Emotion recognition in amyotrophic lateral sclerosis in a dynamic environment.

OBJECTIVE: The aim of our study was to measure the ability of ALS patients to process dynamic facial expressions as compared to a control group of healthy subjects and to correlate this ability in ALS patients with neuropsychological, clinical and neurological measures of the disease. METHODS: Sixty-three ALS patients and 47 healthy controls were recruited. All the ALS patients also underwent i) the Geneva Emotion Recognition Test (GERT) in which ten actors express 14 types of dynamic emotions in brief video clips with audio, ii) the Edimburgh Cognitive and Behavioral ALS Screen (ECAS) test; iii) the ALS Functional Rating Scale Revised (ALSFRS-R) and iv) the Medical Research Council (MRC) for the evaluation of muscle strength. All the healthy subjects enrolled in the study underwent the GERT. RESULTS: The recognition of irritation and pleasure was significantly different between ALS patients and the control group. The amusement, despair, irritation, joy, sadness and surprise had been falsely recognized differently between the two groups. Specific ALS cognitive impairment was associated with bulbar-onset phenotype (OR = 14,3889; 95%CI = 3,96-52,16). No association was observed between false emotion recognition and cognitive impairment (F(1,60)=,56,971, p=,45,333). The number of categorical errors was significantly higher in the ALS patients than in the control group (27,66 ± 7,28 vs 17,72 ± 5,29; t = 8723; p = 0.001). CONCLUSIONS: ALS patients show deficits in the dynamic processing of a wide range of emotions. These deficits are not necessarily associated with a decline in higher cognitive functions: this could therefore lead to an underestimation of the phenomenon.

Perinatal mental health and Covid-19-related distress: the role of personality traits.

BACKGROUND: Perinatal mental health is a topic of growing interest, that could affect mothers in a period of high vulnerability, and the impact of coronavirus disease 2019 (Covid-19) pandemic is an important factor to consider in this field. The aim of our study is to study the correlations between five dimensions of personality and subjective Covid-19-related distress in a sample of women in the perinatal period. METHODS: The study included 114 Italian women in the perinatal period. Subjects were asked to complete the Big Five Inventory (BIG-5) and a version of the Impact of Event Scale - Revised (IES-R) anchored to Covid-19-related distress. RESULTS: When the BIG-5 personality traits and several confounding variables were included in a regression model with IES-R total score as criterion, neuroticism subscale of BIG-5 inventory was the only variable independently associated with higher IES-R total score (p<0.001). CONCLUSION: Our study highlights the importance of considering the personality vulnerability factors that can worsen psychopathological symptoms of women in the perinatal period, especially in periods of high psychological stress.

Barriers to access to mental healthcare among women in the perinatal period: a preliminary report.

This preliminary study investigates factors related to reduced access to mental healthcare among women in the perinatal period. We enrolled 145 pregnant women followed in OB-GYN services, using the Edinburgh Postnatal Depression Scale as a clinical measure for depression symptoms. We observed low levels of adherence to psychiatric screenings and referrals. Our findings confirm the importance of improving access to mental healthcare for women in the perinatal period.

The relationship between personality traits and individual factors with perinatal depressive symptoms: a cross-sectional study.

BACKGROUND: Pregnancy is a crucial transition moment exposing women to potential mental health problems, especially depressive disturbances. Sociodemographic, pregnancy-related, and psychological factors have been related to depressive symptoms in the perinatal period. This study aims at (1) exploring personality and individual factors related with perinatal depressive symptoms, and (2) testing the mediating role of personality in the relation between characteristics of the woman's family of origin and depressive symptoms. METHODS: Women in the perinatal period admitted to the gynecology unit for motherhood-related routine assessments (n = 241) were included in the study. A survey on individual sociodemographic, clinical, and pregnancy-related factors was administered, also including the Edinburgh Postnatal Depression Scale (EPDS) and the BIG-5 personality test. RESULTS: Couple conflict and neuroticism were independent and directly correlated with EPDS total score (respectively: B = 2.337; p = .017; B = 0.303; p < .001). Neuroticism was a significant mediator of the relation between the presence of a psychiatric disorder diagnosis in participant's parents and the EPDS total score (indirect b = 0.969; BCCI95%=0.366-1.607). CONCLUSIONS: Couple relation and neuroticism traits are individual factors related to depressive symptoms in the perinatal period. The family of origin also plays an indirect role on perinatal depressive symptoms. Screening of these factors could lead to early recognition and more tailored treatments, ultimately leading to better outcome for the entire family.

Dissociative experiences of compartmentalization are associated with food addiction symptoms: results from a cross-sectional report.

PURPOSE: Studies have shown significant associations of dissociative symptoms with both eating and addictive disorders; however, the different forms of dissociation have been relatively understudied in relation to food addiction (FA). The main aim of this study was to investigate the association of certain forms of dissociative experiences (i.e., absorption, detachment and compartmentalization) with FA symptoms in a nonclinical sample. METHODS: Participants (N = 755; 543 women; age range: 18-65; mean age: 28.22 ± 9.99 years) were evaluated using self-report measures of FA, dissociation, eating disturbances, and general psychopathology. RESULTS: Compartmentalization experiences (defined as pathological over-segregation of higher mental functions) were independently associated with FA symptoms (ß = 0.174; p = 0.013; CI = [0.008; 0.064]) even when confounding factors were controlled for. CONCLUSION: This finding suggests that compartmentalization symptoms can have a role in the conceptualization of FA, with such two phenomena possibly sharing common pathogenic processes. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

The Relationship Between Childhood Trauma, Pathological Dissociation, and Behavioral Addictions in Young Adults: Findings from a Cross-Sectional Study.

Interactions between childhood trauma (CT) and dissociation can contribute to psychiatric disturbances. We explored this phenomenon in relation to behavioral addictions (BAs) in a sample (n = 633) of young adults (age: 18-34 years). Self-report measures investigating CT, dissociation, and symptoms related to gambling disorder, internet gaming disorder, problematic social media use, exercise dependence and compulsive buying were used. Scales related to BAs were summarized into a single measure ("Total Behavioral Addiction Index" - TBAI) for inferential analyses. A model analyzing the direct and indirect effects of CT on TBAI through the mediation of pathological dissociation was performed, controlling for confounding factors. Measures on CT, dissociation, and TBAI were significantly associated with each other (all p < .001). The total effect of CT on TBAI was significant (B = 0.063; CI: 0.045; 0.081); pathological dissociation significantly mediated such association (B = 0.023; CI: 0.013; 0.036). Our findings support the possibility that the interaction between CT and dissociation contributes to increase disturbances related to BAs.

Suicide-Related Knowledge among Italian Early Career Psychiatrists and Trainees: Results from a Cross-Sectional Survey.

The training of mental health professionals is an important component of suicide-prevention programs. A cross-sectional survey was conducted in different Italian regions to evaluate knowledge of, and attitudes toward, suicide as well as the experience of a patient's suicide or a suicide attempt in early career psychiatrists (ECPs) and trainees (N = 338). The Suicide Knowledge and Skills Questionnaire and the Impact of a Patient's Suicide on Professional and Personal Lives scale were administered. Furthermore, symptoms of intrusion, avoidance, and arousal were examined through the Impact of Event Scale in ECPs and trainees who had experienced the suicide of a patient or a suicide attempt. Participants with training were more confident in the clinical management of suicide-risk patients. The group with experience of a patient's suicide reported more suicide skills except for support and supervision. Finally, the participants who reported a patient's suicide presented a more conservative patient selection, difficulties in relationships, loss of self-esteem, dreams linked to suicide, intrusive thoughts of suicide, guilt, and anger. Our results show that knowledge of, and attitudes toward, suicide are essential in the management of suicide-risk patients.

Problematic Use of the Internet Mediates the Association between Reduced Mentalization and Suicidal Ideation: A Cross-Sectional Study in Young Adults.

Suicide is a major public health problem, and it is urgent to investigate its underlying clinical and psychological concomitants. It has been suggested that low mentalization skills and problematic use of the internet (PUI) are factors that can play a role in suicidal behaviors. It is possible that poor mentalization skills contribute to leading to forms of PUI, which, in turn, can represent triggers for suicidal ideation (SI). We tested this hypothesis through a quantitative and cross-sectional study on a sample (n = 623) of young adults (age range: 18−34). Self-report measures investigating symptoms related to Social Media Addiction (SMA), Internet Gaming Disorder (IGD), mentalization capacity, and SI were used. A single mediation analysis with two mediators was carried out to evaluate the direct and indirect effects of mentalization on SI through the mediating role of SMA- and IGD-related symptoms, controlling for potential confounding factors (e.g., socio-demographic and addiction-related variables). The four explored variables were significantly associated with each other (all p < 0.001) across all subjects; the mediational model showed that the total effect of mentalization on SI was significant (B = −0.821, SE = 0.092 (95% CI: −1.001; −0.641)) and that both SMA- (B = −0.073, SE = 0.034 (95% CI: −0.145; −0.008)) and IGD-related symptoms (B = 0.046, SE = 0.027 (95% CI: −0.107; −0.001)) were significant mediators of such association. Our findings support the possibility that PUI severity plays a relevant role in mediating the association between low mentalization skills and levels of SI.

Tackling Ethnic Health Disparities Through Community Health Worker Programs: A Scoping Review on Their Utilization During the COVID-19 Outbreak.

The coronavirus disease (COVID-19) outbreak has magnified existing health inequities linked to social determinants of health, with racial and ethnic minorities being disproportionately affected by the pandemic. A proposed strategy to address these inequities is based on the implementation of community health worker (CHW) programs able to bridge the gaps between marginalized communities and the formal health care systems. A scoping review was conducted through searching 4 databases: PubMed, Scopus, Web of Science, and Science Direct. Inclusion criteria focused on studies defining any kind of adopted CHW intervention to address inequities related to racial/ethnic groups during the COVID-19 crisis, published from December 31, 2019, to October 31, 2021. Narrative synthesis was undertaken to summarize the findings. In total, 23 studies met the inclusion out of the 107 search results. Data converged on the relevant potential of CHWs on engaging with community leaders, addressing social determinants of health, and issues related to structural racism, promoting culturally tailored health information, and encouraging institutions to policy change in favor of people left behind. Although vulnerability of racial and ethnic minorities was already present before the COVID-19 outbreak, the pandemic has represented a wakeup call to address it more efficiently. In recent years, CHWs have increasingly been acknowledged as valuable members of the health care workforce. As health disparities may increase after our multicultural societies begin to recover from COVID-19, CHWs may play a crucial role in addressing system-level changes to have broad and lasting effects on health outcomes.

Decreased Resting State Inter- and Intra-Network Functional Connectivity Is Associated with Perceived Stress in a Sample of University Students: An eLORETA Study.

INTRODUCTION: Although the study of the Triple Network (TN) model has gained attention in the exploration of stress-related processes, the neurophysiological mechanisms of TN in relation to perceived stress have been relatively understudied in nonclinical samples so far. The main objective of the present study was to investigate, in a sample of university students, the association of perceived stress with resting state electroencephalography (EEG) functional connectivity in the TN. METHODS: Ninety university students (40 males and 50 females; mean age 22.30 ± 2.43 years; mean educational level 16.60 ± 1.62 years) were enrolled. EEG data were analyzed through the exact low-resolution electromagnetic tomography (eLORETA). RESULTS: Higher levels of perceived stress were associated with decreased delta EEG connectivity within the central executive network (CEN) and between the CEN and the salience network (SN). Higher levels of perceived stress were also associated with decreased theta EEG connectivity between the CEN and the SN. The associations between perceived stress and EEG connectivity data were significant even when relevant confounding factors (i.e., sex, age, educational level, and psychopathological symptoms) were controlled for. DISCUSSION: Taken together, our results suggest that higher levels of perceived stress are associated with a dysfunctional synchronization within the CEN and between the SN and the CEN. This functional pattern might in part reflect the negative impact of high levels of perceived stress on cognitive functioning.

The association between social media addiction and eating disturbances is mediated by muscle dysmorphia-related symptoms: a cross-sectional study in a sample of young adults.

PURPOSE: Although the association between problematic use of the internet and eating disorders (EDs) in young adults has been previously established, its underlying mechanisms have not been completely clarified. It has been suggested that exposure to idealized very thin and toned body images (e.g., "thinspiration" and "fitspiration" trends) on social media might lead to increased feelings of body dissatisfaction which, in turn, can represent a trigger for EDs. We have tested this hypothesis in a sample (N = 721) of young adults (504 females, mean age: 24.13 ± 3.70 years; range 18-34). METHODS: Self-report measures investigating symptoms related to social media addiction (SMA), muscle dysmorphia (MD), and EDs were used. A mediational model analyzing the direct and indirect effects of SMA-related symptoms on ED-related symptoms through the mediating role of MD-related symptoms was performed controlling for confounding factors (e.g., socio-demographic variables, substances use, body mass index, psychopathological distress). RESULTS: The model showed that the total effect of SMA-related symptoms on ED-related symptoms was significant (B = 0.213; p = 0.022) and that this association was mediated by MD-related symptoms (B = 0.083; p = 0.021). DISCUSSION: Our findings support the possibility that MD-related symptoms play a relevant role in mediating the association between SMA severity and ED pathology. LEVEL OF EVIDENCE: Level III, evidence obtained from well-designed cohort or case-control analytic studies.

Dissociative-Traumatic Dimension and Triple Network: An EEG Functional Connectivity Study in a Sample of University Students.

AIMS: We investigated the association among triple network electroencephalographic (EEG) functional connectivity, dissociative symptoms, and childhood trauma (CT) in a sample of university students. SAMPLING AND METHODS: Seventy-six participants (30 males and 46 females; mean age 22.12 ± 2.35) completed self-report measures investigating dissociative symptoms, CT, and depressive symptoms. Participants also performed an eyes-closed resting-state EEG recording. EEG analyses were conducted through the exact low-resolution electromagnetic tomography (eLORETA) software. RESULTS: A 2-step cluster analysis revealed 2 groups: participants (N = 23) with high dissociative-traumatic dimension symptoms (DTD+) and participants (N = 53) with low DTD symptoms (DTD-). Compared to DTD- subjects, DTD+ participants showed decreased theta connectivity between the salience network (SN) and central executive network (CEN), specifically between the right anterior insula and the left posterior parietal cortex. No significant correlation was detected between EEG data and clinical variables. CONCLUSION: Our results raise the possibility of a dysfunctional connectivity pattern occurring between the SN and CEN in individuals with high DTD symptoms. Such connectivity pattern might reflect the neuropsychophysiological disintegration related to pathological dissociation.

The association of problematic use of social media and online videogames with aggression is mediated by insomnia severity: A cross-sectional study in a sample of 18- to 24-year-old individuals.

One of the worrying concomitants of problematic use of Internet (PUI) is aggression. Although the mechanisms underlying such link have not been completely clarified, it has been suggested that problematic use of social media and online videogames (i.e., two common forms of PUI among young adults) lead to increased sleep disturbances which, in turn, represent a relevant trigger for aggression. We have tested this hypothesis in a sample (N = 480) of young individuals (351 females and 129 males; mean age: 21.76 ± 1.92 years; range: 18-24). Self-report measures investigating symptoms related to social media addiction (SMA), Internet gaming disorder (IGD), insomnia severity, and aggression were used. Mediational models analyzing the direct and indirect associations of SMA- and IGD-related symptoms on aggression severity through insomnia-related symptoms were performed controlling for confounding factors. The models showed that the total effects of SMA-related symptoms (B = 0.018; p = .010) and of IGD-related symptoms (B = 0.018; p = .041) on aggression severity were significant and that these associations were mediated by insomnia-related symptoms (respectively, p < .001 and p = .003). Our findings support the potential mediating role of insomnia severity in the association of SMA- and IGD-related disturbances with levels of aggression.

Trauma- and stressor-related disorders in survivors from a shipwreck: a short report on forensic implications.

On January 2012 the Costa Concordia cruise ship sank after hitting an underwater rock off Isola del Giglio, in Tuscany, this resulting in a number of deaths and injuries. After the disaster, several survivors developed psychological disturbances. This led to medico-legal evaluations aimed at assessing the psychiatric sequelae of the accident in order to quantify the permanent biological impairment and the related compensations. In the present manuscript we provide an overview of the results of clinical and medico-legal evaluations performed between 2013 and 2019 on 177 survivors complaining psychological disturbances. The most frequently diagnosed condition was Post-Traumatic Stress Disorder (PTSD; n=90), followed by Acute Stress Disorder (n=37), Adjustment Disorders (n=29) and Generalized Anxiety Disorder (n=5). The results of such evaluations are consistent with evidence indicating the risk of developing PTSD and other trauma- and stressor-related disorders among disaster survivors; further, they highlight the potential relevance in the forensic context of individual elements increasing or decreasing the possibility to develop PTSD among subjects exposed to similar life threatening experiences.

Factors influencing lithium versus valproate prescription preference in the maintenance treatment of bipolar patients: a report from the Italian Early Career Psychiatrists (SOPSI-GG).

BACKGROUND: Objective of the present manuscript is to investigate, among Italian early career psychiatrists (ECPs), prescriber and patient-related factors associated with lithium or valproate preference to treat patients affected by Bipolar Disorder (BD). METHODS: An on-line survey was carried out among 252 ECPs, investigating their prescription patterns in relation to lithium and the differences with prescription of valproate. Collected data were compared according to lithium or valproate prescription preference in the long-term treatment of BD by χ2 tests for qualitative variables. RESULTS: Over two thirds of ECPs preferred lithium over valproate for the maintenance treatment of BD. Less than half of the sample used lithium as first-line agent for mania or major depression, and less than one third for mixed episodes. Factors associated with lithium preference as first-line maintenance treatment include perception of having a good knowledge of lithium (p < 0.001) and complete satisfaction with education on lithium (p < 0.001). One of the main factors to prefer valproate was the concern about long-term side effects of lithium (p < 0.001). CONCLUSIONS: Type of education, source of information, clinical experience and safety concerns influence the choice of lithium versus valproate in the long-term treatment of BD. Present findings may guide educational training of ECPs.KEY POINTSLithium has been less prescribed in the last years for long-term treatment of Bipolar Disorder.Educational and clinical factors seem to influence the attitude to prescribe lithium.Only half of the Italian early career psychiatrists declare to have at least an adequate knowledge of lithium.Residency program in psychiatry should consider the implementation of education on lithium.

Mentalization Impairment Is Associated with Problematic Alcohol Use in a Sample of Young Adults: A Cross-Sectional Study.

Background: Alcohol is one of the most widely used drugs among adolescents and young people, and problematic alcohol use (PAU) is related to significant long-term biological, clinical, and psychosocial sequelae. Although preliminary reports have linked deficits in mentalization to increased vulnerability to addiction, no studies have specifically explored this phenomenon in relation to PAU. Methods: The association between mentalization impairment and PAU severity was investigated in a sample of 271 young adults (183 females, 65.9%; mean age: 23.20 ± 3.55 years; range: 18-34). Self-report measures investigating PAU and mentalization were administered to all participants. Results: Individuals with PAU reported a more frequent use of tobacco and illicit drugs in the last 12 months. PAU severity was negatively associated with mentalization capacity (rho = -0.21; p < 0.001), and also, when possible, confounding variables (i.e., gender, age, occupation, education, tobacco and illegal drugs use) were controlled for (rho = -0.17; p = 0.004). Conclusion: The present data showed that mentalization impairment is significantly associated with PAU among young adults, suggesting that it may have a role in the development and/or maintenance of alcohol use.

Relationship between the core features of Tellenbach's Typus Melancholicus and unipolar depressive disorders: a cross-sectional study.

PURPOSE: One of the most consistent models investigating the relationship between premorbid personality and depression was described by Tellenbach. According to this model, concern with orderliness, conscientiousness, hyper/hetereonomia and intolerance of ambiguity are the core features of Typus Melancholicus (TM). Previous studies showed a relationship between unipolar depression and TM. The primary hypothesis of this study was that patients affected by unipolar depressive disorders bare more of TM-related features of concern with orderliness and conscientiousness than healthy subjects. METHODS: In this single center cross-sectional study we recruited 74 patients affected by unipolar depressive disorders according to DSM-5 criteria and 60 healthy controls. In order to assess the presence of TM's orderliness and conscientiousness we adopted the factors of Kasahara's Inventory for the Melancholic Type Personality (KIMTP) named "harmony in personal relationships" and "social norms". Stress-Related Vulnerability Scale (SVS) was administered to explore the relationship between measures of TM and perceived stress. RESULTS: Independent sample t test disclosed significantly higher scores on KIMTP "harmony in personal relationships" (orderliness) but not on "social norms" (conscientiousness) in the clinical sample (p<0.001) compared to the non-clinical sample. Pearson's correlation disclosed a significant positive correlation between stress scores and KIMTP'S "harmony in personal relationships" subscale. DISCUSSION AND CONCLUSIONS: KIMTP's "harmony in personal relationships" (orderliness) was higher in patients with unipolar depression than in non-clinical subjects, and positively associated with perceived stress, while KIMTP's "social norms" (conscientiousness) was (i) similarly represented across the two groups, and (ii) not correlated with perceived stress. This raises the possibility that, among the core features of TM, concern with orderliness can be considered as a relevant and potentially premorbid personality factor in relation to unipolar depressive disorders.

Cognitive remediation for the treatment of neuropsychological disturbances in subjects with euthymic bipolar disorder: findings from a controlled study.

INTRODUCTION: Individuals with euthymic Bipolar Disorder (BD) can experience deteriorated cognitive functioning, with such deterioration being associated with functional impairment. Cognitive remediation (CR) is considered an effective add-on intervention for neuropsychological impairments, but relatively few CR controlled studies have been performed on BD. In the present study the efficacy of a CR intervention designed for the improvement of cognition and functioning in patients with euthymic BD was tested. METHODS: Patients (n = 54) with euthymic BD were assigned to receive active (n = 27) or control (n = 27) intervention. The active intervention (i.e. the Cognitive Remediation in Integrated Treatment - CRIIT - protocol) was made of 20 individual sessions focused on the treatment of attention, memory and executive functioning through the COGPACK software; each session was integrated with psychoeducation and rehabilitation interventions implemented through a metacognitive approach aimed at ameliorating personal agency. RESULTS: A significant (p ≤ 0.015) time x group interaction at repeated measures MANOVA was observed on Rey Auditory Verbal Learning Test, Rey Complex Figure Test, Wisconsin Card Sorting Test, Trail Making Test, Visual Search, Life Skills Profile, and Barratt Impulsiveness Scale. LIMITATIONS: A single-blind approach was used. DISCUSSION: The results showed that patients undergoing active intervention improved in domains related to executive functions, attention, memory, functioning and impulsivity more significantly than patients undergoing control interventions. This study adds to the evidence that CR improves neurocognition in BD, and suggests that CRIIT protocol represents an add-on intervention of potential relevance to increase cognition and functioning in BD euthymic patients.

Neurophysiological correlates of religious coping to stress: a preliminary EEG power spectra investigation.

Religious coping to psychological stress has been linked to positive outcomes on both physical and mental health, but no studies have explored its neurophysiological correlates. Ninety-six participants (43 men and 53 women, mean age: 22.30 ± 2.48 years) were enrolled in the present study; they underwent an evaluation of coping with the brief version of the Coping Orientation to Problems Experienced (brief-COPE) scale and performed an eyes-closed resting state electroencephalographic (EEG) recording. EEG analyses were conducted with the exact Low-Resolution Electromagnetic Tomography software (eLORETA). Positive correlations between religious coping and EEG activity were observed in the theta frequency band in the right hemisphere, specifically in the superior temporal, inferior frontal, and middle temporal gyri. Religious coping scores were significantly positively associated with active coping and positive reframing coping strategies, with the latter not being significantly associated with EEG data. Taken together our results contribute to increase the knowledge on the neurophysiological concomitants of religious coping to stress.