Giovanni Mansueto

Introduction: This cross-sectional case-control study explored the relationship between childhood adversities, recent events, the HPA axis, and panic disorder. Methods: A total of 113 patients with panic disorder and 113 controls were enrolled. Life events were evaluated using a semistructured interview and self-report. HPA functioning was evaluated using cortisol samples. The χ ² , t , Mann-Whitney, odds ratio, regression, and ANCOVA tests were run. Results: Patients had higher rates of life events and higher cortisol levels than controls. There was a cumulative effect between childhood adversities and recent events on panic disorder. The occurrence of more than 1 life event was associated with more severe panic symptoms. Patients with childhood adversities had higher morning cortisol levels than those without and controls. Conclusions: The risk of panic disorder in subjects who underwent childhood adversities may be amplified by exposure to recent events and vice versa. Cortisol dysregulation may be involved in the association between childhood adversities and panic disorder.

Substance use disorders (SUDs) are among the leading causes of morbidity and mortality globally. Identification of aetiological factors related to the severity of substance use can offer targets for therapeutic interventions. Role of impulsivity and emotion dysregulation in SUDs is well established. Based on the evidence that the adverse effects of impulsivity on behavioural and mental health outcomes can be mediated by emotion dysregulation, this study explored the possible mediating role of emotion dysregulation in the association between impulsivity and the severity of substance dependence. One hundred treatment‐seeking substance users (monosubstance users and polysubstance users) were enrolled. Impulsivity, emotion dysregulation and severity of substance dependence were assessed using the Barratt Impulsiveness Scale‐11, the Difficulties Emotion Regulation Scale and the Severity Dependence Scale, respectively. Correlation, mediation and 95% bias‐corrected and accelerated (BCa CI) bootstrapped analyses were run. Emotion dysregulation was found to mediate the association between attention impulsivity (indirect effect [BCa CI]: 0.22 [0.11–0.36]), motor impulsivity (indirect effect [BCa CI]: 0.15 [0.08–0.24]), non‐planning impulsivity (indirect effect [BCa CI]: 0.11 [0.04–0.18]) and severity of substance dependence. The direct effect of different facets of impulsivity on dependence severity was not significant after accounting for emotion dysregulation. Impulsivity was found to have a significant indirect effect on the severity of substance use through emotion dysregulation. Among substance users, emotion dysregulation may be involved in the association between impulsivity and severity of substance dependence. Emotion dysregulation could be considered a possible therapeutic target to reduce the severity of substance dependence among substance users with impulsive tendencies.

Delirium in elderly inpatients needs to be prevented being associated with worse clinical outcome and higher cost burden. Effects of a structured intervention aimed at cognitive stimulation and reorientation to prevent delirium occurrence were tested. A nonrandomized stepped-wedge study was conducted. Patients were consecutively enrolled from 07/05/2024 to 03/10/2024 at an Internal Medicine Unit. Eligibility was verified based on inclusion criteria: age ≥ 65 years; hospitalization at the Unit; and exclusion criteria: personal history of dementia or cognitive impairment; delirium at admission. Demographic and clinical data were collected at enrollment. Delirium was assessed daily via the 4AT. Inpatients received a protocol-driven intervention aimed at cognitive stimulation and reorientation (cases) or usual care (controls). The intervention was administered daily from day 1 of hospitalization to discharge. A total of 222 subjects were evaluated (104 received the intervention, 118 had usual care). Males and females were equally distributed (54 males under the intervention, 62 males under usual care). Mean age was 81·54 ± 8·28 yrs among those who received the intervention and 81·24 ± 8·84 yrs among those under usual care. The two groups differed for delirium incidence: 7·69% (n = 8) among those who received the intervention and 22·03% (n = 26) among those who received usual care. The findings of the pilot study should be interpreted as preliminary feasibility results rather than evidence of efficacy. They need replication in larger samples, being promising in terms of implementation of the intervention in real life of Internal Medicine Units.

This study aimed to evaluate the factor structure, internal consistency and concurrent validity of the Italian version of the Metacognitions about Smoking Questionnaire (MSQ), utilizing the framework of the Self‐Regulation Executive Function model. A total of 532 smokers completed the Italian‐translated version of the MSQ, the Fagerstrom Test for Nicotine Dependence, the Severity Dependence Scale, the Depression Anxiety and Stress Scale‐21. To test the factorial structure of the MSQ, a series of confirmatory factor analyses (CFAs) were run; correlational analyses and structural equation modelling (SEMs) approaches were undertaken to evaluate the concurrent validity. The 12‐item MSQ with four factors was confirmed: positive metacognitions about cognitive regulation (PM‐CR), positive metacognitions about emotional regulation (PM‐ER), negative metacognitions about uncontrollability (NM‐U) and negative metacognitions about cognitive interference (NM‐CI). The MSQ showed an overall satisfactory fit index (TLI = 0.949, CFI = 0.963, RMSEA = 0.082 [0.064–0.101]). Internal consistency was satisfactory. MSQ factors are associated with higher nicotine/cigarette dependence and emotional distress, supporting the concurrent validity of the tool. Specific metacognitions about smoking were associated with different clinical outcomes related to smoking. A higher engagement on PM‐CR and on NM‐U was positively associated with nicotine/cigarette dependence. A higher engagement on PM‐ER and NM‐CI was associated with greater emotional distress. The 12‐item Italian version of the MSQ could be a promising tool to assess specific metacognitions about smoking in both research and clinical contexts. Metacognitions about smoking may be a suitable therapeutic target to reduce the levels of nicotine/cigarette dependence and emotional distress among smokers.

Background and aims: Research has shown a positive association between Problematic Smartphone Use (PSU) and poor sleep quality. However, extant literature has mostly relied on cross-sectional studies and little is known about the factors involved in the maintenance of PSU and connected sleep problems. The aim of this study was to model the associations between Negative Metacognitions about the uncontrollability and danger of excessive Smartphone Use (NMSU), poor sleep quality, and PSU using a 2-wave design. Methods: A total of 361 participants completed an online questionnaire at W1 and W2 (after six months). A cross-lagged panel model was estimated using SEM to examine the longitudinal interrelationships between poor sleep quality, two dimensions of PSU (i.e., Time spent - which covers addiction-like symptoms of PSU including withdrawal and salience, and Daily life interference - which assesses the negative effects of smartphone use on daily functioning, and NMSU. Results: Correlation analyses showed significant positive associations among PSU, NMSU and poor sleep quality at both waves. With regards to cross-lagged effects, only poor sleep quality at W1 significantly predicted NMSU at W2 ( β = 0.202, p = 0.021). Discussion and conclusions: Contrary to previous studies, only a prospective effect of sleep quality on negative metacognitions, rather than bidirectional influence between the three variables, was observed. Sleep hygiene education and interventions based on Metacognitive therapy could be helpful to modify negative metacognitions in the context of PSU.

Introduction: Using the metacognitive model of emotion dysregulation as a basis, this study explored whether metacognitive beliefs are associated with positive emotion dysregulation. Method: A total of 436 participants from the general population and 133 outpatients seeking psychological treatment were recruited. Positive emotion dysregulation, metacognitive beliefs, and affective symptoms were assessed. T t test, chi‐square test, correlation, and hierarchical multiple linear regression analyses were run. Results: In the general population, over and above age, sex, and affective symptoms, a higher endorsement on positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, and beliefs about the need to control thoughts were associated with a poor acceptance of positive emotions ( F = 13.66, p < 0.001), with difficulties in engaging in goal‐directed behavior ( F = 9.06, p < 0.001), and with difficulties in controlling behaviors when experiencing positive emotions ( F = 10.61, p < 0.001). In the clinical sample, over and above age, sex, and affective symptoms, a higher endorsement of negative beliefs about thoughts concerning uncontrollability and danger and lack of cognitive confidence were associated with difficulties in engaging in goal‐directed behavior ( F = 5.74, p < 0.001) and with difficulties in controlling behaviors when experiencing positive emotions ( F = 6.54, p < 0.001). Outpatients seeking psychological treatment also reported more severe positive emotion dysregulation and higher endorsement of metacognitive beliefs when compared with the general population ( p < 0.001). Conclusion: Positive emotion dysregulation appears to be associated with the tendency to endorse metacognitive beliefs. Metacognitive beliefs could be a potential therapeutic target for reducing difficulties in the regulation of positive emotions. Summary: Among participants from the general population, the tendency to endorse metacognitive beliefs is associated with greater positive emotion dysregulation. Among outpatients seeking psychological treatment, the tendency to endorse metacognitive beliefs is associated with greater positive emotion dysregulation. Assessing metacognitive beliefs may allow clinicians to gain a clearer understanding of treatment trajectories to reduce difficulties in the regulation of positive emotions. Metacognitive beliefs could be the potential therapeutic target to reduce positive emotion dysregulation. Metacognitive Therapy techniques could be suitable approaches to reduce positive emotion dysregulation.

Introduction: Using the self‐regulatory executive function model as a basis, this study explored whether, among substance users, metacognitive beliefs and repetitive negative thinking were associated with impulsiveness.Methods: A total of 100 substance users were recruited. Impulsiveness, metacognitive beliefs, rumination and worry were assessed. Correlation and hierarchal regression analyses were run.Results: Beliefs about the need to control thoughts, lower cognitive self‐consciousness and brooding rumination were found to be independent predictors of the total score on impulsiveness in the hierarchical regression analysis. Further regression analyses indicated that motor impulsiveness was predicted by a combination of beliefs about the need to control thoughts and brooding rumination, while non‐planning impulsiveness was predicted by beliefs about the need to control thoughts and lower cognitive self‐consciousness.Conclusion: Among substance users, higher impulsiveness is associated with the tendency to endorse beliefs about the need to control thoughts and brooding rumination. Among substance users, beliefs about the need to control thoughts and brooding rumination (and potentially cognitive self‐consciousness) could be a suitable therapeutic targets to mitigate particularly motor impulsiveness and non‐planning impulsiveness.