Psychiatry Int., Volume 6, Issue 4 (December 2025) – 43 articles

Child sexual abuse (CSA) has consequences beyond the direct victim, affecting non-offending mothers, who may experience psychological, physical, and social symptoms after disclosure. This systematic review examined the impact of CSA on these mothers and the variables that influence coping and recovery. Searches were run in EBSCOhost (MEDLINE, PsycInfo, CINAHL) following PRISMA 2020 and a PEO framework. Three reviewers screened 128 records in Rayyan (Cohen’s κ = 0.73), and 17 empirical studies met the inclusion criteria. Risk of bias was appraised with ROBINS-E. Distress, anxiety, depression, and secondary traumatic stress were the most frequently reported symptoms. These consequences were associated with factors such as maternal history of abuse, perceived social support, coping style, and cultural or religious beliefs, highlighting potentially modifiable cognitive and contextual targets for support. A key contribution of this review is the identification of modifiable cognitive variables that are clinically relevant. Methodological limitations of the evidence base warrant cautious interpretation–comprising seven qualitative, nine quantitative cross-sectional, and one mixed-methods study, with heterogeneity that precluded meta-analysis and limited causal inference. Overall, the findings highlight the need for comprehensive, trauma-informed interventions that address not only the child’s recovery but also the well-being and resilience of their mothers. Full article

Several studies worldwide have shown that adolescents have low levels of mental health literacy (MHL). This is a worrying situation, given the significant prevalence of mental health disorders among adolescents and the role of MHL in identifying these problems early and seeking help. This study aims to characterize MHL in Portuguese adolescents according to sociodemographic variables. The participants were 608 adolescents from the 7th to 12th grade, who filled in questionnaires on sociodemographics, MHL, and positive MHL. Bivariate analysis and hierarchical logistic regression models were conducted. A high level of adequate beliefs was found to be more likely in girls and in those whose mothers had higher levels of education. High rates of knowledge about self-help strategies were related to older age, having a mother who had a high level of education, greater subjective socioeconomic status (SSES), and better self-perception of mental health (SPMH). Help-seeking/first-aid skills were predicted by higher SSES, and lower SPMH predicted high levels of knowledge about mental health problems. Different MHL dimensions were related to diverse sociodemographic variables, and SPMH played a key role in enhancing the models’ ability to explain variation in MHL—particularly in knowledge on self-help strategies. Those topics require further research. These results can be useful in the development of MHL programs tailored to the specific knowledge needs of different adolescent groups. Full article

Numerous studies have investigated the relationship between autism spectrum disorders (ASD) and the use of Assisted Reproductive Technology (ART). However, the results have been inconclusive. This review aims to explore this association via the meta-analysis of existing studies. PubMed, Web of Knowledge, SCOPUS, and Embase databases were searched up to December 2023. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random or fixed effect models to explore the association between ART and ASD. A total of 20 records of cohort and case–control studies were analyzed and diagnosed with Autism Spectrum Disorder (ASD) published between 2013 and 2023. Children between the ages of 2–12 years were included in these studies via a census method. The results of the studies revealed a significant correlation between ART and ASD (RR = 1.43, 95% CI: 1.13–1.71, p = 0.006). Some subgroups revealed statistically significant relationships based on study location, design, and quality. The results suggest that using assisted reproductive technology elevates the susceptibility of children to develop ASD, but more large-scale and prospective studies are required to corroborate this conclusion, particularly in light of the divergent outcomes of some reviewed studies. Full article

Introduction: Adverse Childhood Experiences (ACEs) refer to traumatic events occurring before the age of 18 that can negatively impact physical and mental health, often disrupting development. Numerous studies have shown associations between ACEs and the onset or severity of psychotic disorders. The aim of this study was to assess the prevalence of ACEs among patients with psychotic disorders and to examine an association between ACEs and the sociodemographic and clinical characteristics of psychosis. Material and Methods: The study was conducted at the Center for Mental Health and the Psychiatric Clinic of the University Clinical Center Nis, from March to July 2025. The sample included adult patients of both sexes diagnosed with psychotic spectrum disorders based on ICD-10 criteria. The Adverse Childhood Experiences Questionnaire (ACE-Q), along with sociodemographic and clinical data from medical records, was used. Results: The sample included 60 patients, with a mean age of 36.7 years. The average ACE-Q score was 2.57 ± 1.98, with one-third of patients reporting high exposure (≥4 ACEs) to childhood adversity. Patients with high ACEs exposure (≥4 ACEs) differed significantly from those with low to moderate or no exposure (<4 ACEs) in terms of economic status, family history of psychiatric disorders, substance use, and treatment adherence. Conclusion: Despite the small sample size, our results point to a potential link between childhood adversity and certain sociodemographic and clinical characteristics in patients with psychotic disorders. Integrating systematic assessments of trauma history into routine clinical practice may support the development of more effective treatment strategies. Full article

The global opioid crisis necessitates innovative non-pharmacological interventions for pain management and addiction recovery. This comprehensive narrative review synthesizes evidence from approximately 75 studies supporting manual therapy’s modulation of endogenous opioid systems and explores potential applications in addiction treatment. Manual therapy interventions, including massage and joint manipulation, demonstrate significant neurochemical effects, with controlled studies showing 16% increases in plasma β-endorphin levels (p = 0.025) persisting approximately one hour following treatment. These effects appear mediated through periaqueductal gray-rostral ventromedial medulla descending pathways, with naloxone reversibility studies confirming opioid-mediated mechanisms. The endogenous opioid system undergoes profound dysregulation during addiction, creating therapeutic opportunities for interventions capable of stimulating natural opioid release without exogenous substances. Clinical applications in addiction recovery may include withdrawal symptom management, craving reduction, and restoration of dysregulated reward pathways. Manual therapy’s demonstrated safety profile, accessibility, and compatibility with existing treatment modalities position it as an ideal complementary intervention for comprehensive addiction programs. However, significant methodological limitations in existing studies necessitate cautious interpretation. Rigorous randomized controlled trials specifically examining manual therapy’s effects in addiction recovery populations represent the highest research priority. Manual therapy as an endogenous opioid modulator represents a promising frontier in addiction medicine but warrants rigorous scientific investigation before potential clinical integration into evidence-based treatment protocols. Full article

Mental health problems are widespread in prison populations and can negatively affect inmates’ well-being. Although physical activity (PA) is known to benefit mental health in the general population, less is known about this relationship in correctional settings. This study examined the association between PA levels, symptoms of anxiety and depression, as well as coping strategies among 130 male prisoners at Prison No. 1 in Wroclaw, Poland. Data were collected using validated self-report tools: the International Physical Activity Questionnaire (IPAQ), the Hospital Anxiety and Depression Scale (HADS), and the Mini-COPE inventory. Inmates who met the criteria for Health-Enhancing Physical Activity (HEPA) reported fewer symptoms of anxiety and depression than less active participants. Individuals showing signs of mental health difficulties were also more likely to rely on avoidant coping strategies, though no clear link was found between coping style and activity level. Cluster analysis further supported the observed association between low PA and higher psychological distress. These findings suggest a potential role for PA in supporting mental health in prison settings. They also highlight the importance of identifying individuals who may be at risk due to maladaptive coping strategies. Given its exploratory nature, the study’s findings should be interpreted with caution and verified in future research with larger and more diverse samples. Full article

Problematic smartphone use (PSU) is increasingly recognized as a behavioral concern among university students, with consequences for well-being, risky behaviors, and academic outcomes. However, evidence from Greece remains limited. This study assessed the prevalence and correlates of PSU among students at the University of Piraeus and interpreted findings through Griffiths’ components model of addiction. A cross-sectional survey was conducted between March and June 2023 with 1743 participants, who provided socio-demographic, lifestyle, and health information and completed the Smartphone Addiction Scale–Short Version (SAS-SV). Nearly half of the students (49.2%) exceeded the proposed SAS-SV thresholds for PSU (50.5% men; 48% women). Regression analysis showed that alcohol consumption (p < 0.001), weekly screen time (p < 0.001), younger age (p < 0.001), female sex (p < 0.001), size of household (p < 0.033), and anxiety/depression (p = 0.019) were significant predictors of higher SAS-SV scores, while smoking, BMI, exercise, and academic performance were not associated. For the independent statistical tests, the Benjamini–Hochberg correction was applied to control the false discovery rate. Group comparisons confirmed greater alcohol use (p < 0.001), screen exposure (p < 0.001), and anxiety/depression (p = 0.004) among PSU students. Item-level responses reflected components of tolerance, salience, withdrawal, and conflict. These findings place Greek students at the higher end of international prevalence estimates and highlight the importance of integrating digital-well-being initiatives within student health services in universities. Full article

Introduction: Huntington’s disease is a genetic disorder, also known as an autosomal dominant neurodegenerative disease, that has typical manifestations such as motor disturbances, cognitive decline, and psychiatric symptoms. Neurologists initially classified it as a movement disorder because the diagnosis is primarily based on the presence of extrapyramidal motor symptoms. However, after careful examination of several cases, it was revealed that chorea was only one type of motor dysfunction and that tics and myoclonus were also present. Regarding psychiatric symptoms, studies have shown that patients presenting psychosis-related symptoms have a worse evolution with poor prognosis, and it was concluded that they present distinct clinical, imaging, and biological characteristics. Case presentation: The present case report aims to describe the onset of a particular case of Huntington’s disease, taking into consideration the fact that early psychotic symptoms, very similar to those identified in schizophrenia, could represent indicators of Huntington’s disease onset. An interesting aspect of this case was that our patient had no family history of neurological conditions but had a clinical picture characterized by delusions and hallucinations. These symptoms were considered criteria for schizophrenia. Moreover, chorea motor movements appeared several years after the onset of psychosis, determining the need for the diagnosis to be changed from schizophrenia to Huntington’s disease. Conclusion: We need to point out that psychiatric symptoms could represent the only initial visible change in the clinical picture, being also considered as indicators of Huntington’s disease onset. These features could help patients be easily and faster identified, allowing for proper medical interventions to be provided. Full article

Suicide remains one of the leading causes of death worldwide, yet psychiatry continues to assess risk primarily through suicidal ideation. This narrow focus overlooks a critical factor: sleep. A growing body of evidence demonstrates that insomnia, nightmares, and circadian disruption are consistent and potentially modifiable correlates of suicidal behavior across various diagnoses and age groups, supported primarily by longitudinal and prospective studies. Despite this, structured sleep assessment is seldom integrated into routine psychiatric care, predominantly due to cultural inertia and inadequate training. This perspective necessitates a shift: sleep assessment should be regarded alongside mood and cognition in every evaluation of suicide risk. Brief questionnaires and targeted interventions are readily accessible and feasible for implementation, thereby presenting concrete opportunities for prevention. By incorporating sleep evaluation into standard practice and future predictive models, psychiatry can advance toward more precise, actionable, and timely suicide prevention. To continue neglecting sleep is to overlook one of the most accessible and effective means of saving lives. Full article

Traumatic experiences are among the strongest predictors of suicidal thoughts and behaviors, but the mechanisms that account for this association are still debated. Sleep disturbances, particularly insomnia, nightmares, and fragmented sleep, are highly prevalent after trauma and have been shown to predict suicidality independently of depression and other psychiatric comorbidities. This narrative mini-review synthesizes evidence from epidemiological, clinical, and experimental studies to examine whether sleep may represent a pathway linking trauma and suicidality. Among the proposed mechanisms, alterations in REM sleep regulation, dysregulation of the hypothalamic–pituitary–adrenal axis, and impaired prefrontal control of emotional reactivity have received empirical support, although findings remain inconsistent across populations. Importantly, trauma-related nightmares and persistent insomnia appear to be especially strong markers of elevated suicide risk. Clinically, these observations suggest that routine sleep assessment could add value to suicide risk evaluation in trauma-exposed individuals. Interventions such as cognitive behavioral therapy for insomnia, imagery rehearsal therapy, and REM-modulating pharmacological treatments have shown promise, but their specific impact on suicidality requires further testing in controlled trials. Future research should prioritize longitudinal designs, incorporate both subjective and objective sleep measures, and include culturally diverse samples to clarify causal mechanisms and refine prevention strategies. Full article

Adolescents with Type 1 Diabetes Mellitus (T1DM) face a significantly increased risk of developing disordered eating behaviors (DEBs), a phenomenon that includes the deliberate omission of insulin, commonly referred to as diabulimia. The aim of this systematic review and meta-analysis was to determine the prevalence of diabulimia in adolescents with T1DM and consolidate the scientific evidence on this issue. Following PRISMA guidelines, observational studies published in English and Spanish involving adolescents aged 10 to 19 were identified through comprehensive searches in SCOPUS, LILACS, PubMed, Web of Science, and PsycINFO. After rigorous screening and eligibility assessment, 13 studies were included. Data were extracted independently, and meta-analyses were performed using random-effects models. Reported prevalence rates of DEB in T1DM varied widely among studies, ranging from 20.8% to 48%. The pooled prevalence in the final meta-analytic model was 11% (95% CI: 9–13%), with prevalence substantially higher in females (45%) than males (26%). These findings highlight not only the elevated risk of DEB and diabulimia among adolescents with T1DM but also considerable gender differences likely shaped by psychological, sociocultural, and biological factors. The lack of standardized diagnostic criteria for diabulimia remains a barrier to clinical management. Early detection and gender-sensitive preventive strategies are crucial for reducing complications and improving the quality of life in this vulnerable population. Full article

Background: The public harbors adverse perceptions of individuals with mental illness. The global prevalence of mental health illnesses has consistently risen. Untreated mental illness in high school adolescents can result in social, behavioral, and academic problems. Methods: A respondent-driven sample of 716 high school teachers working in Najran city was surveyed. The participants completed questionnaires assessing their mental health knowledge and Perceived Devaluation and Discrimination. Results: Almost two-thirds of participants had adequate knowledge. The highest knowledge scores were found in the items related to the effectiveness of medication and psychotherapy. Schizophrenia was the most recognized mental health condition, followed by bipolar disorder and depression (mean scores 4.3, 4.0, 3.9, respectively). Almost two-thirds of the study participants (73.6%) had high perceived stigma in the total score of the PDD scale. The highest scores of perceived stigma were found in the scale items related to hiring a qualified person with severe mental illness (86.3%) and being close friends with a person with severe mental illness (85.6%). Participants with adequate knowledge had more perceived social stigma than those with inadequate knowledge (77% versus 66%). There were statistically significant associations between Stigma-related mental health knowledge and socio-demographic characteristics of the study participants (p < 0.05). Conclusions: This study found that, despite the foundational level of knowledge, particularly regarding treatment effectiveness, gaps exist in understanding help-seeking behaviors. Socio-demographic factors play a role in shaping mental health literacy among high school teachers in Najran city. Full article

Mental disorders affect nearly one billion persons worldwide, having a substantial burden on individuals, families, and healthcare systems. Current diagnostic and therapeutic approaches could fail to reach optimal outcomes, highlighting the need for more effective and personalized interventions. Precision psychiatry aims to address this challenge by integrating multidimensional data, ranging from genomics and epigenomics to neuroimaging and psychometric assessments, through advanced computational tools such as machine learning and artificial intelligence. This transdisciplinary approach could allow the study of biologically informed endophenotypes, improve diagnostic accuracy, and support individualized treatment strategies. Emerging technologies, including pharmaco-neuroimaging, virtual histology, and large-scale consortia, are advancing the field by elucidating the molecular and circuit-level correlates of mental disorders. Although significant progress has been made, the translational gap between research and clinical practice remains a critical issue. Effective implementation will require the systematic integration of bioinformatic tools, big data analytics, and clinician-guided interpretation, in a context in which the evolving landscape of precision psychiatry continues to prioritize therapeutic alliance and individualized patient care. Full article

Surrogacy involves a surrogate carrying a baby to transfer to the intended parents after birth. This study examines how surrogacy impacts attachment patterns compared to traditional pregnancies or assisted reproductive technologies. Using PRISMA guidelines, a systematic review of databases like Scopus and PubMed identified nine relevant studies from 806 initial records, involving 1317 participants (115 pregnant women and 118 children). Key variables included maternal–fetal attachment, depression, anxiety, and somatization in surrogates, alongside intended parents’ support and children’s exploration of their origins. Findings reveal the complexity of attachment dynamics in surrogacy, emphasizing the need for psychological support and preparation to foster secure attachments among surrogates, children, and intended parents. Full article

Children with developmental disabilities (DD) require early and coordinated services, yet parents often face obstacles in accessing adequate support. This study examined parents’ experiences with early intervention in Serbia to identify barriers, supports, and context-specific challenges. Semistructured interviews were conducted with 15 parents of children aged ≤ 6 years. Interviews (30–50 min) were audio-recorded, transcribed verbatim, and thematically analyzed in line with the Consolidated Criteria for Reporting Qualitative Studies. Seven themes emerged: recognition of concerns, first steps in seeking help, complexity of procedures, information gaps, emotional and practical challenges, collaboration with professionals, and recommendations for improvement. Parents typically noticed developmental delays, especially in language and motor skills, by age two but encountered lengthy and fragmented referral pathways, long waiting lists, and insufficient guidance. Parents emphasized the value of empathetic professionals and peer networks while also reporting stigma and social isolation. This study contributes new evidence on how structural barriers and cultural attitudes in Serbia shape families’ access to early intervention. Findings highlight the need for streamlined referral systems, transparent and accessible information for families, and interdisciplinary training for professionals. Addressing these issues could reduce delays, alleviate parental stress, and promote better developmental outcomes for children with DD. Full article

Background: Artificial intelligence (AI) has been proposed as a transformative tool in suicide prevention, yet most evidence remains observational. To provide a rigorous benchmark, we systematically reviewed randomized controlled trials (RCTs) evaluating AI-based interventions targeting suicidal thoughts, behaviours, or help-seeking. Methods: Following PRISMA 2020 guidelines, MEDLINE, Web of Science, and Scopus were searched to 31 May 2025. Eligible studies were RCTs in humans that incorporated AI or machine learning for risk prediction, automated intervention, or treatment allocation. Methodological quality was assessed with the PEDro scale and certainty of evidence with GRADE. Results: From 1101 screened records, six RCTs (n = 793) met all criteria. Three studies tested machine learning risk prediction, two evaluated fully automated interventions (a transformer-based recommender and a digital nudge), and one examined AI-assisted treatment allocation. Risk-prediction models stratified short-term suicidal outcomes with accuracies of up to 0.67 and AUC values around 0.70. Digital interventions reduced counsellor response latency or increased crisis-service uptake by 23%. Algorithm-guided allocation reduced the occurrence of suicidal events when randomisation aligned with model recommendations. Methodological quality was moderate to high (median PEDro = 8/10), but GRADE certainty was low due to small samples and imprecision. Conclusions: AI can enhance discrete processes in suicide prevention, including risk stratification, help-seeking, and personalized treatment. However, the current evidence is limited, and larger multisite RCTs with longer follow-up, CONSORT-AI compliance, and equity-focused design are urgently required. Full article

Electronic cigarettes have become increasingly popular, especially among young people when compared to other demographic groups. This study explored young South African women’s experiences of using e-cigarettes. Age of initiation, patterns and reasons for using e-cigarettes, the financial impact and the experience of quitting were explored. This qualitative study used an interpretive research paradigm. Data were collected from three focus groups that were guided by a discussion guide. The total sample comprised 11 young women aged between 18 and 25 years who had used or were using e-cigarettes. Data were analysed using thematic analysis with the aid of NVivo version 12. Findings revealed five key themes: (1) age of e-cigarette initiation ranged from pre-adolescence to adolescence, and in adulthood; (2) patterns of use included occasional and daily use, concurrent use with tobacco products (dual use) and use with tobacco products and alcohol. Participants reported using e-cigarettes at social events, with other peers and alone; (3) reasons for use included emotional regulation (easing stress, boredom), peer pressure, experimentation, the appeal of e-cigarettes’ designs and flavours, ease of access and enhanced social media presence; (4) the impact of e-cigarette use weighed on financial and familial issues; (5) concerning quitting, only one participant reported successfully quitting while some participants had tried to quit but had been unsuccessful and advocated for more cessation support. Interventions to address how to better manage peer pressure, boredom and stress as well as policies to regulate the design and flavours of e-cigarettes are needed to help young women not to get initiated into a lifetime of nicotine addiction. Cessation support is also needed to assist young people (especially women) who wish to quit using e-cigarettes. Full article

This research represents the first in the Republic of Kazakhstan focusing on Afghan war veterans identified as being at risk for Post-Traumatic Stress Disorder (PTSD). A comprehensive investigation was undertaken regarding the comorbidity of PTSD symptoms, somatic diseases (cardiovascular and others), and mental disorders. The study’s sample comprised 293 Afghan war veterans, while the control group consisted of 149 males without combat experience. The research methodology incorporated data extracted from medical records, a demographic questionnaire, the Mississippi PTSD Scale (military and civilian versions), the Spielberger–Khanin Anxiety Inventory, the Beck Depression Inventory (BDI), and the SCL-90-R questionnaire. Subclinical symptoms indicative of chronic PTSD were identified in 25.2% of veterans, as assessed by the Mississippi PTSD Scale. According to the Spielberger–Khanin questionnaire, veterans with subclinical PTSD exhibited a moderate level of situational (44.96 ± 6.39 points) and personal anxiety (44.14 ± 5.49 points), which were significantly higher than those observed in the control group (29.87 ± 6.50, p₂ < 0.001, 36.13 ± 6.82, p₂ = 0.003). Furthermore, based on the BDI, these veterans demonstrated an elevated level of depression (13.32 ± 1.36) in comparison to veterans without PTSD (8.61 ± 0.65, p < 0.001) and the control group (4.06 ± 0.75, p < 0.0001). The findings indicate that veterans exhibiting a high level of PTSD are characterized by a more pronounced manifestation of psychopathological indicators, as assessed by the SCL-90-R questionnaire. Compared to the control group, veterans exhibiting PTSD symptoms were found to have a comorbidity with somatic diseases: stage 3 hypertension in 45.2% vs. 21.3% (p₂ < 0.001), coronary heart disease in 45.5% vs. 13.4% (p₂ < 0.001), and type 2 diabetes mellitus in 20.3% vs. 6.1% (p₂ = 0.001). Consequently, Afghan war veterans should be regarded as a high-risk group for cardiovascular diseases (including hypertension and coronary heart disease), cerebrovascular diseases, and mental health disorders. Accordingly, a comprehensive approach is necessary to identify PTSD symptoms alongside concomitant anxiety–depressive disorders and somatic diseases in individuals who have experienced traumatic events. Full article

Patients with schizophrenia face high mortality from physical comorbidities; nonetheless, the gradual physiological decline preceding death is not well characterized. This retrospective study investigated temporal changes in key biomarkers among 64 inpatients with schizophrenia who died between 2014 and 2022. We analyzed data on body mass index (BMI), serum albumin (ALB), blood urea nitrogen/creatinine ratio (BCR), blood urea nitrogen/ALB ratio (BAR), and estimated glomerular filtration rate (eGFR) collected at five time points: 3, 2, and 1 year, 6 months before death, and prior to death. We hypothesized that these markers would exhibit significant changes during the last 3 years of life. BMI and ALB significantly decreased, while BCR and BAR increased (all p < 0.001). This pattern was also noted in the pneumonia subgroup, the leading cause of death (47%). A high BCR concomitant with low eGFR was attributable to chronic kidney failure in only 6% of patients, suggesting the elevated ratio was mostly driven by non-renal factors such as dehydration or sarcopenia. Therefore, the concurrent decline in BMI and ALB and rise in BCR and BAR represent a pattern of terminal physiological decline among patients with schizophrenia, supporting the need for timely risk assessment. Full article

Background: Social media has become a space for sharing personal experiences and shaping public opinion. This study explored how people respond to substance misuse recovery journeys shared on TikTok. Methods: The researchers collected 3583 comments from 350 TikTok videos under the hashtags #wedorecover, #recovery, and #sobertok using a scraper tool. A discourse analysis categorized comments into Narrative Strategies, Rhetorical Strategies, Linguistic Features, and Power Relationships, each with subcategories revealing public perceptions of substance use and recovery. A correlation analysis was also conducted to examine the role of emojis across narrative and linguistic features. Results: Most comments (94%) expressed support or positivity toward recovery videos. The heart emoji was the most common (93.35% of all emojis), symbolizing connection, encouragement, and solidarity. Four themes emerged reflecting public attitudes: encouragement and positive messaging, acknowledgment of struggle, the culture of sharing, and the influence of broader social narratives. Conclusions: These results provide insight into public responses to recovery content on TikTok, suggesting that peer support may be facilitated through the platform’s algorithmic design. While TikTok shows promise as a supportive digital space, further research is needed to understand its broader implications for substance use recovery support. Full article

Background: Many workers in non-health settings interact with people with living experiences of mental ill-health but have little knowledge about the symptoms, the mental health system, or may hold stigmatising views. Aims: This study evaluated the impact of an online mental health course. It was hypothesised that an increase in mental health literacy would reduce stigmatising beliefs. Methods: Students were invited to complete an online survey pre- and post-course completion as part of a quasi-experimental study with a pre-test–post-test design. Questions were related to demographic data, knowledge on mental ill-health and mental health care, and beliefs towards mental illness. The independent sample t-test, Shapiro–Wilks test for normality, and a Mann–Whitney U-test were used to analyse the data. Results: This study found that there was a significant change, with a large effect size, in self-reported knowledge about mental health and the mental health system. There was a small but significant reduction in Belief Towards Mental Illness scores (rank-biserial correlation = 0.2). The results indicated improved perceptions of those with mental ill-health. Conclusions: A specialised online course can effectively educate the non-clinical community workforce and reduce the stigma associated with mental ill-health. This enables people to assist those experiencing mental health distress from a well-informed and less fearful position. Full article

Psychiatric illness during childhood and adolescence is a growing concern, placing increased pressure on psychiatric services. Reliance on an evidence-based assessment tool may facilitate the identification and management of symptoms and may facilitate accountability. The purposes for this study were to characterize the psychiatric symptoms of a sample of pediatric patients accessing outpatient psychiatry using the DSM Level 1 Cross-Cutting Measure (CCSM), compare patient and caregiver ratings (CCSM), and explore patients’ acceptability of using the CCSM. The sample consisted of 51 patients (mean age 14 years) and 46 caregivers (mean age 43 years). Patient and caregiver ratings suggested problems with sleep, inattention, depression, irritability/anger, and anxiety. The most common discordance concerned suicide ideation. Most patients (34 of 38) reported that the assessment tool was easy to complete. The CCSM may be a useful, evidence-based, standardized, transdiagnostic assessment tool aligned with the DSM-5 that can be used in a variety of mental health settings to identify symptoms, inform treatment planning, and track progress. Full article

Prolonged hospitalization contributes to a decline in physical function and immobilization. This narrative review aims to explore physical rehabilitation approaches that address the specific characteristics of physical dysfunction in patients with schizophrenia. A literature review was conducted following an electronic search of PubMed for English-language articles published between January 2014 and January 2025. Based on the findings, a framework was constructed to categorize symptoms and physical challenges into three domains: (1) movement disorders and obesity induced by antipsychotic medications, which alter motor performance and lead to compensatory movements; (2) negative symptoms and cognitive impairments, which promote sedentary behavior and result in dysphagia, dynapenia, sarcopenia, and frailty; and (3) accelerated brain aging and disuse syndrome by schizophrenia, which impair neuromotor and cognitive function and increases the risk of physical dependency. These interconnected factors emphasize the need for targeted physical rehabilitation to maintain independence and reduce the risk of hospitalization. This review proposes a multidisciplinary approach involving psychiatrists, physical therapists, and occupational therapists, along with individualized nutritional support, as essential components of comprehensive rehabilitation strategies aimed at improving physical outcomes and reducing early mortality in this population. Full article

Background: Dispelling myths is crucial for policy and health communication because misinformation can directly influence public behavior, undermine trust in institutions, and lead to harmful outcomes. This study aims to assess the effectiveness and differences between OpenAI’s ChatGPT and Google Gemini in dispelling myths about children’s and adolescents’ mental health. Methods: Using seven myths about mental health from the UNICEF & WHO Teacher’s Guide, ChatGPT-4o and Gemini were asked to “classify each sentence as a myth or a fact”. Responses of each LLM for word count, understandability, readability and accuracy were analyzed. Results: Both ChatGPT and Gemini correctly identified all 7 statements as myths. The average word count of ChatGPT’s responses was 60 ± 11 words, while Gemini’s responses averaged 60 ± 29 words, a statistically non-significant difference between the LLMs. The Flesch–Kincaid Grade Level averaged 11.7 ± 2.2 for ChatGPT and 10.2 ± 1.3 for Gemini, also a statistically non-significant difference. In terms of readability, both ChatGPT and Gemini’s answers were considered difficult to read, with all grades exceeding the 7th grade level. The findings should nonetheless be interpreted with caution due to the limited dataset. Conclusions: The study adds valuable insights into the strengths of ChatGPT and Gemini as helpful resources for people seeking medical information about children’s and adolescents’ mental health, although the content may not be as easily accessible to those below a college reading level. Full article

Treatment-resistant depression (TRD) affects 20–30% of patients with major depressive disorder and presents a significant clinical challenge due to its biological diversity. This review highlights standard mechanisms that contribute to treatment resistance beyond traditional monoaminergic models. Evidence supports serotonergic dysregulation, including 5-HT1A autoreceptor dysfunction and “serotonin flooding” as well as dopaminergic deficits linked to anhedonia and an imbalance between glutamate and GABA that impair synaptic plasticity. Changes in neurotrophic signaling, such as reduced BDNF and VEGF activity, complicate recovery by limiting neural repair and regeneration. Chronic inflammation and oxidative stress contribute to neuronal dysfunction, while HPA axis dysregulation may exacerbate depressive symptoms and resistance to antidepressants. Emerging evidence suggests that obesity and gut microbiota imbalance reduce the production of short-chain fatty acids by bacteria and increase intestinal permeability, thereby influencing neuroinflammatory and neurochemical processes in TRD. Neuroimaging studies reveal hyperconnectivity within the default mode network and impaired reward circuits, both of which are associated with persistent symptoms and a poor treatment response. By combining evidence on inflammation, oxidative stress, neuroendocrine disturbances, microbiome changes, and brain connectivity issues, this review develops a comprehensive framework for understanding TRD. It emphasizes the importance of biomarker-based subtyping to guide personalized future treatments. Full article

Background: Youth and young adults with early psychosis frequently use cannabis, yet the reliability of self-reported use is uncertain in clinical practice. We examined the concordance between self-reported cannabis use and urine toxicology among patients enrolled in an Early Psychosis Intervention (EPI) program in Southeast Ontario, Canada. Methods: We conducted a cross-sectional chart review of 116 EPI patients (2016–2019). Demographics, self-reported cannabis use (yes/no), concurrent substance use, and urine toxicology results from the initial clinical assessment were extracted. Diagnostic indices (sensitivity, specificity, positive/negative predictive values, and accuracy) were calculated using urine toxicology as the reference. The clinical panel used a 50 ng/mL threshold for THC-COOH; the specific assay platform (immunoassay vs. confirmatory GC-/LC-MS) was not specified in records and is noted as a limitation. Results: Overall, 82.8% (96/116) self-reported cannabis use. Self-report showed high sensitivity (88.4%) but very low specificity (20.3%), with PPV 39.2%, NPV 75.0%, and accuracy 45.30%, indicating limited concordance with urine toxicology. Self-reported cannabis use was significantly associated with self-reported cocaine and MDMA use, while associations with methamphetamine, opioids, and benzodiazepines were not significant. Conclusions: In this EPI cohort, self-reports overestimated cannabis use relative to urine toxicology (high sensitivity, low specificity, and accuracy <50%). These findings support cautious clinical interpretation of self-report and the complementary value of biological verification, especially when use is infrequent or the testing window/threshold may miss exposure. Future work should incorporate use frequency, potency, and timing relative to testing, and clearly specify toxicology assay methods. Full article

The increasing prevalence of Autism Spectrum Disorder (ASD) is a significant health concern influenced by both genetic and environmental factors. However, limited data exist on the socio-demographic and clinical characteristics associated with ASD in our region. This cross-sectional study assessed 200 children (155 boys and 45 girls) diagnosed with ASD at Hawler Psychiatric Hospital in Erbil city between January and December 2023. The Childhood Autism Rating Scale-Second Edition (CARS-2) was used for diagnosis and severity assessment. The mean age of participants was 4.6 ± 1.8 years, with males representing 77.5% of the sample. Cesarean section was the most common mode of delivery. The average parental ages were 34.8 years for mothers and 38.5 years for fathers. The first signs of autism were noticed at a mean age of 25.7 ± 9.7 months, with the first medical consultation at 34.6 ± 15.4 months and diagnosis at 42.4 ± 15.5 months. Delayed speech was the most common reason for seeking medical help. Statistically significant associations were found between severe autism symptoms and several factors, including older child age, younger age at first assessment, delayed speech, parental consanguinity, paternal age over 40, lower paternal education, and lower socioeconomic status. These findings emphasize the critical role of early detection and the influence of both socio-demographic and clinical factors on ASD symptom severity, highlighting the need for targeted early intervention strategies to improve outcomes in affected children. Full article

Background/Objectives: Subjective well-being (SWB) in children is a key indicator of healthy development, influenced by physical activity and sports, with physical literacy (PL) as a potential mediator. Traditional linear models overlook non-linear and heterogeneous effects in diverse populations. This study uses causal machine learning (ML) to examine PL’s mediating role between sports participation and SWB in a multinational cohort. Methods: Data from the International Survey of Children’s Well-Being (ISCWeB) (n = 128,184 children aged 6–14, 35 countries) were analyzed. SWB was a composite (six items, α = 0.85); PL was a proxy (three items excluding sports frequency, α = 0.70); sports participation was continuous (0–5). Confounders were age, gender, parental listening, and school satisfaction. CausalForestDML estimated the effects; GroupKFold and bootstrap were used for robustness; SHAP/PDP was used for interpretability. Results: Total ATE = 0.083 (95% CI [0.073, 0.094]); indirect via PL = 0.055 (CI [0.049, 0.061]); direct = 0.028 (CI [0.020, 0.038]); mediation proportion = 0.660. Sensitivity with lean PL (2 items) was as follows: indirect = 0.045 (CI [0.040, 0.050]). For SHAP, school satisfaction was (+0.28), and parents were (+0.20) top. For PDP, there was a non-linear rise at PL 4–6 (+1.2 units) and a plateau ~9.2. The cross-cultural mean ATE = 0.083 ± 0.01 (from within-country meta-analysis); this was stronger in older children (CATE 0.30 for 12–14). For Rho sensitivity at 0.1, it was indirect −0.129; at Rho sensitivity of 0.2, it was −0.314 (robust to low confounding). Conclusions: The findings, grounded in SDT/PYD, support interventions targeting PL through sports to enhance SWB, addressing inactivity. Limitations are its cross-sectional nature and proxy measures; we recommend longitudinal studies. Full article

N-Acetylaspartate (NAA) plays a critical role in neuronal function, metabolism, and neurotransmitter release. Evidence from magnetic resonance spectroscopy indicates diminished NAA levels in individuals diagnosed with schizophrenia and bipolar disorder; however, this process is time-consuming, expensive, and not viable in individuals with acute illness exacerbation. In order to address these limitations, we developed a novel method for the quantification of plasma NAA based on tandem mass spectrometry coupled to liquid chromatography (HPLC-MS). Our study aimed to assess whether plasma NAA levels change during hospitalization and whether these changes correlate with symptomatic improvement in patients experiencing acute psychiatric exacerbations. We recruited 31 inpatients with acute symptoms of psychotic (48.39%) and/or mood (51.61%) disorders. Symptom severity was assessed using the brief psychiatric rating scale, Positive and Negative Syndrome Scale, and Clinical Global Impression Scale. Plasma NAA was measured at admission and discharge. We observed a significant decrease in symptom scores and a significant increase in plasma NAA levels between admission and discharge. The initiation of therapy with lithium salts significantly influenced plasma NAA changes. Our study shows that our HPLC-MS method can detect clinically meaningful changes in plasma NAA levels. These results might lay the groundwork for future research exploring the relationship between plasma NAA levels and cerebral NAA levels measured by MRS. Full article

The Clinical Descriptions and Diagnostic Guidelines (CDDG) for Mental, Behavioral, and Neurodevelopmental Disorders (MBND) in the International Classification of Diseases 11th Revision (ICD-11) are a substantial improvement over their equivalent in the ICD-10. This study evaluates the usefulness of the synchronous and asynchronous modalities of an online training course on the ICD-11-CDDG-MBND to increase readiness to implement it in routine clinical practice among Spanish-speaking clinicians. A convenience sample of psychiatrists, psychologists, and general practitioners completed online evaluations of one of the two course modalities. Acquired knowledge was evaluated through a multiple-choice questionnaire. Readiness to implement the ICD-11-CDDG-MBND was evaluated before and after the course, using an instrument based on the transtheoretical model of stages of change: precontemplation, contemplation, preparation and action. A total of 310 clinicians completed either the asynchronous (n = 176) or synchronous course (n = 134). Prior to the course, most participants were at the precontemplation stage. By the end of the course, participants reported a moderate level of knowledge. The percentage of clinicians at the preparation and action stages was higher than before the courses, with no differences being observed between course modalities. Online training was associated with increased knowledge and motivation to implement the ICD-11-CDDG-MBND. Full article