Publications by authors named "Ciro Conversano"

70 Publications

Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review.

Front Psychol 2021 29;12:663376. Epub 2021 Sep 29.

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

Several data suggest that coronavirus disease 2019 (COVID-19) pandemic may exacerbate or trigger eating disorders (EDs). The aim of this paper was to summarize current literature studies on COVID pandemic and EDs. Literature search, study selection, methods, and quality evaluation were performed according to the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. A systematic search allowed the initial selection of 172 papers; 21 (12.2%) papers were eligible and included in the review. In selected studies, a total number of 29,108 subjects were enrolled (range: 10-11,391; mean/SD: 1,386 ± 2,800), 6,216 were men (21.4%), 22,703 were women (77.9%), and 189 (0.7%) were gender fluid or not declared. The mean age/SD of subjects was 30.2 ± 7.7. About 12 studies (57.1%) were online surveys, 4 (19.0%) were retrospective studies, 2 (9.5%) were qualitative studies, 2 (9.5%) were longitudinal cohort studies, and 1 was a social media survey (4.8%). Their analysis revealed five main findings: (1) changes in the routines of physical activities were related to the worsening of preoccupation on weight/body shape; (2) food access limitation during pandemic represented the risk factors for both triggering and exacerbating EDs; (3) restriction in healthcare facilities contributed to increase anxiety levels and to modify treatment compliance; (4) social isolation was related to the exacerbation of symptoms in patients with EDs who are home-confined with family members; and (5) conflicts and difficulties in relationships with "no way out" were the maintenance factors for ED symptoms, especially in adolescents and young adults. The COVID-19 pandemic had a negative impact on EDs that might be triggered by the exceptional conditions derived from COVID-19-related stress in predisposed subjects. Patients who were already affected by EDs experienced the worsening of their clinical conditions and related quality of life (QoL).
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http://dx.doi.org/10.3389/fpsyg.2021.663376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511307PMC
September 2021

A Psychometric Examination of the Coronavirus Anxiety Scale and the Fear of Coronavirus Disease 2019 Scale in the Italian Population.

Front Psychol 2021 18;12:669384. Epub 2021 Jun 18.

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

The coronavirus disease 2019 (COVID-19) outbreak has caused not only significant physical health problems but also mental health disorders. Anxiety and fear appear to be the main psychological symptoms associated with COVID-19. The aim of this study was to investigate whether anxiety and fear related to COVID-19 are influenced by sociodemographics and whether specific conditions, such as positivity for COVID-19 or death among relatives and friends, can further enhance these symptoms. In this cross-sectional study, 697 Italians responded to an online survey assessing sociodemographic information, the presence/absence of positive cases, or deaths due to COVID-19 among relatives or acquaintances. The Coronavirus Anxiety Scale (CAS) and Fear of COVID-19 Scale (FCS-19S) were administered in order to assess the levels of anxiety and fear associated with COVID-19. The data were collected in November 2020. Anxiety and fear scores were positively correlated. Both male and female subjects with higher CAS scores also displayed higher FCS-19S scores. The CAS and FCS-19S scores tended to increase with age, with older subjects exhibiting higher scores than younger subjects. Additionally, respondents with lower educational levels demonstrated higher scores on both the CAS and FCS-19S. Similarly, respondents living with older people and/or experiencing the death of one or more relatives due to COVID-19 exhibited corresponding outcomes. This study demonstrates how the levels of anxiety and fear, measured by CAS and FCS-19S associated with COVID-19, are influenced by gender, age, cohabitation status, educational levels, and the presence of positive cases or deaths due to COVID-19.
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http://dx.doi.org/10.3389/fpsyg.2021.669384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249697PMC
June 2021

Catastrophisation, chronic pain and sexuality: a cross-sectional investigation in fibromyalgia and rheumatoid arthritis.

Clin Exp Rheumatol 2021 May-Jun;39 Suppl 130(3):161-169. Epub 2021 Jun 10.

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

Objectives: In the present study we investigate the putative differences in pain catastrophising (PC), pain perception (PP), sexual functioning (SF), satisfaction (SS), and overall quality of life between fibromyalgia (FM) and rheumatoid arthritis (RA) patients as compared to healthy controls (HC).

Methods: Fifty-seven native Italian-speaking female individuals suffering either from FM or RA and thirty-eight healthy female controls (FM = 40; RA = 17; HC = 38) were submitted to a semi-structured interview aimed at assessing PP intensity (Visual Analog Scale; VAS), general health conditions (36-items Short-Form Health Survey; SF-36), PC (Pain Catastrophising Scale; PCS), SF and SS (Index of Sexual Satisfaction; ISS/ Female Sexual Function Index; FSFI).

Results: FM patients had a significantly higher PP both as compared to RA and HC (p<0.002 for both), and higher PC as compared to HC but not as compared to RA patients (p<0.03 and p<0.64). When compared to RA patients and HC, they showed a lower quality of life (p<0.002 for both comparisons), a compromised SF (p<0.003 and p<0.002, respectively) and a lower index of SS with respect to HC (p<0.002). RA patients had higher PP (VAS; p<0.002), lower quality of life and SF as compared to HC (p<0.002 and p<0.003, respectively).

Conclusions: FM and RA patients showed a significantly lower quality of life, SF and SS as compared to HC. PC was significantly related to PP and low quality of life in FM patients while in RA patients it negatively affected quality of life and especially the sexual sphere both when considering SF and SS.
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June 2021

Stress, Burnout, and Resilience among Healthcare Workers during the COVID-19 Emergency: The Role of Defense Mechanisms.

Int J Environ Res Public Health 2021 May 14;18(10). Epub 2021 May 14.

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

The experience of working on the frontlines of the COVID-19 healthcare crisis has presented a cumulative traumatic experience that affects healthcare professionals' well-being. Psychological resources such as resilience and adaptive defense mechanisms are essential in protecting individuals from severe stress and burnout. During September 2020, 233 healthcare workers responded to an online survey to test the impact of demographic variables, COVID-19 exposure, and psychological resources in determining stress and burnout during the COVID-19 emergency. Frontline workers reported higher scores for stress, emotional exhaustion, and depersonalization ( < 0.001) as compared to colleagues working in units not directly serving patients with COVID-19. Mature defensive functioning was associated with resilience and personal accomplishment ( = 0.320; < 0.001), while neurotic and immature defenses were related to perceived stress and burnout. Stress and burnout were predicted by lower age, female gender, greater exposure to COVID-19, lower resilience, and immature defensive functioning among healthcare professionals (R = 463; < 0.001). Working on the frontlines of the COVID-19 pandemic appears to provoke greater stress and burnout. On the other hand, resilience and adaptive defense mechanisms predicted better adjustment. Future reaction plans should promote effective programs offering support for healthcare workers who provide direct care to patients with COVID-19.
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http://dx.doi.org/10.3390/ijerph18105258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156145PMC
May 2021

Long-COVID Syndrome? A Study on the Persistence of Neurological, Psychological and Physiological Symptoms.

Healthcare (Basel) 2021 May 13;9(5). Epub 2021 May 13.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, 56126 Pisa, Italy.

Background: Emerging aspects of the Covid-19 clinical presentation are its long-term effects, which are characteristic of the so-called "long COVID". The aim of the present study was to investigate the prevalence of physical, psychological, and sleep disturbances and the quality of life in the general population during the ongoing pandemic.

Methods: This study, based on an online survey, collected demographic data, information related to COVID-19, sleep disturbances, and quality of life data from 507 individuals. The level of sleep disturbances and quality of life was assessed through the Insomnia Severity Index (ISI) and the EuroQol-5D (EQ-5D), respectively.

Results: In total, 507 individuals (M = 91 and F = 416 women) completed the online survey. The main symptoms associated with "long COVID" were headache, fatigue, muscle aches/myalgia, articular pains, cognitive impairment, loss of concentration, and loss of smell. Additionally, the subjects showed significant levels of insomnia ( < 0.05) and an overall reduced quality of life ( < 0.05).

Conclusions: The results of the study appear in line with recent publications, but uncertainty regarding the definition and specific features of "long COVID" remains. Further studies are needed in order to better define the clinical presentation of the "long COVID" condition and related targeted treatments.
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http://dx.doi.org/10.3390/healthcare9050575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152255PMC
May 2021

Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation.

Res Psychother 2021 Mar 29;24(1):531. Epub 2021 Mar 29.

Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, La Sapienza University of Rome, Rome.

Mentalizing capacities depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states. Operationalized as reflective functioning, mentalization is crucial for regulating emotions and developing of a coherent sense of identity, for interacting with individuals making sense to own and others mental states, and for distinguishing internal and external realities without distortions. Although the clinical literature on interplay between mentalization, attachment, and emotional regulation is rich, the empirical research is limited. This study sought to explore connections between reflective functioning, attachment styles, and implicit emotion regulation, operationalized as defense mechanisms, in a group of depressive patients. Twenty-eight patients were interviewed using the (AAI) and diagnosed using the of the . The and the were applied to AAI transcriptions to assess reflective functioning and defensive profile. Patients with secure attachment showed significantly higher levels in reflective functioning and overall defensive functioning as compared to those with insecure attachment. Good reflective functioning and secure attachment correlated with mature defenses and specific defensive mechanisms that serve in better regulating affective states. Overall, the relationship between mentalization, attachment and emotion regulation lay the foundations for the delineation of defensive profiles associated with attachment patterns and reflective functioning in depressive patients. The systematic assessment of these psychological dimensions with gold-standard tools may help in tailoring personalized therapeutic interventions and promoting more effective treatments.
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http://dx.doi.org/10.4081/ripppo.2021.531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082535PMC
March 2021

Item Reduction, Psychometric and Biometric Properties of the Italian Version of the Body Perception Questionnaire-Short Form (BPQ-SF): The BPQ-22.

Int J Environ Res Public Health 2021 04 6;18(7). Epub 2021 Apr 6.

Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.

Body awareness disorders and reactivity are mentioned across a range of clinical problems. Constitutional differences in the control of the bodily state are thought to generate a vulnerability to psychological symptoms. Autonomic nervous system dysfunctions have been associated with anxiety, depression, and post-traumatic stress. Though interoception may be a transdiagnostic mechanism promoting the improvement of clinical symptomatology, few psychometrically sound, symptom-independent, self-report measures, informed by brain-body circuits, are available for research and clinical use. We validated the Italian version of the body perception questionnaire (BPQ)-short form and found that response categories could be collapsed from five to three and that the questionnaire retained a three-factor structure with items reduced from 46 to 22 (BPQ-22). The first factor was loaded by body awareness items; the second factor comprised some items from the body awareness scale and some from the subdiaphragmatic reactivity scale (but all related to bloating and digestive issues), and the third factor by supradiaphragmatic reactivity items. The BPQ-22 had sound psychometric properties, good convergent and discriminant validity and test-retest reliability and could be used in clinical and research settings in which the body perception assessment is of interest. Psychometric findings in light of the polyvagal theory are discussed.
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http://dx.doi.org/10.3390/ijerph18073835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038843PMC
April 2021

The Psychodynamic Approach During COVID-19 Emotional Crisis.

Authors:
Ciro Conversano

Front Psychol 2021 9;12:670196. Epub 2021 Apr 9.

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

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http://dx.doi.org/10.3389/fpsyg.2021.670196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062854PMC
April 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

Targeting temporal parietal junction for assessing and treating disembodiment phenomena: a systematic review of TMS effect on depersonalization and derealization disorders (DPD) and body illusions.

AIMS Neurosci 2021 12;8(2):181-194. Epub 2021 Jan 12.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine University of Pisa, via Savi, 10, 56126, Pisa, Italy.

The temporal-parietal junction (TPJ) is a key structure for the embodiment, term referred to as the sense of being localized within one's physical body and is a fundamental aspect of the self. On the contrary, the sense of disembodiment, an alteration of one's sense of self or the sense of being localized out of one's physical body, is a prominent feature in specific dissociative disorders, namely depersonalization/derealization disorders (DPD). The aims of the study were to provide: 1) a qualitative synthesis of the effect of Transcranial Magnetic Stimulation (TMS), taking into account its use for therapeutic and experimental purposes; 2) a better understanding on whether the use of TMS could support the treatment of DPD and other clinical conditions in which depersonalization and derealization are displayed. To identify suitable publications, an online search of the PubMed, Cochrane Library, Web of science and Scopus databases was performed using relevant search terms. In addition, an in-depth search was performed by screening review articles and the references section of each included articles. Our search yielded a total of 108 records through multiple databases searching and one additional record was identified through other sources. After duplicates removal, title and abstract reading, we retained 16 records for the assessment of eligibility. According to our inclusion criteria, we retained 8 studies. The selected studies showed that TMS targeting the TPJ is a promising technique for treating disembodiment phenomena DPD and for inducing reversible disembodiment states in healthy subjects. These data represent the first step towards a greater understanding of possible treatments to be used in disembodiment disorders. The use of TMS over the TPJ appears to be promising for treating disembodiment phenomena.
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http://dx.doi.org/10.3934/Neuroscience.2021009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940112PMC
January 2021

Psychological Factors as Determinants of Chronic Conditions: Clinical and Psychodynamic Advances.

Front Psychol 2021 28;12:635708. Epub 2021 Jan 28.

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

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http://dx.doi.org/10.3389/fpsyg.2021.635708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876054PMC
January 2021

Secondary Traumatic Stress and Burnout in Healthcare Workers during COVID-19 Outbreak.

Int J Environ Res Public Health 2021 01 5;18(1). Epub 2021 Jan 5.

Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, 56121 Pisa, Italy.

(1) Background: The present study aims to assess the level of professional burnout and secondary traumatic stress (STS), and to identify potential risk or protective factors among health care workers (HCWs) during the coronavirus disease 2019 (COVID-19) outbreak.; (2) Methods: This cross-sectional study, based on an online survey, collected demographic data and mental distress outcomes from 184 HCWs from 1 May 2020, to 15 June 2020, from 45 different countries. The degree of STS, perceived stress and burnout was assessed using the Secondary Traumatic Stress Scale (STSS), the Perceived Stress Scale (PSS) and Maslach Burnout Inventory Human Service Survey (MBI-HSS) respectively. Stepwise multiple regression analysis was performed to identify potential risk and protective factors for STS; (3) Results: 184 HCWs (M = 90; Age mean: 46.45; SD: 11.02) completed the survey. A considerable proportion of HCWs had symptoms of STS (41.3%), emotional exhaustion (56.0%), and depersonalization (48.9%). The prevalence of STS was 47.5% in frontline HCWs while in HCWs working in other units it was 30.3% ( < 0.023); 67.1% for the HCWs exposed to patients' death and 32.9% for those HCWs which were not exposed to the same condition ( < 0.001). In stepwise multiple regression analysis, perceived stress, emotional exhaustion, and exposure to patients' death remained as significant predictors in the final model for STS (adjusted R2 = 0.537, < 0.001); (4) Conclusions: During the current COVID-19 pandemic, HCWs facing patients' physical pain, psychological suffering, and death are more likely to develop STS.
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http://dx.doi.org/10.3390/ijerph18010337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794988PMC
January 2021

Gender differences on psychological factors in fibromyalgia: a systematic review on the male experience.

Clin Exp Rheumatol 2021 May-Jun;39 Suppl 130(3):174-185. Epub 2020 Dec 2.

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

Objectives: Fibromyalgia (FM) is highly prevalent in the female gender. Scarce attention has been given to the exploration and description of this syndrome, from a psychological point of view, when occurring in males. The aim of the present study is to develop further knowledge, and to summarise the literature regarding subjective psychological experience, characteristics of symptoms presentation (both onset and development), and treatment options for FM in male patients, in order to highlight differences with FM in females.

Methods: All studies published between January 1993 and February 2020 using PubMed and PsycInfo were included, provided that they met the following criteria: 1) written in English; 2) original articles on studies with a longitudinal design; 3) prospective or retrospective, observational (analytical or descriptive), experimental or quasi-experimental, controlled or non-controlled studies. Reviews and non-original articles (i.e. editorials, letters to the editor, and book chapters) were not included. We utilised the following keywords: (male), (female), (fibromyalgia), combined with Boolean operators 'AND' and 'NOT'.

Results: We found an initial number of 55 papers. Duplicated records were excluded (n=13), as well as papers not focusing on male patients or not fulfilling the inclusion criteria (n=25), thus narrowing the research to 17 papers.

Conclusions: FM male patients consider their masculine identity as inefficiently re-negotiated after the onset of symptoms. FM males tend to endure pain for longer periods of time than females before seeking treatment; bodily symptoms are prevalent with a compromised exploration of feelings about FM. Unfortunately, there is still a paucity of evidence on clinical characterisation and treatment options when FM occurs in males. Moreover, no studies have addressed the issue of the psychopharmacological/non-pharmacological management of males with FM and comorbid psychiatric syndromes.
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June 2021

Psychological Impact of Coronavirus Disease 2019 Among Italians During the First Week of Lockdown.

Front Psychiatry 2020 30;11:576597. Epub 2020 Sep 30.

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

Pandemics and government-mandated quarantining measures have a substantial impact on mental health. This study investigated the psychological impact of the coronavirus disease 2019 (COVID-19) crisis on Italian residents during the first week of government-imposed lockdown and the role of defense mechanisms as protective factors against distress. In this cross-sectional study, 5,683 Italians responded to an online survey assessing socio-demographics, overall psychological distress, post-traumatic symptoms, and defense mechanisms using validated measures as the (SCL-90), the (IES-R), and the (DMRS-SR-30). Data were collected from March 13 to March 18, within the first week of lockdown in Italy. Results showed that younger age and female gender were associated with increased psychological distress. Having positive cases nearby, more days on lockdown, and having to relocate were also associated with greater distress. Higher overall defensive functioning (ODF) was associated with lower levels of depression ( = -.44, 95% CI -0.48, -0.40), anxiety ( = -.38, 95% CI -0.42, -0.35), and post-traumatic stress symptoms (PTSS) ( = -.34, 95% CI -0.38, -0.30). Conversely, less adaptive defensive functioning was related to greater affective distress across all domains. Each increased unit of ODF decreased the chances of developing post-traumatic stress symptoms (PTSS) by 71% (odds ratio = 0.29, < 0.001, 95% CI.026,.032). The psychological impact of COVID-19 among Italians during the early weeks of government lockdown has been significant. The pandemic continues to have extraordinary mental health impact as it moves across the globe. Given the salience of defensive functioning in psychological distress, consideration of interventions that foster the use of more adaptive defenses may be an important component of building resilience amidst a pandemic.
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http://dx.doi.org/10.3389/fpsyt.2020.576597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554332PMC
September 2020

Mindfulness, Age and Gender as Protective Factors Against Psychological Distress During COVID-19 Pandemic.

Front Psychol 2020 11;11:1900. Epub 2020 Sep 11.

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

Objective: Mindfulness disposition is associated with various psychological factors and prevents emotional distress in chronic diseases. In the present study, we analyzed the key role of mindfulness dispositions in protecting the individual against psychological distress consequent to COVID-19 social distancing and quarantining.

Methods: An online survey was launched on March 13, 2020, with 6,412 responses by April 6, 2020. Socio-demographic information, exposure to the pandemic, and quarantining were assessed together with psychological distress and mindfulness disposition. Multivariate linear regression analysis was performed to study the influence of predictive factors on psychological distress and quality of life in Italian responders during the early days of lockdown. Pearson correlations were calculated to study the relationship between mindfulness and psychiatric symptoms.

Results: Multivariate linear regression run on socio-demographics, COVID-19-related variables, and mindfulness disposition as moderators of overall psychological distress showed that mindfulness was the best predictor of psychological distress (β = -0.504; < 0.0001). High negative correlations were found between mindfulness disposition and the overall Global Severity Index ( = -0.637; < 0.0001), while moderate to high associations were found between mindfulness and all SCL-90 sub-scales.

Discussion: Findings showed that high dispositional mindfulness enhances well-being and helps in dealing with stressful situations such as the COVID-19 pandemic. Mindfulness-based mental training could represent an effective intervention to stem post-traumatic psychopathological beginnings and prevent the onset of chronic mental disorders.
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http://dx.doi.org/10.3389/fpsyg.2020.01900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516078PMC
September 2020

Preliminary Reliability and Validity of the DMRS-SR-30, a Novel Self-Report Measure Based on the Defense Mechanisms Rating Scales.

Front Psychiatry 2020 26;11:870. Epub 2020 Aug 26.

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

Defense mechanisms are psychological factors that influence emotional distress and quality of life. There are a number of measures assessing the construct of defense mechanisms, but only few available instruments reflect the gold-standard theoretical hierarchical organization of defenses. We report on the development of a novel 30 item self-report questionnaire, the DMRS-SR-30, based on the parent instrument, the Defense Mechanism Rating Scales (DMRS). This study tested preliminary reliability and validity of the Italian version of the DMRS-SR-30. We first extracted 30 items from the DMRS Q-sort version (DMRS-Q) and adapted them for a self-reported format. We then applied the DMRS quantitative scoring algorithms to provide proportional scores for the 28 individual defenses and summary scores for seven defense levels and overall defensive functioning (ODF) scores. A dynamic interview was used for assessing participant's defense mechanisms with the observer-rated DMRS and DMRS-Q. We examined internal consistency of the scales along with criterion, concurrent, convergent and discriminant validity among participants (N = 94) who completed the DMRS-SR-30, SCL-90, BDI, and IES-R. Results showed very good internal consistency for ODF (Cronbach's alpha = .890) and the high adaptive defense level, whereas some subscales with few items had lower values. Correlation analyses between DMRS-SR-30 and the two DMRS-based observer-rated measures showed very good criterion and concurrent validity for ODF and moderate to high for defense levels subscales. Correlations between the DMRS-SR-30 ODF and SCL-90 GSI, BDI and IES=R (r = -.456, r= -.540, r = -.402, respectively, all p <.001), indicated good convergent validity. Despite the well-known limitations of self-report methods of psychodynamic phenomena, self-report measures are highly practicable for assessing large samples. The DMRS-SR-30 is the first self-assessed measure describing the whole hierarchy of 28 defense mechanisms and providing scores for ODF, defensive categories, defense levels, and individual defenses. Preliminary examination of the Italian version of the DMRS-SR-30 showed promising results of internal consistency, criterion and concurrent validity, and convergent validity and of the measure. Further validation is needed to confirm these findings and explore other aspects of validity and reliability.
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http://dx.doi.org/10.3389/fpsyt.2020.00870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479239PMC
August 2020

Defense Mechanisms, Gender, and Adaptiveness in Emerging Personality Disorders in Adolescent Outpatients.

J Nerv Ment Dis 2020 12;208(12):933-941

Department of Clinical and Dynamic Psychology, University La Sapienza of Rome, Rome, Italy.

The present study focused on demographic and personality differences in the use of 30 defense mechanisms in adolescents with personality psychopathology and explored the hierarchical organization of personality traits based on the adaptiveness of defensive functioning. A total of 102 self-referred adolescent outpatients were interviewed and assessed on defense mechanisms and personality traits using the Defense Mechanisms Rating Scales and the Shedler-Westen Assessment Procedure 200 for Adolescents, respectively. Age and gender differences were found throughout the hierarchy. Pearson's correlations revealed a hierarchical organization of emerging personality disorders (PDs) in adolescence. More adaptive defenses were clearly associated with healthier personality style, whereas more pathological personality styles such as those with borderline traits were characterized by more rigid and maladaptive defenses. Dissociation was also associated with maladaptive personality types. Identifying the defenses associated with emerging personality disorders may inform the unconscious function of defense mechanisms in specific PDs. The systematic assessment of defense mechanisms might also help therapists to monitor changes during treatment.
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http://dx.doi.org/10.1097/NMD.0000000000001230DOI Listing
December 2020

Neurological Complications of COVID-19 and Possible Neuroinvasion Pathways: A Systematic Review.

Int J Environ Res Public Health 2020 09 14;17(18). Epub 2020 Sep 14.

Department of Surgical, Medical and Molecular & Critical Area Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy.

The Coronavirus Disease 2019 (COVID-19) outbreak has shocked the whole world with its unexpected rapid spread. The virus responsible for the disease, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), enters host cells by means of the envelope spike protein, which binds to angiotensin-converting enzyme 2 receptors. These receptors are highly expressed in heart, lungs, respiratory tract epithelium, endothelial cells and brain. Since an increasing body of significant evidence is highlighting a possible neuroinvasion related to SARS-CoV-2, a state of the art on the neurological complications is needed. To identify suitable publications, our systematic review was carried out by searching relevant studies on PubMed and Scopus databases. We included studies investigating neurologic manifestations of SARS-CoV-2 in patients over 18. According to the analyzed studies, the most frequent disorders affecting central nervous system (CNS) seem to be the following: olfactory and taste disorders, ischemic/hemorrhagic stroke, meningoencephalitis and encephalopathy, including acute necrotizing encephalopathy, a rare type of encephalopathy. As regards the peripheral nervous system (PNS), Guillain-Barré and Miller Fisher syndromes are the most frequent manifestations reported in the literature. Important clinical information on the neurological manifestations of SARS-CoV-2 would help clinicians raise awareness and simultaneously improve the prognosis of critically ill patients.
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http://dx.doi.org/10.3390/ijerph17186688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558767PMC
September 2020

Mindfulness, Compassion, and Self-Compassion Among Health Care Professionals: What's New? A Systematic Review.

Front Psychol 2020 31;11:1683. Epub 2020 Jul 31.

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

Health care professionals (HCPs) are a population at risk for high levels of burnout and compassion fatigue. The aim of the present systematic review was to give an overview on recent literature about mindfulness and compassion characteristics of HCPs, while exploring the effectiveness of techniques, involving the two aspects, such as MBSR or mindfulness intervention and compassion fatigue-related programs. A search of databases, including PubMed and PsycINFO, was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and the methodological quality for this systematic review was appraised using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews-2). The number of articles that met the inclusion criteria was 58 (4 RCTs, 24 studies with pre-post measurements, 12 cross-sectional studies, 11 cohort studies and 7 qualitative studies). MBSR intervention was effective at improving, and maintaining, mindfulness and self-compassion levels and to improve burnout, depression, anxiety, stress. The most frequently employed interventional strategies were mindfulness-related trainings that were effective at improving mindfulness and self-compassion, but not compassion fatigue, levels. Compassion-related interventions have been shown to improve self-compassion, mindfulness and interpersonal conflict levels. Mindfulness was effective at improving negative affect and compassion fatigue, while compassion satisfaction may be related to cultivation of positive affect. This systematic review summarized the evidence regarding mindfulness- and compassion-related qualities of HCPs as well as potential effects of MBSR, mindfulness-related and compassion-related interventions on professionals' psychological variables like mindfulness, self-compassion and quality of life. Combining structured mindfulness and compassion cultivation trainings may enhance the effects of interventions, limit the variability of intervention protocols and improve data comparability of future research.
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http://dx.doi.org/10.3389/fpsyg.2020.01683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412718PMC
July 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

Exploring the Efficacy of a Mindfulness Program for Boys With Attention-Deficit Hyperactivity Disorder and Oppositional Defiant Disorder.

J Atten Disord 2021 09 26;25(11):1544-1553. Epub 2020 Apr 26.

University of Pisa, Italy.

This study was the first attempt to explore the efficacy of a mindfulness protocol for children with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), and their parents. Fifty male children with ADHD and ODD diagnosis, aged 8 to 12, were randomly assigned to the mindfulness intervention ( = 25) or the wait-list ( = 25) group. Outcome measures included children, parents', and teachers' reports and objective measures of attention. Children from the intervention group had a greater reduction in hyperactive behaviors in the school context (effect size [ES] = 0.59) and a greater improvement in visual sustained attention (ES = 0.77) and in Avoidance and Fusion Questionnaire scores (ES = 0.43) than those in the wait-list control group. No significant effect of the intervention on aggressive behaviors was revealed. A mindfulness intervention for children and their parents showed partial beneficial effects in children with ADHD + ODD.
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http://dx.doi.org/10.1177/1087054720915256DOI Listing
September 2021

The clinical application of transcranial direct current stimulation in patients with cerebellar ataxia: a systematic review.

Int J Neurosci 2021 Jul 7;131(7):681-688. Epub 2020 Apr 7.

Department of Surgical, Medical, Molecular & Critical Area Pathology, University of Pisa, Pisa, Italy.

Aim: The aim of this review was to investigate the effects of transcranial direct current stimulation (tDCS) on motor function in patients with cerebellar ataxia.

Materials And Methods: Our systematic review has been performed by searching full-text articles on Pubmed and Scopus. Only studies investigating the motor effects of tDCS in patients with cerebellar ataxias were considered. A qualitative analysis of data was performed, as the methodology of the selected studies was highly heterogeneous.

Results: Our search yielded a total of twenty-seven hits. Based on the inclusion criteria, 19 of these were excluded and 89 were retained (number of patients = 81).The results reviewed so far suggest that tDCS over cerebellum combined or not with extra-cerebellar areas might be promising approach to improve motor outcomes, with a greater success in patients less impaired. In particular, it is been shown an improvement in both clinical measures assessing cerebellar deficits (i.e. gait, stance and oculomotor disorders) and performance measures (finger dexterity, upper limb coordination and gait speed). Some of the assessed investigations highlighted a restore effect of cerebellar brain inhibition pathway and resting motor threshold after tDCS.

Conclusions: tDCS could be considered an effective approach to promote plasticity in patient with cerebellar ataxia with significant motor effects. Future studies, with larger sample sizes are needed in order to evaluate the effective tDCS benefits on motor functionality. Due to the limited number of studies available so far, conclusions on the effectiveness of the reported approaches are premature.
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http://dx.doi.org/10.1080/00207454.2020.1750399DOI Listing
July 2021

Machine Learning Increases Diagnosticity in Psychometric Evaluation of Alexithymia in Fibromyalgia.

Front Med (Lausanne) 2019 13;6:319. Epub 2020 Jan 13.

Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.

Here, we report an investigation on the accuracy of the Toronto Alexithymia Scale, a measure to assess alexithymia, a multidimensional construct often associate to fibromyalgia. Two groups of participants, patients with fibromyalgia ( = 38), healthy controls ( = 38) were administered the Toronto Alexithymia Scale and background tests. Machine learning models achieved an overall accuracy higher than 80% in detecting both patients with fibromyalgia and healthy controls. The parameter which alone has demonstrated maximum efficiency in classifying the single subject within the two groups has been the item 3 of the alexithymia scale. The analysis of the most informative features, based on all scales administered, revealed that item 3 and 13 of the alexithymia questionnaire and the visual analog scale scores were the most informative attributes in correctly classifying participants (accuracy above 85%). An additional analyses using only the alexithymia scale subset of items and the visual analog scale scores has shown that the predictors which efficiently classified patients with fibromyalgia and controls were the item 3 and 7 (accuracy = 85.53%). Our findings suggest that machine learning models analysis based on the Toronto Alexithymia Scale subset of items scores accurately distinguish patients with fibromyalgia from healthy controls.
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http://dx.doi.org/10.3389/fmed.2019.00319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970411PMC
January 2020

Machine Learning in Psychometrics and Psychological Research.

Front Psychol 2019 10;10:2970. Epub 2020 Jan 10.

Department of General Psychology, University of Padua, Padua, Italy.

Recent controversies about the level of replicability of behavioral research analyzed using statistical inference have cast interest in developing more efficient techniques for analyzing the results of psychological experiments. Here we claim that complementing the analytical workflow of psychological experiments with Machine Learning-based analysis will both maximize accuracy and minimize replicability issues. As compared to statistical inference, ML analysis of experimental data is model agnostic and primarily focused on prediction rather than inference. We also highlight some potential pitfalls resulting from adoption of Machine Learning based experiment analysis. If not properly used it can lead to over-optimistic accuracy estimates similarly observed using statistical inference. Remedies to such pitfalls are also presented such and building model based on cross validation and the use of ensemble models. ML models are typically regarded as black boxes and we will discuss strategies aimed at rendering more transparent the predictions.
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http://dx.doi.org/10.3389/fpsyg.2019.02970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966768PMC
January 2020

Common Psychological Factors in Chronic Diseases.

Authors:
Ciro Conversano

Front Psychol 2019 6;10:2727. Epub 2019 Dec 6.

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

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http://dx.doi.org/10.3389/fpsyg.2019.02727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909152PMC
December 2019

Motor stroke recovery after tDCS: a systematic review.

Rev Neurosci 2020 01;31(2):201-218

Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy.

The purpose of the present study was to investigate the effects of transcranial direct current stimulation (tDCS) on motor recovery in adult patients with stroke, taking into account the parameters that could influence the motor recovery responses. The second aim was to identify the best tDCS parameters and recommendations available based on the enhanced motor recovery demonstrated by the analyzed studies. Our systematic review was performed by searching full-text articles published before February 18, 2019 in the PubMed database. Different methods of applying tDCS in association with several complementary therapies were identified. Studies investigating the motor recovery effects of tDCS in adult patients with stroke were considered. Studies investigating different neurologic conditions and psychiatric disorders or those not meeting our methodologic criteria were excluded. The main parameters and outcomes of tDCS treatments are reported. There is not a robust concordance among the study outcomes with regard to the enhancement of motor recovery associated with the clinical application of tDCS. This is mainly due to the heterogeneity of clinical data, tDCS approaches, combined interventions, and outcome measurements. tDCS could be an effective approach to promote adaptive plasticity in the stroke population with significant positive premotor and postmotor rehabilitation effects. Future studies with larger sample sizes and high-quality studies with a better standardization of stimulation protocols are needed to improve the study quality, further corroborate our results, and identify the optimal tDCS protocols.
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http://dx.doi.org/10.1515/revneuro-2019-0047DOI Listing
January 2020

Alexithymia and Psychological Distress in Patients With Fibromyalgia and Rheumatic Disease.

Front Psychol 2019 31;10:1735. Epub 2019 Jul 31.

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

Background: Fibromyalgia syndrome (FMS) is a chronic rheumatologic disease characterized by widespread musculoskeletal pain and other psychopathological symptoms which have a negative impact on patients' quality of life. FMS is frequently associated with alexithymia, a multidimensional construct characterized by difficulty in identifying feelings (DIF) and verbally communicating them difficulty describing feelings (DDF) and an externally oriented cognitive thinking style (EOT). The aim of the present study was to investigate the relationship between alexithymia, anxious and depressive symptoms and pain perception, in patients with FMS and other rheumatic diseases (RD).

Methods: The sample consisted of 127 participants (M = 25, F = 102; mean age: 51.97; SD: 11.14), of which 48 with FMS, 41 with RD and 38 healthy control group (HC). All groups underwent to a test battery investigating anxiety and depressive symptoms (HADS), pain (VAS; QUID-S/-A) and alexithymia (TAS-20).

Results: A high prevalence of alexithymia (TAS ≥ 61) was found in FMS (47.9%) and RD (41.5%) patients, compared to the HC group (2.6%). FMS patients showed significant higher scores than HC on DIF, DDF, EOT, anxiety and depression. The clinical sample, FMS and RD groups combined ( = 89), alexithymic patients (AL, = 40) exhibited higher scores in pain and psychological distress compared to non-alexithymic patients (N-AL, = 34). Regression analysis found no relationship between alexithymia and pain in AL, meanwhile pain intensity was predicted by anxiety in N-AL.

Conclusion: While increasing clinical symptoms (pain intensity and experience, alexithymia, anxiety, and depression) in patients with fibromyalgia or rheumatic diseases, correlations were found on the one side, between alexithymia and psychological distress, on the other side, between pain experience and intensity. Meanwhile, when symptoms of psychological distress and alexithymia were subthreshold, correlations with pain experience and intensity became stronger.
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http://dx.doi.org/10.3389/fpsyg.2019.01735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685004PMC
July 2019

Mindfulness dispositions and defense style as positive responses to psychological distress in oncology professionals.

Eur J Oncol Nurs 2019 Jun 25;40:104-110. Epub 2019 Apr 25.

Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, Via Bonanno Pisano 10, Building 5, 2nd Floor, 56126, Pisa, Italy.

Purpose: Working in oncology departments is a stressful and emotionally consuming experience and oncology professionals are particularly at risk for developing stress-related syndromes. Defense mechanisms (high-adaptive) and mindfulness dispositions are known as facilitators of well-being and adaptation. In this study we analysed the role of these unconscious and conscious strategies in protecting the oncology clinicians from stress-related symptoms.

Method: A convenience sample of 63 oncology professionals was assessed on defense style, mindfulness disposition, depression and anxiety symptoms using self-reported questionnaires. Demographic and professional information was included in data collection.

Results: Results did not show significance differences in demographic and professional characteristics among all studied variables. Mature defense style and mindfulness were highly and negatively correlated with depression and anxiety, while a positive association was found between immature defense style and both depression and anxiety symptoms. Hierarchical multiple regression analyses found defense styles and mindfulness as predictors of depression, whereas only immature defense style predicted anxiety.

Conclusions: The present study provides the first empirical evidence of the influence of unconscious defense mechanisms and conscious mindfulness dispositions in protecting oncology professionals from depression and anxiety symptoms. Defense mechanisms and mindfulness share several common-points and should be seen as complementary in enhancing physical and psychological well-being. Further studies are required for a deeper understanding of the impact of mindfulness and defenses in improving adaptation.
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http://dx.doi.org/10.1016/j.ejon.2019.04.003DOI Listing
June 2019

Qualitative and quantitative analysis of the defensive profile in breast cancer women: A pilot study.

Health Psychol Open 2019 Jan-Jun;6(1):2055102919854667. Epub 2019 Jun 10.

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

This study analyzed the defensive functioning and profile of nine breast cancer women and identifies the differences from other cancer patients (N0) in the way they deal with internal conflicts and stressful situations related to the illness. Patients were interviewed and evaluated using the Defense Mechanisms Rating Scale Q-sort. Mean differences analysis showed that breast cancer patients use more reaction formation, omnipotence, and rationalization and less idealization of others-image and autistic fantasy, compared with other-site cancer patients. From the qualitative analysis of the defensive profile, displacement and repression appeared among the most representative defense mechanisms of breast cancer patients.
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http://dx.doi.org/10.1177/2055102919854667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558547PMC
June 2019
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