Search Results (3,615)

Purpose: This retrospective study aimed to identify factors associated with postoperative cognitive dysfunction (POCD) in patients undergoing hepatectomy, with particular attention to liver disease-related characteristics and perioperative variables. A secondary aim was to develop a clinically applicable nomogram for individualized risk estimation in this population. Patients and Methods: A retrospective cohort study was conducted in 314 consecutive patients who underwent hepatectomy at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School between January 2023 and December 2024. Patients were included if they had complete clinical data and underwent preoperative and postoperative cognitive assessment. Exclusion criteria included preoperative cognitive impairment (Montreal Cognitive Assessment [MoCA] score < 26), preexisting neurological or psychiatric disorders, and in-hospital death within 72 h after surgery. POCD was defined as a decline of ≥3 points in the MoCA score from baseline to postoperative day 5. Clinical, surgical, nutritional, and perioperative variables were analyzed, and a nomogram was constructed based on the final multivariable logistic regression model. Results: The overall incidence of POCD was 27.4% (86/314). The final multivariable model included sarcopenia, preoperative hemoglobin < 120 g/L, Child–Pugh classification, alcohol consumption, operative duration, and pain score on postoperative day 1. The nomogram incorporating these variables showed good discriminative ability, with an area under the curve of 0.87 (95% CI: 0.83–0.92). Conclusions: In this retrospective cohort of patients undergoing hepatectomy, several perioperative clinical factors were associated with POCD. The proposed nomogram may serve as a practical tool for perioperative risk estimation and support more individualized management in higher-risk patients. Full article

Background: Dissociation is associated with multiple psychiatric disorders and mental health issues. However, there are some limitations in the existing studies, such as the predominant use of clinical samples and the lack of focus on potential mediators that can explain this relationship. Among the latter, an unclear self-concept may serve as a risk factor for many psychological disturbances, while a well-established self-concept may be a resilience factor. This study aimed to examine the gender differences among the variables, to test whether dissociative experiences are associated with psychopathological symptoms in a non-clinical sample, and to explore the mediating role of self-concept clarity. Materials and methods: 257 participants (M_age = 23.92 ± 7.33, 69.6% females) were included in the research. The Symptoms Checklist-90 , The Dissociative Experiences Scale , and The Self-Concept Clarity Scale were used. Results: Women scored higher on somatization (M_women = 1.28, SD = 0.86) than men (M_men = 0.93, SD = 0.70), t(255) = 3.47, p = 0.001, d = 0.42. Moreover, women had a higher level of depression (M_women = 1.37, SD = 0.96) compared to men (M_men = 0.98, SD = 0.77), t(255) = 3.49, p = 0.001, d = 0.43. Dissociative experiences were positively associated with psychopathological symptoms (r = 0.69, p < 0.01). Self-concept clarity mediated this relationship (ꞵ = 0.21, SE = 0.04, 95% CI [0.13, 0.30]). Conclusions: The findings showed gender differences regarding psychopathological symptoms and highlighted the importance of self-concept clarity in reducing the risk of developing them. Full article

Background: Features intersecting neurological and psychiatric disorders impose differential diagnostic challenges, especially in younger, healthy patients. Cognitive biases, such as diagnostic overshadowing, can lead to errors for patients with neurologic deficits in the presence of psychiatric comorbidities. Methods: This case report describes a 22-year-old female patient admitted for acute inpatient rehabilitation with an initial primary diagnosis of Functional Neurologic Disorder (FND), who subsequently underwent additional neurologic work-up following clinical and functional inconsistencies. Results: Physical exam findings, lack of response to therapeutic modalities, and electromyography/nerve conduction study findings led to a full neurological work-up consistent with Acute Motor and Sensory Axonal Neuropathy (AMSAN), treated with intravenous immunoglobulin. Conclusions: Systemic peripheral neuropathies must be addressed during differential diagnosis in suspected FND, a potential gap in current practice. This report emphasizes the essential role of physiatry and the value of an unbiased, patient-centered approach, integrating clinical knowledge and compassion to ensure accurate diagnosis and appropriate treatment. Full article

Background: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) are characterized by neuropsychiatric symptoms linked to immune dysregulation. Emerging evidence highlights the role of host–microbiome interactions in modulating neuro-immune functions via gut–brain axis signaling; however, its contribution to PANDAS pathophysiology remains poorly understood. Methods: We conducted microbiome analysis from samples collected across multiple sites of PANDAS patients including nasal, throat and stool. We performed an integrated multi-omics analysis of stool samples from pediatric PANDAS cases and healthy controls, including discordant twin pairs. Microbial composition and function were assessed using 16S rRNA gene sequencing, shotgun metagenomics, while untargeted metabolomic profiling was performed using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS). Results: PANDAS cases exhibited reduced alpha diversity and significantly altered beta diversity compared to controls, indicating shifts in gut microbial composition. Shotgun metagenomic analysis revealed differential enrichment of functional pathways, including diminished quorum sensing, altered gamma-aminobutyric acid (GABA) biosynthesis, and microbial degradation processes. Multiple gut–brain modules (GBMs) and gut metabolic modules (GMMs) associated with neurotransmission, transport activities and metabolism were significantly perturbed in PANDAS. Metabolomic profiling showed reduced functional diversity and distinct clustering of metabolic profiles, with differential abundance of amino acids, bile acids, and neuroactive compounds. Integrative analysis further identified disrupted microbe–metabolite networks allied to gut–brain signaling. Conclusions: Our findings reveal significant functional shifts in gut microbiota composition, functional capacity and metabolite profile in PANDAS, suggesting dysregulation of the gut–brain axis signaling. This study provides a foundation for development of microbiome-based biomarkers and therapeutic strategies for pediatric neuropsychiatric disorders. Full article

Background/Objectives: A psychiatric consultation is a professional evaluation aimed at establishing a diagnosis, a prognosis, and developing a treatment plan. The objective was to assess psychiatric consultations (PCs) at the Community Mental Health Center (CMHC), Emergency Room (ER) and General Hospital (GH) to highlight differences across settings. Methods: With a retrospective design, we examined all PCs performed between 1 January 2024 and 31 December 2024 at the CMHC, ER and GH of Baggiovara in Modena. Descriptive statistical analysis and a multivariate logistic regression were performed. Results: We collected a total of 3174 PCs for 1801 patients, performed in the three settings: 52% in ER, 30% in CMHC and 18% in GH. In ER, PCs were most frequently requested for suicide risk (26%), psychomotor agitation (14%) and substance intoxication (14%). In CMHC, the most common diagnoses were depressive disorders (22%), acute anxiety (20%) and acute psychotic episodes (13%). In GH, consultations mainly addressed psychiatric symptoms associated with medical and eating disorders. The overall rate of psychiatric hospitalization after PCs was 16.2%, reaching 23.4% for consultations in ER. Discontinuation of pharmacological therapy was significantly associated with an increased risk of hospitalization (p < 0.001), which rose to 17% when therapy had been interrupted for more than one year. Conclusions: PCs at ER were the access point for most hospitalizations. Therapeutic discontinuation, acute psychosis and substance use represented the main predictors of hospitalization. Strengthening shared care pathways among CMHC, ER and GH represents an effective model of integration between hospital and community services, ensuring continuity of care. Full article

Background/Objectives: A sub-anesthetic dose of ketamine has shown promise in reducing craving, withdrawal symptoms, and use of drugs such as alcohol, cocaine, and opioids among individuals with substance use disorders. Ketamine’s therapeutic potential for tobacco use is unknown. Here, we investigated a single sub-anesthetic dose among adults with tobacco use disorder who were not interested in changing their smoking behavior. Methods: Utilizing a randomized, within-subject crossover, double-blinded, counter-balanced, midazolam-controlled design, participants (n = 18) received a 0.71 mg/kg infusion of ketamine and a 0.025 mg/kg infusion of midazolam (i.e., active placebo) at least two weeks apart. Participants were asked to abstain from smoking after the infusions until the post-infusion sessions, 1 day following infusion, where participants completed measures of smoking behavior, craving, and withdrawal symptoms. Participants continued to record their smoking behavior over the 7 days following infusion. Participants also completed a semi-structured qualitative interview regarding their experiences. Results: Compared to midazolam, ketamine infusion led to a non-significant reduction (p = 0.10, ƞ_p² = 0.153) in the number of cigarettes smoked during the requested abstinence period. Following this period, there were no significant differences in ad lib smoking. Ketamine showed no effect on craving or withdrawal symptoms. Participants reported more intense psychological experiences following ketamine infusion (p < 0.001, ƞ_p² = 0.830) and about half reported it felt easier to abstain from smoking after the ketamine infusion. Conclusions: While well tolerated, these findings suggest ketamine has little to no direct effect on quantitative measures of cigarette smoking, craving, or withdrawal. However, the qualitative measures suggest ketamine improves mood and reduces craving in some individuals for several days. Future studies should investigate whether ketamine can indirectly support smoking cessation among individuals with comorbid psychiatric indications for ketamine treatment. Full article

Background: Delirium is a common neuropsychiatric syndrome among hospitalized patients and has been associated with increased short- and long-term mortality. However, data on long-term outcomes and prognostic significance remain limited, particularly in Middle Eastern populations. Methods: This prospective observational cohort study was conducted at a tertiary care hospital in Riyadh, Saudi Arabia. Adult patients admitted to medical, surgical, and intensive care units (ICUs) underwent standardized clinical neuropsychiatric assessment for delirium. Five-year follow-up data were obtained from electronic health records and phone follow-up with patients/caregivers. Clinical outcomes and survival were compared between patients with and without baseline delirium. Kaplan–Meier survival analysis assessed five-year survival, and Cox regression explored the association between delirium and time-to-death adjusting for medical/psychiatric morbidity. Results: Among 278 patients, 71 (25.5%) were diagnosed with delirium during initial hospitalization. At five years, 51 patients (18.3%) had died. Patients with delirium had higher mortality (35.2% vs. 12.6%, p < 0.001), reduced five-year survival, and greater cumulative ward and ICU stays. In Cox regression including 50 deaths with complete data, delirium at initial assessment was associated with a higher hazard of death during follow-up (HR 1.93, 95% CI 1.06–3.55). Older age per year (HR 1.02, 95% CI 1.00–1.04), kidney disease (HR 2.12, 95% CI 1.20–3.75), and psychiatric disorders (HR 2.16, 95% CI 1.17–3.97) were independently associated with a higher hazard of death. Conclusions: Delirium was associated with increased five-year mortality and adverse long-term clinical outcomes. These findings support the prognostic significance of delirium in hospitalized patients. Full article

Dopamine (DA) is essential for motor control, motivation, and cognition, and its dysregulation is associated with neurological and psychiatric disorders such as Parkinson’s disease, schizophrenia, and addiction. Accurate and selective DA quantification in complex biological matrices is important, but remains challenging because of coexisting interferents and the low physiological concentration of DA. Here, we report a disposable electrochemical DA sensor based on screen-printed carbon electrodes (SPCEs) modified with metal–organic framework-derived gold nanocomposites (MOFD-AuNCs). The optimal material, synthesized with a 60 min NaBH₄ reduction step (MOFD-AuNC-60), exhibited superior electron-transfer kinetics compared with materials prepared at other reduction times. A single coating of MOFD-AuNC-60 on SPCEs enabled DA oxidation at a low potential (~0.05 V) with high selectivity in the presence of ascorbic acid and uric acid. In undiluted porcine serum, the sensor exhibited a dynamic range of 2.5–500 nM with a calculated detection limit of 0.5 nM. In undiluted human serum, it exhibited a dynamic range of 5–100 nM with a calculated detection limit of 4.4 nM. The MOFD-AuNC-60/SPCEs further demonstrated excellent reproducibility (relative standard deviation, 3%) and stability (7.5% current loss over 7 days). These results demonstrate that the proposed sensor provides a disposable, robust, and reliable sensing platform for direct DA detection in undiluted serum, showing promise for practical applications. Full article

Background/Objectives: Inflammatory bowel diseases (IBDs) are relapsing–remitting gastrointestinal disorders often emerging in adolescence and frequently associated with psychiatric co-morbidities, including eating disorders (EDs). Deficiency in interoception—awareness of internal bodily sensations—is a transdiagnostic feature in EDs, with emerging evidence suggesting its relevance also in IBDs. This study aimed to assess interoceptive abilities in adolescents with IBDs compared to healthy adolescents. Methods: A total of 76 patients with IBDs and 90 healthy controls were enrolled in the study. All participants completed a comprehensive psychometric assessment, including measures of interoceptive sensibility (MAIA-2) and eating-related symptomatology (EDI-3). Results: Up to one in six (15.8%) patients with IBDs were found to be at high risk of developing EDs (EDI-3 Eating Disorder Risk Composite scale >70th percentile). Mean MAIA-2 scores were largely comparable, with the exception of the MAIA-2 Trusting subscale, which assesses whether the experience of one’s body is rated as safe and trustworthy. Specifically, patients with IBDs at high risk of developing EDs reported lower scores than both healthy controls and patients with IBDs at low risk of developing EDs, with a statistically significant difference emerging in the comparison with the latter group (p = 0.044). Conclusions: Adolescents with IBDs who report an elevated risk of developing eating disorders have a psychological profile characterised by increased disordered eating symptomatology, accompanied by selective impairment in interoceptive trust, as evidenced by reduced trust in internal bodily signal. These findings highlight the clinical relevance of thorough clinical assessment and early psychological intervention in this vulnerable population. Full article

Stock market investors and traders operate in high-pressure environments marked by volatility, uncertainty, financial risk, and intense performance demands. These conditions lead to substantial psychological distress, increasing vulnerability to psychiatric disorders and suicidal behavior. Key psychological risk factors in this population include acute financial loss, chronic stress, impulsivity, perfectionism, and identity fusion with professional performance. Evidence from behavioral psychology and clinical psychiatry indicates elevated rates of mood disorders, anxiety, and burnout in trading environments. Resilience—including emotional regulation, effective stress-coping mechanisms, strong social support, and cognitive flexibility—emerges as a critical protective factor that mitigates suicide risk and promotes adaptive functioning. Strengthening psychological resilience and implementing evidence-based mental-health strategies may help reduce suicide risk and support overall well-being. The medico-legal dimensions of this issue encompass duty of care within high-stress financial workplaces, clinical obligations related to suicide risk assessment and documentation, confidentiality and safety considerations, and questions of foreseeability of suicide in cases involving severe or catastrophic financial loss. Despite growing awareness of mental health challenges in financial professions, the intersection of suicide risk, resilience, and medico-legal responsibilities in this population remains underexplored. Further research is needed to refine assessment frameworks and develop targeted suicide prevention interventions for this at-risk group. Full article

Background/Objectives: Psychiatric inpatient care varies substantially in its clinical goals, resource demands, and financial implications. Acute units focus on short-term crisis stabilization, whereas chronic units provide prolonged supervision for patients with persistent functional impairment. Limited evidence exists from Eastern Europe on how these differing service models impact both hospital costs and clinical outcomes such as early rehospitalization. This study aimed to compare the economic and operational performance of Acute versus Chronic Psychiatry and to identify predictors of 30-day readmission following acute psychiatric hospitalization. Methods: This retrospective observational study analyzed routinely collected data from a Romanian public hospital. All adult admissions to Acute and Chronic Psychiatry recorded between 1 January 2024 and 31 December 2024 were included. Standardized financial indicators were derived from administrative data, while clinical variables and readmission outcomes were extracted from electronic medical records. Between-group comparisons of economic and operational indicators were performed using t-tests. Multivariable logistic regression was used to determine independent predictors of 30-day readmission in Acute Psychiatry, reporting adjusted odds ratios (aOR) with 95% confidence intervals (CI). Model performance was evaluated with area under the curve (AUC), Hosmer–Lemeshow tests, and Nagelkerke R². Results: Acute Psychiatry demonstrated significantly higher mean cost per bed-day (798.76 vs. 373.75 lei; p < 0.001), but a lower mean cost per patient due to shorter hospitalization (10.17 vs. 53.32 days). A total of 188 acute patients (13.7%) were readmitted within 30 days. No early readmissions occurred in Chronic Psychiatry, consistent with its long-stay care model. Independent predictors of readmission included psychotic disorder diagnosis (aOR = 1.62, 95% CI: 1.18–2.23), multiple prior admissions (aOR = 1.35, 95% CI: 1.18–1.54), shorter length of stay (LOS) (aOR = 0.88 per 5-day increase, p = 0.006), and absence of a post-discharge plan (aOR = 0.54, 95% CI: 0.39–0.76). Model discrimination was acceptable (AUC = 0.74). Conclusions: Acute and chronic psychiatric services differ markedly in cost structures and care pathways. Early rehospitalization is a clinically relevant outcome within acute psychiatric care and is influenced by both patient-level and continuity-of-care factors. Enhancing discharge coordination, expanding continuity-of-care strategies, and optimizing resource allocation toward community-based support may reduce early rehospitalizations while improving hospital cost-efficiency. Full article

Gambling disorder (GD) is a behavioral addiction associated with significant psychosocial consequences and high psychiatric comorbidity, including anxiety, depression, and impulsivity; however, the role of physical activity (PA) as a potential modulator of these alterations remains unclear. The aim of this study was to examine the relationship between PA levels and symptoms of anxiety, depression, and impulsivity in patients with GD. An observational study was conducted with 62 adults diagnosed according to DSM-5 criteria, recruited from AJUPAREVA (Valladolid, Spain). PA was assessed using the International Physical Activity Questionnaire (IPAQ), Personality trails where evaluated with CEPER III, impulsivity with the Barratt Impulsiveness Scale (BIS-11) and the Plutchik Impulsivity Scale, and anxiety and depression with the Hamilton Anxiety (HAM-A) and Depression (HAM-D) scales. Participants were predominantly male (91.5%) and reported moderate-to-high PA levels. No significant differences were found in total impulsivity across PA levels; however, motor impulsivity was higher in highly active individuals, while non-planning impulsivity was greater in those with low PA. Anxiety and depression were highly prevalent (~65%) with no significant associations with PA. In conclusion, PA was not significantly associated with psychiatric outcomes in this clinical sample, highlighting the need for larger, longitudinal studies to clarify its potential role within multidisciplinary interventions for GD. Full article

Depression is a highly heterogeneous psychiatric disorder with its pathogenesis increasingly linked to dysregulated neuroinflammation. Microglia, as the resident immune cells of the central nervous system (CNS), play a pivotal role in the initiation and progression of the neuroinflammation and the pathophysiology of depression. These cells exhibit a dual role in pro- and anti-inflammatory processes, dynamically regulating immune responses through immunometabolic reprogramming in response to environmental cues. This review elaborates how metabolic remodeling in microglia, particularly within glucose, lipid, and amino acid pathways, drives their polarization toward a pro-inflammatory phenotype. This shift promotes depression pathogenesis via the release of inflammatory factors, disruption of synaptic plasticity, and mediation of neurotoxicity. We further discuss the impact of existing antidepressants on cellular metabolism and highlight the promise and challenges of targeting specific microglial metabolic pathways as a novel therapeutic strategy. This synthesis provides new insights into the immunometabolic mechanisms of depression and outlines directions for developing targeted treatments. Full article

Astrocytes are now recognized as active and essential participants in neural circuit function, extending far beyond their traditional roles as passive support cells. Emerging evidence highlights their critical involvement in synaptic modulation, information processing, and complex behaviors, making them key targets for understanding cognitive dysfunction in psychiatric disorders. This narrative review synthesizes current findings from rodent models to elucidate the relationship between astrocytic networks and multidomain cognitive performance. We first outline the morphological and physiological features of astrocytes, followed by a comprehensive overview of the modern experimental toolkit, including observational markers and advanced interventional strategies. Next, we evaluate commonly used behavioral assays that capture distinct cognitive domains, ranging from basic spatial and recognition memory to higher-order executive functions, cognitive flexibility, and social cognition. By integrating recent experimental evidence, we detail the specific mechanistic pathways, such as intracellular calcium signaling, gliotransmission, and neuroinflammatory reactivity, through which astrocytes directly govern these cognitive processes. Finally, we highlight critical knowledge gaps stemming from methodological limitations, arguing for the integration of more ethologically relevant, high-throughput behavioral tasks alongside highly specific targeting tools to better capture the functional heterogeneity of astrocytes in cognitive health and disease. Full article

Background/Objectives: Sleep-disordered breathing (SDB), including obstructive sleep apnea, is common in children and is associated with mouth breathing, snoring, and neurobehavioral disturbances. In pediatric orthodontic patients, oral habits and craniofacial imbalances may contribute to airway dysfunction, making orthodontic evaluation a potential setting for early identification of SDB. This study aimed to estimate the prevalence of SDB and to evaluate its associations with parent-reported behavioral symptom profiles in a cohort of pediatric orthodontic patients. Methods: A multicenter cross-sectional study was conducted in 186 children aged 7–13 years attending orthodontic clinics in Oradea and Târgu Mureș, Romania. Parents completed a structured questionnaire on oral habits, the 22-item Pediatric Sleep Questionnaire (PSQ), with SDB defined as 8 or more positive responses, and a parent-reported behavioral screening form assessing ADHD symptom subtypes, oppositional-defiant disorder (ODD), conduct disorder, and anxiety/depression. These behavioral outcomes were based on screening measures and were not intended as clinical psychiatric diagnoses. Associations were analyzed using chi-square or Fisher’s exact tests, and multivariable logistic regression analyses were performed adjusting for age, sex, and weight status. Results: Mouth breathing was reported in 61.8% of participants, snoring in 26.9%, and SDB in 13.4%. Positive screens for ADHD-inattentive (p < 0.001), ADHD-hyperactive/impulsive (p < 0.001), ADHD-combined (p < 0.001), ODD (p < 0.001), and anxiety/depression (p < 0.001) were significantly more frequent among children with SDB. In multivariable analysis, SDB remained independently associated with ADHD-combined subtype (OR = 6.22), ADHD-hyperactive/impulsive symptoms (OR = 5.84), oppositional-defiant disorder (OR = 4.91), and anxiety/depression (OR = 4.38). Conclusions: SDB was identified in a meaningful proportion of pediatric orthodontic patients and was significantly associated with multiple screening-defined behavioral symptom domains. These findings support consideration of brief airway- and sleep-oriented screening during orthodontic assessment, particularly in school-aged children presenting with mouth breathing, snoring, or behavioral concerns. Given the cross-sectional and questionnaire-based design, the findings should be interpreted as associative and warrant confirmation in prospective studies using objective sleep measures. Full article