Neurological sequelae of long COVID: a comprehensive review of diagnostic imaging, underlying mechanisms, and potential therapeutics

One lingering effect of the COVID-19 pandemic created by SARS-CoV-2 is the emergence of Long COVID (LC), characterized by enduring neurological sequelae affecting a significant portion of survivors. This review provides a thorough analysis of these neurological disruptions with respect to cognitive dysfunction, which broadly manifest as chronic insomnia, fatigue, mood dysregulation, and cognitive impairments with respect to cognitive dysfunction. Furthermore, we characterize how diagnostic tools such as PET, MRI, EEG, and ultrasonography provide critical insight into subtle neurological anomalies that may mechanistically explain the Long COVID disease phenotype. In this review, we explore the mechanistic hypotheses of these neurological changes, which describe CNS invasion, neuroinflammation, blood-brain barrier disruption, and gut-brain axis dysregulation, along with the novel vascular disruption hypothesis that highlights endothelial dysfunction and hypoperfusion as a core underlying mechanism. We lastly evaluate the clinical treatment landscape, scrutinizing the efficacy of various therapeutic strategies ranging from antivirals to anti-inflammatory agents in mitigating the multifaceted symptoms of LC.

Vascular amyloidβ load in the meningeal arterial network correlates with loss of cerebral blood flow and pial collateral vessel enlargement in the J20 murine model of Alzheimer's disease

INTRODUCTION

Global reduction in cerebral blood flow (CBF) is an early pathology in Alzheimer's disease, preceding significant plaque accumulation and neurological decline. Chronic reduced CBF and subsequent reduction in tissue oxygenation and glucose may drive neurodegeneration, yet the underlying cause of globally reduced CBF remains unclear.

METHODS

Using premortem delivery of Methoxy-XO4 to label Aβ, and arterial vascular labeling, we assessed Aβ burden on the pial artery/arteriole network and cerebral blood flow in aged male and female WT and J20 AD mice.

RESULTS

The pial artery/arteriole vascular network selectively displayed extensive vascular Aβ burden. Pial collateral arteriole vessels, the by-pass system that reroutes blood flow during occlusion, displayed significant enlargement in J20 mice. Despite this, CBF was decreased by approximately 15% in 12-month J20 mice when compared to WT littermates.

DISCUSSION

Significant Aβ burden on the meningeal arterial network may contribute to the restriction of CBF. Redistribution of CBF through enlarged pial collateral vessels may serve as a compensatory mechanism to alter CBF during disease progression in cases of CAA.

Changes in Alcohol Consumption During and After the Covid-19 Pandemic From 2020 to 2023 in a Prospective Cohort of Italian Adults

BACKGROUND

The lockdowns imposed by the government during coronavirus disease 2019 (COVID-19) pandemic have had a significant impact on the Italian population habits.

METHODS

LOckdown and lifeSTyles in Italy and in Tuscany studies collected data on a representative sample of the Italian adult population in 2020 (n = 6,003) followed up through 2023 via four additional surveys (3,000 ≤ n ≤ 6,600) through an online self-administered questionnaire. The Alcohol Use Disorders Identification Test-Concise was used to identify at-risk drinkers. Considering the cohort of individuals who took part to the first and at least one other wave (n = 5,378), a multilevel logistic model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of being at-risk drinkers.

RESULTS

The prevalence of at-risk drinkers was 26.4% before, 23.4% during the first lockdown, and stabilized around 30.0% thereafter. Being at-risk alcohol consumers decreased with decreasing economic status (P for trend <0.001), was less frequent among middle-aged compared to younger (OR 0.73; 95% CI, 0.60-0.89) and among divorced/separated (OR 0.77; 95% CI, 0.60-0.99) or single (OR 0.75; 95% CI, 0.64-0.89) compared to married individuals. It was more frequent among individuals with anxiety or depressive symptoms (OR 1.24; 95% CI, 1.12-1.37), those using psychotropic drugs (OR 1.99; 95% CI, 1.69-2.35) and users of conventional and/or alternative nicotine products (OR 3.67; 95% CI, 3.00-4.48).

CONCLUSION

The long-term trends in alcohol consumption after the COVID-19 pandemic are unfavorable in Italy. The results point to an increased vulnerability for at-risk alcohol consumption among younger individuals, women with higher economic status, and married individuals. At-risk drinking is strongly related to mental health symptoms and nicotine consumption.

Triangulated evidence provides no support for bidirectional causal pathways between diet/physical activity and depression/anxiety

BACKGROUND

Previous studies (various designs) present contradicting insights on the potential causal effects of diet/physical activity on depression/anxiety (and vice versa). To clarify this, we employed a triangulation framework including three methods with unique strengths/limitations/potential biases to examine possible bidirectional causal effects of diet/physical activity on depression/anxiety.

METHODS

Study 1: 3-wave longitudinal study (n = 9,276 Dutch University students). Using random intercept cross-lagged panel models to study temporal associations. Study 2: cross-sectional study (n = 341 monozygotic and n = 415 dizygotic Australian adult twin pairs). Using a co-twin control design to separate genetic/environmental confounding. Study 3: Mendelian randomization utilizing data (European ancestry) from genome-wide association studies (n varied between 17,310 and 447,401). Using genetic variants as instrumental variables to study causal inference.

RESULTS

Study 1 did not provide support for bidirectional causal effects between diet/physical activity and symptoms of depression/anxiety. Study 2 did provide support for causal effects between fruit/vegetable intake and symptoms of depression/anxiety, mixed support for causal effects between physical activity and symptoms of depression/anxiety, and no support for causal effects between sweet/savoury snack intake and symptoms of depression/anxiety. Study 3 provides support for a causal effect from increased fruit intake to the increased likelihood of anxiety. No support was found for other pathways. Adjusting the analyses including diet for physical activity (and vice versa) did not change the conclusions in any study.

CONCLUSIONS

Triangulating the evidence across the studies did not provide compelling support for causal effects of diet/physical activity on depression/anxiety or vice versa.

Understanding Pediatric Bipolar Disorder Through the Investigation of Clinical, Neuroanatomic, Neurophysiological and Neurocognitive Dimensions: A Pilot Study

Background: Pathophysiological models of pediatric bipolar disorder (PBD) are lacking. Multimodal approaches may provide a comprehensive description of the complex relationship between the brain and behavior. Aim: To assess behavioral, neuropsychological, neurophysiological, and neuroanatomical alterations in youth with PBD. Methods: Subjects with PBD (n = 23) and healthy controls (HCs, n = 23) underwent (a) clinical assessments encompassing the severity of psychiatric symptoms, (b) neuropsychological evaluation, (c) analyses of event-related potentials (related to the passive viewing of fearful, neutral, and happy faces during electroencephalography recording, and (d) cortical thickness and deep gray matter volume measurement using magnetic resonance imaging. Canonical correlation analyses were used to assess the relationships between these dimensions. Results: Youth with PBD had higher levels of anxiety (p < 0.001) and borderline personality features (p < 0.001), greater commission errors for negative stimuli (p = 0.003), delayed deliberation time (p < 0.001), and smaller risk adjustment scores (p = 0.002) than HCs. Furthermore, they showed cortical thinning in the frontal, parietal, and occipital areas (all p < 0.001) and greater P300 for happy faces (p = 0.29). In youth with PBD, cortical thickening and P300 amplitude positively correlated with more commission errors for negative stimuli, longer deliberation times, reduced risk adjustment, higher levels of panic and separation anxiety, and greater levels of negative relationships, whereas they negatively correlated with levels of depression (overall loadings > or <0.3). Limitations: Small sample size, cross-sectional design, and limited variables investigated. Conclusions: This preliminary work showed that multimodal assessment might be a viable tool for providing a pathophysiological model that unifies brain and behavioral alterations in youth with PBD.

Extended postpartum intimate partner violence and its associated factors among Iranian women: Community-based cross-sectional study design

OBJECTIVE

The purpose of this study was to determine the prevalence of different types of intimate partner violence (IPV) and factors associated with it during the postpartum period.

METHODS

In this cross-sectional study, 428 women were enrolled from 10 health centers in the south of Tehran, Iran, between April 2023 and October 2023. We used a sociodemographic questionnaire, Conflict Tactics Scale (CTS2), the short form of the Connor-Davidson Resilience Scale (CD-RISC), and the Depression, Anxiety and Stress Scale (DASS-21) for data collection. Multivariate binary logistic regression was used to determine demographic and psychological predictors of IPV after childbirth.

RESULTS

Approximately two-thirds of women (n=285, 66.6%) experienced IPV within 1 year of childbirth. Psychological aggression (n= 276, 64.5%) was the most common type of IPV, whereas injury (n=96, 22.4%) was the least common. Additionally, one in three women experienced physical assault (n= 134, 31.3%), and over one-third experienced sexual coercion (n= 152, 35.5%). Predictor factors of IPV during the postpartum period were: insufficient family income (adjusted odds ratio [aOR] 4.52, 95% confidence interval [CI] 1.24-15.28), husband's smoking (aOR 3.17, 95% CI 1.70-5.92), history of IPV in pregnancy (aOR 2.44, 95% CI 1.33-4.50), number of children (aOR 3.02, 95% CI 1.79-5.10), and depression (aOR 1.2, 95% CI 1.08-1.14). On the other hand, protective factors of IPV during the postpartum period were: longer marriage duration (aOR 0.85, 95% CI 0.77-0.93) and greater resilience (aOR 0.95, 95% CI 0.90-0.99).

CONCLUSION

IPV is prevalent 1 year after childbirth. Healthcare providers should implement a thorough screening program to identify risk and protective factors related to postpartum IPV.

Alcohol and substance use differentially impact suicidal ideation in a longitudinal cohort of bipolar disorder

BACKGROUND

Across bipolar disorders (BSDs), alcohol and substance use and suicidal ideation (SI) contribute to increased rates of morbidity and mortality. The goal of the present study was to investigate temporal relationships between the intensity/frequency (I/F) of use and impairment related to alcohol and substance use and SI in a longitudinal BSD cohort.

METHODS

Participants with BDI (n=565), BDII (n=162), and BD NOS (n=61) were included (median enrollment=72 months). Alcohol and substance use were measured using a modified version of the AUDIT administered every 6 months. SI was measured every 2 months using item 9 from the PHQ-9. Linear mixed effects models tested concurrent associations and Dynamic Structural Equation Models tested prospective associations between alcohol and substance use I/F and impairment with SI.

RESULTS

Cocaine I/F and alcohol and substance use impairment were concurrently associated with SI. When a person had more frequent and intense cannabis use compared to average, they had higher SI at the next timepoint. When individuals experienced more alcohol and substance use impairment than average, they had higher SI at the next timepoint.

CONCLUSIONS

I/F of cannabis use and alcohol and substance use impairment appear to lead to future increases in SI for those with BSDs.

The daily reciprocal associations between electroencephalography measured sleep and affect

Self-report studies show that sleep and positive and negative affect are closely and bidirectionally linked. However, studies assessing sleep objectively yield more inconsistent results. This study assessed the reciprocal, daily relationship between sleep as measured with electroencephalography (EEG) and affect (measured in the evening) in a natural setting. We assessed sleep both on the macrolevel (i.e., rapid eye movement [REM] sleep and slow-wave sleep [SWS] duration) and on the microlevel (i.e., REM sleep fragmentation). In this study, 33 participants (i.e., healthy college students, mean [standard deviation] age 21.55 [3.73] years, 67% female) were followed for 2 weeks. Each participant wore an EEG headband for 15 nights and had polysomnography during 3 of the 15 nights providing 72 analysable nights of polysomnography and 271 analysable nights with the EEG headband. Every evening participants reported their momentary negative and positive affect. We examined the relationship between pre-sleep affect and the sleep variables, as well as the reverse relationship, with sleep variables predicting evening affect the next day. We detected that higher negative affect in the evening was related to more fragmented REM sleep. However, this result was only found with polysomnography and not with the EEG headband. No significant associations were found between affect and time spent in REM sleep and SWS. Overall, no support was found for the reciprocal association between negative and positive affect and EEG measured sleep. Only limited support was found for an association in one direction (i.e., evening negative affect was associated with more REM sleep fragmentation at night).

Model organisms for investigating the functional involvement of NRF2 in non-communicable diseases

Non-communicable chronic diseases (NCDs) are most commonly characterized by age-related loss of homeostasis and/or by cumulative exposures to environmental factors, which lead to low-grade sustained generation of reactive oxygen species (ROS), chronic inflammation and metabolic imbalance. Nuclear factor erythroid 2-like 2 (NRF2) is a basic leucine-zipper transcription factor that regulates the cellular redox homeostasis. NRF2 controls the expression of more than 250 human genes that share in their regulatory regions a cis-acting enhancer termed the antioxidant response element (ARE). The products of these genes participate in numerous functions including biotransformation and redox homeostasis, lipid and iron metabolism, inflammation, proteostasis, as well as mitochondrial dynamics and energetics. Thus, it is possible that a single pharmacological NRF2 modulator might mitigate the effect of the main hallmarks of NCDs, including oxidative, proteostatic, inflammatory and/or metabolic stress. Research on model organisms has provided tremendous knowledge of the molecular mechanisms by which NRF2 affects NCDs pathogenesis. This review is a comprehensive summary of the most commonly used model organisms of NCDs in which NRF2 has been genetically or pharmacologically modulated, paving the way for drug development to combat NCDs. We discuss the validity and use of these models and identify future challenges.

Effectiveness of a stepped-care programme of WHO psychological interventions in a population of migrants: results from the RESPOND randomized controlled trial

Migrant populations - including labour migrants, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move - are exposed to a variety of stressors that affect their mental health. We designed and tested the effectiveness of a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization (WHO) and locally adapted for migrant populations. A parallel-group randomized controlled trial was conducted in Italy. We recruited migrant adults (≥18 years) with psychological distress (score of at least 16 on the Kessler Psychological Distress Scale, K10). The experimental arm received psychological first aid (PFA) and a stepped-care programme consisting of two WHO interventions adapted for this population group: first, Doing What Matters in Times of Stress (DWM) and, for participants who still reported significant levels of psychological distress after DWM, Problem Management Plus (PM+). Each intervention lasted 5-6 weeks and was delivered remotely by lay facilitators. The control arm received PFA and care as usual (CAU). The primary outcome was the change in symptoms of depression and anxiety from baseline to week 21 after randomization, measured by the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Between December 14, 2021 and April 18, 2023, 108 migrants were randomized to the stepped-care intervention and 109 to CAU. Analysis of the primary outcome revealed that participants receiving the stepped-care programme showed a greater reduction in anxiety and depression symptoms compared to those receiving CAU (coefficient: -3.460, standard error, SE: 1.050, p=0.001) at week 21. The same difference was observed at week 7 (coefficient: -3.742, SE=1.008, p<0.001) and week 14 (coefficient: -6.381, SE=1.039, p<0.001). The stepped-care programme was also associated with a greater improvement of depression and anxiety symptoms assessed separately at all timepoints, of post-traumatic stress disorder symptoms at weeks 14 and 21, and of self-assessed problems, function and well-being at all timepoints. No serious adverse events occurred. This study provides evidence supporting the stepped-care delivery of DWM and PM+ for migrant population groups with elevated distress. As these interventions are low-intensity, transdiagnostic and task-shifting, they are highly scalable. Existing evidence-based guidelines and implementation packages should be updated accordingly.

Alternations of Plasma Fatty Acids in Patients With Bipolar Depression Under Acute Treatment of rTMS Combined With Quetiapine and Mood Stabilizer

PURPOSE

Repetitive transcranial magnetic stimulation (rTMS) represents a potential clinical tool in treating bipolar disorder (BD). However, the intervention of rTMS combined with pharmacotherapy on the plasma fatty acids (FAs) in patients with bipolar depression has not been reported yet.

METHOD

In this study, we assessed the clinical symptoms and evaluated plasma FAs from 30 inpatients with bipolar depression at baseline phase (BD group), after 2 weeks of treatment with rTMS combined with quetiapine and mood stabilizer (BD-2w group), and 32 healthy controls (HCs).

FINDING

We found that acetic acid, propionic acid, isovaleric acid, isobutyric acid, and valeric acid, as well as levels of total short-chain fatty acids (SCFAs), were decreased in both BD and BD-2w groups, and levels of several medium- and long-chain fatty acids (MLCFAs) were altered in BD when compared with HC. Moreover, 2 weeks of treatment increased the levels of various MLCFAs. Finally, we developed combinational FAs panels that could distinguish BD from HC (area under the curve [AUC] = 0.961), BD-2w from HC (AUC = 0.978), and BD from BD-2w (AUC = 0.891) effectively.

CONCLUSION

These findings might provide a basis for developing diagnostic methods and reveal the potential relationship between bipolar depression and plasma FAs.

A scoping review of sleep discrepancy methodology: What are we measuring and what does it mean?

STUDY OBJECTIVES

To examine how past studies have conceptualised sleep discrepancy and identify and evaluate the methods used for its measurement and analysis.

METHOD

We searched MEDLINE, Embase, PsycINFO, CINAHL Plus, PubMed, Scopus, and Web of Science in April 2022 for studies comparing self-report and objective measures of sleep. Methodological information was extracted from relevant studies and included measures of self-report and objective sleep, sleep variables (e.g., total sleep time), derived discrepancy indices (e.g., difference scores), handling of repeated measurements, and methods of measure comparison (e.g., Bland-Altman analyses).

RESULTS

Two hundred and forty-four relevant records were identified. Studies varied according to objective sleep measure; actigraphy algorithm, software, and rest interval; polysomnography setting and scoring criteria; sleep variables; self-report sleep measure; number of nights of objective recording; time frame of self-report measure; self-report sleep variable definition; sleep discrepancy derived index; presence and handling of repeated measurements; and statistical method for measure comparison.

CONCLUSIONS

Sleep discrepancy was predominantly conceived as discordance in sleep states or sleep time variables, and various forms of this discordance differed in their conceptual distance to sleep misperception. Furthermore, studies varied considerably in methodology with critical conceptual and practical implications that have received little attention to date. Substantive methodological issues were also identified relating to the use of derived indices for operationalising sleep discrepancy, defining objective sleep onset latency, calculating actigraphy rest intervals, measuring correlation and concordance, averaging sleep variables across nights, and defining sleep quality discrepancy. Solutions and recommendations for these issues are discussed.

Eight weeks of resistance exercise improves mood state and intestinal permeability in healthy adults: A randomized controlled trial

To explore a potential link between resistance exercise and the gut-brain axis, this study examined the impact of resistance exercise on intestinal permeability, as indicated by lipopolysaccharide binding protein (LBP), and mood state in healthy adults. Sedentary participants (n = 20; 39.5 ± 12.1 y; 27.4 ± 5.3 kg/m2) were randomly assigned to the resistance exercise (REX) or wait-listed control (CON) groups. REX participants strength trained 3× weekly (advancing from 45%-55% to 70%-80% 1RM for 3-4 sets over 8 weeks). Strength testing, evaluation of mood states, and collection of fasting blood occurred at baseline and weeks 4 and 8. At baseline, LBP concentrations were inversely correlated to all strength measures (r range: -0.48 to -0.57; p < 0.05). The gain in total strength [(split squat left + right)/2 + bench press] was 45% higher for REX versus CON participants (p = 0.019), and serum LBP concentrations fell 16% for REX participants and rose 9% in CON participants (p = 0.014). Mood was significantly improved by resistance training versus control (but this improvement was not related to changes in LBP; r = -0.001). These findings support a role for resistance exercise in improving mood state and intestinal barrier function, but more research is warranted to further explore the effects of resistance training on the gut-brain axis.

Impact of COVID-19 on preexisting comorbidities

COVID-19 is a highly contagious viral disease caused by SARS-CoV-2, leading to a tragic global pandemic, where it was ranked in 2020 as the third leading cause of death in the USA, causing approximately 375,000 deaths, following heart disease and cancer. The CDC reports that the risk of death increases with age and preexisting comorbidities such as such as hypertension, diabetes, respiratory system disease, and cardiovascular disease. this report will delineate and analyze the paramount comorbidities and their repercussions on individuals infected with SARS-CoV-2.

Improving cognitive impairment through chronic consumption of natural compounds/extracts: a systematic review and meta-analysis of randomized controlled trials

Introduction

This systematic review and meta-analysis aimed to compare the efficacy of extended supplementation (≥6 weeks) with natural compounds or extracts in improving cognitive function in patients with mild cognitive impairment (MCI) or Alzheimer's disease (AD).

Methods

A comprehensive literature search was conducted across Cochrane, PubMed, PsycARTICLES, Scopus, and Web of Science databases from inception to April 10, 2024. Eligible studies were randomized controlled trials evaluating cognitive outcomes in patients with MCI or AD using the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog).

Results

From an initial pool of 6,687 articles, 45 were deemed relevant for qualitative analysis. Of these, 37 studies demonstrated improvements or positive trends in cognitive outcomes with natural compound or extract supplementation. A total of 35 studies met the criteria for meta-analysis. The meta-analysis, involving 4,974 participants, revealed significant improvements in ADAS-Cog scores (pooled standardized mean difference = -2.88, 95% confidence interval [CI]: -4.26 to -1.50; t24 = -4.31, p < 0.01) following supplementation. Additionally, a suggestive trend toward improvement in MMSE scores was observed in a subgroup analysis of 1,717 participants (pooled standardized mean difference = 0.76, 95% CI: 0.06 to 1.46, t18 = 2.27, p = 0.04).

Conclusion

These findings support the potential cognitive benefits of extended (≥6 weeks) supplementation with natural compounds or extracts in individuals with MCI or AD. Further research is warranted to confirm these results and elucidate the underlying mechanisms.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/.

Comparative Analysis of Healthy Lifestyles in Peruvian University Students During and After the COVID-19 Pandemic

The COVID-19 pandemic has provoked a worldwide mental health crisis, affecting university students in an exacerbated way, exposing them to the risk of emotional isolation and development of eating disorders. The present study aimed to examine the quality of healthy lifestyle practices in university students from the Faculty of Human Medicine and the Faculty of Education of a Peruvian university during and after the COVID-19 pandemic. This study was conducted during the academic period 2020 and 2023. Data collection was performed between July and August 2020, during the first wave of the COVID-19 pandemic (M1) and between November and December 2023, post-pandemic (M2). In M1 and M2, 370 and 82 students participated, respectively. The results of the Mann-Whitney test revealed significant differences between the total healthy lifestyle score of students in M1 and M2. In the nutrition domain, there are significant differences between the scores obtained in M1 and M2, revealing a decrease in nutritional care. Significant differences were also found between both faculties in substance use in M1 and physical activity practice in M2. Although a trend toward the adoption of healthy habits was observed in the initial stages, the longitudinal analysis reveals a generalized decrease in concern for health and well-being. Medical students, on the other hand, showed greater resilience and more successful adaptation to new circumstances, evidencing the importance of academic training in the promotion of healthy lifestyles. These results underscore the need to implement intervention strategies aimed at promoting healthy habits in the student population, especially in contexts of health crisis.

A review of the application of exercise intervention on improving cognition in patients with Alzheimer's disease: mechanisms and clinical studies

Alzheimer's disease (AD) is the most common form of dementia, leading to sustained cognitive decline. An increasing number of studies suggest that exercise is an effective strategy to promote the improvement of cognition in AD. Mechanisms of the benefits of exercise intervention on cognitive function may include modulation of vascular factors by affecting cardiovascular risk factors, regulating cardiorespiratory health, and enhancing cerebral blood flow. Exercise also promotes neurogenesis by stimulating neurotrophic factors, affecting neuroplasticity in the brain. Additionally, regular exercise improves the neuropathological characteristics of AD by improving mitochondrial function, and the brain redox status. More and more attention has been paid to the effect of Aβ and tau pathology as well as sleep disorders on cognitive function in persons diagnosed with AD. Besides, there are various forms of exercise intervention in cognitive improvement in patients with AD, including aerobic exercise, resistance exercise, and multi-component exercise. Consequently, the purpose of this review is to summarize the findings of the mechanisms of exercise intervention on cognitive function in patients with AD, and also discuss the application of different exercise interventions in cognitive impairment in AD to provide a theoretical basis and reference for the selection of exercise intervention in cognitive rehabilitation in AD.

Exploring the relationship between dissociative experiences and recovery in psychosis: cross-sectional study

AIMS AND METHOD

This study explored the association among dissociative experiences, recovery from psychosis and a range of factors relevant to psychosis and analysed whether dissociative experiences (compartmentalisation, detachment and absorption) could be used to predict specific stages of recovery. A cross-sectional design was used, and 75 individuals with psychosis were recruited from the recovery services of the Gloucestershire Health and Care NHS Foundation Trust. Five questionnaires were used - the Dissociative Experiences Scale - II (DES), Detachment and Compartmentalisation Inventory (DCI), Questionnaire about the Process of Recovery, Stages of Recovery Instrument (STORI), and Positive and Negative Syndrome Scale - and a proforma was used to collect demographic data.

RESULTS

Our findings indicated that compartmentalisation, detachment and absorption, as measured by DES and DCI, do not predict stages of recovery as measured by the STORI.

CLINICAL IMPLICATIONS

The results of this study suggest that there is no simple relationship between dissociative and psychotic symptoms. They also suggest a need to assess these symptoms separately in practice and indicate that special approaches to treatment of psychosis may be needed in cases where such symptoms have a significant role.

Parental Mental Health and Child Maltreatment in the COVID-19 Pandemic: Importance of Sampling in a Quantitative Statistical Study

BACKGROUND

Results on parental burden during the COVID-19 pandemic are predominantly available from nonrepresentative samples. Although sample selection can significantly influence results, the effects of sampling strategies have been largely underexplored.

OBJECTIVE

This study aimed to investigate how sampling strategy may impact study results. Specifically, we aimed to (1) investigate if outcomes on parental health and child maltreatment during the COVID-19 pandemic from a convenience sample differ from those of a specific representative sample and (2) investigate reasons for differences in the results.

METHODS

In 2020, we simultaneously conducted 2 studies: (1) a web-based survey using a convenience sample of 4967 parents of underage children, primarily recruited via social media, and (2) a study using a quota sample representative of the German adult population with underage children (N=1024), recruited through a combination of telephone interviews and computer-assisted web interviews. In both studies, the same questionnaire was used. To evaluate the impact of sampling, we compared the results on outcomes (parental stress, subjective health, parental mental health, general stress, pandemic-related stress, and the occurrence of child maltreatment) between the 2 samples. To explain differences in the results between the 2 studies, we controlled for sociodemographic data, parent-related risk factors, and COVID-19-related experiences.

RESULTS

Compared to parents from the quota sample, parents from the convenience sample reported significantly more parental stress (η2=0.024); decreased subjective health (η2=0.016); more anxiety and depression symptoms (η2=0.055); more general stress (η2=0.044); more occurrences of verbal emotional abuse (VEA; φ=0.12), witnessing domestic violence (WDV; φ=0.13), nonverbal emotional abuse (NEA; φ=0.03), physical abuse (φ=0.10), and emotional neglect (φ=0.06); and an increase of child maltreatment (VEA: exp(B)=2.95; WDV: exp(B)=3.19; NEA: exp(B)=1.65). Sociodemographic data, parent-related risk factors, and COVID-19-related experiences explained the differences in parental stress (remaining difference between samples after controlling for covariates: η2=0.002) and subjective health (remaining difference between samples after controlling for covariates: η2=0.004) and partially explained differences in parental mental health (remaining: η2=0.016), general stress (remaining: η2=0.014), and child maltreatment (remaining: VEA: exp(B)=2.05 and WDV: exp(B)=2.02) between the 2 samples. The covariates could not explain the difference in NEA (exp(B)=1.70). We discuss further factors that may explain the unexplained differences.

CONCLUSIONS

Results of studies can be heavily impacted by the sampling strategy. Scientists are advised to collect relevant explaining variables (covariates) that are possibly related to sample selection and the outcome under investigation. This approach enables us to identify the individuals to whom the results apply and to combine findings from different studies. Furthermore, if data on the distribution of these explanatory variables in the population are available, it becomes possible to adjust for sample selection bias.

Factors related to milk donation based on the theory of planned behavior in pregnant women

The willingness to donate milk is influenced by maternal behavior, and the Theory of Planned Behavior is recognized as a significant predictor of this action. This study aims to identify the factors associated with milk donation among pregnant women based on the Theory of Planned Behavior. This descriptive and analytical cross-sectional study utilized stratified and convenience sampling methods on 337 pregnant women attending women's health and midwifery clinics affiliated with Mashhad University of Medical Sciences in 2024. Data were collected using a demographic questionnaire and a milk donation intention questionnaire based on the constructs of the Theory of Planned Behavior. Statistical analyses, including descriptive and inferential tests at a significance level of 0.05, were performed using SPSS-26. The average age of pregnant women was 30.16 years. The willingness of pregnant women to donate milk was relatively adequate. Urban-dwelling pregnant women showed a greater willingness to donate milk compared to their rural counterparts (p = 0.031). Age (r = 0.118), awareness (r = 0.413), attitude (r = 0.562), perceived behavioral control (r = 0.542), and subjective norms (r = 0.521) had positive and significant correlations with the intention to donate milk among participants (p < 0.05). Awareness was significantly correlated with attitude (r = 0.575), perceived behavioral control (r = 0.555), and subjective norms (r = 0.503). According to the results, the Theory of Planned Behavior serves as an appropriate predictor for the intention to donate milk among pregnant women. Therefore, to establish and expand milk banks, policymakers in health should consider utilizing the Theory of Planned Behavior in pregnant women. Tailoring milk donation programs based on related factors identified in this study could enhance overall donation rates and support infants in need.

Anxiety disorders and the gut microbiota: a bibliometric and visual analysis

Introduction

Anxiety disorder is a common mental illness, yet its specific mechanisms remain unclear. Recent research has revealed a connection between gut microbiota and anxiety disorders. This study aims to assess the current global research landscape, highlight current topics of interest, and explore future research directions in the field of anxiety disorders and gut microbiota.

Methods

We extracted research review articles related to anxiety and gut microbiota from the Web of Science, covering the period from 2004 to 2023. We used VOSviewer 1.6.18.0, Scimago Graphica, and CiteSpace 6.2. R2 to visualize the contributions of countries, institutions, journals, authors, citations, and keywords in this field.

Result

A total of 1198 articles were included in this bibliometric analysis. Over the past two decades, both publications and citations have shown a steady increase. China, the United States, and Canada were the top three countries in terms of publication output. John Cryan from University College Cork had the highest number of publications and citation impact in this area of research. The journal Nutrients had the highest number of publications, while Brain Behavior and Immunity had the most citations. Key research themes in recent years have included anxiety, gut microbiota, depression, stress, gut-brain axis, and probiotics, all of which are likely to be important future research directions.

Conclusion

This analysis has key research areas and emerging trends, including risk factors, stressors, inflammatory responses, the gut-brain axis, and probiotics. These insights can guide researchers towards a more comprehensive understanding of recent advancements in this field, help shape future research directions and facilitate the identification of new therapeutic targets for anxiety disorder, ultimately improving clinical outcomes.

Sex and APOE genotype modulate neuropsychological profile and depression in temporal lobe epilepsy

Introduction

Temporal lobe epilepsy is the most common form of focal epilepsy, often associated with cognitive impairments, particularly in memory functions, and depression. Sex and APOE ε4 genotype play a crucial role in modulating cognitive outcomes and depression in various neurological conditions like Alzheimer's disease. However, the combined effects of APOE genotype and sex on cognitive performance and depression in temporal lobe epilepsy have not been previously investigated.

Objective

This study aims to (i) identify impaired cognitive performance and clinically relevant depression; (ii) explore the interaction between sex and APOE ε4 genotype on cognitive performance and depression in individuals with temporal lobe epilepsy.

Methods

We used a comprehensive battery of neuropsychological tests to assess domains such as learning and memory, attention, executive functions, language, and visuo-spatial constructional skills and the Hamilton Depression Rating Scale. We also performed APOE genotyping to assess its role in the study. The final sample was composed by fifty-four patients (53.7% female). Cognitive performance and depression were analyzed using normative cut-off scores. To examine the main effects and interactions of sex and APOE ε4 carrier status on neuropsychological test scores and the Hamilton Depression Rating Scale, we also conducted a two-way Analysis of Variance (ANOVA).

Results

Female APOE ε4 carriers compared to normative cut-offs, exhibited poor performance on multiple test scores, including the MMSE, The Rey Auditory Verbal Learning Test (immediate and delayed recall), The Corsi Block-Tapping Task, The Verbal Fluency Test, The Raven's Standard Progressive Matrices and The Pentagon-copying Test. Males showed impairment only in visuo-spatial short-term memory. ANOVA analysis revealed significant main effects of APOE ε4 status and sex on the MMSE, The Rey Auditory Verbal Learning Test, The Verbal Fluency, The Raven's Standard Progressive Matrices and The Pentagon-copying Test scores. Specifically, female APOE ε4 carriers performed consistently worse than other groups on many tasks. For depression, only an effect of sex emerged. Females scored higher besides APOE genotype.

Conclusions

These findings underscore the importance of considering both sex and APOE genotype when assessing cognitive performance in patients with temporal lobe epilepsy. The significant cognitive deficits we observed among females carrying the APOE ε4 allele highlight previously unexplored genetic and sex-related influences on cognition. This has potential implications for personalized therapeutic strategies, emphasizing the need for targeted assessment and intervention.

Navigating the depths: A comprehensive narrative review on depression in people with epilepsy

Epilepsy presents a significant global health challenge, impacting millions worldwide. Alarmingly, over half of individuals living with epilepsy (PWE) also face concurrent medical conditions, with psychiatric complications, particularly depression, standing out as prevalent issues. The relationship between epilepsy and depression is complex and bidirectional, with approximately a quarter of adults with epilepsy receiving a diagnosis of depression. This complexity underscores the challenges in diagnosing depression in epilepsy patients, hindered by overlapping symptoms and distinct manifestations of depression in this population. Our review highlights that the use of most antidepressant pharmacotherapies does not increase the risk of seizure occurrences. On the contrary, compelling evidence suggests that such treatments may even decrease seizure frequency, offering hope for patients. In addition to pharmacology, non-pharmacological interventions are emerging as vital alternatives, enriching the therapeutic landscape. However, despite these promising avenues, a significant gap in our understanding persists, characterized by a lack of comprehensive, prospective research. Our review rigorously explores the latest pathophysiological insights linking depression and epilepsy while critically evaluating contemporary treatment paradigms for individuals grappling with these comorbid conditions. By focusing on the most current developments, this review aims to equip clinicians with cutting-edge knowledge, fostering a more nuanced and effective approach to managing the intricate interplay between epilepsy and comorbid depression.

Association between physical activity practice and sleep quality of older people in social isolation during the COVID-19 pandemic and Health Guidelines and future studies for the post-COVID period: a systematic review

PURPOSE

Physical activity (PA) is considered an alternative to mitigate the negative impacts of the COVID-19 pandemic on the sleep of older adults. The objective was to verify the association between physical activity and the sleep quality of older people in social isolation during the COVID-19 pandemic, to analyze the Health Guidelines, and suggest future studies for the post-COVID period.

METHODS

This systematic review followed PRISMA recommendations, and the protocol was registered in PROSPERO (CRD 42023406471). The search for articles occurred in April 2024 in the databases PubMed, Web of Science, SCOPUS, and gray literature. Data were extracted and checked in a Microsoft Excel® spreadsheet. The quality assessment was performed using tools from the National Institutes of Health.

RESULTS

In total, 1582 studies were found in the databases, of which nine were included in the analyses. Four studies reported a negative association of reduced levels of PA during the pandemic with sleep quality, while one study showed a positive association of PA with sleep quality. Four studies demonstrated no association.

CONCLUSIONS

PA was associated with the sleep quality of older adults during the COVID-19 pandemic and reduced levels of PA during this period demonstrated a negative association with sleep quality. Practice of PA is recommended for this post-COVID scenario, as a measure to reduce social isolation and its negative effects and improve the quality of sleep in older adults.

Gut Microbiota-Based Interventions for Parkinson's Disease: Neuroprotective Mechanisms and Current Perspective

Recent evidence links gut microbiota alterations to neurodegenerative disorders, including Parkinson's disease (PD). Replenishing the abnormal composition of gut microbiota through gut microbiota-based interventions "prebiotics, probiotics, synbiotics, postbiotics, and fecal microbiota transplantation (FMT)" has shown beneficial effects in PD. These interventions increase gut metabolites like short-chain fatty acids (SCFAs) and glucagon-like peptide-1 (GLP-1), which may protect dopaminergic neurons via the gut-brain axis. Neuroprotective effects of these interventions are mediated by several mechanisms, including the enhancement of neurotrophin and activation of the PI3K/AKT/mTOR signaling pathway, GLP-1-mediated gut-brain axis signaling, Nrf2/ARE pathway, and autophagy. Other pathways, such as free fatty acid receptor activation, synaptic plasticity improvement, and blood-brain and gut barrier integrity maintenance, also contribute to neuroprotection. Furthermore, the inhibition of the TLR4/NF-кB pathway, MAPK pathway, GSK-3β signaling pathway, miR-155-5p-mediated neuroinflammation, and ferroptosis could account for their protective effects. Clinical studies involving gut microbiota-based interventions have shown therapeutic benefits in PD patients, particularly in improving gastrointestinal dysfunction and some neurological symptoms. However, the effectiveness in alleviating motor symptoms remains mild. Large-scale clinical trials are still needed to confirm these findings. This review emphasizes the neuroprotective mechanisms of gut microbiota-based interventions in PD as supported by both preclinical and clinical studies.

Lifestyle and Health Behavior Changes in the COVID-19 Pandemic: A Role for Mental Health Symptoms and Diagnosis and Daily Life Difficulties During Lockdown in Lebanon

Several studies report significant changes in lifestyle habits during the COVID-19 pandemic, yet results are largely heterogeneous across populations. We examined changes in lifestyle and health behaviors during the first COVID-19 lockdown in Lebanon and assessed whether mental and physical health indicators and outbreak- and lockdown-related factors are related to these changes. Data come from a cross-sectional online survey (May-June 2020) which assessed changes in smoking, alcohol, diet, eating behavior, physical activity, sleep hours, sleep satisfaction, social media use, self-rated health, and life satisfaction (n = 494). We examined these changes' association with current depressive and anxiety symptoms, presence of physical and mental disorders, outbreak-related worries, and lockdown-related factors using regression models adjusted for sociodemographic and socioeconomic covariates. Most prevalent changes were increased social media use (63.2%) and decreased life satisfaction (54.9%) and physical activity (53.4%). Higher depressive and anxiety symptoms, higher daily life difficulties, and presence of diagnosed mental disorder were related to worsening of almost all behaviors. Participants with higher outbreak worries had less healthy diet and increased social media use. Higher adherence to lockdown and preventive measures were associated with increased social media use and lower life satisfaction, respectively. Results show a clear clustering of negative lifestyle and health behavioral changes with current mental health symptoms, existing mental health disorder, and daily life challenges during lockdowns. Findings highlight the importance of tracking higher-risk mental health subgroups to mitigate further adverse impact on mental and physical health.

Alterations in the inflammatory homeostasis of aging-related cardiac dysfunction and Alzheimer's diseases

Alzheimer's disease (AD) is well known among the elderly and has a profound impact on both patients and their families. Increasing research indicates that AD is a systemic disease, with a strong connection to cardiovascular disease. They share common genetic factors, such as mutations in the presenilin (PS1 and PS2) and the apolipoprotein E (APOE) genes. Cardiovascular conditions can lead to reduced cerebral blood flow and increased oxidative stress. These factors contribute to the accumulation of Aβ plaques and the formation of abnormal tau protein tangles, which are both key pathological features of AD. Additionally, Aβ deposits and abnormal protein responses have been observed in cardiomyocytes as well as in peripheral tissues. The toxic Aβ deposition intensifies damage to the microvascular structure associated with blood-brain barrier disruption and the initiation of neuroinflammation, which may accelerate the onset of neurocognitive deficits and cardiovascular dysfunction. Thus, we discuss the main mechanisms linking AD and cardiac dysfunction to enhance our understanding of these conditions. Ultimately, insights into the brain-heart axis may help us develop effective treatment strategies in the future.

Microbiota and social behavior alterations in a mouse model of down syndrome: Modulation by a synbiotic treatment

Sex differences in the composition and functionality of gut microbiota are an emerging field of interest in neurodevelopmental disorders, as they may help in understanding the phenotypic disparities between males and females. This study aimed to characterize sex-related specific alterations in gut microbiota composition in a mouse model of Down syndrome (Ts65Dn mice, TS mice) through the sequencing of the PCR-amplified 16S ribosomal DNA fraction. Moreover, it intended to examine whether the modulation of gut microbiota by the administration of a synbiotic (SYN) treatment would be beneficial for the behavioral alterations observed in male and female TS mice. Our results show that male, but not female, TS mice exhibit alterations in beta diversity compared to their wild-type (WT) littermates. Sex-dependent differences are also observed in the relative abundance of the classes Bacilli and Clostridia. Administering the SYN effectively counteracts hypersociability in females, and normalizes the overall abundance of Bacilli, specifically by increasing Lactobacillaceae. On the contrary, it rescues emotional recognition deficits in male TS mice and increases the relative abundance of the families Lactobacillaceae, Streptococcaceae and Atopobiaceae. In addition, a metagenome KEGG analysis of differentially enriched pathways shows relevant changes in the cofactor biosynthesis and the amino acid synthesis categories. Finally, following SYN treatment, both male and female TS mice exhibit a robust increase in propionic acid levels compared to WT littermates. These findings suggest sex-specific mechanisms that could link gut microbiota composition with behavior in TS mice, and underscore the potential of targeted gut microbiota interventions to modulate social abnormalities in neurodevelopmental disorders.

The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review

Some of the millions of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have developed new sequelae after recovering from the initial disease, termed post-acute sequelae of coronavirus disease 2019 (PASC). One symptom is anxiety, which is likely due to three etiologies: brain structural changes, neuroendocrine disruption, and neurotransmitter alterations. This review provides an overview of the current literature on the pathophysiological pathways linking coronavirus disease 2019 to anxiety, as well as the possible mechanisms of action in which an increasingly scrutinized treatment method, enhanced external counter-pulsation (EECP), is able to alleviate anxiety. SARS-CoV-2 triggers increased inflammatory cytokine production, as well as oxidative stress; these processes contribute to the aforementioned three etiologies. The potential treatment approach of EECP, involving sequenced inflation and deflation of specifically-placed airbags, has become of increasing interest, as it has been found to alleviate PASC-associated anxiety by improving patient cardiovascular function. These functional improvements were achieved by EECP stimulating anti-inflammatory and pro-angiogenic processes, as well as improving endothelial cell function and coronary blood flow, partially via counteracting against the negative effects of SARS-CoV-2 infection on the renin-angiotensin-aldosterone system. Therefore, EECP could promote both psychosomatic and cardiac rehabilitation. Further research, though, is still needed to fully determine its benefits and mechanism of action.

Climate change and suicide epidemiology: a systematic review and meta-analysis of gender variations in global suicide rates

Background

Climate change is reshaping public health, introducing extreme weather conditions and environmental stressors-such as high temperatures, atmospheric pollution, desertification, and storms (rain, thunder, and hail)-that critically impact mental health. Evidence increasingly links these factors to higher rates of suicide-related outcomes, including suicidal ideation, attempts, and self-harm. Such interactions underscore the importance of understanding how climate-driven mental health risks vary by environmental factor and gender, as gender-specific vulnerabilities shape responses to climate stressors.

Methods

By April 16, 2024, we conducted a comprehensive search of PubMed, Web of Science, Cochrane Library, PsycINFO, Scopus, ProQuest, and Embase. Two researchers independently reviewed studies and collected demographic data, systematically tracking and recording rates of suicidal ideation, suicide attempts, suicide deaths, self-harm, and anxiety. Data were rigorously cross-verified for accuracy and consistency.

Results

The meta-analysis demonstrated significant associations between climate change variables and mental health outcomes. High temperatures and air pollution were linked to increased suicide attempts (OR: 1.40, 95% CI: 1.34-1.45) and suicide deaths (OR: 1.51, 95% CI: 1.44-1.58), particularly among males. Conversely, atmospheric pollution and desertification correlated with a reduced likelihood of suicidal ideation (OR: 0.73, 95% CI: 0.63-0.85). These findings highlight gender-specific mental health impacts, with females exhibiting higher rates of anxiety and self-harm, underscoring the urgent need for targeted interventions addressing climate-induced mental health risks.

Conclusions

This systematic review and meta-analysis reveal significant gender-specific mental health impacts of climate change, with females experiencing higher rates of anxiety, self-harm, and suicidal ideation, while males show greater incidences of suicide attempts and deaths. These findings emphasize the urgent need for targeted interventions and the integration of mental health services into climate policies to address these gender disparities.

Systematic review registration

This study is registered with PROSPERO [PROSPERO (york.ac.uk)] under the identifier [CRD42024534961].

Lifestyle changes among older adults during and after COVID-19 pandemic in Lithuania

The aim of this study

to analyze lifestyle changes among older adults during and after COVID-19 pandemic in Lithuania, with a particular focus on eating habits, physical activity, social engagement and harmful habits.

Methods

The representative sample of Lithuanian population over 65 years old (1,503 individuals) was involved in the questionnaire survey, performed in January 2024.

Results

Most of the eating habits and the body weight of the older adults did not change during the COVID-19 pandemic in Lithuania. Respondents noted that their physical activity decreased, face-to-face communication became rarer, while remote communication increased. During pandemic, the increased frequency of snacking was more often indicated by persons with lower than secondary education, working, receiving higher incomes, as well as increased snacking and body weight were more prevalent among younger, single or overweight persons; increased body weight during the pandemic was more often mentioned by the persons who assessed their health poorly. Physical activity decreased more often among rural residents and groups with higher or college education; face-to-face communication has become rarer among younger people, rural residents, pensioners, disabled, people with higher income and those with overweight, while remote communication has increased among women, respondents with a university education and those with an average income (p < 0.05). Nearly half of the respondents indicated that the changes in food consumption and smoking frequency that occurred during the pandemic remained after it. After the pandemic, the habits of consuming fast food, confectionery or other sweets and changes in body weight mostly remained, while the patterns of communication returned to the pre-pandemic level. Most of the healthy lifestyle habits formed during the pandemic persisted after the pandemic. The lifestyle habits formed during the pandemic remained more stable in the groups of older persons, residents of smaller towns, respondents with lower than secondary education, higher income, singles, disabled, obese, and those who assessed their health poorly (p < 0.05).

Conclusion

During the COVID-19 pandemic in Lithuania, there were various changes in eating habits, physical activity, communication patterns, and harmful habits. Certain habits formed during the pandemic continued afterward, particularly among specific groups of the older Lithuanian adults.

Depression in adolescence and young adulthood: the difficulty to integrate motivational/emotional systems

Depression is presented as a multi-factorial bio-psycho-social expression that has evolved primarily as an effect of stressors related to the motivational/emotional systems that regulate the BrainMind in our relationship with conspecifics. These stressors may be caused by two sources of threat, firstly, the loss of bonding with the caregiver and later with a partner and/or group which relates to the SEPARATION (PANIC/GRIEF) system, secondly, social defeat as an expression of the social competition and social dominance. The sexual maturity drives the individual to social competition and social dominance, even if the latter often occurs before sexual maturity, e.g., chickens, dogs, non-human primates, and humans. Depression is an evolutionarily conserved mechanism in mammals to terminate both separation anxiety, so as to protect the vulnerable social brain from the consequences of prolonged separation anxiety, and the stress of social competition when social defeat is predictable. Adolescence and Young adulthood are particularly susceptible to these two types of threat because of human developmental characteristics that are summarized by the term neoteny. This refers to the slowing down of growth and development, resulting in both a prolonged period of dependence on a caring/protective adult and the persistence of juvenile characteristics throughout life. Therefore, neoteny makes the transition from childhood to sexual maturity more dramatic, making the integration of the SEPARATION (PANIC/GRIEF) system with the dynamics of social competition and dominance more stressful and a source of depression. Stress is an expression of the HPA-Hypothalamic-Pituitary-Adrenal axis that articulates with other systems, mainly the autonomic nervous system and the immune-inflammatory system. The latter is believed to be one of the most significant components in the dynamics of depressive processes, connected to the prodromes of its activation in childhood, under the pressure of environmental and relational stressors which can lead to learned helplessness. The recurrence of stressors makes it easier for the immune-inflammatory system to be activated in later life, which could make a significant contribution to the establishment of a depressive disease. The possible contribution of children's identification processes with their parents' depressive personalities through observational learning is considered.

Unveiling the Mechanisms of a Remission in Major Depressive Disorder (MDD)-like Syndrome: The Role of Hippocampal Palmitoyltransferase Expression and Stress Susceptibility

Post-translational modifications of proteins via palmitoylation, a thioester linkage of a 16-carbon fatty acid to a cysteine residue, reversibly increases their affinity for cholesterol-rich lipid rafts in membranes, changing their function. Little is known about how altered palmitoylation affects function at the systemic level and contributes to CNS pathology. However, recent studies suggested a role for the downregulation of palmitoyl acetyltransferase (DHHC) 21 gene expression in the development of Major Depressive Disorder (MDD)-like syndrome. Here, we sought to investigate how susceptibility (sucrose preference below 65%) or resilience (sucrose preference > 65%) to stress-induced anhedonia affects DHHC gene expression in the hippocampus of C57BL/6J mice during the phase of spontaneous recovery from anhedonia. Because MDD is a recurrent disorder, it is important to understand the molecular mechanisms underlying not only the symptomatic phase of the disease but also a state of temporary remission. Indeed, molecular changes associated with the application of pharmacotherapy at the remission stage are currently not well understood. Therefore, we used a mouse model of chronic stress to address these questions. The stress protocol consisted of rat exposure, social defeat, restraint stress, and tail suspension. Mice from the stress group were not treated, received imipramine via drinking water (7 mg/kg/day), or received intraperitoneal injections of dicholine succinate (DS; 25 mg/kg/day) starting 7 days prior to stress and continuing during a 14-day stress procedure. Controls were either untreated or treated with either of the two drugs. At the 1st after-stress week, sucrose preference, forced swim, novel cage, and fear-conditioning tests were carried out; the sucrose test and 5-day Morris water maze test followed by a sacrifice of mice on post-stress day 31 for all mice were performed. Transcriptome Illumina analysis of hippocampi was carried out. Using the RT-PCR, the hippocampal gene expression of Dhhc3, Dhhc7, Dhhc8, Dhhc13, Dhhc14, and Dhhc21 was studied. We found that chronic stress lowered sucrose preference in a subgroup of mice that also exhibited prolonged floating behavior, behavioral invigoration, and impaired contextual fear conditioning, while auditory conditioning was unaltered. At the remission phase, no changes in the sucrose test were found, and the acquisition of the Morris water maze was unchanged in all groups. In anhedonic, but not resilient animals, Dhhc8 expression was lowered, and the expression of Dhhc14 was increased. Antidepressant treatment with either drug partially preserved gene expression changes and behavioral abnormalities. Our data suggest that Dhhc8 and Dhhc14 are likely to be implicated in the mechanisms of depression at the remission stage, serving as targets for preventive therapy.

Household food insecurity and symptoms of anxiety and depression during pregnancy: Systematic review and meta-analysis

Household food insecurity (HFI) has been related to adverse maternal-child health outcomes and mental health worsening during pregnancy. Few studies evaluated the temporal association between HFI and anxiety and depressive symptoms in pregnant women, and this association remains not completely understood. This study aimed to systematically review the association between HFI and symptoms of depression and anxiety in pregnant individuals. The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (CRD42022373615). Systematic searches were conducted on 10 electronic databases and grey literature. Two researchers independently conducted the study selection, data extraction process, and the risk of bias assessment. Random-effects meta-analysis models were used, and I2 > 40% indicated high heterogeneity across studies. Eighteen articles were included for the systematic review, comprising n = 27,882, and a total of 18,987 pregnant individuals aged between 14 and 45 years were included in the meta-analysis. The prevalence of HFI reported in studies ranged from 12.6% to 62.1% (n = 17). The prevalence of depressive and anxiety symptoms ranged from 18% to 49% (n = 11) and 23% to 34% (n = 2), respectively. HFI during pregnancy was associated with increased odds of experiencing symptoms of depression [(OR: 2.52; 95% CI: 2.11-3.02), I2 = 73.23%]. The quality of evidence was very low due to high heterogeneity. Our findings highlighted the association between HFI and depression symptoms during pregnancy. Findings from this study suggest the importance of assessing HFI and mental health during pregnancy.

Profile of female survivors of sexual violence in the first 6 months of the COVID-19 quarantine in the city of Campinas, Brazil: A cross-sectional retrospective study

OBJECTIVES

Describe the characteristics and changes in the profile of women who sought care after experiencing sexual violence (SV) during the first six months of the COVID-19 pandemic in a Brazilian city.

METHODS

This is a cross-sectional retrospective study. Data from emergency care and legal abortion requests of women assisted at the Women's Health Care Center Hospital (School of Medical Sciences, University of Campinas, Brazil) due to SV experienced between March 23 and August 23, 2020 (Quarantine Group, QG), were collected and compared with data from the same period of the previous biennium (Comparison Group, CG). χ2 and Fisher's exact tests were used to compare groups; the significance level was 5%.

RESULTS

Data for 236 women were analyzed; 70 women were included in the QG and 166 in the CG. In the QG, there was a restriction in the area of origin of women, with a higher proportion of women who lived in Campinas (P = 0.0007) and a higher frequency of chronic SV (P = 0,035). There were no rapes associated with the use of social media or apps in the QG, but 9.8% of women in the CG experienced rape associated with the use of social media or apps. There were higher rates of domestic violence (P = 0.022) and intimidation through physical force (P = 0.011) in the first two months.

CONCLUSION

The COVID-19 quarantine affected the profile of women who sought care after experiencing SV. The quarantine resulted in changes in the area of origin of patients, hindering access to health services and leading to higher rates of chronic and domestic SV, particularly in the first 2 months of the pandemic.

Major Depression in Comorbidity with Substance use Disorders: Patients' Features and Clinical-Neurobiological Rationale of Antidepressant Treatments

The frequent co-occurrence of major depressive disorder (MDD) and substance use disorders (SUDs) entails significant clinical challenges. Compared to patients with MDD alone, patients with MDD and SUD often show increased anhedonia, emotional blunting, and impaired cognitive function. These symptoms lead to an inability to control cravings, more substance use, increased relapse rates, and poor adherence to the treatment. This fosters a detrimental cycle leading to more severe depressive symptoms, functional impairment, and chronicity, culminating in heightened morbidity, mortality, and healthcare resource utilization. Data on antidepressant treatment of MDD-SUD patients are inconclusive and often conflicting because of a number of confounding factors in clinical trials or difficulty in dissecting the specific contributions of pharmacological versus psychological interventions in real-world studies. The patient's unique clinical features and specific SUD and MDD subtypes must be considered when choosing treatments. Ideally, drug treatment for MDD-SUD should act on both conditions and address core symptoms such as anhedonia, craving, and cognitive dysfunction while ensuring minimal emotional blunting, absence of drug interactions, and no addictive potential. This approach aims to address unmet needs and optimize the outcomes in a clinical population often underrepresented in treatment paradigms.

Evolution of Well-Being and Associated Factors during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic was a global public health crisis with an unparalleled impact worldwide, presenting a significant challenge for both physical and mental health. The main objective of this study was to analyze the risk of depression during the COVID-19 pandemic and how this was affected by sociodemographic factors, pandemic fatigue, risk perception, trust in institutions, and perceived self-efficacy.

METHODS

A cross-sectional study was conducted in the Region of Murcia through two online surveys completed by 1000 people in June 2021 (Round 1) and March 2022 (Round 2). Risk of depression was measured using the 5-item World Health Organization Well-Being Index (WHO-5) questionnaire, and descriptive, bivariate, and multivariate regression analyses were performed to identify factors associated with the risk of depression.

RESULTS

In Round 1, 35.2% of the sample presented a risk of depression, which increased to 39.1% in Round 2. Those at greater risk were women, individuals with lower socioeconomic status, those with less family support, lower trust in institutions, higher perceived risk of contracting the disease, and higher levels of pandemic fatigue.

CONCLUSIONS

Identifying vulnerable populations facing mental health issues can help the authorities and institutions that are responsible for managing public health crises to develop and implement inclusive strategies and interventions tailored to the population's needs.

Women with Schizophrenia: Beyond Psychosis

Although women with schizophrenia face significant lifelong challenges due to their diagnosis and sex-related issues, those challenges are seldom taken into consideration in their medical treatment and general care. In order to report the needs and desires of a group of women with schizophrenia, we conducted a series of semistructured interviews with nine women diagnosed with schizophrenia and attending outpatient clinics at the Hospital Del Salvador in Valparaíso. Our qualitative study followed a phenomenological design. Using ATLAS.ti software, we performed a content analysis of the interview transcripts, developed a coding frame for each major topic addressed in the interviews, and triangulated the results. Despite presenting with psychotic symptoms, some women received different diagnoses. Although acknowledging the benefits of medication, women also reported concerns about weight gain and body image. All women reported experiences with stigma and self-stigma related to the diagnosis of schizophrenia, and most had experienced childhood trauma, including sexual abuse, parental violence, and/or bullying. Young women with schizophrenia also feared that if they become mothers, then their children might also have schizophrenia and/or that they would be unable to adequately care for them. Women with schizophrenia have different experiences and play different roles in society beyond their psychoses, an understanding that should integrated into more personalized treatments for schizophrenia that consider individual characteristics and needs.

Effect of Cariprazine on Anhedonia in Patients with Bipolar I Depression: Post Hoc Analysis of Three Randomized Placebo-Controlled Clinical Trials

INTRODUCTION

Anhedonic symptoms in bipolar I (BP-I) depression are associated with decreased quality of life and impaired functioning. We evaluated the effects of cariprazine in patients with BP-I depression with lower or higher levels of anhedonia at baseline.

METHODS

Data were pooled from three clinical trials (NCT01396447, NCT02670538, NCT02670551) analyzing the effects of cariprazine 1.5 and 3 mg/day in adults with BP-I depression. During post hoc analysis, patients were stratified by baseline median Montgomery-Åsberg Depression Rating Scale (MADRS) anhedonia factor score into a lower (score < median) or higher (score ≥ median) anhedonia subgroup. Outcomes included change from baseline to week 6 in MADRS total and anhedonia factor score, with the latter also evaluated after adjusting for other depressive symptoms. Between-group differences in change from baseline to week 6 were compared using least-squares mean differences (LSMD) analyzed via a mixed-effect model for repeated measures.

RESULTS

Median baseline anhedonia factor score was 19, defining the lower (placebo = 211; cariprazine 1.5 mg/day = 200, 3 mg/day = 212) and higher (placebo = 249; cariprazine 1.5 mg/day = 261, 3 mg/day = 250) anhedonia subgroups. In the lower subgroup, cariprazine 1.5 mg/day but not 3 mg/day was superior to placebo in reducing MADRS total (LSMD [95% CI] 1.5 mg/day = - 2.61 [- 4.28, - 0.93], P = .0024) and anhedonia factor scores (- 1.70 [- 2.77, - 0.62], P = .0021) at week 6. In the higher subgroup, both cariprazine doses were associated with significantly greater reductions than placebo in MADRS total (1.5 mg/day = - 3.01 [- 4.84, - 1.19], P = .0012; 3 mg/day = - 3.26 [- 5.12, - 1.40], P = .0006) and anhedonia factor scores (1.5 mg/day = - 1.97 [- 3.13, - 0.81], P = .0009; 3 mg/day = - 2.07 [- 3.26, - 0.89], P = .0006). Anti-anhedonic effects were preserved after adjusting for other depressive symptoms, suggesting the effect was not pseudospecific. Patients in the higher subgroup had higher baseline depression and therefore the lower subgroup may have had a floor effect.

CONCLUSION

Cariprazine demonstrated antidepressant and specific anti-anhedonic effects regardless of baseline anhedonia symptoms in patients with BP-I depression.

TRIAL REGISTRATION

ClinicalTrials.gov identifiers, NCT02670538, NCT02670551, NCT01396447.

Understanding the Dynamics of Domestic Violence During the First Year of the Pandemic: An Integrative Review

This integrative review aims to analyze and synthesize existing literature to inform our understanding of the multifaceted dimensions of domestic violence during the first year of the COVID-19 pandemic, using a holistic and ecological framework. Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) study design, searches were conducted on six databases, yielding a final sample of 58 articles. The study comprehensively overviews North America, South America, Asia, Europe, Africa, and worldwide research. The literature reveals an alarming increase in domestic violence victimization during the pandemic in most regions and studies, exacerbating pre-existing vulnerabilities. The increase in domestic violence during the pandemic is linked to ecological factors such as lower physical and mental health, rising substance use, and financial stress, which heightened individuals' vulnerability. Lockdowns exacerbated these issues by increasing confinement in homes, disrupting support services, and limiting victims' access to help. Barriers to help-seeking and amplified personal and professional stressors at the care level are identified. Advocacy for improved awareness, cooperation, and inclusive national and institutional policies emerges. This study underscores the urgency of empirical research to generate reliable data on the pandemic's impact on domestic violence. The findings of this study highlight the importance of understanding unique factors affecting specific groups, as well as informing prevention efforts and targeted interventions. Recognizing the mutual benefit of research-practice partnerships is crucial in addressing and preventing domestic violence. This research contributes to a deeper understanding of domestic violence during the pandemic's first year, guiding empirically informed interventions and policy changes.

Measuring influencing factors affecting mortality rates during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has revealed clear deficiencies in global public health policies and healthcare systems when confronted with the emergence of a novel and deadly infectious disease.

OBJECTIVES

With 4 years elapsed since the onset of the pandemic, ample data now exist to analyse the associations between the implementation of diverse public health policies, sociodemographic factors and COVID-19 mortality rates.

METHODS

This study utilised the dataset compiled by 'Our World in Data' spanning the period of the COVID-19 pandemic from 2020 to 2022. Stochastic frontier analysis was employed to assess the influencing factors and their relationship with mortality rates resulting from COVID-19 infections across 156 countries or regions.

RESULTS

This study yielded several key findings: (1) There remains a 33% margin for improvement in the global mortality rate concerning the COVID-19 pandemic; (2) During the initial stage of the pandemic, when an effective vaccine was not yet available, implementing public health control policies could reduce both the infection and mortality rates; (3) Areas characterised by higher population densities, a greater proportion of individuals aged 65 and over, and elevated prevalence rates of diabetes demonstrated higher mortality rates; and (4) Increasing vaccination coverage emerged as an effective strategy for reducing mortality rates.

CONCLUSIONS

As our understanding of the COVID-19 virus improves, global economies and social interactions have gradually returned to normality. It is anticipated that the findings of this study can serve as a valuable reference in combating potential future pandemics caused by unknown viruses.

Experienced Versus Perpetrated Intimate Partner Violence and Psychological Maladjustment: The Role of Adaptive and Avoidant Coping

The present questionnaire study explores the relationship between intimate partner violence (IPV), coping strategies, and psychological maladjustment for both female and male college students, as well as considering the effects of perpetrated IPV. College students are at risk for experiencing and perpetrating IPV, and coping skills may act as important risk and protective factors. In total, 333 (247 women, 86 men) undergraduate college students completed an online survey for research participation credit. Perpetrated intimate partner verbal aggression and experienced and perpetrated relationship violence were significantly correlated with somatization and depression, while for women, perpetrated verbal aggression was significantly correlated with somatization, depression, anxiety, and eating disorder symptoms. Experienced verbal aggression was significantly correlated with depression for women, while perpetrated verbal aggression was significantly correlated with anxiety for men. Path analyses with bootstrapped mediation tests found that, for men, the relationships between experienced violence and somatization and depression were significantly mediated by avoidant coping, while for women, the relationships between perpetrated verbal aggression and somatization, depression, anxiety, and eating disorder symptoms were significantly mediated by avoidant coping. Findings suggest that, particularly for women, the use of avoidant coping behaviors may exacerbate cycles of victimization by and perpetration of IPV that, in turn, lead to greater psychological distress. The present findings suggest that interventions to reduce IPV should put greater emphasis on the teaching of adaptive coping skills in couple relationships to help reduce the impulse to perpetrate violence, on top of coping skills to deal with experienced violence.

The Microbiota-Gut-Brain Axis: Key Mechanisms Driving Glymphopathy and Cerebral Small Vessel Disease

The human microbiota constitute a very complex ecosystem of microorganisms inhabiting both the inside and outside of our bodies, in which health maintenance and disease modification are the main regulatory features. The recent explosion of microbiome research has begun to detail its important role in neurological health, particularly concerning cerebral small vessel disease (CSVD), a disorder associated with cognitive decline and vascular dementia. This narrative review represents state-of-the-art knowledge of the intimate, complex interplay between microbiota and brain health through the gut-brain axis (GBA) and the emerging role of glymphatic system dysfunction (glymphopathy) and circulating cell-derived microparticles (MPs) as mediators of these interactions. We discuss how microbial dysbiosis promotes neuroinflammation, vascular dysfunction, and impaired waste clearance in the brain, which are critical factors in the pathogenesis of CSVD. Further, we discuss lifestyle factors that shape the composition and functionality of the microbiota, focusing on sleep as a modifiable risk factor in neurological disorders. This narrative review presents recent microbiome research from a neuroscientific and vascular perspective to establish future therapeutic avenues in targeting the microbiota to improve brain health and reduce the burden of CSVD.

Association between a large change between the minimum and maximum monthly values of solar insolation and a history of suicide attempts in bipolar I disorder

BACKGROUND

The rate of suicide attempts by patients with bipolar disorder is high. In addition to patient and country specific factors, environmental factors may contribute to suicidal behavior. Sunlight has multiple diverse impacts on human physiology and behavior. Solar insolation is defined as the electromagnetic energy from the sun striking a surface area on earth. We previously found that a large change in solar insolation between the minimum and maximum monthly values was associated with an increased risk of suicide attempts in patients with bipolar I disorder.

METHODS

The association between solar insolation and a history of suicide attempts in bipolar disorder was again investigated using an international database with 15% more data and more sites at diverse locations and countries.

RESULTS

Data were available from 5641 patients with bipolar I disorder living at a wide range of latitudes in 41 countries in both hemispheres. A large change in solar insolation between the minimum and maximum monthly values was associated with a history of suicide attempts in patients with bipolar I disorder, a replication of our prior analysis. The estimated model also associated state sponsored religion in the onset country, female gender, a history of alcohol or substance abuse, and being part of a younger birth cohort with a history of suicide attempts.

CONCLUSIONS

A large change between the minimum and maximum monthly values of solar insolation was associated with a history of suicide attempts in bipolar I disorder, replicating our prior research. Physicians should be aware that daylight has wide ranging physiological and psychiatric impacts, and that living with large changes in solar insolation may be associated with an increased suicide risk.

The pandemic within a pandemic: mental health and wellbeing of racially Minoritised women experiencing domestic abuse during the COVID-19 pandemic in the UK

BACKGROUND

The prevalence of domestic abuse is greater in times of humanitarian crisis, and the COVID-19 pandemic has been no different. Considerable evidence indicates that domestic abuse disproportionately impacts the mental health and wellbeing of racially Minoritised women. The present study aimed to explore racially Minoritised women's experiences of domestic abuse and mental health in the COVID-19 pandemic in the UK.

METHOD

An online cross-sectional survey was used with racially Minoritised women (n = 1202) in the UK during the third national lockdown.

RESULTS

Results demonstrate complex interplay of psychosocial factors, such as the roles of autonomy, resilience, self-silencing, family functioning, and social support as predictors of mental health and wellbeing during the 'shadow pandemic'.

CONCLUSION

Implications such as incorporating culturally competent mental health support, exploring the complex and multiple underpinnings of mental health in racially Minoritised victim-survivors of domestic abuse for future pandemic preparedness and support provision are discussed.

Understanding Cognitive Performance, Psychological Factors, and Personality Traits in Women Exposed to Intimate Partner Violence

Intimate partner violence (IPV) might increase the risk of depression, traumatic stress and affect cognitive performance. We analyzed the cognitive performance, psychological factors, and personality traits of 136 Brazilian women (n = 70 exposed to IPV and n = 66 non-exposed) aged 18 years or older. We utilized clinical interviews, the NEO Personality Inventory, and a neuropsychological testing battery. The statistical analyses employed moderation within variables, resulting in determination coefficients (r2) of 0.15 and 0.35. The husband was the primary aggressor, physical violence was the most frequent (90.6%). Women exposed to IPV exhibited more symptoms of post-traumatic stress disorder (PTSD), depression, neuroticism, difficulties in visual memory, and visuospatial abilities. The analysis indicated the influence of IPV, neuroticism, PTSD, and depression on the cognitive performance of the exposed to IPV.

Emerging role of Nrf2 in Parkinson's disease therapy: a critical reassessment

Parkinson's disease (PD) is the neurodegenerative disorder characterized by the progressive degeneration of nigrostriatal dopaminergic neurons, leading to the range of motor and non-motor symptoms. There is mounting evidence suggesting that oxidative stress, neuroinflammation and mitochondrial dysfunction play pivotal roles in the pathogenesis of PD. Current therapies only alleviate perturbed motor symptoms. Therefore, it is essential to find out new therapies that allow us to improve not only motor symptoms, but non-motor symptoms like cognitive impairment and modulate disease progression. Nuclear factor erythroid 2-related factor 2 (Nrf2) is transcription factor that regulates the expression of numerous anti-oxidants and cytoprotective genes can counteract oxidative stress, neuroinflammation and mitochondrial dysfunction, thereby potentially ameliorating PD-associated pathology. The current review discusses about the Nrf2 structure and function with special emphasis on various molecular signalling pathways involved in positive and negative modulation of Nrf2, namely Glycogen synthase kinase-3β, Phosphoinositide-3-kinase, AMP-activated protein kinase, Mitogen activated protein kinase, nuclear factor-κB and P62. Furthermore, this review highlights the various Nrf2 activators as promising therapeutic agents for slowing down the progression of PD.

Intricate mechanism of anxiety disorder, recognizing the potential role of gut microbiota and therapeutic interventions

Anxiety is a widespread psychological disorder affecting both humans and animals. It is a typical stress reaction; however, its longer persistence can cause severe health disorders affecting the day-to-day life activities of individuals. An intriguing facet of the anxiety-related disorder can be addressed better by investigating the role of neurotransmitters in regulating emotions, provoking anxiety, analyzing the cross-talks between neurotransmitters, and, most importantly, identifying the biomarkers of the anxiety. Recent years have witnessed the potential role of the gut microbiota in human health and disorders, including anxiety. Animal models are commonly used to study anxiety disorder as they offer a simpler and more controlled environment than humans. Ultimately, developing new strategies for diagnosing and treating anxiety is of paramount interest to medical scientists. Altogether, this review article shall highlight the intricate mechanisms of anxiety while emphasizing the emerging role of gut microbiota in regulating metabolic pathways through various interaction networks in the host. In addition, the review will foster information about the therapeutic interventions of the anxiety and related disorder.

Impact of climate change on women mental health in rural hinterland of Pakistan

Background

Climate change significantly impacts global well-being, with rural and agricultural communities, particularly women, bearing a disproportionate burden. In Pakistan's Malakand Division, women face increased mental health challenges due to environmental stressors such as temperature rise, extreme weather, and environmental degradation. These stressors are expected to exacerbate issues like stress, anxiety, and depression. Understanding their effects on rural women's mental health is crucial for developing effective intervention strategies.

Methodology

This study employs quantitative methodologies to assess the impact of climate change on the mental health of rural women in Malakand Division, focusing on Dir Upper, Dir Lower, and Shangla districts. A cross-sectional design was used, with a sample size of 600 women selected through multistage cluster sampling for geographic representation. Data were collected using structured questionnaires addressing stress, anxiety, and community dynamics. Data were analyzed using multiple regression, structural equation modeling (SEM), ANOVA, and logistic regression.

Results

The results revealed that climate change factors-temperature increase (β = 0.42, p < 0.01), extreme weather events (β = 0.36, p < 0.01), precipitation changes (β = 0.31, p < 0.05), and environmental degradation (β = 0.28, p < 0.05)-significantly impacted rural women's mental health. High levels of stress (72%), anxiety (68%), and depression (56%) were reported. Social support (β = -0.45, p < 0.01), community cohesion (β = -0.37, p < 0.05), access to resources (β = -0.39, p < 0.01), and cultural norms (β = -0.33, p < 0.05) were key factors mitigating the effects of climate stress. Gender disparities were evident, with women showing higher mental health challenges compared to men in similar conditions.

Conclusion

The study concludes that climate change significantly exacerbates mental health issues for rural women. It highlights the need for gender-sensitive, community-based interventions that address both climate adaptation and mental health. Strengthening community resilience, improving access to resources, and investing in healthcare and education are vital for enhancing well-being in the face of climate change.

Exploring the Pharmacological and Clinical Features of Lumateperone: A Promising Novel Antipsychotic

Lumateperone is a novel antipsychotic recently approved for the treatment of schizophrenia. Its unique pharmacological profile includes modulation of serotonergic, dopaminergic, and glutamatergic neurotransmission, differentiating it from other second-generation antipsychotics. This paper explores the pharmacological features and clinical potential of lumateperone across neuropsychiatric conditions. A review of current literature, including pharmacokinetic and pharmacodynamic studies, was conducted. It focused on lumateperone's mechanism of action and receptor-binding profile, and clinical trials assessing its efficacy and safety in schizophrenia and other psychiatric disorders. Lumateperone demonstrates high affinity for 5-HT2A receptors, moderate affinity for D2 receptors, and low affinity for H1 and 5-HT2C receptors. It acts as a presynaptic D2 agonist and a postsynaptic antagonist, contributing to a favorable side-effect profile with reduced extrapyramidal symptoms. Clinical trials suggest that lumateperone is effective in reducing both positive and negative symptoms of schizophrenia, with minimal metabolic and cardiovascular risks. It is also being explored as an adjunctive therapy for major depressive disorder and bipolar depression. Lumateperone presents a promising therapeutic option for schizophrenia with a novel mechanism of action and a favorable safety profile. Its potential application in other psychiatric conditions warrants further investigation, particularly in treatment-resistant populations.