Search Results (74)

Depressive symptoms are highly prevalent among individuals with substance use disorders, particularly opioid use disorder (OUD), yet their clinical meaning is often difficult to determine. In routine practice, these symptoms are commonly interpreted within a binary framework, either as manifestations of an independent mood disorder or as substance-induced states related to intoxication, withdrawal, or early abstinence. Although clinically useful, this distinction may not fully capture a third configuration in which depressive psychopathology emerges within the chronic addictive process itself. This Perspective proposes a tripartite model of depressive states in OUD informed primarily by clinical and dimensional studies conducted in populations with heroin use disorder. First, substance-induced depression refers to mood symptoms temporally linked to the acute or subacute pharmacological effects of substances and generally expected to improve with stabilization or sustained abstinence. Second, an independent mood disorder may coexist with OUD, with particular attention warranted for bipolar-spectrum presentations characterized by affective instability, cyclothymic or irritable temperaments, mixed features, and mood-related patterns of substance use. Third, addiction-related depression describes a persistent depressive configuration associated with reward dysregulation, hypophoria, motivational depletion, cognitive inefficiency, and the Worthlessness/Being Trapped dimension identified primarily in dimensional studies of heroin use disorder. These configurations should not be regarded as rigid or mutually exclusive categories, but as longitudinal clinical formulations that may predominate at different stages of the addictive trajectory. Distinguishing among them may improve diagnostic clarity and support a hierarchical clinical approach in which stabilization of OUD is generally an initial therapeutic priority, while antidepressant and mood-stabilizing interventions are guided by symptom severity, temporal course, psychopathological organization, and evidence of an independent mood disorder. Full article

Background and Objectives: Gambling disorder (GD) is a behavioral addiction associated with distress, comorbidity, and functional impairment. This exploratory cross-sectional study examined associations between DSM-5-TR symptom burden, personality dimensions, cognitive emotion regulation, quality of life, and sociodemographic variables in a Romanian clinical sample. Materials and Methods: The sample included 122 adults with psychiatrist-confirmed pathological gambling/GD recruited from “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest. Personality was assessed with the Personality Clinical Form (PCF; 109 valid profiles), cognitive emotion regulation with the Cognitive Emotion Regulation Questionnaire, and quality of life with the Quality of Life Inventory. Symptom burden was measured using a nine-item binary DSM-5 symptom burden index. Results: The symptom burden index showed a pronounced ceiling effect: median = 9.00 (IQR = 9.00–9.00; range = 4–9), with 91.0% classified as severe and 77.9% meeting all nine criteria. In PCF analyses, symptom burden was positively associated, after Benjamini–Hochberg correction, with broad personality pathology, including maladaptive personality dimensions, personality-functioning indicators, and personality-disorder feature scales; the strongest association involved borderline features. Catastrophizing and Blaming Others were positively associated with severity, whereas Positive Reappraisal, Putting into Perspective, and Positive Refocusing were negatively associated. Quality of life was very low overall and associated with personality and coping variables, but not directly with symptom burden. Criterion-count rank distributions differed by marital status and perceived social support; occupational status showed an omnibus distributional difference, but no pairwise contrast survived correction. Conclusions: GD was characterized by severe symptom burden and restricted score variability. Findings support multidimensional assessment of personality functioning, emotion regulation, quality of life, and social–contextual vulnerability. Full article

Objectives: With the rapid development of digital technology, the risk of internet addiction among adolescents has increased. However, the influence mechanism of emotional eating behavior on internet addiction remains unclear. This study aimed to explore the association pathway of emotional eating on internet addiction in junior high school students and test the chain-mediating effects of sleep quality (sleep quality was measured using the PSQI, with higher scores indicating poorer sleep quality) and depression. Methods: Based on data from 3245 junior high school students in Shenzhen, China, internet addiction was measured using Young’s questionnaire, and emotional eating was assessed via the Dutch Eating Behavior Questionnaire’s subscale. The PROCESS macro (Model 6) was used to test the chain-mediating effects. Results: Emotional eating was positively but modestly associated with internet addiction (β = 0.024, p < 0.01). Three significant mediating pathways were identified: (1) emotional eating → sleep quality → internet addiction (β = 0.0062, 14.52% of total effect); (2) emotional eating → depression → internet addiction (β = 0.0084, 19.67%); and (3) emotional eating → sleep quality → depression → internet addiction (β = 0.0041, 9.60%). Conclusions: Based on cross-sectional data, this study found that emotional eating is associated with internet addiction through the independent and chain-mediating effects of sleep quality and depression, revealing a statistical mediation pathway of “maladaptive emotion regulation → circadian disruption → psychopathology → addictive behavior.” These findings provide a basis for interventions targeting sleep management and emotional regulation. Full article

Background: Adults with attention-deficit/hyperactivity disorder (ADHD) often have comorbid substance use disorders (SUDs). In Italy, individuals with both ADHD and heroin use disorder (HUD) are usually treated in addiction services with opioid agonist therapy (OAT), but stimulant medications are rarely prescribed. This may create a treatment gap for core ADHD symptoms. Aim: This study examined the clinical and behavioural profiles of ADHD patients with HUD who receive OAT but no stimulant treatment, compared to ADHD patients without opioid use disorder (ADHD/NoHUD) on standard pharmacotherapy. All participants were considered treatment responders in their respective services. Methods: Data were collected from two outpatient clinics and included 103 adult ADHD patients assessed using validated tools for symptom severity, emotional dysregulation, and global functioning. Differences between groups were analysed using univariate tests and logistic regression. Results: The ADHD+HUD group was significantly older and showed higher levels of emotional dysregulation, impulsivity, and current cocaine use. Despite clinical stability, these individuals presented a more severe psychopathological profile than their ADHD/NoHUD counterparts, who received stimulant-based treatment. Conclusions: Although limited by its cross-sectional nature and setting-related confounders, the study indicates that OAT alone may not be sufficient to manage neurodevelopmental symptoms in ADHD+HUD patients. Further research is necessary to assess the safety and efficacy of integrated stimulant-based treatments, ideally within dual disorder services combining psychiatric and addiction expertise. Full article

Background/Objectives: Obesity results from the complex interplay of biological, psychological, and sociocultural factors. Psychiatric comorbidities and maladaptive eating attitudes are possible contributors to this complexity. Despite accumulating research, current treatment approaches often fail to achieve lasting success, possibly due to the tendency to approach obesity as a uniform condition despite its heterogeneity. This study aimed to identify distinct subgroups of adults with obesity based on their eating behaviors, psychopathology, and food addiction (FA). Methods: The study included 202 adults seeking obesity treatment at Ankara Dışkapı Training and Research Hospital, Turkey. Participants completed the Three Factor Eating Questionnaire-R18, Yale Food Addiction Scale, Night Eating Questionnaire, and Symptom Checklist-90-R (SCL-90-R). Psychiatric diagnoses were confirmed through clinician-administered semi-structured interviews (SCID-5-CV). Two-step cluster analysis was performed using z-standardized variables of eating and psychopathology measures. Subsequent comparisons were conducted between the identified subgroups. Results: Two distinct clusters were identified and described in terms of adaptive and maladaptive eating traits: an Adaptive group (n = 92, 45.5%) and a Maladaptive group (n = 110, 54.5%). The Maladaptive cluster exhibited higher levels of emotional eating, uncontrolled eating, night eating, FA, and general psychopathology (all p < 0.001), along with a greater prevalence of major depressive disorder and binge eating disorder. Conclusions: Our findings indicate that psychopathology and maladaptive eating behaviors meaningfully distinguish two obesity phenotypes. Nearly half of individuals with obesity, characterized by maladaptive eating traits, FA, or elevated psychopathology, may constitute a subgroup that would particularly benefit from psychoeducation or targeted psychiatric intervention. Full article

Background: Heroin addiction is associated with profound dysregulation of the endogenous opioid and stress response systems, yet current diagnostic frameworks may inadequately capture the traumatising aspects of this condition. This perspective proposes the concept of post-heroin post-traumatic stress spectrum (pH-PTSD/S) as a clinical syndrome emerging from chronic opioid-induced neurobiological and psychosocial dysregulation, even in the absence of Criterion A trauma. Methods: The authors review evidence from neuroendocrinology, behavioural neuroscience, and clinical psychopathology to support a sensitisation-based model of trauma vulnerability in heroin use disorder (HUD). Results: Findings suggest that HUD patients frequently exhibit PTSD-spectrum symptoms, including hyperarousal, avoidance, emotional dysregulation, and altered stress reactivity. Opioid agonist treatment (OAT) may mitigate these symptoms by stabilising HPA axis function and reducing exposure to trauma-related contexts. The pH-PTSD/S construct, measured through a dedicated instrument, identifies patients with subthreshold trauma-related symptoms and greater psychopathological burden. Conclusions: Heroin dependence may constitute a traumatising condition, requiring dimensional diagnostic tools and trauma-informed treatment strategies. Further research is needed to validate the nosological status of pH-PTSD/S, clarify its distinction from protracted withdrawal or complex PTSD, and determine its implications for OAT duration and integrated care pathways. Full article

Current research on addressing mobile phone addiction primarily focuses on mitigating the influence of psychopathological factors. In the present work, we conducted three studies to investigate a novel hypothesis that forgiveness, as a form of psychological compensation, may offer a previously underappreciated protective effect against mobile phone addiction in the aftermath of interpersonal transgressions. Study 1 (N = 391), a cross-sectional survey, established an association between negative life events and mobile phone addiction. Utilizing a recall methodology, Study 2 (N = 256) demonstrated that higher levels of forgiveness mitigated the adverse effect of interpersonal transgressions on mobile phone addiction. Moreover, forgiveness was particularly effective in reducing mobile phone addiction in cases involving mild—as opposed to severe—transgressions. Subsequently, in Study 3 (N = 175), we employed a scenario-based approach to investigate the mechanisms through which forgiveness mitigates mobile phone addiction following interpersonal transgressions. The results indicated that social bonding—specifically, reduced social distance and increased positive affect toward transgressors—mediated the relationship between forgiveness and mobile phone addiction. In future research and practice, forgiveness-based interventions may be leveraged to reduce mobile phone addiction. Full article

Background/Objectives: Muscle dysmorphia (MD), a subtype of body dysmorphic disorder, is prevalent among males who engage in the non-medical use of anabolic–androgenic steroids (AASs) and performance-enhancing drugs (PEDs). These individuals often experience severe psychopathology, including mood instability, compulsivity, and a distorted body image. Despite its clinical severity, no randomized controlled trials (RCTs) have evaluated structured psychological treatments in this subgroup. This study aimed to assess the efficacy of a manualized cognitive behavioral therapy (CBT) protocol in reducing MD symptoms and associated psychological distress among male steroid users. Results: Participants in the CBT group showed significant reductions in MD symptoms from the baseline to post-treatment (MDDI: p < 0.001, d = 1.12), with gains sustained at follow-up. Large effect sizes were also observed in secondary outcomes including depressive symptoms (PHQ-9: d = 0.98), psychological distress (K10: d = 0.93), disordered eating (EDE-Q: d = 0.74), and exercise addiction (EAI: d = 1.07). No significant changes were observed in the control group. Significant group × time interactions were found for all outcomes (all p < 0.01), indicating CBT’s specific efficacy. Discussion: This study provides the first RCT evidence that CBT significantly reduces both core MD symptoms and steroid-related psychopathology in men engaged in AAS/PED misuse. Improvements extended to mood, body image perception, and compulsive exercise behaviors. These findings support CBT’s transdiagnostic applicability in addressing both the cognitive–behavioral and affective dimensions of MD. Materials and Methods: In this parallel-group, open-label RCT, 59 male gym-goers with DSM-5-TR diagnoses of MD and a history of AAS/PED use were randomized to either a 12-week CBT intervention (n = 30) or a waitlist control group (n = 29). CBT sessions were delivered weekly online and targeted distorted muscularity beliefs, compulsive behaviors, and emotional dysregulation. Primary and secondary outcomes—Muscle Dysmorphic Disorder Inventory (MDDI), PHQ-9, K10, EDE-Q, EAI, and BIG—were assessed at the baseline, post-treatment, and 3-month follow-up. A repeated-measures ANOVA and paired t-tests were used to analyze time × group interactions. Conclusions: CBT offers an effective, scalable intervention for individuals with muscle dysmorphia complicated by anabolic steroid use. It promotes broad psychological improvement and may serve as a first-line treatment option in high-risk male fitness populations. Future studies should examine long-term outcomes and investigate implementation in diverse clinical and cultural contexts. Full article

Background and Objective: Obesity is currently one of the major challenges in medicine. Research indicates that assessing eating habits can contribute significantly to the development of more effective treatment. This study aims to validate the Eating Behaviors Assessment for Obesity (EBA-O) in a sample of Spanish adults with overweight or obesity. Methods: This cross-sectional study included 384 participants. To evaluate the structure, reliability, and measurement invariance of the Spanish EBA-O, we conducted a confirmatory factor analysis (CFA), calculated McDonald’s omega for reliability, and carried out a hierarchical sequence of multigroup CFAs. Two-way MANOVA was used to assess the effects of sex and body mass index (BMI) categories on EBA-O scores. Results: CFA supported a second-order five-factor structure for the EBA-O, demonstrating excellent fit indices. It respected the configural, metric, and scalar invariance. The Spanish version of the EBA-O exhibited significant correlations with measures of binge eating, food addiction, and eating disorder psychopathology. Internal consistency was high (ω = 0.80). Significant effects of sex and BMI were observed across EBA-O subscales. Conclusions: The EBA-O appears to be a valid, reliable, and easy-to-use instrument for assessing eating behaviors among Spanish-speaking individuals with overweight or obesity. Its strong psychometric properties support its use in both clinical settings and research, enhancing the development of tailored interventions for this population. Full article

Current technological development has made the Internet and new technologies increasingly present in people’s lives, expanding their opportunities but also potentially posing risks for dysfunctional use. This study aims to identify psychopathological factors associated with dysfunctional ICT use, extending the evidence beyond the well-established relationships with mood disorders to include personality disorders (i.e., cluster C in particular). A total of 711 participants (75.70% female; Mage = 28.33 years, SD = 12.30) took part in the data collection. Firstly, the results showed positive correlations between higher levels of addictive patterns for the Internet, social networks, smartphones and applications, and video games and higher levels of borderline symptoms as assessed by the Borderline Symptom List 23—Short Version. Moreover, scores reflecting high addictive patterns also positively correlated with general narcissistic traits as indicated by the total score of the Narcissistic Personality Inventory 13—Short Version and those specifically described by its Entitlement/Exploitativeness dimension, as well as with higher levels of almost all the personality traits assessed by the Personality Inventory for DSM 5—Brief Form (i.e., negative affectivity, detachment, disinhibition, and psychoticism). These findings broaden the still scarce body of evidence on the relationship between personality disorders and dysfunctional ICT use, which, however, needs to be further explored. Full article

Introduction: The introduction of the transdiagnostic approach in psychiatry shifts the focus from discrete diagnoses to shared symptoms across various disorders. The Transdiagnostic Global Impression—Psychopathology (TGI-P) scale is a newly developed tool designed to assess psychiatric symptoms across diagnostic boundaries. It evaluates ten core symptom domains—positive, negative, cognitive, manic, depressive, addiction, anxiety, sleep, hostility, and self-harm—regardless of specific diagnoses. Objective: This study aims to evaluate the efficacy of cariprazine across these ten transdiagnostic symptom domains. Methods: A systematic literature review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed on EMBASE and clinicaltrials.gov. Efficacy measures such as the Positive and Negative Syndrome Scale (PANSS), Montgomery–Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Hamilton Anxiety Rating Scale (HAM-A), and Columbia-Suicide Severity Rating Scale (C-SSRS) were used to assess cariprazine’s effect on the ten transdiagnostic symptoms. Multilevel random-effects meta-analyses were conducted to evaluate the efficacy of cariprazine versus placebo in alleviating depressive and anxiety symptoms across clinical trials. Results: A total of 30 studies were included in the review. Cariprazine showed therapeutic benefits on positive, negative, manic, and depressive symptoms in specifically designed trials. Preliminary positive effects were seen on anxiety, hostility, and cognitive symptoms across disorders. However, specific trials have not been conducted for anxiety disorders or cognitive impairment. Meta-analyses demonstrated that cariprazine significantly reduces both depressive and anxiety symptoms compared to placebo. Cariprazine significantly improved sleep-related symptoms in both mania and depression trials. Suicidality was evaluated in non-suicidal populations, and no increase was observed. Addiction symptoms were part of the exclusion criteria in the RCTs, so they could not be assessed. Previous reports of cariprazine’s anti-craving and anti-abuse effects come from real-world evidence rather than RCT data. Conclusions: Cariprazine appears to be promising in addressing a broad range of symptom domains across psychiatric conditions. Full article

Background/Objectives: Recently, interest in studying food addiction (FA) in the context of behavioral addictions (BAs) has increased. However, research remains limited to determine the FA prevalence among various BAs. The current study aimed to investigate FA in a clinical sample of patients seeking treatment for gaming disorder, compulsive buying-shopping disorder (CBSD), compulsive sexual behavior disorder, and the comorbid presence of multiple BAs, as well as to determine the sociodemographic characteristics, personality traits, and general psychopathology of this clinical population. In addition, we analyzed whether FA is linked to a higher mean body mass index (BMI). Methods: The sample included 209 patients (135 men and 74 women) attending a specialized behavioral addiction unit. The assessment included a semi-structured clinical interview for the diagnosis of the abovementioned BAs, in addition to self-reported psychometric assessments for FA (using the Yale Food Addiction Scale 2. 0, YFAS-2), CBSD (using the Pathological Buying Screener, PBS), general psychopathology (using the Symptom Checklist-Revised, SCL-90-R), personality traits (using the Temperament and Character Inventory-Revised, TCI-R), emotional regulation (using Difficulties in Emotion Regulation Strategies, DERS), and impulsivity (using Impulsive Behavior Scale, UPPS-P). The comparison between the groups for the clinical profile was performed using logistic regression (categorical variables) and analysis of covariance (ANCOVA), adjusted based on the patients’ gender. The sociodemographic profile was based on chi-square tests for categorical variables and analysis of variance (ANOVA) for quantitative measures. Results: The prevalence of FA in the total sample was 22.49%. The highest prevalence of FA was observed in CBSD (31.3%), followed by gaming disorder (24.7%), and the comorbid presence of multiple BAs (14.3%). No group differences (FA+/−) were found in relation to sociodemographic variables, but the comorbidity between FA and any BA was associated more with females as well as having greater general psychopathology, greater emotional dysregulation, higher levels of impulsivity, and a higher mean BMI. Conclusions: The comorbidity between FA and BA is high compared to previous studies (22.49%), and it is also associated with greater severity and dysfunctionality. Emotional distress levels were high, which suggests that the group with this comorbidity may be employing FA behaviors to cope with psychological distress. However, a better understanding of the latent mechanisms that contribute to the progression of this multifaceted comorbid clinical disorder is needed. One aspect that future studies could consider is to explore the existence of FA symptoms early and routinely in patients with BAs. Full article

Background. Sleep disturbances are frequent in patients with substance use disorders (SUDs) and are associated with craving and addiction relapses, leading to increased clinical severity and detrimental outcomes. Daridorexant, a selective dual orexin receptor antagonist, has been approved for persistent insomnia disorder (ID), but specific insights on patients with SUDs are lacking. Methods. This observational, retrospective study investigated the effects of a three-month treatment with daridorexant (50 mg/day) in 41 outpatients with comorbid IDs and SUDs. Improvement in subjective sleep measures, assessed with the Insomnia Severity Index (ISI) and subjective total sleep time, was the primary outcome measure. Changes in anxiety and depression symptoms, quality of life, clinical global severity, and craving were also investigated through the following: Hamilton Anxiety and Depression Rating Scale; Five-item World Health Organization Well-Being Index; Clinical Global Impression Severity Scale; Visual Analog Scale for Craving. Results. All sleep outcomes significantly improved throughout treatment, which was generally safe and well tolerated, with mild and transient drowsiness and sluggishness reported in 21.1% of patients. Similar improvements were observed in psychopathology, quality of life, and craving, and positive correlations were found among ISI scores and anxiety/depression symptoms and craving. An abstinence rate (i.e., absence of any substance use, regardless of the amount, throughout treatment) of 65.8% was also detected at the endpoint. Conclusions. These preliminary findings suggest that daridorexant might represent a promising tool for treating insomnia in patients with SUDs. Identifying interventions effectively targeting insomnia with a good safety/tolerability profile in SUDs is crucial to achieve remission and full functional recovery. Full article

Creativity and the production of artwork can have an impact on the course and treatment of comorbid severe mental illness and neurodegeneration. We report on a 70-year-old male patient with highly original artistic behavior, who suffered from lifelong recurrent major depression and subsequently developed symptoms of progressive bulbar palsy (PBP). In the context of a systematic literature review, we detail the patient’s personal and artistic biographies and portray artwork from his artistic portfolio together with his disease history, clinical examination, psychopathological and neuropsychological evaluations, blood and cerebrospinal fluid analyses, neuroimaging, neurophysiological testing, and psychotherapeutic treatment. The patient’s 1–2-year history of primarily bulbar motor symptoms and signs aligned with electromyography, showing widespread signs of continuing denervation/chronic neurogenic changes. Slight impairments in semantic fluency, executive control, and visuoconstructive abilities were observed in neuropsychological testing, in conjunction with right-sided medial temporal lobe atrophy in an MRI. He was prescribed medication, including extended-release venlafaxine, trazodone, pramipexole, and zolpidem, and took his medication regularly, usually at high doses. For most of his life, the patient had attributed professional “success” and artistic output to, at times, excessive alcohol consumption. Later, however, his interest in creative work continued despite alcohol reduction and cessation. Psychotherapy grounded him in reality via goal-centered behaviors, making him realize that his physical and mental ailments rather hindered his creative output. In summary, creative behavior can be utilized in the treatment of patients with psychiatric conditions (affective or addictive disorders) and/or neurodegenerative diseases. In the reported case, specific psychopharmacology and psychotherapy that address goal-directed self-efficacy experiences of reality were critical to the patient’s treatment. Full article

(1) Background: The observational retrospective study aimed to investigate the prevalence of personality disorders (PDs) and their association with psychopathological symptoms in a group of patients with cocaine addiction. (2) Methods: Ninety-five medical records of the Pathological Addictions Service of the National Health Service of Lecce (Italy) were analyzed. PDs were diagnosed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) and psychopathological symptoms were investigated through the Symptom Checklist 90-Revised (SCL-90-R). (3) Results: Ninety-two out of ninety-five patients met the criteria for at least one PD (96.8%), almost 35% had two Cluster B PDs, and over 25% had three Cluster B PDs. Nine out of ninety-five people met the criteria for all Cluster B PDs. Among the Cluster B PDs, it emerged that the most frequent diagnosis was that of narcissistic–borderline–antisocial (over 20% of the total sample). The analysis highlighted that mental suffering is prevalent in those with multiple comorbid Cluster B PDs. Specifically, depression and psychoticism exceed the clinical cut-off (T score > 63) in all patient groups. At the same time, anxiety and obsessions–compulsions are complained of only by those with more than two PDs as well as the level of general distress. Furthermore, anxiety, hostility, and paranoid ideation are significantly higher in the group of patients with more than three PDs. (4) Conclusions: Further studies should better investigate the relationship between the two aspects and describe the causal effects of PDs on psychopathological symptoms or, on the contrary, the effects of the substance on mental health and the worsening of personality alterations. Full article