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The outbreak of coronavirus disease (COVID-19) in December 2019 has led to massive lifestyle, economic, and health changes. The COVID-19 pandemic has had broad impacts on psychiatric patients, exacerbating symptoms such as psychosis, depression, and suicidal ideation. Therefore, we aimed to review the psychological impacts of COVID-19 on psychiatric patients and mental healthcare staff and provide practical guidance for medical staff and authorities. The main findings of this review included the impacts of COVID-19 on psychiatric patients and mental health professionals as well as the transformation of mental health care. Greater consideration should be given to the care of patients with psychosis and depression because of their lack of self-care ability, neurocognitive impairment, and impaired immune function. Depressive symptoms can be exacerbated due to several factors, such as economic crises, social isolation, and limited physical activity. Unemployment and financial problems can lead to an increased suicide rate. Consequently, mental healthcare workers’ workload can increase, which could lead to burnout and psychological symptoms such as insomnia, depression, and anxiety. A transformation of psychiatric care is needed during the time of the pandemic. While emergency care should be maintained, outpatient care should be limited to decrease viral spread. Shifting care to telemedicine and community-based psychiatry can be helpful. Inpatient services should be adapted by tightening admission criteria, shortening the length of hospital stays, suspending some group activities, limiting visitors, and preparing for quarantine if necessary. Mental healthcare workers can be supported with telecommunication, appropriate work shifts, alternative accommodations, and good communication between the team leader and staff.

Background: Catatonia is a syndrome of altered motor behavior that is mostly associated with general medical, neurologic, mood and schizophrenia-spectrum disorders. The association of newly onset catatonic symptoms with hyponatremia has been rarely reported in the literature. Case Presentation: We present a rare case of a young female patient with schizophrenia, who presented with catatonic symptoms in the context of hyponatremia due to water intoxication. The symptoms were eliminated with the correction of hyponatremia. There are only a few reports of hyponatremia-associated catatonia in psychiatric and non-psychiatric patients. Sometimes, catatonic symptoms may co-occur with newly onset psychotic symptoms and confusion, suggesting delirium. In several cases, the catatonic symptoms responded to specific treatment with benzodiazepines or electroconvulsive therapy. Conclusion: Hyponatremia may induce catatonic symptoms in patients, regardless of underlying mental illness, but this phenomenon is even more relevant in patients with a psychotic or mood disorder, which may itself cause catatonic symptoms. It is important for clinicians not to attribute newly-onset catatonic symptoms to the underlying psychotic or mood disorder without measuring sodium serum levels. The measurement of sodium serum levels may guide treating psychiatrists to refer the patient for further investigation and appropriate treatment.

Background: Cognitive deficits are core features of Schizophrenia, showing poor response to antipsychotic treatment, therefore non-pharmacological rehabilitative approaches to such a symptom domain need to be identified. However, since not all patients with Schizophrenia exhibit the same cognitive impairment profile, individualized rehabilitative approaches should be set up. Objectives: We explored the last five-year literature addressing the issue of cognitive dysfunction response to rehabilitative methodologies in Schizophrenia to identify possible predictors of response and individualized strategies to treat such a dysfunction. Conclusion: A total of 76 studies were reviewed. Possible predictors of cognitive rehabilitation outcome were identified among patient-specific and approach-specific variables and a general overview of rehabilitative strategies used in the last five years has been depicted. Studies suggest the existence of multifaced and multi-domain variables that could significantly predict pro-cognitive effects of cognitive rehabilitation, which could also be useful for identifying individual-specific rehabilitation trajectories over time. An individualized rehabilitative approach to cognitive impairment in Schizophrenia is possible if taking into account both patient and approach specific predictors of outcomes.

Introduction: suicidal behavior is a serious public health problem worldwide and shows large intersocietal variation. This study aimed at comparatively investigating the aspects of suicidal behavior in 22 countries surrounding the Mediterranean Sea. Methods: the study was conducted with official data retrieved from several sources. The suicidal mortality data were collected from World Health Organization’s data repository. Descriptive statistics, group comparison, correlational and regression statistical analyses were used to summarize the data. Results: the average age standardized suicide rates in the Mediterranean countries are lower than the world average. Except in Morocco, more men kill themselves than women. Suicide rates are lower in Mediterranean Muslim than in Mediterranean Christian countries. Slovenia, France and Croatia have the highest suicide mortality rates. Greatest percentages of suicidal ideation are seen in Croatia, Turkey and Slovenia and the greatest percentages of suicidal attempts are seen in Palestine, Cyprus, Greece and Slovenia. According to the results of the multiple regression analyses, the coefficient of human inequality index was associated with lower both-sex and male suicide rates. Greater percentages of people saying religion is unimportant in daily life in a country were found to be related to higher female suicide rates. Conclusion: the findings from the study have shown that the prevalence of suicidal deaths, thoughts and attempts vary between the Mediterranean countries. Lower suicide rates are observed in the Muslim Mediterranean nations than in the Judeo-Christian ones. However, the rates of suicide mortality in non-Arab Muslim nations being comparable to the rates in non-Muslim countries confirm the concerns over mis/underreporting of suicidal behavior in Arab Muslim countries due to religio-cultural stigma attached to suicide. The average suicidal mortality rates are lower in Mediterranean countries than the world average. Generally, more men than women kill themselves. Results from the multivariate analysis revealed that as the level of human inequality increases the rates for both-sex and male suicidal mortality decreases. Religion seem to be protective against female suicides. The study has also shown that more research is needed about suicidal behavior in the Mediterranean countries., NA

Background: In recent years there is a growing interest in public beliefs about mental disorders. Numerous representative population-based studies have been conducted around the globe, also in European countries bordering on the Mediterranean Sea. However, relatively little is known about public beliefs in countries in Northern Africa. Objective: To fill this gap by comparing public beliefs about mental disorders in Tunisia and Germany, focusing on causal beliefs, help-seeking recommendations and treatment preferences. Methods: Representative national population-based surveys have been conducted in Tunisia in 2012 (N = 811) and in Germany in 2011 (N = 1852), using the same interview mode and the same fully structured interview starting with a vignette depicting a person suffering from either schizophrenia or depression. Results: In Tunisia, the public was more likely to adopt psychosocial and to reject biogenetic explanations than in Germany. Correspondingly, psychological treatments were more frequently recommended and biological ones more frequently advised against. There was also a strong inclination to share religious beliefs and to recommend seeking religious advice. Tunisians tended much more than Germans to hold moralistic views and to blame the afflicted person for his or her illness. In Tunisia, the public tended less to differentiate between schizophrenia and depression than in Germany. Conclusion: Marked differences between Tunisia and Germany exist in public beliefs about the causes of mental disorders and their treatment, which correspond to differences in cultural orientations prevailing in these countries. Mental health professionals need to be sensitive to the particular cultural context in which they operate, in order to be able to reach those they intend to care for.

Background:Postpartum Depression (PPD) is a major public health problem affecting mothers and their babies. However, few studies have investigated the prevalence and risk factors for postpartum depression among Arab mothers. This systematic literature review aims to determine the prevalence of PPD among mothers in Arab countries and identify the main risk factors.Methods:A review of all peer-reviewed journal published studies on PPD and its risk factors among Arab mothers until February 2016. The following data bases were searched; PubMed, Springlink, Science direct, EBSCOhost, and Arabpsychnet.Results:25 studies were included in the review. PPD rates were high in general but prevalences were close to the rates observed in other low and lower-middle-income countries. Twelve studies reported PPD prevalences in the region of 15-25%, 7 studies reported prevalences< 15% and 6 studies reported prevalencesConclusion:Prevalence of PPD is high in most Arab countries, with differences due in part to variations in methods of assessment. This review highlights the problem of PPD and advocates for the adoption of necessary changes in the Arab health systems such as routine screening and efficient referral systems in order to detect and treat this potentially debilitating condition.

Background:PTSD and burnout are frequent conditions among emergency healthcare personnel because exposed to repeated traumatic working experiences. Increasing evidence suggests high comorbidity between PTSD and mood symptoms, particularly depression, although the real nature of this relationship still remains unclear. The purpose of this study was to investigate the relationship between PTSD, burnout and lifetime mood spectrum, assessed by a specific scale, among health-care professionals of a major University Hospital in Italy.Methods:N=110 Emergency Unit workers of the Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy) were assessed by the TALS-SR, MOODS-SR lifetime version and the ProQOL R-IV.Results:Approximately 60% of participants met at least one PTSD symptom criterion (criterion B, 63.4%; criterion C, 40.2%; criterion D 29.3%; criterion E, 26.8%), according to DSM-5 diagnosis. Almost sixteen percent of the sample reported a full symptomatic DSM-5 PTSD (work-related) diagnosis, and these showed significantly higher scores in all MOODS-SR depressive domains, as well as in the rhythmicity domain, compared with workers without PTSD. Further, mood-depressive and cognition-depressive MOODS-SR domains resulted to be predictive for PTSD. Significant correlations emerged between either PTSD diagnosis and criteria or ProQOL subscales and all the MOOD-SR domains.Conclusion:A significant association emerged among PTSD, burnout and lifetime MOOD Spectrum, particularly the depressive component, in emergency health care operators, suggesting this population should be considered at-risk and undergo regular screenings for depression and PTSD.

Background:The number of individuals displaced from their original countries due to civil wars, hunger, disasters, and international wars is increasing worldwide day by day. These refugees are more vulnerable to Post-Traumatic Stress Disorder (PTSD).Objective:The present study aimed to examine the effectiveness of the intervention program in improving the well-being and reducing Post-Traumatic Stress Disorder (PTSD) among a sample of Syrian refugee women in Jordan who had been displaced due to civil wars in Syria.Methods:The study recruited 40 Syrian refugee females in Jordan who were psychologically challenged, with high PTSD symptoms (assessed by PCL) and a psychological well-being impairment (assessed by PWD). The culture of Jordanian society discriminates and affects the Syrian refugee women, rendering them vulnerable to PTSD. Quasi-experimental design was used, wherein the participants were randomly distributed in experimental and control groups (n=20/group). The control group members did not receive any services related to psychological support or psychiatric medications, while the experimental group underwent a counseling program.Results:The present study demonstrated that the intervention program improves the well-being and reduces PTSD among the Syrian refugee women who constituted the experimental group. The intervention program and the PTSD manifestation were not affected by age. The present study recommended that the program be applied to the refugees in Jordan to improve the well-being of the women in the residential areas.Conclusion:Furthermore, an intervention on the Jordanian cultural impact on the refugee camps was also essential if the condition for the female refugees worsened. Lastly, the effect of Jordanian culture on Syrian refugees should be investigated since the literature presented a negative impact.

Introduction: It has been found that HIV positive women are becoming increasingly affected by various illnesses, including Common Mental Disorders (CMDs) such as depression. Such comorbidity escalates the disease progression to the severe stage and commonly hinders treatment adherence. This study determined the prevalence of anxiety and depression amidst women living with HIV. Methods: Based on a cross-sectional and facility-based study, 357 HIV positive women were recruited using the systematic sampling technique from two public hospitals in Jijiga town, Ethiopia. The Hospital Anxiety and Depression Scale (HADS) was administered for screening, and followed by a pre-tested questionnaire that comprised of Perceived Social Support and HIV stigma. Results: The results revealed that the prevalence of both anxiety and depression amidst HIV positive women was 28.9% and 32.5%, respectively. In the multivariate analysis, it was discovered that lack of formal education, being divorced, unemployed, and earning a monthly income less than 1400 ETB (37.5 USD) were significantly associated with depression. Women with symptomatic HIV clinical stage III (AOR =2.06, 95% C.I (0.75-5.61), with CD4 cell count below 250 (AOR = 1.14, 95% C.I (0.57-2.28), and with co-infections (AOR= 1.04, 95% C.I (0.40-2.71) also suffered from depression. Conclusion: The study outcomes show that the prevalence of depression in women with HIV was 32.5%, but they were more likely to be depressed if they were illiterate, divorced, unemployed or had a financial burden. In addition, HIV positive women with less CD4 cell count and in the final clinical stage or suffered from a co-infection were also associated with depressive symptoms. This signifies the public health implications of psychological and cognitive morbidities of the illness among these women with chronic illnesses. Hence, future mental health interventions and HIV care should be integrated with substantial emphasis given to vulnerable groups, including HIV positive women.

Background: HRQoL is generally conceptualized as a broad multidimensional construct that refers to patients' perceptions of the impact of disease and its treatment on their physical, psychological, and social functioning and well-being. Little is known in patients with onco-hematological cancer in comparison with the general population and other chronic diseases. Objective: We assessed HRQoL in patients diagnosed with haematological cancers in comparison with the general population and other chronic diseases. Methods: The questionnaire Short Form (SF)-12 was administered to 62 patients with onco-hematological disease and results were compared with 702 controls (184 healthy people, 37 Major Depression, 201 Multiple Sclerosis; 23 Wilson disease; 46 Carotidal Atherosclerosis; 60 Celiac disease; 151 solid tumours). Results: HRQoL in patients diagnosed with a haematological cancer was significantly worse in comparison with the general population (F= 43.853, p Conclusion: This study confirmed that haematological cancers negatively affects overall HRQoL. The results showed an impact of haematological cancers on HRQoL that is similar to what found in patients with solid tumors, Major Depression and Carotid Atherosclerosis. Current successful therapeutic strategy achieved in the treatment of haematological cancers not only positively impact on survival rate but also could improve the overall HRQoL.

Background: Several psychological interventions have been implemented to manage chronic pain. In this study, in addition to the patients, his/her spouses have participated in the program. Besides, this innovative therapy integrates several practical approaches into one comprehensive protocol. Objective: This study aimed to analyze the effectiveness of couple therapy (patient/caregiver-oriented) on improving the quality of life and reducing pain among patients with chronic pain. Methods: The present study is a quasi-experimental and clinical trial with a control group with pretest and posttest. The authors conducted this study at LABAFINEJAD Hospital in Tehran on 30 patients with chronic pain and their spouses by having a short form of a questionnaire for quality of life and chronic pain score questionnaire to measure the effectiveness of the treatment. Results: The results indicated that this treatment increased two aspects of quality of life remarkably, social function and strength for continuing the performance; that help boosts interpersonal relationships as well. Regarding the results, although the couple-based treatment could improve all aspects of pain, the two primary subscales, physical health and mental health, both enhanced. Besides, the treatment reduced the intensity of pain. Conclusion: Couple-based intervention through increasing social support, improving the quality of sex, decentralizing of pain, and paying attention to the neglected needs of caregivers and patients with chronic pain can improve quality of life and reduce pain in patients.

Background: Parental incarceration can produce serious effects on the offspring’s mental health. The presence of Post-Traumatic Stress Disorder (PTSD) in prisoners’ offspring is understudied and the few literature data showed heterogeneous evidence, with some studies suggesting that about 25% of prisoners’ offspring have PTSD and other reporting much lower prevalence rates around 2-3%. There is no systematic review and meta-analysis about PTSD in prisoners’ offspring. Objectives: The present systematic review and meta-analysis aimed to provide a first quantitative synthesis of the prevalence of the PTSD diagnosis in prisoners’ offspring. Moderator variables of the effect sizes were assessed, including offspring’s and parents’ gender, offspring’s generational cohort (children/adolescents versus adults), reasons for parental incarceration (political/war versus crime), and country type (Western versus Non-Western countries). Methods: A systematic review and a meta-analysis were conducted according to the PRISMA guidelines. Studies were included if they assessed the presence of a PTSD diagnosis in child, adolescent or adult offspring of prisoners through a diagnostic classification system, a clinician-administered interview or a self-report questionnaire, if they reported data necessary to calculate the effect sizes or the authors were available to provide them. Studies might have been based upon any design except review, single-case, case series, and case reports. Outcomes might have been measured at any time after parental incarceration. Parental imprisonment was defined as any kind of custodial confinement of a parent by the criminal justice system, including being held as a prisoner of war or for political reasons. Independent reviewers searched published/unpublished studies through electronic databases and additional sources and extracted the data. A random-effect meta-analysis was carried out by calculating the effect sizes as event rates. Heterogeneity was examined by the I2 and the Q statistics. Moderators were assessed through meta-regressions. Results: Six studies (2512 participants) were included. Fifteen percent of prisoners’ offspring had PTSD, as shown by a significant mean effect size of 0.14 without evidence of publication bias (95% CI: 0.081 – 0.249, p< 0.001). There were no significant differences on the mean effect sizes between the studies on adults and those on children/adolescents [Q(1) = 0.00, p = .999], between the studies on parents incarcerated for political/war reasons and those for crime [Q(1) = 0.00, p = .979], and between the studies conducted in Western and non-Western countries [Q(1) = 0.854, p = .355]. While offspring’s gender was not related to the effect sizes [β = -0.01, 95% CI: -0.02 – 0.02, p = .452], parents’ gender was significantly and positively associated with the effect sizes suggesting that in studies with higher percentages of incarcerated mothers, the prevalence of offspring’s PTSD was higher [β = 0.01, 95% CI: 0.0 – 0.01, p = .019]. Conclusion: PTSD is a serious mental health condition among prisoners’ offspring, particularly when mothers are incarcerated. The present findings point out the importance of thorough assessment and timely intervention/prevention strategies implemented by professionals of mental health settings and detention systems. The cross-sectional design of the studies does not allow causal conclusions to be drawn about the effect of parental incarceration as a risk factor for PTSD. Other variables related to parental incarceration may explain these findings. This limitation points out the importance of further longitudinal research.

Background: The Rohingyas are an ethnic minority group from Myanmar who have experienced severe forms of violence such as murder, rape, humanitarian defilement and forcible expellation from their motherland. Exposure to trauma has a long-lasting impact on psychological well-being and Health-related Quality of Life (HRQoL). Objective: The purpose of this study was to examine the prevalence of depression and association with HRQoL for Rohingya displaced persons. Methodology: This was a prospective, cross-sectional study in two refugee camps in Southern Bangladesh, with a structured and language validated questionnaire. Results: The study indicates the prevalence of depression was 70% (n=150 respondents), with 8.7% reporting “severe depression” in PHQ-9. WHOQOL-BREF scores were inversely associated with symptoms on the depression scale with a strong and significant correlation (r= 0.652; p Conclusion: There are higher incidence rates of moderate to severe depression than the population norms and low health-related quality of life than published population norms for Rohingya displaced persons living in refugee camps. Depression rates were inversely associated with HRQoL for Rohingya displaced persons living in refugee camps. Future research may consider the prevention of related medical issues for long term program implementation.

Introduction: Early detection of behavioral and emotional problems in children and adolescents is relevant. For this purpose, the use of questionnaires completed by parents is applicable. Parent questionnaires are also useful preliminary support to the clinical investigation. Methods: Validated tools for the analysis of behavioral and emotional problems suitable for school-age subjects are analyzed in their characteristics and possibilities of use. Results: The following are the main characteristics of the instruments examined. The Child and Adolescent Symptom Inventory 4&5, Parent Checklist (CASI-4&5) and Behavior Assessment System For Children - Parent Rating Scales 2&3 (BASC-2&3) include a high number of questions, with exploration extended to almost all possible pathologies. The Child Behavior Check-List (CBCL) has less items (113), but only 48 refer to DSM pathologies. The use of CASI, BASC and CBCL carries a cost because they are copyrighted. The Pediatric Symptom Checklist (PSC) has 35 items, but only 17 have a reference to 3 clinical areas. The Strength & Difficulties Questionnaire (SDA) is very short (25 items) and concerns only the main externalizing and internalizing disorders. The Child and Adolescent Behavior Inventory (CABI) has 75 items and explores a wide range of psycho-pathological issues, likewise CASI and BASC. PSC, SDA and CABI can be used free of charge. Conclusion: The comparison of the characteristics of the aforementioned questionnaires can guide the psychiatrist and the epidemiologist in choosing the most suitable tool for what is proposed to be assessed, in relation to practicability, extension of the areas explored and costs.

Autistic Spectrum Disorder (ASD) is a complex neurodevelopmental disorder associated with various etiologies and characterized by deficits in social interaction, emotional reciprocity, communication, motor skills and cognitive functions. Studies have proposed that limited levels of physical activity and late motor skills and fitness, particularly in children and adolescents with ASD, may accentuate social and emotional deficits. In view of this, exergames, which are active video-games, can be considered a low-cost and safe type of exercise for children and adolescents with ASD, since they are more enjoyable than ordinary physical activities, influencing on treatment adherence. Thus, our study aims to evidence the effects of exergames on physical fitness, cognitive functions, and repetitive behaviors in children and adolescents with ASD. Despite the small number of studies investigating the effects of exergames as new strategy in children and adolescents with ASD, results suggest exergames as potential tool for the treatment of children and adolescents with ASD for improvement in physical fitness, cognitive functions and repetitive behavior. Our review pointed towards the importance of exergames for children and adolescents with ASD. Despite few studies conducted about this issue, we can consider exergames a potential tool to increase physical fitness, cognitive functions and to decrease repetitive behavior in children and adolescents with ASD. Moreover, health professionals should be careful when attempting to help this population, because the current literature is unclear yet about the improvement of ASD features through exergames.

Background: Depression is the most common mental disorder and a leading cause of disability, which commonly presents unexplained psychological and physical symptoms. Depression and HIV/AIDS are commonly comorbid. This review provides an insight into the effect of depression on disease progression among people living with HIV. Methods: A search for relevant articles was conducted using a database like MEDLINE, Scopus, PsycINFO and CINAHL. Peer-reviewed English journals published between 2015 and 2019 were included in the review. Results: A total of eight studies conducted in different settings were included in the review. This review has found that psychosocial, neurohormonal and virologic factors associated with depression affect HIV disease progression. Yet, the chronicity of depression, absence of the hormones that have a buffer effect on depression and lack of examination if depression is a predictor, or an outcome of disease progression, were some of the gaps that require further investigation. Conclusion: Considerably, more research is needed to better understand the effect of mental disorder, especially depression, on HIV disease progression to AIDS and future interventions should, therefore, concentrate on the integration of mental health screening in HIV clinical setup.

Aims: To identify the strategies for the prevention of burnout syndrome in nurses; and discuss the results for future interventions that can decrease burnout in these professionals. Design: An integrative review of the literature. Data Sources: PubMed, Lilacs, Medline, Scielo, and Science Direct, from April 2018 to July 2018. Methods: The sources were in all 553 references were found. The following guiding question was: Which interventions for the prevention of burnout in nurses have been applied and have obtained high effectiveness? Results: Based on the inclusion and exclusion factors, 30 studies were selected for analysis. The studies were categorized in individual, group and organizational, being the studies with actions in groups those of greater prevalence. Conclusion: The actions used to cope with burnout were, for the most part, effective, with some demonstrating greater success than others. From the 30 reviewed studies, the results did not obtain satisfactory improvement in burnout in only three interventions: 1) Systematic nursing supervision; 2) Basic nursing care; and 3) Psycho-oncological training program.

Background: The aim was to assess the effects of a training program inclusive of contact sports and counseling on school dropout, quality of life (QoL) and psychopathologic symptoms in the youth with a history of school dropout and psychopathic personality traits. Methods: The Experimental Group (EG) consisted of 32 subjects (male 90.6%; age 19.6±4.3 years); the Control Group (CG) consisted of an equal number matched for gender and age with the same psychological features. At the beginning of the experimental Training Program (T0), both cohorts were assessed by a diagnostic psychiatric interview (SCID ANTAS), the Short Form Health Survey (SF-12) to evaluate QoL, the Psychopathy Checklist - Revised (PCL-R) for the assessment of psychopathic traits, the Self Reporting Questionnaire (SRQ) to measure general psychopathology. At the end of the program (T1), the coorths were evaluated by SF-12 and SRQ. Results: Twenty-seven subjects in the EG (84.4%) completed the course and underwent the evaluation at T1. The SF-12 score significantly increased from T0 to T1 in both groups, albeit this was more evident in the EG than in the CG, owing to an interaction between time and group. SRQ score significantly decreased in the EG from T0 to T1, while in the CG it did not, although the interaction between time and group was not significant. Conclusion: The experimental training program was effective in improving QoL and countering school dropout in young citizens with psychopathic traits. Further studies are needed to clarify if such results are due to a relationship between the practical tasks approach including contact sports and an improvement in mentalization processes.

Background:Increasing evidence supports a key role of Oxytocin (OT) as a modulator of social relationships in mammals.Objective:The aim of the present study was to investigate possible sex-related differences in plasma OT levels in human beings.Methods:Forty-five healthy men and 45 women (mean age: 34.9 ± 6.2 years), were included in the study. Plasma preparation, peptide extraction and OT radioimmunoassay were carried out according to standardized methods.Results:The results showed that OT plasma levels (pg ̸ ml, mean ± SD) were significantly higher in women than in men (4.53 ± 1.18 vs 1.53 ± 1.19, p ˂ 0.001).Conclusions:The present finding demonstrates sex-related differences in plasma OT levels in humans. It is tempting to hypothesize that such differences might be related to behaviours, attitudes, as well as susceptibility to stress response, resilience and social emotions specific of women and men.

The death of Hagop Akiskal left a great void in all who knew him, and many of us knew him, indeed, all over the world. Hagop was an attentive clinician and innovative researcher as well as a mentor who accompanied the growth of many young psychiatrists, a researcher sometimes controversial, never predictable, whose reflections have changed the way of seeing and conceiving mental illness in recent decades. And, above all, a gifted visionary that changed the field of bipolar disorders for better and forever. He rawarded of several international prizes, including the Jean Delay Prize of the World Psychiatric Association in 2002 (perhaps the most prestigious award in the field of psychiatry).

Introduction:Problematic Usage of the Internet (PUI) refers to a broad and likely heterogeneous group of Internet-related conditions associated with behavioural disturbances and functional impairment.Methods:Within PUI several conditions have been reported, including Gaming Disorder, Shopping Addiction, Cyberchondria, Gambling Disorder, Cyberpornography Addiction and Cyberbullying. While increasing reports in the field try to define the epidemiologic and clinical boundaries of these conditions, the rapid and continuous evolution of Internet related behaviours as well as their problematic/pathological expressions are often difficult to diagnose, assess, approach with treatment interventions and follow-up.Results:In addition, some of the PUI-related conditions show characteristics of addiction to the Internet as a preferential tool to engage in specific behaviours, while some others exclusively manifest on the Internet, making it necessary to find distinct assessment and treatment pathways.Conclusion:The inclusion of Internet Gaming Disorder in Section III by the DSM-5 and the recognition of Gaming Disorder by the ICD-11 opened the way for a systematic clinical investigation of this and other PUI-related conditions, particularly in terms of preventive and therapeutic strategies. The present article is aimed at offering an updated clinical overview on the main expressions of PUI, focussing on the latest acquisitions in this evolving field.

School closure and home confinement are two of the measures of lockdown chosen by governments and policymakers all over the world to prevent and limit the spread of the infection of COVID-19. There is still an open debate about the real effect of school closure on the reduction of risk of infection on children and the risk of infection on with other age groups (parents, grandparents and others). There is an agreement on the effect of school closure in reducing and delaying the peak of the outbreak. In this Editorial, starting from the ongoing Italian experience, we discuss direct and indirect effects of school closure on children’s psychological health and learning. We also highlight the need for an “on peace time” planning of measures and strategies necessary to face the direct and indirect effect of this outbreak and other outbreaks, on children’s psychological health.

Background: Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposes a model for conceptualizing personality disorders in which they are characterized by impairments in personality functioning and maladaptive personality traits. The Personality Inventory for DSM-5 (PID-5) is a self-report measure that assesses the presence and severity of these maladaptive personality traits. Objective: The current study examined the reliability and validity of the Arabic version of the Personality Inventory for DSM-5 (PID-5) to measure maladaptive personality traits in the Emirati population of the United Arab Emirates. Methods: The Arabic version of the PID-5 was administered to a community sample of 1,090 United Arab Emirates nationals (89.5% female and 10.5% male, mean age = 22.44 years old). The descriptive measures, internal consistency, test-retest reliability, convergent validity with NEO – Five Factor Inventory, as well as PID-5’s factor structure, were all addressed. Results: The PID-5facets and domains mean scores were higher in the Emirati sample compared to the original US sample. Internal consistency of the PID-5 scales was acceptable to high and test-retest coefficients ranged from 0.84 (facets) to 0.87 (domains). As expected, the five domains of the Arabic version of the PID-5 correlated significantly with all Five-Factor Model domains of personality. Additionally, the Arabic version of the PID-5 confirmed a five-factor structure that resembles the PID-5 domains. Conclusion: The findings of this study provided initial support for the use of the Arabic version of the PID-5 to assess maladaptive personality traits in the Emirati population of the United Arab Emirates.

Background:The Mood Disorder Questionnaire (MDQ) is a frequently used screening tool for the early detection of Bipolar Disorder (BD), which is often unrecognized or misdiagnosed at its onset. In this study, data from Tunisia has been used to evaluate the psychometric properties of the Arabic MDQ.Methods:The sample included 151 patients with a current major depressive episode. The Arabic adapted version of the Structured Clinical Interview for DSM-IV-TR was used to formulate a diagnosis, yielding 62 patients with BD and 89 with unipolar Major Depressive Disorder (MDD). Principal component analysis with parallel analysis was used to establish the spontaneous distribution of the 13 core items of the MDQ. Confirmatory Factor Analysis (CFA) was used to check the available factor models. Receiver Operating Characteristic (ROC) analysis was used to assess the capacity of the MDQ to distinguish patients with BD from those with MDD.Results:Cronbach’s α in the sample was 0.80 (95%CI: 0.75 to 0.85). Ordinal α was 0.88. Parallel analysis suggested two main components, which explained 59% of variance in the data. CFA found a good fit for the existing unidimensional, the two-factor, and the three-factor models. ROC analysis showed that at a threshold of 7, the MDQ was able to distinguish patients with BD from those with MDD with extraordinary negative predictive value (0.92) and a positive diagnostic likelihood ratio of 3.8.Conclusion:The Arabic version of the MDQ showed good measurement properties in terms of reliability, factorial validity and discriminative properties.

Introduction: The phenomenon of migration is characterized and influenced by a number of different variables; and the different stages of journey are related to different levels and types of psychological distress. Women, in particular, are exposed to further specific risks during migration. Aim: To determine the factors that affect the psychological health of migrant women during the different stages of the migration journey. Methods: We provide a narrative review of the literature around the experiences of women during migration process, with a geographical focus on women migrating to the Mediterranean area. Results: Little data is currently available on the burden of mental health disorders for female migrants. Most studies about the mental health status of migrants were not gender-disaggregated or focused specifically on migrant women’s experiences of violence. Sexual and Gender-Based Violence (SGBV) was found to be a common risk factor faced by all the women who leave their native country to migrate to other countries. Conclusion: Despite the importance of the issue and the gender-specific variables related to the experience of migrant women, few studies have looked specifically at psychological variables and mental health status in the female migrant population. It is crucial that future studies are conducted around female migration, violence towards women, and women’s mental health, in order to provide an evidence-base for promoting adequate policies and prevention/treatment programs for women.

Mediterranean Diet (MD) is currently considered one of the most healthy dietary models worldwide. It is generally based on the daily intake of fruit and vegetables, whole grains, legumes, nuts, fish, white meats, and olive oil. It may also include moderate consumption of fermented dairy products, a low intake of red meat, and red/white wine during the main course. Even if the effect of MD on cancer prevention as well as on human metabolic and cardiovascular balance has been discussed, including the quality of life of the exposed population, the putative effects on mental health are still not properly investigated. This narrative review reports on some emerging pieces of evidence on the possible impact of MD on general health and the outcome of psychiatric disorders (e.g., major depression, anxiety) and encourages further studies to test the benefits of healthy food selection on the health of the general population.

Background: The Functioning Assessment Short Test (FAST) is an interviewer-administered scale assessing functional impairment originally developed for psychiatric patients. Objectives: To adapt the FAST for the general population, we developed a self-administered version of the scale and assessed its properties in a pilot study. Methods: The original FAST scale was translated into German via forward and backward translation. Afterwards, we adjusted the scale for self-administered application and inquired participants from two ongoing studies in Germany, ‘STAAB’ (Würzburg) and ‘BiDirect’ (Münster), both recruiting subjects from the general population across a wide age range (STAAB: 30-79 years, BiDirect: 35-65 years). To assess reliability, agreement of self-assessment with proxy-assessment by partners was measured via intraclass correlation coefficient (ICC) over the FAST score. Construct validity was estimated by conducting correlations with validated scales of depression (PHQ-9), anxiety (GAD-7), and health-related quality of life (SF-12) and regression analyses using these scales besides potentially disabling comorbidities (e.g. Chronic Back Pain (CBP)). Results: Participants (n=54) had a median age of 57.0 years (quartiles: 49.8, 65.3), 46.3% were female. Reliability was moderate: ICC 0.50 (95% CI 0.46-0.54). The FAST score significantly correlated with PHQ-9, GAD-7, and the mental sub-scale of SF-12. In univariable linear regression, all three scales and chronic back pain explained variance of the FAST score. In multivariable analysis, only CBP and the SF-12 remained significant predictors. Conclusion: The German self-administered version of the FAST yielded moderate psychometric properties in this pilot study, indicating its applicability to assess functional impairment in the general population.

Background:The perception by mental health service staff of respect for users' rights is a fundamental component of organizational well-being. The objective of this work is to examine how cultural differences and the working context can influence the perception of respect for users' rights in mental health professionals in the Mediterranean area.Methods:An observational survey carried out in four different mental health networks in four countries of the Mediterranean area (Tunisia, North-Macedonia, Italy, Palestine). Each invited participant fulfilled a format on socio-demographic information and coded the Well-Being at Work and Respect Right Questionnaire (WWRR). All data were encrypted and analysed using the Statistical Package for Social Sciences (SPSS) version 20. The Games-Howell post-hoc test was used to assess differences between countries. The Games-Howell test does not assume equal variances and sample sizes. Eta-squared (η2) was used as a measure of effect size in the ANOVA (η2around 0.01, 0.06, and 0.14 are considered small, medium, and large, respectively).Results:The sample included 590 professionals working in the mental health field. The four countries showed statistically significant differences with regards to the quality rights assessment tool. Participants from Italy reported, on average, the highest scores across the questions. There were also differences across the countries about the perception of the impact of available resources on the effectiveness of care (η2 = 0.106).Conclusion:Our findings offer a useful insight into the perception of the quality of mental health services, especially from a users’ rights point of view.

Background: The Well-Being at Work and Respect for human Rights Questionnaire (WWRR) was conceived based on the hypothesis that the perception of respect for users' rights is an essential element of well-being in the workplace in healthcare. The objective of the study is to examine the principal components of the WWRR. Methods: A random sample representative of a set of professionals working in three different healthcare networks in Tunisia, North-Macedonia, and Italy was enrolled (n=426). Each professional completed a questionnaire on sociodemographic data and the WWRR. The WWRR consists of six items on beliefs about: satisfaction at work, users’ satisfaction, organization at work, respect of users’ and staff human rights, adequacy of resources. A seventh item assesses the perceived needs of personnel. Correlation between the items was evaluated by analysing the principal components with Varimax rotation and Kaiser normalization (which included all components with an Eigen value> 1). Results: A single factor covered over 50% of the variance, all the items of the questionnaire were closely related and compose a single factor. Tunisia presented some differences regarding the item about the human rights of staff. Conclusion: Satisfaction with the respect for the rights of users is strongly correlated with the other factors that are part of the concept of the organizational well-being of health care providers. The WWRR provides a means of measuring this important and often neglected dimension.

Background: Digital communication technologies can overcome physical, social and psychological barriers in building romantic relationships. Online romance scams are a modern form of fraud that has spread in Western societies along with the development of social media and dating apps. Through a fictitious Internet profile, the scammer develops a romantic relationship with the victim for 6-8 months, building a deep emotional bond to extort economic resources in a manipulative dynamic. There are two notable features: on the one hand, the double trauma of losing money and a relationship, on the other, the victim's shame upon discovery of the scam, an aspect that might lead to underestimation of the number of cases. Objectives: This paper presents a scoping review of the quantitative and qualitative evidence on this issue, focusing on epidemiological aspects, relational dynamics, and the psychological characteristics of victims and scammers. Methods: A literature scoping review was conducted using electronic databases and descriptors. Studies were included if they had analyzed the phenomenon in any population or the relationship dynamics characterizing it through whatsoever typology of design. Scoping reviews are a form of knowledge synthesis, which incorporates a range of study designs and wide eligibility criteria to comprehensively summarize evidence with the aim of informing practice, programs, and policy and providing direction to future research priorities. Results: Twelve studies were included. Sixty-three percent of social media users and 3% of the general population report having been a victim at least once. Some psychological variables appear to be associated with the risk of being scammed, such as female gender, middle-age, higher levels of neuroticism, tendencies to the romantic idealization of affective relations, sensation seeking, impulsiveness and susceptibility to addiction. We analyse literature limitations and future directions. Conclusion: Since this emerging phenomenon is still largely unrecognized, understanding the psychological characteristics of victims and scammers will allow at-risk personality profiles to be identified and prevention/intervention strategies to be developed.

Background:A growing amount of evidence suggests that dental anxiety is associated with other psychiatric disorders and symptoms. A systematic review was conducted to critically evaluate the studies of comorbidity of dental anxiety with other specific phobias and other Axis I psychiatric disorders.Objective:The aim of the review was to explore how dental anxiety is associated with other psychiatric disorders and to estimate the level of comorbid symptoms in dental anxiety patients.Methods:The review was conducted and reported in accordance with the MOOSE statement. Data sources included PubMed, PsycInfo, Web of Science and Scopus.Results:The search produced 631 hits, of which 16 unique records fulfilled the inclusion criteria. The number of eligible papers was low. Study populations were heterogeneous including 6,486 participants, and a total of 25 tests and in few cases clinical interviews were used in the evaluation processes. The results enhanced the idea about the comorbidity between dental anxiety and other psychiatric disorders. The effect was found strong in several studies.Conclusion:Patients with a high level of dental anxiety are more prone to have a high level of comorbid phobias, depression, mood disorders and other psychiatric disorders and symptoms.

Background:The effects of having a child with Autism Spectrum Disorder (ASD) on parents are multifaceted and pervasive. While ample evidence has been provided that these families are under severe stress, there are still several knowledge gaps and unresolved questions.Objective:This study aimed at quantifying the subjective and objective burden of ASD in mothers and fathers, and at improving the understanding of the interplay between parental burden, child’s characteristics, and parents’ coping resources and strategies.Methods:The parents of 359 children/adolescents with ASD were compared to parents of age-matched patients with Down syndrome (N=145) and Type 1 diabetes mellitus (N=155). Child’s clinical characteristics and parents’ caregiving burden, psychological distress, coping resources and strategies were assessed.Results:The parents of children with ASD reported higher objective and subjective burden, more frequent psychological distress, lower social support. Mothers reported greater subjective burden than fathers. Structural equation modeling showed that the most consistent positive and negative predictors of objective and subjective burden were ASD symptom severity and social support, respectively. Other positive predictors were engagement, distraction and disengagement coping, intellectual disability, and adaptive functioning. Other negative predictors were spiritual wellbeing and hardiness. Some effects were indirect through social support and coping strategies.Conclusion:This study confirmed that parents of children with ASD carry a huge caregiving burden, and added to our understanding of the factors associated with burden. The findings may help inform the design of effective interventions aimed at reducing burden among the parents of children with ASD.

Background: Despite the existence of autism spectrum disorder in Ghana, few studies have provided the necessary information on the phenomenon. These studies have mostly focused on speech and language therapy for children and modification of classroom environment for children with autism spectrum disorder. This approach has resulted in a paucity of knowledge on nurse’s knowledge of autism spectrum disorder in Ghana. Objective: The study sought to assess the knowledge of paediatric and psychiatric on autism spectrum disorder. Method: In this study, 130 paediatric and 93 psychiatric nurses sampled from five public hospitals in the Kumasi Metropolis participated in the survey. The Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire was employed to assess their knowledge of autism spectrum disorder. Results: It emerged from the study that psychiatric nurses were more knowledgeable on autism spectrum disorder than paediatric nurses in general and specifically on each of the four domains on the KCAHW questionnaire. However, the level of knowledge on autism spectrum disorder among both groups of nurses remains low. Apart from the previous encounter, there were no significant differences between paediatric and psychiatric nurses’ gender, age, marital status, working experience and their knowledge. Conclusion: In view of the findings, it will be appropriate for autism spectrum disorder to be included in the clinical training curriculum as well as the continuous professional education for both paediatric and psychiatric nurses. This will go a long way in helping paediatric and psychiatric nurses to increase their knowledge of autism spectrum disorder.

Background: Propensity to sexual excitation and inhibition is one of the key dimensions of sexuality. Clinicians working with Obsessive-Compulsive Disorder (OCD) patients rarely assess this and other aspects of sexuality, since treatment targets generally symptom reduction. Literature on sexual functioning in OCD patients is scarce and no study has focused on symptom subtypes, nor investigated the psychological processes related to sexual response. Objective: In the present short report, we describe an exploratory study investigating the association between symptom subtypes and propensity towards sexual excitation/inhibition in OCD patients, controlling for gender, age and antidepressant treatment. Methods: Seventy-two OCD patients (mean age = 34.50 years, 37.50% women) completed the Obsessive-Compulsive Inventory-Revised and the Sexual Inhibition/Sexual Excitation Scales. Results: Patients with more severe compulsive washing habit had a lower propensity towards excitation and a higher one towards inhibition due to threat of performance consequences (i.e., contamination with sexually transmitted diseases/having an unwanted pregnancy). Patients with more severe symptoms of checking showed a higher propensity towards inhibition due to the threat of performance consequences. Gender, age and antidepressant treatment were not related to sexual functioning. Conclusion: Specific OCD symptom subtypes may be associated with some psychological processes involved in sexual response. Sexual well-being should be carefully evaluated by practitioners and should be regarded as a treatment target. Future studies should investigate more comprehensively the processes involved in sexuality.

Background: Depressive and anxious symptoms are common psychological reactions to infertility and Medically Assisted Reproduction (MAR). No study compared depressive and anxious symptoms and infertility stress dimensions across homologous and heterologous MAR, nor explored the specific role of the infertility stress dimensions in the two pathways. Homologous MAR may be associated with higher distress as the couple feel that the responsibility to reproduce and carry on the family line falls on them, and they feel inadequate if they are unable to bear children. Objective: We compared depressive/anxious symptoms and infertility stress dimensions between individuals undergoing homologous and heterologous MAR. We also explored the association between the infertility stress dimensions and depressive/anxious symptoms separately in two MAR pathways. Methods: Two-hundred twenty-six individuals participated [mean age = 39.71 years; 54.45% women]: 118 (52.2%) in homologous and 108 (47.8%) in heterologous MAR. The Fertility Problem Inventory, Beck Depression Inventory-II, and State and Trait Anxiety Inventory-Y form were administered. Results: Individuals in homologous MAR had higher depressive/state-trait anxious symptoms, general infertility stress, and infertility-related sexual concerns than those in heterologous MAR. In homologous MAR, social and sexual concerns were associated with depressive/trait anxious symptoms while gender had no effect. In heterologous MAR, male gender was associated with lower state anxious symptoms while infertility stress dimensions had no effect. Conclusion: Individuals in homologous MAR are a more distressed subgroup which requires a tailored supportive psychological intervention specifically on sexual and social concerns.

Objective: No data are available about learning needs and career attitudes of Italian Psychiatry Residents (IPRs). Authors aimed to assess such needs through a survey to generate insight for implementing educational programs close to IPRs’ perceived learning needs. Methods: A 54-item questionnaire was developed in order to investigate career information, educational preference and learning needs of IPRs. A sample of 298 IPRs participated to the survey and was divided into four subgroups according to their location (North, Centre, South and Islands). The subgroups were compared through ANOVA for age and chi-square tests for qualitative variables (including gender and all sub-items of the survey), with Bonferroni post-hoc analysis. Results: IPRs were found to pursue, along with traditional and theoretical training, a quite practical approach, characterized by working groups, discussions on clinical cases and practical interactive sessions. The topics of major interest included: clinical psychiatry, psychopharmacology, psychiatric emergencies, communication and relationship skills (97%, 98.0%, 98.3% and 95.7% of the total sample, respectively). Indeed, a strong need for interaction with healthcare professionals emerged (97% of the total sample). North and Centre IPRs were more involved in Day Hospital activities than residents from South Italy and Islands (pp Conclusion: Reported findings should be taken into account as a starting point for planning and developing future targeted packages of educational proposals for IPRs and they should stand as a useful pilot study for further investigation in the field.

Introduction: The study aimed to see if a community survey conducted by clinical interviewers with semi-structured psychiatric interviews shows lifetime prevalence rates of Specific Phobia (SP) similar to those found by surveys carried out by lay interviewers and if the high level of impairment found in SP may be confirmed. Methods: This is a community survey on an Italian nationwide sample randomly selected from registers of municipalities. Tools: semi-structured ANTAS psychiatric interview derived from the SCID-DSM-IV, carried out by clinicians (psychologists or physicians); Short Form Health Survey (SF-12) as a measure of Quality of Life (QoL). Analyses: means of the χ2 test odds ratios were adopted to test several associations regarding SP prevalence. One-way ANOVA was used to compare different groups on attributable burden due to SP and/or other disorders in worsening QoL. Results: The lifetime prevalence of SP was 2.3%. No difference was found by age class. Females showed more than twice the frequency of males (pp p = 0.809). Conclusion: An epidemiological study conducted by clinical interviewers through semi-structured interviews appears to re-dimension the impact of SP, at least from the public health perspective. Future prospective studies will better clarify the role of SP in the context of anxiety disorders.

Background:Methylphenidate (MPH) is the most commonly used medication for Attention-Deficit/Hyperactivity Disorder (ADHD), but to date, there are neither consistent nor sufficient findings on conditions differentiating responsiveness to MPH response in ADHD.Objective:To develop a predictive model of MPH response, using a longitudinal and naturalistic follow-up study, in a Spanish sample of children and adolescents with ADHD.Methods:We included all children and adolescents with ADHD treated with MPH in our outpatient Clinic (2005 to 2015), evaluated with the K-SADS interview. We collected ADHD-RS-IV.es and CGI-S scores at baseline and at follow up, and neuropsychological testing (WISC-IV, Continuous Performance Test (CPT-II) & Stroop). Clinical response was defined as>30% reduction from baseline of total ADHD-RS-IV.es score and CGI-S final score of 1 or 2 maintained for the previous 3 months.Results:We included 518 children and adolescents with ADHD, mean (SD) age of patients was 11.4 (3.3) years old; 79% male; 51.7% had no comorbidities; and 75.31% had clinical response to a mean MPH dose of 1.2 mg/kg/day. Lower ADHD-RS-IV.es scores, absence of comorbidities (oppositional-defiant symptoms, depressive symptoms and alcohol/cannabis use), fewer altered neuropsychological tests, higher total IQ and low commission errors in CPT-II, were significantly associated with a complete clinical response to methylphenidate treatment.Conclusion:Oppositional-defiant symptoms, depressive symptoms, and a higher number of impaired neuropsychological tests are associated with worse clinical response to methylphenidate. Other stimulants or non-stimulants treatment may be considered when these clinical and neuropsychological variables converged in the first clinical interview.

Background: A link between depression and insecure attachment has long been postulated. Although many studies examined the relationship between depressive symptoms and attachment, relatively few studies were performed on patients diagnosed with depression. Also, research on patients with bipolar disorder is scarce. Objective: We aimed at testing the association between attachment insecurity and unipolar and bipolar depression. Methods: We studied 21 patients with bipolar disorder, current episode depressed, and three age- and sex-matched groups, each consisting of 21 individuals: patients with major depressive disorder, recurrent episode; patients with epilepsy; non-clinical participants. The Experience in Close Relationships questionnaire was used to assess adult attachment style. Results: Patients with both bipolar and unipolar depression displayed significantly higher scores on attachment-related avoidance as compared with patients with epilepsy and non-clinical participants. Also, patients with bipolar depression scored significantly higher on attachment-related anxiety than all other groups. In both psychiatric groups, attachment dimensions were not significantly correlated with global clinical severity or severity of depression. Conclusion: Despite some study limitations, our results are consistent with some previous studies and provide support to Bowlby's seminal hypothesis that attachment insecurity may predispose to depression. Attachment theory may provide a valuable theoretical framework for future research and for guiding treatment.

Introduction: The aim of the study was to measure the lifetime prevalence of Post-Traumatic Stress Disorder (PTSD) among women of an Italian community sample, the comorbidity of PTSD with mood and anxiety disorders and the burden attributable to PTSD in worsening the Quality of Life (QoL). Methods: Community survey on a sample of 1961 adult women randomly selected. Tools: psychiatric clinical interview ANTAS partially derived from the SCID-DSM-IV, administered by psychologists or medical doctors; Short Form Health Survey (SF-12); Mood Disorder Questionnaire (MDQ). Results: Lifetime prevalence of PTSD in women was 1.3%, (1.4% in44 years aged; p=0.8). In order of risk of comorbidity, PTSD was associated with: Bipolar Spectrum Disorders (MDQ+), Panic Disorders (PD) and Major Depressive Disorder (MDD). People with PTSD showed an SF-12 mean score lower than women of the same sample without PTSD (standardized by gender and age), with a mean difference (attributable burden) of 3.9±0.9 similarly to MDD and Eating Disorders and higher than PD. Among the analyzed nonpsychiatric diseases, Multiple Sclerosis and Carotid Atherosclerosis showed a higher burden in impairing QoL than PTSD; Wilson’s Disease showed a similar burden and Celiac Disease was found less impairing on QoL than PTSD. Conclusion: The attributable burden in worsening women’ perceived QoL due to a lifetime diagnosis of PTSD was found comparable to those caused by MDD, Eating Disorders or by neurological condition such as Wilson’s Disease. The comorbidity of PTSD with Bipolar Spectrum Disorders was remarkable, even further studies are needed to clarify the direction of causality.

Background:The aims were: 1) to measure the attitudes of learners (and future trainers) before and after a course on WHO-Quality Rights (QR); 2) to evaluate a psychiatric ward, by previously trained staff on QR, comparing it with a previous evaluation and discussing an improvement plan.Methods:1) Training sample: 19 subjects (8 males), 41.4±10.6 years, including jurists/lawyers, health professionals, and experts.The QR team developed the 26-item tool to assess the knowledge and attitudes of participants.2) Evaluation of quality of care and respect for human rights in the ward was carried out on 20 staff representatives, 20 family members and 20 users with QRToolkit.Results:1) Learning in QR has partially changed the knowledge and attitudes of trained people.2) The evaluation shows significant delays in the implementation of the rights advocated by the United Nations Convention on the Human Rights of Persons with Disabilities (CRPD). In Themes 1, 3, 4 and 5, the evaluation shows no differences compared to 2014, but in Theme 2, the level was lower than four years before.Conclusion:The scarcity of resources due to the economic crisis that Tunisia is going through, cannot be considered the only cause of the delays highlighted. However, it is likely that in a context of uncertainty for the future, scarcity of resources and a decrease in staff (i.e., professionals dedicated to psychosocial intervention) may have demotivated the team towards recovery. The improvement in knowledge and attitudes of many staff members after the training may open future positive scenarios.

Background:While growing literature is stressing the link between Autistic Traits (AT) and trauma-/stress-related disorders, in both conditions significant differences have been separately reported.Objective:This study aims to evaluate the relationship between AT and trauma-/stress-related symptoms with respect to sex.Methods:178 university students were assessed with the Structured Clinical Interview for DSM-5, the Trauma and Loss Spectrum (TALS) and the Adult Autism Subthreshold Spectrum (AdAS). In order to evaluate sex differences in trauma-/stress-related symptoms among subjects with higher or lower AT,the sample was split in two groups with an equal number of subjects on the basis of the median score reported on AdAS Spectrum (“AdAS high scorers” and “AdAS low scorers”).Results:Females reported significantly higher TALS total score,Loss eventsandGrief reactiondomain scores than males in the whole sample, while AdAS high scorers reported significantly higher TALS total and domain scores than AdAS low scorers. A significant interaction between high/low AdAS score and sex emerged for TALS domains, with females scoring significantly higher than males only among AdAS low scorers, specifically onLoss events,Grief reaction,Re-experiencingandPersonal characteristics/Risk factorsdomains. Finally, among AdAS high scorers a significantly higher rate of subjects fulfilled symptomatological criteria for PTSD than among AdAS low scorers, without sex differences.Conclusion:Our results confirm a significant relationship between AT and trauma-/stress-related symptoms, which seems to prevail on sex differences among high-risk subjects.

Background: The physical activity has been indicated as an experience that can help achieve positive, self-oriented own body awareness. This awareness is an aspect that tends to get worse with age. Objective: Our study aims to verify the internal consistency of a questionnaire on physical awareness in a sample of Italian elders; a secondary objective is to measure if there is a relationship between physical awareness and perceived level of physical activity. Methods: Cross sectional study on a consecutive sample of elderly people was administered the “Physical Body Experiences Questionnaire simplified for active aging (PBE-QAG)”, inspired by the “Physical Body Experiences Questionnaire”, modified, simplified and adapted to be used in the elderly over 65. To elderly people the International Physical Activity Questionnaire. Cronbach’s alpha was also used to assess internal reliability of the total PBE-QAG. The factor structure was evaluated through Confirmatory Factor Analyses (CFAs). Results: The Cronbach’s alpha was 0.8 for the “body-mind relationship” scale, 0.81 for the “accepting your body” scale, 0.83 for the “awareness of physical skills” scale, and 0.65 for the “awareness of physical limits” scale. Cronbach’s alpha for the total PBE-QAG was 0.89. The CFA indicated a model with the 4 factors (CFI = 0.989, TLI = 0.984, RMSEA = 0.076). People who conducted physical activity assiduously or regularly and over 10 minutes showed a better score to the PBE-QAG than those who declared a sporadic activity and for “less than 10 minute”, respectively. Conclusion: Our study revealed that the PBE-QAG shows an excellent total internal consistency. In the Italian sample of elderly people the questionnaire shows the model with the 4 factors described in literature.

Background:National projections about the increase in the elderly population over 60 years bring with it an increase in the number of people affected by Parkinson's Disease (PD), making it an important public health problem. Therefore, the establishment of effective strategies for intervention in people with PD needs to be more clearly investigated.Objective:The study aimed to report the effectiveness of exercise on functional capacity and neurobiological mechanisms in people with PD.Methods:This study is a critical review of the literature.Results:The progressive death of dopaminergic neurons in the substantia nigra is described as one of the main physiological mechanisms manifested before PD, directly interfering with motor behavior. However, PD is not only related to motor symptoms, but also to cognitive, autonomic, and mood impairments. Such effects may be attenuated by pharmacological influence, but also evidence suggests that the implementation of regular physical exercise programs may exhibit potential benefits over PD. The synthesis and expression of monoaminergic neurotransmitters can act positively on motor disorders, as well as directly or indirectly influence the neuronal plasticity of the brain, restoring neuronal pathways previously affected.Conclusion:Physical exercise contributes effectively to the treatment of PD, and can play a preventive and maintenance role of physical fitness and mental health.

There is enough evidence that, nowadays, the sedentary lifestyle is one of the major health problems worldwide, linked to many chronic diseases, including mental comorbidities, systemic hypertension, metabolic dysregulation, and cancer. Although health societies recommend engagement to physical activities, there is an overwhelming number of people remaining sedentary, even knowing the health benefits of regular exercises. One of the main factors that justifies this scenario is the lack of motivation, which is a barrier to people intended to start new habits for health. Considering this previous information, new alternatives for exercises may help people engage in a healthier lifestyle. Technology has contributed to this with devices that allow movements based on virtual reality approaches, including the exergames. These are games available even in commercial devices, as video-games, that allow people to work with different physical components. Furthermore, exergames add cognitive gain through its dual-task characteristic. Moreover, due to the combination of these benefits, they are feasible to acquire, and easy to use. Exergames are not only a potential strategy to reduce sedentary lifestyle but also a good method to improve health gains and rehabilitation in different populations and pathological conditions: older adults, stroke survivors, and Parkinson’s disease. In this review, we aim to demonstrate some conditions that literature supports the intervention with exergames due to its physical and cognitive benefits. Furthermore, at the end of this review, we also explore the neurobiological mechanisms behind virtual-reality based exercises.