The Modal Components of Judgements in a Quantum Model of Psychoanalytic Theory.

In the present paper, we develop a theory of thinking based on an attempt to formalize the construction of mental representations as described in psychoanalytic theory. In previous work, we described Freud's and Matte Blanco's structural Unconscious in a formal model in which the properties of unconscious representations are captured by particular sets-infinite singletons-that can be derived in first-order logic language. Here, we afford the issue of the finitization of unconscious representations by assuming that the mind can form an all-purpose modality, originating from abstraction from infinite singletons; in this way, a symmetric prelogical setting for mental representations is formally created, and this is interpreted in a quantum spin model by a modal (necessity) projector. Then, by introducing time, one can describe the links that mental representations can establish with reality, and hence finitize the representations. The modality is so split into finite components, here termed positive, negative and irreal; the splitting of the modality is traced back to the decomposition of the spin observables by means of the Pauli matrices, which can offer a quantum semantics to the method applied. Here, we suggest that the development of the modal approach and its quantum logic implementation can be considered as a proper formalization of some aspect of the psychoanalytic theory of thinking proposed by Bion; namely, we will show that the process of abstraction leading from raw data to preconceptions, and therefore to the definition of the content-container relationship, is adequately captured by our model, and further correspondences can be detected with Bion's theory about links and transformations, implying different ways in which the mind can get in touch with both internal and external reality.

Underestimated Needs for Lymphoma Patients: An Assessment Issue.

BACKGROUND AND AIM OF THE WORK: The aim of the current study was to explore under-considered psychosocial needs for lymphoma cancer group. A model of the role of psychosocial factors and Stressful Life Events was operationalized. METHOD: We used Discriminant Analysis to test predictive power of the model. 103 oncological patients (gender: 42.7 % vs 49.3 % of females 55.2 ±15.6 vs 53.7±14.9) were matched with 140healthy control groups in the study. The following instruments were utilized to conduct the study: the Florence Psychiatric Interview, Hospital Anxiety Depression Scale, Multidimensional Scale of Perceived Social Support, Beck Depression Inventory I, and Sense of Mastery. RESULTS: The model satisfied the assumption criteria and were significant (Ʌ= .665, χ2= 105.83, p< .001). CONCLUSION: Stressful events, depression and anxiety were adequate markers of the psychological status of lymphoma patients. Our results point out the relevance of taking into account psychosocial factors in hematology.

Subjective Response Measurement to Prosthesis or Device Use: Validation of the Prosthetic-Bionic Paradigm Questionnaire (PBP-Q).

Many subjects with somatic pathologies or traumas in their recent anamnesis tend to experience symptoms and changes to their daily life parameters after technically successful treatment. Hence, this study aims to validate an investigation tool inspired by the prosthetic-bionic paradigm-namely, the PBP-Q-which allows for the evaluation of variation in questions relating to identity, psychosociality, and psychopathology in relation to the use of a prosthesis or device. We gathered 118 participants (68 females and 50 males) aged between 27 and 94 years (Mean = 58.42 ± 15.17). We performed both exploratory (EFA) and confirmatory (CFA) factor analyses on this sample. Moreover, we calculated the internal consistency for the PBP-Q scales and the total score for the questionnaire's final 26-item and 5-factor versions. The five scales are psychological well-being; interpersonal relationships; professional relationships; autonomy and safety; addictions, compulsions, and obsessions. The internal consistency is good for both the total score and the subscales. In conclusion, overall, the PBP-Q has satisfactory psychometric properties, especially considering the measure's complexity. It provides a quick and effective way to evaluate the changes that might arise after the use of a prosthesis or device and, subsequently, has implications for clinical practice.

An Exploratory Study on the Effectiveness of Virtual Reality Analgesia for Children and Adolescents with Kidney Diseases Undergoing Venipuncture.

The current study evaluated the effectiveness of VR analgesia among pediatric and adolescent patients with kidney disease undergoing venipuncture. Patients at an Italian Children's hospital (N = 82, age range 7-17 years) undergoing venipuncture were randomly assigned to a No VR group (non-medical conversation) vs. a Yes VR group (VR analgesia). After the procedure, patients gave 0-10 Verbal Numeric Pain Scale ratings. Compared with patients in the No VR Group, patients in the Yes VR group reported significantly lower "Pain intensity"(No VR mean = 2.74, SD = 2.76 vs. Yes VR mean = 1.56, SD = 1.83) and the VR group also rated "Pain unpleasantness" significantly lower than the No VR group (No VR mean = 2.41, SD = 0.94 vs. Yes VR mean = 1.17, SD = 1.80). Patients distracted with VR also reported having significantly more fun during the venipuncture procedure. No side effects emerged. In addition to reducing pain intensity, VR has the potential to make venipuncture a more fun and less unpleasant experience for children with CKD, as measured in the present study for the first time. Finally, in exploratory analyses, children aged 7-11 in the VR group reported 55% lower worst pain than control subjects in the same age range, whereas children aged 12 to 17 in the VR group only reported 35% lower worst pain than control subjects. Additional research and development using more immersive VR is recommended.

Pre-operative anxiety management: What needs to be implemented?

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Assessing psychological needs in female cancer patients: a tailored model.

BACKGROUND AND AIM OF THE WORK: Psychosocial needs in cancer patients seem to be underestimated and undertreated. The present research was designed to explore under-considered psychosocial needs (e.g., stressful life events, perceived social support, sense of mastery and depressive/anxious symptoms) of a female cancer group. The aim of the study was to test an assessment psycho-oncological model for female cancer patients. An assessment model of psychosocial needs and Stressful Life Events was operationalized and tests its predictive power. METHODS: We used Discriminant Analysis to test predictive power of the model and of the single variables included in it. 236 oncological patients (mean age 55.50 ± 13.09) were matched with 232 healthy control groups in the study. The following instruments were chosen: the Florence Psychiatric Interview, Hospital Anxiety Depression Scale, Multidimensional Scale of Perceived Social Support, Beck Depression Inventory I, and Sense of Mastery. RESULTS: The model satisfied the assumption criteria and was significant (Ʌ= .680, X2 = 109.73, p< .001). CONCLUSIONS: Stressful events, depression and anxiety were adequate markers of the assessment psycho-oncological model proposed for female cancer patients. The present study provides contributions in a clinical perspective: the results support the relevance of considering an assessment psychosocial model to use in female oncology for an accurate estimation of the women's needs. Women affected by female cancer with an history of Stressful Early and Recent life events and high level of anxiety and depression could positively benefit from a psychotherapy treatment.

Development of a New Measure for Assessing Mentalizing: The Multidimensional Mentalizing Questionnaire (MMQ).

This research consists of two studies which aimed to: (1) evaluate the psychometric properties of a new self-report measure for the assessment of mentalizing, the Multidimensional Mentalizing Questionnaire (MMQ); and (2) investigate the ability of the instrument to discriminate between community and clinical populations. A sample of 349 participants (19% male, 81% female; Mage = 38.6, SD = 15.3) filled in the MMQ and other self-report measures, in order to assess the factor structure, reliability and some aspects of construct validity of the measure. Then, a clinical sample (N = 46; 52% male and 48% female; Mage = 33.33, SD = 12.257) and a community one (N = 50; 42% male and 58% female; Mage = 38.86, SD = 16.008) filled in the MMQ, to assess its clinical sensitivity. The factorial analysis identified six principal dimensions of the measure: reflexivity, ego-strength, relational attunement, relational discomfort, distrust, and emotional dyscontrol. The MMQ showed satisfactory psychometric properties and a theoretically relevant factor structure. Furthermore, significantly greater impairment in mentalizing was found in the clinical sample in respect of the community one. The findings are discussed in terms of clinical implications, emphasizing the usefulness of the MMQ in both research and clinical practice.

Psychological Needs and Resources of the Staff in a Pediatric Neurosurgery Ward: A Phenomenological-Hermeneutic Study.

Brain tumors are a common form of solid tumors in children and, unfortunately, they are characterized by a very uncertain prognosis. The treatment of this pathology often includes one or more very invasive surgical procedures, quite often in the very first steps of the treatment. Cases of brain tumors in children represent one of the greatest challenges for health care professionals in the domain of pediatric neurosurgery. This is clearly due to the complexity of the therapeutic plan, but also to the nature of the bond that is established between the child, the parents, and the members of the staff during the often-dramatic initial phase of the illness. In this phenomenological-hermeneutic study, we explore both the emotional and organizational needs, as well as the available professional and personal resources of the staff in the Neurosurgery ward of the Meyer Children's Hospital in Florence (Italy). The ward staff, composed of 7 surgeons, a pediatric neuro-oncologist, 12 nurses, and 4 auxiliary health care professionals, underwent in-depth interviews that were recorded (with the consensus of the participants). The recordings were then transcribed and submitted to content analysis according to COREQ standards. A complex picture of emotional as well as organizational demands emerged from the data. Shared experiences were pointed out, together with more specific and idiosyncratic contents characteristic of different professional roles. The focus of the present paper was twofold, first, we considered the needs that are overtly expressed by the staff, and then we discussed the main sources of their motivational drives. We found that the latter is mainly found in the quality of the therapeutic bond that is established with the children and the family members, together with the deep interest in one's own professional activity and the effective complementarity and integration of the personal and professional qualities of the staff members within the multidisciplinary caring group.

Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review.

A maladaptive response to surgical stress might lead to postoperative complications. A multidisciplinary approach aimed at controlling the surgical stress response may reduce procedural complications and improve patients' quality of life in the short and long term. Several studies suggest that psychological interventions may interact with the pathophysiology of surgical stress response, potentially influencing wound repair, innate and adaptive immunity, inflammation, perception of pain, and patients' mood. The aim of this systematic review is to summarise the effects of perioperative psychological interventions on surgical pain and/or anxiety in adult patients scheduled for elective general abdominal and/or urologic surgery.We conducted a systematic review of controlled clinical trials and observational studies involving psychological interventions for adult patients scheduled for elective general abdominal and/or urologic surgery. Only studies reporting pain and/or anxiety among outcome measures were included in the systematic review. The following psychological interventions were considered: (1) relaxation techniques, (2) cognitive-behavioural therapies, (3) mindfulness, (4) narrative medicine, (5) hypnosis and (6) coping strategies.We examined 2174 papers. Among these, 9 studies were considered eligible for inclusion in this systematic review (1126 patients cumulatively): 8 are randomised controlled trials and 1 is an observational prospective pre/post study.Psychological characteristics widely influence the pathophysiological mechanisms underlying the neuroendocrine and inflammatory response to surgical stress, potentially interfering with surgical outcomes. Psychological interventions are technically feasible and realistically applicable perioperatively during abdominal and/or urologic surgery; they influence the pathophysiological mechanisms underlying maladaptive surgical stress response and might have positive effects on patients' surgical outcomes, such as pain and anxiety.

Assessment of depression symptoms in female cancer patients: focus on concurrent validity.

BACKGROUND AND AIM OF THE WORK: The present research explores Concurrent Validity of two depression measures the Beck Depression Inventory (BDI) and the Depression Subscale of the Hospital Anxiety and Depression Scale (HADS- Depression subscale) in specific oncological groups (female cancer and onco-hematological patients). METHOD: A correlational study was designed and took place at Careggi Universitary Hospital in Florence, including 339 oncological patients, in particular 103 (59 Women and 44 men) patients suffering from lymphoma, and 236 patients suffering from female cancer. We estimated, by Pearson's r, Concurrent Validity between BDI and HADS depression's subscale. RESULTS: Correlations failed to reach the 0.55 cut-off in the female cancer group (r=.34, p<.001) but not in the onco-hematological patients (r= 0.56, p<.001). CONCLUSION: The results stressing the need to develop and validate assessing tools that are specifically devoted to different groups of oncological patients. (www.actabiomedica.it).

Construct validity of the Amsterdam Preoperative Anxiety and Information Scale (Italian Version) in women undergoing breast biopsy: a brief research report.

The goal of this paper was to test Construct Validity of the Amsterdam Preoperative Anxiety and Information Scale (Italian Version) in women undergoing Breast Biopsy. To answer this purpose we have utilized Exploratory Factor Analysis (EFA) in a sample of 80 women undergoing Breast Biopsy at the Breast Unit of the Careggi University Hospital in Florence from January to February 2015. Overall the results support the construct validity of the Italian version of the APAIS for the population of women undergoing Breast Biopsy suggesting that the Italian version of APAIS can be useful to detect this clinically very relevant dimension.

Virtual Reality Analgesia for Pediatric Dental Patients.

Background: Dental procedures often elicit pain and fear in pediatric dental patients. Aim: To evaluate the feasibility and effectiveness of immersive virtual reality as an attention distraction analgesia technique for pain management in children and adolescents undergoing painful dental procedures. Design: Using a within-subjects design, five patients (mean age 13.20 years old, SD 2.39) participated. Patients received tethered immersive interactive virtual reality distraction in an Oculus Rift VR helmet (experimental condition) during one dental procedure (a single dental filling or tooth extraction). On a different visit to the same dentist (e.g., 1 week later), each patient also received a comparable dental procedure during the control condition "treatment as usual" (treatment order randomized). After each procedure, children self-rated their "worst pain," "pain unpleasantness," "time spent thinking about pain," "presence in VR," "fun," and "nausea" levels during the dental procedures, using graphic rating scales. Results: Patients reported significantly lower "worst pain" and "pain unpleasantness," and had significantly more fun during VR, compared to a comparable dental procedure with No VR. Using Oculus Rift VR goggles, patients reported a "strong sense of going inside the computer-generated world," without side effects. The dentist preferred having the patients in VR. Conclusion: Results of this pilot study provide preliminary evidence of the feasibility of using immersive, interactive VR to distract pediatric dental patients and increase fun of children during dental procedures.

Virtual Reality Analgesia During Venipuncture in Pediatric Patients With Onco-Hematological Diseases.

Background: Venipuncture is described by children as one of the most painful and frightening medical procedures. Objective: To evaluate the effectiveness of Virtual Reality (VR) as a distraction technique to help control pain in children and adolescents undergoing venipuncture. Methods: Using a within-subjects design, fifteen patients (mean age 10.92, SD = 2.64) suffering from oncological or hematological diseases received one venipuncture with "No VR" and one venipuncture with "Yes VR" on two separate days (treatment order randomized). "Time spent thinking about pain", "Pain Unpleasantness", "Worst pain" the quality of VR experience, fun during the venipuncture and nausea were measured. Results: During VR, patients reported significant reductions in "Time spent thinking about pain," "Pain unpleasantness," and "Worst pain". Patients also reported significantly more fun during VR, and reported a "Strong sense of going inside the computer-generated world" during VR. No side effects were reported. Conclusion: VR can be considered an effective distraction technique for children and adolescents' pain management during venipuncture. Moreover, VR may elicit positive emotions, more than traditional distraction techniques. This could help patients cope with venipuncture in a non-stressful manner. Additional research and development is needed.

Metastable structures and size effects in small group dynamics.

In his seminal works on group dynamics Bion defined a specific therapeutic setting allowing psychoanalytic observations on group phenomena. In describing the setting he proposed that the group was where his voice arrived. This physical limit was later made operative by assuming that the natural dimension of a therapeutic group is around 12 people. Bion introduced a theory of the group aspects of the mind in which proto-mental individual states spontaneously evolve into shared psychological states that are characterized by a series of features: (1) they emerge as a consequence of the natural tendency of (both conscious and unconscious) emotions to combine into structured group patterns; (2) they have a certain degree of stability in time; (3) they tend to alternate so that the dissolution of one is rapidly followed by the emergence of another; (4) they can be described in qualitative terms according to the nature of the emotional mix that dominates the state, in structural terms by a kind of typical "leadership" pattern, and in "cognitive" terms by a set of implicit expectations that are helpful in explaining the group behavior (i.e., the group behaves "as if" it was assuming that). Here we adopt a formal approach derived from Socio-physics in order to explore some of the structural and dynamic properties of this small group dynamics. We will described data from an analytic DS model simulating small group interactions of agents endowed with a very simplified emotional and cognitive dynamic in order to assess the following main points: (1) are metastable collective states allowed to emerge in the model and if so, under which conditions in the parameter space? (2) can these states be differentiated in structural terms? (3) to what extent are the emergent dynamic features of the systems dependent of the system size? We will finally discuss possible future applications of the quantitative descriptions of the interaction structure in the small group clinical setting.

The perspective of the nursing staff on terminal sedation in pediatric onco-hematology: a phenomenologic-hermeneutic study.

OBJECTIVE: The study was designed to explore the subjective perspective on end-of-life practices in three different groups of pediatric onco-hematologic nurses. METHOD: In 2004-2005 each member of the nursing staff of the Pediatric Onco-Hematology Ward of the University of Padua, Italy, and the Oncology Ward and Home Assistance Module of the Giannetta Gaslini Hospital, Genoa, Italy was interviewed using a semistructured questionnaire with open questions on end-of-life procedures. The results were returned to the interviewees through group meetings. Here, we examine replies given regarding terminal sedation. RESULTS: With regard to the nurses from Padua, common features came together in a consolidated practice. The amount of suffering and physical pain was considered an element in determining the use of sedation: "when there is atrocious suffering." Another aspect was "painful awareness," the difficulty in being able to bear the fact that the child is aware that death is imminent. The nurses from Genoa stated that the procedure was adopted mainly for three reasons: to sedate the pain, to calm the hunger for air, and to control the anguish caused by the realization that death was imminent or unavoidable. It was noted that the nursing staff of the Home Assistance Unit, Genoa found themselves in a privileged position regarding this procedure both because of the strong relationship established among child, parents, and nurse, and because of being able to take shared decisions after in-depth discussion. SIGNIFICANCE OF RESULTS: The results enlighten the critical role of the nursing staff with respect to this procedure, given the involvement with the families and their ability to understand the child's demands and intimate expectations.

Lack of strategy holding: a new pattern of learning deficit in cortical dementias.

The aim of this study was to demonstrate, by means of systematic research and qualitative data analysis, the presence, among a group of patients with fronto-temporal lobar degeneration of a subgroup that, at variance with the standard pattern, is able to devise and implement learning strategies, but appear impaired at carrying them on from a trial to the next. In order to provide evidence of the existence of a group of patients showing this type of learning disability, that we refer to as lack of strategy holding, we performed a stepwise hierarchical cluster analysis of a set of variables whose scores were selected from the subject's performance at the Test de Aprendizaje Verbal España-Complutense. Results substantiate the segregation of three groups of subjects characterized by the following patterns of performance: normal elderly individuals, who show a quite preserved ability to discover a semantic strategy along the learning trials and to carry it from a trial to the next, patients presenting with a deficit in implementing semantic learning strategies and possibly use of serial and/or phonological strategies to perform the task, and to patients who, although able to generate and implement appropriate learning strategies, appear unable to carry them over the learning trials. The presence of this new pattern raises a few questions that seem worth trying to address.

Differential impact of brain damage on the access mode to memory representations: an information theoretic approach.

Different access modes to information stored in long-term memory can lead to different distributions of errors in classification tasks. We have designed a famous faces memory classification task that allows for the extraction of a measure of metric content, an index of the relevance of semantic cues for classification performance. High levels of metric content are indicative of a relatively preferred semantic access mode, while low levels, and similar correct performance, suggest a preferential episodic access mode. Compared with normal controls, the metric content index was increased in patients with Alzheimer's disease (AD), decreased in patients with herpes simplex encephalitis, and unvaried in patients with insult in the prefrontal cortex. Moreover, the metric content index was found to correlate with a measure of the severity of dementia in patients with AD, and to track the progression of the disease. These results underline the role of the medial-temporal lobes and of the temporal cortex, respectively, for the episodic and semantic routes to memory retrieval. Moreover, they confirm the reliability of information theoretic measures for characterizing the structure of the surviving memory representations in memory-impaired patient populations.

Dissociating episodic from semantic access mode by mutual information measures: evidence from aging and Alzheimer's disease.

Re-thinking the semantic vs. episodic distinction with new experimental paradigms, we have designed a simple classification task to assess episodic and semantic access modes to memory for famous faces. The task requires to post 54 cards into nine mail boxes arranged in a 3x3 (nationality by field of activity) array, allowing for a quantitative analysis of the distribution of their responses, in particular of their classification errors. By using an information theoretical approach, we have developed an index of the concentration of errors, i.e. the metric content index. High levels of metric content indicate strong dependence of the classification performance on perceived relations among the set of stimuli, and therefore a preferred semantic access mode. We have found (1) a significant effect of age on the metric content, indicative of a shift from episodic to semantic access in older subjects (Experiment 1); (2) a significant correlation between the metric content and relevant measures assessing episodic and semantic retrieval mode in the Remember (R)/Know (K) paradigm introduced by Tulving [Tulving, E. 1985. Memory and consciousness. Can. Psychol. 26, 1-12] (Experiment 2); (3) a significant increase in metric content in early Alzheimer's disease patients compared to normal controls, consistent with their specific impairment in episodic access (Experiment 3).

Agnosia for global patterns: When the cross-talk between grouping and visual selective attention failS.

We present a single case study of a 72-year-old mild AD patient, MC, with a highly specific deficit in deriving the global pattern of visual stimuli, in the absence of visuospatial neglect. MC shows a specific difficulty in segregating overlapping figures, in object decision, and in all neuropsychological tasks requiring perception of a global structure from local cues, such as the Street Completion Test and the perception of illusory contours and of the global level of hierarchical stimuli. The detailed neuropsychological assessment prompted a psychophysical experiment aiming to quantify the limits of perceptual grouping in MC. We measured the thresholds of integration for a closed chain of Gabor Patches as a function of background noise using stimuli with different values of the distance between the local elements. When compared to normal controls, the patient displays a statistically significant drop of performance for stimuli with the larger interelement distance. The data are interpreted in the context of the "association field" theory (Field, Hayes, & Hess, 1993). As MC presents with a marked atrophy of the right temporoparietal junction, we interpret our data as providing further evidence of a neuromodulatory role of the right temporoparietal junction over the occipital cortices, in line with recent functional evidence (Fink et al., 1997a). The study also highlights the benefits of complementing classical neuropsychological investigations with more quantitative psychophysical procedures.