Search Results (537)

Tobacco use disorder remains a leading cause of preventable mortality, with nicotine playing a central role in the development and maintenance of dependence, mainly through its action on α4β2 nicotinic acetylcholine receptors (nAChRs). Smoking cessation treatments must address both physiological withdrawal and the affective disturbances (such as anxiety, irritability, and mood lability) which often facilitate relapses. This review compares two pharmacotherapies used in smoking cessation, varenicline and cytisinicline (cytisine), with particular focus on their impact on emotional regulation, psychological symptoms, and neuropsychiatric safety. Varenicline, a high-affinity partial agonist at α4β2 nAChRs, has demonstrated superior efficacy in maintaining abstinence and is well-supported by robust clinical data, including in psychiatric populations. However, its use may be limited by adverse effects such as nausea and sleep disorders. Cytisinicline, a structurally similar but less potent partial agonist, has recently gained renewed interest due to its lower cost, favorable tolerability profile, and comparable effectiveness in the general population. Although less extensively studied in patients with serious mental illness, preliminary data suggest cytisinicline may offer a better side effect profile, particularly regarding sleep disturbances and emotional reactivity. Both agents appear to ameliorate withdrawal-related affective symptoms without significantly increasing psychiatric risk. Ultimately, pharmacotherapy choice should be guided by individual clinical features, mental health status, treatment tolerability, and resource availability. Further research is needed to establish cytisinicline’s efficacy and safety across diverse clinical contexts, particularly among individuals with severe psychiatric comorbidities. Full article

Background/Objectives: Schizophrenia has been associated with increased inflammatory and metabolic disturbances. Perceived family support potentially affects inflammatory and metabolic biomarkers. The aim of this study was to determine the interrelations between family support, C-reactive protein (CRP) and Body Mass Index (BMI) in a sample of outpatients with schizophrenia. Importantly, this study sought to elucidate the effect of perceived family support on inflammatory processes among patients with schizophrenia. Methods: In this cross-sectional correlation study, 206 outpatients with schizophrenia in clinical remission completed a standardized self-report questionnaire that assessed family support (Family Support Scale—FSS). Sociodemographic, clinical and laboratory data were also recorded. Results: Among the participants, 49.5% had detectable CRP values (≥0.11 mg/dL), whereas 14.6% had positive CRP levels (>0.6 mg/dL). There was a significant difference in CRP levels among the different BMI groups (normal weight/overweight vs. obese). For obese patients, the crude odds ratios (ORs) for detectable and positive CRP values were 1.980 (95% confidence interval (CI) [1.056, 3.713]) and 27.818 (95% CI [6.300, 122.838]), respectively. Significant positive correlations were observed among CRP, BMI and illness duration, while scores on the FSS were negatively associated with these variables. The results of binary logistic regression analysis indicated that both BMI and family support were significant factors in determining the likelihood of having positive CRP levels, with each unit increase in the BMI associated with a 17% (95% CI [0.025, 0.337]) increase in the odds, and with each unit increase in family support leading to an 8.6% (95% CI [0.018, 0.15]) decrease. A moderation analysis revealed that the association between family support and the probability of having positive CRP levels depends on the BMI value, but only for obese patients did the protective effect of family support significantly decrease the magnitude of the risk of having positive CRP (b = −0.1972, SE = 0.053, OR = 0.821, p = 0.000, 95% CI [−0.3010, −0.0934]). Conclusions: The effect of perceived family support on inflammatory responses becomes evident in cases where beyond metabolic complications, inflammatory processes have already been established. Increased perceived family support seems to protect against inflammation and, notably, the association between low perceived family support and increased inflammation is even stronger. Establishing the role of family involvement during the treatment of patients with schizophrenia through inflammatory processes is a novelty of this study, emphasizing the need to incorporate family therapy into psychiatric treatment plans. However, primary interventions are considered necessary for patients with schizophrenia in order to maintain their BMI within normal limits and avoid the subsequent nosological sequelae. Full article

Schizophrenia is a complex psychiatric disorder traditionally linked to neurotransmitter dysregulation, particularly within dopamine and glutamate pathways. However, recent evidence implicates the gut–brain axis as a potential contributor to its pathophysiology. This perspective article proposes a systems-level understanding of schizophrenia that incorporates the role of gut microbial dysbiosis specifically, reductions in short-chain fatty acid (SCFA)-producing taxa, and elevations in pro-inflammatory microbes. These imbalances may compromise gut barrier integrity, stimulate systemic inflammation, and disrupt neurochemical signaling in the brain. We synthesize findings from animal models, clinical cohorts, and microbial intervention trials, highlighting mechanisms such as SCFA regulation, altered tryptophan–kynurenine metabolism, and microbial impacts on neurotransmitters. We also explore microbiome-targeted interventions like probiotics, prebiotics, dietary strategies, and fecal microbiota transplantation (FMT) and their potential as adjunctive therapies. While challenges remain in causality and translation, integrating gut–brain axis insights may support more personalized and biologically informed models of schizophrenia care. Full article

Background and Clinical Significance: Herein, we describe the clinical case of a 17-year-old patient with psychotic disorder secondary to cerebral venous thrombosis due to primary thrombophilia, which was related to protein S deficiency and a heterozygous MTHFR gene mutation with the p.Ala222Val variant. Case presentation: A 17-year-old female, with no history of previous illnesses, was admitted to the emergency service department due to a psychotic break. Psychiatric evaluation detected disorganized thought, euphoria, ideas that were fleeting and loosely associated, psychomotor excitement, and deviant judgment. On the fifth day, an inflammatory process in the parotid gland was detected, pointing out a probable viral meningoencephalitis, prompting antiviral and antimicrobial treatment. One week after antiviral and steroidal anti-inflammatory treatments, the symptoms’ improvement was minimal, which led to further neurological workup. MRI venography revealed a filling defect in the transverse sinus, consistent with cerebral venous thrombosis. Consequently, anticoagulation treatment with enoxaparin was initiated. The patient’s behavior improved, revealing that the encephalopathic symptoms were secondary to thrombosis of the venous sinus. Hematological studies indicated the cause of the venous sinus thrombosis was a primary thrombophilia caused by a heterozygous MTHFR mutation variant p.Ala222Val and a 35% decrease in plasmatic protein S. Conclusions: This case highlights the possible relationship between psychiatric and thrombotic disorders, suggesting that both the MTHFR mutation and protein S deficiency could lead to psychotic disorders. Early detection of thrombotic risk factors in early-onset psychiatric disorders is essential for the comprehensive management of patients. Full article

Anorexia Nervosa (AN) is a psychiatric illness with serious medical and physiological implications. Anorexia Nervosa is characterised by significant disruptions in weight, growth and physical health resulting from disordered behaviours such as food restriction, purging and inappropriate exercise. The illness is associated with substantial physical, psychological, social and economic burdens affecting all areas of functioning. Typically emerging in adolescence, AN can have a chronic course and high risk of mortality, with evidence suggesting that approximately 10% of individuals diagnosed with AN will die from medical complications or completed suicide. Whilst inpatient treatment reduces mortality risks through nutritional and weight restoration, outpatient treatment is the preferred level of intervention. In the case of adolescents, family-based treatment (FBT) is the recommended and most researched outpatient model for medically stable adolescents. However, access to FBT is limited, and there are several barriers that exist to receiving care from trained clinicians. This review provides a literature update on studies reporting the real-world access challenges for FBT, with particular attention paid to non-research settings. The review also highlights how digitally delivered treatment, specifically telehealth, has been used to increase access to FBT and examines the preliminary outcomes of telehealth-delivered FBT, which appear comparable to traditional in-person care. Despite these promising findings, provider, intervention and systemic factors have challenged the delivery of traditional in-person and telehealth FBT in real-world settings. Critical areas for future research include the need to understand the impact of potential confounders and what adaptions may be required to increase model feasibility in community settings, where access to specialist services is often limited and access challenges are most felt. Full article

Background/Objectives: Globally, one in eight people live with a mental disorder, with depression being a leading cause of disability. This study aimed to identify sociodemographic factors associated with public belief and perception of mental disorders among adults in Poland. Methods: A cross-sectional study with a self-prepared questionnaire (5-point Likert scale) was administered to a nationally representative quota sample of 1114 Polish adults (March 2025). The computer-assisted web interview (CAWI) method was applied. Results: A cross-sectional survey of 1114 adults found that 23.2% had visited psychiatrists, 15.9% psychotherapists, and 21.1% reported a family history of mental disorders. Most respondents (73.8%) believed employers are reluctant to hire individuals with mental disorders, and 53.8% perceived discrimination. Additionally, 19.4% thought mental health patients receive lower-quality care than those with physical illnesses like diabetes. Respondents from large cities (≥500,000 residents, aOR: 1.67; 95%CI: 1.11–2.51; p = 0.01), with higher education (aOR: 1.62; 95%CI: 1.26–2.07; p < 0.001), or a family history of mental disorders (p < 0.05) were more likely to hold this view. Higher education (aOR: 1.47; 95%CI: 1.11–1.94; p = 0.01), good economic status (aOR: 1.60; 1.06–2.40; p = 0.02), and personal psychiatric experience (aOR: 1.89; 95%CI: 1.24–2.87; p = 0.003) increased belief in treatment effectiveness. Males (aOR: 1.88; 95%CI: 1.36–2.61; p < 0.001) and medium-city residents (aOR: 1.82; 95%CI: 1.01–3.27; p = 0.04) more often perceived mental disorders as a sign of weakness, while women (aOR: 1.74; 95%CI: 1.36–2.22; p < 0.001) and those with affected relatives (p < 0.05) more frequently reported discrimination. Older respondents (p < 0.05), those with higher education (aOR: 1.65), and individuals with a family history of mental disorders (p < 0.05) were more likely to state that employers fear hiring people with psychiatric conditions. Conclusions: These findings underscore the need for public health interventions to reduce stigma, improve awareness, and address misconceptions about mental disorders in Poland. Full article

Background/Objectives: Child abuse is a pervasive global issue with significant implications for the physical, emotional, and psychological well-being of victims. This review highlights the clinical, molecular, and therapeutic dimensions of child abuse, emphasizing its long-term impact and the need for interdisciplinary approaches. Early exposure to abuse activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to chronic cortisol release and subsequent neuroplastic changes in brain regions such as the hippocampus, amygdala, and prefrontal cortex. These molecular alterations, including epigenetic modifications and inflammatory responses, contribute to the heightened risk of psychiatric disorders and chronic illnesses in survivors. Clinically, child abuse presents with diverse manifestations ranging from physical injuries to psychological and developmental disorders, making timely diagnosis challenging. Methods: A multidisciplinary approach involving thorough clinical evaluation, detailed histories, and collaboration with child protection services is essential for accurate diagnosis and effective intervention. Results: Recent advances in molecular biology have identified biomarkers, such as stress-related hormones and epigenetic changes, which provide novel insights into the physiological impact of abuse and potential targets for therapeutic intervention. Current treatment strategies prioritize the child’s safety, psychological well-being, and prevention of further abuse. Trauma-focused cognitive behavioral therapy and family-centered interventions are pivotal in promoting recovery and resilience. Conclusions: Emerging research focuses on integrating molecular findings with clinical practice, utilizing digital health tools, and leveraging big data to develop predictive models and personalized treatments. Interdisciplinary collaboration remains crucial to translating research into policy and practice, ultimately aiming to mitigate the impact of child abuse and improve outcomes for survivors. Full article

Improved medical treatments have extended survival and life expectancy in adults with congenital heart defects (ACHD), placing greater emphasis on psychosocial health. Up to one-third of ACHD experience anxiety or depression, and half develop a mental illness during their lifetime. While there is solid evidence on the prevalence of mental health, many do not receive psychological, psychotherapeutic, or psychiatric treatment (PST) and the psychological care situation remains understudied. In a nationwide, online cross-sectional survey conducted in Q1 2024, 1486 ACHD aged 18 to 85 (M_age = 36.84 years; 60.8% female) registered in the German National Register for Congenital Heart Defects (NRCHD) completed self-report questionnaires on sociodemographics, illness identity (Illness Identity Questionnaire), mental well-being, and utilisation of PST. CHD diagnoses were determined in conformity with the International Pediatric and Congenital Cardiac Code (IPCCC) and CHD was classified according to Warnes et al. (simple/moderate/complex). Analyses included chi-square tests, t-tests, and binary logistic regression. Overall, 32.8% of participants reported current and/or previous PST (women 37.5%, men 25.3%). PST utilisation was significantly higher in those with complex (40.2%) compared to moderate (29.6%) and simple CHD (25.3%) (ps < 0.01). Primary treatment reasons were mental illness (41.7%) and CHD-related concerns (37.2%). Nearly half of treatments were self-initiated (45.8%) and about one-third were physician-recommended (30.8%). Logistic regression revealed CHD severity as a significant predictor of PST use (ps < 0.05), with lower odds for simple (OR = 0.48) and moderate (OR = 0.66) compared to complex CHD when controlling for sex (p < 0.001, OR = 1.87), age (p = 0.022, OR = 1.011), education level (ps between 0.060 and 0.780), and net income (ps < 0.05). Those receiving PST showed significantly higher maladaptive illness-identity scores (engulfment, rejection) and lower acceptance. Approximately one in three ACHD requires mental health support, particularly those with complex CHD. The CHD itself acts as a key stressor and treatment motivator. Findings underscore the need for integrated care linking cardiological and psychosocial services. Routine screening for psychological distress and low-threshold access to PST—also for patients with simple and moderate CHD—are essential to identify and address mental health needs early. Full article

Coronary artery disease (CAD) and mental health disorders, particularly depression and anxiety, exhibit a complex, bidirectional relationship that adversely influences clinical outcomes and mortality. Mental illnesses account for approximately 8 million deaths annually, while cardiovascular diseases, including CAD, contribute to about 17 million deaths, with CAD alone responsible for one-third of deaths among individuals aged ≥35 years. This review offers a structured synthesis of current knowledge focusing on the (1) epidemiology, emphasizing the reciprocal risk between CAD and psychiatric conditions; (2) pathophysiological insights, including inflammation, neurohormonal dysregulation, platelet hyperactivation, and shared genetic determinants; and (3) therapeutic approaches, encompassing pharmacological management, psychotherapeutic interventions, and integrated care models. Selective serotonin reuptake inhibitors (SSRIs) remain the pharmacologic agents of choice in patients with CAD and depression due to their favorable cardiac profile, while cognitive behavioral therapy (CBT) offers psychological benefit. However, evidence for mortality reduction remains limited. Emerging research highlights the importance of biomarker-driven care, gut–brain–heart axis modulation, and AI-enabled clinical integration. Full article

Psychiatric neurosurgery is undergoing a profound transformation, propelled by advances in neurotechnology, connectomics, and personalized medicine. Once controversial, surgical interventions are now guided by detailed functional brain mapping and precise neuromodulation techniques, such as deep brain stimulation (DBS), which offer therapeutic options for patients with severe, treatment-resistant psychiatric disorders. This manuscript reviews the current techniques, including lesion-based procedures and DBS, and explores their mechanisms of action, from synaptic plasticity to large-scale network modulation. It highlights recent progress in neuroimaging, connectomic targeting, and artificial intelligence applications for surgical planning and the prediction of treatment responses. Ethical considerations—including informed consent, identity, and long-term follow-up—are critically examined in light of these advances. Furthermore, the growing role of minimally invasive procedures and wearable integrated neurotechnologies is discussed as part of a shift toward dynamic and adaptive interventions. Although still investigational, psychiatric neurosurgery is emerging as a technologically sophisticated field that demands rigorous clinical evaluation, ethical accountability, and an individualized approach to restoring function and autonomy in some of the most disabling mental illnesses. Full article

Oligodendrocyte precursor cells (OPCs) are a dynamic and heterogeneous population of glial cells essential for brain development and myelination. Beyond their well-established role in oligodendrogenesis, emerging evidence suggests that OPCs contribute to synaptic regulation, neuronal communication, and brain plasticity. Recent studies have increasingly implicated OPC dysfunction in the pathophysiology of psychiatric disorders, particularly schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD). This narrative review integrates clinical, genetic, transcriptomic, and histological findings to examine the role of OPC alterations in mental illnesses. In SCZ, OPC abnormalities predominantly affect myelination, but recent data also suggest deficits in non-canonical functions, including neuron–OPC communication. Findings in BD largely mirror those in SCZ, implying shared OPC-related mechanisms across these disorders. In contrast, OPC involvement in MDD appears more complex, with evidence supporting both myelination deficits and non-canonical dysfunctions, such as impaired neuro–glial interactions and perineuronal network alterations. The developmental timing of OPC dysfunction may represent a common denominator underlying psychiatric disorders, as early-life stress and neurodevelopmental disturbances have been linked to OPC impairments. Moreover, given the shared developmental origins of OPCs and parvalbumin-positive interneurons, disruptions in their mutual interactions may contribute to broader neural network dysregulation. Despite these insights, the field remains in its infancy. Future studies integrating independent human cohorts with robust preclinical models are needed to clarify the extent of OPC involvement in psychiatric pathophysiology. Understanding OPC dysfunction may reveal novel biomarkers and open new avenues for individualized therapeutic interventions and preventive strategies in mental health. Full article

Background: Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such as severe malnutrition in patients with anorexia nervosa, a psychiatric disorder characterized by extreme restriction of food intake. Methods: Here, we describe the management of three patients with anorexia nervosa and severe cardiogenic shock, who were treated in our cardiological intensive care unit between December 2022 and January 2025. Two patients were successfully resuscitated after experiencing cardiac arrest, and two required mechanical circulatory support, including Venoarterial Extracorporeal Membrane Oxygenation and microaxial flow pump. The patients presented with a range of complications including multi-organ failure and respiratory distress. Due to the fragile balance between intensive cardiac and nutritional management, as well as the comorbidity of chronic malnutrition, therapeutic decisions were made carefully, including cautious electrolyte management, targeted nutritional therapy, and the use of advanced circulatory support. Conclusions: The treatment approach and beneficious outcomes underline the necessity of a multidisciplinary strategy in managing these critically ill patients with complex, interwoven pathologies. Our experience suggests that early recognition of cardiogenic shock and timely intervention with mechanical circulatory support may significantly improve patient survival in this high-risk cohort. Careful management of nutritional therapy and supplementation of trace elements and vitamins is crucial. Full article

Background/Objectives: According to a diathesis–stress model for the development of mental illness, it is assumed that, in addition to pre-existing individual vulnerability, the occurrence of acute strains is an etiological factor. The SARS-CoV-2 pandemic was a collective massive stressor, which could predispose to a first manifestation of a mental disorder or the exacerbation of a pre-existing mental disorder. The aim of this study was to investigate the effects of the pandemic on the cohort of patients admitted to hospital during the first year of the pandemic. Methods: Patients admitted to inpatient treatment in a university psychiatric hospital in an urban region from April 2020 to March 2021 were interviewed using a systematic questionnaire assessing individual stress factors in the context of the pandemic. On the basis of the interview, clinical practitioners rated the influence of the pandemic on the admission. Results: Six hundred and forty-five patients were interviewed. Only 6.4% showed a strong influence of the pandemic on inpatient admission. This group was characterized by a comparatively high level of socioeconomic functioning. Additionally, the majority of this group had a pre-existing mental disorder. Conclusions: For the majority of patients, the pandemic had only a minor influence on their hospitalization; only for 6.4% was a high impact of the pandemic reported. We hypothesize that this group’s higher socioeconomic functioning in addition to a pre-existing mental disorder made them vulnerable to pandemic-associated limitations. These data confirm a complex diathesis–stress model for the development of mental illness in the context of an acute collective stressor. Full article

Background/Objectives: The understanding of the mechanisms involved in the etiopathogenesis and maintenance of Bipolar Disorder (BD) should be a priority to identify potential early clinical markers that could help in improving treatment strategies and prevention. The aim of this study was to investigate the potential correlation between hopelessness, alexithymia, mind wandering, and rumination in patients with a primary diagnosis of BD, evaluating whether these psychopathological aspects could negatively affect bipolar illness. Methods: A semi-structured interview was used to collect sociodemographic and clinical characteristics. Several psychometric tools were administered: the Beck Hopelessness Scale; Toronto Alexithymia Scale; Rumination Response Scale; Mind Wandering Questionnaire; Mind Wandering: Deliberate; Mind Wandering: Spontaneous; and the Daydreaming Frequency Scale. Results: Patients with high levels of hopelessness have a greater number of psychiatric and medical comorbidities and are more frequently on polypharmacotherapy. Additionally, patients with high levels of hopelessness show a greater likelihood of having attempted suicide during their lifetime. The presence of alexithymia is associated with longer hospitalization and psychiatric comorbidities. Higher levels of rumination correlate with a greater number of psychiatric and medical comorbidities, and with the presence of residual symptoms. Mind wandering is associated with the presence of medical comorbidities and residual symptoms. Conclusions: Hopelessness, alexithymia, mind wandering, and rumination should be identified as important proxies of impaired subjective well-being that should be carefully monitored because they could further worsen the clinical course of BD and suicidal risk in this vulnerable population. Full article

Background and Objectives: Major depressive disorder (MDD) is a prevalent psychiatric illness increasingly recognized as a systemic condition with implications for cardiovascular diseases. Growing evidence indicates that individuals with MDD have an elevated risk of cardiovascular mortality, underscoring the need for reliable, non-invasive biomarkers to assess cardiac risk. While underlying mechanisms remain unclear, electrocardiogram (ECG)-based markers offer a promising, non-invasive means of evaluation. Among these, the electrical risk score (ERS), a composite derived from specific ECG parameters, has emerged as a predictor of adverse cardiac outcomes. This study aimed to investigate the association between ERS and MDD, and whether ERS correlates with depression severity and illness duration. Materials and Methods: In this retrospective cross-sectional study, 12-lead ECGs were evaluated to calculate the ERS based on six ECG parameters: heart rate, corrected QT interval, Tp-e interval, frontal QRS-T angle, QRS transition zone, and presence of left ventricular hypertrophy according to Sokolow–Lyon criteria. The Hamilton Depression Rating Scale (HAM-D) was utilized. Results: The study included 102 patients with MDD and 62 healthy controls. No significant differences were observed in baseline or laboratory parameters between the groups. However, heart rate, Tp-e interval, frontal QRS-T angle, and ERS were significantly higher in the depression group. ROC analysis identified ERS as the strongest predictor of depression. ERS was significantly higher in patients with severe depression compared to those with mild symptoms and showed a positive correlation with both disease duration and HAM-D score. Conclusions: Here, we show that the ECG-derived ERS is significantly elevated in patients with MDD and is associated with increased cardiac risk. ERS outperformed conventional ECG parameters in identifying individuals with depression and demonstrated positive associations with both illness duration and symptom severity. These findings suggest that ERS may serve as a practical, non-invasive biomarker for assessing cardiovascular vulnerability in this population. Full article