The interplay between previous infection and mental health condition on antibody response to COVID-19 mRNA vaccination.

Increasing evidence has been pointing towards the existence of a bi-directional interplay between mental health condition and immunity. Data collected during the COVID-19 outbreak suggest that depressive symptoms may impact the production of antibodies against SARS-CoV-2, while a previous infection could affect the immune response and cause neuropsychological disturbances. A prospective observational study was designed to investigate the association between mental health conditions and immune response over time. We analyzed the mental health at baseline and the antibodies before and after immunization with the COVID-19 mRNA vaccine in a cohort of healthcare professionals in southern Switzerland. One-hundred and six subjects were enrolled. Anxiety, distress and depression correlated to each other. There were no correlations between the mentioned variables and the vaccine induced IgG antibodies against the receptor binding domain (RBD) of the spike protein. For those who had a previous COVID-19 infection, the antibodies increased according to the grade of depression. For those who did not, the anti-RBD IgG levels remained similar when comparing presence or absence of depression symptoms. Our results show that previous SARS-CoV-2 natural infection in subjects with mental health conditions enhances the immune response to COVID-19 mRNA vaccination. The correlation between immune response to COVID-19 vaccination, a previous exposure to the virus, and symptoms of mood disorders, makes it necessary to explore the direction of the causality between immune response and depressive symptoms.

Eliciting empathetic drives to prosocial behavior during stressful events.

In the current pandemic situation, psychological science is increasingly considered by public health policy. Empathy is mainly recognized as a crucial drive for prosocial behavior. However, this rich body of evidence still lacks visibility and implementation. Effective social programs are needed, and little is known about how to elicit empathetic drives. The paper gives first a clear foundation to the role of empathy during stressful events. It provides then a comprehensive overview of innovative interventions triggering empathic response in the public such as fiction, film, and theater. Moreover, it integrates interactive ways of sharing personal views that could elicit empathetic feelings in different people. Advances deriving from this perspective could be of significant public interest in the current and future health crises and help authorities develop innovative social programs, which should be the focus of further scientific inquiry.

Phantosmia and psychogenic non-epileptic seizures in a patient with burning mouth syndrome suffering from severe depression.

Burning mouth syndrome (BMS) is a rare but serious medical condition with important psychiatric comorbidity and specific psychological correlates. Psychopathology related with BMS represents a real challenge for clinical decision-making. In this case, depression is the leading psychiatric diagnosis associated with patient's BMS somatic pain and is driven by anxiety and a dissociative functioning. Facing a complex psychosomatic symptomatology, we offer new clinical perspectives for the screening of psychological traits of BMS. Moreover, we highlight the need to foster interdisciplinarity to improve differential diagnosis and defining an optimal care path. This case report stimulates a reflection on management challenges for the consultation-liaison psychiatry and shows the importance of a person-centred approach when communicating the diagnosis.

Health professionals' view on the role of hope and communication challenges with patients in palliative care: A systematic narrative review.

OBJECTIVE: To identify health professionals' (HPs) perspectives on the role of hope and the main challenges faced when communicating with patients in palliative care (PC). METHODS: Search on PubMed, Scopus, SocIndex, Cochrane, and Web of Science using: palliat*, palliative care, palliative medicine, hospice care, terminal care, long term care, supportive care, end of life (EOL) care and hope*, followed by a thematic narrative analysis. RESULTS: Thirty-five studies were included. HPs' views were grouped in: Bringing out hope and Taking down hope. HPs believe that hope is elicited through a personal patient-provider bond and exhibited through medical treatment delivery. HPs face difficulties when delivering prognosis, referring to hospice, and providing palliation. CONCLUSION: Hope is conveyed through verbal and non-verbal communication. HPs struggle to account for hope's shifting character, challenging the engagement in EOL discussions. PRACTICAL IMPLICATIONS: Findings show a patient-provider clash of perspectives, suggesting a gap in acknowledging the shifting nature of hope. An important question emerges: Are the existing theories of hope that are solely explained from a patient experience relevant for HPs' own interpretation? Investigating the HPs' attitudes gathered in collective experiences in PC, might contribute to answering the question in the context of building more constructive communication approaches.

Affective empathy predicts self-isolation behaviour acceptance during coronavirus risk exposure.

Health risk exposure during the global COVID-19 pandemic has required people to adopt self-isolation. Public authorities have therefore had the difficult task of sustaining such protective but stressful behaviour. Evidence shows that besides egoistic drives, the motivation for self-isolation behaviour could be altruistic. However, the type and role of prosocial motivation in the current pandemic is underestimated and its interaction with risk exposure and psychological distress is largely unknown. Here we show that affective empathy for the most vulnerable predicts acceptance of lockdown measures. In two retrospective studies, one with a general population and one with COVID-19 positive patients, we found that (1) along with health risk exposure, affective empathy is a predictor of acceptance of lockdown measures (2) social covariates and psychological distress have no significant impact. Our results support the need to focus on altruistic behaviours while informing the public instead of on fear-inducing messages.

Therapeutic Alliance in COVID-19 Era Remote Psychotherapy Delivered to Physically Ill Patients With Disturbed Body Image.

The COVID-19 pandemic outbreak has led to a general reorganization of health services and an increase in outpatient telemedicine in mental healthcare for physically ill people. Current literature highlights facilitators and obstacles concerning the use of new technologies in psychotherapy, an underrated topic of research in the context of supportive expressive psychotherapy. More insight is needed to explore the characteristics of video in therapeutic alliance for treatment of specific mental disorders experienced in psychosomatics, particularly with people suffering from a disturbed body- and self-image. Using two clinical vignettes, it is the authors' intention to enrich the critical debate on current knowledge in psychosomatic remote psychotherapy, with special focus on mentalization deficits and their impact on therapeutic alliance in the consultation-liaison psychiatry setting. In particular, we will question the interpersonal processes at stake related to mirroring and the disruption caused by the use of videoconference applications. We will also reflect upon the relationship between the therapeutic alliance and the medical team, and that between patient and psychotherapist. The aim is to improve psychotherapeutic alliance maintained during the pandemic for specific mental disorders and to inform about possible clinical factors that could be the subject of future empirical studies or professional guidelines.

Potential Space in Hospitals: Insight From a Health Psychologist.

OBJECTIVE: Humanization is a challenge for the future of healthcare. Architecture may play a major role in designing spaces that enhance communication and help the patient to maintain mental health during physical illness. Health psychologists struggle to find adequate space for taking care of their patients. There is an urgent need to better define how relational space, defined here as potential, can be guaranteed in everyday hospital psychological consultations. BACKGROUND: The author relates to his work as a health psychologist and psychotherapist in a consultation-liaison psychiatry (CLP) service operating in a general hospital in Lugano (Switzerland). METHODS: An autoethnographic method is applied through calling on childhood memories on architecture and analyzing insights regarding the healthcare space in everyday work as a psychologist. Photographs and drawings are employed as evocative material. RESULTS: Autoethnographical data show that building interiors can be a metaphor for an inner dimension. Spaces can be perceived as depersonalized in hospital. Through psychoanalytical theory, it is argued that space becomes ideal for CLP if it can ensure the continuity of the patient's self during hospitalization. Proximity, confidentiality, and privacy are healthcare design requirements to be considered for favoring potential space and psychological intervention. CONCLUSION: Fostering potential space represents an outstanding challenge for the hospital of tomorrow in order to humanize healthcare spaces and promote a person-centered approach.

Hope and therapeutic privilege: time for shared prognosis communication.

Communicating an unfavourable prognosis while maintaining patient hope represents a critical challenge for healthcare professionals (HPs). Duty requires respect for the right to patient autonomy while at the same time not doing harm by causing hopelessness and demoralisation. In some cases, the need for therapeutic privilege is discussed. The primary objectives of this study were to explore HPs' perceptions of hope in the prognosis communication and investigate how they interpret and operationalise key ethical principles. Sixteen qualitative semistructured interviews with HPs from different positions and experience, including doctors and nurses in four different departments (intensive care, oncology, palliative care, rehabilitation), were conducted in the Ticino Cantonal Hospital, Switzerland. The interviews were recorded, transcribed verbatim and analysed using thematic analysis. HPs defined prognosis and patient hope as interdependent concepts related to future perspectives for subjective quality of life. Two main factors allow HPs to maximise the benefits and minimise the harm of their communication: respecting the patient's timing and sharing the patient's wishes. Time is required to reframe needs and expectations. Furthermore, communication needs to be shared by HPs, patients and their relatives to build common awareness and promote a person-centred approach to prognosis. In this process, interprofessional collaboration is key: doctors and nurses are complementary and can together guarantee that patients and relatives receive information in the most appropriate form when they need it. Organisational aspects and the HPs' emotional difficulties, particularly in coping with their own despair, are barriers to effective communication that need further investigation.

Influence of Empathy Disposition and Risk Perception on the Psychological Impact of Lockdown During the Coronavirus Disease Pandemic Outbreak.

During the current COVID-19 pandemic, and especially in the absence of availability of an effective treatment or a vaccine, the main health measure is neither chemical nor biological, but behavioral. To reduce the exponential growth of infections due to the new coronavirus (SARS-CoV-2) and the resulting overburdening of the healthcare system, many European Countries, parts of the US and Switzerland gradually implemented measures of quarantine and isolation defined as lockdown. This consideration leads to the need to understand how individuals are motivated to protect themselves and others. Recent research suggested that prosocial mental dispositions, such as empathy, might promote adherence to social norms of distancing. Other research conducted during the COVID-19 outbreak indicates, however, that empathy levels might fluctuate according to anxiety linked to the risk of death, and this negatively predicted prosocial willingness. The present protocol proposes a study on whether people's empathic dispositions, interacting with the levels of risk, influence the psychological impact of lockdown. The rationale is that emphatic dispositions, encouraging the acceptance of the lockdown, determine a better psychological adaptation and less distress. One retrospective study will be developed in Switzerland and, if the pandemic conditions force a new wave of lockdown on the population, one prospective study as well. A total of 120 participants will be involved, distinguished by their level of objective risk: (1) high objective risk (COVID-19 positive patients, hospitalized in isolation in post-acute phase); (2) moderate objective risk (COVID-19 positive patients, isolated at home); (3) minimum objective risk (non-positive adults, in lockdown). Measures of perceived risk of being contagious for third parties, empathic dispositions and acceptance of lockdown will be collected. The expected results provide important answers related to the immediate impact of empathic dispositions, effective risk and risk perception on the psychological impact of lockdown during a pandemic outbreak. Data gathered from this study could inform policy makers and public health managers about the best communication strategies that will take into account the various stages of health risk and, in particular, to modulate messages to the population aimed at inducing self-isolation behaviors.

The role of hope for health professionals in rehabilitation: A qualitative study on unfavorable prognosis communication.

BACKGROUND: The communication of prognosis represents an ethical and clinical challenge in medical practice due to the inherent uncertain character of prognostic projections. The literature has stressed that the mode of communicating prognoses has an impact on patients' hope, which is considered to play a major role in adapting to illness and disability. In light of this, this study aims to explore health professionals' (HPs) perceptions of the role of hope in rehabilitation and to examine if and how they use strategies to maintain hope when discussing prognostic information with patients. METHODS: Eleven qualitative semi-structured interviews with a purposive sample of HPs were conducted at two rehabilitation clinics in the Canton of Ticino, Switzerland. The interviews were analyzed using thematic analysis. RESULTS: The HPs perceive hope in rehabilitation as a double-edged sword. Three main strategies were identified to maintain hope while avoiding false hope: 1) giving space for self-evaluation; 2) tailoring the communication of prognostic information; and 3) supporting the patient in dealing with the prognosis. These strategies are particularly suitable when HPs consider that patients might not be ready to accept the prognosis, due to their expectations for recovery. CONCLUSIONS: The strategies identified here support a person-centered approach to the communication of prognosis and are in line with existing protocols for the communication of unfavorable medical information. The findings emphasize the need for strengthening communication and inter-professional collaboration skills of rehabilitation HPs.

New perspectives on substituted relational autonomy for shared decision-making in critical care.

In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives. Whereas patient-centred approaches are widely discussed and fostered, managing communication in complex, especially end-of-life, situations in open intensive care units is still a point of debate and a possible source of conflict and moral distress. In particular, healthcare teams are often sceptical about the growing role of families in shared decision-making and their ability to represent patients' preferences. New perspectives on substituted relational autonomy are needed for overcoming this climate of suspicion and are discussed through recent literature in the field of medical ethics.

Sharing intimacy in "open" intensive care units.

PURPOSE: Opening intensive care units (ICUs) is particularly relevant because of a new Swiss law granting the relatives of patients without decision-making capability a central role in medical decisions. The main objectives of the study were to assess how the presence of relatives is viewed by patients, health care providers, and relatives themselves and to evaluate the perception of the level of intrusiveness into the personal sphere during admission. MATERIAL AND METHODS: In a longitudinal and prospective design, qualitative questionnaires were submitted concomitantly to patients, relatives, and health care providers consecutively over a 6-month period. The study was conducted in the 4 ICUs of the public hospitals of Canton Ticino (Switzerland). RESULTS: The questionnaires collected from patients, relatives, and health care providers were 176, 173, and 134, respectively. The analysis of the answers of 120 patient-relative pairs showed consistent results (P < .0001), whereas those of health care providers were significantly different (P < .0001), regarding both the usefulness of opening ICUs to patient relatives and what was stressful during admission. CONCLUSIONS: Relatives in these "open" ICUs share a great deal of intimacy with the patients. Their presence and the deriving benefits were seen as very positive by patients and relatives themselves. Skepticism, instead, prevailed among health care providers.

Medical Humanities: a question of style.

The Medical Humanities go beyond bioethics, cross over multiple disciplines and represent a new way of perceiving, seeing and thinking about illness. They represent a different view that gives value to the human side of treatment, that recognizes in self-narration an authentic and living foundation. Today, the technical aspects of medicine need more than ever to be accompanied by content derived from the arts and social or human sciences that focus on other, but not less important, aspects of being sick or in health. Everyday clinical practice in a "Medical Humanities style" can change the encounter with patients and their families, as well as the relationship with one's self and with colleagues. Adopting this wider perspective allows us to go further than contemporary biomedicine and continue to explore a unique understanding of mankind.