Investigation of the Impacts of Parental Chronic Illness on Youth Caregiving Experiences and Psychosocial Adjustment.

Objective: Parental chronic illness has an impact on several aspects of offspring’s life. Three major impediments to research progress in this field are undeveloped and untested theoretical frameworks, no clear conceptualization of youth caregiving, and no available instrument to assess such construct in Italian. To address these weaknesses, the aims of this PhD dissertation were: (1) to investigate the psychometric properties of the Italian version of the Young Caregiver of Parents Inventory-Revised (YCOPI-R); (2) to empirically examine a model of the effects of parental illness on youth and family functioning innovatively analyzing the role of psychological flexibility; (3) to test a refined conceptualization of youth caregiving. Methods: A total of 501 adolescents aged 11 to 24 (295 young caregivers and 206 young noncaregivers) completed a questionnaire regarding youth caregiving, parental illness, and youth adjustment. In the first study, young caregivers were compared to noncaregivers, while the other studies used only the young carers subgroup. Results: The first study indicated that the Italian version of the YCOPI-R demonstrated sound psychometric and was able to discriminate between young caregivers and noncaregivers. The second study underlined the key protective role of psychological flexibility in shaping youth adjustment and family functioning in the context of parental illness. The third study innovatively clarified the nature of youth caregiving, indicating that it is a tripartite construct related to both positive and negative youth adjustment outcomes. Conclusions. This PhD project drew attention towards youth of chronically ill parents, a segment of the young population which is presently almost completely neglected in Italy by health policies and healthcare providers. This PhD project ultimately shed light into the processes through which parental illness results in detrimental youth outcomes and highlighted avenues for interventions that target empirically supported mechanisms which ameliorate the detrimental effects of parental illness on youth.

From emerging adults' unmet psychosocial needs to their problematic use of social networking sites: the mediating role of Fear of Missing Out

Fear of Missing Out (FoMO) is a pervasive apprehension that others might be having rewarding experiences from which one is absent. Consequently, individuals experiencing FoMO wish to stay constantly in contact with what others are doing and engage with social networking sites for this purpose. In recent times, FoMO has received increased attention from psychological research, as a minority of users experiencing high levels of FoMO - particularly young people - might develop a problematic social networking site use, defined as the maladaptive and excessive use of social networking sites, resulting in symptoms associated with other addictions. According to the theoretical framework of the Interaction of Person-Affect-Cognition- Execution (I-PACE) model, FoMO and certain motives for use may foster problematic use in individuals who display unmet psychosocial needs. However, to date, the I-PACE model has only conceptualized the general higher-order mechanisms related to the development of problematic use. Consistently, the overall purpose of this dissertation was to deepen the understanding of the mediating role of FoMO between specific predisposing variables and problematic social networking sites use. Adopting a psychological approach, two empirical and exploratory cross-sectional studies, conceived as independent research, were conducted through path analysis.

Profilo psicopatologico e qualità della vita in bambini e adolescenti narcolettici: studio caso-controllo

Scopo del nostro lavoro è stato descrivere ed inquadrare gli aspetti psico-comportamentali e la qualità di vita della narcolessia in età evolutiva. Metodi: Abbiamo pertanto disegnato uno studio caso-controllo comprendente 30 pazienti narcolettici, 39 epilettici, e 39 controlli sani, appaiati per sesso e età. Risultati: La nostra popolazione di bambini e adolescenti affetti da narcolessia mostra un aumento delle problematiche internalizzanti. I due gruppi patologici hanno in comune punteggi più elevati rispetto ai controlli per i disturbi d’ansia, le difficoltà attentive e di socializzazione, i disturbi oppositivo-provocatori. Ciò che distingue, invece, i pazienti narcolettici, sono gli aspetti di ritiro e depressione, la tendenza alla somatizzazione, i problemi del pensiero ed i disturbi affettivi. Fattori di rischio psicopatologici per i giovani narcolettici sono risultati essere l’esordio precoce, il ritardo diagnostico, il sonno notturno disturbato, la minor latenza di sonno all’addormentamento, un maggior numero di SOREMP all’MSLT. Dall’altro lato la terapia farmacologica, un maggior numero di sonnellini spontanei e la durata di malattia, sembrano influenzare positivamente l’evoluzione comportamentale. La salute psicosociale dei giovani narcolettici, inoltre, risulta essere peggiore rispetto ai controlli sani, mentre la salute fisica non mostra differenze. I problemi internalizzanti influenzano negativamente tutti gli ambiti della salute di questi ragazzi, mentre la durata di malattia sembra migliorare il funzionamento scolastico. Conclusioni: Il nostro lavoro conferma che i giovani narcolettici presentano un maggior rischio psicopatologico sia rispetto ai controlli sani sia rispetto un’altra patologia neurologica cronica. Se da un lato alcuni aspetti comportamentali possono essere giustificati come una reazione adattativa verso una patologia neurologica invalidante, dall’altro un quadro distimico caratterizzato da ritiro e lamentele somatiche, sembra essere tipico dei bambini ed adolescenti narcolettici.

The role of medial parieto occipital cortex in visuospatial attention and reach planning: electrophysiological studies in human and non-human primates

We usually perform actions in a dynamic environment and changes in the location of a target for an upcoming action require both covert shifts of attention and motor planning update. In this study we tested whether, similarly to oculomotor areas that provide signals for overt and covert attention shifts, covert attention shifts modulate activity in cortical area V6A, which provides a bridge between visual signals and arm-motor control. We performed single cell recordings in monkeys trained to fixate straight-ahead while shifting attention outward to a peripheral cue and inward again to the fixation point. We found that neurons in V6A are influenced by spatial attention demonstrating that visual, motor, and attentional responses can occur in combination in single neurons of V6A. This modulation in an area primarily involved in visuo-motor transformation for reaching suggests that also reach-related regions could directly contribute in the shifts of spatial attention necessary to plan and control goal-directed arm movements. Moreover, to test whether V6A is causally involved in these processes, we have performed a human study using on-line repetitive transcranial magnetic stimulation over the putative human V6A (pV6A) during an attention and a reaching task requiring covert shifts of attention and reaching movements towards cued targets in space. We demonstrate that the pV6A is causally involved in attention reorienting to target detection and that this process interferes with the execution of reaching movements towards unattended targets. The current findings suggest the direct involvement of the action-related dorso-medial visual stream in attentional processes, and a more specific role of V6A in attention reorienting. Therefore, we propose that attention signals are used by the V6A to rapidly update the current motor plan or the ongoing action when a behaviorally relevant object unexpectedly appears at an unattended location.

Adulthood with Turner Syndrome: Quality of life, psychosocial adjustment and clinical management in 70 Italian women

Abstract Background: Turner syndrome (TS) is a chromosomal abnormality (total or partial absence of one of the sexual chromosomes in some or all cells of the body), which affects approximately 1:2000 female. Principal characteristics are short stature and gonadal disgenesis. Clinical management consist of Growth Hormone (GH) treatment and oestrogen replacement therapy (HRT), to induce development of secondary characteristics and to avoid the sequelae of oestrogen deficiency. Aim of the study: To assess clinical management, quality of life (QoL) and general psychosocial adjustment of women with TS. Population: 70 adult Caucasian females with TS (mean age: 27.8, ± 7.6; range 18-48 y.). Setting: Specialist service for Rare Disease care, University Hospital. Methods: Subjects were required to fill in questionnaires collecting ASR, WHOQOL, and 8 open questions. Data were compared with those of the Italian population or to those collected in a comparison group (70 healthy females, mean age: 27.9, ±7.3, range 21-48 y.). Results: Women with TS are educated as well as the Italian Population, but they have a less successful professional life. They show good QoL in general, but they appeared less satisfied in social area. They had statistically higher scores than the comparison group for depression, anxiety and withdrawal. Are less involved in a love relationship. Diagnosis communication was mostly performed by doctors or parents, satisfaction was higher when information was given by parents. Main preoccupation about TS are infertility, feeling of being different and future health problem. Conclusions: Italian people with TS were generally well adapted and have a good QoL, but lived more often with parents and show impaired sentimental and sexual life. They have higher degree of psychological distress compared to a comparison group. Psychological intervention should firstly address parents in order to encourage an open communication on diagnosis issues and on sexual education.

Psychosocial correlates of rehabilitation from stroke: a longitudinal study

The general aim of this dissertation was to uncover the association between psychosocial factors and rehabilitation outcome after stroke. METHOD. A sample of patients with stroke (n=40) and their caregivers (n=36) were assessed at admission to and six months after discharge from rehabilitation hospital, using the following instruments: Structured Clinical Interview for DSM-IV, structured interview based on Diagnostic Criteria for Psychosomatic Research, Symptom Questionnaire, Psychosocial Index, Psychological Well-Being Scales, and Family Assessment Device. 40 subjects from the general population underwent the same psychological assessment. In addition, patients' functional status was measured using the Functional Independence Measure. RESULTS. Stroke survivors reported lower education and higher alcohol consumption than controls. No significant differences emerged between the two groups in the prevalence of psychiatric diagnoses or psychosomatic syndromes, however patients reported significantly higher levels of anxiety, depression, somatic symptoms, and lower autonomy than controls. Caregivers reported significantly higher scores in anxiety, depression, and somatic symptoms compared to normative data, while no impairments emerged in psychological well-being and family functioning. At six-month follow-up, in patients a significant decrease in smoking habit and an increase in DSM diagnoses were reported. Both stroke survivors and caregivers showed significant reductions in anxiety, with patients displaying also a decrease in somatic symptoms, an increase in stress and a deterioration in quality of life. Significant deteriorations in several aspects of family functioning was perceived only by patients. An association between patients' functional recovery in the cognitive domain and family behavior control emerged. For caregivers, family functioning significantly predicted hostility and somatic symptoms were associated with family affective involvement. CONCLUSIONS. These data highlight the utility in the Italian setting of the adoption of a psychosocial assessment and a family-systems approach in stroke rehabilitation, in order to development interventions properly targeted to the characteristics of patients and their family members.