Anna Contardi

Objectives: Our aim was to investigate the association between diagnostic delay and the clinical and psychosocial features in patients with psoriatic arthritis (PsA), with particular focus on the mental health, wellbeing, and pain-related mechanisms. Methods: A monocentric cross-sectional study was conducted including consecutive patients with PsA classified according to the Classification Criteria for Psoriatic Arthritis. Diagnostic delay was defined as the time between symptom onset and diagnosis, and patients were stratified according to delays ≥1 year and ≥2 years. Clinical assessment included demographic and clinical parameters, such as the Psoriasis Area and Severity Index (PASI), Leeds Enthesitis Index (LEI), Disease Activity in Psoriatic Arthritis (DAPSA), and treatment history. Psychosocial evaluation included evaluation of pain, fatigue, and sleep quality using the Numeric Rating Scale (NRS) from the corresponding Psoriatic Arthritis Impact of Disease (PsAID) domains, Hospital Anxiety and Depression Scale (HADS), the Mental Health Continuum—Short Form (MHC-SF), the PainDETECT questionnaire (PDQ), the Central Sensitization Inventory (CSI), and the Brief Pain Inventory (BPI). Patients were stratified according to the presence of at least 1 year or at least 2 years of diagnostic delay. Univariable and multivariable analyses were performed to compare the demographic and clinical variables across different groups and to identify factors associated with the diagnostic delay. Results: A total of 112 patients were enrolled, with 38.4% experiencing a diagnostic delay ≥1 year and 25.8% a delay ≥2 years. Both groups showed higher BMI, longer disease duration, and higher NRS pain compared with patients with less than 1 year and less than 2 years of delay. No significant differences were observed in disease activity, fatigue, sleep, PDQ, CSI, and BPI. Lower social wellbeing assessed through the MHC Social Well-Being (MHS-SWB) subscale was observed in patients with >2 years of delay. Two logistic regression models selecting diagnostic delay >2 years as the dependent variable and MHC-SWB first, then NRS pain together with BMI, disease duration, and DAPSA as covariates, confirmed the independent association of both NRS pain (OR = 1.3, 95%CI = 1–1.6) and MHC-SWB (OR = 0.9, 95%CI = 0.8–0.9) with diagnostic delay. Conclusion: Diagnostic delay in our PsA cohort is independently associated with higher patient pain perception and reduced social wellbeing, suggesting an association with selected patient-reported outcomes beyond traditional clinical outcomes. However, the lack of association with other measures, such as central sensitization, depression, and anxiety, supports a multifactorial and incomplete interpretation, highlighting the need for larger, longitudinal studies to clarify the relationship between diagnostic delay and psychosocial outcomes.

Psoriasis affects both physical and psychological health. This study explored how demoralization and the satisfaction or frustration of basic psychological needs (autonomy, competence, and relatedness), and demoralization are related to euthymia and fatigue in psoriasis patients, and how these psychological factors are linked to disease severity. This cross-sectional study of 215 psoriasis patients assessed psychological variables using the Euthymia Scale, Basic Psychological Need Satisfaction and Frustration Scale, Demoralization Scale-II, FACIT-F, Patient Health Questionnaire-4, and Physician Global Assessment. Lower anxiety and higher satisfaction with autonomy, relatedness, and competence were associated with greater euthymia. Fatigue was associated with autonomy frustration and depression. Lower relatedness satisfaction and higher Meaning and Purpose dimension of demoralization were linked to higher risk of disease severity. Considering basic psychological needs could complement existing treatments for psoriasis.

Mentalization is an important interpersonal ability, necessary for adaptive interpersonal relationships and emotion regulation. Deficits in mentalization have been associated with poor psychological outcomes and have been observed in patients with Borderline Personality Disorder. The Mentalization Questionnaire (MZQ) has been developed as self-report measure of mentalization deficit. The aim of the study was to investigate the dimensionality of the MZQ in a nonclinical sample composed of Italian adults from the general population and to analyze its performance in categorizing individuals with higher risk of borderline symptoms. A non-clinical sample of 1,015 adults (709 women and 306 men) was administered the Italian versions of the MZQ, the Reflective Functioning Questionnaire (RFQ), and a measure of borderline psychopathology. A revised single-factor solution fitted the data well and demonstrated metric invariance across gender. The internal consistency (Ordinal α = 0.87) and stability (r = 0.84) were satisfactory. The MZQ was moderately associated with the RFQ dimensions. The ROC curve analysis showed that the MZQ was able to discriminate satisfactorily people with higher risk for borderline symptomatology from those with lower risk. The MZQ may, therefore, be considered a reliable and valid measure of mentalization for categorizing people at higher risk for borderline pathology.

Affect lability, an important aspect of emotion dysregulation, characterizes several psychiatric conditions. The short Affective Lability Scales (ALS-18) measures three aspects of changeability between euthymia and affect states (Anxiety/Depression, AD; Depression/Elation, DE; and Anger, Ang). The aim of our study was to investigate the psychometric characteristics of an Italian version of the ALS-18 in a sample of adults recruited from the general population. The sample was composed of 494 adults (343 women and 151 men) aged 18 and higher (mean age = 31.73 years, SD = 12.6). All participants were administered a checklist assessing socio-demographic variables, the ALS-18 and measures of depression and difficulties in emotion regulation. Confirmatory factor analyses indicated adequate fit of the three-factor model (RMSEA = 0.061, 95% CI = 0.054/0.069; CFI = 0.99; SRMR = 0.055), and the presence of a higher-order general factor. Internal consistency was satisfactory for all the lower-order dimensions and the general factor (ordinal α > 0.70). The ALS-18 was significantly associated with concurrent measures of depression and difficulties in emotion regulation. These findings indicate that the ALS-18 is a valid and reliable instrument for measuring affect lability, although discriminant validity of subdimensions scores could be problematic.

Background: Chronic Insomnia is a severe and disabling condition characterized by difficulty in initiating or maintaining sleep, waking up too early, despite adequate opportunity and circumstances for sleep. Maladaptive thoughts and dysfunctional beliefs about sleep are considered crucial factors in developing and perpetuating this disorder. Aims: The aim of the study was to explore the usefulness, in patients with chronic insomnia, of a one-session psychoeducational intervention on sleep-related maladaptive thoughts and beliefs, and on sleep perception. Methods: Thirty-eight patients with chronic insomnia were enrolled in the study and randomly assigned to receive psychoeducational intervention (PI+) or to act as controls (PI–). Patients wore an actigraph and compiled a sleep diary for 14 d. After the first 7 d, only PI+ patients received one session of psychoeducational intervention. Results: A significant reduction of sleep related preoccupations, a reduction of dysfunctional beliefs about sleep, and an improvement of subjective perception of sleep were observed in the PI+ group, but not in the PI– group. No significant modification was observed for objective total sleep time. Conclusions: Our results suggest that one-session psychoeducational intervention is associated with a decrease of sleep-related maladaptive thoughts and beliefs, and with an improvement on subjective sleep perception.

Several studies showed the effectiveness of alpha/theta (A/T) neurofeedback training in treating some psychiatric conditions. Despite the evidence of A/T effectiveness, the psychological and neurobiological bases of its effects is still unclear. The aim of the present study was to explore the usefulness of the A/T training in increasing mentalization in a non-clinical sample. The modifications of electroencephalographic (EEG) functional connectivity in Default Mode Network (DMN) associated with A/T training were also investigated. Forty-four subjects were enrolled in the study and randomly assigned to receive ten sessions of A/T training [neurofeedback group (NFG) = 22], or to act as controls [waiting list group (WLG) = 22]. All participants were administered the mentalization questionnaire (MZQ) and the Symptom Checklist-90-Revised (SCL-90-R). In the post training assessment, compared to WLG, NFG showed a significant increase of MZQ total scores (3.94 ± 0.73 vs. 3.53 ± 0.77; F_1;43 = 8.19; p = 0.007; d = 0.863). Furthermore, A/T training was also associated with a significant increase of EEG functional connectivity in several DMN brain areas (e.g. Posterior Cingulate Cortex). Taken together our results support the usefulness of the A/T training in enhancing mentalization and DMN connectivity.

Recent neuroimaging studies have shown that alexithymia is characterized by functional alterations in different brain areas [e.g., posterior cingulate cortex (PCC)], during emotional/social tasks. However, only few data are available about alexithymic cortical networking features during resting state (RS). We have investigated the modifications of electroencephalographic (EEG) power spectra and EEG functional connectivity in the default mode network (DMN) in subjects with alexithymia. Eighteen subjects with alexithymia and eighteen subjects without alexithymia matched for age and gender were enrolled. EEG was recorded during 5 min of RS. EEG analyses were conducted by means of the exact Low Resolution Electric Tomography software (eLORETA). Compared to controls, alexithymic subjects showed a decrease of alpha power in the right PCC. In the connectivity analysis, compared to controls, alexithymic subjects showed a decrease of alpha connectivity between: (i) right anterior cingulate cortex and right PCC, (ii) right frontal lobe and right PCC, and (iii) right parietal lobe and right temporal lobe. Finally, mediation models showed that the association between alexithymia and EEG connectivity values was directed and was not mediated by psychopathology severity. Taken together, our results could reflect the neurophysiological substrate of some core features of alexithymia, such as the impairment in emotional awareness.