Hopelessness and burnout in Italian healthcare workers during COVID-19 pandemic: the mediating role of trait emotional intelligence.

Objective: The study aims to assess the impact of COVID-19 on healthcare workers' work-related stress during the first wave of the pandemic in Italy. The main objective is to investigate the existence of a positive correlation between hopelessness and burnout, assuming that burnout may be a risk factor for the development of hopelessness, and to analyze the role that trait Emotional Intelligence (TEI) and changes in workload could have in this relationship. Furthermore, evaluate any significant differences in burnout and hopelessness levels in the function of some demographic variables, such as gender, professional profiles, and different working zones of Italy, to better understand how the diverse diffusion of pandemic had affected Italian healthcare workers. Methods: An online survey was used to collect data between April and June, 2020, with 562 responses among nurses (52.1%) and physicians (47.9%). Demographics and changes in workload and work conditions were collected through an ad hoc questionnaire. The Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), The Beck Hopelessness Scale (BHS), and the Link Burnout Questionnaire (LBQ) were used to assess Trait Emotional Intelligence (TEI), hopelessness, and burnout, respectively. Results: Correlation analysis showed a significant positive relationship between hopelessness and each burnout dimension. TEI showed negative correlations both with burnout dimensions and hopelessness. Significant differences in burnout and hopelessness levels emerged as a function of some demographic variables such as gender, professional profiles (nurses or physicians), and different working zone of Italy (northern or southern). Results showed that TEI partially mediated the relationship between hopelessness and every burnout dimension, while the interaction of changes in workload was non-significant. Discussion: The mediating role of TEI in the burnout-hopelessness relationship partly explains the protective role that individual factors had on healthcare workers' mental health. Our findings support the need to integrate considerations on both psychological risk and protective factors into COVID-19 care, including the monitoring of psychological symptoms and social needs, especially among healthcare workers.

The Relationship between Knowing Sign Language and Quality of Life among Italian People Who Are Deaf: A Cross-Sectional Study.

Deafness is a medical condition with important relational implications. This condition could affect well-being and self-esteem and cause social anxiety. Sign language is not only a simple mimic but can be considered as a different kind of communication that could be protective for those who have learned it. However, some people do not use sign language because they think it can be marginalizing. The present study aimed to compare the quality of life (QoL) between people who learned Italian sign language as their first language with those who had never learned it or learned it later. This cross-sectional study involved 182 deaf Italian adults (70.3% females) who were recruited from Ente Nazionale Sordi (ENS) and by the main online deafness groups. The present results suggest that the deaf condition does not seem to significantly affect the dimensions of QoL pertaining to satisfaction and self-esteem, while it could have an effect on preventing high levels of social anxiety and in particular, the group who learned Italian sign language showed significantly less social anxiety than those who had never learned it.

Sexual Satisfaction and Quality of Life in Cardiovascular Patients: The Mediating Role of Anxiety.

BACKGROUND: Cardiovascular diseases represent one of the most important problems for public health. Research indicates that elderly patients consider sexual satisfaction as a fundamental aspect of their quality of life and a better sexual function is related to higher general wellbeing. OBJECTIVE: The main objective of this study was to investigate the mediating role of anxiety and depression in the relationship between quality of life and sexual satisfaction in cardiovascular (CVD) patients. METHODS: The sample comprised 128 adult patients, males and females, hospitalized in a Cardiology Rehabilitation clinical center. To collect data, the following were used: a demographic information sheet, the left ventricular ejection fraction (EF) to evaluate cardiac function, cardiovascular diagnosis type, the HADS scale to evaluate anxiety and depression states, a test for sexual satisfaction evaluation (SAS) and the SF-36 survey to measure quality of life. RESULTS: The results indicated that only SF-36 physical health is indirectly related to SAS through its relationship with anxiety. CONCLUSION: A mediating model was proposed to explore the underlying association between sexual satisfaction and quality of life. We recommend investigating perceived general health and sexuality as clinical indicators for therapeutic decisions and risk evaluation for the management of cardiovascular diseases.

Emotional Competence in Primary School Children: Examining the Effect of a Psycho-Educational Group Intervention: A Pilot Prospective Study.

Emotional competence (EC) is a key component of children's psychological, cognitive, and social development, and it is a central element of learning. The primary goal of this study was to evaluate the effectiveness of implementing a psycho-educational group intervention aimed at improving children's emotional competence (EC), quality of integration and scholastic skills. A total of 229 children (123 females; M Age = 7.22 years; SD = 0.97 years) completed the Pictures of Facial Affect (POFA), the Drawn Stories Technique, the Classroom Drawing, and the Colored Progressive Matrices. The total sample was randomly divided into an intervention group (N = 116) who took part in psycho-educational activities and a control (no-intervention) group (N = 84). Both groups were tested at baseline, before the intervention started, and at the end of the intervention (4 months from baseline). Results from mixed-model ANOVA revealed a significant main effect for POFA score over time (F = 6.24, p = 0.01) and an interaction effect between POFA and group (F = 4.82, p = 0.03). No significant main effect was found for classroom drawing over time (F = 0.81, p > 0.05) or for quality of integration and group intervention. These findings support the importance of developing psycho-educational programmes in school for promotion of emotional health for preventing not only the onset of problematic behaviours at school such as bullying but also the development of clinical conditions linked to difficulties in emotional recognition, expression, and regulation such as alexithymia.

Quality of Life and Job Loss during the COVID-19 Pandemic: Mediation by Hopelessness and Moderation by Trait Emotional Intelligence.

This study contributes to the knowledge on the effects of the COVID-19 pandemic by examining a moderated mediation model in which the impact of job loss over quality of life (QoL) is mediated by hopelessness and moderated by trait emotional intelligence (trait EI). Data were collected from a large nationally representative Italian sample of adult workers (N = 1610), who completed a series of anonymous online questionnaires. Total, direct and indirect effects were estimated through bootstrapped mediated moderation analyses providing 95% bias corrected bootstrap confidence intervals. After controlling for the effects of gender and age range, job loss was found to be negatively associated with QoL, and hopelessness partially mediated such relationship. These relationships were in turn moderated by trait EI. Our study suggests that trait EI levels act as protective factor for a good QoL, mitigating the impact of both job loss and hopelessness over QoL levels during the COVID-19 pandemic. Identifying psychological protective and/or risk factors for a better QoL is crucial for the development of interventions aimed at reducing the emotional impact of the pandemic and of its negative real-life consequences.

Relationship between Multimorbidity and Quality of Life in a Primary Care Setting: The Mediating Role of Dyspnea.

Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner's surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40-88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health "PCS" and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV1/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient's global health.

Drawing techniques as tools for the evaluation of scholastic integration and emotional components in primary and secondary school: A cross-sectional study.

Introduction: In the last decades, many studies have emphasized emotion's role in psycho-educational processes during childhood, such as scholastic integration. Emotional variables in childhood can be assessed through projective graphic techniques, as they allow children to use kinetic components of the draws to communicate emotions. Method: 1.757 couple of draws were collected, from primary school children (N = 1.270; F = 643 [50.6%]; Age = 8.6; SD = 1.31) and secondary school children (N = 487; F = 220 [45.2%]; Age = 11.72; SD = 0.70) and from eight schools in Sicily and over 60 different classrooms. The Drawn Stories Technique and the Classroom Draw were used to assess children's current emotional state and scholastic integration. Results: Pearson's correlation showed significant relationships between the Drawn Stories Technique and both sex and age. In contrast, Classroom Drawing total score showed a significant relationship with the female sex but no significant relationship with age. Linear regression analysis, including sex and age as independent variables, showed that sex is a significant predictor of Negative Outcomes of the Drawn Stories Technique, while no effect of age was detected. Discussion: These findings showed that adequate attention is needed to the learners' emotional-affective world that influences their relationships and their vision within the class group. Although the drawing techniques alone seem to be not as such sufficient to explain children's individual differences in the classroom on the whole, they could be helpful for the teacher to facilitate dialogues with children, modulate didactical materials, and detect and prevent some problems in group class functioning.

The Impact of COVID-19 Pandemic and Lockdown Measures on Quality of Life among Italian General Population.

The COVID-19 pandemic that has hit the world in the year 2020 has put a strain on our ability to cope with events and revolutionized our daily habits. On 9 March, Italy was forced to lockdown to prevent the spread of the infection, with measures including the mandatory closure of schools and nonessential activities, travel restrictions, and the obligation to spend entire weeks in the same physical space. The aim of this study was to assess the impact of the COVID-19 pandemic and lockdown measures on quality of life (QoL) in a large Italian sample, in order to investigate possible differences in QoL levels related to both demographic and pandemic-specific variables. A total of 2251 Italian adults (1665 women, mainly young and middle adults) were recruited via a snowball sampling strategy. Participants were requested to answer to an online survey, which included demographic and COVID-related information items, and the World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF). The results showed statistically significant differences in QoL depending on a number of variables, including sex, area of residence in Italy, and being diagnosed with a medical/psychiatric condition. To our knowledge, this is the first study to assess QoL during COVID-19 pandemic in Italy, therefore the present findings can offer guidelines regarding which social groups are more vulnerable of a decline in QoL and would benefit of psychological interventions.

Haptic Perception in Extreme Obesity: qEEG Study Focused on Predictive Coding and Body Schema.

Haptic perception (HP) is a perceptual modality requiring manual exploration to elaborate the physical characteristics of external stimuli through multisensory integrative cortical pathways. Cortical areas exploit processes of predictive coding that collect sensorial inputs to build and update internal perceptual models. Modifications to the internal representation of the body have been associated with eating disorders. In the light of this, obese subjects were selected as a valid experimental model to explore predictive coding in haptic perception. To this purpose, we performed electroencephalographic (EEG) continuous recordings during a haptic task in normally weighted versus obese subjects. EEG power spectra were analyzed in different time intervals. The quality of haptic performance in the obese group was poorer than in control subjects, though exploration times were similar. Spectral analysis showed a significant decrease in theta, alpha and beta frequencies in the right temporo-parietal areas of obese group, whereas gamma bands significantly increased in the left frontal areas. These results suggest that severe obesity could be characterized by an impairment in haptic performances and an altered activation of multisensory integrative cortical areas. These are involved in functional coding of external stimuli, which could interfere with the ability to process a predicted condition.

Eating disorders in males: an overview of research over the period 2007-2017. / I disturbi della nutrizione e dell'alimentazione nei maschi: una panoramica sulle ricerche nel periodo 2007-2017.

Introduction: Despite the extensive literature, the gender differences in eating disorders (ED) have been poorly investigated. Most of the studies, in fact, have been conducted so far on female samples, emphasizing the misleading belief that such disorders are of exclusive relevance of women. Aim: The review aim at highlighting as this preconception is still widespread among the male patients and the clinicians and as it represents an impediment to a correct diagnosis and a proper treatment planning. Method: Included studies were selected in the scientific literature published between January 2007 and December 2017 through the main databases, combining the words: "males", "eating disorder", "anorexia nervosa", "bulimia nervosa", "binge eating disorder". Results: Fifty-four studies have been selected in accordance with the followed methodological criteria. Discussion: Only recently, the attention of researchers have been also focused on male population: many differences between genders have emerged in prevalence, onset, phenomenology, diagnosis, comorbidity and outcomes of ED. The studies on risk factors have also pointed out significant differences between males and females, especially in relation to the different weight exerted by psychological variables involved in the aetiology of eating disorders. Conclusions: Compared with a little knowledge of ED in the male population, it is important to widespread the comprehension taking into account the gender perspective. The attention must be paid particularly to critical developmental periods, such as puberty and adolescence, where early detection and prevention of these disorders is of greatest importance, inside a conceptual framework which considers the mutual influence between biological and psychological vulnerability, and sociocultural factors.

Autism spectrum disorders in children affected by Duchenne muscular dystrophy.

BACKGROUND: Duchenne muscular dystrophy (DMD) is the most frequent and severe form of the dystrophinopathies. The literature shows that about 30-40% of DMD subjects have intellectual disability. In males with Duchenne muscular dystrophy, neuropsychiatric disorders have also been observed: attention deficit disorder and hyperactivity, autism spectrum disorders, and obsessive-compulsive disorder. Duchenne muscular dystrophy is not just a muscle disorder, but also a disease that affects the brain. The aim of the present study was to describe a case series of children with Duchenne muscular dystrophy that have also the presence of autism spectrum disorders (ASDs). They have been assessed by means of standardized autism scales and the most appropriate psycho-educational treatment is herein discussed. METHODS: In order to evaluate and identify the presence and intensity of autistic symptoms have been used the Childhood Autism Rating Scale and Autism Diagnostic Observation Schedule tools. Moreover, in order to assess the intelligence of subjects and their lower limb function, Wisch-R intelligence scale and Vignos function scale were used, respectively. RESULTS: Atypical behaviors included a preference for being alone, and selective interest in privileged objects used in a stereotyped manner, motor fretting, and attention instability were present in all children. By the administration of these scales was confirmed the presence of an autism spectrum disorders in all subjects. CONCLUSIONS: It is important for clinical practice to consider this association increased.

[The Rorschach method for obesity assessment: clinical study on a group of obese women]. / Il metodo Rorschach per la valutazione dell'obesità: studio clinico su un gruppo di donne obese.

AIM: The purpose of this study is to explore through the Rorschach method the psychological and personological profile of the woman with obesity. METHODS: The Rorschach test was administered to 10 women with body mass index of 41.86±9.9 kg/m2 at the clinic for obesity surgical treatment at the University Hospital "Paolo Giaccone" of Palermo. RESULTS: The quantitative and qualitative analysis of the Rorschach responses detected in the study show: limited practical and creative sense in managing daily life situations, rigid control of emotions, affective turmoil, sense of inadequacy; sufficient examination of reality and adaptation social. CONCLUSION: The Rorschach method can be the privileged instrument for obesity, for its remarkable projective value, because it allows to capture the psychic suffering of the obese person, the representation and the image of the self, to identify the interaction between psycho-physical state and emotional investments.

Type D Personality and Alexithymia: Common Characteristics of Two Different Constructs. Implications for Research and Clinical Practice.

In the last few decades, particular attention has been paid to the role of personality specific traits that can affect the loss of health, i.e., Type D personality and Alexithymia. They have been conceptualized in a different period, this means that they are different both for their theoretical positions and their empirical studies. Some authors have speculated that there is a potential conceptual overlap between Type D personality and alexithymia constructs but there is a shortcoming in the literature. The aim of the study was to examine the potential overlap between the constructs of type D personality and alexithymia, replicating previous two studies, to extend these findings to Italian population. The participants were 247 Italian adults (males = 43%), recruited in primary health care practices of Palermo. All participants did not have chronic diseases during tests administration. They ranged in age from 35 to 69 years old (M = 52.34 years, SD = 9.76). Participants were administered Type D Personality Scale (DS-14) and Toronto Alexithymia Scale (TAS-20). A series of confirmatory factor analyses was performed to evaluate the factorial structure underlying the TAS-20 and DS-14 items. Globally results showed that alexithymia and type D personality are distinct constructs, but they are also strictly positively related with each other. Negative affectivity (NA) was highly correlated with Difficulties in identifying feelings and Difficulties in describing feelings, while Social inhibition (SI) was highly correlated with Difficulties in describing feelings. These results are consistent with those of other studies conducted in this area. Future research should consider evaluating the relationship between a deficit of affect regulation and type D personality to improve the effectiveness of interventions of health cure.

Mediating Effects of Global Negative Effect Expectancies on the Association between Problematic Cannabis Use and Social Anxiety.

The relationship between social anxiety (SA) and cannabis use among adolescents and young adults is a highly debated topic. In this cross-sectional study, we tested whether cannabis use expectancies mediated the association between SA and cannabis use severity in a sample of 343 young adults (74.3% male) who used cannabis. They completed self-report measures for the screening of problematic cannabis use (Cannabis Use Problems Identification Test) and SA symptoms (Social Interaction Anxiety Scale and Social Phobia Scale). A multiple mediation analysis was used to test whether marijuana effect expectancies mediate SA effect on problematic cannabis use. SA was negatively associated with cannabis use severity in this sample, and we found evidence that cannabis use expectancies fully mediated this relationship. Specifically, global negative effect expectancies influence the relationship between SA and problematic cannabis use. These findings may inform current prevention strategies and clinical intervention for young adults who use cannabis.

Paternal and Maternal Transition to Parenthood: The Risk of Postpartum Depression and Parenting Stress.

Transition to parenthood represents an important life event increasing vulnerability to psychological disorders. Postpartum depression and parenting distress are the most common psychological disturbances and a growing scientific evidence suggests that both mothers and fathers are involved in this developmental crisis. This paper aims to explore maternal and paternal experience of transition to parenthood in terms of parenting distress and risk of postpartum depression. Seventy-five couples of first-time parents were invited to compile the Edinburgh Postnatal Depression Scale and the Parenting Stress Index-Short Form in the first month of children life. Study sample reported very high levels of parenting distress and a risk of postpartum depression in 20.8% of mothers and 5.7% of fathers. No significant correlation between parenting distress and the risk of postpartum depression emerged, both in mothers than in fathers group while maternal distress levels are related to paternal one. The first month after partum represents a critical phase of parents life and it could be considered a developmental crisis characterized by anxiety, stress and mood alterations that could have important repercussions on the child psycho-physical development.

The relationship between self-Image and social anxiety in adolescence.

BACKGROUND: Self-image is the subjective perception about one's own self, body, mental functioning, social attitudes, and adjustment in different aspects of life. Research has linked negative self-image with a number of problem behaviors and psychiatric symptoms in adolescence; however, studies of the relationship between self-image and anxiety disorders are still scarce. METHOD: This study involved a community sample of 1305 high-school students (51.4% female) who ranged in age from 14 to 19 years old. They completed self-report measures of self-image and social anxiety disorder (SAD). RESULTS: A quarter of the students reported high levels of social anxiety. Statistical analyses showed significant differences between these students and the other students in all the self-image subscales. Several dimensions of impaired self-image (emotional tone, social attitudes, vocational and educational goals, family relationships, external mastery, and psychological health) were associated with high levels of social anxiety, with some gender differences underpinning these relationships. CONCLUSIONS: Clinicians treating SAD in youth may wish to consider that a negative self-image may play a critical role in the onset and retention of social anxiety symptoms.

Rhinitis as a risk factor for depressive mood in pre-adolescents: a new approach to this relationship.

BACKGROUND: Respiratory allergic symptoms impact on social life and school activities, influencing the patient's mood states. We evaluated the relationships between allergic respiratory diseases and depressive/anxious mood in a large sample of Italian middle school students, using the partial directed acyclic graph (P-DAG). METHODS: We studied 1283 subjects aged 10-13. A health respiratory questionnaire including questions relevant to socioeconomic status (HCI) and a test for depression and anxiety were administered. All subjects performed spirometry and skin prick tests. RESULTS: A causal role of rhinitis on depression was found: the likelihood of being depressed increased from 11.2 to 17.7%, when rhinitis was present. Moreover, a direct effect of low HCI on depressive mood was shown (p < 0.0001) as well as the correlation between anxiety and depression (p < 0.0001). Gender was not a direct causal factor for depressive mood, but their relation was mediated through anxious mood. Anxiety appeared to have a stronger association with depression than gender. Allergic sensitization was significantly related to both asthma and rhinitis (p < 0.0001, respectively). Asthma and rhinitis were also directly associated (p < 0.0001). Conversely, asthma was not directly associated with depressive mood, but their relation was mediated through rhinitis. Body mass index (BMI) and impaired lung function (IPF) were not associated with the other variables. CONCLUSIONS: The use of this novel approach to analyzing the dynamic relationships allowed us to find a causal role of rhinitis on depressive state. Moreover, anxious condition and low socioeconomic status contributed to induce depressive mood.

Acceptance of noninvasive computed tomography coronary angiography: for a patient-friendly medicine.

PURPOSE: This study was done to evaluate the psychological state and anxiety of patients undergoing computed tomography coronary angiography (CTCA), and assess their acceptance and satisfaction compared to invasive conventional coronary angiography (CCA). MATERIALS AND METHODS: A total of 442 consecutive patients (282 male; mean age 57.7 ± 9.5 years) who underwent CTCA for suspected or known coronary artery disease were evaluated with the Endler Multimodality Anxiety Scales (EMAS) before and after the scan, and a questionnaire administered after the scan. Among the 442 patients, 181 had a history of CCA. Two radiologists assessed the image quality of CTCA. RESULTS: Anxiety was more intense prior to the scan (EMAS score 51.7 vs. 46.7, p < 0.01) and in patients with a history of CCA (EMAS score 55.5 vs. 49.1, p < 0.01). Women presented more intense anxiety (EMAS score 59.5 vs. 47.3, p < 0.01), higher mean heart rate (63.5 ± 7.6 vs. 60.7 ± 7.3 beats per minute, p < 0.01) and a lower image quality than men (p < 0.0001). CTCA proved to be more acceptable than CCA because of accurate preparation, lower concern prior to the examination, negligible pain, higher comfort, and greater overall satisfaction (p < 0.0001). CONCLUSIONS: Computed tomography coronary angiography is a patient-friendly imaging method because of the minimal perceived discomfort. Anxiety may affect CTCA image quality in women.

[Thinking organization and defense mechanisms in bipolar disorders. Clinical and psychopathological study on bipolar I and bipolar II]. / Pensiero e difese nei disturbi bipolari. Studio clinico e psicopatologico su bipolari I e bipolari II.

AIM: The aim of this research is to explore the psychical functioning in bipolar I or bipolar II disorder people through the analysis and comparison of their thought styles and defense patterns. METHODS: 29 bipolar I and bipolar II people afferent to Palermo University Policlinical Psychriatic Hospital Department were selected during the whole 2009-2010 year. The following tests were administred: Wechsler Adult Intelligent Scale-R (WAIS-R) in order to measure the general cognitive function; Defense Mechanisms Inventory (DMI) in order to measure defense patterns. Afterwards, the results of the two tests were analysed and compared. OUTCOME: Bipolar disorder people use cognitive mechanisms and defense strategies that are very different from standard population. Bipolar I subjects show both wider and more serious cognitive deterioration and stricter defense mechanisms than bipolar II subjects. Generally bipolar patients show an immature personality based on archaic mechanisms that can be found in all the spheres of their personality: emotions, cognition, Ego-strength, adaptability to reality. DISCUSSION: The peculiar achieved cognitive and defense profile leads to important considerations about how psychological strategies can contribute to use "bespoke" treatments for these patients.

Sturge-weber syndrome: a report of 14 cases.

Sturge-Weber-Krabe syndrome (SWS), also known as encephalotrigeminalangiomatosis and named the forthfacomatosis, recall the names of the authors who first describedit in its basic clinical, radiological andanatomopathological aspects. We report here 14 cases of Sturge-Weber disease. In 6 of these, despite what had been previously described in literature, an extension of the angioma has been noted in other parts of the body. The study of these subjects stresses not only the need for a pharmacological/neuropsychomotor intervention, but alsothe need of a psychotherapeutic approach, for the emotional and affective implications thatcould derive from this syndrome. The reported cases are similar to those presented in literature for their main features. In particular, two elements are interesting: i) the exceptional diffusion of the red nevousto the whole hemicorpo; and ii) the evaluation of the way the patients live the disease, which has not beenpreviously considered in literature. We can conclude that SWS is a multisystem disorder that requires the neurologist to be aware of the possible endocrine, psychiatric, ophthalmological, and other medical issues that can arise and impact on the neurological status of the patients.