Feasibility and preliminary efficacy of brief tele-psychotherapy for COVID-19 patients and their first-degree relatives.

BACKGROUND: The SARS-CoV-2 pandemic compromised the mental health of COVID-19 patients and their family members. Due to social distancing and lockdown measures, a remote, tele-psychotherapy program for former or current COVID-19 patients and their relatives was implemented. OBJECTIVE: The primary goal of this project was to evaluate intervention feasibility. The secondary aim was to assess the impact of the intervention by means of pre-post psychological changes. METHODS: After a phone-based eligibility screening and remote neuropsychological testing, participants completed online self-reports assessing baseline COVID-related psychopathology. Next, participants attended eight tele-psychotherapy sessions. After treatment, the online self-reports were completed again. RESULTS: Of 104 enrolled participants, 88 completed the intervention (84.6 % completion rate). Significant pre-post improvements were observed for generalized anxiety (d = 0.38), depression (d = 0.37), insomnia (d = 0.43), post-traumatic psychopathology (d = 0.54), and general malaise (d = 0.31). Baseline cluster analysis revealed a subgroup of 41 subjects (47.6 %) with no psychopathology, and a second subgroup of 45 subject (52.3 %) with moderate severity. Thirty-three percent of the second group reached full symptom remission, while 66 % remained symptomatic after treatment. CONCLUSIONS: Remote brief tele-psychotherapy for COVID-19 patients and their first-degree relatives is feasible and preliminary efficacious at reducing COVID-related psychopathology in a subgroup of patients. Further research is needed to investigate distinct profiles of treatment response.

CBT-informed psychological interventions for adult patients with anxiety and depression symptoms: A narrative review of digital treatment options.

BACKGROUND: Across a range of age, educational and clinical characteristics, adults experiencing depression and anxiety already use digital technology to manage their symptoms. Although several reviews and meta-analyses indicated feasibility and efficacy for adults with depression and anxiety, digital treatments are poorly accessed and disseminated. This review illustrates potentials and limitations of interventions that specifically leveraged unique features of digital technology and were grounded in the principles of Cognitive Behavioral Therapy (CBT). METHODS: This systematic review followed the PRISMA guidelines. An electronic database search was conducted in October 2021. Peer-reviewed, English-language studies were included if i) they reported data from RCTs for adults aged 18+ who engaged with CBT-informed digital interventions targeting primarily depression and anxiety; ii) they used at least PHQ-9 or GAD-7 as standardized and validated assessment self-report measures for depression and anxiety. RESULTS: Findings from 35 RCTs examining 33 interventions (25 internet-based, 6 mobile-based, a2 mobile/web) are discussed. The quality of the evidence differed widely as many small-scale RCTs reported only short-term feasibility and preliminary efficacy. Effects of CBT-informed digital interventions were substantially larger when compared to waitlist than active control conditions. Greater therapeutic benefits were observed for interventions that offered clinical assistance or were used in combination with other treatments. CONCLUSIONS: CBT-informed digital interventions have accumulated enough scientific evidence to be positioned today as: i) a low-intensity tool for those with subclinical levels of symptoms; ii) a first step in a stepped-care approach to service delivery iii) a low-cost, easily accessible option for targeted preventive programs.

An attachment-based framework for disordered personality development: Implications for intersubjective psychodynamic psychotherapy.

Infant-caregiver dyads show high heterogeneity in terms of compatibility. Several lines of evidence indicate that the modalities by which areas of good and poor fit were emotionally recognized and managed by caregivers influence the infant's personality development, the integration of their personality traits, the overall sense of authenticity, as well as the modalities of transference that typically manifest during psychodynamic psychotherapy. Within an intersubjective framework, the relationship between patient and psychotherapist will inevitably recreate compatibility issues, although the specific areas of incompatibility will likely differ from the scenarios present in the caregiver relationship. In other words, emotional friction may originate from personality traits that were not problematic in the first place. The author hypothesizes that disclosure of the challenges associated with the management of areas of incompatibility will not only promote emotional honesty within the dyad, but also offer an excellent opportunity for introjection. Such disclosures are not at risk of being interpreted as an attempt to build an intersubjective experience, but represent a window into authenticity, which in turn enables patients to develop awareness of their personality and relational traits, along with the challenges and vulnerabilities that occur when such traits interface with otherness.

Developing a Brief Tele-Psychotherapy Model for COVID-19 Patients and Their Family Members.

Objective: The COVID-19 pandemic is negatively impacting the mental health of COVID-19 patients and family members. Given the restrictions limiting in person contact to reduce the spread of the virus, a digital approach is needed to tackle the psychological aftermath of the pandemic. We present the development of a brief remote psychotherapy program for COVID-19 patients and/or their relatives. Methods: We first reviewed the literature on psychotherapeutic interventions for COVID-19 related symptoms. Based on this evidence, we leveraged ongoing clinical experiences with COVID-19 survivors and family members to design an intervention model that could be disseminated and integrated into the workflow of the mental health system. Results: This 8-session model -inspired by constructivist and hermeneutic-phenomenological therapies- serves COVID-19 patients during hospitalization, remission and recovery. This model can also be delivered to people dealing with the COVID-19 hospitalization/discharge of a family member, or the loss of a family member due to COVID-19. Conclusion: We described a remote psychotherapeutic approach to tackle the COVID-19 pandemic psychological aftermath. To date, the approach seems feasible and highly customizable to patients' needs. Studies are underway to test its preliminary efficacy. Once proven efficacious, this treatment model could provide a blueprint for future tele-psychology wide-scale interventions.

Neuroinflammation in Major Depressive Disorder: A Review of PET Imaging Studies Examining the 18-kDa Translocator Protein.

BACKGROUND: Major Depressive Disorder (MDD) is a severe psychiatric disorder whose pathological mechanisms are largely unknown. In the field of immuno-psychiatry, several evidences suggested a prominent role of inflammation in MDD not only in peripheral immune system but also in the brain. To date, brain inflammation is traceable in vivo with Positron Emission Tomography (PET), through the quantification of the expression of 18-kda Translocator Protein (TSPO) by active microglia. In this context, this review aimed to summarize the results of all in vivo PET imaging studies that evaluated microglia activation in MDD. METHODS: A bibliographic search in PubMed up to June 2020 was performed. A total of 9 studies that used first and second generation TSPO radiotracers met our inclusion criteria. RESULTS: Overall the results suggested the presence of TSPO upregulation in MDD, especially in anterior cingulate cortex, prefrontal cortex, hippocampal formation and insula. Notably, from a therapeutic point of view, results suggested that the symptoms amelioration, caused by both antidepressant medication and cognitive behavioural therapy, may be accompanied by reduced inflammatory status in the brain. Finally, a positive effect of the anti-inflammatory treatment with a cyclooxygenase inhibitor has also been observed. LIMITATIONS: The heterogeneity across the studies in experimental designs, sample selection and methods limited the studies comparison. CONCLUSIONS: These findings supported the presence of neuroinflammation in MDD, suggesting that microgliosis may be an important pathophysiological mechanism that merits further investigation as a potential target for novel treatment strategies.

Ultra-high field imaging in Major Depressive Disorder: a review of structural and functional studies.

BACKGROUND: Major depressive disorder (MDD) is a severe and pervasive psychiatric condition with a lifetime prevalence of 15-25%. Numerous Magnetic Resonance Imaging (MRI) studies employing scans at field strengths of 1.5T or 3T have been carried out in the last decades, providing an unprecedented insight into the neural correlates of MDD. However, in recent years, MRI technology has largely progressed and the use of scans at ultra-high field (≥ 7T) has improved the sensitivity and the resolution of MR images. In this context, with this review we aim to summarize evidence of structural and functional brain mechanisms underlying MDD obtained with ultra-high field MRI. METHODS: We conducted a search on PubMed, Scopus and Web of Science of neuroimaging studies on MDD patients, which employed ultra-high field MRI. We detected six structural MRI studies, two Diffusion Tensor Imaging (DTI) studies and five functional MRI (fMRI) studies. RESULTS: Overall, the MRI and DTI studies showed volumetric and structural connectivity alterations in the hippocampus and, to a lesser extent, in the amygdala. In contrast, more heterogeneous results were reported by fMRI studies, which, though, described functional abnormalities in the cingulate cortex, thalamus and several other brain areas. LIMITATIONS: The small sample size and the heterogeneity in patients' samples, processing and study design limit the conclusion of the present review. CONCLUSIONS: Studies employing scans at ultra-high magnetic field may provide a useful contribution to the mixed body of literature on MDD. This preliminary but promising evidence confirms the importance of performing ultra-high field MRI investigations in order to detect and better characterize subtle brain abnormalities in MDD.

Stigma on Mental Health among High School Students: Validation of the Italian Version of the Attribution Questionnaire-27 (AQ-27-I) in a High School Student Population.

The purpose of this study was to describe the psychometric characteristics of the AQ-27-I in a high school student population. Students aged between 17 and 20 years and attending the fourth and fifth year of a scientific high school in Milan were approached at the school and were asked to fill in an anonymous socio-demographic form and the AQ-27-I. Cronbach's alpha was used to estimate the instrument reliability and confirmatory factor analysis (CFA) was conducted and compared to the original English version factor structure. The AQ-27-I demonstrated acceptable internal consistency, with a Cronbach's alpha of 0.87 and only one subscale (Personal responsibility) with an alpha lower than 0.60. Fit indices were very positive for the Dangerousness Model supporting the factor structure and paths of the original version. The Personal Responsibility Model, on the other hand, showed some weakness, concerning the process dynamics of the model. The results obtained are similar with those from other studies carried out in Italy and other countries. The questionnaire can be used for the quantitative description of stereotypes, emotions and behaviors associated with stigma in mental health in high school student populations.

Mindfulness-based interventions in the early phase of affective and non-affective psychoses: Special Section on "Translational and Neuroscience Studies in Affective Disorders" Section Editor, Maria Nobile MD, PhD.

BACKGROUND: In the last 10 years, psychological approaches based on mindfulness techniques have been proposed for the management of psychotic experiences. METHOD: In this brief review we summarized, to our knowledge for the first time, published studies on mindfulness-based interventions (MBIs) applied to the early phase of major psychoses (affective and non-affective). RESULTS: Despite the great variability in terms of MBIs protocols, available studies on young people at risk to develop or with a first episode of psychosis suggest MBIs as a feasible, well-tolerated and effective approach in ameliorating symptoms, functioning, emotion regulation, and finally reducing the psychological distress associated with the onset of mania and/or psychotic experience. LIMITATIONS: The small sample size and inconsistencies between studies in terms of design, MBIs protocols and outcome measures suggest being cautious in interpreting and generalizing results. Moreover, specific guidelines are missing for the adaptation of MBIs to youth at risk of developing affective psychoses. CONCLUSIONS: Preliminary findings show that MBIs may be considered a promising adjunctive therapy for the treatment of major psychoses in the early phases of the illness. However, the conduct of further studies in larger samples and with a more rigorous methodology is warranted to confirm the beneficial effect of MBIs in the early stages of major psychoses.

The Assertive Brain: Anterior Cingulate Phosphocreatine plus Creatine Levels Correlate With Self-Directedness in Healthy Adolescents.

Despite various advances in the study of the neurobiological underpinnings of personality traits, the specific neural correlates associated with character and temperament traits are not yet fully understood. Therefore, this study aims to fill this gap by exploring the biochemical basis of personality, which is explored with the temperament and character inventory (TCI), during brain development in a sample of adolescents. Twenty-six healthy adolescents (aged between 13 and 21 years; 17 males and 9 females) with behavioral and emotional problems underwent a TCI evaluation and a 3T single-voxel proton magnetic resonance spectroscopy (1H MRS) acquisition of the anterior cingulate cortex (ACC). Absolute metabolite levels were estimated using LCModel: significant correlations between metabolite levels and selective TCI scales were identified. Specifically, phosphocreatine plus creatine (PCr+Cre) significantly correlated with self-directedness, positively, and with a self-transcendence (ST), negatively, while glycerophosphocholine plus phosphocholine (GPC+PC) and myo-inositol negatively correlated with ST. To the best of our knowledge, this is the first study reporting associations of brain metabolites with personality traits in adolescents. Therefore, our results represent a step forward for personality neuroscience within the study of biochemical systems and brain structures.

Can Machine Learning help us in dealing with treatment resistant depression? A review.

BACKGROUND: About one third of patients treated with antidepressant do not show sufficient symptoms relief and up to 15% of patients remain symptomatic even after multiple trials are applied, configuring a state called treatment resistant depression (TRD). A clear definition of this state and the understanding of underlying mechanisms contributing to chronic disability caused by major depressive disorder is still unknown. Therefore, Machine Learning (ML) techniques emerged in the last years as interesting approaches to deal with such complex problems. METHODS: We performed a bibliographic search on Pubmed, Google Scholar and Medline of clinical, imaging, genetic and EEG ML classification studies on treatment-responding depression and TRD as well as studies trying to predict response to a specific treatment in already established TRD. The inclusion criteria were met by eleven studies. Seven focused on the definition of predictors of TRD onset while four attempted to predict the response to specific treatments in TRD. RESULTS: The results showed that it seems possible to classify between responders MDD and TRD with good accuracies based on clinical variables. Moreover, some studies reported the possibility of using EEG measures to predict response to different pharmacological and non-pharmacological treatments in established TRD. LIMITATIONS: The definition of TRD, the selection of variables together with ML algorithms and pipelines varies across the studies, ultimately determining the unfeasibility to implement these models in clinical practice. CONCLUSIONS: The findings suggest that ML could be a valid approach to increase our understanding of TRD and to better classify and stratify this disorder, which may ultimately help clinicians in the assessment of major depressive disorders.

Altered syntactic abilities in first episode patients: An inner phenomenon characterizing psychosis.

BACKGROUND: Research has consistently shown that language abilities represent a core dimension of psychosis; however, to date, very little is known about syntactic comprehension performance in the early stages of psychosis. This study aims to compare the linguistic abilities involved in syntactic comprehension in a large group of First Episode Psychosis (FEP) patients and healthy controls (HCs). METHODS: A multiple choice test of comprehension of syntax was administered to 218 FEP patients (166 non-affective FEP patients [FEP-NA] and 52 affective FEP patients [FEP-A]) and 106 HCs. All participants were asked to match a sentence they listen with one out of four vignettes on a pc screen. Only one vignette represents the stimulus target, while the others are grammatical or non-grammatical (visual) distractors. Both grammatical and non-grammatical errors and performance in different syntactic constructions were considered. RESULTS: FEP committed greater number of errors in the majority of TCGB language domains compared to HCs. Moreover, FEP-NA patients committed significantly more non-grammatical (z = -3.2, p = 0.007), locative (z = -4.7, p < 0.001), passive-negative (z = -3.2, p = 0.02), and relative (z = -4.6, p < 0.001) errors compared to HCs as well as more passive-affirmative errors compared to both HCs (z = -4.3, p < 0.001) and FEP-A (z = 3.1, p = 0.04). Finally, we also found that both FEP-NA and FEP-A committed more grammatical (FEP-NA: z = -9.2, p < 0.001 and FEP-A: z = -4.4, p < 0.001), total (FEP-NA: z = -8.2, p < 0.001 and FEP-A: z = 3.9, p =  0.002), and active-negative (FEP-NA: z = -5.8, p < 0.001 and FEP-A: z = -3.5, p = 0.01) errors compared to HCs. CONCLUSIONS: This study shows that the access to syntactic structures is already impaired in FEP patients, especially in those with FEP-NA, ultimately suggesting that language impairments represent a core and inner feature of psychosis even at early stages.

The effects of cognitive remediation on cognitive abilities and real-world functioning among people with bipolar disorder: A systematic review: Special Section on "Translational and Neuroscience Studies in Affective Disorders". Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders.

BACKGROUND: Bipolar disorder (BD) is characterized by cognitive impairments that are known to predict psychosocial functioning and quality of life. While cognitive remediation (CR) was originally developed to directly target cognitive symptoms in traumatic brain injury and psychotic illnesses, the efficacy of CR in BD has begun to emerge only in the last decade. Functional Remediation (FR) is an integrated intervention that has been developed to restore psychosocial functioning by means of ecological neurocognitive techniques that involve psychoeducation about cognitive dysfunctions and their impact on the general functioning. Because of the heterogeneity of treatment targets and mechanisms of actions, here we aim to illustrate the effects induced by existing CR/FR approaches in BD. METHODS: In this systematic review, we evaluated cognitive and functional outcomes after CR/FR in studies conducted in BD. RESULTS: Eleven studies met inclusion criteria: 3 RCTs that compared CR/FR to one or more control condition (n = 354), 5 secondary analyses that further examined data from these trials, 2 single-arm studies, and 1 naturalistic study. While features such as the use of computerized training tools and a group-based format recurred across studies, CR/FR paradigms targeting different cognitive and functional domains showed specificity of training focus to outcomes. Effect sizes were in the medium-large range, suggesting that patients with BD respond to treatment at or above the level reported in psychotic patients. Integrated approaches that combined cognitive exercises with group-based experiences were associated with both cognitive and functional improvements. CONCLUSIONS: In this review, we found support for the use of CR/FR paradigms in patients with BD with evidence of cognitive and functional improvements. The scarcity of currently published RCTs as well as of data examining mechanisms of action and neural correlates limits the generalizability of our findings.

Disentangle the neural correlates of attachment style in healthy individuals.

Since its development and theorisation in the 60s, attachment theory has greatly influenced both clinical and developmental psychology suggesting the existence of complex dynamics based on the relationship between an infant and its caregiver, that affects personality traits and interpersonal relationships in adulthood. Many studies have been conducted to explore the association between attachment styles and psychosocial functioning and mental health. By contrast, only a few studies have investigated the neurobiological underpinnings of attachment style, showing mixed results. Therefore, in this review, we described current evidence from structural and functional imaging studies with the final aim to disentangle the neural correlates of attachment style in healthy individuals. Overall, different attachment styles have been correlated with volumetric alterations mainly in the cingulate cortex, amygdala, hippocampus and anterior temporal pole. Consistently, functional imaging studies suggested patterns of activations in fronto-striatal-limbic circuits during the processing of social and attachment-related stimuli. Further studies are needed to clarify the neurobiological signature of attachment style, possibly taking into consideration a wide range of demographic, psychosocial and clinical factors that may mediate the associations between the style of attachment and brain systems (e.g., gender, personality traits, psychosocial functioning, early-life experience).

Corrigendum: The Assertive Brain: Anterior Cingulate Phosphocreatine Plus Creatine Levels Correlate With Self-Directedness in Healthy Adolescents.

[This corrects the article DOI: 10.3389/fpsyt.2019.00763.].

Short-Term Psychodynamic Psychotherapy with Mentalization-Based Techniques in Major Depressive Disorder patients: Relationship among alexithymia, reflective functioning, and outcome variables - A Pilot study.

OBJECTIVES: In depressed patients, recent advances have highlighted impairment in mentalizing: identifying and interpreting one's own or other's mental states. Short-Term Psychodynamic Psychotherapy (STPP) has proven to be effective in reducing symptoms and improving relational/functional abilities in these subjects. Therefore, the first aim of our study was to evaluate effectiveness of STPP with Mentalization-Based Techniques (STMBP) on their clinical outcomes and the second, to investigate Reflective Functioning and alexithymia concerning treatment outcomes in depressed subjects. DESIGN: A baseline evaluation of reflective functioning, alexithymia and depression was conducted before an STMBP treatment. Patients were re-tested successively after 40 weeks (T1) and in a follow-up after 1 year at the end of the treatment (T2). METHODS: A total of 24 patients principally diagnosed with Major Depressive Disorder (MDD) underwent a STMBP conducted by two expert therapists. Global Assessment Functioning (GAF), Toronto Alexithymia Scale-20 (TAS-20) and Hamilton Depression Rating Scale (HAM-D) data were collected at the baseline (T0) by two clinical therapists, along with RF scores rated by two trained raters. HAM-D, TAS-20 and GAF follow-ups were conducted at the end of the treatment after 40 weeks (T1) and after 1-year follow-up (T2). RESULTS: Results highlighted an improvement of both HAM-D and TAS-20 scores in our sample. Moreover, a negative correlation between RF and TAS-20 was found. Both HAM-D and RF at T0 influenced depressive outcomes at the end of the treatment. CONCLUSIONS: Results confirmed the effectiveness of STMBP in MDD, suggesting also an inverse association between RF and alexithymia. PRACTITIONER POINTS: Our study demonstrates how STMBP could be effective in MDD even after 40 sessions, maintaining its effect in a 1-year follow-up. STMBP improves subjective capability of reflecting on the mental states of oneself and others. Our intervention allows patients to orientate thoughts from inside to outside, reducing negative beliefs also in absence of a pharmacological therapy (during the follow-up).

[Efficacy of short-term psychodynamic psychotherapy vs treatment as usual in a sample of patients with anxiety and depressive disorders]. / Efficacia della psicoterapia psicodinamica breve vs trattamento psichiatrico di routine in un campione di pazienti con disturbi d'ansia e dell'umore.

INTRODUCTION: The aim of this study is to evaluate the clinical efficacy of short-term psychodynamic psychotherapy (STPP) in comparison with treatment as usual (TAU) in treatment of patients suffering from anxiety and depressive disorders. METHODS: Sixty patients were recruited from the Psychotherapy Service, University of Milan, Department of Psychiatry, at Milan's IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico with the diagnosis of depressive or anxiety disorders according to DSM-IV-TR criteria. These subjects were randomly assigned in a 1:1 ratio to an intervention group (STPP) or control group (TAU) for 12 months (T1). Each patient was clinically evaluated at the moment of recruitment (T0) and after 12 months using a battery composed of these scales: Clinical Global Impression Scale (CGI), Symptom Checklist-90-Revised (SCL-90-R), Inventory of Interpersonal Problems (IIP). RESULTS: Statistical analysis highlighted significant improvements (p<0.05) for the group treated with STPP in every clinical scale. Instead control group revealed significant changes (p<0.05) only for SCL-90 scale scores. We noticed a clinical improvement in both groups without particular differences, but the IIP scores went through a significant higher enhancement only in STPP group. CONCLUSIONS: Our results suggest that STPP is so effective as TAU in treatment of anxiety and depressive disorders. Moreover STPP leads to a better recover of relational functioning.

Is it possible to assess subjective well-being among bipolar inpatients? An 18-week follow-up study.

OBJECTIVE: The study evaluates the association between subjective well-being and psychopathology in bipolar inpatients at the time of hospitalization and during a follow-up period. METHOD: One hundred twenty consecutive inpatients with a diagnosis of bipolar affective disorder were studied on admission (T0), at discharge (T1) and every 6 weeks for 18 weeks after hospitalization. The Young's Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HAM-D) were used to determine affective symptoms, while subjective well-being was assessed by subjective well-being under neuroleptic (SWN). Associations between SWN and HAM-D or YMRS scores and between their changes were analyzed across the different time points by using Pearson correlation coefficients. Linear regression models were constructed using SWN as the dependent variable and demographic and clinical characteristics as possible predictors. RESULTS: At baseline, depression explained 24% and mania explained an additional 16% of baseline SWN variance. Changes in SWN and HAM-D total score displayed an inverse correlation during hospitalization and follow-up. End point severity of depression was associated with the end point SWN total score explaining additional 26% of SWN total score variance, whereas severity of mania was inversely associated with SWN total score. CONCLUSION: Data of this study provide further support for the need to consider the subjective well-being as a personal variable associated to psychopathological state in bipolar patients. However, results seem to be in line with authors who suggest to use other subjective quality of life scales in acute mania.

Short-term psychodynamic psychotherapy versus treatment as usual for depressive and anxiety disorders: a randomized clinical trial of efficacy.

This randomized clinical trial aimed to evaluate the clinical efficacy of short-term psychodynamic psychotherapy (STPP) in the treatment of patients suffering from anxiety or depressive disorders, as compared with a control case sample composed of patients undergoing treatment as usual (TAU). Sixty patients with depressive or anxiety disorders according to DSM IV-TR were randomly assigned in a 1:1 ratio to an intervention group (STPP) or control group for 12 months (T1). Primary outcome measures were the Symptom Checklist 90-Revised (SCL-90-R), the Inventory of Interpersonal Problems (IIP), and the Clinical Global Impression Improvement Scale. Intention to treat analysis revealed that patients who received STPP showed significantly more improvements in comparison with those who were in the TAU group on Clinical Global Impression Improvement Scale and IIP measures. This study offers evidence that STPP is an effective treatment for patients with anxiety or depressive disorders, and it could be more effective than TAU in improving interpersonal problems as measured by IIP.

Burnout among psychiatrists in Milan: a multicenter survey.

OBJECTIVES: This study evaluated the prevalence of job burnout and estimated psychiatric morbidity and job satisfaction among psychiatrists in Milan. Also investigated were the contributions of personal and environmental factors to burnout. METHODS: Data were gathered via a cross-sectional, descriptive, multicenter survey. All psychiatrists working in departments of psychiatry within the Italian Public Health System in Milan were invited to participate, and an overall response rate of 70% (N=81) was achieved. The Maslach Burnout Inventory, the 12-item General Health Questionnaire, a job satisfaction measure, and a study-specific questionnaire were used in the assessments. RESULTS: Psychiatrists showed high levels of emotional exhaustion and depersonalization. Main sources of stress were related to work environment. According to regression models, the variable that most predicted burnout was a low level of job satisfaction. CONCLUSIONS: Data suggested that psychiatrists had higher levels of burnout than other physicians employed in general medical settings and confirmed that job satisfaction could have a protective role.

Expressed emotion in wives of myocardial infarction patients: an exploratory feasibility study.

INTRODUCTION: We assessed the emotional components expressed by the spouses of patients at the first episode of acute myocardial infarction (AMI) and considered potential underlying links among these components and the course of the cardiac symptoms over time. This was an exploratory prospective cohort study. METHODS: A sample of 50 consecutive male inpatients with a diagnosis of AMI and their wives was studied. At baseline spouses were assessed with the Camberwell Family Interview and ratings of Expressed Emotion were made. Patients completed the State-Trait Anxiety Inventory (STAI XI-X2) and the Beck's Depression Inventory (BDI). After 12 months (T1), during appropriate treatment by a cardiologist blinded to the Expressed Emotion ratings, the existence or absence of serious adverse events (death or hospitalizations because of cardiac causes) were determined as an all-or-none phenomenon. Stepwise logistic regression analysis was performed to estimate associations among illness course and Expressed Emotion subscales, STAI X1-X2, BDI scores and clinical variables. RESULTS: High family Emotional Overinvolvement (EOI) scores were associated with higher study entry levels of depression (P = 0.003) among the patients and high Warmth was related to higher score on state anxiety scale (P = 0.000). Poor illness course at T1 was associated with high EOI [P = 0.005, exp(B) = 0.502, 95% confidence interval 0.308-0.818]. CONCLUSION: The association among wives' emotional profile, patients' psychological variables and illness course suggested the importance of a family assessment and of interventions directed towards changing emotional behaviours which could threaten the patient's psychological adjustment and the clinical course following a heart attack.