The relationship between peritraumatic distress, mental health symptoms, and functioning impairment in healthcare workers during the COVID-19 emergency.

OBJECTIVE: Healthcare workers (HCWs) were considered a population at risk for developing psychiatric symptoms during the COVID-19 pandemic, such as anxiety, depression, and post-traumatic stress disorder (PTSD). Peritraumatic distress is associated with post-traumatic psychopathological symptoms; however, little is known about how it may affect functioning. The study aimed at evaluating the level of peritraumatic distress in a sample of HCWs during the first wave of the COVID-19 pandemic and at examining the relationship between peritraumatic distress, mental health symptoms, and functioning impairment. METHODS: A sample of 554 frontline HCWs were consecutively enrolled in major university hospitals and community services in Italy. The PDI, IES-R, PHQ-9, and GAD-7 were used to assess peritraumatic distress, symptoms of PTSD, depression, and anxiety, respectively, and the WSAS to investigate functioning impairment. PDI scores were higher among females, community services, physicians, and nurses. Furthermore, the PDI correlated significantly with the GAD-7, PHQ-9, IES-R, and WSAS. RESULTS: In a mediation analysis, the direct effect of PDI on WSAS and the indirect effects through the PHQ-9 and IES-R were statistically significant (P < .001). CONCLUSION: Peritraumatic distress reported by HCWs was associated with symptoms of PTSD, depression, and anxiety, but the association with reduced functioning may be only partially mediated through symptoms of depression and PTSD.

Chronotype is differentially associated with lifetime mood and panic-agoraphobic spectrum symptoms in patients with bipolar disorder and healthy controls.

OBJECTIVE: Although the association between chronotype and mood disorders has been consistently reported, conversely, attempts to measure the association between chronotype and anxiety symptoms have generated inconsistent results. We aimed at evaluating whether chronotype (assessed through subjective and objective measures) is associated with lifetime mood and panic-agoraphobic spectrum symptoms in healthy controls (HCs) and in patients with bipolar disorder (BD). METHODS: Overall, 173 subjects, patients with BD in euthymic phase (n = 76) and HC (n = 97), were evaluated through the reduced Morningness-Eveningness Questionnaire (rMEQ), actigraphy monitoring and mood and panic-agoraphobic spectrum self-report (MOODS-SR and PAS-SR). The discrepancy between objective (actigraphic-based) versus subjective (rMEQ-based) circadian typology was estimated through the Circadian Classification Discrepancy Index (CCDI). RESULTS: rMEQ-based evening chronotype (ET) was associated with higher scores in MOODS-SR depressive and rhythmicity and vegetative functions domains in HC and BD.Both ET and morning chronotypes (MT) were associated with higher PAS-SR scores in BD only. Actigraphic-based MT was associated with higher MOODS-SR depressive scores in HC. Likewise, the discrepancy between actigraphic-based and rMEQ-based circadian typology was associated with depressive symptoms in HC only. CONCLUSION: Self-reported ET was consistently associated with mood symptoms, while associations with panic-agoraphobic symptoms only emerged in BD and involved both extreme chronotypes. The discrepancy between the preferred circadian typology (rMEQ-based) and the actual one (actigraphic-based) could contribute to depressive symptoms in HC. These results pave the way for interventional studies targeting circadian typology in an attempt to prevent or treat mental health disorders.

PTSD trajectories across different mental disorders in the second year of the COVID-19 pandemic in Italy: a naturalistic, longitudinal, multicenter study.

The potentially traumatic impact of the COVID-19 pandemic in subjects with pre-existing mental disorders is still unclear, especially regarding its long-term consequences. The aim of this study was to prospectively assess post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSS) in patients with mental disorders, during the 3rd wave of the infection (T0, March-April 2021) while strict containment measures were applied in Italy, and after 3 months (T1, June-July 2021), with reduced restrictive measures. A total sample of 527 subjects, with different DSM-5 diagnoses, was consecutively enrolled at nine Italian psychiatric outpatient services. Assessments at T0 included: the Trauma and Loss Spectrum-Self Report (TALS-SR), the Impact of Event Scale-Revised (IES-R) and the Work and Social Adjustment Scale (WSAS). These two latter were repeated at T1. Results showed that at T0, 43.6% of the sample reported symptoms of PTSD, with females (p = .004), younger subjects (p = .011), unemployed/students (p = .011), and living with their parental families (p = .017), resulting more affected. Differences in PTSD rates emerged across diagnostic groups ranging from 10% in patients with psychoses up to 59% in those with feeding and eating disorders. An improvement at T1 emerged in all diagnostic groups for the IES-R scores, while WSAS scores improved only in subjects with mood disorders. In conclusions, subjects with mental disorders presented relevant rates of PTSD and PTSS at 1-year into the pandemic. Further long-term studies are needed to follow-up the course of pandemic traumatic burden especially in patients with severe mental disorders.

Naturalistic 6-month antidepressants follow-up in patients with fibromyalgia: impact on somatic and mood spectrum symptoms.

OBJECTIVES: Literature shows high rates of comorbidity between fibromyalgia (FM) and mood disorders, especially major depressive disorder (MMD), reported in more than half of the cases. Consistently, patients with FM also present high rates of mood spectrum symptoms, despite scant data are still available on the relationship with antidepressant treatment outcomes. The present study was aimed at exploring the clinical outcome of patients with FM-MDD comorbidity naturalistically treated with antidepressant drugs, besides the relationships between mood spectrum symptoms and the treatment response. METHODS: A total sample of 40 patients with FM and MDD, who started a treatment with an antidepressant drug, was recruited at the Rheumatology Unit of the University of Pisa, Italy. Patients were evaluated at baseline and after 1 (T1) and 6 months (T2) of the treatment with an antidepressant drug. Assessments included: the Mood Spectrum-Self Report (MOODS-SR) for mood spectrum symptoms, the Short Form Health Survey (SF-36) for the global functioning and the Clinical Global Impression (CGI) for the clinical severity and improvement. All instruments were administered at baseline and the SF-36 and CGI were repeated at T1 and T2. RESULTS: Twenty-eight (70%) patients reported an improvement at the CGI at T2. At T1 and T2 the CGI item-1 and most of the SF-36 domain scores significantly improved with respect to the T0, with the exception of the "role physical" and "role emotional" subscales. Improved patients reported higher scores in the energy depressive MOODS-SR domain. Furthermore, correlations emerged between several MOODS-SR domains and the CGI or SF-36 subscales scores at T0. CONCLUSIONS: Our results corroborate previous findings on the role of antidepressant drugs in the management not only of MDD symptoms, but also of the painful component of FM. FM patients should be investigated for Mood Spectrum symptomatology considering its prominent role on the manifestations of the disorder and treatment outcome.

Adult Autism Subthreshold spectrum correlates to Post-traumatic Stress Disorder spectrum in patients with fibromyalgia.

OBJECTIVES: Fibromyalgia (FM) is an increasingly prevalent disorder that usually shows a chronic course and a disappointing therapeutic response in which psychiatric features seem to play a relevant role. Most recently, the relationship between FM and Post-traumatic Stress Disorder (PTSD) has gained interest since several studies demonstrated a higher rate of PTSD, both full blown and partial, and Post-traumatic Stress spectrum symptoms. While the relationship between higher burden of autistic symptoms and PTSD is reported in literature, the relationship between FM and autism spectrum symptoms is still unexplored. In this study we investigated both post-traumatic and autistic spectrum in a sample of FM patients with the aim of exploring the relationships between these dimensions. METHODS: One hundred and nineteen patients with FM, diagnosed according the American College of Rheumatology 2010 criteria, were consecutively enrolled at the Unit of Rheumatology, University of Pisa, Italy. Assessments included: the Trauma And Loss Spectrum-Self Report (TALS-SR), for the post-traumatic stress spectrum symptomatology, the Adult Autism Subthreshold spectrum (AdAS spectrum) for the assessment of subthreshold autism spectrum. The scores reported to AdAS (total and per domain) by the entire sample and subgroups with PTSD diagnosis, partial PTSD and no PTSD were compared in order to detect a relation between Autistic Traits (ATs) and post-traumatic spectrum in this clinical sample. RESULTS: Our results show that FM patients with PTSD report an AdAS total score significantly higher than those reported by patients without PTSD. Moreover, through an examination of the correlation between AdAS spectrum and TALS-SR scores, significant correlations between the total score of the two instruments has emerged. The correlation resulted to be particularly significant between TALS-SR scores and non-verbal communication domain of the AdAS and between hyper-hypo reactivity to sensory input domain and several TALS-SR domains. CONCLUSIONS: These results highlight the clinical relevance of autistic traits in FM patients with PTSD. In this regard, we may claim a potential role of abnormal processing of sensory input and deficits in non-verbal communication in explaining this association.

A 3-Month Naturalistic Follow-Up Treatment With Selective Serotonin Reuptake Inhibitors in Frequent Attenders of General Medical Practice: What Correlates With a Good Response?

ABSTRACT: Frequent attenders (FAs), defined as patients repeatedly attending general practitioners, frequently exhibit underdiagnosed psychiatric comorbidities, leading to the hypothesis that frequent attendance may be related to an undetected psychiatric burden. This study explores the role of psychiatric comorbidities and psychopharmacological treatment on the clinical outcomes of a cohort of FAs of the general medical practice in Italy. The study included 75 FAs assessed by the Structured Clinical Interview for DSM-5, Clinical Global Impression, Global Assessment Functioning, and Illness Behavior Inventory, administered at baseline (T0) and after 3 months (T1). Data were analyzed on the bases of the presence of any mental disorder and selective serotonin reuptake inhibitor (SSRI) treatment, with respect to other psychopharmacological treatments. Results showed better outcomes among patients with a mental disorder, particularly anxiety, depression, and somatic symptoms disorders, and when under SSRI treatment. Our findings corroborate the role of psychiatric comorbidity on frequent attendance in the context of general clinical practice with a positive outcome when receiving appropriate treatment with SSRI.

Comparing re-hospitalisation rates in a real-world naturalistic 24-month follow-up of psychotic patients with different treatment strategies: Oral versus LAI antipsychotics.

AIM & BACKGROUND: Non-adherence to antipsychotic treatment is a major issue in the management of severe psychiatric disorders, because it is usually related to future relapses and re-hospitalisations. Long-Acting-Injection (LAI) antipsychotics can be useful to increase treatment adherence in these patients. The aim of the present study was to compare the re-hospitalisation rates of psychotic patients discharged from a psychiatric ward and then, divided into three groups upon the treatment received: LAI antipsychotic, oral antipsychotic at home or oral antipsychotic administered daily by psychiatric nurse staff as patients lived in a long-term care facility. METHODS: Data on all inpatients consecutively admitted to the Psychiatric Unit of the Nuovo Ospedale Apuano (Massa, Italy), between January 2017 and December 2018, were obtained by the registration record system. Information about eventual re-hospitalisations of these patients, occurred within a 24-month timeframe since discharge, were collected from the same database. RESULTS: In a Kaplan-Meyer analysis, patients treated with LAI antipsychotics showed significantly lower re-hospitalisation rates in the first 24 months after discharge than those treated with oral ones. CONCLUSIONS: This study highlights the impact of LAI antipsychotics in preventing re-hospitalisation in severe psychotic patients at high risk in a naturalistic setting. The benefits appear relevant also with respect to a controlled long-term oral antipsychotic treatment, however, further studies are needed to develop more tailored intervention strategies in such complex psychiatric population.

PTSD and Depression in Healthcare Workers in the Italian Epicenter of the COVID-19 Outbreak.

BACKGROUND: Increasing evidence highlights the susceptibility of Healthcare Workers to develop psychopathological sequelae, including Post-Traumatic Stress Disorder (PTSD) and depression, in the current COronaVIrus Disease-19 (COVID-19) pandemic, but little data have been reported in the acute phase of the pandemic. OBJECTIVE: To explore Healthcare Workers' mental health reactions in the acute phase of the COVID-19 pandemic in the first European epicenter (Lodi/Codogno, Italy), with particular attention to post-traumatic stress and depressive symptoms and their interplay with other psychological outcomes. METHODS: 74 Healthcare Workers employed at the Azienda Socio Sanitaria Territoriale of Lodi (Lombardy, Italy) were recruited and assessed by means of the Impact of Event Scale- Revised, the Professional Quality of Life Scale-5, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 item, the Resilience Scale and the Work and Social Adjustment Scale. Socio-demographic and clinical variables were compared across three subgroups of the sample (No PTSD, PTSD only, PTSD and depression). RESULTS: A total of 31% of subjects endorsed a diagnosis of PTSD and 28.4% reported PTSD comorbid with major depression. Females were more prone to develop post-traumatic stress and depressive symptoms. Subjects with PTSD and depression groups showed high levels of PTSD, depression, burnout and impairment in functioning. Anxiety symptoms were higher in both PTSD and depression and PTSD groups rather than in the No PTSD group. CONCLUSION: Our results showed high rates of PTSD and depression among Healthcare Workers and their comorbidity overall being associated with worse outcomes. Current findings suggest that interventions to prevent and treat psychological implications among Healthcare Workers facing infectious outbreaks are needed.

Is Sexual Dysfunction in Young Adult Survivors to the L'Aquila Earthquake Related to Post-traumatic Stress Disorder? A Gender Perspective.

BACKGROUND: Mental disorders are frequently related to sexual dysfunction (SD) but scant data are still available on trauma-related disorders, particularly post-traumatic stress disorder (PTSD). AIM: To evaluate the relationships between SD and PTSD in 2009 L'Aquila (Italy) earthquake young adult survivors, with particular attention to gender differences. METHODS: Five hundred twelve high-school senior students were assessed 21 months after exposure by the following: Trauma and Loss Spectrum-Self-Report (TALS-SR), for post-traumatic spectrum symptoms; Mood Spectrum-Self-Report (MOODS-SR) lifetime version, for mood spectrum symptoms (including SD-related symptoms). Descriptive and inferential statistics were adopted. OUTCOMES: TALS-SR and MOODS-SR scores were analyzed to evaluate PTSD- and SD-related symptoms. RESULTS: Around 6.5% of subjects reported SD-related symptoms with males showing higher rates than females in each symptom, with a statistically significant difference in item n = 154 (…less sexually active). Survivors with symptomatological PTSD reported rates up to 10%, with higher ratio of endorsing at least one SD-related symptom than with NO-PTSD. Significantly higher total MOODS-SR SD-related symptom scores emerged in survivors with symptomatological PTSD than in those with NO-PTSD, and a 2-way ANOVA showed a significant main effect of symptomatological PTSD and gender and gender × PTSD interaction. CLINICAL IMPLICATIONS: SD-related symptoms are reported among young adult survivors to earthquake exposure and the number of symptoms is related to PTSD, particularly in males, suggesting the need for accurate evaluation. STRENGTHS & LIMITATIONS: Strengths are the large sample of young adult survivors to a massive natural disaster; the long-time frame from exposure corroborating the role of PTSD; the assessment of symptoms specifically occurring after exposure. Limitations are as follows: the lack of a specific scale for SD; the self-report instruments other than clinical interviews, that may be less accurate; the lack of information on the presence of somatic illness and other mental disorders; the lack of a control group; the young age of the sample because of the lifetime sexual experiences of the subjects, in addition to the lack of a comparison measure of sexual functioning before the earthquake. CONCLUSIONS: Our results highlight relevant rates of SD-related symptoms in young adults exposed to the L'Aquila earthquake, particularly males and subjects with PTSD, suggesting SD may represent a specific male gender-related somatic complaint. Our results highlight the need for accurate investigation of SD in such population to improve clinical management and appropriate treatment. Carmassi C, Dell'Oste V, Pedrinelli V, et al. Is Sexual Dysfunction in Young Adult Survivors to the L'Aquila Earthquake Related to Post-traumatic Stress Disorder? A Gender Perspective. J Sex Med 2020;17:1770-1778.

PTSD and Burnout are Related to Lifetime Mood Spectrum in Emergency Healthcare Operator.

BACKGROUND: PTSD and burnout are frequent conditions among emergency healthcare personnel because exposed to repeated traumatic working experiences. Increasing evidence suggests high comorbidity between PTSD and mood symptoms, particularly depression, although the real nature of this relationship still remains unclear. The purpose of this study was to investigate the relationship between PTSD, burnout and lifetime mood spectrum, assessed by a specific scale, among health-care professionals of a major University Hospital in Italy. METHODS: N=110 Emergency Unit workers of the Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy) were assessed by the TALS-SR, MOODS-SR lifetime version and the ProQOL R-IV. RESULTS: Approximately 60% of participants met at least one PTSD symptom criterion (criterion B, 63.4%; criterion C, 40.2%; criterion D 29.3%; criterion E, 26.8%), according to DSM-5 diagnosis. Almost sixteen percent of the sample reported a full symptomatic DSM-5 PTSD (work-related) diagnosis, and these showed significantly higher scores in all MOODS-SR depressive domains, as well as in the rhythmicity domain, compared with workers without PTSD. Further, mood-depressive and cognition-depressive MOODS-SR domains resulted to be predictive for PTSD. Significant correlations emerged between either PTSD diagnosis and criteria or ProQOL subscales and all the MOOD-SR domains. CONCLUSION: A significant association emerged among PTSD, burnout and lifetime MOOD Spectrum, particularly the depressive component, in emergency health care operators, suggesting this population should be considered at-risk and undergo regular screenings for depression and PTSD.

DSM-5 criteria for PTSD in parents of pediatric patients with epilepsy: What are the changes with respect to DSM-IV-TR?

Increasing literature suggests the need to explore for post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in parents and caregivers of children with acute and chronic illnesses but scant data are available on epilepsy. The aim of the present study was to estimate full and partial PTSD rates among parents of children with epilepsy comparing DSM-5 and DSM-IV-TR criteria. Further, the aim of the present study was to examine possible gender differences between mothers and fathers. Results showed 9.1% and 12.1% PTSD rates in the total sample, according to DSM-5 or DSM-IV-TR criteria, respectively, with an overall consistency of 92.9% (Kohen's K=0.628, p=.453). Significant gender differences emerged for Avoidance/Numbing and Hyperarousal symptoms diagnosed by means of DSM-IV-TR criteria, as well as for Negative alterations in cognitions/mood and Hyperarousal symptoms, when adopting DSM-5 criteria. This study underscores the relevance of detecting PTSD in parents of children with a chronic illness such as epilepsy.

Unexpected subthreshold autism spectrum in a 25-year-old male stalker hospitalized for delusional disorder: a case report.

This paper highlights the clinical challenges faced when assessing patients with stalking behaviors with psychotic disorders, suggesting the need for an accurate assessment of adult autism spectrum symptoms. A 25-year-old man with a diagnosis of delusional disorder, erotomanic type, was hospitalized for acute psychotic symptoms occurred in the framework of a repeated stalking behavior towards his ex girlfriend. When assessed for adult autism spectrum symptoms upon an accurate clinical evaluation, he reported elevated scores in the mentalizing deficit and social anxiety domains by means of the 14 item Ritvo Autism and Asperger Diagnostic Scale (RAADS-14). Authors discuss a possible role of adult (subthreshold) autism spectrum symptoms, generally disregarded in adult psychiatry, on the type of psychotic features and stalking behavior developed that may help for appropriate diagnosis and treatment.

Alterations in circadian/seasonal rhythms and vegetative functions are related to suicidality in DSM-5 PTSD.

BACKGROUND: Alterations in rhythmicity and vegetative functions have been reported as correlates of suicidality, particularly in patients with mood disorders. No investigation has addressed their impact on patients with post-traumatic stress disorder (PTSD). Aim of the present study was to fulfill this gap. METHODS: Sixty-five out- and inpatients with DSM-5 PTSD were assessed by using the Mood Spectrum-Self Report-Lifetime Version (MOODS-SR), a questionnaire for lifetime mood spectrum symptomatology including alterations in circadian/seasonal rhythms and vegetative functions. Six items of the MOODS-SR were combined and dichotomized to assess suicidal ideation and/or attempts. RESULTS: Significant and positive associations were found between symptoms of lifetime dysregulations in rhythmicity and vegetative functions and suicidal ideation and/or attempts. All MOODS-SR sub-domains (rhythmicity, sleep, appetite/weight, sexual function, physical symptoms) were associated with an increased likelihood of suicidal ideation, but only changes in appetite/weight were associated with greater odd ratios of suicide attempts (OR = 2.099, 95% CI 1.148-3.841). CONCLUSIONS: Our results suggest that lifetime dysregulations in rhythmicity and vegetative functions may represent correlates of suicidality in patients with DSM-5 PTSD.

New DSM-5 maladaptive symptoms in PTSD: gender differences and correlations with mood spectrum symptoms in a sample of high school students following survival of an earthquake.

BACKGROUND: Gender differences in post-traumatic stress disorder (PTSD) rates were confirmed across different DSM editions as well as the role of bipolar disorder (BD) comorbidity on prevalence and course, but little data is available upon new DSM-5 criteria, including maladaptive behaviors. The aim of this study was to investigate gender differences in DSM-5 PTSD in a sample of young adult earthquake survivors and the impact of lifetime mood spectrum comorbidity. METHODS: Five hundred twelve young adult survivors from the L'Aquila 2009 earthquake were evaluated by Trauma and Loss Spectrum-Self Report (TALS-SR) and Mood Spectrum-Self Report (MOODS-SR). RESULTS: Females showed significantly higher DSM-5 PTSD prevalence rates than men. Similarly, female survivors with DSM-5 PTSD showed significantly higher scores in several of the MOODS-SR and TALS-SR domains with respect to males. Males showed significantly higher scores in the TALS-SR maladaptive coping domain only. A significant positive association between the MOODS-SR manic-hypomanic component and TALS-SR potentially traumatic events and maladaptive coping domains emerged in the whole sample, particularly among men. CONCLUSION: This study allows a first glimpse on gender differences in DSM-5 PTSD criteria in a sample of earthquake survivors. Further, possible correlations with subthreshold manic-hypomanic comorbidity are suggested among males, showing a significant trend particularly for lifetime trauma exposure and for the newly introduced maladaptive behaviors.

A 12-month longitudinal naturalistic follow-up of cariprazine in schizophrenia.

Background: Cariprazine, a third-generation antipsychotic (TGAs), has demonstrated efficacy in the treatment of schizophrenia with good tolerability profile. Actual real-world literature data are lacking, particularly when exploring its efficacy in the long term. The present study examined the effects of cariprazine treatment on specific psychopathological domains with a particular focus on outcomes and side effects in real-life experience, after a long-term treatment. Methods: The present 12-month longitudinal naturalistic study included a sample of subjects with a DSM-5-TR diagnosis of schizophrenia, recruited in the outpatients' psychiatric services of university and community hospitals in Italy, naturally treated with cariprazine. The assessments included: a sociodemographic data sheet, the Structured Clinical Interview for the DSM-5 (SCID-5), the Positive and Negative Symptom Scale (PANSS) and the St. Hans Rating Scale (SHRS). The PANSS was also administered after 6 (T1) and 12 (T2) months of treatment with cariprazine while the SHRS at T1. Results: The total sample consisted of 31 patients, 15 males and 16 females. A significant decrease of the PANSS' subscales, Marder factors and total mean scores emerged at both T1 and T2 with respect to T0. Extrapyramidal symptoms occurred in a minority of patients and in mild or mild/moderate forms: no patient showed moderate forms of psychic/motor akathisia or dystonia, three subjects showed moderate parkinsonism. Conclusions: This study confirms a good efficacy profile of cariprazine in both positive and negative symptoms in patients with Schizophrenia, combined with a good tolerability profile in extrapyramidal symptoms.

Validation of the Spanish Version of the Trauma and Loss Spectrum Self-Report (TALS-SR): A Study on Healthcare Workers Facing the COVID-19 Pandemic.

Background: The present study aimed at reporting about the validity and reliability of the Spanish version of the Trauma and Loss Spectrum-Self Report (TALS-SR), an instrument based on a multidimensional approach to Post-Traumatic Stress Disorder (PTSD) and Prolonged Grief Disorder (PGD), including a range of threatening or traumatic experiences and significant losses, besides the spectrum of peri-traumatic stress reactions and post-traumatic stress symptoms that may occur. Methods: A sample of 87 Health Care Workers (HCWs) employed in the COVID-19 Emergency Department at the Virgen de la Arrixaca and Reina Sofia Hospitals (Murcia, Spain) during the pandemic, was consecutively recruited and fulfilled the TALS-SR. Assessments also included the Impact of Event Scale-Revised (IES-R), to examine post-traumatic stress symptoms and probable PTSD. Nineteen HCWs fulfilled the TALS-SR again after three weeks from baseline for test-retest reliability. Results: This study provides evidence of good internal consistency and test-retest reliability of the Spanish version of the TALS-SR. Strong support for the internal validity structure was obtained, with positive and significant correlations between the five symptomatologic domains and the symptomatologic total score. Significant and good correlations between the TALS-SR symptomatologic domains and the IES-R total and single domains' scores were found. The Questionnaire also demonstrated to discriminate between subjects with and without PTSD, with subjects with PTSD showing significantly higher mean scores in each domain of the TALS-SR. Conclusion: This study validates the Spanish version of TALS-SR, providing a useful instrument for a spectrum approach to PTSD and confirms the potential utility of this psychometric tool in both clinical practice and research settings.

Mental Health Symptoms among General Practitioners Facing the Acute Phase of the COVID-19 Pandemic: Detecting Different Reaction Groups.

During the 2020 first wave of the COVID-19 pandemic, general practitioners (GPs) represented the first line of primary care and were highly exposed to the pandemic risks, with a consequent risk of developing a wide range of mental health symptoms. However, scant data are still available on factors associated with a worse outcome. The aim of the present study was to investigate mental health symptoms in 139 GPs in the aftermath of the first COVID-19 national lockdown in Italy, detecting groups of subjects with different depressive, anxiety, and post-traumatic stress symptom severity. The impact of the mental health symptoms on quality of life and individual functioning were also evaluated. A cluster analysis identified three groups with mild (44.6%), moderate (35.3%), and severe psychopathological burden (20.1%). Higher symptom severity was related to younger age, fewer years in service as GPs, working in a high incidence area for the pandemic, having a relative at risk of medical complications due to COVID-19, besides more severe global functioning impairment, burnout, and secondary traumatic stress. The present findings showed that GPs, forced to perform their professional activity in extremely stressful conditions during the COVID-19 pandemic, were at high risk of developing mental health problems and a worse quality of life.

Pharmacological Treatment of Acute Psychiatric Symptoms in COVID-19 Patients: A Systematic Review and a Case Series.

Delirium and psychomotor agitation are relevant clinical conditions that may develop during COVID-19 infection, especially in intensive care unit (ICU) settings. The psychopharmacological management of these conditions is receiving increasing interest in psychiatry, considering hyperkinetic delirium as one of the most common neuropsychiatries acute consequences in COVID-19 recovery patients. However, there are no actual internationally validated guidelines about this topic, due to the relatively newly introduced clinical condition; in addition, a standardized psychopharmacologic treatment of these cases is a complex goal to achieve due to the risk of both drug-drug interactions and the vulnerable conditions of those patients. The aim of this systematic review and case series is to evaluate and gather the scientific evidence on pharmacologic handling during delirium in COVID-19 patients to provide practical recommendations on the optimal management of psychotropic medication in these kinds of patients. The electronic databases PubMed, Embase and Web of Science were reviewed to identify studies, in accordance with the PRISMA guidelines. At the end of the selection process, a total of 21 studies (n = 2063) were included. We also collected a case series of acute psychomotor agitation in COVID-19 patients hospitalized in ICU. Our results showed how the symptom-based choice of the psychotropic medication is crucial, and even most of the psychotropic drug classes showed good safety, one must not underestimate the possible drug interactions and also the possible decrease in vital functions which need to be strictly monitored especially during treatment with some kinds of molecules. We believe that the evidence-based recommendations highlighted in the present research will enhance the current knowledge and could provide better management of these patients.

Three-Month Follow-up Study of Mental Health Outcomes After a National COVID-19 Lockdown: Comparing Patients With Mood or Anxiety Disorders Living in an Area With a Higher Versus Lower Infection Incidence.

Objective: The COVID-19 pandemic and the related containment measures can represent a traumatic experience, particularly for populations living in high incidence areas and individuals with mental disorders. The aim of this study was to prospectively examine posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms since the end of the first COVID-19 pandemic wave and Italy's national lockdown in subjects with mood or anxiety disorders living in 2 regions with increasing pandemic incidence.Methods: 102 subjects with a DSM-5 anxiety or mood disorder were enrolled from June to July 2020 and assessed at baseline (T0) and after 3 months (T1) with the Impact of Event Scale-Revised, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, and Work and Social Adjustment Scale. At T1, subjects were also assessed by means of the Trauma and Loss Spectrum Self-Report for PTSD.Results: At T0, subjects from the high COVID-19 incidence area showed higher levels of traumatic symptoms than those from the low COVID-19 incidence area (P < .001), with a decrease at T1 with respect to T0 (P = .001). Full or partial DSM-5 PTSD related to the COVID-19 pandemic emerged in 23 subjects (53.5%) from the high COVID-19 incidence area and in 9 (18.0%) from the low COVID-19 incidence area (P < .001).Conclusions: Subjects with mood or anxiety disorders presented relevant rates of PTSD, depressive, and anxiety symptoms in the aftermath of the lockdown, and in most cases these persisted after 3 months. The level of exposure to the pandemic emerged as a major risk factor for PTSD development. Further long-term studies are needed to follow up the course of traumatic burden.

Gender and occupational role differences in work-related post-traumatic stress symptoms, burnout and global functioning in emergency healthcare workers.

OBJECTIVES: To explore gender and occupational role impact on work-related Post-Traumatic Stress Symptoms, Post-Traumatic Stress Disorder, burnout and global functioning in a sample of emergency healthcare workers. DESIGN: A cross-sectional study. PARTICIPANTS/SETTING: 126 healthcare workers of the Emergency Department, including Intensive Care Unit, Emergency Room and Emergency Medicine, of a major University Hospital in central Italy were recruited. MAIN OUTCOME MEASURES: Participants were assessed by means of the: Trauma and Loss Spectrum-Self Report (TALS-SR) to explore Post-Traumatic Stress Spectrum Symptoms, Professional Quality of Life (ProQOL) Scale to assess Compassion Satisfaction, Burnout and Compassion Fatigue and Work and Social Adjustment Scale (WSAS) to measure global functioning. RESULTS: The present findings showed females were more prone to develop Post-Traumatic Stress Symptoms, particularly re-experiencing (p = .010) and hyperarousal (p = .026) symptoms and medical doctors reporting higher Burnout (p < .001) and lower Compassion Satisfaction (p = .009) mean scores than nurses. Higher levels of functioning impairment emerged amongst medical doctors rather than nurses, in both social (p = .029) and private (p = .020) leisure activities. Linear correlations highlighted relationships between the TALS-SR, ProQOL and WSAS scores. Finally, medical doctor status was significantly associated with lower Compassion Satisfaction (p = .029) and higher Burnout (p = .015). CONCLUSION: Our results highlight high post-traumatic stress symptoms and burnout levels in emergency healthcare workers with a relevant impact of female gender and occupational role, supporting the need for preventive strategies, also in light of the current COVID-19 pandemic.