Psychological stress in seafarers: a review

Background: Seafaring is a particular profession, in which workers are usually exposed to several stressors that are related to the different duties on board ships. This paper has reviewed the main publications on different factors affecting seafarers with the purpose of identifying specific stress factors related to a particular duty on board. Materials and methods: A literature search was conducted using the online databases PubMed and OvidSP. A survey on health, stress, and fatigue of Australian Seafarers published by the Australian Maritime Safety Authority (AMSA) fulfilling the selection criteria was also examined. This publication provided relevant data obtained from a large sample of seafarers. Results: Our analysis confirmed that seafaring is associated with mental, psychosocial, and physical stressors. The most important factors were separation from family, loneliness on board, fatigue, multi-nationality, limited recreation activity, and sleep deprivation. The AMSA report gave a more detailed analysis on lifestyle and relevant factors inducing psychological distress. Stressors affecting seafarers working in the engine room were different from those involving the deck crew. Sleep quality and duration were reported to be poor mainly in pilots, whereas deck crew tended to be less adherent to physical exercise and healthy lifestyle recommendations. Conclusions: Seafaring is still associated with relevant mental health risks. Information on known stress factors on board should be provided to seafarers to help them in lowering stress perception. Strategies for coping with “inevitable” stress conditions should also be investigated and developed. Strategies to decrease risks of stress should be directed to the different categories of seafarers, and the results of specific interventions should be evaluated

Psychological consequences in victims of maritime piracy: the Italian experience

Background and aim: Maritime piracy is a worrying phenomenon. Its recurrence in the last few years iscausing several problems to the safety of maritime routes. In spite of the number of seafarers kidnappedand maintained in captivity, psychological/mental disorders developed in victims of these criminal actshave not been investigated. This study has assessed psychological consequences of kidnapping in a groupof Italian seafarers held in captivity from 7 to 10 months.Materials and methods: Four Italian seafarers were examined at the 5th month after release. An initial, semi-structured interview was followed by 2 structured clinical evaluations for assessing the possible presence of psychopathological disorders. Instruments used were the Cognitive Behavioural Assessment (CBA 2.0) and the Clinician-Administered Post Traumatic Stress Disorder (PTSD) Scale (CAPS-DX).Results: All victims showed high scores of state anxiety (56.00 ± 3.36) and social adjustment disorder (12.75 ± 2.21) to CBA 2.0. Moreover, 3 of them revealed traits of anxiety (58.75 ± 8.50) and emotionalinstability (8.25 ± 2.50). Two of them had somatic disorders (63.25 ± 15.94), depression (17.25 ± 4.78) and phobic problems (91.00 ± 7.02). In 3 of 4 victims examined, a PTSD diagnosis was made. Symptomsof recall resulted in higher CAPS-DX (13.00 ± 4.05) scores.Conclusions: Traumatic experiences such as being kept in captivity by pirates could entail relevant psychopathological disorders in victims and their families. Quality care interventions, aimed to develop paradigms for resilience training, represent a priority. An international partnerships and collaboration between institutions, clinicians and seafarer organisations can be useful to evaluate psychological conditions of these workers

Psychological distress in families of victims of maritime piracy — the Italian experience

Background: This work has investigated the psychological status of family members of kidnapped seafarers, 5 months after their release.Aim: The goal of this study was to assess if relatives of victims of maritime piracy showed signs of psychological distress, to diagnose eventual pathologies and to measure their severity.Materials and methods: Twelve family members (8 females and 4 males) of 4 kidnapped seafarers were examined. They were first interviewed by a semi-structured approach and then examined using the self-report questionnaire State-Trait Anxiety Inventory (STAI-Y), and the Hamilton Depression Rating Scale (HDRS).Results: Five months after the relatives had been released, 42% of the family members of kidnapped seafarers obtained pathological scores in the STAI-Y questionnaire, and 33% showed depression according to the HDRS.Conclusions: Family members of kidnapped seafarers show significant psychopathological symptoms 5 months after relatives have been released. Symptoms may be severe enough to interfere with daily life in about one half of them. Kidnapping is a changing life experience and both victims and relatives require attention and support

Brain volume changes in Alzheimer’s disease patients treated with a cholinesterase inhibitor plus the cholinergic precursor choline alphoscerate

Cholinergic precursors have represented the first approach recognized from a regulatory point of view to counter cognitive impairment occurring in adult-onset dementia disorders. ASCOMALVA [Effect of association between a cholinesterase inhibitor (ChE-I) and choline alphoscerate on cognitive deficits in AD associated with cerebrovascular injury] is a double-blind, controlled, randomized clinical trial investigating if the ChE-I donepezil and the cholinergic precursor choline alphoscerate in combination are more effective that donepezil alone. In this study, MRI from ACOMALVA patients were analyzed for the evaluation of brain atrophy. Participants to the ASCOMALVA trial underwent yearly MRI for diagnostic purposes. In 56 patients who achieved two years of therapy, MRI scans were analyzed by voxel morphometry techniques to assess if addition of choline alphoscerate to treatment with donepezil had an effect on brain volume changes known to occur in AD. Reference group patients (treated with donepezil alone) developed a greater atrophy of the gray and white matter compared with the group treated with donepezil plus choline alphoscerate. In the reference group a concomitant increase of the space of the cerebrospinal fluid and of the volume of the ventriculi was noticeable. One of the most affected areas was the hippocampus. Neuropsycological tests over the 24-month observation period showed in patients of the reference group a moderate time-dependent worsening in all the parameters investigated. Treatment with donepezil plus choline alphoscerate resulted in better scores of the cognitive and functional items and in an improvement in behavioural parameters, superior to that induced by donepezil alone. The above results have shown that treatment with choline alphoscerate plus donepezil versus donepezil alone counters to some extent hippocampal volume loss occurring in the brain of AD patients. The observation of a parallel improvement of cognitive and functional tests in patients treated with the cholinergic precursor loading strategy using choline alphoscerate indicates that morphological changes observed by MRI may have functional relevance

psychological distress in families of victims of maritime piracy the italian experience

Background: This work has investigated the psychological status of family members of kidnapped seafarers, 5 months after their release. Aim: The goal of this study was to assess if relatives of victims of maritime piracy showed signs of psychological distress, to diagnose eventual pathologies and to measure their severity. Materials and methods: Twelve family members (8 females and 4 males) of 4 kidnapped seafarers were examined. They were first interviewed by a semi-structured approach and then examined using the self-report questionnaire State-Trait Anxiety Inventory (STAI-Y), and the Hamilton Depression Rating Scale (HDRS). Results: Five months after the relatives had been released, 42% of the family members of kidnapped seafarers obtained pathological scores in the STAI-Y questionnaire, and 33% showed depression according to the HDRS. Conclusions: Family members of kidnapped seafarers show significant psychopathological symptoms 5 months after relatives have been released. Symptoms may be severe enough to interfere with daily life in about one half of them. Kidnapping is a changing life experience and both victims and relatives require attention and support. (Int Marit Health 2014; 65, 1: 28–32

Sea piracy sequelae: assessment according to the Diagnostic and Statistical Manual of Mental Disorders-5

Abstrac t Background: Our previous studies have investigated the psychological consequences of kidnapping in a group of Italian seafarers assaulted by sea pirates and held in captivity and in their family members by the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-4. These studies have shown that both the victims and the family members showed significant psychological disturbances, corresponding to a chronic Post-Traumatic Stress Disorder (PTSD), in the victims, and a pattern of anxiety and depression in their family members. After publication of these studies, an updated edition of the DSM became available, namely, the DSM-5. The DSM-5 redefines some diagnostic criteria, including those related to the PTSD. This work was focused on the re-evaluation of the results of our previous studies in the light of the DSM-5 diagnostic criteria. Materials and methods: Sixteen Italians including 4 kidnapped seafarers and 12 family members were examined by a semi-structured interview followed by Clinician-Administered PTSD Scale (CAPS-DX) and the Cognitive Behaviour al Assessment (CBA 2.0) for victims and by State-Trait Anxiety Inventory (STAI) X-1 and X-2 of CBA 2.0 and the Hamilton Depression Rating Scale (HDRS) for family members. Data already obtained were reviewed and re-analysed according to the DSM-5 criteria and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Results: The use of the CAPS-5 did not modify the diagnosis for the victims’ group: 3 of 4 had a PTSD diagnosis performed through the CAPS-5. Seven of 12 family members had PTSD diagnosis performed through the CAPS-5, with negative cognitions and mood symptoms being those obtaining the highest score. Conclusions: Using DSM-5 criteria, the diagnosis of PTSD in the direct victims of piracy was confirmed. The same diagnosis could apply to a group of their family members. Besides anxiety and fear, in fact, we found in 7 out 12 subjects the presence of symptoms included by the DSM-5 in the PTSD spectrum. These symptoms were: avoidance, negative alterations in mood and cognition, blame of self or others. The use of updated diagnostic criteria may enable more correct assessment of the consequences of piracy acts. This may be also useful for establishing proper compensations for the damage suffered by seafarers, depending on the degree of disability resulting from the criminal acts they suffered

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension