Search Results (545)

Codeine, an opioid analgesic present in many over-the-counter (OTC) formulations, is frequently misused through non-medical extraction techniques such as cold water extraction (CWE). These practices carry substantial risks, including incomplete removal of hepatotoxic co-formulants, contamination, and highly unpredictable dosing. We report a fatal case of a 29-year-old man who ingested codeine extracted from Antidol^® tablets in combination with energy drinks and psychotropic medications. Post-mortem LC–MS/MS analysis revealed the presence of codeine (0.66 µg/mL), morphine (0.02 µg/mL), hydroxyzine (2.52 µg/mL), alprazolam (0.15 µg/mL), paracetamol (30.64 µg/mL), and additional substances in blood samples. Concentrations of codeine and hydroxyzine exceeded therapeutic ranges and were consistent with values reported in fatal intoxications, confirming a poly-drug poisoning. This case highlights the danger associated with non-medical codeine use, particularly when combined with central nervous system (CNS) depressants, and underscores the need for stricter regulation of OTC codeine-containing products as well as improved public awareness of the risks associated with domestic extraction methods. Full article

Background/Objectives: Bipolar disorder (BD) is increasingly recognized as a multisystem condition in which metabolic abnormalities, particularly insulin resistance (IR), may be linked to illness severity and neuroprogression. Despite growing evidence linking IR to adverse clinical outcomes, the data is heterogeneous and preliminary, and its specific association in hospitalized patients with BD remains underexplored. Methods: This cross-sectional study included 86 inpatients with a primary diagnosis with BD at the IRCCS Ospedale Policlinico San Martino, Genoa, Italy, between July 2023 and January 2024. Sociodemographic, clinical, and metabolic characteristics were systematically investigated. IR was defined as a HOMA-IR index ≥ 2.5. Results: Twenty-eight patients met criteria for IR. Insulin resistant patients showed a significantly longer illness duration, more frequent residual symptoms, and higher rates of ≥5 lifetime psychiatric hospitalizations. They also exhibited greater polypharmacy (≥4 psychotropics at discharge) and daily alcohol use. Furthermore, the IR subgroup was significantly associated with higher body mass index and triglycerides, lower HDL cholesterol and physical activity levels. Conclusions: Our findings indicate that IR is associated with markers of greater illness burden in BD. While these results are consistent with emerging hypotheses on metabolic dysfunction in BD, longitudinal studies are required to clarify temporal and causal relationships. These associations suggest that IR may represent a clinically relevant component of BD rather than a secondary metabolic consequence. Routine metabolic screening and the preferential use of metabolically neutral agents may improve long-term outcomes and align with the emerging paradigm of precision psychiatry. Full article

Background/Objectives: Adults with intellectual disability (ID) experience high rates of psychiatric comorbidity but often face diagnostic challenges and treatment barriers, leading to inappropriate psychotropic medication use. This study examined the extent to which specialized psychiatric assessment and improved diagnostic accuracy had an impact on medication management and clinical outcomes in adults with ID and co-occurring psychiatric disorders. Methods: This observational retrospective study analyzed medical records from 25 adults with ID who underwent specialized psychiatric assessment at a community-based service in Italy between January 2023 and January 2024. Psychopathological diagnoses were established according to Diagnostic Manual—Intellectual Disability, Second Edition (DM-ID2) criteria, based on clinical observation and a comprehensive assessment using validated instruments. Clinical outcomes were assessed using a psychometric tool encompassing multiple psychopathological and behavioral dimensions. Data on psychotropic prescriptions and side effects were also collected. Non-parametric analyses were performed, with significance set at α = 0.05. Results: The proportion of patients with a psychiatric diagnosis increased from 32% to 96% after specialized assessment (p < 0.001), with notable rises in depressive (0% to 32%), bipolar (8% to 36%), anxiety (4% to 24%), and impulse control (0% to 16%) disorders. First-generation antipsychotic prescriptions decreased (from 36% to 8%, p = 0.023), while antidepressant use increased (from 12% to 52%, p = 0.004). The mean number of side effects per patient declined from 1.6 to 0.5 (p < 0.001), particularly the elevated prolactin level and psychomotor retardation. Significant improvements were observed in symptom intensity and frequency across multiple domains, including aggression, mood disturbances, and compulsions (p < 0.001). Conclusions: In this single-center retrospective study, specialized psychiatric assessment was associated with improved diagnostic accuracy, medication management, and clinical outcomes in adults with ID. The increase in psychiatric diagnoses likely reflects improved identification, addressing key challenges in precision diagnosis for people with neurodevelopmental disorders. Although the overall number of prescribed medications remained stable, optimization of treatment regimens reduced first-generation antipsychotic use and related adverse effects. These findings indicates that access to specialized assessment and precision diagnosis could improve psychopharmacological interventions and outcomes for this vulnerable population, but larger, multi-center and longer-term studies are needed to confirm these results. Full article

People with intellectual disabilities frequently use psychotropic and other medications, sometimes inappropriately. To promote shared decision-making, they require accessible information about their medication. This study combined data from two similar intervention studies, conducted in two different settings, to assess the appropriateness of medication use and the shared decision-making process among adults with mild intellectual disabilities who used psychotropic medication. The intervention consisted of a structured, multidisciplinary medication review, including the provision of accessible psychotropic medication leaflets, and a discussion of the pharmacotherapeutic treatment plan with the patient by either a pharmacist or physician, depending on the setting. Outcomes included medication use, pharmacotherapeutic problems, implementation of recommendations, and perceived shared decision-making, measured with the Shared Decision-Making Questionnaire Q9. The 15 included participants used an average of nearly seven medications, which were mainly neurotropic, gastrointestinal, cardiovascular, and respiratory agents. On average, two pharmacotherapeutic problems were identified; the most common were overtreatment, side effects, and administration difficulties. Recommendations often involved dose reduction or tapering, and about 75% were fully or partially implemented. Both participants and clinicians reported high satisfaction with shared decision-making. Multidisciplinary, structured medication reviews, incorporating accessible medication leaflets, may enhance appropriate medication use and shared decision-making, but more research is needed. Full article

The global population aged 65 and older is expected to double from 761 million in 2021 to 1.6 billion by 2050. Despite often being treated separately in clinical practice and policy, oral health and mental health are fundamentally interconnected in older adulthood, forming a bidirectional relationship that exacerbates disability, social inequity, and systemic healthcare challenges. This narrative review aims to summarize the two-way relationship between mental and oral health and emphasize their combined impact on systemic health, social engagement, and independence among ageing populations. The bidirectional relationship has profound clinical significance. Untreated oral diseases induce chronic pain and cause social embarrassment, aggravating pre-existing depression and anxiety. Periodontal disease can worsen systemic conditions such as diabetes, cardiovascular disease, and dementia via a shared inflammatory pathway. Conversely, mental health issues—including depression, anxiety, cognitive decline, and the use of psychotropic medications—reduce motivation for oral care, prompt dental neglect, and affect salivary function, deteriorating oral health. Despite clear connections, systemic gaps persist, including fragmented healthcare systems, financial barriers, stigma, lack of awareness, and caregiver burnout. To address these challenges, strategies such as developing integrated care models to unify dental and mental health services, reforming policies to prioritize oral and mental health parity, advocating anti-stigma campaigns to clear the misconceptions, and implementing community-based healthcare programmes to reach underserved older adults are essential. By recognizing oral health as a vital component of mental resilience, societies can transform ageing into an era of empowered well-being, where the mouth–mind connection promotes holistic health rather than functional decline. Full article

Cathinone and its synthetic derivatives are among the most popular classes of narcotics worldwide. Experimental studies have demonstrated variable cytotoxic activity among these substances. Until now, the research on cathinones has been limited to their psychotropic activity. Therefore, the structure–activity correlation in this group remains poorly understood. The current study aimed to expand the understanding of the influence of cathinone structural modifications on cytotoxic activity. A group of cathinones whose cytotoxic activity has been experimentally analyzed by a single research group was studied in silico using density functional theory (DFT). A systematic characterization of the substituent effect and the aromaticity changes depending on the polarity of the medium is presented in this paper. A correlation between growing electron-withdrawing properties of the N-end and its carbonyl fragment as well as aromaticity decrease with growing cytotoxic activity were observed. Full article

Background: Sexualized substance use (SSU) describes the use of psychotropic substances in the context of sexual activity. Less is known about the role of sexualized substance use among individuals with substance use disorders (SUD) and its effect on the course of the disorder, e.g., regarding relapses after abstinence. Methods: A convenience sample of individuals undergoing SUD rehabilitation in Germany was surveyed. A questionnaire asked about SSU, sex as a risk factor for relapse, and the importance of sexuality in treatment. Results: N = 490 (30.1% female) participated; 55% of men and 63% of women reported SSU, and 56.5% of heterosexual and 82.9% of homosexual men reported SSU (p < 0.017; r = 0.20). Stimulant users are more likely to report SSU than alcohol (p < 0.001) and sedative users (p < 0.001; r = 0.296 and r = 0.261). Furthermore, 15% of women and 18% of men consider sexual activity a risk factor for relapse; homosexual men (65%) consider it significantly more often than heterosexual men (14%), while 41.2% of heterosexual women and 55% of homosexual women consider it a factor. Additionally, 27.4% of heterosexual and 69.4% identified sexuality as an important topic for therapy, while 19.8% of heterosexual women, 30% of homosexual women, 13.5% of heterosexual men, and 47.2% of homosexual men reported that sexuality had been addressed in their therapy. Conclusions: SSU was reported by individuals with a SUD who were undergoing rehabilitation treatment. Furthermore, patients consider sexual activity as a potential risk factor for relapse, with this being particularly the case for stimulant users. The topic of sexuality is highly important for patients and should, therefore, be given greater consideration in therapy in the future. Full article

Psychotropic medicinal plants are commonly used among oncology patients, yet their relevance in the perioperative setting remains insufficiently characterized. We conducted a literature-based identification of 18 neuroactive plants and surveyed 123 cancer patients and 109 healthcare professionals at a tertiary hospital in Northern Thuringia, Germany. Seventy-five percent of patients reported using at least one psychotropic plant. Knowledge levels were high and similar across groups (median 11 plants), while professionals reported a broader usage spectrum (p = 0.042). Frequently known and applied species included Valeriana officinalis, Lavandula angustifolia, Hypericum perforatum, and Urtica. Women used more plants than men (p = 0.024), and higher usage rates were observed in breast cancer and head and neck cancer patients. Heat-map analyses showed substantial overlap in knowledge but differences for species such as Atropa, Cannabis, and Papaver somniferum. Given the potential interactions with anesthetic and analgesic medications, structured preoperative assessment of herbal use is warranted to enhance perioperative safety. Full article

Over the past decade, significant progress has been made in the treatment of chronic hepatitis C virus (HCV) infection. The introduction of direct-acting antivirals (DAAs) has revolutionized the treatment of HCV infection, offering nearly 100% efficacy. Furthermore, additional therapeutic regimens with pangenotypic efficacy have been registered. These drugs are also characterized by a few adverse events and good treatment tolerance. As DAA therapy is now accessible to virtually all patients, including those with multimorbidity who often take multiple medications, drug interactions (DDIs) have become a significant clinical challenge. One of the groups of patients who are frequently infected with HCV is those with mental disorders. Due to frequently overlapping metabolic pathways, DDIs can occur, affecting the effectiveness of both psychiatric and antiviral therapy. Knowledge of these interactions is crucial in these cases and influences patient management. This paper discusses the most significant interactions between pangenotypic DAA regimens and psychotropic medications. Full article

Ground meat is highly perishable and has a short shelf life due to microbial contamination with food spoilage bacteria along with foodborne pathogens, which increases the risk of food poisoning. Controlling microbial growth by using chemical or synthetic food additives or preservatives is of great health concern. Natural, plant-derived antimicrobial food additives are safer alternatives. Therefore, the main objective of this study was to evaluate the antimicrobial efficacy of different forms and concentrations of clove against food spoilage and foodborne pathogens and to determine their ability to enhance sensory quality and extend the shelf life of buffalo meatballs during refrigerated storage. Clove oil (0.25, 0.50, and 1.0 g/kg), clove extract (0.5, 1.0, and 1.5 g/kg), and clove powder (2.5, 5.0, and 7.5 g/kg) were assessed against aerobic plate counts (APCs), psychotropic counts (PCs), and foodborne pathogens such as Staphylococcus aureus, Salmonella enterica serovar Typhimurium, and Escherichia coli O157:H7, artificially inoculated in buffalo meatballs. Clove oil, clove extract, and clove powder treatments showed a significant (p < 0.01) reduction in the counts of S. aureus, S. enterica serovar Typhimurium, and E. coli O157:H7 compared to control samples. Among all tested forms and concentrations of clove, clove oil at 1.0 g/kg proved to be the most effective against the tested pathogens, as by the end of storage (day 12), it achieved 5.3 and 5.56 log reductions in S. aureus and S. enterica serovar Typhimurium, respectively, along with complete reduction in E. coli O157:H7, followed by clove extract at 1.5 g/kg, which produced 4.2, 4.92, and 7.01 log reductions in the corresponding three foodborne pathogens. The results showed that different concentrations of clove oil and extract treatments applied effectively improved the sensory attributes (flavor, tenderness, juiciness, and overall acceptability) of buffalo meatballs, while the sensory properties of clove powder were considered unacceptable, as it alters the taste and smell of meat. The ground buffalo meat treated with different concentrations of clove oil, clove extract, and clove powder significantly reduced the growth of APCs and PCs during refrigerated storage, resulting in 1.5 to 2.6 log reductions with a prolonged shelf life ranging from 9 to 12 days. Overall effects on shelf life and meat quality showed that all clove forms significantly slowed microbial growth and extended the shelf life of buffalo meatballs to 9–12 days, in contrast to 6 days or less for the control. The findings indicate that clove oil and clove extract are promising natural preservatives capable of improving microbial safety, maintaining sensory attributes, and enhancing the overall quality of buffalo meatballs during refrigerated storage. Full article

Children and adolescents with mental illness are at increased risk of developing overweight and obesity, a relationship that is complex, bidirectional, and often exacerbated by the weight-related side effects of psychotropic medications. This review addressed the research question: How are overweight and obesity addressed in children and adolescents with mental illness? Following JBI and PRISMA-ScR guidelines, a systematic search of PubMed, CINAHL, EMBASE, and PsycINFO was conducted, including studies in English or Scandinavian languages, across all designs, that focused on non-pharmacological approaches for this population aged 0–19 years. The search was completed in May 2025. Nine studies met the inclusion criteria, comprising four qualitative studies, four cohort studies, and one cross-sectional study. Based on inductive content analysis, three overarching themes were developed: approaches to weight and health, showing a predominant focus on individual lifestyle modifications; roles, resources, and prioritization, reflecting how constrained resources influence healthcare professionals’ decisions; and critical repercussions and future directions, highlighting the consequences for children, adolescents, and their families. Overall, interventions mainly target behavior change, with limited attention to structural or systemic factors. These findings underscore the need for tailored guidance and clear clinical strategies to support healthcare professionals and families in addressing weight-related issues in child and adolescent mental health care. Full article

Background and Objectives: Renal and metabolic disorders frequently coexist with psychiatric and psychosomatic conditions, forming complex multimorbidity clusters that challenge traditional models of care. Anxiety, depression, and stress-related disorders may amplify the clinical trajectory of chronic kidney disease (CKD) and metabolic dysfunction. This study aimed to characterize the renal–psychiatric/psychosomatic burden profile of a real-world clinical cohort and to introduce a novel integrative multimorbidity score (RePsy-Risk) quantifying the combined renal, metabolic, and psychiatric burden. Materials and Methods: We conducted a cross-sectional analysis of 148 adult patients stratified into a reno-metabolic group (group 1) and a comparison group with other comorbidities (group 2). Clinical, biochemical, and psychiatric data were extracted from routine medical records. RePsy-Risk was constructed from three domains: renal impairment (eGFR, UACR), metabolic load (TyG index, diabetes/metabolic diagnosis), and psychiatric/psychosomatic involvement (diagnostic text-mining, psychotropic treatment). Group differences were assessed using Mann–Whitney U and t-tests, and associations were explored via Spearman correlation and heatmap visualization. Results: The reno-metabolic group exhibited significantly higher serum creatinine (1.07 vs. 0.86 mg/dL, p = 0.0027), a greater medication burden (7.07 vs. 5.70 drugs, p = 0.0007), and a higher RePsy-Risk score (mean 4.11 vs. 3.20, p = 0.00028). Overall, 52.0% of patients were classified as low risk, 45.3% as moderate risk, and 2.7% as high risk. RePsy-Risk correlated strongly with renal dysfunction (eGFR: ρ = –0.62; UACR: ρ = 0.38) and with metabolic load (TyG: ρ = 0.53), while psychiatric factors contributed independently (RePsy_C: ρ = 0.48). Heatmap analysis confirmed clustering of renal and metabolic domains, with psychosomatic features forming a distinct but additive dimension. Conclusions: Reno-metabolic disease is associated with a significantly elevated renal–psychiatric/psychosomatic burden, shaped by the interplay between impaired renal function, metabolic stress, and psychiatric comorbidity. The RePsy-Risk score offers a practical tool for capturing this multidimensional vulnerability, highlighting the need for integrated clinical strategies that simultaneously address renal, metabolic, and mental health pathways. Further validation in larger cohorts is warranted. Full article

Background and Objectives: Preterm birth is a common obstetric problem. Attention-deficit hyperactivity disorder (ADHD) affects an increasing number of children. There is evidence that all subcategories of preterm birth are related to the occurrence of ADHD. The present article reviews the findings of the last two years regarding this association. Materials and Methods: PubMed was screened for relevant articles published in English between January 2024 and November 2025. Keyword combinations of the words “preterm birth”, “prematurity”, “attention deficit disorder”, “attention disorders”, “ADHD”, “preterm” and “attention deficit hyperactivity disorder” were used. A total of 28 articles were retrieved, reviewed and selected. Results: Preterm birth results in higher risk of ADHD, while early preterm births are characterized by an even higher risk of ADHD. Additionally, postnatal complications commonly experienced by preterm infants are associated with the presence of ADHD. It seems that the maternal use of ADHD medications during pregnancy is associated with a high risk of preterm birth, although there is a concern about the role of other psychotropic medications during pregnancy. Various neurodevelopmental disorders are also associated with preterm birth. Maternal use of glucocorticoids combined with preterm birth leads to higher risk of ADHD. However, the outcome of ADHD is shaped by a wide range of social, familiar and biological factors. Conclusions: Prematurity is a significant risk factor for the development of ADHD symptoms in children. However, many biological, environmental, and psychosocial factors, such as neurodevelopmental vulnerability, perinatal complications, maternal health and adverse psychosocial factors, act as regulators in this relationship. Researching and understanding these associations will help in implementing preventive measures in children who are at increased risk of developing ADHD. Full article

Objective: The objective of this study was to determine whether Non-Hispanic Black (NHB) or Non-Hispanic White (NHW) Alzheimer dementia patients with neuropsychiatric symptoms (ADNPS) differ regarding treatment with second-generation antipsychotics (SGAs), central acetylcholinesterase inhibitors (CAIs), and selective serotonin reuptake inhibitors (SSRIs). Methods: Pharmacologic and demographic factors associated with male and female ADNPS were examined using retrospective data collected from a registry from 2016 and 2020 in a regional AD care center. The logistic regression model was developed to generate odds ratios (OR) to determine factors that were associated with male or female ADNPS. Results: A total of 7031 AD patients were identified. Overall, 6237 patients were NHWs, and 794 were NHBs. Among the NHW AD patients, 1909 presented with behavioral disturbances or neuropsychiatric symptoms (NPS), and 168 NHB AD patients presented with NPS. In the adjusted analysis, NHW ADNPS patients were more likely to be treated with galantamine (OR = 1.538, 95% CI, 1.001–2.364, p = 0.049), memantine (OR = 1.222, 95% CI, 1.086–1.375, p < 0.001), olanzapine (OR = 2.323, 95% CI, 1.794–3.009, p < 0.001), risperidone (OR = 4.181, 95% CI, 3.539–4.939, p < 0.001), and escitalopram (OR = 1.401, 95% CI, 1.225–1.602, p < 0.001). In contrast, NHB ADNPS patients were more likely to be treated with memantine (OR = 2.601, 95% CI, 1.746–3.875, p < 0.001) and risperidone (OR = 5.526, 95% CI, 3.411–8.951, p < 0.001). Conclusions: Our findings show the use of memantine and risperidone to treat both NHB and NHW ADNPS patients. NHW ADNPS patients were more likely to be treated with galantamine, memantine, olanzapine, risperidone, and escitalopram. In contrast, NHB patients with ADNPS were more likely to be treated with memantine and risperidone. Full article