Confirmatory validation of the Mesothelioma Psychological Distress Tool-Patients: A brief patient-reported outcome measure assessing psychological distress in malignant mesothelioma patients.

OBJECTIVE: Psychological suffering in patients with Malignant Mesothelioma (MM) is different from the one experienced by patients with other cancers due to its occupational or environmental etiology and its peculiar symptomatology and prognosis (i.e., poor prognosis, reduced effectiveness of the therapies, poor quality of residual life, and advanced age at the time of diagnosis). Therefore, the Mesothelioma Psychological Distress Tool-Patients (MPDT-P) has been developed to evaluate the specific profile of psychological suffering in this population. This paper describes the item selection, factor analysis, and psychometric evaluation of the revised MPDT-P. METHODS: The analyses of the current work aimed to confirm the factorial structure found in the first version of the MPDT-P. In the case of nonfit, it aimed to find an alternative structure and causes of nonfit in the model. The search for the fit of the factorial model was conducted using a Bayesian approach. RESULTS: The two-factor model reported in the first version of the instrument did not fit the data. Confirmatory Bayesian analyses showed adequate fit for the three-factor solution. Based on the content of the items, we labeled the factors as dysfunctional emotions, claims for justice, and anxieties about the future. CONCLUSIONS: Integrating the MPDT-P into clinical practice could help clinicians gain insight into the specific suffering related to MM and investigate potential differences related to different occupational and environmental exposure contexts.

Spiritual well-being, dignity-related distress and demoralisation at the end of life-effects of dignity therapy: a randomised controlled trial.

OBJECTIVES: This single-centre prospective randomised controlled study aimed to investigate the effectiveness of dignity therapy on spiritual well-being, demoralisation and dignity-related distress compared with standard palliative care. METHODS: A total of 111 terminally ill hospice patients were randomly allocated to one of two groups: dignity therapy plus standard palliative care (intervention group) or standard palliative care alone (control group). The main outcomes were meaning, peace, faith, loss of meaning and purpose, distress and coping ability, existential distress, psychological distress and physical distress. Assessments were conducted at baseline, 7-10 and 15-20 days. RESULTS: Following randomisation, 11 dropped out before baseline assessment and 33 after post-treatment assessment. A total of 67 patients completed the study, 35 in the experimental group and 32 in the control group. Repeated measures general linear model showed significant differences between groups on peace and psychological distress over time, but not on existential distress, physical distress, meaning and purpose, distress and coping ability, meaning and faith. Specifically, patients in the dignity therapy intervention maintained similar levels of peace from baseline to follow-up, whereas patients in the control group significantly declined in peace during the same time period. Moreover, psychological distress significantly decreased from pretreatment to post-treatment in the intervention group and increased in the control group. CONCLUSIONS: Dignity therapy may be an effective intervention in maintaining sense of peace for terminally ill patients. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of this psychological intervention.

Meaning in Life and the Acceptance of Cancer: A Systematic Review.

Meaning in life and acceptance of cancer are critical for patients to adjust to a cancer diagnosis and to improve psychological wellbeing. Little is known about the relationship between meaning in life and the acceptance of cancer. This study provides a systematic review of the associations between meaning in life and the acceptance of cancer in cancer patients. CINAHL, MEDLINE, PsycINFO, and SCOPUS databases were searched until 15 March 2021. Studies were included if they quantitatively examined the association between meaning in life and the acceptance of cancer in adult cancer patients/survivors and if they were published in peer-reviewed journals or in books. The study quality was assessed using Joanna Briggs Institute critical appraisal tools. Of the 4907 records identified through database searches, only 3 studies quantitatively examined the associations between meaning in life and the acceptance of cancer. The total sample involved 464 women with cancer. All three studies reported positive correlations between meaning in life and the acceptance of cancer (ranging from r = 0.19 to r = 0.38), whereas meaning in life did not predict the acceptance of cancer. Overall, the meaning in life-acceptance relationship has not been sufficiently investigated, though it has relevant theoretical and clinical implications for coping with cancer. High-quality studies are needed to better understand the relationship between meaning in life and the acceptance of cancer.

The refused interpretation in Freud, Jung and beyond: what if the patient says "no" / La interpretación rechazada en Freud, Jung y más allá: ¿y si el paciente dice "no"?

Abstract The paper attempts to illustrate how refusing an interpretation can lead to very different consequences within Freudian, Jungian, and other psychotherapeutic models. In some cases, a "no" may refute the model of reference, while in others it may have less radical meanings. Refusing an interpretation (if it is consistent with the model and the patient's history) within a Freudian environment can also challenge the validity of the model. From a Jungian perspective, a refusal may simply lead the therapist to change the model of reference, since no single model is considered universally valid. Other examples are also provided from the psychoanalytic, cognitive-behavior, and family therapy research traditions.

Resumen Este artículo intenta ilustrar cómo rechazar una interpretación puede tener consecuencias muy diferentes dentro de los modelos psicoterapéuticos de Freud, Jung y otros. En algunos casos, un "no" puede refutar el modelo de referencia, mientras que en otros puede tener significados menos radicales. Rechazar una interpretación (si es consistente con el modelo y la historia del paciente) dentro de un entorno freudiano también puede cuestionar la validez del modelo. Desde una perspectiva de Jung, una negativa puede llevar simplemente al terapeuta a cambiar el modelo de referencia, ya que ningún modelo único se considera universalmente válido. También se muestran otros ejemplos de las tradiciones de investigación psicoanalítica, cognitivo-conductual y de terapia familiar.

Measuring Knowledge, Attitudes, and Barriers to Medication Adherence in Potential Bariatric Surgery Patients.

BACKGROUND: Bariatric surgery is an effective treatment for the obesity epidemic, but the poor attendance and adherence rates of post-surgery recommendations threaten treatment effectiveness and health outcomes. Preoperatively, we investigated the unique contributions of clinical (e.g., medical and psychiatric comorbidities), sociodemographic (e.g., sex, age, and educational level), and psychopathological variables (e.g., binge eating severity, the general level of psychopathological distress, and alexithymia traits) on differing dimensions of adherence in a group of patients seeking bariatric surgery. METHODS: The final sample consisted of 501 patients (346 women). All participants underwent a full psychiatric interview. Self-report questionnaires were used to assess psychopathology, binge eating severity, alexithymia, and three aspects of adherence: knowledge, attitude, and barriers to medical recommendations. RESULTS: Attitude to adherence was associated with alexithymia (ß = -2.228; p < 0.001) and binge eating disorder (ß = 0.103; p = 0.047). The knowledge subscale was related to medical comorbidity (ß = 0.113; p = 0.012) and alexithymia (ß = -2.256; p < 0.001); with age (ß = 0.161; p = 0.002) and psychiatric comorbidity (ß =0.107; p = 0.021) manifesting in the barrier subscale. CONCLUSION: We demonstrated that alexithymia and psychiatric and eating disorders impaired adherence reducing attitude and knowledge of treatment and increasing the barriers. Both patient and doctor can benefit from measuring adherence prior to surgery, with a qualitative approach shedding light on the status of adherence prior to the postsurgical phase when the damage regarding adherence is, already, done. Graphical Abstract.

Neurocognitive and Psychopathological Predictors of Weight Loss After Bariatric Surgery: A 4-Year Follow-Up Study.

Twenty to thirty percent of patients experience weight regain at mid and long-term follow-up. Impaired cognitive functions are prevalent in people suffering from obesity and in those with binge eating disorder, thereby, affecting the weight-loss outcomes. The aim of our study was to investigate neurocognitive and psychopathological predictors of surgical efficacy in terms of percentage of excess weight loss (%EWL) at follow-up intervals of one year and 4-year. Psychosocial evaluation was completed in a sample of 78 bariatric surgery candidates and included psychometric instruments and a cognitive battery of neuropsychological tests. A schedule of 1-year and 4-year follow-ups was implemented. Wisconsin Sorting Card Test total correct responses, scores on the Raven's Progressive Matrices Test, and age predicted %EWL at, both, early and long-term periods after surgery while the severity of pre-operative binge eating (BED) symptoms were associated with lower %EWL only four years after the operation. Due to the role of pre-operative BED in weight loss maintenance, the affected patients are at risk of suboptimal response requiring ongoing clinical monitoring, and psychological and pharmacological interventions when needed. As a result of our findings and in keeping with the latest guidelines we encourage neuropsychological assessment of bariatric surgery candidates. This data substantiated the rationale of providing rehabilitative interventions tailored to cognitive domains and time specific to the goal of supporting patients in their post-surgical course.

Assessing psychopathology in bariatric surgery candidates: discriminant validity of the SCL-90-R and SCL-K-9 in a large sample of patients.

PURPOSE: Pre-surgical psychosocial evaluation of bariatric surgery (BS) patients should identify psychiatric issues that could worsen after surgery and those requiring additional ongoing intervention. In this view, the use of reliable, appropriate and concise evaluating instruments is of critical importance. The aim of the present study was to investigate the clinical utility of both the Symptom Checklist 90-Revised (SCL-90-R) and its brief unidimensional version, the so-called Symptom-Checklist-K-9 (SCL-K-9) in detecting the presence of psychiatric disorders among bariatric surgery (BS) candidates. METHODS: Seven-hundred-and-ninety-eight BS candidates (563 women and 235 men; mean age: 44.15 ± 11.45) were enrolled in the present study. All participants underwent a full psychiatric interview and were administered the SCL-90-R. RESULTS: Three-hundred-and-sixty-two patients (45.4%) met the criteria for a diagnosis of at least one psychiatric disorder and ninety-nine patients (12.4%) had psychiatric comorbidities. In the current sample, 219 patients (27.4%) met the criteria for binge eating disorders (BED), 158 (19.8%) met the criteria for major depressive disorder (MDD), and 67 (8.4%) met both criteria. A receiver operating characteristic (ROC) curves procedure showed that both the SCL-90-R and the SCL-K-9 satisfactorily categorize patients with any psychiatric disorder, both BED and MDD (area under the ROC curve ≥ 0.70, p < 0.001). CONCLUSION: Our results suggest that the SCL-90-R and the SCL-K-9 may represent first-level screening tests identifying at-risk patients, eligible for a more expensive or time-consuming clinical assessment. LEVEL OF EVIDENCE: Level V, cross-sectional, descriptive study.

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

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

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

AIM: The main aim of the present study was to investigate the prevalence of Food Addiction (FA) and clinical level of Binge Eating in an Italian sample of overweight/obese patients attending low energy-diet therapy, and in an Italian sample of obese bariatric surgery candidates. METHODS: Participants were: i) 122 overweight/obese patients (86 women) referred to a medical center in Rome (Italy), specialized in nutritional treatment of obesity (i.e., non-surgery patients group), and ii) 281 surgery candidates (207 women) referred to the center for Bariatric Surgery at the University of Rome Tor Vergata (i.e., surgery candidates group). All patients were administered self-report measures investigating FA, binge eating, and psychopathology. RESULTS: Non-surgery patients and surgery candidates did not differ in the prevalence of FA (31.1% vs 26.3%), moderate level of binge eating (32.0% vs 31.8%), and severe level of binge eating (11.05% vs 13.6%). Compared to non-surgery patients, surgery candidates reported higher prevalence in two FA symptoms: i) food consumed more than planned (13.9% vs 25.3%; p=0.011) and ii) persistent desire or repeated unsuccessful attempts (89.3% vs 96.8; p=0.002). DISCUSSION AND CONCLUSION: Our results confirm that both FA and clinical level of binge eating are common problems in both overweight/obese patients seeking low-energy-diet therapy and in obese bariatric surgery candidates, justifying the clinical utility of assessing these dysfunctional eating patterns.

Psychiatric comorbidity and suicidal ideation in psoriasis, melanoma and allergic disorders.

OBJECTIVE: Psychiatric disorders and suicide risk (especially in psoriasis) are frequent and disabling conditions in patients with skin diseases. The aim of this study was to examine the risk of suicide and stressful life events in a sample of patients with skin disease. METHODS: A sample of 242 dermatological patients (142 women and 100 men), 112 of which had psoriasis, 77 had melanoma, and 53 were suffering with chronic allergic diseases. Patients were administered the MINI International Neuropsychiatric Interview (MINI), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Patients were also asked about their experiences with stressful life events. RESULTS: Patients with psoriasis were more likely to have a history of psychiatric disorders (36.6% vs. 13.2% χ2(1) = 9.55; p = 0.002) compared to patients with allergies. Specifically, patients with psoriasis more likely had a diagnosis of a mood disorder (16.1% vs. 3.9% χ2(1) = 6.85; p = 0.009; 16.1% vs. 0% χ2(1) = 9.56; p = 0.002) and reported past suicidal ideation (33.9% vs. 15.6% χ2(1) = 7.89; p = 0.005; 33.9% vs. 18.9% χ2(1) = 3.96; p = 0.047) as compared to those with melanoma and allergy. CONCLUSIONS: The results from this study suggest that patients affected by psoriasis have an increased risk of psychiatric comorbidities and suicidal ideation compared to those who have other dermatological disorders.

Suicide risk and psychiatric comorbidity in patients with psoriasis.

OBJECTIVES: To examine the occurrence of stressful life events, psychological comorbidity and suicide risk in patients with psoriasis or other dermatological conditions. METHODS: Consecutive adult outpatients with psoriasis or other dermatological conditions completed a sociodemographic questionnaire and the Hamilton scales for depression and anxiety. RESULTS: The study included 157 patients (91 with psoriasis; 66 with other conditions [melanoma; allergy]). Patients with psoriasis were significantly more likely to have experienced major life events in the 12 months before diagnosis, have had a psychiatric diagnosis and to have experienced past suicidal ideation than patients with other dermatological conditions. CONCLUSIONS: Patients with psoriasis have an increased risk of psychiatric comorbidities, suicidal ideation, and long-term course of the disease compared with patients who have other dermatological conditions. Psychiatric assessment is highly recommended in patients with psoriasis.

Second-generation antipsychotics and neuroleptic malignant syndrome: systematic review and case report analysis.

BACKGROUND: Neuroleptic malignant syndrome (NMS) is a rare, severe, idiosyncratic adverse reaction to antipsychotics. Second-generation antipsychotics (SGAs) were originally assumed to be free from the risk of causing NMS, however several cases of NMS induced by SGAs (SGA-NMS) have been reported. OBJECTIVES: The aim of this study was to systematically review available studies and case reports on SGA-NMS and compare the presentation of NMS induced by different SGAs. DATA SOURCES: Citations were retrieved from PubMed up to November 2013, and from reference lists of relevant citations. STUDY ELIGIBILITY CRITERIA: Eligibility criteria included (a) primary studies reporting data on NMS, with at least 50 % of the sample receiving SGAs; or (b) case reports and case reviews reporting on NMS induced by SGA monotherapy, excluding those due to antipsychotic withdrawal. STUDY APPRAISAL AND SYNTHESIS METHODS: A standardized method for data extraction and coding was developed for the analysis of eligible case reports. RESULTS: Six primary studies and 186 individual cases of NMS induced by SGAs were included. Primary studies suggest that SGA-NMS is characterized by lower incidence, lower clinical severity, and less frequent lethal outcome than NMS induced by first-generation antipsychotics. Systematic analysis of case reports suggests that even the most recently marketed antipsychotics are not free from the risk of inducing NMS. Furthermore, clozapine-, aripiprazole- and amisulpride-induced NMS can present with atypical features more frequently than other SGA-NMS, i.e. displaying less intense extrapyramidal symptoms or high fever. LIMITATIONS: Case reports report non-systematic data, therefore analyses may be subject to bias. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Clinicians should be aware that NMS is virtually associated with all antipsychotics, including those most recently marketed. Although apparently less severe than NMS induced by older antipsychotics, SGA-NMS still represent a relevant clinical issue.

Psychosocial correlates of adolescent cannabis use: data from the Italian subsample of the second International Self-Reported Delinquency study.

To provide a comprehensive picture of the whole spectrum of psychosocial factors potentially associated with adolescent cannabis use, bivariate and multivariate analyses were used to assess a variety of social, demographic, psychological, and behavioral correlates of last-month cannabis use and age of first use among 6,838 students. Results showed that only family problems, alcohol and/or other drug use/misuse, deviant behavior, and victimization were independently associated with either recent cannabis use or early onset of cannabis use when multiple, interacting factors were considered. Certain family and behavioral factors might be more important than other psychosocial correlates of adolescent cannabis use.

Psychiatric pathology and suicide risk in patients with cancer.

The aims of the study were to assess sociodemographic and clinical factors associated with suicidal ideation in patients with cancer who required a psycho-oncological support. Among 504 participants, there were 136 (23 men and 113 women) cancer patients who completed psychological assessment when admitted to the Psycho-oncology Outpatient Clinic between 2006 and 2011. Suicidal ideation was assessed by Item 9 of the Brief Symptom Inventory, Hopelessness was assessed by the hopelessness subscale of the Mini-Mental Adjustment to Cancer Scale, and Depression was assessed by the depression subscale of the Hospital and Anxiety Depression Scale. Around 30% of this sample reported affective symptoms and around 20% reported suicidal ideation and hopelessness. Patients who reported suicidal ideation were more hopeless (18.8 ± 6.7 vs. 15.7 ± 5.2; t(134) = 2.54; p < 0.05) and reported more depression (11.8 ± 4.8 vs. 6.8 ± 4.1; t(134) = 5.30; p < 0.001). It is evident that cancer can result in a strong psychological distress in the patient. It is important, therefore, that cancer patients receive a proper assistance and psychological support and that both the possible presence of depression and suicidal ideation are constantly monitored.

Quality of life and personality traits in patients with malignant pleural mesothelioma and their first-degree caregivers.

Asbestos exposure causes significant pleural diseases, including malignant pleural mesothelioma (MPM). Taking into account the impact of MPM on emotional functioning and wellbeing, this study aimed to evaluate the quality of life and personality traits in patients with MPM and their first-degree caregivers through the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). The sample was composed of 27 MPM patients, 55 first-degree relatives enrolled in Casale Monferrato and Monfalcone (Italy), and 40 healthy controls (HC). Patients and relatives reported poorer physical health than the HC. Patients had a higher overall sense of physical debilitation and poorer health than relatives and the HC, more numerous complaints of memory problems and difficulties in concentrating, and a greater belief that goals cannot be reached or problems solved, while often claiming that they were more indecisive and inefficacious than the HC. First-degree relatives reported lower opinions of others, a greater belief that goals cannot be reached or problems solved, support for the notion that they are indecisive and inefficacious, and were more likely to suffer from fear that significantly inhibited normal activities than were HC. In multinomial regression analyses, partial models indicated that sex, physical comorbidities, and the True Response Inconsistency (TRIN-r), Malaise (MLS), and Behavior-Restricting Fears (BRF) dimensions of the MMPI-2-RF had significant effects on group differences. In conclusion, health care providers should assess the ongoing adjustment and emotional wellbeing of people with MPM and their relatives, and provide support to reduce emotional distress.

Tobacco smoking and suicidal ideation in school-aged children 12-15 years old: impact of cultural differences.

This cross-sectional study examined the association between tobacco smoking and suicidal ideation in school-aged children from 9 countries in Africa, the Americas, and the Western Pacific region. Data were collected through the Global school-based Student Health Survey, a collaborative surveillance project between the World Health Organization, the United Nations, UNICEF, UNESCO, UNAIDS, and the U.S. Centers for Disease Control and Prevention. Suicidal ideation, tobacco smoking, and drug and alcohol use were included in loglinear models to analyze higher order interactions among suicidality and regional and country differences separately for boys and girls. School-aged children who reported suicidal ideation had a higher risk of smoking tobacco even after controlling for drug and alcohol misuse. Furthermore, analyses indicated higher order interactions between suicidal ideation and countries belonging to different regions with different exposure to tobacco smoking among school-aged children. Future studies analyzing the mechanism and sequencing of the relationship among suicidal ideation and tobacco smoking should explore cultural factors.

Preventing suicide in jails and prisons: suggestions from experience with psychiatric inpatients.

Both among psychiatric inpatients and inmates of prisons and jails, suicide is highly prevalent with alarming rates. In many countries, there has been a call for action to prevent such deaths and to educate staff in the early recognition of suicide risk. A careful MedLine search was used to identify relevant papers dealing with suicide prevention in psychiatric inpatients. This paper reviews this research and the policy recommendations that have been developed for psychiatric hospitals in order to reduce the incidence of suicide in their patients. Results derived from this search indicated that these policy recommendations can be applied to suicide prevention in correctional settings, and it is argued that suicide prevention programs in correctional settings can benefit from the research conducted and the policy recommendations for suicide prevention in psychiatric facilities. In conclusion, the best practices for preventing suicides in jail and prison settings should include the following elements: training programs, screening procedures, communication between staff, documentation, internal resources, and debriefing after a suicide.