Publications by authors named "Giorgio Di Lorenzo"

85 Publications

Genetics Influences Drug Consumption in Medication Overuse Headache, Not in Migraine: Evidence From Wolframin His611Arg Polymorphism Analysis.

Front Neurol 2020 22;11:599517. Epub 2021 Jan 22.

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.

The Wolframin His611Arg polymorphism can influence drug consumption in psychiatric patients with impulsive addictive behavior. This cross-sectional study aims to assess the prevalence of the Wolframin His611Arg polymorphism in MOH, a secondary headache belonging to the spectrum of addictive disorders, episodic migraine (EM), and healthy subjects (HS), and its influence on drug consumption. One-hundred and seventy-two EM, 107 MOH, and 83 HS were enrolled and genotyped for the Wolframin His611Arg polymorphism. Subjects were classified as homozygous for allele His (H/H subjects), homozygous for allele Arg (R/R subjects), and heterozygous (H/R subjects), regrouped as R/R and carriers of allele H (non-R/R), and matched for clinical data. There were no differences in allelic distributions between the three groups ( = 0.19). Drug consumption and other clinical characteristics were not influenced by the Wolframin His611Arg polymorphism ( = 0.42; β = 0.04) in the EM group. Among the MOH population, R/R subjects consumed more analgesics ( < 0.0001; β = -0.38), particularly combination drugs ( = 0.0001; = 2.32). The Wolframin His611Arg polymorphism has a similar prevalence between the MOH, EM, and HS groups. The presence of the R/R genotype does not influence symptomatic drug consumption in EM, whereas it determines an increased use of symptomatic drugs in the MOH group, in particular combination drugs (i.e., drugs containing psychoactive compounds). Our findings are consistent with the hypothesis that the Wolframin His611Arg polymorphism plays its effect only in the MOH population, influencing the impulsivity control underlying addictive behavior.
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http://dx.doi.org/10.3389/fneur.2020.599517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862332PMC
January 2021

Personal and contextual components of resilience mediate risky family environment's effect on psychotic-like experiences.

Early Interv Psychiatry 2020 Dec 23. Epub 2020 Dec 23.

Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.

Background: Psychotic-like experiences (PLEs) index an increased risk for subsequent psychotic disorders. A risky family environment is a well-established risk factor for PLEs; however, different contextual and personal resiliency factors may differentially mediate its effect on PLEs.

Objective: In this study, we propose a two-dimensional model of resilience. Our aim is to address separately the mediational role of personal and contextual resiliency factors between a risky family environment and PLEs in a community sample.

Methods And Materials: Five-hundred University students completed an on-line questionnaire, including the Resilience Scale for Adults (RSA), the 16-item version of the Prodromal Questionnaire (iPQ-16) and the Risky Family Questionnaire (RFQ). Mediation was assessed using Structural Equation Modelling with bootstrapping estimation of indirect effect.

Results: The direct effects of personal and contextual resilience on PLEs were respectively -0.69 [-0.97, -0.41] (P < .001) and - 0.19 [-0.58, 0.20] (ns); the indirect effect through personal resilience was 0.03[0.01, 0.04] (P < .001). Personal resilience mediated 27.4% of the total effect of risky family environment on PLEs.

Discussion: Personal resilience, as opposite to contextual resilience, mediates the effect of a risky family environment on PLEs. Low personal resilience may represent an individual risk factor that transmits the effect of risky family environment on PLEs and could represent a central aspect of individualized prevention and treatment strategies.
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http://dx.doi.org/10.1111/eip.13111DOI Listing
December 2020

Mental Health Outcomes Among Healthcare Workers and the General Population During the COVID-19 in Italy.

Front Psychol 2020 8;11:608986. Epub 2020 Dec 8.

Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

Introduction: During the COVID-19 pandemic, healthcare workers in Italy have been exposed to an unprecedented pressure and traumatic events. However, no direct comparison with the general population is available so far. The aim of this study is to detail mental health outcomes in healthcare workers compared to the general population.

Methods: 24050 respondents completed an on-line questionnaire during the contagion peak, 21342 general population, 1295 second-line healthcare workers, and 1411 front-line healthcare workers. Depressive, anxious, post-traumatic symptoms and insomnia were assessed. Specific COVID-19 related potential risk factors were also considered in healthcare workers.

Results: Depressive symptoms were more frequent in the general population (28.12%) and front-line healthcare workers (28.35%) compared to the second-line healthcare workers (19.98%) groups. Anxiety symptoms showed a prevalence of 21.25% in the general population, 18.05% for second-line healthcare workers, and 20.55% for front-line healthcare workers. Insomnia showed a prevalence of 7.82, 6.58, and 9.92% for the general population, second-line healthcare workers, and front-line healthcare workers, respectively. Compared to the general population, front-line healthcare workers had higher odds of endorsing total trauma-related symptoms. Both second-line healthcare workers and front-line healthcare workers had higher odds of endorsing core post-traumatic symptoms compared to the general population, while second-line healthcare workers had lower odds of endorsing negative affect and dissociative symptoms. Higher total traumatic symptom score was associated with being a front-line healthcare worker, having a colleague infected, hospitalized, or deceased, being a nurse, female gender, and younger age.

Conclusion: This study suggests a significant psychological impact of the COVID-19 pandemic on the Italian general population and healthcare workers. Front-line healthcare workers represent a specific at-risk population for post-traumatic symptoms. These findings underline the importance of monitoring and intervention strategies.
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http://dx.doi.org/10.3389/fpsyg.2020.608986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753010PMC
December 2020

Auditory Mismatch Negativity in Youth Affected by Autism Spectrum Disorder With and Without Attenuated Psychosis Syndrome.

Front Psychiatry 2020 24;11:555340. Epub 2020 Nov 24.

Child Neurology and Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

The present study investigates the differences in auditory mismatch negativity (MMN) parameters given in a sample of young subjects with autism spectrum disorder (ASD, = 37) with or without co-occurrent attenuated psychosis syndrome (APS). Our results show that ASD individuals present an MMN decreased amplitude and prolonged latency, without being influenced by concurrent APS. Additionally, when correlating the MMN indexes to clinical features, in the ASD + APS group, we found a negative correlation between the severity of autistic symptoms and the MMN latency in both frequency (f-MMN = -0.810; < 0.0001) and duration (d-MMN = -0.650; = 0.006) deviants. Thus, our results may provide a more informative characterization of the ASD sub-phenotype when associated with APS, highlighting the need for further longitudinal investigations.
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http://dx.doi.org/10.3389/fpsyt.2020.555340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732489PMC
November 2020

Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout.

J Sex Med 2021 01 23;18(1):35-49. Epub 2020 Oct 23.

Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. Electronic address:

Background: The COVID-19-related lockdown has profoundly changed human behaviors and habits, impairing general and psychological well-being. Along with psychosocial consequences, it is possible that sexual behavior was also affected.

Aims: With the present study, we evaluated the impact of the community-wide containment and consequent social distancing on the intrapsychic, relational, and sexual health through standardized psychometric tools.

Methods: A case-control study was performed through a web-based survey and comparing subjects of both genders with (group A, N = 2,608) and without (group B, N = 4,213) sexual activity during lockdown. The Welch and chi-square tests were used to assess differences between groups. Univariate analysis of covariance, logistic regression models, and structural equation modeling were performed to measure influence and mediation effects of sexual activity on psychological, relational, and sexual outcomes.

Outcomes: Main outcome measures were General Anxiety Disorder-7 for anxiety, Patient Health Questionnaire-9 for depression, Dyadic Adjustment Scale for quality of relationship and a set of well-validated sexological inventories (International Index of Erectile Function, Female Sexual Function Index, and male-female versions of the Orgasmometer).

Results: Anxiety and depression scores were significantly lower in subjects sexually active during lockdown. Analysis of covariance identified gender, sexual activity, and living without partner during lockdown as significantly affecting anxiety and depression scores (P < .0001). Logistic regression models showed that lack of sexual activity during lockdown was associated with a significantly higher risk of developing anxiety and depression (OR: 1.32 [95% CI: 1.12 - 1.57, P < .001] and 1.34 [95% CI: 1.15 - 1.57, P < .0001], respectively). Structural equation modeling evidenced the protective role of sexual activity toward psychological distress (β = -0.18 and β = -0.14), relational health (β = 0.26 and β = 0.29) and sexual health, both directly (β = 0.43 and β = 0.31), and indirectly (β = 0.13 and β = 0.13).

Clinical Translation: The demonstrated mutual influence of sexual health on psychological and relational health could direct the clinical community toward a reinterpretation of the relationship among these factors.

Strengths And Limitations: Based on a large number of subjects and well-validated psychometric tools, this study elucidated the protective role of sexual activity for psychological distress, as well for relational and sexual health. Main limitations were the web-based characteristics of the protocol and the retrospective nature of prelockdown data on psychorelational and sexual health of subjects recruited.

Conclusions: COVID-19 lockdown dramatically impacted on psychological, relational, and sexual health of the population. In this scenario, sexual activity played a protective effect, in both genders, on the quarantine-related plague of anxiety and mood disorders. Mollaioli D, Sansone A, Ciocca G, et al. Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout. J Sex Med 2021;18:35-49.
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http://dx.doi.org/10.1016/j.jsxm.2020.10.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584428PMC
January 2021

Hypersexuality and Trauma: a mediation and moderation model from psychopathology to problematic sexual behavior.

J Affect Disord 2021 Feb 16;281:631-637. Epub 2020 Nov 16.

Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy. Electronic address:

Introduction: . Hypersexuality is a clinical condition regarding the psychopathology of sexual behavior. In this study, we aimed to investigate the role of trauma, through the post-traumatic stress-disorder (PTSD), depression, shame and guilt on the hypersexual behavior.

Methods: . Through an online platform, a convenience sample of 1025 subjects was recruited (females: n=731; 71.3%; males: 294; 28.7%; age: 29.62±10.90). Recruited subjects compiled a psychometric protocol composed by the Hypersexual Behavior Inventory (HBI) to assess hypersexuality, the International Trauma Questionnaire (ITQ) for PTSD, the Patient Health Questionnaire (PHQ-9) to evaluate depression and the State Shame and Guilt Scale (SSGS) for shame and guilt. Then a mediation/moderation model was performed for the data analysis.

Results: . There was a statistically significant direct effect of post-traumatic symptoms (ITQTotal) on hypersexual behavior (HBTotal). Furthermore, indirect effects were also statistically significant, providing support to the hypothesis that depression and guilt would be serial mediators of trauma-hypersexual behavior relations. The paths through depression and guilt have been found to be the most significant with moderate and high indirect effects on hypersexuality. Moreover, male gender, as covariate variable, is a relevant risk factor for hypersexual behavior.

Conclusion: . We found the relationship between hypersexuality and trauma describing a possible etiological pathway mainly involving depression, shame and guilt. Hypersexuality can be considered as a reactive form of a major affective psychopathology representing a tip of the iceberg hiding the real issues of a suffering personality. Clinicians and researchers should therefore consider hypersexual behavior in the light of a symptomatic manifestation of a major psychopathology involving the affective aspects of personality.
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http://dx.doi.org/10.1016/j.jad.2020.11.100DOI Listing
February 2021

Which factors delay treatment in bipolar disorder? A nationwide study focussed on duration of untreated illness.

Early Interv Psychiatry 2020 Oct 15. Epub 2020 Oct 15.

Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatry Unit 2, ASST-Fatebenefratelli-Sacco, Milan, Italy.

Aim: The aim of the present study was to detect factors associated with duration of untreated illness (DUI) in bipolar disorder (BD).

Method: A total of 1575 patients were selected for the purposes of the study. Correlation analyses were performed to analyse the relation between DUI and quantitative variables. The length of DUI was compared between groups defined by qualitative variables through one-way analyses of variance or Kruskal-Wallis's tests according to the distribution of the variable. Linear multivariable regressions were used to find the most parsimonious set of variables independently associated with DUI: to this aim, qualitative variables were inserted with the numeric code of their classes by assuming a proportional effect moving from one class to another.

Results: An inverse significant correlation between length of DUI and time between visits in euthymic patients was observed (r = -.52, P < .001). DUI resulted to be longer in patients with: at least one lifetime marriage/partnership (P = .009), a first psychiatric diagnosis of major depressive disorder or substance abuse (P < .001), a depressive polarity of first episode (P < .001), no lifetime psychotic symptoms (P < .001), BD type 2 (P < .001), more lifetime depressive/hypomanic episodes (P < .001), less lifetime manic episodes (P < .001), presence of suicide attempts (P = .004), depressive episodes (P < .001), hypomanic episodes (P = .004), hospitalizations (P = .011) in the last year.

Conclusions: Different factors resulted to increase the length of DUI in a nationwide sample of bipolar patients. In addition, the DUI was found to show a negative long-term effect in terms of more suicidal behaviour, more probability of hospitalization and depressive/hypomanic episodes.
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http://dx.doi.org/10.1111/eip.13051DOI Listing
October 2020

Special Report on the Impact of the COVID-19 Pandemic on Clinical EEG and Research and Consensus Recommendations for the Safe Use of EEG.

Clin EEG Neurosci 2021 Jan 25;52(1):3-28. Epub 2020 Sep 25.

Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.

Introduction: The global COVID-19 pandemic has affected the economy, daily life, and mental/physical health. The latter includes the use of electroencephalography (EEG) in clinical practice and research. We report a survey of the impact of COVID-19 on the use of clinical EEG in practice and research in several countries, and the recommendations of an international panel of experts for the safe application of EEG during and after this pandemic.

Methods: Fifteen clinicians from 8 different countries and 25 researchers from 13 different countries reported the impact of COVID-19 on their EEG activities, the procedures implemented in response to the COVID-19 pandemic, and precautions planned or already implemented during the reopening of EEG activities.

Results: Of the 15 clinical centers responding, 11 reported a total stoppage of all EEG activities, while 4 reduced the number of tests per day. In research settings, all 25 laboratories reported a complete stoppage of activity, with 7 laboratories reopening to some extent since initial closure. In both settings, recommended precautions for restarting or continuing EEG recording included strict hygienic rules, social distance, and assessment for infection symptoms among staff and patients/participants.

Conclusions: The COVID-19 pandemic interfered with the use of EEG recordings in clinical practice and even more in clinical research. We suggest updated best practices to allow safe EEG recordings in both research and clinical settings. The continued use of EEG is important in those with psychiatric diseases, particularly in times of social alarm such as the COVID-19 pandemic.
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http://dx.doi.org/10.1177/1550059420954054DOI Listing
January 2021

Haemodynamic activity characterization of resting state networks by fractal analysis and thalamocortical morphofunctional integrity in chronic migraine.

J Headache Pain 2020 Sep 14;21(1):112. Epub 2020 Sep 14.

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.

Background: Chronic migraine (CM) can be associated with aberrant long-range connectivity of MRI-derived resting-state networks (RSNs). Here, we investigated how the fractal dimension (FD) of blood oxygenation level dependent (BOLD) activity may be used to estimate the complexity of RSNs, reflecting flexibility and/or efficiency in information processing in CM patients respect to healthy controls (HC).

Methods: Resting-state MRI data were collected from 20 untreated CM without history of medication overuse and 20 HC. On both groups, we estimated the Higuchi's FD. On the same subjects, fractional anisotropy (FA) and mean diffusivity (MD) values of bilateral thalami were retrieved from diffusion tensor imaging and correlated with the FD values.

Results: CM showed higher FD values within dorsal attention system (DAS) and the anterior part of default-mode network (DMN), and lower FD values within the posterior DMN compared to HC. Although FA and MD were within the range of normality, both correlated with the FD values of DAS.

Conclusions: FD of DAS and DMN may reflect disruption of cognitive control of pain in CM. Since the normal microstructure of the thalamus and its positive connectivity with the cortical networking found in our CM patients reminds similar results obtained assessing the same structures but with the methods of neurophysiology, in episodic migraine during an attack, this may be yet another evidence in supporting CM as a never-ending migraine attack.
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http://dx.doi.org/10.1186/s10194-020-01181-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490862PMC
September 2020

COVID-19 Pandemic and Lockdown Measures Impact on Mental Health Among the General Population in Italy.

Front Psychiatry 2020 7;11:790. Epub 2020 Aug 7.

Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

Background: The psychological impact of the COronaVIrus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown. The current study assesses rates of mental health outcomes in the Italian general population three to 4 weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors.

Methods: A web-based survey spread throughout the internet between March 27 and April 6 2020. Eighteen thousand one hundred forty-seven individuals completed the questionnaire, 79.6% women. Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, perceived stress, and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors.

Results: Endorsement rates for PTSS were 6,604 (37%), 3,084 (17.3%) for depression, 3,700 (20.8%) for anxiety, 1,301 (7.3%) for insomnia, 3,895 (21.8%) for high perceived stress and 4,092 (22.9%) for adjustment disorder. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress, and insomnia.

Conclusion: We found high rates of negative mental health outcomes in the Italian general population 3 weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population's mental health.
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http://dx.doi.org/10.3389/fpsyt.2020.00790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426501PMC
August 2020

'Too many BeEPs in our teens!' Behavioral and emotional problems in a large group of Italian adolescents.

Psychol Med 2020 Aug 11:1-10. Epub 2020 Aug 11.

Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

Background: One in six adolescents suffers from mental health problems. Despite the presence of general information on Italian adolescents' mental health, researches conducted with standardized assessment tools are scarce in the literature. We evaluated the prevalence of self-reported behavioral and emotional problems in a group of Italian adolescents and examined their relation to socio-demographical variables.

Methods: This population-based sampling survey was conducted on high school students aged 14-18 from urban areas of Rome and Latina. Participants completed Youth Self-Report (YSR) and a socio-demographic schedule to collect information on age, gender, type of school attended, socio-economic status, urbanicity.

Results: Final sample consisted of 1400 adolescents (38.61% male, mean age 16 years, s.d. 1.42). Prevalence of Internalizing Problems, Externalizing Problems and Total Problems was 29.55%, 18.34% and 24.13%. In our multivariable model, Internalizing Symptoms were not explained by sociodemographic variables while Externalizing Symptoms were explained by Male Gender [OR = 1.53 (1.14-2.06)], older age [OR = 2.06 (1.52-2.79)] and attending a Technical and Professional Institute [OR = 2.15 (1.53-3.02)], with an adjusted R2 = 4.32%. Total Problems were explained by School Type [Technical and Professional Institutes and Art and Humanities v. Grammar and Science School; OR respectively 1.93 (1.40-2.67) and 1.64 (1.08-2.47)], adjusted R2 = 1.94.

Conclusions: The study provides, for the first time, evidence of a great prevalence of self-reported behavioral and emotional problems in a large sample of Italian adolescents, highlighting the role of different socio-demographic variables as risk factors for externalizing behaviors. Our results emphasize the urgent need for implementing prevention programs on mental health in adolescence.
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http://dx.doi.org/10.1017/S0033291720002767DOI Listing
August 2020

Long-lasting connectivity changes induced by intensive first-person shooter gaming.

Brain Imaging Behav 2020 Aug 7. Epub 2020 Aug 7.

Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy.

Action videogames have been shown to induce modifications in perceptual and cognitive systems, as well as in brain structure and function. Nevertheless, whether such changes are correlated with brain functional connectivity modifications outlasting the training period is not known. Functional magnetic resonance imaging (fMRI) was used in order to quantify acute and long-lasting connectivity changes following a sustained gaming experience on a first-person shooter (FPS) game. Thirty-five healthy participants were assigned to either a gaming or a control group prior to the acquisition of resting state fMRI data and a comprehensive cognitive assessment at baseline (T0), post-gaming (T1) and at a 3 months' follow-up (T2). Seed-based resting-state functional connectivity (rs-FC) analysis revealed a significant greater connectivity between left thalamus and left parahippocampal gyrus in the gamer group, both at T1 and at T2. Furthermore, a positive increase in the rs-FC between the cerebellum, Heschl's gyrus and the middle frontal gyrus paralleled improvements of in-gaming performance. In addition, baseline rs-FC of left supramarginal gyrus, left middle frontal gyrus and right cerebellum were associated with individual changes in videogame performance. Finally, enhancement of perceptual and attentional measures was observed at both T1 and T2, which correlated with a pattern of rs-FC changes in bilateral occipito-temporal regions belonging to the visual and attention fMRI networks. The present findings increase knowledge on functional connectivity changes induced by action videogames, pointing to a greater and long-lasting synchronization between brain regions associated with spatial orientation, visual discrimination and motor learning even after a relatively short multi-day gaming exposure.
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http://dx.doi.org/10.1007/s11682-020-00350-2DOI Listing
August 2020

Celiac Disease Diagnosed in an Older Adult Patient with a Complex Neuropsychiatric Involvement: A Case Report and Review of the Literature.

Brain Sci 2020 Jul 3;10(7). Epub 2020 Jul 3.

Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 200, 00128 Rome, Italy.

We present a case of celiac disease (CD) diagnosis in a 75-year-old woman with a long-term history of chronic delusional jealousy and a complex neurological involvement. The case describes a very unusual clinical picture, provides some clinical clues, and highlights the importance of being aware of CD extraintestinal manifestations in order to get a timely diagnosis.
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http://dx.doi.org/10.3390/brainsci10070426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408423PMC
July 2020

The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis.

J Affect Disord 2020 08 15;273:384-390. Epub 2020 May 15.

Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy. Electronic address:

Introduction: Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation.

Methods: One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome.

Results: Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress.

Conclusions: The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.
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http://dx.doi.org/10.1016/j.jad.2020.05.014DOI Listing
August 2020

High Frequency of Undiagnosed Psychiatric Disorders in Inflammatory Bowel Diseases.

J Clin Med 2020 May 8;9(5). Epub 2020 May 8.

Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.

Inflammatory bowel diseases (IBD) are associated with comorbid depressive and anxiety disorders, but a significant proportion of IBD patients with psychiatric disorders (PsychD) remain undiagnosed and untreated. The aim of this study was to assess the frequency and type of undiagnosed PsychD in IBD patients. Two hundred and thirty-seven adult IBD (136 Crohn's disease (CD) and 101 ulcerative colitis (UC)) outpatients were consecutively recruited at a single university hospital centre between January 2018 and June 2019. After a scheduled follow-up visit for IBD clinical evaluation, participants underwent a semi-structured interview with a trained psychiatrist. One hundred and fourteen (48%) IBD patients had at least one PsychD, and in 67 (59%) of them, a diagnosis was made for the first time during the study. The remaining 47 (41%) patients had received a previous psychiatric diagnosis, but in only six cases was it consistent with the diagnosis made during the study. PsychD were equally distributed in CD (72/136, 53%) and UC (42/101, 42%), and mostly represented by mood disorders (54/114, 47%) and anxiety (27/114, 24%) disorders. PsychD were not related to the disease severity, phenotype or localisation of IBD, even though having three or more concomitant PsychD was associated with more severe disease in CD. Our data indicate that undiagnosed PsychD are common in IBD and highlight the importance of considering psychiatric evaluation in the management of IBD patients.
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http://dx.doi.org/10.3390/jcm9051387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291309PMC
May 2020

Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS): a validation study in Italian population.

Riv Psichiatr 2020 Mar-Apr;55(2):98-105

Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Italy.

Background: Although cognitive deficit in persons with schizophrenia is well documented, the assessment of the patient's perception of its own cognitive functioning is a relevant issue not adequately studied. Several evaluation tools have been elaborated, however none has been validated in Italian. The aim of the study is the validation of the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), a rating scale designed to measure subjective cognitive deficits complaints in persons with schizophrenia. < span class="text116">Method. 146 persons meeting the DSM-5 diagnostic criteria for schizophrenia have been recruited. The SSTICS was translated in Italian in accordance with international standard methods. Subjects were also evaluated using the Positive and Negative Syndrome Scale (PANSS) and the Subjective Well-being under Neuroleptic scale (SWN). Cronbach's alpha coefficient was used to assess internal consistency. Constructs were examined using exploratory factor analysis (principal component with varimax rotation). The factorial model was then tested via confirmatory factor analysis.

Results: The factorial analysis revealed a 4-factor structure, which is more parsimonious than those obtained in previous studies. Correlations between STICSS and the other rating scales were significant for several domains.

Conclusions: The Italian version of the SSTICS showed good psychometric properties and is suitable to measure the patients' subjective perception of cognitive impairment. Subjective evaluation can integrate objective measures of cognitive performances, supporting a multidimensional model of functional impairment in schizophrenia.
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http://dx.doi.org/10.1708/3333.33024DOI Listing
January 2021

ResilienCity: Resilience and Psychotic-Like Experiences 10 Years After L'Aquila Earthquake.

Front Psychiatry 2020 28;11:77. Epub 2020 Feb 28.

Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

An earthquake hit the city of L'Aquila in central Italy in 2009, leaving the city completely destroyed and 309 casualties. Unexpectedly, lower rates of psychotic experiences in persons affected by the earthquake compared to non-affected persons were found 10 months after the earthquake. The very long-term impact of a natural disaster on the prevalence of psychotic experiences deserves more in-depth detailing. The Authors examined resilience and psychotic experiences in a university student sample of 494. No effect of direct exposure to the earthquake (odds ratio = 0.64, 95%CI [0.37, 1.11]), material damages (odds ratio = 0.86, 95%CI [0.60, 1.23]), psychological suffering (odds ratio = 1.06, 95% CI [0.83, 1.36]), or global impact severity (odds ratio = 0.92, 95%CI [0.76, 1.12]) on psychotic experiences was detected. Resilience levels did not differ between affected and non-affected persons. Resilience showed a strong protective effect on psychotic experiences (odds ratio=0.38, 95% CI [0.28, 0.51]. The protective effect of the RSA factor "Perception of Self" was significantly stronger in individuals affected by the earthquake compared to non-affected subjects. Being affected by an earthquake is not a risk factor for psychotic experiences in a university student sample, as no direct effect of the earthquake was detected after 10 years after the event. Resilience is confirmed as a strong protective factor for psychotic experiences irrespectively of large collective traumatic events. Extension of these results to a general population sample could provide interesting insights into recovery from natural disasters.
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http://dx.doi.org/10.3389/fpsyt.2020.00077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059251PMC
February 2020

The Symptom-Checklist-K-9 (SCL-K-9) Discriminates between Overweight/Obese Patients with and without Significant Binge Eating Pathology: Psychometric Properties of an Italian Version.

Nutrients 2020 Mar 1;12(3). Epub 2020 Mar 1.

Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy.

A general personality and psychopathology evaluation is considered to be crucial part of the multidisciplinary assessment for weight-related problems. The Symptom Checklist-90-Revised (SCL-90-R) is commonly used to assess general psychopathology in both overweight and obese patients seeking weight-loss treatment. The main purpose of the present research was to investigate the psychometric properties of the brief form of the SCL-90-R (i.e., the SCL-K-9) in a clinical sample ( = 397) of patients seeking weight-loss treatment (i.e., bariatric surgery and a nutritional weight-loss program). The results of the confirmatory factor analysis supported a one-factor solution of the SCL-K-9, with all nine items loading significantly on the common latent factor (lambdas ≥ 0.587). The ordinal α (= 0.91), the inter-item mean indices of correlation ( = 0.53), and the convergent validity were also satisfactory. A receiver operating characteristic curves procedure showed that both SCL-90-R and SCL-K-9 were able to classify patients with and without significant binge eating pathology according to the Binge Eating Scale (BES) total score. Overall, our results suggest that the SCL-K-9 has adequate psychometric properties and can be applied as a short screening tool to assess general psychopathology in overweight/obese individuals seeking weight-loss treatment and at follow-up interviews when time restraints preclude the use of the full-length form.
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http://dx.doi.org/10.3390/nu12030674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146623PMC
March 2020

Sexological Aspects Related to Tinder Use: A Comprehensive Review of the Literature.

Sex Med Rev 2020 Jul 20;8(3):367-378. Epub 2020 Feb 20.

Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. Electronic address:

Introduction: Tinder is the most popular and used meeting application for dating. However, its impact on sexual behavior and sexual health has not yet been thoroughly investigated.

Objectives: To review the current empirical knowledge on the sexual health and sexual behavior effects related to Tinder use.

Methods: A literature review was conducted based on empirical studies published in the last 5 years. A computerized search was performed to identify all relevant studies in PubMed and Google Scholar. The following search terms were used: "Tinder" AND "Sexuality" OR "Tinder" AND "Sexual Behavior" OR "Tinder" AND "Sexual Dysfunctions" OR "Tinder" AND "Sexual Health." 34 articles fully satisfied the established criteria.

Results: We found sociosexuality, that is, sexual activities outside a committed relationship, to be the main predictor for casual sex in the Tinder users. The sexual aims appeared gender-influenced: men used Tinder mostly for casual sex compared with women. With respect to other dating apps, it has been also found that the Tinder use is less related to the risk of sexually transmitted infections. However, specific personality traits related to dark personality (ie, the association of Machiavellianism, narcissism, and psychopathy) were more frequently reported among male Tinder users.

Conclusion: Existing literature concerning Tinder use shows the advantages and disadvantages of this dating technology. Casual sex might be a risk for sexual health, but Tinder users have also been committed to romantic relationships. Moreover, some pathological aspects of personality characterize some Tinder users. From an evolutionary perspective, sociosexuality partially explains the reasons of the Tinder user's interest for casual sex. Finally, this review highlights the need of further studies on Tinder as a new, pivotal virtual place to promote sex education and sexual health. Ciocca G, Robilotta A, Fontanesi L, et al. Sexological Aspects Related to Tinder Use: A Comprehensive Review of the Literature. Sex Med Rev 2020;8:367-378.
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http://dx.doi.org/10.1016/j.sxmr.2019.12.004DOI Listing
July 2020

A Case of Comorbid PTSD and Posttraumatic OCD Treated with Sertraline-Aripiprazole Augmentation.

Case Rep Psychiatry 2020 27;2020:2616492. Epub 2020 Jan 27.

Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

Several studies report on traumatic history in Obsessive Compulsive Disorder (OCD) and comorbidity between Posttraumatic Stress Disorder (PTSD) and OCD. First-line pharmacological treatments for both OCD and PTSD are primarily based on antidepressants, including Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Noradrenaline Reuptake Inhibitors (SNRI) such as Venlafaxine for PTSD. Second-Generation Antipsychotic (SGA) augmentation has shown good outcomes for nonresponsive OCD cases. However, evidence on the use of SGA in PTSD is more limited. In the present paper, we report on comorbid OCD-PTSD successfully treated with aripiprazole augmentation of sertraline. Shared psychopathological and pharmacological aspects of the disorders are discussed.
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http://dx.doi.org/10.1155/2020/2616492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007739PMC
January 2020

Surgical treatment for giant retroperitoneal well-differentiated liposarcoma (WDLPS): case report and literature review.

G Chir 2019 Nov-Dec;40(6):539-543

WDLPS are very rare retroperioneal tumors that can reach huge size before becoming symptomatic. The aim of this article is show the diagnostic management and the surgical approach to giant WDLPS. A standard treatment has yet to be established because the pre-operative diagnosis is very difficult. We present a case of a 69-year-old male patient with progressive increase of abdominal girth, weight loss and light abdominal pain and with an abdominal mass of over 15 kg that displaced the right kidney. A complete tumor resection and right nephrectomy were performed. Histology revealed a well-differentieated liposarcoma. CT scan is the most common imaging technique and laparotomic open radical resection represent the most common surgical approach.
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July 2020

Acute massive bleeding from splenic artery aneurysm rupture: a case report.

G Chir 2019 Nov-Dec;40(6):530-534

Splenic artery aneurysm (SAA) is the most common aneurysm of visceral vessels. Usually the rupture occurs into the free peritoneal cavity and causes massive bleeding, much less frequently the rupture happens into the lumen of the gastrointestinal tract. We describe the case of a 39-year-old male patient with a spontaneous rupture of a splenic artery aneurysm and an acute massive peritoneal bleeding. The case described confirms the rupture of SAA is always a dramatic event and an emergency laparotomy is a life-saving procedure.
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July 2020

A Randomized Double-Blind, Cross-Over Trial of very Low-Calorie Diet in Overweight Migraine Patients: A Possible Role for Ketones?

Nutrients 2019 Jul 28;11(8). Epub 2019 Jul 28.

Department of Experimental Medicine, Sapienza University of Rome, 00161 Roma, Italy.

Here we aimed at determining the therapeutic effect of a very low-calorie diet in overweight episodic migraine patients during a weight-loss intervention in which subjects alternated randomly between a very low-calorie ketogenic diet (VLCKD) and a very low-calorie non-ketogenic diet (VLCnKD) each for one month. In a nutritional program, 35 overweight obese migraine sufferers were allocated blindly to 1-month successive VLCKD or VLCnKD in random order (VLCKD-VLCnKD or VLCnKD-VLCD). The primary outcome measure was the reduction of migraine days each month compared to a 1-month pre-diet baseline. Secondary outcome measures were 50% responder rate for migraine days, reduction of monthly migraine attacks, abortive drug intake and body mass index (BMI) change. Only data from the intention-to-treat cohort ( = 35) will be presented. Patients who dropped out ( = 6) were considered as treatment failures. Regarding the primary outcome, during the VLCKD patients experienced -3.73 (95% CI: -5.31, -2.15) migraine days respect to VLCnKD ( < 0.0001). The 50% responder rate for migraine days was 74.28% (26/35 patients) during the VLCKD period, but only 8.57% (3/35 patients) during VLCnKD. Migraine attacks decreased by -3.02 (95% CI: -4.15, -1.88) during VLCKD respect to VLCnKD ( < 0.00001). There were no differences in the change of acute anti-migraine drug consumption ( = 0.112) and BMI ( = 0.354) between the 2 diets. A VLCKD has a preventive effect in overweight episodic migraine patients that appears within 1 month, suggesting that ketogenesis may be a useful therapeutic strategy for migraines.
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http://dx.doi.org/10.3390/nu11081742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722531PMC
July 2019

Prevalence of Food Addiction and Binge Eating in an Italian sample of bariatric surgery candidates and overweight/obese patients seeking low-energy-diet therapy.

Riv Psichiatr 2019 May-Jun;54(3):127-130

Department of Human Science, European University of Rome, Italy.

Aim: The main aim of the present study was to investigate the prevalence of Food Addiction (FA) and clinical level of Binge Eating in an Italian sample of overweight/obese patients attending low energy-diet therapy, and in an Italian sample of obese bariatric surgery candidates.

Methods: Participants were: i) 122 overweight/obese patients (86 women) referred to a medical center in Rome (Italy), specialized in nutritional treatment of obesity (i.e., non-surgery patients group), and ii) 281 surgery candidates (207 women) referred to the center for Bariatric Surgery at the University of Rome Tor Vergata (i.e., surgery candidates group). All patients were administered self-report measures investigating FA, binge eating, and psychopathology.

Results: Non-surgery patients and surgery candidates did not differ in the prevalence of FA (31.1% vs 26.3%), moderate level of binge eating (32.0% vs 31.8%), and severe level of binge eating (11.05% vs 13.6%). Compared to non-surgery patients, surgery candidates reported higher prevalence in two FA symptoms: i) food consumed more than planned (13.9% vs 25.3%; p=0.011) and ii) persistent desire or repeated unsuccessful attempts (89.3% vs 96.8; p=0.002).

Discussion And Conclusion: Our results confirm that both FA and clinical level of binge eating are common problems in both overweight/obese patients seeking low-energy-diet therapy and in obese bariatric surgery candidates, justifying the clinical utility of assessing these dysfunctional eating patterns.
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http://dx.doi.org/10.1708/3181.31602DOI Listing
February 2020

A ketogenic diet normalizes interictal cortical but not subcortical responsivity in migraineurs.

BMC Neurol 2019 Jun 22;19(1):136. Epub 2019 Jun 22.

Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University Rof Rome Polo Pontino, Latina, Italy.

Background: A short ketogenic diet (KD) treatment can prevent migraine attacks and correct excessive cortical response. Here, we aim to prove if the KD-related changes of cortical excitability are primarily due to cerebral cortex activity or are modulated by the brainstem.

Methods: Through the stimulation of the right supraorbital division of the trigeminal nerve, we concurrently interictally recorded the nociceptive blink reflex (nBR) and the pain-related evoked potentials (PREP) in 18 migraineurs patients without aura before and after 1-month on KD, while in metabolic ketosis. nBR and PREP reflect distinct brain structures activation: the brainstem and the cerebral cortex respectively. We estimated nBR R2 component area-under-the-curve as well as PREP amplitude habituation as the slope pof the linear regression between the 1st and the 2nd block of 5 averaged responses.

Results: Following 1-month on KD, the mean number of attacks and headache duration reduced significantly. Moreover, KD significantly normalized the interictal PREP habituation (pre: + 1.8, post: - 9.1, p = 0.012), while nBR deficit of habituation did not change.

Conclusions: The positive clinical effects we observed in a population of migraineurs by a 1-month KD treatment coexists with a normalization at the cortical level, not in the brainstem, of the typical interictal deficit of habituation. These findings suggest that the cerebral cortex may be the primary site of KD-related modulation.

Trial Registration: ClinicalTrials.gov NCT03775252 (retrospectively registered, December 09, 2018).
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http://dx.doi.org/10.1186/s12883-019-1351-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588932PMC
June 2019

Assessing Learning Needs and Career Attitudes of Italian Psychiatry Residents: Results from a National Survey Conducted by the Italian Society of Psychopathology Young Psychiatrists Section (SOPSI-GG).

Clin Pract Epidemiol Ment Health 2019 20;15:21-29. Epub 2019 Feb 20.

Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy.

Objective: No data are available about learning needs and career attitudes of Italian Psychiatry Residents (IPRs). Authors aimed to assess such needs through a survey to generate insight for implementing educational programs close to IPRs' perceived learning needs.

Methods: A 54-item questionnaire was developed in order to investigate career information, educational preference and learning needs of IPRs. A sample of 298 IPRs participated to the survey and was divided into four subgroups according to their location (North, Centre, South and Islands). The subgroups were compared through ANOVA for age and chi-square tests for qualitative variables (including gender and all sub-items of the survey), with Bonferroni post-hoc analysis.

Results: IPRs were found to pursue, along with traditional and theoretical training, a quite practical approach, characterized by working groups, discussions on clinical cases and practical interactive sessions. The topics of major interest included: clinical psychiatry, psychopharmacology, psychiatric emergencies, communication and relationship skills (97%, 98.0%, 98.3% and 95.7% of the total sample, respectively). Indeed, a strong need for interaction with healthcare professionals emerged (97% of the total sample). North and Centre IPRs were more involved in Day Hospital activities than residents from South Italy and Islands (p<.001). South IPRs appeared to be more prone to invest for their education than residents from other areas (<.01).

Conclusion: Reported findings should be taken into account as a starting point for planning and developing future targeted packages of educational proposals for IPRs and they should stand as a useful pilot study for further investigation in the field.
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http://dx.doi.org/10.2174/1745017901915010021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407657PMC
February 2019

Disorganization and cognitive impairment in schizophrenia: New insights from electrophysiological findings.

Int J Psychophysiol 2019 11 18;145:99-108. Epub 2019 Mar 18.

Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.

In subjects with schizophrenia (SCZ), the disorganization dimension is a strong predictor of real-life functioning. "Conceptual disorganization" (P2), "Difficulty in abstract thinking" (N5) and "Poor attention" (G11) are core features of the disorganization factor, evaluated using the Positive and Negative Syndrome Scale. The heterogeneity of this dimension and its overlap with neurocognitive deficits are still debated. Within the multicenter study of the Italian Network for Research on Psychoses, we investigated electrophysiological and neurocognitive correlates of disorganization and its component items to assess the heterogeneity of this dimension and its possible overlap with neurocognitive deficits. Resting state EEG was recorded in 145 stabilized SCZ and 69 matched healthy controls (HC). Spectral amplitude was averaged in ten frequency bands. Neurocognitive domains were assessed by MATRICS Consensus Cognitive Battery (MCCB). RAndomization Graphical User software explored band spectral amplitude differences between groups and correlations with disorganization and MCCB scores in SCZ. Correlations between disorganization and MCCB scores were also investigated. Compared to HC, SCZ showed increased delta, theta, and beta 1 and decreased alpha 2 activity. A negative correlation between alpha 1 and disorganization was observed in SCZ. At the item level, only "N5" showed the same correlation. MCCB neurocognitive composite score was associated with disorganization, "P2" and "N5". Our findings suggest only a partial overlap between disorganization and neurocognitive impairment. The association of alpha 1 with the "N5" item suggests that some aspects of disorganization could be underpinned by the impairment of basic neurobiological functions that are only partially evaluated using MCCB.
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http://dx.doi.org/10.1016/j.ijpsycho.2019.03.008DOI Listing
November 2019

Psychological and Brain Connectivity Changes Following Trauma-Focused CBT and EMDR Treatment in Single-Episode PTSD Patients.

Front Psychol 2019 25;10:129. Epub 2019 Feb 25.

Department of Medicine, Surgery and Neuroscience, School of Medicine, University of Siena, Siena, Italy.

Among the different therapeutic alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Therapy have shown promising results in helping patients cope with PTSD symptoms. However, given the different theoretical and methodological substrate of TF-CBT and EMDR, a potentially different impact on the brain for the two interventions could be hypothesized, as well as an interaction between trauma-specific PTSD symptomatology and response to a given psychotherapy. In this study, we monitored psychological and spontaneous functional connectivity fMRI patterns in two groups of PTSD patients who suffered by the same traumatic event (i.e., natural disaster), before and after a cycle of psychotherapy sessions based on TF-CBT and EMDR. Thirty-seven (37) PTSD patients were enrolled from a larger sample of people exposed to a single, acute psychological stress (i.e., 2002 earthquake in San Giuliano di Puglia, Italy). Patients were randomly assigned to TF-CBT ( = 14) or EMDR ( = 17) psychotherapy. Clinical assessment was performed using the Clinician-Administered PTSD Scale (CAPS), the Davidson Trauma Scale (DTS) and the Work and Social Adjustment Scale (WSAS), both at baseline and after treatment. All patients underwent a fMRI data acquisition session before and after treatment, aimed at characterizing their functional connectivity (FC) profile at rest, as well as potential connectivity changes associated with the clinical impact of psychotherapy. Both EMDR and TF-CBT induced statistically significant changes in clinical scores, with no difference in the clinical impact of the two treatments. Specific changes in FC correlated with the improvement at the different clinical scores, and differently for EMDR and TF-CBT. However, a similarity in the connectivity changes associated with changes in CAPS in both groups was also observed. Specifically, changes at CAPS in the entire sample correlated with an (i) increase in connectivity between the bilateral superior medial frontal gyrus and right temporal pole, and a (ii) decrease in connectivity between left cuneus and left temporal pole. Results point to a similar, beneficial psychological impact of EMDR and TF-CBT for treatment of natural-disaster PTSD patients. Neuroimaging data suggest a similar neurophysiological substrate for clinical improvement following EMDR and TF-CBT, involving changes affecting bilateral temporal pole connectivity.
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http://dx.doi.org/10.3389/fpsyg.2019.00129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397860PMC
February 2019

Body image dissatisfaction in individuals with obesity seeking bariatric surgery: exploring the burden of new mediating factors.

Riv Psichiatr 2019 Jan-Feb;54(1):8-17

Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

Introduction: For bariatric surgery candidates body image dissatisfaction (BID) may influence both psychological well-being and motivation to obtain surgery. This study aims to examine possible psychiatric predictors of BID. In particular, we explored the burden of new associated factors such as early trauma and attachment style (AS), which have not been assessed in previous literature.

Methods: In this study, 536 patients with extreme obesity (mean Body Mass Index, BMI=43 kg/m2, SD=6.62) undergoing presurgical psychiatric evaluations as part of a mandatory workup before surgery were chosen as participants. A semi-structured clinical interview was performed to assess psychiatric diagnosis and patients' history of early trauma. BID was assessed using the Body Shape Questionnaire (BSQ). Depression, binge eating, and AS were assessed using self-report instruments.

Results: Binge eating behavior (p<0.0001), depression severity (p<0.0001), female gender (p<0.0001), and the "need for approval" dimension of insecure AS (p<0.0001) were found to be independent and significant predictors of BSQ score. However, early trauma and BMI were not included in the significant regression model (F4,442=90.784, p<0.0001, adjR2=0.446).

Discussion: Our results increased the understanding of BID among individuals with extreme obesity. Similar to previous studies, we reported that binge-eating, depressive symptoms, and gender influenced BID. Neither early trauma nor BMI were associated with BID. Our novel finding was the significance of insecure AS. Implications for multidisciplinary approaches to obesity treatment are discussed. Identifying critical features of BID to be targeted in pre- and post-operative behavioral interventions may open new possibilities for providing effective support for individuals over the course of their therapy.

Conclusions: For some individuals living with obesity, developmental and relational processes such as insecure AS may play a substantial role in the development of BID.
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http://dx.doi.org/10.1708/3104.30935DOI Listing
August 2019