Emerging strategies and clinical recommendations for the management of novel depression subtypes

INTRODUCTION

The phenomenology of depression is characterized by a wide array of emotional, cognitive, and physical symptoms that significantly disrupt an individual's life. Societal changes, driven by technological advancements, economic pressures, environmental concerns including climate change, and shifting cultural norms, have influenced how depression manifests and is understood. These developments have led to the identification of new depression subtypes, highlighting the need for personalized treatment approaches based on individual symptoms and underlying causes.

AREAS COVERED

The authors provide a comprehensive narrative review of the literature on managing novel depression subtypes, focusing on both pharmacological and non-pharmacological treatments. Specifically, scenarios recorded were related to i) depression in adolescents and young adults; ii) depression and social disconnection; iii) depression and alcohol/substance use disorder; iv) depression and gender dysphoria; v) depression, stressful events, and other environmental factors.

EXPERT OPINION

In the novel depression subtypes discussed, individualized treatment approaches tailored to the individual's specific circumstances are necessary. While selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) remain the cornerstone of treatment for many forms of depression, atypical antidepressants such as trazodone, and emerging therapies like ketamine, neuromodulation techniques, and personalized psychotherapy offer hope for those with complex or treatment-resistant presentations.

Risky sexual behavior and associated factors among people with severe mental illness in Africa: A systematic review and meta-analysis

BACKGROUND

Individuals, who suffer from severe mental illnesses (SMI), such as bipolar disorder (BD), schizophrenia (SCZ), and major depressive disorder (MDD), are more likely to engage in risky sexual behavior. A severe mental illness can lead to a decrease in impulse control, a reduction in cognitive function and memory, and a psychosocial impairment that increases risky sexual behavior. Risky sexual behavior (RSB) can lead to health problems such as sexually transmitted infections, including HIV/AIDS, early pregnancy, and unplanned pregnancies. The purpose of this systematic review and meta-analysis was to determine the pooled prevalence of risky sexual behavior and factors among individuals with severe mental illness in Africa.

METHOD

A systematic review of observational studies: cross-sectional and prospective cohort studies published between 2009 and 2022 that reported relative risks (RR) and odd ratios (OR) that had explicit the prevalence of RSB. We conducted primary article searches in PubMed/MEDLINE, Scopus, African Journal Online, PsycINFO, EMBASE, Psychiatry Online, CINAHL, Science Direct, and the Cochrane Library. This review's included studies were critically appraised, and those with scores >5 were included in the meta-analysis. Meta-regression was used to investigate other reasons for heterogeneity in the dataset.

RESULTS

This systematic review and meta-analysis includes twelve main studies with a total of 3625 participants, of whom 1605 were male and 2020 were female. The pooled prevalence of RSB among people with severe mental illness in Africa was 43.4 % (95 % CI 34.56-52.23). Being male OR = 2.83 (95 % CI 1.96-4.08), having active mania symptoms OR = 2.07(95 % CI 1.35-3.18), young adults OR = 2.79 (95 % CI 1.27-6.16), and current use of alcohol OR = 2.55 (95 % CI 1.71-3.79) were significantly associated with risky sexual behavior in this review.

CONCLUSION

This systematic review and meta-analysis revealed a high prevalence of risky sexual behavior (RSB) among individuals with severe mental illness in Africa, highlighting a critical public health concern. Several important factors were significantly associated with RSB in this population: being male, having active mania symptoms, young adults, and current alcohol use. These findings emphasize the need for targeted interventions and comprehensive support systems to address the behavioral and environmental risk factors that contribute to RSB in individuals with severe mental illness. Preventive strategies, including gender-sensitive approaches, integrated mental health and substance use services, and age-specific interventions, are essential to mitigate the risks associated with RSB and improve overall well-being in this vulnerable population.

Exploratory analysis of the professional quality of life in an Italian radiotherapy department: The role of empathy and alexithymia

PURPOSE

Professional quality of life (QoL) is crucial for healthcare workers as it affects performance at work and interaction with patients, but little is known about stressors influencing radiation oncology professionals. The present study aims to explore the professional QoL of radiation oncologists (ROs) and radiation therapists (RTTs) in an Italian radiotherapy department and to report data about the possible impact of personality factors, such as alexithymia and empathy.

MATERIAL AND METHODS

Participants filled out three validated questionnaires measuring the professional QoL, alexithymia, and empathy: (i) Professional Quality of Life Scale (ProQOL); (ii) Toronto Alexithymia Scale (TAS-20); (iii) Interpersonal Reactivity Index (IRI). Correlation, regression analyses and non-parametric tests were run.

RESULTS

A total of 48 professionals completed the survey (66.7% ROs, 33.3% RTTs). Considering the ProQOL dimensions, moderate levels of risk for burnout (BO) and secondary traumatic stress (STS) were found. BO was found to be predictive by TAS-20 total score (β=.37, p=.010), while STS resulted to be predictive by TAS-20 total score (β=.54, p <.001) and IRI Empathic Concern subscale (β=.45, p <.001). No significant differences were found between ROs and RTTs for all the considered variables, except for TAS-20 total score (p=.032), higher for RTTs.

CONCLUSIONS

Results showed no evidence of high risk of burnout and no intrinsic differences regarding the professional QoL between ROs and RTTs. Findings suggest a significant role of alexithymia and empathy predicting professional QoL. These results underscore the importance of promoting a positive work environment and emotional competencies to prevent high stress levels.

Co-Occurring Bipolar and Substance Use Disorders: A Review of Impacts, Biopsychosocial Mechanisms, Assessment, and Treatment

Individuals with bipolar disorder are at significant risk for having a co-occurring substance use disorder-particularly, alcohol and cannabis use disorders. Having a co-occurring substance use disorder is associated with a more pernicious clinical course, lower quality of life, and poorer treatment outcomes. Despite its increased morbidity, there is little research and clinical evidence-based guidelines on the treatment of individuals with co-occurring bipolar and substance use disorders. This review details current knowledge on the prevalence, clinical correlates, and biopsychosocial mechanisms underlying co-occurring bipolar and substance use disorders. The authors present recent research that highlights underlying mechanisms of comorbidity, including aberrant reward processing, stress sensitization, early childhood maltreatment, and gene-environment interactions. Next, the authors review current evidence-based recommendations for the assessment and treatment of co-occurring bipolar and substance use disorder, highlighting areas of needed future clinical research.

Concordance of Mother and Father Reports of Intimate Partner Violence and Observed Interactions in Unmarried Black Coparents Expecting Their First Child

Concordance between partner reports of Intimate Partner Violence (IPV) is generally low, but self-reporting of IPV and concordance between partners among expectant parents in marginalized communities has not been explored, nor have associations among each partner's reports of IPV and their behaviors in observed conflict discussions. This study will examine these gaps. One hundred and thirty-eight low-income, unmarried, Black, coparenting dyads expecting their first child together (136 mothers and 136 fathers) completed the Revised-Conflict Tactics Scale and a video recorded and coded conflict discussion. There was low concordance between parent's reports of IPV overall with moderate levels of concordance for coparents who were living together and had more harmonious relationships. Linear regression analyses indicated only mothers' reports of fathers' psychological and physical IPV but not fathers' reports of IPV were significantly associated with observed negative communication. Neither coparents' reports of psychological or physical IPV were associated with positive communication during a conflict discussion. These findings suggest that at the time of parenthood transitions, mothers' reports of fathers' IPV behaviors may be more robust in their association with negative/unhealthy couple communication patterns than fathers' reports and should be used when making safety determinations with families.

The impact of pharmacotherapy for premenstrual dysphoric disorder on sleep

Premenstrual dysphoric disorder (PMDD) affects a subset of women of reproductive age, characterized by severe mood disturbances and physical symptoms during the luteal phase of the menstrual cycle. Symptoms include mood swings, irritability, anxiety, fatigue, physical discomfort, and disruptions to sleep and circadian rhythms, such as altered melatonin secretion. Despite the prevalence of these symptoms, the impact of PMDD treatments on sleep and circadian markers, like melatonin, remains insufficiently understood. This review examines how dysregulated serotonin signaling, disrupted allopregnanolone activity (a neurosteroid derived from progesterone), and aberrant circadian rhythms contribute to PMDD. It also explores the effects of pharmacological treatments, including selective serotonin reuptake inhibitors, on sleep and melatonin regulation, and how these factors influence treatment outcomes. Additionally, the use of hypnotics and sedatives to manage sleep disturbances in PMDD is considered, weighing their potential benefits and risks. A deeper understanding of the interaction between PMDD symptoms, sleep, and circadian rhythms is crucial for developing more effective treatments. Further research is needed to explore the relationship between symptom management, sleep patterns, and circadian function in PMDD, and to determine how these factors can be optimized to improve clinical outcomes and quality of life for women affected by the disorder.

Napping during cognitive behavioural therapy for insomnia: Friends or foes?

Cognitive and Behavioural Therapy for Insomnia (CBT-I) is the gold standard treatment for chronic insomnia, with one crucial step being the restriction of time spent in bed. This restriction often intensifies early afternoon sleepiness, leading to a natural gateway for a short recuperative nap, which might foster adherence to CBT-I over time. In practice, mental health professionals providing CBT-I lack consensus on whether or not to tolerate short naps during the CBT-I period for requesting patients. In this pilot study, we examined the effects of authorised napping on CBT-I efficiency in patients with insomnia (a napping group was compared with a matched non-napping group, n = 108). We report that napping enhanced early afternoon alertness and importantly did not affect CBT-I-mediated improvements in the Insomnia Severity Index and Beck Depression Inventory-2 and in self-reported sleep efficiency, latency, and wake after sleep onset (assessed by the sleep diaries). Further investigations using objective methods of sleep assessments are now needed to confirm that napping behaviour does not compromise the improvements enabled by CBT-I and may even strengthen adherence to the treatment.

Leveraging a Global Partnership to Address COVID-19-Related Mental Health Challenges

INTRODUCTION

The COVID-19 pandemic profoundly affected nurses globally. As frontline workers, nurses faced increased responsibilities amid challenges such as isolation, infection risks, family obligations and disrupted social support systems. Coping with these challenges was associated with adverse mental health outcomes.

AIM/QUESTION

This perspective paper examines a collaboration between two schools of nursing in the United States and India to address these mental health challenges.

METHODS

Faculty from both institutions identified key mental health topics, leading to five webinars that delved into topics such as acute and long-term impacts of COVID-19 on nurse mental health, coping mechanisms, caregiving responsibilities and children's needs during the pandemic.

RESULTS

Impressively, over 11,000 nurses from 60 countries engaged, fostering a global platform for sharing evidence-based knowledge, experiences and strategies.

IMPLICATIONS FOR PRACTICE

This partnership exemplifies the value of international collaboration. By pooling resources and expertise across cultural contexts, the initiative not only disseminated crucial knowledge but also cultivated a sense of global community among nurses. The success of this collaboration underscores the potential of such global partnerships for healthcare institutions worldwide, offering avenues to share best practices and enhance support systems for nurses confronting similar crises globally.

The potential of dibenzazepine carboxamides in cancer therapy

Cancer is a leading cause of mortality worldwide, with most conventional treatments lacking efficacy and having significant challenges like drug resistance. Finding new molecules is quite challenging in terms of cost, time and setbacks. Hence, drug repurposing is considered sensible for skipping the long process of drug development. Dibenzazepine carboxamides, as traditional anticonvulsants, primarily function by blocking voltage-gated sodium channels, which not only mitigate seizures but also influence mood disorders through modulation of serotonin and dopamine. Recent studies have uncovered their anticancer properties, demonstrated by both in vitro and in vivo experiments. This review comprehensively examines dibenzazepine's pharmacodynamics, pharmacokinetics, and clinical applications, focusing on their emerging role in oncology. By highlighting the anticancer mechanisms of action-including apoptosis induction, inhibition of HDAC, Wnt/β-Catenin signaling, and Voltage-gated sodium channels, we suggest further research to fully elucidate their therapeutic potential and application in cancer treatment.

Novel Insights into Addiction Management: A Meta-Analysis on Intervention for Relapse Prevention

Background and Objectives: Addiction and relapse prevention of alcohol and drug users is a real problem globally. Studies report different pharmacological and non-pharmacological methods in preventing relapse with varying ranges of results across the time of relapse. The study aims to identify novel insights into relapse prevention for high-risk alcohol and drug addiction across diverse global populations, ages, and intervention types during detoxification. Materials and Methods: This meta-analysis followed PRISMA guidelines, synthesizing 12 eligible studies published between 2013 and 2023, totaling 2162 participants. Data extraction and statistical analysis were conducted using Python-based libraries. Regression models were applied to examine the influence of age, gender, and intervention type on the mean relapse period. Results: 12 studies with 2162 patients were identified. These studies examined substances, interventions, and demographics, highlighting male predominance in addictive behaviors. OSL regression assessed factors influencing mean relapse periods, finding that age explained 44.2% of the variability (p = 0.0131). The male percentage explained 17.1%, but the significance was inconclusive, as was the female gender's negligible impact (14.7% variability). Intervention types significantly influenced relapse periods, supported by a large F-statistic. Linear regression showed no consistent trend in relapse periods, with declining research post-2018. Forest plots indicated disparities in relapse periods due to treatment or methodology. Most participants were high-risk drug users, though alcohol use was also represented. A declining trend in publication rates after 2018 was observed. Conclusions: Age and intervention type were identified as key factors influencing relapse duration, while gender and substance-specific effects require further study. The findings underscore the need for more targeted, gender-sensitive, and context-aware treatment strategies.

Iron Overload, Microbleeding and the Role of Bilirubin in Alzheimer's Disease Brain: Revisiting the Vascular Hypothesis

Alzheimer's disease (AD) and vascular dementia (VaD) are the two most prevalent forms of dementia, sharing overlapping clinical features yet distinct pathophysiological mechanisms. While AD is primarily driven by amyloid-beta (Aβ) plaques and tau neurofibrillary tangles, VaD results from cerebrovascular pathology, including ischemic lesions and chronic hypoperfusion. However, accumulating evidence suggests that vascular dysfunction is a crucial contributor to both conditions, bridging neurodegenerative and cerebrovascular pathologies. In this review, we explore the interplay between AD and VaD, focusing on shared pathways such as blood-brain barrier (BBB) breakdown, neuroinflammation, and microvascular damage. Notably, cerebral microbleeds have emerged as a common feature in both AD and VaD, further linking vascular pathology to neurodegeneration. Microbleeding contributes to BBB disruption, iron deposition, and exacerbated oxidative stress, creating a vicious cycle that accelerates cognitive decline. We highlight the role of iron dysregulation as a key driver in AD, exacerbating Aβ accumulation, tau hyperphosphorylation, and ferroptosis. Conversely, bilirubin emerges as a molecule with theranostic potential, acting as both a biomarker and a neuroprotective agent due to its antioxidant and anti-inflammatory properties. Despite its protective role, bilirubin's dysregulation under pathological conditions may contribute to oxidative damage and neurovascular dysfunction. In this context, the accumulation of iron from recurrent microbleeds may further disrupt bilirubin homeostasis, amplifying oxidative injury and inflammation. We propose a vascular hypothesis that integrates iron metabolism and bilirubin homeostasis, suggesting that their imbalance plays a central role in AD pathogenesis and worsening. Understanding the intricate molecular interplay between neurodegeneration and vascular dysfunction could provide novel insights into targeted interventions aimed at mitigating cognitive decline. Finally, we discuss the potential of bilirubin-based therapeutic strategies, including its role in counteracting oxidative stress and modulating neuroinflammatory pathways, offering promising avenues for future research and precision medicine in dementia.

Gender Differences in Alexithymia, Emotion Regulation, and Impulsivity in Young Individuals with Mood Disorders

Background/Objectives: Alexithymia, emotion regulation, and impulsivity are key factors in youths with mood disorders. However, gender differences within these dimensions remain insufficiently studied in this population. This study seeks to explore these dimensions in a sample of adolescents and young adults with mood disorders, aiming to identify gender-specific characteristics with important clinical implications. Methods: We assessed 115 outpatients aged 13 to 25 years with a DSM-5 diagnosis of mood disorder. The evaluation included the Toronto Alexithymia Scale (TAS-20), the Difficulties in Emotion Regulation Scale (DERS), and the UPPS-P Impulsive Behavior Scale. The associations with suicidal ideation were tested using two different multivariate models. Results were controlled for age and intelligence measures. Results: The first model (Wilks' Lambda = 0.720, p < 0.001) revealed significantly higher scores in women than men for TAS-20 (p < 0.001), DERS (p < 0.001), and the UPPS-P subscales "Lack of Premeditation" (p = 0.004) and "Lack of Perseverance" (p = 0.001). Regression analyses confirmed gender as a significant predictor of these variables, also controlling for age and intelligence. Furthermore, intelligence measure influenced Lack of Premeditation and age influenced Lack of Perseverance. Conclusions: Women with mood disorders exhibit greater alexithymia, emotional dysregulation, and impulsivity, particularly in difficulties with planning and task persistence. These findings highlight the need for gender-sensitive interventions that address emotional awareness and impulse control to improve clinical outcomes.

Evolving evidence in the neural sensitization of prurigo nodularis

Prurigo nodularis is a chronic inflammatory skin disorder characterized by relentlessly pruritic, hyperkeratotic nodules. Recent studies have provided compelling evidence for the pivotal role of dysregulated interactions between the nervous and immune systems in its pathogenesis. This article reviews the latest findings on the neurogenic mechanisms contributing to prurigo nodularis, particularly how these processes lead to the sensation of increased itch intensity. Peripheral sensitization is primarily driven by abnormal innervation of histamine-independent, small unmyelinated C fibers, epidermal hypoplasia, and dermal hyperinnervation. This sensitization is further amplified by the cyclic release of neuropeptides such as Substance P, calcitonin gene-related peptide, and nerve growth factor. Although the mechanisms underlying central sensitization in prurigo nodularis remain less understood, it likely involves enhanced itch signaling in the dorsal spinal cord or a lowered threshold for itch perception. Additionally, parallels between pruritus and pain-such as allodynia and alloknesis, as well as hyperalgesia and hyperknesis-along with the association of prurigo nodularis with various comorbid systemic conditions, offer valuable insights into the disorder's pathology. A deeper understanding of the complex neural sensitization mechanisms in prurigo nodularis may lead to the identification of novel therapeutic targets, ultimately alleviating the burden of this debilitating condition.

Physical illness in schizophrenia and the role of tolerability in antipsychotic selection: an expert consensus with a focus on cariprazine

BACKGROUND

Schizophrenia is a highly heterogeneous disease, and a high percentage of patients are at high risk of developing somatic comorbidities, which must be taken into account in disease management and treatment selection.

MAIN BODY

Antipsychotics are often associated with side effects that worsen the somatic comorbidities. Among the different options, cariprazine is generally safe and usually well tolerated in both acute and long-term treatment and is often a good choice when balancing clinical benefits and side effects. Given the lack of consensus on the priority of symptoms to treat and the reasons for switching therapy based on the balance between side effects and symptom resolution, twelve psychiatrists met for an expert meeting to discuss the most common and worrisome antipsychotic side effects leading to switching, the most important somatic comorbidities, and the best way to address specific symptoms in both the acute and maintenance phases of treatment in schizophrenia. Special attention was given to metabolic comorbidities, sexual dysfunction, and cardiovascular disease. This paper aims to examine the relationship between schizophrenia and specific somatic comorbidities, to discuss how the balance between efficacy and tolerability influences treatment choice in the acute and maintenance treatment of schizophrenia, and how these two variables may have different priorities at different stages of treatment.

CONCLUSION

The choice of treatment is based primarily on efficacy and tolerability. Cariprazine is beneficial in patients with positive and negative symptoms, and it has a side-effect profile with low rates of metabolic side effects, sedation, and sexual dysfunction.

Online Safety When Considering Self-Harm and Suicide-Related Content: Qualitative Focus Group Study With Young People, Policy Makers, and Social Media Industry Professionals

BACKGROUND

Young people are disproportionately impacted by self-harm and suicide, and concerns exist regarding the role of social media and exposure to unsafe content. Governments and social media companies have taken various approaches to address online safety for young people when it comes to self-harm and suicide; however, little is known about whether key stakeholders believe current approaches are fit-for-purpose.

OBJECTIVE

From the perspective of young people, policy makers and professionals who work within the social media industry, this study aimed to explore (1) the perceived challenges and views regarding young people communicating on social media about self-harm and suicide, and (2) what more social media companies and governments could be doing to address these issues and keep young people safe online.

METHODS

This qualitative study involved 6 focus groups with Australian young people aged 12-25 years (n=7), Australian policy makers (n=14), and professionals from the global social media industry (n=7). Framework analysis was used to summarize and chart the data for each stakeholder group.

RESULTS

In total, 3 primary themes and six subthemes are presented: (1) challenges and concerns, including the reasons for, and challenges related to, online communication about self-harm and suicide as well as reasoning with a deterministic narrative of harm; (2) roles and responsibilities regarding online safety and suicide prevention, including who is responsible and where responsibility starts and stops, as well as the need for better collaborations; and (3) future approaches and potential solutions, acknowledging the limitations of current safety tools and policies, and calling for innovation and new ideas.

CONCLUSIONS

Our findings highlight tensions surrounding roles and responsibilities in ensuring youth online safety and offer perspectives on how social media companies can support young people discussing self-harm and suicide online. They also support the importance of cross-industry collaborations and consideration of social media in future suicide prevention solutions intended to support young people.

Psycho-gastroenterological profile of an Italian population of children with disorders of gut-brain interaction: A case-control study

BACKGROUND

Disorders of gut-brain interaction (DGBI) are common, but knowledge about their physiopathology is still poor, nor valid tools have been used to evaluate them in childhood.

AIM

To develop a psycho-gastroenterological questionnaire (PGQ) to assess the psycho-gastroenterological profile and social characteristics of a pediatric population with and without DGBI.

METHODS

One hundred and nineteen Italian children (age 11-18) were included: 28 outpatient patients with DGBI (Rome IV criteria) and 91 healthy controls. They filled the PGQ, faces pain scale revised (FPS-R), Bristol stool chart, gastrointestinal symptoms rating scale, state-trait anxiety inventory, Toronto alexithymia scale 20, perceived self-efficacy in the management of negative emotions and expression of positive emotions (APEN-G, APEP-G), irritable bowel syndrome-quality of life questionnaire, school performances, tobacco use, early life events, degree of digitalization.

RESULTS

Compared to controls, patients had more medical examinations (35% of them went to the doctor more than five times), a higher school performance (23% vs 13%, P < 0.05), didn't use tobacco (never vs 16%, P < 0.05), had early life events (28% vs 1% P < 0.05) and a higher percentage of pain classified as 4 in the FPS-R during the examination (14% vs 7%, P < 0.05).

CONCLUSION

Pediatric outpatients with DGBI had a higher prevalence of early life events, a lower quality of life, more medical examinations rising health care costs, lower anxiety levels.

Regional variations in Italy's COVID-19 death toll: a descriptive analysis of excess mortality and associated factors from 2020 to 2021

BACKGROUND

Italy implemented various measures, including lockdowns and a mass vaccination campaign, to address the COVID-19 pandemic. This study aims to describe the temporal and regional differences in mortality trends between March 2020 and December 2021, along with associated socioeconomic, policy, and behavioral factors.

METHODS

We used National Ministry of Health data on COVID-19 mortality, excess mortality (EM), and vaccine uptake, along with data from the Italian arm of a European survey of preventive behaviors and attitudes, such as trust in institutions. The analysis was conducted across four macro regions and five study periods. Avertable mortality was calculated as observed EM minus the lowest EM at the macro-regional level for each study period.

RESULTS

In 2020-21, the estimated total EM was 180,169 deaths, with 76.4% officially attributed to COVID-19. This proportion ranged from 13.5% in the South and Islands (June-October 2020) to 140.0% in the Northeast (March-July 2021). Excess and avertable mortality peaked in the North during the first two periods (March 2020 - February 2021) and in the South and Islands thereafter (March-December 2021). Survey data revealed reduced adherence to stay-at-home orders in the North and lower trust in hospitals and reduced vaccine uptake, especially among the elderly, in the South and Islands. After the initial period, 33,587 deaths (18.6%) could have been averted if each macro-region had matched the lowest rates observed in that period. An estimated 40.7% of avertable deaths occurred in Southern and Insular Italy, which constitutes 33.7% of the national population.

CONCLUSIONS

Due to differential misreporting, EM estimates offer a more accurate view of regional and temporal patterns in COVID-19 mortality than official rates. The higher EM in northern Italy during the first year of the pandemic might be linked to lesser adherence to control policies, possibly associated with higher private-sector employment. The higher EM in the South and Islands post-March 2021, contributing to 40.7% of avertable EM, could be partly explained by the lower vaccination rates in the population aged 80 and older, who experienced the highest age-specific mortality rates and lower trust in the healthcare system in this macro-region.

Using Natural Language Processing Methods to Build the Hypersexuality in Bipolar Reddit Corpus: Infodemiology Study of Reddit

BACKGROUND

Bipolar is a severe mental health condition affecting at least 2% of the global population, with clinical observations suggesting that individuals experiencing elevated mood states, such as mania or hypomania, may have an increased propensity for engaging in risk-taking behaviors, including hypersexuality. Hypersexuality has historically been stigmatized in society and in health care provision, which makes it more difficult for service users to talk about their behaviors. There is a need for greater understanding of hypersexuality to develop better evidence-based treatment, support, and training for health professionals.

OBJECTIVE

This study aimed to develop and assess effective methodologies for identifying posts on Reddit related to hypersexuality posted by people with a self-reported bipolar diagnosis. Using natural language processing techniques, this research presents a specialized dataset, the Talking About Bipolar on Reddit Corpus (TABoRC). We used various computational tools to filter and categorize posts that mentioned hypersexuality, forming the Hypersexuality in Bipolar Reddit Corpus (HiB-RC). This paper introduces a novel methodology for detecting hypersexuality-related conversations on Reddit and offers both methodological insights and preliminary findings, laying the groundwork for further research in this emerging field.

METHODS

A toolbox of computational linguistic methods was used to create the corpora and infer demographic variables for the Redditors in the dataset. The key psychological domains in the corpus were measured using Linguistic Inquiry and Word Count, and a topic model was built using BERTopic to identify salient language clusters. This paper also discusses ethical considerations associated with this type of analysis.

RESULTS

The TABoRC is a corpus of 6,679,485 posts from 5177 Redditors, and the HiB-RC is a corpus totaling 2146 posts from 816 Redditors. The results demonstrate that, between 2012 and 2021, there was a 91.65% average yearly increase in posts in the HiB-RC (SD 119.6%) compared to 48.14% in the TABoRC (SD 51.2%) and an 86.97% average yearly increase in users (SD 93.8%) compared to 27.17% in the TABoRC (SD 38.7%). These statistics suggest that there was an increase in posting activity related to hypersexuality that exceeded the increase in general Reddit use over the same period. Several key psychological domains were identified as significant in the HiB-RC (P<.001), including more negative tone, more discussion of sex, and less discussion of wellness compared to the TABoRC. Finally, BERTopic was used to identify 9 key topics from the dataset.

CONCLUSIONS

Hypersexuality is an important symptom that is discussed by people with bipolar on Reddit and needs to be systematically recognized as a symptom of this illness. This research demonstrates the utility of a computational linguistic framework and offers a high-level overview of hypersexuality in bipolar, providing empirical evidence that paves the way for a deeper understanding of hypersexuality from a lived experience perspective.

Oxidative Stress Indicated by Nuclear Transcription Factor Nrf2 and Glutathione Status in the Blood of Young Children with Autism Spectrum Disorder: Pilot Study

This pilot study investigated the relationship between nuclear transcription factor Nrf2 and glutathione homeostasis in children with autism spectrum disorder (ASD), addressing the role of oxidative stress in ASD pathophysiology. Oxidative stress, characterized by an imbalance between reactive oxygen species and antioxidant defenses, has been implicated in ASD and may contribute to neuroinflammation and mitochondrial dysfunction. Nrf2, a key regulator of the antioxidant response, influences glutathione synthesis and recycling, making it critical for cellular redox balance. This study included 23 children with ASD and 21 neurotypical healthy controls, and measured levels of Nrf2, Keap1 (Kelch-like ECH-associated protein 1), reduced glutathione (GSH), oxidized glutathione (GSSG), glutathione reductase (GR), and peroxidase (GPx3) in blood samples. Our study reveals altered antioxidant defense in children with autism spectrum disorder, as evidenced by reduced levels of Nrf2, Keap1, GSH, and GR, along with elevated GSSG and a lower GSH/GSSG ratio. These findings indicate an increased oxidative stress burden in this population. Additionally, the observed positive correlation between Nrf2, GSH, and GR levels suggests an important role for Nrf2 in maintaining glutathione homeostasis. Our results underscore the potential involvement of oxidative stress in ASD and emphasize the need for further research into targeted therapeutic approaches to address this imbalance.

Effect of intravenous esketamine on postoperative sleep disturbance, anxiety, and depression in elderly patients undergoing laparoscopic abdominal surgery: a randomized controlled trial

BACKGROUND

The population of elderly individuals undergoing surgical procedures is increasing, necessitating effective postoperative management strategies. Postoperative sleep disturbance, anxiety, and depression are significant contributors to overall recovery in this demographic, especially following laparoscopic abdominal surgery.

METHODS

This study included 200 records of elderly patients undergoing laparoscopic abdominal surgery. Patients were divided into an esketamine group, receiving intravenous esketamine, and a control group, receiving normal saline. Parameters such as surgery and anesthesia duration, fluid volume, blood loss, urine output, sleep disturbance, anxiety, depression, pain assessment, and adverse events were compared between the two groups.

RESULTS

The esketamine group had significantly fewer postoperative sleep disturbances, lower anxiety and depression scores on days 1 and 3, and lower Visual Analog Scale (VAS) scores compared to the control group (P < 0.05). They also required less rescue analgesia, used fewer opioids, and consumed fewer non-opioid analgesics (P < 0.05). However, the esketamine group experienced a higher incidence of dissociative symptoms (P < 0.05), while other adverse events were similar between the groups. Overall, esketamine improved pain management and reduced anxiety and depression but increased the risk of dissociative symptoms.

CONCLUSIONS

Intravenous esketamine administration in elderly patients undergoing laparoscopic abdominal surgery was associated with reduced postoperative sleep disturbance, lower postoperative pain scores, lower anxiety and depression scores, decreased rescue analgesia requirements, reduced opioid consumption, and a lower use of non-opioid analgesic medications.

CLINICAL TRIAL NUMBER

This clinical study was registered at Chinese Clinical Trial Registry (ChiCTR, ChiCTR2400087795).

Association of optic neuritis with incident depressive disorder risk in a Korean nationwide cohort

Studies have highlighted complex bidirectional relationships between autoimmune diseases and depressive disorders. Given that early mental health interventions have substantial public health implications, this study investigated association between optic neuritis, an autoimmune inflammatory disorder of the optic nerve, and risk of developing depressive disorders. Utilizing extensive national health insurance data encompassing almost the entire Korean population, this cohort study included 11,745 patients with optic neuritis and 58,725 age- and sex- matched controls between 2010 and 2017. The diagnosis of optic neuritis was confirmed using ICD-10 code H46 and patient medical records. The association with depression risk identified by ICD-10 codes F32 and F33 was assessed using Cox proportional hazards regression models after adjusting for demographics, lifestyle variables, and other comorbidities. Newly diagnosed optic neuritis was associated with an increased risk of depression (hazard ratio = 1.349, 95% confidence interval: 1.277-1.426), independent of potential confounding factors. Subgroup analysis revealed a stronger association for individuals under 50 years, males, current smokers, and those without hypertension. This association suggests that autoimmune neuroinflammatory responses impact mental health differently across demographics. These findings underscore the importance of implementing routine depression screening and developing targeted early intervention strategies for patients with optic neuritis, particularly for those with a high-risk of depression.

Prevalence of suicidal ideation and associated factors among perinatal women living with HIV: a systematic review and meta-analysis

Perinatal women living with HIV face increased susceptibility to mental health challenges, including suicidal ideation (SI). This study aimed to determine the prevalence of SI among perinatal women with HIV and identify associated factors. A systematic search was done across PubMed, Embase, Scopus, ScienceDirect, and Google Scholar. Data analysis was executed using R software. Publication bias was assessed via funnel plot and Egger's test, while heterogeneity was investigated using the I2 statistic. A total of 11 studies involving 4329 participants were included. The pooled prevalence of SI was 23.4% (95% CI: 16.3-32.4). Subgroup analysis showed higher prevalence in postnatal women (36.4%) than antenatal women (27.8%), although this difference was not statistically significant. Studies employing the Edinburgh Postnatal Depression Scale reported a higher prevalence (38.9%). Studies published between 2013-2017 showed a higher prevalence (37.6%) compared to those published between 2018-2022 (18.2%). Factors associated with SI included depression during pregnancy or postpartum, unplanned pregnancy, intimate partner violence, undisclosed HIV status, lack of social support, and recent diagnosis of sexually transmitted infections other than HIV. The high prevalence of SI emphasizes the need for mental health screening and interventions. Mental health assessments should be integrated into routine antenatal and postnatal care.

Sleep disturbances in anorexia nervosa

INTRODUCTION

Sleep is crucial for physical and psychological health, and disturbances are closely linked to psychiatric disorders, making their management essential for improving treatment outcomes and preventing relapse. Although sleep disturbances are implicated in psychopathology of eating disorders, its role in anorexia nervosa (AN) remains unclear. This review aimed to characterise sleep in AN.

METHODS

A systematic search was conducted in four scientific databases, including papers from inception to 25 May 2024. A machine learning algorithm (ASReview) was utilised to screen titles and abstracts for eligibility. Sleep quantity, architecture, and quality were investigated. Meta-analyses were conducted to investigate the difference between patients with AN and healthy controls (HC) in total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), sleep efficiency, Sleep Stage 1, 2, slow wave sleep, rapid eye movement (REM) sleep and REM latency. Certainty of evidence was assessed using the GRADE approach.

RESULTS

Out of 67 potentially eligible papers, 31 were included in this review, with 15 in the meta-analyses. Statistically significant average mean differences were found for TST (-32.1 min [95% CI: -50.9, -13.4]), WASO (19.0 min [95% CI: -2.4, 40.3]), and sleep efficiency (-4.4% [95% CI: -7.9, -0.9]). Additionally, Sleep stage 1 was significantly increased (2.4% [95%-CI: 0.05, 4.7]), while REM sleep was reduced (-2.1% [95%-CI: -4.2, -0.02]). Subgroup analysis showed that TST and WASO did not improve significantly after weight restoration.

CONCLUSION

Sleep in patients with AN is impaired, with lower TST and sleep efficiency, higher WASO, more time in stage 1 sleep, and less in REM. Weight restoration alone may not improve sleep. While more research is needed, substantial accompanying sleep disturbances in AN justifies addressing these in current treatment practice, also because of the chronic character of AN and importance of sleep for long term (mental) health.

A comprehensive bibliometric analysis of prurigo nodularis literature (1951-2024): Key contributors, trends, and thematic evolution

This study provides a comprehensive bibliometric analysis of prurigo nodularis (PN) literature, identifying influential studies, key contributors, and emerging trends to understand the evolution of research and guide future investigations. A total of 499 contributions published between 1951 and October 2024, containing the term "prurigo nodularis" in their abstracts, were analyzed. Keyword analysis was conducted to determine the main themes across these publications. Additionally, the top 100 most cited articles on PN from 1979 to 2023 were examined, involving 51 journals. Metrics such as mean total citations per contribution (MeanTCperArt) and mean total citations per year (MeanTCperYear) were calculated for these top 100 articles. The analysis of the top 100 most cited articles revealed contributions from 453 authors. The number of publications, citations, h-index, g-index, m-index, hg composite, and Q2 index were calculated for each author. We have illustrated the dynamics of top authors, universities, and countries, as well as their respective collaboration networks. The thematic evolution of PN research was assessed using coword analysis, followed by a systematic discussion of the findings. This bibliometric analysis provides a comprehensive overview of the key contributors and research trends in PN literature, offering valuable insights for guiding future investigations.

The brain-gut microbiota network (BGMN) is correlated with symptom severity and neurocognition in patients with schizophrenia

The association between the human brain and gut microbiota, known as the "brain-gut-microbiota axis", is involved in the neuropathological mechanisms of schizophrenia (SZ); however, its association patterns and correlations with symptom severity and neurocognition are still largely unknown. In this study, 43 SZ patients and 55 normal controls (NCs) were included, and resting-state functional magnetic resonance imaging (rs-fMRI) and gut microbiota data were acquired for each participant. First, the brain features of brain images and functional brain networks were computed from rs-fMRI data; the gut features of gut microbiota abundance and the gut microbiota network were computed from gut microbiota data. Second, we propose a novel methodology to construct an individual brain-gut microbiota network (BGMN) for each participant by combining the brain and gut features via multiple strategies. Third, discriminative models between SZ patients and NCs were built using the connectivity matrices of the BGMN as input features. Moreover, the correlations between the most discriminative features and the scores of symptom severity and neurocognition were analyzed in SZ patients. The results showed that the best discriminative model between SZ patients and NCs was achieved using the connectivity matrices of the BGMN when all the brain and gut features were integrated, with an accuracy of 0.90 and an area under the curve value of 0.97. The most discriminative features were related primarily to the genera Faecalibacterium and Collinsella, in which the genus Faecalibacterium was linked to the visual system and subcortical cortices and the genus Collinsella was linked to the default network and subcortical cortices. Furthermore, parts of the most discriminative features were significantly correlated with the scores of neurocognition in the SZ patients. The methodology for constructing individual BGMNs proposed in this study can help us reveal the associations between the brain and gut microbiota and understand the neuropathology of SZ.

Neurobiology of COVID-19-Associated Psychosis/Schizophrenia: Implication of Epidermal Growth Factor Receptor Signaling

COVID-19 exhibits not only respiratory symptoms but also neurological/psychiatric symptoms rarely including delirium/psychosis. Pathological studies on COVID-19 provide evidence that the cytokine storm, in particular (epidermal growth factor) EGF receptor (EGFR, ErbB1, Her1) activation, plays a central role in the progression of viral replication and lung fibrosis. Of note, SARS-CoV-2 virus (specifically, S1 spike domain) mimics EGF and directly transactivates EGFR, preceding the inflammatory process. In agreement, the anticancer drugs targeting EGFR such as Nimotuzumab and tyrosine kinase inhibitors are markedly effective on COVID-19. However, these data might raise a provisional caution regarding implication of psychiatric disorder such as schizophrenia. The author's group has been investigating the etiologic and neuropathologic associations of EGFR signaling with schizophrenia. There are significant molecular associations between schizophrenia and EGFR ligand levels in blood as well as in the brain. In addition, perinatal challenges of EGFR ligands and intraventricular administration of EGF to rodents and monkeys both resulted in severe behavioral and/or electroencephalographic endophenotypes relevant to this disorder. These animal models also display postpubertal abnormality in soliloquy-like self-vocalization as well as in intercortical functional connectivity. Here, we discuss neuropsychiatric implication of coronavirus infection and its interaction with the EGFR system, by searching related literatures in PubMed database as of the end of 2023.

Post-COVID social engagement and depression among Chinese older adults: exploring rural/urban and gender differences

PURPOSE

This study investigates the impact of post-COVID social engagement on depression levels among Chinese older adults, with a focus on rural/urban and gender differences.

METHODS

Using the year 2018 and year 2020 data from the China Health and Retirement Longitudinal Study (CHARLS), this study analyzed pre- and post-COVID depression levels and social engagement indicators, including going-out, activities and networking among Chinese older adults (N = 8,793).

RESULTS

Results showed a significant increase in depression levels across all demographic groups post-COVID, with rural females exhibiting the highest levels of depression. Reduced social engagement was associated with increased depression, particularly among rural males and females. Subgroup analyses highlighted nuanced patterns: rural males suffered from decreased intense activities and online contacts, while urban males experienced heightened depression with reduced visiting and light activities. Rural females reported increased depression with decreased moderate activities and dancing outdoors but decreased levels with reduced online contacts. Conversely, urban females experience decreased depression with reduced social engagements, suggesting areevaluation of priorities amidst pandemic challenges.

CONCLUSION

This study has underscored the importance of considering individual, cultural, and contextual factors in understanding mental health outcomes among Chinese older adults. Findings inform targeted interventions aimed at promoting psychological well-being and resilience among Chinese older adults in the post-COVID era, including community-based programs and mental health screenings, to foster social connection and emotional support.

Body Image and Self-Identity in Transgender Patients: A Comprehensive Review from a Psycho-Oncological Perspective

As the number of transgender and gender-diverse (TGD) individuals seeking gender-affirming care continues to increase, it is crucial for healthcare providers to acknowledge the distinct challenges that this community faces and to offer personalized care. This article proposes a comprehensive review aimed at synthesizing current knowledge on the psycho-oncological challenges faced by TGD individuals. By exploring existing literature, it seeks to identify research gaps and provide a framework for addressing the intersection of gender identity, body image, and cancer-related healthcare needs. We aim to explore the complex relationship between being transgender and an oncologic patient, focusing primarily on the effects of gender-affirming hormone therapy (GAHT) and the implications of anatomical structures that remain after gender-affirming surgeries. The complex interplay between GAHT and cancer risks is highlighted, emphasizing the need for ongoing monitoring and tailored healthcare strategies. Psychological aspects of body image and self-identity among transgender individuals, particularly in the context of cancer treatment, are explored, as these treatments may involve significant bodily changes. For TGD individuals, these changes are intricately linked to their sense of identity and self-worth, leading to heightened distress and impaired quality of life. The disruption of sexual function due to cancer treatments can profoundly impact sexual identity and relationships, areas already vulnerable in the TGD population due to societal stigma. The role of social factors in shaping the experiences of TGD individuals in healthcare settings is also discussed, noting how these stressors can influence both the accessibility and quality of care. Research and clinical practice currently face gaps, and more comprehensive studies and guidelines that address the specific healthcare needs of TGD patients are warranted. The importance of an interdisciplinary approach, combining oncological care with gender-affirming practices, is underscored as essential for improving the overall health outcomes and quality of life for TGD individuals facing cancer.

Effects of natural source polysaccharides on neurological diseases: A review

With the aging of society and changes in lifestyle, the incidence of neurological diseases (NDs) has been increasing year by year, bringing a heavy burden to patients and society. Although the efficacy of chemical drugs in the treatment of NDs is remarkable, there are problems such as high side effects and high costs. Therefore, finding mild and efficient drugs for NDs treatment has become an urgent clinical need. Natural source polysaccharides (NSPs) are macromolecules with unique bioactivity and low toxicity characteristics, which have great potential to become novel therapeutic agents for NDs. In the present study, the pharmacological activities and potential molecular mechanisms of NSPs to alleviate NDs are systematically reviewed from the perspectives of inflammation, oxidative stress, apoptosis, neuronal cell autophagy, neurotoxicity, and sedation-hypnosis. In addition, the limitations of the existing studies were analyzed and discussed, and the future research direction was suggested. This study may provide scientific basis for the research and development of therapeutic agents for NDs based on NSPs.

The relationship between family conflict resolution methods and depressive symptoms in patients with chronic diseases

BACKGROUND

Individuals with chronic diseases are more sensitive to depressive symptoms and stress compared to the general population. The complexity and unpredictability of these diseases necessitate family involvement in their management. However, long-term disease can exhaust both patients and their families, leading to conflicts and increased stress, thus exacerbating depressive symptoms. This longitudinal study investigated the impact of family conflict resolution methods on depressive symptoms among chronic disease patients in Korea.

METHODS

We used data from the Korean Welfare Panel Study, collected from 2012 to 2022, analyzing 10,969 chronically ill cohabiting or married individuals. Chi-square tests were used to compare group characteristics, and generalized estimating equation models were used for regression analysis, focusing on Center for Epidemiologic Studies Depression Scale-11 scores, family conflict resolution changes, and covariates.

RESULTS

Participant groups that changed from positive to negative conflict resolution methods were more likely to have depressive symptoms than the group that did not change from positive methods (positive →  negative odds ratios (OR) =  1.34, confidence intervals (CI) =  1.24-1.44). In addition, participants who did not change from negative methods were significantly more depressed than those who maintained positive methods over time (negative →  negative OR =  1.48, 95% CI =  1.37-1.59). Uncollaborative discussions and domestic violence resolution methods were related to depressive symptoms in family conflict resolution methods.

CONCLUSION

Negative family conflict resolution methods influence depressive symptoms in individuals with chronic diseases. Even after transitioning to positive conflict resolution methods, prior negative experiences continued to impact depressive symptoms.

The relationship of body image with sexual dysfunction and dyadic adjustment in individuals diagnosed with bipolar disorder in Türkiye

Introduction

The objective of this study is to evaluate the relationship of body image (BI) with sexual dysfunction (SD) and dyadic adjustment (DA) in individuals diagnosed with Bipolar Disorder (BD). Dyadic adjustment has been defined as a dynamic process determined by variables such as relationship differences, interpersonal tensions and personal concerns, relationship satisfaction, and couple consensus. In this context, it was specifically aimed to determine the link between these factors and quality of life (QoL) in individuals with BD based on the effects of BI on sexual function and marital adjustment.

Methods

This study was conducted in a psychiatric hospital in Turkiye. The population of this cross-sectional, single-center study consisted of 110 individuals who applied to the outpatient clinics of Istanbul Erenköy Mental Health and Neurological Diseases Training and Research Hospital between March 2020 and August 2020. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)Disorders-Clinician Version (SCID-5-CV), sociodemographic and clinical data form, Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), Dyadic Adjustment Scale (DAS), Body Image Scale (BIS) and the Brief Quality of Life in Bipolar Disorder (Brief QoL.BD) Questionnaire were used to collect the research data.

Results

The study sample consisted of 80 individuals, 50 females and 30 males, who were diagnosed with BD and were in remission. The rate of SD in individuals with BD was found to be 55%. The most common SD was vaginismus in female individuals with BD and premature ejaculation in male individuals with BD. It has been observed that SD negatively affected DA in individuals with BD. On the other hand, no significant relationship was found between body mass index (BMI) and BI or between BI and SD in individuals with BD. However, increased satisfaction with BI positively affected DA and QoL.

Discussion

The study's findings indicated a significant relationship between sexual satisfaction, marital adjustment, BI, and QoL in individuals with BD. While no significant change was observed in DA in male individuals with BD, it was found that sexual satisfaction decreased as DA deteriorated in female individuals with BD. Additionally, it was found that BI affected DA in individuals with BD but not sexual satisfaction. Lastly, no significant relationship was observed between BMI and BI, DA, or QoL.

Changes in internalizing and externalizing problems in Dutch children and adolescents receiving outpatient youth care before and during the COVID-19 pandemic

The COVID-19 pandemic significantly impacted the mental health of children and adolescents, but its effects on treatment outcomes in youth care remain unclear. This study examines whether the pandemic influenced treatment outcomes for internalizing and externalizing problems in children receiving outpatient youth care. We analyzed data from three groups of children who received outpatient youth care (N = 1090, Mage = 12.85): those treated entirely before the pandemic, those who transitioned into pandemic-related measures during treatment, and those treated entirely during the pandemic. The Child Behavior Checklist was used to assess internalizing and externalizing problems at the start and end of treatment. Repeated measures ANCOVAs and χ2 tests of independence were conducted to evaluate changes in problem severity and clinical status, and ANCOVAs were used to compare between-group differences. The results suggest that while overall treatment outcomes were not directly affected by the pandemic, fewer children treated during the pandemic recovered from externalizing problems compared to those treated before the pandemic. Additionally, children treated entirely during the pandemic exhibited higher levels of internalizing and externalizing problems at both the start and end of treatment, and those transitioning into the pandemic also had elevated externalizing problems at both time points. Although the pandemic did not affect the change in problems during treatment, the increased severity of issues at both the start and end of treatment indicates a deterioration in child mental health since the pandemic. Appropriate support, preventive interventions, and regular monitoring of mental health problems may mitigate future impacts.

Pharmacological Interventions for Negative Symptoms in Schizophrenia: A Systematic Review of Randomised Control Trials

Background/Objectives: While positive symptoms of schizophrenia are often satisfactorily controlled, negative symptoms are difficult to treat, persisting despite treatment. Different strategies have been devised to deal with this problem. We aimed to review drug treatment for negative symptoms of schizophrenia in controlled trials of marketed drugs. Methods: We searched the PubMed database and the resulting records' reference lists to identify eligible trials using schizophrenia[ti] AND "negative symptom*"[ti] as a search strategy. We determined eligibility through Delphi rounds among all authors. Results: On 11 February 2025, we identified 1485 records on PubMed and 3 more from reference lists. Eligible were 95 records. Most studies were double-blind, randomized controlled trials, carried-out in add-on in patients stabilized with antipsychotics. Other antipsychotics were the most frequent comparators, followed by antidepressants, and recently, antioxidants are gaining importance in trials. Many trials, especially those conducted in the Western world, found no significant effects compared to placebo, while most Iranian studies were positive, although not with a strong effect size. Conclusions: Current research has contributed little to progress in the treatment of the negative symptoms of schizophrenia. The reason might reside in the absence of knowledge of the mechanisms whereby these symptoms are generated, which prevents us from designing possibly effective treatment strategies, and/or to the chronicity of negative symptoms, as they are the first to be established even when they do not become fully apparent.

Mental Illness Strikes at the Heart: Impact of Psychiatric Diseases on Ventricular Ejection Fraction in Patients with Acute Coronary Syndromes

Mental illnesses can have a significant impact on individuals experiencing acute coronary syndromes (ACS). Mental illnesses are associated with an increased cardiovascular risk profile and early onset of cardiovascular disease. A critical aspect of this interplay is the effect of psychiatric conditions on left ventricular ejection fraction (LVEF), a key parameter in evaluating cardiac function and predicting long-term outcomes in ACS patients. The present single-center, retrospective study investigated the associations between psychiatric conditions and cardiac function, with a focus on LVEF in ACS patients. The inclusion criteria were Italian nationality and 30 years or older. One hundred and sixty-four patients without (Mage = 68.8 ± 10.6, 62 females) and 161 patients with a psychiatric diagnosis (Mage = 68.4 ± 13.7, 63 females) were enrolled. The data collected included sociodemographic variables, psychiatric diagnoses, LVEF, ACS type (STEMI/NSTEMI), smoking status, previous interventions, and pharmacological treatments. Statistical analyses included chi-square, t-tests, ANOVAs, and ANCOVA to assess differences across groups. Findings revealed lower LVEF in patients with a psychiatric diagnosis compared to patients without a psychiatric diagnosis (p = 0.004, d = 0.36). Patients without a psychiatric diagnosis were associated with NSTEMI (p = 0.047, φ = 0.11), hypertension (p = 0.003, φ = -0.16), and dyslipidemia (p = 0.022, φ = -0.13). In contrast, patients with a psychiatric diagnosis were associated with STEMI (p = 0.047, φ = 0.11), neurological dysfunction (p = 0.014, φ = 0.14), and chronic obstructive pulmonary disease (p = 0.010, φ = 0.14). Among psychiatric diagnoses, anxiety disorders were associated with lower LVEF compared to substance abuse disorders (p = 0.012, d = -0.81). The findings underscore the complex relationship between mental illness and cardiac function, emphasising the need to integrate psychiatric evaluations into cardiology care to optimise the management of both mental and cardiovascular health. This study has several limitations, including its design, which prevents causal conclusions, and the use of convenience sampling, which limits the generalizability of the findings.

Biological treatments for co-occurring eating disorders and psychological trauma: a systematic review

Introduction

Many people with eating disorders report having experienced childhood maltreatment or a traumatic event prior to developing an eating disorder. Although many people with eating disorders have significant traumatic exposure or symptoms of post-traumatic stress disorder, very little research has examined the effects of combined treatments for this group. The purpose of this systematic review was to synthesize all existing research on biological treatments for those with eating disorders and psychological trauma, evaluate their safety, and identify future areas of research in this area to support patients with eating disorders and psychological trauma.

Method

A multi-step literature search, according to an a priori protocol was performed on PubMed, Embase, APA PsycINFO, Web of Science, Scopus and Cochrane Central. Studies needed to include a biological intervention and report on at least one eating disorder or psychological trauma outcome. Given the limited research in this area, minimal exclusion criteria were applied. A quality assessment of all included studies was completed using the Risk of Bias in Non-Randomized Studies-or Interventions (ROBINS-I) tool.

Results

After removing duplicates, 2623 article titles and abstracts were screened, with 43 articles selected for a full-text review. Following the full-text review, 11 articles met the inclusion criteria. The biological treatments examined included repurposed medications (n = 3), ketamine (n = 2), repetitive transcranial magnetic stimulation (rTMS; n = 2), deep brain stimulation (n =1) electroconvulsive therapy (ECT; n = 1), 3,4-methylenedioxymethamphetamine (MDMA; n = 1), and neurofeedback (n = 1). All studies reported on some improvement in either eating disorder or trauma pathology, with the strongest effect for repetitive transcranial magnetic stimulation and MDMA. While some effects were promising, missing data and selective reporting limited the interpretability of the findings. Adverse events across interventions were common.

Conclusion

Although psychological trauma is common in those with eating disorders, very few treatments have been evaluated in this population. Future work should aim to investigate biological treatments for those with co-occurring eating disorders and psychological trauma, as these evolving treatments show potential benefits for this complex group.

Hypotension with neurovascular changes and cognitive dysfunction: An epidemiological, pathobiological, and treatment review

ABSTRACT

Hypotension is a leading cause of age-related cognitive impairment. The available literature evidences that vascular factors are associated with dementia and that hypotension alters cerebral perfusion flow and can aggravate the neurodegeneration of Alzheimer's disease (AD). Despite the discovery of biomarkers and the recent progress made in neurovascular biology, epidemiology, and brain imaging, some key issues remain largely unresolved: the potential mechanisms underlying the neural deterioration observed in AD, the effect of cerebrovascular alterations on cognitive deficits, and the positive effects of hypotension treatment on cognition. Therefore, further well-designed studies are needed to unravel the potential association between hypotension and cognitive dysfunction and reveal the potential benefits of hypotension treatment for AD patients. Here, we review the current epidemiological, pathobiological, and treatment-related literature on neurovascular changes and hypotension-related cognitive dysfunction and highlight the unsettled but imminent issues that warrant future research endeavors.

Using estrogen and progesterone to treat premenstrual dysphoric disorder, postnatal depression and menopausal depression

Female gonadal hormones, particularly estrogen and progesterone, are not only central to reproductive health but also play a crucial role in regulating mood, cognition, and overall brain health. These hormones have a significant impact on the central nervous system, influencing key processes such as neurotransmission, neuroplasticity, and brain development. Increasing evidence shows that hormonal fluctuations contribute to the onset and progression of mental health disorders that disproportionately affect women, particularly premenstrual dysphoric disorder (PMDD), postnatal depression (PND), and menopausal depression. This paper explores the current evidence regarding the neurobiological effects of female hormones on the brain and discusses the therapeutic approaches in conditions such as PMDD, PND, and menopausal depression.

Examination of factors associated with physical activity among medical students pre and post-COVID-19 in Serbia

The association of physical activity (PA) with the prevention and treatment of various diseases is well known. The issue of insufficient physical activity among university students has worsened due to the effects of the COVID-19 pandemic. The aim of this research is to examine the social, lifestyle, and health factors associated with moderate and high levels of PA in two cross-sectional studies conducted before and after COVID-19 involving 1,266 medical students from five universities in Serbia. Two cross-sectional studies were conducted on the population of fifth-year medical students from five different universities in Serbia before and after the COVID-19 pandemic (in 2019 and 2023). The research instrument was a questionnaire specially designed based on similar research. The mean energy expenditure in MET-minutes per week increased from 2,265.26 ± 1,930.67 in 2019 to 2,871.65 ± 2,301.99 in 2023 (p < 0.001). Multivariate logistic regression analysis with high PA as an outcome variable for the entire sample showed the association of high PA with the University of Kosovska Mitrovica and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2019 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. Multivariate logistic regression analysis with high PA as an outcome variable for 2023 showed the association of high PA with the University of Kosovska Mitrovica, number of meals per day, and score on the Zung anxiety scale. The average energy expenditure was significantly higher in 2023. Factors such as studying in Kosovska Mitrovica, scores on the Zung Anxiety Scale, alcohol consumption, binge drinking in the past month, and the number of meals consumed per day were associated with either moderate or high levels of PA or both.

Intracranial pressure estimated non-invasively and postoperative outcomes in surgery in the Trendelenburg position with pneumoperitoneum

BACKGROUND

Surgery in the Trendelenburg position (TP) with pneumoperitoneum (PP) is beneficial in several aspects but is associated with postoperative complications, such as postoperative nausea and vomiting (PONV). The mechanism behind this is unknown, but an increase in intracranial pressure (ICP) has been suggested. There are several studies of non-invasively estimated ICP during surgery in TP with PP. The association between perioperative estimated ICP and postoperative complications has not yet been reviewed.

METHODS

We performed a scoping review of peer-reviewed clinical studies reporting on both perioperative estimation of ICP and postoperative complications in patients undergoing surgery in TP with PP. The literature search was performed in February 2025 on PubMed, CINAHL, and Web of Science.

RESULTS AND CONCLUSIONS

Ten of 12 included studies suggested associations between perioperative elevation of estimated ICP and postoperative complications, most notably PONV. This may have clinical implications since elevated ICP can be treated. Future research should focus on the association between perioperative ICP estimation and postoperative complications and the effects of ICP-lowering strategies on postoperative outcomes.

Sleep Alterations in the Population of the Metropolitan Area of Mexico and Their Association with Lifestyle Changes During COVID-19 Confinement

Home confinement due to Coronavirus Disease 2019 (COVID-19) led to lifestyle changes that increased sleep disturbances, particularly in areas with higher infection and mortality rates. This study is a retrospective study based on data collected through an online survey conducted during the COVID-19 confinement. It aims to analyze changes in sleep quantity and quality and their association with lifestyle changes in the metropolitan area of Mexico City. A total of 899 adults from this area completed an online questionnaire between June 2020 and February 2021. This study assessed sleep quantity, sleep quality, insomnia symptoms, and lifestyle changes during the confinement period. Results showed that sleep quantity increased (7.10 ± 1.37 vs. 7.43 ± 1.42 h, p < 0.0001), with more participants, especially young adults and women, reporting later bed and wake-up times. The Pittsburgh Sleep Quality Index increased by 1.4 units, with poor sleep quality associated with lifestyle during confinement. Insomnia symptoms, sleep latency, and poor sleep quality also increased, particularly in women. Males and those without chronic comorbidities were less likely to experience poor sleep quality, while tobacco use and later bedtimes increased this risk. This study concludes that, while sleep quantity increased, sleep quality declined, particularly among young adults, women, and those with unhealthy lifestyles. These findings could guide sleep health initiatives tailored to specific lifestyle changes in different population groups.

Lipopolysaccharide preconditioning disrupts the behavioral and molecular response to restraint stress in male mice

Major depressive disorder (MDD) is a complex neuropsychiatric disorder potentially influenced by factors such as stress and inflammation. Chronic stress can lead to maladaptive brain changes that may trigger immune hyperactivation, contributing to MDD's pathogenesis. While the involvement of inflammation in MDD is well established, the effects of inflammatory preconditioning in animals subsequently exposed to chronic stress remain unclear. This study aimed to investigate the impact of inflammatory preconditioning on behavioral, biochemical, and molecular changes in adult male Swiss mice subjected to chronic restraint stress (CRS). The mice received a single injection of lipopolysaccharide (LPS) 24 h before thefirst CRS and performed 6 h daily for 28 days. Behavioral tests were conducted 24 h after the last CRS, across 4 days, and euthanasia followed 24 h after the final tests. Results indicated that only the LPS + CRS group exhibited depressive- and anxiety-like behaviors, accompanied by demotivation and apathy. Biochemical and molecular analyses revealed anoxidative imbalance in the hippocampus, marked by elevated H2O2 levels and MPO activity. In the prefrontal cortex, theLPS + CRS group demonstrated a central inflammatory imbalance, with reduced IL-10 levels, increased Iba1 gene expression, and decreased Gfap and Bdnf gene expression. A trend toward elevated IL-17 levels was also observed at the peripheral level. These findings indicate that inflammatory preconditioning contributes significantly to behaviors phenotypically associated with MDD. Furthermore, the study suggests that these behavioral changes are linked to a dysfunctional immune response and impaired neuroplasticity.

Transitioning to fatherhood: Prospective effects of wellbeing on future depression symptoms

BACKGROUND

Becoming a father is a critical period of life transition. Evidence suggests that a lifetime history of mental health disorder/s and elevated depressive symptoms prior to conception increase risk for men's post-natal depression. Less is understood about the role of positive mental health, or wellbeing, as a protective factor for future depressive outcomes during the transition to fatherhood. The present study investigated whether men's post-natal depressive outcomes were associated with pre-conception levels of wellbeing and whether wellbeing during the post-natal period predicted depressive outcomes post-infancy.

METHODS

Secondary analysis of data from a national, longitudinal cohort study of men's health, namely, The Ten to Men (TTM) Study, was conducted. Participants in the pre-conception sample were n = 350 men for whom data were available at both a pre-conception baseline and post-natal follow-up period. The post-natal sample were n = 427 men with post-natal baseline data and post-infancy follow-up data. Multivariate negative binomial regressions and logistic regression models were used to determine pre-conception and post-natal predictors of future depressive outcomes.

RESULTS

Men's pre-conception depressive symptoms were the best predictor of post-natal depressive symptoms (IRR = 1.089, p < 0.001) and risk of moderate-severe depression (IRR = 1.193, p = 0.005) the latter of which was also predicted by a previous mental health diagnosis (IRR = 3.079, p = 0.029). Similarly, post-natal depressive symptoms were the best predictor of post-infancy depressive symptoms (IRR = 1.089, p < 0.001) and risk of moderate-severe depression (IRR = 1.193, p = 0.005) alongside lifetime prevalence of a mental health disorder (symptoms: IRR = 1.317, p = 0.011; moderate-severe depression: IRR = 2.606, p = 0.023). Pre-conception levels of wellbeing predicted lower post-natal depressive symptoms (IRR = 0.988, p < 0.001) and reduced risk of moderate-severe depression (IRR = 0.940, p = 0.002) after controlling for baseline symptoms and socio-demographic and behavioural confounds; however, wellbeing during the post-natal period did not predict either of the depressive outcomes post-infancy.

LIMITATIONS

Fatherhood-specific risk factors for mental health outcomes (e.g., conception difficulties, maternal post-natal mental health) were not assessed in the present study, and only one aspect of wellbeing was captured.

CONCLUSIONS

Screening for history of common mental health disorders and current symptoms is recommended to inform preventative approaches to paternal mental health care during early fatherhood. Inclusion of wellbeing in such screening procedures may be beneficial; however, further research is required to elucidate the prospective associations between wellbeing and depressive symptoms during the transition to fatherhood.

Omega-3 Fatty Acids for the Treatment of Bipolar Disorder Symptoms: A Narrative Review of the Current Clinical Evidence

BACKGROUND

Bipolar disorder is a chronic mental disease that is characterized by depressive and manic episodes. Antipsychotics and mood stabilizers are known therapies that work, but their restrictions and disadvantages resulted in the need for complementary and alternative therapies, such as natural compounds. Omega-3 fatty acids, as basic ingredients of fishes and seafood, play crucial roles in brain development, function of brain membrane enzymes, learning, and many other instances, and their deficiency has been associated with many mental diseases, including bipolar disorder.

METHODS

The present narrative review aims to critically summarize and scrutinize the available clinical studies on the use of omega-3 fatty acids in the management and co-treatment of bipolar disorder episodes and symptoms. For this purpose, a thorough and in-depth search was performed in the most accurate scientific databases, e.g., PubMed., Scopus, Web of Science, Cochrane, Embase, and Google Scholar, applying effective and relevant keywords.

RESULTS

There are currently several clinical studies that assessed the effect of omega-3 fatty acids on the severity of BD symptoms. Some of them supported evidence for the potential beneficial impact of omega-3 fatty acids supplementation in the prevention and/or co-treatment of bipolar disorder severity and symptomatology. Nevertheless, a considerable number of clinical studies did not show high efficiency, rendering the existing data rather conflicting. The above may be ascribed to the fact that there is a high heterogeneity amongst the available clinical studies concerning the dosage, the administration duration, the combination of fatty acids administration, the method designs and protocols, and the study populations.

CONCLUSION

Although the currently available clinical evidence seems promising, it is highly recommended to accomplish larger, long-term, randomized, double-blind, controlled clinical trials with a prospective design in order to derive conclusive results as to whether omega-fatty acids could act as a co-treatment agent or even as protective factors against bipolar disorder symptomatology. Drug design strategies could be developed to derive novel synthetic omega-3 fatty acids analogs, which could be tested for their potential to attenuate the severity of BD episodes and symptoms.

Unraveling the Complex Interplay Between Neuroinflammation and Depression: A Comprehensive Review

The relationship between neuroinflammation and depression is a complex area of research that has garnered significant attention in recent years. Neuroinflammation, characterized by the activation of glial cells and the release of pro-inflammatory cytokines, has been implicated in the pathophysiology of depression. The relationship between neuroinflammation and depression is bidirectional; not only can inflammation contribute to the onset of depressive symptoms, but depression itself can also exacerbate inflammatory responses, creating a vicious cycle that complicates treatment and recovery. The present comprehensive review aimed to explore the current findings on the interplay between neuroinflammation and depression, as well as the mechanisms, risk factors, and therapeutic implications. The mechanisms by which neuroinflammation induces depressive-like behaviors are diverse. Neuroinflammation can increase pro-inflammatory cytokines, activate the hypothalamus-pituitary-adrenal (HPA) axis, and impair serotonin synthesis, all of which contribute to depressive symptoms. Furthermore, the activation of microglia has been linked to the release of inflammatory mediators that can disrupt neuronal function and contribute to mood disorders. Stress-induced neuroinflammatory responses can lead to the release of pro-inflammatory cytokines that not only affect brain function but also influence behavior and mood. Understanding these mechanisms is crucial for developing targeted therapies that can mitigate the effects of neuroinflammation on mood disorders.

Therapeutic role of gut microbiota in lung injury-related cognitive impairment

Lung injury can lead to specific neurocognitive dysfunction, and the "triple-hit" phenomenon may be the key theoretical mechanism for the progressive impairment of lung injury-related cognitive impairment. The lung and brain can communicate biologically through immune regulation pathway, hypoxic pathway, neural circuit, mitochondrial dysfunction, and microbial influence, which is called the "lung-brain axis." The gut microbiota is a highly complex community of microorganisms that reside in the gut and communicate with the lung via the "gut-lung axis." The dysregulation of gut microbiota may lead to the migration of pathogenic bacteria to the lung, and directly or indirectly regulate the lung immune response through their metabolites, which may cause or aggravate lung injury. The gut microbiota and the brain interact through the "gut-brain axis." The gut microbiota can influence and regulate cognitive function and behavior of the brain through neural pathway mechanisms, immune regulation pathway and hypothalamic-pituitary-adrenal (HPA) axis regulation. Based on the gut microbiota regulation mechanism of the "gut-lung axis" and "gut-brain axis," combined with the mechanisms of cognitive impairment caused by lung injury, we proposed the "triple-hit" hypothesis. It states that the pathophysiological changes of lung injury trigger a series of events such as immune disorder, inflammatory responses, and microbiota changes, which activate the "lung-gut axis," thus forming a "triple-hit" that leads to the development or deterioration of cognitive impairment. This hypothesis provides a more comprehensive framework for studying and understanding brain dysfunction in the context of lung injury. This review proposes the existence of an interactive tandem network for information exchange among the gut, lung, and brain, referred to as the "gut-lung-brain axis." It further explores the potential mechanism of lung injury-related cognitive impairment caused by multiple interactions of gut microbiota in the "gut-lung-brain axis." We found that there are many numerous pathophysiological factors that influence the interaction within the "gut-lung-brain axis." The impact of gut microbiota on cognitive functions related to lung injury may be mediated through mechanisms such as the "triple-hit" hypothesis, direct translocation of microbes and their metabolites, hypoxic pathway, immune modulation, vagal nerve activity, and the HPA axis regulation, among others. As the research deepens, based on the "triple-hit" hypothesis of lung injury, it is further discovered that gut microbial therapy can significantly change the pathogenesis of the inflammatory process on the "gut-lung-brain axis." It can also relieve lung injury and therapeutically modulate brain function and behavior. This perspective provides a new idea for the follow-up treatment of lung injury-related cognitive impairment caused by dysregulation of gut microbiota.

A Community-Based Intervention for Mental Health and Wellbeing in Pregnancy and Postpartum: One Healthy Start Site's Story

Purpose

Perinatal mood and anxiety disorders (PMADs) are the leading cause for maternal morbidity and are associated with underlying causes of pregnancy-related death. Healthy Start (HS) programs around the country seek to lower the risk of maternal mortality through services that screen for and address social determinants of health, including mental health. This study used secondary data from the University of Houston Healthy Start (UHHS) to examine postpartum depression screening and referral rates among program participants and feedback from participating mothers about the program's mental health services.

Patient and Methods

Secondary quantitative data from the program's administration of services (n = 164) and secondary qualitative data from a sub-set of program participants (n = 23) were analyzed. Using data from the standardized HS tools (required for all sites), aggregate demographic data and screening results of depression and interpersonal violence were assessed. Anonymous qualitative data from focus groups were analyzed for themes related to mental health.

Results

Screening for postpartum depression was 97% with a 78% referral rate. Screening for interpersonal violence (IPV), a known correlate of PMADs, was 98% with a 100% referral rate for the 4 women who screened positive for IPV. Qualitative themes revealed close-knit relationships with case managers and doulas that encouraged disclosure of symptoms, honest discussions, and an increased desire to ask for help when needed. Emergent themes revealed that Persistence and authenticity were critical to gain participant trust; a culture of sisterhood positively participants' mental health; and case managers were proactive with emotional support and resource referral.

Conclusion

High rates of mental health screening and referral at the UHHS site were documented and participant stories revealed that trust with case managers was instrumental to their wellbeing. More robust data is needed to allow statistical comparisons are needed in future research.

Irritable Bowel Syndrome: A Hallmark of Psychological Distress in Women?

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, bloating, and altered bowel habits. Women are disproportionately affected by IBS due to a complex interplay between genetic, environmental, and psychosocial factors, along with a crucial role of the gut-brain axis in modulating both bowel function and pain perception. Evidence suggests a strong association between psychological distress and IBS symptoms. Women with IBS report higher levels of psychological distress compared to men, and sex is a biological variable that shapes several aspects of the mechanisms, epidemiology, and clinical manifestations of IBS. This paper explores the bidirectional relationship between psychological factors and IBS with a focus on women. Stress, anxiety, depression, and childhood trauma contribute to IBS symptomatology, and societal and biological factors unique to women may exacerbate this condition. Strategies for integrated care approaches and gender-specific treatment strategies to improve patient outcomes and quality of life are needed.

Population pharmacokinetics of levetiracetam in Chinese adult epilepsy patients with varying renal function: exposure simulation and individualized dosing adjustments

Levetiracetam (LEV) has become a first-line treatment option for various types of epilepsy with a broad spectrum of efficacy and favorable pharmacokinetic profile. We aimed to develop a population pharmacokinetic (PPK) model for LEV and devise a model-based dosing guideline specific to Chinese adult epilepsy patients. Employing Phoenix NLME 7.0 software, we utilized the first-order conditional estimation and extended least squares method to establish the PPK model. The PK of LEV was effectively characterized using a one-compartment model. Monte Carlo simulations were then performed to generate dosing guidelines suitable for various patient groups. The Bayesian feedback method was employed to develop the clinical individual predictive model. Data from 80 Chinese adult patients yielded 148 LEV plasma concentrations for analysis. In the final model, the absorption rate constant was fixed at 2.44. The apparent volume of distribution and the apparent clearance (CL/F) had population typical values of 35.34 L and 3.24 L/h, respectively. CL/F of LEV was significantly influenced by creatinine clearance (CrCL), identified as a major covariate. Monte Carlo simulations indicated that regimens of 0.5 g, 0.75 g, 1.0 g, 1.5 g, 2.0 g, 2.5 g, and 3.5 g twice daily were associated with the highest probability of target attainment (PTA) in patients with different renal function levels. Accordingly, a user-friendly dose recommendation was formulated for these patients. The individual predictive model accurately matched the observed concentrations and managed to guide the personalized dose adjustment. The PPK model linked CL/F to CrCL. Model-based simulations suggest that higher dosage adjustments may be necessary for those with augmented renal function. The developed clinical individual predictive model could effectively guide personalized dose adjustments, potentially reducing the need for frequent drug concentration measurements.

Acute Schizophrenia-like Psychotic Disorder Against the Background of COVID-19

Background and Objectives: Research in this area focuses on acute schizophrenia-like psychotic disorder, as more than half of cases progress to a chronic course, manifesting as schizophrenia or schizoaffective disorder. Research has shown a link between viral infection and the onset of psychosis, and the influence of viruses on the clinical course of the disease is also being studied. Consequently, in cases where this type of psychosis co-occurs with a viral illness, there is a compelling rationale for identifying commonalities in both treatment and outcome. The ongoing global pandemic of COVID-19 provides a unique opportunity to assess these changes. The aim of this study is twofold: first, to examine the clinical characteristics of acute schizophrenia-like psychotic disorder in the context of the pandemic, and second, to analyze therapeutic interventions and outcomes. Materials and Methods: A non-invasive observational study was conducted in which 310 patients with acute schizophrenia-like psychotic disorder admitted as inpatients to a psychiatric hospital were divided into two groups according to the presence of COVID-19 (group I-F23.2 with COVID-19): 222 patients; Group II-F23.2 without COVID-19: 88 patients). After discharge, the patients in both groups were clinically followed in outpatient treatment for 36 months. Results: The results showed that acute schizophrenia-like psychotic disorder associated with COVID-19 was characterized by a greater severity of productive symptoms and the inclusion of the pandemic theme in psychotic symptoms. These patients were given higher doses of antipsychotic medication. Conclusions: The outcome of this type of psychosis is consistent, irrespective of the infection suffered at the onset of the disease, and is characterized by a chronic course with a predominant transition to the schizophrenic process.

Aesthetic Gynecology and Mental Health: What Does It Really Mean for Women?

Body image, a complex interplay of perceptions, thoughts, and feelings about one’s physical appearance, has been a subject of extensive research. It is a dynamic construct that evolves throughout a woman’s lifespan, influenced by a multitude of biological, psychological, and sociocultural factors. From adolescence, marked by the onset of puberty and societal pressures to conform to specific beauty standards, to adulthood and the physical changes associated with aging, women’s body image undergoes significant transformations. Aging is a universal process that affects all organs, including the female genitalia. The vaginal tract undergoes significant atrophy due to declining estrogen levels, particularly during and after menopause. Aesthetic gynecology offers a range of procedures to address both functional and aesthetic concerns related to aging genitalia. Aesthetic gynecology, a burgeoning field within women’s health, provides various procedures aimed at enhancing genital appearance and function. It also helps balance the hormonal and anatomical changes that every woman experiences over time. The goal is to strengthen each patient’s intimate well-being and self-esteem, enabling them to experience intimacy peacefully. While often driven by concerns about physical attractiveness and sexual satisfaction, the psychological implications of these procedures are complex and multifaceted. It is crucial to recognize the interplay between psychological factors and the decision to undergo these procedures. Collaboration between surgeons and mental health professionals can ensure that candidates are psychologically prepared and have realistic expectations. By adopting a patient-centered approach and conducting rigorous research, healthcare providers can ensure that aesthetic gynecology is used as a tool for empowerment rather than exploitation. This article explores the intricate relationship between psychological well-being and aesthetic gynecology, examining how these procedures can impact body image, self-esteem, and overall quality of life.