Search Results (210)

Background/Objectives: Nitrous oxide (N₂O), commonly known as laughing gas, is increasingly being used recreationally. While neurological risks are recognized, psychiatric effects remain underexplored. This study investigates neuropsychiatric presentations among patients referred to the Emergency Mental Health (EMH) team at Sunshine Hospital, Melbourne, Australia, associated with recreational N₂O use. Methods: We conducted a retrospective observational review of EMH referrals between August 2020 and July 2024. Inclusion criteria were patients with documented recreational N₂O use within the preceding 12 months. Cases were operationally defined as presenting with either predominantly psychiatric features (psychosis or suicidal ideation/self-harm documented by clinician) or predominantly neurological features (ataxia, paresthesia, pyramidal signs, or other focal deficits). Primary outcomes included type and severity of neuropsychiatric presentation, concurrent substance use, and disposition from the Emergency Department. Results: Of 25 identified patients, 23 met inclusion criteria (12 males, 11 females; mean age 29.3 ± 8.3 years). Psychotic symptoms were reported in 11/23 (47.8%, 95% CI 27.3–69.0) and suicidal ideation or self-harm in 8/23 (34.8%, 95% CI 17.2–55.7). Neurological symptoms, including paraesthesia and ataxia, occurred in 5/23 (21.7%, 95% CI 7.5–43.7). Concurrent substance use was documented in 19/23 (82.6%, 95% CI 61.2–95.0), most frequently cannabis, alcohol, and tobacco. Over half of patients (12/23; 52.2%, 95% CI 30.6–73.2) identified as culturally and linguistically diverse (CALD). Conclusions: Among EMH-referred ED patients, recreational N₂O use is associated with a spectrum of neuropsychiatric presentations, including psychosis, suicidality, and neurological symptoms. These findings reflect clinical associations rather than causal relationships and highlight the need for early recognition, targeted assessment, and appropriate follow-up in high-risk patients. Full article

Background: During adolescence, the brain is undergoing anatomical and physiological maturation processes with changes to cognitive development. However, in adolescents with phenylketonuria (PKU), executive function and mental health are adversely affected by high blood phenylalanine (Phe) levels. Objectives: We aim to describe clinical outcomes in adolescents with PKU. Methods: Cross-sectional questionnaires were performed on quality of life (EuroQol “EQ-5D-5L” questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale- HADS) and food neophobia in a single PKU centre. Retrospective data on metabolic control (previous 12 months) and medical history, and current data on anthropometry, dietary treatment, and comorbidities were collected. Results: In total, 33 adolescents with PKU participated with a mean age of 13.5 ± 1.3 y (16 boys, 17 girls). All were on a Phe restricted diet, with 3 also prescribed sapropterin. Questionnaires were self-completed by n = 25/33 (76%) adolescents. A mean of 36 ± 26 blood Phe spots were performed over 12 months. There was a mean of 83% of blood Phe < 600 µmol/L and 49% < 360 µmol/L. In total, 39% (n = 13/33) of adolescents were overweight/obese, 18% (n = 6/33) overweight and 21% (n = 7/33) obese. Medical history documented mental health disorders (anxiety/depression) in 7 cases, low mood, suicidal thoughts and self-harming in 5, and neuro diversity in 4 (autism and/or attention-deficit hyperactivity disorder (ADHD). In the HADS questionnaire, 12% (n = 3/25) of adolescents scored borderline abnormal for anxiety and 12% (n = 3/25) abnormal for depression. Mean anxiety scores for females were almost twice as high compared to males. No significant correlation was found between blood Phe and anxiety/depression scores. However, higher Phe levels showed a trend towards reduced enjoyment and emotional responsiveness, including lower scores on measures of pleasure, cheerfulness, and emotional reactivity. Although not statistically significant, these findings suggest a potential subtle association between poorer metabolic control and mood disturbances in adolescents with PKU. No food neophobia was identified in our study. Conclusions: Adolescents with PKU presented with high levels of depression and anxiety. Long term studies focusing on quality of life and neurocognition even when achieving the PKU European guidelines are necessary. Different therapeutic options are needed to improve the outcome of patients with PKU. Full article

Background: The deployment of large language models (LLMs) in mental health therapy presents a compelling yet deeply fraught opportunity to address widespread disparities in access to psychological care. Recent empirical evidence reveals that these AI systems exhibit substantial shortcomings when confronted with complex clinical contexts. Methods: This paper synthesizes key findings from a critical analysis of LLMs operating in therapeutic roles and argues for the urgent establishment of comprehensive risk management frameworks, policy interventions, and ethical protocols governing their use. Results: LLMs tested in simulated therapeutic settings frequently exhibited stigmatizing attitudes toward mental health conditions and responded inappropriately to acute clinical symptoms such as suicidal ideation, psychosis, and delusions. Real-world evaluations reinforce these concerns. Some studies found that therapy and companion bots endorsed unsafe or harmful suggestions in adolescent crisis vignettes, while others reported inadequate chatbot responses to self-harm and sexual assault queries, prompting concern from clinicians, disappointment from patients, and calls for stronger oversight from policymakers. These failures contravene fundamental principles of safe clinical practice, including non-maleficence, therapeutic alliance, and evidence-based care. Moreover, LLMs lack the emotional intelligence, contextual grounding, and ethical accountability that underpin the professional responsibilities of human therapists. Their propensity for sycophantic or non-directive responses, driven by alignment objectives rather than clinical efficacy, further undermines their therapeutic utility. Conclusions: This analysis highlights barriers to the replacement of human therapists with autonomous AI systems. It also calls attention to the regulatory vacuum surrounding LLM-based wellness and therapy applications, many of which are widely accessible and unvetted. Recommendations include professional standards, transparency in training and deployment, robust privacy protections, and clinician oversight. The findings underscore the need to redefine AI as supportive, not substitutive. Full article

Suicidality is a complex multifactorial phenomenon strongly associated with major depression and other psychiatric disorders. Building on evidence implicating the Major Histocompatibility Complex (MHC) in modulating the immune and inflammatory processes characterizing psychiatric disorders, we hypothesized that specific HLA-DQB1 and HLA-DRB1 variants may contribute to an increased genetic susceptibility to suicidal behavior. Human Leucocyte Antigen (HLA) typing by sequence-specific primers (PCR-SSP) was performed on a sample of 196 individuals, including 70 non-lethal suicide attempters, 28 cases of completed suicide, and matched controls. The *HLA-DQB1 02/06 (RR 1.60, CI95% 1.22–2.09, p = 0.03 *) and *HLA-DRB1 11/15 (RR 1.70, CI95% 1.3–2.24, p = 0.04 *) genotypes and the HLA-DRB115~DQB103 haplotype (RR 1.58, CI95% 1.22–2.04, p = 0.03 *) were found to favor suicidal behavior. Psychosocial determinants associated with an increased suicidal risk were bereavement of close relatives (linked with HLA-DQB1*02), memory dysfunction (HLA-DQB1*06), disillusionment (HLA-DRB1*07 and HLA-DRB1*15), and self-harm (HLA-DRB1*15). Our findings support the contributory role of HLA polymorphisms in shaping susceptibility to suicidal behavior. Full article

Self-harm is often stigmatised by healthcare professionals. Little is known about how certain characteristics of the behaviour, like the degree of suicidal intent, affect clinicians’ judgements and responses. This study explored how intent of self-harm (suicidal or non-suicidal) affects trainee practitioners’ views and attitudes towards behaviour and clinical decision-making. A qualitative study using semi-structured online interviews was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using a reflexive thematic analysis. Fifteen trainee healthcare practitioners (psychological wellbeing practitioners, clinical/counselling psychologists, nurses, and medics) were interviewed. Three themes were identified: (1) interpreting intent in self-harm: clinical utility and challenges, (2) the perceived responsibility of self-harm, (3) trainees’ struggle for equal care in a hierarchical system. Participants observed staff expressing pejorative views towards both forms of self-harm but did not share them. Across most clinical decisions, intent informed trainees’ judgements and beliefs. Clients presenting with suicidal-related self-harm received more urgent care but fewer therapeutic interventions. Trainees felt ambivalent about distinguishing intent. Nevertheless, this distinction was evident across treatment, risk and care decisions. A consistent approach towards suicidal and non-suicidal self-harm is important. Trainees should be supported in addressing difficult emotions arising from this work, helping to shift the blame culture and promoting a more empathic approach. Full article

Background: The widespread use of social media among children and adolescents has raised increasing concern about its potential impact on mental health. Given the unique neurodevelopmental vulnerabilities during adolescence, understanding how digital platforms influence psychiatric outcomes is critical. Objectives: This narrative review aims to synthesize current evidence on the relationship between social media exposure and key psychiatric symptoms in youth, including depression, anxiety, body image disturbances, suicidality, and emotional dysregulation. Methods: We conducted a comprehensive narrative review of the literature, drawing from longitudinal, cross-sectional, and neuroimaging studies published in peer-reviewed journals. Specific attention was given to moderators (e.g., age, gender, and personality traits) and mediators (e.g., sleep, emotion regulation, and family context) influencing the relationship between social media use and mental health outcomes. Results: Evidence indicates that certain patterns of social media use, especially passive or compulsive engagement, are associated with increased risk of depression, anxiety, body dissatisfaction, and suicidal ideation. Adolescent girls, younger users, and those with low self-esteem or poor emotional regulation are particularly vulnerable. Neuroimaging studies show that social media activates reward-related brain regions, which may reinforce problematic use. Family support and digital literacy appear to mitigate negative effects. Conclusions: Social media use is not uniformly harmful; its psychological impact depends on how, why, and by whom it is used. Multilevel prevention strategies, including media education, parental involvement, and responsible platform design, are essential to support healthy adolescent development in the digital age. Full article

Background/Objectives: Blunt trauma injury of the diaphragm is uncommon. Even after imaging examination, accurate diagnosis remains difficult. We sought to identify clinical factors that raise suspicion of such injuries, which can be applied during the initial evaluation of trauma patients. Methods: We retrospectively analyzed patients with blunt trauma who were diagnosed with diaphragmatic injury between January 2015 and July 2025. Demographic variables, clinical findings, operative records, and imaging findings were reviewed. Results: The most common mechanism of injury in patients with diaphragmatic injury was traffic accidents (64.2%), and 77.4% were identified as severe injuries with an Injury Severity Score (ISS) ≥ 16. Computed tomography (CT) scans of these patients frequently showed hemothorax, hemoperitoneum, and pneumothorax, but 49.1% of cases did not show diaphragmatic injury on preoperative imaging. In these patients, pneumothorax, lower rib fractures, and liver injury were more common. Notably, pneumothorax strongly suggested the possibility of diaphragmatic injury in patients where intrathoracic herniation was not clear. Conclusions: In patients with polytrauma and unstable vital signs, CT evaluation of torso injuries and careful interpretation are essential. Even when CT does not reveal diaphragmatic injury, suspicion should be elevated in cases with high ISS accompanied by pneumothorax, hemoperitoneum, hemothorax, lower rib fractures, or extremity injuries. If the injury mechanism further raises clinical suspicion, repeated physical examinations and imaging studies should be performed. When suspicion remains high, surgical intervention should be considered to confirm the diagnosis. Full article

Background/Objectives: Although non-suicidal self-harming behaviors (NSSHBs) are increasingly recognized as both a symptom and risk factor in adolescent development, few studies have explored their biopsychosocial correlates, such as stress management, quality of life, family and peer support, and school-related factors, within a longitudinal framework. The present study aims to explore self-harm behaviors among adolescents from an ecological and biopsychosocial perspective over three distinct time points: pre-pandemic (2018), during the pandemic (2022), and post-pandemic (2024). Methods: The total sample comprised 12,233 adolescents, with 5695 in 2018, 5931 in 2022, and 607 in 2024. The percentage of adolescents reporting self-harm behaviors increased from 18.0% in 2018 to 21.8% in 2022 and slightly decreased to 20.2% in 2024. Results: Results show that, in both groups, stress management skills were positively predicted by family support, teacher relationship, quality of friendship, and future expectations, and they were negatively predicted by psychosomatic symptoms. The explained variance (adjusted R²) was consistently higher in the self-harm behavior group. The findings confirm that NSSHB is not only a symptom of individual distress but also a marker of insufficient psychosocial support and coping resources. Conclusions: Stress management skills emerged as a key vulnerability domain and were consistently lower among adolescents with NSSHB. Family support, school relationships, and mental well-being were central predictors of coping skills, reinforcing the relevance of multilevel, ecological approaches to prevention and intervention. Full article

Background/Objectives: Depression is a mental disorder that can lead to self-harm or suicidal thoughts if left untreated. Psychiatrists often face challenges in identifying the most effective courses of treatment for patients with depression. Two widely recommended depression-related therapies are selective serotonin reuptake inhibitors (SSRIs) and repetitive transcranial magnetic stimulation (rTMS). However, their response rates are approximately 50%, which is relatively low. This study introduces a computer-aided decision (CAD) system designed to determine the effectiveness of depression therapies and recommends the most appropriate treatments for patients. Methods: Each channel of the EEG is plotted in two-dimensional (2D) space via a novel technique called the amplitude polar map (APM). In each channel, the 2D plot of APM is utilized to extract distinctive features via the binary pattern of five successive lines method. The extracted features from each channel are fused to generalize the pattern of EEG signals. The most relevant features are selected via the neighborhood component analysis algorithm. The chosen features are input into a simple feed-forward neural network architecture to classify the EEG signal of a depressed patient into either a respondent to depression therapies or not. The 10-fold cross-validation strategy is employed to ensure unbiased results. Results: The results of our proposed CAD system show accuracy rates of 98.06% and 97.19% for predicting the outcomes of SSRI and rTMS therapies, respectively. In SSRI predictions, prefrontal and parietal channels such as F7, Fz, Fp2, P4, and Pz were the most informative, reflecting brain regions involved in emotional regulation and executive function. In contrast, rTMS prediction relied more on frontal, temporal, and occipital channels such as F4, O2, T5, T3, Cz, and T6, indicating broader network modulation via neuromodulation. Conclusions: The proposed CAD framework holds considerable promise as a clinical decision-support tool, assisting mental health professionals in identifying the most suitable therapeutic interventions for individuals with depression. Full article

Brief Admission by Self-referral (BA), a standardized crisis intervention for individuals with repeated self-harm or suicidal behavior, was adapted for adolescents from 13 years in Region Skåne, Sweden, in 2018. BA aims to offer access to support based on autonomy and has been associated with reduced need of emergency care. Interviews with adolescents and legal guardians have pointed to BA as valuable and challenging, and professional support as key. This study aims to describe healthcare professionals’ (HCPs) experiences of BA for adolescents with self-harm at risk of suicide. Interviews six years after implementation with fourteen HCPs from outpatient and inpatient psychiatric care were analyzed with qualitative content analysis. BA was perceived as valuable caretaking without taking over, promoting mental growth and agency by being brief and granting access. It was described as offering relief to families and HCPs, although perceived to lack a sufficient level of legal guardian participation. Key work processes included being grounded in leadership and outpatient treatment. Challenges included system inflexibility and fitting BA into the physical care context. The results of this study may support future implementation of BA for adolescents with self-harm at risk of suicide and add guidance around potential pitfalls. Full article

Mental disorders (MDs) constitute significant risk factors for self-harm and suicide. The incidence of MDs has been increasing annually, primarily due to inadequate diagnosis and intervention. Early identification and timely intervention can effectively slow the progression of MDs and enhance the quality of life. However, the high cost and complexity of in-hospital screening exacerbate the psychological burden on patients. Moreover, existing studies primarily focus on the identification of individual subcategories and lack attention to model explainability. These approaches fail to adequately address the complexity of clinical demands. Early screening of MDs using EEG signals and deep learning techniques has demonstrated simplicity and effectiveness. To this end, we constructed a Dual-Branch Network (DBN) leveraging resting-state Quantitative Electroencephalogram (QEEG) features. The DBN is designed to enable the detection of multiple categories of MDs. Firstly, a dual-branch feature extraction strategy was designed to capture multi-dimensional latent features. Further, we propose a Multi-Head Attention Mechanism (MHAM) that integrates dynamic routing. This architecture assigns greater weights to key elements and enhances information transmission efficiency. Finally, the diagnosis is derived from a fully connected layer. In addition, we incorporate SHAP analysis to facilitate feature attribution. This technique elucidates the contribution of significant features to MD detection and improves the transparency of model predictions. Experimental results demonstrate the effectiveness of DBN in detecting various MD categories. The performance of DBN surpasses that of traditional machine learning models. Ablation studies further validate the architectural soundness of DBN. The DBN effectively reduces screening complexity and demonstrates significant potential for clinical applications. Full article

Background: Cerebral palsy (CP) is a lifelong neurodevelopmental disorder characterised by motor impairment and commonly associated with comorbidities such as cognitive, communicative, and behavioural difficulties. While the physical and functional aspects of CP have been extensively studied, the mental health needs of this population remain largely underexplored, particularly concerning suicidal ideation and self-injurious behaviours. The purpose of this review is to synthesise the existing literature on suicidality in individuals with CP, explore theoretical and clinical risk factors, and identify key gaps in the current evidence base. Methods: A narrative literature review was conducted focusing on studies addressing suicidal ideation, self-harm, or related psychiatric outcomes in individuals with CP. Additional literature on risks and protective factors was included to support theoretical inferences and clinical interpretations. Results: Only a limited number of studies addressed suicidality directly in CP populations. However, several reports document elevated rates of depression, anxiety, and emotional distress, particularly among adults and individuals with higher levels of functioning. Communication barriers, chronic pain, social exclusion, and lack of accessible mental health services emerged as critical risk factors. Protective elements included strong family support, inclusive environments, and access to augmentative communication. Conclusions: Suicidality in individuals with CP is a neglected yet potentially serious concern. Evidence suggests underdiagnosis due to factors such as communication barriers and diagnostic overshadowing. Future research should prioritise disability-informed methodologies and validated tools for suicidal ideation, while clinicians should incorporate routine, adapted mental health screening in CP care to ensure early detection and person-centred management. Full article

Background: Eating disorders (EDs) and self-harm (SH) are both associated with distress, poor psychosocial functioning, and increased risk of mortality. Much of the literature discusses the complex interplay between SH and ED behaviours where co-occurrence is common. The onset of both is typically seen during teenage years into early adulthood. A better understanding of the functions of these behaviours is needed to guide effective prevention and treatment, particularly during the crucial developmental years. An earlier review has explored the functions of self-harm, but an equivalent review for eating disorder behaviours does not appear to have been completed. Objectives: This evidence synthesis had two objectives. First, to identify and synthesise published first-hand accounts of the reasons why people engage in eating disorder behaviours with the view to develop a broad theoretical framework of functions. Second, to draw comparisons between the functions of eating disorder behaviours and self-harm. Methods: A qualitative evidence synthesis reporting first-hand accounts of the reasons for engaging in eating disorder behaviours. A ‘best fit’ framework synthesis, using the a priori framework from the review of self-harm functions, was undertaken with thematic analysis to categorise responses. Results: Following a systematic search and rigorous screening process, 144 studies were included in the final review. The most commonly reported functions of eating disorder behaviours were distress management (affect regulation) and interpersonal influence. This review identified significant overlap in functions between self-harm and eating disorder behaviours. Gender identity, responding to food insecurity, to delay growing up and responding to weight, shape, and body ideals were identified as functions more salient to eating disorder behaviours. Similarly, some self-harm functions were not identified in the eating disorder literature. These were experimenting, averting suicide, personal language, and exploring/maintaining boundaries. Conclusions: This evidence synthesis identified a prominent overlap between psychological functions of eating disorder behaviours and self-harm, specifically in relation to distress management (affect regulation). Despite clear overlap in certain areas, some functions were found to be distinct to each behaviour. The implications for delivering and adapting targeted interventions are discussed. Full article

Background/Objectives: Juvenile idiopathic arthritis (JIA) and inflammatory bowel disease (IBD) are chronic autoimmune conditions that impact the physical and psychological well-being of pediatric patients. While previous studies have shown a high prevalence of mental health challenges among youth with chronic conditions, the prevalence of mental health issues in Canadian pediatric patients with JIA and IBD remains unclear. We aimed to estimate the prevalence of documented mental health disorders and related medication use of youth with JIA or IBD at a tertiary care centre. Methods: We conducted a retrospective chart review of youths aged 12–17 diagnosed with JIA or IBD at McMaster Children’s Hospital (MCH) to understand the prevalence of generalized anxiety disorder (GAD), separation anxiety disorder, social anxiety disorder (SAD), obsessive–compulsive disorders (OCD), eating disorders, major depressive disorder (MDD), adolescent adjustment disorder, suicide attempt/suicide ideation, self-harm behaviour, substance use disorder, and attention deficit disorders (ADD). Results: We reviewed 429 patient charts, including 303 patients with IBD and 126 with JIA. Our findings identified 90 IBD patients and 20 JIA patients who had one or more documented mental health conditions. Proportionately, there was a higher prevalence of mental health conditions among IBD patients (30%) compared to JIA patients (16%). The most frequently observed conditions in both IBD and JIA patients were GAD (63%, 50%), ADD (33%, 35%), and MDD (29%, 15%). Conclusions: These findings highlight the critical need for early mental health screening and integrated care approaches that address both medical and psychosocial needs in adolescents with chronic illnesses. Future research should incorporate prospective study designs, include diverse geographic and demographic populations, and explore targeted interventions to improve mental and physical health outcomes in this vulnerable group. Full article

Background: Self-harm in young people is influenced by multiple factors, with media playing a significant role. While research has examined its harmful and protective effects, little attention has been paid to how healthcare professionals interpret and respond to media’s role in shaping young people’s experiences of self-harm. To our knowledge, no research has examined adolescent mental health professionals’ perspectives and, crucially, how these are constructed and understood. The study aimed to examine the following: (1) how mental health practitioners construct and use discourses to interpret the role of media in young people’s self-harm; and (2) how these discourses shape clinical understanding and practice. Methods: This qualitative study employed semi-structured interviews with ten clinicians from child and adolescent mental health services across England working with young people who self-harm. Data were analysed using critical discourse analysis to uncover how broader societal and institutional narratives shape clinicians’ perspectives. Results: Two dominant discourses were identified: “Media as Disruptor” and “The Hidden World of Youth”. These discourses framed media as both a risk factor and a potential intervention tool, positioning media as a powerful yet morally ambiguous force in young people’s lives. Clinicians largely framed media’s influence as negative but acknowledged its capacity for education and intervention. Conclusions: This research offers new insights into how media-related self-harm risks and benefits are framed and managed in mental health care settings. The study underscores the need for systemic changes in clinical practice, enhanced training, updated guidelines and a shift towards broader sociocultural perspectives in understanding self-harm and suicidal behaviour. Full article