The need for a change in medical research thinking. Eco-systemic research frames are better suited to explore patterned disease behaviors.

Many practicing physicians struggle to properly evaluate clinical research studies - they either simply do not know them, regard the reported findings as 'truth' since they were reported in a 'reputable' journal and blindly implement these interventions, or they disregard them as having little pragmatic impact or relevance to their daily clinical work. Three aspects for the latter are highlighted: study populations rarely reflect their practice population, the absolute average benefits on specific outcomes in most controlled studies, while statistically significant, are so small that they are pragmatically irrelevant, and overall mortality between the intervention and control groups are unaffected. These observations underscore the need to rethink our research approaches in the clinical context - moving from the predominant reductionist to an eco-systemic research approach will lead to knowledge better suited to clinical decision-making for an individual patient as it takes into account the complex interplay of multi-level variables that impact health outcomes in the real-world setting.

Life, complexity, and psychotherapy: A systemic perspective on the elusive construct of extra-therapeutic factors.

Study Aims: Despite being mentioned in well-known models of psychotherapeutic change, the concept of extra-therapeutic factors seems to have left the scene across time, eaten away by the progressive refinement of the construct of common factors. Aim of the present study is to better understanding the historical evolution of the concept of extra-therapeutic factors and its importance for psychotherapy today.

Methods: This is a position paper based on a literature review on extra-therapeutic factors and psychotherapy outcome and process.

A consulting room with a view: Psychotherapy and the ecological context.

Background: The field of psychotherapy is witnessing a lively debate today. The literature on the efficacy of psychological interventions has grown exponentially, but the assumptions of the prevailing research paradigms have been criticised from many points of view. One of the main concerns is that of a too often simplistic conception of psychotherapy, viewed as a set of specific methods for the treatment of point-like problems or symptoms.

A critical evaluation of choice negotiation for patient-centred medicine and psychotherapy.

Study Aims: The present paper aimed at discussing how the process of decision-making should be taken care of in healthcare services.

Methods: This is a position paper based on a review of the relevant literature about meaning-making processes in medical encounters and psychotherapy.

Discussion: Authors argued that choice options could be perceived as meaningful by patients if their uncertainties were taken into account and grounded on mutual understanding and reciprocal trust.

Methods for informing people with amyotrophic lateral sclerosis/motor neuron disease of their diagnosis.

Background: Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), causes increasing physical impairment and disability. People with ALS/MND face huge physical challenges, and the diagnosis can be a source of great psychological distress for both people with ALS/MND and their carers. In such a context, how news of the diagnosis is broken is important.

Thick description and systems thinking: Reiterating the importance of a biopsychosocial approach to mental health.

Study Aims: The article aims at reiterating the importance of a biopsychosocial approach to mental health, taking stock of the critiques that have been raised and moving forward throughout a reconsideration of the theoretical background of systems thinking and emphasizing the relevance of the concept of thick description for the promotion of an adequate reflection on methodology and case formulation.

Literature Review: It is our opinion that the biopsychosocial approach is still a powerful framework for making sense of the growing data collected in the different fields related to mental health and for designing proper treatment plans. A crucial challenge for mental health is that of surpassing the dichotomies and ideological disputes that still contaminate the field with detrimental effects on the advancement of knowledge and on the integration and continuity of different kind of interventions.

Psycho-social impact of social distancing and isolation due to the COVID-19 containment measures on patients with physical disabilities.

Background: While the COVID-19 pandemic was spreading worldwide, the Italian government stated lockdown, with a drastic reorganization of healthcare systems. The psychological and social effects of the pandemic and the restrictions of freedom could have had a detrimental impact on people with physical disabilities, for whom well-being depends strongly on their social environment.

Aim: Our main aim was to describe the overall impact of the pandemic on mental health, social condition and illness perception among patients with disabilities, to provide early interventions for this particularly vulnerable population.

Family functioning and psychological distress in a sample of mental health outpatients: Implications for routine examination and screening.

Rationale, Aims, And Objectives: Clinical and research evidence suggests that family functioning is an important variable in shaping psychological well-being, despite being often overlooked in the prevailing approaches to mental health. The aim of the present study is to examine the associations between psychological distress and family functioning in a sample of patients accessing a public mental health service.

Method: CORE-OM and FACES IV questionnaires were administered to 112 patients, and all the correlations between the scales and subscales were calculated.

Caregiver burden and family functioning in different neurological diseases.

Aim of this study is to examine caregiver burden and family functioning in different neurological conditions. Forty-two primary caregivers of patients with Amyotrophic Lateral Sclerosis (ALS), Alzheimer's Disease and other dementia (AD), Parkinson's Disease (PD), Acquired Brain Injuries (ABI) and Multiple Sclerosis (MS) were administered scales for the evaluation of caregiver burden (CBI) and family functioning (FACES IV). Caregiver burden was overall high, with caregivers of patients with ALS and ABI having exceeded the CBI cut-off score for possible burn-out.

Relationship quality of persons with obstructive sleep apnoea syndrome.

In the field of sleep disorders, the quality of couple relationship is arousing increasing attention, given its implications for quality of life and treatment adherence. The aim of the present study was to evaluate relationship quality in a sample of treated or untreated patients with Obstructive Sleep Apnoea Syndrome. Eighty-seven patients were recruited in a hospital-based Centre for Sleep Medicine.

Sleep disorders in menopause: results from an Italian Multicentric Study.

Menopause in the female life cycle is a special period due to important hormonal, physical and psychological changes. Sleep disruption represents a common complaint for midlife and menopausal women, related to primary sleep disorders, including insomnia, sleep disordered breathing, restless legs syndrome (RLS), mood and anxiety disorder, other medical illness, hormonal-related vasomotor symptoms, and aging per se. Aims of our study were to evaluate the prevalence of sleep disorders in a sample of pre and post menopausal women, and to investigate the relationship between sleep and other medical disorders, and life habits.

Psychological well-being of patients with insomnia and its relationship with anxiety and depression.

The aims of the present study are to evaluate the impact of insomnia on psychological well-being and to examine the associations of insomnia and psychological well-being with anxiety and depression. Forty-one patients attending our hospital-based Centre for sleep medicine were administered scales for the evaluation of insomnia (ISI), anxiety (STAI-Y), depression (BDI-II) and psychological well-being (PWB). The scores were compared to those of a control group of 68 subjects attending the hospital for routine examinations or as accompanying persons.

Family functioning in severe brain injuries: correlations with caregivers' burden, perceived social support and quality of life.

Severe brain injuries have long-term consequences on functional status and psychosocial functioning. Family life can be greatly influenced as well, and features of high caregiver burden can emerge. Although the data on caregivers' distress are constantly increasing, less information is available about the role of family functioning.

Relationship quality and perceived social support in persons with spinal cord injury.

Study Design: This is a cross-sectional study.

Objectives: The objective of this study was to examine the associations among the quality of couple relationship, perceived social support and health-related quality of life (HRQoL) in persons with spinal cord injury (SCI).

Setting: The study was conducted in Italy.

Functional status and quality of life of stroke survivors undergoing rehabilitation programmes in a hospital setting.

Background: While the positive effects of rehabilitation on physical functioning are well documented in stroke literature, more controversial results arise from the evaluation of the impact on quality of life.

Objective: The aim of the present study is to examine the associations among functional status and different measures of quality of life in a sample of inpatients undergoing rehabilitation programmes, and to consider the role of psychological distress, coping strategies and social support.

Methods: Twenty-nine stroke survivors were evaluated at the admission to a hospital-based Rehabilitation Unit and just before discharge.

A permanent emergency: a longitudinal study on families coping with amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that has a strong impact on the lives of the people affected and on their close relatives, who have to tackle the demanding duties of caring for and assisting them. Family life can be profoundly influenced by this disease, and evaluating how the relevant parameters of family functioning relate to the markers of psychological adjustment of patients and caregivers is an important research objective, with implications for clinical practice. We examined the associations of family cohesion and adaptability (FACES III) with patients' coping strategies (MND Coping Scale) and caregivers' burden (CBI) in a longitudinal study with a sample of 19 pairs of patients with ALS and primary caregivers.

Age, gender, kinship and caregiver burden in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis is a neurodegenerative disease that affects the motor neurons and causes progressive physical impairment. Also, other functions, such as breathing, swallowing and speech are compromised, and the loss of independence makes caregiver burden extremely high. The present study aimed at evaluating the differences in the caregiver burden due to age, gender and kinship.

Individualised and health-related quality of life of persons with spinal cord injury.

Study Design: Cross sectional.

Objectives: To examine associations among functional status, health-related and individualised quality of life (QoL) and coping style in subjects with spinal cord injury (SCI).

Setting: Italy.

Balancing between autonomy and support: coping strategies by patients with amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) makes a strong psychological impact, and the study of efforts by patients to cope with the course of the disease could be an important first step in the optimisation of care treatment. With this aim, in our study we assessed the coping strategies by a population of ALS patients, according to some clinical parameters and the worsening of the disease. We have administered the MND coping scale to 62 patients, firstly at the admission to our neurorehabilitation unit and secondly after 1year.

Quality of life of patients with amyotrophic lateral sclerosis.

The aim of this study is to evaluate the correlation between different measures of quality of life (QoL), functional status and mood status in patients with amyotrophic lateral sclerosis (ALS). A sample of 40 patients with ALS was recruited and scales for the evaluation of health-related QoL (SF36), patient-centered QoL (SEIQoL), functional status (ALSFRS) and depression (ZDS) have been administered to them. All the correlations (Pearson's r) between the scores have been considered and the t-test was performed in order to compare male with female patients.