Paola Aceto

Internet addiction: hours spent online, behaviors and psychological symptoms

OBJECTIVE The aim of this study was to investigate psychopathological symptoms, behaviors and hours spent online in patients with internet addiction disorder (IAD) at a new psychiatric service for IAD inside a policlinic. METHOD Eighty-six subjects participated in the study. Thirty-three patients asking for psychiatric consultation regarding their excessive use of the internet were assessed with IAD interview, internet addiction test (IAT), Symptom Checklist-90-Revised (SCL-90-R) and a brief sociodemographic survey. Moreover, patients had to respond to the following question: Over the last month, how much time have you spent online per week? At the end of psychiatric assessment, 21 of the 33 patients satisfied inclusion (IAD interview) and exclusion (psychotic disorders, neurocognitive deficits, dementia, serious mental delay, current alcohol or drug abuse) criteria. Twenty-one patients of the clinical group were compared with 65 subjects of a control group who were recruited online using IAT. RESULTS IAD patients showed significantly higher scores on the IAT compared to subjects of the control group. Only item 7 (How often do you check your e-mail before something else that you need to do?) showed a significant inverse trend. SCL-90-R anxiety and depression subscale scores and item 19 (How often do you choose to spend more time online over going out with others?) of the IAT were positively correlated with number of weekly hours spent online in IAD patients. CONCLUSION Findings suggest that a misuse of internet, characterized by many hours spent online avoiding interpersonal relationships with real and known people, could be an important criterion in the clinical interview in order to diagnose the IAD. The association between the lost interest in communicating with real people and psychological symptoms such as anxiety and depression could be relevant to detect IAD patients.

Ropivacaine vs. levobupivacaine combined with sufentanil for epidural analgesia after lung surgery

Background and objectives: There are no clinical studies that compare epidural infusion of ropivacaine and levobupivacaine in patients undergoing lung surgery. The aim of this prospective, randomized double‐blind study was to evaluate the efficacy and safety of two commercially available solutions of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) when administered by continuous epidural infusion together with sufentanil in patients undergoing lung surgery. Methods: After obtaining informed consent, 54 patients, ASA physical status I‐III undergoing lung resection, were enrolled. Patients were randomly assigned to two groups in which analgesia was performed by continuous thoracic epidural infusion of ropivacaine 0.2% w/v (Group R) or levobupivacaine 0.125% w/v (Group L) with or without sufentanil 1 &mgr;g mL−1. After a test and a loading dose of each drug for the respective group, continuous epidural infusion, set at 5 mL h−1, began. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient‐controlled analgesia. Visual analogue scale at rest and when coughing, rescue patient‐controlled analgesia morphine amount, haemodynamics, sensory and motor block, sedation, nausea and vomiting, patient satisfaction score, were evaluated within 48 h. Results: The two groups were similar regarding patient characteristics, quality of analgesia, level of sensory block, morphine consumption and satisfaction score. Postoperative haemodynamic profile was stable in all the patients. Minor side‐effects occurred with a similar incidence. Motor block was not seen. Conclusions: Equivalent volumes of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) provided similar static and dynamic analgesia with similar incidence of minor side‐effects after thoracotomy.

Attachment style predict compliance, quality of life and renal function in adult patients after kidney transplant: preliminary results

Abstract Aim: Aim of this study was to evaluate the association between attachment style, compliance, quality of life and renal function in adult patients after kidney transplantation. Methods: A total of 43 adult patients who received a kidney transplant more than 3 months before were enrolled and were asked to complete two Self-Report questionnaires: Attachment Style Questionnaire (ASQ-40) and Short Form Health Survey (SF-36). Also compliance was measured using appropriate questions. Results: Linear regression analysis showed associations between the confidence in relationships (ASQ-40) and compliance [beta = −0.37; B = −0.02; t(41) = −2.51; p = 0.02]; aspects of anxious attachment style (ASQ-40) and creatinine levels [beta = 0.3; B = 0.13; t(41) = 2.03; p = 0.04]; aspects of avoidant attachment style (ASQ-40) and compliance [beta = −0.37; B = −3.15; t(41) = −2.35; p = 0.02]. Patients who exhibited avoidant attachment had a significantly better perception of their own general health than patients with anxious [F(2,37) = 6.8; p < 0.05] or secure attachment; however, they had a worse perception regarding role limitations due to emotional problems, compared to patients with anxious attachment [F(2,37) = 6.4; p < 0.05]. Discussion: The results of this study suggest that the evaluation of the attachment style in adult kidney transplant patients can contribute to plan a goal-directed psychological support program for these patients, in order to increase their compliance. The association between aspects of anxious attachment style and creatinine level needs more investigations.

Predictive Role of Different Dimensions of Burden for Risk of Complicated Grief in Caregivers of Terminally Ill Patients

The aim of the study was to test whether high levels of caregiver burden, as other confirmed predictors, are associated with the risk of prolonged grief disorder in caregivers of terminally ill patients. A predictive study was carried out in order to test the hypothesis. A demographic schedule, the Prolonged Grief 12 (PG-12), the Toronto Alexithymia Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Caregiver Burden Inventory were administered to 60 caregivers of 51 patients who were admitted in Hospice. In the regression analysis, difficulty in recognizing emotions, total burden, depression, and developmental burden dimension were significant predictors of PG-12 levels. Findings showed that feeling of deprivation of existential expectations represents the greater risk factor for the prolonged grief disorder, among the burden dimensions.

Psychological Risk Factors for Graft Rejection Among Liver Transplant Recipients

The purpose of this prospective study was to find psychological risk factors predicting acute, chronic, and psychological rejection in patients undergoing liver transplantation using Cognitive Behavioural Assessment (CBA-2.0). The primary scale included an assessment of fears, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression. We prospectively recruited 44 patients undergoing orthotopic liver transplantation (OLT). Exclusion criteria were: education level below secondary school, unstable clinical situation in an out-patient setting, fulminant hepatitis, psychotic disorders, neurocognitive deficits, dementia, serious mental retardation, current alcohol or drug abuse, recent ideation of or attempted suicide, and non-adherence to therapy. CBA-2.0 primary scale series of questionnaires were handed out to patients immediately after the medical examination, which had been performed to ascertain eligibility for OLT. Rejection (acute and/or chronic) was diagnosed according to clinical and histopathological criteria. Psychological rejection was diagnosed when patients declared, after transplantation, a refusal of the new organ which caused psychiatric symptoms requiring medical treatment and/or psychotherapy. Analysis of variance and logistic regression of psychological variables was performed to detect possible risk factors for each type of rejection. A greater fear of repulsive animals was able a predictor for an acute rejection episode (odds ratio=1.1; P<.05). No other psychological pretransplant predictor was noted for chronic or psychological rejection. In patients undergoing OLT, preoperative emotions of fear could predict an acute graft rejection episode. These findings imply that pre-OLT screening should include psychological factors in addition to traditional medical criteria with intervention in selected cases.

Dreams recall and auditory evoked potentials during propofol anaesthesia

It is unclear whether shorter wave latencies of middle-latency-auditory-evoked-potentials may be associated to cognitive function other than nondeclarative memory. We investigated the presence of declarative, nondeclarative and dreaming memory in propofol-anaesthetized patients and any relationship to intraoperatively registered middle-latency-auditory-evoked-potentials. An audiotape containing one of two stories was presented to patients during anaesthesia. Patients were interviewed on dream recall immediately upon emergence from anaesthesia. Declarative and nondeclarative memories for intraoperative listening were assessed 24 h after awakening without pointing out positive findings. Six patients who reported dream recall showed an intraoperative Pa latency less than that of patients who were unable to remember any dreams (P<0.001). A high responsiveness degree of primary cortex was associated to dream recall formation during anaesthesia.

Neural correlate of the projection of mental states on the not-structured visual stimuli

Projection is a spontaneous and complex mental activity responsible for the subjective meaning attribution. The hypotheses of this study were that the neural correlate of projection may involve frontal, parietal, and temporal brain areas, and that alexithymia may be negatively associated with intensities in limbic and paralimbic areas during projection. EEG data were recorded continuously at 250 Hz using NetStation 4.5.1 with 256-channels HydroCel Geodesic Sensor Net in 20 healthy subjects during the presentation of structured and not-structured visual stimuli. The tasks were paying attention to the stimuli and thinking about the possible meaning of each image. Event related potential (ERP) components and low-resolution electromagnetic tomography (sLoreta) were analyzed. Participants were administered the 20-Item Toronto Alexithymia Scale before stimulus presentation. Source analyses (sLORETA) showed a greater activated source in the left primary somatosensory cortex (BA1) compared to all the others BA in both conditions through all the ERP components. An involvement of the frontal (right-BA4, left- and right-BA9, left-BA11) and parietal (left and right-BA2 and left-BA7) areas was found in projective response to not-structured visual stimuli. Alexithymia levels were negatively correlated with the anterior (right-BA32) and posterior (left-BA29) cingulate cortex. Findings show the relevance of fronto-parieto circuits during projection, where the internally generating somatosensory representations could drive an intermodal meaning attribution during the task. Moreover, high alexithymia levels were associated with a reduced activation of the cingulated cortex.

Effects of switching from twice-daily to once-daily tacrolimus formulation on quality of life, anxiety, and transplant benefit perception after kidney transplantation

OBJECTIVE This study investigated whether switching from the twice-daily (Prograf; TAC) to the once-daily formulation of tacrolimus with extended release (Advagraf; XL) affected quality of life, anxiety, and transplant benefit perception after allogeneic kidney transplantation. METHODS After local Institutional Review Board approval, 78 adult patients prescribed twice-daily tacrolimus for ≥1 year after kidney transplantation were asked to participate in this study. All patients were evaluated at T0 (before the switch), and the 49 who accepted the change were reassessed after 6 months (T1). The following tests were used: (State and Trait Anxiety Inventories Y1 and Y2, (Psychologic General Well-Being Index), and modified Transplant Effect Questionnaire for posttransplantation symptoms. Blood samples for laboratory profiles and determinations of drug concentrations were obtained throughout the study period. RESULTS There were no significant differences between the psychologic variables at T0 among patients who switched from TAC to XL (n=49) versus those who did not participate (n=29). Eight of the 49 patients who accepted the drug conversion were reswitched to TAC because of adverse events. At T1, the remaining switched patients (n=41) showed an increase in the disclosure of having undergone transplantation (P<.05) versus nonswitched patients; whereas reswitched patients (n=8) showed less positivity and well-being (P<.05) compared with those who remained in the switched regimen. CONCLUSION The findings suggested increased disclosure of having undergone transplantation among patients who decided to switch from TAC to XL.

Attachment Style Dimensions Can Affect Prolonged Grief Risk in Caregivers of Terminally Ill Patients With Cancer

Objective: The aim of the present study was to evaluate the predictive role of attachment dimensions on the risk of prolonged grief. Sixty caregivers of 51 terminally ill patients with cancer who had been admitted in a hospice were selected. Methods: Caregivers were interviewed using Attachment Scale Questionnaire, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Prolonged Grief Disorder 12 (PG-12). Results: The consort caregivers showed higher PG-12 level compared to the sibling caregivers. Anxiety, depression, need for approval, and preoccupation with relationships levels were significantly correlated with PG-12 scores. Conclusion: Female gender, high levels of depression, and preoccupation with relationships significantly predicted higher levels of prolonged grief risk.

Fear of missing out (FOMO) is associated with activation of the right middle temporal gyrus during inclusion social cue

Aim of this research was to investigate the neurobiological correlates of fear of missing out in response to the social exclusion and social inclusion cue.Fear of Missing Out scale (FOMOs), Social Media Engagement Questionnaire (SMEQ), and Attachment Style Questionnaire (ASQ) were administered to twenty-six healthy participants. Afterward, EEG activity was acquired during a visual task showing exclusion and inclusion social images.Event Related Potentials (ERP) and sLoreta analyses were performed.In the ERP analyses the main effect of condition was found in temporo-parietal and frontal montages. sLoreta analyses showed a greater intensity of the left secondary somatosensory cortex (BA7) in inclusion compared with exclusion condition and a greater intensity of left temporal-parietal junction (BA41, BA42, BA43) and left prefrontal cortex (BA47) in exclusion versus inclusion condition. Moreover, the main finding of correlations analyses was that the FOMOs score was positively correlated with ASQ-need for approval and with right middle temporal gyrus (BA21) only during inclusion condition.Findings sustain that fear of missing out is associated to a greater sensitivity towards social inclusive experiences rather than social exclusion and with need of belong. Neurobiological correlates of FOMO in response to the social exclusion/inclusion cue.Left BA7 showed a greater intensity during inclusion compared to exclusion cue.FOMOs score was positively correlated with right BA21 only during inclusion cue.FOMOs score was positively correlated with ASQ-need for approval.