"Coronaphobia" in Paraguay: Spanish Validation of the COVID-19 Phobia Scale.

BACKGROUND: The COVID-19 is a highly transmissible disease caused by a new zoonotic coronavirus called SARS-CoV-2 that has led to several health, social, and economic issues worldwide. Anxiety and stress are predominant symptoms in the population during the quarantine; also, levels of fear or phobia have been reported. SUBJECTS AND METHODS: This study validate the Spanish version of the COVID-19 Phobia Scale (C19P-S). Participants were recruited using an Internet-based survey. The survey was open from July 20 to July 31, 2021 and 1079 subjects were included. RESULTS: Kaiser-Meyer-Olkin test was adequate (KMO=0.956) and sphericity tested significantly (p<0.0001). The model of adjustment was good as shown by fit indices (S-B χ2=351.67, df=164, p>0.05; RMSEA=0.033; SRMSR=0.042; CFI=0.995, NFI=0.990). CONCLUSIONS: This confirms that the model of the Spanish version of the C19P-S may reproduce the same four-factors model from the original version of the scale and all items of these factors reported standardized loadings higher than 0.40 (p<0.001).

Hair-pulling disorder (Trichotillomania): Etiopathogenesis, diagnosis and treatment in a nutshell.

Hair-pulling disorder (Trichotillomania) is a disabling mental disorder. Patient's behavior is characterized by the recurrent pulling of own hair with hair loss and a marked dysfunction in various areas of daily life. Trichotillomania is a relatively common disorder with pediatric onset, often associated with significant morbidity, comorbidity, and functional decline. Surprisingly, children or adolescents have been little studied in the research studies on the pathophysiology and psychopathology of trichotillomania. Furthermore, more evidences regarding the effective and evidence-based pharmacological interventions for the treatment of this condition are encouraged. This narrative review will report on the etiopathogenesis and clinical manifestations of trichotillomania including criteria for diagnosis and treatment issues of this complex mental disorder.

Psychodermatological mechanisms of psoriasis.

Psoriasis is a chronic disease, mediated by the human immune system, based on a polygenic vulnerability, with cutaneous and systemic manifestations and substantial negative effects on the quality of life of patients. The physical and psychological impacts of psoriasis affect all areas of patient's functioning. Likewise, the prevalence of depression and anxiety in patients with psoriasis is significantly higher than that in the general population, and the quality of life is lower when compared to patients with different dermatological conditions. Both anxiety and depression may increase the clinical severity of psoriasis. Although psychiatric disorders in patients with psoriasis may be secondary to the stress due to the shame and social anxiety related to the skin lesions, the high rate of comorbidity has led to hypothesize that there may be common pathophysiological (psychodermatological) mechanisms involved. Inflammation is a key factor, since alterations in inflammatory modulators such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system have been described. This narrative review of the literature highlights the psychodermatological aspects of the etiopathogenesis of psoriasis as well as the impact of illness on patients' personal identity, functioning, and professional, social, and family areas.

Psychodermatology of skin picking (excoriation disorder): A comprehensive review.

Excoriation disorder (ED) is a primary psychiatric disorder characterized by recurrent skin picking, which may lead to self-induced cutaneous lesions and significant distress or functional impairment. The affected patient is aware of his/her self-destructive behavior but feels unable to give up this habit, despite having made repeated attempts to decrease or stop it. ED is a relatively frequent disorder, of notable heterogeneity and phenomenological complexity, accompanied by significant emotional and physical consequences. Therefore, further research is necessary to enhance the knowledge on its clinical manifestations, epidemiology, and comorbidities. This article presents an update regarding the etiopathogenesis, clinical aspects, and treatment options of ED to provide an up-to-date review for psychiatrists, dermatologists, and general practitioners.

Evolution of psychopathology, purpose in life, and moral courage in healthcare workers during the COVID-19 pandemic: a longitudinal study.

Introduction: Almost 2 years and five infection waves after the COVID-19 pandemic started, healthcare workers continued dealing with the pandemic situation and facing the health consequences and the mental health disorders it caused. This study aimed to evaluate the onset and progression of psychopathology as well as the role of predictor variables such as purpose in life and moral courage among healthcare workers during this time. Materials and methods: This was a longitudinal prospective study carried out with 45 Spanish healthcare workers who answered two questionnaires, the first questionnaire in April-May 2020 (T1) and the second questionnaire in September-October 2021 (T2). Results: Although 29.5% of the sample considered that their mental health had improved over this time, almost half of them (47.7%) said it had not changed, while 22.7% reported a decline in their mental health from the first time they were asked. Specifically, 46.8% presented anxiety, 23.4% depression, and 42.6% acute stress at T1, and 38.3% had anxiety, 17% depression, and 27.7% post-traumatic stress disorder at T2. Despite this, there were no differences between T1 and T2 anxiety scores (p = 0.53), although there was a decrease in depression (p = 0.03) and acute stress (p = 0.02) scores. Predictor variable outcomes such as purpose in life (p = 0.88) and moral courage (p = 0.86; p = 0.38) did not change over time, but when modelling the data, purpose in life predicted psychopathology at T1, which in turn affected the psychopathology results at T2. Conclusion: This study showed that, although psychopathology decreased over the months, its prevalence remained high. Even though the purpose in life predicted psychopathology at T1, it seems that once the psychopathology is established (T2), the factors that would improve it would be different from the protective factors that prevented its establishment, which become secondary.

Relationship of DRD5 and MAO-B VNTR polymorphisms with paranoid and antisocial personality disorders in polydrug users.

Although multiple studies have shown the role genetics plays in personality disorders and in addictions, few have studied the genetic aspects of their comorbidity. Here, we carried out a cross-sectional study in a sample comprising 303 Caucasian polydrug-consuming patients. The presence of personality disorders was evaluated using the International Personality Disorder Examination, and genes related to dopamine, serotonin and monoamine oxidase (MAO) were genotyped. A significant relationship was observed between the bp 279 DRD5 variable number of tandem repeat (VNTR) polymorphism and paranoid personality disorder OR 95 % CI = 2.186 1.074 ; 4.449 ; p = 0.006 . The bp 182 OR 95 % CI = 0.407 0.178 ; 0.931 ; p = 0.033 and bp 184 OR 95 % CI = 0.391 0.188 ; 0.813 ; p = 0.012 alleles of the MAOB VNTR were also associated with antisocial personality disorder. Among patients with addictions, paranoid personality disorder should also be considered in addition to the importance of antisocial and borderline personality disorders. The higher frequency of the bp 279 DRD5 VNTR allele found in patients with paranoid personality disorder, as well as the associations between alleles of the MAOB VNTR and antisocial personality disorder, support the monoaminergic bases of these personality disorders, especially when dealing with patients with addictions.

Dermatitis Artefacta: A Practical Guide for Diagnosis and Management.

Dermatitis artefacta (DA) is a psycho-dermatologic condition based on patients' behavioral patterns, characterized by an intentional production of cutaneous lesions on their own skin. The clinical presentation can be highly variable. Patients with DA seldom seek psychological support or psychiatric consultation. More often, they seek help from their primary care physician or dermatologist. This review article aims to provide a practical guide for the diagnosis and management of AD and affected patients. A broad literature search was performed using the PubMed and Google Scholar electronic online databases, using key words "dermatitis artefacta", "diagnosis", "management", and "psychodermatology". The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. DA can occur in a variety of clinical presentations, and physicians should suspect DA in patients with a history of psychiatric disorders or extensive use of healthcare services. The ultimate goal of DA treatment may be a proper referral to mental health services. However, the prognosis is poor even when successful mental health referrals are achieved, with low recovery rates. A useful approach may include the suggestion that a mental health provider can help with the anxiety and the distress generated by the lesions: in this case in this case it will be crucial to discuss this with the mental health provider after obtaining informed consent from the patient. Considering the difficulty in promoting patients' adherence to treatment, the ideal setting for DA treatment is a psycho-dermatologic clinic, where both dermatologic and psychological interventions can be seamlessly integrated.

Hope, resilience and subjective happiness among general population of Paraguay in the post COVID-19 pandemic.

BACKGROUND: Positive mental health includes not only the absence of mental disorders but also the presence of subjective well-being, good coping strategies for life stress, and strategies for adapting to community life. It is well known that the COVID-19 pandemic has challenged mental health in general population worldwide. However, research has not measured protective factors for mental health in the general population after the declared end of pandemic by the World Health Organization. METHODS: This observational, cross-sectional study surveyed 591 Paraguayan participants aged ⩾18 years, who were recruited through an online survey. Demographic characteristics, socioeconomic status were collected as well as mental health and validated tools for hope, resilience, subjective happiness were administered. RESULTS: Of the participants, 81.6% were women, 54% were married or in a relationship and 90.7% reported an university education. The main source of stress was economic issues (30.3%). A total of 22.7% had been previously diagnosed with a mental disorder, 22.2% had consulted a mental health professional and 10.8% had consumed prescription drugs. 42.6% reported flourishing, 36.2% reported moderate and 21.2% reported languishing mental health. CONCLUSIONS: This large survey has shown that most of participants reported a flourishing mental health with high ratings at hope, resilience, and subjective happiness scales. Also, the main sources of stress were economic issues, not consequently related to the pandemic. This may add evidences to the international debate on the long term effects of the global pandemic and probably suggests that recovery processes have been collectively adopted in Paraguay.

Satisfaction with Telepsychiatry during the COVID-19 pandemic: Patients' and psychiatrists' report from a University Hospital.

BACKGROUND: The COVID-19 pandemic has led to important changes in the approach to patients worldwide. Different agencies have proposed and implemented telemedicine-based care services in order to ensure access to health care for all people. AIM: The aim of this study was to determine the satisfaction of patients using the Telepsychiatry service offered by the Department of Psychiatry of the Hospital de Clínicas (National University of Asunción, Paraguay). METHODS: A cross sectional and descriptive study has been conducted. Participants were recruited through a phone-based survey. Satisfaction with Telepsychiatry has been measured with an adapted version of a satisfaction survey in Teleneurology. As a complement, psychiatrists from the Hospital de Clínicas were also interviewed about their rate of satisfaction with Telepsychiatry. RESULTS: A total of 530 patients were included, 51.3% of whom were women. The consultation satisfaction scale ranged between 2.15 and 4.30 with a mean score of 3.02 ± 0.32. Cronbach's alpha for the scale was .897, indicating a good internal consistency. Patients' satisfaction was higher for the perception of Telepsychiatry and lower for the doctor-patient relationship. Of the physicians, 87.5% were satisfied with the Telepsychiatry service. CONCLUSION: The satisfaction overall score indicates patients' general satisfaction with the quality of care in Telepsychiatry, mainly regarding the perception of health care. and lower satisfaction with the doctor-patient relationship. Nine out of 10 psychiatrists felt satisfied with the Telepsychiatry service and considered that the degree of patient's satisfaction was acceptable during the Telepsychiatry consultation.

Suicides among adults in Paraguay: An 18-year national exploratory study (2004-2022).

BACKGROUND: The number of suicides has been increasing worldwide, year after year, becoming the fourth leading cause of death among young people between 15 and 29 years of age. AIM: In this study, we explored the frequency and characteristics of suicides among the adult general population in Paraguay between 2004 and 2022, considering that suicide attempts and suicidal risk/ideation are frequent and relevant issues in the consultation activity, even if epidemiological evidence on the national rates of suicide is scarce. METHODS: In this observational, descriptive, and exploratory study, official records of all deaths by suicide were reviewed and information analyzed. In addition, an attempt was made to predict the number of suicides in the next 5 years according to a mathematical modeling. RESULTS: In the 18-year period, 5,527 suicides of adults were recorded. Patients' mean age was 36.8 ± 17 years old. A 76.77% of them were males, 77.44% were from an urban area and 25.98% from the Greater Asunción and Central Department of Paraguay. The most frequently used method of suicide was intentional self-inflicted injury by hanging, strangulation, or suffocation (all 67.6%). The expected number of national suicides in the following years from 2023 to 2027 will range between 462 and 530. Limitations include the lack of information regarding diagnoses and personal history in the suicide reports as well as the possibility of underreporting of national suicide cases. CONCLUSION: Our results represent the first large national epidemiological report of suicides in Paraguay and may be of interest for mental health professionals and health authorities in order to reduce the suicide mortality rate within the country.

The Chikungunya anxiety scale (CHIKAS): Development, validation, and relationship between its items and illness-related factors.

Background: Paraguay has recently experienced an exponential increase in chikungunya cases, leading to psychological distress, particularly anxiety. Aim: To develop and validate the Chikungunya Anxiety Scale (CHIKAS). Materials and Methods: An initial scale of 18 items was used, which was subjected to validation by expert judgment to obtain 14 items. To determine construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have been employed, and internal and convergent validity were determined. Demographic, socioeconomic, and health status data were also collected. Results: The study included 974 participants. The final scale consisted of 12 items with evidence of a two-factor model (psychological and physical). The internal validity was good (McDonald's omega = 0.882). The CFA showed good adjustment indices. Regarding participant characteristics, a relationship was found between anxiety due to chikungunya and gender, employment, mental diagnosis, medication use, and chikungunya infection. Conclusion: The final 12-item CHIKAS had strong psychometric properties and was a two-factor model.

Burnout, psychopathology and purpose in life in healthcare workers during COVID-19 pandemic.

Background: The COVID-19 pandemic has led to a significant increase in the workload of healthcare workers that, together with the risks associated with exposure to this new virus, has affected their mental health. Objectives: The objective of the current study was to determine the prevalence of psychopathology and burnout syndrome in healthcare workers and the predictive role of purpose in life and moral courage in this relationship. Methods: A cross-sectional study was carried out in 115 Spanish healthcare workers. Results: Participants with burnout had higher anxiety (p = 0.001), depression (p < 0.001), post-traumatic stress (p = 0.01) and alcohol consumption (p = 0.03) levels. The different components of burnout (emotional fatigue and despersonalization) were associated with the occurrence of anxiety (OR = 0.31) and depression (OR = 0.26), respectively. A strong purpose in life decreased emotional fatigue (OR = -0.39) depersonalization (OR = -0.23) scores, increased personal accomplishment (OR = 0.52), subsequently reducing burnout levels (OR = -0.45). Conclusions: Purpose in life was most strongly related to decreased levels of burnout. Furthermore, an association between anxiety, depression and the components of burnout was found.

Phone-based outpatients' follow-up in mental health centers during the COVID-19 quarantine.

BACKGROUND: The current COVID-19 pandemic is affecting mental health of global population and, particularly, of people suffering from preexisting mental disorders. AIMS: This study aims to report on findings from a phone-based clinical follow-up conducted in two large catchment areas in Italy and Paraguay, during the COVID-19 lockdown, in order to provide psychiatric assessments and measure the level of stress related to the quarantine in a large sample of psychiatric outpatients. METHODS: A clinical phone-based follow-up has been conducted in two large catchment areas in the province of Chieti (Vasto, Italy) and City of Asunción (Paraguay), during the COVID-19 national lockdown. The following rating scales have been employed: Hamilton Anxiety Rating Scale (HAM-A); Hamilton Depression Rating Scale (HAM-D); 18-items Brief Psychiatric Rating Scale (BPRS-18). The psychological distress related to the outbreak has been assessed employing the Impact of Event Scale - Revised (IES-R). RESULTS: A total of 110 outpatients were consecutively included and followed among those reporting a stable phase of illness before the COVID-19 lockdown. Findings confirmed a significant increase of general psychopathology, anxiety and fear as well as mild levels of stress related to the quarantine. Also, significant weight gain during the lockdown was detected among patients. CONCLUSIONS: This study confirmed the impact of COVID-19 lockdown on mental health of people suffering from psychiatric disorders and may also add evidence on the employment of digital psychiatry in the current pandemic.

Alopecia areata: A psychodermatological perspective.

BACKGROUND: Alopecia Areata (AA) is an autoimmune dermatological disease that could be influenced by psychological factors as part of the pathophysiology of the illness. AIMS: This review article aims to report on psychodermatological and psychopathological aspects involved in the etiopathogenesis and comorbidities of AA, as well as on the psychiatric and psychological management of affected patients. METHODS: We conducted a literature search on PubMed and Google Scholar from January 1980 to May 2021 employing the search terms of alopecia areata, psychological factors, psychological impact, psychodermatology, and psychopathology. All lists of references from the identified articles were screened for further relevant studies. The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. No specific quality criteria were used for the studies selection. RESULTS: Several authors have found a high comorbidity rate between AA and mental disorders, concluding that stress and psychological factors are involved in both the development and exacerbation of the illness. More evidences are needed in order to describe the associations between the immune response, stress, and the physiological factors observed in AA patients. CONCLUSION: AA is a complex illness characterized by multifactorial etiology. An interaction between genetic, autoimmune, hormonal, neural, and psychological factors is supposed. Psychopathological aspects of illness need to be better described and considered in the clinical setting.

Anxiety, Addiction to Social Networks, Internet and Smartphones in Paraguayan Adolescents: A Brief Report.

Background: Several authors have pointed out that the use of smartphones might have an impact on mental health in general. Most of the evidences are focused on the incorrect or overblown use of smartphones, videogame or Internet, particularly focusing on related addiction problems among adolescents. Objective: The present study, although preliminary, aims to report the first evidence in Paraguay regarding the association between anxiety and addiction to social networks/internet as well as the use of smartphones among adolescents. Method: Participants (100 adolescents, aged 12- 17 years old) were assessed in a school setting with the Beck Anxiety Inventory (BAI) and the Scale of risk of Addiction to Social Networks and Internet for adolescents (ERA-RSI). Categorical variables and associations were statistically assessed. Results: The average smartphone use in boys rated 8.06 ±3.81 hours and in girls 9.46 ±4.4 hours. The BAI mean score was 20.71 ± 13.2. Of the participants, 27% reported moderate anxiety, and 36% severe anxiety and scores on this scale were not associated with hours of smartphone use. The ERA-RSI mean score was 1.94 ± 0.46 and anxiety was related to the symptoms-addiction, social-use, and nomophobia dimensions of the scale. Conclusion: The misuse of smartphones in the Paraguayan pediatric population has been reported to be closely related to anxious symptoms. Our results suggest further research with an impact on possible public health policies aimed at preserving the mental health of children and adolescents exposed to internet and electronic devices.

COVID-19 infodemic and depressive symptoms: The impact of the exposure to news about COVID-19 on the general Paraguayan population.

INTRODUCTION: The COVID-19 pandemic has led to an increase of social stressors and mental health issues in the general population as well as among mentally ill patients. A COVID-19- related "infodemic", including too much information in digital and physical environments, has been recognized globally. AIM: This study aimed to describe the impact of COVID-19 infodemic (exposure to news related to COVID-19) in terms of depressive symptoms in the Paraguayan general population. METHODS: This was a descriptive and cross-sectional study. An online survey, designed in Google Forms, has been launched nationwide through the most popular social networks (Facebook, Twitter, Instagram) and messaging applications (WhatsApp, Telegram) in April (1st-30th) 2021. The Mental Health Inventory-5 (MHI-5) was employed for detecting depressive symptoms. RESULTS: The survey included 1102 responders aged 35.4 ± 12.9 years old, 74.9% were women. MHI-5 mean score was 44.07 ± 14.16 in the general population with 34.4% (n = 379) of responders suffering from severe symptoms of depression (>52, as cut-off point). 53.5% of sample reported to have been exposed between 1 and 3 h to COVID-19 news, daily. An OR 1.933 (95% CI 1.48 - 2.52) was found between the exposure to news and depressive symptoms. CONCLUSIONS: This study suggests that people exposed to a higher number of hours of COVID-19 news were 93.3% more likely to develop depressive symptoms.

Atopic dermatitis in psychodermatology: a concise review for dermatologists.

Atopic dermatitis (AD) is a chronic disease of the skin with significant pruritus and phases of exacerbation and remission. The hallmarks of AD are changes in the epithelial barrier and chronic inflammation. This condition is associated with an increased risk of developing mental disorders such as depression, anxiety, and suicidal ideation. It has been proposed that psychological stress may impact on immunological factors with an up-regulation of mediating neuropeptides at the level of central nervous system and secondary involvement of endocrine glands, peripheral nervous system, and immune resident skin cells. This article provides a concise review for dermatologists on the psychodermatology of AD, in order to highlight the putative common pathways between the dermatologic and mental health issues in this illness.

Technostress, anxiety, and depression among university students: A report from Paraguay.

BACKGROUND: Although technologies (including information, e-learning, and communication) have been daily employed by University students in the last years, the COVID-19 pandemic has led to a considerable increase in their use. Technostress is a modern term referring to levels of stress caused by the prolonged exposure to technology. AIM: The aim of this study is to assess the technostress and related anxiety and depression among Paraguayan University students, describing their sociodemographic characteristics and relevant associations. METHODS: A cross-sectional and descriptive study has been conducted. Participants were recruited through an Internet-based survey. Technostress, anxiety, and depression have been assessed with the Technostress Questionnaire (TechQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and the Patient Health Questionnaire-2 (PHQ-2), respectively. RESULTS: A total of 378 participants were included, 74.1% of whom were women. According to the TechQ scores, 47.4% of the participants reported a low/moderate level of technostress whereas 5.2% showed severe scores. About 58.5% of participants reported a GAD-7 score ⩾10, meeting diagnostic criteria for generalized anxiety. About 60.3% scored ⩾3 at the PHQ-2 reporting significant levels of depression. Technostress has been significantly associated with levels of anxiety (p < .001) as well as depression (p < .001). CONCLUSION: Our results suggest further research regarding the implications of technostress on the well-being of University students. Specific measures aimed to improve students' coping with the challenges of technology and technostress should be promoted.

The outbreak of COVID-19 coronavirus and its impact on global mental health.

BACKGROUND: The current outbreak of COVID-19 coronavirus infection among humans in Wuhan (China) and its spreading around the globe is heavily impacting on the global health and mental health. Despite all resources employed to counteract the spreading of the virus, additional global strategies are needed to handle the related mental health issues. METHODS: Published articles concerning mental health related to the COVID-19 outbreak and other previous global infections have been considered and reviewed. COMMENTS: This outbreak is leading to additional health problems such as stress, anxiety, depressive symptoms, insomnia, denial, anger and fear globally. Collective concerns influence daily behaviors, economy, prevention strategies and decision-making from policy makers, health organizations and medical centers, which can weaken strategies of COVID-19 control and lead to more morbidity and mental health needs at global level.