Psychiatry International

Miscarriage or perinatal loss constitutes one of the most important emotional stressors a woman can experience and can be associated with bereavement. This mourning is a way of adapting and coping with the circumstances. However, inadequate management of this process can lead to the development of complicated grief and psychopathologies such as anxiety, depression, and post-traumatic stress disorder. The aim of this systematic review was to evaluate the prevalence of psychopathology (anxiety, depression, and post-traumatic stress disorder) in women with a history of miscarriage or perinatal loss in the year prior, and to compare these results with women without this history. A peer review was conducted in PubMed, Cochrane, Scopus, and Web of Science databases. We included (1) articles that included women of any age who had had a miscarriage or perinatal loss in the year prior, and (2) articles with a longitudinal cohort design with a comparison group of women without a history of miscarriage or perinatal loss. After the screening process, three articles met these inclusion criteria and were included in this study. Psychopathology in women after miscarriage or perinatal loss was higher than in the control groups. In addition, it was observed that these psychopathologies gradually decreased over the first year from the loss. In conclusion, abortion and perinatal loss pose a risk factor for the development of psychopathology. Therefore, we emphasize the importance of implementing a mental health plan for these women. Full article

This study aims to analyze the main and most recent forms of gambling and related psychopathological disorders, also proposing psychological clinical recommendations. From November 2022 to February 2023, we searched the databases of PubMed, Web of Science, Health & Medical Collection, Elsevier Journal, and Springer for relevant studies performing different searches through different search strings. New forms of gambling are mostly related to new technological tools, such as the Internet, smartphones, social media, or electronic machines. The prevalence of online gambling affects all demographic groups, although 35–44-year-olds appear to have the largest share. Online gambling can lead to addiction, financial hardship, and mental health problems. It has also been statistically significantly associated with high levels of Gambling disorder, high levels of depression and anxiety, poor overall mental health, and alcohol use. Furthermore, it has been noted that online gamblers are more likely to engage in high-risk gambling behaviors and have a higher prevalence of comorbid mental disorders. The review highlights the need for continued research on the impact of new forms of gambling and the development of effective prevention and treatment strategies. Further research is needed to better understand the complex relationship between new forms of gambling and the development of gambling disorders. Full article

The study of wording and its impact on medical practice is key for the training of future physicians. Negative, imprecise, and disrespectful terms are still widespread in the medical field and contribute to the stigmatization of people in treatment, which ultimately limits their access to care. In this study, we explore the feasibility and acceptability of a method to investigate medical students’ perceptions of wording and stigma. This method involves a questionnaire that medical students complete after having read a clinical vignette. One of the two versions of the vignette is made available, which only varies in the way the patient is referred to (“substance abuser” vs. “having a substance use disorder”). Medical students from the University of Lausanne between their first and sixth year were contacted via the university’s mailing lists. They were randomly exposed to one of the two versions of the vignette and responded to the questionnaire online. This exploratory study shows that it is feasible and acceptable to assess the influence and perceptions of stigmatizing terminology among students through a vignette-based questionnaire comparing two wording options. In line with the initial study, we find trends in favor of the non-stigmatizing terminology; however, beliefs are widely held about the need for judicial “punishment” to address consumption behavior. No statistically significant differences are found between the two groups. The study of wording and its impact on access to care is a crucial issue which seems necessary to integrate into pre-graduate training. It permits the deconstruction of prejudices related to medical knowledge and offers perspectives for intervention and research to improve the right to health, which includes the fundamental right to access to care. Full article

This quasi-experimental study aimed to investigate how rational emotive behavior therapy (REBT) works in Indonesian outpatient settings, especially in the context of the COVID-19 pandemic. This study evaluated depression, anxiety, and sleep among 60 Atma Jaya Hospital patients (public and private) using several assessment tools (PHQ-9, GAD-7, and PSQI). The majority of participants were under 40 (53.3%), female (58.3%), married (56.6%), and working formally (65%), with either high school or diploma/bachelor’s level education (86.6%). After six REBT therapy sessions, significant improvements were evident in anxiety, depression, and sleep quality scores (p < 0.001). Participants showed improvements in anxiety and depression during the third and sixth sessions; and in sleep quality during the sixth session. These findings suggest that REBT-based interventions are effective in public and private outpatient settings, highlighting the importance of psychotherapy and cross-division collaboration in the Indonesian healthcare system. Full article

Intolerance of Uncertainty (IU) is described as the tendency to avoid uncertain states and exhibit negative responses to uncertain situations on cognitive, emotional, and behavioral levels. It is considered a transdiagnostic cognitive bias that plays a role in developing and maintaining psychopathology. The Intolerance of Uncertainty Scale-12 (IUS-12) has proven to be a sound measure of intolerance of uncertainty with excellent validity and reliability. Although research has supported a two-factor structure of IUS-12, most recent studies also suggest a bifactor model. The present study examines the factorial structure, validity, and reliability of the Greek version of IUS-12 with a sample of 959 university students (66.6% female) aged 19.63 years (SD = 3.20). Confirmatory Factor Analysis showed that although the two-factor solution adequately fit the data, the bifactor model better fit with IU total as an underlying one-factor. Internal consistency and validity were excellent for the total IUS-12 and Prospective and Inhibitory Anxiety subscales. Our findings support recent findings concerning the factorial structure of IUS-12 and the scale’s psychometric qualities in a Greek undergraduate sample. We expect that future research with clinical samples will confirm the screening and clinical utility of IUS-12. Full article

Lying is seemingly common in daily life, but it is scarcely researched despite its possible relevance to understanding a range of pathological behaviors and associated deception. Our aim was to investigate whether the acceptability of lying might indicate other personality constructs by analyzing a variety of questionnaire responses collected from a cross-sectional sample (n = 138). Total scores for lying acceptability were moderately associated with Machiavellianism and with functional impairment due to lying at work, in social settings, and at home. Scores for these tests were not closely associated with problematic usage of the internet, self-esteem, or religious activity/religiosity. Three distinct groupings produced by a multidimensional scale informed us of how lying might be better understood as an explanatory mechanism for compulsive behaviors. We also noted possible avenues for future research into the acceptability of lying and deception. Full article

When investigating the feelings of caregivers to patients with T1DM, parental stress, anxiety, and depression are found to be most prevalent, especially in the diagnostic phase and in the first months after diagnosis. In this pilot study, we research various significant elements regarding the well-being of mothers with children between 10 and 15 years of age with a chronic condition. The study focuses on a period of at least three years after the child’s diagnosis. The aims of the study are to describe our sample’s levels of satisfaction (SWLS) and subjective happiness (SHS) and to evaluate possible associations. A sample of 40 mothers was offered a series of assessment tools about psychological skills that could play a role in improving mothers’ well-being: the use of specific coping mechanisms (CISS), the methods of narrating the experience of life with a son/daughter with diabetes, the sense of coherence (SOCS 29), health parameters vs. child’s disease (HbA1c, CBCL), and socio-demographic, such as education and work. The most significant associations with respect to subjective happiness are with the sense of coherence, as a unitary value and as distinct factors, and with task-oriented coping. Sense of coherence is also associated with satisfaction. Full article

Background: The association between personality and life outcome has been widely studied in Western countries, and one might question whether the association exists in China. The official documentation from the Twenty-Six Histories of Imperial China, which presents life-long data on the social elite, may offer a convenient way to realize this effort. Meanwhile, a possible association might help identify competent personalities and offer treatment hints for personality disorders or other psychiatric deviations worldwide. Methods: Based on these historical records (about 618–1911 AD) on 18 social elite groups with long longevity (Macrobian group) and 30 with normal lifespans (Control group), we assessed personality traits/facets using the revised NEO Personality Inventory (NEO-PI-R) and destiny using the Destiny Evaluation Questionnaire (DEQ). Results: Compared to the Controls, the Macrobian group scored higher on the DEQ’s Health and Destiny in General and lower on the NEO-PI-R traits Openness to Experience and Extraversion and facets such as Openness to Fantasy, Openness to Aesthetics, Openness to Feelings, Excitement-Seeking, and Self-Consciousness. In the Macrobian group, the Trust and Compliance facets predicted the DEQ’s Family and Marriage and Social Relationships aspects, respectively; Conscientiousness and its facets Dutifulness, Self-Discipline, and Competence predicted Family and Marriage, Career Achievement, and Destiny in General, respectively; and the Self-Consciousness facet predicted worse performance in Career Achievement, Family and Marriage, and Social Relationships and the Depression facet of Destiny in General. In the Control group, Openness to Feelings positively and Anxiety negatively predicted Health. Conclusions: Less self-focused attention and more interdependence between individuals were beneficial to several aspects of individual destiny in Imperial China, which might be profound for the individual career development and clinical treatment of personality disorders in contemporary society. Full article

The Alice in Wonderland Syndrome (AIWS) is an unusual and uncommon condition that falls under the umbrella of neurology and psychiatry. It is characterized by the presence of complex perceptual and visual discord. Additionally, there are visual hallucinations that are multi-dimensional. This syndrome was first described by John Todd in the 1950s, and it was loosely based on the book Alice in Wonderland. A man in his 30s arrived at his doctor’s appointment with a chief complaint of a pounding cluster headache that lasted over a full day. In addition, he mentioned that there was an aura preceding his headaches. The pain was so intense, it was debilitating him from routine activities. Before the headaches, he explained that he would sense bizarre physical and visual behaviors. During these episodes, he explained that things around him appeared distorted and of various sizes. Things in his room appeared to be more distant than they really were and larger in size (macropsia and micropsia). He described the fingers on his right hand to be much smaller compared to his left hand (micropsia). Objects around him were deformed and distorted (metamorphopsia). His symptoms lasted 45 minutes. He did not suffer from any previous headaches or hallucinations. He was a healthy man with a clean bill of health as per his medical records. Upon examination, the attending physician described the patient as alert, oriented to time and place, and under no obvious distress. All labs performed returned normal including a 10-panel drug test. These were tested to see if he was under the influence of any narcotic, stimulant, or other substances. The physician prescribed 500 mg of valproic acid to take daily. Three months later during his follow-up, he mentioned his symptoms had subsided but were still present. His dose was again increased to 1000 mg/day, eventually stopping all further symptoms from surfacing. He has not had another episode in three months. The Alice in Wonderland Syndrome is known to be associated with headaches with preceding auras. It is common in the pediatric and adult populations. In this paper, I introduce a case of a patient who displays migraines with preceding auras, indicative of AIWS. Full article

Catatonic syndrome is frequently observed over the course of severe mental disorders and general medical conditions, but when catatonia occurs in psychiatric patients with co-morbid medical or neurologic conditions, diagnosis and management may be challenging. Several medical conditions may cause catatonia in psychiatric patients, but some, such as brain injury, infections, hyponatremia and critical illness, may be most relevant in this population. Alongside appropriate etiologic treatment, benzodiazepines and electroconvulsive therapy in refractory cases are effective and safe, and may resolve catatonic syndrome rapidly. When newly-onset psychotic symptoms in catatonic patients with established psychotic disorders occur, delirium should be suspected and appropriately managed. An extensive clinical and laboratory diagnostic workup to determine the underlying etiology of catatonic syndrome should be carried out. In cases of acute multi-morbidity, the exact cause of catatonic syndrome in psychiatric patients may be unclear. It is recommended to avoid antipsychotic drugs in acutely catatonic patients, because they may exacerbate the catatonic symptoms. The akinetic type of catatonia should be differentiated from hypoactive delirium, as treatments for these syndromes differ substantially. When a psychiatric patient presents with symptomatology of both catatonia and delirium, treatment is particularly challenging. Full article

In recent years, “difficult” patients have gained attention, and behavior contracts have been introduced into clinical practice. This is because some patients behave inappropriately toward healthcare providers, and behavior contracts require patients to refrain from such behavior. However, it has been highlighted that behavior contracts have ethical problems. We present an ethical analysis of behavior contracts from the viewpoint of psychiatric practice and patient psychology. We analyze why patients become “difficult” for medical practitioners and explain why consideration must be given to the psychological aspects of the patient and the burden of mental illness. Behavior contracts are inappropriate because they do not consider individual patients’ psychological or psychiatric conditions and are applied uniformly. Moreover, the behavioral model that behavior contracts assume is not justified by today’s psychiatry. Furthermore, in this article, we show how behavior contracts promote the stigmatization of mental illness. For these reasons, we argue that the use of behavior contracts in clinical practice is not ethically justified. However, we add that physical violence against healthcare providers should not be tolerated under any circumstances. Full article

Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, an environment that has been complicated by the COVID-19 pandemic. Firefighters, paramedics, and public safety communicators were among the front-line workers that continued to serve the public throughout the course of the pandemic. The present study considered the potential impacts of the COVID-19 pandemic on self-reported symptoms of mental health challenges in Canadian firefighters, paramedics, and public safety communicators. Participants were firefighters (n = 123), paramedics (n = 246), and public safety communicators (n = 48), who completed an online survey, including demographics, questions related to COVID-19 exposure and worry, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Social Interaction Phobia Scale, and the Posttraumatic Stress Disorder Checklist-5. Results revealed that risk factors for increased mental health symptom reporting were paramedic occupation, self-identified female, younger in age, COVID-19 personal contact, requirement to self-isolate, and self-perception of COVID-19 contraction (without confirmation through testing). The COVID-19 pandemic should be considered a risk factor for increased mental health symptom reporting in PSP. Full article

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition impacting children and adults. Current treatments are limited and there is increasing interest in the use of mindfulness, which is growing in popularity. Previous systematic reviews have typically focused on specific ages, outcome measures or interventions. The current review aimed to take a more comprehensive approach. Title and abstract searches were performed in five databases for randomized and non-randomized controlled trials or pre-post studies with participants with an ADHD diagnosis or a score above a clinically relevant cut-off on a validated ADHD measure. Studies had to measure symptoms of ADHD, global or social functioning. Extraction of key information including participant status (i.e., diagnosis, scale scores, comorbidities, medication use), study design, and outcome measures was conducted. Effect sizes (Hedge’s g) were calculated and where a measure had been used in at least three studies with the same population, meta-analyses were considered. Twenty-nine studies were initially identified, with seven deemed poor quality and removed from further analysis leaving, 22 studies containing data from 1237 children and adults with ADHD along with data from 525 family members. The data indicate possible benefits of mindfulness on self-compassion, quality of life, wellbeing, depression, and anxiety. The findings also suggest that mindfulness may also improve ADHD symptoms, executive function, problematic behaviours, and emotional dysregulation, although results vary by age of patient and measures used. Parent stress and parenting style have received limited attention, highlighting the need for more studies in these areas. Whilst the data presented suggest that mindfulness may be beneficial, the evidence base is not as strong as the popularity of the approach. Many of the studies lacked blind assessment, adequate randomization, or suitable control conditions. As such high-quality controlled studies considering medication, other psychosocial interventions, use of active and in active controls and comorbidity as well as longer follow-up periods, are needed to confirm this. Full article

Is war evitable? Besides being a question to which humanity is struggling to answer, it is the title of the letter exchange between Freud and Einstein that inspired this editorial. The aim is to address this question and analyse whether there is a pattern behind some historical events and mass behaviour, starting with Freud and ending with the possibility of applying chaos theory. What has been hypothesized for centuries is that the masses behave in a manner that can overcome the individual’s interest but are subject to the same risks and patterns as the individual is, i.e., hypernarcissism that fuels the vicious circle of victims and executioners. Is there a reason why historical memory does not stop humankind from pursuing war? Is there an intrinsic death drive that fuels man against one another, or are there other, more complex reasons why war could be (or could not be) inevitable? Full article

Workplaces can be associated with occupational stress, detrimental consequences in terms of loss of health and reduced psychosocial well-being. Importantly, employees may be particularly at risk of poorer well-being during times of adversity at work, when not able to apply adaptive coping strategies and adopt a more empathetic approach. This study aimed to develop a scale to estimate occupational stress both in terms of situational and individual components, by performing item selection, internal reliability assessment, and investigation of the ceiling/floor effect. The target population consisted of veterinarians (n = 116), based on evidence of high risk of occupational stress and related mental distress. Out of twenty initial candidate entries, exploratory factor analysis retained fifteen items consisting of three domains related to occupational stress, copying strategies, and empathy (SCOPE). The SCOPE scale demonstrated good internal consistency as a whole (Cronbach’s alpha = 0.79) and when considering the three subscales (stress, 0.85; coping, 0.77; and empathy, 0.71). On a possible range from 15 (worst adjustment) to 75 (best adjustment), the sample mean performance was 51.68 (SD, 8.50). Preliminary evidence indicated that the SCOPE questionnaire may reveal differential effects of type of work on levels of occupational stress and related coping and empathy skills. Full article

Anxiety sensitivity social concerns (ASSC), or the fear of observable anxiety symptoms, is a risk factor for social anxiety. ASSC predicts anxiety following the niacin biological challenge, a paradigm in which niacin is used to manipulate facial flushing during a speech task. However, it remains unclear if ASSC predicts physiological arousal during this task. The current study was designed to examine the effects of ASSC on self-reported distress and electrodermal activity (EDA) during the niacin biological challenge in a sample of undergraduates (N = 36; M age = 18.9, SD = 0.84; 69.4% female). Participants were randomly assigned to one of four conditions in a 2 (100 mg niacin vs. 100 mg sugar) × 2 (instructional set) design. Participants completed a speech task in a virtual reality environment. Participants rated their distress halfway through the speech and EDA was averaged over four intervals. There was a main effect for ASSC on subjective distress. There was a significant ASSC by condition interaction predicting EDA, in that ASSC was related to EDA only in the niacin condition. ASSC also was more strongly related to EDA anticipating the speech. These findings highlight the role of ASSC in predicting anxiety and physiological arousal. Full article