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Caring for a patient with Alzheimer disease (AD) represents a real challenge that can have considerable long-term psychological and physical consequences. The aim of this study was to evaluate the impact of the perception of being recognized on both the psychophysical health and the level of burden reported in caregivers of patients with AD. The secondary aim was to evaluate the association between the use of a home care assistance service and the burden and psychophysical health in caregivers. The Caregiver Burden Inventory (CBI), the 36-item Short-Form Health Survey (SF-36), and a visual analog scale (VAS) to evaluate the level of perception of being recognized were administered to 31 caregivers of patients with AD. Data were also collected from patients with AD using the Mini-Mental State Examination (MMSE). The level of perception of being recognized was significantly and negatively correlated with total burden ( r = −0.36; P = .045) and objective burden ( r = −0.53; P = .002). It was also significantly and positively correlated with the MMSE score ( r = 41; P = .02). Regression models showed that only the perception of being recognized, and not MMSE, significantly predicted lower caregiver objective burden scores. Furthermore, the use of a home care assistance service significantly predicted higher caregiver physical functioning. The perception of being recognized by an AD relative significantly predicted the caregiver’s objective burden associated with a shortage of time. The use of a home care assistance service also resulted in a promotion in the caregiver’s social functioning. Further studies are needed to confirm these results.

The aim of the study was to investigate the association between psychological characteristics and biological markers of adherence in chronic kidney disease patients receiving conservative therapy, hemodialysis, peritoneal dialysis (PD), or kidney transplantation. Seventy-nine adult patients were asked to complete the following questionnaires: Toronto Alexithymia scale, Snaith–Hamilton Pleasure Scale, and Short Form Health Survey. Biological markers of adherence to treatment were measured. Peritoneal dialysis patients showed a lower capacity to feel pleasure from sensorial experience (p = .011) and a higher values of phosphorus compared to the other patients’ groups (p = .0001). The inability to communicate emotions was negatively correlated with hemoglobin levels (r = −(0).69; p = .001) and positively correlated with phosphorus values in the PD patients (r = .45; p = .050). Findings showed higher psychological impairments and a lower adherence to the treatment in PD patients and suggest the implication of emotional competence in adherence to treatment.

Objective: Aims of the present study were to investigate the association between awareness of own illness condition and psychological outcome in end-of-life phase and to test the association between the spirituality and the awareness of own illness condition. Methods: Three hundred and ninety-nine terminally ill patients with cancer were enrolled in a hospice in central Italy. One hundred patients satisfied the inclusion criteria. The Systems of Belief Inventory, the Hospital Anxiety and Depression Scale, and a psychological interview to determine the level of awareness of the illness diagnosis (aware; partially aware; and not aware) were administered to terminally ill patients. Results: The main finding was that the awareness of one’s own illness condition was positively associated with the extrinsic spirituality and negatively associated with intrinsic spirituality (regression model R = .26; R2 = .07; adjusted R2 = .05; F2, 97 = 3.45; P = .036). The aware group showed lower anxiety and depression ( F2, 97 = 1.9; P = . 075; F2, 97 = 2.6; P = .04) scores than partially aware and not aware groups. The psychological outcome was not associated with the spirituality level. Conclusion: In terminally ill patients with cancer, the levels of depression and anxiety were lower in patients aware of their own illness state. Moreover, higher levels of extrinsic and lower levels of intrinsic spirituality predicted the awareness of one’s own illness state.

Aim of the present study was to investigate the neurophysiologic correlates of the conscious and not conscious perception of faces (presented for 14, 40, 80 ms) with happy and sad emotional valence. Electroencephalographic data of 22 participants during a report-based visual task were recorded. Both happy and sad faces presented for 14 ms showed a longer N170 latency compared to the faces presented for 40 and 80 ms. A shorter latency of early components (before N170) was found in the right hemisphere and a longer latency in the left one in response to the happy faces presented for 14 ms compared to those presented for longer times. The faces presented for 14 ms, declared as consciously perceived, evoked a higher brain response compared to those declared as not perceived. Parietal and cingulate brain areas showed a lower intensity of the brain response to the consciously perceived faces in the early components. Happy faces showed a greater brain response when consciously detected, while the sad faces induced a greater brain response when not consciously detected. The findings suggest that the N170 may be the epiphenomenon of an earlier consciously detection. Moreover, these preliminary results seem to support a main role of parietal and cingulate brain areas into not conscious perception.

Exposure to violence in video games has been associated with a desensitization toward violent content, a decrease of empathy, and prosocial behavior. Moreover, violent video games seem to be related to a reduction of neural activation in the circuits linked to social emotional processing. The purpose of the present study was to compare the neural response to social inclusion images after violent and nonviolent video game playing. Electroencephalographic data of the 32 participants were recorded during a visual task with three presentations (T0, T1, T2) of 60 stimuli (30 social inclusion vs. 30 neutral images). After the T0 presentation, the participants played with a video game (orientation or violent). After the T1 presentation, the participants played with the other video game (orientation or violent). The two types of video games were randomly displayed. Event-related potential (ERP) components and low-resolution electromagnetic tomography (sLORETA) were analyzed. The main findings showed a longer latency of the P2 component on occipito-temporal montage and a lower activation of the limbic and temporal areas in response to the social inclusion images post violent video game compared with the post orientation video game. The findings suggest a reduction of emotional engagement in social processing after playing violent video game.

In the present study, we aimed to explore neural correlates of survivors of the 2009 L'Aquila, Italy earthquake in response to being shown pictures featuring their own city before and after an earthquake as well as those of an unfamiliar city. Moreover, we explored the associations among psychological variables and brain responses to the pictures of L'Aquila after the earthquake. Our final sample (N = 30 adults) comprised 15 survivors (M age = 31.40 years, SD = 9.42) and 15 controls (M age = 30.53 years, SD = 10.01). Participants' electroencephalographic (EEG) data were recorded during a visual task that included earthquake-related stimuli. Participants were assessed for posttraumatic and dissociation symptoms and event-related potential components, and low-resolution electromagnetic tomography (sLORETA) were analyzed. Compared to the control group, source localization in survivors indicated a lower intensity of the amygdala, hippocampal, parahippocampal, and temporopolar areas in response to visual stimuli concerning the earthquake, p < .001 to p < .0001. Results indicated a reduced limbic activation in response to visual stimuli that evoked the recall of earthquake in survivors. This finding suggests that survivors likely adopted a distancing strategy toward stimuli that may have elicited an emotional activation related to collective trauma.

The new version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5th) proposed the Internet Gaming Disorder for the diagnosis of Internet addiction (IA) considering the neurobiological evidence of the craving.The aim was to test the neural correlate in response to the Internet cue in patients with IA.Sixteen males with IA diagnosis (clinical group) and 14 healthy male (control group) were recruited for an experimental visual task composed of Internet images and emotional images. During the visual presentation of Internet cue, electroencefalographic data were recorded using Net Station 4.5.1 with a 256-channels HydroCel Geodesic Sensor Net. Event-related potential (ERP) components and low-resolution electromagnetic tomography (sLoreta) were analysed.sLoreta analyses showed that patients from the clinical group presented a higher primary somatosensorial cortex and lower paralimbic, temporal and orbito-frontal activation in response to both Internet and emotional images compared to those of the control group.These results suggest that clinically recognized pathological use of Internet could be linked to dissociative symptoms.

Introduction/Background FM is a prototypical form of central sensitization syndrome that affects the dysregulation of mechanisms that normally govern pain sensation and should have to be treated in a multidisciplinary approach, which entails physical exercise, multimodal cognitive behavioral therapy, and pharmacological therapy. The aim of this research is to investigate whether a neurocognitive rehabilitative approach based on the use of motor imagery (MI) could be efficacy in reducing chronic pain in FM. Furthermore, as a secondary outcome, we assess the efficacy of MI on the improvement in the recognition and awareness respect pain by EEG. Material and method Ten females (mean age 51 ± 6.1 years) with FM were recruited and performed ten rehabilitation sessions, twice a week lasting one hour, using the motor imagery. The following evaluation scales were used at the baseline (T0), after treatment (T1) and after two months of follow-up (T2): the Fibromyalgia Impact Questionnaire (FIQ), the Visual Analogue Scale (VAS), the Fibromyalgia Assessment Status (FAS) and the Health Assessment Questionnaire (HAQ), the SF-12 was administered to assess the quality of life. The EEG was used to record cortical activation with respect to recognize pictures divided into “algic” and “non-algic”, versus a control group of healthy women. Results By Mann–Whitney test, at baseline, by EEG there is a statistically significant difference in the recognition of “algic” images compared to “non-algic” ones between the FM group and the healthy group (P Conclusion A neurocognitive rehabilitation approach with motor imagery improves the recognition and perception of pain in the FM patient and is efficacy in reducing pain and improving related symptoms.

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.

The proposal of persistent complex bereavement disorder (PCBD) in the DSM-V increased the interest on the impact of grief on the psychological health.Investigating the time course of psychological symptoms, emotional and social abilities in caregivers (undergoing or not to supportive-expressive treatment) of terminally ill cancer patients from 1 months before loss to 14 months after it.Thirty-three of 60 caregivers were assessed by PG-12, HAM-A, HAM-D, TAS-20 and ASQ, at the admission in Hospice, and after 3, 10 and 14 months from the loss. Twelve caregivers adhered to follow a supportive-expressive treatment and 21 caregivers did not.PG-12, anxiety, and depression scores decreased in both groups over time. The score of difficulty in identifying emotions and confidence with closeness decreased significantly only in the treated-group. PG-12 score at T0 was able to predict the DSM V diagnosis of PCBD at T3.Findings showed a decrease of the anxiety, depression, security in the attachment style and an increase of the ability to identify emotions during the first year after loss in caregivers of terminally ill cancer patients. Pre-loss assessment of prolonged grief risk seems useful to predict the diagnosis of PCBD 1 year after loss.

The aim of the present study was to investigate the association between alexithymia scores and biological markers of adherence in dialyzed patients. The hypothesis was that higher scores of alexithymia would be associated with lower adherence to treatment.Fifty-four adult dialyzed patients were enrolled during a follow-up visit. Participants were asked to complete a self-report questionnaire, namely, the Toronto Alexithymia Scale (TAS-20). Moreover, biological markers levels of adherence to treatment (phosphorus, creatinine, and serum uric acid) were measured.A positive correlation was found between phosphorous levels and TAS-F2 (r = 0.28; P = .04) and TAS-F3 (r = -0.31; P = .02). Stepwise regression with TAS-F2 and TAS-F3 as predictors of adherence to treatment showed a significant model, adjusted R(2) = 0.08, F(1,52) = 5.4; P .02, where only TAS-F3 was able to predict phosphorous levels (P = .02).Findings showed that external oriented thinking was able to predict a biological marker of adherence to treatment in dialyzed patients.

Recent studies show that alexithymia may influence compliance and quality of life in different clinical situations. The aim of this study was to evaluate the associations between alexithymia or emotional self-efficacy and compliance, quality of life (QoL) and renal function in renal transplant patients. Methods Forty-three patients were enrolled during a follow-up visit (> 3 months post-transplant) and were asked to complete three self-report questionnaires (TAS-20, SF-36, RESE) to answer the following items: “In the past four weeks, how many times did you fail to take your prescribed dose?” and “How would you rate your adherence levels from 0 to 100?” (visual analogue scale). Results Alexithymia was positively correlated with non-compliance (r = .314; p = .04), and negatively with QoL dimensions. Analysis of variance confirmed that patients with high levels of alexithymia reported a negative perception of their QoL (mental health: F(1,41) = 7,6; p = .008) and lower levels of compliance (F(1,41) = 12,5; p = .001) compared with patients with low levels of alexithymia. The self-efficacy in the management of negative emotions was significantly correlated (r = − .314; p = .04) with creatinine levels and positively with the QoL (mental health: r = .421; p = .005). Discussion The inability to recognize and express emotions, as well as the ability to manage negative emotions, may influence compliance and QoL of renal transplant patients. Focused psychological support could be useful in these patients in order to increase their compliance and QoL.

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.

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.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.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].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.

The role of spirituality on the psychological health was mostly investigated through studies conducted in terminally ill patients. However, there are not studies investigating the role of religious and spiritual beliefs on psychological state and on burden dimensions in caregivers. The purpose of this study was to investigate the association between spirituality, burden, and psychological state in caregivers of terminally ill cancer patients. Two hundred caregivers of terminally ill patients with cancer were interviewed using Prolonged Grief Disorder 12 (PG-12), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Scale (HAM-D), Caregiver Burden Inventory (CBI) and System of Belief Inventory (SBI-15R). The caregiver burden was positively correlated with anxiety, depression and PG-12 scores. The intrinsic spirituality was a significant predictor of the time-dependence burden (positively associated); and of the emotional burden (negatively associated). In caregivers of terminally ill cancer patients, higher levels of intrinsic spirituality predicted a higher amount of time devote to caregiving, and also protected against the emotional distress linked to providing assistance.

Mourning is a natural response to a loss and a condition which most people experience several times during their lives. Most individuals adjust adequately to the loss of a relative, neverthless, a small but noteworthy proportion of bereaved individuals experience a syndrome of prolonged psychological distress in relation to bereavement. Prolonged distress and disability in connection with bereavement has been termed Complicated Grief (CG) or Prolonged Grief Disorder (PGD). The purpose of this paper is to analyze the literature on loss and mourning making a review of the main studies published between 1993 and 2013, identified through a search conducted on Medline/PubMed, in order to describe the epidemiological and clinical aspects of "normal" grief and "complicated" grief, pointing out the path of the clinical definition of PGD and proposed diagnostic criteria for inclusion in the next edition of the Diagnostic and Statistic Manual of Mental Disorders, Fifth edition (DSM-5). The two main diagnostic systems proposed by Horowitz and Prigerson are also compared.

Aims The behavioural-addiction perspective suggests that Internet addiction (IA) and pathological gambling (PG) could share similar characteristics with substance dependence. Despite the similarities between IA and PG, it is not clear whether these disorders share different or similar psychopathological conditions. The aim of the present study was to test whether IA patients presented different psychological symptoms, temperamental traits, coping strategies and relational patterns compared with PG patients. The hypothesis was that IA patients will show greater interpersonal disengagement than PG patients. Methods Two clinical groups (31 IA patients and 11 PG patients) and a control group (38 healthy subjects) matched with the clinical groups for gender and age were enrolled. The clinical groups were gathered in a psychiatric service for IA and PG in a hospital. Anxiety, depression, coping strategies, attachment, temperament, and global assessment of functioning were measured. MANOVAs, ANOVAs and post-hoc comparisons were carried out in order to test the hypothesis. Results Despite IA and PG showing similar differences with the control group on the levels of depression, anxiety and global functioning, the two clinical groups showed different temperamental, coping and social patterns. Specifically IA patients compared with the PG patients showed a greater mental and behavioural disengagement associated with an important interpersonal impairment. The two clinical groups shared an impulsive coping strategy and socio-emotional impairments. Conclusions Despite IA and PG patients presenting similar clinical symptoms, IA condition was characterised by a more relevant mental, behavioural, and social disengagement compared to PG condition.

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.

Background. The aim of this study was to investigate whether pretransplant psychological variables included in the CBA 2.0 Primary Scale—fear, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression— could predict graft rejection among patients undergoing kidney transplantation. Methods. After ethical committee approval we enrolled 33 consecutive adult patients undergoing kidney transplantation. The inclusion criteria were a stable clinical situation in an out-of-hospital setting; Italian language literacy; a minimum of secondary school-level education, and written informed consent. We excluded patients with a psychotic disturbance, neurocognitive deficit, dementia, serious mental delay (IQ

Il trapianto d’organo e oggi un’efficace terapia in grado di migliorare la qualita di vita di pazienti cronicamente malati, anche se e ancora alto lo squilibrio tra il numero di persone in lista di attesa e gli organi disponibili, il che fa si che la stessa permanenza in lista sia spesso lunga e fonte di continua tensione. Quanto piu l’organo e simbolicamente importante, tanto piu e investito di significati psicologicamente rilevanti. Inoltre, la garanzia di continuita nell’aiuto psicologico, dal momento dell’inserimento in lista fino ai follow-up successivi, contribuisce a una buona riuscita dell’intervento stesso, migliorandone la compliance e favorendo un maggiore adattamento e, generalmente, un miglioramento della qualita di vita del paziente.

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 TO (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 TO 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.