Search Results (305)

Background: Emotional dysregulation (ED) is increasingly recognized as a clinically relevant dimension of adult attention-deficit/hyperactivity disorder (ADHD), yet its multidimensional structure and independent contribution beyond impulsivity and psychiatric comorbidity remain incompletely understood. This study aimed to characterize the profile of ED and its clinical correlates in a large, well-characterized clinical sample of adults with ADHD. Methods: In this cross-sectional observational study, 231 adults with a DSM-5 diagnosis of ADHD, confirmed through structured interview (DIVA 5), completed the Difficulties in Emotion Regulation Scale (DERS). Associations between ED and ADHD presentation, psychiatric comorbidity, current substance use disorder (SUD), impulsivity (BIS-11), problematic internet use (IAT), camouflaging behaviors (CAT-Q), and clinical functioning were examined using independent-samples t-tests, Pearson correlation analyses, and multiple linear regression models. Results: Participants showed elevated emotional dysregulation relative to reference data. When DERS subscales were interpreted against Italian reference values, the largest elevation was observed for Clarity, followed by Goals, Nonacceptance, and Impulse, whereas Strategies showed a more modest elevation and Awareness was only slightly higher than the reference value. The combined ADHD presentation was associated with significantly greater dysregulation compared to the predominantly inattentive presentation. Higher DERS total scores were observed among participants with combined ADHD presentation, psychiatric comorbidity, and current SUD. DERS total score was positively correlated with current ADHD symptoms, retrospective childhood ADHD symptoms, depressive symptoms, state and trait anxiety, impulsivity, problematic internet use, and camouflaging behaviors, and negatively correlated with ADHD-related quality of life. In multiple regression models, current SUD, current ADHD symptoms, retrospective childhood ADHD symptoms, trait anxiety, and ADHD-related quality of life were independently associated with DERS total score. Conclusions: Emotional dysregulation in adult ADHD represents a clinically relevant affective dimension that is only partially accounted for by impulsivity and is closely associated with psychosocial impairment and maladaptive coping behaviors. These findings support an integrated affective–executive framework for the assessment and treatment of adult ADHD, with implications for targeted, skills-based interventions addressing emotional regulation across clinical subgroups. Full article

Introduction: Problematic internet use has been increasingly associated with depression, anxiety and other psychiatric symptoms; however, its impact on attentional functioning has not been thoroughly researched. This cross-sectional study was conducted in Târgu Mureș, Romania, and aimed to examine the associations between problematic internet use, attentional control, and symptoms of depression and anxiety in adults, and to determine whether problematic internet use independently predicts attentional control after accounting for emotional symptoms. Methods: A cross-sectional study was conducted on 224 adults who completed an anonymous online survey between 1 January 2026 and 1 April 2026. Problematic internet use was assessed using the Compulsive Internet Use Scale-14 (CIUS-14), attentional control using the Attentional Control Scale (ACS), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the Generalized Anxiety Disorder-7 scale (GAD-7), and eating disorder risk using the SCOFF questionnaire. Descriptive statistics, internal consistency analyses, Pearson correlations, group comparisons according to the CIUS-14 screening threshold, and multiple linear regression analyses were performed. Results: Problematic internet use was significantly associated with lower attentional control (r = −0.493, p < 0.001), higher depressive symptoms (r = 0.408, p < 0.001), and higher anxiety symptoms (r = 0.467, p < 0.001). In the regression model, problematic internet use remained the only significant independent predictor of attentional control (B = −0.597, p < 0.001), whereas depressive and anxiety symptoms were not significant after adjustment. Participants above the CIUS-14 screening threshold reported significantly lower attentional control and higher depression and anxiety scores than those below the threshold. Conclusions: Problematic internet use was associated with poorer attentional control and greater emotional symptom severity in Romanian adults. These findings suggest that problematic internet use may be linked to a broader cognitive–emotional vulnerability profile. However, because of the cross-sectional design, self-report measures, convenience sampling, and lack of detailed information on specific online activities, the findings should be interpreted cautiously. Longitudinal studies using objective cognitive measures and more detailed assessment of digital behaviors are needed. Full article

Background/Objectives: The increasing reliance on the Internet for health information has contributed to the emergence of cyberchondria, a phenomenon closely associated with health anxiety and potentially linked to sleep disturbances. Evidence remains limited in the Saudi context, particularly regarding differences between individuals with and without psychosomatic disorders. Methods: A cross-sectional observational study was conducted among 1224 Saudi adults (535 with psychosomatic disorders and 689 without). Data were collected using validated instruments, including the Cyberchondria Severity Scale (CSS-12), Short Health Anxiety Inventory (SHAI-18), and Pittsburgh Sleep Quality Index (PSQI). Statistical analyses included Pearson correlation coefficients and two-way ANOVA. Results: The prevalence of cyberchondria was 56.78%, health anxiety 38.76%, and poor sleep quality 56.9%. Significant positive correlations were observed between cyberchondria, health anxiety, and poor sleep quality across both groups, with stronger associations among individuals with psychosomatic disorders. Two-way ANOVA revealed a significant main effect of clinical status on all variables and a significant effect of sex on health anxiety, with higher levels among females. Conclusions: Findings highlight a significant interplay between cyberchondria, health anxiety, and sleep quality, particularly among individuals with psychosomatic disorders. These results underscore the need for targeted public health interventions addressing digital health behaviours and mental health. Full article

Background: Internet Gaming Disorder (IGD) has been linked to sleep disturbances, yet evidence from Saudi students is limited. Objective: We examined IGD symptom burden and its associations with daily gaming time and sleep quality among high school and university students in Riyadh, Saudi Arabia. Methods: In a cross-sectional online survey, participants completed the applicable consent process and were screened for gaming. Gamers completed a DSM-5–based IGD checklist and the Pittsburgh Sleep Quality Index (PSQI). IGD symptom count was analyzed using negative binomial regression (IRR), adjusting for sociodemographic and academic covariates and then adding PSQI total score. Results: Of invited students (N = 534), (n = 408) were gamers. Among those with complete PSQI totals (n = 352), the mean PSQI was (7.49) (SD = 3.46), and poor sleep (PSQI > 5) affected about two-thirds. Longer daily gaming time was significantly associated with higher expected IGD symptom counts. After adjustment, higher PSQI total score remained significantly associated with greater symptom burden (Adjusted IRR = 1.049 per 1-point increase), while demographic variables and academic-performance score were not significant. Conclusions: IGD symptom burden and poor sleep were common among student gamers in Riyadh. Longer daily gaming time and poorer sleep quality were associated with higher IGD symptom counts. These findings may inform prevention efforts related to gaming habits and sleep hygiene; however, longitudinal studies are needed to clarify temporal directionality and determine whether these associations reflect causal pathways. Full article

The rapid expansion of digital technologies has created an unprecedented level of increased connectivity, yet the neurobiological mechanisms underlying these changes remain incompletely understood. This systematic review synthesizes the currently available evidence on neurobiological findings related to problematic internet use, problematic smartphone/social media use, and internet gaming disorder, with a focus on reward processing, attentional control, and emotional regulation. Across the included studies, recurrent findings suggested the involvement of fronto-striatal circuitry, salience- and reward-related regions, and executive-control networks. Alterations in large-scale brain networks, including the default mode, salience, and frontoparietal systems, were also reported, although the evidence base was heterogeneous and consisted largely of cross-sectional studies with modest sample sizes. Overall, the findings support a provisional neurobiological framework linking reward-related processing, inhibitory-control difficulties, and large-scale network alterations, but better-standardized studies are needed to draw conclusions. Full article

Autoimmune pancreatitis (AIP) represents a rare multifaceted disorder group with currently three types that were recently supplemented by a newly described AIP type causally related to sunlight exposure, not previously reported in any of the AIP publications. The internet search disclosed that the new AIP type was different from three existing AIP types: the AIP-1 or AIP-2 types, both featured by idiopathy, and the AIP-3 type, triggered by immune checkpoint inhibitors. Accordingly, it seemed appropriate to classify the novel AIP as the AIP-4 type, with typical features such as a clear culprit of sunlight exposure, ascertained by a positive result of an unintentional re-exposure and considered a diagnostic gold standard; coexisting secondary sclerosing cholangitis without progression to vanishing bile duct syndrome; and ultimately unavoidable pancreatic atrophy with clinical exocrine insufficiency despite long-term treatment with immunosuppressive drugs. Thus, the recent description of a new AIP type, now classified as the AIP-4 type, is strongly associated with significant sunlight exposure and calls for a reclassification of AIP types that includes AIP-4, whereby additional efforts are essential to identify the causative factors of the AIP-1 and AIP-2 types, including drugs commonly used in the respective cohorts, which also comprise older patients with comorbidities. Full article

Sleep disorders, such as insomnia, obstructive sleep apnea (OSA), narcolepsy, REM sleep behavior disorder, and circadian rhythm disturbances, represent a rapidly expanding global health burden that is strongly associated with cardiovascular, metabolic, neurological, and psychiatric diseases. Advancements in wearable sensing technologies and Internet of Medical Things (IoMT) infrastructures have expanded the possibilities for continuous, home-based sleep assessment beyond conventional polysomnography laboratories. These Sleep Health Internet of Things (S-HIoT) systems combine multimodal physiological sensing (EEG, ECG, SpO₂, respiratory effort and actigraphy) with wireless communication and cloud-based analytics for automated sleep-stage classification and disorder detection. Nonetheless, the digitization of sleep medicine brings about significant cybersecurity concerns. The constant transmission of sensitive biomedical information makes S-HIoT networks open to anomalous traffic flows, signal manipulation, replay attacks, spoofing, and data integrity violation. Existing studies mostly focus on analyzing physiological signals and network intrusion detection independently, resulting in a systemic vulnerability of cyber–physical sleep monitoring ecosystems. With the aim of addressing this empirical deficiency, this review integrates emerging advances (2022–2026) in the AI-assisted categorization of sleep phases and IoMT anomaly detector designs on the finer analysis of CNN, LSTM/BiLSTM, Transformer-based systems, and a component part of federated schemes and the lightweight, edge-deployable intruder assessor models available. The aim of this study is to uncover a gap in the literature: integrated architectures to trade off audiences of faithfulness of physiological modeling with communication-layer security. To counter it, we present a single framework to include CNN-based spatial feature extraction, Bidirectional Long Short-Term Memory (BiLSTM)-based temporal models and Random Forest-based ensemble classification using a dual task-learning approach. We propose a multi-objective optimization framework to jointly optimize the performance of sleep-stage prediction and that of network anomaly detection. Performance on publicly available datasets (Sleep-EDF and CICIoMT2024) confirms that hybrid integration can be tailored to achieve high accuracy [99.8% sleep staging; 98.6% anomaly detection] whilst being characterized by low inference latency (<45 ms), which is promising for feasibility in real-time deployment in view of targeting edge devices. This work presents a comprehensive framework for developing secure, intelligent, and clinically robust digital sleep health ecosystems by bridging chronobiological signal modeling with cybersecurity mechanisms. Furthermore, it highlights future research directions, including explainable AI, federated secure learning, adversarial robustness, and energy-aware edge optimization. Full article

Internet Gaming Disorder (IGD) has become a major behavioral health concern among adolescents, yet current assessment tools remain limited. These tools often fail to capture the disorder’s complex symptom variations and lack clinical interpretability. This study, taking an interdisciplinary approach that combines clinical psychology and psychometrics, summarizes recent progress in understanding adolescent IGD and the development of its assessment methods. We compare the diagnostic criteria of the DSM-5 TR and ICD-11 and argue that the nine DSM-5 TR criteria are particularly suited for transformation into distinct diagnostic attributes due to their detailed and actionable nature. We then review the strengths and weaknesses of Classical Test Theory (CTT), Item Response Theory (IRT), and Cognitive Diagnostic Models (CDMs) in assessing IGD. The review emphasizes the limitations of total-score and single latent-trait approaches in capturing the disorder’s multidimensional symptoms. Based on these insights, we propose a conceptual assessment framework, Cognitive Diagnosis Computerized Adaptive Testing (CD-CAT), that integrates CDMs with computerized adaptive testing. Rather than presenting an empirically validated system, this framework offers a theoretically grounded proposal that specifies the key components, logical relationships, and methodological pathways necessary for advancing precision assessment of adolescent IGD. CD-CAT uses a system of attributes and a Q-matrix based on the DSM-5 TR criteria to efficiently classify IGD symptoms in adolescents, reducing the number of items required while enhancing clinical relevance. Lastly, we discuss the theoretical contributions of the proposed framework, acknowledge its limitations as a conceptual proposal, and outline directions for future empirical research. Full article

Background: research suggests that adolescents with a migrant background may be particularly vulnerable to behavioral addictions, including problematic gaming and Internet use. Methods: we compared Italian (ITA) and non-Italian (WIC) students on Internet Gaming Disorder (IGD) and Internet Addiction (IA) and examined whether coping strategies and interpersonal-relationship quality were associated with these outcomes, using robust linear models estimated with the GENLIN procedure in IBM SPSS Statistics 31 and regression-based models on observed variables. A total of 535 students (64.5% female; aged 9–18) completed the Video Games Addiction Questionnaire (VGA), the Internet Addiction Test (IAT), the Children’s Coping Strategies Checklist–Revised (CCSC), and the Assessment of Interpersonal Relations (AIR). Results: robust generalized linear models showed that WIC adolescents reported significantly higher IGD levels than their Italian peers, while no differences emerged for IA. Gender differences were evident only in unadjusted models, with males reporting higher IGD and females higher IA; however, these effects were not significant once age and nationality were considered simultaneously. Age was positively associated with IA but not with IGD. Avoidance coping was associated with higher levels of both IGD and IA, whereas active coping was negatively associated with IGD. Relationship quality was not associated with IGD but showed protective effects for IA: better relationships with mothers and with both male and female peers were associated with lower IA scores. Overall, the findings highlight that IGD and IA follow partially distinct developmental patterns. Migrant background emerged as a specific vulnerability factor for IGD, while IA appears more closely linked to age-related processes, coping styles, and interpersonal-relationship quality. Conclusions: the results call for differentiated prevention and intervention approaches targeting the distinct etiological mechanisms of each problematic behavior, focusing on coping and migration-related stress and belonging for IGD, and on strengthening coping repertoires and relational resources for IA. Full article

Background/Objectives: Adolescents and university students appear to be at increased risk for internet addiction (IA), while disordered eating behavior (DEB) is common in these age groups. At the same time, adherence to the Mediterranean diet (MD) has declined in many countries. This study aimed to explore the potential association between IA, DEB and MD compliance among high school and university students. Methods: A total of 212 students aged 15–24 years participated in this cross-sectional study conducted in Greece. Data were collected via an online questionnaire including the Internet Addiction Test (IAT), KIDMED, and EAT-26 scales. Descriptive statistics, chi-square tests, and univariate and multivariate logistic regression analyses were performed. Results: Most participants demonstrated normal internet use (69.8%), while 23.1% showed mild IA and 7.1% moderate IA. Regarding dietary habits, 9.4% had low MD adherence, 52.8% moderate and 37.7% high adherence. A total of 15.6% scored above the EAT-26 cut-off, indicating risk for disordered eating behavior. IA was only significantly associated with urbanization (p = 0.014). MD adherence was not associated with gender, urbanization, financial or education status. Multivariate logistic regression showed that female gender (OR = 9.28, 95% CI: 2.10–40.91, p = 0.003) and moderate IA (OR = 6.70, 95% CI: 1.71–26.35, p = 0.006) were significant predictors of disordered eating, while educational status and MD adherence were not significant predictors. Conclusions: Moderate IA and female gender were strongly associated with an increased risk for disordered eating. Further qualitative and clinical studies are needed to better understand the interaction between IA, eating behaviors, and dietary patterns in young people. Full article

Internet gaming disorder (IGD) and nonmedical prescription drug use (NMPDU) are prevalent, co-occurring concerns among young adults. Although prior research links problematic gaming and substance misuse, few studies have examined this relationship in non-college populations or whether student status modifies this association. This study examined the relationship between Gaming Addiction Scale (GAS) score and NMPDU among 1022 Rhode Island young adults aged 18 to 25. In the total sample, 44.6% identified as cisgender heterosexual female, 42.4% as sexual or gender minority (SGM), and 13.0% as cisgender heterosexual male. Multivariable logistic regression estimated the adjusted association between GAS scores and NMPDU, and an interaction term between GAS and student status was tested. Overall, 12.1% reported lifetime NMPDU. Higher GAS scores were associated with increased odds of NMPDU (adjusted odds ratio [AOR] = 1.05; 95% confidence interval [CI]: 1.01–1.09). Student status alone was not significantly associated with NMPDU; however, a significant interaction was observed between GAS and student status (AOR = 1.09, 95% CI: 1.01–1.18, p = 0.031). Higher GAS scores were positively associated with NMPDU, with student status strengthening this association. Findings support screening for problematic gaming, particularly among students, and integrated prevention strategies addressing both behavioral and substance-related risks. Full article

Background: Addictive disorders are characterized by the dysregulation of neural circuits involved in reward processing, salience attribution, emotional regulation, and cognitive control. Traditional neuroimaging paradigms based on static or two-dimensional stimuli show limited ecological validity and may fail to capture the contextual complexity of real-world addictive triggers. Immersive virtual reality (VR) offers a novel approach to simulate realistic, multisensory environments capable of eliciting craving and emotional responses. Although several reviews have examined VR in addictive disorders, most combined immersive and non-immersive tools and did not restrict inclusion to studies with brain-based outcomes. Methods: This systematic review with narrative synthesis was conducted in PubMed/MEDLINE and APA PsycINFO for studies published up to 30 December 2025. This systematic review followed PRISMA 2020 and was prospectively registered in PROSPERO; due to heterogeneity, findings were synthesized narratively. Eligible studies included human participants with substance-related or behavioral addictions and employed immersive VR paradigms (e.g., head-mounted display–based environments) combined with neuroimaging or neurophysiological measures (EEG, fMRI, fNIRS, PET, or DTI). Risk of bias was assessed using ROB-2 or ROBINS-I, and overall certainty of evidence was evaluated with the GRADE framework. Results: Ten studies met the inclusion criteria, encompassing over 1450 participants with alcohol, nicotine, methamphetamine, opioid use disorders, and internet gaming disorder. Immersive VR was associated with craving-related neural responses across modalities, involving prefrontal, insular, limbic, and striatal networks. EEG studies reported spectral power changes associated with craving and attentional salience, while fMRI, fNIRS, and PET studies demonstrated activation and modulation of executive control and reward-related circuits. Preliminary longitudinal and interventional studies indicate that repeated VR exposure may induce neurobiological changes consistent with therapeutic modulation. Conclusions: Immersive VR combined with neuroimaging supports the use of immersive VR as an ecologically grounded framework to probe addiction-related brain circuits; however, larger trials and standardized reporting are needed to strengthen clinical translation. Future studies should prioritize adequately powered randomized designs, harmonized VR cue-reactivity paradigms, and transparent neuroimaging reporting to enable reproducibility and cumulative inference. Full article

Background/Objectives: Insomnia is common among adolescents and is associated with emotional, behavioral, and academic difficulties. Although high rates have been reported globally, evidence in Latin America—particularly in Peru—remains limited and heterogeneous. Many previous studies relied on small samples, descriptive designs, omitted key psychosocial variables, or were conducted during early pandemic waves, despite the rise in sleep disturbances following COVID-19 restrictions. This study aimed to estimate the prevalence of insomnia and identify associated factors among adolescents in northern Peru. Methods: An analytical cross-sectional study was conducted using secondary data from students attending five schools in Lambayeque, Peru. Insomnia was assessed using the Insomnia Severity Index (ISI). Sociodemographic, psychosocial, behavioral, and health-related variables—including self-esteem, family dysfunction, eating disorders, acne severity, mental health help-seeking, and digital behavior—were evaluated. Generalized linear models estimated prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Among 1313 adolescents (54.3% male; mean age 14.6 years), the prevalence of insomnia was 38.9% (95% CI: 36.1–41.5). In adjusted analyses, insomnia was associated with urban residence, non-Catholic religion, seeking mental health support, high social media use, internet use of 6–10 h/day, low self-esteem, eating disorders, greater acne severity, and experiencing the death of a family member due to COVID-19. Conclusions: Nearly four in ten adolescents reported insomnia, influenced by sociodemographic, psychosocial, and lifestyle-related factors. These findings provide updated post-pandemic evidence for the Peruvian context and highlight the multifactorial nature of adolescent insomnia. Further research is needed to clarify causal pathways and understand the long-term mental health implications of large-scale stressors such as the COVID-19 pandemic. Full article

Background/Objectives: Digital environments have intensified exposure to interpersonal stressors and appearance-related evaluation, raising concerns about cyberbullying and problematic internet use among women with eating disorders (EDs). This study examined whether cyberbullying exposure and problematic online use are associated with health-related quality of life in women receiving specialized outpatient care for eating disorders in Spain. Methods: We conducted a cross-sectional analysis of baseline data collected between 2018 and 2019 from a clinical cohort of 124 women in specialized ED treatment. ED symptoms were assessed using the SCOFF and the Bulimic Investigatory Test, Edinburgh (BITE). Problematic online use was measured with the Internet Addiction Test (IAT) and the Bergen Facebook Addiction Scale (BFAS), and cyberbullying exposure was summarized using a composite index. HRQoL was assessed with the EQ-5D index and visual analogue scale (EQ-VAS). Associations were examined using correlation analyses, group comparisons, and exploratory multiple linear regression models adjusting for age, body mass index (BMI), diagnosis, and comorbidity. Results: Cyberbullying exposure was strongly positively correlated with problematic internet and social media use (IAT and BFAS). Its bivariate associations with ED symptom measures were small and not statistically significant. Participants with physical or mental health comorbidities reported lower HRQoL on both the EQ-5D index and EQ-VAS scores (p < 0.01). In the exploratory adjusted regression model predicting EQ-5D, coefficients for cyberbullying exposure, IAT, and BITE severity were small and imprecisely estimated, whereas diagnosis category showed between-group differences (with the “other ED” category reporting lower EQ-5D scores relative to the reference group). The overall model explained approximately 26.7% of the variance in EQ-5D (adjusted R² = 0.22). Conclusions: In this clinical sample, digital-use measures co-occurred strongly with one another, and comorbidity was associated with poorer HRQoL at the bivariate level. In exploratory adjusted models, estimated associations of cyberbullying and problematic online use with HRQoL were imprecise, supporting cautious interpretation. Prospective and intervention studies are needed to determine whether digital interpersonal stressors contribute to HRQoL trajectories in women receiving specialized ED care and whether targeting these stressors improves patient-reported outcomes. Full article

Mental health disorders affect nearly one billion people worldwide, yet treatment gaps exceed 75% in low- and middle-income countries. Teletherapy has emerged as a scalable solution, but its adoption differs sharply by economic context. This comparative ecological policy analysis used secondary aggregate data from WHO, World Bank, ITU, and national reports to examine teletherapy adoption in low-income (Nigeria, Kenya), middle-income (South Africa, India), and high-income countries (Norway, Canada). Descriptive statistics and simple linear regression were applied, with findings interpreted through the Consolidated Framework for Implementation Research (CFIR), Technology Acceptance Model (TAM), and Diffusion of Innovations theory. High-income countries achieved widespread adoption (>70%), enabled by universal broadband, comprehensive regulation, and strong reimbursement. Middle-income countries showed moderate uptake (15–30%), constrained by rural–urban digital divides and inconsistent policies. Low-income countries reported minimal integration (<5%), limited by unreliable internet, severe workforce shortages, high data costs, and sociocultural barriers. Digital infrastructure, regulatory maturity, and mental health workforce density explained 78% of the cross-country variance in adoption rates (R² = 0.78). Equitable scale-up of teletherapy directly supports SDGs 3, 9, 10, and 17. Targeted investment and cross-income collaboration are essential to prevent digital mental health solutions from exacerbating existing inequities. Full article