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BackgroundDespite the increasing focus on perinatal care, preventive digital interventions are still scarce. Furthermore, the literature suggests that the design and development of these interventions are mainly conducted through a top-down approach that limitedly accounts for direct end user perspectives. ObjectiveBuilding from a previous co-design study, this study aimed to qualitatively evaluate pregnant women’s experiences with a chatbot (Juno) prototype designed to deploy a preventive behavioral activation intervention. MethodsUsing a multiple–case study design, the research aims to uncover similarities and differences in participants’ perceptions of the chatbot while also exploring women’s desires for improvement and technological advancements in chatbot-based interventions in perinatal mental health. Five pregnant women interacted weekly with the chatbot, operationalized in Telegram, following a 6-week intervention. Self-report questionnaires were administered at baseline and postintervention time points. About 10-14 days after concluding interactions with Juno, women participated in a semistructured interview focused on (1) their personal experience with Juno, (2) user experience and user engagement, and (3) their opinions on future technological advancements. Interview transcripts, comprising 15 questions, were qualitatively evaluated and compared. Finally, a text-mining analysis of transcripts was performed. ResultsSimilarities and differences have emerged regarding women’s experiences with Juno, appreciating its esthetic but highlighting technical issues and desiring clearer guidance. They found the content useful and pertinent to pregnancy but differed on when they deemed it most helpful. Women expressed interest in receiving increasingly personalized responses and in future integration with existing health care systems for better support. Accordingly, they generally viewed Juno as an effective momentary support but emphasized the need for human interaction in mental health care, particularly if increasingly personalized. Further concerns included overreliance on chatbots when seeking psychological support and the importance of clearly educating users on the chatbot’s limitations. ConclusionsOverall, the results highlighted both the positive aspects and the shortcomings of the chatbot-based intervention, providing insight into its refinement and future developments. However, women stressed the need to balance technological support with human interactions, particularly when the intervention involves beyond preventive mental health context, to favor a greater and more reliable monitoring.

BackgroundDigital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration. ObjectiveThis study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women’s needs. Usability and user engagement were evaluated. MethodsA total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring

Abstract Background Similarly to cortisol-secreting adrenal tumors, also non-functioning adrenal tumors (NFAT) may be associated with an increased cardiovascular risk. We assessed in NFAT patients: (i) the association between hypertension (HT), diabetes mellitus (DM), obesity (OB), dyslipidemia (DL) and cardiovascular events (CVE) and cortisol secretion; (ii) the cut-off of the cortisol secretion parameters for identifying NFAT patients with a worse cardiometabolic profile. Patients and methods In 615 NFAT patients (with cortisol levels after 1 mg overnight dexamethasone suppression test, F-1mgDST

Over the past few decades, the worldwide incidence of cutaneous melanoma, a malignant neoplasm arising from melanocytes, has been increasing markedly, leading to the highest rate of skin cancer-related deaths. While localized tumors are easily removed by excision surgery, late-stage metastatic melanomas are refractory to treatment and exhibit a poor prognosis. Consequently, unraveling the molecular mechanisms underlying melanoma tumorigenesis and metastasis is crucial for developing novel targeted therapies. We found that the multiple endocrine neoplasia type 1 (MEN1) gene product Menin is required for the transforming growth factor beta (TGFβ) signaling pathway to induce cell growth arrest and apoptosis in vitro and prevent tumorigenesis in vivo in preclinical xenograft models of melanoma. We further identified point mutations in two MEN1 family members affected by melanoma that led to proteasomal degradation of the MEN1 gene product and to a loss of TGFβ signaling. Interestingly, blocking the proteasome degradation pathway using an FDA-approved drug and RNAi targeting could efficiently restore MEN1 expression and TGFβ transcriptional responses. Together, these results provide new potential therapeutic strategies and patient stratification for the treatment of cutaneous melanoma.

ObjectiveEvidence suggests that many adults with type 1 diabetes (T1D) experience clinically relevant levels of diabetes distress, indicating coping difficulties. Studies have primarily focused on emotion regulation as a possible construct to be addressed in psychological interventions to alleviate diabetes distress. This study extends the literature by investigating the cross-sectional association between emotion regulation, diabetes distress and the construct of emotional self-awareness as an additional variable to be considered in potentially reducing diabetes distress.MethodsVia an online survey, data was collected on emotional self-awareness dimensions (attention to feelings, clarity of feelings), emotion regulation strategies (cognitive reappraisal, expressive suppression, mood repair) and diabetes distress, along with self-reported clinical and sociodemographic information. Multiple linear regression with stepwise backward method was used to examine associations, controlling for country.ResultsN = 262 Italian and Dutch adults with T1D (80.5% women, M = 38.12 years, SD = 12.14) participated. Clarity of feelings was significantly negatively associated with diabetes distress, resulting in a medium effect size (β = −0.22, p

IntroductionHypophosphatasia (HPP) is a rare genetic disease caused by inactivating variants of the ALPL gene. Few data are available on the clinical presentation in Italy and/or on Italian HPP surveys.MethodsThere were 30 suspected HPP patients recruited from different Italian tertiary cares. Biological samples and related clinical, biochemical, and anamnestic data were collected and the ALPL gene sequenced. Search for large genomic deletions at the ALPL locus (1p36) was done. Phylogenetic conservation and modeling were applied to infer the effect of the variants on the protein structure.ResultsThere were 21 ALPL variants and one large genomic deletion found in 20 out of 30 patients. Unexpectedly, NGS-driven differential diagnosis allowed uncovering three hidden additional HPP cases, for a total of 33 HPP subjects. Eight out of 24 coding variants were novel and classified as “pathogenic”, “likely pathogenic”, and “variants of uncertain significance”. Bioinformatic analysis confirmed that all the variants strongly destabilize the homodimer structure. There were 10 cases with low ALP and high VitB6 that resulted negative to genetic testing, whereas two positive cases have an unexpected normal ALP value. No association was evident with other biochemical/clinical parameters.DiscussionWe present the survey of HPP Italian patients with the highest ALPL mutation rate so far reported and confirm the complexity of a prompt recognition of the syndrome, mostly for HPP in adults. Low ALP and high VitB6 values are mandatory for the genetic screening, this latter remaining the gold standard not only to confirm the clinical diagnosis but also to make differential diagnosis, to identify carriers, to avoid likely dangerous therapy in unrecognized cases.

AimsThe current study aimed to validate the Italian version of the Staff Attitude to Coercion Scale (SACS), which assesses mental health care staff’s attitudes to the use of coercion in treatment.MethodsThe original English version of the SACS was translated into Italian, according to the back-translation procedure. Subsequently, it was empirically validated by performing an exploratory factor analysis on a sample of 217 mental health professionals (Mean = 43.40 years, SD = 11.06) recruited form Italian general hospital (acute) psychiatric wards (GHPWs), with at least 1 year of work experience (i.e., inclusion criteria).ResultsResults confirmed the three-factor solution of the original version for the Italian version of the SACS, though three items loaded on different factors, compared to the original. The three extracted factors, explained 41% of total variance, and were labeled similarly to the original scale and according to their respective item content, i.e., Factor 1 “Coercion as offending” (items: 3, 13, 14, and 15), Factor 2 “Coercion as care and security” (items: 1, 2, 4, 5, 7, 8, and 9), and Factor 3 “Coercion as treatment” (items: 6, 10, 11, and 12). The internal consistency of the three-factor model of the Italian version of the SACS was assessed through Cronbach’s α and yielded acceptable indexes, ranging from 0.64 to 0.77.ConclusionThe present findings suggest that the Italian version of the SACS is a valid and reliable tool that can be used to assess healthcare professionals’ attitudes toward coercion.

Objective: The mandibular advancement device (MAD) is currently suggested in patients with mild to moderate obstructive sleep apnea (OSA). This study investigated the effects of a new fully customizable MAD-type device called, "It Makes You Sleep" (IMYS), in patients with mild to moderate OSA. Methods: Sixteen patients (14 men and 2 women; mean age 62; SD ± 11 years) were retrospectively enrolled. Each patient received home sleep apnea testing (HSAT) at baseline (T0) and after three months (T1) of IMYS treatment. The Apnea-Hypopnea Index (AHI), the Oxygen Desaturation Index (ODI), the Minimum Oxygen Saturation (minSO2) and the Medium Oxygen Saturation (medSO2) were analyzed. Results: From T0 to T1, the IMYS treatment showed a significant reduction of AHI and ODI and a significant increase of minSO2 and medSO2. Conclusion: The IMYS appliance is an effective device for treating mild or moderate OSA. [ABSTRACT FROM AUTHOR]

BackgroundPregnancy is a complex period that implies many biopsychosocial changes, and the way women adapt to these changes impacts their well-being and the chances of developing mental health problems. During the perinatal period, women have expressed a preference for support delivered on the web. In this regard, interventions such as behavioral activation (BA), which are brief and structured psychosocial interventions, seem particularly suited to be delivered through digital solutions. ObjectiveThis study aimed to map the literature investigating digital BA interventions deployed during the perinatal period. We paid particular attention to the methodological underpinnings of the studies, the potential impact of BA interventions on symptoms other than depression, and the existence of differences occurring when these interventions were administered during pregnancy versus the postpartum period. MethodsA systematic search compliant with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines was conducted considering 5 bibliographic databases; reference lists and key journals were also screened by 2 independent authors following a double-blind approach. ResultsA total of 7 studies published between 2013 and 2022 were included. In total, 2 studies were protocols for randomized controlled trials, 5 were empirical studies, and 1 was a qualitative study. All studies focused on the postpartum period, except for 1 that focused on the broader perinatal period. Promising effects on depression symptoms were reported but not on other psychosocial symptoms. Low intervention adherence has emerged, whereas the usability associated with the digital means used to deploy interventions was scarcely addressed; moreover, information on the digital platforms used was poorly reported overall. ConclusionsOur findings highlight the scarcity and preliminary nature of digital BA interventions deployed during the perinatal period, where the focus seems more on treatment rather than prevention. Moreover, future studies should also consider and address usability and user engagement, given their relevance to intervention efficacy.

Abstract Background Intravenous drug abuse (IDA) is a known risk factor for infective endocarditis (IE) and is associated with frequent relapses, but its prognostic impact is still debated. The potential futility of surgery in this population is a further issue under discussion. We aimed to describe the clinical characteristics, the therapeutic strategy, and the prognosis associated with IDA in IE. Methods We retrospectively analysed 440 patients admitted to a single surgical centre for definite active IE from January 2012 to December 2020. Results Patients reporting IDA (N = 54; 12.2%) were significantly younger (p

The current study aimed to examine whether executive functioning (EF) moderates the expected association between poor parental supervision and emotional-behavioral problems among early adolescents with and without a migration background in Italy. In total, 97 Chinese immigrant and 165 Italian nonimmigrant early adolescents, aged 11 to 13 years (52% girls), completed a series of performance and computer-based tasks assessing their EFs, whereas primary caregivers rated their own parental supervision and their offspring's emotional-behavioral problems. Regression analyses indicated that in both groups, a better working memory capacity was associated with fewer problems. Moreover, low levels of inhibitory control strengthened the association between poor parental supervision and emotional-behavioral problems. In addition, among Chinese immigrant youth, higher levels of cognitive flexibility enhanced the link between poor parental supervision and emotional-behavioral problems. Results underscore the importance of parental supervision and EF processes for Chinese immigrant youths' psychological functioning.

A 62-year-old patient with metastatic hypopharyngeal carcinoma underwent treatment with nivolumab, following which he developed symptoms suggestive of diabetes insipidus. Nivolumab was stopped and therapy with methylprednisolone was started. During corticosteroid therapy, the patient presented himself in poor health condition with fungal infection and glycemic decompensation. Methylprednisolone dose was tapered off, leading to the resolution of mycosis and the restoration of glycemic compensation, nevertheless polyuria and polydipsia persisted. Increase in urine osmolarity after desmopressin administration was made diagnosing central diabetes insipidus as a possibility. The neuroradiological data by pituitary MRI scan with gadolinium was compatible with coexistence of metastatic localization and infundibulo-neurohypophysitis secondary to therapy with nivolumab. To define the exact etiology of the pituitary pathology, histological confirmation would have been necessary; however, unfortunately, it was not possible. In the absence of histological confirmation, we believe it is likely that both pathologies coexisted.

Introduction Virtual coaches (VCs) can support people with Diabetes Mellitus (DM) by motivating them to better manage their health. Few VCs were aimed at providing psychosocial support. In this regard, motivation is a pivotal construct in diabetes self-management as it allows adults with DM to adhere to the clinical recommendations. Objectives The present study aimed to develop a VC able to motivate adults with DM to adopt and acquire healthier coping strategies, to decrease symptoms of depression, anxiety, perceived stress, and diabetes-related emotional distress, while also improving their well-being. Methods A total of 12 adults with DM (M=27.91 years; SD=9.82) interacted with a VC, called Motibot using Telegram for an overall duration of 12 sessions. Participants completed a battery of instruments at pre-, post-intervention and follow-up. Results highlighted a decrease in anxiety, and depression symptoms between pre-, post-intervention and follow-up, as also showed by the results that emerged through the text mining. Motibot was perceived as motivating and encouraging in the adoption of appropriate coping strategies, such as mindfulness practices. Motibot was also perceived as trustworthy, reflective, and stimulating in its dialogical interaction. Indeed, adults felt involved in the interaction with Motibot, thereby showing an overall perception of a better quality of life, in the absence of diabetes distress. Conclusions This study sheds light on the importance of VCs in health care for people with DM for psychosocial support. This is the first experimental study on the matter, and thus, further iterations of the intervention are needed using a larger sample size. Disclosure No significant relationships.

The Covid-19 pandemic and its related restriction measures might negatively impact diabetes management and well-being of adolescents with Type 1 Diabetes Mellitus (T1DM) and their caregivers. Accordingly, the present scoping review is aimed at mapping the literature in line with the question “How has the Covid-19 influenced diabetes management and well-being of adolescents with T1DM and their caregivers?”. A systematic search has been conducted through three academic databases. Studies carried out during the Covid-19 pandemic focused on adolescents aged between 10 and 19 years with T1DM and/or their caregivers were included. A total of 9 studies, performed between 2020 and 2021, have been identified. In particular, N = 305 adolescents with T1DM and N = 574 caregivers were considered. Overall, studies were not specific in reporting adolescents’ age, and only 2 studies were primarily focused on the adolescent population with T1DM. In addition, studies were mainly focused on evaluating adolescents’ glycemic control, which remained stable or has improved throughout the pandemic. Contrarily, psychosocial variables have been marginally considered. Indeed, only one study investigated adolescents’ diabetes distress, which remained stable from pre-to during post-lockdown, albeit improving among girls, specifically. As regards caregivers of adolescents with T1DM, studies showed mixed results concerning their psychological state during the Covid-19 pandemic. Prevention measures, which are aimed at supporting adolescents with T1DM during the lockdown, were considered by one study only, showing the favorable role of telemedicine during lockdown for adolescents’ glycemic control. Altogether, the current scoping review has identified many shortcomings of the available literature, which are given by the limited specificity of the age group considered and by the limited consideration of psychosocial variables, particularly their interplay with the medical ones.

BackgroundMobile health solutions aimed at monitoring tasks among people with diabetes mellitus (DM) have been broadly applied. However, virtual coaches (VCs), embedded or not in mobile health, are considered valuable means of improving patients’ health-related quality of life and ensuring adherence to self-care recommendations in diabetes management. Despite the growing need for effective, healthy coping digital interventions to support patients’ self-care and self-management, the design of psychological digital interventions that are acceptable, usable, and engaging for the target users still represents the main challenge, especially from a psychosocial perspective. ObjectiveThis study primarily aims to test VC interventions based on psychoeducational and counseling approaches to support and promote healthy coping behaviors in adults with DM. As a preliminary study, university students have participated in it and have played the standardized patients’ (SPs) role with the aim of improving the quality of the intervention protocol in terms of user acceptability, experience, and engagement. The accuracy of users’ role-playing is further analyzed. MethodsThis preliminary study is based on the Obesity-Related Behavioral Intervention Trial model, with a specific focus on its early phases. The healthy coping intervention protocol was initially designed together with a team of psychologists following the main guidelines and recommendations for psychoeducational interventions for healthy coping in the context of DM. The protocol was refined with the support of 3 experts in the design of behavioral intervention technologies for mental health and well-being, who role-played 3 SPs’ profiles receiving the virtual coaching intervention in a Wizard of Oz setting via WhatsApp. A refined version of the healthy coping protocol was then iteratively tested with a sample of 18 university students (mean age 23.61, SD 1.975 years) in a slightly different Wizard of Oz evaluation setting. Participants provided quantitative and qualitative postintervention feedback by reporting their experiences with the VC. Clustering techniques on the logged interactions and dialogs between the VC and users were collected and analyzed to identify additional refinements for future VC development. ResultsBoth quantitative and qualitative analyses showed that the digital healthy coping intervention was perceived as supportive, motivating, and able to trigger self-reflection on coping strategies. Analyses of the logged dialogs showed that most of the participants accurately played the SPs’ profile assigned, confirming the validity and usefulness of this testing approach in preliminary assessments of behavioral digital interventions and protocols. ConclusionsThis study outlined an original approach to the early development and iterative testing of digital healthy coping interventions for type 2 DM. Indeed, the intervention was well-accepted and proved its effectiveness in the definition and refinement of the initial protocol and of the user experience with a VC before directly involving real patients in its subsequent use and testing.

BackgroundMotivation is a core component of diabetes self-management because it allows adults with diabetes mellitus (DM) to adhere to clinical recommendations. In this context, virtual coaches (VCs) have assumed a central role in supporting and treating common barriers related to adherence. However, most of them are mainly focused on medical and physical purposes, such as the monitoring of blood glucose levels or following a healthy diet. ObjectiveThis proof-of-concept study aims to evaluate the preliminary efficacy of a VC intervention for psychosocial support before and after the intervention and at follow-up. The intent of this VC is to motivate adults with type 1 DM and type 2 DM to adopt and cultivate healthy coping strategies to reduce symptoms of depression, anxiety, perceived stress, and diabetes-related emotional distress, while also improving their well-being. MethodsA total of 13 Italian adults with DM (18-51 years) interacted with a VC, called Motibot (motivational bot) using the Telegram messaging app. The interaction covered 12 sessions, each lasting 10 to 20 minutes, during which the user could dialogue with the VC by inputting text or tapping an option on their smartphone screen. Motibot is developed within the transtheoretical model of change to deliver the most appropriate psychoeducational intervention based on the user’s motivation to change. ResultsResults showed that over the 12 sessions, there were no significant changes before and after the intervention and at follow-up regarding psychosocial factors. However, most users showed a downward trend over the 3 time periods in depression and anxiety symptoms, thereby presenting good psychological well-being and no diabetes-related emotional distress. In addition, users felt motivated, involved, encouraged, emotionally understood, and stimulated by Motibot during the interaction. Indeed, the analyses of semistructured interviews, using a text mining approach, showed that most users reported a perceived reduction in anxiety, depression, and/or stress symptoms. Moreover, users indicated the usefulness of Motibot in supporting and motivating them to find a mindful moment for themselves and to reflect on their own emotions. ConclusionsMotibot was well accepted by users, particularly because of the inclusion of mindfulness practices, which motivated them to adopt healthy coping skills. To this extent, Motibot provided psychosocial support for adults with DM, particularly for those with mild and moderate symptoms, whereas those with severe symptoms may benefit more from face-to-face psychotherapy.

Background: Research has shown an increased risk for Non-suicidal self-injurious (NSSI) behavior as well as Problematic Smartphone Use (PSU) and particularly in adolescence, a developmental period defined by multi-level changes and still poor self-control capacities associating with risk-taking behaviors. Objective: The current study was aimed to assess the pattern of mutual relations characterizing NSSI considering self-control, internalizing and externalizing problems, and investigating how PSU fits within the network since NSSI and PSU are here conceptualized as attempts at emotion regulation. Age and gender differences were also assessed. Method: Participants were Italian adolescents presenting NSSI behavior (N = 155; Mage = 14.68; SD = 1.647; Range = 11–18; 43.2%-females); the sample is based on community recruitment. A Network Analysis was performed to assess the organizational structure of NSSI; age and gender differences were assessed through multivariate rank tests further applying multiplicity control. Results: The emerged Network showed the centrality of low self-control and internalizing problems for NSSI. NSSI and PSU were associated through low self-control, and so were PSU and externalizing problems. Significant age differences were observed showing a decrease in NSSI as age increases (stat = −2.86; adj.p = .029). No gender differences have emerged. Conclusions: The current findings provide support for the consideration and investigation of PSU as regards NSSI behavior in adolescence. Moreover, these findings point to the relevance of prevention practices during this peculiar developmental period, particularly sustaining self-control capacities and the use of more adaptive emotion regulation strategies, thereby limiting the accrue of at-risk behaviors.

Aims: The COVID-19 pandemic and consequent extreme restrictions imposed by governments across the world forced psychotherapists to abruptly change their working modality. The first aim of the current study was to assess psychotherapists’ self-perceptions (i.e., affective and cognitive perceptions about their self and their self in relation to clients) when providing telepsychotherapy during the first peak of the COVID-19 pandemic in Italy. The second aim was to explore the associations between psychotherapists’ self-perceptions, characteristics, and clinical practices.Method: An online survey was administered to 281 Italian licensed psychotherapists (Mage=45.15; SD=10.2; 83.6% female) between April 5 and May 10, 2020. The survey comprised ad-hoc questions that were designed to collect sociodemographic details and information related to working practices. Moreover, a semantic differential (SD) scale was developed to assess psychotherapists’ self-perceptions, and a factor analysis was performed from the SD items.Results: The SD scale showed an overall trend of positive psychotherapist self-perception during telepsychotherapy, despite reports of greater fatigue and directive and talkative behavior during sessions. Four SD factors accounted for 45% of the variance: “Affective Availability,” “Attitude Predisposition,” “Well-being,” and “Interventionism.” Scores on the first three factors were indicative of psychotherapists’ Positive vs. Negative self-perception. A comparison of the Positive and Negative attitudinal profiles using the chi-squared test with Yates’s correction and a Monte Carlo simulation found that psychotherapists with a Positive profile reported greater satisfaction with the telematic modality and were more likely to perceive that their clients were able to maintain privacy during sessions.Conclusion: The results suggest that Italian psychotherapists have been able to promptly adapt to the imposed telematic modality during the COVID-19 pandemic. However, they may have attempted to compensate for their physical distance from clients by intervening more during sessions. These findings may support psychotherapists who are currently practicing and inform future practitioners who are considering the use of telematic treatment as a routine component of psychotherapeutic care.

The aim is to assess the commonalities and interdependence referred to body-image avoidance among 118 couples newly introduced to first-level assisted reproductive techniques. Results showed non-clinical functioning levels, and partners showed a correlated, yet low, dyadic adjustment. The couple-effect was modeled through an Actor Partner Interdependence Model. For both partners, dyadic adjustment’s actor-effect associates with body-image avoidance. Moreover, psychological symptoms’ actor-effect associate to body-image avoidance, resulting significantly more influential than the partner-effect. Only for males, alexithymia’s actor-effect was significant. To conclude, partners’ functioning is quite specular yet not interdependent, as they do not show a couple-as-a-unit modality of functioning. Clinical implications are discussed.

This study aimed to identify the variables (i.e., internalizing, and externalizing problems, self-control, emotion dysregulation, and alexithymia) relevant for Smartphone Addiction and non-suicidal self-injury (NSSI), conceptualized as emotion-regulation strategies, also assessing age and gender differences. Based on power analysis, N = 78 Italian adolescents (11–19 years; M age = 14.24; SD = 1.56; 73.1% females) were considered. Step-wise multivariate linear regressions evidence a mutual association between NSSI and Smartphone Addiction, particularly relevant in pre-adolescence. Low self-control is significantly associated with the Smartphone Addiction, while emotion dysregulation and alexithymia with NSSI. This study supports NSSI and Smartphone Addiction conceptualization as emotion-regulation strategies and the importance of prevention interventions.

Chimney/snorkel endovascular aneurysm repair (Ch-EVAR) enables the minimally invasive treatment of abdominal aortic aneurysm in anatomically challenging and high-risk surgical cases. Here, we present the case of a 77-year-old man with an abdominal aortic aneurysm associated with crossed fused renal ectopia and an ectopic renal artery arising directly from the aneurysm sac. After successful implementation of Ch-EVAR, computed tomography angiography at 18 months revealed no endoleaks, patency of the parallel graft, and normal renal vascularization and function. This report underscores the feasibility of Ch-EVAR in a case with high anatomic complexity. Keywords: Abdominal aortic aneurysm, Chimney endovascular aneurysm repair, Crossed fused renal ectopia

Research studies focusing on separation anxiety and its relation with other measures of anxiety and personality-relevant variables in community samples are still scarce. This study aimed to describe in a dimensional perspective the relationship between separation anxiety symptoms, anxiety levels, and personality traits in a community sample of Italian emerging adults. A sample of 260 college students [mean age (Mage)=21.22, standard deviation (SD)=1.91, 79.6% females) completed the adult separation anxiety questionnaire-27 (ASA-27), the state and trait anxiety inventory-Y (STAI-Y), and the personality assessment inventory borderline scale (PAI-BOR). ASA-27 was significantly and positively correlated with the PAI borderline scale. The mediation model showed that ASA-27 influenced the PAI-BOR through trait anxiety. Clinical implications of the study for psychotherapy research are discussed.

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We used an epidemiological study to explore the perception of change in several psychosocial dimensions during the COVID-19 quarantine. We focused on emotions, use of social network sites (SNSs), family life, important relationships, body functions, and school life. Using snowball recruitment, N = 1047 Italian children, pre-adolescents, and adolescents (M = 13.74 ± 3.59) were selected to complete ad hoc online questionnaires. A differential semantic inventory plot was prepared to analyze the emotional experience of children, pre-adolescents, and adolescents during quarantine compared to the pre-quarantine period. The Kruskal–Wallis test was run to assess gender and age differences in emotions experienced, habitual SNS use, and the experience of attending classes remotely. A post hoc Wilcoxon test was performed to compare such differences. Results showed that most of the sample (93.1%) attended classes using technological devices and reported missing their classmates very much (59.3%). Adolescents experienced more negative emotions (M = 3.69 ± 1.33) than pre-adolescents (M = 4.64 ± 1.32), who experienced negative emotions more than children (M = 5.11 ± 1.24). Females were more prone to experience negative emotions compared to males. Adolescents were also the most prolific SNS users (78.1%), particularly female adolescents. Overall, these finding highlight the necessity of preserving the emotional state and relational well-being of youth in these developmental phases by considering their school and social lives.

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BackgroundThe use of technological devices can support the self-management of individuals with type 2 diabetes mellitus (T2DM), particularly in addressing psychological distress. However, there is poor consistency in the literature regarding the use of psychological instruments for the web-based screening of patients’ psychological distress and subsequent monitoring of their psychological condition during digital interventions. ObjectiveThis study aims to review previous literature on the types of psychological instruments delivered in digital interventions for assessing depression, anxiety, and stress in patients with T2DM. MethodsThe literature review was conducted using the PsycINFO, CINAHL and PubMed databases, in which the following terms were considered: diabetes mellitus, measure, assessment, self-care, self-management, depression, anxiety, stress, technology, eHealth, mobile health, mobile phone, device, and smartphone. ResultsIn most studies, psychological assessments were administered on paper. A few studies deployed self-reporting techniques employing automated telephonic assessment, a call system for screening and monitoring patients’ conditions and preferences, or through telephone interviews via interactive voice response calls, a self-management support program leveraging tailored messages and structured emails. Other studies used simple telephone interviews and included the use of apps for tablets and smartphones to assess the psychological well-being of patients. Finally, some studies deployed mood rating scales delivered through tailored text message–based support systems. ConclusionsThe deployment of appropriate psychological tools in digital interventions allows researchers and clinicians to make the screening of anxiety, stress, and depression symptoms faster and easier in patients with T2DM. Data from this literature review suggest that mobile health solutions may be preferred tools to use in such digital interventions.

Aims: Recent meta-analytic data show that approximately 40% of individuals at clinical high risk for psychosis (CHR) receive at least one personality disorder (PD) diagnosis. Personality pathology could significantly influence CHR patients' prognosis and response to treatment. We aimed at exploring the PD traits of CHR adolescents, in order to outline a prototypic description of their most frequently observed personality characteristics.Methods: One hundred and twenty-three psychiatrists and psychologists used a Q-sort procedure [i.e., the Shedler–Westen Assessment Procedure-200 for Adolescents (SWAP-200-A)] to assess personality traits and disorders in 58 (30 male; mean age = 16 years, range = 13–19 years) CHR adolescents and two gender- and age-matched samples, respectively, with (n = 60) and without PDs (n = 59).Results: Differences between the CHR, PD, and clinical groups showed that CHR adolescents had pervasive and more clinically relevant schizoid, schizotypal, borderline, and avoidant traits, as well as poorer adaptive functioning. Moreover, by collecting the highest mean SWAP-200-A items, we empirically outlined a prototypic description of CHR youths, comprised of avoidance of social relationships; suspiciousness; obsessional thoughts; lack of psychological insight; dysphoric and overwhelming feelings of anxiety and depression; odd and anomalous reasoning processes or perceptual experiences; symptoms of depersonalization and derealization; and negative symptoms of avolition, abulia, blunted affects, and impaired role functioning.Conclusions: The results suggest that avoidant interpersonal strategies, impaired mentalization, and difficulties in emotional regulation could become important targets for psychosocial interventions with CHR adolescent populations.

Aims: Italy was one of the first countries to be significantly affected by the coronavirus disease 2019 (COVID-19) pandemic, determining a unique scenario for Italian psychotherapists to consider changing the modality in which they deliver treatment. The present study aimed at studying which factors related to psychotherapists and their clinical practice had a major role in predicting two main outcomes: (1) the rate of interrupted treatments during lockdown and (2) psychotherapists’ satisfaction with the telepsychotherapy modality.Methods: An online survey was administered to licensed psychotherapists (n = 306), who worked mainly as private practitioners, between April 5 and May 10, 2020 (i.e., the peak of the pandemic in Italy).Results: Psychotherapists reported that 42.1% (SD = 28.9) of their treatments had been interrupted, suggesting that Italy faced an important undersupply of psychotherapy during the lockdown. Using the Akaike information criterion (AIC) model selection, we identified three predictors of the rate of interrupted treatments: (1) psychotherapists’ lack of experience with telepsychotherapy prior to the lockdown, (2) their theoretical orientation (with cognitive behavioral psychotherapists reporting a higher rate of interrupted treatments), and (3) patients’ lack of privacy at home, as reported to the psychotherapists. Furthermore, we found four predictors of psychotherapists’ satisfaction with the telepsychotherapy modality: (1) the rate of interrupted treatments, (2) psychotherapists’ previous experience with telepsychotherapy, (3) their beliefs about the compatibility of telepsychotherapy with their theoretical orientation, and (4) their use of a video-conferencing modality, rather than telephone.Conclusion: The following recommendations can help policy makers, professional associations, and practitioners in promoting the continuity of psychotherapy treatments during the COVID-19 outbreak and in future emergencies: (i) disseminating training programs for practitioners on telepsychotherapy, (ii) supporting patients to pragmatically access a private space at home, (iii) encouraging practitioners to use video-conferencing (instead of telephone) to deliver remote therapy, and (iv) increasing the acceptance of telepsychotherapy among both clinicians and the general public.

Research within psychotherapy and psychopathology frameworks has been inspired by the central concept of defense mechanisms, which play a pivotal role in psychoanalysis. Defense specificities have only recently been studied systematically in the context of several clinical diagnoses. The present study aimed to explore the specificities of defense mechanisms in adolescents at ultra-high risk of developing psychosis and test the relationship between defensive functioning and attenuated psychotic symptoms. Twenty-six adolescent inpatients at ultra-high risk of developing psychosis and a matched clinical control group of inpatients not at risk of psychosis were interviewed. Two observer-rater methods, the Defense Mechanism Rating Scales and the Psychotic-Defense Mechanism Rating Scales were applied to interview transcripts to assess the individual use of defenses. Ultra-high-risk patients demonstrated lower defense mechanisms (i.e., total instances of defense mechanisms observed) and lower overall adaptiveness of the defenses presented. When specific differences between groups were observed, psychotic defenses were the sole defenses that could partially discriminate between ultra-high-risk and not at-risk patients. Regarding the relationship between defense mechanisms and subthreshold psychotic symptoms, psychotic defenses were associated with negative and disorganization symptoms, rather than with positive symptoms. The psychological vulnerability of ultra-high-risk patients is discussed and treatment implications for psychotherapy with such challenging patients are addressed.

In psychodynamic psychotherapy, verbal (structures and intents) and non-verbal (voice and interruptions) dimensions of communication intertwine conveying information and determining the mutual regulation between therapist and patient through conversational sequences. The communication components interplay is the foundation for building the therapeutic alliance, a relational dimension that predicts a psychotherapy outcome and change, influenced by patient-therapist exchanges from the initial stages of their encounter. Depressed patients present specific verbal and non-verbal communication and show difficulties in developing and maintaining the therapeutic alliance. Based on the reviewed literature, the main aim of this study was to analyze how the action of specific communicative modes, implemented by the therapist and depressed patients, affect the reciprocal construction of the early therapeutic alliance by each participant during the mutual regulation processes. We employed a mixed methods approach based on a systematic observation of communication and alliance ruptures and repairs within the audio recordings and verbatim transcripts of 20 psychotherapy sessions (6,232 speaking turns) with seven depressed patients. The observational design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified because we developed a comprehensive procedure that integrates an ad hoc indirect observation system (the Communicative Modes Analysis System in Psychotherapy), analyzing verbal and non-verbal communication, and an observational tool with deductive categories (the Collaborative Interactions Scale-Revised), assessing the therapeutic alliance construction. Once we confirmed the intra-and inter-observer reliability for the ad hoc system and the inter-rater reliability for the tool with deductive (or theoretical) categories, we performed descriptive statistics (to describe quantitatively communicative modes and alliance ruptures and repairs), lag sequential analysis (to detect stable patterns in communication-alliance interactions), and polar coordinate analysis (to identify significant relationships between communicative modes and alliance ruptures and repairs). Results confirm that the therapist's verbal (asking and exploring) and non-verbal (elaborating and cooperatively interrupting) modes and the depressed patients' verbal (asserting and exploring) and non-verbal (expressing emotions and cooperatively interrupting) modes determine stable patterns and significant associations with collaborative behaviors connected to the reciprocal construction of alliance by each participant. All this may provide professionals with useful information to increase the psychotherapy effectiveness with depressed patients.

Background: The occurrence of parathyroid carcinoma in multiple endocrine neoplasia type I (MENI) is rare and the 15 cases of malignant parathyroid tumor reported so far have been associated with MENI in individuals and not with multiple members within a family. Methods: We report on a 61-year-old male, operated for a 7.3 cm parathyroid carcinoma infiltrating the esophagus. In his brother, a 4.6 cm parathyroid carcinoma was diagnosed histologically, while in the daughter, neck ultrasonography revealed 2 extrathyroidal nodules, yet to be excised. Results: Screening of the MEN1 gene identified a known germline heterozygous missense mutation (c.1252G>A; p.D418N) in exon 9, in all affected subjects. Conclusions: The occurrence of parathyroid carcinoma in more than one affected member of a single MEN1 family represents the first reported familial case. This suggests that additional constitutional genetic mutations may contribute to the variation in malignant potential and clinical behavior of parathyroid tumors in MEN1.

AbstractBackground.Stigma is one of the most important barriers to help-seeking and to personal recovery for people suffering from mental disorders. Stigmatizing attitudes are present among mental health professionals with negative effects on the quality of health care.Methods.Network and moderator analysis were used to identify what path determines stigma, considering demographic and professional variables, personality traits, and burnout dimensions in a sample of mental health professionals (n = 318) from six Community Mental Health Services. The survey included the Attribution Questionnaire-9, the Maslach Burnout Inventory, and the Ten-Item Personality Inventory.Results.The personality trait of openness to new experiences resulted to determine lower levels of stigma. Burnout (personal accomplishment) interacted with emotional stability in predicting stigma, and specifically, for subjects with lower emotional stability lower levels of personal accomplishment were associated with higher levels of stigma.Conclusions.Some personality traits may be accompanied by better empathic and communication skills, and may have a protective role against stigma. Moreover, burnout can increase stigma, in particular in subjects with specific personality traits. Assessing personality and burnout levels could help in identifying mental health professionals at higher risk of developing stigma. Future studies should determine whether targeted interventions in mental health professionals at risk of developing stigma may be effective in stigma prevention.

The Interest Section on Therapist Training and Development of the Society for Psychotherapy Research (SPRISTAD) has launched a multisite collaborative longitudinal study of psychotherapy trainees’ development, a large-scale study involving a number of countries all over the world. In the present article, we present an overview of the early Italian contribution to the SPRISTAD study, based on preliminary paper-and-pencil data collection. Our preliminary findings showed cross-sectional differences at different years of training and two-years longitudinal changes in trainees’ perceived development. Moreover, trainees’ characteristics such as their motivation, relational manner, current life, and personal background have shown to deserve attention in research on trainees’ development. These findings encourage the continuation of the SPRISTAD online data collection.

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