Search Results (1,397)

Substance use disorders (SUDs) are increasingly associated with systemic inflammatory, neuroendocrine, and cardiometabolic dysregulation; however, the biological signatures underlying distinct substance-use patterns remain incompletely characterized. This study compared biomarker profiles among healthy controls and clinical groups comprising alcohol-associated polysubstance users (A + PS), non-alcohol substance users (PS-A), and alcohol-associated polysubstance users with comorbid post-traumatic stress disorder (PTSD+). Plasma levels of interleukin-6 (IL-6), C-reactive protein (CRP), cortisol, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were evaluated through comparative, multivariate, dose–response, and receiver operating characteristic (ROC) curve analyses. All clinical groups exhibited significantly increased IL-6, CRP, cortisol, and NT-proBNP levels compared with controls, indicating systemic physiological dysregulation associated with substance exposure. Among the evaluated biomarkers, IL-6 demonstrated the most robust and consistent performance across all analytical approaches. Multivariate regression identified alcohol consumption as an independent predictor of IL-6 elevation (p = 0.0003), while dose–response analysis revealed progressive increases in IL-6 according to alcohol consumption severity. ROC analysis further demonstrated that IL-6 exhibited the highest discriminatory performance (AUC = 0.844), outperforming CRP, cortisol, and NT-proBNP in distinguishing substance-using individuals from controls. Collectively, these findings were able to identify IL-6 as a central biomarker associated with substance-related systemic inflammatory dysregulation and support its translational potential as a sensitive indicator of physiological burden associated with chronic alcohol and substance exposure. Full article

(1) Background: Prehospital emergency workers frequently experience workplace violence and trauma, raising their risk of post-traumatic stress disorder (PTSD) symptoms and burnout, yet their link to quiet quitting remains poorly understood. We tested whether the PTSD–quiet quitting association is statistically patterned through perceived occupational stress and emotional exhaustion. (2) Methods: In a cross-sectional online survey, prehospital emergency professionals in Türkiye who reported workplace violence within the previous six months completed the PTSD-Short Scale, Perceived Occupational Stress Scale, Job-Related Emotional Exhaustion Scale, and Quiet Quitting Scale. Serial mediation was tested with PROCESS Model 6 (5000 bootstrap resamples), with an age- and gender-adjusted sensitivity analysis, and reporting followed the STROBE checklist. (3) Results: Of 327 respondents, 305 were analysed. PTSD symptoms were associated with quiet quitting (β = 0.460, p < 0.001). With both mediators entered, the direct path was non-significant (β = 0.105, p = 0.071), indicating full statistical mediation. The serial route through stress and exhaustion was the largest indirect pathway (B = 0.155, 95% CI [0.091, 0.217]), and the model explained 42.1% of the variance. Self-reported, single-session data mean the indirect effects are best treated as upper-bound estimates. (4) Conclusions: PTSD symptoms were indirectly related to quiet quitting through occupational stress and emotional exhaustion. The high correlation between the two mediators suggests one broad strain process rather than two distinct stages. Because the design is cross-sectional, it precludes causal ordering; longitudinal studies are needed. Clinically, the findings highlight reducing workplace violence and monitoring stress and exhaustion to limit disengagement among prehospital staff. Full article

1-in-5 people are prescribed an antidepressant for a common mental disorder (CMD), such as depression or anxiety. Most people do not require lifelong treatment, however more than half continue antidepressants for ≥2 years despite no ongoing symptoms. Antidepressant deprescribing is not routine practice in primary care and healthcare professionals report barriers including concerns about withdrawal effects, perceived patient attachment to antidepressants and limited availability of withdrawal-informed support. Drawing on realist principles and behavioural science, this review will identify behavioural mechanisms and contexts from academic and grey literature to formulate programme theories describing how to facilitate primary care healthcare professionals to deprescribe antidepressants. The review is guided by the Behavioural science Approach to Realist Reviews/Evaluations (BARR/E) and will follow five steps: (1) define the review scope, (2) develop initial programme theories, (3) evidence search, (4) selection and appraisal and (5) data extraction and synthesis. Peer-reviewed literature will be identified through MEDLINE, Embase, PsycINFO and CINAHL, supplemented by grey literature identified through expert consultation, database and citation searches. The evidence will be assessed for relevance, rigour and richness, and data extracted and synthesised to develop context–mechanism–outcome configurations. Findings will be reported in accordance with RAMESES quality and publication standards. Full article

Post-traumatic stress disorder (PTSD) is a severe condition triggered by traumatic exposure, characterized by symptoms like trauma re-experiencing, avoidance, mood alterations, hypervigilance, and sleep disturbances. While its exact mechanisms remain uncertain, PTSD involves dysregulation across neurobiological systems underlying fear conditioning, threat appraisal, executive control, and stress response. Although research highlights the sympathetic–adreno–medullary (SAM) system and the hypothalamic–pituitary–adrenal (HPA) axis, findings on stress-related mediators remain inconsistent regarding their precise contributions over time. To address this, we propose a hypothetical model viewing PTSD as a multistable system shifting from physiological to pathological steady states. We assume that intense, repeated emotional stress triggers spike activation in the amygdala, driving an amygdala–locus coeruleus loop into a high-activation state via reciprocal excitation, mediated by corticotropin-releasing hormone (CRH) and noradrenaline. This sequentially alters amygdala–hippocampus and prefrontal cortex loops, reinforcing fear expression and impairing extinction. This model is consistent with key features of PTSD, including its higher prevalence among females, increased glucocorticoid receptor sensitivity, the frequently observed hypocortisolism, and the partial efficacy of serotonin and norepinephrine reuptake inhibitor (SNRI) and CRH receptor antagonists. While requiring experimental validation, this framework connects molecular, circuit, and behavioral data to help identify novel interventions for restoring adaptive stress-response dynamics. Full article

Background/Objectives: Stress-enhanced fear learning (SEFL) tests whether severe stress amplifies a later, separate fear-learning episode. Although SEFL studies commonly report increased freezing, its overall effect size, robustness, protocol-level variation, and translational interpretation have not been systematically quantified. This review evaluated SEFL as a focused paradigm of stress-induced fear-learning sensitization rather than as a comprehensive model of posttraumatic stress disorder (PTSD). Methods: Web of Science Core Collection, PubMed, Embase, and Scopus were searched from inception to June 2026. Eligible studies used an SEFL-related procedure, included independent stress-exposed and control groups, and reported extractable freezing outcomes during later fear testing. Hedges’ g values were pooled using restricted maximum-likelihood random-effects models. We also examined exploratory subgroup analyses, sensitivity analyses, and small-study-effect assessments. Results: Twenty-five studies comprising 49 comparisons were included. Stress-exposed animals showed higher freezing than controls during later fear testing (Hedges’ g = 1.71, 95% CI [1.38, 2.04], p < 0.001). Heterogeneity was substantial (I² = 81.91%, τ² = 1.07), and the 95% prediction interval crossed zero (−0.40 to 3.82), indicating that SEFL is not protocol-invariant. Exploratory subgroup analyses suggested protocol- and sample-level variation, particularly by species, strain, stress method, testing interval, and stress type. Contextual-fear-conditioning-only, study-level, non-footshock-exclusion, and leave-one-out sensitivity analyses supported the overall positive effect, although possible small-study effects should be considered when interpreting the pooled estimate. Conclusions: SEFL is best interpreted as a protocol-sensitive behavioral neuroscience paradigm for studying stress-enhanced later fear learning after severe stress rather than as a broad PTSD model. The current evidence supports a large average freezing-defined SEFL effect, but the marked heterogeneity and limited intervention-related evidence indicate that the paradigm should be interpreted with attention to protocol conditions and translational scope. Full article

Background and Objectives: Cardiac implantable electronic devices (CIEDs), including permanent pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, are increasingly used in an aging population characterized by multimorbidity and a high prevalence of psychiatric and cognitive disorders. Depression, anxiety, post-traumatic stress disorder (PTSD), mild cognitive impairment, and dementia may affect informed consent, adherence to therapy, quality of life, and long-term cardiovascular outcomes in patients undergoing CIED implantation. The aim of this review was to summarize the prevalence and clinical significance of psychiatric and cognitive disorders in patients undergoing CIED implantation and to discuss practical strategies for their assessment in routine cardiology practice. Materials and Methods: This narrative review was based on a literature search of PubMed, Web of Science, and the National Health Library database covering the literature from 2010 to 2025, including a broad search strategy. Original studies and review articles were included, having confirmed their definite association with the subject. Results: Psychiatric disorders and cognitive impairment were highly prevalent among patients with CIEDs and were associated with impaired adherence, reduced participation in rehabilitation, lower quality of life, and worse cardiovascular outcomes. ICD therapies, particularly inappropriate therapies, were strongly associated with anxiety, depressive symptoms, and PTSD-related distress. Cognitive impairment may compromise informed consent, recognition of complications, and compliance with post-implantation recommendations. Several validated screening tools, including MMSE, MoCA, HADS, BDI-II, STAI, and FSAS, may facilitate early identification of high-risk patients, and their most appropriate use in various clinical scenarios, including pre- and post-CIED implantation was described. Conclusions: Psychiatric disorders and cognitive impairment are common and clinically relevant in patients undergoing CIED implantation. Routine psychological and cognitive assessment before and after implantation should be considered an important component of modern multidisciplinary cardiac care, potentially affecting the decision to implant the device, and likely influencing the type of the implanted device. Full article

Background: Post-traumatic growth (PTG) refers to positive psychological changes resulting from the struggle with highly challenging or traumatic life events. Psychosocial interventions have demonstrated efficacy in promoting psychological well-being in the aftermath of traumatic experiences. Cognitive Behavioral Therapy (CBT) is among the most extensively studied such interventions, aligning with the PTG model’s prerequisites for growth. Objective: The aim of this systematic review was to assess the efficacy of CBT and CBT-based interventions in promoting PTG. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Scopus, and Google Scholar databases from inception to December 2024. Eligibility criteria included: (a) the inclusion of a CBT or CBT-based intervention, (b) measurement of PTG using the Post-Traumatic Growth Inventory (PTGI), (c) study participants having experienced traumatic life events, and (d) articles written in English. Risk of bias was assessed independently by two reviewers. Due to the heterogeneity of included studies, a qualitative narrative synthesis approach was adopted. Risk of bias was assessed using the RoB-2 tool for RCTs, ROBINS-1 for quasi-experimental studies and Newcastle–Ottawa scale for cohort studies. Certainty of evidence, assessed using the GRADE framework, is considered low. Results: A total of 19 studies were included (13 randomized controlled trials, 3 quasi-experimental, and 3 longitudinal studies). While traditional CBT produced mixed results in fostering PTG, CBT-based therapeutic protocols—particularly those explicitly designed to target PTG or incorporating structured cognitive–emotional techniques—demonstrated more consistent benefits. Limitations of the included studies include measurement of PTG as a secondary outcome, small sample sizes, and the presence of confounding variables. Conclusions: Further high-quality, multicenter randomized controlled trials with standardized protocols are needed to clarify the role of CBT in promoting growth after trauma. Full article

Using the Hierarchical Taxonomy of Psychopathology (HiTOP) as our framework, the current study examines how 13 common psychological disorders can be grouped into different spectra in two groups of adolescents: a community sample (N = 951), and a clinic-referred sample (N = 173). Scores for the disorders were obtained using the parent version of the Child and Adolescent PsychProfiler. Taken together, the findings across the two samples for factor structure, reliability, and discriminant and concurrent validity indicate the most support for a three-factor CFA oblique model with primary factors for neurodevelopment disorders (that include Specific Learning Disorder, Autism Spectrum Disorder, Language Disorder, and Speech Sound Disorder), internalizing disorder problems (that include Generalized Anxiety Disorder, Persistent Depressive Disorder, Separation Anxiety Disorder, Obsessive–Compulsive Disorder, Posttraumatic Stress Disorder, Anorexia Nervosa, and Bulimia Nervosa), and externalizing disorder problems [(that include Attention Deficit/Hyperactivity Disorder (ADHD), and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD)], with a covariance for the error variance for Anorexia Nervosa and Bulimia Nervosa. Additionally, the analysis for Sample 2 supports the concurrent validity of the factors in this model. A modification of this model, with ADHD cross-loading on the neurodevelopment disorders factor, did not produce an admissible solution. The findings indicate support for a neurodevelopmental spectrum in the HiTOP model, with ADHD and ODD/CD showing stronger statistical association with the externalizing factor than with the neurodevelopmental factor in the models tested. This finding pertains to dimensional structure and does not invalidate the neurodevelopmental classification of ADHD in DSM-5-TR. Full article

Burn injuries are increasingly recognized as chronic conditions with enduring physical, psychological and social consequences that extend beyond acute survival. This narrative review synthesizes and interpretatively discusses recent evidence on health-related quality of life (HRQoL) in adult burn survivors, focusing on recovery patterns following discharge. Persistent physical sequelae—particularly chronic pain, pruritus, contractures and scarring—remain major determinants of reduced HRQoL, mainly mediated by functional limitation and self-perception. Psychological morbidity is common, with high rates of depression, anxiety and post-traumatic stress disorder, particularly early after injury, although post-traumatic growth may also emerge. Social reintegration, including return to work, is often delayed or incomplete and is influenced by injury severity, mental health status and social support. Recovery trajectories are nonlinear: the greatest improvements occur within the first six months, followed by slower gains up to 18–24 months, after which many patients fail to reach population norms. Pain and psychological symptoms may persist for years. Overall, these findings support a multidisciplinary, longitudinal approach to burn care, emphasizing early risk stratification and rehabilitation to optimize individualized recovery. In this narrative review, we aim to outline the main dimensions of long-term quality of life, with a particular focus on the temporal dynamics of recovery patterns. Full article

Background/Objectives: The Al Haouz earthquake that struck Morocco on 8 September 2023, resulted in substantial material, human, and psychological impacts. Children are at increased risk of psychological disorders, notably post-traumatic stress disorder (PTSD). This study aims to assess probable PTSD and its associated factors among children exposed to the Al Haouz earthquake. Methods: This cross-sectional study, conducted between December 2024 and January 2025, included 536 children from the affected areas. Probable PTSD was assessed using the 20 item Child and Adolescent Trauma Screen (CATS). Sociodemographic and exposure-related data, including post-earthquake conditions, were collected using a structured questionnaire. Data analysis was performed using SPSS software, version 25. Results: Analysis revealed that 47.6% of the children presented with probable PTSD. Multivariable analysis identified several factors independently associated with probable PTSD among children exposed to the earthquake, including age between 11 and 15 years (AOR = 2.02; p < 0.001), female gender (AOR = 1.82; p = 0.001), advanced level of education (AOR = 1.87; p = 0.006), housing damage (AOR = 2.08; p = 0.015), physical injury (AOR = 1.86; p = 0.012), proximity to the epicenter (AOR = 2.22; p = 0.006), temporary shelter in tents (AOR = 1.75; p = 0.02), difficulty of evacuation (OR = 1.97; p = 0.01), and loss of a family member (AOR = 1.98; p = 0.013). Conclusions: This study revealed a high frequency of probable PTSD in children exposed to the Al Haouz earthquake and identifies several associated factors, highlighting the need to targeted, multidimensional interventions. Full article

Post-Traumatic Stress Disorder (PTSD) is a prevalent and costly mental health condition characterized by symptoms such as hyperarousal, avoidance, and re-experiencing. While machine learning (ML) approaches have shown promise in detecting PTSD-related physiological patterns, most validation efforts rely on computational metrics rather than real-world user perceptions. This study evaluates the perceived precision of a smartwatch-based ML tool designed to detect PTSD hyperarousal events using heart rate and activity data. The tool, previously developed using XGBoost 1.0.0, was deployed in a 21-day naturalistic study with 12 participants diagnosed with PTSD. Quantitative results showed a median perceived precision of 65.27%, with substantial variability across participants. A Mann–Kendall trend analysis revealed a significant increase in perceived precision over time for most participants, suggesting calibration of trust. Qualitative findings indicated high usability, general trust in the system, and acceptance of false positives, though concerns about notification design and battery life were noted. The results highlight the importance of incorporating user-centered, real-world validation into the evaluation of ML-based mental health monitoring tools. This work provides preliminary evidence supporting the feasibility of wearable-based PTSD monitoring and underscores the role of perceived precision in technology adoption and sustained use. Full article

Background and Objectives: This study aimed to examine the level of depression in children who had undergone pediatric liver transplantation and to evaluate the potential role of liver enzymes as biomarkers of depression. Materials and Methods: The study was conducted with 50 pediatric liver transplant recipients followed at the Liver Transplantation Institute of İnönü University, and data were collected through face-to-face interviews. The Personal and Transplant Information Form, Child Revised Impact of Event Scale, and Patient Health Questionnaire–Depression were used as data collection tools. In addition to descriptive statistics, Student’s t-test, Mann–Whitney U test, correlation analyses, and regression analyses were performed. Results: The median PHQ-9 score was 1.00 (Q1–Q3: 0.00–5.00), indicating generally low levels of depression. A significant positive correlation was found between CRIES and PHQ-9 scores (r = 0.414, p < 0.01). In contrast, no consistent significant associations were observed between liver enzyme levels and depression scores in multivariate analyses, although bilirubin showed a modest negative correlation with PHQ-9 scores. In the multivariate analysis, although the overall regression model was not statistically significant, the CRIES score showed an individual association with PHQ-9 scores within the model (B = 0.117, p = 0.037). Conclusions: Liver enzymes cannot be considered strong biomarkers of depression in pediatric liver transplant recipients; however, post-traumatic stress symptoms may be an important clinical indicator for assessing psychological adjustment. Full article

Military burn pits used during post-9/11 U.S. military deployments functioned as uncontrolled combustion systems and were widely utilized to dispose of large volumes of outdoor waste by burning. Burn pits involved heterogeneous waste materials burned under variable temperature and oxygen conditions. These combustion environments generated complex, toxic, multipollutant airborne emission mixtures that included particulate matter (PM_2.5), polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs). This narrative review synthesizes epidemiologic, experimental, and mechanistic evidence linking burn pit emissions to disruption of the lung–brain axis and adverse neurological outcomes. We specifically aim to address a critical gap in understanding how combustion-derived toxicants impact brain health and are associated with unfavorable neuropsychiatric outcomes, including increased risk of post-traumatic stress disorder (PTSD) and depression. Combustion-related exposures promote pulmonary inflammation and system-wide immune signaling that propagate to the central nervous system, contributing to neuroinflammation and dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. These interconnected mechanisms are associated with toxic encephalopathy and related cognitive and mood disturbances, underscoring the need to integrate fire science with military and environmental health services research to better define the systemic and neurological consequences of acute and chronic fire-derived inhalation exposures. Full article

Background and Clinical Significance: We report an exceptionally rare case of mechanical aortic valve replacement necessitated by self-inflicted needle penetration with aortic valve and left ventricular involvement in a patient with recurrent self-harm behavior. Case Presentation: A 24-year-old female with post-traumatic stress disorder and emotionally unstable personality disorder, borderline type, presented with dyspnea two weeks after self-inserting multiple needles into her thorax. Computed tomography revealed a needle lodged in the aortic root and an intramyocardial needle with hemorrhagic pericardial effusion. Emergency sternotomy revealed inflammatory destruction of the right coronary aortic cusp with complete perforation. Following failed reconstruction attempts, mechanical aortic valve replacement was performed. The patient survived the immediate postoperative period but demonstrated recurrent non-adherence to oral anticoagulation, including multiple episodes of over- and under-anticoagulation. More than six years after surgery, she presented with cardiogenic shock due to prosthetic valve thrombosis after discontinuing warfarin for two weeks. Despite venoarterial ECMO and fibrinolytic therapy, she died from refractory left ventricular failure. Conclusions: This case highlights critical challenges in managing patients with severe psychiatric disorders requiring mechanical valve prostheses and suggests that bioprosthetic valves may warrant careful consideration in patients with major concerns regarding long-term anticoagulation adherence. Full article

Post-traumatic stress disorder (PTSD) remains inadequately treated by existing pharmacological and psychological interventions, prompting growing interest in psychedelic-assisted psychotherapy. Although randomised controlled trials have evaluated several psychedelic agents for PTSD, to our knowledge, no prior PTSD-specific synthesis has quantitatively examined multiple agent classes within a single review framework. This systematic review and meta-analysis searched PsycINFO, CINAHL, Embase, MEDLINE, and clinical trial registries to identify RCTs of psychedelic-assisted psychotherapy for PTSD. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and random-effects meta-analyses were conducted for efficacy outcomes; safety and therapeutic protocols were synthesised narratively. Eleven RCTs involving 358 participants met inclusion criteria, evaluating MDMA, ketamine, and cannabidiol, of which eight contributed to meta-analyses. MDMA-assisted psychotherapy demonstrated a significant moderate-to-large reduction in PTSD symptom severity with negligible heterogeneity, and participants were significantly more likely to achieve clinical response and loss of PTSD diagnosis. The pooled effect for ketamine was small and non-significant, and a single cannabidiol trial showed no clear benefit. All agents were generally well tolerated. MDMA-assisted psychotherapy showed a promising efficacy signal for PTSD symptom reduction, although safety data were heterogenous and remain insufficient for strong comparative conclusions. Evidence for ketamine and cannabidiol remains too limited to support clinical implementation and it is noted that the current evidence base is dominated by MDMA trials. Further adequately powered trials with standardised outcomes and direct comparative studies across agents are needed. Full article