Marco Liotta

Caregiver's Burden and Quality of Life: Caring for Physical and Mental Illness

Several studies have been focused on the quality of life of caregivers caring for patients with exclusively physical or mental diseases, but little is known about the differences related to the burden experienced. This study had as its subject the burden of caregivers and their quality of life involved in helping patients with diseases (1) physical, (2) mental and (3) both pathological conditions. We interviewed 294 caregivers of outpatients undergoing physiotherapic, psychiatric and neuroriabilitative treatment. The evaluation was carried out with three instruments: an informative questionnaire, the Caregiver Burden Inventory (CBI) and the Quality of Life Index (QoL -I). Results show that both the burden and the quality of life are significantly worse for caregivers who care for patients with both physical and mental diseases. Caregivers most disadvantaged are those who indicate as a reason of care the sense of duty rather than the affection. Finally, the sons and daughters, differently from the parents, showed a greater burden of required time and a lower quality of life. The investigation of the motivational aspects of the caregivers and the increased knowledge of the differences between the emotional experience of parents and children can contribute to the definition of more specific psycho-educational interventions and support.

Changes in hormonal and metabolic parameters in transgender subjects on cross-sex hormone therapy: A cohort study

OBJECTIVES Gender identity disorder is defined as a strong and persistent cross-gender identification that is associated with a remarkable uneasiness of living in an incongruent gender (gender dysphoria). We performed a retrospective study on the hormonal and metabolic effects of cross-sex hormone therapy (CSHT) in a small cohort of transgender patients. STUDY DESIGN Retrospective study. MEAN OUTCOME MEASURES Hormonal and biochemical parameters at baseline (i.e. before commencement of CSHT) and while on CSHT in 32 patients (21 male to female [MtF], 11 female to male [FtM]) referred to our Endocrinology Unit for gender dysphoria between January 2012 and February 2017. RESULTS Compared with baseline, in MtF patients systolic blood pressure, red cell count, hemoglobin, hematocrit and total testosterone decreased significantly, while 17-β estradiol and SHBG increased significantly and trendwise significantly, respectively. In FtM patients, total testosterone, red cell count, hemoglobin, hematocrit, creatinine, ɣ-glutamyl transferase and alkaline phosphatase increased significantly, while fasting plasma glucose decreased trendwise significantly. In MtF patients 17-β estradiol correlated positively with SHBG and alkaline phosphatase and negatively with total cholesterol and HDL-c, whereas total testosterone correlated positively with systolic blood pressure, red cell count and hematocrit, and negatively with SHBG. In FtM patients total testosterone correlated positively with creatinine and alkaline phosphatase, while 17-β estradiol correlated positively with HDL-c. CONCLUSIONS Our data are partly in line with other studies concerning the impact of CSHT on hormonal and metabolic parameters in transgender people. Metabolic changes appear, overall, to be modest, confirming the safety of CSHT.

Dental aesthetics perception and eating behavior in adolescence

Abstract Background: This correlational study explored the psychosocial aspects related to eating behavior in different age samples of adolescents in treatment from 0 to 60 months at the Clinic of Orthodontics and Dentistry of Messina, Messina, Italy. The aim of the study was to investigate the relationship between psychosocial impact, levels of self-esteem, and the possible connection with eating habits of adolescents under orthodontic treatment. Methods: Sixty-one adolescents, aged between 12 and 22 years (mean=15.6±2.8) participated to the study. Each adolescents was interviewed with the Eating Attitudes Test, the Rosenberg Self Esteem Scale, and the Psychosocial Impact of Dental Aesthetics Questionnaire. Results: Data did not show a direct connection between eating disorder and dental aesthetics, nevertheless, adolescents under orthodontic treatment, especially in the earliest phase of wearing braces, showed peculiar eating habits and underwent a higher psychological impact of dental aesthetics. Eating behaviors are strictly linked to global self-esteem. The processing of the results was made through the Student’s t-test and using Pearson’s correlation analysis. Conclusion: Increased knowledge of the psychological aspects involved in orthodontic treatment compliance may have positive effects in the relationship between adolescent patients and orthodontists. More attention should be paid to aspects that are often underestimated in clinical practice, thus, influencing the outcome of treatment and patient satisfaction, not only in terms of dental health, but also of mental health.

RELATIONSHIP BETWEEN TEMPERAMENT AND ANXIETY DISORDERS: A SYSTEMATIC REVIEW

The relationship between anxiety disorders and personality traits, in their temperamental and character dimensions, has been the subject of numerous studies using the dimensional approach of the psychobiological personality. The aim of this review was to identify temperament and character traits linked both to anxiety symptoms and to specific anxious disorders comparing the data obtained from studies using the two forms of Cloninger temperament and character inventory (TCI and TCI-R). Besides the study aimed to identify, through the comparison of data, the most appropriate model to represent the relationship between personality traits and anxiety disorders. Results showed a high direct correlation between the temperamental dimension of Harm Avoidance and anxiety symptoms and an high inverse correlation between the character dimension of Self-Directedness and anxiety symptoms. Moreover specific anxiety disorders has showed typical correlation with specific temperamental and character traits. The comparison between the longitudinal studies argues in favor of a “precursor model” of explanation of these correlations whereby personality can be used to individuate early manifestations of anxiety disorder.

Dental anxiety in relation to aggressive characteristics of patients

Dental anxiety is defined as the response to a stressful stimulus that is specific to a dental context. The dental treatment itself may provoke excitation and aggressive response relating to multiple sources of motivation that have been examined by the literature. The hypothesis to test in the present paper is to what extent dental anxiety can be explained by looking at patients’ characteristics solely or by considering latent aggressiveness that could be manifested before and during the dental treatment. The results of the study should give some indications to dentists to better understand the presence of a greater or lesser anxiety associated with orthodontic treatment in order to provide an appropriate assistance and, eventually, to help patients in developing coping strategies. As a consequence, it should be clear how intervening on each component of dental anxiety and/or aggressiveness may have a positive impact on the outcome of dental treatment.

Clinical Psychology of Oral Health: The Link Between Teeth and Emotions

The effects of oral health conditions on physical and psychosocial dimensions have been a matter of interest for several authors over the last decades. Nevertheless, literature lacks studies that address the relationship between the oral health–related quality of life (OHRQoL) and emotions. The present study aimed to investigate the psychological impact of oral disorders on people’s emotional well-being, with a particular attention to gender and age differences. Two hundred twenty-nine dental patients in care at private dental clinics were individually tested. One hundred thirty of them were females (56.8%) and 99 males (43.2%), aged between 18 and 83 years (M = 38.11; SD = 16.7). For the evaluation, the Profile of Mood States (POMS) and the Oral Health Impact Profile (OHIP-14) were used. Data were analyzed using Pearson’s correlations, the ANOVA, and the Kruskal–Wallis test. OHRQoL showed several correlations with all the emotions explored, overcoming the well-known relationship with anxiety and depression (p < .05). The degree of OHRQoL produced differences on mood states, which could appear normal, moderately altered, or psychopathological (p < .03). Furthermore, in different life stages, patients showed specific OHRQoL and emotions.

Type D Personality in infarcted patients a study with the Rorschach projective technique

Background: The Type D personality is a vulnerability factor associated with the psychological suffering that affects the physical and mental health state. Literature shows that the Type D personality is defined by a combination of two independent constructs: the negative affectivity (NA) which refers to the tendency to experience negative emotions over time and in several situations; and the social inhibition (SI) or the tendency to inhibit emotions and behaviors in social interactions. Objective: The present study aims to explore the emotions of a group of patients with heart disease, through the use of the Rorschach projective tecnique. Method: Fourty subjects with an history of heart attack, aged between 32 and 76 years, were evaluated in order to find some possible indicators of Type D personality such as the quality of contents, movements response, popular responses and Erlebnistypus. Results: Findings shows that the majority of patients present a prevalence of responses belonging to Animal and Anatomy contents and the Erlebnistypus is mostly introversive. Conclusions: The study points out some scientific element useful both in research and in clinical practice, confirming the Rorschach potential in the assessment and identification of specific personality traits, involved in the Type D personality, that characterizes the majority of cardiac impared patients.