Effects of transcutaneous auricular vagus nerve stimulation (taVNS) on motor planning: a multimodal signal study

Motor planning plays a pivotal role in daily life. Transcutaneous auricular vagus nerve stimulation (taVNS) has been demonstrated to enhance decision-making efficiency, illustrating its potential use in cognitive modulation. However, current research primarily focuses on behavioral and single-modal electrophysiological signal, such as electroencephalography (EEG) and electrocardiography (ECG). To investigate the effect of taVNS on motor planning, a total of 21 subjects were recruited for this study and were divided into two groups: active group (n = 10) and sham group (n = 11). Each subject was required to be involved in a single-blind, sham-controlled, between-subject end-state comfort (ESC) experiment. The study compared behavioral indicators and electrophysiological features before and following taVNS. The results indicated a notable reduction in reaction time and an appreciable increase in the proportion of end-state comfort among the participants following taVNS, accompanied by notable alterations in motor-related cortical potential (MRCP) amplitude, low-frequency power of HRV (LF), and cortico-cardiac coherence, particularly in the parietal and occipital regions. These findings show that taVNS may impact the brain and heart, potentially enhancing their interaction, and improve participants' ability of motor planning.

Gambling disorder comorbidity a narrative review

Introduction: Problematic and pathological gambling (PG) lead to major adverse consequences for individuals, their families, and society and is highly comorbid with numerous other mental health disorders.

Methods: This narrative review summarized population-based, cross-sectional, treatment and prospective studies on gambling disorder and comorbidity over the past 14 years.

Results: These studies show a high rate of comorbidity of PG and substance and alcohol use disorders, mood and anxiety disorders. Prospective studies indicate that, in some cases, gambling precedes the onset of the comorbid disorder, while in other instances, the temporal relationship is reversed. Women face greater psychiatric comorbidity and are more likely to have mood disorders, suicidality, mania, anxiety and alcohol dependence. Treatment of PG can be effective by improving the gambling and depressive symptoms of PG.

Conclusions: Over the past 15 years, significant progress has been made in understanding and treating GD and its psychiatric comorbidities, with evidence highlighting the reciprocal relationships between GD and conditions like substance use, mood and anxiety disorders.

Physical symptoms and inflammatory levels characterize post-COVID-19 depressive episodes compared to non-post-COVID-19 depression

Major depressive episodes (MDE) following COVID-19 have been described in approximately 30 % of cases. A clinical picture characterized by physical and cognitive symptoms with underlying immune-inflammatory changes has been reported. However, a comparison of post-COVID-19 MDE with non-post-COVID-19 depression is still lacking. This study aims to characterize 209 patients with MDE, post-COVID-19 vs. non-post-COVID-19, focusing on physical and cognitive symptomatology evaluated through Hamilton Depression (HDRS) and Anxiety Rating Scales (HARS), Digit Symbol Substitution Test (DSST), Perceived Deficits Questionnaire-Depression 5-items (PDQ-D5). Inflammatory levels were assessed with blood count-derived indexes. Post-COVID-19 group (46.9 % of patients) displayed higher rates of first-onset depressive episodes (p = 0.001), an older age at onset (p = 0.006), more physical and cognitive features according to subitems of HDRS (p = 0.001), HARS (p < 0.001), and PDQ-D5 scores (p = 0.019), as well as higher inflammatory indexes (p < 0.001). Logistic regression showed a significant association of post-COVID-19 MDE with physical symptomatology (p = 0.02) and Systemic Immune-Inflammatory Index (p = 0.04). Receiver Operating Characteristic (ROC) curves displayed a discriminative potential for this association (AUC = 0.921). These results highlight the specific clinical presentation of post-COVID-19 MDE, with prominent physical symptoms and increased inflammation levels, suggesting that a more careful characterization might inform personalized interventions and promote full functional recovery in these patients.

Affective temperament modulates the relationship between physical and psychiatric symptoms during long-COVID: results from the Gemelli against COVID-19 post-acute care service

BACKGROUND

Affective temperaments represent the substrate of personality that can influence the expression of chronic infectious diseases, including COVID-19 and its sequelae. However, research conducted so far on this topic focused on narrow aspects of psychopathology.

AIM

To investigate the effect of affective temperaments on the relationship between physical and psychiatric symptoms in patients with long-COVID.

METHODS

The sample consisted of 1513 patients who have been hospitalized for COVID-19 and developed long-COVID. Participants performed a multidisciplinary assessment including psychiatric evaluation through the administration of rating scales. The psychiatric dimensions assessed included severity of depressive, anxiety, manic symptoms, anhedonia, hopelessness, suicidal risk, psychological distress, levels of well-being, resilience, emotion regulation, and levels of post-traumatic stress disorder (PTSD). Affective temperament was assessed through the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire (TEMPS-A). We used TEMPS-A subscales as moderators and sociodemographic and COVID-19/long-COVID-related clinical characteristics as predictors. Psychiatric rating scales total scores were outcome variables.

RESULTS

Cyclothymic, irritable, and depressive temperaments strengthened the relationship between number of long-COVID symptoms, levels of anhedonia and poor psychological well-being. Cyclothymic and irritable temperaments weakened the relationship between number of long-COVID symptoms and history of intensive care unit admission and PTSD severity. Depressive temperament strengthened the latter relationship.

LIMITATION

The clinical variables included in the analyses do not represent the entire range of psychopathology.

CONCLUSIONS

Depressive temperament enhanced the relationship between physical and psychiatric symptoms in patients with long-COVID, whereas the effects of cyclothymic and irritable temperaments may depend on the psychiatric dimension assessed.

Dietary interventions targeting the neurolipidome in epilepsy: From preclinical models to clinical applications and future therapeutic approaches

Epilepsy is a neurological disorder affecting approximately 50 million people globally and is characterised by recurrent, unprovoked seizures resulting from abnormal, excessive synchronised firing of neurons. Developing new therapeutic targets and biomarkers is key to improving the diagnosis, treatment, and management. This scoping review examines the current literature on the preclinical and clinical applications of dietary interventions that target the neurolipidome in epilepsy. Specifically, it investigates the role of lipids in the underlying pathogenesis of epilepsy. A comprehensive search of databases was conducted to identify peer-reviewed articles published in the past ten years. Original research articles focusing on both adult and paediatric epilepsy and disrupted lipid metabolism were included, resulting in a total of 101 papers. Our review identified several key lipids implicated in the pathogenesis of epilepsy, including sphingolipids, free fatty acids, endocannabinoids, cholesterol, triglycerides, and phospholipids, and also explores the complex interactions between these lipids and their roles in the disease process. Furthermore, our study highlighted that the Ketogenic Diet (KD) and Modified Atkins Diet (MAD) have proven effective adjunctive or alternative treatments in paediatric and adult populations, improving patient quality of life and reducing seizure frequency. Additionally, treatment with lipid-based supplements, such as eicosapentaenoic acid, docosahexaenoic acid, fish oil, and cannabidiol, has been associated with a reduction in seizure rates in patients with drug-resistant epilepsy. In summary, findings from this study indicate that KD and MAD lipid-based supplements are effective for managing epilepsy in paediatrics, adults, and animal models. However, further research is necessary to elucidate the pathophysiological mechanisms underlying the role of lipids in the development and progression of epilepsy.

Dysregulation of peripheral oxidative stress and the Nrf2 antioxidant system in Major Depressive Disorder

BACKGROUND

Oxidative stress and inflammation have been found to be involved in the development of major depressive disorder (MDD). The aim of this study was to investigate the peripheral levels of oxidative stress and the nuclear factor erythroid 2-related factor 2 (Nrf2) antioxidant system markers in patients with MDD and to evaluate the changes in these markers after 12 weeks of antidepressant treatment.

METHODS

We consecutively enrolled 104 drug-naïve or drug-free patients with an acute episode of MDD and 50 healthy controls (HCs). Plasma levels of Nrf2, phospho-Nrf2 (p-Nrf2), heme oxygenase-1 (HO-1), superoxide dismutase (SOD), malondialdehyde (MDA), phospholipase A2 (PLA2) and cyclooxygenase-2 (COX-2), were measured with the enzyme-linked immunosorbent assay.

RESULTS

Patients with MDD exhibited lower levels of the antioxidant system Nrf2, p-Nrf2, HO-1, SOD and higher levels of oxidative stress markers COX-2, PLA2, MDA compared to HCs (all p < 0.001). HO-1 levels differed significantly among melancholic, anxious, and atypical depression (p = 0.002). In addition, we found a negative correlation between somatic symptoms in HAMA scores and Nrf2 levels in MDD group (p = 0.04). At 12 weeks, COX-2 levels significantly increased in the non-remission group compared to baseline (p = 0.039), whereas no significant changes were observed in the remission group.

CONCLUSIONS

Peripheral oxidative stress and the Nrf2 antioxidant system were found to be dysregulated in patients with MDD. The Nrf2 antioxidant system might be a protective factor for somatic symptoms in MDD, whereas COX-2 might be a risk factor for poor antidepressant efficacy.

Chinese postpartum mothers' perspectives about the usage of donor milk and human milk banks: A qualitative study

INTRODUCTION

Human milk banks (HMBs) were established to provide safe human milk for infants in need. However, the number and volume of donors are insufficient in China. This study aimed to explore Chinese postpartum mothers perspectives on the use of donor milk and the implementation of HMBs.

METHOD

A descriptive phenomenology design with semi-structured interviews was used to collect data involving 18 postpartum mothers from January to June 2021.

RESULTS

The study revealed that participants had limited knowledge of donor milk and human milk banks, faced multiple barriers to accessing donor milk, and exhibited diverse motivations for considering its use. Key barriers included misconceptions about the value of donor milk for premature infants, concerns over quality and safety, psychological hesitations, and limited access to human milk banks. However, some participants saw donor milk as a way to support breastfeeding beliefs and alleviate the burdens associated with breastfeeding.

DISCUSSION

This study explored challenges in HMBs and donor milk use, emphasizing the necessity for targeted education.

Changes in recreational drug use, reasons for those changes and their consequence during and after the COVID-19 pandemic in the UK

Changes in drug use in the general population during the COVID-19 pandemic and their long-term consequences are not well understood. We employed natural language processing and machine learning to analyse a large dataset of self-reported rates of and reasons for drug use during the pandemic, along with their associations with anxiety, depression and substance use problems post-pandemic. Our findings revealed a transient decrease in drug use at the pandemic's peak, primarily attributed to reduced social opportunities. Conversely, some participants reported increased drug use for self-medication, boredom, and lifestyle disruptions. While users of psychedelics and MDMA had anxiety and depression rates similar to non-users, users of opioid agonists and depressants-representing one in ten active drug users-reported greater mental health challenges post-pandemic. These results suggest that a subset of active drug users with distinct profiles faces elevated risks, particularly for anxiety and depression, and may benefit from targeted support.

Feelin' the burn: Post-pandemic burnout among United States neuropsychologists

Objective: Burnout is a multidimensional concept in many professions. Research documented increased burnout within the field of neuropsychology during the COVID-19 pandemic. The present study assessed burnout levels in neuropsychology post-pandemic, identified factors contributing to burnout, and assessed the impact of the pandemic on burnout levels. Method: United States neuropsychologists (N = 304, 81.9% women, Mage = 41.77) completed a survey about demographics, professional background, current experiences of burnout using the Copenhagen Burnout Inventory, and the impact of the pandemic on burnout. The authors calculated the frequencies for demographics, professional background, impact of the pandemic, and burnout levels. One-way multivariate analysis of variance and chi-square tests compared subspecialties on demographics and occupation. One-way multivariate analysis of covariance compared subspecialty differences in burnout. An independent sample t-test identified significant differences in burnout levels and demographics. Pearson correlations assessed the relationships between demographics, occupation, and burnout. Results: Respondents indicated moderate personal (M = 53.10, SD = 18.67) and work burnout (M = 52.17, SD = 20.84) and mild patient burnout (M = 36.88, SD = 20.28). While professional burnout increased due to the impact of COVID-19, most respondents reported that their burnout started prior to the onset of the pandemic. Personal and work burnout levels were higher in women. Younger, early-career clinicians were more likely to experience greater levels of personal, work, and patient burnout. Burnout levels did not differ by subspecialty. Conclusions: A need exists to continue monitoring burnout levels and implementing strategies to reduce burnout and optimize patient care post-pandemic.

Prevalence rates of depression, anxiety, and suicidal ideation in patients with ovarian cancer: A systematic review from 1977 to 2024

ObjectiveOvarian cancer patients are more likely to have mental disorders than other patients. However, to our knowledge, there has been no systematic analysis of its global epidemiology. Therefore, a systematic review was conducted to identify the prevalence of depression, anxiety, and suicidal ideation in ovarian cancer patients in different countries.MethodWe searched PubMed, Embase, Elsevier ScienceDirect, China National Knowledge Infrastructure, WanFang Data Knowledge Service Platform, and Duxiu Academic Search Platform to identify observational studies on depression, anxiety, and suicidal ideation in patients with ovarian cancer published up to 30 June 2024. We estimated the prevalence of depression, anxiety, and suicidal ideation in ovarian cancer patients worldwide and by region, country, research period, and assessment scales.ResultsA total of 31 studies were identified involving 8315 ovarian cancer patients. The prevalence rates of depression and anxiety were 35% and 37%, respectively. In China, the prevalence of suicidal ideation of ovarian cancer patients was 32%. Ovarian cancer patients in Asia had the highest prevalence of depression, while those in Oceania (Australia, New Zealand, etc.) had the lowest. Additionally, the prevalence rates of depression and anxiety increased considerably worldwide after 2000 and have gradually stabilized since then.ConclusionThis study found that the prevalence of depression and anxiety was high (more than one-third) among ovarian cancer patients. These findings underscore the need for a comprehensive study to address mental health problems in these patients, including the determination of incidence rates, investigation of regional differences, and assessment of comorbidities and treatment strategies.

Disorders of gut-brain interaction are a new challenge of our increasingly complex society, with worldwide repercussions

The term disorders of gut-brain interaction (DGBIs) encompasses gastrointestinal disorders that globally affect more than one third of all people. The Rome IV criteria replaced the former term "functional gastrointestinal disorders." DGBIs can seriously challenge health and quality of life (QoL). A traditional but outdated approach differentiated "organic" vs "functional" disorders, seen by some as real vs psychiatric or undefined ones. This traditional distinction did not help patients whose health and QoL are seriously affected. DGBIs include motility disturbance; visceral hypersensitivity; altered mucosal and immune function; altered central nervous system processing, and more. Several DGBIs affect both children and adolescents. DGBIs are characterized by clusters of symptoms. Their pathophysiology relates to combinations of altered motility, visceral sensitivity, mucosal immune function, and more. Routine investigations find no structural abnormality that would easily explain the symptoms. Symptom-based criteria were developed to better understand patients where no mechanistic explanation was available for clinical practice and inclusion into clinical trials. To understand DGBIs and to find ways to treat them, these rigid mechanistic views fall short.

Prescribing lithium for the management of persons suffering from bipolar disorders: expert consensus based on a Delphi study

BACKGROUND

According to international guidelines, lithium treatment represents the gold standard for the appropriate management of persons with bipolar disorder. However, prescription rates in ordinary practice are not in line with clinical guidelines' suggestions. Clinicians prefer to use drugs other than lithium, considering its low therapeutic window, the need for regular lab tests and its side effects profile. Based on these premises, a Delphi-method study focused on highly-debated aspects of lithium treatment in bipolar disorder has been promoted with the aim to reach a consensus among an expert panel of Italian psychiatrists.

METHODS

The Delphi method is a structured technique aimed to obtain a consensus from repeated rounds of questionnaires where opinion/agreement among experts are important. A Steering Committee of experts has developed a 24-items questionnaire exploring: (1) the use of lithium as first choice for treating different phases of bipolar disorder; (2) the side effect and tolerability profile of lithium treatment as hampering factors for its use in clinical practice; (3) the lithium prescribing in special target population, such as adolescents, elderly patients, and pregnant women.

RESULTS

The questionnaire was delivered to a panel of 100 Italian psychiatrists, experts in the field of managing people with bipolar disorders. An almost complete positive consensus was reached for statements dealing with the use of lithium treatment as first choice in the management of patients with bipolar disorder, and as the first choice for preventing manic/hypomanic and depressive episodes.

CONCLUSIONS

Current clinical guidelines and scientific evidence support the use of lithium as first choice treatment in patients with bipolar disorder. However, over the last decades a downward tendency in lithium's prescription has been registered worldwide. The present Delphi study confirmed the "good clinical reasons" for supporting lithium prescription in clinical practice. Our findings should be used to develop clinical practice guidelines and reduce the discrepancy between international guidelines and ordinary care.

Territories of mourning: Addressing submerged problems of grief through multidisciplinary care

Mourning and grief are natural responses to loss and can be especially complex and prolonged in the context of end-of-life care. Caregivers play a crucial role in supporting individuals through this difficult journey, often balancing their own grief with the need to provide care. This paper explores the experiences of mourning and grief in hospice settings, with a focus on the emotional challenges faced by both patients and caregivers during the grieving process. Psychological support plays a crucial role at the end of life in a multidisciplinary care approach. By addressing the complex interplay between biological disease and psychological well-being, healthcare professionals can provide more comprehensive and compassionate care. A deep understanding of mourning and elaboration of grief would improve the implementation of suitable support interventions and facilitate collaboration among family members and healthcare teams, ultimately improving the quality of end-of-life care and promoting the well-being of both patients and their families.

New pharmacological approaches in the treatment of schizophrenia

Schizophrenia is a primary health concern, imposing a significant burden on both patients and healthcare systems globally. It is a disease with a complex etiology in which both genetic and environmental factors are involved. Despite numerous studies, the mechanism of its origin is still not fully understood. The hypotheses are synaptic, serotonergic, muscarinic, dopaminergic, microRNA-related, and neurodegenerative theories. Treatment to date is mainly based on antipsychotic drugs that act on the dopaminergic system. Although they are effective in reducing positive symptoms, their effect on negative and cognitive symptoms is limited, and their use is often associated with numerous side effects. A breakthrough in the treatment of schizophrenia came with the approval of the first drug with a non-dopaminergic mechanism of action, which opens up new therapeutic possibilities. As a result, there is intensive research into innovative substances that could increase the effectiveness of treatment and improve the quality of life of patients. In this review, we present the current state of knowledge about schizophrenia, its prevalence, risk factors, and its impact on patients' functioning. We pay special attention to new therapeutic directions, including drugs that affect systems other than the dopaminergic one, which could open up new prospects for treating the condition.

Effectiveness of psychological interventions for mental health problems among war refugees: A systematic review and meta-analysis

BACKGROUND

Globally 117.3 million people are displaced due to war, with one in five refugees experiencing psychological distress. Despite the availability of numerous psychological interventions for war refugees, their overall efficacy is still unexplored. Thus, this review examines the effectiveness of psychological interventions in reducing the mental health issues of war refugees.

METHODS

A systematic search was conducted in PubMed, Web of Science, APA PsycNET, ScienceDirect and Google Scholar for studies published on the effectiveness of psychological interventions for mental health issues among war refugees in July 2024. JBI and NHLBI checklists were employed to appraise the risk of bias in the included studies. Review Manager version 5.4 was used to run the meta-analysis.

RESULTS

Out of 22,197 initially identified records, a total of 21 studies were included for systematic review and eight randomized controlled trials (RCTs) for meta-analysis. Random effects meta-analysis showed significant medium effect size for psychological interventions (SMD = -0.69; 95 % CI:0.87, -0.51; p < .00001) in reducing the mental health issues among war refugees. Sub group analysis based on the mode of delivery revealed that interventions delivered through in-person mode reported a significant large effect size (SMD = -1.03; 95 % CI:1.36, -0.71; p < .00001) while, telehealth interventions showed significant small effect size (SMD = -0.44; 95 % CI:0.61, -0.28; p < .00001).

CONCLUSION

In-person and telehealth based psychological interventions offer promising findings in addressing mental health issues among war refugees. However, given the barriers to accessing face to face treatments and limited evidence on telehealth interventions, future research on digital interventions is recommended.

Forensic homicidal strangulation in women: Case series and systematic literature review

This systematic review explores women's homicidal strangulation using PRISMA method. A total of 40 Google Scholar, 26 PubMed and 4 manual searching articles were analyzed, while other sources were excluded due to lack of full texts, irrelevance, or outdated content. Review highlights gender violence as an underestimated issue and provides a socio-demographic analysis. Diagnosing strangulation can be challenging, particularly in absence of visible asphyxial signs in the external examination. Judicial authorities' collaboration and reliance on circumstantial evidence are crucial in forensic investigations. Strangulation is statistically prevalent in sexually motivated crimes and employs various methods. We reported four different strangulation cases at the Institute of Forensic Medicine, University of Palermo, to emphasize findings, forensic characteristics, and interpretation difficulties. The primary goal of this review is to shed light on homicidal strangulation's specific characteristics, given its underreported nature, and to stress the importance of mechanical asphyxia in forensic differential diagnosis. Distinguishing strangulation from other asphyxial deaths is difficult, as is identifying potential third-party involvement. This review also aims to provide key indicators that assist forensic pathologists in differentiating strangulation from other asphyxial causes of death. Future perspectives highlight the use of specific protocols, using artificial intelligence (AI), and instrumental investigations to support forensic pathologists in performing differential diagnoses and providing compatibility assessments.

Effect of ponatinib on the metabolism of cariprazine in vitro and in vivo and the underlying mechanism

Cariprazine is an antipsychotic medication that has been approved for the treatment of schizophrenia and manic or mixed episodes. Patients with tumors frequently develop psychiatric disorders, necessitating the combination of antitumor and antipsychotic drugs. The objective of the present study was to examine the inhibitory impacts of three antitumor drugs (olmutinib, napabucasin and ponatinib) on the metabolism of cariprazine, and the molecular docking of cariprazine and ponatinib in relation to CYP3A4 was also evaluated. As the results, the half-maximal inhibitory concentration (IC50) values of ponatinib and olmutinib in vitro were < 10 μM, whereas napabucasin was >20 μM. Among these, ponatinib exhibited the smallest IC50 value. The metabolic stability of cariprazine was observed in the presence or absence of ponatinib in rat liver microsomes (RLM). The IC50 shift experiments demonstrated that the inhibition of cariprazine by ponatinib was non-time-dependent. In addition, ponatinib was shown to inhibit cariprazine in a mixed manner (RLM) and a competitive manner (HLM), respectively. In the in vivo study, the co-administration of ponatinib resulted in a significant 0.35-fold increase in both AUC(0-t) and AUC(0-∞) for cariprazine, accompanied by a significant 0.25-fold decrease in the CLz/F. Furthermore, the metabolites desmethyl-cariprazine (DCAR) and didesmethyl-cariprazine (DDCAR) exhibited disparate increases in both AUC(0-t) and AUC(0-∞). Molecular docking studies had demonstrated that both cariprazine and ponatinib could engage in hydrophobic interactions with residue PHE-304 on CYP3A4. Consequently, when ponatinib is employed in conjunction with cariprazine in a clinical setting, it is imperative to assess the efficacy and adverse effects, and adjust the dosage to attain the optimal efficacy.

Resilience and Self-Care in Patients with Inflammatory Bowel Disease: A Multicentre Cross-Sectional Study in Outpatient Settings

Background/Objectives: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), significantly affects patients' quality of life. Resilience and self-care are vital for disease management, yet their relationship with IBD remains underexplored. This study investigates how self-care behaviours influence resilience in patients with IBD, taking into account sociodemographic and clinical factors. Methods: This was a multicentre observational study. Data were collected during routine outpatient visits between April and June 2024. Participants (≥18 years) with an IBD diagnosis for at least 12 months were recruited. Data were collected using validated instruments, including the Connor-Davidson Resilience Scale (CD-RISC-25), the Self-Care of Chronic Illness Inventory (SC-CII), and sociodemographic and clinical questionnaires. Disease activity was assessed using the Mayo Score (UC) and the Harvey-Bradshaw Index (CD). Descriptive, correlational, and regression analyses explored variable relationships. This study was conducted as part of the N-ECCO Research Grant initiative. Results: A total of 401 participants (CD: 196, UC: 205) were enrolled, with equal gender distribution (50.1% male). The descriptive analysis of self-care levels showed a mean score of 72.6 (SD = 12.5) for self-care maintenance, 81.0 (SD = 18.2) for self-care monitoring, and 70.5 (SD = 18.4) for self-care management. The UC patients had higher self-care management scores than the CD patients (p = 0.002). The median resilience score was 45, and self-care management positively predicted resilience (β = 0.041, p < 0.001). Disease severity negatively affected resilience and self-care, particularly in severe cases (β = -8.334, p < 0.001). The females reported higher resilience and self-care monitoring scores than the men. Conclusions: Resilience and self-care are interrelated and crucial in IBD management. Enhancing resilience through personalised nursing interventions and integrating psychological and educational support may improve self-care and clinical outcomes.

Antipsychotic Discontinuation and Re-initiation in Pregnant Women With Schizophrenia: A Retrospective Cohort Study From South Korea

BACKGROUND AND HYPOTHESIS

Pregnant women with schizophrenia are more likely to discontinue treatment, which could trigger a relapse of symptoms. However, data on patterns and risk factors related to antipsychotic discontinuation and re-initiation in Asian pregnant women are insufficient.

STUDY DESIGN

We conducted a retrospective cohort study using a nationwide Korean database. The pregnancy group included women who had received antipsychotics before pregnancy and was matched 1:2 with a non-pregnancy group. Using Kaplan-Meier curves, we assessed discontinuation patterns during pregnancy and re-initiation patterns among those who discontinued treatment within the first trimester. A Cox proportional hazards regression analysis was used to examine factors associated with first-trimester discontinuation and re-initiation among those who discontinued during this period.

STUDY RESULTS

Pregnant women (n = 2066) had a significantly higher risk of discontinuation than did non-pregnant women (adjusted hazard ratio 3.09; 95% confidence interval 2.85-3.34). Within the first trimester, 67.5% of pregnant women (n = 1394) discontinued antipsychotic use. Women aged 25-29 years were more likely to discontinue (1.25; 1.07-1.47). Among first-trimester discontinuers, 35.2% (n = 491) re-initiated treatment before delivery. A longer duration of antipsychotic use (1.60; 1.06-2.42) and higher daily doses (2.47; 1.76-3.45) were associated with re-initiation of antipsychotics.

CONCLUSIONS

We revealed that most pregnant women discontinued schizophrenia treatment, but those using higher cumulative doses had a higher likelihood of re-initiation. Our findings imply that treatment decisions for pregnant women should consider various clinical factors, including the history of prescriptions and obstetric characteristics. Moreover, these patients require close monitoring after discontinuation.

Harnessing Probiotics: Exploring the Role of the Gut Microbiome in Combating Obesity

Obesity has become a global health crisis driven by genetic, environmental, and lifestyle factors, often linked to gut microbiome imbalances. Probiotics, particularly Lactobacillus and Bifidobacterium strains, have shown promise in clinical trials by promoting weight loss, improving lipid profiles, and addressing gut dysbiosis associated with obesity. This review surveys the literature on the microbiome and obesity, emphasizing the clinical relevance of probiotics in treatment strategies. Our comprehensive PubMed search highlights the mechanisms through which probiotics influence metabolic health, including their effects on inflammation and appetite regulation. We also explore promising future research directions and the potential for integrating probiotics into clinical practice. While results are encouraging, the evidence is limited by strain variability, small sample sizes, short trial durations, and individual differences in microbiota composition. More extensive, long-term studies with standardized methods are crucial to confirm the effectiveness of probiotics as viable anti-obesity treatments.

Association of Cortical Atrophy Patterns With Clinical Phenotypes and Histopathological Findings in Patients With Rasmussen Syndrome

BACKGROUND AND OBJECTIVES

Automated MRI analyses have identified variable patterns of cortical atrophy in Rasmussen syndrome. In this study, we aim to identify imaging phenotypes of Rasmussen syndrome, to clinically characterize these phenotypes, and to validate this imaging-based approach through histopathologic analysis.

METHODS

For this retrospective case-control study, individuals with Rasmussen syndrome diagnosed according to the European Consensus Statement and at least one 3D T1-weighted MRI scan (<20 years after onset) were identified from the University Hospital Bonn (1995-2023). Healthy controls were selected from databases at the University Hospital Bonn, Charité University Hospital Berlin, and the Human Connectome Project. Disease epicenters, describing brain regions highly connected to atrophy regions, were mapped individually using network-based atrophy modeling. Subtypes were identified through k-means clustering. Neuropsychological test results and results from neuropathologic analyses of biopsies were ascertained, and correlations between subtype-specific atrophy maps and normative maps (enhancing neuro imaging genetics through meta analysis [ENIGMA] and neuromaps toolbox) were used to characterize atrophy profiles and epicenter susceptibility.

RESULTS

The study incorporated 54 individuals with Rasmussen syndrome (median age at MRI: 18 years, range 2-61, 65% female) and 270 healthy individuals (median age at MRI: 26.5 years, range 3-61, 49% female). Four distinct atrophy subtypes were identified (temporoparietal, centrotemporal, frontal, and bilateral). Individuals with the centrotemporal subtype were younger at onset (median 5.5 years) than individuals with temporoparietal (median 11.5 years, p = 0.02) and frontal (median 6 years, p = 0.02) subtypes. Most severe neuropsychological impairment was observed for the temporoparietal and frontal subtypes. In the temporoparietal and frontal subtypes, atrophy occurred preferentially in hubs (r = -0.28, p = 0.006; r = -0.30, p = 0.02). Disease epicenter susceptibility was associated with higher cortical thickness (r = -0.57, p = 0.005), lower myelin content (r = 0.47, p = 0.02), lower cerebral blood flow (r = 0.42, p = 0.03), lower blood volume (r = 0.57, p = 0.006), and lower oxygen metabolism (r = 0.47, p = 0.01). Brain biopsies showing strong inflammation were taken from likely epicenters, whereas biopsies with weaker inflammation came from less likely epicenters (p = 0.04).

DISCUSSION

Using Rasmussen syndrome as a model, we validate imaging-based mapping of individual disease epicenters with histopathologic evidence. With further validation, network-based mapping of individual disease epicenters could potentially be used in Rasmussen syndrome to guide biopsy site selection, inform treatment decisions, and improve outcome prognoses.

Supplementary approaches to perinatal depression: a review of pathogenesis, herbal interventions, and dietary supplements

Although perinatal depression (PND) has garnered increasing attention, few specific pharmacological treatments exist, particularly for breastfeeding mothers concerned about antidepressant safety. The misconception that "natural is harmless" merits caution; herbal remedies and dietary supplements should be regarded as supplementary interventions pending robust safety evidence. This review summarizes recent advances in PND pathogenesis (neurotransmitter dysregulation, inflammation, hormonal imbalance, and microbiota alterations) and emerging drug development strategies, alongside clinical evidence for herbal and dietary supplements. Randomized controlled trial (RCT) findings reveal that while interventions like saffron and vitamin D show promise, significant limitations persist, including inconsistent efficacy, limited long-term safety data, and potential interactions with perinatal physiology. Caution is warranted until comprehensive studies validate the safety and reliability of natural interventions. This review underscores the need for rigorous trials to identify safe, effective PND treatments, particularly for vulnerable populations.

Innovations in the diagnosis, treatment, and management of disorders of gut-brain interaction (DGBI)

INTRODUCTION

Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are the most prevalent disorders of gut-brain interaction (DGBI), frequently overlapping and associated with complex pathophysiological mechanisms. Increasing evidence implicates gut microbiota alterations in driving symptoms via immune activation, altered motility, gut vascular barrier and gut-brain axis disruption.

AREAS COVERED

This review explores the role of gut microbiota in FD and IBS pathogenesis and symptomatology. A comprehensive literature search was conducted using PubMed, EMBASE, and Google Scholar databases, including studies published between January 2013 and March 2025. Particular focus is given to microbiota-targeted therapies such as prebiotics, probiotics, synbiotics, postbiotics, and fecal microbiota transplantation (FMT). The review also discusses multidimensional treatment strategies combining dietary and lifestyle modification, cognitive-behavioral therapy, and pharmacological neuromodulation. Recent advances in diagnostic methods, including capsule-based microbiota sampling and digital tools for remote psychogastroenterology care, are highlighted.

EXPERT OPINION

Despite scientific progress, current DGBI management remains insufficiently personalized. Future approaches should integrate individualized microbiota profiling with targeted interventions and utilize innovative diagnostic and digital health technologies to enhance clinical outcomes in FD and IBS.

The Role of RS Type 2 (High-Amylose Maize Starch) in the Inhibition of Colon Cancer: A Comprehensive Review of Short-Chain Fatty Acid (SCFA) Production and Anticancer Mechanisms

Dietary fiber, especially resistant starch (RS) Type 2 (RS2) found in high-amylose maize starch (HAMS), is vital for gut health and helps prevent colon cancer. In contrast to most nutrients, dietary fiber is not degraded by the intestinal enzymes; it reaches the distal parts of the gut, where it is fermented by the gut microbiota into short-chain fatty acids (SCFAs), such as acetate, propionate, and butyrate. SCFAs energize colonocytes, reduce inflammation, and enhance gut immunity. HAMS is absorbed in the colon, where it ferments to create SCFAs that feed good gut flora and have antiinflammatory and antiproliferative effects. RS2 in HAMS modulates gene signaling, activates tumor-suppressor genes like tumor suppressor protein (p53), exhibits antidiabetic, cholesterol-lowering, and antiinflammatory effects. Incorporation of RS2-rich sources enhances gut barriers, decreases colorectal cancer biomarkers, and counteracts the negative impacts of low-fiber Western diets, making HAMS a promising functional food for chronic disease prevention and health promotion.

Transactional Associations Between Physical Activity and Depressive and Anxious Symptoms in Adolescent Girls and Boys: Considering Screen Time and Sleep Duration

The nature of the associations between physical activity and depressive and anxious symptoms, as well as the differences between adolescent girls and boys, remain poorly understood. The benefits of physical activity may depend on other lifestyle habits, including screen time and sleep duration, but the mechanisms underlying these associations have not often been explored. Thus, the present study aimed to examine (1) the bidirectional associations between physical activity and depressive and anxious symptoms during adolescence while controlling for screen time and sleep, (2) whether these associations are mediated by screen time and sleep, and (3) sex differences. The variables used were mostly self-reported by participants of the Québec Longitudinal Study of Child Development at ages 13, 15 and 17 (N = 1556). Random intercept crosslagg panel models and multigroup analyses were conducted. A high level of physical activity significantly but weakly predicted a low level of depressive symptoms from 15 to 17 in girls and boys. Physical activity was also associated with less screen time in girls aged 13 to 15, and in everyone aged 15 to 17. No associations between physical activity and anxious symptoms were found significant. The sample is more representative of White Quebec adolescents from a higher socioeconomic status, from 2011 to 2015. In conclusion, among all life habits, promotion of physical activity should be a part of prevention efforts for depression in youth, especially among older adolescents. Physical activity could also be promoted to reduce screen time in adolescents, and earlier for girls.

Psychoactive cocktail consumption on Reunion Island: a case report

Reunion Island is a French department located in the southwestern Indian Ocean, with distinct trends in drug use, drug diversion, and intoxication compared with metropolitan France (e.g. the misuse of drugs-clonazepam and trihexyphenidyl-combined with cannabis or cocaine, which is not observed in metropolitan France). The authors report a case of atypical intoxication in a 16-year-old female who consumed cannabis in conjunction with an unusual powdered mixture containing psychotropic substances. The intoxication led to confusion, hallucinations, sinus tachycardia, and hospitalization. A comprehensive high-resolution mass spectrometry and liquid-chromatography mass spectrometry analysis of her plasma, her urine and a powder found in her possession revealed the presence of the same five medicines: citalopram/escitalopram, paroxetine, sertraline, venlafaxine, and trihexyphenidyl. This case underscores the intricate interactions between psychoactive substances that are never prescribed together in clinical settings, along with the issue of diverted prescription drugs like trihexyphenidyl. It also emphasizes the potential circulation and use of crushed mixtures of medication for recreational purpose. Fortunately, powder analysis provided crucial insight to understand the intoxication.

Orgasmic birth: the anatomy of pleasure in childbirth

Contemporary childbirth practices, which have long been globally dominated by a biomedicalized framework, have sterilized the birthing experience, have stripped away emotional and physical pleasures as well as essential aspects of women's sexuality, and have led to a loss of autonomy for many women and birthing people. In this article, I propose an alternative model of care- "orgasmic birth". And I explain that this model emphasizes respectful perinatal care, pleasurable births, and childbearers' empowerment. By drawing on my reviews of the extensive scientific literature on hormonal interplays, the anatomies of pleasure, and sexuality, in this article, I also discuss how biomedical interventions such as synthetic hormones, epidural nerve blocks, and cesareans disrupt the natural hormonal flow that is associated with pleasurable births. The results of my literature reviews have shown that a more holistic, respectful approach to perinatal care can reduce pain, decrease birth traumas, and improve satisfaction by acknowledging the important roles of pleasure and sexuality during childbirth. I also strongly argue that future research should explore how biomedical systems can integrate practices that honor both safety and the potential for pleasure during childbirth.

The Weight of Words: An analysis of Autobiographical Narratives and Psychopathological Measures in Anorexia Nervosa

This study aims to explore the relationship between linguistic features of the Referential Process (RP) applied to autobiographical narratives, personality dimensions, and affect regulation capabilities in a group of women diagnosed with restrictive anorexia nervosa (AN). The study included 40 female participants hospitalized with AN during an acute phase, with a mean age of 19.50 (SD = 3.8). Participants completed several assessments, including the Minnesota Multiphasic Personality Inventory 2 (MMPI-2), the Eating Disorder Inventory (EDI-3), the 20-item Toronto Alexithymia Scale (TAS-20), the Emotion Regulation Questionnaire (ERQ), and the Relationship Anecdotes Paradigm Interview (RAP). The RAP interviews were audio-recorded and transcribed for the application of RP Linguistic Measures. The results of the correlation analysis revealed several significant associations among linguistic measures, EDI-3 scale scores, affect regulation measures, and personality dimensions. The linguistic measures indicating higher rationality, abstraction, and cognitive word usage, were associated with higher psychopathological severity in AN. Alexithymia showed significant correlations with the Affect words, supporting the perspective of MCT concerning dissociation of emotional schemas. These findings confirm the relationship between linguistic measures and the severity of the disease. Therefore, autobiographical narratives can be considered not only as diagnostic indicators, but also as variables to verify the efficacy of treatments in patients with AN.

Suicide Notes: A Scoping Review of Qualitative Studies to Highlight Methodological Opportunities for Prevention

Suicide is a public health concern, and prevention programs are fundamental to decreasing its rates. Suicide notes might be crucial to understanding motives associated with suicidal behaviours. In this way, it is necessary to understand the qualitative methods that are most frequently used to analyze this data. Investigating these factors is crucial for developing targeted and preventive interventions. This scoping review aimed to answer the question "What is the state of art about qualitative methods adopted to analyze suicide notes?" by systematically mapping the literature on this topic. This review adopted the JBI guidelines for Scoping Reviews and followed the PRISMA-ScR guidelines. A comprehensive search strategy has been implemented across PubMed, Web of Science, and Scopus databases. Grey literature was not included in this review. Eligible studies encompassed qualitative studies on suicide notes published in English. Two independent researchers screened titles and abstracts and subsequently conducted full-text assessments based on predefined inclusion criteria. Relevant data have been systematically extracted and tabulated. The findings were thematically organized and qualitatively summarized, with potential visual aids such as graphs and tables. The studies highlighted the most used qualitative methods to analyze suicide notes, such as LIWC, Leenar's, Grounded Theory, Thematic Analysis and others. This study summarizes the current knowledge about qualitative methods to analyze suicide notes. Further research is necessary for the development of prevention programs destined for this population.

Neuroinflammation and Natural Antidepressants: Balancing Fire with Flora

Background/Objectives: Major depressive disorder (MDD) is a major global health concern that is intimately linked to neuroinflammation, oxidative stress, mitochondrial dysfunction, and complicated metabolic abnormalities. Traditional antidepressants frequently fall short, highlighting the urgent need for new, safer, and more acceptable therapeutic techniques. Phytochemicals, i.e., natural antidepressants derived from plants, are emerging as powerful plant-based therapies capable of targeting many pathogenic pathways at the same time. Summary: This narrative review synthesizes evidence from preclinical and clinical studies on the efficacy of phytochemicals such as curcumin, polyphenols, flavonoids, and alkaloids in lowering depressed symptoms. Consistent data show that these substances have neuroprotective, anti-inflammatory, and antioxidant properties, altering neuroimmune interactions, reducing oxidative damage, and improving mitochondrial resilience. Particularly, polyphenols and flavonoids have great therapeutic potential because of their capacity to penetrate the blood-brain barrier, inhibit cytokine activity, and encourage neuroplasticity mediated by brain-derived neurotrophic factor (BDNF). Despite promising results, the heterogeneity in study designs, phytochemical formulations, and patient demographics highlights the importance of thorough, standardized clinical studies. Conclusions: This review identifies phytochemicals as compelling adjuvant or independent therapies in depression treatment, providing multimodal mechanisms and enhanced tolerability. Additional research into improved dosage, pharmacokinetics, long-term safety, and integrative therapy approaches is essential. Using phytotherapeutics could considerably improve holistic and customized depression care, encouraging new research routes in integrative neuroscience and clinical psychiatry.

Oral Health and Dietary Habits Before and After COVID-19 Restrictions in a Portuguese Adult Population: An Observational Study

Background: The declaration of COVID-19 as a pandemic by the World Health Organization in 2020 led to the widespread suspension of clinical practices, including dentistry. This study aims to evaluate the impact of these restrictions on oral health and dietary habits. Methods: A retrospective cross-sectional study was conducted at Egas Moniz University Clinic (Lisbon Metropolitan Area), covering from June 2019 to June 2021. A total of 3380 participants were included and categorized into two cohorts: pre- and post-COVID-19 restrictions. Data were collected through a structured questionnaire assessing oral health behaviors and dietary habits. Results: Of 3469 incoming patients, 3380 met the inclusion criteria. Statistically significant post-lockdown changes were observed, including increased smoking prevalence, higher coffee with sugar consumption, reduced use of dental floss and mouthwash, and redistribution in tooth brushing frequency, with fewer individuals brushing 2-3 times daily. Conclusions: COVID-19-related restrictions had a heterogeneous impact on oral health and dietary behaviors. While some individuals reported improved hygiene routines, others showed negative changes, such as increased tobacco use or decreased use of oral hygiene products. These contrasting effects call for targeted public health strategies to reduce inequalities and support vulnerable groups during crises.

Perspectives on Personalized Treatment in Difficult-to-Treat Depression: A Case Report

Introduction: This case highlights the unique challenge of difficult-to-treat depression (DTD), a complex condition that distinguishes itself from treatment-resistant depression (TRD) due to its multifaceted nature. DTD is characterized by comorbidities, childhood trauma, symptomatic variability, personal history, substance use, and adherence issues, presenting a significant clinical challenge. Unlike TRD, typically defined by the failure of at least two adequate pharmacological treatments, DTD requires a more comprehensive approach. Recent literature supports a multidisciplinary treatment strategy as the most effective in managing DTD. The patient's main concerns and important clinical findings: We present the case of a 63-year-old female patient with a long-standing history of unresolved depressive disorder despite multiple pharmacological treatments. Her primary concerns included severe anhedonia, persistent suicidal ideation, and impaired personal and familial functioning. The patient's history included prior failed treatments, highlighting the complexity of her case. Primary diagnoses, interventions, and outcomes: The patient was diagnosed with DTD. A personalized treatment plan was implemented, integrating a clearly defined multidisciplinary approach: pharmacotherapy, psychotherapy (with a focus on grief and trauma processing), and psychosocial support, including active family involvement through psychoeducation sessions. Neurostimulation techniques were discussed as a potential alternative but were not applied in this case. Over time, the patient demonstrated significant improvement, with a reduction in depressive symptoms, resolution of suicidal ideation, and enhanced personal and familial functioning. Conclusion: This case underscores the need for a personalized treatment approach for DTD that goes beyond pharmacotherapy to include psychotherapy, psychosocial support, and alternative options, such as neurostimulation when indicated. Active involvement of patients and their families is crucial, as evidenced by improvements in clinical and functional scores. Continuous monitoring and treatment adjustments based on objective measures (e.g., HRS-D, GAF, DTDQ) further optimize outcomes. The case exemplifies how an integrated treatment strategy can address the complexities of DTD, leading to long-term recovery and improved quality of life. The key takeaway is that managing DTD requires a comprehensive and individualized approach.

Association between ambient temperature and emergency psychiatric consultations: A case-crossover study in a South American emergency setting (2021-2023)

BACKGROUND

Although environmental factors have been studied for their impact on mental health, the link between ambient temperature and mental disorders remains insufficiently explored.

AIM

This study aimed to explore the relationship between ambient temperature and the frequency of emergency psychiatric consultations at the sole university hospital in Paraguay from 2021 to 2023.

METHODS

This investigation adopted a quantitative, observational, cross-sectional design, using a case-crossover approach. Data collection entailed reviewing patient records and meteorological data, focusing on the daily mean temperatures and other meteorological variables. Statistical analysis was conducted using RStudio and SPSS, applying a distributed lag non-linear model (DLNM) for a seven-day lag period. Multinomial logistic regression was used to estimate odds ratios (ORs) for the likelihood of specific diagnoses resulting in emergency consultations in relation to temperature exposure.

RESULTS

The analysis covered 2,186 first-time emergency psychiatric consultations, with anxiety disorders being the most frequent diagnosis (24.3%), followed by depressive disorders (23.4%) and personality disorders (15.8%). Women accounted for 70.6% of all patients. The findings indicated that higher temperatures were associated with a greater frequency of consultations for certain disorders, including bipolar (OR up to 27.12 at Lag 1) and eating disorders (OR up to 100 at Lag 1). Conversely, a negative association was observed for schizophrenia, dissociative disorders, and trauma- and stressor-related disorders as temperature increased. Additionally, a linear relationship was found between lower relative humidity and increased number of consultations.

CONCLUSIONS

The findings underscore the impact of ambient temperature on psychiatric emergency consultations, revealing that the frequency of consultations for different conditions varies with temperature. These insights could inform public health strategies to mitigate the effects of climatic variation on mental health. These findings suggest the need for targeted mental health interventions to address vulnerabilities during periods of climatic stress, particularly in resource-limited settings.

Examining the Changes in Bullying Discourse on Reddit: A Comparative Analysis Before and After the COVID-19 Pandemic

Bullying, a type of power abuse, deserves to be addressed, and this study examines bullying-related discussions on Reddit before and after the pandemic to better understand its dynamics during this time. We analyzed 8,720 posts and 21,607 comments from the r/Bullying subreddit using static and dynamic topic modeling (DTM) to understand the major topics discussed in the subreddit. Based on static topic modeling, we discovered that before the COVID-19 pandemic, the topics surrounding bullying focused on bullying in the school context, cyberbullying, and help-seeking, but changed to bullying against minority groups, workplace bullying, relationships and communication, and coping strategies. The long-term impact of bullying has emerged for both periods, implying that more efforts to prevent and combat bullying are needed to reduce the negative impacts throughout an individual's lifecycle. We also discovered that the proportion of cyberbullying/antibullying, negative emotions, and self-esteem increased following the COVID-19 pandemic, according to DTM. Our findings suggest that following the pandemic, victims and places of bullying became more distinct. In addition to the widely studied and disseminated bullying research and policies concerning children at school, more assistance is needed to prevent and assist bullying victims who are racial and religious minorities in various settings.

Lithium carbonate exposure disrupts neurodevelopment by perturbing primary cilia and ER homeostasis

Lithium, which is widely used in medicine and batteries, has become increasingly prevalent in the environment, raising concerns about its impact on human health. Lithium carbonate (Li2CO3) is a common treatment and relapse prevention method for bipolar disorder. It can freely cross the placental barrier; however, lithium treatment is accompanied by side effects, particularly in women of reproductive age. Among these, neural tube defects (NTDs) have the most severe impact on nervous system development; however, their underlying mechanisms remain unclear. This study explored the potential mechanisms by which Li2CO3 exposure contributes to NTDs. Pregnant mice were intraperitoneally injected with Li2CO3 (360 mg/kg), which mimicked high-exposure scenarios such as an unintended pregnancy during lithium therapy or exposure to industrial contamination. Embryos were assessed for morphological changes, primary cilia length, and endoplasmic reticulum (ER) homeostasis using histological analysis, scanning electron microscopy, PCR array analysis, immunofluorescence, and quantitative real-time PCR. Network and bioinformatics analyses were used to identify primary molecular targets and pathways. We also evaluated the effects of inositol supplementation on cilia during Li2CO3 exposure. The results revealed that treatment with Li2CO3 at 360 mg/kg induced exencephaly in some embryos, reduced primary cilia length, and dysregulated cilia-associated gene expression in the neural tube. PCR Array, network metabolism, and immunofluorescence analyses revealed that HSP90AB1, a critical regulator of ER homeostasis, was upregulated in Li2CO3-treated embryos with NTDs. Li2CO3 exposure disturbed ER homeostasis in the developing brain. Interestingly, inositol supplementation partially rescued ciliogenesis impairment in lithium-treated NIH3T3 cells. Li2CO3 exposure disrupted primary ciliary development and ER homeostasis in the embryonic neural tube. Maintaining adequate maternal inositol levels during Li2CO3 exposure before and during pregnancy prevents NTDs. These findings help in better understanding and reassessing the risks associated with lithium, especially in terms of maternal and fetal health.

Strategies to overcome barriers to the statistical representation of femicide data-a technical note

Mortality data systems are upstream determinants of health, providing critical information on causes of death and population health trends and influencing health outcomes by shaping policies, research, and resource allocation. Moreover, the gender-related deaths of women and girls are significantly underrepresented or underrecognized in mortality data across many countries. This paper seeks to identify potential barriers and facilitators to improving the representation of femicide data. The primary barriers affecting data representation of femicide are related to definitions, data collection, coding, comparability, access, and systemic challenges. Key recommendations include establishing a nationwide consensus on the definition of femicide, updating training modules for medicolegal professionals, improving pathology reporting processes, ensuring quality assurance in documentation, refining coding practices, developing new analytic methods, and providing deidentified access to cases still under investigation.

Revictimization of women victims of intimate partner violence in the French press: A social representations approach

OBJECTIVE

This study aims to analyze how the press portrays cases of revictimization experienced by women in France, through the lens of social representation theory.

METHOD

An exploratory, descriptive study was conducted using a corpus of 157 online press articles. A total of 187,773 words and 5,240 segments were analyzed using Iramuteq version 7, employing top-down hierarchical classification and lexical similarity analysis.

RESULTS

The analysis identified four classes: 1. Violent incidents (25.5%); 2. Political actions against violence (26%); 3. Institutional revictimization (26.6%) and 4. Violence and breaking the silence (21.9%).

CONCLUSIONS

The findings illustrate how media portrayals contribute to the construction of social representations surrounding revictimization. Class 1 reveals a focus on extreme cases of violence, such as femicides, and highlights a potential gender bias in media reporting through the omission of terms like 'femicide'. Class 2 demonstrates the influence of ideological perspectives on the portrayal of political measures against violence, with conservative outlets framing such actions within traditional values, while progressive newspapers advocate for systemic reform. Class 3 shows a gap in the conceptualization of institutional revictimization in the French press compared to other countries, revealing how conservative portrayals can minimize systemic issues and perpetuate harmful stereotypes. Class 4 shows the role of female journalists in addressing various forms of violence, despite the limited impact of the #MeToo movement in recent coverage. Collectively, these findings elucidate how media representations shape public attitudes and institutional responses to gender-based violence through the lens of social representations.

Neuroimaging as a Tool for Advancing Pediatric Psychopharmacology

Neuroimaging, specifically magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and positron emission tomography (PET), plays an important role in improving the therapeutic landscape of pediatric neuropsychopharmacology by detecting target engagement, pathway modulation, and disease-related changes in the brain. This review provides a comprehensive update on the application of neuroimaging to detect neural effects of psychotropic medication in pediatrics. Additionally, we discuss opportunities and challenges for expanding the use of neuroimaging to advance pediatric neuropsychopharmacology. PubMed and Embase were searched for studies published between 2012 and 2024 reporting neural effects of attention deficit hyperactivity disorder (ADHD) medications (e.g., methylphenidate, amphetamine, atomoxetine, guanfacine), selective serotonin reuptake inhibitors (e.g., fluoxetine, escitalopram, sertraline), serotonin/norepinephrine reuptake inhibitors (e.g., duloxetine, venlafaxine), second-generation antipsychotics (e.g., aripiprazole, olanzapine, risperidone, quetiapine, ziprasidone), and others (e.g., lithium, carbamazepine, lamotrigine, ketamine, naltrexone) used to treat pediatric psychiatric conditions. Of the studies identified (N = 57 in 3314 pediatric participants), most (86%, total participants n = 3045) used MRI to detect functional pathway modulation or anatomical changes. Fewer studies (14%, total participants n = 269) used MRS to understand neurochemical modulation. No studies used PET. Studies that included healthy controls detected normalization of disease-altered pathways following treatment. Studies that focused on affected youth detected neuromodulation following single-dose and ongoing treatment. Neuroimaging is positioned to serve as a biomarker capable of demonstrating acute brain modulation, predicting clinical response, and monitoring disease, yet biomarker validation requires further work. Neuroimaging is also well suited to fill the notable knowledge gap of long-term neuromodulatory effects of psychotropic medications in the context of ongoing brain development in children and adolescents. Future studies can leverage advancements in neuroimaging technology, acquisition, and analysis to fill these gaps and accelerate the discovery of novel therapeutics, leading to more effective prescribing and ensuring faster recovery.

One-year exercise improves cognition and fitness and decreases vascular stiffness and reactivity to CO2 in amnestic mild cognitive impairment

BackgroundAmnestic mild cognitive impairment (aMCI) is often a precursor stage to Alzheimer's disease (AD). Aerobic exercise (AE) has received increasing attention in the prevention of AD. While there is some evidence that it improves neurocognitive function in older individuals, the effect of exercise in the long-term is not well understood.ObjectiveTo assess the effect of long-term exercise on cognition, fitness, vascular stiffness, and cerebrovascular reactivity (CVR).MethodsIn this prospective clinical trial, 27 aMCI participants were enrolled into two groups and underwent 12 months of intervention. One group (n = 11) underwent AE training (6M/5F, age = 66.2 years), and the control group (n = 16) performed stretch training (ST group, 9M/7F, age = 66.4 years). Both groups performed training three times per week with duration and intensity gradually increased over time. CVR was measured at pre- and post-training using blood-oxygenation-level-dependent MRI.ResultsIn the AE group, aerobic fitness improved (p = 0.034) and carotid artery stiffness decreased (p = 0.005), which was not observed in the ST group. In all participants, decreases in carotid artery stiffness were associated with increases in aerobic fitness (p = 0.043). The AE group displayed decreases in CVR in the anterior cingulate cortex and middle frontal gyrus (p < 0.05, FWE corrected); the ST group did not show significant changes in CVR. Several measures of cognition (i.e., inhibition and delayed recall), neuropsychiatric symptoms, and functional status ratings improved only in the AE group.ConclusionsThese results suggest that AE may alter cerebral hemodynamics in patients with aMCI which may improve cognitive, psychological, and functional status.

Mental and Physical Health in Wilson Disease Patients With SARS-CoV-2 Infection and Relevance of Long-COVID

SARS-CoV-2 infection and Long COVID (LC) might lead to a significant deterioration of physical and mental health. Wilson disease (WD) patients have a chronic liver and/or neuropsychiatric disease, making it particularly interesting to investigate LC in WD. 51 WD patients were retrospectively examined, evaluating physical and mental health by a survey and neuropsychological tests (SF-12, PSQI, ISI, Epworth, Chalder-fatigue scale, PHQ-9, GAD-7, PSS, FLei) before and ~11 months after SARS-CoV-2 infection. LC was defined as the development of new, at least moderately severe symptoms (shortness of breath, chest pain, fatigue, brain fog, exercise capacity, concentration disturbances) and/or worsening of pre-existing symptoms. 70.6% had predominant hepatic and 29.4% had neuropsychiatric symptoms at WD diagnosis. Median age was 39 years; 56.1% were female. Patients were in stable maintenance phase with a median treatment duration of 23 years. When compared to before COVID-19, WD patients had significantly worse physical life quality, sleeping quality, and fatigue. After COVID-19, a high percentage of WD patients reported concentration disorders (60%), fatigue (55%), reduced exercise capacity (50%), shortness of breath (40%), chest pain (20%) and feeling of brain fog (15%). 39.2% (n = 20) of the WD patients were classified as LC. This LC-WD subgroup showed significantly impaired quality of life, a high stress level, and sleeping disturbances, fatigue, depression, anxiety, and cognitive impairment. A large proportion of WD patients experience LC symptoms, reduced life quality, and sleeping disorders after SARS-CoV-2 infection. WD patients post-infection should be well monitored and supported if they develop persisting symptoms or neuro-psychological problems.

Association between work-from-home policies and United States public interest in foot surgery conditions during the COVID-19 pandemic: A Google Trends analysis

BackgroundThe COVID-19 pandemic, marked by significant lifestyle changes and healthcare-seeking behavior shifts, prompted the implementation of widespread Work from Home (WFH) policies.ObjectiveThis study aimed to explore the impact of the COVID-19 pandemic and WFH policies on public interest in foot surgery by using Google Trends searches as a proxy for public interest in the United States.MethodsA comprehensive dataset of foot-related orthopaedic terms was compiled using Google Trends data from March 2018 to March 2022 and captured weekly, representing over 200 observations. The dataset was separated into pre-pandemic and post-pandemic periods. Shaprio-Wilk testing demonstrated nonparametric data, so Mann-Whitney U tests with Cohen's d for effect size were calculated between the two subgroups.ResultsAn analysis of 26 terms showed declines in five and increased interest in four. The largest decrease was noted in "bunion," "foot pain," and "foot fracture." Terms that were newly coined during the pandemic, including "COVID toe" and "COVID feet" were significantly increased. The remaining 17 terms showed nonsignificant fluctuations in search interest.ConclusionThe decline in search interest for foot-related orthopaedic terms during the COVID-19 pandemic may represent the reduced prioritization of nonurgent conditions in the United States. Healthcare professionals should address this through targeted public health initiatives. In a post-pandemic era, healthcare providers should adapt to shifting patient sentiments, public policies, and patient needs.

Lifetime prevalence of psychotic experience, and its associated factors among Senegalese women: a cross-sectional study

BACKGROUND

Psychotic experiences, which include a range of symptoms such as delusions and hallucinations, is an indication of elevated risk for mental disorders and poor quality of life. These experiences are often underreported and undertreated in low- and middle-income countries, including Senegal. This study aimed to investigate the lifetime prevalence of psychotic experience, its associated factors and adverse outcomes among Senegalese women.

METHODS

This study analyzed the 2023 demographic and health survey data of 16,521 Senegalese women. Descriptive analysis, cross-tabulations, chi-square test, and binary logistic regression models were computed in STATA 18. The multivariable logistic regression analysis followed a backward stepwise approach.

RESULTS

Overall, 6,819 women (41.3% [95%CI: 38.4-44.2]) had a lifetime prevalence of psychotic experience. Referential delusions were the most prevalent (24.5%), followed by paranoid ideation (17.1%), auditory hallucinations (14.1%), bizarre delusions (13.3%), possession (12.4%), visual hallucinations (11.5%), and thought insertion/broadcasting (11.4%). The odds of psychotic experience increased consistently with age. Higher educational attainment (AOR = 0.73, 95%CI: 0.61-0.88) and being currently in union were associated with lower odds of psychotic experiences (AOR = 0.90, 95%CI: 0.81-0.99). A higher risk of psychotic experience was found among women who were exposed to media (AOR = 1.08, 95%CI: 1.00-1.17), those in the richest wealth index (AOR = 2.33, 95%CI: 2.06-2.63), and currently employed women (AOR = 1.21, 95%CI: 1.12-1.30). Dietary habits were relevant, as consuming fried and processed food (AOR = 1.25, 95%CI: 1.15-1.37) and soda and energy drinks (AOR = 1.14, 95%CI: 1.03-1.27) were both associated with increased odds of psychotic experiences. Women who reported a lifetime prevalence of psychotic experience were significantly more likely to attempt suicide (AOR = 10.89; 95%CI: 7.10-16.72), anxiety (AOR = 4.64; 95%CI: 3.89-5.52), and depression (AOR = 7.39; 95%CI: 5.14-10.62).

CONCLUSION

In conclusion, four out of ten women in Senegal had a lifetime prevalence of psychotic experience. These experiences increase the likelihood of anxiety, depression and suicidal attempts. We also conclude that psychotic experiences are associated with sociodemographic and lifestyle factors including age, educational level, employment status, media exposure and dietary habits. Interventions to reduce psychotic experiences should focus on education, media exposure, employment, and dietary habits.

Progress on the mechanism of intestinal microbiota against colorectal cancer

The intestinal microbiota plays a crucial role in the occurrence and development of colorectal cancer, and its anti - colorectal cancer mechanism has become a research hotspot. This article comprehensively expounds on the molecular mechanisms of the intestinal microbiota in anti - colorectal cancer, including aspects such as immune regulation, activation of carcinogenic signaling pathways (it should be noted that it is more reasonable to be "inhibition of carcinogenic signaling pathways"), metabolite - mediated effects, and maintenance of intestinal barrier function. At the same time, it explores the roles and potential mechanisms of intervention methods such as probiotic supplementation therapy, immunotherapy, and fecal microbiota transplantation. In addition, it analyzes the impact of the intestinal flora on the therapeutic efficacy of colorectal cancer. The existing research results are summarized, and the future research directions are prospected, with the aim of providing new theoretical bases and treatment ideas for the prevention and treatment of colorectal cancer.

Patient Experience with Intranasal Esketamine in Treatment-Resistant Depression: Insights from a Multicentric Italian Study (REAL-ESKperience)

Background. Treatment-resistant depression (TRD) is a prevalent, high-burden disorder. Esketamine nasal spray (ESK-NS) has been approved for, T.R.D.; and efficacy has been observed in both clinical trials and real-world studies. However, observations integrating patients' perspective on this treatment are limited. This multicentric Italian study explored experiences with ESK-NS in TRD patients, focusing on perceived therapeutic effects and overall satisfaction. Methods. A self-report survey was administered to 236 outpatients with TRD (55.1% females, 54.1 ± 14.1 years) treated with ESK-NS for at least three consecutive months within standard clinical care. Based on satisfaction levels, participants were classified as "unsatisfied" (10.2%), "partially satisfied" (19.1%), "satisfied" (44.4%), or "very satisfied" (26.3%), and compared for sociodemographic, clinical characteristics, and feedback on perceived benefits. Artificial intelligence (OpenAI) served to categorize responses to an open-ended question. Results. Enhanced quality of life was reported by 88.4% of participants. Significant differences emerged in earliest self-perceived benefits, most relevant effects, and impact on global functioning across groups. Specifically, "very satisfied" patients described the following: early improvements in depressed mood, suicidal thoughts, and restlessness; decreased suicidal thoughts among the most significant effects; and functional gains across all domains. OpenAI identified experiences of personal growth and rediscovery and a desire for tailored settings and approaches as recurring topics. Conclusions. Most patients reported a positive perception of ESK-NS treatment. The most satisfied participants highlighted significant benefits to depressed mood, suicidal thoughts, and overall functioning. Patient-reported experiences offer insights into different psychopathological dimensions, including functional outcomes and quality of life. Integrating these perspectives into clinical practice might assist treatment personalization, improving patients' adherence and satisfaction.

Nutritional knowledge, fiber intake, body mass index, and sex associated with constipation symptoms in Peruvian adults

Functional constipation is a common gastrointestinal disorder influenced by dietary, anthropometric, and demographic factors. However, the combined impact of these factors on constipation symptoms remains underexplored, particularly within the Peruvian population. To assess the association of nutritional knowledge, fiber-rich food consumption, body mass index (BMI), and sex with functional constipation symptoms in Peruvian adults. A cross-sectional study was conducted among 404 Peruvian adults selected through non-probability sampling. Nutritional knowledge (assessed using the Dietary Fiber Habits and Knowledge Questionnaire), fiber-rich food consumption (measured with the Block Instrument), BMI (self-reported and calculated), and constipation symptoms (evaluated using the Rome III International Diagnostic Questionnaire) were analyzed. Hierarchical regression analysis was performed to evaluate the impact of the variables on constipation symptoms. The hierarchical regression analysis, conducted in four blocks, demonstrated a progressive increase in the explained variance. In the fourth block, nutritional knowledge (β = - 0.173, p = 0.006, CI [- 0.296, - 0.050]) and consumption of high-fiber foods (β = - 0.227, p < 0.001, CI [- 0.351, - 0.103]) were associated with a reduction in constipation symptoms, while BMI (β = 0.230, p < 0.001, CI [0.108, 0.353]) and being female (β = 0.153, p = 0.014, CI [0.031, 0.274]) were associated with an increase in symptoms. The final model accounted for 16.4% of the total variance (adjusted R2 = 0.164), with fiber consumption contributing to a 5.2% increase in explained variance (∆R2 = 0.052). These findings underscore the importance of implementing public health educational and dietary strategies to address constipation through preventive and personalized approaches.

Cognitive Correlates of Borderline Personality Disorder Features in Youth with Bipolar Spectrum Disorders and Bipolar Offspring

Background: Bipolar disorder (BD) and borderline personality disorder (BPD) share common cognitive impairments. These deficits are also shared by bipolar offspring (BD-OFF). Nevertheless, little is known regarding the association between cognitive impairments and BPD features in youth with BD and BD-OFF. Objectives: This study aimed to investigate the association between BPD features and cognitive impairments in youth with BD and BD-OFF. Methods: Thirty-nine participants (7-17 years) with BD, 18 BD-OFF, and 50 healthy controls (HCs) were recruited. BPD features were assessed using the Borderline Personality Features Scale for Children (BPFS-C). Deficits in executive functions and affective processing were assessed using tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB), namely, the Cambridge gambling task (CGT), the stockings of Cambridge (SOC), and the Affective Go/No-Go (AGN) and rapid visual processing (RVP) tasks. Between-group differences were analyzed through ANOVAs. Relationships between the BPFS-C and cognitive tasks were examined using multiple linear regressions in youth with BD and BD-OFF. Results: Youth with BD and BD-OFF showed higher scores on the BPFS-C. Youth with BD had increased deficits in the CGT and SOC compared to HCs. In both youth with BD and BD-OFF, BPD features were associated with increased deficits in the CGT, and a bias toward positive emotions in the AGN task. Conclusions: In youth with BD and BD-OFF, clinical and cognitive assessments for BPD features are of relevance as they have the potential to inform targeted interventions.

Efficacy and safety of adjunctive therapy with lumateperone in major depressive disorder: a randomized-, double-blind, placebo-controlled clinical trial

This study aimed to investigate the effects of lumateperone as a combination therapy with sertraline in major depressive disorder (MDD). The 8-week, double-blind, placebo-controlled trial was registered with the Iranian Registry of Clinical Trials (registration date: 2022-03-01, registration number: IRCT20090117001556N141). Patients with MDD were randomized to receive either sertraline (100 mg/day) combined with lumateperone (42 mg/day) or sertraline (100 mg/day) with placebo. The Hamilton Depression Rating Scale (HDRS) was used to assess treatment efficacy. Fifty-eight patients with MDD were analyzed (age: 36.91 ± 9.81 and male: 69.0%). The two groups were comparable across baseline sociodemographic and clinical characteristics except for marital status. There was a significant time × treatment interaction on HDRS (P = 0.027), suggesting greater improvement in depressive symptoms following the lumateperone adjuvant therapy. Compared with the placebo group, a significantly larger proportion of individuals receiving lumateperone experienced an HDRS reduction rate greater than or equal to 50% at weeks 4 (90.0 vs. 60.7%, P = 0.014) and 8 (100 vs. 82.1, P = 0.021). However, the remission rate was not different. No serious adverse events were reported. This study suggests that lumateperone can be considered an effective and safe adjuvant treatment for MDD. Future larger clinical trials with extended follow-up periods are needed to confirm its efficacy for clinical use.