Eating behaviors and body self-esteem in couple's satisfaction during COVID-19 quarantine.

Background: Many experts agree that the Covid-19 pandemic and lockdown restriction have had an impact on relationships and eating habits in couples, but this hypothesis lacks evidence and empirical studies. Aim: The aim of the study was to investigate the relationship between satisfaction with the couple's relationship, body self-esteem, and eating behaviors during the Covid-19 lockdown. Method: Three hundred and eighty-one subjects, aged between 18 and 60 years (M = 26.88; SD = 9.22), of whom 89.8% women, participated in the survey. The online assessment included: the Relationship Assessment Scale; the Multidimensional Self Concept Scale and the Eating Disorder Examination Questionnaire. Results: The results showed that the relationship and the levels of couple's satisfaction are independent of respect to body experience and eating behavior. On the contrary, bodily experience is negatively correlated with diet, weight, body shape, and restriction attempts. However, the eating style of couple showed a change during the quarantine period, both in healthy and at-risk of ED subjects. Conclusion: The psychological impact of Covid-19 and its lockdown has had profound repercussions on the subjective relationship with body and food but have apparently preserved stable and satisfying bonds. The importance of the study confirmed the primary relation between self and body's satisfaction in subjective dimensions of life.

The Role of Hyperarousal and Aberrant Salience in the Acceptance of Anti-COVID-19 Vaccination.

Background and Objectives: This present study was aimed at exploring hyperarousal and aberrant salience in a sample of the Italian general population to understand their possible role in the acceptance of anti-COVID-19 vaccination. Materials and Methods: Sociodemographic data questions, the "Acceptance of Vaccination" measure, the Hyperarousal Scale (H-Scale), and the Aberrant Salience Inventory (ASI) were sent as an unpaid online survey to the general population (age range 18-80 years) within the Italian territory. Results: The enrolled subjects were divided into two subgroups: "Pro-vax" (n = 806; 87.4%) and "No-vax" (n = 116; 12.6%). Statistical analysis showed significant differences between groups in the "Education Level" (p = 0.001) category, higher in the "Pro-vax" group, and in the ASI "Senses Sharpening" (p = 0.007), "Heightened Emotionality" (p = 0.008), and "Heightened Cognition" (p = 0.002) subscales with the "Total Score" (p = 0.015), all higher in "No-vax" subjects. Furthermore, a linear regression model evidenced that only "Education Level" (ß = 0.143; p < 0.0001) and "Senses Sharpening" (ß = -0.150; p = 0.006) were, respectively, direct and inverse predictors of "Acceptance of Vaccination". Conclusions: Our results show that several subthreshold conditions, such as somatosensory amplification, anxiety traits, and panic experiences, should be taken into account by authoritative sources involved in health education, communication, and policy to alleviate public concerns about vaccine safety, for the present and also future pandemics, and to provide more inclusive, informed, and accurate public health preventive and treatment programs.

Eco-Anxiety: An Evolutionary Line from Psychology to Psychopathology.

According to the scientific literature, climate change, due to human activities, can damage the environment, with psycho-physical consequences for humans. The scientific literature has highlighted how severe weather events can cause fear, stress, concern for the future, and eco-anxiety. In light of this information, this study aims to explore the concept of eco-anxiety. However, climate change is still perceived as a secondary problem. It would also be worth investigating the real importance that people attach to environmental issues compared to other circumstances, such as wars or pandemics.

'In the night kitchen': A scoping review on the night eating syndrome.

BACKGROUND: First described in 1955, night eating syndrome refers to an abnormal eating behavior clinically defined by the presence of evening hyperphagia (>25% of daily caloric intake) and/or nocturnal awaking with food ingestion occurring ⩾ 2 times per week. AIMS: Although the syndrome is frequently comorbid with obesity, metabolic and psychiatric disorders, its etiopathogenesis, diagnosis, assessment and treatment still remain not fully understood. METHODS: This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; PubMed database was searched until 31 October 2020, using the key terms: 'Night Eating Syndrome' AND 'complications' OR 'diagnosis' OR 'drug therapy' OR 'epidemiology' OR 'etiology' OR 'physiology' OR 'physiopathology' OR 'psychology' OR 'therapy'. RESULTS: From a total of 239 citations, 120 studies assessing night eating syndrome met the inclusion criteria to be included in the review. CONCLUSION: The inclusion of night eating syndrome into the Diagnostic and Statistical Manual of Mental Disorders-5 'Other Specified Feeding or Eating Disorders' category should drive the attention of clinician and researchers toward this syndrome that is still defined by evolving diagnostic criteria. The correct identification and assessment of NES could facilitate the detection and the diagnosis of this disorder, whose bio-psycho-social roots support its multifactorial nature. The significant rates of comorbid illnesses associated with NES and the overlapping symptoms with other eating disorders require a focused clinical attention. Treatment options for night eating syndrome include both pharmacological (selective serotonin reuptake inhibitors, topiramate and melatonergic drugs) and non-pharmachological approaches; the combination of such strategies within a multidisciplinary approach should be addressed in future, well-sized and long-term studies.

Subthreshold psychiatric symptoms as potential predictors of postpartum depression.

The authors' purpose in the present study is to examine the role of subthreshold mental disorders as predictors of Postpartum Depression (PPD). 110 pregnancy women were evaluated as follow: the General 5-Spectrum Measure at 26 weeks of gestation; the Edinburgh Postnatal Depression Scale at 3/6 months after delivery. Only 4.5% of the sample developed PPD at 3/6 months after delivery. Agoraphobia/panic, depressed mood, social anxiety and eating problems relate positively to PPD at 3/6 months. Early identification of symptoms that could indicate the development of future mood problems in the mother is of crucial importance for mental health and prevention.

The role of body image in obese identity changes post bariatric surgery.

PURPOSE: Body image is a multidimensional construct that encompasses perceptions about body size, emotions, and cognition about physical appearance. Obese identity is related to body image in the lifetime, and according to scientific literature body image dissatisfaction among obese patient persist after bariatric surgery. The objective of this review is to examine the body image changes in patients with obesity pre-and post-bariatric surgery. METHODS: We have carried out a systematic review of literature on PubMed. Initially, 169 publications have been identified, but in total, in compliance with inclusion and exclusion criteria, 15 studies have been analyzed. RESULTS: According to the examined literature, body image does not change after bariatric surgery. These patients will be difficult to adapt for a new body, because there is a persistent obese view of self. Furthermore, ex-obese patients are dissatisfied with the excessive skin after bariatric surgery. Excessive body weight, and negative self-image are replaced with dissatisfaction with excessive skin, and the factors associated with body image stability are still unknown. CONCLUSION: Literature examination raises the issue of body image dissatisfaction, but does not explain why it varies so widely across bariatric patients. Obese identity is related to body image across the lifetime and is an important factor of post-surgical outcomes. Longitudinal studies based on ideal body image pre- and post- bariatric surgery and evidence-based controlled studies on psychotherapeutic treatment for body image dissatisfaction are strongly recommended. Psychotherapy could improve body image quality and wellbeing. LEVEL I: Evidence obtained from: systematic reviews of experimental studies.

IL-33 in Mental Disorders.

Mental disorders are common in the general population; every year about 25% of the total European population is affected by a mental condition. The prevalence of psychiatric disorders might be underestimated. Emerging evidence highlights the role of immune response as a key factor in MDs. Immunological biomarkers seem to be related to illness progression and to treatment effectiveness; several studies suggest strong associations among IL-6, TNFa, S100b, IL 1b, and PCR with affective or schizophrenic disorders. The purpose of this review is to examine and to understand the possible link between mental disorders and interleukin 33 to clarify the role of this axis in the immune system. We found 13 research papers that evaluated interleukin 33 or interleukin 31 levels in subjects affected by mental disorders. Eight studies investigated cytokines in affective disorders. Three studies measured levels of IL-33 in schizophrenia and two studies focused on patients affected by autism spectrum disorders. Alterations in brain structure and neurodevelopmental outcome are affected by multiple levels of organization. Disorders of the autoimmune response, and of the IL-33/31 axis, may therefore be one of the factors involved in this process. These results support the evidence that alarmins, particularly the IL-33/31 axis, need more consideration among researchers and practitioners.

Central Serous Chorioretinopathy and Personality Characteristics: A Systematic Review of Scientific Evidence over the Last 10 Years (2010 to 2020).

Background and Objectives: to investigate the current state of art in the study of personality disorders in central serous chorioretinopathy (CSC), also taking into account the dimensional approach. Materials and Methods: this systematic review was conducted according to PRISMA guidelines. We included articles written in English or Italian, published in peer reviewed journals from 1 January 2010 to 31 December 2020. Results: after the screening, 10 studies were included. The results suggest that CSC patients are not characterized by the prevalence of a formal personality disorder, but they are better explained by typical personality traits that may alter their relationship with others. CSC patients seems to be characterized by high levels of aggressiveness and anxiety traits along with low sociability. We propose a model of disease where stress exacerbates prior specific traits in a vicious circle where some traits might be involved in disease progression and manifestation. Conclusions: maladaptive personality traits might be an essential feature of the disease and may represent a possible link between psychiatric symptoms, such as insomnia, anxiety, and depression, and endocrinological patterns. Further research should use a specific assessment scale evaluating both the level of interpersonal functioning and specific maladaptive traits.

Adolescence, Adulthood and Self-Perceived Halitosis: A Role of Psychological Factors.

(1) Background: Halitosis is a frequent condition that affects a large part of the population. It is considered a "social stigma", as it can determine a number of psychological and relationship consequences that affect people's lives. The purpose of this review is to examine the role of psychological factors in the condition of self-perceived halitosis in adolescent subjects and adulthood. (2) Type of studies reviewed: We conducted, by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, systematic research of the literature on PubMed and Scholar. The key terms used were halitosis, halitosis self-perception, psychological factors, breath odor and two terms related to socio-relational consequences ("Halitosis and Social Relationship" OR "Social Issue of Halitosis"). Initial research identified 3008 articles. As a result of the inclusion and exclusion criteria, the number of publications was reduced to 38. (3) Results: According to the literature examined, halitosis is a condition that is rarely self-perceived. In general, women have a greater ability to recognize it than men. Several factors can affect the perception of the dental condition, such as socioeconomic status, emotional state and body image. (4) Conclusion and practical implication: Self-perceived halitosis could have a significant impact on the patient's quality of life. Among the most frequent consequences are found anxiety, reduced levels of self-esteem, misinterpretation of other people's attitudes and embarrassment and relational discomfort that often result in social isolation.

Vortioxetine on Cognition in Schizophrenia: A Pilot Study.

BACKGROUND: Given the wide implications of cognitive impairment for prognosis and outcome in schizophrenia, the research on pharmacological approaches aimed at addressing dysfunctional cognition has been extensive; nevertheless, there are no currently available licensed drugs, and the evidence in this field is still unimpressive. Vortioxetine is a multimodal antidepressant, which has been proposed as a suitable treatment option for cognitive symptoms in depression. METHODS: Twenty schizophrenia outpatients (mean age ± SD, 40.7 ±10.6 years) on stable clozapine treatment, assessed by neuropsychological (Wisconsin Card Sorting Test, Verbal Fluency, and Stroop task) and psychodiagnostic instruments (Positive and Negative Syndrome Scale [PANSS] and Calgary Depression Scale for Schizophrenia), received vortioxetine at the single daily dose of 10 mg/d until week 12; the dose was increased at 20 mg/d afterward, and this dosage was maintained unchanged until week 24. A physical examination, electrocardiogram with QTc measurement, and laboratory tests were also performed. RESULTS: Vortioxetine supplementation significantly improved Stroop test (P = 0.013) at week 12 and Stroop test (P = 0.031) and Semantic Fluency (P = 0.002) at end point. Moreover, a significantly reduction of PANSS domains "positive" (P = 0.019) at week 12 and of PANSS domains positive (P = 0.019) and total score (P = 0.041) and of depressive symptoms (Calgary Depression Scale for Schizophrenia, P = 0.032) at end point. There was no significant change in clinical, metabolic, and safety parameters, and no subject spontaneously reported adverse effects. CONCLUSIONS: Despite the limitations (open design, lack of a control group, small sample size, and short intervention period), our findings suggest for the first time that vortioxetine augmentation of clozapine may be a promising therapeutic strategy for addressing cognitive deficits in patients with schizophrenia.

Effect of Red Yeast Rice on Cognitive Functioning in Schizophrenia: Data From a Pilot Study.

BACKGROUND: Cognitive deficits (CDs) in schizophrenia affect poor outcome and real-world community functioning. Because redox imbalance has been implicated, among other factors, in the pathophysiology of CDs, antioxidant compounds may have a beneficial effect in their treatment. Red yeast rice (RYR), besides its lipid-lowering effect, exhibit antioxidant and anti-inflammatory. METHODS: Thirty-five schizophrenia outpatients (age range, 18-60 years) on stable antipsychotic treatment and assessed by neuropsychological (Wisconsin Card Sorting Test [WCST], Verbal Fluency, and Stroop task) and psychodiagnostic instruments (Brief Psychiatric Rating Scale) received RYR at daily dosage of 200 mg/d (total monacolin K/capsule content, 11.88 mg) for 12 weeks. RESULTS: Red yeast rice supplementation significantly improved WCST "perseverative errors" (P = 0.015), "total errors" (P = 0.017, P = 0.001), and phonemic fluency test (P = 0.008); a trend for improvement on other WCST variables ("nonperseverative errors," "perseverative responses," and "categories") was observed. Effect sizes, according to Cohen's suggestions, were small in all explored cognitive dimensions. There were no significant change in clinical symptoms and no subject-reported adverse effects. CONCLUSIONS: Despite several limitations (open design, lack of a control group, short period of observation, small sample size, mode of controlling patients' compliance, the lack of assessment of patients' functional improvement), results suggest that RYR supplementation may be a potentially promising strategy for addressing CDs in schizophrenia; further randomized, placebo-controlled studies are needed to better evaluate the potential role of RYR for the treatment of CDs in schizophrenia.

Bergamot Polyphenolic Fraction Supplementation Improves Cognitive Functioning in Schizophrenia: Data From an 8-Week, Open-Label Pilot Study.

BACKGROUND: Novel treatment strategies for cognitive dysfunctions may prevent long-term disability in patients with schizophrenia, and polyphenolic compounds might be a promising strategy. Bergamot (Citrus bergamia), a citrus fruit characterized by a high amount of flavonoids and flavonoid glycosides, may represent a potential nutraceutical approach to cognitive dysfunction. The present study was aimed to explore the efficacy of bergamot polyphenolic fraction (BPF) supplementation on cognitive/executive functioning in a sample of patients with schizophrenia receiving second-generation antipsychotics. METHODS: Twenty outpatients treated with second-generation antipsychotics assumed BPF at an oral daily dose of 1000 mg/d for 8 weeks. Brief Psychiatric Rating Scale, Wisconsin Card Sorting Test (WCST), Verbal Fluency Task-Controlled Oral Word Association Test, and Stroop Color-Word Test were administered. RESULTS: At end point, (week 8) BPF supplementation significantly improved WCST "perseverative errors" (P = 0.004) and semantic fluency test (P = 0.004). Moreover, a trend for other cognitive variable (WCST "categories," phonemic fluency, and Stroop Color-Word Test) improvement was observed. CONCLUSIONS: The findings provide evidence that BPF administration may be proposed as a potential supplementation strategy to improve cognitive outcome in schizophrenia. Further clinical trials with adequately powered and well-designed methodology are needed to better explore the BPF effectiveness on cognitive impairments in patients with schizophrenia.

Anger, Smoking Behavior, and the Mediator Effects of Gender: An Investigation of Heavy and Moderate Smokers.

BACKGROUND: The existing literature suggests the presence of a possible relationship between high anger levels and smoking behavior; however, there are no available data highlighting possible differences between moderate and heavy smokers and the putative effect of gender on smoking behavior. OBJECTIVES: The aims of the current study were to assess the relationship among anger, depression, and anxiety and smoking patterns taking into account the possible mediator role of gender. METHODS: 150 smokers and 50 nonsmokers volunteers were recruited from the staff of the University of Messina, Italy. The final sample consisted of 90 smokers, divided in 50 heavy smokers (HS: more than 40 cigarettes per day), 40 moderate smokers (MS: 10-30 cigarettes per day), and 42 nonsmokers (NS). All subjects were assessed by State-Trait Anger Expression Inventory-2, Self-Rating Depression Scale, and Self-Rating Anxiety Scale. RESULTS: On anger, depression, and anxiety measures the HS group scored higher than MS and NS groups. HS showed higher than expected levels of trait-anger, a greater tendency to control anger reactions and to access to anger-management techniques. A moderate consumption of cigarettes (10-30 cigarettes per day) was not associated with negative emotions, as MS only showed higher than expected levels of state-anger. Cigarettes consumption was related to gender-specific anger features. Conclusions/Importance: Our study highlighted the importance of anger in smoking behavior and its related gender differences. Recognizing the link among anger, gender differences and smoking behavior could improve the knowledge for future-focused interventions on smoking cessation.

Clinical, autoimmune, and psychiatric parameters correlate with sleep disturbance in patients with systemic sclerosis and rheumatoid arthritis.

OBJECTIVES: Sleep disturbance is an important contributor to poor quality of life in rheumatic disorders. This study aims to test whether clinical, autoimmune and psychological factors are associated with sleep disturbance in systemic sclerosis (SSc) compared to rheumatoid arthritis (RA) patients and controls. METHODS: 101 female subjects (SSc=33, RA=34, healthy controls=34) participated in this observational, cross-sectional, parallel group study. Sleep disturbance was assessed with the Pittsburgh Sleep Quality Index (PSQI). Other assessments included the visual analogue scale (VAS) for pain, 36-item Short-Form Health Survey (SF-36), Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Clinical parameters, therapeutic regimen, and serologic status were recorded. RESULTS: In SSc patients, PSQI scores were higher than in RA patients and controls. Linear regression analysis showed that in SSc patients PSQI scores was associated with BDI, disease duration, modified Rodnan skin score and VAS, while DAS28 and BDI were associated with PSQI scores in RA patients. Anti-Scl70 and ANA positive SSc patients showed higher PSQI scores compared to those ANA positive only, while no differences were observed in RA patients classified according to rheumatoid factor positivity. SSc patients treated with immunosuppressants had lower PSQI scores compared to those not on therapy, whereas only corticosteroid treatment was significantly associated with higher PSQI scores in RA patients. RA patients with disease activity higher than moderate (DAS28≥3.2) had higher PSQI scores than those with lower than moderate (DAS28<3.2). CONCLUSIONS: Longitudinal studies are needed to identify disease-specific patterns associated with sleep disturbances and the influence on sleep function induced by immunosuppressive therapy among rheumatic patients.

Efficacy and safety of sertindole in schizophrenia: a clinical review.

Sertindole is an atypical antipsychotic reintroduced into the European market in 2005 after a reevaluation of its risks and benefits, under the agreement that close electrocardiographic screening would be conducted. It has a high affinity for dopamine D2, serotonin 5-HT2A and 5-HT2C, and α1 adrenergic receptors. Moreover, sertindole shows modest affinity for H1-histaminergic and muscarinic receptors. The pharmacological properties, clinical efficacy, safety, and tolerability of sertindole are covered in this article based on a literature review from 1990 to 2014. Given current available findings, sertindole is at least effective as haloperidol, risperidone, and olanzapine on schizophrenia symptoms. Regarding its efficacy on cognitive symptoms, sertindole effect is supported by both preclinical and clinical studies versus haloperidol and olanzapine; however, its role on cognition needs further clarification. Concerning safety and tolerability issues, sertindole is characterized by a low potential to cause sedation and extrapyramidal symptoms, and by an acceptable metabolic profile; nevertheless, cardiac safety remains a major concern, and the electrocardiographic monitoring should be carried out during treatment to substantially reduce cardiovascular risk. In conclusion, although it has an equivalent profile compared to other antipsychotic drugs, sertindole actually remains a second-line choice for schizophrenic patients intolerant to at least one other antipsychotic agent.

Augmentation of clozapine with agomelatine in partial-responder schizophrenia: a 16-week, open-label, uncontrolled pilot study.

The present 16-week open-label uncontrolled trial was aimed to explore the efficacy of adjunctive agomelatine on clinical symptoms and cognitive functioning in 20 schizophrenia patients showing partial response (Brief Psychiatric Rating Scale, mean [SD] baseline total score = 37.5 [6.6]) to clozapine monotherapy at the highest tolerated dosage. The results obtained evidenced that agomelatine at a dosage of 50 mg/d was associated with score reduction in all Positive and Negative Syndrome Scale domains (positive, P = 0.011 and Cohen d = 0.7; negative, P < 0.0001 and Cohen d = 1.1; psychopathology, P = 0.001 and Cohen d = 0.9) and total score (P = 0.001, Cohen d = 1.2), depressive (Calgary Depression Scale for Schizophrenia, P = 0.013 and Cohen d = 0.6), and overall clinical symptoms (Brief Psychiatric Rating Scale, P = 0.001 and Cohen d = 0.6 ); moreover, improved performances on Stroop task (P = 0.006, Cohen d = 0.7) and Wisconsin Card Sorting Test "perseverative errors" (P = 0.033, Cohen d = 0.3) were observed. The favorable effect of agomelatine on clinical and cognitive symptoms was encouraging, and more research is needed to better identify subgroups of patients who are partially responsive to clozapine monotherapy in which agomelatine augmentation may be of benefit.

The relationship between alexithymia, anxiety, depression, and internet addiction severity in a sample of Italian high school students.

We aimed to assess whether Internet addiction (IA) severity was related to alexithymia scores among high school students, taking into account the role of gender differences and the possible effect of anxiety, depression, and age. Participants in the study were 600 students (ages ranging from 13 to 22; 48.16% girls) recruited from three high schools in two cities from Southern Italy. Participants completed a sociodemographic questionnaire, the Toronto Alexithymia Scale, the Internet Addiction Test, the Hamilton Anxiety Scale, and the Hamilton Depression Scale. The findings of the study showed that IA scores were associated with alexithymia scores, over and above the effect of negative emotions and age. Students with pathological levels of alexithymia reported higher scores on IA severity. In particular, results showed that difficulty in identifying feelings was significantly associated with higher scores on IA severity. No effect of gender was found. Implications for clinicians were discussed.

Neuroanatomical correlates of peripersonal space: bridging the gap between perception, action, emotion and social cognition.

Peripersonal space (PPS) is a construct referring to the portion of space immediately surrounding our bodies, where most of the interactions between the subject and the environment, including other individuals, take place. Decades of animal and human neuroscience research have revealed that the brain holds a separate representation of this region of space: this distinct spatial representation has evolved to ensure proper relevance to stimuli that are close to the body and prompt an appropriate behavioral response. The neural underpinnings of such construct have been thoroughly investigated by different generations of studies involving anatomical and electrophysiological investigations in animal models, and, recently, neuroimaging experiments in human subjects. Here, we provide a comprehensive anatomical overview of the anatomical circuitry underlying PPS representation in the human brain. Gathering evidence from multiple areas of research, we identified cortical and subcortical regions that are involved in specific aspects of PPS encoding.We show how these regions are part of segregated, yet integrated functional networks within the brain, which are in turn involved in higher-order integration of information. This wide-scale circuitry accounts for the relevance of PPS encoding in multiple brain functions, including not only motor planning and visuospatial attention but also emotional and social cognitive aspects. A complete characterization of these circuits may clarify the derangements of PPS representation observed in different neurological and neuropsychiatric diseases.

Compassion Fatigue in a Cohort of South Italian Nurses and Hospital-Based Clinical Social Workers Following COVID-19: A Cross-Sectional Survey.

Background/Objective: The COVID-19 pandemic has led to a significant increase in the workloads of healthcare workers (HCWs). The fear of contracting the new virus with the frequent medical consequences has affected their mental health. As a result, they are at high risk of compassion fatigue (CF). In this multicentric study, as a primary objective, we evaluate the incidence and/or prevalence of CF in a cohort of Italian nurses and HCWs (hospital-based clinical social workers of neurological patients) who have contracted SARS-CoV-2 infection. Our secondary aim is to evaluate the difference in experiencing CF between subjects with and without long-term COVID. Methods: In this study, 101 HCWs attending three different neurorehabilitation settings (the Neurorehabilitation Unit of the "Bonino Pulejo" Neurolesi Center of Messina, the Neurorehabilitation Department of Crotone, and the Psychiatric Unit of the University Hospital of Messina) were enrolled from May 2021 to May 2023. Data were collected through self-administered semi-structured interviews. Results: We observed high percentages of CF difficulties in both nurses and HCWs, related to mood alteration in 57.7%, headaches in 44.4%, and fatigue in 62%. Higher percentages were found in individuals with long-term COVID-19, including mood alteration in 93.9%, headache in 88.6%, and memory-related problems in 98.5%. Conclusions: The complexity of a patient's care pathway, especially in chronic disease situations, requires an enormous commitment that can lead to burnout and CF, which should be considered to initiate preventive interventions aimed at helping "those who help", for the well-being of patients, healthcare teams, and healthcare organizations.

Sleep disorders and hyperarousal among patients with endometriosis: A case-control survey study.

BACKGROUND: Endometriosis has been associated with sleep disorders, and hyperarousal appears to be involved in their pathogenesis; however, the presence of hyperarousal in the endometriosis population was never investigated. METHODS: We conducted a case-control survey study by sending a questionnaire to all endometriosis patients followed up at our Centers. Controls were recruited among the general population. The questionnaire included demographic information, symptoms and history of endometriosis, the Hyperarousal Scale (H-Scale), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). RESULTS: A total of 847 women completed the questionnaires: 430 (50.8 %) had endometriosis, and 417 (49.2 %) were controls. Endometriosis was associated with higher H-scale score (OR 2.9, 95 % CI 2.4-3.8, p = 0.000), higher PSQI score (OR 4.3, 95 % CI 3.2-5.7, p = 0.000), and higher ISI score (OR 4.6, 95 % CI 3.5-6.1, p = 0.000) in multivariable ordinal logistic regressions analysis. With path analysis, hyperarousal (H-Scale) reported a partial mediating role in the association between endometriosis and sleep disorders. The mediation effect represented 22.3-27.8 % of the entire association between endometriosis and sleep disturbances. CONCLUSION: Endometriosis patients complaining sleep disorders may benefit by investigating the presence of hyperarousal given cognitive behavioral therapy was reported effective in improving hyperarousal and associated sleep disorders.