Off-label Uses of Selective Serotonin Reuptake Inhibitors (SSRIs).

Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reuptake inhibitors (SSRIs) are highly versatile and, therefore, widely prescribed. Moreover, they are commonly considered as having a better safety profile compared to other antidepressants. Thus, when it comes to off-label prescribing, SSRIs rank among the top positions. In this review, we present the state of the art of off-label applications of selective serotonin reuptake inhibitors, ranging from migraine prophylaxis to SARS-CoV-2 antiviral properties. Research on SSRIs provided significant evidence in the treatment of premature ejaculation, both with the on-label dapoxetine 30 mg and the off-label paroxetine 20 mg. However, other than a serotoninergic syndrome, serious conditions like increased bleeding rates, hyponatremia, hepatoxicity, and post-SSRIs sexual dysfunctions, are consistently more prominent when using such compounds. These insidious side effects might be frequently underestimated during common clinical practice, especially by nonpsychiatrists. Thus, some points must be addressed when using SSRIs. Among these, a psychiatric evaluation before every administration that falls outside the regulatory agencies-approved guidelines has to be considered mandatory. For these reasons, we aim with the present article to identify the risks of inappropriate uses and to advocate the need to actively boost research encouraging future clinical trials on this topic.

Trauma-spectrum symptoms among the Italian general population in the time of the COVID-19 outbreak Síntomas del espectro traumático en la población general italiana en el tiempo del brote de COVID-19 COVID-19爆发时意大利一般人群中的创伤谱系症状

Background: Recent evidence showed adverse mental health outcomes associated with the COVID-19 pandemic, including trauma-related symptoms. The Global Psychotrauma Screen (GPS) is a brief instrument designed to assess a broad range of trauma-related symptoms with no available validation in the Italian population. Aims: This study aimed to examine the factor structure of the Italian version of the GPS in a general population sample exposed to the COVID-19 pandemic and to evaluate trauma-related symptoms in the context of COVID-19 related risk factors associated with lockdown measures. Methods: We conducted a cross-sectional web-based observational study as part of a long-term monitoring programme of mental health outcomes in the general population. Eighteen thousand one hundred forty-seven participants completed a self-report online questionnaire to collect key demographic data and evaluate trauma-related symptoms using the GPS, PHQ-9, GAD-7, ISI, and PSS. Validation analyses included both exploratory and confirmatory factor analysis and correlation analyses. The relation with putative COVID-19 related risk factors was explored by multivariate regression analysis. Results: Exploratory factor analyses supported a two-factor model. Confirmatory factor analysis showed that the best fitting model was a three-factor solution, with core Post-traumatic Stress Symptoms (PTSS) (re-experiencing, avoidance, hyperarousal), Negative Affect (symptoms of depressed mood, anxiety, irritability), and Dissociative symptoms. GPS Risk factors and specific COVID-19 related stressful events were associated with GPS total and the three factor scores. Conclusions: Our data suggest that a wide range of trauma-spectrum symptoms were reported by a large Italian sample during the COVID-19 pandemic. The GPS symptoms clustered best in three factors: Negative Affect symptoms, Core PTSS, and Dissociative symptoms. In particular, high rates of core PTSS and negative affect symptoms were associated with the COVID-19 pandemic in Italy and should be routinely assessed in clinical practice. HIGHLIGHTS • This study examines the factor structure of the Global Psychotrauma Screen. • Data were collected during the first COVID-19 lockdown in Italy. • A three-factor model was the best solution. • Core Post-Traumatic and Negative Affect symptoms were associated with the COVID-19 pandemic.

Building a resilient hospital in Tor Vergata: The role of emotional defusing for health care workers during COVID-19 pandemic

The COronaVIrus Disease 2019 (COVID-19) epidemic crisis caused the re-organization of different hospitals. A key factor in this process of answering mainly for functionality and health security was played by resilience, i.e., the ability to find and apply resources for support, engage in successful coping, or utilize other accessible protective factors. In the process of building a hospital that could show resilience, we adopted the emotional defusing that, by dealing with psychological distress of health care worker in our COVID-19 university hospital, has proven to be a technique at the basis of the growth of individual and group level. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Trauma-spectrum symptoms among the Italian general population in the time of the COVID-19 outbreak.

Background: Recent evidence showed adverse mental health outcomes associated with the COVID-19 pandemic, including trauma-related symptoms. The Global Psychotrauma Screen (GPS) is a brief instrument designed to assess a broad range of trauma-related symptoms with no available validation in the Italian population. Aims: This study aimed to examine the factor structure of the Italian version of the GPS in a general population sample exposed to the COVID-19 pandemic and to evaluate trauma-related symptoms in the context of COVID-19 related risk factors associated with lockdown measures. Methods: We conducted a cross-sectional web-based observational study as part of a long-term monitoring programme of mental health outcomes in the general population. Eighteen thousand one hundred forty-seven participants completed a self-report online questionnaire to collect key demographic data and evaluate trauma-related symptoms using the GPS, PHQ-9, GAD-7, ISI, and PSS. Validation analyses included both exploratory and confirmatory factor analysis and correlation analyses. The relation with putative COVID-19 related risk factors was explored by multivariate regression analysis. Results: Exploratory factor analyses supported a two-factor model. Confirmatory factor analysis showed that the best fitting model was a three-factor solution, with core Post-traumatic Stress Symptoms (PTSS) (re-experiencing, avoidance, hyperarousal), Negative Affect (symptoms of depressed mood, anxiety, irritability), and Dissociative symptoms. GPS Risk factors and specific COVID-19 related stressful events were associated with GPS total and the three factor scores. Conclusions: Our data suggest that a wide range of trauma-spectrum symptoms were reported by a large Italian sample during the COVID-19 pandemic. The GPS symptoms clustered best in three factors: Negative Affect symptoms, Core PTSS, and Dissociative symptoms. In particular, high rates of core PTSS and negative affect symptoms were associated with the COVID-19 pandemic in Italy and should be routinely assessed in clinical practice.

Antecedentes: Evidencias recientes revelaron resultados adversos para la salud mental asociados con la pandemia de COVID-19, incluyendo síntomas relacionados con el trauma. El Mapeo Global de Psicotrauma (GPS, en sus siglas en inglés) es un breve instrumento diseñado para evaluar una amplia gama de síntomas relacionados con el trauma, sin validación disponible en la población italiana.Objetivos: El objetivo de este estudio fue examinar la estructura de factores de la versión italiana del GPS en una muestra de la población general expuesta a la pandemia de COVID-19 y evaluar los síntomas relacionados con el trauma en el contexto de los factores de riesgo relacionados con COVID-19 asociados con las medidas de confinamiento.Métodos: Realizamos un estudio observacional transversal basado en la web como parte de un programa de vigilancia a largo plazo de los resultados de salud mental en la población general. Dieciocho mil ciento cuarenta y siete participantes completaron un cuestionario en línea de autorreporte para recopilar datos demográficos claves y evaluar los síntomas relacionados con el trauma utilizando el GPS, PHQ-9, GAD-7, ISI y PSS. Los análisis de validación incluyeron análisis factoriales y de correlación tanto exploratorios como confirmatorios. La relación con los posibles factores de riesgo relacionados con COVID-19 se exploró mediante un análisis de regresión multivariante.Resultados: Los análisis factoriales exploratorios apoyaron un modelo de dos factores. El análisis factorial confirmatorio mostró que el modelo que mejor se ajustaba era una solución de tres factores, con los principales síntomas de estrés postraumático (PTSS, en sus siglas en inglés) (reexperimentación, evitación, hiperactivación), el efecto negativo (síntomas de depresión, ansiedad, irritabilidad) y los síntomas disociativos. Los factores de riesgo del GPS y los eventos estresantes específicos relacionados con COVID-19 se asociaron con el total del GPS y las tres puntuaciones de los factores.Conclusiones: Nuestros datos sugieren que una amplia gama de síntomas de espectro traumático fueron reportados por una gran muestra italiana durante la pandemia de COVID-19. Los síntomas del GPS se agruparon mejor en tres factores: Síntomas de Afecto Negativo, PTSS Central y Síntomas Disociativos. En particular, las altas tasas de PTSS central y los síntomas de afecto negativo se asociaron con la pandemia de COVID-19 en Italia y deben ser evaluados rutinariamente en la práctica clínica.

Bariatric Surgery Closure During COVID-19 Lockdown in Italy: The Perspective of Waiting List Candidates.

Background: From the beginning of March 2020, lockdown regimens prevented patients with obesity from receiving bariatric surgery. Surgical emergencies and oncological procedures were the only operations allowed in public hospitals. Consequently, patients with morbid obesity were put in a standby situation. With the aim at exploring the viewpoint of our future bariatric surgery patients, we built a questionnaire concerning obesity and COVID-19. Method: A total of 116 bariatric surgery candidates were approached using a telephonic interview during the Italian lockdown. Results: Of the total sample, 73.8% were favorable to regular bariatric surgery execution. Forty percent were concerned about their own health status due to the COVID-19 emergency, and 61.1% were troubled by the temporary closure of the bariatric unit. The majority of the sample were eating more. Forty-five percent and the 27.5% of patients reported a worsening of the emotional state and physical health, respectively. Most of the patients (52.2%) considered themselves more vulnerable to COVID-19, especially individuals with class III obesity. Patients who reported an increased consumption of food were younger (43.44 ± 12.16 vs. 49.18 ± 12.66; F = 4.28, p = 0.042). No gender difference emerged. Conclusion: The lockdown had a negative result on Italian patients' psychological well-being and eating habits. The majority of patients would have proceeded with the surgery even during the COVID-19 emergency. Effective management and bariatric surgery should be restarted as soon as possible.

COVID-19 Pandemic and Lockdown Measures Impact on Mental Health Among the General Population in Italy.

BACKGROUND: The psychological impact of the COronaVIrus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown. The current study assesses rates of mental health outcomes in the Italian general population three to 4 weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors. METHODS: A web-based survey spread throughout the internet between March 27th and April 6th 2020. Eighteen thousand one hundred forty-seven individuals completed the questionnaire, 79.6% women. Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, perceived stress, and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors. RESULTS: Endorsement rates for PTSS were 6,604 (37%), 3,084 (17.3%) for depression, 3,700 (20.8%) for anxiety, 1,301 (7.3%) for insomnia, 3,895 (21.8%) for high perceived stress and 4,092 (22.9%) for adjustment disorder. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress, and insomnia. CONCLUSION: We found high rates of negative mental health outcomes in the Italian general population 3 weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population's mental health.