Search Results (151)

Lithium remains a cornerstone mood stabilizer for bipolar disorder, with strong evidence for relapse prevention and a unique association with reduced suicide risk. Its benefit is counterbalanced by renal adverse effects, ranging from impaired urinary concentrating capacity and nephrogenic diabetes insipidus (NDI) to chronic tubulointerstitial nephropathy with progressive loss of glomerular filtration rate in a minority of long-term users. Mechanistically, lithium enters collecting duct principal cells via the epithelial sodium channel, disrupts vasopressin-regulated water handling by downregulating aquaporin-2, and can drive chronic interstitial injury. Risk is amplified by episodes of lithium intoxication, dehydration, interacting medications that reduce renal lithium clearance, longer treatment duration, and comorbid kidney disease. This review integrates psychiatric and nephrologic perspectives on lithium’s indications, mechanisms, renal phenotypes, and prevention strategies, and proposes a practical shared-care pathway for patients with bipolar disorder who develop polyuria, NDI, acute kidney injury, or chronic kidney disease during lithium therapy, emphasizing monitoring, targeted treatment of polyuria, mitigation of toxicity, and structured shared decision-making when renal function declines. Full article

Background/Objectives: Depression is a mood disorder characterized by persistent sadness and loss of interest. Pharmacy students exhibit a relatively high prevalence of depressive symptoms, which may negatively impact quality of life, academic performance, and, in severe cases, lead to suicidal ideation. Given the increasing trend of medication use among young adults, we hypothesized that this behavior may be associated with depressive symptoms, potentially reflecting attempts to manage concurrent physical symptoms or reduced psychological well-being. Therefore, the objective of this study was to assess the association between depressive symptoms and medication use among pharmacy students. Methods: A cross-sectional study was conducted among students enrolled in pharmacy-related programs from University Center for Exact Sciences and Engineering (CUCEI), University of Guadalajara. Participants completed a personalized questionnaire assessing sociodemographic variables, medication use, comorbid conditions, and depressive symptoms using the Patient Health Questionnaire-9. Descriptive statistics were used to summarize participant characteristics. Categorical variables were reported as frequencies and percentages and compared using the chi-square test. Continuous variables were summarized as means and standard deviations and compared using Student t-test. To evaluate factors associated with moderate-to-severe depressive symptoms, logistic regression and multivariable linear regression analyses were performed. Results: A total of 365 students completed our personalized questionnaire; nearly half of the sample (47.3%) presented moderate-to-severe depressive symptoms. Multivariable analyses showed that insufficient sleep, academic stress, psychological support, and the number of medications used simultaneously were significantly associated with depressive symptoms. Logistic regression identified being in a relationship and receiving psychological support for at least one year as protective factors, while employment, insufficient sleep, academic stress, and a greater number of concomitant medications were associated with increased odds of moderate-to-severe depressive symptoms. Conclusions: A modest association was observed between self-reported medication use and moderate-to-severe depressive symptoms among pharmacy students. These findings suggest that medication use patterns may warrant further investigation as a potential marker of depressive symptoms in pharmacy students. Future longitudinal studies are needed to clarify the nature and direction of this association and to determine whether medication use could contribute to the identification of students at increased risk of depression. Full article

Background: The increasing use of advanced cardiac surgical therapies, particularly left ventricular assist devices (LVADs), has improved survival in patients with end-stage heart failure. However, the psychological burden associated with these therapies—especially depression and suicidality—remains underrecognized. Objectives: This narrative review synthesizes current evidence on the prevalence, underlying mechanisms, risk factors, screening strategies, and management of depression and suicidality in patients undergoing LVAD implantation and other advanced cardiac surgical interventions. Methods: A structured literature search of PubMed, Embase, and Scopus was conducted for studies published between 2020 and 2025 addressing depression, suicidal ideation, suicide attempts, and psychological distress in LVAD and advanced cardiac therapy populations. Results: Depression affects approximately 20–42% of patients with advanced heart failure, including those supported with LVADs, while suicidal ideation is reported in up to 12% of LVAD recipients, with higher rates of suicide attempts compared to other chronic disease populations. Risk factors are multifactorial and can be categorized into patient-related, disease-related, device-related, and psychosocial domains. Proposed mechanisms include neurohormonal dysregulation, systemic inflammation, and psychological processes such as loss of autonomy and existential distress. Although validated screening tools and multidisciplinary management strategies are available, their implementation in routine clinical practice remains inconsistent. Conclusions: Depression and suicidality represent significant and complex challenges in patients undergoing advanced cardiac therapies, particularly LVAD support. Systematic mental health screening and integrated, multidisciplinary care models are essential to improve patient outcomes. Future research should focus on longitudinal assessment, standardized suicide risk monitoring, and the development of targeted, evidence-based interventions for this vulnerable population. Full article

Stock market investors and traders operate in high-pressure environments marked by volatility, uncertainty, financial risk, and intense performance demands. These conditions lead to substantial psychological distress, increasing vulnerability to psychiatric disorders and suicidal behavior. Key psychological risk factors in this population include acute financial loss, chronic stress, impulsivity, perfectionism, and identity fusion with professional performance. Evidence from behavioral psychology and clinical psychiatry indicates elevated rates of mood disorders, anxiety, and burnout in trading environments. Resilience—including emotional regulation, effective stress-coping mechanisms, strong social support, and cognitive flexibility—emerges as a critical protective factor that mitigates suicide risk and promotes adaptive functioning. Strengthening psychological resilience and implementing evidence-based mental-health strategies may help reduce suicide risk and support overall well-being. The medico-legal dimensions of this issue encompass duty of care within high-stress financial workplaces, clinical obligations related to suicide risk assessment and documentation, confidentiality and safety considerations, and questions of foreseeability of suicide in cases involving severe or catastrophic financial loss. Despite growing awareness of mental health challenges in financial professions, the intersection of suicide risk, resilience, and medico-legal responsibilities in this population remains underexplored. Further research is needed to refine assessment frameworks and develop targeted suicide prevention interventions for this at-risk group. Full article

Background: Post-psychotic depression (PPD) is an underestimated but clinically significant affective syndrome that occurs during remission from psychosis, particularly in schizophrenia. Material and Methods: This comprehensive review traces the evolution of this concept over five decades of research, starting from its initial differentiation from primary depression and schizoaffective disorders in the 1970s. Relying on more than thirty studies, we analyze historical definitions, biological and psychosocial mechanisms, diagnostic controversies, and therapeutic implications. Results: Research indicates that PPD develops from multiple contributing factors, including psychological insight, autobiographical disturbances, pharmacological influences, and social losses, rather than simply as a byproduct of psychosis or pharmacological treatment. We discuss the persistence of depressive symptoms after acute remission, their role in suicidal tendencies, and the diagnostic challenges arising from the overlap of negative symptoms and demoralization. Despite its exclusion from current diagnostic standards, PPD continues to affect a significant fraction of patients, particularly those with high insight and early onset. Conclusions: Effective treatment requires a multidimensional, phase-specific approach combining antidepressants, atypical antipsychotics such as lurasidone, and psychological interventions targeting identity, self-esteem, and narrative processing. We argue that PPD should be reintroduced as a distinct clinical unit and incorporated into psychiatric guidelines to reduce diagnostic oversights and improve patient outcomes. Full article

Background/Objectives: Psychological pain—also termed psychache or mental pain—has been suggested to constitute a relevant factor in the emergence of suicidal behaviour. Despite conceptual advances, empirical research on interventions specifically designed to alleviate psychological pain in individuals who have attempted suicide remains scarce. The present scoping review maps existing psychological and pharmacological interventions targeting psychological pain, identifies their core components, delineates gaps for future research, and proposes a therapeutic intervention protocol. Methods: Literature was searched through PubMed, PsycInfo, and ClinicalTrials.gov (until October 2025) using combinations of the terms suicide, psychache, psychological pain, intervention, treatment, therapy, pharmacological treatment, and psychotherapy. Both randomised controlled trials, non-randomised controlled trials, and literature reviews were included. Results: Evidence indicates that few interventions explicitly target psychological pain. Most suicide-specific therapies indirectly address components of psychological pain—such as unbearable affect, loss of meaning, and social disconnection. Narrative-based, emotion regulation, and acceptance-based therapies appear promising. Emerging pharmacological approaches may relieve psychological pain; however, further evidence is required. Conclusions: Integrating psychological pain as a therapeutic focus—through narrative, tolerance-building, and relational strategies—may enhance post-attempt interventions. Future trials should systematically measure psychological pain and test its role as a mediator of suicidal outcomes. Full article

Metabolic and bariatric surgery (MBS) has evolved into a highly effective neurohormonal intervention for severe obesity; however, it introduces unique long-term vulnerabilities, particularly regarding alcohol (AUD) and substance use disorders (SUD). This review synthesizes the epidemiological, pharmacokinetic, and neurobiological drivers of postoperative substance misuse. Procedures like Roux-en-Y gastric bypass (RYGB) radically alter ethanol metabolism, eliminating first-pass metabolism and accelerating gastric emptying, while simultaneously recalibrating reward pathways, creating a “reward gap” that facilitates addiction transfer. These physiological shifts exacerbate critical micronutrient deficiencies (thiamine, B12, iron), increase the risk of post-bariatric hypoglycemia, and correlate with higher rates of liver cirrhosis and suicide. Furthermore, substance use is a primary driver of suboptimal weight loss trajectories and weight regain. Mitigation requires a lifelong, multidisciplinary framework involving preoperative risk stratification, validated screening (e.g., AUDIT-C), and targeted nutritional supplementation to safeguard the long-term metabolic and psychological benefits of MBS. Full article

Background: Glucagon-like peptide-1 receptor agonists are increasingly prescribed for weight loss, but concerns remain regarding adverse events beyond gastrointestinal, renal, and pancreatic effects. Understanding these risks is essential to guide safe clinical application and public health policy. The study aims to characterize psychiatric risks, administration-related adverse events, and patterns of inappropriate use associated with semaglutide, liraglutide, and tirzepatide for weight management. Methods: Disproportionality analysis using proportional reporting ratios and reporting odds ratios was conducted to detect significant signals in adverse event reports within the U.S. Food and Drug Administration Adverse Event Reporting System, identifying semaglutide, liraglutide, or tirzepatide as drugs used for weight loss while excluding gastrointestinal, renal, and pancreatic adverse events. Results: Among 40,253 adverse event reports (68.6% female; median ages: semaglutide, 62 years; liraglutide, 59 years; tirzepatide, 53 years), semaglutide demonstrated the strongest disproportionality signal for psychiatric adverse events, notably anxiety (PRR 1.34, 95% CI 1.18–1.51), depression (PRR 1.83, 95% CI 1.62–2.07), and suicidal ideation (PRR 3.44, 95% CI 2.98–3.97). Tirzepatide showed markedly higher signals for injection-site reactions (PRR 7.98, 95% CI 7.8–8.18) and inappropriate use, including incorrect dosing and off-label administration (PRR 5.98, 95% CI 5.9–6.06). Conclusions: In real-world use, semaglutide is disproportionately associated with psychiatric adverse events, whereas tirzepatide demonstrates higher rates of injection-site complications and misuse. Liraglutide presents a comparatively lower risk profile. These findings underscore the need for vigilant psychiatric monitoring, patient education on injection technique and dosing, and stronger regulatory oversight to reduce misuse of GLP-1 receptor agonists for weight loss. Full article

Background/Objectives: The second victim phenomenon is increasingly recognized as a significant issue affecting nurses involved in adverse events resulting from clinical decisions or interventions. Although patients and families, considered the first victims, are directly impacted, nurses often undergo challenges as second victims. With the growing awareness of these effects, this study aimed to map recent evidence on the second victim phenomenon among nurses in Western countries. Methodology: A Scoping Review was conducted following the Joanna Briggs Institute methodology in September 2024 and updated in November 2025. Eligibility criteria were defined using the PCC (Population, Concept, Context) framework. Searches were performed in PubMed, CINAHL, SciELO, and Scopus. Two independent reviewers carried out study selection, data extraction, and synthesis. Rayyan^® supported screening, performed in two phases: title/abstract review and full-text analysis. Data extraction was conducted in Excel^®, and data were analyzed using descriptive statistics and categorized into thematic areas. The review followed PRISMA-ScR guidelines and was registered in the Open Science Framework. Results: Of the 111 articles retrieved, 39 met the inclusion criteria. Evidence shows that although several support programs exist for nurses as second victims, they are often perceived as inadequate or inconsistently implemented. Second victim experience is associated with physical (e.g., sleep disturbances), emotional (e.g., fear), and psychological (e.g., distress) symptoms, with consequences such as absenteeism, professional dissatisfaction, loss of meaning in life, and even suicide. Conclusion: Findings highlight the need for more comprehensive, accessible, and consistently implemented support strategies to meet the complex needs of nurses affected by the second victim phenomenon. Full article

Background/Objectives: Thyroid hormones, considered safe in therapeutic doses, are used to treat hypothyroidism, a common condition. Due to a combination of factors, including their mechanism of action, availability, and low price, these drugs are used illegally, mainly to improve performance, to assist in weight loss, or for attempting suicide. Their overuse can lead to serious health consequences, including death. Although thyroid hormones are abused, there are no studies assessing the scale, characteristics, and consequences of their illegal use. The aim of this study was to evaluate case reports of thyroid hormone poisoning from the last 30 years, assessing their dynamics and characteristics. Methods: Full-text clinical case studies were obtained by searching PubMed, Google Scholar, MEDLINE, Embase, Web of Science, and Scopus for the following terms: “thyroid hormones”, “thyroxine”, “levothyroxine”, “triiodothyronine”, and “liothyronine”, as well as “intoxication”, “overdose”, and “poisoning”. This study adhered to Preferred Reporting for Systematic Reviews and Meta-analyses (PRISMA) guidelines for systematic reviews. Results: Thyroid hormones are abused particularly by athletes, persons trying to lose weight, or those attempting suicide. There has been an upward trend in thyroid hormone poisoning over the past 30 years, particularly since 2015. The same trend has been observed in cases of thyroid hormone use for doping, among other performance-enhancing drugs. Thyroid hormone use for doping was the most common cause of poisoning with these drugs, with other clinical manifestations from poisonings due to other causes. No upward trend has been observed in the use of thyroid hormones in suicide attempts since 2017, as this number remains stable. Conclusions: Although exploratory in nature, our work indicates that thyroid hormone poisoning, associated mostly with the illegal use of anabolic–androgenic steroids, exhibits an increasing tendency. Moreover, thyroid hormone abuse is an important issue in suicidology. Full article

Background: Workplace bullying, harassment and sexual abuse cause psychological harm, and can pose a significant threat to the success of an organization as well. This type of violence in the workplace, comprising negative actions and often abuse of power, can lead to trauma, anxiety, depression, PTSD and in severe cases, suicide. These acts impact workplace performance, negatively impact psychological safety and lead to high turnover and loss of productivity in an organization. Objectives: This narrative review outlines the key concepts of bullying, its impact on the individual, and the ways an organization can obstruct and manage it, using recent works (2018–2025) and some highlighted literature on trauma, power, and psychological safety. Methodology: Research conducted on leadership, safety climate, psychological safety and trauma-informed- as well as meta-analyses and relevant gray literature, journal articles, and other studies on bullying that A narrative synthesis of peer-reviewed and selected gray literature was conducted across PsycINFO, MEDLINE, Scopus, and Web of Science were integrated to this review. Results: Exposure to bullying was connected to anxiety, depression, burnout, post-traumatic stress disorders, cardiovascular problems, absenteeism, and turnover. Diminished psychological safety, as well as disordered leadership, increases the damaging effect. In contrast, ethical trauma-informed leadership and a strong psychosocial safety climate promote recovery and decrease the incidence of bullying. Conclusions: Recognizing workplace bullying, harassment, and sexual abuse as forms of violence—and as both occupational and public health hazards—underscores the urgency of prevention. Embedding psychological safety as a core organizational value at every level is essential to fostering healthier, more resilient workplaces. Full article

Background/Objectives: Suicide is a critical public health issue that leads to premature mortality among young people and requires substantial public health interventions. Demonstrating the importance of developing effective suicide prevention programs through health indicators can be valuable. This study aims to examine the change in suicide rates and Years of Life Lost (YLL) in Türkiye over the 2013–2023 period—a country that displays characteristics of both developed and developing nations—and to reveal the productivity losses using the human capital approach. Methods: The data for this descriptive study were obtained from the Turkish Statistical Institute between 2012 and 2023. YLL was computed by determining the difference between the age at which an individual died by suicide and their expected age of death for both males and females. Years of Potential Life Lost (YPLL) was estimated using the same method as YLL for individuals aged 15–64 (working age). The time trend of suicide and YLL rates was calculated using Annual Percentage Change and the Average Annual Percent Change values, based on a Poisson-based Generalized Linear Model and the Joinpoint regression method. Using the human capital approach, the economic cost of the labor force lost due to suicide was estimated. Results: The YLL per death was 33.57 years for males, 47.73 years for females, and 37.06 years overall. The age group with the highest YLL percentage is 20–24 among males (23.55%) and 15–19 among females (33.06%). An increase of 7.8% was observed among males from 2018 to 2021. The mean changes in the overall time trend were found to be significant in male suicides. Among females, there was a 5.3% decrease until 2017, followed by a 4.5% increase from 2017 onwards. Combined, male and female suicide rates have significantly increased since 2017. The financial loss associated with suicide over a 12-year period totaled USD 10,775,943,197 with an annual loss of USD 897,995,266. The premature mortality cost per death was estimated at USD 278,400.84 for men and USD 186,625.16 for women, while the premature mortality cost per YLL was USD 8292.23 for men and USD 3910.36 for women. Conclusions: Changes in the temporal trend of suicide may be associated with societal events. The study reveals that premature deaths due to suicide in Türkiye are a multidimensional public health problem that significantly affects not only individuals but also the overall productivity and economic structure of society. Full article

Background/Objectives: Electroconvulsive therapy (ECT) is used for treatment-resistant depression (TRD). Despite high effectiveness, its most prevalent side effect is memory loss, particularly autobiographical memory deficits. Some patients and physicians might associate post-ECT improvement in depressive symptoms with a higher risk of autobiographical amnesia or even consider this side effect ECT’s mechanism of action. Here, we aimed to study the association between improvement in depressive symptoms and the severity of autobiographical amnesia, as well as identify factors associated with the degree of memory loss. Methods: In this prospective naturalistic observational pilot study, we included 20 patients who underwent ECT for TRD. Attending psychiatrists decided on the electrode placement. Electrical dosage was based on the seizure-titration procedure. Depressive symptoms (Hamilton Depression Scale-21) and autobiographical memory (AMI-SF) were assessed before and after the full course of ECT. The correlation between symptomatic improvements and severity of memory loss was studied using Spearman’s correlation. Demographic and clinical baseline data were examined to look for associations with the decline in autobiographical memory. Results: Symptomatic improvement was not correlated with autobiographical memory loss (r = −0.14, p = 0.58) or any of its domains. Suicidal ideation at baseline was associated with a stronger decline in autobiographical memory (r = −0.53, p = 0.016). Patients treated with bilateral electrode placement had worse amnesia than those treated with right unilateral treatment, though the difference was not significant (MD = −17.4 vs. −13.1, p = 0.2). Conclusions: ECT improved depressive symptoms irrespective of autobiographical amnesia severity. Patients with suicidal ideation at baseline might experience worse post-ECT amnesia than those without. Full article

Suicide is a leading cause of death among construction workers, particularly younger and lower-skilled employees. Barriers such as stigma, low mental health literacy, and traditional masculine norms hinder help-seeking in this male-dominated sector. Few mental health interventions are tailored to this context. This study developed a co-designed, theory-informed training to improve mental health literacy, reduce stigma, and increase help-seeking among construction workers in Ireland. Using the Medical Research Council’s framework, the training was developed with the Theory of Planned Behavior (TPB), Behavior Change Techniques, and extensive stakeholder co-design. Two systematic reviews, a broad literature review, and focus groups with industry managers informed the content and structure. The training will be pilot-tested using validated measures: the Literacy of Suicide Scale (LOSS), the Stigma of Suicide Scale (SOSS), and the General Help-Seeking Questionnaire (GHSQ), the results of which will be the subject of a separate study. CAIRDE is a promising, evidence-based training that addresses key mental health barriers in Irish construction. Embedding the TPB within a co-design methodology has resulted in the development of a training program that is underpinned by theoretical fidelity and cultural relevance and provides a framework for other male-dominated industries to draw upon. Future work should address remaining challenges related to stigma and help-seeking, and explore broader implementation through integration into mandatory safety training. Full article

Introduction: Non-missile penetrating brain injury (PBI) involving the anterior skull base constitutes a rare subclass of traumatic brain injury in civilians. Management of this type of trauma is poorly described in the literature, with only case series and reports available. Materials and Methods: A systematic search was conducted across PubMed, Scopus, and Web of Science databases. The study included reports of adult patients with non-missile PBI with foreign bodies crossing the anterior skull base, published between the years 2000 and 2024. The patients were divided into three groups based on the entry point of foreign bodies: transorbital, transmental, and transnasal injuries. The obtained data were analyzed through descriptive statistics. A case report of a 20-year-old male following PBI involving the anterior skull base caused by suicidal self-shooting with a crossbow is presented. Results: A total of 17 articles reporting 40 patients and the current case were included. The mean age of the patients was 37.4 ± 13.1 years, and 92.7% of them were male. Transorbital injury was the dominant type of PBI (29 cases), followed by transmental injury (7 cases) and transnasal injury (5 cases). A total of 37 patients (90.2%) were managed operatively due to retained foreign bodies after PBI. Antibiotic prophylaxis was implemented in 33 cases (80.5%), mostly in transorbital (93.1%) and transnasal (100%) PBI. In seven reported cases, antiepileptic drugs were preventively administered. At the last follow-up, 18 patients (47.4%) did not fully recover neurological functions, with vision loss as the most common deficit. Conclusions: Management of non-missile PBIs involving the anterior part of the skull base is complex, challenging, and often requires a multidisciplinary team including neurosurgeons, ENT surgeons, ophthalmologists, and maxillofacial surgeons. In this type of traumatic brain injury, following proper management may lead to favorable outcomes with minimal neurological deficits. Full article