Parallel process as a tool for supervision and therapy: A cognitive behavioral and schema therapy perspective.

INTRODUCTION: The parallel process is a psychosocial phenomenon where the relationship dynamics between the therapist and the client are repeated in the supervisory relationship between the therapist and the supervisor. The concept of the parallel process can be a useful tool for understanding and solving problems in therapy. However, it can induce supervision drift or block the supervision process. OBJECTIVE: This article aims to familiarize the reader with parallel processes in cognitive-behavioural therapy (CBT) and schema therapy supervision and discuss how to manage this phenomenon in supervision. METHOD: This article is a narrative review with illustrations of supervision interviews in which the parallel process unfolds. The text provides an overview of theoretical constructions and empirical studies related to the parallel process. We searched PubMed, PsycINFO, Web of Science, and Google Scholar for relevant resources using the keywords "parallel process," "cognitive behavioural therapy," "schema therapy," "transference," and "countertransference." Case vignettes were collected from trainees, training leaders and supervisors to provide real-life examples of how self-reflection and self-experience can enhance CBT and schema therapy training, practice, and supervision.

The river of life method in a schema therapy groups.

Schema therapy is an integrative approach to treat patients with personality disorders and other complex psychological problems. Group schema therapy has been developed to enhance the effectiveness and efficiency of schema therapy by providing a supportive and stimulating environment for change. This article introduces the River of Life Method, a novel technique for facilitating group schema therapy, based on the metaphor of a river of life. The method helps patients to identify and modify their maladaptive schemas and modes in a nurturing process in the group. The article describes the theoretical background, the practical steps, and the clinical applications of the method. It also presents the patients' experience with the method, based on their feedback and self-reports. The results showed that the method was well received by both patients and therapists, and that it had positive effects on schema modes, psychological distress, and coping with adversities and hope for the future.

Exploring self-care within the context of cognitive behavioural therapy and supervision.

This article emphasizes the critical role of self-care in the professional lives of cognitive behavioural therapy (CBT) therapists and supervisors. It delves into the importance of self-care, elucidating its significance in maintaining therapists' mental health and effectiveness. The article presents a range of practical strategies that promote self-care, providing therapists and supervisors with specific steps to incorporate self-care into their daily routines. Moreover, the article explores common challenges and barriers to self-care, such as a lack of time, feelings of guilt associated with prioritizing one's needs, and a lack of available resources for self-care. The article aims to deepen our understanding of the complexities of practising self-care by shedding light on possible obstacles. In addition, the article includes case vignettes that demonstrate tangible examples of the positive impact of self-care on therapists' mental health and effectiveness. The overarching goal of this article is to encourage ongoing discussion and research on self-care. It advocates a greater emphasis on self-care in CBT and CBT supervision (CBTS), intending to promote the health and well-being of those who dedicate their lives to caring for others. The insights and strategies presented in this article serve as a resource for therapists and supervisors striving to achieve a balanced lifestyle while effectively catering to the needs of their clients.

Problematic internet use during the COVID-19 pandemic: A systematic review and meta-analysis of prevalence data.

AIMS: This study sought to synthesize prevalence rates of problematic internet use (PIU) during the COVID-19 pandemic in the general adult (age over 18 years old) population and to investigate its possible moderators. METHODS: A preregistered systematic literature review using the PubMed/MEDLINE, EBSCOhost/PsycINFO, Web of Science, Cochrane Library, GSK Clinical Study Register, and ClinicalTrials.gov databases was conducted. Research was completed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. RESULTS: A total of 22 publications were identified, fulfilling inclusion criteria from a total of 595 studies. The analysis revealed that the prevalence of PIU during the COVID-19 pandemic period was 25%, however applying a stringent threshold for the PIU, resulted in a much lower prevalence of 7.9%. CONCLUSION: The PIU prevalence rate during the COVID-19 pandemic in the general population was 7.9%. Measuring the prevalence of PIU remains complicated due to the large methodological and cultural diversity that exists, so global prevalence estimates of PIU vary substantially. More methodologically sound research on psychodiagnostic assessment and cultural variances is required. (Neuropsychopharmacol Hung 2023; 25(3): 131-141) Keywords: COVID-19; internet addiction; problematic usage of the internet; prevalence; systematic review, meta-analysis Systematic review registration: PROSPERO registration number: CRD42021284619.

Psychophysiological responses to psychological stress exposure and neural correlates in adults with mental disorders: a scoping review.

Introduction: The dysregulation of psychophysiological responses to mental stressors is a common issue addressed in individuals with psychiatric conditions, while brain circuit abnormalities are often associated with psychiatric conditions and their manifestations. However, to our knowledge, there is no systematic overview that would comprehensively synthesize the literature on psychophysiological responses during laboratory-induced psychosocial stressor and neural correlates in people with mental disorders. Thus, we aimed to systematically review the existing research on psychophysiological response during laboratory-induced stress and its relationship with neural correlates as measured by magnetic resonance imaging techniques in mental disorders. Methods: The systematic search was performed on PubMed/Medline, EBSCOhost/PsycArticles, Web of Science, and The Cochrane Library databases during November 2021 following the PRISMA guidelines. Risk of bias was evaluated by employing the checklists for cross-sectional and case-control studies from Joanna Briggs Institute (JBI) Reviewers Manual. Results: Out of 353 de-duplicated publications identified, six studies were included in this review. These studies were identified as representing two research themes: (1) brain anatomy and psychophysiological response to mental stress in individuals with mental disorders, and (2) brain activity and psychophysiological response to mental stress in individuals with mental disorders. Conclusions: Overall, the evidence from studies exploring the interplay between stress psychophysiology and neural correlates in mental disorders is limited and heterogeneous. Further studies are warranted to better understand the mechanisms of how psychophysiological stress markers interplay with neural correlates in manifestation and progression of psychiatric illnesses.

Problems in Cognitive-Behavioral Supervision: Theoretical Background and Clinical Application.

Cognitive-behavioural therapists and trainees are encouraged to undergo supervision when offering therapy to troubled clients and to process personal attitudes and events likely to affect their therapeutic work. We discuss common problems in cognitive behavioural therapy (CBT) supervision, which may arise at the client, supervisee, or supervisor level. These issues include difficulties with case formulation, therapeutic strategies, and the therapeutic relationship. A supervisor can help their supervisee deal with clients with multifaceted or particularly challenging problems, such as difficulties with compliance, complex psychosocial problems, or chronic mental disorders. We also discuss matters related to the supervision process, the supervisor's role, different supervisory styles, and issues affecting a supervisee's feelings of vulnerability and shame. Furthermore, we analyze distinct supervision styles and potential problems arising from the supervision of experienced CBT therapists.

Validation of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 in Lithuanian individuals with anxiety and mood disorders.

The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) are short self-report questionnaires used to screen and assess depression and anxiety severity in medical and community samples. However, little is known about their psychometric properties in individuals with anxiety and mood disorders (AMD) This study evaluated the psychometric properties of the PHQ-9 and GAD-7 in individuals with AMD. Individuals (n = 244, mean age 39.9 ± 12.3 years) with AMD completed the PHQ-9, GAD-7, as well as other measures of depression, anxiety, and a structured diagnostic interview. The PHQ-9 and GAD-7 demonstrated good internal consistency (Cronbach's alpha 0.87 and 0.84, respectively). The PHQ-9 and GAD-7 showed a weak correlation with clinician-rated scales HAM-D and HAM-A (r = 0.316, p < 0.01, r = 0.307, p < 0.01, respectively). For the PHQ-9, a cut score of ≥11 resulted in 72% sensitivity and 72% specificity at recognizing depression symptoms. For the GAD-7, a cut score ≥7 resulted in 73% sensitivity and 54% specificity at recognizing any anxiety disorders. The confirmatory factor analysis suggested a two-factor structure ("cognitive/affectional", "somatic") for both the PHQ-9 and GAD-7. In conclusion, the PHQ-9 and GAD-7 have adequate formal psychometric properties as severity measures for symptoms of anxiety and depression in individuals with AMD. The PHQ-9 performs well as a screener using a cut score of ≥11. However, the clinical utility of the GAD-7 as a diagnostic tool for recognition of anxiety disorders is limited.

Mental fatigue in individuals with psychiatric disorders: a scoping review.

OBJECTIVE: The aim of this study was to complete a scoping review of the published literature describing the relationship between mental fatigue and various psychiatric disorders, to better understand its frequency and clinical impact, and to provide recommendations for future clinical research. METHODS: A scoping review using PubMed/MEDLINE, Cochrane and PsychArticles databases was conducted using the keywords 'mental fatigue', 'mental tiredness' or 'mental exhaustion', and completed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews 2018 checklist. RESULTS: We extracted 10 studies fulfilling our inclusion criteria from a total of 2937 publications. Mental fatigue was studied within mood disorders, anxiety disorders, obsessive compulsive disorder and obsessive-compulsive personality disorder. A commonly used tool to measure mental fatigue in these samples was the Multidimensional Fatigue Inventory-20. Specific cognitive factors (unhelpful beliefs about sleep, symptom-focussed rumination) and personality risk factors (harm avoidance, self-directedness, cooperativeness, persistence) were relevant to predicting mental fatigue symptoms and rates of mental fatigue may vary with gender and diagnosis. CONCLUSION: Research into mental fatigue in adult psychiatric sample was limited to a few psychiatric disorders and requires further investigation.Key pointsA commonly used tool to measure mental fatigue was the Multidimensional Fatigue Inventory-20. However, more research into the validity and reliability for illness specific instruments to measure mental fatigue in psychiatric population is required.Reduction of mental fatigue was associated with improvement on quality of life.Specific cognitive factors (unhelpful beliefs about sleep, symptom-focussed rumination) and personality risk factors (harm avoidance, self-directedness, cooperativeness, persistence) were relevant to predicting mental fatigue symptoms and rates of mental fatigue may vary with gender.Reviewed articles indicated that mental fatigue presence was associated with lower odds of OCD. In addition, the results suggested that mental fatigue symptoms were more common in individuals with OCPD rather than OCD.Research into mental fatigue in adult psychiatric sample was limited to a few psychiatric disorders and requires further investigation to prevent potential misattribution as mental fatigue symptoms overlap between different psychiatric disorders.

Cortisol response to psychosocial stress, mental distress, fatigue and quality of life in coronary artery disease patients.

We aimed to explore the relationship between cortisol response to psychosocial stress, mental distress, fatigue and health related quality of life (HRQoL) in individuals with coronary artery disease (CAD) after recent acute coronary syndrome (ACS). A cross-sectional study initially included 113 subjects (88% men, 53 ± 7 years) 1-3 weeks after ACS. Cortisol response was assessed by measuring salivary cortisol during Trier Social Stress Test. Mental distress was measured with Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory, and Type D Scale-14. Fatigue symptoms were evaluated using Multidimensional Fatigue Inventory 20-items, while HRQoL was assessed with 36-Item Short Form Medical Outcome Questionnaire. After conducting multivariable linear regression analyses, diminished cortisol response sampled after Public speech (T3-T1, + 15 min) was significantly associated with higher anxiety symptoms (ß = -0.224; p = 0.035), while diminished cortisol response sampled after preparation time (T2-T1, + 10 min) was significantly linked with the presence of Type D personality (ß = -0.290; p = 0.006; ß = -0.282; p = 0.008 respectively), even after controlling for confounders (i.e., sex, age, education, New York Heart Association functional class, beta-blockers and baseline levels of cortisol measures). We found that mental distress, but not fatigue and HRQoL, was linked with blunted cortisol response during anticipation time of psychosocial stress, independently of potential covariates.

Contribution of Obstructive Sleep Apnoea to Cognitive Functioning of Males With Coronary Artery Disease: A Relationship With Endocrine and Inflammatory Biomarkers.

Introduction: Our exploratory study aimed to determine whether obstructive sleep apnoea (OSA) could affect cognitive functioning in males with coronary artery disease (CAD), and whether such impact could be associated with changes in thyroid hormones and inflammatory marker regulation on cognitive functioning. Method: We evaluated different endocrine and inflammatory biomarkers, including free triiodothyronine [fT3], free tetraiodothyronine [fT4], N-terminal pro-B-type natriuretic peptide [NT-pro-BNP], and high-sensitivity C-reactive protein [hs-CRP] serum levels in 328 males ( x ¯ = 57 ± 10 years), undergoing cardiac rehabilitation after an acute coronary event. Participants underwent full-night polysomnography and were classified in mild/non-OSA (n = 253) and OSA (n = 75) according to an apnoea-hypopnoea index ≥ 15 event/h. Cognitive functioning testing included the Digit Span Test, Digit Symbol Test (DSST), and Trail Making Test. Analyses of variance assessed the impact of OSA on cognitive functioning and possible relationships of fT3/fT4, NT-pro-BNP and with hs-CRP on cognitive measures. Results: Significant group (OSA, mild/non-OSA) × NT-pro-BNP (<157.0 vs. ≥157.0, ng/L) interactions were found for the DSST raw score (F (2,324) = 3.58, p = 0.014). Decomposition of interactions showed that the DSST scores of the OSA group with NT-pro-BNP ≥ 157.0 ng/L (M = 33.2; SD = 8.1) were significantly lower, p = 0.031, than those of the mild/non-OSA with NT-pro-BNP < 157.0 ng/L (M = 37.7; SD = 8.9). Conclusion: These findings indicate that males with OSA and clinically elevated NT-pro-BNP levels experienced inferior psychomotor performance compared to those without OSA and reduced NT-pro-BNP levels.

Efficacy and tolerability of pharmacotherapy for obsessive-compulsive personality disorder: a systematic review of randomized controlled trials.

INTRODUCTION: Although obsessive-compulsive personality disorder (OCPD) is one of the most prevalent personality disorders, it is one of the least studied. There is debate as to whether pharmacotherapy is efficacious for OCPD. We aimed to systematically evaluate the efficacy and tolerability of pharmacotherapy for OCPD. AREAS COVERED: This systematic review found two randomized controlled trials investigating pharmacotherapy of OCPD. In a study of major depression (n = 308) with comorbid OCPD (n = 71), citalopram was more effective for OCPD than sertraline with fewer drop-outs from treatment. In a small study of OCPD (n = 24), fluvoxamine was more effective than placebo, and there was a low drop-out rate. Risk of bias and quality assessment of these studies was not possible, and findings have very low levels of certainty. EXPERT OPINION: Two studies provide preliminary evidence in support of citalopram and fluvoxamine for OCPD. Further randomized controlled trials are required before firm conclusions can be drawn regarding efficacy of pharmacotherapy for OCPD.

Prevalence of problematic Internet use during the coronavirus disease 2019 pandemic.

The present paper reviews recent studies on problematic Internet use (PIU) prevalence before and during the coronavirus disease 2019 (COVID-19) pandemic. Several pre-pandemic meta-analyses reported PIU prevalence estimates ranging from 6% to 9.7%. Experts in the field of online addictions speculated that PIU would increase during the pandemic because of increased time spent on the Internet. However, it is still unclear if increased time on the Internet resulted in higher PIU prevalence estimates during the pandemic. Prevalence estimates differed greatly across studies during the COVID-19 pandemic. Possible inconsistencies are outlined together with future directions for PIU prevalence studies.

Validation of the patient health questionnaire-9 and the generalized anxiety disorder-7 in Lithuanian student sample.

BACKGROUND: The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Questionnaire- 7 (GAD-7) are short screening instruments used for detection of depression and anxiety symptoms in various settings, including general and mental health care as well as the general population. The aim of this study is to evaluate psychometric properties and factorial structure of the PHQ-9 and the GAD-7 in a sample of Lithuanian university students. METHODS: 1368 students (mean age 22.5±4.8) completed the PHQ-9 and the GAD-7 questionnaires online; after the completion of the survey, students were asked to provide phone contact for an additional interview. Eligible students were approached later by trained interviewers and completed The Clinical Interview Schedule-Revised for assessment of depressive and anxiety disorders. RESULTS: Results showed that the PHQ-9 and the GAD-7 are reliable screening tools for depression and anxiety (Cronbach alpha 0.86 and 0.91, respectively). The one-factor structure of the PHQ-9 and the GAD-7 was confirmed by the Confirmatory Factor Analysis. A cut-off of ≥10 for the PHQ-9 resulted in 71% sensitivity and 66% specificity recognizing students with increased risk for mood or anxiety disorder. For the GAD-7, a cut-off ≥9 resulted in 73% sensitivity and 70% specificity recognizing students at risk. The PHQ-9 was sensitive but not specific in recognizing students with depressive disorders. The sensitivity and specificity of the GAD-7 in differentiating students with generalized anxiety disorders were low. CONCLUSIONS: The PHQ-9 and the GAD-7 have sufficient formal psychometric properties, but their clinical utility as diagnostic tools for recognition of depressive and anxiety disorders in students is limited. Due to low specificity and high false positive rates, both scales are recommended only as an initial screening tool for recognition of subjects with increased risk of mental disorders, however positive cases should be later assessed using more comprehensive instruments.

Predictive value of baseline cognitive functioning on health-related quality of life in individuals with coronary artery disease: a 5-year longitudinal study.

AIMS: Emerging studies suggest an association exists between coronary artery disease (CAD) and the development of neurodegenerative diseases, with CAD acting as a precursor. Our study aimed to investigate the relationship between baseline measures of cognitive functioning and long-term health-related quality of life (HRQoL) in individuals with CAD with specification to Type D personality traits and sex. METHODS AND RESULTS: This prospective observational cohort study consisted of 864 participants (mean age 58 SD = 9 years, 74.0% men) with CAD after acute coronary syndrome. Baseline characteristics included comprehensive cognitive testing, measures of sociodemographic and clinical factors, and psychological assessment scales, such as Type D personality scale and the Hospital Anxiety and Depression scale. The Minnesota Living with Heart Failure Questionnaire assessed participants' HRQoL, conducted through phone interviews at baseline, every 6 months for up to 2 years, and after 5 years. Cognitive functioning correlated with HRQoL at all time intervals over the 5-year follow-up. Regarding sex and Type D personality, significant differences emerged in associations between impaired cognitive functioning at baseline and HRQoL measured over the period of 5 years. Men participants with characteristics of Type D personality were especially vulnerable to impaired cognitive functioning affecting the 5-year quality of life. CONCLUSION: Men with CAD who obtained scores indicating characteristics of Type D personality were significantly more likely to have lower baseline cognitive functions and long-term HRQoL outcomes. This information could inform healthcare practitioners to screen for personality characteristics and closely follow-up those at a greater risk.

Fatigue, Social Support, and Depression in Individuals With Coronary Artery Disease.

Background: Given that approximately one-third of individuals with coronary artery disease (CAD) remain severely fatigued after completion the cardiac rehabilitation, it is necessary to identify reliable intervention targets aimed at reducing fatigue. Perceived social support is closely linked to health outcomes and depressive symptoms in individuals with CAD. However, to our knowledge, the relationship between subjective fatigue levels and social support in those with CAD has not been analyzed. Objective: We aimed to examine the associations between perceived social support and subjective fatigue levels in individuals with CAD with and without depression symptoms. Methods: This cross-sectional study was comprised of 1,036 participants with CAD (57±9years, 77% men) 1-2weeks after acute coronary syndrome (ACS). Participants completed the Hospital Anxiety and Depression scale (HADS), Multidimensional Fatigue Inventory-20 (MFI-20), and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: In total, 12% (n=129) of study participants had elevated depression symptoms (HADS score≥8). In individuals with CAD and depressive symptoms, after adjustment for sex, age, New York Heart Association (NYHA) functional class, and anxiety, linear regression analyses showed significant inverse associations between higher social support from others and general, physical fatigue as well as reduced activity and motivation (p<0.001). Following the same method of statistical analysis and control in non-depressed individuals with CAD (88%), social support from family was inversely linked to mental fatigue (p's<0.05). Similarly, social support from friends was significantly associated with lower general, physical, and mental fatigue as well as reduced activity, while social support from others was significantly associated with lower general and mental fatigue (p's<0.001). The overall higher total support was linked with reduced motivation (p<0.05) in the depressed study participants, while there was lower general and mental fatigue (p<0.05) in non-depressed individuals. Conclusion: The results of this study suggest that fatigue and its features could be associated by the perceived social support in individuals with CAD following ACSs. While in individuals with CAD and depressive symptoms, greater subjective fatigue is associated with less perceived social support from others, higher levels of subjective fatigue in non-depressed individuals with CAD are significantly associated with reduced perceived social support from friends.

Fatigue Is Associated With Diminished Cardiovascular Response to Anticipatory Stress in Patients With Coronary Artery Disease.

BACKGROUND: Fatigue and psychophysiological reactions to mental stress are known to be problematic in coronary artery disease (CAD) patients. Currently, studies exploring the relationship between fatigue and cardiovascular reactivity to stress are scarce and inconsistent. The current study aimed to investigate the links between cardiovascular response to mental stress and fatigue in CAD patients after acute coronary syndrome (ACS). METHODS: The cross-sectional study investigated 142 CAD patients (85% males, 52 ± 8 years) within 2-3 weeks after recent myocardial infarction or unstable angina pectoris. Fatigue symptoms were measured using Multidimensional Fatigue Inventory 20-items, while cardiovascular reactivity to stress [i.e., systolic (S) and diastolic (D) blood pressure (ΔBP), and heart rate (ΔHR)] was evaluated during Trier Social Stress Test (TSST). In addition, participants completed psychometric measures, including the Hospital Anxiety and Depression scale and the Type D Scale-14. Multivariable linear regression analyses were completed to evaluate associations between fatigue and cardiovascular response to TSST, while controlling for confounders. RESULTS: After controlling for baseline levels of cardiovascular measures, age, gender, education, heart failure severity, arterial hypertension, smoking history, use of nitrates, anxiety and depressive symptoms, Type D Personality, perceived task difficulty, and perceived task efforts, cardiovascular reactivity to anticipatory stress was inversely associated with both global fatigue (ΔHR: ß = -0.238; p = 0.04) and mental fatigue (ΔSBP: ß = -0.244; p = 0.04; ΔHR ß = -0.303; p = 0.01) as well as total fatigue (ΔSBP: ß = -0.331; p = 0.01; ΔHR: ß = -0.324; p = 0.01). CONCLUSION: In CAD patients after ACS, fatigue was linked with diminished cardiovascular function during anticipation of a mental stress challenge, even after inclusion of possible confounders. Further similar studies exploring other psychophysiological stress responses are warranted.

Obsessive-Compulsive (Anankastic) Personality Disorder in the ICD-11: A Scoping Review.

Introduction: With the shift from a categorical to a dimensional model, ICD-11 has made substantial changes to the diagnosis of personality disorders (PDs), including obsessive-compulsive (anankastic) personality disorder (OCPD). The ICD-11 PD model proposes a single diagnosis of PD with specifications regarding severity and domains. However, a systematic overview of ICD-11 anankastia is lacking. In this review we address the reformulation of the OCPD diagnosis in the ICD-11, and draw comparisons with the DSM-5, with a particular focus on diagnostic validity and clinical utility. We hypothesized that the ICD-11 PD model provides a diagnostically valid and clinically useful approach to OCPD, with specific emphasis on the anankastia domain as the primary trait qualifier. Methods: Literature published from 2010 to 2020 was systematically searched using the PubMed/MEDLINE, PsychInfo, Cochrane, and Web of Sciences search engines, in order to find all articles that addressed ICD-11 anankastia. Relevant articles were collated, and themes of these articles subsequently extracted. Results: Out of the 264 publications identified, 19 articles were included in this review. Four themes were identified, namely (a) overlap of DSM-5 OCPD with the ICD-11 PD model, (b) the factorial structure of the ICD-11 PD model with respect to the anankastia domain, (c) the clinical utility of the ICD-11 PD model, and (d) comparison of the ICD-11 PD model of anankastia with the DSM-5 alternative model for OCPD. Conclusions: The ICD-11 anankastia domain overlaps with DSM-5 OCPD traits, and the factor analyses of the ICD-11 PD model further support the diagnostic validity of this domain. There is some support for the clinical utility of the ICD-11 PD model of anankastia but further studies are needed, including of its relationship to obsessive-compulsive and related disorders.

Impulsivity Mediates Associations Between Problematic Internet Use, Anxiety, and Depressive Symptoms in Students: A Cross-Sectional COVID-19 Study.

Background: Problematic internet use (PIU) is a serious global mental health issue that especially manifested during the Coronavirus disease (COVID-19) pandemic. Engagement in PIU as an impulsive coping with mental distress may pose a long-lasting threat to develop anxiety and depressive disorders. The first aim of our study was to investigate the prevalence of PIU and mental distress symptoms during the COVID-19 pandemic among university students in Lithuania. The second aim was to test the hypothesis that PIU affects anxiety and depressive symptoms through the mediating role of impulsivity. Methods: The cross-sectional study was comprised of 619 university students (92.9% females and 7.1% males) with a mean age of 22 ± 3 years who participated in an online survey from May to November, 2020. Participants completed the following scales: the Problematic Internet Use Questionnaire-9, the Generalized Anxiety Disorder Questionnaire-7, the Patient Health Questionnaire-9, and the Barratt Impulsiveness Scale-11. K-means cluster analysis and one-way multivariate analysis of variance were used for group comparison in terms of internet use time and habit change during COVID-19 pandemic. Structural equation modeling was applied to examine the mediating effect of impulsivity in association between PIU and mental distress, while controlling for age. Results: In sum, 45.1% of the participants reported PIU and 38.1% had markedly expressed symptoms of anxiety while 43.6% of the students reported moderate to severe depressive symptoms. During the COVID-19 pandemic 76% of the students reported at least moderate increase in their internet use time. Anxiety and depressive symptoms were significantly higher in the group of frequent internet users. The results of the structural equational modeling analysis showed a statistically significant effect of PIU on subjective anxiety symptoms and the statistically significant effect of PIU on subjective depression symptoms, both mediated via impulsivity. Conclusions: During COVID-19 pandemic, PIU, anxiety and depression symptoms are highly prevalent among students. Findings also suggest that relationships between PIU, anxiety and depressive symptoms are mediated via impulsivity. These results underscore the importance of the inclusion of impulsivity factor in the studies analyzing longitudinal effects of PIU on mental distress during COVID-19 pandemic.

Validation and Psychometric Properties of the Minnesota Living With Heart Failure Questionnaire in Individuals With Coronary Artery Disease in Lithuania.

BACKGROUND: Health-related quality of life (HRQoL) is known to be impaired in individuals with coronary artery disease (CAD), especially in those after a recent acute coronary syndrome (ACS). Heart failure (HF) is a common burden in this population that significantly contributes to worsening HRQoL. To accurately measure the level of HRQoL in individuals with CAD after ACS, disease-specific scales, such as the Minnesota living with heart failure questionnaire (MLHFQ), are recommended. Nevertheless, to date, there has not been a study that would comprehensively evaluate the psychometric properties of the MLHFQ in a large sample of individuals with CAD after ACS. The debate regarding the internal structure of MLHFQ is also still present. Hence, this study aimed to translate the MLHFQ and evaluate its internal structure, reliability/precision, and validity in individuals with CAD following ACS in Lithuania. METHODS: In the cross-sectional study, 1,083 participants (70% men, age M = 58, SD = 9) were evaluated for sociodemographic and clinical characteristics. HRQoL was measured using the MLHFQ and the Short Form-36 health survey (SF-36). In addition, exercise capacity (EC) was also evaluated in the study patients, using a standardized computer-driven bicycle ergometer. RESULTS: The internal consistency of the MLHFQ subscales (0.79-0.88) was found to be good. Confirmatory factor analysis (CFA) provided the support for the three-factor model ("physical domain," "social domain," and "emotional domain") of the MLHFQ and showed acceptable fit [comparative fit indices (CFI) = 0.894; goodness-of-fit (GFI) = 0.898; non-normal fit index (NFI) = 0.879, and root mean square error of approximation (RMSEA) = 0.073]. Regarding convergent evidence, significant associations were found between the MLHFQ domains and the SF-36 domains and EC (r's range 0.11-0.58). CONCLUSION: The current study completed cultural validation and provided further information on the psychometric characteristics of the MLHFQ in Lithuania, suggesting MLHFQ as a valid and reliable instrument to measure HRQoL. The Lithuanian version of MLHFQ is best described by a three-factor solution, measuring physical, social, and emotional dimensions of HRQoL among individuals with CAD following ACS.

Multidimensional Structure of the Alcohol Use Disorders Identification Test: Factorial Validity and Reliability in Patients With Anxiety and Mood Disorders in Lithuania.

AIMS: The current study aimed to evaluate the factorial structure of the Lithuanian version of the Alcohol Use Disorders Identification Test (AUDIT) in patients with anxiety and mood disorders (AMD). METHODS: The AUDIT was completed by 199 consecutive outpatients with AMD (21% men, mean age 39 ± 12 years), as defined by AMD criteria in DSM-5. The MINI International Neuropsychiatric Interview was used for current diagnosis of alcohol use disorder (AUD). Sociodemographic and clinical data were also collected. RESULTS: In patients with AMD, the AUDIT showed high internal consistency (Cronbach's alpha = 0.88) and good psychometric characteristics for identifying current AUD at a cut-off value of ≥9 (positive predictive value = 83.7%, sensitivity = 94.7%, specificity = 95.7%). The confirmatory factor analysis suggested a three-factor ('consumption', 'dependence' and 'related consequences') structure and indicated adequate fit to the model (comparative fit index = 0.966, normed fit index = 0.936, root mean square error of approximation = 0.072). CONCLUSIONS: The findings are in line with increasing evidence suggesting that the AUDIT measures three separate factors related to alcohol misuse level of consumption, dependence and alcohol-related consequences and support the utility of AUDIT as a screening instrument for AUD in AMD patients in Lithuania.