Search Results (89)

Background: Post-concussion syndrome (PCS) and Functional Neurological Disorder (FND), including Functional Cognitive Disorder (FCD), are two frequently encountered but diagnostically complex conditions. While PCS is conceptualized as a sequela of mild traumatic brain injury (mTBI), FND/FCD encompasses symptoms incompatible with recognized neurological disease, often arising in the absence of structural brain damage. Yet, both conditions exhibit considerable clinical overlap—particularly in the domains of cognitive dysfunction, emotional dysregulation, and symptom persistence despite negative investigations. Objective: This review critically examines the shared and divergent features of PCS and FND/FCD. We explore their respective epidemiology, diagnostic criteria, and risk factors—including personality traits and trauma exposure—as well as emerging insights from neuroimaging and biomarkers. We propose the “Functional Overlay Model” as a clinical tool for navigating diagnostic ambiguity in patients with persistent post-injury symptoms. Results: PCS and FND/FCD frequently share features such as subjective cognitive complaints, fatigue, anxiety, and heightened somatic vigilance. High neuroticism, maladaptive coping, prior psychiatric history, and trauma exposure emerge as common risk factors. Neuroimaging studies show persistent network dysfunction in both PCS and FND, with overlapping disruption in fronto-limbic and default mode systems. The Functional Overlay Model helps to identify cases where functional symptomatology coexists with or replaces an initial organic insult—particularly in patients with incongruent symptoms and normal objective testing. Conclusions: PCS and FND/FCD should be conceptualized along a continuum of brain dysfunction, shaped by injury, psychology, and contextual factors. Early recognition of functional overlays and stratified psychological interventions may improve outcomes for patients with persistent, medically unexplained symptoms after head trauma. This review introduces the Functional Overlay Model as a novel framework to enhance diagnostic clarity and therapeutic planning in patients presenting with persistent post-injury symptoms. Full article

Eating disorders (EDs) in children and adolescents pose significant diagnostic and therapeutic challenges due to their early onset, developmental complexity, and frequent psychiatric comorbidities. This narrative review identifies key clinical and systemic challenges, including difficulties in early detection, overlapping symptomatology, limited pharmacological options, and unequal access to specialized care. Recent progress includes revisions in diagnostic criteria (e.g., DSM-5 and ICD-11), advancements in psychometric assessment tools tailored for pediatric populations, and increasing evidence supporting psychotherapeutic interventions such as cognitive behavioral therapy, family-based therapy, and digital health approaches. Future directions involve long-term outcome studies on treatment efficacy, developing culturally sensitive and personalized care models, and implementing integrated multidisciplinary treatment frameworks. By synthesizing empirical literature from 2018 to 2024, this review underscores the urgent need for developmentally informed, evidence-based strategies to enhance the early detection, treatment, and recovery outcomes for young individuals affected by EDs. Full article

The internet has revolutionized communication, becoming central to daily life. Consequently, news consumption shifted dramatically with increased media access, exposing individuals to global traumatic events, such as armed conflicts. Adolescents are particularly vulnerable to the negative effects of this exposure due to their media expertise and developmental stage. Young adults are more mature and independent but remain vulnerable to the harmful effects of internet exposure. This study examined the relationship between internet media exposure to armed conflict and post-traumatic symptoms and psychiatric symptomology among adolescents and young adults. Additionally, self-mastery was explored as a resilience factor in both groups. A sample of 329 participants, including 159 adolescents (ages 12–18) and 168 young adults (ages 20–26), completed questionnaires assessing direct and internet media exposure to armed conflict events, self-mastery, post-traumatic symptoms and psychiatric symptomology. Structural equation modeling (SEM) revealed that internet media exposure was positively associated with post-traumatic symptoms and psychiatric symptomatology only among adolescents, whereas direct exposure was significantly related to post-traumatic symptoms only among young adults. Self-mastery moderated these effects in both groups, buffering the psychological impact of the most relevant exposure. The findings underscore the need for interventions that foster self-mastery to mitigate the adverse effects of traumatic media exposure, particularly among adolescents. Developmental implications are discussed. Full article

Obsessive-compulsive disorder (OCD) is a complex psychiatric condition characterized by significant heterogeneity in symptomatology and treatment response. Advances in neuroimaging, EEG, and other multimodal datasets have created opportunities to identify biomarkers and predict outcomes, yet traditional statistical methods often fall short in analyzing such high-dimensional data. Deep learning (DL) offers powerful tools for addressing these challenges by leveraging architectures capable of classification, prediction, and data generation. This brief review provides an overview of five key DL architectures—feedforward neural networks, convolutional neural networks, recurrent neural networks, generative adversarial networks, and transformers—and their applications in OCD research and clinical practice. We highlight how these models have been used to identify the neural predictors of treatment response, diagnose and classify OCD, and advance precision psychiatry. We conclude by discussing the clinical implementation of DL, summarizing its advances and promises in OCD, and underscoring key challenges for the field. Full article

Background/Objectives: Psychosocial and cultural determinants have a special influence on the development, manifestation and prognosis of common mental disorders such as anxiety and depression. The objectives of this study were to define the psychosocial profile of the people most vulnerable to the development of these health problems, analyse the symptomatology and health determinants that may influence these from a gender perspective, and evaluate the quality of life and coping strategies among the adult population with this diagnosis in a rural area of Catalonia (Spain). Methods: An observational, cross-sectional, and analytical study was conducted on 180 people diagnosed with anxiety or depression. Patients completed an ad hoc sociodemographic questionnaire, the Brief Symptom Checklist (LSB-50), the Quality of Life Scale (EQ-5D-5L) and the Brief Cope Inventory (COPE-28). Results: Women aged 45–64 with a low socioeconomic profile may be more vulnerable to common mental disorders, although psychiatric symptomatology was more pronounced in men. Women were more likely to have problems with mobility (aOR= 2.93, p = 0.039) and daily activities (aOR = 2.75, p = 0.033), as well as lower self-perceived health scores (p = 0.002). Women used active coping, venting and seeking social support as coping strategies, while men used behavioural disengagement. Conclusions: It has been observed that the people most susceptible to developing depression and anxiety disorders may have a specific profile. Although a greater number of women have these common mental disorders, men tend to have more noticeable symptomatology. The coping strategies most used also differ according to gender. Full article

Cognitive disorders and psychiatric pathologies, particularly Alzheimer’s disease (AD) and Major depressive disorder (MDD), represent a considerable health burden, impacting millions of people in the United States and worldwide. Notably, comorbidities of MDD and anxiety are prevalent in the early stages of mild cognitive impairment (MCI), which is the preceding phase of Alzheimer’s disease and related dementia (ADRD). The symptoms of MDD and anxiety affect up to 80% of individuals in the advanced stages of the neurodegenerative conditions. Despite overlapping clinical manifestations, the pathogenesis of AD/ADRD and MDD remains inadequately elucidated. Until now, dozens of drugs for treating AD/ADRD have failed in clinical trials because they have not proven beneficial in reversing or preventing the progression of these neuropsychiatric indications. This underscores the need to identify new drug targets that could reverse neuropsychiatric symptoms and delay the progress of AD/ADRD. In this context, phosphodiesterase 4 (PDE4) arises as a primary enzyme in the modulation of cognition and mood disorders, particularly through its enzymatic action on cyclic adenosine monophosphate (cAMP) and its downstream anti-inflammatory pathways. Despite the considerable cognitive and antidepressant potential of PDE4 inhibitors, their translation into clinical practice is hampered by profound side effects. Recent studies have focused on the effects of PDE4 and its subtype-selective isoform inhibitors, aiming to delineate their precise mechanistic contributions to neuropsychiatric symptoms with greater specificity. This review aims to analyze the current advances regarding PDE4 inhibition—specifically the selective targeting of its isoforms and elucidate the therapeutic implications of enhanced cAMP signaling and the consequent anti-inflammatory responses in ameliorating the symptomatology associated with AD and ADRD. Full article

Background/Objectives: The treatment of tics and psychiatric comorbidities is crucial when they affect the patient’s well-being and relationships. However, the optimal pharmacological treatment (PT) tailored to each patient’s phenotype remains unclear. The primary objective of this study is to describe the clinical characteristics and treatment received for tics and psychiatric comorbidities in our cohort of children and adult patients with tic disorders. Additionally, a further aim was to quantify the severity of tics, comorbidities and overall severity, and the overall clinical changes observed during the follow-up. Methods: Retrospective descriptive study of patients with tic disorders under follow-up at our Tic Functional Unit from January 2022 to March 2024. Two independent neurologists retrospectively applied the Clinical Global Impression of Change (CGI-C) and the Clinical Global Impression of Severity (CGI-S) scales at baseline and at last assessment. Results: A total of 36 individuals were included (63.8% males, median age = 18 years, IQR 19): 94.4% with Tourette syndrome (TS), 2.8% with chronic tic disorder (CTD), and 2.8% with provisional tic disorder (PTD). A total of 86% had at least one psychiatric comorbidity, the most common being obsessive–compulsive symptomatology (OCS) (52%), anxiety (52%), and attention deficit hyperactivity disorder (ADHD) (35%). At last assessment, 26 patients (72.2%) were on undergoing PT for tics and 3 were receiving additional botulinum toxin. The most used medication for tics were aripiprazole (46.2%) and clonazepam (46.2%), and for psychiatric comorbidities, SSRIs (42.9%), methylphenidate (19%), and benzodiazepines (57.1%). Overall improvement according to the CGI-C scale was mild (CGI-C 3). Children and adolescents showed greater improvement than adults (CGI-C 2 vs. 3; p = 0.005). Aripiprazole and clonazepam produced similar outcomes in reducing CGI-C. Conclusions: We observed a favorable clinical course in patients treated with aripiprazole and clonazepam, which appear to be better than that obtained with other treatments. We consider that clonazepam may be useful as a first-line monotherapy and as an adjuvant for both tics and comorbidities in selected cases. Full article

Background/Objectives: Tic disorders are neurodevelopmental conditions often associated with comorbidities like attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Our aims were: (a) in a sample of youth with tic disorders to explore the clinical and psychopathological characteristics of different phenotypes based on the presence of comorbid ADHD and/or ASD and gender; (b) in a subgroup of patients treated with Aripiprazole, to evaluate symptoms variation over time and to identify potential predictors of response. Methods: A total of 95 subjects with tic disorders (age range 6 to 17.9 years, mean 11.1 ± 2.11 years, 80 males) were naturalistically recruited. Questionnaires and semi-structured interviews were administered to assess the symptomatology and investigate the presence of psychiatric comorbidities (Clinic Global Impression-Severity (CGI-S), Children’s Global Assessment Scale (C-GAS), Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), Child Yale–Brown Obsessive Compulsive Scale for Children (CYBOCS), Child Behavior Checklist 6–18 (CBCL 6–18), Conners’ Parent Rating Scale-Revised—short form (CRSR-S), Reactivity Intensity Polarity Stability Questionnaire—youth version (RIPoSt-Y), and Social Communication Questionnaire—lifetime version (SCQ); Autism Diagnostic Observation Scale—second version (ADOS-2) and Autism Diagnostic Interview—revised version (ADI-R) were administered where ASD was suspected). A total of 22 subjects treated with Aripiprazole were reassessed through the use of some of the clinical measures used at baseline. Results: The presence of ADHD was associated with higher externalizing problem scores on the CBCL 6–18, while ASD was linked to higher internalizing problem scores. A positive correlation was found between the ADHD–ASD interaction and increased internalizing symptoms on CBCL 6–18 and higher ADOS-2 scores. Patients treated with Aripiprazole showed significant improvement across all scales during follow-up. ADHD was identified as a negative predictor of reduced tic severity on the YGTSS. Conclusions: Comorbid neurodevelopmental disorders, such as ADHD or ASD, result in worse emotional and behavioral functioning in patients with tic disorders. ADHD–ASD interaction may be linked to more internalizing symptoms and autistic behaviors. Aripiprazole improves overall clinical outcomes, although comorbid ADHD may hinder the reduction of tic symptoms. Full article

Wilson’s disease (WD) is an autosomal recessive disorder of copper metabolism. The genetic defect in WD affects the ATP7B gene, which encodes the ATP7B transmembrane protein, which is essential for maintaining normal copper homeostasis in the body. It is primarily expressed in the liver and acts by incorporating copper into ceruloplasmin (Cp), the major copper transport protein in the blood. In conditions of excess copper, ATP7B transports it to bile for excretion. Mutations in ATP7B lead to impaired ATP7B function, resulting in copper accumulation in hepatocytes leading to their damage. The toxic “free”—unbound to Cp—copper released from hepatocytes then accumulates in various organs, contributing to their damage and clinical manifestations of WD, including hepatic, neurological, hematological, renal, musculoskeletal, ophthalmological, psychiatric, and other effects. While most clinical manifestations of WD correspond to identifiable organic or cellular damage, the pathophysiology underlying its psychiatric manifestations remains less clearly understood. A search for relevant articles was conducted in PubMed/Medline, Science Direct, Scopus, Willy Online Library, and Google Scholar, combining free text and MeSH terms using a wide range of synonyms and related terms, including “Wilson’s disease”, “hepatolenticular degeneration”, “psychiatric manifestations”, “molecular mechanisms”, “pathomechanism”, and others, as well as their combinations. Psychiatric symptoms of WD include cognitive disorders, personality and behavioral disorders, mood disorders, psychosis, and other mental disorders. They are not strictly related to the location of brain damage, therefore, the question arises whether these symptoms are caused by WD or are simply a coincidence or a reaction to the diagnosis of a genetic disease. Hypotheses regarding the etiology of psychiatric symptoms of WD suggest a variety of molecular mechanisms, including copper-induced CNS toxicity, oxidative stress, mitochondrial dysfunction, mitophagy, cuproptosis, ferroptosis, dysregulation of neurotransmission, deficiencies of neurotrophic factors, or immune dysregulation. New studies on the expression of noncoding RNA in WD are beginning to shed light on potential molecular pathways involved in psychiatric symptomatology. However, current evidence is still insufficient to definitively establish the cause of psychiatric symptoms in WD. It is possible that the etiology of psychiatric symptoms varies among individuals, with multiple biological and psychological mechanisms contributing to them simultaneously. Future studies with larger samples and comprehensive analyses are necessary to elucidate the mechanisms underlying the psychiatric manifestations of WD and to optimize diagnostics and therapeutic approaches. Full article

Background/Objectives: We aimed to determine the prevalence and clinical correlations of mood disorders in a sample of systemic lupus erythematosus (SLE) patients. Hence, we hypothesized that the prevalence of mood disorders would be lower than reported in the literature and that patients would remain clinically stable and show less damage accrual despite low-dose corticosteroid prescription. Methods: In total, 92 SLE outpatients gave informed consent to participate in this cross-sectional study. Psychiatric and autoimmune clinical data were obtained, and a structured psychiatric interview was performed. The main clinical scales for the assessment of clinical symptomatology were included. To examine the potential relationships of presenting a mood disorder in SLE, clinical correlations and multivariate analyses were performed. Results: Mood disorders were the most prevalent disorder reported by SLE patients (16%), followed by adjustment disorders (5%). A significant proportion of patients presented psychosocial disturbances that did not meet the ICD-10 criteria for psychiatric diagnosis. According to the cut-off criterion for the Montgomery–Åsberg Depression Rating Scale (MADRS), up to 27% of the sample met the clinical criteria for depression. The multivariate analysis revealed a relationship between the presence of a mood disorder with total scores of the MADRS and the Young Mania Rating Scale (YMRS). Conclusions: The prevalence of mood disorders in patients with SLE was lower than previously reported. Although self-report clinical scales are useful for assessing clinical symptomatology, they should not be used in place of a comprehensive standardized interview conducted by a trained mental health specialist. Multidisciplinary teamwork is required for the early identification and therapeutic management of autoimmune patients with neuropsychiatric disorders. Full article

Individuals with inflammatory bowel diseases (IBDs) have an increased risk of developing psychiatric comorbidities, including eating disorders (EDs). We aimed to investigate the potential association between key disease characteristics, including psychological features, and the development of EDs in a clinical sample of adolescents with IBDs. We enrolled 52 adolescents with IBDs, 83% of whom were in clinical remission, and systematically collected additional information on disease duration, the total number of relapses, the use of steroids, and the number of hospital admissions. All participants completed a validated psychometric battery assessing psychological symptoms (Symptom Checklist-90–Revised, SCL-90-R), alexithymia (Toronto Alexithymia Scale-20, TAS-20), and ED symptomatology (Eating Disorders Inventory-3rd edition, EDI-3). About one in ten patients (9.6%) reported Eating Disorder Risk scores higher than the cut-off on the EDI-3 subscale, specifically addressing the risk of developing EDs. According to the EDI-3 scores, the risk of developing EDs directly correlated with the number of total relapses of IBDs (p < 0.05). The TAS-total scores also correlated with the number of total relapses (p < 0.01), as well as with the number of steroid cycles (p < 0.05), the number of hospital admissions (p < 0.05), and overall disease duration (p < 0.05). Our findings suggest that disease relapses increase the risk of developing both EDs and alexithymia in adolescents with IBDs. The recurrence of disease relapses should be identified and screened early on to prevent the onset of psychiatric disorders, including EDs. Research should be conducted on larger samples with different IBD phenotypes to further investigate the characteristics of patients with IBDs at risk of developing EDs. Full article

Introduction: The one unifying and distinguishing feature of all neuropsychiatric illnesses is the co-occurrence of cognitive dysfunction. Cognitive training (CT) was developed to enhance neural connectivity and cognition and improve day-to-day functioning. However, the benefits of CT are still debated. This current systematic review aimed to examine the efficacy of CT and to identify diagnostic and CT characteristics associated with superior outcomes across a range of psychiatric disorders. Method: Studies investigating CT in psychiatric illnesses were extracted from Embase, PubMed, CINAHL, PsycINFO, and PsycARTICLES up to 17 August 2023. Inclusion criteria were randomised control trials (RCT) and English language. The primary search strategy included terms relating to cognitive training, cognitive remediation, cognitive enhancement, or cognitive rehabilitation and randomised control trials, clinical trials, or experiments. Risk of bias was assessed using RevMan Web version 8.1.1. Narrative synthesis was used to analyse findings. Due to the heterogeneity of participant demographics, diagnoses, and interventions, meta-analyses were considered inappropriate. Results: Fifteen studies, including a total of 1075 participants, were identified. Approximately 67% of studies reported significant improvements in at least one trained domain of cognitive function after CT, and 47% observed improvements in psychiatric symptoms or function. Cognitive transfer effects were not observed. Sample sizes for studies were generally small, and most CT durations were 6 weeks or less. Conclusions: Findings suggest that CT can improve cognitive function in trained domains, though little evidence of cognitive transfer effects was observed. Due to the lack of standardisation in CT format and delivery, and inadequate measures of psychiatric symptoms or daily function, there is insufficient evidence to conclude whether or not this technique may benefit cognitive impairment in psychiatric disorders, or lead to subsequent improvement in disease symptomatology. Further studies of longer duration and using consistent methodologies must be conducted to identify the benefits of CT in psychiatric disorders. Full article

Functional gastrointestinal disorders (FGIDs) are characterized by chronic gastrointestinal symptoms in the absence of overt pathology and affect a significant percentage of the worldwide population. They are commonly accompanied by co-morbid psychiatric symptomatology and are associated with significant suffering and great healthcare services utilization. There is growing evidence that dysregulation of the gut–brain axis and disturbances in the processing of afferent interoceptive signals lie at the heart of these disorders. In this context, the aim of the current review was to detect and critically review original articles focusing on the role of interoception in the pathophysiology of FGIDs. Our search yielded 38 relevant studies. FGID patients displayed increased visceral sensitivity, enhanced attention to gastrointestinal interoceptive cues, and greater emotional arousal when coping with gut-derived sensations. Neuroimaging studies have shown significant structural and functional changes in regions of the interoceptive network, while molecular and genetic studies have revealed significant associations between interoceptive signaling and deficits in excitatory neurotransmission, altered endocrine and immune physiological pathways, and aberrant expression of transient receptor potential channel genes. Finally, there were emerging data suggesting that interoception-based interventions may reduce physical symptoms and improve quality of life and should be integrated into FGID clinical management practices. Full article

Background and Objectives: One of the most significant psychiatric problems in women is depression related to the perinatal period. Our study aims to determine the frequency and course of depressive symptomatology in the perinatal period with particular reference to objective rate and outcome of postpartum depression. Materials and Methods: One hundred and eighty-eight pregnant/postnatal women were included in a prospective, longitudinal, observational study during which the depressive symptomatology was estimated at the third trimester of pregnancy, and the first, sixth, and twelfth month‚ postpartum. All participants completed a semi-structured sociodemographic questionnaire constructed for research purposes, the Edinburgh Postnatal Depression Scale, Toronto Alexithymia Scale, Beck Anxiety Inventory, and The Mood Disorder Questionnaire at each time point. Postpartum depression diagnosis was confirmed by a trained and certified psychiatrist with long-standing experience. For a better understanding of the trajectory of depressive symptomatology and genuine postpartum depression, we classified depression into those with new-onset and those left over from the previous observation period. Results: In general, 48.9% of participants in the study were depressed at some point during the investigation. A total of 10.6% of women were depressed in the third trimester. The highest percentage of new-onset depression (25%) was in the first month after giving birth and was maintained for up to six months, after which the appearance was sporadic. Most of the postpartum depression resolved in the period from the first month to the sixth month after childbirth (20.7%). The episodes mainly had characteristics of unipolar depression. Conclusions: Our results imply that a new onset of depression is most intensive during the first six months, and after that, it is sporadic. Further studies are needed to explore whether all depressive symptomatology in the postnatal period is the same, or perhaps postpartum depression, classified in this way, has specific characteristics, etiology, and consequently different treatment and preventive options. Full article

Premenstrual Dysphoric Disorder (PMDD) is a psychiatric condition characterized by debilitating affective symptomatology in the luteal phase of the menstrual cycle. Based on the previous reports that PMDD may be related to GABAergic cellular dysfunction(s), we assessed whether cation–chloride cotransporter (CCC) gene expression across the menstrual cycle is altered in PMDD. As there are limitations in accessing the human CNS to study CCC-encoding genes, we utilized peripheral blood mononuclear cells (PBMCs) as an alternative model. We first sought to replicate previous reports characterizing CCC gene expression patterns in PBMCs of reproductive age women. We subsequently investigated potential distinct CCC mRNA expression patterns in women with PMDD. We collected blood samples across 8 menstrual cycle visits for PBMC separation/RNA extraction to study mRNA expression of four KCCs (KCC1, KCC2, KCC3, KCC4) and two NKCCs (NKCC1, NKCC2) cotransporters. We mostly replicated the earlier gene expression pattern findings, and found that the expression levels of KCC1 were significantly downregulated during the mid-follicular and periovulatory subphases of the menstrual cycle in women with PMDD. The present study shows that PBMCs is a valid model for studying GABAergic mechanisms underlying PMDD. Full article