Search Results (4,452)

Background/Objectives: Dental anxiety is a common clinical problem that negatively affects patient cooperation, treatment acceptance, and physiological stability during dental procedures. This randomized controlled clinical trial study aimed to evaluate the effectiveness of music-based interventions in reducing dental anxiety and stress responses during restorative dental treatment. The null hypothesis was that music exposure would not result in significant differences in anxiety levels or physiological stress parameters compared with standard dental care. Methods: Seventy-five patients with moderate to high pre-treatment dental anxiety (MDAS ≥10) were randomly assigned to three groups: classical music, Turkish music, and control (no music) (n = 25 per group). Anxiety levels were assessed using the Modified Dental Anxiety Scale (MDAS). Restorations were performed using a standardized adhesive protocol. Physiological parameters, including systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and oxygen saturation (SpO₂), as well as salivary cortisol and alpha-amylase levels, were measured before and after restorative treatment. Salivary cortisol and amylase levels were measured using a Human ELISA Kit. Statistical analysis was performed using paired t-tests and one-way ANOVA with Tukey’s post hoc test (p < 0.05). Results: Both music groups showed significant reductions in SBP, DBP, HR, cortisol, amylase, and MDAS scores compared to the control group (p < 0.05). Oxygen saturation increased significantly in the music groups, whereas it decreased significantly in the control group. There were no significant differences between classical and Turkish music regarding their anxiety-reducing effects. Conclusions: Music-based interventions effectively reduce dental anxiety and physiological stress during restorative dental procedures. This study is novel in simultaneously evaluating subjective anxiety scores and multiple physiological and biochemical stress markers in adult patients undergoing restorative treatment, supporting music as a simple and non-invasive adjunct in clinical dentistry. Full article

Background/Objectives: This study aimed to investigate plasma duloxetine concentrations, factors influencing these concentrations, and the relationship between plasma levels and clinical response in patients diagnosed with generalized anxiety disorder who were treated with duloxetine. Additionally, the study evaluated whether dose escalation resulted in proportional increases in plasma concentration and assessed the clinical utility of therapeutic drug monitoring (TDM) for duloxetine. Methods: In this study, plasma duloxetine levels were analyzed in 68 patients with generalized anxiety disorder who had been receiving duloxetine treatment for at least three months. A review of digital medical files revealed that duloxetine was initiated at 30 mg/day in all patients, and doses were increased to 60 or 90 mg/day in those with insufficient symptom improvement. Digital medical files indicated that participants had been on the final prescribed duloxetine dose for at least four weeks at the time of plasma level measurement. Baseline Hamilton Anxiety Rating Scale (HAM-A) and Generalized Anxiety Disorder-7 (GAD-7) scores were compared with scores obtained on the day of blood sampling. Plasma duloxetine concentrations were quantified using liquid chromatography–tandem mass spectrometry (LC-MS/MS). Associations between dose, plasma concentration, and clinical response were statistically analyzed. Results: Plasma duloxetine concentrations increased significantly following dose escalation. However, no significant correlation was observed between plasma concentrations and percentage change in HAM-A scores. Although patients receiving 60 or 90 mg/day had higher plasma levels than those maintained on 30 mg/day, clinical improvement did not differ significantly between dose groups. In addition to dose, increasing age and non-smoking status were associated with higher plasma duloxetine concentrations. Conclusions: Duloxetine demonstrates a predictable dose–concentration relationship; however, in this response-guided titration setting, plasma concentrations were not consistently associated with clinical improvement. Accordingly, these findings suggest that routine therapeutic drug monitoring may not consistently predict clinical response to duloxetine in generalized anxiety disorder; nevertheless, considering the study’s limitations, it could still offer clinically relevant insights in selected pharmacokinetically sensitive or treatment-resistant cases. Full article

Background/Objective: Informal caregiving for individuals with severe mental disorders (SMDs) often leads to significant psychological distress. However, the specific coping strategies that determine mental health outcomes among siblings remain poorly understood. This study aimed to analyze the predictive capacity of various coping strategies regarding health, perceived stress, self-esteem, and caregiving experience for siblings. Methods: A cross-sectional study was conducted with a sample of siblings of patients with SMDs (N = 60) from mental health service. Self-report measures were used to assess perceived health, perceived stress, self-esteem, coping strategies, and caregiving experience. Multiple linear regression analyses were performed for each dependent variable, controlling for collinearity. Results: The siblings reported a higher mean use of problem-focused coping strategies compared to emotion-focused coping strategies. Regression models were statistically significant for all analyzed variables, except for somatic symptoms. Emotion-focused maladaptive coping (EFMC) strategies emerged as the most consistent and powerful predictor, showing a significant association with positive caregiving appraisal (β = 0.657), depression (β = 0.500), poor health (β = 0.453), negative stress (β = 0.449), social dysfunction (β = 0.429), self-esteem (β = −0.390), and anxiety (β = 0.368). In contrast, problem-focused strategies were largely non-significant, except for an association with positive and negative aspects of caregiving (β_PFMC = 0.509, β_PFMC = 0.312, respectively), and positive stress (β_PFAC = −0.272). Conclusions: These results suggest that while siblings of people with SMDs report a greater use of problem-focused coping strategies, the adoption of EFMC strategies is the most detrimental factor observed, given their negative influence on mental health, self-esteem, and caregiving experience. Full article

Background: Cardiac rehabilitation (CR) is a key component of secondary prevention after acute coronary events, coronary and valve interventions, and device implantation, yet participation and long-term adherence remain suboptimal. Digital technologies offer the potential to extend CR beyond the centre-based model and to support more flexible, patient-centred care. Methods: This narrative “review on a systematic backbone” synthesizes original clinical studies published between 2005 and 2025 that evaluated the use of digital technologies as an integral part of CR in adults after myocardial infarction, revascularization, valve procedures or implantation of cardiac devices. Interventions were grouped into four categories: mobile health (mHealth) and tele-rehabilitation, virtual reality (VR) and exergaming, virtual education platforms, and other multi-component digital CR solutions. Only original studies with clinical, functional, or patient-reported outcomes were included. Results: Twenty-one studies on the categories mentioned above met the eligibility criteria. mHealth-enabled home-based or hybrid CR programs consistently achieved improvements in functional capacity and physical activity that were broadly comparable to centre-based CR, with generally high adherence. VR and exergaming interventions were feasible and safe, produced at least similar functional gains, and showed more consistent benefits as far as anxiety levels and engagement levels. Virtual education platforms delivered knowledge and produced behaviour change similar to traditional education and, in some studies, supported better control of blood pressure and lipids. Comprehensive digital CR platforms improved risk-factor profiles and quality of life to a degree comparable with face-to-face CR. Conclusions: Digital technologies can credibly support core objectives of CR in high-risk patients and expand access, but must be implemented as a complement to, rather than a replacement for, multidisciplinary, patient-centred rehabilitation. Full article

Background and Objectives: Multiple sclerosis (MS) is a chronic neurological disorder causing physical, cognitive, and psychological impairments that affect daily functioning and quality of life (QoL). Psychological distress, cognitive deficits, and reduced physical activity often co-occur, yet their associations with QoL across disability levels are unclear. This study examined these relationships in people with relapsing–remitting MS, stratified by disability severity. Materials and Methods: This cross-sectional study included 149 adults with RRMS. Disability severity was classified as mild, moderate, or severe using the Patient-Determined Disease Steps (PDDS) scale. Psychological distress was assessed using the Depression, Anxiety, and Stress Scale–21 (DASS-21), cognitive function using the Montreal Cognitive Assessment (MoCA), and physical activity using the International Physical Activity Questionnaire (IPAQ). QoL was evaluated using the Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire. Stratified comparative analyses were conducted to examine differences in overall and domain-specific QoL according to levels of psychological distress, cognitive function, and physical activity within disability categories. Results: In participants with mild and moderate disability, higher levels of depression, anxiety, and stress were associated with lower QoL scores, particularly in domains related to activities of daily living, psychological well-being, and symptoms. Higher cognitive function and greater physical activity were associated with more favorable QoL across several domains. In those with severe disability, associations between psychological distress and QoL were less consistent, although stress remained associated with selected QoL domains. Conclusions: Psychological distress, cognitive function, and physical activity show distinct patterns of association with daily functioning and QoL across disability levels in RRMS. Although causal inferences cannot be drawn from this cross-sectional design, disability-stratified analyses provide clinically relevant insights into how these factors co-vary with QoL at different stages of disease severity. Full article

5a-reductase (5a-R) isozymes are essential for androgen metabolism and neurosteroid biosynthesis, linking endocrinology and neuropsychiatry. This systematic review, conducted in accordance with PRISMA 2020 guidelines, aimed to synthesize current evidence on the tissue distribution of SRD5A1, SRD5A2, and SRD5A3 and their implications in mental health. A systematic search of the PubMed, Scopus, and Web of Science databases up to February 2025 identified 257 articles, of which 83 met the inclusion criteria. SRD5A1 is broadly expressed in the liver, skin, and central nervous system, contributing to allopregnanolone synthesis; SRD5A2 is mainly restricted to androgen-dependent tissues, playing a key role in prostate development and alopecia; and SRD5A3 is associated with glycosylation processes and oncogenesis. Converging evidence suggests that impaired neurosteroidogenesis due to 5α-R inhibition may underlie vulnerability to anxiety, depression, and suicidality. While earlier epidemiological findings were heterogeneous, recent pharmacovigilance data have strengthened the evidence supporting this association. Pharmacovigilance and clinical reports show that a subset of patients treated with finasteride or dutasteride may experience persistent psychiatric and sexual adverse effects, known as post-finasteride syndrome. The current findings underscore the need for careful patient counseling, systematic monitoring, and further translational studies integrating genetics, neuroendocrine markers, and standardized psychiatric outcomes to identify individuals at risk and advance personalized medicine in this field. Full article

Anxiety disorders are commonly assessed using instruments such as HAM-A and GAD-7. These tools rely on patient self-report and clinician interpretation, which may introduce variability. This study proposes an EEG-based computational framework for estimating anxiety levels using portable EEG recordings from the Unicorn Hybrid Black device. These data were harmonized with the DASPS public dataset to ensure methodological consistency. After standardized preprocessing and multi-domain feature extraction, three classifiers—logistic regression, multilayer perceptron (MLP), and k-nearest neighbors (KNN)—were trained and evaluated. Logistic regression achieved 81.25% accuracy (F1 = 0.8247), while the MLP reached 87.5% accuracy (F1 = 0.859). ROC analysis (AUC = 0.98 for logistic regression and 0.92 for MLP) confirmed that both classifiers reliably separated non-anxious from moderate participants. Severe anxiety could not be classified, reflecting the extremely limited number of participants in this category. Predicted anxiety probabilities showed significant correlations with HAM-A scores (r up to 0.71, p < 0.01), supporting the external validity of the proposed approach. Full article

Objective: In Vitro Fertilization (IVF) has revolutionized reproductive medicine, offering hope to individuals and couples facing infertility. However, the psychological impact of IVF varies significantly based on gender, necessitating a systematic review of the existing literature. This review explores the emotional effects of IVF on both men and women, highlighting gender-specific psychological responses throughout the treatment process. Methods: A systematic literature search using various databases (such as PubMed) was made. Studies published in English from the years 2000 to 2023 were included in the review. Results: A total of 47 studies examined the psychological impact of IVF on both women and men, covering the IVF programming period, the initial stages of IVF treatment, and subsequent stages, as well as the long-term psychological distress effects of IVF in both genders. Both female and male infertile patients are dealing with anxiety, depression and low quality of life. However, women were found to experience higher levels of psychological distress, including increased anxiety and depression symptoms, compared to men at nearly all stages of IVF treatment. Conclusions: Understanding these gender-specific differences is crucial for developing targeted psychological support interventions to improve mental well-being during IVF treatments. Full article

Background/Objectives: Patients admitted to intensive care units (ICUs) are confronted with complex clinical situations that impact their physical condition and psychological well-being. Psycho-emotional disorders such as pain, anxiety and post-traumatic stress are highly prevalent in this context, significantly affecting both the patient’s experience and the quality of care provided. Effective communication can help manage patients’ psycho-emotional states and prevent post-ICU disorders. To evaluate the effectiveness of the CONECTEM communicative intervention in improving the psycho-emotional well-being of critically ill patients admitted to the intensive care unit, regarding pain, anxiety, and post-traumatic stress symptoms. Methods: A quasi-experimental study employed a pre–post-test design with both a control group and an intervention group. The study was conducted in two ICUs in a tertiary Hospital in Spain. A total of 111 critically ill patients and 180 nurse–patient interactions were included according to the inclusion/exclusion criteria. Interactions were classified according to the level of the patient’s consciousness into three groups: G1 (Glasgow 15), G2 (Glasgow 14–9), and G3 (Glasgow < 9). Depending on the patient’s communication difficulties, nurses selected one of three communication strategies of the CONECTEM intervention (AAC low teach, pictograms, magnetic board, and musicotherapy). Pain was assessed using the VAS or BPS scale, anxiety using the STAI, and symptoms of PTSD using the IES-R. The RASS scale was utilized to evaluate the degree of sedation and agitation in critically ill patients receiving mechanical ventilation. Data analysis was performed using repeated ANOVA measures for the pre–post-test, as well as Pearson’s correlation test and Mann–Whitney U or Kruskal–Wallis statistical tests. Results: The results showed pre–post differences consistent with pain after the intervention in patients with Glasgow scores of 15 (p < 0.001) and 14–9 (p < 0.001) and in anxiety (p = 0.010), reducing this symptom by 50% pre-test vs. 26.7% post-test. Patients in the intervention group with levels of consciousness (Glasgow 15–9) tended to decrease their post-traumatic stress symptoms, with reductions in the mean IES scale patients with a Glasgow score of 15 [24.7 (±15.20) vs. 22.5 (±14.11)] and for patients with a Glasgow score of 14–9 [(Glasgow 14–9) [30.2 (±13.56) 27.9 (±11.14)], though this was not significant. Given that patients with a Glasgow score below 9 were deeply sedated (RASS-4), no pre–post-test differences were observed in relation to agitation levels. Conclusions: The CONECTEM communication intervention outcomes differed between pre- and post-intervention assessments in patients with a Glasgow Coma Scale score of 15–9 regarding pain. These findings are consistent with a potential benefit of the CONECTEM communication intervention, although further studies using designs that allow for stronger causal inference are needed to assess its impact on the psycho-emotional well-being of critically ill patients. Full article

Background/Objectives: This study examined the reasons and sociodemographic drivers behind delays in seeking medical care among participants in the All of Us Research Program. Methods: A cross-sectional study was conducted using data collected between 2018 and 2024. The primary outcome was the prevalence of reasons for delayed medical care (DMC). Descriptive statistics were used to calculate the prevalence of the various reported reasons for delayed medical care. Binary logistic regression was applied to examine the association between sociodemographic characteristics and each reported reason for delayed medical care. Results: Out of a total of 633,000 All of Us participants, 300,820 participants had complete data on the healthcare utilization and access survey and were eligible for final analysis. The most common reported reasons for DMC were out-of-pocket expenses (16.68%), nervousness about seeing a provider (14.18%), and inability to get time off work (11.04%). Females had significantly higher odds of DMC due to out-of-pocket costs (OR = 1.31, 95% CI: 1.28–1.33). Black (OR = 0.81, 95% CI: 0.78–0.84) and Asian (OR = 0.94, 95% CI: 0.89–0.99) individuals had lower odds of DMC due to out-of-pocket costs. Married individuals had more than twice the odds of DMC due to childcare responsibilities (OR = 2.45, 95% CI: 2.33–2.56). Conclusions: A significant proportion of participants reported DMC due to various reasons, with financial, medical visit anxiety, and work-related reasons being the most common. These findings highlight actionable intervention targets, including nurse-led cost navigation and financial counseling, flexible scheduling/telehealth to reduce work-related delays, and patient-centered communication and outreach strategies to reduce visit-related anxiety and support caregiving and transportation needs. Full article

Background: Postpartum depression and anxiety are common in the perinatal period and can adversely affect maternal functioning and infant outcomes. Self-esteem is a relevant psychosocial factor, yet evidence from Eastern Europe remains limited. Objectives: To describe self-esteem levels among postpartum Romanian women, examine correlational associations between self-esteem and postpartum depression/anxiety symptoms, and assess whether these associations persist after adjustment for sociodemographic and clinical covariates, across two maternity centers in a cross-sectional design. Methods: This cross-sectional study included 201 postpartum women recruited consecutively during their initial postpartum hospitalization from two public maternity hospitals in Western Romania (Bihor, n = 100; Timiș, n = 101) during 2024–2025. Participants completed the Rosenberg Self-Esteem Scale (RSES), Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Associations were assessed with χ² tests (categorical comparisons), Pearson correlations, and multivariable linear regression models including center and selected sociodemographic/obstetric covariates. Results: Self-esteem showed a strong inverse correlation with postpartum depressive symptoms (RSES–EPDS: r = −0.542 overall; r = −0.537 in Bihor; r = −0.552 in Timiș; all p < 0.001). Negative correlations were also observed with anxiety (RSES–GAD-7: r = −0.400; p < 0.001) and PHQ-9 depressive severity (r = −0.370; p < 0.001). Stratified analyses indicated graded symptom burden across self-esteem categories, with higher EPDS risk proportions among women with moderate/low self-esteem within each center (χ²p ≤ 0.039). In adjusted models, EPDS (B = −0.37; p < 0.001) and GAD-7 (B = −0.15; p = 0.021) remained independently associated with lower RSES, alongside study center (Timiș vs. Bihor: B = −1.08; p = 0.043) and educational attainment. Conclusions: Lower self-esteem co-occurs with postpartum depressive symptoms and, secondarily, anxiety in Romanian women. While the cross-sectional design precludes causal inference, these robust correlational associations support the potential value of self-esteem assessment for early psychosocial risk identification. Longitudinal research is needed to establish temporal relationships and evaluate whether self-esteem can prospectively predict postpartum mental health outcomes. Full article

Background/Objectives: The gluten-free diet (GFD) is the primary treatment for patients with neurological gluten-related disease, which may occur with or without coeliac disease (CD). Dietary adherence is arguably most important in such patients, as ongoing gluten exposures have been shown to exacerbate irreversible neurological deterioration. We utilised a cross-sectional postal questionnaire to explore factors affecting dietary adherence in a large sample of such patients, highlighting potential areas of dietetic need. Methods: Patients returned a postal questionnaire (N = 225), which assessed self-reported GFD adherence by the Biagi scale and a visual analogue scale. CD status was ascertained, alongside symptomatology and mood (via the Hospital Anxiety and Depression Scale). Dietary knowledge was tested by a “quiz” where respondents identified which of 10 foodstuffs should be avoided on a GFD. Results: Self-reported adherence was high across the cohort, but was significantly higher in those with CD than those without. Patients with CD more often reported a number of gastrointestinal symptoms as acute reactions if they were to eat gluten. Similarly, the CD subgroup reported greater overall acute discomfort following gluten, while across the cohort greater such discomfort correlated with greater dietary adherence. Overall, 6.2% of the participants both reported strict diets (scoring ≥ 90 on the visual analogue scale) but via the quiz indicated an erroneous belief that they could eat a gluten-containing foodstuff. Lower adherence was correlated with higher depressive scores, with post hoc analyses finding that this was driven by patients without CD. Conclusions: This study highlights a need for increased dietary support in patients with neurological gluten sensitivity, particularly when there is no co-diagnosis of CD. Therapies targeting depression may additionally bolster dietary adherence. Full article

Background: Spine surgeries present challenges for patients, including postoperative pain and difficulties with mobilization. Studies indicate that fear and anxiety prolong recovery; multidisciplinary care, including psychoeducation, which informs patients about their condition, addresses emotional challenges, and teaches coping strategies have benefits on recovery. Objectives: This study investigated whether preoperative psychoeducation improves outcomes in spinal surgery by reducing postoperative analgesic use and accelerating mobilization, with the hypothesis that it decreases medication needs and shortens recovery time. Methods: Data of 100 patients operated on spinal disease were analysed: 50 of them underwent microscope-assisted discectomy for lumbar disc herniation (LDH), and 50 were treated with transpedicular posterior lumbar interbody fusion (PLIF) for monosegmental instability. Each group was subdivided into a psychoeducation group (N = 25) and a control group (N = 25). All patients completed the Surgical Fear Questionnaire (SFQ). Postoperative analgesic use and time to mobilization were analysed. Results: Patients receiving psychoeducation in both groups reported lower preoperative anxiety, required fewer analgesics, and, in the PLIF group, achieved earlier mobilization. A strong correlation was found between SFQ scores and analgesic consumption (p < 0.01). Discussion: Preoperative psychoeducation reduced anxiety, decreased postoperative analgesic use, and enhanced mobilization, suggesting clinical and economic benefits if integrated into standard care. Full article

Background: Non-motor symptoms in Parkinson’s disease (PD) consist of a wide spectrum of gastrointestinal impairment, urinary dysfunction, sleep disturbances, fatigue and psychiatric disorders. Mood disorders like anxiety and depression are linked to general well-being and overall quality of life, therefore influencing the amount and quality of restful sleep that the patients can achieve. Objectives: The aim of this study is to determine the prevalence and characteristics of anxiety and depression in PD and to identify the factors that correlate with sleep disturbances. Methods: We conducted a case–control study which included 131 PD patients and 131 controls. Descriptive data was collected, and validated scales and questionnaires regarding sleep, motor symptoms and symptoms related to anxiety and depression were administered. Patients were divided into groups by the presence or absence of sleep disorders (“bad sleepers” and “good sleepers”) and by the presence or absence of anxiety and depression. Comparative analysis was performed. Results: PD patients reported more clinically significant depression than controls and those with concomitant sleep impairment scored higher on depression- and anxiety-specific scales than their better-sleeping counterparts. Age, motor status and sleep impairment were found to be factors associated with depression in PD patients. The presence of sleep disorders was also associated with anxiety. Conclusions: Depression and anxiety are frequent in PD and are associated with comorbid sleep disturbances. Full article

Background: Intermittent theta burst stimulation (iTBS), a patterned form of repetitive transcranial magnetic stimulation (rTMS), has gained increasing attention as a time-efficient neuromodulation protocol for major depressive disorder (MDD). However, its clinical effectiveness in individuals with co-occurring depression and anxiety remains insufficiently characterized. This systematic review aimed to evaluate clinical outcomes, including depressive and anxiety symptom severity, response, and remission, following rTMS in individuals with major depressive disorder and elevated anxiety symptoms. The primary outcome was the reduction of depressive and anxiety symptoms, while secondary outcomes included response and remission rates, adverse events, and potential predictors of treatment response. Methods: A systematic search was performed following the PRISMA guidelines in the following databases: PubMed, Scopus, Embase, PsycInfo, Web of Science, Elsevier, Google Scholar. The protocol was registered in PROSPERO (CRD420251117784). Six studies that met the inclusion criteria were selected as eligible; these included one randomized controlled trial, one controlled clinical trial, three open-label studies, and one retrospective study on iTBS alone or compared to conventional 10 Hz rTMS or pharmacotherapy. iTBS has demonstrated safety and efficacy in reducing depressive and anxiety symptoms. The response rate ranged between 30 and 60%, and the remission rate between 10 and 40%. Regarding comparative findings, the results are mixed, with some studies showing superior or comparable improvements to 10 Hz rTMS and others reporting no significant differences. Reported treatment outcomes were largely influenced by age, baseline severity, medication status, and comorbid anxiety. Antipsychotics, anticonvulsants, and benzodiazepines were associated with attenuated clinical benefit, and bupropion use was associated with increased response. Conclusions: Current evidence supports iTBS as an effective, well-tolerated, and time-efficient intervention for adults with depression and comorbid anxiety. However, variability in treatment outcomes and limited mechanistic data highlight the need for larger, harmonized, and mechanistically informed randomized trials to refine stimulation parameters, improve patient stratification, and clarify the neurobiological substrates of treatment response. Full article