Several studies highlighted how COVID-19-related isolation and quarantine deeply weighed on the mental health of both the general and psychiatric population. There has been limited investigation about self-harm and impulsivity during the COVID-19 pandemic.

The aim of this study is to evaluate how COVID-19-related lockdown affected self-harm rates in an Italian hospital.

Data on 59 patients were retrospectively collected from the Emercency deparment of the Policlinico Tor Vergata, Rome, from March 11 to May 4, 2020 (Italian mass quarantine) and the same periods of 2019 and 2021. Demographics, psychiatric history, substance use/abuse, types of self-harm and admission in psychiatric acute unit (PAU) rates were recorded.

No statistical difference was reported in self-harm rates [9.8%(26/266) in 2019 vs 13.2%(10/76) in 2020 vs 10.7%(23/215) in 2021;p>0.05]. In 2020 subjects were younger (31.9±12.1 vs 39.2±14.4,p=0.22;vs 38.1±14.4;p=0.15) and had higher incidence of psychiatric history [90%(9/10) vs 73.1%(19/26), p=0.42;vs 65.2% (15/23),p=0.29],than 2019 and 2021 respectively. Substance use/abuse rates were significantly lower in 2020 compared to 2019 and 2021 [10%(1/10) vs 53.8%(14/26),p=0.04;vs 60.9% (14/23), p=0.02]. In 2020, subjects committing self-harms were more frequently admitted to PAU compared to 2019 and 2021 [60%(6/10)vs19.2%(5/26),p=0.04; vs 17.4% (4/23), p=0.04).

Consistent with the literature, lockdown-related measures negatively impacted on younger people, with higher rates of self-harm between March and May 2020. This, together with a higher rate of admissions to PAU, should warn the mental health system to target with specific programs to support adolescents and youngers.

No significant relationships.

A few studies have analyzed the impact of COVID-19 pandemic on psychiatric Emergency Department (ED) accesses. The pandemic may indeed have influenced the phase of day accesses for patients with psychiatric disorders.

Aim of this cross-sectional study is to analyze how COVID-19 weighed on psychiatric patients daily accesses over the course of three years.

Data on 219 patients were retrospectively collected from the ED in the Policlinico Tor Vergata, Rome. According to the stage of the day, accesses were divided into 4 groups: between 00:00 and 6:00; between 6:00 a.m. and 12:00 a.m.; between 12:00 a.m. and 18:00 p.m.; between 18:00 p.m. and 00:00 p.m.

Performing a regression analysis, a relation was found between psychiatric symptoms, stage of the day admission and year. In 2019 the admissions seem to be homogeneously distributed, however during 2021 and 2020 the admissions rates have a delayed evening trend.

Despite the low number of accesses considered, the Covid-19 pandemic appears to exert an effect that still lasts in terms of both accesses and worsening or new onset of psychiatric symptoms. Measures taken to prevent the spread of infections may have affected access in the ED of patients in various ways. However, the trend of increasing evening accesses could be related to a saturation of territorial psychiatric services that work mainly until the afternoon. Thus, an enhancement of territorial psychiatric services seems highly necessary to cope with what could be an increase in psychopathology in patients without previous diagnosis.

No significant relationships.

Italy has been one of the most affected countries by Covid-19 pandemic. Our University General Hospital, Policlinico of “Tor Vergata” (PTV) in Rome, has become a Covid Hub in order to manage the spread of the epidemic. Thus, our Psychiatric Emergency Service (PES)’s access has been partially limited. Direct indicators of PES activity, as admission rates, can be useful for evaluating the psychological impact of Covid epidemic.

To assess psychiatric admittance rates to PES of PTV before and during Covid-19 global pandemic.

Data from our PES register have been obtained and analyzed. We compared all the psychiatric access during the trimester March – May 2019 and 2020. All patients have been characterized according to clinical features.

A marked reduction of the number of patients presenting to PES has been observed (76 patients) in the 57-day period (March 11–May 04, 2020) of lockdown compared to the same period in 2019 (266 patients). The cutback was visible for all diagnostic groups, except for “Borderline Personality Disorder” diagnosis which have slightly increased. On the other hand, hospitalization rates in our psychiatric inpatients unit remained steady.

Although larger study are needed to understand the mental consequences of the lockdown experience, people’s fear of potential infection might explain our results. Interestingly, personality disorder patients represent an exception to it, suggesting the importance of the clinical characteristics of fearless, engagement in dangerous behavior and detachment from reality. These findings might be helpful to improve psychosocial crisis interventions during the pandemic.

In Spain, we are forced to familiarize ourselves with Arab-Muslim culture to properly treat our patients. The diagnosis becomes complicatedbecause western health professionals are not usually familiar with thisform of symptom presentation.

The objective of this work is to study the influence of Arab culture and Muslim religion on the psychopathological symptoms presented duringa psychotic episode.

We present two cases of psychosis in two brothers of Maghreb originwho were treated for the first psychotic episode in the acute psychiatricunit in a Spanish regional hospital. Then, we carried out a litle researchfrom the literatura.

The common psychopathological symptoms presented by two brothersof 26 and 27 years were: symptoms of thought, control and influence of the self. Delusional ideas of self-referential harm and persecution. Auditory and cenesthetic hallucinations. In the literature we find that patients with Islamic backgrounds whosuffer hallucinations can attribute these experiences to different beliefssuch as geniuses (jinn), black magic and the evil eye. One of the siblings was diagnosed with a psychotic episode withoutspecification, while the other brother got the schizophrenia label. Webelieve that this may be related to the fact that mental healthprofessionals generally tend to label fantastic stories as mind-blowingor delusional in nature.

1. Religious beliefs and fantastic tales of Muslim culture can be considered psychotic symptoms if healthcare professionals are notfamiliar with this culture. 2. Teamwork between mental health professionals, translators and religious counselors can improve care for Muslim patients.

Occupational Burnout (OB) is currently measured through several Patient-Reported Outcome Measures (PROMs) and some of them have become widely used in occupational health research and practice. We, therefore, aimed to review and grade the psychometric validity of the five OB PROMs considered as valid for OB measure in mental health professionals (the Maslach Burnout Inventory (MBI), the Pines' Burnout Measure (BM), the Psychologist Burnout Inventory (PBI), the OLdenburg Burnout Inventory (OLBI) and the Copenhagen Burnout Inventory (CBI)).

We conducted systematic literature searches in MEDLINE, PsycINFO and EMBASE databases. We reviewed studies published between January 1980 and September 2018 following a methodological framework, in which each step of PROM validation, the reference method, analytical technics and result interpretation criteria were assessed. Using the COnsensus-based Standards for the selection of health Measurement Instruments we evaluated the risk of bias in studies assessing content and criterion validity, structural validity, internal consistency, reliability, measurement error, hypotheses testing and responsiveness of each PROM. Finally, we assessed the level of evidence for the validity of each PROM using the GRADE approach.

We identified 6541 studies, 19 of which were included for review. Fifteen studies dealt with MBI whereas BM, PBI, OLBI and CBI were each examined in only one study. OLBI had the most complete validation, followed by CBI, MBI, BM and PBI, respectively. When examining the result interpretation correctness, the strongest disagreement was observed for MBI (27% of results), BM (25%) and CBI (17%). There was no disagreement regarding PBI and OLBI. For OLBI and CBI, the quality of evidence for sufficient content validity, the crucial psychometric property, was moderate; for MBI, BM and PBI, it was very low.

To be validly and reliably used in medical research and practice, PROM should exhibit robust psychometric properties. Among the five PROMs reviewed, CBI and, to a lesser extent, OLBI meet this prerequisite. The cross-cultural validity of these PROMs was beyond the scope of our work and should be addressed in the future. Moreover, the development of a diagnostic standard for OB would be helpful to assess the sensitivity and specificity of the PROMs and further reexamine their validity.

The study protocol was registered in PROSPERO (CRD 42019124621).

Axis I anxiety disorders are often comorbid in psychoses and mostly assessed during the hospitalization. In the present study anxiety comorbidity was investigated in 98 patients (with schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features) previously hospitalized for psychotic symptoms.

Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorder Fourth Edition (SCID-P), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impressions Scale (CGI), were performed during hospitalization (t0) and subsequently in a phase of clinical remission, lasting for at least 6 months besides a stable pharmacological treatment for at least 3 months (t1). Comorbid anxiety disorders were assessed only at t1 in order to avoid the influence of an acute clinical state.

Our sample confirmed that anxiety comorbidity is a relevant phenomenon in psychoses, being present in nearly half of the patients (46.9%). Our specific prevalences were: obsessive-compulsive disorder (OCD) 20.4%, panic disorder (PD) 24.5%, social anxiety disorder (SAD) 19.4%, generalized anxiety disorder (GAD) 2%, post-traumatic stress disorder (PTSD) 0%. In our sample, patients with schizophrenia had a rate of anxiety disorders (73.9%) significantly higher (p<.05) than those with schizoaffective disorder (31.6%) or bipolar disorder (41.1%). Patients with PD or with OCD showed higher severity of illness only at t0; on the contrary, those with SAD demonstrated greater severity at t1.

PD, OCD and SAD resulted frequently comorbid in psychotic patients; SAD more prevalent in schizophrenia with a negative impact on the course of the illness.

Face processing is crucial for social interaction, but impaired in schizophrenia in terms of delays and misperceptions of identity and affective content. One important functional region for early stages of human face processing is the right fusiform face area. Thus, this region might be affected in schizophrenia. Aim of the study was to investigate whether face processing deficits are related to dysfunctions of the right fusiform face area in schizophrenics compared to controls.

In a rapid event-related fMRI design encoding of new faces as well as the recognition of newly learned, famous, and unknown faces was investigated in 13 schizophrenics and 21 healthy controls. Region of interest analysis was applied to each individual's right fusiform face area and tested for group differences.

Controls displayed more BOLD activation during the memorization of faces that were later successfully recognized. In schizophrenics this effect was not present. During the recognition task schizophrenics had lower BOLD responses, less accuracy, as well as longer reaction times to famous and unknown faces.

Our results support the hypothesis that impaired face processing in schizophrenia is related to early stage deficits during the encoding and immediate recognition of faces.

Key to the distinctiveness of the burnout construct is the idea that burnout is etiologically anchored in the occupational context and mainly dependent on job-related factors. This idea, however, needs further empirical validation.

The aim of the present study was to examine whether burnout is more strongly associated with chronic occupational stress and workplace social support (job-related factors) than with global stress and life satisfaction (generic factors).

This study included 2124 French teachers (mean age: 41.36; 73% female). Participants were enrolled during the last trimester of the 2013-2014 school year. Burnout was assessed with the Maslach Burnout Inventory. Chronic occupational stress and workplace social support were measured with the Job Content Questionnaire. Global stress and life satisfaction were assessed with the Perceived Stress Scale (10-item version) and the Satisfaction with Life Scale, respectively. Multiple regression analyses were carried out.

Global stress was found to be the main predictor of burnout (β = .35), followed by chronic occupational stress (β = .22), life satisfaction (β = -.20), and workplace social support (β = -.12), all ps < .001. A model coupling global stress and life satisfaction as predictors accounted for 42% of the variance in burnout. A model coupling chronic occupational stress and workplace social support as predictors accounted for 31% of the variance in burnout.

Burnout may not be better predicted by job-related indicators than by generic indicators. Thereby, the dominant view of burnout is questioned. Longitudinal investigation should be conducted.

Whether burnout is a form of depression or a distinct nosological entity is unclear. In addition, the cognitive style associated with burnout remains poorly characterized.

The aim of the present study was to examine whether depressive cognition (ruminative responses, dysfunctional attitudes, and depressive attributions) discriminates burnout from depression.

A total of 277 Northern American teachers were included in this study. Burnout was assessed with the Shirom-Melamed Burnout Measure (α = .95) and depression with the 9-item depression-dedicated module of the Patient Health Questionnaire (α = .85). With regard to depressive cognition measurement, each participant completed the Ruminative Responses Scale, the Dysfunctional Attitudes Scale, and the Depressive Attributions Questionnaire. Data processing was carried out by using IBM® SPSS® Amos (version 22.0.0).

Ruminative responses, dysfunctional attitudes, and depressive attributions were positively and similarly correlated to burnout and depression. Depressive attributions appeared as the strongest predictor of both burnout and depression. Ruminative responses, dysfunctional attitudes, and depressive attributions accounted for about 27% of the variance in burnout and 28% of the variance in depression.

The present study suggests that depressive cognition does not discriminate burnout from depression. Our findings confirm that isolating substantial differences between burnout and depression is difficult, in support of the hypothesis that burnout is essentially a form of depression.

Burnout is usually viewed as a combination of emotional exhaustion, depersonalization, and reduced personal accomplishment. The link between burnout and anxiety is not well understood.

We examined the extent to which history of anxiety disorders (HAD) and current anxiety symptoms (CAS) predict burnout.

The present study included 5575 French teachers (mean age: 41; mean job tenure: 15 years). The Maslach Burnout Inventory was used to assess emotional exhaustion, depersonalization, and reduced personal accomplishment. Participants indicated whether they had ever been diagnosed for an anxiety disorder by a health expert and self-reported their CAS by using the 7-item Generalized Anxiety Disorder scale. A multiple regression analysis was carried out with HAD, CAS, age, and job tenure as predictors.

CAS predicted both emotional exhaustion (β = 0.67; 95% CI: 0.65-0.69), depersonalization (β = 0.36; 95% CI: 0.33-0.39), and reduced personal accomplishment (β = 0.25; 95% CI: 0.23-0.28), all ps < .0001. HAD only predicted emotional exhaustion (β = 0.03; 95% CI: 0.01-0.05), p < .01, and reduced personal accomplishment (β = 0.03; 95% CI: 0.00-0.06), p < .05. Age and job tenure did not predict burnout. The tested model accounted for about 46% of the variance in emotional exhaustion, 13% of the variance in depersonalization, and 7% of the variance in reduced personal accomplishment.

CAS predicted all dimensions of burnout, particularly the emotional exhaustion dimension. Although HAD may be a risk factor for burnout, its importance seems much more limited.

It has been assumed that a key difference between burnout and depression is that burnout is job-related and situation-specific whereas depression is context-free and pervasive. This view has recently been challenged at a theoretical level and additional empirical investigation has been called for.

The aim of this study was to examine whether chronic occupational stress—the putative cause of burnout—discriminated burnout from depression. Following a scope-based approach to the burnout-depression distinction, chronic occupational stress should be primarily related to burnout and only to a lesser degree to depression. This hypothesis was tested.

A total of 2124 French teachers took part in this study (mean age: 41.36; 73% female) during the last trimester of the 2013-2014 school year. Burnout was assessed with the Maslach Burnout Inventory and depression with the 9-item depression module of the Patient Health Questionnaire. The Effort-Reward Imbalance Questionnaire short form (ERIQ) was used for assessing chronic occupational stress.

Burnout and depression were almost identically correlated to effort-reward imbalance at work. Interestingly, the job over-commitment component of the ERIQ was slightly more correlated to depression than to burnout. Multiple regression analyses showed that effort-reward imbalance at work and job over-commitment predicted depression as much as burnout, controlling for gender, age, and length of employment.

Chronic occupational stress was not found to discriminate burnout from depression. These results further question the relevance of a scope-based distinction between burnout and depression and supports the idea that burnout overlaps with depression.

A Metacognitive Training for Schizophrenia patients (MCT) was developed to target the cognitive biases that characterize the illness. Results suggest positive MCT effects encompassing several aspects of psychopathology and subjective well-being. There are still open questions concerning the effect on different cognitive biases and the interplay between them and both psychopathology and neurocognition. Specifically, the bias against disconfirmatory evidence (BADE) has never been tested in previous trials on MCT. In this study we evaluated the feasibility of MCT combined with a cognitive remediation therapy (CACR) in schizophrenia and its effect on BADE. Moreover, we investigated the relationships between BADE and both neuropsychology and psychopathology, taking into account mutual influences on the degree of improvement.

Fifty-seven schizophrenia outpatients were randomly assigned to CACR + control group or MCT+CACR and assessed at baseline and after treatment for psychopathology, neurocognition and BADE.

After MCT+CACR patients showed significantly greater improvements on BADE. Although BADE baseline performances correlated with several cognitive domains, no association was found between BADE improvement and neurocognitive nor psychopathological measures.

This study enlightened for the first time the efficacy of MCT+CACR on BADE in schizophrenia, suggesting the importance to develop a more specific intervention tailored on individual needs of patients.

Whether burnout is anything other than a (job-related) depressive syndrome is unclear. A growing body of research suggests that the overlap of burnout with depression has been largely underestimated.

The aim of this longitudinal study was to examine whether burnout at baseline helped predict depression at follow-up when depression at baseline was controlled for.

A total of 627 French teachers took part in the two waves of this study, launched in 2012. About three of four participants were female and mean age at time 1 (T1) was 41. Depression was assessed with the 9-item depression module of the Patient Health Questionnaire (PHQ-9). Using the PHQ-9, the severity of depressive symptoms can be graded and provisional diagnoses of major depressive disorders can be established. Burnout was measured with the Maslach Burnout Inventory. Participants completed the follow-up on an average 21 months after completing the initial survey.

Hierarchical multiple regression analysis showed that a model involving T1 burnout and depression as predictors did not explain more variance in depression at follow-up than a model involving T1 depression as the only predictor. Binary logistic regression analyses indicated that T1 burnout no longer predicted cases of major depression at follow-up when T1 depression was included in the tested model. All these results were obtained controlling for gender, age, and length of employment.

This study confirms that burnout overlaps with depression. Assessing burnout in addition to depression may not be as useful as assumed in the past.

Burnout and depression are ordinarily assessed within different time frames. Burnout is most frequently assessed on an annual or a monthly basis whereas depression is generally assessed over a one- or two-week period. This state of affairs may have partly obscured the burnout-depression relationship in past research and contributed to an underestimation of burnout-depression overlap.

We investigated burnout-depression overlap using time-standardized measures of the two constructs. We additionally examined whether burnout and depression were differently associated with work-related effort and reward, occupational social support, and intention to quit the job.

We enrolled 257 Swiss schoolteachers (76% female; mean age: 45). Burnout was assessed with the Shirom-Melamed Burnout Measure and depression with a dedicated module of the Patient Health Questionnaire. Work-related effort and reward were measured with a short version of the Effort-Reward Imbalance Scale and occupational social support with a subscale of the Job Content Questionnaire. Intention to quit the job was assessed with 3 generic items (e.g., “I plan on leaving my job within the next year”).

We observed a raw correlation of .82 and a disattenuated correlation of .91 between burnout and depression. Burnout's dimensions (physical fatigue; cognitive weariness; emotional exhaustion) did not correlate more strongly with each other (mean r = .63) than with depression (mean r = .69). Burnout and depression showed similar associations with the job-related factors under scrutiny.

Burnout and depression may be empirically-redundant constructs. Measurement artifacts probably contributed to an underestimation of burnout-depression overlap in many studies.

The authors have not supplied their declaration of competing interest.

Several studies suggested that anxiety can significantly affect the outcome of schizophrenia. Despite this evidence, non-pharmacological interventions targeting anxiety are still heterogenous. This study aims to test the efficacy of a novel training specifically designed to target anxiety in patients with schizophrenia. Innovatively, this training, beyond psychoeducation and problem solving, also targets Theory of Mind, as it provides coping strategies.

Twenty-seven outpatients with schizophrenia received a novel rehabilitative training targeting anxiety (Anxiety Management Group [AMG]) combined with a Computer-Assisted Cognitive Remediation (CACR), and twenty received CACR plus a control intervention (Control Newspaper discussion Group [CNG]). All patients were assessed at baseline and after treatment for quality of life, neurocognition and anxiety.

After training, patients treated with AMG + CACR showed significantly greater improvements on anxiety. A significant increase in quality of life was observed only for AMG + CACR group. Moreover, the participants’ appraisal showed a significant difference between treatment groups with higher ratings among patients who received the AMG + CACR.

This study thus suggests feasibility and efficacy of the proposed intervention, that could be implemented in rehabilitative programs for patients with schizophrenia with potential benefits also on disease course and outcome.

More than 40 years after the introduction of the construct in the literature, the status of “burnout” remains unclear. Whether burnout is anything other than a depressive syndrome has been increasingly discussed in recent years.

We examined the extent to which burnout can be considered distinct from depression.

We reviewed the literature dedicated to burnout-depression overlap over the last decade.

Recent research suggests that burnout and depression overlap in terms of (a) etiology, with (chronic) unresolvable stress a common, key causal factor, (b) clinical picture and course, with burnout and depressive manifestations inextricably linked such that they increase or decrease together over time, (c) cognitive biases, with burnout and depressive symptoms similarly predicting increased attention to negative stimuli and decreased attention to positive stimuli, (d) dispositional correlates (e.g, neuroticism, rumination, pessimism), and (e) allostatic load—an index of the biological cost of adaptation to life adversity. Hypocortisolism has been linked to both burnout and depression with atypical features—a highly prevalent form of depression. The often-invoked argument that burnout is singularized by its job-related character is actually invalid given that (a) depression can also be job-related and (b) the “job-relatedness” of a syndrome is not nosologically discriminant in itself.

Robust evidence that burnout overlaps with depression has accumulated in recent years. The burnout construct is unlikely to capture a distinct pathological phenomenon. We propose that burnout be characterized as a depressive syndrome for the sake of conceptual parsimony, theoretical clarity, and effective public health policies.

The authors have not supplied their declaration of competing interest.

Burnout has widely infiltrated the popular culture and has been extensively studied in both psychiatry and psychology. However, there are currently no consensual or binding diagnostic criteria for burnout. A major obstacle to the elevation of burnout to the status of nosological category is the overlap of burnout with depression.

We examined whether burnout and depressive symptoms can be distinguished from each other using a person-centered approach.

A total of 1759 French schoolteachers took part in the present study (77% female; mean age: 41; mean length of employment: 15). Burnout symptoms were assessed with the Shirom-Melamed Burnout Measure (14 items) and depressive symptoms with a dedicated module of the Patient Health Questionnaire (9 items). Data were primarily processed using two-step cluster analysis. Correlation analysis and analysis of variance (ANOVA) were additionally carried out.

Considered as continuous variables, burnout and depression were found to be closely intertwined (r = 0.81; disattenuated correlation: 0.91). Our cluster analysis revealed four different participant profiles, identifiable as “minimal burnout-depression” (n = 542; 31%), “low burnout-depression” (n = 566; 32%), “medium burnout-depression” (n = 412; 23%), and “high burnout-depression” (n = 239; 14%). Burnout and depression played equivalently important roles in cluster construction. Our ANOVA confirmed that the four clusters differed from each other in terms of burnout and depressive symptoms.

Our findings are consistent with the view that the burnout syndrome is depressive in nature. A diagnostic category dedicated to burnout may therefore not be needed.