THE ROLE OF CLINICAL HYPNOSIS AND SELF-HYPNOSIS TO RELIEF PAIN AND ANXIETY IN SEVERE CHRONIC ILLNESSES AND IN PALLIATIVE CARE A LONG TERM FOLLOW-UP OF TREATMENT IN A PROSPECTIVE OBSERVATIONAL NON-RANDOMIZED CONTROLLED STUDY

ABSTRACT Introduction: Patients with severe chronic diseases and advanced cancer in Palliative care, have a complex array of physical and psychosocial needs that can arise early in the course of illness. We solicited the thoughts of patients who participated in a non-randomized trial of early integration in palliative care of clinical hypnosis, versus standard pharmacological care, regarding an early palliative care group therapy. Materials and Methods: This is a nonrandomized prospective trial. We studied fifty patients: 25 in a group therapy with the hypnosis intervention as adjuvant therapy to medicines, 25 in a control group, who received only a pharmacological intervention. Evaluations with VAS for pain and HAMA scale for anxiety were conducted for a long-term follow-up, after one year and two years, and analyzed using VAS scale for pain, and Hamilton Anxiety Scale for anxiety. Results: Fifty subjects 14 men and 36 women participated to the study. The patients suffered from 3 main types of severe advanced chronic disease: rheumatic (n=21), neurologic (n=16) and cancer (n=13). Sixteen of them (32%) were administered with opioids for pain control. Half of the patients (n=25) were assigned to the group administered with the self-hypnotic protocol (hypnosis group), while the remaining 25 followed the conventional pain therapies (control group). The VAS score at baseline was similar between the hypnosis and the control group (mean \ub1 standard deviation, sd: 78 \ub1 16 and 77 \ub1 14, respectively). After 1 year follow-up, we observed a significant decrease of pain and anxiety in the group-hypnosis compared to the control-group: the group- hypnosis had a decrease of 7 points in the Hamilton anxiety score and a decrease of 16 points in the VAS score compared to the group that had not the hypnotic treatment. Only the 16% of the patients treated with hypnosis had to increase opioids, but the 52% of the control group, had to increase opioids. Who practice hypnosis has a less risk of 60% to have to increase the opioids therapy, compared with the control group. After 2 years, we have a total of 13 drop-out in the 2 groups: 7 drop-out in the hypnosis group and 6 drop-out in the control group. The decrease of the pain (VAS) was most important with the patient of the group hypnosis than in the control group (p=0.0001). The Hamilton score is decreased in group-hypnosis from 32.6 at baseline to 22.9 and 17.1 . In the control group anxiety it is the same at baseline (29.8), after 1 year (26.1) and after 2 years (28.5). ANOVA shows that the difference between the two groups is statistically significant (p<0.0001). After 1 and 2 years follow-up subjects in the hypnosis group were at lower risk of increasing the pharmacological treatment with opioids for pain control. Conclusions After 1 year and 2 years follow-up, subjects administered with the hypnosis therapy had a greater reduction in pain and in anxiety and the use of opioids, compared with the group that used only conventional pharmacological therapy

The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia

The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p &lt; .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p &lt; .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

Insight in cognitive impairment assessed with the Cognitive Assessment Interview in a large sample of patients with schizophrenia

The Cognitive Assessment Interview (CAI) is an interview-based scale measuring cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZ). The present study aimed at assessing, in a large sample of SCZ (n = 601), the agreement between patients and their informants on CAI ratings, to explore patients' insight in their cognitive deficits and its relationships with clinical and functional indices. Agreement between patient- and informant-based ratings was assessed by the Gwet's agreement coefficient. Predictors of insight in cognitive deficits were explored by stepwise multiple regression analyses. Patients reported lower severity of cognitive impairment vs. informants. A substantial to almost perfect agreement was observed between patients' and informants' ratings. Lower insight in cognitive deficits was associated to greater severity of neurocognitive impairment and positive symptoms, lower severity of depressive symptoms, and older age. Worse real-life functioning was associated to lower insight in cognitive deficit, worse neurocognitive performance, and worse functional capacity. Our findings indicate that the CAI is a valid co-primary measure with the interview to patients providing a reliable assessment of their cognitive deficits. In the absence of informants with good knowledge of the subject, the interview to the patient may represent a valid alternative

The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses

Background. Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions. Methods. Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression. Results. After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms. Conclusions. In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem

Social cognition in people with schizophrenia: A cluster-analytic approach

Background The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. Method A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. Results We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. Conclusions If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person

Clinical Hypnosis, spirituality and Palliation: the way of inner peace

The speciality of pain management has developed in medicine and other disciplines to address the need for comfort, functional restoration and treatment of associated problems. Cancer pain and chronic non malignant pain, can have devastating effects on patients\u2019 quality of life. The multidisciplinary teams that staff these programs include anaesthesiologists, surgical physicians, psychologists, acupuncturists and hypnotherapists. Based on a careful assessment, the team offers a treatment approach tailored to the patient\u2019s diagnosis and targeted to the patient\u2019s specific physical and psychosocial condition. The goals of this book are how to reduce pain and suffering with clinical hypnosis, improving functioning, enhancing the quality of life, and reducing dependence on medicines and the health care system

Mental training nello sport

L'allenamento della mente addestra l'atleta anche disabile a riconoscere e a sfruttare al meglio le proprie potenzialit\ue0, ad aumentare le proprie capacit\ue0 di attenzione e di autocontrollo, a dominare l'ansia da prestazione durante le gare. L'uso delle tecniche illustrate in questo libro non solo migliora il rendimento sportivo, ma favorisce anche l'autostima, le relazioni con gli altri, un atteggiamento positivo nei confronti della vita

A New Classification of the Neurophysiological Modified States of Consciousness: From Neuroscience to Neurophilosophy. A peer-reviewed, referenced resource. Whorkshop

A basic understanding of the different states and stages of the consciousness and its psychological and neural correlates, is of major importance for all scientists and clinicians. Before we define what makes up a modified state of consciousness, it is important to establish what consciousness is. Consciousness is not static: experiences constantly move in and out of our awareness as our states of mind and environments change. Conscious experience is like to feel pain, to see blue, and so on. We can define consciousness as the awareness we have of our environment and ourselves. Phenomenal consciousness and knowledge are understanding of conscious experience. Phenomenal concepts are concepts associated with that knowledge: those that express phenomenal qualities from the experiencing subject's perspective (Torin A., Sven W., 2007). What is the nature of such consciousness? How are the different modified states of consciousness related to abilities, such as the ability to visualize, or to feel inner sensations? How are they related to neuro-physical knowledge, psychological, philosophical and spiritual concepts? These are just a few of the questions that the essays in this workshop address. This workshop would like to be a starting project managing, to mark specific points, to study the neurophysiological modified states of consciousness timeline. It focus on major development points that must be reached in future, to achieve a deepest knowledge on this important matter. This work has combined with a scheduling methodology, such as a review technique, a clinical method to study and observe, to much more accurately determine a new classification