Reduced interoceptive accuracy in patients with obsessive-compulsive disorder: A case-control study.

According to traditional and recent literature, one of the core features of obsessive-compulsive disorder (OCD) is pathological doubt, defined as a lack of certitude or confidence in one's memory, attention, intuition, and perceptions. Recent studies have shown that uncertainty, amongst other cognitive and emotional processes, might be linked to an impairment in interoceptive abilities. Here we aimed to assess Interoceptive Accuracy (IA) in a population of OCD patients, and to determine whether alexithymia and symptoms of depression and anxiety would be associated with IA. We recruited 18 patients with OCD and 18 healthy controls (HC). Interoceptive accuracy was tested with the Heartbeat Counting Task. Participants also underwent a psychometric assessment for Obsessions and Compulsions (Y-BOCS), Alexithymia (TAS-20), Impulsivity (BIS-11), Anxiety and Depression (HAM-A and HAM-D). OCD patients had lower Interoceptive Accuracy than HC (p = 0.016) and presented more anxiety and depressive symptoms, along with more alexithymic features than HC. However, these psychological elements were not associated with the reduced IA. This study replicates previous findings and fits with the current literature investigating interoceptive abilities in patients with OCD, which might be used to design specific therapeutic interventions focused on internal bodily signals.

Emergently planned exclusive hub-and-spoke system in the epicenter of the first wave of COVID-19 pandemic in Italy: the experience of the largest COVID-19-free ICU hub for time-dependent diseases.

BACKGROUND: Lombardy was the epicenter in Italy of the first wave of COVID-19 pandemic. To face the contagion growth, from March 8 to May 8, 2020, a regional law redesigned the hub-and-spoke system for time-dependent diseases to better allocate resources for COVID-19 patients. METHODS: We report the reorganization of the major hospital in Lombardy during COVID-19 pandemic, including the rearrangement of its ICU beds to face COVID-19 pandemic and fulfill its role as extended hub for time-dependent diseases while preserving transplant activity. To highlight the impact of the emergently planned hub-and-spoke system, all patients admitted to a COVID-19-free ICU hub for trauma, neurosurgical emergencies and stroke during the two-month period were retrospectively collected and compared to 2019 cohort. Regional data on organ procurement was retrieved. Observed-to-expected (OE) in-ICU mortality ratios were computed to test the impact of the pandemic on patients affected by time-dependent diseases. RESULTS: Dynamic changes in ICU resource allocation occurred according to local COVID-19 epidemiology/trends of patients referred for time-dependent diseases. The absolute increase of admissions for trauma, neurosurgical emergencies and stroke was roughly two-fold. Patients referred to the hub were older and characterized by more severe conditions. An increase in crude mortality was observed, though OE ratios for in-ICU mortality were not statistically different when comparing 2020 vs. 2019. An increase in local organ procurement was observed, limiting the debacle of regional transplant activity. CONCLUSIONS: We described the effects of a regional emergently planned hub-and-spoke system for time-dependent diseases settled in the epicenter of COVID-19 pandemic in Italy.