Emotional Dysregulation in Adolescents: Implications for the Development of Severe Psychiatric Disorders, Substance Abuse, and Suicidal Ideation and Behaviors

Validation of the Difficulties in Emotion Regulation Scale-Short Form in a sample of Italian adolescents

OBJECTIVE

The primary objective of the present study is to validate the Difficulty in Emotion Regulation Scale-Short Form (DERS-SF) in a sample of Italian adolescents. Additionally, we aim to evaluate its factorial structure by examining the contribution of each subscale (i.e., Nonacceptance, Clarity, Awareness, Goals, Impulse, Strategy) on the general factor using bi-factor models by replicating a past study.

METHOD

The sample comprises N = 704 adolescents aged 11-17 years (M = 13.38, SD = 1.37; 53.12% females). To establish external validity, correlation and path analyses were conducted between the DERS-SF sub-scales, the total score, and measures of internalizing and externalizing symptoms, as well as Problematic Smartphone Use (PSU). Measurement invariance was tested comparing males versus females and pre-adolescents and adolescents.

RESULTS

Overall, results supported the multidimensional nature of the DERS-SF, confirming its original six-factor structure. However, bi-factor models analysis revealed that the Awareness subscale should be excluded when calculating the total score. Furthermore, findings indicated that the Strategy subscale variance is largely accounted for by the general factor rather than the specific subscale. In terms of external validity, significant positive associations between the DERS-SF sub-scales, the total score, and PSU, internalizing and externalizing symptoms were observed. Measurement invariance was supported.

CONCLUSIONS

Altogether, findings support the validity of the DERS-SF among Italian Adolescents and provide insights relevant to the understanding of the multifaceted facets of emotion regulation, emphasizing its relevance as a transdiagnostic process.

The relationship between urban greenspace perception and use within the adolescent population: A focused ethnography

INTRODUCTION

Greenspace is beneficial for improving adolescent mental health, yet healthcare professionals still do not understand the connection between the built environment and subjective mental well-being. We also need to understand how this population uses greenspace and how they feel when in it.

AIM

The aim of this qualitative study was threefold: to understand why adolescents use greenspace, to identify how they use greenspace and to explore how they feel when they are in greenspace.

DESIGN

Focused ethnography.

METHODS

Data were collected between June 2022 and August 2022 using participant observation, photo elicitation and semi-structured interviews. Braun and Clarke's (2006) six phases of thematic analysis were used to guide data collection and analysis.

RESULTS

A total of 11 adolescents between ages 12 and 18 who resided in and around Newark, NJ, were recruited. Three themes were identified from the data: (1) A tranquil space in an unsafe place; (2) Park means family connection with burgeoning independence; and (3) My park: Sense of ownership and responsibility.

CONCLUSIONS

This study deepens the understanding between subjective mental well-being and urban greenspace exposure. Adolescents accepted responsibility for maintaining "my park", which strengthens community cohesion, detailing the importance of youth input during urban planning.

IMPLICATIONS FOR PRACTICE

Implications from this study suggest that environmental interventions may help ameliorate an ongoing mental health care crisis among adolescents. Healthcare providers should consider the built environment as another approach to promoting mental health.

PATIENT OR PUBLIC CONTRIBUTION

None other than research participants.

Childhood sexual abuse and suicide attempts in patients with substance use disorders: The mediating role of emotion dysregulation

BACKGROUND

Suicide attempts (SA) are a public health concern because of increasing prevalence and clinical implications. Childhood trauma (CT) and emotion dysregulation (ED) have been proposed as predictors of SA, but few data are available in patients with Substance Use Disorder (SUD).

OBJECTIVE

Our study aims to investigate the association of sociodemographic/clinical variables, CT typologies, and ED features with SA in SUD patients.

PARTICIPANTS AND SETTING

Subjects with SUD were screened in an outpatient setting. The final sample consisted of 226 patients, subdivided according to the presence of lifetime SA (SUD, n = 163 vs. SUD-SA, n = 63).

METHODS

Participants were compared for sociodemographic and clinical information. CT and ED were assessed through the Childhood Trauma Questionnaire - Short Form (CTQ-SF) and the Difficulties in Emotion Regulation Scale (DERS), respectively. We performed a mediation analysis to test the effect of CT and ED on SA.

RESULTS

Patients with a history of SA (27.9 %) displayed more psychiatric comorbidities (p = 0.002) and hospitalizations (p < 0.001), higher scores at CTQ-SF sexual abuse (p < 0.001) and DERS 'impulse' (p = 0.002), 'goals', 'non-acceptance', 'strategies' (p < 0.001) subscales. The relationship between CTQ-SF sexual abuse and SA was significantly mediated by DERS 'strategies' (p = 0.04; bootstrapped 95 % LLCI-ULCI = 0.004-0.024).

CONCLUSIONS

CT and different dimensions of ED were associated with SA in SUD patients. In our sample, the effects of childhood sexual abuse on SA were mediated by limited access to emotion regulation strategies. SUD patients are burdened with higher all-cause mortality, and CT and lifetime SA can worsen clinical outcomes. Clarifying the reciprocal interactions of psychopathological dimensions may help deliver targeted interventions and reduce suicide risk in specific populations.

Reliability and validity estimation of Urdu version of Children Emotion Management Scales (CEMS) in Pakistan

Introduction

The present study aimed to translate and validate Children's Emotion Management Scales into Urdu, the national language of Pakistan.

Method

The current study comprised three different phases, i.e., phase I: Cross-language validation over a sample of (N = 169) school children, estimated at a 1-week interval.

Results

The results indicate a significant correlation (r = 0.846-0.891) at p < 0.01. In phase II, the internal consistency reliability (r = 0.808-0.904) and split-half reliability (r = 0.737-0.898) of the scale were assessed (N = 683) at p < 0.01. Furthermore, significant results for test-retest reliability analysis (N = 168) were obtained (r = 0.736-0.917 at p < 0.01), following the confirmatory factor analysis (CFA) (N = 1,083). Exploratory factor analysis (EFA) was conducted on the same sample chosen for CFA. EFA resulted in the retention of original inhibition (INH), dysregulated expression (DYS), and emotional coping (EMO) factors. CFA findings suggest a good model fit. In phase III, convergent validity and divergent validity were checked (N = 385, 255, and 213). Convergent validity of INH and DYS subscales and divergent validity of EMO subscales were established, with SBI (r = 0.217-0.609; 0.210-0.445; -0.026 to -0.553), SHS (r = 0.417-0.441; 0.480-0.546; -0.338 to -0.582), and suppression subscale of ERQ (r = 0.430-0.480; 0.468-0.522; -0.245 to -0.369) at p < 0.01. For divergent validity of INH and DYS subscales and convergent validity of EMO subscales, their scores were correlated with the SPS (r = -0.204 to -0.350; -0.318 to -0.459; 0.191-0.531), RSE Scale (r = -0.226 to -0.351; -0.279 to -0.352; 0.255-0.507), DTS (-0.290 to -0.617; -0.369 to -0.456; 0.246-0.680), and reappraisal subscale of ERQ (r = -0.456 to -0.541; -0.329 to -0.544; 0.446-0.601) at p < 0.01.

Discussion

It is concluded that the scale is reliable and valid with sound psychometric properties.

Exploring the Potential of Artificial Intelligence in Adolescent Suicide Prevention: Current Applications, Challenges, and Future Directions

ObjectiveThe global surge in adolescent suicide necessitates the development of innovative and efficacious preventive measures. Traditionally, various approaches have been used, but with limited success. However, with the rapid advancements in artificial intelligence (AI), new possibilities have emerged. This paper reviews the potentials and challenges of integrating AI into suicide prevention strategies, focusing on adolescents. Method: This narrative review assesses the impact of AI on suicide prevention strategies, the strategies and cases of AI applications in adolescent suicide prevention, as well as the challenges faced. Through searches on the PubMed, web of science, PsycINFO, and EMBASE databases, 19 relevant articles were included in the review. Results: AI has significantly improved risk assessment and predictive modeling for identifying suicidal behavior. It has enabled the analysis of textual data through natural language processing and fostered novel intervention strategies. Although AI applications, such as chatbots and monitoring systems, show promise, they must navigate challenges like data privacy and ethical considerations. The research underscores the potential of AI to enhance future suicide prevention efforts through personalized interventions and integration with emerging technologies. Conclusion: AI possesses transformative potential for adolescent suicide prevention by offering targeted and adaptive solutions, while they also raise crucial ethical and practical considerations. Looking forward, AI can play a critical role in mitigating adolescent suicide rates, marking a new frontier in mental health care.

Uncovering transcriptomic biomarkers for enhanced diagnosis of methamphetamine use disorder: a comprehensive review

Introduction

Methamphetamine use disorder (MUD) is a chronic relapsing disorder characterized by compulsive Methamphetamine (MA) use despite its detrimental effects on physical, psychological, and social well-being. The development of MUD is a complex process that involves the interplay of genetic, epigenetic, and environmental factors. The treatment of MUD remains a significant challenge, with no FDA-approved pharmacotherapies currently available. Current diagnostic criteria for MUD rely primarily on self-reporting and behavioral assessments, which have inherent limitations owing to their subjective nature. This lack of objective biomarkers and unidimensional approaches may not fully capture the unique features and consequences of MA addiction.

Methods

We performed a literature search for this review using the Boolean search in the PubMed database.

Results

This review explores existing technologies for identifying transcriptomic biomarkers for MUD diagnosis. We examined non-invasive tissues and scrutinized transcriptomic biomarkers relevant to MUD. Additionally, we investigated transcriptomic biomarkers identified for diagnosing, predicting, and monitoring MUD in non-invasive tissues.

Discussion

Developing and validating non-invasive MUD biomarkers could address these limitations, foster more precise and reliable diagnostic approaches, and ultimately enhance the quality of care for individuals with MA addiction.

The Moderating Effect of Self-Efficacy on Pregnancy Stress and Smartphone Addiction of Pregnant Women in Late Pregnancy: A Longitudinal Study

Purpose

We aimed to understand the current situation of smartphone addiction in pregnant women, and explored the moderating effect of self-efficacy between pregnancy stress and smartphone addiction.

Patients and Methods

This study adopted a longitudinal design to collect pregnant women from the obstetrics and gynecology department of a tertiary hospital in Shenyang in 2020 from early pregnancy (T1) to their late pregnancy (T2). A total of 342 questionnaires were collected, including the Smartphone Addiction Scale-Short Version (SAS-SV), the Pregnancy Pressure Scale (PPS), and the Chinese version of the General Self-Efficacy Scale (GSES). Multiple hierarchical regression and simple slope test were used to test the moderating effect of self-efficacy.

Results

Smartphone addiction in T2 (44.74) was more sever than in T1 (33.11). The interaction item of T1 pregnancy stress and T2 self-efficacy was positively correlated with smartphone addiction (β=0.205, P<0.01) and explained an additional 3.2% variance (ΔR2=0.032, P<0.01). The influence of pregnancy stress on smartphone addiction was gradually decreased in the low, mean, and high groups of self-efficacy.

Conclusion

Smartphone addiction in late pregnancy was more severe than that in early pregnancy, possibly due to increased pregnancy stress. The self-efficacy of pregnant women could reduce the impact of pregnancy stress on smartphone addiction. Medical staff can alleviate the bad behavior by improving their self-efficacy.

Developmental Neuroendocrinology of Early-Life Stress: Impact on Child Development and Behavior

Our internal balance, or homeostasis, is threatened or perceived as threatened by stressful stimuli, the stressors. The stress system is a highly conserved system that adjusts homeostasis to the resting state. Through the concurrent activation of the hypothalamic-pituitary-adrenal axis and the locus coeruleus/norepinephrine-autonomic nervous systems, the stress system provides the appropriate physical and behavioral responses, collectively termed as "stress response", to restore homeostasis. If the stress response is prolonged, excessive or even inadequate, several acute or chronic stress-related pathologic conditions may develop in childhood, adolescence and adult life. On the other hand, earlylife exposure to stressors has been recognized as a major contributing factor underlying the pathogenesis of non-communicable disorders, including neurodevelopmental disorders. Accumulating evidence suggests that early-life stress has been associated with an increased risk for attention deficit hyperactivity disorder and autism spectrum disorder in the offspring, although findings are still controversial. Nevertheless, at the molecular level, early-life stressors alter the chemical structure of cytosines located in the regulatory regions of genes, mostly through the addition of methyl groups. These epigenetic modifications result in the suppression of gene expression without changing the DNA sequence. In addition to DNA methylation, several lines of evidence support the role of non-coding RNAs in the evolving field of epigenetics. In this review article, we present the anatomical and functional components of the stress system, discuss the proper, in terms of quality and quantity, stress response, and provide an update on the impact of early-life stress on child development and behavior.

Automatic Positive and Negative Emotion Regulation in Adolescents with Major Depressive Disorder

INTRODUCTION

Adolescents with major depressive disorder (MDD) exhibit hypoactivity to positive stimuli and hyperactivity to negative stimuli in terms of neural responses. Automatic emotion regulation (AER) activates triple networks (i.e., the central control network, default mode network, and salience network). Based on previous studies, we hypothesized that adolescents with MDD exhibit dissociable spatiotemporal deficits during positive and negative AER.

METHODS

We first collected EEG data from 32 adolescents with MDD and 35 healthy adolescents while they performed an implicit emotional Go/NoGo task. Then, we characterized the spatiotemporal dynamics of cortical activity during AER.

RESULTS

In Go trials, MDD adolescents exhibited reduced N2 amplitudes, enhanced theta power for positive pictures, and stronger bottom-up information flow from the left orbitofrontal cortex (OFC) to the right superior frontal gyrus compared to top-down information flow than the controls. In contrast, in NoGo trials, MDD adolescents exhibited elevated P3 amplitudes, enhanced theta power, and stronger top-down information flows from the right middle frontal gyrus to the right OFC and the left insula than the controls.

CONCLUSION

Overall, adolescents with MDD exhibited impaired automatic attention to positive emotions and impaired automatic response inhibition. These findings have potential implications for the clinical treatment of adolescents with MDD.

Concomitant medications associated with ischemic, hypertensive, and arrhythmic events in MDMA users in FDA adverse event reporting system

3,4-Methylenedioxymethamphetamine (MDMA) is currently being investigated as an adjunctive treatment to therapy for posttraumatic stress and other anxiety related disorders in clinical trials. Within the next few years MDMA-assisted therapy is projected for approval by regulatory authorities. MDMA's primary mechanism of action includes modulation of monoamine signaling by increasing release and inhibiting reuptake of serotonin, norepinephrine, and, to a lesser extent, dopamine. This pharmacology affects sympathomimetic physiology. In controlled trials, special attention has been given to cardiovascular adverse events (AEs), because transient increases in heart rate and blood pressure have been observed during the MDMA-assisted therapy sessions. Finding and quantifying the potential drivers of cardiac AEs in clinical trials is difficult since only a relatively small number of participants have been included in these studies, and a limited set of allowed concomitant drugs has been studied. In this study a more diverse set of reports from the FDA Adverse Event Reporting System was surveyed. We found 17 cases of cardiovascular AEs, in which the individuals had taken one or more substances in addition to MDMA. Interestingly, all of those concomitant medications and illicit substances, including opioids, stimulants, anticholinergics, and amphetamines, had been previously associated with cardiovascular AEs. Furthermore, in none of the reports MDMA was marked as the primary suspect.

Regional clozapine, ECT and lithium usage inversely associated with excess suicide rates in male adolescents

Advanced psychiatric treatments remain uncertain in preventing suicide among adolescents. Across the 21 Swedish regions, using nationwide registers between 2016-2020, we found negative correlation between adolescent excess suicide mortality (AESM) and regional frequencies of clozapine, ECT, and lithium (CEL) usage among adolescents (β = -0.613, p = 0.0003, 95% CI: -0.338, -0.889) and males (β = -0.404, p = 0.009, 95% CI: -0.130, -0.678). No correlation was found among females (p = 0.197). Highest CEL usage among male adolescents was seen in regions with lowest quartile (Q1) AESM (W = 74, p = 0.012). Regional CEL treatment frequency in 15-19-year-olds was related to lower AESM in males, reflecting potential treatment efficacy, treatment compliance or better-quality mental health care. Suicide prevention may benefit from early recognition and CEL treatment for severe mental illness in male adolescents. The results indicate association but further research, using independent samples and both prospective and observational methodologies, is needed to confirm causality.

Dissociative episode and panic attacks triggered by pitolisant in a narcoleptic patient

Pitolisant is a histamine 3-receptor antagonist/inverse agonist effective and safe for the treatment of excessive daytime sleepiness and cataplexy in narcolepsy. We report a 19-year-old woman affected by narcolepsy type 1 who presented panic attacks and dissociative symptoms induced by pitolisant. The patient medical history was unremarkable except that for familiarity for anxiety disorder and chronic insomnia. Moreover, a detailed psychometric evaluation revealed a profile of low resilience, a severe grade of depression, an anxiety trait and a propension to dissociative symptoms. Our report suggests that caution should be used in patients with predisposing factors to psychiatric disorders, especially during the first period of treatment with pitolisant. In consideration of the high prevalence of psychiatric comorbidities in narcolepsy, it seems worth to carefully investigate psychiatric background of narcoleptic patients.

Externalising Behaviours, Impulsivity, Alexithymia, and Emotional Dysregulation in Adolescents' Suicidality

Objective

suicide represents the second leading cause of death among adolescents (WHO, 2021). A deeper understanding of the characteristics that lead to it is crucial to increase the ability of clinicians in evaluating, treating, and preventing it. The objective of this study is to analyze the differences in impulsivity, externalizing behaviors, emotion dysregulation, and alexithymia between two groups of adolescents, the first presenting suicidal ideation (SI), the second presenting at least one suicide attempt (SA), in an ideation-to-action framework.

Method

we conducted a retrospective study with 190 adolescents (M= 14.5, SD _age = 1.63; SI: n = 97, SA: n = 93). All were hospitalized in the Complex Operative Child Neuropsychiatry Hospital Unit (UOC-NPI) of the Hospital-University of Padua. Data were collected using the Youth Self-Report (YSR 11-18), Barratt's Impulsiveness Scale (BIS-11) and the Toronto Alexithymia Scale (TAS-20) questionnaires.

Results

the SA group obtained higher clinical scores in the YSR "rule-breaking behavior" and "conduct problems" scales, and in total TAS-20.

Conclusions

the role of externalizing problems and alexithymia could open new frontiers in the understanding of suicide. These new data could be useful for the implementation of early screening protocols and for directing clinical interventions, promoting greater emotion regulation and anger management skills among patients.

Challenges and future trends in wearable closed-loop neuromodulation to efficiently treat methamphetamine addiction

Achieving abstinence from drugs is a long journey and can be particularly challenging in the case of methamphetamine, which has a higher relapse rate than other drugs. Therefore, real-time monitoring of patients' physiological conditions before and when cravings arise to reduce the chance of relapse might help to improve clinical outcomes. Conventional treatments, such as behavior therapy and peer support, often cannot provide timely intervention, reducing the efficiency of these therapies. To more effectively treat methamphetamine addiction in real-time, we propose an intelligent closed-loop transcranial magnetic stimulation (TMS) neuromodulation system based on multimodal electroencephalogram-functional near-infrared spectroscopy (EEG-fNIRS) measurements. This review summarizes the essential modules required for a wearable system to treat addiction efficiently. First, the advantages of neuroimaging over conventional techniques such as analysis of sweat, saliva, or urine for addiction detection are discussed. The knowledge to implement wearable, compact, and user-friendly closed-loop systems with EEG and fNIRS are reviewed. The features of EEG and fNIRS signals in patients with methamphetamine use disorder are summarized. EEG biomarkers are categorized into frequency and time domain and topography-related parameters, whereas for fNIRS, hemoglobin concentration variation and functional connectivity of cortices are described. Following this, the applications of two commonly used neuromodulation technologies, transcranial direct current stimulation and TMS, in patients with methamphetamine use disorder are introduced. The challenges of implementing intelligent closed-loop TMS modulation based on multimodal EEG-fNIRS are summarized, followed by a discussion of potential research directions and the promising future of this approach, including potential applications to other substance use disorders.

Persistent Depressive Disorder-Related Effect of Sleep Disorder on the Highest Risk of Suicide in Taiwan, 2000-2015

OBJECTIVE

to investigate whether persistent depressive disorder (PDD) affects sleep disorders (SDs) and increased suicide risk.

METHODS

in this study, we used the National Health Insurance Research Database (NHIRD) to select 117,033 SD patients, of whom 137 died by suicide, and 468,132 non-SD patients, of whom 118 died by suicide, and analyzed gender, age, and co-existing diseases. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated using a multivariate Cox proportional hazards model.

RESULTS

the hazard ratio of suicide in SD patients was 1.429 times that of non-SD patients. The hazard ratio of suicide in female patients was 1.297 times higher than in males. Compared with people without PDD, people with PDD had a 7.195 times higher hazard ratio for suicide than those without PDD. PDD patients with SDs had a 2.05 times higher hazard ratio for suicide than those with no SDs.

CONCLUSIONS

suicide risk was increased in SD patients, and the maximum suicide risk was greater in SD patients with PDD than in non-PDD patients. PDD affected SDs and increased suicide risk. Clinicians should be aware of the possibility that PDD affects patients with SDs and contributes to suicide risk.

A Pre-Adolescent and Adolescent Clinical Sample Study about Suicidal Ideation, Suicide Attempt, and Self-Harming

Suicide is the second cause of death among adolescents, and nonsuicidal self-injury (NSSI) is one of the main risk factors for suicidal behavior. However, the possible variables specifically associated with suicidal ideation and suicide attempt, as well as the psychopathological characteristics linked to the concomitant presence of suicidal ideation/attempt and NSSI are still under-investigated in youth. The current study aimed to address these issues in a sample of 174 young Italian inpatients (M_age = 14.3 years ± 1.93, 78.2% girls). Sociodemographic and clinical variables were assessed through psycho-diagnostic interviews and ad hoc questionnaires. A binomial logistic regression was performed to identify the predictors of suicidal ideation and suicide attempt. Then, Kruskal-Wallis tests were run to analyze the psychopathological differences between patients with suicidal ideation and suicide attempt considering the coexistence of NSSI. The results highlighted that previous access to child mental health services and general psychopathological problems significantly predicted suicidal ideation, while previous hospitalizations, borderline personality functioning, and affective disorders significantly predicted suicide attempt. In general, inpatients with also NSSI reported higher levels of internalizing, somatic and total problems, impulsiveness, alexithymia, and emotional dysregulation. The clinical implications of our findings in terms of primary and secondary preventive programs are discussed.

The Influence of Emotion Regulation on Estimation Strategy Execution in Individuals with Trait Anxiety

Previous studies have shown that some negative emotions hinder estimation strategy execution. However, these studies rarely investigate the influence of negative emotions on the estimation strategy execution in individuals with trait anxiety. The present study examines the relationship between negative emotions and trait anxiety in individuals’ estimation strategy execution. Moreover, it looks into the influence of different emotion regulation strategies on their estimation strategy execution. In October 2010, 803 college students were evaluated using the Trait Anxiety Scale. From these participants, individuals with high and low trait anxiety were selected to complete the double-digit multiplication estimation task. The results showed that the estimation strategy’s execution speed in individuals with high trait anxiety was slower than those with low trait anxiety under negative emotions (t (113) = −2.269, p = 0.025, d = 0.427). Both expression inhibition and cognitive reappraisal could significantly improve the execution speed of the estimation strategy in low trait anxiety (p < 0.001). For individuals with high trait anxiety, cognitive reappraisal regulating negative emotions can promote the estimation strategy’s execution speed (p = 0.031). However, the use of expression inhibition has no significant effect on estimation strategy execution (p = 0.101). In summary, the present study revealed that different emotion regulation strategies moderated the arithmetic strategy execution of individuals with trait anxiety, and cognitive reappraisal had a better effect in individuals with high trait anxiety.

STAIR Plus Narrative Therapy-Adolescent Version (SNT-A) in An 11-Year-Old Girl With PTSD and Suicidal Behaviors Following Rape/Sexual Assault: A Case Report

Rape/sexual assault can profoundly affect the physical, mental, and social well-being of victims. Post-traumatic stress disorder (PTSD) and suicide in rape/sexual assault survivors are significantly more frequent than the national prevalence of the condition, indicating that existing treatments require improvement. In this case report, we presented an 11-year-old Iranian girl with PTSD and suicidal behaviors following rape/sexual assault. We specifically focused on the process of helping the victim to develop effective coping skills and overcome the trauma through 16 weekly sessions of Skill Training in Affective and Interpersonal Regulation (STAIR) plus Narrative Therapy-Adolescent Version (SNT-A). During this therapeutic approach, the patient regained emotional control over the traumatic experience and made sense of the experience. Our findings revealed that SNT-A might be an effective intervention to reduce suicidal ideation among adolescent victims of rape/sexual assault. Nonetheless, further investigations in this field need to be carried out through randomized controlled trials.

Recent Investigations on the Functional Role of Cerebellar Neural Networks in Motor Functions & Nonmotor Functions -Neurodegeneration

The cerebellum is a well-established primary brain center in charge of controlling sensorimotor functions and non-motor functions. Recent reports depicted the significance of cerebellum in higher-order cognitive functions, including emotion-processing, language, reward-related behavior, working memory, and social behavior. As it can influence diverse behavioral patterns, any defects in cerebellar functions could invoke neuropsychiatric diseases as indicated by the incidence of alexithymia and induce alterations in emotional and behavioral patterns. Furthermore, its defects can trigger motor diseases, such as ataxia and Parkinson's disease (PD). In this review, we have extensively discussed the role of cerebellum in motor and non-motor functions and how the cerebellum malfunctions in relation to the neural circuit wiring as it could impact brain function and behavioral outcomes in patients with neuropsychiatric diseases. Relevant data regarding cerebellar non-motor functions have been vividly described, along with anatomy and physiology of these functions. In addition to the defects in basal ganglia, the lack of activity in motor related regions of the cerebellum could be associated with the severity of motor symptoms. All together, this review delineates the importance of cerebellar involvement in patients with PD and unravels a crucial link for various clinical aspects of PD with specific cerebellar sub-regions.

Suicidal Ideation among University Students: A Moderated Mediation Model Considering Attachment, Personality, and Sex

The present study aimed to examine the link between attachment, personality traits, and suicidal ideation with consideration of the potential moderating role of age and sex. The Suicidal History Self-Rating Screening Scale, the Personality Inventory for DSM-5-Brief Form, and the Attachment Style Questionnaire were administered to 183 students. There was a significant indirect effect of need for approval on suicidal ideation via detachment. Moreover, the moderated mediation models of need for approval and preoccupation with relationships on suicidality via negative affectivity were significant in men, but not women, whereas the moderated mediation model of need for approval on suicidality via detachment was significant in women, but not men. Young men and women seem at risk for increased suicidal ideation based on specific attachment and personality characteristics, which should be considered for the development of prevention and therapeutic interventions.

Emotion Regulation Difficulties and Health-Risk Behaviours in Adolescents

Health-Risk Behaviours (HRBs) are significantly associated with avoidable mortality in adolescents, and preventing HRBs requires an adequate understanding of related factors. Among associated factors, emotion regulation difficulties may impact youths’ engagement in HRBs. Researchers explored the relation of emotion regulation with HRBs; however, specific emotion regulation difficulties for less severe and more prevalent HRBs, such as self-harming behaviour, risky-driving, violence, unhealthy dietary behaviour, and poor adherence to prescribed medication, has not been much explored. The current study aimed to explore the predictability of adolescents’ specific difficulties in emotion regulation in relation to their engagement in HRBs. For this purpose, six different HRBs, that is, self-harm, violence, risky-driving, unhealthy dietary behaviour, inadequate physical activity, and lack of medication adherence, were studied. A total of 617 (Males = 356) adolescents (Mage = 15.77) from five districts of Punjab state (India) provided required information on standardised self-report measures. The data were subjected to regression analysis, and the findings show that the participants who scored high on emotion regulation difficulties reported engagement in HRBs more than their counterparts. Some specific difficulties are more important than others for different forms of HRBs. It implies that the intervention programmes targeting specific HRBs should address specific facets of emotional dysregulation.

Exploring the Effect of a Nature-based Virtual Reality Environment on Stress in Adolescents

Adolescent mental health is a growing public health issue, with 30% of teens reporting increased stress and 20% of adolescents suffering from depression. Given the scarcity and lack of scalability of mental health services available, the use of self-administered, evidence-based technologies to support adolescent mental health is both timely and imperative. We conducted a mixed-methods pilot study with 31 adolescents ages 14-19 (m = 17.97) to explore the self-administration of a nature-based virtual reality tool. Participant use of the VR environment ranged from 1 to 10 sessions (m = 6.6) at home over a 2-week period while reporting their daily stress and mood levels. All participants completed all of the study protocols, indicating our protocol was feasible and the VR environment engaging. Post-study interviews indicated that most participants found the VR tool to be relaxing and helpful with stress. The themes of Calm Down, Relaxation, and Escape emerged to articulate the participants' experiences using the VR environment. Additionally, participants provided rich data regarding their preferences and activity in the VR environment as well as its effect on their emotional states. Although the sample size was insufficient to determine the impact on depression, we found a significant reduction in momentary stress as a result of using the VR tool. These preliminary data inform our own virtual reality environment design, but also provide evidence of the potential for self-administered virtual reality as a promising tool to support adolescent mental health.

Relations between parental response to children's negative emotions and suicidal ideation in chinese adolescents: Internalizing problems, emotion regulation, and perceived relationship quality with parents as mediators

Past work points to the crucial role of parents' responses to children's negative emotions (PRCNE) in adolescents' socioemotional adjustment. The presence of suicidal ideation (SI) is an important sign of significant distress and suicide risk. However, research on the relations between PRCNE and adolescents' SI is lacking. This research aimed to investigate whether parental reactions to children's negative emotions (PRCNE) was related to adolescents' SI and, if so, through which processes. This research utilized data from a sample of Chinese adolescent families (N = 4,574; Parents: 35.81% males, M = 44.07 years old; Adolescents: 55.40% males, M = 16.28 years old), with parents giving their reports on PRCNE and adolescents self-evaluating their psychosocial development (i.e., internalizing problems, emotion regulation, perceived relationship quality with parents) and SI. We examined the relations between six types of PRCNE and adolescents' SI, and analyzed the mediating roles of adolescents' internalizing problems, emotion regulation (i.e., cognitive reappraisal and expressive suppression), and perceived relationship quality with parents. The results showed that emotion-focused response, problem-focused response, and expression encouragement negatively predicted, while punitive response and distress response positively predicted adolescents' SI. However, no statistically significant association emerged between minimization and adolescents' SI. Moreover, adolescents' internalizing problems, usage of expressive suppression, and perceived relationship quality with parents could mediate the relations between PRCNE and adolescents' SI. Contrary to our hypothesis, the results did not support an indirect effect of PRCNE on adolescents' SI through adolescents' cognitive reappraisal. The present research illuminates adolescents' SI by emphasizing the roles of PRCNE. The findings also highlight the importance of paying attention to adolescents' internalizing problems, expressive suppression, and perceived relationship quality with parents in relation to PRCNE in interventions aimed at reducing adolescents' SI.

Psychological Correlates of Excessive Healthy and Orthorexic Eating: Emotion Regulation, Attachment, and Anxious-Depressive-Stress Symptomatology

Orthorexia nervosa, the pathological obsession with eating healthy, shares risks and significant comorbidity with other mental disorders. Based on a behavioral conceptualization of the overlap, emotion regulation, attachment style, and anxious-depressive-stress symptomatology are prominent but insufficiently researched endophenotypes for orthorexia nervosa. This study aimed at identifying ways in which difficulties in emotion regulation and attachment-related anxiety and avoidance become apparent in orthorexia nervosa and healthy orthorexia. Additionally, the moderating role of anxious, depressive, and stress symptoms was explored. A convenience sample of 399 adults (266 women) completed questionnaires to measure orthorexia nervosa and healthy orthorexia, difficulties in emotion regulation, partnership-related bond, and anxious-depressive-stress symptomatology. The healthy orthorexia subscale was negatively associated with lack of emotional awareness but no other subscale of difficulties in emotion regulation or attachment-related anxiety and avoidance. Orthorexia nervosa scores were positively linked to difficulties in emotion regulation as well as attachment-related anxiety and avoidance. Multiple linear regression indicated non-acceptance of emotional responses and impulse control difficulties to be the strongest predictors for orthorexia nervosa. Both subscales also mediated the effects of attachment style on orthorexia nervosa with anxious-depressive-stress symptomatology moderating some of these effects. Individuals with higher orthorexia nervosa tendencies showed difficulties in emotion regulation, a common feature also of affective and eating disorders. Improvement in understanding the psychological features of orthorexia nervosa can enable a better differentiation from other disorders, advances in the development of treatment approaches and treatment planning, and outlines directions for future research on mechanisms.

Childhood Maltreatment, Mental Well-Being, and Healthy Lifestyle in Patients With Chronic Thromboembolic Pulmonary Hypertension

Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially life-threatening condition associated with high morbidity and mortality. However, advances in medical, surgical and interventional treatment have markedly improved the outcome of patients with CTEPH. Additional factors potentially influencing quality of life (QoL) and outcome in CTEPH are yet to be defined. Child maltreatment is a major risk factor for unfavorable behavioral, mental as well as physical health outcomes and has been associated with decreased QoL. To date, no study assessed the impact of childhood trauma in patients with CTEPH.

Methods

Patients with CTEPH were invited to complete the Childhood Trauma Questionnaire (CTQ). Data were compared to prevalence data from the German population. Mental well-being was assessed using the Hospital Anxiety and Depression Scale (HADS) and quality of life was measured using the WHO Quality of Life Questionnaire (WHOQOL). Furthermore, lifestyle factors and physical health parameters were studied.Logistic regression analysis was used to investigate a possible impact of child maltreatment on markers of disease severity.

Results

One-hundred and seven patients with CTEPH completed the CTQ. These patients reported higher rates of emotional abuse and physical abuse and emotional neglect compared to the German population while rates of physical neglect and sexual abuse did not differ between patients and German population with prevalence of 20.6% for emotional abuse, 20% for physical abuse, 22% for emotional neglect, 46% for physical neglect, and 6% for sexual abuse in patients with CTEPH. Higher CTQ scores were associated with anxiety symptoms as well as negatively associated with QoL. No direct impact of childhood trauma on CTEPH severity was found.

Conclusion

We found a higher rate of child maltreatment in patients with CTEPH in comparison to the German population. Correlations suggest moderate associations between CTQ scores and mental health and QoL. Child maltreatment had no significant impact on disease severity. Further investigation on proper interventions to support affected patients is needed.

Obesity and overweight among children and adolescents with bipolar disorder from the general population: A review of the scientific literature and a meta-analysis

There is substantial evidence of the high prevalence of obesity (OB) and overweight (OW) and their association with increased medical and psychiatric burden among adults with bipolar disorder (BD). However, little is known regarding its prevalence among young people with BD, other than the risk from psychotropic medication, which has been the focus of research in this population. We present a systematic review and meta-analysis of the literature on prevalence and correlates of OB and OW children and adolescents with BD using a different perspective than impact of medication. Four studies met inclusion criteria. The prevalence of OB in children and adolescents with BD was 15% (95% CI 11-20%). We observed a higher prevalence of OB in comparison to the general population. Different studies found significant associations between OB, OW, and BD in young populations including non-Caucasian race, physical abuse, suicide attempts, self-injurious behaviours, psychotropic medication, and psychiatric hospitalizations.

Emotion Regulation Difficulties Mediate the Relationship between Neuroticism and Health-Risk Behaviours in Adolescents

Health-Risk-Behaviors (HRBs) are significant antecedent conditions of adolescents' poor health and mortality. Prevention of avoidable adverse health outcomes requires an in-depth understanding of the factors associated with such outcomes. Among other possible pathways, the 'Neuroticism- HRBs-adverse health' link has been supported in previous studies. However, more extensive exploration of this link is required to identify the underlying modifiable risk factors. In the present study, one such factor, namely, emotion regulation difficulties, was explored to see its mediating effect in the relationship between neuroticism and HRBs-the first two constructs of the mentioned link. In this quantitative study, a total of 759 adolescents belonging to the Indian state of Punjab (Males= 402; M(age)=16.08) provided relevant information on a set of standardized questionnaires. Mediation analysis supported the major hypothesis of the present study. The results suggest that emotion regulation difficulty may be a significant mediator in the neuroticism-HRBs link. One's difficulty in regulating emotions might be an underlying mechanism through which high neuroticism increases the probability of indulging in HRBs, resulting in adverse health outcomes. The study implies that the assessment of emotion regulation difficulties should be included in interventional programs aimed at achieving adolescents' wellbeing, and early intervention may avoid progression toward adverse health outcomes in adulthood.

Present hedonism and future time perspectives predicting hypersexuality and problematic pornography use

The Time Perspective (TP) theory (i.e., the psychological experience regarding time) was often examined in association with different addictive behaviors, and the different TPs (i.e., Past Positive, Past Negative, Present Hedonistic, Present Fatalistic, and Future TPs) demonstrated different relationship patterns with them. However, most studies were conducted in relation to substance use-related disorders, leaving crucial knowledge gaps concerning the associations between TPs and potential behavioral addictions. The aim of the present study was to examine the associations between the five TP dimensions, hypersexuality, and problematic pornography use (PPU), considering potential gender differences. Participants from two independent samples (N₁ = 554; N₂ = 453) completed a self-report survey on TPs and sexual behaviors. Structural equation modeling results indicated that the Present Hedonistic TP had a positive, moderate, and the Future TP had a negative, weak association with hypersexuality in both samples. Only the Present Hedonistic TP had a significant, positive, weak-to-moderate association with PPU across the samples. The explained variances of the models were higher in case of hypersexuality (28 and 27%, respectively), than in case of PPU (1 and 14%, respectively). No significant gender differences were observed. In line with previous findings concerning other predictors of hypersexuality and PPU, the results of the present study suggest that hypersexuality and PPU may differ from each other in terms of their TP background. Yet, present hedonism, which is related to impulsivity, may play an important role in both problematic sexual behaviors, suggesting that interventions focusing on this TP might be successful in reducing hypersexuality and PPU.

Self-injury and Smartphone Addiction: Age and gender differences in a community sample of adolescents presenting self-injurious behavior

This study aimed to identify the variables (i.e., internalizing, and externalizing problems, self-control, emotion dysregulation, and alexithymia) relevant for Smartphone Addiction and non-suicidal self-injury (NSSI), conceptualized as emotion-regulation strategies, also assessing age and gender differences. Based on power analysis, N = 78 Italian adolescents (11-19 years; M_age = 14.24; SD = 1.56; 73.1% females) were considered. Step-wise multivariate linear regressions evidence a mutual association between NSSI and Smartphone Addiction, particularly relevant in pre-adolescence. Low self-control is significantly associated with the Smartphone Addiction, while emotion dysregulation and alexithymia with NSSI. This study supports NSSI and Smartphone Addiction conceptualization as emotion-regulation strategies and the importance of prevention interventions.

Mental Disorders in Individuals With Exercise Addiction-A Cross-Sectional Study

Background and Aims: Exercise addiction has not yet been designated as an addictive disorder in the DSM-5 due to a lack of detailed research. In particular, associations with other psychiatric diagnoses have received little attention. In this study, individuals with a possible exercise addiction are clinically assessed, in order to establish a profile of co-occurring psychiatric disorders in individuals with exercise addiction. Methods: One hundred and fifty-six individuals who reported exercising more than 10 h a week, and continued to do so despite illness or injury, were recruited for the study. Those who met the cut-off of the Exercise Dependence Scale (n = 32) were invited to participate in a screening with the Structured Clinical Interview for DSM-5 (SCID-5-CV) and personality disorders (SCID-5-PD). Additionally, an interview based on the DSM-5 criteria of non-substance-related addictive disorders was conducted to explore the severity of exercise addiction symptoms. Results: 75% of participants fulfilled the criteria for at least one psychiatric disorder. Depressive disorders (56.3%), personality disorders (46.9%) and obsessive-compulsive disorders (31.3%) were the most common disorders. Moreover, there was a significant positive correlation between the number of psychiatric disorders and the severity of exercise addiction (r = 0.549, p = 0.002). Discussion: The results showed a variety of mental disorders in individuals with exercise addiction and a correlation between the co-occurrence of mental disorders and the severity of exercise addiction. Exercise addiction differs from other addictive und substance use disorders, as obsessive-compulsive (Cluster C), rather than impulsive (Cluster B) personality traits were most commonly identified. Conclusions: Our results underscore the importance of clinical diagnostics, and indicate that treatment options for individuals with exercise addiction are required. However, the natural history and specific challenges of exercise addiction must be studied in more detail.

Association Between Alexithymia, Social Support, and Duration of Methamphetamine Use Among Male Methamphetamine-Dependent Patients

Introduction: China has 1.18 million methamphetamine abusers. Among the illegal drugs in China, methamphetamine has the highest abuse rate. Although previous studies have indicated a positive relationship between alexithymia and declining social support, the incidence of alexithymia, the total duration of methamphetamine dependence, social support, and the relationships between them among methamphetamine-dependent patients in the Chinese population have been rarely reported. Methods: A total of 113 methamphetamine-dependent patients (all male, mean age 30.45 ± 3.81 years) were enrolled in this cross-sectional study. General demographic data were collected. Alexithymia and social support were measured by Toronto Alexithymia Scale and Social Support Rating Scale. Results: Duration of methamphetamine use among Chinese male methamphetamine-dependent patients in compulsory detoxification was 8.01 ± 3.80 years on average, 23% (26/113) methamphetamine-dependent patients were considered to have alexithymia personality traits. Compared with short-duration methamphetamine-dependent patients (≤8 years), long-duration methamphetamine-dependent patients (> 8 years) were characterized by older age, higher incidence of alexithymia, less subjective social support and support availability, and greater difficulty in identifying feelings. The results of correlation analysis and multiple linear regression analysis indicated that the total duration of methamphetamine use was positively correlated with difficulty in identifying feelings, but negatively correlated with subjective social support. Conclusions: This study provides support for an association between the duration of methamphetamine use and difficulty in identifying feelings or subjective social support. Although the causality is still unclear, this finding should be considered in the psychotherapy of methamphetamine rehabilitation.

Serum Lipid Levels and Suicide Attempts Within 2 Weeks in Patients With Major Depressive Disorder: Is There a Relationship?

The potential correlation between serum lipid profiles and suicidal tendencies has been previously reported, however, it is unclear whether serum lipid profiles have definite relevance to recently attempted suicides in individuals suffering from major depressive disorder (MDD). In this study, the relationship between blood lipids and suicide attempts in first-episode MDD patients in research were used to examine whether there is a connection. The cross-sectional study recruited 580 patients at the time of their first episode, measuring up to the diagnostic standard of MDD. Baseline demographic, clinical data, and blood lipid level data were collected. Depression severity was measured with the Hamilton Depression Rating Scale (HAMD). Our results revealed that the level of TC may be identified as a promising and effective biomarker for first-episode MDD suicide risk, suggesting that screening of serum lipid profiles in depressive patients is essential for suicide prevention.

Psychological Capital, College Adaptation, and Internet Addiction: An Analysis Based on Moderated Mediation Model

Using data from a baseline survey of college students, this study examined the possible mechanism by which psychological capital influences college students' internet addiction through the mediation effect of their individual college adaptability. The study constructed a parallel multiple mediation effect model to help understand the effect mechanisms among these factors. The results indicated that psychological capital had a triple effect on internet addiction: (1) Psychological capital had a direct effect of helping reduce college students' internet addiction; (2) emotional, learning, and interpersonal adaptation not only reduced internet addiction directly but also played mediating roles in the relationship between psychological capital and internet addiction; and (3) the mediation effects of emotional and interpersonal adaptation were moderated by psychological capital, leading to two different modes of mediation effects. As a whole, psychological capital imposes a quadratic effect on internet addiction. The campus policy implications of these findings are discussed.