Search Results (128)

Background and Objectives: Toe walking (TW) is frequently observed in children with Autism Spectrum Disorder (ASD), yet its clinical significance and association with comorbid conditions remain poorly understood. This study aimed to examine the prevalence of TW in a large Italian cohort of children with ASD and to explore its association with ASD severity, sleep disturbances, feeding behaviors, and gastrointestinal symptoms. Materials and Methods: A total of 289 children with ASD and 289 typically developing controls (TDC), matched for age and sex, were evaluated in a multicentric observational study. TW was assessed during neurodevelopmental evaluations. Sleep quality was assessed using the Sleep Disturbance Scale for Children (SDSC), feeding behaviors via the Brief Autism Mealtime Behavior Inventory (BAMBI), and gastrointestinal symptoms through clinical reporting. Statistical analyses included Chi-square tests, Mann–Whitney U tests, Spearman correlations, and logistic regressions. Results: TW was significantly more prevalent in the ASD group (27.3%) than in TDC (5.5%, p < 0.0001). Within the ASD group, TW occurred in 50.5% of children with Level 3 severity but was absent in Levels 1 and 2 (p < 0.0001). Males exhibited TW more frequently than females. Children with TW had higher SDSC scores (ρ = 0.33, p < 0.0001), though no subscale independently predicted TW. Constipation was reported in 100% of children with Level 3 ASD and was strongly correlated with SDSC total scores (ρ = 0.58, p < 0.0001). The Disorders of Arousal (DA) subscale emerged as an independent predictor of constipation (β = 0.184, p = 0.019). Conclusions: TW in ASD appears to be a marker of greater neurodevelopmental severity and is associated with sleep disturbances and gastrointestinal dysfunction. These findings support the hypothesis that TW may reflect broader dysfunctions involving the gut–brain axis, sensory processing, and motor control. The routine clinical assessment of TW should include the evaluation of sleep and somatic symptoms to better understand the multisystemic nature of ASD phenotypes. Full article

Current technological development has made the Internet and new technologies increasingly present in people’s lives, expanding their opportunities but also potentially posing risks for dysfunctional use. This study aims to identify psychopathological factors associated with dysfunctional ICT use, extending the evidence beyond the well-established relationships with mood disorders to include personality disorders (i.e., cluster C in particular). A total of 711 participants (75.70% female; Mage = 28.33 years, SD = 12.30) took part in the data collection. Firstly, the results showed positive correlations between higher levels of addictive patterns for the Internet, social networks, smartphones and applications, and video games and higher levels of borderline symptoms as assessed by the Borderline Symptom List 23—Short Version. Moreover, scores reflecting high addictive patterns also positively correlated with general narcissistic traits as indicated by the total score of the Narcissistic Personality Inventory 13—Short Version and those specifically described by its Entitlement/Exploitativeness dimension, as well as with higher levels of almost all the personality traits assessed by the Personality Inventory for DSM 5—Brief Form (i.e., negative affectivity, detachment, disinhibition, and psychoticism). These findings broaden the still scarce body of evidence on the relationship between personality disorders and dysfunctional ICT use, which, however, needs to be further explored. Full article

Background and Objectives: Evidence regarding how dispositional traits, antenatal anxiety, substance use, and obstetric events converge to shape post-partum depression (PPD) in South-East Europe is limited. We analysed 102 third-trimester women and followed them to six weeks post-partum, and 102 age-matched community controls were used to (i) compare baseline psychological profiles, (ii) chart antenatal-to-post-partum symptom trajectories, and (iii) build an integrated model of clinically relevant PPD (Edinburgh Post-natal Depression Scale, EPDS ≥ 12). Materials and Methods: All 96 raw variables were forward–backward translated from Romanian, reconciled, and harmonized. The principal instruments used were EPDS, State–Trait Anxiety Inventory form Y (STAI-Y), Revised Obsessive–Compulsive Inventory (OCI-R), NEO Five-Factor Inventory (NEO-FFI-60), and the four-item Maternal Worry and Satisfaction Scale (MWSS). Results: Groups were age-matched (31.1 ± 5.4 vs. 30.3 ± 5.1 years, p = 0.268) but differed in urban residence (39% vs. 17%, p = 0.001) and current substance use (smoking 21% vs. 34%, p = 0.041; alcohol 6% vs. 22%, p = 0.002). Of five personality domains, only openness scored lower in peripartum women (26.1 ± 4.6 vs. 29.3 ± 5.2, p < 0.001). State anxiety rose significantly from pregnancy to puerperium (+5.1 ± 8.4 points, p < 0.001). Post-partum EPDS correlated most strongly with state anxiety (r = 0.62) and neuroticism (r = 0.50). A final model (pseudo-R² = 0.30) identified post-partum state anxiety (OR 1.10 per point, 95% CI 1.05–1.15, p < 0.001) as the independent predictor; neuroticism showed a trend (OR 1.08, p = 0.081). Obstetric factors (prematurity, birth weight, caesarean section) were not significant. Conclusions: In this Romanian cohort, heightened state anxiety—in synergy with high neuroticism and lower openness—dominated the risk landscape of early onset PPD, whereas delivery mode and neonatal status were neutral. Routine perinatal mental health screening should therefore incorporate anxiety metrics alongside depression scales and brief trait inventories to refine preventive targeting. Full article

Background/Objectives: The joint presence of chronic pain (CP) and depression is frequent, exacerbating symptoms of both conditions. Although tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors are effective treatments, they are frequently not well tolerated, and selective serotonin reuptake inhibitors are not useful for controlling CP. This study investigated vortioxetine’s effectiveness in relieving CP in patients with any degree of depression. Methods: Patient data with any degree of depression and with CP (Visual Analog Scale [VAS] score ≥ 4) were collected and analyzed. Included patients (n = 142) were initially treated with vortioxetine 10 mg/day for 3 months. Improvement of patients’ pain and condition was measured with the VAS, Patient Global Impression (PGI), and Clinical Global Impression (CGI) scales at 1 and 3 months. Brief Pain Inventory (BPI) was measured at baseline and 3 months. Additionally, at baseline and after 3 months of treatment, the Satisfaction with Medicines Questionnaire (SATMED-Q) and 9-item Patient Health Questionnaire (PHQ-9) were evaluated. Adverse Events (AEs) were recorded. Results: Patients showed significant improvement (p < 0.001) in VAS from baseline to 1 and 3 months (mean [SD]: 7.19 [0.62], 6.23 [0.80], and 5.41 [1.15], respectively). BPI and PHQ-9 scores also showed a significant decrease from baseline (mean [SD] of 6.05 [0.75] and 11.73 [4.89], respectively) to 3 months (5.11 [1.04] and 6.95 [2.52], respectively). Clinical improvement with the CGI and PGI scales were reported. According to the SATMED-Q, patients were satisfied with the treatment. Only a few mild EAs were recorded. Conclusions: Vortioxetine can improve both the severity and intensity of CP in patients with any degree of depression. Full article

Background: Borderline Personality Disorder (BPD) is a growing health concern, characterized by emotional dysregulation, impulsivity, and unstable interpersonal relationships. One of the core features of BPD is self-harm, which has significant implications for clinical management, risk assessment, and treatment planning. Accurate assessment tools are essential in evaluating symptom severity and identifying individuals at high risk of self-injurious behaviors, thereby guiding clinical interventions effectively. This study aimed to assess the psychometric properties, factor structure, and diagnostic utility of the Greek version of the Borderline Personality Disorder Severity Index-IV (BPDSI-IV), providing preliminary evidence for its reliability and validity. Methods: A total of 128 individuals with BPD and 32 healthy controls were assessed using the BPDSI-IV together with the Brief Symptom Inventory-53 (BSI-53), the BPD Checklist, the Rosenberg Self-Esteem Scale, the WHOQOL-BREF, and the Defense Style Questionnaire-40 (DSQ-40). BPD diagnoses were confirmed using the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Internal consistency, confirmatory factor analysis (CFA) of previously suggested models, exploratory and confirmatory bifactor modeling, and validity assessments were conducted. Results: The BPDSI-IV showed strong internal consistency (α = 0.92, ωt = 0.96), with most subscales demonstrating adequate reliability. Exploratory bifactor analysis using the Schmid–Leiman transformation supported a model with a dominant severity factor (ωh = 0.69), reinforcing the dimensional nature of BPD. CFA supported this bifactorial approach. BPDSI-IV scores significantly discriminated BPD patients from controls (p < 0.001). Strong correlations with measures of psychopathology and self-esteem, and correlations with quality of life further supported its validity. Conclusions: The Greek BPDSI-IV demonstrated strong reliability and validity indicators. Structured assessment tools, such as the BPDSI-IV, can enhance early intervention and research on the course of borderline personality disorder symptoms. Full article

Objective: To explore the feasibility and acceptability of using an evidence-based Tai Chi intervention to manage the fatigue–sleep disturbance–depression symptom cluster (FSDSC) in female breast cancer patients. Methods: This study reported the feasibility outcomes of a pilot randomized controlled trial (RCT), along with a nested qualitative process evaluation. Seventy-two female breast cancer patients experiencing the FSDSC were randomized into either a Tai Chi group or a control group. The Tai Chi group received an eight-week Tai Chi intervention consisting of two one-hour sessions per week, along with routine care, while the control group received routine care only. The feasibility and acceptability of the study procedure and Tai Chi intervention protocol were assessed by measuring recruitment, referral, retention and drop-out rates, questionnaire completion rates (including the Brief Fatigue Inventory [BFI], Pittsburgh Sleep Quality Index [PSQI], Hospital Anxiety and Depression Scale-Depression [HADS-D], and Functional Assessment of Cancer Therapy-Breast [FACT-B]), intervention adherence, and safety outcomes. The nested qualitative process evaluation consisted of semi-structured interviews conducted among 22 participants to further explore their experiences of participating in this study and practicing Tai Chi. Descriptive data analysis was employed to present the feasibility and acceptability outcomes. Content analysis was employed to analyze the data from the qualitative process evaluation. Results: A total of 72 breast cancer patients were successfully recruited over six months, with a recruitment rate of 79.1%, retention rate of 95.8%, and dropout rate of 4.2%. No missing data was found in the BFI, PSQI, or HADS-D. However, a notable number of missing values were found in the FACT-B, particularly for items related to sexual satisfaction. The Tai Chi intervention demonstrated a high level of feasibility, with an average adherence rate of 86.8%. Only eight participants reported minor discomforts, such as minor musculoskeletal discomfort and dizziness, but they were transient and manageable after stopping Tai Chi practice. Semi-structured interviews with 22 participants highlighted that Tai Chi was experienced to be generally convenient, energy-saving, and low intensity for FSDSC management. Participants also felt that the study questionnaires were comprehensible and straightforward. Many interviewees from the Tai Chi group reported perceiving favorable effects on FSDSC management, as well as overall functional health and well-being. Conclusions: The evidence-based Tai Chi intervention proved feasible, safe, and convenient as a non-pharmacological intervention for managing FSDSC in breast cancer patients. Future large-scale studies are needed to evaluate Tai Chi’s definite effects on improving FSDSC among breast cancer patients. Full article

Background/Objectives: The present study aimed to reveal the differences in changes in and risk factors for depressive symptoms between people with and without various psychiatric disorders during the pandemic. Methods: Longitudinal web-based surveys were conducted from 2020 to 2022. The diagnosis of mental disorders was based on self-reports by participants. Depressive symptoms were measured via the Patient Health Questionnaire-9 (PHQ-9), and coping was measured via the Brief Coping Orientation to Problems Experienced Inventory. A linear mixed model of PHQ-9, two-sample t-tests on Brief-COPE, and multiple linear regression for with and without mental disorders were conducted. Results: A total of 1443 participants were analyzed, of whom 9.3% had mental disorders. Depressive symptoms significantly decreased from January 2021 to January 2022, regardless of mental disorder status. Participants with mental disorders used certain coping styles more frequently than those without mental disorders. In a multiple linear regression analysis, no coping strategy was significantly effective for PHQ-9 scores among participants with mental disorders. However, being single was a risk factor, and emotional support use was associated with PHQ-9 scores. Additionally, behavioral disengagement was linked to PHQ-9 scores, regardless of mental disorder status. Conclusions: These results showed depressive symptoms might decrease in the long term regardless of the presence of mental disorders. Although there was no evidence of coping strategies effectively reducing depressive symptoms in people with mental disorders, the presence of a spousal relationship may play an important protective role for people with mental disorders and behavioral guidelines regardless of the presence of mental disorders. Full article

Scope: The rationale of the present study is to measure the impact of chemotherapy on the pain caused by the disease. Materials and Methods: The present study was based on the completion of two standardized questionnaires for the assessment of physical symptoms (Brief Pain Inventory—BPI—and the revised Edmonton Symptom Assessment System—ESASr) in three different moments. The research was conducted at the Oncology Institute “Prof. Dr. Ion Chiricuță” Cluj-Napoca between 2022 and 2023. Results: 24 patients were included in the study, and they received different cytostatic treatment regimens, adapted to the underlying pathology. We analyzed the distribution of all symptoms from the ESASr and the total score. In terms of the general situation, if we exclude pain, there is never a difference between Time 2 and 3. Furthermore, in all cases where there is a statistically significant effect, there is a difference between Time 1 and 3. We also analyzed the distribution of activities with which pain interacts in BPI. Regarding the general situation, three patterns of influence of pain on the examined parameters are found: for general activity, mood, ability to work, and sleep, there are significant differences between moments 1 and 2 and 1 and 3, without significant differences between moments 2 and 3. The second pattern identified refers to the lack of effect of pain on the ability to walk and on the relationship with other people. The peculiarity is represented by the influence on the enjoyment of life that was significantly improved only from Time 1 to 3. Conclusions: The present study demonstrated a considerable effect of cytostatic treatment on the management of cancer-related pain, as shown across different evaluations. Full article

Background/Objectives: Psychosocial and cultural determinants have a special influence on the development, manifestation and prognosis of common mental disorders such as anxiety and depression. The objectives of this study were to define the psychosocial profile of the people most vulnerable to the development of these health problems, analyse the symptomatology and health determinants that may influence these from a gender perspective, and evaluate the quality of life and coping strategies among the adult population with this diagnosis in a rural area of Catalonia (Spain). Methods: An observational, cross-sectional, and analytical study was conducted on 180 people diagnosed with anxiety or depression. Patients completed an ad hoc sociodemographic questionnaire, the Brief Symptom Checklist (LSB-50), the Quality of Life Scale (EQ-5D-5L) and the Brief Cope Inventory (COPE-28). Results: Women aged 45–64 with a low socioeconomic profile may be more vulnerable to common mental disorders, although psychiatric symptomatology was more pronounced in men. Women were more likely to have problems with mobility (aOR= 2.93, p = 0.039) and daily activities (aOR = 2.75, p = 0.033), as well as lower self-perceived health scores (p = 0.002). Women used active coping, venting and seeking social support as coping strategies, while men used behavioural disengagement. Conclusions: It has been observed that the people most susceptible to developing depression and anxiety disorders may have a specific profile. Although a greater number of women have these common mental disorders, men tend to have more noticeable symptomatology. The coping strategies most used also differ according to gender. Full article

Background/Objectives: Hypermobile Ehlers-Danlos syndrome (hEDS) is the most common form of EDS, characterized by joint hypermobility, skin findings, and joint pains or recurrent dislocations that may also be associated with other several extra-articular symptoms. A deficit in the affect regulation represents a risk element in the development of both physical and mental health, as well as in a greater pain perception. The present study aims at exploring the associations between linguistic characteristics associated with different autobiographical memories and affect regulation and pain measures in patients affected by hEDS. A further aim is to explore the possible differences in linguistic measures between different episodes. Methods: Twenty-five patients with hEDS diagnoses (mean age = 38.32; SD = 17.00; 23 female) in treatment at the Physical Medicine and Rehabilitation Department of Umberto I Hospital in Rome completed a socio-demographic questionnaire, the Difficulties in Emotion Regulation Scale (DERS), the 20-item Toronto Alexithymia Scale (TAS-20), and the Brief Pain Inventory (BPI), as well as an interview aimed at collecting memories regarding neutral, positive, and negative events and the medical condition. The transcriptions of the interviews were analyzed using a computerized linguistic measure of the referential process (RP). Results: A correlational analysis showed several significant associations among the linguistic measures, affect regulation, and perception of pain, applied to neutral, positive, and disease condition narratives. Only few significant associations emerged regarding the negative episode. Moreover, significant differences emerged between the neutral event compared with the positive, negative, and diagnosis episodes, especially with the latter. Conclusions: The present findings seem to confirm the association between affect regulation, pain, and linguistic measures, sustaining an elaborative process. Specifically, the experience of chronic pain associated with the discovery of the rare disease becomes a meaningful experience in one’s life condition and supports the ability to cope with the experience of chronicity. Full article

Background: Induced after-death communication (IADC) therapy is an emerging approach for addressing grief-related distress, particularly in individuals experiencing complicated grief (CG). Developed from eye movement desensitization and reprocessing (EMDR), IADC therapy aims to change the meanings with which loss is read and to transform acute grief into integrated grief. While spontaneous after-death communications (ADCs) have been widely reported across different cultures, IADC therapy provides a structured procedure for inducing a state of mind in which such experiences can spontaneously arise and develop. Methods: This study employed a prospective observational cohort design with a retrospective analysis, comparing the effectiveness of IADC therapy (experimental group, n = 42) to standard grief interventions combining talk therapy and EMDR (control group, n = 43). Participants completed standardized measures, including the Inventory of Complicated Grief (ICG) and the IADC Grief Questionnaire (IADC-GQ), at pre-treatment (T1), post-treatment (T2), and six-month follow-up (T3). Additional analyses explored the role of spirituality, religious affiliation, and therapist characteristics in grief processing. Results: IADC therapy led to a significantly greater reduction in grief intensity (ICG scores) immediately after the intervention and at the six-month follow-up compared to the control group. The experimental group also showed a more pronounced decrease in distress symptoms (CS scores) and higher ratings of therapeutic satisfaction. Furthermore, participants in the experimental group exhibited a significantly greater increase in their continuing bond (CB) scores, suggesting a more adaptive connection with the deceased. Additional analyses examined therapist characteristics, treatment-related factors, and the nature of ADC experiences, which are further explored in the discussion. Conclusions: These findings highlight the clinical utility of IADC therapy as a brief and cost-effective grief intervention, offering comparable or superior outcomes to traditional grief therapies. The results suggest that recognizing and integrating spontaneous ADC experiences into grief therapy may provide a valuable therapeutic pathway. Future research should further explore the long-term effects, cultural variations, and therapist characteristics to optimize the integration of IADC therapy into mainstream clinical practice. Full article

Incarcerated women report extremely high rates of lifetime sexual violence victimization. Survivors Healing from Abuse: Recovery through Exposure (SHARE) is an exposure-based group therapy specifically designed for incarcerated women survivors of sexual violence. SHARE has been continuously delivered in a women’s prison for more than 12 years. However, like many prisons during the COVID-19 pandemic, the prison ceased all in-person programming between March 2020 and July 2021. In response, the SHARE treatment team pivoted to a hybrid telehealth delivery model (i.e., group participants gathering in a facility group room and therapists joining via video, displayed on a computer screen within the group room). Given the lack of evidence for hybrid telehealth in carceral settings, and specifically for group therapy for sexual trauma, the current study compared ratings on internalizing symptoms (Brief Symptom Inventory-18 or BSI-18), posttraumatic stress symptoms (Posttraumatic Checklist-5 or PCL-5), and group cohesion ratings (Inclusion of Self in Other scale, or IOS) for participants who received SHARE in person (n = 21) or through hybrid telehealth (n = 19). The results demonstrated that participants of in-person and hybrid telehealth SHARE groups reported similar significant reductions in BSI-18 (15.21 in person vs. 16.00 in hybrid telehealth) and PCL-5 (30.78 in person vs. 26.40 in hybrid telehealth) scores pre- to post-treatment and comparable IOS ratings (5.06 in person vs. 5.31 in hybrid telehealth). The findings suggest hybrid telehealth is an effective and feasible treatment modality for meeting the need for trauma-focused therapy in prisons. Future studies examining the effectiveness and implementation of trauma-focused hybrid telehealth groups in prisons are warranted. Full article

Background/Objectives: Elevated cytokine levels, including IL-6 and IL-1β, can contribute to persistent brain inflammation in children with autism and cytomegalovirus (CMV) infection, exacerbating autism-related behaviours and symptoms. This study evaluates the impact of CMV-induced cytokine increases on the eating behaviours and sensory profiles of children with autism. Methods: A cross-sectional design was employed, involving children aged two to five years (CMV-reactive IgG), with ASD (n= 98) and TD (n = 96). Serological tests using ELISA were conducted to measure IgG CMV, IL-6, and IL-1β biomarkers. Eating behaviours were evaluated using the BAMBI (Brief Autism Mealtime Behaviour Inventory), and sensory profiles were assessed using the SSP (Short Sensory Profile). Statistical analyses were performed using Spearman’s rank and chi-square tests. Results: The results show that autism significantly affects children’s eating behaviours and sensory profiles (p < 0.001), with notable differences found between the groups. Correlation analysis revealed a significant association between IgG CMV and IL-6 (p = 0.026) and IL-1β (p = 0.014) in the ASD group. Additionally, eating behaviours (food refusal and limited variety) in ASD correlated with IL-6 and IL-1β. Sensory characteristics, such as tactile sensitivity, were found to correlate with IL-6 (p = 0.027) and IL-1β (p = 0.002) in the ASD group. Conclusions: These findings suggest that CMV-infected children with autism are at increased risk of IL-6 and IL-1β dysregulation, contributing to sensory processing issues and eating behaviours. Further research is needed to enhance CMV testing protocols and better understand the virus’s role in the development of sensory and behavioural issues in children with autism. Full article

Recent studies indicate that nurses experienced high levels of occupational burnout and insomnia during and after the pandemic and highlight resilience as a crucial competence for overcoming adversity. The aim of this study was to assess occupational burnout, insomnia, and psychological resilience and to explore their interrelations among Greek nurses 14 months after the official ending of the pandemic which was declared in May 2023. The study was conducted online in July 2024 and included 380 nurses currently working in Greek hospitals, who completed the Copenhagen Burnout Inventory (CBI), the Athens Insomnia Scale (AIS), and the Brief Resilience Scale (BRS). Overall, 56.1% of the nurses exhibited insomnia symptoms and 46.8% displayed signs of occupational burnout. Low resilience scores were observed in 26.3%. Multiple regression analysis indicated that CBI explained 34.4% of the variance in the AIS scores, while an additional 3% was explained by the BRS. Mediation analysis revealed that resilience operates protectively as a negative mediator in the relationship between burnout and insomnia. In conclusion, one year after the end of the pandemic the levels of occupational burnout and insomnia among nurses remain high, whereas psychological resilience seems to be retained at moderate levels. Consequently, there is an urgent need to regularly monitor for risk of burnout and insomnia and to implement resilience-building strategies for nurses to combat burnout and improve insomnia symptoms. Full article

Background: The current study is intended to examine how positive family functioning, collectively constructed by parents and children in the family context, may contribute to their gratitude and depression, two pivotal human emotions closely related to human health, in which the gratitude and depression of parents and children are assumed to affect each other bidirectionally and parental and children’s gratitude is expected to link the relations between positive family functioning and their depression. Methods: The data for analysis came from a community sample of 310 Chinese parent–child dyads, which were measured by the Family Functioning Style Scale (FFSS), Gratitude Questionnaire (GQ), and depression subscale of the Brief Symptom Inventory (BSI) from both the parent and child participants. Results: The results indicated that positive family functioning contributed to higher parental and children’s gratitude and their less depression, and parental and children’s gratitude and depression affected each other positively. Furthermore, serial mediation analyses discovered the complex processes from positive family functioning to the actor’s depression in parents or children through their gratitude or the links from the partner effect to the actor effect of parental and children’s gratitude or from the partner effect of parental or children’s gratitude to their partner effect of depression. Conclusions: Findings of the current study prove the collective effects of family functioning on the emotional development of gratitude and depression among parents and children, in which parental and children’s gratitude and depression bidirectionally impact each other and lead to the actor’s depression in them through the complex serial mediated effects. For this, pro-family and health-related policies and services should be provided to promote family functioning and emotional management in a home context to enhance family and emotional health among parents and children. Full article