Search Results (443)

This study estimates the prevalence of co-use of alcohol and cannabis, assesses the sociodemographic risk factors of co-use, and examines the associations between mental health and heavy episodic drinking (HED) and alcohol–cannabis co-use in Canada during the early years of the COVID-19 pandemic. Nine successive cross-sectional surveys, held from May 2020 to January 2022, of adults (aged ≥18 years) living in Canada were pooled for 9011 participants. The prevalence of co-use was calculated across sociodemographic groups. Logistic regressions were used to assess associations. Alcohol–cannabis co-use was associated with a greater likelihood of engaging in HED and experiencing symptoms of anxiety, depression, and loneliness. The prevalence of co-use of alcohol was different across sociodemographic groups. The highest prevalence was among TGD people (35.5%), followed by individuals aged 18–39 years (14.5%). Additionally, being TGD (aOR = 3.61, 95% CI 2.09–6.25), separated/divorced/widowed (aOR = 1.60, 95% CI 1.23–2.07), living in an urban area (aOR = 1.26, 95% CI 1.07–1.56), and having a high household income (aOR = 1.41, 95% CI 1.09–1.82) increased the likelihood of reporting alcohol–cannabis co-use. These findings underscore the fact that developing public health and clinical interventions for preventing and treating excessive alcohol or cannabis use must consider both alcohol and cannabis use patterns and should be tailored to the highest-risk TGD and young adults. 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

Temporomandibular disorders (TMDs) encompass a heterogeneous group of musculoskeletal and neuromuscular conditions affecting the temporomandibular joint (TMJ) and masticatory system. Due to academic stress and parafunctional habits, dental students may be particularly vulnerable to TMD. Objective: To determine the prevalence of TMD symptoms and their psychosocial and functional correlates among students at the Faculty of Dental Medicine, UMPh Iasi, Romania, using the diagnostic criteria for TMD (DC/TMD) self-report axis and axis II instruments. Methods: In this cross-sectional survey, 356 volunteer students (66.0% female; mean age, 22.9 ± 3.6 years) out of a total population of 1874 completed an online DC/TMD–based questionnaire. Axis I assessed orofacial pain, joint noises, and mandibular locking. Axis II instruments included the Graded Chronic Pain Scale (GCPS), Jaw Functional Limitation Scale (JFLS-20), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Oral Behaviors Checklist (OBC). Descriptive statistics summarized frequencies, means, and standard deviations; χ² tests and t-tests compared subgroups by sex; Pearson correlations explored relationships among continuous measures (α = 0.05). Results: A total of 5% of respondents reported orofacial pain in the past 30 days; 41.6% observed TMJ noises; 19.7% experienced locking episodes. Mean JFLS score was 28.3 ± 30.5, with 4.8% scoring > 80 (severe limitation). Mean PHQ-9 was 5.96 ± 5.37 (mild depression); 15.5% scored ≥ 10. Mean GAD-7 was 5.20 ± 4.95 (mild anxiety); 16.0% scored ≥ 10. Mean OBC score was 12.3 ± 8.5; 30.1% scored ≥ 16, indicating frequent parafunctional habits. Symptom prevalence was similar by sex, except temporal headache (43.4% females vs. 24.3% males; p = 0.0008). Females reported higher mean scores for pain intensity (2.09 vs. 1.55; p = 0.0013), JFLS (32.5 vs. 18.0; p < 0.001), PHQ-9 (6.43 vs. 5.16; p = 0.048), and OBC (13.9 vs. 9.7; p = 0.0014). Strong correlation was observed between PHQ-9 and GAD-7 (r = 0.74; p < 0.001); moderate correlations were observed between pain intensity and PHQ-9 (r = 0.31) or GAD-7 (r = 0.30), between JFLS and pain intensity (r = 0.33), and between OBC and PHQ-9 (r = 0.39) (all p < 0.001). Conclusions: Nearly half of dental students reported TMD symptoms, with appreciable functional limitation and psychosocial impact. Parafunctional behaviors and psychological distress were significantly associated with pain and dysfunction. These findings underscore the need for early screening, stress-management interventions, and interdisciplinary care strategies in the dental student population. Full article

Background: This study aims to evaluate the efficacy of a combined transcranial magnetic stimulation (TMS) protocol incorporating intermittent theta burst stimulation (iTBS) and low-frequency TMS in adults diagnosed with first-episode and recurrent depressive disorders. Methods: A prospective, double-blind, parallel-group trial was conducted involving 42 participants (21 with first-episode depressive disorder and 21 with recurrent depressive disorder) recruited from Chengdu, China. All subjects received 10 sessions of TMS over two weeks. The primary outcome measure was suicidal ideation, assessed using the Beck scale for suicide ideation. Secondary outcomes included sleep quality, depressive symptoms, anhedonia, and cognitive function. Event-related potentials (ERPs) were also recorded. Data were analyzed using SPSS V.21.0, with statistical significance defined as p < 0.05. Results: Both patient groups exhibited significant reductions in suicidal ideation following the composite TMS intervention. Secondary outcomes showed significant improvements in sleep quality, overall depressive symptoms, anhedonia, and cognitive function. Notably, a significant association was found between improvements in sleep quality and depressive symptoms in the first-episode group, suggesting differential underlying mechanisms compared to recurrent depression. Limitations: The relatively short intervention and follow-up period limits the ability to assess the long-term sustainability of the observed benefits. Future studies with extended follow-up periods are warranted to evaluate the persistence of TMS effects and the potential need for maintenance sessions. Conclusions: The combined protocol of iTBS and low-frequency TMS effectively reduces suicidal ideation and improves various clinical outcomes in both first-episode and recurrent depressive disorders, indicating the effectiveness of the physical intervention, especially for the first-episode patients. These findings underscore the importance of personalized treatment strategies based on the clinical history of depressive episodes. Further research with longer follow-up periods is warranted to assess the long-term sustainability of TMS effects. Full article

The protozoan parasite Toxoplasma gondii (T. gondii) has been implicated in various neuropsychiatric disorders, including depression. Our aim in this study was to assess the seroprevalence of T. gondii IgG antibodies as well as potential risk factors associated with seropositivity in patients with depression compared to healthy blood donors. This seroepidemiological study included 230 participants from Western Romania, divided equally into two groups: 115 patients diagnosed with depressive disorders which represented the study group and 115 age and gender-matched healthy blood donors, representing the control group. A structured questionnaire was used to assess risk factors potentially linked to T. gondii infection. The T. gondii IgG antibodies overall seroprevalence was significantly higher in the depression group (70.43%) compared to the control group (45.22%) (OR = 2.89; 95% CI: 1.68–4.97; p < 0.001). Higher seropositivity was noted in patients aged 50–59, 60+ years and in females. Patients with lower educational attainment showed significantly increased odds of T. gondii seropositivity (72.29% vs. 44.3%, OR = 3.28; 95% CI: 1.71–6.31; p < 0.001) compared with the control group. Stratification by ICD-10 diagnostic subtypes revealed significantly higher seropositivity in all categories, with the strongest association in patients with recurrent severe depressive episodes without psychotic symptoms (F33.2) (81.25%, OR = 3.5; 95% CI: 1.51–8.13; p = 0.004). These findings suggest a possible link between T. gondii infection and depression, particularly in relation to disease severity and sociodemographic factors. To our knowledge, this is the first study to investigate T. gondii seroprevalence and associated risk factors in Romanian patients with depression, providing a foundation for future longitudinal and preventive research. Full article

Background/Objectives: This study is an investigation of the occurrence, remission and recurrence of major depressive disorders (MDDs) in adults with type 2 diabetes (T2DM). Methods: Interviews were conducted with individuals (N = 176) who met the criteria for MDD using the Structured Clinical Interview for the DSM-IV-TR (SCID). Results: N = 176 T2DM adults, with a mean (SD) age of 55.5 (10.4) years, 74% of whom were female and 62% were white, completed the Structured Clinical Interview for the DSM-IV-TR (SCID). A mean (SD) number of 1.8 (0.9) episodes of major depression (MDD) were recorded from birth to the date of interview, with a mean (SD) onset age of the first episode of 40.4 (15.9) years. Median (IQR) MDD episode duration was 13.9 (5.6–31.9) months and the median (IQR) cumulative lifetime exposure duration to MDD was 33 (12.9–63.1) months. Kaplan–Meier survival analysis along with the frailty model, to account for the correlation among multiple recurrences or remissions within a subject, indicated that the median first episode duration was shorter than the median second episode duration (14 vs. 37.9 months, p < 0.0001). Of those who had at least three episodes, the median second episode duration was shorter than the median third-episode duration (13.0 vs. 28.0 months, p = 0.006). The median recurrence time following first remission was significantly longer than the median recurrence time following second remission (138.0 vs. 80.6 months, p = 0.02). Conclusions: These results document that clinical depression is recurrent in adults with T2DM. Moreover, depressive episodes in individuals with T2DM are persistent well beyond episode durations observed in the general population. Full article

Background/Objectives: Continuous ventilation monitoring during pediatric sedation is essential, as respiratory depression may occur silently and may not be detected promptly by conventional methods such as pulse oximetry. Non-invasive capnography has been proposed to improve early detection of respiratory compromise. This prospective observational study evaluated the diagnostic accuracy of non-invasive capnography, compared to pulse oximetry, for detecting respiratory depression in pediatric patients undergoing sedation. Methods: We conducted a single-center, prospective observational study at a tertiary pediatric hospital, enrolling 101 patients (ages 1–17 years) undergoing sedation for diagnostic or therapeutic procedures. Patients were monitored using both pulse oximetry and non-invasive capnography. Episodes of respiratory depression—defined as apnea, hypopneic hypoventilation, bradypneic hypoventilation, and desaturation—were recorded. We compared the diagnostic performance and time to detection between capnography and pulse oximetry. Results: We identified 93 episodes of respiratory depression in 52 patients (51.1%). Capnography detected all apnea episodes and 76.9% of hypopneic hypoventilation episodes that were not identified by pulse oximetry. The median time advantage of capnography over pulse oximetry was 35 s (p = 0.0055). Combining capnography and pulse oximetry identified more events than pulse oximetry alone (93 vs. 53 episodes). Conclusions: Non-invasive capnography improves the early detection of respiratory depression compared to conventional monitoring with pulse oximetry in pediatric procedural sedation. While these findings support its routine use to enhance patient safety, larger multicenter studies are needed to demonstrate its diagnostic accuracy and impact on clinical outcomes. Full article

Background: Perinatal depression refers to a major depressive episode that begins during pregnancy or within four weeks after childbirth and persists through the first year postpartum. Perinatal depression is one of the most common complications of pregnancy, with significant adverse maternal and infant outcomes. Numerous reviews and policy guidelines have emerged from Canada; however, a bibliometric analysis that focuses not only on the international sources for perinatal depression research, but also on Canadian sources, has not been undertaken. Purpose: To provide insight on perinatal depression publications conducted by researchers affiliated with Canadian institutions, within an international context. Methods: A bibliometric analysis was performed using performance analysis and science mapping techniques, with data retrieved from Scopus until 31 December 2022. The analysis focused on original peer-reviewed publications, applying no language restrictions and ensuring at least one author was affiliated with a Canadian institution. VOSviewer version 1.6.20 was used to generate visual networks for analysis. Results: In total, there were 763 publications identified in 160 different journals. Among these publications, there were 123 institutions represented. At least one author was associated with a Canadian institution per publication. The University of Toronto had the highest frequency of affiliations (n = 313). Most publications (79.55%) occurred between 2011 and 2022, with 2021 as the year with the most publications (n = 80). The journal with the most publications was Archives of Women’s Mental Health (n = 57, 35.65%). Canadian institution-affiliated authors with the largest number of publications were Dennis (n = 57), Oberlander (n = 39), Meaney (n = 38), and Letourneau (n = 37). Conclusion: This is the first study mapping publications on perinatal depression research within a Canadian context. This bibliometric analysis provides a valuable reference for future research by identifying key authors, institutions, journals, and research areas that prioritize perinatal mental health. Full article

Background. Major Depressive Disorder (MDD) is a highly prevalent and disabling condition frequently accompanied by cognitive deficits, impaired psychosocial functioning, and biological rhythm disturbances. Despite extensive literature on individual associations between depression and circadian disruptions, the mediating role of biological rhythms in the functional outcomes of MDD remains underexplored. Objectives. This study aimed to explore the associations between depression severity, biological rhythms, sleep quality, and psychosocial functioning, and to assess whether biological rhythm disturbances mediate the impact of depression on functioning. Methods. Sixty-one inpatients diagnosed with moderate-to-severe MDD were assessed using standardized instruments: BDI-II for depressive symptoms, BRIAN for biological rhythms, PSQI for sleep quality, and FAST for global functioning. Group comparisons, non-parametric correlations, and a mediation analysis were conducted to test direct and indirect effects. Results. Participants showed severe depressive symptoms, impaired functioning, disrupted biological rhythms, and poor sleep. Women reported more depressive episodes, reduced autonomy, and worse sleep than men. Depression severity was associated with circadian and sleep disturbances, which in turn related to functional impairment. Mediation analysis suggested that biological rhythms partially mediate the impact of depression on functioning. Conclusions. Findings from this preliminary analysis suggest that biological rhythm disturbances may play a mediating role in the relationship between depressive symptoms and daily psychosocial functioning. While not conclusive, these results highlight the potential relevance of chronobiological factors in understanding functional outcomes in MDD. Further research using longitudinal and controlled designs is needed to clarify these associations and their clinical implications. Full article

The Aptian–Albian interval represents a significant cooling phase within the Cretaceous “hothouse” climate, marked by dynamic climatic fluctuations. High-resolution continental records are essential for reconstructing terrestrial climate and ecosystem evolution during this period. This study examines a lacustrine-dominated succession of the Shahezi Formation (Lishu Rift Depression, Songliao Basin, NE Asia) to access paleo-weathering intensity and paleoclimate variability between the Middle Aptian and Early Albian (c. 118.2–112.3 Ma). Multiple geochemical proxies, including the Chemical Index of Alteration (CIA), were applied within a sequence stratigraphic framework covering four stages of lake evolution. Our results indicate that a hot and humid subtropical climate predominated in the Lishu paleo-lake, punctuated by transient cooling and drying events. Periods of lake expansion corresponded to episodes of intense chemical weathering, while two distinct intervals of aridity and cooling coincided with phases of a reduced lake level and fan delta progradation. To address the impact of potassium enrichment on CIA values, we introduced a rectangular coordinate system on A(Al₂O₃)-CN(CaO* + Na₂O)-K(K₂O) ternary diagrams, enabling more accurate weathering trends and CIA corrections (CIA_corr). Uncertainties in CIA correction were evaluated by integrating geochemical and petrographic evidence from deposits affected by hydrothermal fluids and external potassium addition. Importantly, our results show that metasomatic potassium addition cannot be reliably inferred solely from deviations in A-CN-K diagrams or the presence of authigenic illite and altered plagioclase. Calculations of “excess K₂O” and CIA_corr values should only be made when supported by robust geochemical and petrographic evidence for external potassium enrichment. This work advances lacustrine paleoclimate reconstruction methodology and highlights the need for careful interpretation of weathering proxies in complex sedimentary systems. Full article

Background: In Oman, primary healthcare physicians (PHPs) are often the first point of contact in the healthcare system. Understanding the prevalence and impact of stigma among these professionals is crucial to fostering a supportive work environment and promoting access to mental health care. This study evaluated mental health stigma and its association with help-seeking behaviors among PHPs in Muscat, Oman. Methods: A cross-sectional analytical study was conducted from March to May 2023 using cluster random sampling to recruit 191 PHPs. Participants completed a structured questionnaire that evaluated demographic and clinical characteristics, help-seeking behaviors, and perceived stigma. The PPSS developed for this study underwent expert review, pilot tests, and reliability analysis. Data were analyzed using descriptive statistics, Chi-square tests, and multivariate logistic regression, with a significance set at p < 0.05. Results: Most of the participants were women (78.5%), aged 30–39 years (49.7%), and Omani nationals (71.2%). More than half (57.6%) reported experiencing depressive episodes, yet only 21.8% sought professional help. High levels of stigma were associated with reluctance to seek professional mental health support, and 24.6% of participants preferred not to seek help at all. Those in the stigma group were significantly more likely to rely on family or friends for support (adjusted OR = 2.873; 95% CI = 1.345–6.138; p = 0.006). Common barriers to help-seeking included a lack of belief in the effectiveness of treatment (23.0%) and concerns about confidentiality (19.9%). Conclusions: Mental health stigma remains a widespread problem among primary healthcare physicians in Oman, influencing their behavior and preferences. Interventions to reduce stigma and address barriers to mental health care, such as enhanced confidentiality safeguards and treatment skepticism, are critical to improving physician well-being and healthcare delivery. This study can inform policy and training programs aimed at improving physician well-being and patient care. Full article

Background: Physical activity is essential for the physical and psychological development of children, contributing to both fitness and overall well-being. However, children with neurological conditions such as childhood absence seizures (CAE), a type of epilepsy characterized by brief episodes of impaired consciousness, may face barriers to participating in regular physical activities. This limitation can negatively affect their quality of life, motor coordination, and cognitive function. Despite this, there is limited research focusing on the physical activity levels of children with absence seizures in comparison to healthy children. Methods: This study aims to compare physical activity levels in children with absence seizures and healthy controls, using the Physical Activity Questionnaire for Children (PAQ-C), a validated tool for assessing children’s engagement in physical activity. The sample included 125 children with absence seizures and 125 healthy controls. The study also assessed anxious–depressive traits using the Children’s Depression Inventory (CDI-2) and the Multidimensional Anxiety Scale for Children (MASC-2). Additionally, seizure frequency and severity were documented for the seizure group, and the impact of different treatment regimens (levetiracetam, valproate, lamotrigine) was explored. Results: The results revealed that children with absence seizures exhibited lower physical activity levels compared to healthy children, although the difference did not reach statistical significance. Furthermore, they had higher scores for anxious–depressive traits. There were no significant differences in physical activity levels between the different treatment groups. The study also found that lower physical activity was correlated with poorer quality of life and increased psychological distress in the seizure group. Conclusion: Children with absence seizures face significant barriers to physical activity, which may be further compounded by psychological distress. These findings emphasize the need for targeted interventions to improve physical activity and address mental health concerns in this population. By enhancing physical activity levels and supporting psychological well-being, interventions can improve the quality of life and overall health of children with absence seizures. Additionally, the results highlight the importance of promoting inclusive physical activity programs for children with neurological conditions. Full article

Lamotrigine is the drug of choice for the treatment of depressive episodes in bipolar disorder (BD). Despite its generally favorable tolerability profile, lamotrigine use is associated with a risk of Cutaneous Adverse Drug Reactions (cADRs), including Stevens–Johnson Syndrome (SJS) and Lyell’s syndrome, also known as toxic epidermal necrolysis (TEN). Genetic markers HLA and, in particular, HLA-B 15:02 and HLA-A 31:01 are crucial in predicting individuals’ susceptibility to developing the symptoms. The symptoms are triggered by type IV hypersensitivity developing because of CTL and NK cell activation, leading to keratinocyte apoptosis, epidermal necrosis and skin detachment. The exact pharmacotherapy that should be widely utilized in treating affected patients has not yet been established. New therapies including JAK inhibitors or cyclosporine show potential in improving outcomes by reducing mortality and enhancing the period of recovery. Key factors in preventing cADRs may include adequate patient observation, gradual titration of the patient’s dose, and reduction of risk factors through screening for HLA polymorphisms. When the initial symptoms of cADR are identified, it is imperative to make an immediate decision to discontinue treatment, as this can significantly reduce the risk of progression to SJS/TEN and systemic complications. The purpose of this review is to identify a significant correlation between lamotrigine use in BD and the occurrence of SJS by showing the risk factors, neuropharmacological mechanisms, immune response and correctness of pharmacotherapy. Full article

Cognitive aging is a complex, multifactorial process influenced by genetic, metabolic, and environmental factors. Among modifiable risk factors, nutrition has emerged as a promising target to preserve cognitive function. This review provides a comprehensive overview of the impact of dietary interventions—including specific nutrients and dietary patterns—on cognitive domains (memory, executive function, global cognition) and mental health. Recent findings: multinutrient supplementation, particularly combinations of B vitamins and omega-3 fatty acids, appears beneficial for episodic memory, especially in individuals with metabolic risk or early cognitive impairment. Antioxidant-rich diets and the MIND diet are consistently associated with better memory and global cognitive outcomes in observational studies. Effects on executive function and mental health remain heterogeneous, although subgroups such as those with mild cognitive impairment or depression may derive benefit. Evidence from interventional studies remains limited by methodological variability. In conclusion, dietary interventions offer a safe and promising approach to support cognitive health in aging. Future research should focus on developing personalized, multidomain prevention models tailored to individual risk profiles. Full article

Background/Objectives: Cariprazine, a D3/D2 partial agonist, is one of the few recommended treatment options for bipolar 1 disorder (BP1D) in Southeast Asia. This study aims to generate insights from leading experts on the safe and effective use of cariprazine for BP1D, specifically by formulating practical recommendations not thoroughly covered in the existing literature. Methods: A formal consensus methodology using the modified RAND/UCLA Appropriateness Method was employed to develop consensus recommendations. The methodology included a targeted literature search, creation of clinical scenarios, two rounds of rating of the appropriateness of each scenario on a nine-point Likert scale by an expert panel of psychiatrists from Southeast Asia (n = 13), and a face-to-face discussion among the expert panel between the two rounds of rating. In the absence of disagreement, scenarios were classified as appropriate (7–9), equivocal (4–6), or inappropriate (1–3) based on median scores. Clinical scenarios were subsequently converted to consensus recommendations upon approval by the expert panel. Results: Most experts recommended a 4–8-week trial of cariprazine for bipolar depression (85%) and 3–4 weeks for acute mania/mixed (71%). For longer treatment, 61.5% and 69% recommended >1 year for acute mania/mixed and bipolar depression, respectively. Cariprazine was also considered suitable as first-line therapy, including for first-episode bipolar depression (Mdn: 8, IQR: 7–9) and first-episode mania (Mdn: 8; IQR: 8–9). Conclusions: The consensus recommendations may serve as practical guidance for clinicians to make informed decisions regarding the management of adult patients with BP1D, while considering the preferences and circumstances of individual patients. Full article