Search Results (1,377)

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

Background/Objectives: Clinical childbirth in high-income countries is increasingly shaped by standardised routines that do not always accommodate individual preferences. In Germany, approximately one in eight pregnant persons experiences clinically significant childbirth-related post-traumatic stress disorder symptoms, with pregnant persons facing language or health-literacy barriers being at particular risk of inadequate preference integration. Methods: This paper presents the conceptual foundation and proposed study design for FAIR-Birth, an interdisciplinary initiative to develop and feasibility-test a mobile application supporting Advance Birth Planning (ABP) embedded within midwifery-led antenatal care. The intervention combines four elements: transfer of the Advance Care Planning concept to antenatal care, a domain-restricted Large Language Model (LLM) supporting multilingual preference articulation, integration of the resulting ABP document into midwifery-led continuity of care, and iterative adaptation. Following the updated MRC framework, this study will employ a sequential mixed-methods design encompassing systematic review, participatory instrument development, Delphi consensus on the knowledge base, iterative technical development with usability testing, and a feasibility study across two perinatal centres in Bavaria. Results/Conclusions: FAIR-Birth is expected to generate a content-validated ABP instrument, a domain-restricted multilingual LLM dialogue system, and an evaluated application prototype. The work corresponds to the development and feasibility phases of the MRC framework; effectiveness questions are reserved for a planned subsequent randomised controlled trial. Full article

Introduction: Medical cannabis is increasingly used to manage post-traumatic stress disorder (PTSD), a condition frequently linked to high healthcare utilization, particularly for acute services. Methods: We conducted a retrospective cohort study using data from Leafwell among patients with PTSD who either used medical cannabis for at least one year (treated group) or were cannabis-naïve (untreated group). The primary outcomes were urgent care, emergency department (ED), or hospitalization visits in the past six months. We applied inverse probability weighting with regression adjustment (IPWRA) to estimate the average treatment effect (ATE) of medical cannabis exposure, adjusting for demographics, PTSD severity, and other health factors. Sensitivity analyses were performed to assess robustness. Results: Out of 1946 participants, 1261 were in the treated group and 685 in the untreated group. The treated group had a 35.6% lower probability of urgent care visits (coefficient = −0.024, SE = 0.0117) and a 35.1% lower probability of ED visits (coefficient = −0.027, SE = 0.0124). Although hospitalization rates were 26.3% lower, this difference was not statistically significant. Findings remained consistent across multiple ATE estimation methods, and adjusting the IPWRA model’s tolerance levels strengthened these associations. Fewer than 2% of the treated group reported adverse events. Conclusions: Medical cannabis use among patients with PTSD was associated with reduced urgent care and ED visits. These results were robust across analytical methods, supporting the potential role of medical cannabis in lowering acute healthcare needs. Further longitudinal research is warranted to assess causality and clarify effects on hospitalization. Full article

Background/Objectives: This study aimed to evaluate burnout, psychological distress, and intention to quit among healthcare workers one year after the 6 February 2023 earthquakes, and to examine the relative contributions of disaster-related exposures and organizational factors using a hierarchical analytical approach. Methods: This cross-sectional study included 640 healthcare workers from a tertiary referral hospital in one of the provinces most severely affected by the earthquakes. Data were collected using validated instruments, including the Maslach Burnout Inventory, Hospital Anxiety and Depression Scale, Impact of Event Scale–Revised, and Intention to Quit Scale. Hierarchical multiple linear regression analyses were performed to evaluate factors associated with burnout dimensions, psychiatric symptoms, and intention to quit. Results: Clinically significant anxiety symptoms were observed in 32.5% of participants, depressive symptoms in 55.8%, and PTSD risk in 54.1%. Low personal accomplishment was the most prevalent burnout dimension (69.1%), while high emotional exhaustion and depersonalization were observed in 43.0% and 18.9% of participants, respectively. Workplace climate variables accounted for the largest increment in explained variance across all seven models. Low job satisfaction was the strongest and most consistent factor associated with adverse outcomes, with standardized coefficients ranging from β = +0.27 to +0.61. Non-close colleague relations were independently associated with higher burnout, anxiety, depression, and intention to quit scores, as well as lower personal accomplishment. Despite the high prevalence of psychological symptoms, post-earthquake psychiatric help-seeking was reported by only 6.2% of participants. Conclusions: One year after the earthquakes, healthcare workers continued to experience a substantial psychological burden. Although disaster-related exposures were associated with several adverse outcomes, organizational factors appeared to demonstrate more consistent associations with mental health indicators. These findings highlight the potential importance of improving modifiable workplace conditions to support psychological well-being and workforce sustainability in post-disaster healthcare systems. Full article

Background/Objectives: Extant data suggest that the Stellate Ganglion Block (SGB) is effective for posttraumatic stress disorder (PTSD). Clinical data from a large healthcare system are lacking. We report data from a clinical project in the Veterans Health Administration. Methods: Retrospective data of PTSD and anxiety for 579 patients who received one or more SGBs were analyzed on the full sample and on those who had complete data using general linear models. Results: Receiving the first SGB provided a 36% and 30% reduction in PTSD symptom scores at 1-week and 1-month post-SGB, respectively. Those who received 2–4+ SGBs showed lower pre-SGB PTSD symptom scores and trends for lower scores at 1-week and 1-month post-SGB. Overall, 78% and 71% of patients had a reliable (Δ ≥ −5 points) change and 68% and 60% had a clinically meaningful (Δ ≥ −10 points) change in PTSD symptom scores from pre-SGB to 1-week and 1-month post-SGB, respectively. There were clinically meaningful reductions for anxiety in 51.5% and 48.3% at 1-week and 1-month post-SGB, respectively. Conclusions: These data corroborate existing data about the benefit of SGB for PTSD and anxiety and are unique in showing an association between repeat SGBs and lower PTSD symptoms at subsequent baseline. Full article