Search Results (580)

Background: The dual nature of cannabis, as both a promising therapeutic tool and a widely used recreational substance with potential risks, raises important societal controversies, including its unclear impacts regarding mental health. This narrative review provides a comprehensive overview of cannabis, addressing (i) its historical context; (ii) its chemical composition and pharmacokinetics; (iii) its pharmacological effects; (iv) its negative impacts on physiological and mental health; (v) its potential use as a drug for the treatment of neurological and psychiatric disorders; (vi) its relationship with the gut microbiome and how this interaction might influence mental functioning; (vii) the pathophysiology, prevalence, comorbidities, and treatment strategies of cannabis use disorder; and (viii) social perspectives on its legalization. Results: Cannabis presents a complex chemical profile and pharmacokinetics that show promise in treating numerous neurological, psychiatric, and psychological conditions. However, its use carries risks, which depend on factors such as compound concentration, dosage, consumption method, frequency of use, and individual vulnerability. Cannabis use disorder seems to be less severe than other substance use disorders, but it still constitutes a significant concern, as its manifestation is not uniform across all users. Conclusions: Cannabis demands a thorough understanding that goes beyond simplistic explanations and prejudices, standing as a plant of substantial clinical significance and highlighting the importance of personalized approaches to its use and increased awareness of how individuals respond to its effects. Full article

The use of opioids for cancer-related pain is essential but poses significant challenges due to the risk of misuse and the development of opioid use disorder (OUD). This review takes a multidisciplinary perspective based on the current scientific literature to analyze the pharmacological mechanisms, classification, and therapeutic roles of opioids in oncology. Key risk factors for opioid misuse—including psychiatric comorbidities, prior substance use, and insufficient clinical monitoring—are discussed in conjunction with validated tools for pain assessment and international guidelines. The review emphasizes the importance of integrating toxicological, pharmacological, physiological, and public health perspectives to promote rational opioid use. Pharmacogenetic variability is explored as a determinant of treatment response and addiction risk, underscoring the value of personalized medicine. Evidence-based strategies such as early screening, psychosocial interventions, and the use of buprenorphine-naloxone are presented as effective measures for managing OUD in cancer patients. Ultimately, this work advocates for safe, patient-centered opioid prescribing practices that ensure effective pain relief without compromising safety or quality of life. Full article

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by inattention, hyperactivity, and impulsivity, frequently observed in juvenile offenders. This systematic review explores the interplay between ADHD and juvenile delinquency, focusing on behavioural, psychological, and social dimensions. Following the PRISMA guidelines, a systematic literature review was conducted using EBSCO Discovery Service, Science Direct, PubMed, and snowballing techniques. Studies meeting specific inclusion criteria, including juvenile offenders diagnosed with ADHD and comparisons to non-offender or non-ADHD control groups, were analysed. The methodological quality of studies was assessed using the Joanna Briggs Institute appraisal tools. A total of 21 studies were included, highlighting significant associations between ADHD and juvenile delinquency. ADHD symptoms, especially impulsivity and emotional dysregulation, were linked to an earlier onset of offending and higher rates of property crimes. Comorbidities such as conduct disorder, substance use disorder, and depression exacerbated these behaviours. Sociodemographic factors like low education levels and adverse family environments were also critical modifiers. Early intervention and tailored treatment approaches were emphasised to address these challenges. The findings underscore the need for early diagnosis, individualised treatment, and integrative rehabilitation programmes within the juvenile justice system to mitigate long-term risks and promote social inclusion. Full article

Canada’s national surveillance shows an 11% year-over-year decline in deaths from opioid and other unregulated drug poisonings, and a 10% drop in related hospitalisations in 2024. In stark contrast, Québec, home to more than nine million residents, and Montréal, the country’s second-largest city, experienced a continued rise in suspected drug-poisoning mortality through 2024, with fentanyl or analogues detected in almost two-thirds of opioid deaths. We conducted a narrative synthesis of provincial coroner and public-health surveillance tables, Health Canada dashboards, and the 2022–2025 Québec Strategy on Psychoactive-Substance Overdose Prevention. Results indicate a 40% increase in opioid-related mortality since 2018, a parallel uptick in stimulant toxicity, and a five-fold rise in overdose reversals at Montréal supervised-consumption services during the COVID-19 pandemic recovery. We aim to summarise the key problems underlying this epidemic and offer province-specific public-health strategies while also sending a call to action for first-line clinicians and psychiatrists to integrate overdose-risk screening, take-home naloxone, and stimulant-use-disorder treatments into routine care. We further urge Québec healthcare professionals to deepen their knowledge of provincial services such as supervised-injection sites and stay up to date with the rapidly evolving substance-use-prevention literature. Québec’s divergent trajectory underscores the need for region-tailored harm-reduction investments and stronger policy-to-clinic feedback loops to reduce preventable deaths. Full article

Background: Female Sexual Dysfunction (FSD) encompasses a range of conditions that can profoundly impact quality of life and intimate relationships. The primary classifications of FSD include female sexual interest and arousal disorder (FSIAD), genitopelvic pain and penetration disorder (GPPPD), female orgasmic disorder (FOD), and substance or medication-induced sexual dysfunction (SM-ISD). Despite its prevalence, FSD is often underdiagnosed and undertreated. Objectives: This scoping review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate the existing literature on both U.S. Food and Drug Administration (FDA)-approved and off-label pharmacotherapies for FSD by study type, outcomes, and limitations. Eligibility Criteria: Eligible studies comprised randomized controlled trials (RCTs), systematic reviews, and cohort studies involving adult women (≥18 years) with any subtype of FSD. These studies assessed pharmacologic interventions against a comparator and reported at least one treatment efficacy outcome. Studies outside this scope were excluded. Sources of Evidence: A 25-year literature search was conducted using PubMed/MEDLINE, the Cochrane Library, reference lists of relevant articles, academic handbooks, and targeted journals. Charting Methods: Three independent reviewers screened and extracted data. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Findings were organized into summary tables and categorized by pharmaceutical agent, pertinent study information, outcomes, and limitations. Results: A total of 44 human-based pharmacologic studies met inclusion criteria. FDA-approved agents were the most thoroughly studied pharmacotherapies. Hormonal, topical, and adjunctive agents demonstrated less robust evidence. Heterogeneity in outcome measures and inadequate long-term data were common limitations. Conclusions: Pharmacologic treatment for FSD shows promise but requires further research. Individualized, multifaceted care is essential for optimizing FSD outcomes. Full article

Alcohol is a prevalent psychoactive substance and a risk factor for developing injuries and non-communicable diseases, representing a significant health and economic burden. Alcohol involves numerous molecular pathways. Its metabolism is regulated by alcohol dehydrogenases and aldehyde dehydrogenases; it also stimulates cholinergic interneurons, increasing the sensitivity of 5-HT3 receptors, while chronic alcohol consumption alters the mesolimbic dopaminergic system involved in reward processing. The treatment of alcohol use disorder (AUD) is essential to manage complex patients, following an evidence-based approach. The aim of this narrative review is to provide a clear and practical summary to support and assist healthcare professionals in the Italian context. Approved pharmacological treatments for AUD include oral naltrexone and acamprosate, sodium oxybate, disulfiram, and nalmefene. Off-label therapies include baclofen, topiramate, gabapentin, pregabalin, ondansetron, and cytisine. A more informed clinical and practical approach that understands the altered neuronal signaling pathways is essential for offering effective, efficient, appropriate, and safe therapeutic algorithms for complex patients with alcohol use disorder. A comprehensive framework should include integrated treatments with a personalized approach. Full article

Introduction: Substance use disorders (SUDs) pose a significant public health challenge, with current treatments often exhibiting limited effectiveness and high relapse rates. Transcranial direct current stimulation (tDCS), a noninvasive neuromodulation technique that delivers low-intensity direct current via scalp electrodes, has shown promise in various psychiatric and neurological conditions. In SUDs, tDCS may help to modulate key neurocircuits involved in craving, executive control, and reward processing, potentially mitigating compulsive drug use. However, the precise neurobiological mechanisms by which tDCS exerts its therapeutic effects in SUDs remain only partly understood. This review addresses that gap by synthesizing evidence from clinical studies that used neuroimaging (fMRI, fNIRS, EEG) and blood-based biomarkers to elucidate tDCS’s mechanisms in treating SUDs. Methods: A targeted literature search identified articles published between 2008 and 2024 investigating tDCS interventions in alcohol, nicotine, opioid, and stimulant use disorders, focusing specifically on physiological and neurobiological assessments rather than purely behavioral outcomes. Studies were included if they employed either neuroimaging (fMRI, fNIRS, EEG) or blood tests (neurotrophic and neuroinflammatory markers) to investigate changes induced by single- or multi-session tDCS. Two reviewers screened titles/abstracts, conducted full-text assessments, and extracted key data on participant characteristics, tDCS protocols, neurobiological measures, and clinical outcomes. Results: Twenty-seven studies met the inclusion criteria. Across fMRI studies, tDCS—especially targeting the dorsolateral prefrontal cortex—consistently modulated large-scale network activity and connectivity in the default mode, salience, and executive control networks. Many of these changes correlated with subjective craving, attentional bias, or extended time to relapse. EEG-based investigations found that tDCS can alter event-related potentials (e.g., P3, N2, LPP) linked to inhibitory control and salience processing, often preceding or accompanying changes in craving. One fNIRS study revealed enhanced connectivity in prefrontal regions under active tDCS. At the same time, two blood-based investigations reported the partial normalization of neurotrophic (BDNF) and proinflammatory markers (TNF-α, IL-6) in participants receiving tDCS. Multi-session protocols were more apt to drive clinically meaningful neuroplastic changes than single-session interventions. Conclusions: Although significant questions remain regarding optimal stimulation parameters, sample heterogeneity, and the translation of acute neural shifts into lasting behavioral benefits, this research confirms that tDCS can induce detectable neurobiological effects in SUD populations. By reshaping activity across prefrontal and reward-related circuits, modulating electrophysiological indices, and altering relevant biomarkers, tDCS holds promise as a viable, mechanism-based adjunctive therapy for SUDs. Rigorous, large-scale studies with longer follow-up durations and attention to individual differences will be essential to establish how best to harness these neuromodulatory effects for durable clinical outcomes. Full article

Background: This study examined treatment outcomes for cannabis use disorder (CUD) among adolescents (12–17 years old) in the United States. Methods: Data from the 2018–2021 Treatment Episode Data Set-Discharges (TEDS-D) included 40,054 adolescents diagnosed with CUD. Descriptive statistics, Chi-square tests, and multivariable logistic regression assessed treatment outcomes and factors associated with treatment completion. Results: Only 36.8% of adolescents completed treatment. The most common reasons for not completing treatment were dropping out (28.4%) and transferring to another facility/program (17.0%). Males and Black non-Hispanic adolescents had lower odds of completing treatment (OR = 0.79, 95%CI: 0.75–0.84), while Hispanic (OR = 1.13, 95%CI: 1.08–1.18), Asian (OR = 1.56, 95%CI: 1.3–1.86) and Native Hawaiian/Pacific Islander adolescents (OR = 2.31, 95%CI: 2.04–2.61) had higher odds of completion compared to their White counterparts. Independent living arrangements, homelessness, arrests in the past 30 days and younger age (<15 years old) decreased the likelihood of treatment completion. Adolescents with co-occurring mental health and substance use disorders also had lower completion rates (OR = 0.79, 95%CI: 0.77–0.86). Referral from schools/employers and treatment settings were associated with a higher success, particularly with stays of 4–6 months and 7–12 months. Conclusion: This study highlights the need for targeted CUD treatment programs that support at-risk adolescents, especially those experiencing homelessness or facing legal issues. High dropout and transition rates suggest a need for continuity of care and program integration between facilities. Strengthening coordination among public health officials, community organizations, and stakeholders is essential to developing culturally responsive treatment interventions that address social determinants of health, substance use, and mental health in this vulnerable population. Full article

Introduction: Chronic alcohol use is a complex condition influenced by psychological, behavioral, and socio-demographic factors. This study aimed to develop a comprehensive psychosocial profile of individuals with alcohol use disorder (AUD) by examining associations between psychometric variables and relapse risk including repeated psychiatric hospitalizations. Methodology: A cross-sectional observational analytical study was conducted on a sample of 104 patients admitted for alcohol withdrawal management at the “Prof. Dr. Al. Obregia” Psychiatric Clinical Hospital in Bucharest between March 2023 and September 2024. Participants completed a set of validated psychometric tools: the Drinker Inventory of Consequences—Lifetime Version (DrInC), Readiness to Change Questionnaire—Treatment Version (RTCQ), Drinking Expectancy Questionnaire (DEQ), and Drinking Refusal Self-Efficacy Questionnaire (DRSEQ). Additional data were collected on the socio-demographic (education level, socio-professional category), genetic (family history of alcohol use), and behavioral factors (length of abstinence, tobacco use, co-occurring substance use disorders). Results: Higher alcohol-related consequence scores (DrInC) were significantly associated with lower education (p < 0.001, η² = 0.483), disadvantaged socio-professional status (p < 0.001, η² = 0.514), and family history of alcohol use (p < 0.001, η² = 0.226). Self-efficacy (DRSEQ) was significantly lower among individuals with co-occurring substance use (p < 0.001) and nicotine dependence (p < 0.001). Logistic regression showed that the DrInC scores significantly predicted readmission within three months (OR = 1.09, p = 0.001). Conclusions: Psychometric tools are effective in identifying individuals at high risk. Personalized, evidence-based interventions tailored to both psychological and socio-professional profiles, combined with structured post-discharge support, are essential for improving long-term recovery and reducing the readmission rates. Full article

Background/Objectives: Cerebrolysin is a well-known mixture of peptides that has been used for many years, primarily in patients with neurological disorders. Thanks to its unique properties, this substance supports endogenous repair mechanisms and protects the brain from damaging factors. Cerebrolysin is most widely used in Eastern European countries. However, data on the potential use of cerebrolysin in mental disorders are difficult to find in the literature. This review focuses on the potential use of cerebrolysin in psychiatry, and two independent researchers searched three full-text medical article databases to compile it. Methods: To conduct this scoping review, two independent researchers searched three full-text article databases, Embase, Scopus, and Web of Science, by entering the following phrases: “cerebrolysin psychiatry”, “cerebrolysin depression”, “cerebrolysin mood”, “cerebrolysin bipolar”, “cerebrolysin schizophrenia”, and “cerebrolysin addiction”. Results: The results show that this specific substance could have a relatively small application in psychiatry. Conclusions: The limited amount of available research on the use of cerebrolysin suggests that it may have some significance in supporting the treatment of depression and autism spectrum disorders and alleviating adverse effects during treatment with neuroleptics. Full article

Background: Invasive and non-invasive neuromodulation in psychiatry represents a burgeoning field that leverages advanced neuromodulation techniques to address substance use disorders (SUDs). Aims: This narrative review synthesizes findings from multiple reviews to evaluate the efficacy of neuromodulation in treating SUDs. Methods: A comprehensive literature search was conducted between December 2024 and April 2025, focusing on systematic reviews and meta-analyses that examined various neuromodulation modalities, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The selected reviews were analyzed to identify common themes, outcomes, and gaps in the current understanding of these treatments for SUDs. Results: 11 reviews met the final inclusion criteria; 5 focused on non-invasive neuromodulation (rTMS, tDCS) and 6 on invasive neuromodulation (DBS). Non-invasive neurostimulation was associated with modest improvements in craving and cognitive dysfunction in individuals with SUDs. Similarly, invasive neuromodulation (DBS), through high-frequency stimulation of the bilateral nucleus accumbens, appeared to reduce cravings and improve comorbid psychiatric symptoms in both preclinical and human studies. Importantly, small sample sizes, heterogeneity in targets and stimulation protocols, and short follow-up periods significantly limit the generalizability of current findings from both non-invasive and invasive neuromodulation studies. Conclusions: As novel and more effective therapies for the treatment of SUD are desperately needed, procedural interventional psychiatry holds promise. However, despite encouraging results, existing evidence is still preliminary, and larger, rigorously designed studies are warranted to further establish the safety and efficacy of neuromodulatory interventions for SUD treatment. Full article

Background/Objectives: Rates of receiving opioid use disorder (OUD) treatment among adolescents and young adults (AYA) aged 16–25 are low. The current study qualitatively analyzed informants’ perspectives regarding the availability of, developmental considerations relevant to, and barriers associated with OUD treatment for AYA. Methods: Thirty key informants involved with OUD treatment in the northeastern United States completed individual, semi-structured interviews, including treatment providers (N = 11) and clinic leaders in programs that provide medication and psychosocial treatments for AYA with OUD (N = 10), as well as opioid-related policymakers (N = 6) and patient advocates (N = 3). Interviews were transcribed and independently double coded. Template-style thematic analysis methods were used and revealed seven themes. Results: The first theme highlighted limited treatment program availability for adolescents (aged < 18 years) with OUD. Four themes related to developmentally optimizing OUD treatment for AYA, describing the importance of caregiver involvement, AYA peer connections, wraparound services, and early intervention. Two themes described barriers to AYA OUD treatment, including stigma and knowledge gaps about medications for OUD as well as deficits in AYA’s access to basic resources (e.g., housing, food security) that prohibit effective participation in treatment. Conclusions: Results highlight concerns from systems-level key informants regarding gaps in OUD treatment options for youth under the age of 18 and a high need for OUD treatment that is developmentally tailored to AYA. Findings point toward potential modifications and additions to existing adult treatment programs to make OUD treatment more accessible, relevant, and engaging for AYA. Full article

Ketamine, originally developed as an anesthetic, is gaining increasing attention due to its multifaceted pharmacological properties. In addition to its use in anesthesia, ketamine exerts potent analgesic effects via N-methyl-D-aspartate (NMDA) receptor antagonism, modulating pain perception and reducing central sensitization, particularly in chronic and neuropathic pain conditions. Emerging evidence also supports ketamine’s potential in the treatment of substance use disorder, where it may disrupt maladaptive reward-related memories and promote neuroplasticity which facilitates behavioral change. Moreover, in recent years, S-ketamine has shown rapid and potent antidepressant effects, especially in treatment-resistant depression (TRD), probably due to increased glutamatergic signaling, synaptic plasticity and the release of neurotrophic factors. This heterogeneous therapeutic profile positions ketamine as a unique agent at the interface of anesthesia, pain management, addiction medicine and psychiatry, warranting further exploration into its mechanism and long-term effectiveness. Full article

Background and aims: Opioid maintenance therapy (OMT) is the first-line treatment for opioid use disorder (OUD), reducing opioid use and mortality while improving physical and mental health. However, concomitant substance use remains common, with cannabis being the most frequently used substance. This study assessed the prevalence and clinical correlates of cannabis use in OMT patients, as well as individual motivations. Methods: In this cross-sectional, single-center study, 128 OUD patients (96 male, 32 female) receiving OMT were assessed using standardized questionnaires: the Marijuana Smoking History Questionnaire (MSHQ), Cannabis Problems Questionnaire (CPQ) and the Severity of Dependence Scale (SDS). Cannabis users and non-users were compared regarding type (methadone vs. buprenorphine) and dosage of maintenance medication. Results: Cannabis use was reported by 41% of patients, 73% met criteria for cannabis dependence, 30% of the full sample. Of the patients, 85% reported cannabis-related legal issues. Common reasons for use included recreational motives (mood change, enhancement) and reduction in cravings for other substances. Cannabis dependence was significantly more common in patients receiving buprenorphine than methadone. Higher methadone doses were also associated with increased cannabis use. These results suggest a clinically relevant pattern. Conclusions: Cannabis use is highly prevalent and appears to be influenced by type and dosage of substitution medication. These findings highlight a complex interaction between opioid treatment and cannabis use, possibly involving behavioral coping or regulatory processes. Further longitudinal and placebo-controlled trials are needed to investigate the clinical and pharmacological interactions between cannabis and OMT, including effects on craving, withdrawal, and overall treatment outcomes. Full article

Background/Objectives: The co-occurrence of posttraumatic stress disorder (PTSD) and cannabis use disorder (CUD) symptoms is common following sexual assault, particularly among emerging adult women. CUD is associated with more severe PTSD symptoms and other mental health comorbidities including depression, suicidality, and emotion dysregulation. Addressing these issues concurrently soon after sexual assault could help decrease the risk for downstream negative health outcomes. Integrated trauma-focused interventions for PTSD and co-occurring substance use disorders have been shown to decrease PTSD severity and substance use. Yet, existing protocols are lengthy and have rarely been applied following recent trauma exposure or specifically to address CUD symptoms. Methods: This case series describes the application of Written Exposure Therapy (WET) for PTSD adapted to integrate cognitive-behavioral skills training for substance use among women following recent sexual assault. The adapted integrated intervention, Skills Training and Exposure for PTSD and Substance Misuse (STEPS), was delivered to three emerging adult women (age range = 19–25) who experienced recent sexual assault (weeks since assault range = 1–12 weeks). Results: This case series describes the novel intervention and examines clinical outcomes post-treatment and at the 1-month follow-up. Past-week PTSD symptoms (based on a clinical interview) and past-month cannabis use decreased among all participations after receiving STEPS. Conclusions: Preliminary findings from the case series provide new knowledge and insights regarding the application of STEPS following recent sexual assault among individuals with co-occurring PTSD and CUD. Therapeutic strategies for addressing PTSD and CUD concurrently and implications for future clinical research are discussed. Full article