Search Results (96)

Background/Objectives: Providing appropriate treatment for pediatric patients after traffic accidents remains a significant challenge. Furthermore, limited studies have validated the long-term effectiveness and safety of integrative Korean medicine treatment (IKMT) based on follow-up periods of 6 months or longer for pediatric patients. Methods: A retrospective chart review was conducted, focused on children aged 0–6 years who visited one of seven Korean medicine hospitals after traffic accident injuries and received IKMT between 1 January 2019 and 30 June 2023. The primary outcome was the Numeric Rating Scale (NRS) scores of chief complaints, and the secondary outcomes were quality of life, adverse events, and satisfaction with IKMT. Statistical analyses were conducted using paired t-tests and descriptive statistics, with a significance level of 5%. Results: Sixty-four participants were included in the retrospective chart review, and fifty-seven guardians responded to the surveys (mean age: 4.84 ± 1.26 years; mean duration of treatment: 19.20 ± 25.38 days). Among the immediate symptoms after the accidents, flashbacks and intrusive symptoms as well as nightmares and crying were the most common (50.9%). Following treatment, the NRS scores for flashbacks and intrusive symptoms and for nightmares and crying showed meaningful improvements from the time right after the accidents to the survey period. Follow-up confirmed that quality of life scores on all dimensions corresponded with those of healthy children. Nine adverse events were reported, and the participants fully recovered without the need for additional treatment. Furthermore, 91.2% of the survey respondents were satisfied with IKMT. Conclusions: IKMT was effective and safe for alleviating the post-accident symptoms in infants and young children aged 0–6 years involved in traffic accidents. Full article

Sleep paralysis (SP), an REM parasomnia, can be characterized as one of the symptoms of narcolepsy. The SP phenomenon involves regaining meta-consciousness by the dreamer during REM, when the physiological atonia of skeletal muscles is accompanied by visual and auditory hallucinations that are perceived as vivid and distressing nightmares. Sensory impressions include personification of an unknown presence, strong chest pressure sensation, and intense fear resulting from subjective interaction with the unfolding nightmare. While the mechanism underlying skeletal muscle atonia is known, the physiology of hallucinations remains unclear. Their complex etiology involves interactions among various membrane receptor systems and neurotransmitters, which leads to altered neuronal functionality and disruptions in sensory perception. According to current knowledge, serotonergic activation of 5-hydroxytryptamine-receptor-2A (5-HT2A)-associated pathways plays a critical role in promoting hallucinogenesis during SP. Furthermore, they share similarities with psychedelic-substance-induced ones (i.e., LSD, psilocybin, and 2,5-dimethoxy-4-iodoamphetamine). These compounds also target the 5-HT2A receptor; however, their molecular mechanism varies from serotonin-induced ones. The current review discusses the intracellular signaling pathways responsible for promoting hallucinations in SP, highlighting the critical role of β-arrestin-2. We propose that the β-arrestin-2 signaling pathway does not directly induce hallucinations but creates a state of network susceptibility that facilitates their abrupt emergence in sensory areas. Understanding the molecular basis of serotonergic hallucinations and gaining better insight into 5-HT2A-receptor-dependent pathways may prove crucial in the treatment of multifactorial neuropsychiatric disorders associated with the dysfunctional activity of serotonin receptors. Full article

Given the suboptimal responses to medication and cognitive behavioral therapies in the treatment of post-traumatic stress disorder (PTSD), new approaches are needed. Background/Objectives: Therapies that include a somatic component such as Emotional Freedom Techniques (EFT) and Eye Movement Desensitization and Reprocessing (EMDR) have demonstrated efficacy in the treatment of PTSD in numerous clinical trials. This case series introduces the Trauma Reintegration Process (TRP), a psychotherapeutic process developed by the author that can be combined with somatic therapies to enhance their effectiveness, especially in patients with dissociation. Methods: This case series describes the use of TRP in combination with EFT, an energy-based somatic treatment that engages the meridian system of the body through gentle tapping on acupressure points. TRP uses EFT in combination with a focused guided imagery sequence. This case series describes the treatment of two patients: a 20-year-old woman who experienced PTSD and somatic symptoms following a serious motor vehicle accident (MVA) and a 45-year-old woman with a history of severe abuse as a child as well as adult trauma who had also been in a serious MVA. The cases contrast the way TRP can be applied in patients with single versus multiple traumas and who experience dissociation. Results: In both cases, EFT treatment stalled when the patient dissociated. After TRP was introduced, however, the EFT treatment regained momentum, leading to significant improvement in PTSD symptoms including a reduction of nightmares and flashbacks and resolution of other somatic symptoms. Conclusions: The trauma reintegration process (TRP) in combination with EFT has the potential to assist in the memory processing of patients with dissociation and complicated trauma presentation without retraumatizing the client and causing further distress or dissociation. In addition, it provides the patient with a self-empowering method to alleviate any additional traumatic sequelae. Full article

In Mexico, pervasive violence, forced disappearances, and homicides have deeply impacted certain groups, particularly journalists, activists, and human rights defenders, who are at high risk of victimization. While these groups receive state support for physical and legal safety, mental health and sleep-focused interventions remain insufficient. Collaborating with a Mexico City-based institution supporting human rights defenders and journalists, we conducted a psychometric assessment of 47 individuals affected by violence. Results showed that 80% exhibited symptoms of post-traumatic stress disorder, 25.5% showed depression, and 57.4% displayed anxiety; 95.7% reported poor sleep quality based on the Pittsburgh Sleep Quality Index. In a second phase, neuropsychological tests and polysomnographic recordings identified cognitive impairments in attention, memory, and decision-making in some participants, along with sleep disorders such as insomnia, primary snoring, obstructive sleep apnea, and bruxism. A third phase introduced Cognitive Behavioral Therapy for insomnia, nightmares, and circadian rhythm issues. Results showed improvements in sleep quality, total sleep time, and a reduction in depression, anxiety, and post-traumatic stress disorder symptoms. This approach suggests that treating sleep issues in high-risk populations can improve mental health. Full article

Using Dungeons & Dragons (D&D) as a therapeutic tool is more feasible than previously thought. While role-playing games (RPGs) have existed for decades, their application in therapy can be challenging for those unfamiliar with tabletop gaming. This article explores the history of D&D, its therapeutic applications, and case studies of five individuals (ages 7–19) using RPGs addressing anxiety, depression, Dissociative Identity Disorder (DID), and nightmares. It also examines group therapy settings for individuals with Autism Spectrum Disorder (ASD), LGBTQ adolescents exploring identity, and women in residential treatment for substance use and trauma recovery. Each case study highlights both the successes and challenges of integrating RPGs into therapy, demonstrating how D&D fosters social skills, identity exploration, trauma recovery, and emotional growth. The findings suggest that RPGs are flexible and effective tools for addressing diverse mental health concerns by encouraging emotional exploration and personal development. While the results are promising, further research is needed to assess the long-term impact of RPGs in therapy and their broader clinical applications. Expanding this research could solidify D&D’s role as a valuable therapeutic intervention across various mental health settings. Full article

Background: Sleep disturbances are a core feature of post-traumatic stress disorder (PTSD), affecting up to 90% of patients and often persisting after standard PTSD treatment. As all the current interventions have limitations, amygdala-targeted neuromodulation may offer a novel treatment pathway. Methods: Secondary analysis of a prospective, single-arm trial (n = 58) was carried out evaluating Prism™ amygdala-derived-EEG-fMRI-Pattern neurofeedback (Amyg-EFP-NF). Sleep outcomes were assessed using the Clinician-Administered PTSD Scale (CAPS-5) sleep item, PTSD Checklist (PCL-5) sleep item, and Patient Health Questionnaire (PHQ-9) sleep items at baseline, post-treatment, and 3-month follow-up. Treatment consisted of 15 sessions over 8 weeks. Results: At 3-months’ follow-up, 63.79% of participants demonstrated clinically meaningful reduction in sleep disturbances (≥1 point reduction in CAPS-5 Item 20). Sleep improvement showed a moderate correlation with overall PTSD symptom reduction (r = 0.484, p < 0.001) and a balanced improvement pattern (−15.1% early, −9.1% late). Sleep responders sustained improvement across multiple measures and showed significant increases in cognitive reappraisal (mean change: +2.57 ± 1.0, p = 0.006), while non-responders showed initial but un-sustained improvement in trauma-related dreams. Conclusions: Amyg-EFP-NF shows preliminary promise for treating PTSD-related sleep disturbances. Our exploratory analyses suggest distinct temporal patterns of sleep improvement and potential associations with enhanced cognitive reappraisal capacity that warrant rigorous investigation in future randomized controlled trials. Full article

Background: Insomnia disorder in childhood and adolescence has severe implications on overall well-being and development. Age-specific treatments for insomnia disorder with cognitive behavioral interventions (CBT-I) are available and effective. Nightmare disorder also has severe consequences in children and adolescents. However, less is known about children with insomnia (I) and comorbid nightmare disorder (I + N). Methods: In this retrospective study, data from 499 children and adolescents with insomnia disorder were included. The prevalence of a comorbid nightmare disorder (I + N) was calculated within three subsamples (toddlers and preschoolers 0.5–4 years, elementary school children 5–10 years, and adolescents 11–18 years). Differences between children with insomnia (I) and those with additional nightmare disorder (I + N) regarding age, sex, family background, sleep quality (SOL, WASO, TST, and SE) based on sleep logs, behavior sleep problems (based on interviews), and behavioral problems (CBCL and YSR) were calculated within each age group. Results: The overall prevalence of additional nightmares or nightmare disorder in children or adolescents with insomnia was 15–24%. We found various clinically relevant differences between I and I + N for each age group; for example, there were more sleep onset association problems in I + N elementary school children, prolonged SOL of 56 min, and about 50 min less TST and SE of 76.8% in I + N adolescents. However, most statistical tests were not significant. Especially sleep parameters but also emotional burden were more pronounced in I + N groups than in the I groups. Toddlers and preschoolers with I + N were significantly older than those with only I, had another family situation (e.g., divorced parents) significantly more often, and I + N adolescents were statistically more often anxious and depressed. Discussion: Descriptively, I + N children and adolescents seemed to be more impaired than those with insomnia only. However, a comorbid nightmare disorder cannot be recognized by insomnia-specific sleep parameters. Therefore, diagnostic procedures for insomnia should always screen for nightmares but also other sleep disorders. If necessary, CBT-I should be supplemented with nightmare-specific interventions. Full article

In post-mortem (PM) investigations, forensic toxicologists attempt to identify legal or illegal substances present before death and determine how they contributed to the cause of death. A critical challenge is ensuring that PM sample concentrations accurately reflect those at the time of death, as postmortem redistribution (PMR) can alter these levels due to anatomical and physiological changes. The PMR phenomenon is called a ‘toxicological nightmare’. PMR significantly affects post-mortem drug concentrations, particularly for lipophilic drugs and those with a high volume of distribution. The emergence of new psychoactive substances (NPSs) has led to a growing recognition of their role as a significant public health concern, frequently associated with fatalities related to polydrug use. These substances are renowned for their ability to induce intoxication at low doses, which has led to the continuous updating of toxicological and forensic methods to improve detection and adopt new analytical standards. The comprehensive detection of NPS metabolites, some of which are still undiscovered, presents an additional analytical challenge, as do their metabolic pathways. This complicates their identification in fatal cases using standard analytical methods, potentially leading to an underestimation of their actual prevalence in toxicological results. Furthermore, the interpretation of analytical results is hindered by the absence of data on PM blood levels and the specific contributions of NPS to causes of death, exacerbated by the lack of knowledge of whether the PMR phenomenon influences them. This paper presents a comprehensive review of the literature on post-mortem cases involving various NPS, categorized according to classifications by the United Nations Office on Drugs and Crime (UNODC) and the European Union Drugs Agency (EUDA). These categories include cathinones, phenylethylamines, arylalkylamines, phencyclidine-type substances, phenmetrazines, piperazines, phenidates, aminoindanes, LSD-like NPSs, tryptamines, fentanyl analogs, designer benzodiazepines, synthetic cannabinoids, and nitazenes. This review covers not only postmortem blood levels but also the stability of the substances studied, the methods of analysis, and attempts to shed some light on the PMR phenomenon. This review used various key terms, such as PMR, NPS, and the names of previously categorized substances and drug analyses across multiple peer-reviewed journals and databases, including Scopus, Google Schoolar, Springer, PubMed, and Wiley Online Library. In addition, references from retrieved articles were examined to identify additional relevant research. Interpreting post-mortem toxicological results is complex and lacks definitive guidelines, requiring a nuanced understanding of its challenges and potential pitfalls. As a result, post-mortem toxicology is often regarded as an art. The primary aim of this review is to provide forensic toxicologists with a comprehensive framework to assist in the evaluation and interpretation of NPS analysis. This guide is intended to complement the existing knowledge and practices applied in forensic laboratories within the toxicological analysis of post-mortem cases. Full article

Background/Objectives: Although rare in the Western world, dog bites may be lethal or lead to physically severe outcomes. However, little attention is given to their psychological consequences. We aimed to review their psychological consequences in children 1–14 years of age, focusing on the prevalence and nature of psychological disorders, evaluating the impact on future mental health of children and their families, and assessing the effectiveness of preventive interventions and measures. Methods: On 23 May 2024, we investigated the PubMed, CINAHL, and PsycINFO/PsycARTICLES databases using (“dog bite” OR animal-induced OR animal-caused) AND (psychol* OR mental OR psychiatr* OR anxiety OR anxious OR depress* OR obsess* OR trauma* OR psychosis OR psychotic OR schizophren* OR schizoaffect*) filtered for ages 0–18 years. This resulted in 311 records, of which 50 were eligible. These included original research, case reports, patient surveys, and reviews/meta-analyses. Results: Findings indicate that younger children are particularly vulnerable, often suffering head/neck bites, leading to severe injuries and psychological distress, with post-traumatic stress disorder (PTSD) being a common outcome. Symptoms such as nightmares, flashbacks, anxiety, and social withdrawal were frequently reported. Positive parental support and timely psychological interventions were found to mitigate these effects. Conclusions: Interdisciplinary approaches integrating education, cognitive restructuring, and behaviour modification are needed to effectively prevent and address the psychological impacts of dog bites. Summarising, dog bites in children result in substantial psychological sequelae, necessitating robust prevention and intervention strategies to improve their quality of life and reduce the risk of chronic mental conditions. Full article

Per- and polyfluoroalkyl substances (PFAS) are diverse synthetic chemicals manufactured over seven decades. It is an aliphatic molecule with a basic hydrophobic structure of carbon and fluorine linked to a hydrophilic end group. Due to their physicochemical properties associated with the unique structure, PFAS has been used in a wide variety of applications including aqueous film-forming foams (AFFF), paper, carpets, non-stick cookware, etc. as they make products resistant to water, heat, and stains. These molecules have drawn great attention recently for their unique properties, high stability and low degradability, and so-called “Forever Chemicals”. PFAS has the strongest carbon-fluorine bond which makes them persistent in the environment. Hence it contaminates natural resources and endangers public health. This review discusses the discovery, development, and evolution of PFAS from the wonder chemical era to a nightmare chemical era, exposure and its impacts on human health and the environment, current remediation techniques, and future trends of PFAS molecules and related products. The primary objective of this review is to identify knowledge gaps on PFAS contamination, remediation methods, and possible PFAS alternatives. Full article

Climate change has become a global nightmare, and the awareness of the causes of carbon emissions has resulted in rigorous studies. These studies linked the increase in global warming with booming economic growth. Since global warming has become more apparent, researchers have explored ways to decouple economic activities from carbon growth. Economic and carbon growth must be decoupled to achieve a low-carbon economy to support the carbon-growth plan or emission-reduction strategy. The world is transitioning toward a carbon-neutral and green ecosystem, so finding ways to decouple carbon emissions from economic activities is an exciting topic to explore. This study reviews current information on the importance of decoupling energy from economic growth innovative techniques that thoroughly examine the challenges and constraints of low-carbon energy systems. In order to examine the detrimental effects of carbon emissions on ecosystems and the ways in which economic expansion contributes to carbon footprints, more than three hundred research papers were gathered using several search engines, including Elsevier and Google Scholar. This review revealed that decarbonization and dematerialization had been achieved without declining global economic growth. It also provides information on energy use and economic activities leading to global carbon emissions and alternative solutions to the global challenge of climate change. The decoupling methods commonly used to determine the impact of energy decarbonization on economic growth are explored. All the results suggest that economic growth is a primary mover of global carbon emission increase and must be separated to achieve a carbon environment. Full article

Introduction: Bariatric surgery is the mainstay of treatment of obesity, with a proven, long-lasting effect on body weight reduction and remission of co-morbidities. Sleep disorders, including insomnia, and deteriorated sleep quality and duration are associated with obesity, and a reduction in body weight can be associated with a reduction in prevalence of sleep disorders. The purpose of this study was to assess the influence of laparoscopic sleeve gastrectomy (LSG) on the prevalence and intensity of different sleep disturbances. Methods: This observational prospective study included 80 patients qualified for bariatric surgery who filled in a questionnaire with a set of structured questions about different sleep disturbances, such as difficulties in falling asleep, night awakenings, early morning awakenings, snoring, and nightmares, as well as eating at night and daytime dysfunction, supplemented with Athens Insomnia Scale (AIS), before and 6 months after bariatric surgery. Results: There was a statistically significant reduction in incidence of night awakenings, with 40.00% of participants reporting night awakenings before surgery and, respectively, 25.00% after surgery. A significant reduction was also observed in the rate of patients who reported snoring, with 60.00% before the surgery and 38.75% after the surgery (p < 0.05). There was a correlation present between estimated weight loss % (EWL%) and reduction in snoring (p < 0.05). The mean total AIS score before surgery was 7.21 and 5.99 after surgery, and the change was statistically significant (p < 0.05). A total AIS score of 8 or more, the cutoff score for insomnia diagnosis according to the Polish validation of the Athens Insomnia Scale, was present in 44.16% of cases before surgery and in 38.00% after surgery (p = 0.52). There was a significant difference in the incidence of awakening during the night score before and after surgery (p < 0.05; CI 0.022–0.341), sleep quality (p < 0.05; CI 0.0105–0.4311), well-being during the day (p < 0.05; CI 0.0273–0.4143), and sleepiness during the day (p < 0.05; CI 0.101–0.444). Conclusions: LSG is observed to have a positive effect on selected sleep disturbances and insomnia remission in patients with obesity, measured by a significant reduction in Athens Insomnia Scale scores in follow-up 6 months after surgery. Additionally, patients after bariatric surgery reported less night awakenings and there was a lower rate of snoring. Therefore, LSG can be considered an effective therapeutic tool for insomnia in patients with obesity. Full article

Suicidality in adolescents has been associated with emotional distress, stressful life events, relationship issues, and nightmares to name a few. This study explored the actual dream content and the mood at pre-sleep, during a reported dream, and in the morning in 33 adolescents admitted to the hospital on account of a suicide attempt. In all aspects, hospitalized adolescents were compared to 33 matched adolescents who had followed the same protocol. In accordance with the Continuity and the Threat Simulation theories of dream formation, it was hypothesized that the waking-life experiences of suicidal adolescents would transpire in both dream mood and content as well as in the frequency of nightmares. Dreams were analyzed by independent judges using traditional dream content scales, including for the presence of negative and destructive themes and types of interpersonal relationships. As predicted, more suicidal adolescents experienced frequent nightmares, which was significant. A higher negative mood at pre-sleep, within dreams, and at post-sleep was also observed. Furthermore, their dreams contained a higher prevalence of destructive themes and failures, as well as self-directed and death-resulting aggressions. Regression analyses indicated that morning mood was most accurately predicted by positive and negative dream mood in the normative adolescents, whereas only negative dream mood appeared to predict subsequent waking affect in suicidal participants. Our results underline the valuable potential of implementing nightmare-reducing therapies in the presence of suicidal adolescents who suffer from frequent nightmares. Full article

The original conceptualization of REM sleep as paradoxical sleep was based on its EEG resembling wakefulness and its association with dreaming. Over time, the concept of paradox was expanded to include various associations with REM sleep, such as dream exclusivity, high recall, and pathophysiology. However, none of these associations are unique to REM sleep; they can also occur in other sleep states. Today, after more than fifty years of focused research, two aspects of REMS clearly retain paradoxical exclusivity. Despite the persistent contention that the EEG of human REMS consists of wake-like, low-voltage, non-synchronous electrical discharges, REMS is based on and defined by the intracranial electrical presence of 5–8 Hz. theta, which has always been the marker of REMS in other animals. The wake-like EEG used to define REMS on human polysomnography is secondary to a generalized absence of electrophysiological waveforms because the strong waves of intracranial theta do not propagate to scalp electrodes placed outside the skull. It is a persistent paradox that the theta frequency is restricted to a cyclical intracranial dynamic that does not extend beyond the lining of the brain. REMS has a persistent association with narratively long and salient dream reports. However, the extension of this finding to equate REMS with dreaming led to a foundational error in neuroscientific logic. Major theories and clinical approaches were built upon this belief despite clear evidence that dreaming is reported throughout sleep in definingly different physiologic and phenomenological forms. Few studies have addressed the differences between the dreams reported from the different stages of sleep so that today, the most paradoxical aspect of REMS dreaming may be how little the state has actually been studied. An assessment of the differences in dreaming between sleep stages could provide valuable insights into how dreaming relates to the underlying brain activity and physiological processes occurring during each stage. The brain waves and dreams of REMS persist as being paradoxically unique and different from waking and the other states of sleep consciousness. Full article

Taxonomic studies of dreams that continue to influence the dreamer’s thoughts and feelings after awakening have distinguished three types of impactful dreams: nightmares, existential dreams, and transcendent dreams. Of these, existential dreams and transcendent dreams are characterized by recurrent metacognitive appraisal of the epistemic tension between complementary (a) metaphoric (A “is” B) assertions and (b) literal (A “is not” B) assertions. Metacognitive appraisal of such complementary metaphoric and literal assertions is detectable as the felt sense of inexpressible realizations. The poesy of such inexpressible realizations depends upon the juxtaposition of a metaphoric topic and vehicle that are both “semantically dense” but at an abstract level “distant” from each other. The result is “emergence” of attributes of the metaphoric vehicle that are sufficiently abstract to be attributes also of the metaphoric topic. The cumulative effect of successive metaphoric/literal categorical transformations produces a higher-level form of metacognition that is consistent with a neo-Kantian account of sublime feeling. Sublime feeling occurs as either sublime disquietude (existential dreams) or as sublime enthrallment (transcendent dreams). The aftereffects of these two dream types are thematically iterative “living metaphors” that have abstract (but not “totalizing”) ontological import. Full article