Search Results (171)

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

Background/Objectives: Chronic pain and eating disorders are two prevalent and disabling pediatric health concerns, with serious, life-threatening consequences. These conditions can co-occur, yet little is known about best practices addressing comorbid pain and eating disorders. Delayed intervention for eating disorders may have grave implications, as eating disorders have one of the highest mortality rates among psychological disorders. Moreover, chronic pain not only persists but worsens into adulthood when left untreated. This study aimed to understand pediatric clinicians’ experiences with adolescents with chronic pain and eating disorders. Methods: Semi-structured interviews were conducted with hospital-based physicians (N = 10; 70% female; M years of experience = 15.3) and psychologists (N = 10; 80% female; M years of experience = 10.2) specializing in anesthesiology/pain, adolescent medicine/eating disorders, and gastroenterology across the United States. Audio transcripts were coded, and thematic analysis was used to identify key themes. Results: Clinicians described frequently encountering adolescents with chronic pain and eating disorders. Clinicians described low confidence in diagnosing comorbid eating disorders and chronic pain, which they attributed to lack of screening tools and limited training. Clinicians collaborated with and consulted clinicians who encountered adolescents with chronic pain and/or eating disorders. Conclusions: Results reflect clinicians’ desire for additional resources, training, and collaboration to address the needs of this population. Targets for future research efforts in comorbid pain and eating disorders were highlighted. Specifically, results support the development of screening tools, program development to improve training in complex medical and psychiatric presentations, and methods to facilitate more collaboration and consultation across health care settings, disciplines, and specialties. Full article

Background: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent episodes of intense nausea and vomiting. Despite increasing awareness, a standardized treatment approach remains lacking in pediatric populations. Lifestyle factors and anxiety are common triggers, yet their systematic management has not been fully incorporated into therapeutic strategies. Objective: To evaluate the effectiveness of lifestyle modifications and selective serotonin reuptake inhibitors (SSRIs) in the management of pediatric CVS and to compare their outcomes with standard cyproheptadine prophylaxis. Methods: This retrospective study included 119 patients aged 1.2–17.5 years who were diagnosed with CVS according to Rome IV criteria between September 2021 and January 2025. Clinical, psychiatric, and lifestyle data were retrieved from the university’s digital medical records. Patients were grouped according to treatment modality: cyproheptadine, SSRI, or acute attack management alone. Treatment success at 12 weeks was defined as complete cessation of vomiting episodes or absence of hospitalization, prolonged attacks, and school/work absenteeism. Results: Anxiety symptoms were present in 78.2% of patients. SSRIs were prescribed to 34 patients with moderate to severe anxiety, all of whom achieved treatment success. Lifestyle adherence was observed in 73.9% and was found to be a predictor of treatment success. Cyproheptadine was administered to 66 patients but did not provide additional benefit over effective lifestyle modification. Six patients discontinued cyproheptadine due to drowsiness or weight gain. Conclusions: Lifestyle interventions significantly improve outcomes in pediatric CVS. SSRIs represent a safe and effective prophylactic option for patients with comorbid anxiety or poor adherence to behavioral recommendations. These findings support the integration of psychosocial and lifestyle-based strategies into standard CVS treatment protocols. Full article

Depression, anxiety, and perceived stress are common comorbidities in patients with inflammatory bowel disease (IBD) and may negatively influence the disease course. Likewise, severe IBD may contribute to the development or worsening of psychiatric symptoms. Despite the established relevance of the gut–brain axis and frequent use of psychotropic medications in IBD patients, limited evidence exists regarding the effects of psychiatric treatments on gastrointestinal disease activity. Therefore, the aim of this systematic review is to evaluate the effectiveness of psychiatric therapies on gastrointestinal symptoms and disease activity in patients with IBD. The work was conducted in accordance with PRISMA guidelines. Searches were performed across PubMed, Web of Science, and Scopus up to July 2024. Eligible studies evaluated the effectiveness of psychiatric medications—including antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers, anticonvulsants, and others—on at least one gastrointestinal outcome in patients with IBD. Outcomes included changes in commonly used clinical and endoscopic scores for Crohn’s disease (CD) and ulcerative colitis (UC), number of bowel movements, stool consistency, presence of blood in stool, severity of abdominal pain, as well as in surrogate markers of disease activity following treatment. Out of 8513 initially identified articles, 22 studies involving 45,572 IBD patients met the inclusion criteria. Antidepressants, particularly bupropion, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and duloxetine, were associated with improvements in IBD activity scores, including Crohn’s Disease Activity Index (CDAI) and Simple Endoscopic Score for Crohn’s Disease (SES-CD) for CD, Mayo score and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for UC. Case reports highlighted potential benefits of pregabalin and lithium carbonate, respectively, showed by the reduction in clinical and endoscopic score of disease activity for pregabalin and improvement of UC symptoms for lithium carbonate, while topiramate showed limited efficacy. Clonidine and naltrexone determined the reductions in clinical and endoscopic score of disease activity, including CDAI and Crohn’s disease endoscopy index severity score (CDEIS) for CD and Disease Activity Index (DAI) for UC. Despite the limited data and study heterogeneity, antidepressants, naltrexone, and clonidine were associated with improvements in IBD activity. Larger, prospective studies are needed to confirm the therapeutic potential of psychiatric medications in modulating IBD activity and to guide integrated clinical management. Full article

Background/Objectives: The understanding of the mechanisms involved in the etiopathogenesis and maintenance of Bipolar Disorder (BD) should be a priority to identify potential early clinical markers that could help in improving treatment strategies and prevention. The aim of this study was to investigate the potential correlation between hopelessness, alexithymia, mind wandering, and rumination in patients with a primary diagnosis of BD, evaluating whether these psychopathological aspects could negatively affect bipolar illness. Methods: A semi-structured interview was used to collect sociodemographic and clinical characteristics. Several psychometric tools were administered: the Beck Hopelessness Scale; Toronto Alexithymia Scale; Rumination Response Scale; Mind Wandering Questionnaire; Mind Wandering: Deliberate; Mind Wandering: Spontaneous; and the Daydreaming Frequency Scale. Results: Patients with high levels of hopelessness have a greater number of psychiatric and medical comorbidities and are more frequently on polypharmacotherapy. Additionally, patients with high levels of hopelessness show a greater likelihood of having attempted suicide during their lifetime. The presence of alexithymia is associated with longer hospitalization and psychiatric comorbidities. Higher levels of rumination correlate with a greater number of psychiatric and medical comorbidities, and with the presence of residual symptoms. Mind wandering is associated with the presence of medical comorbidities and residual symptoms. Conclusions: Hopelessness, alexithymia, mind wandering, and rumination should be identified as important proxies of impaired subjective well-being that should be carefully monitored because they could further worsen the clinical course of BD and suicidal risk in this vulnerable population. Full article

Background: Feeding and eating disorders (FEDs) represent a global health problem with an increasing incidence and a progressively earlier onset. Residential treatment is notable for its intensity and ability to provide multidisciplinary support to both patients and families. The objective of this study was to clinically characterize patients and to evaluate the impact of treatment at the “Orti di Ada” facility on the evolution of FEDs in adolescent patients. Methods: A cohort of 47 minors, treated in 2019–2024, was studied through longitudinal observation. Data were collected from medical records, and standardized questionnaires were administered at baseline (T0) and at the conclusion of treatment (T1). Comparisons between scores on the scales were made using paired t-tests for within-group changes from T0 to T1 or using Mann–Whitney tests for between-group comparisons. Spearman’s correlation coefficient was used to assess the relationship between pairs of variables. Results: The sample consisted of female patients (mean age: 15 years). The mean body mass index (BMI) at T1 was 16.6 kg/m². The majority of patients (74.5%) had been undergoing treatment for less than one year. Most patients had been diagnosed with restrictive-type anorexia nervosa (74.5%), while 53.2% had multiple concomitant psychiatric comorbidities. The mean BMI increased to 18.7 kg/m², suggesting biological recovery, along with the restoration of the menstrual cycle. Conclusions: Psychological measures showed significant improvements in subjects with exclusive depressive comorbidity. The correlations of age and disease duration with changes in questionnaire scores suggest that earlier treatment leads to more favorable outcomes. The results provided insights into the appropriateness of intensive treatment that, when targeting specific psychological factors, improves biological and psychological recovery. Full article

This review explores the origins and principles of milieu therapy, which is traditionally rooted in psychiatric settings, and examines how these concepts can be adapted for patients with dementia. While milieu therapy initially focused on long-term psychiatric inpatients, the increasing prevalence of dementia—often with complex neuropsychiatric symptoms and extended care needs—warrants a renewed look at structured therapeutic environments. Unlike psychiatric conditions that may show significant improvement with medication, dementia typically involves progressive cognitive decline and multiple comorbidities, calling for a greater emphasis on safety, predictability, and emotional support. Core principles—therapeutic environment, social interaction, consistency, shared responsibility, empowerment, and individualized interventions—can be tailored to address dementia-specific needs, including orientation aids, simplified routines, and nonverbal communication strategies. Moreover, considering that dementia predominantly affects older adults, comprehensive geriatric care becomes crucial, requiring a collaborative team approach that includes medical, psychiatric, and rehabilitative expertise. In such environments, the focus shifts from cure to maximizing well-being, dignity, self-control, and residual abilities, underscoring the relevance of milieu therapy in modern dementia care. Full article

Background/Objectives: Multiple sclerosis (MS) is often associated with comorbidities that affect clinical outcomes. Data on comorbidities can be sourced from self-reports, medical records, and administrative databases. The gold standard for collecting such data is prospective clinical collection, as in clinical trials, but this is not feasible in large epidemiological studies. This study aimed to assess the agreement between two data sources, clinical interviews and administrative records, identifying major comorbidities in people with MS (pwMS). Methods: We evaluated the agreement between clinical interview data and administrative records in pwMS enrolled at two sites (2021–2022). Seven comorbidities were investigated: depression, anxiety, diabetes, hypertension, autoimmune disease, chronic lung disease, and hyperlipidemia. We used kappa (κ), sensitivity, specificity, and predictive values to assess agreement. Results: The frequency of comorbidities varied between the sources. Administrative data often underestimated hypertension, autoimmune diseases, hyperlipidemia, and anxiety, but over-reported depression. It had high sensitivity for diabetes (80%) and moderate sensitivity for hypertension (62%). The agreement for diabetes (κ = 98.9%, PABAK = 0.98, positive agreement = 83.3%) and hypertension (κ = 89.8%, PABAK = 0.80, positive agreement = 70.8%) was high. Conclusions: The agreement between administrative data and clinical interviews was excellent for diabetes and hypertension. For other conditions, such as psychiatric, hyperlipidemia, and autoimmune comorbidities, administrative data had lower sensitivity, and often under-reported or misclassified the data. Full article

Background/Objectives:Tinnitus, the perception of sound without an external source, is a prevalent and often distressing condition with complex neurobiological and psychological underpinnings. A growing body of literature suggests a frequent co-occurrence between tinnitus and psychiatric symptoms such as anxiety, depression, and sleep disturbances. However, the extent to which these conditions are associated, and whether treatments targeting one domain impact the other, remains unclear. This scoping review aimed to (1) identify associations between tinnitus and mental health comorbidities, (2) evaluate whether tinnitus treatments affect psychiatric outcomes, and (3) explore whether psychiatric treatments influence tinnitus symptoms. Methods: A comprehensive search of PubMed, MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and Google Scholar was conducted for articles published between January 2014 and May 2025. Eligible studies were written in English, French, or Spanish, focused primarily on tinnitus, included at least one co-occurring psychiatric condition, and described how tinnitus was evaluated. A total of 30 studies were included. Data were extracted and synthesized thematically. Study quality was assessed using the Mixed Methods Appraisal Tool and relevant Joanna Briggs Institute checklists. Results: Most studies reported significant associations between tinnitus and psychiatric symptoms, particularly anxiety, depression, stress, insomnia, and, in some cases, psychosis. Treatments aimed at tinnitus, such as eye movement desensitization and reprocessing and cognitive behavioral therapy, were sometimes associated with secondary improvements in mental health. Conversely, limited evidence suggested that psychiatric treatment, including antipsychotic medication and psychotherapy, may reduce tinnitus severity in selected cases. Conclusions: Tinnitus and psychiatric comorbidities frequently co-occur, and early evidence suggests that addressing one may benefit the other. Given the specific inclusion criteria, this review presents a selected subset of the broader literature, focusing only on studies that evaluated tinnitus alongside clinically measured psychiatric symptoms. Future research should prioritize integrated, longitudinal interventions to better understand these complex interactions. Full article

Background: Individuals with inflammatory bowel diseases (IBDs) have an increased risk of developing psychiatric co-morbidities, including restrictive eating disorders (REDs), with which they share common pathogenic mechanisms, including gut–brain axis dysregulation. We conducted a case–control study systematically exploring the psychopathological profiles and alexithymia in adolescents with IBDs compared with a clinical group of adolescents diagnosed with REDs in order to test the hypothesis of common psychological characteristics between the two patient populations. Methods: We recruited 76 patients with IBDs and 76 age-matched controls with REDs (64 adolescents with anorexia nervosa and 12 adolescents with avoidant/restrictive food intake disorder). All participants completed a validated psychometric battery assessing psychological symptoms (SCL-90-R), ED features (EDI-3), and alexithymia (TAS-20). Comprehensive socio-demographic and clinical data were extracted from the medical records. Results: A total of 12 patients with IBDs (15.8%) scored higher than the cut-off (>70th percentile) on the EDI-3 scale for Eating Disorder Risk (EDI-EDRC), with a psychological profile comparable to RED patients. Female gender (OR = 0.133, p = 0.020) and longer disease duration (OR = 1.055, p = 0.036) were identified as significant risk factors for the development of EDs. Conclusions: Our findings suggest common psychological traits between patients with REDs and patients with IBDs at risk of developing EDs during adolescence, highlighting the need for early screening for EDs in patients with IBDs who present with specific socio-demographic and disease characteristics. Full article

Background/Objectives: Psoriasis is a chronic inflammatory skin disease increasingly linked to psychiatric and behavioral comorbidities, including depression, anxiety, and substance use disorders. Shared inflammatory pathways, including elevated IL-6, TNF-α, and IL-17, may link psoriasis with psychiatric disorders such as depression and anxiety. The bidirectional interaction between systemic inflammation and mental health may exacerbate the disease burden and affect treatment outcomes. The objective of this study was to determine the prevalence of psychiatric and behavioral comorbidities in patients with psoriasis and to explore potential demographic and clinical correlations. Assessing these correlations contributes to a better understanding of the mental health status of psoriasis patients, potentially influencing both therapeutic efficacy and quality of life. Methods: We conducted a cross-sectional observational study on 316 patients with clinically and histopathologically confirmed psoriasis, evaluated between January 2021 and March 2025 at the Clinical Railway Hospital in Iași, Romania. Psychiatric and behavioral comorbidities were assessed through clinical interviews, medical record reviews, and standardized tools including AUDIT-C, Fagerström Test for Nicotine Dependence, and the Binge Eating Scale. Psoriasis severity was evaluated using the Psoriasis Area and Severity Index (PASI). Results: Of 316 participants, 88 (27.8%) had psychiatric/behavioral comorbidities. The most frequent conditions were tobacco use disorder (11.1% overall; 39.8% among comorbid patients), alcohol use disorder (9.2%; 32.9%), binge eating (7.9%; 28.4%), anxiety (6.3%; 22.7%), and depression (4.1%; 14.8%). Additional diagnoses included personality disorders, dementia, PTSD, and sleep disorders. Conclusions: Psychiatric and behavioral comorbidities, particularly substance use disorders, are relatively common in patients with psoriasis. These findings support the need for regular mental health screening and integrated care approaches in psoriasis management. Full article

Background: Stellate Ganglion Blocks (SGB) involve injecting local anesthetic near the stellate ganglion, which includes the C6, C7, and T1 ganglia. This procedure induces a sympathetic blockade and has been employed to address various conditions, such as post-traumatic stress disorder (PTSD), ventricular arrhythmias, and chronic pain syndromes like complex regional pain syndrome (CRPS). Central to this case series is the exploration of SGB as a unified treatment for PTSD and chronic low back pain—two conditions linked by central sensitization. Case Series Overview: The study presents three female veterans with histories of PTSD, chronic low back pain, and myofascial pain. These patients had not responded to conventional treatments, including medications and interventional procedures. They underwent SGB with a combination of 10 mg preservative-free dexamethasone sodium phosphate, 4 mL preservative-free lidocaine 2% with epinephrine, and 1 mL preservative-free bupivacaine 0.25%. The procedure was well tolerated without adverse effects. All three patients experienced significant improvements. The first and third patients reported reductions in PTSD symptoms, low back pain, and myofascial pain. The second patient experienced relief from PTSD symptoms and prolonged reduction in myofascial pain. This case series is the first to document SGB’s effectiveness in treating chronic low back pain alongside PTSD. Conclusions: The findings suggest that SGB could be an effective therapy for chronic overlapping conditions like PTSD, chronic low back pain, and myofascial pain, all of which share central sensitization mechanisms. The literature supports the notion that these conditions involve both physical and psychiatric components potentially responsive to SGB. By targeting sympathetic hyperactivity and reducing norepinephrine levels, SGB may alleviate symptoms across these interconnected syndromes. This case series highlights the potential of SGB as a novel approach for managing comorbid PTSD and chronic pain conditions. Further research is warranted to confirm its efficacy and explore its broader applications in treating central sensitization-related disorders and chronic overlapping pain conditions (COPC), potentially responsive to sympathetic blockade. Full article

Background/Objectives: Adolescents and young adults (AYAs) with opioid use disorder (OUD) frequently have co-occurring psychiatric conditions and substance use disorders (SUDs). This study evaluated the association of psychiatric comorbidities and other SUDs with treatment retention and urine drug test (UDT) results in AYAs with OUD. Methods: This retrospective cohort study included AYAs enrolled in the Substance Use Treatment and Recovery clinic from 2009 to 2022. Participants were categorized into four groups: no comorbidities, only mental health disorders, only other SUDs, and both disorders. Treatment outcomes included retention time and UDT results for medication for OUD (MOUD) and illicit substances, including tetrahydrocannabinol (THC). Kruskal–Wallis tests were used to evaluate differences across groups, and regression models identified variables associated with outcomes. Statistical significance was set at p < 0.05. Results: Among 157 patients, the median retention time was 300 days. Depression (p = 0.04), post-traumatic stress disorder (p = 0.002), and alcohol use disorder (p = 0.04) were associated with prolonged retention, whereas cannabis use disorder predicted shorter retention (p = 0.02). The median proportion of positive UDTs was 0.9 for MOUD, 0.1 for illicit substances, and 0.0 for THC. Older age (p = 0.02) and the use of antidepressants and anxiolytics were associated with greater adherence to MOUD. Cannabis use disorder (p = 0.02) and male sex (p = 0.04) predicted positive UDTs for THC, while MOUD use was linked to lower THC positivity (p = 0.02). The main limitations of this study were related to its retrospective study design and single-center setting. Conclusions: Psychiatric and substance use comorbidities significantly influence retention and treatment adherence in AYAs with OUD. Integrated treatment may improve engagement and outcomes. Further research is needed to tailor interventions for AYAs with co-occurring disorders. Full article

Background/Objectives: Despite documented benefits across multiple outcome areas, referral and uptake into pulmonary rehabilitation (PR) following discharge after an exacerbation of chronic obstructive pulmonary disease (COPD) is low in many health care systems. Surveys documenting this underutilization may ignore the fact of disease severity or comorbidity severe enough to make many patients ineligible based on accepted selection criteria for the intervention. The aim of this study was to evaluate the magnitude of non-eligibility for PR following discharge after a COPD exacerbation. Methods: Medical records of COPD patients discharged over a one-year period in two hospitals were reviewed. Records from 353 patients discharged home were reviewed by six clinicians with experience in respiratory medicine and/or PR, three at each hospital. Results: The mean age of the total sample was 71 ± 12 years; 53% were female. Full concordance (all three reviewers agreed on the eligibility or non-eligibility of each patient) was 73%. Our eligibility criterion (two of three reviewers agreed) for PR was 39%. Categories (%) of non-eligibility criteria included the severity of medical condition(s) (44%), cognitive problems, psychiatric disease or substance abuse (24%), incorrect diagnosis (18%), institutionalized post-discharge (9%), and language barriers (4%) (patients may have been placed into more than one criteria category). Conclusions: Our study indicates that a majority of patients with clinical diagnoses of COPD discharged following exacerbations may not be appropriate referrals to PR based on accepted inclusion and/or exclusion criteria for the intervention. However, even after taking this into account, PR uptake is still critically underutilized. Full article

Dry eye disease (DED) is often comorbid with psychiatric conditions and psychological disturbances like anxiety and depression. The psychological symptoms are mostly considered to be a consequence of DED or a side-effect of medication. However, the possible psychological etiology of DED is seldom explored. This study explores the relationship between anxiety sensitivity (AS), unpleasant emotional states, and the severity of DED symptoms in a healthy general population sample in Croatia. A total of 766 adults (62.27% females) aged between 18 and 88 years completed an online survey consisting of the Ocular Surface Disease Index (OSDI), Anxiety Sensitivity Index (ASI), and Depression Anxiety Stress Scales (DASS21) together with socio-demographic data. The results revealed significant positive correlations between ASI, emotional states, and OSDI (r = 0.25–0.29, p < 0.01). Mediation analysis showed that DASS21 significantly mediates the relationship between ASI and OSDI (B = 0.1, CI = [0.004, 0.2]). Highly anxiety sensitive people are more sensitive to DED symptoms, which additionally increases in a state of emotional stress. Thus, DED symptoms are perceived more intensely and frequently than in less sensitive people. Understanding these associations is crucial for comprehensive DED management, indicating potential benefits from addressing psychological health in DED patients and eye health in psychiatric patients. Full article