Search Results (872)

Background: Suicidal ideation and attempts are major public health concerns among young adults, particularly those in demanding academic settings. Medical students exhibit disproportionately high rates compared to peers in the general population and other fields of study, highlighting the urgent need to understand and address mental health challenges in medical education. Objective: This scoping review summarizes evidence from systematic reviews and meta-analyses on the prevalence and risk factors of suicidal ideation and suicide attempts among medical students worldwide. Methods: Following PRISMA-ScR guidelines, six databases were searched for peer-reviewed reviews published in the last ten years. Studies focused exclusively on medical students and reporting prevalence or risk factors of suicidal ideation or attempts were included. Data were charted on prevalence, risk factors, study characteristics, and recommendations. Results: Twelve reviews comprising 378,081 medical students were included. Lifetime prevalence of suicidal ideation ranged from 2.9% to 53.6% among the systematic reviews, with pooled estimates from meta-analyses ranging from 11% and 25%. Attempted suicide pooled prevalences ranged from 1.64% to 8%. Depression was frequently reported as the most significant risk factor for both suicidal ideation and attempts. Other significant risk factors for suicidal ideation included anxiety, burnout, female gender, financial strain, and academic stress. Suicidal ideation was higher during the COVID-19 pandemic and among clinical-phase students. Gender differences in suicide attempts were inconsistent. Medical students’ rates of suicidal behavior exceeded those of other university students. Conclusion: Suicidal behavior remains a critical mental health issue for medical students globally. Despite known risk factors, targeted interventions are limited. Future research should emphasize longitudinal studies, post-pandemic effects, regional gaps, and intervention development. Implications are discussed. Full article

Background: Free fatal falls (FFF) represent a distinct form of blunt force trauma (BFT) that is frequently encountered in forensic practice. Distinguishing FFF injuries from other forms of BFT, such as motor vehicle accidents (MVAs), can pose challenges. Despite its growing usage, the role of postmortem computed tomography (PMCT) in diagnosing FFF and its comparison with autopsy remains underexplored. Purpose: This review synthesizes fracture patterns in FFF, examining both extrinsic and intrinsic variables that influence skeletal injuries. It also compares PMCT and autopsy findings to establish a replicable database for forensic analysis. Methods: PubMed and Google Scholar were systematically searched by three independent reviewers. The inclusion criteria required studies to be published in English, report at least 10 cases, focus on fatal falls, and provide precise data on skeletal injuries. Studies lacking detailed descriptions, focusing on survivors, or involving non-free falls were excluded. Data extraction tables facilitated synthesis and analysis. Key Findings: FFF are characterized mainly by axial skeletal fractures, particularly of the chest, skull, and pelvis. A history of intoxication and psychiatric disorders often correlates with the manner of death. Fracture patterns vary by fall height, impact surface, and cause: accidental falls show greater chest and skull involvement, whereas suicidal falls present more pelvic and skull fractures. PMCT detects fractures more frequently than traditional autopsy. Conclusions: Distinct fracture patterns aid in differentiating suicidal from accidental FFF, shaped by extrinsic and intrinsic factors. Given its superior fracture detection capabilities, PMCT should be integrated into forensic protocols for FFF investigations. Full article

Suicide is a public health concern worldwide. The methods used worldwide can vary based on geographical context and the ease with which victims can find the means to act on suicidal thoughts. In this context, the recent emergence of an online market for toxic and narcotic substances has increased accessibility to these substances for recreational and suicidal purposes. The presented case concerns a fatal sodium nitrite dose purchased online. The body exhibited the characteristic blue-gray staining of hypostasis, more evident on the neck and the upper third of the posterior surface of the chest, and toxicological analysis revealed methemoglobin levels exceeding 30%. Although there is no standardized analytical procedure, the determination of nitrite in postmortem samples is crucial in these cases. Additionally, nitrite is difficult to detect postmortem because it rapidly turns into sodium nitrate. In the case presented, capillary ion analysis (CIA) with direct UV detection was performed for the qualitative and quantitative determination of nitrite and nitrate in the cadaveric central blood samples. The analytical determination identified the presence of nitrite ions and sodium nitrate, in a concentration of 9515 µmol/L. Full article

Background: Endometriosis is a chronic disease defined by the presence of endometrial-like tissue outside the uterine cavity. While typically confined to the pelvis, extrapelvic manifestations—including thoracic endometriosis—can occur. Although rare, thoracic endometriosis is the most common extragenital form. In clinical practice, this presentation is often described as thoracic endometriosis syndrome (TES), a constellation of cyclic thoracic symptoms temporally associated with menstruation but not always histologically confirmed. Its atypical symptoms and limited clinical awareness frequently lead to delayed diagnosis, mismanagement and increased patient burden. Methods: In accordance with the CARE guidelines, we present a case report of a female patient with thoracic endometriosis syndrome, emphasizing the prolonged interval between symptom onset and final diagnosis. Case Report: We describe a 42-year-old woman with a longstanding history of dysmenorrhea and menorrhagia, who developed cyclical chest pain and dyspnea in 2019. Despite multiple thoracoscopic procedures, her symptoms persisted and were repeatedly misattributed to anxiety or infection. Thoracic endometriosis syndrome (TES) was suspected in 2022, and although histopathological confirmation was lacking, intraoperative visualization revealed diaphragmatic fenestrations. In 2025, a second laparoscopic intervention targeting the abdominal surface of the diaphragm resulted in significant symptom relief. The patient is currently continuing hormonal therapy with Dienogest and has reported a marked improvement in quality of life. Nevertheless, the protracted diagnostic and therapeutic process—marked by chronic pain and repeated hospitalizations—had a profound psychosocial impact, culminating in a suicide attempt. Conclusions: This case illustrates the substantial burden associated with the delayed recognition of thoracic endometriosis syndrome and the consequences of fragmented care. The patient’s experience underscores the urgent need for coordinated, multidisciplinary management and psychological support, particularly for patients with extrapelvic manifestations. Early multidisciplinary evaluation, with readiness to consider surgical intervention alongside individualized hormonal therapy, may support improved outcomes, provided they are reinforced by increased clinical awareness and systemic improvement in diagnostic pathways. Full article

The ability of enzymes to access various conformational states is often essential for their catalytic activity. Lysine 5,6-aminomutase (5,6-LAM), a pyridoxal 5′-phosphate (PLP) and 5′-deoxyadenosylcobalamin (dAdoCbl)dependent enzyme, catalyzes 1,2-amino shift in lysine isomers by shuttling between an open conformational state and a closed conformational state. Nevertheless, suicide inactivation of 5,6-LAM is an obstacle to the realization of its potential as a biocatalyst. In this work, the fate of the reaction of 5-hydroxylysine, an analogue of lysine, is investigated using spectroscopic and computational methods. Although 5-hydroxylysine does not afford any product, results obtained from UV–visible and electron paramagnetic resonance (EPR) spectroscopies demonstrate that initial steps of the catalytic cycle are performed with it. Simulation of the weakly spin-coupled spectrum estimates an intermediate distance between the PLP substrate-based radical and Co(II) in comparison to the that in the open state and the closed state. This distinct conformational state, different from the open state and the closed state, is alluded to in its putative role in suicide inactivation and denoted as the suicidally-inactivated state. Our findings highlight the emergence of EPR spectroscopy as a powerful tool to uncover the hidden conformations in radical enzymes. These results provide new insights into the suicide inactivation of dAdoCbl-dependent enzymes. Full article

Individuals with severe mental illness face a substantially higher risk of suicide compared with the general population, with drug overdose representing one of the most common and potentially lethal methods. This narrative review explores toxidromes frequently encountered in psychiatric populations, such as opioid, anticholinergic, and serotonergic toxicity, highlighting the clinical presentation in intentional overdose. Emphasis is placed on clinical recognition, antidote-based treatment, and systems-level strategies for the prevention of lethal overdose. We conducted a comprehensive literature search of PubMed, Google Scholar, and Web of Science for English-language articles using combinations of the following keywords: mental disorders; persons with psychiatric disorders; drug overdose; poisoning; serotonin syndrome; neuroleptic malignant syndrome; anticholinergic agents/poisoning; cholinergic antagonists/poisoning; psychotropic drugs/adverse effects; substance-related disorders; drug-related side effects and adverse reactions; polypharmacy; suicide, attempted; emergency service, hospital. By embedding toxidrome awareness into routine emergency and psychiatric practice, we aim to expedite treatment and improve patient outcomes. Full article

Background: Youth suicide is a global issue and a type of death that can be prevented through early access to evidence-based mental health interventions, which can contribute to improved quality of life as well as health, educational and employment outcomes. Young people are encouraged to seek help for mental health problems, yet help-seeking rates remain low. Objective: The aim of this research was to explore how young people with a mental health problem decide to search and ask for professional help, and the impact of help-seeking experiences. Methods: Young people aged 16–25 years with experiences of help-seeking to mental health services were recruited (N = 18). Data analysis was informed by Constructivist Grounded Theory methods, and the findings were presented across four sub-categories: 1. Deciding to Seek Help; 2. Searching for the Right Help; 3. Reflecting on Help-seeking Experiences; and 4. Living with the Impacts of Help-seeking. Findings: Young people often sought help while highly distressed and required the skills and resources of a family member or friend to access the right type of help. Help-seeking was multi-episodic and had lasting positive and negative impacts. Young people’s help-seeking patterns were found to be similar to the ways in which they problem-solve in learning contexts, and the concept of a formal help-seeking skillset was presented. Full article

Background/Objectives: The child and adolescent mental health service (CAMHS) hand-over to adult mental health service (AMHS) remains an ongoing shortfall in eating disorder (ED) treatment, typically in tandem with diagnostic drift, heightened suicide risk, and carer burn-out. We created one 14-to-25 Transition—ED track within our own unit, where a single multidisciplinary team continuously follows each patient and family across the CAMHS–AMHS boundary (via weekly joint paediatric and adult clinician meeting) without changing the individual psychotherapist, family therapist, or dietitian at the age 18 transition. We investigated the manner in which patients and parents perceive this model. Methods: A survey of two naturalistic parent cohorts—CAMHS (n = 16) and Transition—Adult arm (n = 15)—also joined, alongside the original group of young adults who had entered the programme during its set-up phase (n = 9). Here, the 14–25 pathway denotes one unified route of care across adolescence and young adulthood; the Transition—Adult arm is its ≥ 18-years component. All index patients had a primary DSM-5-TR diagnosis of restricting-type anorexia nervosa. Participants completed the Client Satisfaction Questionnaire-8 (CSQ-8; range 8–32) and four bespoke Continuity-of-Care items (1–4 Likert). Results: Overall, the caregivers in both cohorts were pleased (median CSQ-8 = 28.5 [CAMHS] vs. 27.0 [Transition]; p = 0.75). Continuity items were universally well rated across cohorts. Cohort parents reported a median of two unchanged core clinicians (i.e., the individual psychotherapist, the family therapist, or the dietitian), which was nonsignificantly positively correlated with CSQ-8 scores (ρ = 0.22). Early-group patients mirrored caregiver impressions (mean CSQ-8 = 27.0 ± 3.9). Conclusions: It is feasible and highly acceptable to both caregivers and anorexia nervosa young adults to have the same key staff and family-centred sessions over the 14-to-25 age span. Constrained by single-site study and small sample size, these preliminary data provide a rationale for wider implementation and controlled follow-up studies. Full article

Objectives: This study explored the relationship between physical activity, generalized anxiety disorder, and suicidal risk among South Korean adolescents, considering individual characteristics. Methods: The study analyzed raw data from the 2023 Youth Health Behavior Survey conducted by the Korea Disease Control and Prevention Agency. A total of 52,880 adolescents’ data (weighted to 2,581,964) were analyzed using a complex sample design. Results: Physical activity level had a negative effect on anxiety. Anxiety had a positive effect on suicidal risk, including thoughts, plans, and attempts. Physical activity level indirectly affected suicidal risk negatively by mediating anxiety. Individual characteristics such as gender, alcohol consumption, smoking, drug use, and household economic status also influenced suicidal risk. Conclusions: This study emphasizes that effectively reducing adolescent suicide rates requires a multifaceted approach. Such an approach should include promoting physical activity, addressing mental health challenges like anxiety, and providing tailored support for vulnerable populations. Full article

Background/Objectives: Mental health awareness is rising; thus, neurological and psychiatric side effects also benefit from increased attention from the medical and scientific community. Ibuprofen is a well-known non-steroidal anti-inflammatory drug (NSAID) that is often available over-the counter (OTC) for both adults and children, expressing good efficacy in reducing pain and fever through non-selective cyclooxygenase inhibition. As ibuprofen has already been associated with different neuropsychiatric disorders, the aim of this study was to perform an up-to-date analysis of such signals detected in the cases reported in EudraVigilance (EV). Methods: The disproportionality analysis offered a contextual insight into the real-world situation depicted in the analyzed database. Results: From the total cases reported for ibuprofen (n = 58,911), 13.9% contained nervous system disorders (n = 8214) and 10.7% entailed psychiatric disorders (n = 6295). The cases were distributed between all age groups, with a sensible higher incidence in teenagers and in women in general. Severe cases, including deaths, have been reported. By comparison with ketoprofen, acetylsalicylic acid, and diclofenac, ibuprofen presented a higher probability of reporting psychiatric and behavioral symptoms. Regarding cognitive and attention disorders and disturbances, no disproportionate signal was observed between ibuprofen and all other NSAIDs. Sleep disturbances (hypersomnia, narcolepsy and sleep paralysis) are reported as more probable for ibuprofen than for acetylsalicylic acid, naproxen, and diclofenac. A higher risk of reporting suicidal and self-injurious behaviors was noted for ibuprofen versus all other selected NSAIDs. A limitation of the study can be noted as due to suspected causality, not an established one, and EV reports cannot accurately determine adverse drug reaction frequencies. Conclusions: Considering that ibuprofen is easily accessible as an OTC drug and the higher probability of reporting several neuropsychiatric adverse effects as shown by this study, patient counseling, when possible, and general education for the public are valuable tools in managing these adverse reactions. Full article

Background/Objectives: Problematic polydrug use represents a relevant public health concern, with strong relationships with mental health problems and suicide behavior. Existing studies have just focused on problematic use, overlooking the potentially cumulative effect of coexisting substance use and addictive behaviors. This study aims to analyze the association between the polydrug use profile (no problematic use, problematic use of a single drug, and polydrug use) and mental health outcomes, specifically anxiety symptoms, depressive symptoms, and suicide behavior. Methods: A sample of 1307 Spanish young adults (66.2% male; M = 21.2 years, SD = 3.31) were assessed for problematic use of substances and behavioral addictions as well as for the internalizing symptoms and suicide behavior. Participants were categorized into three groups: no problematic drug use (n = 880), problematic single drug use (n = 316), and polydrug use (n = 111). Results: Results showed an increasing level in depressive symptoms and suicide behavior with polydrug use, with significant differences between groups (p < 0.05). Moreover, both groups of problematic use presented higher levels of anxiety than no-use participants, regardless of the number of use modalities. Conclusions: These findings suggest that problematic polydrug use is associated with greater clinical severity, particularly in terms of depressive symptoms and suicide behavior, while anxiety remains elevated even when a problematic single drug pattern is observed. This study highlights the importance of considering polydrug use in dual diagnosis and the need for an integrative clinical approach. Full article

Background and Objectives: Suicide is one of the leading causes of death worldwide. Identifying psychopathological factors and personality traits associated with suicidal ideation is crucial for improving prevention. This study investigates the association between current suicidal ideation—measured by item 4 of the Brief Psychiatric Rating Scale-24 items (BPRS-24)—and personality traits assessed with the Personality Inventory for DSM-5 (PID-5) in a transdiagnostic outpatient psychiatric population. The association of BPRS-24 item 4 with early traumatic experiences, attachment styles, and dissociative phenomena is also explored as a secondary objective. Materials and Methods: We propose a secondary analysis on a sample of 137 individuals receiving care at an academic community mental health center. Personality traits were assessed using the PID-5, while attachment styles were assessed with the Experiences in Close Relationships-Revised (ERC-R), childhood traumas with the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), and dissociative experiences with the Dissociative Experience Scale II (DES-II). Suicidal ideation was measured with item 4 of the BPRS-24. Associations were examined using Spearman’s correlation and ordinal logistic regression models, adjusted for age, sex assigned at birth, and global clinical severity (CGI-S). Results: We found statistically significant associations between suicidal ideation and the PID-5 trait of depressivity (OR = 1.80, 95 % CI 1.23–2.63, p = 0.002, p-value adjusted Holm’s method 0.012). However, this association lost significance after adjusting for depressive symptoms (BPRS-24 item 3), suggesting a mediating role of depression. We found no significant associations with childhood trauma, attachment styles, or dissociative experiences. Conclusions: Our findings suggest a potential link between specific personality traits and suicidal ideation, mediated by depressive symptomatology. We explore how future studies may evaluate PID-5 as a clinical tool to support the identification of individuals at long-term risk of suicidality or for targeting specific populations for tailored interventions. Full article

Background/Objectives: Recent evidence suggests that gut microbiota plays an important role in anxiety and stress-related disorders through interactions along the gut–brain axis. Our aim was to determine the microbiological diversity of intestinal microorganisms in individuals with acute and remission phases of PD when compared to healthy individuals. Another aim was also to analyze the differences in the metabolic pathways occurring in the intestinal microbiota of individuals from the three analyzed groups. Methods: A diagnosis was established using the Mini-International Neuropsychiatric Interview (M.I.N.I). The gut’s microbiota composition was analyzed through bacterial 16S rRNA gene sequencing (V1–V2 regions). The clinical evaluations included a BMI measurement, Short Form-36 Health Survey (SF-36), Hamilton Anxiety Scale (HAM-A), Montgomery–Åsberg Depression Rating Scale (MADRS), Columbia-Suicide Severity Rating Scale (C-SSRS), and State-Trait Anxiety Inventory (STAI). Results: We recruited 62 participants (31 PD and 31 controls). After conducting quality control filtering, data from 54 participants were analyzed (25 PD, 11 acute, 14 remission, and 29 controls). Observed richness was lower in the acute PD (63) group than in the control (74) and remission (66) (p = 0.038) groups, whereas the Shannon and Simpson indices and beta diversity (PERMANOVA) were not significantly different. The Ruminococcus gnavus group was enriched in acute PD; no other deconfounded differences in microbial composition were detected. Predicted functional differences were detected by edgeR only and included the pathways that are related to steroid biosynthesis and innate immune signaling. Conclusions: Distinct gut microbial signatures were associated with PD, implicating both the metabolic and inflammatory pathways in disease pathophysiology. Full article

Objectives: Social isolation is an important public health issue that is becoming increasingly prevalent among adolescents today. Recognizing the risk of social isolation in children and adolescents during their developmental years can contribute to the prevention of depression and anxiety disorders, as well as risky behaviors such as suicide and substance abuse. Valid and reliable measurement tools are needed to assess social isolation in adolescents. There is a lack of surveys to identify gaps in social isolation among Turkish adolescents. This study aims to adapt the Social Isolation Questionnaire (QIS) scale, which was developed for adolescents, to Turkish culture and to evaluate its psychometric properties. Methods: This descriptive and methodological study was conducted between July and November 2024 with 1922 adolescents. Data were collected using an introductory information form, the QIS, and the UCLA Loneliness Scale. In the evaluation of the data, explanatory and confirmatory factor analysis, Cronbach’s alpha, split-half, item–total score correlation, and test–retest analysis were used. Results: The average age of the adolescents was 13.97 ± 1.67 years (min = 12, max = 17). A total of 50.6% of the adolescents were male and 49.4% were female. A total of 81.2% of the adolescents had a nuclear family structure. Exploratory factor analysis revealed a three-factor structure explaining 55.97% of the variance. The factor loadings were greater than 0.30, and all fit indices were greater than 0.90. The total Cronbach’s α value of the scale was 0.83, while the values for the subdimensions ranged from 0.73 to 0.75. Conclusions: The Turkish version of the QIS is a valid and reliable measurement tool for assessing social isolation in adolescents. This questionnaire can be used by health professionals and researchers to identify adolescents at risk of social isolation and plan appropriate mental health interventions. This questionnaire can be used in studies focusing on adolescent mental health and well-being, contributing to the development and implementation of strategies in line with the Sustainable Development Goals. Full article

Murder-suicide, also referred to as homicide-suicide, results in multiple casualties. The victims are typically human, and cases involving the inclusion of pets, sometimes termed “murder-suicide-peticide”, have been rarely reported worldwide. The aim of this study is to present and examine the characteristics of three forensic veterinary cases in which pets were found dead alongside human victims in suspected domestic murder-suicide incidents in Japan. We analyzed information provided by the police agency about the owners, families, and the animals, as well as necropsy findings of three cases. In all three cases, it was determined that both the human and animal victims died from the same cause, suggesting a tendency for perpetrators to kill pets using the same methods as those used on human victims. Murder-suicide is regarded as the most extreme form of domestic violence and abuse. Ongoing interdisciplinary research is essential for developing effective intervention strategies to protect vulnerable individuals, both human and non-human, within the household. Full article