Stay foolish, stay fit: An excursus on strategies to prevent burnout of mental health professionals

Burn-Out (BO) is commonly described as a growing situation of work stress and conceptualized as a combination of emotional exhaustion, depersonalization/cynicism and reduced personal efficacy. Some professionals are exposed to a higher risk, depending on their specific work mansions (most typically the so called helping professions) and on personal and contextual conditions. Evidence from scientific literature has confirmed that being younger and working in the field of mental health are very significant risk factors for BO. Furthermore, BO is an essential target for preventive strategies: prevention of BO, rather than treatment of potential psychopathological consequences, has been proved to be more effective and cost-effective, though unfortunately very often disregarded or left to individual initiatives. Physical activity, diet, and other features of a healthy life-style are core targets of interventions aimed at prevention of BO. Increasing evidence is collected on the effectiveness of mindfulness-based techniques and yoga. Supervision, and more specifically Balint-inspired models of group case discussions. Scientific and professional associationism is also effective as a strategy to avoid isolation. Finally, interventions aimed at improving work organization, targeting logistic aspects (eg. time schedules), infrastructures (eg. parking places) or dynamics and human interactions, are also essential and effective

Tako-Tsubo cardiomyopathy and psychiatric disorders: Review of comorbidity

Background: In recent times, the connections between mental health and cardiac outcomes have been under increasing investigation. Tako-Tsubo Cardiomyopathy (TTC) is also called “broken heart syndrome”, since it has been described to occur after emotionally stressful events; it presents as an acute reversible coronary syndrome due to a transient failure of the left ventricle, in the absence of obstructive coronary heart disease. It has a 10-timehigher prevalence in postmenopausal women and may have a strong correlation with biopsycho- social stress. Aim: To review existing studies on TTC in comorbidity with psychiatric disorders. Method: Four PubMed literature searches performed during January 2015 (search terms: tako-tsubo AND psy*; tako-tsubo AND anxiety; tako-tsubo AND depression; tako-tsubo AND mania) provided 9 references: 4 case reports, 2 reviews, 2 prospective studies and 1 case–control study. Results: Not only chronic psychological stress (present in 2/3 of these patients, on average), but also a high co-occurrence of anxiety and depression (from 50 to 70% of patients with this cardiopathy), panic attacks (diagnosed in almost 20% of women with tako-tsubo), subthreshold and full-blown PTSD (co-morbid in almost 40% of patients according to a 2-year prospective study) were associated with TTC. It has been suggested that changes in circulating levels of catecholamines combined to heart's abnormal response to these hormones could be at the pathophysiological basis for such associations. Conclusion: The present literature review confirms a high cooccurrence of comorbid conditions with increased sympathetic activity (in particular anxiety, depression and panic disorder), which could be risk factors for TTC. More studies, especially longitudinal ones, are needed to better clarify the causative pathways of this usually reversible, but potentially lethal, syndrome, especially among post-menopausal women

Impact of anxiety-depressive symptoms on outpatients\u2019 quality of life: Preliminary results from an Italian observational study

Introduction Several studies have shown an association between the Short-Form 36 (SF36) scores and anxiety-depressive symptoms, suggesting that depression in particular could reduce Quality of Life (QoL) to the same, and even greater, extent than chronic noncommunicable diseases, such as diabetes and hypertension. Aims To explore the relationshipamongQoL and anxiety, depressive and anxiety-depressive symptoms in an outpatient sample. Methods Cross-sectional study. Inclusion criteria: outpatients aged 6540 years, without history for cancer, attending colonoscopy after positive faecal occult blood test. Collected data: blood pressure, blood glucose, lipid profile. Psychometric test: Hospital Anxiety and Depression Scale (HADS). QoL was assessed with SF36. Statistics performed with STATA13. Results 54 patients enrolled (27 females). Sixteen patients (30.2%) were positive for anxiety symptoms, ten (18.9%) for depressive symptoms and five (9.4%) for anxiety-depressive symptoms. The perceived QoL was precarious in twelve subjects (22.2%): eight (15.9%) had low score ( 64 42) at \u201cMental Component Summary\u201d (MCS) subscale, three (5.7%) at the \u201cMental Health\u201d item and one patient (1.9%) at the \u201cVitality\u201d one. At the multiple regression analysis, depressive (OR = 28.63; P = 0.01) and anxiety-depressive symptoms (OR = 11.16; P = 0.02) were associated with MCS. Conclusions The association emerging from the present study between depressive/anxiety symptoms and the MCS component of SF36 is consistent with available literature. Study design and small sample size do not allow to generalize results, that need further studies to be confirmed

Association of blood pressure with anxiety and depression in a sample of primary care patients

Introduction According to international scientific literature, and as summarized in the guidelines of the International Society of Hypertension, lowering of blood pressure can prevent cardiovascular accidents. Some studies suggest that hypertension, anxiety, and depression might be inversely correlated. Objective To investigate whether blood pressure is associated with anxiety and depression. Methods Cross-sectional design. Male and female primary care patients were enrolled, aged 40–80. Criteria of exclusion adopted: use of antidepressants or antipsychotics; previous major cardiovascular event; psychosis or major depression; Type 1-DM; pregnancy and hereditary disease associated to obesity. Anxiety and depression symptoms were assessed using HADS. Waist circumference, hip circumference, blood pressure, HDL, triglycerides, blood sugar, hypertension, albumin concentrations and serum iron were also assessed. Results Of the 210 subjects, 84 were men (40%), mean age was 60.88 (SD ± 10.88). Hypertension was found to correlate significantly to anxiety (OR = 0.38; 95% CI = 0.17–0.84), older age (OR = 3.96; 95% CI = 1.88–8.32), cigarette smoking (OR = 0.35; 95%CI = 0.13–0.94), high Body Mass Index (OR = 2.50; 95% CI = 1.24–5.01), Waist-hip ratio (OR = 0.09; 95% CI = 0.02–0.46) and the Index of comorbidity (OR = 16.93; 95% CI = 3.71–77.29). Conclusions An inverse association was found between anxiety and hypertension, suggesting the need to clinically manage these two dimensions in a coordinated way. Other findings are well known and already included in prevention campaigns. Further research is needed, also to better understand and explain the causative pathways of this correlation

Users' choice and change of allocated primary mental health professional in community-based mental health services: A scoping review

Background. The recovery model in mental health care emphasizes users\u2019 right to be involved in key decisions of their care, including choice of one\u2019s primary mental health professional (PMHP). Aims. The aim of this paper was to provide a scoping review of the literature on the topic of users\u2019 choice, request of change and preferences for the PMHP in community mental health services. Method. A search of Pubmed, Cochrane Library, Web of Science and PsycINFO for papers in English was performed. Additional relevant research articles were identified through authors\u2019 personal bibliography. Results. 2774 articles were screened and 38 papers were finally included. Four main aspects emerged: 1) the importance, for users, to be involved in the choice of their PMHP; 2) the importance, for users, of the continuity of care in the relationship with their PMHP; 3) factors of the user/PMHP dyad influencing users\u2019 preferences; 4) the effect of choice on treatments\u2019 outcomes. Conclusions. While it is generally agreed that it is important to consider users\u2019 preferences in choosing or requesting to change their PMHP, little research on this topic is available. PMHPs\u2019 and other stakeholders\u2019 views should also be explored in order to discuss ethical and practical issues

An update on intimate partner violence and mental health

INTRODUCTIONː Intimate partner violence (IPV) is a problem worldwide and a human rights issue. The present paper summarizes recent literature on the relationship between IPV and mental health, exploring risk factors for psychiatric patients to be victims and/or perpetrators of violent behavior in intimate relationships. EVIDENCE ACQUISITION: A search of PubMed, PsychINFO and Cochrane Library databases was performed, looking for papers concerning IPV and psychiatry published between 2011 and 2016. Papers were retrieved and reviewed according to PRISMA statement guidelines. Only research papers with sample sizes >50 adult subjects were included, leading to a first selection of 1486 records. Titles and abstracts were independently screened by three pairs of researchers, following predefined criteria agreed by the authors, yielding 93 articles for review. EVIDENCE SYNTHESIS: Mental disorders, especially posttraumatic stress disorder (PTSD) and depression, are associated with risk for perpetrating IPV. Confounding factors of this association are substance use/dependence, childhood adversity, previous IPV perpetration. Psychiatric patients are at high risk of becoming victims of IPV, but specific risk factors for victimization in this population have been poorly investigated. Rates of PTSD, depression, anxiety and substance use disorders are higher among IPV victims than in the general population. Interpersonal variables and social factors play a key role both in the onset and in the recovery from mental disorders in the aftermath of IPV. CONCLUSIONS: Individuals suffering from a mental disorder are prone to be both victims and perpetrators of IPV. Further research efforts are needed to elucidate the risk factors for victimization, in order to devise effective risk management strategies

Cardiovascular risk factors, anxiety symptoms and inflammation markers: Evidence of association from a cross-sectional study

Introduction Anxiety disorders and Cardiovascular (CV) diseases, among the most common disorders in Western World, are often comorbid. A chronic systemic inflammatory state might be a shared underlining pathophysiological mechanism. Aims To investigate the association between anxiety symptoms, CV risks factors and inflammatory markers in an outpatient sample. Methods Cross-sectional study. Inclusion criteria: outpatients aged ≥40 years, attending colonoscopy after positive faecal occult blood test, negative medical history for cancer. Collected data: blood pressure, glycaemia, lipid profile, waist circumference, BMI, PCR (C Reactive Protein), LPS (bacterial Lipopolysaccharide). Psychometric tests: HADS, TCI, IMSA, SF36. Statistical analysis performed with STATA13. Results Fifty four patients enrolled (27 males, 27 females). Sixteen patients (30.19%) were positive for anxiety symptoms. Thirty-three patients (61.11%) had hypertension, 14 (25.93%) hyperglycaemia and 64.81% were overweight, with frank obesity (BMI≥ 30) in 11 subjects (20.37%). Anxiety symptoms were associated with low hematic HDL values (OR = 0.01; P = 0.01) and high concentration of triglycerides (OR = 0.023; P = 0.02) at the multiple regression model. At the univariate logistic analysis, anxiety was associated with LPS (OR = 1.06; P = 0.04). Conclusions Further evidence over the epidemiological link between common mental disorders and CV diseases was collected, with possible hints on pathophysiology and causative mechanisms related to inflammation. The importance of screening for anxiety and depression in medical populations is confirmed. Suggestions on future availability of screening tools based on inflammatory-related indicators should be the focus of future research

Prevalence of metabolic syndrome and of symptoms of anxiety and depression in patients undergoing colonoscopy

Introduction Metabolic syndrome (MetS) is defined by metabolic and cardio-vascular impairments and is frequently associated with anxiety and depressive disorders. Both MetS and anxiety-depressive syndromes feature similar systemic inflammatory alterations. Inflammation of the large bowel is also a key factor for the development of colorectal cancer (CRC). Objective To measure the prevalence of MetS and symptoms of anxiety and depression among patients undergoing colonoscopy. Methods Cross-sectional study. Patients undergoing colonoscopy aged 40 or more, with negative history for neoplasia or inflammatory bowel disease, were enrolled. Data collected: colonoscopy outcome, presence/absence of MetS (IDF and ATP III criteria), presence/absence of depressive and anxiety symptoms assessed with HADS. Results The sample was made up of 53 patients (female 24, 45.3%). Mean age was 60.66 ± 9.08. At least one adenoma was found to 23 patients (43.3%). Prevalence of MetS ranged from 34% to 36% (ATP III and IDF criteria, respectively). Prevalence of depressive and anxiety symptoms was 20% and 33%, respectively. Conclusion Prevalence of MetS, anxiety and depressive symptoms among patients undergoing colonoscopy was higher than in the general population

How are personality traits and physical activity involved in colorectal carcinogenesis? A cross-sectional study on patients undergoing colonoscopy

Introduction Inflammatory state of the large bowel is a key factor for the development of colorectal cancer (CRC). It has multifactorial aetiology, including psychological determinants. Physical activity may have a protective function against CRC via anti-inflammatory properties; on the contrary, personality traits correlate with an unhealthy and dangerous lifestyle. Objective To measure the association between personality traits, lifestyle and colonoscopy outcome. Methods Cross sectional study. Patients undergoing colonoscopy aged 40 or more, with a negative history for cancer or inflammatory bowel disease, were enrolled. Data collected: colonoscopy outcome, smoke, alcohol, physical activity, presence/absence of Metabolic Syndrome, personality traits assessed by the Temperament & Character Inventory (TCI). Results In a sample of 53 subjects (females = 24, 45.3%), the mean age was 60.66 ± 9.08. At least one adenoma was found to 23 patients (43.3%). Twenty patients were smokers (37.74%), 36 (67.92%) drank alcohol at least weekly; approximately 60% reported regular physical activity. At the multivariate regression, the outcome was associated to: TCI Self Transcendence domain (ST) (OR = 1.36, P = 0.04) and physical activity (OR = 0.14, P = 0.03). Conclusion People with ST's characteristic personality traits and sedentary life style are more likely to have precancerous colorectal lesions. This confirms the protective role of physical activity, and suggests to further explore the role of personality in cancerogenesis