHOA and TBOA group compared to isolated non-EHOA (p ≤ 0.001) and in isolated EHOA vs isolated non-EHOA (p < 0.01 and p < 0.001, respectively). HAQ, SF-36 resulted significantly better in isolated non-EHOA patients compared to the other groups. Finally, we observed a significant correlation between FIHOA and all the Kallman scales in EHOA patients with TBOA and between FIHOA and Kallman's thumb score in non-EHOA-TBOA group.

Conclusions: EHOA has a more severe clinical burden than non-EHOA; the presence of TBOA appeared an important determinant of pain and disability in non-EHOA.Key Points• Each subset of HOA can have a different impact on pain and functionality, with EHOA determining more severe effects on hand symptoms and disability than non-EHOA.• The presence of TBOA appeared an important determinant of pain and disability in non-EHOA, but not in EHOA.• Our findings support the need for an individualized therapy for each phenotype of hand osteoarthritis.
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http://dx.doi.org/10.1007/s10067-020-04982-zDOI Listing
July 2020

Do patients with chronic low-back pain experience a loss of health-related quality of life? A protocol for a systematic review and meta-analysis.

BMJ Open 2020 02 9;10(2):e033396. Epub 2020 Feb 9.

Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy

Introduction: Health-related quality of life in chronic low back pain (LBP) is an important issue since various individual factors such as perceived loss of autonomy, inability to continue daily life and anxiety can contribute to maintenance or deterioration of this condition. Health-related quality of life is also important because it can predict the probability of recovery or recrudescence over time. In the literature, there is no systematic review on this topic. The present paper describes a protocol of the first systematic review and meta-analysis aimed at summarising the data on health-related quality of life in patients with chronic LBP compared with healthy controls. Gender, age and comorbidity of psychiatric disorders (mood or anxiety disorders) will be explored as moderators. Studies will be included if they used a case-control design comparing adults with chronic LBP to healthy controls on health-related quality of life through validated interviews/questionnaires.

Methods And Analysis: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review and meta-analysis will be conducted from 10th to 17th January 2020. Independent reviewers will search published/unpublished studies through electronic databases (Scopus, PubMed, EMBASE and the Cochrane Library) and additional sources, will extract the data and assess the methodological quality through the Newcastle-Ottawa Scale. Random-effect meta-analysis will be carried out by calculating effect sizes as Cohen's d indices. Publication bias will be assessed and moderators of the effect sizes will be investigated through weighted least squares meta-regression.The knowledge whether health-related quality of life is better or worse as a function of some individual characteristics may suggest personalised care pathways according to a precision medicine approach.

Ethics And Dissemination: The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals.

Prospero Registration Number: CRD42019131749.
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http://dx.doi.org/10.1136/bmjopen-2019-033396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044949PMC
February 2020

Sexual dysfunction and satisfaction in obsessive compulsive disorder: protocol for a systematic review and meta-analysis.

Syst Rev 2020 01 9;9(1). Epub 2020 Jan 9.

Department of Health Sciences, University of Florence, Florence, Italy.

Background: Obsessive compulsive disorder (OCD) is a chronic mental health condition recognized as one of the most serious causes of disability and impaired quality of life. In the literature, there is no review about sexual dysfunction and satisfaction in OCD. The current paper presents the protocol for a systematic review and meta-analysis aimed to summarize data (1) comparing the presence of sexual dysfunction between groups with OCD and non-clinical groups, (2) investigating prevalence of each one of the sexual dysfunctions in patients with OCD, (3) comparing risk for sexual dysfunction in OCD groups with the prevalence in control groups, (4) comparing sexual satisfaction between OCD groups and non-clinical groups, and (5) investigating moderators of sexual dysfunction in OCD groups as compared with control groups. Gender, age, marital status, OCD symptom severity and subtypes, comorbid depressive disorders, comorbid anxiety disorders, concurrent psychiatric medications, comorbid general medical disease, and study quality will be investigated as moderators.

Methods: The protocol is reported according to PRISMA-P guidelines. The search will be conducted by independent reviewers during the second week of December 2019 by using electronic databases (Scopus, PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Library), by contacting the authors of the included studies to identify further data, by examining the references of the included studies, and by handsearching conference proceedings and theses/doctoral dissertations. The study quality will be independently evaluated using the Newcastle-Ottawa Quality Assessment Scale. Random-effect meta-analyses will be computed. If there is insufficient data for a specific outcome, only a systematic review will be performed.

Discussion: This review may support clinical practice highlighting the importance of the assessment of sexuality in patients with OCD and suggesting the use of therapeutic strategies dedicated to sexuality in this clinical population with the aim of improving patients' quality of life. Potential limitations will regard the heterogeneity of the studies in terms of the instruments used to assess sexual dysfunction/satisfaction and of the definitions used to conceptualize sexual dysfunction.

Systematic Review Registration: Prospero CRD42019132264.
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http://dx.doi.org/10.1186/s13643-019-1262-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953228PMC
January 2020

Propensity to Sexual Response among Adults with Obsessive-Compulsive Disorder.

Clin Pract Epidemiol Ment Health 2019 30;15:126-133. Epub 2019 Sep 30.

Department of Health Sciences, University of Florence, Florence, Italy.

Background: Propensity to sexual excitation and inhibition is one of the key dimensions of sexuality. Clinicians working with Obsessive-Compulsive Disorder (OCD) patients rarely assess this and other aspects of sexuality, since treatment targets generally symptom reduction. Literature on sexual functioning in OCD patients is scarce and no study has focused on symptom subtypes, nor investigated the psychological processes related to sexual response.

Objective: In the present short report, we describe an exploratory study investigating the association between symptom subtypes and propensity towards sexual excitation/inhibition in OCD patients, controlling for gender, age and antidepressant treatment.

Methods: Seventy-two OCD patients (mean age = 34.50 years, 37.50% women) completed the Obsessive-Compulsive Inventory-Revised and the Sexual Inhibition/Sexual Excitation Scales.

Results: Patients with more severe compulsive washing habit had a lower propensity towards excitation and a higher one towards inhibition due to threat of performance consequences (, contamination with sexually transmitted diseases/having an unwanted pregnancy). Patients with more severe symptoms of checking showed a higher propensity towards inhibition due to the threat of performance consequences. Gender, age and antidepressant treatment were not related to sexual functioning.

Conclusion: Specific OCD symptom subtypes may be associated with some psychological processes involved in sexual response. Sexual well-being should be carefully evaluated by practitioners and should be regarded as a treatment target. Future studies should investigate more comprehensively the processes involved in sexuality.
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http://dx.doi.org/10.2174/1745017901915010126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882137PMC
September 2019
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