# Background Cognitive impairments, prevalent in 75-80% of schizophrenia patients, severely impact rehabilitation and quality of life. Current therapies, including antipsychotics, have limited success in addressing these deficits. Virtual reality (VR) offers a promising avenue for cognitive training by providing realistic, interactive scenarios for skill application. # Objective This study evaluates the efficacy of a novel VR-based cognitive training intervention in improving cognitive deficits in schizophrenia compared to standard treatment as usual (TAU). # Methods A randomized clinical trial was conducted with 16 inpatients diagnosed with schizophrenia. Participants were allocated to either a VR intervention group, receiving six weekly sessions of VR cognitive training, or a control group undergoing TAU. Pre- and post-intervention assessments included the Trail Making Test, Positive and Negative Syndrome Scale, Frontal Assessment Battery, and Tower of London test. Two VR scenarios, "Supermarket" and "Beach," were developed to target working memory, attention, and executive functioning. Data were analyzed using t-tests and linear mixed-effects models. # Results The VR intervention group showed significant improvements in frontal lobe functioning as measured by the Frontal Assessment Battery (FAB) and trends toward better executive function and attention. Scenario-specific analyses revealed reduced errors, omissions, and execution times across sessions. However, broader cognitive and psychiatric symptom improvements were limited and did not persist after multiple-comparison corrections. # Conclusion VR cognitive training shows potential as an innovative tool for enhancing executive functioning in schizophrenia patients. While immediate task performance improved, broader cognitive impacts and psychiatric symptom reductions were minimal. Future research should focus on long-term efficacy, functional outcomes, and scalability of VR interventions.

The COVID-19 pandemic greatly impacted global health. Frontline healthcare workers involved in the response to COVID-19 faced physical and psychological challenges that threatened their wellbeing and job satisfaction. The pandemic crisis, alongside pre-existing critical issues, exposed healthcare workers to constant emotional fatigue, creating an increased workload and vulnerability to stress. Maintaining such stress levels increased their levels of anxiety, irritability and loneliness. Evidence shows that the Psychological Capital (PsyCap) was a strong protective factor against these stressors. The aim of this study was to analyze the level of job satisfaction among health workers facing the COVID-19 pandemic. The possible antecedent factors to satisfaction and the role that PsyCap plays in preserving and fostering higher levels of job satisfaction were investigated. A total of 527 healthcare workers from different areas of Italy were recruited for the study. The results revealed that psychological stress factors have a considerable impact on job satisfaction. All four predictors (Stress Vulnerability, Anxiety Symptoms, Loneliness and Irritability) had the potential to decrease job satisfaction. Loneliness had a more significant effect than other factors assessed in this study. Moreover, the results showed how PsyCap could decrease the effects of psychological stressors on job satisfaction. Consistent with previous studies, our findings show that PsyCap could alleviate negative impacts in work-related circumstances.

The JSS is based on the theoretical position that job satisfaction represented an affective or attitudinal reaction to a job, and today is one of the most popular instruments used in I-O psychology. This paper discusses the contribution to the validation of an Italian adaptation of the Job Satisfaction Survey. Five hundred and twenty-seven participants (258 men, 269 women) were enrolled to participate in this study, aged between 19 and 65 (Mage = 36.0, SD = 11.7). The sample mostly worked in public administration, in health care, and in the educational sector. A self-report questionnaire is used to investigate the psychometric properties of this scale, also measuring other variables. A back-translation procedure is used. The results pinpointed the goodness of the scale and the normality distribution. Confirmative factor analyses and multigroup confirmative factor analyses were performed to verify the factorial structure of the scale. The results confirmed the same factorial structure of the original version, suggesting a nine higher-order factor structure. The results from the multigroup confirmatory factor analysis showed that this factor solution was invariant across gender (men vs. women) and found evidence for metric invariance, uniqueness invariance, and scalar and structural invariance. The findings confirmed the applicability in the Italian context.

ABSTRACT Background Smoking prevalence among people with mental disorders is about two to four times higher than in the general population. As a result of high smoking rates, people with a mental health condition also have high rates of morbidity and mortality from smoking-related diseases compared with the general population. Progress in reducing smoking prevalence in people with mental health diagnoses has been very slow compared to the general population. Consequently, there is a pressing need for alternative and more efficient interventions to reduce or prevent morbidity and mortality in smokers with schizophrenia spectrum disorders. Methods A volunteer population of 258 adult smokers with Schizophrenia Spectrum Disorder will be recruited for the GENESIS study, a randomized, double blind, smoking cessation trial comparing effectiveness, safety and subjective effects between 5% and 1.5% nicotine e-cigarette. The study duration will be 12-month. The primary endpoint of this study will be the continuous quit rate defined as the proportion of study participants who self-report that they had stopped smoking at 6-month, biochemically verified by exhaled CO measurements of ≤ 7 ppm. These participants will be referred to as “Quitters”. The differences in continuous variables between the two groups for normally distributed data will be evaluated by one-way analysis of variance (ANOVA). The differences between the two groups for not normally distributed data will be evaluated by the Mann-Whitney U test. Any correlation between the variables under evaluation will be assessed by Spearman r correlation. To analyze differences in frequency distribution of categorical variables we will use the Chi-square test with the Yates correction or the Fisher exact test. All statistical tests are two-tailed and are considered to be statistically significant at a P value <0.05. The consistency of effects for pre-specified subgroups will be assessed using tests for heterogeneity. Subgroups will be based on age, sex, education, level of nicotine dependence. Discussion This will be the first multicenter randomized trial directly comparing high (JUUL 5% nicotine) with low nicotine strength devices (JUUL 1.5% nicotine) in term of reduction in cigarette consumption, adoption rates, product acceptability, tolerability, and tobacco harm reduction potential. This knowledge can contribute to a better understanding of e-cigarette with high nicotine content as a pragmatic and much less harmful alternative to tobacco smoking with the possibility of significant health gains in smokers with schizophrenia spectrum disorders. Trial registration ClinicalTrials.gov ID: NCT04452175 . Registered June 29, 2020.

Schizophrenia is a serious psychiatric disorder characterized by positive symptoms, negative symptoms and neurocognitive deficits. The aim of this study was to estimate relationships between wellness, yoga and quality of life in patients affected by schizophrenia spectrum disorders. Participants were 30 patients with a diagnosis of schizophrenia in care at the Rehabilitative Psychiatry and Research Villa Chiara Clinic in Mascalucia (Catania, Italy), after that randomly assigned to two groups. The first group followed the experimental treatment with sets of yoga exercises conducted by a yoga trainer and a psychiatrist or a clinical psychologist expert in yoga, while a second control group was treated with usual care. The results revealed a significant difference, before and after treatment, between the experimental group and the control group in quality of life.

PURPOSE:This study aims to investigate the effects of combining 12-week group psychotherapy with yoga exercises on stress perception and quality of life in mental health professionals.DESIGN/METHODOLOGY/APPROACH:This study was a parallel-arm randomized controlled trial, in which the participants was unaware of which group was the experimental one. Participants involved in our research were assigned to two groups of separate treatment that followed for three months group psychotherapy combined with yoga program for stress management or usual stress coping strategies.FINDINGS:The findings did not reveal a significant difference in stress perception assessed in the two groups either before or after intervention but reveal a significant difference in the quality of life in the two groups before and after the psycho behavioral interventions.ORIGINALITY/VALUE:The findings did not reveal a significant difference in stress perception assessed in the two groups either before or after intervention but reveal a significant difference in the quality of life in the two groups before and after the psycho behavioral interventions.

Cognitive dysfunctions are a common clinical feature of schizophrenia and represent important indicators of outcome among patients who are affected. Therefore, a randomized, controlled, monocentric, single-blind trial was carried out to compare two different rehabilitation strategies adopted for the restoration and recovery of cognitive functioning of residential patients with schizophrenia. A sample of 110 residential patients were selected and, during the experimental period, a group of 55 patients was treated with sets of domain-specific exercises (SRT+CRT), whereas an equal control group was treated with sets of non-domain-specific exercises (SRT+PBO) belonging to the Cogpack® software. The effects on the scores (between T0 and T1) of the variables treatment and time and of the interaction time X treatment were analyzed: for the total BACS, the main effect of the between-factors variable treatment is statistically significant (F=201.562 P=0.000), as well as the effect of the within-factors variable “time” (F=496.68 P=0.000).The interaction of these two factors is also statistically significant (F=299.594 P=0.000). The addition of cognitive remediation therapy (CRT) to a standard treatment of metacognitive training (MCT) resulted in a significant improvement in global neurocognitive functioning and has reported positive effects with regard to the strengthening of verbal and working memory, selective and sustained attention at T1. A relevant result is the statistically significance of “time X treatment” for all the tests administered: we can assume that the domain-specific cognitive training amplifies the effects of SRT, as the primary and secondary goals of the present study were achieved.

BACKGROUND:It is well established in studies across several countries that tobacco smoking is more prevalent among schizophrenic patients than the general population. Electronic cigarettes are becoming increasingly popular with smokers worldwide. To date there are no large randomized trials of electronic cigarettes in schizophrenic smokers. A well-designed trial is needed to compare efficacy and safety of these products in this special population.METHODS/DESIGN:INTERVENTION:We have designed a randomized controlled trial investigating the efficacy and safety of electronic cigarette. The trial will take the form of a prospective 12-month randomized clinical study to evaluate smoking reduction, smoking abstinence and adverse events in schizophrenic smokers not intending to quit. We will also monitor quality of life, neurocognitive functioning and measure participants' perception and satisfaction of the product.OUTCOME MEASURES:A ≥50% reduction in the number of cigarettes/day from baseline, will be calculated at each study visit ("reducers"). Abstinence from smoking will be calculated at each study visit ("quitters"). Smokers who leave the study protocol before its completion and will carry out the Early Termination Visit or who will not satisfy the criteria of "reducers" and "quitters" will be defined "non responders".STATISTICAL ANALYSIS:The differences of continuous variables between the three groups will be evaluated with the Kruskal-Wallis Test, followed by the Dunn multiple comparison test. The differences between the three groups for normally distributed data will be evaluated with ANOVA test one way, followed by the Newman-Keuls multiple comparison test. The normality of the distribution will be evaluated with the Kolmogorov-Smirnov test. Any correlations between the variables under evaluation will be assessed by Spearman r correlation. To compare qualitative data will be used the Chi-square test.DISCUSSION:The main strengths of the SCARIS study are the following: it's the first large RCT on schizophrenic patient, involving in and outpatient, evaluating the effect of a three-arm study design, and a long term of follow-up (52-weeks).The goal is to propose an effective intervention to reduce the risk of tobacco smoking, as a complementary tool to treat tobacco addiction in schizophrenia.TRIAL REGISTRATION:ClinicalTrials.gov, NCT01979796.

Pasquale Caponnetto, PhD1,2,3, Roberta Auditore, MD3, Cristina Russo, MD, PhD1,2,3, Angela Alamo, MD1,2, Davide Campagna, MD1,2, Shirin Demma, MD1,2, Riccardo Polosa, MD, PhD1,2 1Smoking Prevention/Cessation Centre, A.O.U, Policlinico-V. Emanuele, University of Catania, Catania, Italy 2Institute of Internal Medicine, G. Rodolico Hospital, A.O.U, Policlinico-V. Emanuele, University of Catania, Catania, Italy 3CTA-Villa Chiara Psychiatric Rehabilitation Clinic and Research, Mascalucia, Catania, Italy

BACKGROUND:Cigarette smoking is a tough addiction to break. This dependence is the most common dual diagnosis for individuals with schizophrenia. Currently three effective drugs are approved for smoking cessation: nicotine replacement therapy (NRT), varenicline and bupropion. However, some serious side effects of varenicline have been reported, including depression, suicidal thoughts, and suicide. The use of bupropion also has side effects. It should not be used by people who have epilepsy or any condition that lowers the seizure threshold, nor by people who take a specific class of drugs called monoamine oxidase inhibitors. Hence, there are pharmacodynamic reason to believe they could precipitate or exacerbate psychosis. For its capacity to deliver nicotine and provide a coping mechanism for conditioned smoking cues by replacing some of the rituals associated with smoking gestures, electronic-cigarettes may reduce nicotine withdrawal symptoms without serious side effects. Our recent work with ECs in healthy smokers not intending to quit consistently show surprisingly high success rates. We hypothesised that these positive findings could be replicated in difficult patients with schizophrenia This tool may help smokers with schizophrenia remain abstinent during their quitting attempts or to reduce cigarette consumption. Efficacy and safety of these devices in long-term smoking cessation and/or smoking reduction studies have never been investigated for this special population.METHODS:In this study we monitored possible modifications in smoking habits of 14 smokers (not intending to quit) with schizophrenia experimenting with the "Categoria" e-Cigarette with a focus on smoking reduction and smoking abstinence. Study participants were invited to attend six study visits: at baseline, week-4, week-8, week-12 week-24 and week 52. Product use, number of cigarettes smoked, carbon monoxide in exhaled breath (eCO) and positive and negative symptoms of schizophrenia levels were measured at each visit. Smoking reduction and abstinence rates were calculated. Adverse events were also reviewed.RESULTS:Sustained 50% reduction in the number of cig/day at week-52 was shown in 7/14 (50%) participants; their median of 30 cig/day decreasing significantly to 15 cig/day (p = 0.018). Sustained smoking abstinence at week-52 was observed in 2/14 (14.3%) participants. Combined sustained 50% reduction and smoking abstinence was shown in 9/14 (64.3%) participants. Nausea was observed in 2/14 (14.4%) of participants, throat irritation in 2/14 (14.4%) of participants, headache in 2/14 (14.4%) of participants , and dry cough in 4/14 (28.6%) of participants. However, these adverse events diminished substantially by week-24. Overall, one to two cartridges/day were used throughout the study. Positive and negative symptoms of schizophrenia are not increased after smoking reduction/cessation in patients using e-cigarettes.CONCLUSIONS:We have shown for the first time that the use of e-cigarette substantially decreased cigarette consumption without causing significant side effects in chronic schizophrenic patients who smoke not intending to quit. This was achieved without negative impacts on the symptoms of schizophrenia as assessed by SAPS and SANS symptoms scales.

Le fondamenta di ogni attività investigativa relativa ad un delitto si trovano nell’analisi della scena del crimine ovvero nel sopralluogo. E’ da lì che si parte con le indagini ed è lì che, eccetto casi particolari, si nascondono i dettagli che possono contribuire all’individuazione dell’autore del reato. L’obiettivo di questa trattazione è quello di porre in evidenza la necessità di adottare una prospettiva diversa nell’analisi della scena del crimine, specie per quanto riguarda i crimini di stampo occultista. Bisogna necessariamente abbandonare ogni tipo di analisi che tenda a scomporre gli eventi e gli elementi presenti sulla scena del crimine e adottare una prospettiva che unisca, che guardi al tutto per comprenderne le parti, una prospettiva, dunque, di tipo sistemico.Les bases de chaque enquête criminelle sont dans l’analyse de la scène de crime, c’est-à-dire l’inspection.L’objectif de cet article est de mettre en évidence la nécessité d’adopter une perspective différente pour analyser la scène du crime, en particulier pour des crimes liés aux sectes sataniques. Dans ces cas, il est nécessaire d’abandonner toutes les analyses qui visent à morceler les événements et les éléments de la scène de crime. En revanche, il faut adopter une perspective systémique qui examine le tout et les parties en les considérant dans leur ensemble.The first step in any background investigation related to a crime may be found in crime scene analysis, or rather in the inspection. The goal of this article is to highlight the need to adopt a different approach in crime scene analysis particularly for crimes linked to satanic cults. In these cases, we need to give up any analysis aimed at breaking up all the events and elements of the crime scene; a systemic perspective looking at all parts must be adopted in order to combine them and to understand each of these.

In a prior study on electronic cigarette (EC) refill fluids, Cinnamon Ceylon was the most cytotoxic of 36 products tested. The purpose of the current study was to determine if high cytotoxicity is a general feature of cinnamon-flavored EC refill fluids and to identify the toxicant(s) in Cinnamon Ceylon. Eight cinnamon-flavored refill fluids, which were screened using the MTT assay, varied in their cytotoxicity with most being cytotoxic. Human embryonic stem cells were generally more sensitive than human adult pulmonary fibroblasts. Most products were highly volatile and produced vapors that impaired survival of cells in adjacent wells. Cinnamaldehyde (CAD), 2-methoxycinnamaldehyde (2MOCA), dipropylene glycol, and vanillin were identified in the cinnamon-flavored refill fluids using gas chromatography–mass spectrometry and high-pressure liquid chromatography (HPLC). When authentic standards of each chemical were tested using the MTT assay, only CAD and 2MOCA were highly cytotoxic. The amount of each chemical in the refill fluids was quantified using HPLC, and cytotoxicity correlated with the amount of CAD/product. Duplicate bottles of the same product were similar, but varied in their concentrations of 2MOCA. These data show that the cinnamon flavorings in refill fluids are linked to cytotoxicity, which could adversely affect EC users.

La coppia criminale è un fenomeno poco comune nell'ambito dei delitti in quanto la maggior parte dei criminali commette il crimine da solo o coinvolge altri individui solo per caso. Ciò nonostante, la letteratura rivela una serie di coppie criminali che hanno commesso diversi crimini, fino ad arrivare all’omicidio. Alcuni hanno ucciso per denaro, altri per odio, altri ancora per amore, per vendetta, per perversione. Bonnie e Clyde, Olindo e Rosa, Erika e Omar sono espressione di un viaggio nel fenomeno del “crimine di coppia” in cui manifestazioni di follia a due, al di là dell’infatuazione reciproca e della dipendenza psicologica, si svuotano di qualsiasi accezione romantica per concretizzarsi in qualcosa di spaventoso e incontenibile, capace di sfuggire ad ogni tipo di catalogazione e comprensione. Nel presente lavoro, in particolare, si andrà ad analizzare la coppia criminale degli autori della strage di Erba, che verrà esaminata nell’ottica della coscienza intersoggettiva di Stern. Le couple criminel est un phénomène rare puisque la majorité des crimes sont commis par des criminels seuls ou ce n’est que par hasard qu’ils impliquent d’autres personnes. Toutefois, la littérature parle d’une série de couples criminels qui ont commis des différents types de crimes (homicide inclus). Certains d’entre eux tuent pour de l’argent, certains autres à cause de la haine, de l’amour, de la revanche ou de la perversion. Bonnie et Clyde, Olindo et Rosa, Erika et Omar constituent des exemples du phénomène du « crime en couple ». Ce sont des situations de folie à deux qui n’ont aucune acception romantique et qui se traduisent en quelque chose d’horrifiant et d’incontrôlé. Dans cet article, les auteurs vont analyser le couple criminel composé par les responsables du massacre de Erba (Italie du Nord). L’objectif est d’examiner ce couple en utilisant l’approche de la conscience intersubjective de Daniel Stern. A criminal couple is an uncommon phenomenon because the majority of criminals commit crime alone or they involve other people only by chance. Nevertheless, literature tells about a series of criminal couples who committed different types of crimes (homicide included). Some of them kill for money, some others because of hatred, love, revenge or perversion. Bonnie and Clyde, Olindo and Rosa, Erika and Omar are some examples of the phenomenon of “crime in a couple”. These are situations of “madness shared by two” (folie à deux), deprived of any romantic meaning and materialised in something horrifying and uncontrolleable. In this article, we are going to analyse the criminal couple presented by the authors of the massacre of Erba (Northern Italy). Our aim is to examine this couple using the approach of the intersubjective conscience of Daniel Stern.

Commonly abused drug are cocaine, marijuana, cigarettes, heroin, and alcohol. The review emphasizes the importance for clinicians to be alert to the possibility of this substance as a precipitating factor for acute asthma. Substance use disorders to characterize illnesses associated with drug use. The use of drugs of abuse increases risk of developing more severe symptoms, higher frequency of exacerbations and having and significant effect on care resources due to clinicians visits and frequent hospital admissions. Abused drug has been shown to accelerate the decline in lung function and to increase numbers of life-threatening asthma attacks, and greater asthma mortality.

The association between nicotine dependence and affective disorders, particularly major depressive disorder (MDD), is well known with high prevalence rates being reported for smokers. The reason for this association is not clear, but, it has been argued that smoking may help individuals to cope with stress or medicate depressed mood. Smoking cessation programs are useful in helping smokers to quit, but smoking is a very difficult addiction to break, especially for people suffering from depression, and the need for novel and effective approaches to smoking cessation interventions for this special population is unquestionable. The e-cigarette is a battery-powered electronic nicotine delivery device (ENDD), which may help smokers to remain abstinent during their quit attempt. Here, we report for the first time objective measures of smoking cessation in two heavy smokers, suffering from depression, who experimented the e-cigarette.

Le fondamenta di ogni attivita investigativa relativa ad un delitto si trovano nell’analisi della scena del crimine ovvero nel sopralluogo. E’ da li che si parte con le indagini ed e li che, eccetto casi particolari, si nascondono i dettagli che possono contribuire all’individuazione dell’autore del reato. L’obiettivo di questa trattazione e quello di porre in evidenza la necessita di adottare una prospettiva diversa nell’analisi della scena del crimine, specie per quanto riguarda i crimini di stampo occultista. Bisogna necessariamente abbandonare ogni tipo di analisi che tenda a scomporre gli eventi e gli elementi presenti sulla scena del crimine e adottare una prospettiva che unisca, che guardi al tutto per comprenderne le parti, una prospettiva, dunque, di tipo sistemico. Les bases de chaque enquete criminelle sont dans l’analyse de la scene de crime, c’est-a-dire l’inspection. L’objectif de cet article est de mettre en evidence la necessite d’adopter une perspective differente pour analyser la scene du crime, en particulier pour des crimes lies aux sectes sataniques. Dans ces cas, il est necessaire d’abandonner toutes les analyses qui visent a morceler les evenements et les elements de la scene de crime. En revanche, il faut adopter une perspective systemique qui examine le tout et les parties en les considerant dans leur ensemble. The first step in any background investigation related to a crime may be found in crime scene analysis, or rather in the inspection. The goal of this article is to highlight the need to adopt a different approach in crime scene analysis particularly for crimes linked to satanic cults. In these cases, we need to give up any analysis aimed at breaking up all the events and elements of the crime scene; a systemic perspective looking at all parts must be adopted in order to combine them and to understand each of these.