Giovanni Del Puente

A proposal for including nomophobia in the new DSM-V

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.

Health Locus of Control and Multiple Sclerosis: A Systematic Review

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.

Somatic perception, cultural differences and immigration: results from administration of the Modified Somatic Perception Questionnaire (MSPQ) to a sample of immigrants.

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.

Why P6 medicine needs clinical psychology and a trans-cultural approach

In the last decades, medicine has undergone profound and deep changes and challenges, such as the introduction of new medical devices and nanobiotechnologies,1-3 that have enabled the understanding of molecular pathogenesis at unprecedented levels. Nanogenomics and nanoproteomics represent the frontiers of biomedicine,4-7 paving the way for a personalized diagnosis and treatment, that is to say not just a one-size-fits-it-all therapy as before but a tailored, targeted therapeutics. There has been a shift from P0 medicine to a P6 model (where the six Ps stay for preventive, predictive, personalized, participatory, public and psycho-cognitive medicine).8 However, the introduction of new bio-techniques and procedures with their ethical implications as well as the emerging paradigm of a proactive medicine, focusing not only on acute diseases but above all on chronic pathologies, make psychology a not negligible and secondary component of this highly integrative approach. A patient is not only a disease, a clinical case or a genetic and biological entity but, first of all, a person and for a real personalized treatment a holistic integrated bio-psychosocial approach should be carried out.9-11 A good clinical practice should focus on the patient-recorded outcomes and measurements (PROMs), such as quality of life, customer satisfaction of the health-care process, if really wants to transform itself in a person-related and patient-centered medicine (as Carl Rogers and Michael Balint advocated). This would overcome paternalism and asymmetry in the physician-patient relationship and involving and empowering the patient and taking shared clinical decisions would result in a better health outcome. Understanding the behavioral and cognitive aspects of the patient’s decisions and preferences is fundamental and vital, considering that nowadays therapies are more complex being combination of drugs and that patient’s adherence and compliance can have an impact on the success or failure of the treatment. Moreover, a culturally competent perspective should inform clinician’s approach in a globalized era,12,13 considering that immigrants are more likely to suffer from mental health problems and psycho-social issues.14-17 For these reasons, psychology and a trans-cultural informed approach are an important component of the nowadays emerging P6 medicine.

Chronic kidney disease, spirituality and religiosity: a systematic overview with the list of eligible studies

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.

Understanding the missing link between musical attitudes, preferences and psychological profiles: music as automedication and self-administered therapy? Implications for music therapy

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

Incorporating and integrating cognitive event-related potentials in the management of psychiatric disorders

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.

To fast or not to fast during the month of Ramadan? A comprehensive survey on religious beliefs and practices among Moroccan diabetic patients

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.

Data of the Modified Somatic Perception Questionnaire (MSPQ) administered to a sample of immigrants in Genoa (Italy)

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].

Ethnopsychiatry fosters creativity and the adoption of critical and reflexive thinking in higher education students: insights from a qualitative analysis of a preliminary pilot experience at the Faculty of Medicine and Surgery, University of Genoa, Italy

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.