Adaptation and Validation of the Subjective Risk Intelligence Scale for Italian Adolescents (SRIS-A).

Subjective Risk Intelligence (SRI) is the ability to consider risky and uncertain situations as opportunities rather than threats. SRI is constituted by four dimensions: attitude toward uncertainty, imaginative capability, problem solving self-efficacy and stress management. Adolescence is a period in life in which individuals face crucial life-tasks, that nowadays become complex due to uncertainty about future life and career. The present study aims to adapt the Subjective Risk Intelligence Scale (SRIS-A) for use with adolescences and examine its factor structure, psychometric properties, and relationships with related constructs (coping strategies, problem solving self-efficacy and courage). Participants were 641 Italian adolescents, balanced by gender. The results of the study showed that the suggested four-dimension scale structure adequately explained item correlations. Further, adequate reliability, construct validity and measurement invariance by gender were supported, suggesting that SRIS-A has adequate concurrent and convergent validity. Suggestions for further studies of SRI during adolescence using the SRIS-A are discussed.

A Comprehensive Model for Gambling Behaviors: Assessment of the Factors that can Contribute to the Vulnerability and Maintenance of Gambling Disorder.

Gambling Disorder is a complex and multifaceted phenomenon which requires a careful understanding by analysing both the life experiences and the psychopathological components linked to this type of behaviour. This study aimed to apply a Comprehensive Model of Addiction and to delve deeper the dimensions involved in the vulnerability and maintenance of the disease. Therefore, the effect of alexithymia and traumatic experiences in mediating the relationship between insecure attachment and dissociation, as well as the roles of impulsiveness and compulsiveness in influencing obsessiveness were explored in pathological gamblers. A sample composed of 253 individuals with a mean age of 47.8 years (SD = 12.4) with a diagnosis of Gambling Disorder (82.6% males, 17.4% females) completed the battery of measures. Results showed that alexithymia significantly mediates the relationship between insecure attachment and dissociation, while no significance was found in the effect of complex trauma. Furthermore, a significant impact role of impulsiveness and compulsiveness in determining obsessiveness was found. Therefore, the data suggested that alexithymia may increase the risk of developing a gambling disorder, mediating the association between insecure attachment and dissociation. The model of craving which could have a core role in disease maintenance processes was also confirmed, highlighting a significant influence of impulsiveness and compulsiveness on obsessiveness. Such findings might have relevant implications to increase the effectiveness of both preventive interventions and therapeutic works, favouring positive results for a better mental health of the subjects.

Flow Diversion for Acutely Ruptured Intracranial Aneurysms Treatment: A Retrospective Study and Literature Review.

OBJECTIVE: Flow diversion is becoming an increasingly established practice for the treatment of acutely ruptured intracranial aneurysms. In this study the authors present a literature review and meta-analysis, adding a retrospective review of institutional registry on emergency treatment of aRIA with flow diverter stent. MATERIALS AND METHODS: A systematic search of PubMed, SCOPUS, Ovid MEDLINE, and Ovid EMBASE was performed on April 20th, 2021, extrapolating 35 articles. R language 'meta' and 'metafor' packages were used for data pooling. The DerSimonian-Laird model was used to calculate the pooled effect. The I2 value and Q statistic evaluated study heterogeneity. Additionally, the authors retrospectively reviewed their institutional database for the treatment and outcomes of all patients with acutely ruptured intracranial aneurysms treated with flow diverter stent placement from May 2010 to November 2020 was performed. RESULTS: From the systematic literature review and meta-analysis, the pooled proportion of complete aneurysm occlusion was 78%, with a pooled rate of 79%, 71%, 80%, and 50% for dissecting, saccular, fusiform, and mycotic aneurysms, respectively. The pooled proportion of aneurysm rebleeding and intrastent stenosis was 12% and 15% respectively, for a total of 27% rate. The analysis of authors retrospective register showed an overall mortality rate of 16.7% (3/18), with a low but not negligible postprocedural rebleeding and intrastent thrombosis rates (5.6% and 11.1% respectively). CONCLUSION: Although increasingly utilized in the management of selected patients with acutely ruptured intracranial aneurysms, flow diversion for acutely ruptured intracranial aneurysms treatment presents rebleeding and intrastent stenosis rates not negligible.

Can we rewire criminal mind via non-invasive brain stimulation of prefrontal cortex? Insights from clinical, forensic and social cognition studies.

Non-compliance with social and legal norms and regulations represents a high burden for society. Social cognition deficits are frequently called into question to explain criminal violence and rule violations in individuals diagnosed with antisocial personality disorder (APD), borderline personality disorder (BPD), and psychopathy. In this article, we proposed to consider the potential benefits of non-invasive brain stimulation (NIBS) to rehabilitate forensic population. We focused on the effects of NIBS of the prefrontal cortex, which is central in social cognition, in modulating aggression and impulsivity in clinical disorders, as well as in forensic population. We also addressed the effect of NIBS on empathy, and theory of mind in non-clinical and/or prison population. The reviewed data provide promising evidence on the beneficial effect of NIBS on aggression/impulsivity dyscontrol and social cognitive functions, suggesting its relevance in promoting reintegration of criminals into society.

Comparing Main, Goldwyn, and Hesse (Berkeley) and Crittenden (DMM) coding systems for classifying Adult Attachment Interview transcripts: an empirical report.

Few studies have compared different systems in classifying Adult Attachment Interview (AAI) transcripts. In this study, the AAI was administered to 90 Italian parents (45 couples), and the AAI transcripts were independently classified according to Main, Goldwyn, and Hesse's (Berkeley) and Crittenden's (Dynamic-Maturational Model [DMM]) criteria. The two classification systems were not significantly associated, with some limited convergent results only when the interviews resulted in organized (Berkeley) and normative (DMM) attachment classifications. Otherwise, the Berkeley system identified more secure individuals than the DMM system, and many texts judged secure on the Berkeley system were identified as insecure on the DMM system. Since the Berkeley and the DMM systems rest on remarkably different conceptualizations of the nature and functioning of the attachment behavioral system (e.g. fear is conceived as organizing in the DMM and as potentially disorganizing in the Berkeley), the attachment classifications resulting from their applications should not be considered measurements of the same phenomena.

Magical thinking and decision-making strategies among late adolescent regular gamblers: A mediation model.

In the present study, the relation between the tendency to seek supernatural connections between external events and one's own thoughts, words, and actions and gambling among late adolescents has been studied. Psychologists have called this tendency magical thinking. The principal aim of the present study was to test the fit of an explanatory model of risk that starts from magical thinking and passes through maladaptive decision-making strategies, culminating with pathological gambling. Two hundred twenty-two Italian late adolescents, regularly attending bingo halls, aged between 19 and 21 years, completed measures on magical thinking, decision-making strategies, and gambling. Results highlight that young adults adopting dysfunctional modes of thought (i.e. magical thinking) tend to engage with maladaptive styles of decision-making that predispose them to gamble.

Psychopathological features in a sample of substance-abusing individuals with criminal history: Towards a definition of a personality prototype of an 'Addict with Criminal Conduct'.

BACKGROUND: The relationship between substance use disorders and criminal activity is strong, and one that is not easily resolved in the criminal justice system. A better understanding of personality traits among substance misusers who commit offences could support better treatment efforts. AIMS: The aim of this study is to explore associations between the psychopathology of people addicted to substances who have also committed crimes. METHODS: We recruited 263 substance-dependent individuals (80% male, 20% female) from a cohort of people attending regional community services in Italy. They all completed an extensive evaluation of their current mental health and personality traits. Their official criminal records were obtained, and the psychopathology of those who had a criminal record compared with those who did not. RESULTS: The criminal group was more likely to perceive the external world as hostile and to consider others as responsible for their own problems and difficulties; in addition, substance-dependent individuals with criminal records showed more personality traits within the psychopathy range and fewer in the dependent personality range than the substance abusers who had never committed crimes. CONCLUSIONS: These findings allow us to hypothesise that substance abusers who also have criminal convictions may have a specific personality profile. If further research were to confirm this, then it could have important implications for identifying people for particular treatment pathways and developing more effective treatments. Copyright © 2016 John Wiley & Sons, Ltd.

Intimate partner violence: relationships between alexithymia, depression, attachment styles, and coping strategies of battered women.

INTRODUCTION: One of the most common forms of violence against women is the intimate partner violence (IPV). This term includes physical, sexual, and emotional abuse and controlling behaviors by an intimate partner. AIM: This exploratory study investigates the relationship between alexithymia, adult attachment styles, depression, and coping strategies in a group of female victims of IPV and a control group. METHODS: Participants were 80 female victims of IPV with an age range from 18 years to 54 years (mean 31.62; standard deviation 9.81). The control group included 80 women with no history of IPV with an age range from 19 years to 37 years (mean 25.05; standard deviation 3.67). MAIN OUTCOME MEASURES: We administered the following self-report questionnaires: (i) 20-Item Toronto Alexithymia Scale (TAS-20); (ii) Coping Orientation Problems Experienced; (iii) Beck Depression Inventory (BDI)-II; and (iv) Attachment Style Questionnaire (ASQ). RESULTS: Compared with control group, the IPV group showed higher mean scores on TAS-20 (52.9 vs. 41.1, P < 0.001) and BDI-II (19.50 vs. 9.95, P < 0.001). In both groups, we found significant correlations between BDI-II and TAS-20 total scores (P < 0.001) and between BDI-II and the following dimensions of ASQ: confidence (P < 0.001), discomfort with closeness (P = 0.002), relationships as secondary (P < 0.001), need for approval (P < 0.001), and preoccupation with relationships (P < 0.001). Differently from the control group, in the IPV group, social support correlated significantly and positively (P < 0.001) with the dimension preoccupation with relationships on ASQ, but not with the secure attachment style. CONCLUSIONS: In comparison to the control group, alexithymia, depressive symptoms, and an insecure attachment style were negatively correlated with the ability to cope with stress for women in the IPV group.

Assessment of the relationship between the use of birth control pill and the characteristics of mate selection.

INTRODUCTION: In recent research, scientists have begun to suspect that birth control pill use could interfere with key mechanisms that play a role when women choose a sexual partner. Many studies have shown that women, particularly during the most fertile days of their menstrual cycle, look for specific physical, psychological, and behavioral characteristics indicative of genetic quality in a short-term partner. AIMS: Analysis of the psychometric properties of the Partner's Masculinity Index (PMI) scale. The scale was built to assess the degree of masculinity in hypothetical short-term partners. METHODS: A total of 395 female Italian volunteers from Central Italy (M = 32.9 years old, SD = 8.58, range = 18-50 years) completed the study. The psychometric properties of PMI were then evaluated. MAIN OUTCOME MEASURES: We administered the following self-report questionnaires: (i) PMI; (ii) Minnesota Multiphasic Personality Inventory-2 Masculinity/Femininity scale; and (iii) Demographic Questionnaire. RESULTS: Exploratory and confirmatory factor analysis showed a four-factor structure for the PMI. Internal consistency of the measure, evaluated with the Cronbach's alpha, was satisfactory. Factorial ANOVA results showed that the group of nonpill users obtained higher scores on the PMI scale than the group of pill users (considering the fertile phase of the cycle). CONCLUSIONS: From an evolutionary point of view, changes in preference for indicators of genetic quality in a sexual partner are considered to be functional and adaptive. Pill use may have implications for both current and future generations. Directions for future research are discussed.

Antisocial and psychopathic personalities in a sample of addicted subjects: differences in psychological resources, symptoms, alexithymia and impulsivity.

OBJECTIVE: Psychopathy and antisocial personality disorder (ASPD) are two constructs not interchangeable. Compared to the ASPD, psychopathy is characterized by lack of anxiety, low withdrawal, and high levels of attention seeking. METHOD: The sample of this study included 76 subjects with a substance use disorder. Subjects were aged between 18 and 59 years old (M=32.87, SD=9.36). With respect to level of education 3 subjects are elementary school graduates, 49 have a middle school diploma, 21 own a high school diploma, and 3 participants have a bachelor's degree. We administered the following measures: a) Psychopathic Personality Inventory-Revised (PPI-R); b) Psychological Treatment Inventory (PTI); c) 20-Item-Toronto Alexithymia Scale (TAS-20); d) Barratt Impulsiveness Scale (BIS). RESULTS: Most of the significant correlations between the Psychopathic Index (PPI-R total score), and the measures administered are listed below: PPI-R total score and Deviance (r=.482, p<.001), PPI-R total score and Hypomania (r=.369, p < .001), PPI-R total score and Unresolved attachment (r=.293, p<.001), PPI-R total score and Manipulativeness (r=.550, p<.001), PPI-R total score and the TAS-20 total score (r=.230; p<.001), PPI-R total score and Difficulty in Identifying Feelings (DIF) factor (r=.250, p<.001), PPI-R total score and Attentional Impulsiveness (r=.409, p<.001); PPI-R total score and Motor Impulsiveness (r=.526, p<.001). Results of MANOVAs between the two groups also revealed significant differences on several variables analyzed. CONCLUSIONS: Our study showed that addicted subjects with psychopathic tendencies are more likely to experience negative emotions and have a peculiar cognitive style with respect to antisocial addicts. These results partially confirm those ones of previous studies underlining that psychopathic population is generally characterized for a major need for stimulation, poor behavioral controls, lack of realistic long-term goals, impulsivity, irresponsibility.

Preferred Imaging for Target Volume Delineation for Radiotherapy of Recurrent Glioblastoma: A Literature Review of the Available Evidence.

BACKGROUND: Recurrence in glioblastoma lacks a standardized treatment, prompting an exploration of re-irradiation's efficacy. METHODS: A comprehensive systematic review from January 2005 to May 2023 assessed the role of MRI sequences in recurrent glioblastoma re-irradiation. The search criteria, employing MeSH terms, targeted English-language, peer-reviewed articles. The inclusion criteria comprised both retrospective and prospective studies, excluding certain types and populations for specificity. The PICO methodology guided data extraction, and the statistical analysis employed Chi-squared tests via MedCalc v22.009. RESULTS: Out of the 355 identified studies, 81 met the criteria, involving 3280 patients across 65 retrospective and 16 prospective studies. The key findings indicate diverse treatment modalities, with linac-based photons predominating. The median age at re-irradiation was 54 years, and the median time interval between radiation courses was 15.5 months. Contrast-enhanced T1-weighted sequences were favored for target delineation, with PET-imaging used in fewer studies. Re-irradiation was generally well tolerated (median G3 adverse events: 3.5%). The clinical outcomes varied, with a median 1-year local control rate of 61% and a median overall survival of 11 months. No significant differences were noted in the G3 toxicity and clinical outcomes based on the MRI sequence preference or PET-based delineation. CONCLUSIONS: In the setting of recurrent glioblastoma, contrast-enhanced T1-weighted sequences were preferred for target delineation, allowing clinicians to deliver a safe and effective therapeutic option; amino acid PET imaging may represent a useful device to discriminate radionecrosis from recurrent disease. Future investigations, including the ongoing GLIAA, NOA-10, ARO 2013/1 trial, will aim to refine approaches and standardize methodologies for improved outcomes in recurrent glioblastoma re-irradiation.

Individual predictors of vaccine hesitancy in the Italian post COVID-19 pandemic era.

A wide range of survey studies have explored vaccination hesitancy/resistance during the COVID-19 pandemic and provided evidence that this can be explained by several individual variables from the ideological, clinical, and socio-affective domain. However, evidence about which individual variables predict vaccine hesitancy in the post-pandemic state of COVID-19 is meager. We administered a battery of questionnaires to a group of 120 Italian participants with high and low scores on the adult vaccine hesitancy scale (aVHS) to investigate the predictive role of ideological (i.e. political orientation), clinical (i.e. anxiety, interoceptive accuracy), and socio-affective (i.e. alexithymia, disgust sensitivity/propensity, empathy) variables on vaccine hesitancy/resistance. This study provides evidence that lower interoceptive awareness and cognitive empathy are predictors of a greater hesitancy to get vaccinated in the post-pandemic COVID-19 state.

Internet Addiction Test (IAT): which is the best factorial solution?

BACKGROUND: The Internet Addiction Test (IAT) by Kimberly Young is one of the most utilized diagnostic instruments for Internet addiction. Although many studies have documented psychometric properties of the IAT, consensus on the optimal overall structure of the instrument has yet to emerge since previous analyses yielded markedly different factor analytic results. OBJECTIVE: The objective of this study was to evaluate the psychometric properties of the Italian version of the IAT, specifically testing the factor structure stability across cultures. METHODS: In order to determine the dimensional structure underlying the questionnaire, both exploratory and confirmatory factor analyses were performed. The reliability of the questionnaire was computed by the Cronbach alpha coefficient. RESULTS: Data analyses were conducted on a sample of 485 college students (32.3%, 157/485 males and 67.7%, 328/485 females) with a mean age of 24.05 years (SD 7.3, range 17-47). Results showed 176/485 (36.3%) participants with IAT score from 40 to 69, revealing excessive Internet use, and 11/485 (1.9%) participants with IAT score from 70 to 100, suggesting significant problems because of Internet use. The IAT Italian version showed good psychometric properties, in terms of internal consistency and factorial validity. Alpha values were satisfactory for both the one-factor solution (Cronbach alpha=.91), and the two-factor solution (Cronbach alpha=.88 and Cronbach alpha=.79). The one-factor solution comprised 20 items, explaining 36.18% of the variance. The two-factor solution, accounting for 42.15% of the variance, showed 11 items loading on Factor 1 (Emotional and Cognitive Preoccupation with the Internet) and 7 items on Factor 2 (Loss of Control and Interference with Daily Life). Goodness-of-fit indexes (NNFI: Non-Normed Fit Index; CFI: Comparative Fit Index; RMSEA: Root Mean Square Error of Approximation; SRMR: Standardized Root Mean Square Residual) from confirmatory factor analyses conducted on a random half subsample of participants (n=243) were satisfactory in both factorial solutions: two-factor model (χ²132= 354.17, P<.001, χ²/df=2.68, NNFI=.99, CFI=.99, RMSEA=.02 [90% CI 0.000-0.038], and SRMR=.07), and one-factor model (χ²169=483.79, P<.001, χ²/df=2.86, NNFI=.98, CFI=.99, RMSEA=.02 [90% CI 0.000-0.039], and SRMR=.07). CONCLUSIONS: Our study was aimed at determining the most parsimonious and veridical representation of the structure of Internet addiction as measured by the IAT. Based on our findings, support was provided for both single and two-factor models, with slightly strong support for the bidimensionality of the instrument. Given the inconsistency of the factor analytic literature of the IAT, researchers should exercise caution when using the instrument, dividing the scale into factors or subscales. Additional research examining the cross-cultural stability of factor solutions is still needed.

What is the direction of the association between social support and coping in cancer patients? A systematic review.

The aims of this systematic review were (a) to analyze recent studies about the association between social support and coping strategies in cancer patients after an established diagnosis; (b) to evaluate the direction of this association; and (c) to highlight any differences among different cancer types. Seven databases were searched for studies reporting the association between coping and social support for cancer patients in the last 51 years. Most of the 52 included studies highlighted the association between coping and social support, regardless of the source. Our findings supported a bidirectional association. No significant differences were found among the different types of cancer. In conclusion, our results sustain the importance of knowledge in studying this association to identify social limits and resources for the well-being of oncological patients. This knowledge could lead to the creation of holistic protocols to prevent poor adjustment to cancer.

An addictive disorders severity model: a chained mediation analysis using structural equation modeling.

BACKGROUND: The clinical relevance of the degree of severity in addiction disorders supports the need to investigate the variables underlying this aspect of the phenomenon. OBJECTIVE: This study aimed to explore the relationships between factors that may influence the severity of addiction disorder, with a particular focus on temperamental disinhibition, emotion dysregulation, interpersonal vulnerability, and their interactions. METHODS: A clinical sample of 502 (77% males and 22% females) was involved. All participants received a DSM-5 clinical diagnosis of "Substance-Related and Addictive Disorders" and were recruited from the Italian National Health System. The collected data were analyzed by implementing a chained mediation model using structural equation modeling. RESULTS: The statistical appropriateness of the hypothesized latent 4- factors model was confirmed. Specifically, temperamental disinhibition (composed of impulsiveness, compulsiveness, and obsessiveness), emotion dysregulation (composed of affect dysregulation, alexithymia, and dissociation), interpersonal vulnerability (composed of traumatic experiences, preoccupied, avoidant and unresolved attachment), and Addictive Disorders Severity (composed by substance use severity, alcohol use severity, gambling severity, and Internet use severity) were the four factors which have been identified. Furthermore, a total chained mediation model emerged, where emotion dysregulation and interpersonal vulnerability mediated the relationship between temperamental disinhibition and Addictive Disorders Severity. CONCLUSIONS: Our findings offer a better understanding of the variables associated with addictive disorder severity, providing important indications for therapeutic interventions.

An Integrated Approach to Addictive Behaviors: A Study on Vulnerability and Maintenance Factors.

This study aimed to explore the relationships among the variables involved in a Comprehensive Model of Addiction (CMA), which posits that the presence and severity of addictive behaviors are related to the configuration of seven psychological variables, namely childhood trauma, insecure attachment, affect dysregulation, dissociation, impulsivity, compulsiveness, and obsessiveness. A vulnerability model was proposed, in which it was suggested that affect dysregulation and complex trauma mediated the association between insecure attachment and dissociation. Furthermore, a maintenance model was elaborated, in which it was hypothesized that dissociation influenced affect dysregulation via impulsivity, compulsiveness, and obsessiveness. A clinical sample of 430 individuals with substance use disorder was involved. All participants received a DSM-5 clinical diagnosis of Substance-Related and Addictive Disorders and were recruited from the Italian National Health System. A parallel mediation emerged, confirming the vulnerability model, with complex trauma and affect dysregulation mediating the relationship between insecure attachment and dissociation. Furthermore, a mixed serial-parallel mediation described the maintenance model, where impulsiveness, compulsiveness, and obsessiveness significantly mediated the relationship between dissociation and affect dysregulation. Our findings offer a better understanding of the variables associated with addictive disorders, thus providing important indications for both treatment and preventive interventions.

A New Short Version of Internet Gaming Disorder-20: An Exploratory Structural Equation Modeling.

Objective: The purpose of this paper was to contribute to the psychometric properties and dimensionality of the IGD-20. Method: An online survey was completed by 392 Italian online gamers (Mage = 29.2, SD = 11.3; 45.2% males). A battery of self-report questionnaires was administered to assess internet gaming disorder, internet addiction, loneliness, anxiety, depression, stress, social-interaction anxiety, self-esteem, and perceived social support. To test the factor structure of IGD-20, both traditional (i.e., EFA and CFA) and innovative (i.e., ESEM) techniques were applied. Convergent, concurrent, discriminant, and criterion-related validity were evaluated. Results: Our study revealed the outperforming 3-factor ESEM model (χ2=39.951, p = 0.0021; RMSEA = 0.056, 90% C.I. [0.032 - 0.079]; CFI = 0.986; TLI = 0.965; and SRMR = 0.017; ω = .76, .77, and .79, respectively) as a new short version (IGD-10SV) for the IGD-20. The validity of the IGD-10SV was supported by significant associations with theoretically related measures. Conclusions: The current findings support the adoption of the analytic ESEM approach for complex multidimensional measures and the use of the IGD-10SV for the assessment of internet gaming disorder.

Evidence of abnormal scalar timing property in alexithymia.

Evidence suggests that incidental modulation of affective states affects the ability to keep track of time. Alexithymia represents an ideal condition to further address the emotion-time processing link, as it refers to a trait characterized by a deficit of affective processing. 31 healthy participants completed an online version of the TAS-20 scale, which measures alexithymia, and a time reproduction task of visual stimuli related to positive (i.e., happiness) and negative (i.e., anger) facial expressions. Results documented a positive correlation between TAS-20 score and the variability in reproducing sub-second durations of the anger expression stimuli We also found an overestimation of sub-second durations of non-affective expressions in borderline/alexithymic participants. Finally, in line with the literature, we confirmed the overall tendency to overestimate the duration of anger expression stimuli. These findings, which can be interpreted in terms of abnormal scalar timing property in alexithymia, expand previous investigations linking this personality trait with abnormal processing of negative emotions. The evidence that alexithymia predicts the reproduction variability of sub-second durations of negative affective stimuli corroborates previous neuroimaging studies documenting cerebellar deficits in these individuals.

Flow diversion for indirect carotid-cavernous fistula: Still an off-label indication?

Background: Flow diversion (FD) is an established treatment for large or giant wide-necked unruptured intracranial aneurysms. In the past few years, the use of flow diverter devices was extended to several other "off-label" indications, including solitary or adjunctive treatment to coil embolization for direct (Barrow A type) carotid cavernous fistulas (CCFs). The use of liquid embolic agents still represents the first-line treatment for indirect CCFs. Typically, the ipsilateral inferior petrosal sinus or superior ophthalmic vein (SOV) is the preferred transvenous routes to access CCFs. In some cases, vessel tortuosity or different features make the endovascular access challenging, thus requiring different approaches and strategies. The aim of the study is to discuss rational and technical aspect in treating indirect CCFs referring to the most up-to-date literature. An alternative experience-based endovascular strategy with FD is described. Methods: We report the case of a 54-year-old woman diagnosed with indirect CCF and treated with flow diverter stent. Results: After multiple unsuccessful attempts at transarterial right SOV catheterization, a right indirect CCF fed by a single trunk at the ophthalmic origin from the internal carotid artery (ICA) was treated by ICA stand-alone FD. Blood flow was redirect and successfully reduced through the fistula, with immediately postprocedure improvement of the patient's clinical status (ipsilateral proptosis and chemosis). Ten-months radiological follow-up showed the complete obliteration of the fistula. No adjunctive endovascular treatment was performed. Conclusion: FD appears a reasonable alternative stand-alone endovascular strategy also for selected difficult-to-access indirect CCFs, when all conventional routes are judged unfeasible. Further investigations will be necessary to better define and support this potential lesson-learned application.

Psychological Well-Being of Cancer Patients before and during the Pandemic: The Impact of COVID-19 Peritraumatic Distress.

BACKGROUND: This study aimed to evaluate the psychological impact of the COVID-19 pandemic on cancer patients. METHODS: Ninety cancer patients undergoing chemotherapy with antiblastics were recruited from a tertiary medical center and completed a battery of standardized questionnaires to assess anxiety, depression, peritraumatic stress, and quality of life before and during the pandemic. RESULTS: Quality of life worsened significantly during the pandemic compared with the pre-pandemic period. Anxiety and depression levels also increased significantly during the pandemic. COVID-19 peritraumatic distress significantly predicted lower quality-of-life scores during the pandemic. CONCLUSIONS: COVID-19 distress affected the overall quality of life of patients who already had lower levels of quality of life before the pandemic and who had advanced cancers. Cancer patients must receive adequate support from psychiatrists and psychologists to mitigate the psychological distress related to the pandemic.