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Objective Internet represents a major source of information related to health issues, increasingly used by providers. Indeed, there are numerous websites concerning eating and weight disorders, such as anorexia nervosa. The aim of the current investigation was to systematically perform a reliability and content analysis of Italian language anorexia nervosa-related websites. Methods Reliability of the anorexia nervosa website pages was assessed using the Health on the Net Foundation Code of Conduct Standards (HonCode®) certification mark. A comprehensive content analysis (thematic cluster analysis, correspondence analysis of emerging themes and topics, density and degree-centrality analysis, and co-word analysis) was performed using the commercial software T-Lab. Results 402 unique website pages were included and analyzed in the current study. Statistically significant differences related to the accomplishment or less to the items of the HonCode® certificate mark were found for all items, except for confidentiality and webmaster/additional contact. From the thematic cluster analysis, four clusters were identified: namely, treatment (26.6%), vomiting (24.7%), weight (24.4%) and onset-age (24.3%). Treatment (in particular, cognitive-behavioral psychotherapy) was the most represented theme (with a frequency of 97.76%, recurring in 393 websites). Pro-ana content characterized 147 website pages (with a frequency of 36.57%). Conclusion The quality of Italian language anorexia nervosa-related websites was rather moderate-poor, being generally inconsistent with the principles of the HonCode® certification mark. Therefore, physicians and health authorities should be aware of such findings to provide their patients with proper answers and education.

Mohammad Adawi,1 Riccardo Zerbetto,2 Tania Simona Re,2,3 Bishara Bisharat,4,5 Mahmud Mahamid,4 Howard Amital,6,7 Giovanni Del Puente,8 Nicola Luigi Bragazzi2,3,8,9 1Bar-Ilan Faculty of Medicine, Padeh and Ziv Hospitals, Zafat, Israel; 2GESTALT Study Center (CSTG), Milan, Italy; 3UNESCO Chair “Health Anthropology, Biosphere and Healing Systems”, University of Genoa, Genoa, Italy; 4EMMS Nazareth Hospital, Nazareth, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; 5The Society for Health Promotion of the Arab Community, The Max Stern Yezreel Valley College, Nazareth, Israel; 6Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 7Zabludowicz Center for Autoimmune Diseases, Department of Medicine B, Sheba Medical Center, Tel HaShomer, Israel; 8DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy; 9Department of Health Sciences, Postgraduate School of Public Health, University of Genoa, Genoa, Italy Background: The Brief Symptom Inventory (BSI), developed by Derogatis in 1975, represents an important standardized screening instrument that enables one to quantitatively assess psychological distress and psychiatric disorders. The BSI is a 53-item self-report scale, measuring nine dimensions that can be summed up to reflect three global indices, including the General Severity Index (GSI). In the era of new information and communication technologies, nomophobia (“no mobile phobia”) is an emerging disorder, characterized by the fear of being out of mobile phone contact. Nothing is known, however, about the factor structure and reliability of the BSI in a population of nomophobic subjects. This study aimed at addressing this gap in knowledge.Methods: A sample of 403 subjects aged 27.91±8.63 years (160 males, 39.7% of the entire sample, and 243 females, 60.3%), recruited via snowball sampling, volunteered to take part in the study. The Italian versions of the Nomophobia questionnaire and the BSI were administered. Exploratory factor analyses, confirmatory factor analyses, and clustering analysis were carried out together with correlation analysis, analysis of variance, and multivariate regression analysis.Results: For each BSI subscale, scores were significantly higher than the norms. The nine subscales exhibited acceptable-to-good Cronbach’s alpha coefficients, varying from 0.733 for psychoticism to 0.875 for depression. Overall, the reliability of the entire instrument proved to be excellent (alpha coefficient=0.972). Furthermore, all BSI subscales as well as BSI synthetic indexes correlated with nomophobia in a significant way. Stratifying the population according to the severity of nomophobia (mild, 206 individuals, 51.1% of the sample; moderate, 167 subjects, 41.4%; and severe, 30 individuals, 7.4%), the GSI score could distinguish (P0.05). Similar patterns could be found for the other subscales of the BSI. Finally, looking at the fit indexes, the second-order 9-factor model best fit the data compared with the Derogatis 1-factor model.Conclusion: The findings of our study show that the BSI is a reliable and valid instrument with acceptable psychometric properties, and can be administered to populations of nomophobic subjects. Keywords: nomophobia, Brief Symptom Inventory, psychometric properties, questionnaire, confirmatory factor analysis

BACKGROUND Suicide represents a public health concern, imposing a dramatic burden. Prosuicide websites are “virtual pathways” facilitating a rise in suicidal behaviors, especially among socially isolated, susceptible individuals. OBJECTIVE The aim of this study is to characterize suicide-related webpages in the Italian language. METHODS The first 5 most commonly used search engines in Italy (ie, Bing, Virgilio, Yahoo, Google, and Libero) were mined using the term “suicidio” (Italian for suicide). For each search, the first 100 webpages were considered. Websites resulting from each search were collected and duplicates deleted so that unique webpages could be analyzed and rated with the HONcode instrument RESULTS A total of 65 webpages were included: 12.5% (8/64) were antisuicide and 6.3% (4/64) explicitly prosuicide. The majority of the included websites had a mixed or neutral attitude toward suicide (52/64, 81.2%) and had informative content and purpose (39/64, 60.9%). Most webpages targeted adolescents as an age group (38/64, 59.4%), contained a reference to other psychiatric disorders or comorbidities (42/64, 65.6%), included medical/professional supervision or guidance (45/64, 70.3%), lacked figures or pictures related to suicide (41/64, 64.1%), and did not contain any access restraint (62/64, 96.9%). The major shortcoming to this study is the small sample size of webpages analyzed and the search limited to the keyword “suicide.” CONCLUSIONS Specialized mental health professionals should try to improve their presence online by providing high-quality material.

BACKGROUND Selfie addiction is one of the behavioral addictions or addictive behaviors that have recently emerged, together with the internet addiction, the smartphone addiction. OBJECTIVE The aim of the investigation was to explore the relationships between selfie addiction, nomophobia and locus of control. METHODS 242 subjects (median age 26 years, n=182, 75.2%, females and n=60, 24.8%, males) were recruited. The primary objective of the study was to validate the Italian translation of the Selfie-liking Scale conceived by Charoensukmongkol, a short scale used to measure the attitude towards the use of the selfie. The second part of the research links this test with the Nomophobia Questionnaire (NMP-Q), used to measure the level of nomophobia in the participants and, finally, we have related the Selfie-liking Scale with the Internal-External (I-E) Rotter Scale, used to measure the orientation of the Locus of Control, with particular attention to the external orientation of this psychological construct. RESULTS Cronbach’s alpha in Selfie-liking Scale was good (0.88). A significant correlation was found between the total score of the selfie scale and nomophobia and correlation between external locus of control and selfie resulted statistically borderline. CONCLUSIONS The selfie-liking scale is a reliable instrument and can be utilized in future studies to explore further psuychological determinants of such a behavior.

Background Suicide represents a public health concern, imposing a dramatic burden. Prosuicide websites are “virtual pathways” facilitating a rise in suicidal behaviors, especially among socially isolated, susceptible individuals. Objective The aim of this study is to characterize suicide-related webpages in the Italian language. Methods The first 5 most commonly used search engines in Italy (ie, Bing, Virgilio, Yahoo, Google, and Libero) were mined using the term “suicidio” (Italian for suicide). For each search, the first 100 webpages were considered. Websites resulting from each search were collected and duplicates deleted so that unique webpages could be analyzed and rated with the HONcode instrument Results A total of 65 webpages were included: 12.5% (8/64) were antisuicide and 6.3% (4/64) explicitly prosuicide. The majority of the included websites had a mixed or neutral attitude toward suicide (52/64, 81.2%) and had informative content and purpose (39/64, 60.9%). Most webpages targeted adolescents as an age group (38/64, 59.4%), contained a reference to other psychiatric disorders or comorbidities (42/64, 65.6%), included medical/professional supervision or guidance (45/64, 70.3%), lacked figures or pictures related to suicide (41/64, 64.1%), and did not contain any access restraint (62/64, 96.9%). The major shortcoming to this study is the small sample size of webpages analyzed and the search limited to the keyword “suicide.” Conclusions Specialized mental health professionals should try to improve their presence online by providing high-quality material.

Eisa Al-Balhan,1,* Hicham Khabbache,2,* Abdelhadi Laaziz,2 Ali Watfa,3 Abdelkader Mhamdi,4 Giovanni Del Puente,5 Nicola Luigi Bragazzi5–8 1Department of Educational Psychology, College of Education, Kuwait University, Kuwait City, Kuwait; 2Faculty of Literature and Humanistic Studies, Sais, Sidi Mohamed Ben Abdellah University, Fez, Morocco; 3Faculty of Education, Kuwait University, Kuwait City, Kuwait; 4Department of Sociology, Sais, Sidi Mohamed Ben Abdellah University, Fez, Morocco; 5DINOGMI, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; 6UNESCO Chair “Health Anthropology, Biosphere and Healing Systems”, University of Genoa, Genoa, Italy; 7Gestalt Study Center (CSTG), Milano, Italy; 8Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy *These authors contributed equally to this work Background: Diabetes represents a major public health concern. According to the International Diabetes Federation, about 8%–9% of the population have diabetes, and rates are even higher among Muslim communities. Despite the risks, about half (43%) with type 1 diabetes and most (86%) of those with type 2 diabetes fast during Ramadan. However, there is a dearth of information concerning the determinants that drive diabetic people to fast. Therefore, the present study was designed to fill this gap in knowledge. Materials and methods: A sample of 201 subjects volunteered to take part in this study. Mean age was 45.39±15.74 years. Most participants were female, married and had received at least primary education. They fasted for 22.98±8.53 days. Results: For the overall questionnaire, the Cronbach’s alpha coefficient was found to be excellent (α=0.910). The coefficient was good, yielding a value of 0.879, for the items concerning Ramadan fasting beliefs and practices, whereas the subscale for religious beliefs and practices obtained a score of 0.847. At the univariate analysis, patients with complicated diabetes (n=66, 32.8% of the sample) fasted for 20.77±9.21 days vs subjects with diabetes (n=135, 67.2% of the interviewees), who fasted for 24.05±7.99 days. The difference was statistically significant (P=0.014). The multivariate analysis indicated that religious beliefs and practices influenced the number of fasting days in a statistically significant way, after adjusting for confounders (beta coefficient =−0.199, t=−2.917, P=0.004). Another variable that impacted on the number of fasting days was the presence of complications (beta coefficient=−0.194, t=−2.775, P=0.006). Conclusion: Our results warrant further studies in the field. Keywords: diabetes, Ramadan fasting, religious beliefs and practices, survey

(2015). On: Hijab and homosexuality – a case report and review of the literature. The International Journal of Psychoanalysis: Vol. 96, No. 5, pp. 1417-1420.

Background: Nomophobia, which is a neologism derived from the combination of “no mobile,” “phone,” and “phobia” is considered to be a modern situational phobia and indicates a fear of feeling disconnected.\ud \ud \ud \ud Objective: No psychometric scales are available in Italian for investigating such a construct. We therefore planned a translation and validation study of the Nomophobia Questionnaire (NMP-Q), which is an instrument developed by Yildirim and Correia. Subjects were recruited via an online survey using a snowball approach.\ud \ud \ud \ud Methods: The NMP-Q was translated from English into Italian using a classical “backwards and forwards” procedure. In order to explore the underlying factor structure of the translated questionnaire, an exploratory factor analysis was carried out. A principal component analysis approach with varimax rotation was performed. Multivariate regression analyses were computed to shed light on the psychological predictors of nomophobia.\ud \ud \ud \ud Results: A sample of 403 subjects volunteered to take part in the study. The average age of participants was 27.91 years (standard deviation 8.63) and the sample was comprised of 160 males (160/403, 39.7%) and 243 females (243/403, 60.3%). Forty-five subjects spent less than 1 hour on their mobile phone per day (45/403, 11.2%), 94 spent between 1 and 2 hours (94/403, 23.3%), 69 spent between 2 and 3 hours (69/403, 17.1%), 58 spent between 3 and 4 hours (58/403, 14.4%), 48 spent between 4 and 5 hours (48/403, 11.9%), 29 spent between 5 and 7 hours (29/403, 7.2%), 36 spent between 7 and 9 hours (36/403, 8.9%), and 24 spent more than 10 hours (24/403, 6.0%). The eigenvalues and scree plot supported a 3-factorial nature of the translated questionnaire. The NMP-Q showed an overall Cronbach alpha coefficient of 0.95 (0.94, 0.89, and 0.88 for the three factors). The first factor explained up to 23.32% of the total variance, while the second and third factors explained up to 23.91% and 18.67% of the variance, respectively. The total NMP-Q score correlated with the number of hours spent on a mobile phone.\ud \ud \ud \ud Conclusions: The Italian version of the NMP-Q proved to be reliable.

This article reports the data of the Modified Somatic Perception Questionnaire (MSPQ) administered to a sample of 143 immigrants accessing an outpatient clinic or the general practitioners offices in Genoa (Italy) compared with 186 Italian patients. For further details and for the interpretation of the data, the reader is referred to the original publication “Somatic perception, cultural differences and immigration: results from administration of the Modified Somatic Perception Questionnaire (MSPQ) to a sample of immigrants” by Bragazzi et al. (2014) [1] .

Anna Siri,1 Giovanni Del Puente,2 Mariano Martini,3 Nicola Luigi Bragazzi1–3 1Department of Mathematics (DIMA), 2Department of Neuroscience, Rehabilitation (DINOGMI), 3Section of History of Medicine and Ethics, Department of Health Sciences (DISSAL), University of Genoa, Genoa,Italy Abstract: Creativity is an ability that plays a major role in the modern economy and society. It should represent an important component of the medical syllabus. However, it is often overlooked by the formal courses at universities. The current study aimed at evaluating whether the interactive educational models, recently adopted by the Faculty of Medicine and Surgery, at the University of Genoa, Italy, would favor the adoption of critical thinking, attitudes to changes, cultural diversity acceptance, and the adoption of relational soft skills versus traditional and frontal didactic teaching. Thirty students, who attended the last year of health care professional course at the Faculty of Medicine, volunteered to take part in the study and were randomly allocated to two groups: one group receiving an innovative, interactive excellence course and the other group receiving a more traditional approach. Ethnopsychiatry was chosen as the topic since it was hypothesized that it would have contributed to generation of a new approach toward diseases and patients. The first group of students, exposed to interactive lectures with the aim of promoting the adoption of critical thinking, were more satisfied than the second group. Participants who were involved in an active manner and had to work in small groups, actively finding their own solutions to solve the problems, perceived the utilized teaching method and experience more stimulating, involving, and effective. Implications for education policy makers are also envisaged. Keywords: creative thinking, clinical case/example, medical education, medical syllabus, medical teaching&nbsp

Religiosity/spirituality is generally considered as a powerful tool for adjusting and coping with stressors, attributing purposes and meanings (either existential/philosophical, cognitive, or behavioral ones) to daily situations and contexts. While studies generally investigate these effects in Judaism and Christianity believers, there is a dearth of data concerning oriental religions. We sampled from Italian Nichiren Buddhists, the most widespread branch of Buddhism in Italy (n = 391). Participants were Buddhists on average since 5 years and self-defined moderate practitioners. Adaptive strategies exhibited higher scores than maladaptive ones. Specifically, the adaptive strategy of active coping positively correlated with self-evaluated degree of being a practicing Buddhist, as well as positive reframing and religion, while maladaptive strategies such as use of substances, venting and behavioral disengagement correlated negatively. Only the subscale of religion correlated significantly and positively with the time from which the participant had become Buddhist, while the use of emotional support correlated negatively. Most participants had a predominantly internal locus of control. External locus of control negatively correlated with time the participant became Buddhist and the self-reported degree of being a practicing Buddhist, whereas internal locus positively correlated only with the latter variable. Furthermore, Buddhist participants exhibited a low psychopathological profile when compared with the normative scores.

Non-Suicidal Self-Injury (NSSI) is a complex behavior. Many Web-sites devoted to NSSI are available and in this manuscript we have performed a content analysis, analyzing how NSSI is portrayed. From a clinical point of view, as suggested by Lewis and collaborators, the clinician while interviewing the patient should inquire about his/her online activities. More quantitative- based research is needed to shed light on this topic.

Nicola Luigi Bragazzi,1 Giorgio Ratto,2,3 Nicola Dalle Luche,4 Tiziana Canfori,5 Claudio Proietti,5 Giovanni Del Puente6 1Department of Health Sciences, School of Public Health, University of Genoa; 2Giacomo Puccini Conservatory of Music, La Spezia; 3Carlo Soliva School of Music, Casale Monferrato; 4La Scala Theatre, Milan; 5Niccolo Paganini Conservatory of Music, Genoa; 6Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Italy

Nicola Luigi Bragazzi,1,2 Giovanni Del Puente21School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; 2DINOGMI, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, ItalyAbstract: The Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered to be the gold standard manual for assessing the psychiatric diseases and is currently in its fourth version (DSM-IV), while a fifth (DSM-V) has just been released in May 2013. The DSM-V Anxiety Work Group has put forward recommendations to modify the criteria for diagnosing specific phobias. In this manuscript, we propose to consider the inclusion of nomophobia in the DSM-V, and we make a comprehensive overview of the existing literature, discussing the clinical relevance of this pathology, its epidemiological features, the available psychometric scales, and the proposed treatment. Even though nomophobia has not been included in the DSM-V, much more attention is paid to the psychopathological effects of the new media, and the interest in this topic will increase in the near future, together with the attention and caution not to hypercodify as pathological normal behaviors.Keywords: behavioral dependence, mobile phone, social phobia, specific phobia

Dear editor Dr Salvatore Campanella has recently advocated the urgent need to incorporate cognitive event-related potentials (ERPs) for a proper diagnosis, treatment, and prognosis of psychiatric disorders, on the basis of four working hypotheses, which are theoretically solid and experimentally supported.1 Psycho-pathological diseases are characterized by a cognitive impairment (first argument) and the task of ERP methodology is to investigate these very cognitive alterations (second argument), in a more effective, fast, reliable and comprehensive way than the traditional administration of neuropsychological tests and questionnaires, which are rather time-consuming and difficult to implement in everyday clinical practice. Furthermore, ERP is able to discriminate among similar behaviors (third argument), thus having potential benefits and clinically relevant implications, as it would enable an ERP-based neuropsychological and cognitive treatment (a “directed cognitive retraining procedure”) (fourth argument). Moreover, this treatment would be targeted and personalized, since specifically designed and focused on the cognitive deficit of the patient, and ERP would logically and coherently link the three moments of clinical practice: diagnosis, treatment and prognosis. ERP, indeed, does not only provide the approach and the target of the clinical intervention, but makes also possible to monitor its effects.2 Interest in ERP, however, is not recent, even though it has been quite erratic throughout the decades, and examples of ERP-like paradigms can be found in Bleuler’s clinical observations of schizophrenic patients.3 Scholars have progressively enriched the ERP paradigm with phenomenological, clinical, and psychological observations, and some researchers have speculated that ERPs could have a genetic and/or environmental basis and thus could be inherited, meeting with the requirements of the Gottesman and Gould principles4 for defining a trait as an endophenotype. ERPs have been proven to be reproducible, with good-to-excellent psychometric properties and are promising biomarkers.5 The technical and technological advancements in the field of electroencephalography (EEG) (the transition from scalp EEG to source EEG and quantitative EEG, and the introduction of portable and wearable sensors for real-time monitoring) coupled with powerful computational processing approaches5,6 have further revolutionized the usefulness and the applications of ERPs, making more feasible the transition from bench to patient bedside. Moreover, ERP can be integrated with functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and other sophisticated and advanced imaging devices, thus acquiring more clinical significance and relevance.7 In conclusion, psychiatric disorders are complex diseases8 and complex problems call for complex solutions: an integrated, multidisciplinary team, including all the professional figures who deal with all the different aspects of brain-related disorders – from the psychiatrist to the social worker and occupational therapist; from the psychologist to the neurologist – could cope with the challenges that arise from the necessity to integrate and coordinate the different methods and approaches. This, of course, should be reflected also in designing the university syllabus and residential curricula, putting emphasis on the different souls of the psychiatry (the biological and the psychological strains) and its intrinsic multidisciplinary nature.

Chronic Kidney Disease (CKD) has a tremendous psychological burden, which sometimes is overlooked or underestimated in the daily clinical routine practice, since in the health care process physicians prefer to focus on the objective aspects of the pathology. In this contribution, we make a systematic overview of the relationship between spirituality/religiosity and CKD, an emerging theme which only recently has raised interest from the scientific community despite its importance. We investigate different variables, axis and categories (from the quality of life to customer’s satisfaction, treatment adherence and therapeutic alliance, clinical parameters, as well as overall survival, and coping strategies adopted by the patient). Moreover, we underpin the principal clinically relevant implications (like the possibility of psycho-therapeutic interventions based on the spiritual and religious attitudes of the patient) and we discuss the main gaps, methodological barriers and difficulties in the field, fostering and advocating further research and clinical studies. This last aspect, together with the quality assessment of the studies, will be further explored in the second part of the study.

Multiple sclerosis is a chronic neurological disease whose etiology has not been fully understood yet in details. Empirical findings show how psychosocial symptoms are very important features of the clinical presentation of multiple sclerosis, having a deep impact on patient’s quality of life, and thus psychological coping strategies may play a central role in reducing the burden of the disease and improving patient’s satisfaction of life. Multiple sclerosis’ progression and relapses/exacerbations may depend on factors such as stressor chronicity, frequency, severity and type and individual patient characteristics such as depression, health locus of control, optimism and perceived social support. Here, we make a review on the current state of art concerning the relationship between health locus of control and multiple sclerosis.

Nicola Luigi Bragazzi, Giovanni Del Puente, Werner Maria NattaDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, ItalyAbstract: The number of immigrants in Italy has doubled every 10 years from 1972 and Genoa hosts two large communities of immigrants from South America and Africa. We investigated differences in the somatic perception between immigrants and Italians and between South Americans and Africans living in the city of Genoa. During a 7 month period, an anonymous questionnaire asking for sociodemographic information and the Modified Somatic Perception Questionnaire (MSPQ) were administered to all immigrants accessing an outpatient clinic or the general practitioners offices. MSPQ mean scores were significantly higher in immigrant patients than in Italian patients, after adjusting for sex and age differences. We found no differences between South Americans and Africans in MSPQ score. The tendency to express discomfort through physical symptoms appears to be related to being a foreigner who arrived in Italy through a migratory trip and also to being a person who comes from a cultural context that is very different from the one of developed countries.Keywords: immigrants, Modified Somatic Perception Questionnaire (MSPQ), somatization, transcultural psychiatry

Both Alessandro Pannitti and Franco Rossi have a solid and reputed experience of several years in the field of Coaching, and in this book they have provided the readers with their expert, authoritative overview on the different coaching techniques...

The psychic reevocation of disturbance of the colon or disturbances of other body districts not felt by the patient at the time facilitates the accentuation of colon motility or tone, leading to the exacerbation of the pathogenetic premises of the disturbances complained of. The colonmetrographic findings are instructive in this respect. Direct functional disturbance of various districts is also suggested, and the pathology of such forms in psychosomatically oriented patients is described. Such orientation takes the form of a ready translation of ideas into rather diffuse somatic changes that are partly aspecific, due to the predominance of response mechanisms that are more physiological than psychological. The picture is one of a primordial reaction to difficulties and problems, coupled with increased stress, sometimes to the points of vegetative or motor storms, in the expectation of help from outside, such help being represented in the past by intervention on the part of the mother.