The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study.

BACKGROUND: A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency. METHODS: An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers-80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors. RESULTS: A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress. CONCLUSIONS: The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education.

Suicide among migrants: a comprehensive narrative review of literature.

Suicidality among migrants represents a multifaceted and complex issue with significant implications and challenges for public mental health and policies. This narrative review aims to explore the factors contributing to suicidality within the migrant groups, consequently highlighting the need for tailored interventions and supporting strategies. Firstly, we reviewed the evidences on the prevalence of suicidal ideation, attempted suicides, and deaths by suicide among migrants. The results were extremely heterogeneous, mostly depending on the different migrant group considered. Significant differences in suicide risk have been found depending on the legal status of migrants and their country of origin/migration. The second section explored the protective and risk factors for suicidal ideation and behaviours in different migrant groups. The analysis concluded that a set of factors may interact in various ways, contributing to a heterogeneous and complex framework underpinning the phenomenon of suicide. Migration itself may be a challenging and traumatizing experience, characterized by social isolation, cultural dislocation and adjustment, as well as economic and financial distress, all of which may exacerbate pre-existing mental health vulnerabilities or trigger new mental disorders. Acculturative stress, discrimination, and language barriers further compound these challenges, often hindering access to mental health services.

The prevalence of suicidal ideation and behaviour among migrant populations consistently varies across studies, mostly depending on the different characteristics of the various subgroups of migrants sampled.Literature comparing suicide risk among migrants and the native populations of the host countries has shown contrasting findings.Some studies have suggested that refugees report a higher risk of suicide compared to the general population but also to other migrant groups.Studies focused on asylum seekers have suggested that this group reports a particularly higher suicide risk than the native population of the hosting country.Migrants seem to carry with them the suicide risk rate registered in their homeland. In fact, migrants from countries with a high baseline suicide rate (i.e. Northern and Eastern European countries) are at higher risk of suicide attempts and death by suicide; nonetheless, over time, their risk rates tend to overlap with those of the country of migration.Factors that protect or predispose individuals to suicidality may differ between ethnic groups.Conflicts and war-related traumatic experiences, irrespectively of the presence of mental disorders, are common risk factors for suicidal ideation among refugees.Research suggests that second-generation migrants are more likely to exhibit suicidal behaviors compared to first-generation migrants.Migrant mothers may be a particularly vulnerable group, as they are less likely to seek help from professional services due to various barriers, including stigma, language, poor knowledge of community services, and prioritizing their children's needs.Poor living conditions are associated with an increased prevalence of mental disorders and suicidal behaviour among migrants. Concerns about safety and lack of shelter, food, water, clothing, and toilets were all associated with higher rates of PTSD symptoms and suicidal ideation.Migrants face several challenges in accessing mental health treatments, including stigma, language barriers and distrust due to the lack of cultural-competent and gender-sensitive assistance.

Suicide mortality in Paraíba (Brazil) between 2010 and 2021 and the impact of the Covid-19 pandemic: an ecological study.

This study aims to analyze the rates of suicide mortality in the State of Paraíba (Brazil) between 2010 and 2021, describing the impact of the COVID-19 pandemic on the suicide rates in 2020 and 2021. We here proposed a mixed longitudinal - ecological study that employed secondary data provided by the Mortality Information System regarding deaths from self-harm in 2010 - 2021 in the state of Paraíba. It also included cases of death from intentional self-inflicted injuries, coded X60-X84 according to the 10th International Classification of Diseases (ICD-10). A linear regression was used to evaluate the relationship between the mortality rates and the years analyzed and also to calculate the predicted values for 2020 and 2021 based on findings from previous years. Although the suicide rates observed in 2020 and 2021 were higher than expected (6.387 and 6.789, respectively), they were still within the confidence interval. The present study found a constant increase in the suicide mortality during the period studied, even if without a significant difference between the expected trends according to previous years and those observed during the COVID-19 pandemic.

Suicidal hanging in Pakistan: an exploratory two-year content analysis study.

Suicidal hanging is common in Pakistan and is considered a serious challenge globally. We conducted a content analysis of reports about suicidal hangings published in six English-language newspapers in Pakistan between 1 January 2021 and 31 December 2022, employing a web-searching technique.124 news reports were yielded; suicidal authors were males (68.5%), Muslims (69.4%), and unmarried (31.4%), aged 16- 30 years old. Ligatures employed in hanging suicides were ropes (28.2%), fabrics (20.9%), and electric wires (20.1%). The most frequent leverage-points selected in suicides were ceiling fans (37%) followed by trees (11.2%). Familial discords (19.2%) and poverty (9.6%) were the leading risk factors for hanging suicide. Most of the suicides (58%) occurred equally in the spring (29%) and autumn (29%) months. These evidences suggest that psychological interventions on families are crucial. Also, dealing with poverty and other social consequences in Pakistan as in the rest of the world may probably reduce the rate of yearly suicides.

Adherence to the WHO guidelines of newspaper-reporting on suicides in Pakistan: a content analysis.

There is a lack of evidence regarding the rate of adherence to the World Health Organization (WHO) media guidelines of vernacular newspapers reporting on suicides in Pakistan. Also, the relevance of this report is based on the lack of official data regarding the number of suicides across the country. The aim of this study was to explore the rate of adherence to the WHO guidelines of two popular newspapers in reporting on suicides in Pakistan. We daily analysed the online version of two popular newspapers in Pakistan, the daily Jeejal (in Sindhi) and daily Jang (in Urdu), from 1 August 2021 to 31 July 2022; we performed a content analysis of news reporting on national suicides and evaluated their rate of adherence to the WHO media guidelines. One hundred and seventy-three reports of suicides were identified and analysed; 84% of them reported the names of victims, 70% reported their age, and 46% included information regarding their occupation. Characteristics of suicide methods were reported in 87% of reports, reasons for suicide in 66%, as well as locations in 87%. In general, 84% of newspapers reported incomplete information regarding suicide prevention and help-seeking, so we may conclude they were not fully adherent to the WHO recommendations. This study indicates that national vernacular newspapers may improve their reporting on suicides and should revise their policy in order to be adherent to the WHO guidelines. Also, better and responsible reporting may provide an accurate epidemiological source regarding suicide where official data are missing at the national level.

Speculation fit for a king? Medical announcements from the British royal family and the recurring ethical complexities of personal privacy and public commentary from physicians.

This article explores the ethical complexities of openly-expressed medical commentary using recent cancer diagnoses within the British monarchy as illustrative cases. Specifically, it examines tensions between public interest, personal privacy, and professional standards, underlining the adverse implications of conjectural discourse, alongside the role of physicians in enhancing wider medical understanding.

Individualized strategies for depression: narrative review of clinical profiles responsive to vortioxetine.

BACKGROUND: Depression is a highly heterogeneous disorder, often resulting in suboptimal response and remission rates. This underscores the need for more nuanced clinical characterization of patients to tailor individualized treatment plans. Emerging evidence highlights the critical role of cognitive and emotional dysfunction in major depression, prompting the exploration of novel therapeutic interventions that target these specific symptom domains. MAIN TEXT: Vortioxetine, a multimodal antidepressant, enhances serotonergic activity while also modulating several other neurotransmitter systems involved in depressive symptoms such as emotional blunting, anhedonia, and cognitive dysfunction. Numerous randomized, placebo-controlled trials have demonstrated vortioxetine's efficacy and safety in treating depression, particularly in specific subgroups of depressed patients, including those with cognitive deficits and comorbid anxiety symptoms or disorders. Although not randomized or placebo-controlled, studies have also shown vortioxetine's efficacy in depressed patients with emotional blunting or anhedonia. Vortioxetine's ability to effectively treat a range of depressive symptoms, including anhedonia, emotional blunting, anxiety, and cognitive dysfunction, provides an individualized treatment solution for depressed individuals suffering from these symptoms. The purpose of this paper is to identify clinical profiles of patients who may benefit from vortioxetine, with the goal of optimizing therapeutic outcomes. CONCLUSION: Vortioxetine has been shown to be effective for patients with depression and symptoms such as anhedonia, emotional blunting, anxiety, and cognitive dysfunction. Tailoring treatment plans to individual needs and personalizing treatment choices based on the specific symptoms presented by depressed patients improve treatment outcomes.

Mental health of ethnic minorities: the role of racism.

Racism and racial discrimination heavily impact on health and mental health of ethnic minorities. In this conceptual paper and narrative review, we aim to report on relevant evidence from the international literature describing the prevalence and the qualitative aspects of mental illness due to racism and ethnic- discrimination in different settings and populations. Some variables related to racism, such as cultural, institutional, interpersonal factors, as well as the concepts of perceived and internalised racism will be described and discussed. These are relevant characteristics in the explanatory model of the relationship between racism and mental health. Epidemiological data on the prevalence of depressive and psychotic symptoms as well as substance abuse/misuse among ethnic minorities in large catchment areas, such as United States and United Kingdom, will be represented. We conclude that anti-racism policies are essential in order to address racism and racial discrimination around the world. Pluralistic societies should be promoted in order to understand mental illnesses among ethnic and cultural minorities. Also, anti-racism programs should be delivered in the educational and health-care settings and their impact evaluated.

Mental health, minority stress and discrimination against transgender people: a cross-sectional survey in Russia.

Mental health needs of transgender people in Russia remain unmet and stigmatised as in many other countries around the globe. The aim of this study was to assess the stressors and perceived need for mental health care among transgender people in Russia. A structured online survey was conducted in November 2019. A total of 588 transgender adults (mean age: 24.0 ± 6.7) was included in the final analysis. An overwhelming majority of respondents (95.1%) reported stress in their lives. Financial burden (73.5%), relationships with relatives (59.4%), and intimate relationships (37.9%) were among the most frequently reported sources of stress. Most of respondents (71.8%) indicated that the psychological distress they perceived interfered with their ability to lead a fulfilling social life. More than half of the respondents (52.4%) had visited a mental health professional prior to their gender transition. Virtually half of them (49%) reported problems related to seeking mental healthcare attributed to stigma. Over one third (37.8%) reported taking non-prescription or off-label medications to improve their well-being or mood. Our study confirmed high rates of psychiatric problems in this vulnerable group and problems in help-seeking. The article also discusses the challenges of providing psychiatric care to transgender people in Russia.

"Otherness", otherism, discrimination, and health inequalities: entrenched challenges for modern psychiatric disciplines.

Identity is a complex concept that can be informed by various factors, involving biological, psychological, experiential, and social influences. Specifically, one's social identity refers to the ways in which individuals can adopt attributes from established collective categories, like cultural identities, ethnic identities, gender identities, and class identities, amongst others. Social identity can encompass unique and diverse interactions at an individual level, known as micro-identities, that may be selectively expressed, hidden, or downplayed, contingent on distinct sociocultural settings. However, the formation of social identity is recurrently defined in opposition to perceptions of the Other, which can entail adverse paradigms of marginalisation, stigma, and discrimination. Although this theory of Otherness has been developed across different fields, particularly sociology, it may be important in psychiatric contexts as it can engender inherent risk factors and mental health inequalities. Consequently, this paper seeks to bring attention towards these issues, exploring the construction of Otherness and its detrimental outcomes for psychiatry, such as systemic discrimination and disparities in therapeutic support, alongside recommended initiatives to mitigate against the effects of Otherness. This may require multifactorial approaches that include cultural competency training, interventions informed by micro-identities and intersectionality, patient advocacy, and structural changes to mental health policy.

Discrimination, stigma and mental health: what's next?

Stigma and discrimination are a major ongoing problem in the field of mental health as these impact on patient outcomes, access to and acceptability of therapeutic interventions, their quality of life, general wellbeing, social inclusion and opportunities. Social stereotypes, culture and prejudices all contribute to continuing discrimination in mental health. Different settings where people function may also be sources of discrimination such as work and educational environments. The lack of knowledge and understanding of mental health/illness by individuals, their families, carers and policymakers as well as the social media reporting also impact on social attitudes to discrimination. It has been also described a relevant impact of stigma among specific social minorities reporting poor mental health such as elderly people, youths, sexual variants, persons with disability. Educational programs, raising awareness trainings and proper public policies may be developed in order to reduce stigma at social level with favourable outcomes for people with mental illness.

Unravelling the landscape of Cannabis craving pharmacological treatments: a PRISMA-guided review of evidence.

Currently, few treatments are available for craving in general, and none of them have received approval for cannabis craving. The objective of this review is to evaluate existing studies analysing treatments for cannabis craving and explore novel treatment possibilities for these patients. The study followed PRISMA guidelines and conducted an extensive database search. Inclusion criteria included human randomised controlled trials examining drug effects on craving symptoms. Exclusion criteria involved studies unrelated to craving, non-pharmacological treatments, duplicates, and non-English/Spanish/Portuguese articles. Our included 22 studies that investigated a wide range of compounds used for cravings related to other drugs, as well as interventions based on healthcare professionals' empirical knowledge. The current pharmacological treatments largely involve off-label drug use and the utilisation of cannabinoid-based medications, such as combinations of THC and lofexidine, oxytocin, progesterone, and N-acetylcysteine. These emerging treatments show promise and have the potential to revolutionise current clinical practices, but further investigation is needed to establish their efficacy. In this context, it is essential to consider non-pharmacological interventions, such as psychotherapy and behavioural treatments. These approaches play a crucial role in complementing pharmacological interventions and addressing the complex nature of the disorder.

Bariatric surgery and its influence on alcohol consumption: Differences before and after surgery - A systematic review and meta-analysis.

BACKGROUND: Through new publications on the subject, the main goal of this article is to seek a change in the pattern of alcohol use before and after bariatric surgery. METHODS: We searched the National Library of Medicine, CINAHL, and PsycINFO databases. We included original articles regarding alcohol consumption before and after bariatric surgery to conduct the systematic review. RESULTS: Our systematic review, which included 18 articles, yielded mixed results. Meta-analysis of six articles did not reveal statistically significant differences in alcohol use behaviours before and one year after bariatric surgery. However, throughout the perspective of follow-up after bariatric surgery, nine out of the twelve articles showed improvement in the pattern of alcohol consumption when evaluated up to two years after the end of the surgical period, and four out of the five articles with monitoring beyond two years showed worsening in consumption, compared to pre-surgery alcohol use behaviours. CONCLUSIONS: Conclusions about the relationship between alcohol consumption and bariatric surgery are challenging primarily because of the variety of the methods used and the alcohol consumption measures. Despite that, our research pointed to an increased risk of alcohol use disorders two years after bariatric surgery.

Psychopharmacology of smoking cessation medications: focus on patients with mental health disorders.

The adverse effects of smoking cessation in individuals with mental health disorders have been a point of concern, and progress in the development of treatment has been slow. The primary first-line treatments for smoking cessation are Nicotine Replacement Therapy, Bupropion, Varenicline, and behavioural support. Nortriptyline and Clonidine are second-line treatments used when the first-line treatments are not effective or are contraindicated. Smoking cessation medications have been shown to be effective in reducing nicotine cravings and withdrawal symptoms and promoting smoking cessation among patients living with mental disorders. However, these medications may have implications for patients' mental health and need to be monitored closely. The efficacy and side effects of these medications may vary depending on the patient's psychiatric condition, medication regimen, substance use, or medical comorbidities. The purpose of this review is to synthesise the pharmacokinetics, pharmacodynamics, therapeutic effects, adverse effects, and pharmacological interactions of first- and second-line smoking cessation drugs, with an emphasis on patients suffering from mental illnesses. Careful consideration of the risks and benefits of using smoking cessation medications is necessary, and treatment plans must be tailored to individual patients' needs. Monitoring symptoms and medication regimens is essential to ensure optimal treatment outcomes.

Comparing the Addiction Severity Index (ASI) and Measurements in the Addictions for Triage and Evaluation (MATE).

Substance use disorder (SUD) assessment and measurement in Brazil, as well as in many other countries, face significant shortcomings. The Measurement in the Addictions for Triage and Evaluation (MATE) was developed as a public domain tool, drawing from validated scales and incorporating World Health Organization International Classification of Functioning, Disability, and Health (ICF) framework. The Brazilian version of the MATE (MATE-pt-BR) was evaluated for its reliability and validity, with a total of 239 subjects participating in the study, and data collected between 11/01/2021 and 09/01/2022. The majority were male (79.2%), with diverse racial backgrounds. The substances most prevalently used in the last 30 days were. Alcohol (73.2%), nicotine (63.6%), and cocaine (44.2%). The mean scores for MATE modules showed variations, with Module Q2 assessing psychological well-being having high internal consistency (Cronbach's alpha = 0.92). MATE-pt-BR demonstrated robust internal consistency, with Module 6 (personality) and Module 2 (medical and psychiatric consultation indicators) being exceptions. MATE-pt-BR exhibited significant correlations among its sections and strong discriminant validity. Moreover, the paper compares MATE-pt-BR with the Addiction Severity Index (ASI-6), which is considered the gold-standard measure for SUD assessments. MATE-pt-BR offers a valuable tool for assessing substance use and related functional impairments in the Brazilian context.

Mental health issues and psychological risk factors among Paraguayan healthcare workers during the COVID-19 pandemic.

BACKGROUND: There is an increasing concern regarding the mental health of healthcare workers during the COVID-19 pandemic. AIMS: This study aimed to assess the psychological impact of the COVID-19 exposure among Paraguayan healthcare workers. METHODS: A cross-sectional descriptive study has been carried out in five hospitals of Paraguay. Demographic and occupational exposure to COVID-19 were collected through a short questionnaire. Mental health status was assessed with the GAD-7, the PHQ-9, and the PCL-C. Logistic regression was used to determine psychological risk factors. RESULTS: 432 participants were surveyed. 218 (50.46%) were physicians. The prevalence of symptoms of anxiety, depression and PTSD was 48.15, 41.90, and 5.79%, respectively. There were no significant differences in anxiety (128 [29.63%] vs. 80 [18.52%]; p = 0.3303), depression (102 [23.61%] vs. 79 [18.29%]; p = 0.6703), or PTSD (14 [3.24%] vs. 11 [2.55%]; p = 0.8074) between frontline versus second-line workers. Main risk factors associated with psychological distress included work experience <5 years for depression and a COVID-19 positive diagnosis or having family/friends with a COVID-19 positive diagnosis for PTSD. CONCLUSIONS: Paraguayan healthcare workers reported high prevalence of anxiety, depression, and a low prevalence of PTSD. A positive diagnosis of COVID-19 and work experience <5 years are important psychological risk factors.

NEWSPAPER-REPORTING ON SUICIDES DURING THE COVID-19 LOCKDOWN IN PAKISTAN: A CONTENT ANALYSIS.

BACKGROUND: Suicide is a social relevant issue and a leading cause of deaths in the world; it has been reported that COVID-19 has significantly increased the rate of suicide worldwide. This study aimed to review media reporting on suicide cases occurred in Pakistan during the COVID-19 lockdown. SUBJECTS AND METHODS: A content analysis has been performed considering the electronic version of the daily Kawish newspaper reporting suicide cases from March to August 2020 in Pakistan. RESULTS: A total of 213 news regarding suicide in Pakistan during the lockdown period were identified. Suicide committers reported age ranging 19-30 years old, and the majority of them were males (74%). Suicide methods ranged as following: harmful practices (79%) > hanging (37%) > self-poisoning (28%). Factors associated to the risk of suicide were: familial discords (36%), poverty (21%) and joblessness (14%). CONCLUSION: Findings of this study have shown that pandemic lockdown in Pakistan have increased the number of factors, such as family issues, unemployment and poverty, leading to suicide especially in young males. The report of suicides may have an impact on the public general opinion and a responsible news-reporting is needed by press agencies and media.

Food Addiction: A Comprehensive Review.

ABSTRACT: Food addiction is associated with dysfunctions in the reward circuit, such as hyperresponsiveness during the exposure to high-calorie flavors in overweight and obese individuals. Similar to drug addiction, there is also impaired self-regulatory control supported by deregulation of the frontostriatal circuit. The inclusion of validated measures of food addiction in clinical research, such as the Yale Food Addiction Scale, has increased the understanding of the clinical utility of this concept. Furthermore, food addiction, eating disorders, and obesity are interrelated. Thus, it is important to recognize food addiction among individuals affected by obesity and candidates for bariatric surgery (ie, preoperative and postoperative assessment). In this context, it has been reported that food addiction may impede weight loss and increase the likelihood of regaining weight when associated with personality traits such as neuroticism and impulsiveness, which are also related to mood disorders, anxiety, and addictive behaviors.

Homelessness and Depressive Symptoms: A Systematic Review.

ABSTRACT: The present systematic review aimed to summarize data on the prevalence and treatment of depressive symptoms among homeless people. We referred to the PubMed and Google Scholar databases to identify relevant studies on the topic. Among the 43 included studies, we found great variability in the prevalence of depressive symptoms among homeless people (ranging from 9.9% to 77.5%). Comparative studies among the homeless versus nonhomeless population showed that rates of depressive symptoms are 5 to 14 times higher in the homeless population. Similar differences were also found for suicidal ideation. The lack of research and treatment plans for this specific population further encourages more evidence and special therapeutic intervention. Although little has been found in the literature, a substantial improvement in the quality of life and reduction in depressive symptoms was demonstrated when therapeutic interventions were performed among homeless people (i.e., housing, nursing, access to community care and effective services and supports programs, mindfulness, pharmacological treatment).

LGBT + medical students and disclosure of their sexual orientation: more than in and out of the closet.

Medical students face many challenge in their academic path. The disclosure of their own sexual orientation may be problematic since it impacts negatively on their acceptance in the educational environmental and the course of their career. Mental health issues may also occur among medical students as consequences of their perceived homophobia as well as stigma after the coming out. Research shows that students' attitude to the sexual orientation disclosure may vary across countries and cultures as well as students' homophobic attitudes towards sexual minorities: the latter should be addressed since prejudice might affect the quality of medical care for LGBT+ (Lesbian, Gay, Bisexual, Transgender) patients. We suggest that more education and training on LGBT + health issues is needed in the medical students' core-curricula: this would improve the health care of sexual minorities and LGBT + students' acceptance in the academic milieu.