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

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. (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

Late and early onset dementia: what is the role of vascular factors? A retrospective study.

Neuropathology of Alzheimer's disease (AD) demonstrates that the common occurrence of vascular lesions and vascular factors is suggested to contribute significantly to the clinical progression of the disease. This study has assessed the presence of vascular brain lesions and risk factors in subjects with diagnosis of AD and their influence on the disease course both in Late Onset Dementia (LOD) and in Early Onset Dementia (EOD). METHODS: MRI scans of 374 LOD and of 67 EOD patients were evaluated for the presence of vascular associated lesions and rated according to the age-related white matter changes (ARWMC) scale as "pure degenerative", "mixed" and "vascular" cases of dementia. Vascular risk factors burden (hypertension, diabetes, dyslipidemia, myocardial infarction) and disease progression were also assessed. RESULTS: 44% of LOD cases and 46% of EOD were classified as "mixed dementia cases". The vascular risk factors burden showed an increase from the pure degenerative to the pure vascular forms. Disease progression, calculated in two years using the Mini Mental State Evaluation (MMSE), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores, did not reveal differences among the three different classes of dementias. CONCLUSIONS: Vascular lesions are found in the majority of LOD cases and in about one half of EOD. This observation is consistent with the hypothesis of a synergistic effect of the degenerative and vascular factors on the development of cognitive dysfunction. The linear increase of the vascular burden supports the idea of a continuum spectrum between the pure degenerative and the pure vascular forms of adult-onset dementia disorder

Psychological online assessment/counseling on victims of maritime piracy and their families

Background. Several symptom screening instruments have frequently been administering online, but the majority of psychological assessment procedures have originally been designed and developed for in-person administration. This research aims to detect the level of agreement between telepsychological assessment and face-to-face interview with a group of kidnapped seafarers and their families. Moreover the online counseling was provided for people needed it.\ud Methods. Sixteen subjects (4 victims and 12 family members) were examined at 5 month after the release. Besides face-to-face assessment through the Clinician-Administered Post-Traumatic Stress Disorder (PTSD) Scale (CAPS-DX), further web-based instruments were the Cognitive Behavioural Assessment (CBA 2.0) for the kidnapped victims and the self-report questionnaire State-Trait Anxiety Inventory (STAI-Y), and the Hamilton Depression Rating Scale (HDRS) for family members. Comparing face-to-face and video-conferencing assessment by psychologists, an agreement on any psychological symptom was calculated.\ud Results. For 3 of 4 victims PTSD was diagnosed. The raw agreement of CBA 2.0 symptoms was 80%, furthermore control indices fall within a normal range. All victims showed high scores of state anxiety (56.00 ± 3.36) and social adjustment disorder (12.75 ± 2.21). Moreover, 3 of them revealed trait anxiety (58.75 ± 8.50) and emotional instability (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). The raw agreements for STAI-Y and HDRS symptoms reached 85%. 42% of the family members obtained pathological scores in the STAI-Y questionnaire and 33% showed depression according to the HDRS.\ud The victims participating to online counseling showed a reduction of PTSD symptoms (p<.0001) and some psychopathological problems (p<.0001). While the relatives showed a reduction of state anxiety (p<.0001) and depression (p<.0001).\ud Conclusions. The CBA 2.0 in video-conferencing, as well as the STAI-Y and HDRS, demonstrated high agreement with the face-to-face assessment. Our preliminary evidences about online assessment push toward reliable clinical diagnoses for psychological disorders in e-Health setting. Moreover our results suggested that the online counseling is a necessary psychological intervention for people showing post-traumatic disorders

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

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

The application of Kubler-Ross model in Newly Diagnosed Patients with Relapsing-Remitting Multiple Sclerosis

Background: Anxiety and depressive disorders affect Multiple Sclerosis (MS) patients since the early stages of the disease. Although the presence of these symptoms is widely recognized, the beginning and the psychological mechanisms at the basis of these disorders have rarely been examined in detail. This observational study aims to assess the presence of emotional distress in the early stages of the disease in patients with relapsing-remitting MS (MS-RR) and to check similarities and dissimilarities with a shared conceptual framework: the “curve of change” of the Kubler-Ross model.</p

Validation of an iPad version of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)

Background: The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is the most widely used screening tool for cognitive impairment in Multiple Sclerosis (MS). However, the administration and scoring procedures of the paper version are time consuming and prone to errors. Aim of our study was to develop a tablet version of BICAMS (iBICAMS), and to assess its reliability compared to the paper version. Methods: We administered both BICAMS and iBICAMS to 139 MS patients in two different sessions. We compared scores on both versions using a paired t-test. We used a repeated measures ANOVA to test the impact of rater, order of administration and test-retest time on test-retest performances. We used the Intraclass Correlation Coefficient (ICC) to assess the reliability between BICAMS and iBICAMS. Results: All three sub-tests of the BICAMS (SDMT, CVLT-II and BVMT-R) were different between the paper and the tablet versions. Order of administration influenced test-retest performances at the SDMT (p<0.001), CVLT- II (p<0.001) and BVMT-R (p<0.001). Intraclass coefficient correlation (ICC) revealed a high level of agreement between the paper BICAMS and the iPad version for all three tests: SDMT (0.92), CVLT-II (0.83) and BVMT-R (0.82). Conclusions: We found a high reliability between BICAMS and iBICAMS. Considering the inherent advantages of automated scoring, digital storage of data, standardized timing, the iBICAMS could become a standard in clinical practice

The Safety Profile of COVID-19 Vaccines in Patients Diagnosed with Multiple Sclerosis: A Retrospective Observational Study

In the current COVID-19 pandemic, patients diagnosed with multiple sclerosis (MS) are considered to be one of the highest priority categories, being recognized as extremely vulnerable people. For this reason, mRNA-based COVID-19 vaccines are strongly recommended for these patients. Despite encouraging results on the efficacy and safety profile of mRNA-based COVID-19 vaccines, to date, in frail populations, including patients diagnosed with MS, this information is rather limited. We carried out a retrospective observational study with the aim to evaluate the safety profile of mRNA-based COVID-19 vaccines by retrieving real-life data of MS patients who were treated and vaccinated at the Multiple Sclerosis Center of the Hospital A.O.R.N. A. Cardarelli. Three-hundred and ten medical records of MS patients who received the first dose of the mRNA-based COVID-19 vaccine were retrieved (63% female; mean age: 45.9 years). Of these patients, 288 also received the second dose. All patients received the Pfizer-BioNTech vaccine. Relapsing-Remitting Multiple Sclerosis (RRSM) was the most common form of MS. The Expanded Disability Status Scale (EDSS) values were &lt;3.0 in 70% of patients. The majority of patients received a Disease Modifying Therapy (DMT) during the study period, mainly interferon beta 1-a, dimethyl fumarate, and natalizumab and fingolimod. Overall, 913 AEFIs were identified, of which 539 were after the first dose of the vaccine and 374 after the second dose. The majority of these AEFIs were classified as short-term since they occurred within the first 72 h. The most common identified adverse events were pain at injection site, flu-like symptoms, and headache. Fever was reported more frequently after the second dose than after the first dose. SARS-CoV-2 infection occurred in 3 patients after the first dose. Using historical data of previous years (2017-2020), the relapses' rate during 2021 was found to be lower. Lastly, the results of the multivariable analysis that assessed factors associated with the occurrence of AEFIs revealed a statistical significance for age, sex, and therapy with ocrelizumab (p &lt; 0.05). In conclusion, our results indicated that Pfizer-BioNTech vaccine was safe for MS patients, being associated with AEFIs already detected in the general population. Larger observational studies with longer follow-up and epidemiological studies are strongly needed