Cognitive behavioral treatment to improve psychological adjustment in people recently diagnosed with type 2 diabetes: Psychological treatment in type 2 diabetes

Type 2 diabetes mellitus (T2DM) is a chronic disease that affects a person's general well-being. Current evidence sets an association between psychological well-being and controlled metabolic parameters. People newly diagnosed with T2DM show higher prevalence of depression and anxiety symptoms. Cognitive behavioral therapy (CBT) has effectively improved psychological adjustment, but most studies do not specifically address recently diagnosed people nor usually include long-term follow-up measures.

Objective

We sought to assess changes in psychological variables in people with newly diagnosed diabetes who received a cognitive-behavioral intervention, within a comprehensive care program.

Method

1208 adults with T2DM (≤5 years) who attended a national health institute in Mexico received a cognitive-behavioral intervention aimed at improving quality of life and reducing emotional distress that often interferes with diabetes control, as well as evaluating cognitive and emotional resources and social support. Measures of quality of life, diabetes-related distress, anxiety and depression questionnaires were compared at pre-test, post-test and follow up using Friedman's ANOVAs. Multiple logistic regression models evaluated glycosylated hemoglobin (HbA1c) and triglycerides control at post-test and follow up.

Results

Questionnaire measures and metabolic variables significantly decreased symptomatology at post-test and these changes maintained at follow-up. Significant associations were found between quality-of-life scores and HbA1c and triglycerides levels in post-test and follow-up. Diabetes-related distress scores increased the odds of having adequate HbA1c control at post-test.

Conclusion

This study contributes to the evidence on the importance of considering psychological factors as part of comprehensive diabetes care to improve quality of life and emotional burden and facilitate the achievement of metabolic goals.

Preoperative Psychological Evaluation Outcomes, Reasoning, and Demographic and Diagnostic Correlates

PURPOSE

Little is known about associations between preoperative psychiatric, disordered eating, and substance use diagnoses with the clinical decision to require follow-up after the preoperative psychological evaluation. To determine the proportion of patients who require follow-up (no required follow-up (NFU), required follow-up (RFU), placed on hold (POH)) from the preoperative psychological evaluation, associations with diagnoses, and noted reasons for follow-up.

MATERIALS AND METHODS

The sample included 508 patients (77.6% female; 64.4% White) pursuing bariatric metabolic surgery with completed psychological evaluations between August 2019 and December 2020 at a Midwest medical center. Patient demographics, psychological evaluation outcome and corresponding reasoning, and psychiatric, disordered eating, and substance use diagnoses were extracted from the health record. Descriptive and bivariate analyses determined associations between demographics and diagnoses with psychological evaluation outcomes and corresponding reasoning.

RESULTS

The breakdown of psychological evaluation outcomes was 60.6% (n = 308) NFU, 38.4% (n = 195) RFU, and 1.0% (n = 5) POH. Demographic correlates of RFU included higher BMI, being single, lower educational attainment, unemployment, public/no insurance, and receiving multiple or any psychiatric diagnosis (all p-values < 0.05). Diagnostic correlates of RFU included anxiety, depression, not having a current trauma or stressor-related disorder, disordered eating, and substance use diagnoses (all p-values < 0.001). RFU/POH was primarily due to psychiatric (61%) reasons.

CONCLUSION

Higher rates of RFU were observed for patients with higher economic need and with psychiatric, disordered eating, or substance use diagnoses. Future work should establish preoperative programming to assist patients with addressing ongoing psychiatric concerns prior to bariatric metabolic surgery.

Orthodontic emergencies and mental health of patients undergoing orthodontic treatment during COVID-19 pandemic: A questionnaire study

Objectives

To evaluate the impact of COVID-19 pandemic on orthodontic treatment and mental health of patients undergoing orthodontic treatment and to compare their mental health with the age-matched control group.

Materials and methods

484 orthodontic patients (245 males and 239 females) and 200 age-matched control subjects were divided into two age groups. Group 1 had 14-18 years of adolescents (N = 274) and 100 control participants (Group 2) and Group 3 comprised of 19 years above adults (N = 210) and 100 control participants (Group 4). Group 1 and 3 patients filled the 4 sections of the questionnaire related to orthodontic emergencies (Sections 1-3) and mental distress (Kessler Psychological Distress Scale-Section 4), while groups 2 and 4 were asked to fill only Section-4. The comparison of mental distress on high/low Kessler scores was made using the Chi-Square test/Fisher's exact test. The factors which came out to be significant were put to bivariate logistic regression analysis.

Results

The percentage of patients with high Kessler scores among Group 1 and Group 3 were 9.9% and 17.2% respectively, and their differences with age-matched control groups were non-significant. The mean differences of Kessler score were significantly higher for Group 3 compared to group 1. The higher Kessler score was associated with age, higher education, a feeling of concern for non-availability of appointments, increased treatment duration, its effect on the quality of treatment, and sabotaging of definitive future plans.

Conclusions

The orthodontic treatment and emergencies may not be a significant factor contributing to increased stress among patients during the lockdown.

Associations between psychological evaluation outcomes, psychiatric diagnoses, and outcomes through 12 months after bariatric surgery

BACKGROUND

There is limited evidence about how patients' initial preoperative psychological evaluation outcomes (require follow-up [RFU], no required follow-up [NFU], and place on hold [POH]) and current psychiatric diagnoses associate with postoperative outcomes.

OBJECTIVES

To test the hypotheses that patients who receive a clinical decision of RFU versus NFU from their initial psychological evaluation will be (1) more likely to experience postoperative complications, readmissions, and emergency room visits and (2) experience less weight loss over 12-months. Specific diagnoses (any psychiatric diagnosis, depression, and anxiety) are also examined for their association with weight loss over 12 months.

SETTING

Midwestern medical center, United States.

METHODS

The sample included 322 patients (81.1% female and 64.0% White) with completed psychological evaluations between August 2019 and December 2020. Patient demographics, psychological evaluation outcomes, current diagnoses, and postoperative outcomes were extracted from the health record. Bivariate analyses determined associations between NFU/RFU and postoperative complications (yes, no), readmissions (yes, no), and emergency room visits (yes, no). Mixed multilevel models were conducted with dichotomous variables NFU/RFU, any psychiatric diagnoses (yes, no), depression diagnoses (yes, no), or anxiety diagnoses (yes, no) as the main fixed within-group factors with weight loss (weight or percent total weight loss) used as the repeated measures. Insurance and surgical procedure were included as covariates.

RESULTS

There were no significant differences in postoperative complications, readmissions, and emergency room visits between NFU and RFU groups. Patients who received a RFU versus an NFU had higher weights over 12 months (P = .001).

CONCLUSION

Hypothesis 2 was only partially supported. Patients who received an RFU versus an NFU had higher weights over 12 months, but this association was not found for percent total weight loss or any of the psychiatric within-subjects variables (i.e., psychiatric diagnoses, depression, and anxiety).

Emotional and behavioral problems in pediatric patients with migraine and tension-type headache

OBJECTIVE

This study aimed to investigate the associations between psychopathological characteristics of children and adolescents with primary headache, as measured by the Strengths and Difficulties Questionnaire (SDQ), and treatment outcomes.

METHODS

A cohort study was conducted on 124 pediatric patients with primary headache. At the first consultation, the SDQ was completed by the parents. The analysis of treatment efficacy was conducted on 90 patients with a follow-up period of at least one year. Treatment responders were defined as those who showed 50% reduction in the headache frequency. First, an analysis of the SDQ total scores and five subscales, among the migraine and tension-type headache groups, was conducted for 124 participants. Second, the association between the SDQ scores and treatment outcomes in the groups with periods of improvement of less than three months and three months or more were analyzed in 90 patients.

RESULTS

Migraine patients displayed more difficulties than strengths in terms of the total score (p = .004) and in the emotional symptoms subscale (p = .012) compared with tension-type headache patients. Migraine patients who required more than three months to show improvement displayed more peer problems (p = .020), while tension-type headache patients who required more than three months to show improvement displayed fewer conduct problems (p = .007).

CONCLUSION

Evaluation of patient characteristics using the SDQ at first consultation can predict the treatment outcome. Moreover, it can help provide appropriate initial treatment and improve outcome of primary headache in children.

A safety study of laparoscopic single-anastomosis duodeno-ileal bypass with gastric plication (SADI-GP) in the management of morbid obesity

Background

Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG.

Methods

Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena.

Results

Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) =  − 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) =  − 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) =  − 1.914; p = 0.02; p < 0.05) in MMPI-2 data.

Conclusion

According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00423-021-02276-9.

An approach to MCGDM based on multi-granulation Pythagorean fuzzy rough set over two universes and its application to medical decision problem

Exploring efficiency approaches to solve the problems of decision making under uncertainty is a mainstream direction. This article explores the rough approximation of the uncertainty information with Pythagorean fuzzy information on multi-granularity space over two universes combined with grey relational analysis. Based on grey relational analysis, we present a new approach to calculate the relative degree or the attribute weight with Pythagorean fuzzy set and give a new descriptions for membership degree and non-membership. Then, this paper proposes a multi-granulation rough sets combined with Pythagorean fuzzy set, including optimistic multi-granulation Pythagorean fuzzy rough set, pessimistic multi-granulation Pythagorean fuzzy rough set and variable precision Pythagorean fuzzy rough set. Several basic properties for the established models are investigated in detail. Meanwhile, we present an approach to solving the multiple-criteria group decision making problems with fuzzy information based on the proposed model. Eventually, a case study of psychological evaluation of health care workers in COVID-19 show the principle of the established model and is utilized to verify the availability. The main contributions have three aspects. The first contribution of an approach of calculating the attribute weight is presented based on Grey Relational Analysis and gives a new perspective for the Pythagorean fuzzy set. Then, this paper proposes a mutli-granulation rough set model with Pythagorean fuzzy set over two universes. Finally, we apply the proposed model to solving the psychological evaluation problems.

Reducing the discomfort in viewing 3D video with a prism device modified eye convergence

A prism device is utilized in this study for modifying the eye convergence to reduce eye accommodation and enhance the comfort in viewing 3D video. Without changing the contents of 3D films, it aims to apply the myosis, convergence, and accommodation visual triad of eyeballs viewing near distance to not change the eyeball pupillary distance when viewing 3D films. Without convergence, the discomfort caused by intraocular muscle contraction when viewing near distance is reduced. Such an effect of a small prism lens is also proven in this study. When viewing 3D films with 1.0△ lenses, the physiological accommodation reaction of eyes would reduce (the right eye decreases 65% and the left eye decreases 70%), revealing the decreasing tension of intraocular muscle. The subjective psychological evaluation result also shows that viewing 3D images with small prism lenses could enhance the comfort. The evaluation of optical simulation, physiological reaction, and mental fatigue proves that the small prism lens proposed in this study could actually improve the comfort in viewing 3D films.

Sociodemographic Factors Associated with Loss to Follow-Up After Bariatric Surgery

PURPOSE

Despite the importance of follow-up and multidisciplinary care after bariatric surgery, many patients do not attend postoperative appointments, particularly those with the medical team. The present study aimed to identify factors associated with loss to follow-up after bariatric surgery.

MATERIALS AND METHODS

We recruited patients who underwent bariatric surgery between 01/01/2012 and 31/12/2013. Data were collected on demographic and socioeconomic information and comorbidities. Ten baseline psychological evaluations were blindly reviewed to evaluate the relationship between emotions and compliance with follow-up. During the 3-year postoperative period, we defined frequent attendees as those who attended at least two visits, whereas non-attendees were those who attended one visit or none. We evaluated baseline variables associated with non-adherence with follow-up schedules.

RESULTS

Among 92 patients, 41 patients (44.6%) attended at least two postoperative appointments, while 51 (55.4%) were classified as non-attendees. Among the non-attendees, significantly more were younger than 45 years compared with attendees. No other statistically significant differences were found in terms of socioeconomic variables. Multivariate logistic regression revealed male gender and psychological issued related to obesity to be independent predictors of poor compliance with follow-up. Blinded psychological evaluation of ten patients did not suggest that psychological factors are predictive of follow-up attendance.

CONCLUSION

Identifying factors associated with loss to follow-up after bariatric surgery is challenging. However, this is important in order to enable the design of personalized follow-up plans, especially for younger patients and those with psychological issues.

Addiction Transfer and Other Behavioral Changes Following Bariatric Surgery

Despite its important treatment implications for obesity and related comorbidities, bariatric surgery requires several behavioral changes that warrant comprehensive evaluation and support before and after surgery. This article outlines emerging scientific and anecdotal evidence for addiction transfer after bariatric surgery. Other common behavioral changes that impact adherence, weight loss, and psychiatric risk after surgery are also reviewed. Last, recommendations for presurgical psychological evaluation and postoperative support are provided.

The Role of Religion and Spirituality in Conceptualizing Reproductive Loss: Clinical Implications of the Narratives of Gestational Surrogates in the USA

Reproductive losses experienced by gestational surrogates, who do not share a genetic connection to the child they are carrying, may not be acknowledged or treated as compassionately as women who lose their "own" pregnancies. In-depth, semi-structured interviews were conducted with 17 gestational surrogates from diverse religious backgrounds. Grounded theory analysis of data included line-by-line coding, and emergent themes were identified. The results suggest that understanding and utilizing the religious/spiritual beliefs of a gestational surrogate may be one way for health professionals to provide implications counseling prior to surrogacy and also as a means to help process and grieve losses that may occur within surrogacy.

Sleep disturbance and insomnia in individuals seeking bariatric surgery

BACKGROUND

Sleep disturbance is well established in individuals with obesity, and the relationship between poor sleep and obesity is supported by population, longitudinal, experimental, and intervention studies. However, the prevalence and characteristics of poor sleep in individuals seeking bariatric surgery have thus far been poorly examined.

OBJECTIVES

We sought to characterize self-reported sleep parameters in individuals seeking bariatric surgery and to compare these data with controls.

SETTING

Two Academic Medical Centers, United States, and an online survey of healthy controls.

METHOD

Individuals seeking bariatric surgery (n = 427) completed presurgical psychological evaluations at 2 comprehensive bariatric surgery programs. Data on medical co-morbidities and from self-report questionnaires on sleep quality, insomnia, anxiety, and depression were abstracted from charts. Data from controls (n = 180) were collected using an online survey tool and compared with bariatric cases.

RESULTS

Across study sites, 40.4% of bariatric cases took at least 30 minutes to fall asleep, 46.7% had insufficient total sleep time (<6.5 hr), 65.1% reported general poor sleep quality, and 30.8% reported clinically significant insomnia symptoms. Approximately 20% of the variance in poor sleep quality and insomnia was explained by body mass index, obstructive sleep apnea, anxiety, and depression. Cases and controls were similar, although bariatric cases reported significantly poorer sleep efficiency.

CONCLUSIONS

Our results suggest that similar to a control population, the majority of patients seeking bariatric surgery are experiencing sleep difficulties. Presurgical assessment and treatment of sleep problems may be beneficial to patients and may help improve weight loss treatment outcomes. Optimally, assessment would include 1 of the 2 self-report questionnaires used herein, and treatment would involve Cognitive Behavioral Therapy for Insomnia. Future research assessing sleep patterns with objective measurement tools and evaluating the impact of sleep on postsurgical outcomes is warranted.

Epidemiological assessment of distress during chemotherapy: who is affected?

Objectives

Following the rise in the incidence of cancer, the need for chemotherapy has escalated, as have its side effects. Psychological distress is one of the known side effects of chemotherapy; however, it has not received adequate attention. The purpose of this study was to measure psychological distress in patients receiving chemotherapy, making comparisons on the basis of age, gender, marital status, and chemotherapy dose, and to assess the patients' willingness to continue with treatment.

Methodology

A descriptive cross-sectional study was performed on outpatients receiving chemotherapy beyond the first dose at the Radiation & Isotopes Centre Khartoum (Rick). Data were collected via a face-to-face interview with the patients using the Hospital Anxiety and Depression Scale.

Results

Among patients undergoing chemotherapy, 55 (25.5%) experienced anxiety and depression. Of the 216 patients recruited, the majority were middle-aged (30–50 years old) married women. Development of psychological distress followed a U-shaped curve in relation to the number of chemotherapy doses received. Patients who received 1–5 and >10 doses experienced more psychological distress than those who received 6–10 chemotherapy doses. As many as 212 (98%) patients were willing to continue with chemotherapy.

Conclusion

In our study, psychological distress burdened a quarter of the patients receiving chemotherapy. Psychological distress plays a role in cancer recurrence and recovery; thus, there is a need for a holistic approach to the management of patients with cancer, including psychological evaluation to identify those at risk.

Predictors of Binge Eating among Bariatric Surgery Candidates: Disinhibition as a Mediator of the Relationship Between Depressive Symptoms and Binge Eating

BACKGROUND

Current and lifetime psychopathology is common in adult patients seeking bariatric surgery, with major depressive disorder and binge eating disorder affecting a higher proportion of this group than the general population. While depressive symptoms have been previously associated with eating pathology, potential mediators of this relationship are not well understood.

METHODS

This study used a naturalistic, retrospective design to investigate cognitive and behavioral aspects of eating behavior (cognitive restraint, disinhibition, and hunger) as potential mediators of the relationship between depressive symptoms and binge eating within a sample of 119 adult patients (82.4% female; 96.6% white; mean age = 47 years) seeking bariatric surgery (Roux-en-Y and sleeve gastrectomy) at a large university medical center. Patients completed a standardized presurgical psychological evaluation to determine appropriateness for bariatric surgery as part of routine clinical practice. Binge eating was assessed via clinician rating (number of binge eating episodes per week) based on DSM-IV diagnostic criteria and self-report measures (Binge Eating Scale) in order to account for potential methodological differences. Depressive symptoms were assessed using the Beck Depression Inventory.

RESULTS

Depressive symptoms were a significant predictor of binge eating, disinhibition, and hunger. However, only disinhibition emerged as a significant mediator of the relationship between depressive symptoms and binge eating.

CONCLUSIONS

Behavioral disinhibition, or a tendency toward overconsumption of food and challenges restraining impulses associated with a loss of control eating, may represent an important variable in determining the relation between depressive symptoms and binge eating, in bariatric surgery patients.

Decompressive craniectomy for severe traumatic brain injury in children: analysis of long-term neuropsychological impairment and review of the literature

OBJECTIVE

The effectiveness of decompressive craniectomy (DC) in the context of neurocritical care in adult patients has been recently under debate. The aim of our study was to evaluate the impact of decompressive craniectomy in severe traumatic brain injury (TBI) in children, focusing on short and long-term neurological and neuropsychological outcomes.

METHODS

Retrospective review of the medical records of children admitted at a level I trauma center, between January 2012 and December 2015, submitted to DC due to severe TBI. Additionally, an extensive review of literature on this subject was carried out.

RESULTS

Sixteen patients underwent DC for TBI at our institution during the evaluated period. 62.5% were males and the mean age was 12 years. Road traffic accident (RTA) was the main mechanism of trauma (62.5%). Average Glasgow Coma Scale (GCS) at admission was 5.2, whereas 75% of the patients presented with pathological pupillary reaction. Initial computed tomography (CT) showed skull fractures in 62.5% and acute subdural hemorrhage (ASH) in 56.3% of the patients. The mean intracranial pressure (ICP) was 27.2 mmHg prior to surgery, and the mean time window between admission and DC was 36.3 h. Unilateral DC was performed in 68.8% of the cases. The average Glasgow Outcome Scale (GOS) at 6-month follow-up was 3.7, whereas 70% of the survivors presented good recovery (GOS 4-5). Abnormal pupillary reaction at hospital admission increased 3-fold the risk of long-term neuropsychological disturbances. Follow-up evaluation revealed cognitive abnormality in 55.6% of the patients. The overall mortality at 6-month follow-up was 37.5%.

CONCLUSION

The present study indicates towards a potential benefit of DC in children with severe TBI; nevertheless, our data demonstrated a high incidence of neuropsychological impairment in the long-term follow-up. Psychological and cognitive assessment should be computed in prognosis evaluation in future prospective studies.

Revising the bariatric psychological evaluation to improve clinical and research utility

Although psychological evaluations are a routine component of the bariatric surgery process, the goals commonly identified for bariatric psychological evaluations have not been realized. This brief report describes a revised bariatric psychological evaluation designed to repurpose the evaluation towards more achievable and equally valuable goals. Changes include revisions to the evaluation contents and administration methods. The revised evaluation: (1) includes pre- and post-bariatric psychological assessments to capture important surgery-related changes in psychosocial status, physical functioning, and quality of life; (2) incorporates measures of functional capacity, treatment adherence, and patient-centered goals; (3) improves clinical utility by using the post-surgery assessment data to identify patients who may benefit from psychosocial interventions; (4) expands opportunities for bariatric psychology research.

Special Phenomena in Rorschach Protocols in Patients Diagnosed with Schizophrenia

The Rorschach method has been proved as an effective tool for personality dynamics assessment, as well as for identify psychopathological patterns, especially with regard to the dissociation of consciousness, which makes it relevant in the context of schizophrenia. The aim of this study was to contribute to the evaluation of the so-called special phenomena in Rorschach protocols in patients diagnosed with schizophrenia. The sample consisted of ten patients previously diagnosed with ICD-10 F20 who were hospitalised in the Federal District, Brazil, in the Centre for Living and Psychosocial Care (Life Mansion). The participants were chosen in the free choice form by the lead researcher. All were under regular psychiatric care and used medication continuously to treat the illness. Data were analysed according to the interpretative principles of Bruno Klopfer's theoretical and clinical approach. It was found eight fixed special phenomena in the schizophrenic patients' responses to Rorschach tests. All patients responses showed the following special phenomena: confabulation; contamination; named colour; self-referential ideation; referential ideation; looking at the back of the card; perseveration and position response. Normal patients did not present high frequency and intensity of special phenomena in their respective protocols. Taken together, this clinical study supports the conclusion that the Rorschach technique is an important tool for the evaluation of schizophrenic patients.

Self-perception of quality of life in patients with functional voice disorders: the effects of psychological and vocal acoustic variables

PURPOSE

Functional voice disorders (FVD) are multifactorial and may have a significant impact on the patients' quality of life (QOL). The aim of this study was to explore and analyze the relationship between the VHI scores, psychological variables, and objective voice measurements, and to develop a psychological and/or vocal acoustic model for the overall self-perceived evaluation of quality of life for three different types of FVD.

METHODS

After ENT examination, 83 women were classified into three groups: psychogenic voice disorder (PVD = 39), primary muscle tension voice disorder (MTVD1 = 16), and secondary muscle tension voice disorder (MTVD2 = 28). All patients were evaluated according to a multidisciplinary assessment protocol, which included the self-evaluation of quality of life (Voice Handicap Index, VHI), psychological evaluation (Hamilton Rating Scales for Depression (HAM-D) and for Anxiety (HARS), and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto questionnaire (TEMPS-A)), and vocal acoustic analysis [mean fundamental frequency (F0, Hz), jitter (local, %), shimmer (local, %), and harmonic-to-noise ratio (HNR, dB)].

RESULTS

Our findings revealed a moderate impact on QOL, regardless of the type of FVD. There were significant correlations between VHI scores, psychological variables, and voice perturbation parameters, with the exception of the MTVD1 and MTVD2 groups. The stepwise multiple linear regression analysis suggested that QOL could be explained by: anxious temperament together with shimmer in PVD group, jitter in the MTVD1 group, and depressive temperament in the MTVD2 group.

CONCLUSIONS

Affective temperaments and/or voice perturbation parameters were meaningful predictors of self-evaluation of quality of life in patients with different types of FVD.

Predictors of psychological recommendations in child protection evaluation

Child protection matters from an important social and legal challenge, in which psychologists may be called upon to address a series of questions relevant for judicial decision-making. In an explorative manner, the current study investigates variables that influence psychological evaluators' recommendations in child protection cases. The data is based on a quantitative content review of 103 psychological evaluation reports, conducted at an institute of forensic psychology in Germany. Using bivariate and logistic regression analyses, the following predictors were analyzed in this study: Child-related factors, familial risk factors, and general custody criteria. The outcome measure was the evaluator's recommendation regarding long-term placement of the child and long-term custody arrangements. Evaluators were more likely to recommend permanent foster placement if the child showed insecure or disorganized attachment patterns, especially when combined with developmental delays, or if the child was temporarily in institutional or foster placement at the time of evaluation. The results support the conclusion that the most important factors for psychological expert recommendations refer to the "harm of the child" criterion in terms of developmental and psychological maladaptation.

The credibility of testimony from minors allegedly victims of abuse within the Italian legislative framework

The authors aim to analyze the key aspects related to the testimony of children who might have been victims of sexual harassment and abuse. The issue of medico-legal psychiatric assessment of minors who claim to have been sexually abused is extremely contentious and widely-debated, not only due to the growing spread of such claims, but also on account of the technical challenges it raises. For these reasons, national as well as European lawmakers have intervened by enacting new legislation, and scientific communities have established new sets of guidelines aimed at improving the overall conditions under which a child is called to testify as well as the process through which depositions are collected and evaluated, so as to ensure that any assessment of the reliability of the testimony is scientifically grounded. The authors also highlight the importance of regulatory measures meant to minimize the risk that the questioning of a child might negatively affect his or her emotional balance by limiting and lessening stressful conditions and anxiety, which may traumatize and irretrievably scar the child. Moreover, they stress the importance of dealing with the social issue of child abuse by strengthening a preventive set of measures.

Methodological Issues for Psychological Evaluation across the Lifespan of Individuals with a Difference/Disorder of Sex Development

The aim of the current report is to provide guidance relevant to psychological evaluation for healthcare providers and researchers working in the field of disorders of sexual development (DSD). In doing so, we give careful consideration to methodological issues and limitations that may influence the utility of investigations. For example, rarity and heterogeneity of DSD conditions restrict sample sizes when conducting evaluations aimed at establishing condition-specific psychological outcomes. At the same time, the potential for stigmatization by virtue of conducting psychological evaluations is particularly high given the fundamental contribution of sex and gender to one's sense of self and integrity. This article will provide basic theory for psychological evaluation as well as give a review of specific measures that can be employed for clinical purposes depending on a variety of parameters, including life stage of the patient and goal(s) of the evaluation. Care providers and service users may benefit from guidance in coping with the difficulties inherent in having and/or treating DSD. The potential for identification with the patient with DSD is higher than in other domains of medicine because sexual and gender identities are fundamental to all humans and are continually evolving from a sociological perspective.

Key psychosocial challenges in vascularized composite allotransplantation

Psychosocial factors are important elements in the assessment and follow-up care for vascularized composite allotransplantation (VCA) and require multidisciplinary evaluation protocols. This review will highlight differences between VCA with solid organ transplantation (SOT), provide information on the psychosocial selection of VCA candidates, ethical issues, psychological outcomes, and on the need for multicenter research. VCA is primarily a life-enhancing procedure to improve recipients' quality of life and psychological well-being and it represents a potential option to provide reproduction in case of penile or uterine transplantation. The risk benefit ratio is distinctly different than SOT with candidates desiring life enhancing outcomes including improved body image, return to occupations, restored touch, and for uterine transplant, pregnancy. The Chauvet Workgroup has been convened with membership from a number of transplant centers to address these issues and to call for multicenter research. A multicenter research network would share similar evaluation approaches so that meaningful research on psychosocial variables could inform the transplant community and patients about factors that increase risk of non-adherence and other adverse psychosocial and medical outcomes.

Cognitive effort and pupil dilation in controlled and automatic processes

The Five Digits Test (FDT) is a Stroop paradigm test that aims to evaluate executive functions. It is composed of four parts, two of which are related to automatic and two of which are related to controlled processes. It is known that pupillary diameter increases as the task's cognitive demand increases. In the present study, we evaluated whether the pupillary diameter could distinguish cognitive effort between automated and controlled cognitive processing during the FDT as the task progressed. As a control task, we used a simple reading paradigm with a similar visual aspect as the FDT. We then divided each of the four parts into two blocks in order to evaluate the differences between the first and second half of the task. Results indicated that, compared to a control task, the FDT required higher cognitive effort for each consecutive part. Moreover, the first half of every part of the FDT induced dilation more than the second. The differences in pupil dilation during the first half of the four FDT parts were statistically significant between the parts 2 and 4 (p=0.023), and between the parts 3 and 4 (p=0.006). These results provide further evidence that cognitive effort and pupil diameter can distinguish controlled from automatic processes.

The Psychological Evaluation of Patients with Chronic Pain: a Review of BHI 2 Clinical and Forensic Interpretive Considerations

Pain is the most common reason why patients see a physician. Within the USA, it has been estimated that at least 116 million US adults suffer from chronic pain, with an estimated annual national economic cost of $560-635 billion. While pain is in part a sensory process, like sight, touch, or smell, pain is also in part an emotional experience, like depression, anxiety, or anger. Thus, chronic pain is arguably the quintessential biopsychosocial condition. Due to the overwhelming evidence of the biopsychosocial nature of pain and the value of psychological assessments, the majority of chronic pain guidelines recommend a psychological evaluation as an integral part of the diagnostic workup. One biopsychosocial inventory designed for the assessment of patients with chronic pain is the Battery for Health Improvement 2 (BHI 2). The BHI 2 is a standardized psychometric measure, with three validity measures, 16 clinical scales, and a multidimensional assessment of pain. This article will review how the BHI 2 was developed, BHI 2 concepts, validation research, and an overview of the description and interpretation of its scales. Like all measures, the BHI 2 has strengths and weaknesses of which the forensic psychologist should be aware, and particular purposes for which it is best suited. Guided by that knowledge, the BHI 2 can play a useful role in the forensic psychologist's toolbox.

Percutaneous spinal cord stimulation for chronic pain: indications and patient selection

Percutaneous spinal cord stimulation has a clinical benefit in selected patients with chronic neuropathic pain related to failed back surgery syndrome and complex regional pain syndrome. Patients with other peripheral neuropathic pain syndromes may also respond favorably. The cause of the chronic pain must be established to rule out remediable causes. Drug abuse or aberrant drug-related behaviors should be assessed before proceeding. A psychological evaluation identifies patients who may not benefit. Risk factors for infection should be corrected where possible. This safe, reversible treatment should be considered early for patients with intractable peripheral neuropathic pain.