Search Results (5,726)

Background/Objectives: Impairment in self-awareness (ISA) is one of the common consequences of an acquired brain injury (ABI) and is associated with anosodiaphoria. Collectively, these co-occurring neuropsychological disorders pose significant obstacles in the neurorehabilitation of moderate-to-severe ABI patients. Individuals who recover from ISA may present with anxiety and/or depression as adaptive reactions to the ABI, along with related functional disabilities. The present study investigated whether the level of metacognitive self-awareness (SA) is associated with the presence of anxiety and depression, apathy, or anosodiaphoria in patients with moderate-to-severe ABI. It aimed also at investigating the possible relationship between the severity of disability and both psycho-emotional diseases and the presence of PTSD symptoms in patients with high metacognitive SA. Methods: Sixty patients with moderate-to-severe ABI and different levels of metacognitive SA completed a series of questionnaires, which assessed their self-reported metacognitive SA, anosodiaphoria, anxiety and depression, apathy, and PTSD symptoms. Results: Low-metacognitive-SA patients showed lower levels of anxiety and depression and higher anosodiaphoria than high-metacognitive-SA patients. Patients with high metacognitive SA and high levels of disability showed significant higher states of anxiety and PTSD symptoms than patients with high metacognitive SA and low levels of disability. Conclusions: The neurorehabilitation of individuals with moderate to severe ABI should address, in particular, the complex interaction between ISA and anxiety and depression in patients during the rehabilitation process. Full article

The relationship between metabolic dysfunction and mental health disorders is complex and has received increasing attention. This review integrates current research to explore how stress-related growth differentiation factor 15 (GDF15) signaling, ceramides derived from gut microbiota, and mitochondrial dysfunction in the brain interact to influence both metabolic and psychiatric conditions. Evidence suggests that these pathways converge to regulate brain energy homeostasis through feedback mechanisms involving the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. GDF15 emerges as a key stress-responsive biomarker that links peripheral metabolism with brainstem GDNF family receptor alpha-like (GFRAL)-mediated anxiety circuits. Meanwhile, ceramides impair hippocampal mitochondrial function via membrane incorporation and disruption of the respiratory chain. These disruptions may contribute to sustained pathological states such as depression, anxiety, and cognitive dysfunction. Although direct mechanistic data are limited, integrating these pathways provides a conceptual framework for understanding metabolic–psychiatric comorbidities. Furthermore, differences in age, sex, and genetics may influence these systems, highlighting the need for personalized interventions. Targeting mitochondrial function, GDF15-GFRAL signaling, and gut microbiota composition may offer new therapeutic strategies. This integrative perspective helps conceptualize how metabolic and psychiatric mechanisms interact for understanding the pathophysiology of metabolic and psychiatric comorbidities and highlights therapeutic targets for precision medicine. Full article

Almost one in three firefighters develop mental health disorders at some point during their careers, a rate double that in the general population. Frequent exposures to potentially traumatic situations can contribute to symptoms of these disorders, two of the most common being depression and post-traumatic stress disorder (PTSD). While various psychological interventions have been implemented among this group, reports of their effectiveness include mixed results. To this end, the current study endeavored to test the effectiveness of a 12-week intervention combining occupationally-tailored high-intensity functional training (HIFT) and psychological resilience training (RES) in reducing depressive and post-traumatic stress symptoms (PTSSs), as well as increasing psychological resilience and mental wellbeing, in career firefighters. Thirty career firefighters completed four mental health measurements over 17 weeks while anthropometrics and physical performance (i.e., number of stations completed in 20 min during an eight-station simulated job-task circuit workout [T-CAC]) were measured pre- and post-intervention. Pre to post comparisons were made via repeated-measures t-tests. Significant mean differences were observed for T-CAC stations completed, PTSSs, and psychological resilience between pre- and post-intervention. In future interventions, researchers should actively engage firefighters, maximize integration with daily operations, and employ culturally-relevant practices to explore the links between physical and mental health. Full article

Background: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic vestibular disorder characterized by dizziness, instability, and visual hypersensitivity. Vestibular Physical Therapy (VPT) is commonly used, but its efficacy remains uncertain due to limited and heterogeneous evidence. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of VPT in reducing dizziness and improving balance in individuals with PPPD. Methods: A systematic search of MEDLINE and PEDro was conducted in January 2025. Studies were selected following PRISMA guidelines and included if they assessed VPT interventions in patients diagnosed with PPPD. Risk of bias was assessed using the PEDro scale and the modified Newcastle–Ottawa Scale. The meta-analysis focused on pre- and post-intervention changes in Dizziness Handicap Inventory (DHI) scores using a random-effects model. Results: Six studies met the inclusion criteria. VPT significantly reduced DHI scores (pooled Hedges’ g = 1.60; 95% CI: 0.75–2.45), indicating a moderate to large improvement. Additional outcomes included improvements in postural control (e.g., mini-BESTest and posturography) and psychological well-being (anxiety and depression questionnaires). However, high heterogeneity (I² = 92%) was present across studies. Conclusions: VPT may improve dizziness and balance in PPPD, though evidence is limited. Further high-quality trials with standardized protocols are needed. Full article

Workplace violence (WV) is a ubiquitous risk in healthcare settings where it has been associated with physical and mental health problems. We aimed to investigate the relationship between the violence experienced by healthcare workers (HCWs) and the presence of eating disorders (EDs). During routine health surveillance, 1215 HCWs were questioned about their experience of WV and the short version of the Eating Disorder Examination Questionnaire (EDE-QS) was used to assess their eating behaviors. Sleep quality, stress, and the presence of common mental illnesses and metabolic disorders were also evaluated. HCWs who had experienced one or more assaults in the previous year had a significantly higher EDE score than their colleagues. In a multivariate model, WV doubled the risk of EDs (odds ratio 2.33, confidence intervals 95% 1.30; 4.18, p < 0.01). A very significant association was observed between common mental disorders and EDs (OR 1.13, CI 95% 1.04; 1.23, p < 0.01), while low sleep quality almost reached a significant level (OR 1.09, CI 95% 0.99; 1.20). The higher frequency of EDs among workers subjected to violence may result from maladaptive coping mechanisms used when stress and mental health problems caused by WV lead to compensatory overeating. However, reverse causation, where WV is induced by stigmatization, cannot be ruled out. Because of the considerable impact EDs have on physical and mental health, productivity, and patient care, healthcare organizations should adopt programs designed to prevent these disorders in HCWs. Full article

Background: Cognitive behavioral therapy (CBT) has shown consistent efficacy in individuals with psychosis, as supported by many trials. One classical distinction is that between affective and non-affective psychosis. Few studies have specifically examined the possible moderating role of substantial affective elements. In this systematic review and meta-regression analysis, we assess how CBT response differs across the affective spectrum in psychosis. Methods: We included studies assessing various CBT modalities, including third-wave therapies, administered in people with psychosis. The study protocol is published in the Open Science Framework. Meta-regression was conducted to assess whether the proportion of participants with affective psychosis (AP), as proxied by a documented diagnosis of schizoaffective (SZA) disorder, moderated CBT efficacy across positive, negative, and depressive symptom domains. Results: The literature search identified 4457 records, of which 39 studies were included. The median proportion of SZA disorder participants was 17%, with a total of 422 AP participants represented. Meta-regression showed a trend toward lower CBT efficacy for positive symptoms with a higher SZA disorder proportion (β = +0.10 SMD per 10% increase in AP; p = 0.12), though it was not statistically significant. No significant associations were found for negative (β = +0.05; p = 0.73) or depressive symptoms (β = −0.02; p = 0.78). Heterogeneity was substantial across all models (I² ranging from 54% to 80%), and funnel plot asymmetry was observed in negative and depressive symptoms, indicating possible publication bias. Risk of bias assessment showed the anticipated inherent difficulty of psychotherapies in blinding and possibly dropout rates affecting some studies. Conclusions: Affective symptoms may reduce the effectiveness of CBT for positive symptoms in psychotic disorders, although the findings did not reach statistical significance. Other patient-level characteristics in psychosis could indicate which patients can benefit most from CBT modalities. Full article

Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract. Although the aetiology of IBD remains largely unknown, several studies suggest that an individual’s genetic susceptibility, external environmental factors, intestinal microbial flora, and immune responses are all factors involved in and functionally linked to the pathogenesis of IBD. Beyond the gastrointestinal manifestations, IBD patients frequently suffer from psychiatric comorbidities, particularly depression and anxiety. It remains unclear whether these disorders arise solely from reduced quality of life or whether they share overlapping biological mechanisms with IBD. This review aims to explore the bidirectional relationship between IBD and depressive disorders (DDs), with a focus on four key shared mechanisms: immune dysregulation, genetic susceptibility, alterations in gut microbiota composition, and dysfunction of the hypothalamic–pituitary–adrenal (HPA) axis. By examining recent literature, we highlight how these interconnected systems may contribute to both intestinal inflammation and mood disturbances. Furthermore, we discuss the reciprocal pharmacologic interactions between IBD and DDs: treatments for IBD, such as TNF-alpha and integrin inhibitors, have demonstrated effects on mood and anxiety symptoms, while certain antidepressants appear to exert independent anti-inflammatory properties, potentially reducing the risk or severity of IBD. Overall, this review underscores the need for a multidisciplinary approach to the care of IBD patients, integrating psychological and gastroenterological assessment. A better understanding of the shared pathophysiology may help refine therapeutic strategies and support the development of personalized, gut–brain-targeted interventions. Full article

Objective: This study aimed to investigate the impact of depression and anxiety disorders on mortality in women diagnosed with gynecologic cancers, utilizing nationwide retrospective cohort data. Methods: Data from the Korean National Health Insurance Service (NHIS) database, covering women diagnosed with cervical, endometrial, or ovarian cancers between 2007 and 2014, were analyzed. Women diagnosed with depression or anxiety disorders within one year after cancer diagnosis were identified and compared with a control group comprising patients with gynecologic cancers who did not develop either disorder during the same post-diagnosis period. Mortality was evaluated as the primary outcome. Results: Of 85,327 women analyzed, 784 (0.9%) were diagnosed with depression or anxiety disorders. Patients with depression or anxiety exhibited significantly higher mortality (38.4% vs. 29.9%; p < 0.001). Multivariate analysis indicated that depression significantly increased mortality risk (OR 1.46, 95% CI 1.27–1.66), whereas anxiety alone showed no significant effect (OR 0.97, 95% CI 0.74–1.27). Combined depression and anxiety showed the highest mortality risk (OR 1.47, 95% CI 1.31–1.65). Conclusions: Depression and anxiety disorders are significant predictors of increased mortality in women with gynecologic cancers, emphasizing the necessity for integrated mental health assessment and interventions in oncologic care to improve both survival and quality of life. Full article

Background: About half of all Major Depressive Disorder (MDD) patients have anxiety disorder. There is a neurologic basis for the comorbidity of balance (vestibular) disorders and anxiety. To detect comorbid anxiety disorder in MDD patients and, importantly, to investigate its relationship with depressive severity, we use Electrovestibulography (EVestG), which is predominantly a measure of vestibular response. Methods: In a population of 42 (26 with anxiety disorder) MDD patients, EVestG signals were measured. Fourteen (eight with anxiety disorder) were not on any anti-depressants, anti-psychotics or mood stabilizers. Using standard questionnaires, participants were depression-wise labelled as reduced symptomatic (MADRS ≤ 19, R) or symptomatic (MADRS > 19, S) as well as with or without anxiety disorder. Analyses were conducted on the whole data set, matched (age/gender/MADRS) subsets and compared with medication free subsets. Low-frequency EVestG firing pattern modulation was measured. Results: The main differences between MDD populations with and without anxiety disorder populations, regardless of being medicated or not, were (1) the presence of an increased 10.8 Hz component in the dynamic movement phase recordings, (2) the presence of asymmetric right versus left 7.6–8.9 Hz and 12.1–13.8 Hz frequency bands in the no motion (static) phase recordings, and (3) these differences were dependent on depressive severity. Conclusions: The EVestG measures are capable of quantifying anxiety in MDD patients. These measures are functions of depressive severity and are hypothesized to be linked to Hippocampal Theta (~4–12 Hz). Full article

Background: Bipolar disorder (BD) is a chronic and disabling psychiatric condition characterized by recurring episodes of mania, hypomania, and depression. Despite the availability of mood stabilizers, antipsychotics, and antidepressants, long-term management remains challenging due to incomplete symptom control, adverse effects, and high relapse rates. Methods: This paper is a narrative review aimed at synthesizing emerging trends and future directions in the pharmacological treatment of BD. Results: Future pharmacotherapy for BD is likely to shift toward precision medicine, leveraging advances in genetics, biomarkers, and neuroimaging to guide personalized treatment strategies. Novel drug development will also target previously underexplored mechanisms, such as inflammation, mitochondrial dysfunction, circadian rhythm disturbances, and glutamatergic dysregulation. Physiological endophenotypes, such as immune-metabolic profiles, circadian rhythms, and stress reactivity, are emerging as promising translational tools for tailoring treatment and reducing associated somatic comorbidity and mortality. Recognition of the heterogeneous longitudinal trajectories of BD, including chronic mixed states, long depressive episodes, or intermittent manic phases, has underscored the value of clinical staging models to inform both pharmacological strategies and biomarker research. Disrupted circadian rhythms and associated chronotypes further support the development of individualized chronotherapeutic interventions. Emerging chronotherapeutic approaches based on individual biological rhythms, along with innovative monitoring strategies such as saliva-based lithium sensors, are reshaping the future landscape. Anti-inflammatory agents, neurosteroids, and compounds modulating oxidative stress are emerging as promising candidates. Additionally, medications targeting specific biological pathways implicated in bipolar pathophysiology, such as N-methyl-D-aspartate (NMDA) receptor modulators, phosphodiesterase inhibitors, and neuropeptides, are under investigation. Conclusions: Advances in pharmacogenomics will enable clinicians to predict individual responses and tolerability, minimizing trial-and-error prescribing. The future landscape may also incorporate digital therapeutics, combining pharmacotherapy with remote monitoring and data-driven adjustments. Ultimately, integrating innovative drug therapies with personalized approaches has the potential to enhance efficacy, reduce adverse effects, and improve long-term outcomes for individuals with bipolar disorder, ushering in a new era of precision psychiatry. Full article

Depression is a common mental disorder with high economic burden, characterized by high disability and mortality rates. The etiology of depression remains unclear to date, and there are various hypotheses regarding the pathogenesis of depression in clinical practice, including the monoamine neurotransmitter hypothesis, the hypothalamic–pituitary–adrenal (HPA) axis dysregulation hypothesis, the inflammatory cytokine hypothesis, and the neurotrophic factor hypothesis. These theories offer specific directional aid in the clinical management of individuals suffering from depression. Medicinal intervention stands as a critical approach within the spectrum of depression treatments, and this article reviews the specific mechanisms of different hypotheses on the pathogenesis of depression in recent years, as well as the research progress on related therapeutic drugs. Full article

Post-traumatic stress disorder (PTSD) is a chronic mental health condition resulting from exposure to traumatic events. It is associated with long-term neurobiological changes and disturbances in emotional regulation. Understanding the sociodemographic profiles, biomarkers, and emotional control in patients with PTSD helps to better comprehend the impact of the disorder on the body and its clinical course. An analysis of biomarkers such as Interleukin-18 (IL-18), Inositol-Requiring Enzyme 1 (IRE1), Phosphorylated Extracellular Signal-Regulated Kinase (pERK), and Activating Transcription Factor–6 (ATF-6) in PTSD patients with varying durations of illness (≤5 years and >5 years) and a control group without PTSD revealed significant differences. Patients with recently diagnosed PTSD (≤5 years) showed markedly elevated levels of inflammatory and cellular stress markers, indicating an intense neuroinflammatory response during the acute phase of the disorder. In the chronic PTSD group (>5 years), the levels of these biomarkers were lower than in the recently diagnosed group, but still significantly higher than in the control group. An opposite trend was observed regarding the suppression of negative emotions, as measured by the Courtauld Emotional Control Scale (CECS): individuals with chronic PTSD exhibited a significantly greater suppression of anger, depression, and anxiety than those with recent PTSD or healthy controls. Correlations between biomarkers were strongest in individuals with chronic PTSD, suggesting a persistent neuroinflammatory dysfunction. However, the relationships between biomarkers and emotional suppression varied depending on the stage of PTSD. These findings highlight the critical role of PTSD duration in shaping the neurobiological and emotional mechanisms of the disorder, which may have important implications for therapeutic strategies and patient monitoring. Full article

Background and Objectives: Multiple sclerosis (MS) is a chronic immune-mediated neurological disorder that primarily affects young adults and is frequently accompanied by psychiatric comorbidities such as depression and anxiety, both of which significantly diminish patients’ quality of life (QoL). This study investigated the effect of two oral disease-modifying therapies (DMTs), fingolimod and cladribine, on mental health and QoL in patients with relapsing-remitting MS (RRMS). The aim of the study was to compare levels of depression, anxiety, and health-related quality of life (HRQoL) in RRMS patients treated with fingolimod or cladribine, and to evaluate their associations with clinical and radiological parameters. Materials and Methods: Eighty RRMS patients aged 18 to 50 years with Expanded Disability Status Scale (EDSS) scores of 3.0 or less, no recent disease relapse, and no history of antidepressant use were enrolled. Forty patients were treated with fingolimod and forty with cladribine. Depression and anxiety were assessed using the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). QoL was evaluated using the Multiple Sclerosis QoL-54 (MSQOL-54) instrument. Additional clinical data, including MRI-based lesion burden, EDSS scores, age, disease duration, and occupational status, were collected. Results: No statistically significant differences were observed between the two groups regarding HDRS and HARS scores (p > 0.05). However, patients treated with fingolimod had significantly higher scores in the Energy/Fatigue subdomain (7.55 ± 2.02 vs. 6.56 ± 2.57, p = 0.046) and Composite Mental Health (CMH) score (64.73 ± 15.01 vs. 56.00 ± 18.93, p = 0.029) compared to those treated with cladribine. No significant differences were found in the independent items of the MSQOL-54. A negative correlation was identified between total lesion load and QoL scores. Conclusions: Although fingolimod and cladribine exert comparable effects on depression and anxiety levels, fingolimod may be associated with better mental health outcomes and reduced fatigue in RRMS patients. Furthermore, lesion burden and clinical parameters such as age and EDSS score may independently influence QoL, regardless of the DMT used. Full article

There is limited information on the prevalence of mental health symptoms among the population of Mexico City. To provide an update and determine the prevalence of symptoms associated with various disorders in the city, a modified version of the “Screener Questionnaire” was used, the same instrument employed in the National Survey on Drug, Alcohol, and Tobacco Use (ENCODAT) 2016–2017. Data were collected at PILARES centers in different boroughs of Mexico City. A total of 868 questionnaires on symptoms of psychiatric disorders and the use of drugs, alcohol, and tobacco were completed. The most frequently reported symptoms were anxiety (52.67%), depression (39.34%), and post-traumatic stress disorder (44.57%). Additionally, results showed alcohol use at 15.1%, followed by tobacco (13.6%) and illicit drug use (6.8%). The prevalence of these symptoms was also compared with data from ENCODAT 2016–2017 to observe changes over the years. Full article

Introduction: Night shift work (NSW) has been increasingly addressed in the scientific literature, as it is considered a probable carcinogen. In this study, we investigated the association of NSW with health problems, unhealthy behaviors, and occupational carcinogens. Methods: Cross-sectional study with a sample of 47,953 workers from the 2019 National Health Survey. NSW prevalence was estimated according to sociodemographic characteristics. To investigate the associations of NSW with all study variables, gender stratified logistic regression models were used. The odds-ratio and 95% confidence intervals were estimated. Results: Among men, there was a significant association of NSW with sleep disorders (OR = 1.39; 95% CI: 1.17–1.65), tiredness (OR = 1.68; 95% CI: 1.41–2.00), obesity (OR = 1.41; 95% CI: 1.20–1.66), unhealthy food consumption (OR = 1.28; 95% CI: 1.12–1.46), handling of radioactive material (OR = 2.45; 95% CI: 1.61–3.72), and biological material (OR = 3.18; 95% CI: 3.15–4.80). Among females, NSW was associated with the same variables except obesity, but depressive feelings (OR = 1.35 95% CI: 1.09–1.67), frequent alcohol intake (OR = 1.48; 95% CI: 1.23–1.78), handling of chemical substances (OR = 1.54; OR = 1.54; 95% CI: 1.20–1.97), and passive smoking at work (OR = 1.45; 95% CI: 1.12–1.86) were highly significant. Conclusion: Night shift workers are more vulnerable to occupational carcinogen exposure, experience greater impacts on their well-being, and are more likely to engage in unhealthy behaviors. These findings should be considered in managing and organizing night work in the workplace. Actions to promote healthy work environments should be encouraged to protect workers’ health. Full article