Search Results (131)

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

Self-forgiveness is identified as a contributor to psychological wellbeing and may serve as a mechanism through which religiosity supports mental health. There is a dearth of research on wellbeing and the role of self-forgiveness in the English-speaking Caribbean. This preliminary study explored the relationship between religiosity, self-forgiveness, and wellbeing among persons with serious mental illness (SMI), a population largely overlooked in this context. A convenience sample of 362 out-patients receiving care in Trinidad and Tobago completed self-reported measures of self-forgiveness, the Religious Commitment Inventory, and Havard’s Flourishing Measure. Inferential statistics examined group differences in religiosity and wellbeing, and predictive relationships among key variables. Among persons with SMI, higher religiosity was significantly associated with greater wellbeing (p < 0.0001). Additionally, there was greater wellbeing among those who reported a propensity to self-forgive compared to those who did not (p < 0.0001). Self-forgiveness explained a significant part of the relationship between religiosity and wellbeing. Furthermore, among the non-highly religious, self-forgiveness was also significantly associated with greater wellbeing (p < 0.001). Our findings suggest that self-forgiveness may mediate the link between religiosity and wellbeing, highlighting its potential as a therapeutic coping mechanism for individuals with serious mental illness. This study adds to the growing literature on religious coping in mental health and underscores the need for further research to clarify the mediating role of self-forgiveness. Full article

Background: Gun-related homicide remains a persistent public health crisis in the United States, with over 48,000 firearm-related deaths reported in 2022, including 19,651 homicides and 27,032 suicides. Despite frequent calls for tighter gun control, firearm access alone does not explain the complexity of violence. Objective: This commentary aims to unpack the socioeconomic, psychological, and biological drivers of gun-related homicide and propose integrative, evidence-based solutions that extend beyond legislative reform. Methods: We synthesized data from peer-reviewed literature, national crime and health databases (e.g., Centers for Disease Control and Prevention and Federal Bureau of Investigation), and international reports. We examined patterns related to poverty, trauma, male aggression, neurobiology, and firearm acquisition, as well as cross-national comparisons with countries like Switzerland and Mexico. Findings: Young males, particularly those aged 10–29, accounted for 50% of homicide offenders in 2022. African Americans experienced homicide rates of 23.1 per 100,000, ten times the rate among Whites. Up to 56% of incarcerated men report childhood physical trauma, and over 40% of those in prison exhibit symptoms of serious mental illness. While firearm legislation varies widely, analysis reveals that over 90% of crime guns are acquired illegally or through informal sources. International comparisons show that poverty and weak rule of law, more than gun laws alone, correlate with elevated homicide rates. Conclusions: Reducing gun violence sustainably requires a multifaceted approach. Authors advocate for investments in trauma-informed mental health care, focused deterrence programs, early childhood interventions, and improved enforcement against illegal gun trafficking. A public health strategy that integrates social reform with targeted regulation holds the greatest promise for long-term change. Full article

In the current clinical psychiatric practice in most of the world, treatment decisions are based on a person’s capacity to make these decisions. When a person lacks the capacity to understand and appreciate treatment decisions, in many jurisdictions a third-party substitute decision maker (SDM) is appointed on his or her behalf in order to promote safety and optimal clinical outcome. In Ontario, Canada, for example, family members (typically) or public guardians are appointed as SDMs, and they form an integral part of the medical–legal system in psychiatric care. Clinicians working with both patients and their SDMs in these circumstances encounter unique challenges and deliver care in specialized ways, though little research has focused on their experiences and reflections. Based on focus group data, this qualitative study uses a descriptive and interpretative phenomenological approach through thematic analysis to examine these aspects from clinicians working in both inpatient and outpatient settings of an urban teaching hospital’s psychiatric services in Toronto, Canada. Seven key themes emerged: Clinicians (1) appreciate hardships and challenges in lives of SDMs and patients—including the challenging emotions and experiences on both sides, and the risks and relational changes from being an SDM; (2) have an understanding of the patient’s situation and respect for patient autonomy and wishes—they are promoter of autonomy and mindful of patients’ prior wishes amidst patients’ fluctuating capacity, facilitating communication, keeping patients informed and promoting transitioning from SDM to self-determination; (3) have a special working relationship with family SDMs—including supporting SDMs, avoiding harm from delayed or denied treatment, and educating and collaborating with SDMs while maintaining professional boundaries; (4) at times find it difficult working with SDMs—stemming from working with over-involved or uninterested family SDMs, coping with perceived poor SDM decisions, and they sometimes ponder if SDMs are necessary; (5) delineate differences between family and Public Guardian and Trustee (PGT) SDMs—they see PGT as closely aligned with medical decision makers, while family SDMs are more intimately involved and more likely to disagree with a physician’s recommendation; (6) recognize the importance of the SDM role in various contexts—through seeing social values in having SDMs, and acknowledging that having SDMS help them to feel better about their actions as they work to protect the patients; and (7) express ideas on how to improve the current system—at public, societal, and family SDM levels. We conclude that clinicians have unique mediating roles, with privilege and responsibility in understanding the different roles and challenges patients and SDMs face, and have opportunities to improve patient and SDM experiences, clinical outcomes, carry out education, and advocate for ethically just decisions. These clinical roles also come with frustration, discomfort, moral distress and at times vicarious trauma. Clinicians’ unique understanding of this complex and nuanced intersection of patient care provides insight into the core issues of autonomy, duty to care and protect, advocacy, and emotional dynamics involved in this sector as a larger philosophical and social movement to abolish SDMs, as advocated by the Convention on the Rights of Persons with Disability (CRPD), is taking place. We briefly discuss the role of supported decision making as an alternative as. Full article

Depression is a mood disorder that is highly prevalent and is characterized by cognitive, emotional, and physical symptoms. This study aimed to describe the physical health status of individuals with depressive symptoms in Qatar and examine the relationships between physical health indicators and depressive symptoms. A cross-sectional correlational design was used, and data were extracted from the Qatar Biobank. Depression was measured using the Patient Health Questionnaire (PHQ-9). The physical health measurements included heart rate, blood pressure, lung capacity, body mass index (BMI), waist-to-hip ratio, and a self-reported questionnaire. The sample included 687 participants with an average age of 35.39 ± 9.82 years old. The comorbidities reported by participants included diabetes, hypertension, and hypercholesterolemia, and their prevalence ranged from 10 to 26.2%. The BMI data revealed that 38.6% of the participants were either overweight or obese. Approximately 29% of females and 22% of males had an abnormally high waist-to-hip ratio. The percentage of individuals who complained of recurrent chest pain, headache/migraine, or body pain ranged between 12.2 and 43.2%. The mean score of the PHQ-9 was 10.07 ± 4.05, and 43.1% of the sample reported having moderate to severe depression. Several factors were significantly related to depression scores: heart rate, waist-to-hip ratio, headache/migraine, chest pain, body pain, and recent weight change. Healthcare professionals should screen individuals for both depressive symptoms and physical symptoms. This may help in the earlier detection of mental illness and/or physical disease, and thus may ensure better recovery or prognosis and may prevent serious complications. Full article

Background/objectives: Individuals with severe mental illness (SMI) have a reduced life expectancy of 15–25 years. This is due to a number of modifiable and non-modifiable risk factors. Levels of overweight and obesity in this group are 1.8 times higher than in the general population and diet quality is poor. Excess weight is linked to a range of serious long-term physical and mental health conditions. This paper presents the findings of a large cross-sectional survey of adults living with SMI. The survey aimed to understand the current weight, weight gain and diet quality of this group and secondly, to explore the association between weight change, diet quality, antipsychotic medication and weight management. Methods: Five hundred and twenty-nine participants (58% male, mean age 49.3) living with SMI completed the survey. Results: Results showed 42% of the sample were living with obesity and almost half reported having gained 6 kg or more at least once in their adult life. Overall, 6% of the sample reported eating no fruit or vegetables and the same proportion had the highest consumption of carbonated drinks. There was no difference by weight category. Those taking antipsychotic medication and currently managing their weight were more likely to experience weight gain or fluctuation. Conclusions: These results suggest that excess weight and poor diet quality are a major problem in adults with SMI and that current weight management provision is ineffective in addressing the specific needs of people living with SMI. Full article

Background: Women diagnosed with serious mental illness (SMI) face increased vulnerability and significant risks to their sexual and reproductive health, an issue that is often overlooked in healthcare systems. Aim: This study aimed to explore the sexual and reproductive healthcare provided to women with SMI, based on the perspectives of professionals specialising in mental health and sexual and reproductive health. Methods: A descriptive qualitative design was used. Semi-structured interviews were conducted with a purposive sample of professionals from community mental health and sexual and reproductive health in Catalonia (Spain). Data were analysed using thematic analysis. Results: Two themes were identified: clinical practice and professional context. The clinical practice theme had three sub-themes: lack of a preventive framework, attention to sexual and reproductive needs, and supporting women in their desire for motherhood and in pregnancy. The professional context theme had four sub-themes: cross-disciplinary coordination, lack of protocols, lack of human resources and time, and lack of training in mental health. Conclusions: Mental health professionals and sexual and reproductive health professionals expressed different perspectives about sexual and reproductive healthcare for women with SMI, pointing to a need for greater training and coordination. Full article

Background/Objectives: The prevalence of Diabetes Mellitus (DM) is a major concern in Saudi Arabia, making it a challenge for health delivery for those with severe mental illness (SMI). This study aims to explore the barriers to access and utilization of diabetes care among patients with diabetes and serious mental illnesses, their relatives, and healthcare providers to provide evidence-based recommendations for health policy improvement. Methods: A qualitative interpretive research design was used via Braun and Clarke’s framework to analyze the data thematically. Semi-structured interviews were conducted with 35 participants, including patients, relatives, and healthcare providers between September and October 2023, in Jeddah city, Saudi Arabia. Results: The following four themes emerged from the qualitative data: (1) The status of integrated care, (2) Barriers to access to diabetes care at different levels, (3) Navigating obstacles to providing comprehensive diabetes care, and (4) Evidence-based recommendations for health policy improvement. Conclusions: This study underscores the necessity for a comprehensive and integrated approach to care, educational programs, specialized clinics, and improved healthcare logistics. Integrating mental health and diabetes management is needed to ensure better utilization. Full article

Depression and anxiety are two common mental health issues that require serious attention, as they have significant impacts on human well-being, with both being emotionally and physically reflected in the increasing number of suicide cases globally. The World Health Organization (WHO) estimated that about 322 million people around the world experienced mental illnesses in 2017, and this number continues to increase. Cortisol is a major stress-controlled hormone that is regulated by the hypothalamic–pituitary–adrenal (HPA) axis. The HPA axis has three main components, including the hypothalamus, pituitary gland, and adrenal gland, where cortisol, the primary stress hormone, is released. It plays crucial roles in responding to stress, energy balance, and the immune system. The cortisol level in the bloodstream usually increases when stress develops. Molecularly imprinted polymers (MIPs) have been highlighted in terms of creating artificial bioreceptors by mimicking the shape of detected biomolecules, making natural bioreceptor molecules no longer required. MIPs can overcome the limitations of chemicals and physical properties reducing over time and the short-time shelf life of natural bioreceptors. MIPs’ benefits are reflected in their ease of use, high sensitivity, high specificity, reusability, durability, and the lack of requirement for complicated sample preparation before use. Moreover, MIPs incur low costs in manufacturing, giving them a favorable budget for the market with simple utilization. MIPs can be formulated by only three key steps, including formation, the polymerization of functional monomers, and the creation of three-dimensional cavities mimicking the shape and size of targeting molecules. MIPs have a high potential as biosensors, especially working as bioanalytics for protein, anti-body, antigen, or bacteria detection. Herein, this research proposes an MIP-based cortisol biosensor in which cortisol is imprinted on methyl methacrylate (MMA) and methacrylic acid (MAA) produced by UV polymerization. This MIP-based biosensor may be an alternative method with which to detect and monitor the levels of hormones in biological samples such as serum, saliva, or urine due to its rapid detection ability, which would be of benefit for diagnosing depression and anxiety and prescribing treatment. In this study, quantitative detection was performed using an electrochemical technique to measure the changes in electrical signals in different concentrations of a cortisol solution ranging from 0.1 to 1000 pg/mL. The MIP-based biosensor, as derived by calculation, achieved its best detection limit of 1.035 pg/mL with a gold electrode. Tests were also performed on molecules with a similar molecular structure, including Medroxyprogesterone acetate and drospirenone, to ensure the sensitivity and accuracy of the sensors, demonstrating a low sensitivity and low linear response. Full article

Recent years have seen a surge of interest in the interface between mental health and areas formerly viewed as unrelated (the arts, philosophy and religion). In this article, I zoom in on the ways in which central texts and insights from the Daoist corpus can open a window into modern mental health issues. In its critique of the Confucian insistence on ‘mental hygiene’, the Daoist position vouches for an important level of flexibility conducive to what we now refer to as mental health. Importantly, this removes the stigma on so-called neurodiversity by placing it on a spectrum, away from the strict Confucian emphasis on order and harmony. As such, texts like the Zhuangzi discussed below have an uncanny relevance for any serious investigation of mental health and illness in twenty-first-century China. Full article

Older adults with serious mental illness (SMI) (i.e., schizophrenia, schizoaffective disorder, bipolar disorder) have compromised physical function that adversely affects their quality of life. Exercise is an effective intervention to improve function in older persons; however, older people with SMI experience barriers to exercise engagement. This study sought to obtain feedback on an exercise program in development for older people with SMI that comprised home-based exercise delivery, individualized exercise prescription, and motivational health coaching calls. Individual interviews and focus groups were conducted with older Veterans with SMI (n = 3) and clinical staff serving this population (directors: n = 3; clinicians: n = 15, k = 3) to elicit feedback on the perceived feasibility and acceptability of the preliminary program and recommendations for modifications to the program. Rapid analysis was used to summarize transcripts of audio-recorded interviews and focus groups. Results indicated a strong perceived feasibility and acceptability of the preliminary intervention because of how the individualized exercise prescription component (i.e., exercise plan) would be personalized to the Veteran’s preferences and abilities. Clinical staff participants expressed concerns about how the lack of real-time supervision would negatively affect exercise completion. Participants recommended tailoring the home-based exercise delivery and motivational health coaching calls components to each Veteran’s unique context. Full article

Chemotherapy-induced peripheral neuropathy and the accompanying affective disorders are serious side effects, and their resolution is not guaranteed. Oxidative stress and elevated levels of Nod-like receptor protein 3 (NLRP3) have been detected in the peripheral and central nervous systems of animals with neuropathic pain provoked by several antineoplastic drugs, such as paclitaxel (PTX). Several studies have further indicated that NLRP3 inflammasome inhibition could be an approach for treating chronic pain, but its impact on the anxiodepressive-like behaviors and memory deficits related to PTX-provoked neuropathy has not yet been investigated. MCC950 is a potent and specific inhibitor of the NLRP3 pathway that acts through inhibiting NLRP3 activation and inflammasome formation. We hypothesized that the administration of MCC950 could alleviate the affective and cognitive disorders accompanying PTX-provoked neuropathy. Using male C57BL/6 mice, we assessed the effects of MCC950 on the mechanical and thermal allodynia, anxiodepressive-like behavior, and memory deficits incited by this taxane. The results indicated that the intraperitoneal administration of 10 mg/kg of MCC950 twice daily for three consecutive days fully reversed the PTX-induced mechanical and thermal allodynia. This treatment also completely attenuated the anxiolytic (p < 0.004) and depressive-like behaviors (p < 0.022) and memory deficits (novel object recognition test; p < 0.0018) incited by PTX. These actions were mainly achieved through blocking NLRP3 inflammasome activation in the sciatic nerve, amygdala, and hippocampus, and oxidative stress in the amygdala and hippocampus. MCC950 also normalized the p-ERK 1/2 overexpression in the sciatic nerve and apoptotic responses in the sciatic nerve and the amygdala. This study suggests that MCC950 might be a promising treatment for PTX-induced mental illnesses and neuropathy. Full article

Depression, a serious mental illness, is characterized by high risk, high incidence, persistence, and tendency to relapse, posing a significant burden on global health. The connection between depression and gut microbiota is an emerging field of study in psychiatry and neuroscience. Understanding the gut–brain axis is pivotal for understanding the pathogenesis and treatment of depression. Gut microbes influence depression-like behaviors by impacting the hypothalamic–pituitary–adrenal axis (HPA), monoamine neurotransmitters, immune responses, cell signaling, and metabolic pathways. Tea, widely used in clinical practice to improve neuropsychiatric disorders, contains Epigallocatechin gallate (EGCG), a major ingredient of green tea, which effectively regulates intestinal flora. This review examined the risks and causes of depression, the complications associated with intestinal flora, their role in the development and treatment of depression, and how EGCG may alleviate depression through interactions with gut microbiota and other mechanisms. Full article

Family members who live with relatives with serious mental illness face unique mental health risks, which become worse with alcohol use and without social support. Research has highlighted the damaging effects of harmful substance use among people who feel like they do not matter to others, but few studies have assessed links between mattering and alcohol use within marginalized populations. In the present study, a sample of family members who reside with a relative with mental illness completed an online survey. Using the AUDIT alcohol screening measure, participants were classified into a No–Low Risk Alcohol Use (n = 52) or a Hazardous Drinking (n = 28) group. Hazardous alcohol use was alarmingly high, reaching triple the rate of the general population and categorized at the most severe level of harm. Those who drank hazardously felt like they mattered less to others (p < 0.001), felt like they mattered less to their relative with mental illness (p = 0.035), had greater anti-mattering (e.g., they felt invisible and unheard) (p = 0.008), experienced more hopelessness (p < 0.001), felt less supported by significant others (p = 0.003), endorsed having more problems with mental health services (p = 0.017), had higher stigma (p < 0.001), and had lower psychological well-being (p < 0.001). Findings highlight under-recognized public health risks, implications for public health initiatives, and the need for tailored interventions that boost mattering and reduce harmful alcohol use in this vulnerable family member population. Full article

Background: Economically disadvantaged patients diagnosed with serious mental illness (SMI) experience post-hospitalizations disparities due to fragmented care transitions. Purpose: To describe the pre-implementation strategies used to adapt and implement a nurse-led transitional care intervention (Thrive) to meet the needs of economically disadvantaged patients diagnosed with an SMI. Methods: Two pre-implementation strategies, Evidence Based Quality Improvement (EBQI) meetings and Formative Evaluation (FE) research, were used to adapt intervention components. FE data included semi-structured interviews analyzed using Rapid Qualitative Analysis. Findings: Adaptations were made to core components of Thrive and strategies to support implementation were identified. Conclusions: Participatory strategies help to adapt interventions that are person-centered and tailored to the organizational context. Trial: NCT06203509. Full article