Search Results (1,824)

Background: Problematic pornography use (PPU) has emerged as a clinically significant phenomenon with severe repercussions for mental health and interpersonal relationships. Despite advances in prevalence studies, a gap remains in understanding the subjective processes of recovery and personal transformation. Objective: To describe the lived experience of individuals in recovery from PPU and compulsive sexual behavior and to analyze the perceived factors and dynamics of group support within their process of change. Methods: A qualitative study was conducted following Van Manen’s phenomenological-hermeneutical approach. In-depth semi-structured interviews were held with 27 individuals (26 men, 1 woman) engaged in structured recovery. Data analysis was performed through thematic analysis supported by ATLAS.ti Scientific Software Development GmbH, 2026. Results: A structured trajectory was identified across three phases: personal collapse, group engagement, and transformative mechanisms. Accountability emerged as a salient perceived mechanism of change, fostering sincerity (35.7%) and relapse prevention (19.1%). The "mirror effect" and "rational hope" within the support group facilitate a profound identity shift from a "spoiled identity” to a state of personal authenticity. Conclusions: For individuals engaged in structured support groups, recovery from PPU transcends mere abstinence, requiring a profound identity transformation facilitated by collective connection and honesty. These findings suggest the potential utility of integrating group-based accountability into therapeutic interventions for behavioral addictions tailored to the patient’s experiential profile. Full article

Background: Immune mechanisms are increasingly implicated in the heterogeneity of schizophrenia spectrum disorders. Cytomegalovirus (CMV), a latent immunomodulatory herpesvirus, is linked to cognitive and immunological alterations, but its electrophysiological correlates remain largely unexplored. This study investigates the relationships among CMV serostatus, EEG features, inflammatory markers, and clinical–cognitive variables. Methods: In this prospective cross-sectional study, 123 patients with schizophrenia spectrum disorders underwent integrated clinical, cognitive, laboratory, and qualitative visual EEG assessments. CMV exposure was determined via IgG serology. Results: Global electroencephalographic EEG organization did not differ by CMV serostatus. However, a descriptive increase in resting-state sharp-wave discharges was observed in CMV-seronegative patients, independent of baseline cortical rhythms. Immunologically, CMV-seropositive individuals exhibited significantly higher total leukocyte counts, consistent with latent viral immune remodeling rather than overt systemic inflammation. Clinically, CMV-seropositive patients demonstrated descriptively higher scores on the disorganization dimension derived from the PANSS (Positive and Negative Syndrome Scale) five-factor consensus model. While these variations did not retain statistical significance after multiple testing correction, separate dimensional analyses revealed that patients exhibiting sharp waves demonstrated better overall cognitive functioning and superior performance within a memory-related item grouping. Notably, the presence of sharp-wave activity was independent of both peripheral inflammatory profiles and treatment-resistant status, underscoring a distinct electrophysiological phenotype. Conclusions: CMV exposure represents a modulating biological background associated with corrected leukocyte elevations and subtle electrophysiological variability, rather than a direct determinant of global clinical severity. The nominal EEG variations and their independent link to better-preserved memory performance highlight non-linear neuroimmune interactions. Given the cross-sectional design, these exploratory patterns warrant a non-causal interpretation but outline a foundation for future longitudinal investigations. Full article

Dimensional and transdiagnostic models have become central to contemporary efforts to move psychiatric nosology beyond DSM/ICD categories. This shift reflects persistent limitations of categorical syndromes as final biological targets, including within-diagnosis heterogeneity, cross-diagnostic comorbidity, developmental instability, and incomplete alignment with underlying mechanisms. This article examines a central unresolved problem in this transition: when, if ever, a descriptive or predictive psychiatric dimension can be interpreted as a candidate disease axis. We conducted a conceptual synthesis of major dimensional and transdiagnostic frameworks, including Research Domain Criteria (RDoC), Hierarchical Taxonomy of Psychopathology (HiTOP), the general psychopathology factor, cross-disorder genomic models, clinical staging approaches, and data-driven subtyping. The analysis separates three levels of inference that are often conflated in psychiatric research: descriptive structure, predictive utility, and disease-level biological validity. The synthesis identifies a recurrent inferential error in which reproducible factors, clusters, or classifiers are prematurely treated as evidence of disease architecture. Such constructs may describe real covariance patterns or improve prognostic prediction without establishing biological validity. We propose an eight-domain hierarchical framework for promotion to candidate disease-axis status, organized into four core gatekeepers—replication across cohorts, ascertainment, and methods, developmental coherence, incremental prognostic value beyond diagnosis and nonspecific severity, and discriminability from nonspecific severity—and four supporting/disciplining domains: cross-level convergence, mechanistic constraint, clinical leverage, and explicit falsifiability/boundary conditions. On this basis, middle-level transdiagnostic spectra and selected cross-disorder genomic liabilities appear more defensible as candidate disease axes than highly global or weakly specified constructs. Psychiatry was justified in turning toward dimensional models, but dimensionality alone does not confer biological validity. The key task is not to choose between categories and dimensions, but to define the evidential thresholds under which dimensional constructs warrant ontological promotion. Full article

Background: Treatment-resistant obsessive–compulsive disorder (TR-OCD) remains a major therapeutic challenge. Although current guidelines recommend optimized serotonin reuptake inhibitor (SRI) therapy, clomipramine switching, exposure and response prevention, and antipsychotic augmentation, a substantial proportion of patients continue to experience severe and disabling symptoms. In such cases, clinicians may consider pharmacological intensification strategies beyond guideline-endorsed algorithms. Methods: This study combines a structured narrative synthesis of pharmacological strategies for TR-OCD with a retrospective observational case series from a tertiary OCD referral clinic. Treatment resistance was defined as failure to achieve at least a 35% reduction in Yale–Brown Obsessive Compulsive Scale (Y-BOCS) score after at least two adequate SRI trials, including clomipramine, and optimized exposure and response prevention when available. Five patients treated with pharmacological intensification strategies were included. The primary outcome was percentage change in Y-BOCS score at 12 weeks. Results: The case series illustrates five strategies used in highly refractory OCD: supratherapeutic SSRI dosing, SSRI plus mirtazapine augmentation, dual SSRI therapy, serotonergic intensification in a clozapine-treated patient, and glutamatergic/GABAergic augmentation with topiramate. Baseline Y-BOCS scores ranged from 28 to 32. At 12 weeks, symptom reduction ranged from 23% to 36%. One patient met criteria for response, three showed near-response, and one demonstrated partial improvement. No cases of serotonin toxicity or clinically significant cardiac complications occurred. Conclusions: These cases suggest that carefully monitored pharmacological intensification may be feasible in selected specialist settings, but efficacy and safety require confirmation in prospective controlled studies. Recommendations: Pharmacological intensification should be reserved for highly refractory patients managed in specialist services, implemented with gradual titration, structured serotonin toxicity and electrocardiographic monitoring, and explicit individualized risk–benefit discussion; dual SSRI therapy should be regarded as the most experimental and highest-risk serotonergic option; and prospective controlled studies incorporating standardized functional outcomes are needed to refine patient-selection criteria and clarify which patients may benefit. Full article

Background/Objectives: Autistic traits are distributed dimensionally across psychiatric populations, yet their systematic assessment in mood and psychotic spectrum disorders remains limited. While elevated autistic traits have been documented in schizophrenia spectrum disorders, evidence in bipolar disorder (BD) and major depressive disorder (MDD) is scarce, and no studies have applied the clinician-rated PANSS Autism Severity Score (PAUSS) to mood disorder populations. This study aims to investigate the presence and severity of autistic traits across psychotic spectrum disorder (PSD), BD, and MDD in an outpatient sample using the PAUSS. Methods: In this cross-sectional naturalistic outpatient study, clinically stable adult patients with MDD, BD, or PSD, without autism spectrum disorder, were assessed with the Brief Psychiatric Rating Scale (BPRS) and PAUSS. Group comparisons, adjusted models, correlation analyses, principal component analysis, and multinomial logistic regression were performed. Results: A total of 165 patients were included (MDD, n = 84, BD, n = 45, PSD, n = 36). Compared with the mood disorder groups, PSD patients were younger and showed higher BPRS scores. PSD was also characterized by significantly higher PAUSS total, social, and communication scores, whereas PAUSS RRB did not differ in univariate analyses. In the overall sample, BPRS severity correlated positively with all PAUSS dimensions, while age showed only weak or non-significant associations. Diagnosis-stratified analyses revealed that the association between psychopathology and autistic traits was present in MDD and BD, but not in PSD. PCA showed that autistic trait dimensions converged on a broad common profile and differed across diagnostic groups, with PSD showing the most distinct pattern. In multinomial logistic regression, higher BPRS, higher PAUSS social and communication scores, and younger age independently distinguished PSD from MDD and BD; PAUSS RRB showed an inverse association only in the multivariable model. Conclusions: This study supports a transdiagnostic perspective on autistic traits in adult psychiatric populations, highlighting disorder-specific differences across diagnostic categories. Social and communication impairments emerged as key dimensions distinguishing PSD from mood disorders. Assessing autistic traits in psychiatric settings may improve diagnostic precision and inform personalized, stratified treatment approaches. Full article

Perinatal mental illness affects up to 20% of new mothers worldwide, yet despite a growing research interest over the past decade, the etiology is still not fully understood, and clinical treatment guidelines remain inconsistent across countries and services. In this review, recent findings on neurobiological processes and evolutionary mechanisms, as they occur during the menstrual cycle, pregnancy, birth, postpartum and breastfeeding, are discussed. The intention is to raise awareness of physiological changes in pregnancy that might be relevant to the differential diagnosis and clinical treatment of perinatal psychiatric disorders such as depression, anxiety, PTSD after childbirth, bipolar relapse, postpartum psychosis, obsessive-compulsive symptoms, substance-use disorders, and suicidality. Areas addressed include the activities of the immune system, thyroid gland, cortisol, sleep and individual sensitivity to ovarian hormone fluctuations. Evolutionary biological mechanisms intended to sustain pregnancy and to ensure the survival of the newborn are assumed to have potent effects on the maternal brain. These non-pathological adaptations could provide grounds for a better understanding of risk factors and the etiology of perinatal mental illness. Full article

Objectives: To assess maternal readiness for newborn self-care and its associations with breastfeeding readiness and psychophysical condition in early postpartum rooming-in care. Methods: This cross-sectional study included 200 women at 48–72 h postpartum. Maternal readiness was assessed with three 0–10 self-report scales: daytime newborn care, nighttime newborn care, and breastfeeding readiness. Psychometric, pain, anxiety, obstetric, haemoglobin, and haematocrit data were analysed using stepwise ordinal regression with bootstrap sensitivity analyses. Results: Breastfeeding readiness was the strongest correlate of daytime and nighttime caregiving readiness, with a marked and partially non-linear gradient (OR ≈ 13 for linear trend, p < 0.001). Higher anxiety on day 2 was associated with lower readiness across all domains (daytime care: OR = 0.61; nighttime care: OR = 0.69; breastfeeding: OR = 0.73; all p < 0.001). Daytime readiness was associated with sleep disturbance (lower readiness; OR = 0.63, p = 0.006) and goal-directed behaviour despite low mood (higher readiness; OR = 1.47, p < 0.001). Nighttime readiness correlated with concentration under emotional strain (OR = 1.63, p < 0.001) and was reduced in women reporting suicidal ideation (OR = 0.24, p = 0.012). Breastfeeding readiness was associated with greater current engagement in breastfeeding (OR = 1.90, p < 0.001) and higher parity (OR = 2.46, p = 0.002), while sleep disturbance was associated with lower readiness (OR = 0.69, p = 0.013). Somatic factors and social support were not independent predictors, while psychological variables showed stronger associations with readiness. Conclusions: Maternal readiness for newborn self-care is related to breastfeeding readiness but remains a distinct, psychologically shaped construct. These findings question the assumption that breastfeeding readiness reflects readiness for continuous newborn care. Assessment of maternal readiness may help identify support needs and guide flexible postpartum care. Full article

Background: Socio-cognitive deficits constitute a core and persistent feature of adolescent-onset schizophrenia, significantly impairing functional outcomes. However, the interplay between genetic metabolic markers such as CYP2D6 and specific socio-cognitive phenotypes remains poorly understood. Methods: This cross-sectional study included 73 adolescents with schizophrenia and 58 matched healthy controls. Theory of Mind (ToM) was evaluated using the Reading the Mind in the Eyes Test (RMET), while empathy was assessed with the Cambridge Empathy Quotient. Symptom severity was measured via the Positive and Negative Syndrome Scale (PANSS). CYP2D6 polymorphisms were genotyped using RT-PCR, classifying participants as Normal or Reduced (Intermediate) metabolizers. Hierarchical multiple regression analyses were performed, controlling for sex, IQ, and psychosocial factors. Results: Patients demonstrated significantly lower RMET and empathy scores compared to controls. Reduced CYP2D6 metabolizers exhibited poorer ToM performance and more severe negative symptoms. The final RMET model accounted for 88.8% of variance (p < 0.001), with CYP2D6 status emerging as a significant independent predictor (β = 0.178, p = 0.005), alongside IQ and negative symptoms. In contrast, the empathy model explained 49.0% of variance, with CYP2D6 effects fully mediated by negative symptom severity. Conclusion: Adolescents with reduced CYP2D6 metabolic activity exhibit greater negative symptom burden and impaired social-cognitive functioning. Our findings reveal a double dissociation: ToM functions as a stable, biologically anchored trait, while empathy serves as a state-dependent construct primarily driven by the negative syndrome. These insights advocate for the integration of pharmacogenetic stratification in the treatment of early-onset schizophrenia. Full article

Perinatal depression (PND), encompassing both major and minor depressive episodes during pregnancy and up to one year postpartum, is a prevalent and debilitating condition with profound consequences for maternal, infant, and family well-being. Clinical screening of PND remains challenging due to obstacles in early detection, symptom overlap with normal perinatal experiences, lack of standardized screening protocols, and considerable interpatient variability. Furthermore, the complexity of treating PND arises from multiple interconnected factors, including medication safety considerations during pregnancy and lactation, information barriers resulting from the separation of mental health services from obstetric and pediatric care systems, and unique sociocultural obstacles. The absence of systematically integrated care pathways often leads to severe and potentially irreversible outcomes for both mothers and infants. Hence, this review summarizes recent advances in PND screening and treatment, emphasizing the critical transition toward integrated or collaborative care models. Notably, future efforts should focus on overcoming implementation barriers, digital health solutions, task-sharing frameworks, and personalized treatment strategies to ensure equitable access to these innovations for affected populations. Full article

Background/Objectives: Major depressive disorder (MDD) frequently coexists with chronic diseases and inflammatory processes, particularly in primary care. The primary aim of this study was to investigate the association between MDD and multimorbidity burden (≥2 chronic diseases), while the secondary aim was to examine the relationship between MDD and routinely available inflammatory biomarkers. Methods: This retrospective cross-sectional study used electronic medical records from a Family Health Center in Türkiye between 1 January 2025 and 31 December 2025. Individuals aged ≥18 years with accessible records, complete laboratory data, and recorded sociodemographic/lifestyle variables were included. Patients were considered to have MDD if a psychiatrist-diagnosed MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was recorded in the electronic medical system within the past year. Multimorbidity burden was defined as the total number of chronic diseases and was further dichotomized as ≥2 versus <2 for multivariable regression analysis. Inflammatory biomarkers were calculated from routine blood tests: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune–inflammation index (SII), and monocyte-to-HDL cholesterol ratio (MHR). Group comparisons and logistic regression were performed to evaluate associations with MDD. Results: A total of 3006 patients were analyzed; 375 (12.5%) had MDD. Participants with MDD were older and more frequently female, had higher body mass index and waist circumference, and exhibited a substantially higher burden of chronic comorbidities. PLR was higher in the MDD group (p = 0.019), whereas MHR was lower (p = 0.004); NLR, MLR, and SII did not differ significantly. In multivariable analysis, increasing age (OR 1.029, 95% CI 1.019–1.039, p < 0.001), female sex (OR 2.659, 95% CI 1.949–3.636, p < 0.001), and multimorbidity (OR 2.162, 95% CI 1.650–2.833, p < 0.001) were independently associated with MDD, whereas PLR and MHR were not independently associated after adjustment. Conclusions: In this large real-world primary care cohort, MDD was common and strongly linked to multimorbidity. Although PLR and MHR differed significantly between groups, they were not independently associated with MDD after adjustment, suggesting that these differences may be driven by multimorbidity and related clinical factors rather than independent disease-specific effects. Full article

Background: This study examined peer interactions among late-diagnosed autistic adolescents, focusing on biological sex differences. Methods: Participants included 61 adolescents aged 12–18 years (31 boys, 30 girls) with an Intelligence Quotient (IQ) > 75, all diagnosed within the past three years. Peer interactions were assessed using the APIOS-A, an adapted version of the preschool observational tool (APIOS). Parents reported on autistic traits via the Social Responsiveness Scale (SRS-2), which measures social communication difficulties; socialization skills through the Adaptive Behavior Assessment System (ABAS-II), which assesses adaptive functioning; and behavioral problems using the Child Behavior Checklist (CBCL), which identifies emotional and behavioral issues. These measures were utilized to compare social profiles across sexes. Results: The APIOS-A demonstrated good reliability for identifying socio-communicative difficulties in both boys and girls. Findings indicated that boys and girls showed similar peer interaction challenges, with subtle differences in conversational reciprocity, cognitive flexibility, and humor use. Associations between behavioral characteristics and peer patterns varied by sex, highlighting the importance of tailored approaches. Conclusions: These results underscore the need for sex-sensitive assessment tools and tailored interventions for late-diagnosed autistic adolescents. Integrating observational and parental measures may enhance understanding and support their social development. Full article

Background/Objectives Occupational burnout is a significant health concern among healthcare professionals, particularly among nurses working in anesthesiology and intensive care units who are exposed to high psychological workload. Previous studies indicate a relationship between burnout and deteriorating mental health; however, the role of individual burnout dimensions in shaping overall mental health remains insufficiently explored. Methods: This cross-sectional study included 842 nurses working in anesthesiology and intensive care units. Occupational burnout was assessed using the Oldenburg Burnout Inventory (OLBI), while mental health was evaluated using the General Health Questionnaire (GHQ-28). Sociodemographic variables and subjective assessment of work–life balance were also included. Statistical analyses comprised non-parametric tests, Spearman’s rank correlation, and multiple regression models. Results: The strongest correlations were observed between the exhaustion dimension and the overall GHQ-28 score (rS = 0.539; p < 0.001). Additionally, poorer work–life balance was associated with increased symptoms of mental health disorders (rS = 0.42; p < 0.001). Regression analysis showed that gender, exhaustion, and work–life balance were significant predictors of mental health (p < 0.001). Conclusions: The results indicate a significant relationship between occupational burnout and mental health in nurses working in anesthesiology and intensive care units. In particular, exhaustion and work–life balance were identified as important predictors of mental health outcomes. Full article