Søren Kierkegaard’s philosophy, particularly his exploration of anxiety, serves as a cornerstone in existential thought. His concepts of “authenticity,” “choice,” and the confrontation with the self underlie much of the contemporary understanding of anxiety as both a psychological and philosophical experience. Kierkegaard’s works, especially Either/Or, offer a profound analysis of human freedom, responsibility, and the resulting anxiety. The objective of this analysis is to bridge the philosophical with the practical and artistic, providing a multidimensional understanding of anxiety.

This study seeks to explore Kierkegaard’s conceptualization of anxiety, its application in psychotherapy, and its resonance in contemporary culture. Specifically, it investigates how these ideas can aid individuals in confronting existential anxiety in therapeutic settings.

A philosophical and qualitative approach is used, analyzing Kierkegaard’s Either/Or. The study incorporates interpretations from existential thinkers, psychotherapists and artists. Theoretical analysis is coupled with psychological insights, exploring anxiety as a pathway to self-awareness.

Kierkegaard presents anxiety as inherent to human freedom and choice. His stages of life—the aesthetic, ethical, and religious—represent different ways of engaging with anxiety. In the aesthetic stage, individuals pursue pleasure but encounter despair when they confront their limitations. The ethical stage offers structure but introduces existential guilt. The religious stage, requiring a leap of faith, is seen as the highest form of existence, where anxiety leads to transcendence. Kierkegaard’s ideas are reflected in existential psychotherapy, where anxiety is viewed not only as a symptom but as a catalyst for personal growth. Elliott Smith’s Either/Or album mirrors these themes, portraying modern struggles with freedom, despair, and self-doubt. Songs like “Between the Bars” and “Ballad of Big Nothing” articulate the tension between aesthetic escape and ethical responsibility, offering a visceral interpretation of Kierkegaard’s philosophical concerns.

Kierkegaard’s exploration of anxiety offers profound insights into human existence, emphasizing the need to confront, rather than avoid, existential dilemmas. His framework of life stages provides a guide for understanding the progression toward authenticity, where anxiety is a key driver. The study shows that Kierkegaard’s ideas remain relevant in psychotherapy, helping individuals navigate anxiety to achieve self-realization. Ultimately, this research affirms that embracing anxiety is crucial for personal freedom, growth, and authenticity, aligning with Kierkegaard’s vision of a life well-lived.

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The benefits of breastfeeding for mothers, infants, and society as a whole are well documented. These benefits appear to be linked to the duration of breastfeeding for both mother and child. Despite this knowledge, the rates of exclusive breastfeeding and continued breastfeeding at 6 and 12 months in Greece are exceptionally low.

To explore Greek parents’ attitudes towards breastfeeding according to their sociodemographic characteristics.

A cross-sectional study was conducted using self-administered questionnaires completed by 862 parents—both mothers and fathers—who had received support from a private maternity and breastfeeding support center in Athens.

The choice of breastfeeding was positively correlated with parents’ higher educational level (p<0.001), normal delivery (p<0.001), residence in Athens or another urban area ((p=0.017), positive attitude towards breastfeeding during pregnancy (p<0.001) and for breastfeeding after 12 months (p<0.001), previous breastfeeding experience (p<0.001), not using a pacifier (p<0.001), introducing whole foods at 6 months ( p<0.001), co-sleeping with their baby (p<0.001) and not implementing sleep training (p<0.001). Accordingly, the duration of breastfeeding was positively associated with living in another urban area (p<0.001), and unemployment (p=0.009). Longer duration of breastfeeding showed children who were exclusively breastfed (p<0.001), who weaned naturally (p<0.001), who were born naturally (p<0.001), who did not take a pacifier (p<0.001), who started with whole foods ( p<0.001), who stayed longer in their parents’ room (p<0.001), who did not receive sleep training (p<0.001) and those whose parents were informed about breastfeeding (p<0.001).

This study could serve as a foundation for more extensive research on breastfeeding. Findings can be utilized by health professionals to enhance their awareness, empathy, and effectiveness regarding issues related to breastfeeding.

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In the dynamic setting of psychiatric care, patient satisfaction and shared decision-making are crucial for optimal, personalized treatment. This approach is particularly vital in the context of a psychiatric ward, where engaging patients in treatment decisions could enhance their satisfaction and the overall therapeutic outcomes.

This study evaluated the impact of shared decision-making on patient satisfaction from services among patients treated in a psychiatric ward. Additionally, it examined whether there are differences in satisfaction between psychotic and non-psychotic patients.

53 patients (30 women and 23 men) who were hospitalized in the 4th Inpatient Department of the Psychiatric Hospital of Attica were assessed using the Client Satisfaction Questionnaire (CSQ-8) and the 9-Item Shared Decision-Making Questionnaire (SDM-Q-9). Diagnoses were based on the Mini International Neuropsychiatric Interview (M.I.N.I.). A multiple linear regression analysis was conducted to evaluate the effect of the SDM-Q-9 total score and of the presence of psychotic symptoms on the CSQ-8 total score. The relationship of separate SDM-Q-9 and CSQ-8 items, controlling for the presence of psychosis was further analyzed through partial correlation analyses. The Bonferroni method was employed in order to adjust for multiple comparisons.

The mean age of the participants was 47.49 years (SD=13,65), and the mean duration of the disease was 15 years (SD=12,36). Thirty-two patients were diagnosed with psychotic disorders (psychotic disorder=28, bipolar disorder=1, mood disorder with psychotic features=3), while twenty-one were diagnosed with non-psychotic disorders (including Major Depressive Disorder, Obsessive Compulsive Disorder, Bipolar Disorder and Substance Use disorders). Increasing SDM-Q-9 total score significantly correlated with increasing CSQ-8 total score (B=0,276, 95% CI=,177, 0.374, t=5,627, p<0.001). Partial correlation analyses showed that separate SDM-Q-9 items significantly correlated with separate CSQ-8 items, while many correlations survived the stringent bonferonni correction. The presence of psychotic symptoms was not associated with client satisfaction.

Our findings suggest that shared decision-making correlates positively with patient’s satisfaction from services during their hospitalization in a psychiatric ward and this was independent of the presence of psychosis. In the ongoing effort to find real-world solutions in mental health, integrating shared decision-making practices into psychiatric care can be a fundamental strategy to empower and satisfy patients suffering from mental disorders.

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Borderline Personality Disorder (BPD) was historically an underdiagnosed condition in Kyrgyzstan, often identified only in extreme cases, such as when individuals engaged in self-harm or displayed severe emotional instability. Traditionally, psychiatric consultations for BPD were initiated not by the individuals themselves but by concerned family members, typically parents. As mental health was heavily stigmatized in Kyrgyz society, especially personality disorders, many individuals likely went undiagnosed or untreated.

From 2020 to 2022, the Institute of Behavioral Health at the American University of Central Asia (AUCA) identified only 15 cases of BPD, However, since 2022, there has been a significant rise in BPD diagnoses, with over 70 cases recorded in just two years.

This study aims to examine the factors contributing to the increase in BPD diagnoses in the Kyrgyz Republic over the past two years.

The study’s methodology includes the analysis of secondary data provided by mental health organizations, including the AUCA Institute of Behavioral Health, which has tracked BPD cases in recent years. Additionally, anecdotal reports from practicing clinicians offer insights into the evolving nature of mental health diagnoses and treatments in Kyrgyzstan.

Several key factors have contributed to the rise in BPD diagnoses in Kyrgyzstan over the past two years. First, socio-economic stressors have intensified, particularly following the political and economic challenges of 2022. Financial instability and high unemployment rates have exacerbated psychological stress for many individuals. These conditions often worsen emotional dysregulation, a core feature of BPD, particularly for those already predisposed to the disorder. Second, the proliferation of social media has played a notable role in shaping mental health patterns, especially among young people. Increased social media exposure has been linked to feelings of inadequacy, identity confusion, and emotional instability—all key components of BPD. Third, domestic violence and trauma remain significant public health concerns in Kyrgyzstan. BPD has long been associated with adverse childhood experiences, including emotional neglect, sexual abuse, and physical violence, making trauma a significant factor in the development of the disorder. As trauma rates rise, so too does the likelihood of developing BPD, especially in those with preexisting vulnerabilities. Moreover, the reduction in stigma surrounding mental health in recent years has also contributed to the rise in diagnoses. Consequently, mental health professionals are now diagnosing BPD earlier and more frequently than in previous years.

The sharp increase in BPD cases in Kyrgyzstan can be attributed to a combination of socio-economic, psychological, and cultural shifts. Addressing underlying socio-economic and trauma-related factors remains crucial.

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Effective suicide risk assessment remains a significant challenge in psychiatric care, particularly when dealing with patients undergoing acute crises. This case study highlights the limitations of current assessment practices and underscores the need for a more nuanced understanding of suicide risk, particularly through the lens of personal narrative crisis and Suicide Crisis Syndrome (SCS).

The objective of this study is to describe a clinical case involving a patient with Suicide Crisis Syndrome (SCS), which emerged from a fundamental alteration in his personal life narrative. Additionally, this study reflects on the existing clinical gap due to the lack of consensual or homogeneous approaches for detecting suicide risk in psychiatric patients experiencing a crisis.

Methodology: A detailed review of the clinical process and hetero-anamnesis was conducted. The case explores the concept of SCS—an acute mental state that precedes a genuine suicide attempt.

The patient, a 45-year-old single male with no children, had a biographical history marked by traumatic events during military service and the loss of a child in combat at age 30. For years, he exhibited symptoms consistent with Post-Traumatic Stress Disorder (PTSD), which he managed effectively through meditation and martial arts, resulting in total symptom remission for over a decade. However, following complex cardiac surgery two years ago, he experienced a significant loss of functionality and autonomy, leading to the abandonment of his martial arts practice and lifelong profession as a rehabilitation therapist. This change had profound emotional, behavioral, and socio-economic impacts, resulting in depressive symptoms. During psychiatric evaluation, the patient exhibited affective dysregulation, marked hopelessness, a sense of loss of meaning, feelings of non-belonging, social defeat, and difficulty adjusting unrealistic goals to his current situation. Although he denied active suicidal ideation, he reported intrusive thoughts of death.

Conclusion and Implications: The assessment of self-reported suicidal ideation is often unreliable. There is an urgent need to adopt more comprehensive approaches that focus on the personal narrative crisis and SCS, as current evidence suggests that SCS is a strong predictor of actual suicidal behavior within 1-2 months after discharge.

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Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two common neurodevelopmental conditions, whose prevalence in the general population has significantly increased in the last decade (2.2% and 2.5%, respectively). The co-occurring prevalence of ASD and ADHD is estimated at approximately 28% (Lai et al. 2019), and the differential diagnosis between these two conditions has become increasingly challenging, especially in adulthood. For instance, both individuals diagnosed with either ASD or ADHD might present social difficulties, despite the underlying causes are notably different: individuals with ASD struggle with social approach and communication, while individuals with ADHD might show distractibility and rapid loss of interest in social activities, or even exhibit behaviors perceived as annoying or rude, such as interrupting and intruding conversations (Antshel & Russo, 2019). Most importantly, in both ASD and ADHD (and especially in women) copying strategies such as the well-known “camouflaging” were observed, to mask autistic- or ADHD-related traits, to try to fit into a society mainly structured by and for neurotypical individuals (Lai & Baron-Cohen, 2015), but ultimately affecting their physical and mental health.

Aim of this study was to estimate the prevalence of ADHD traits and diagnosis in a sample of adult individuals with ASD without intellectual disabilities, examine sex differences in ADHD features, and explore the association between impulsivity and autistic traits.

146 adults with ASD completed assessments for autistic-, ADHD-traits, and impulsivity. Those above the ADHD-traits cut-off underwent the Diagnostic Interview for ADHD in adults (DIVA-5).

42 subjects (28.8%) were diagnosed with ADHD comorbid with ASD (26 combined type, 16 inattentive, 0 impulsive). Most diagnosed subjects (71.4%) were females, but males scored higher on inattentive and hyperactive-impulsive symptoms. Autistic traits were positively correlated with attentive impulsiveness.

Adults with ASD without intellectual disabilities show a significant prevalence of comorbid ADHD, particularly with inattentive symptoms. Attention difficulties are common in both disorders. Further studies and tailored diagnostic processes are needed to assess sub-threshold symptoms in ASD, ADHD, and other neurodevelopmental conditions.

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Distinguishing between bipolar and unipolar disorder is essential for effective treatment, yet accurate diagnosis remains challenging despite extensive research. The MDQ (Mood Disorder Questionnaire) and BSDS (Bipolar Spectrum Diagnostic Scale) are widely used self-assessment tools, each offering unique advantages. However, these tools are typically used based on total scores, potentially overlooking valuable information within individual items.

This study aims to employ clustering analysis on the MDQ and BSDS, utilizing subscales derived from factor analysis, to better differentiate patients with bipolar and unipolar disorders.

The study included patients diagnosed with bipolar and bipolar depression, with diagnoses confirmed by a psychiatrist according to DSM-IV-TR criteria. A total of 299 patients with bipolar depression and 142 with unipolar depression completed the MDQ and BSDS. Based on prior factor analysis, the MDQ was divided into two subscales: the positive activation subscale (items 3, 4, 8, 9) and the negative activation subscale (items 1, 2, 6, 7, 12, 13). K-means clustering was performed twice: once using the total scores from the MDQ and BSDS (two scores), and using the positive activation subscale, negative activation subscale from the MDQ, and the total score from the BSDS (three scores). The analysis was iterated 1000 times to avoid overfitting.

The analysis identified an optimal solution with K=2. Cluster 1, characterized by high scores on both questionnaires, predominantly comprised bipolar patients. In contrast, Cluster 2, with lower scores, was primarily composed of unipolar patients. Using the total scores from both the MDQ and BSDS for clustering yielded an accuracy of 67.88%. In the second analysis using the MDQ subscales and the BSDS total score, the accuracy improved to 77.55%.

Clustering based on the MDQ and BSDS achieved a 77.55% accuracy in distinguishing bipolarity when using MDQ subscales alongside the BSDS score, demonstrating a promising level of precision with self-report questionnaires. Importantly, segmenting the MDQ into positive and negative activation subscales resulted in a nearly 10% increase in accuracy compared to using total scores alone. This suggests that increasing the dimensionality of the data by incorporating disorder-specific subscales can improve clustering accuracy. These findings highlight the potential of using high-dimensional psychiatric data to develop more effective classification models.

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Trans women can encounter various struggles throughout their gender-affirmation. There is a need for further understanding of trans women’s experiences to gain deeper insights into how they cope throughout this process. The development of psychosocial support services that are adapted to their personal needs is crucial to enhancing their coping strategies.

The current study aimed to examine the coping experiences of trans women throughout their gender-affirmation.

This qualitative descriptive study utilized in-person, semi-structured interviews with 12 trans women to gather in-depth data on their coping experiences. Content analysis was employed to analyze the data.

The experiences of trans women emerged in five themes. Four themes correspond to four distinct phases: “self-discovery,” “self-acceptance,” “coming out to others,” and “after coming out to others,” each characterized by its own coping mechanisms. The fifth theme was labeled “to facilitate coping…”. Trans women have a heightened need for support during the periods “when they confront the possibility that their situation will not change,” “when they accept themselves but attempt to decide how they can move forward in life,” and “when they first come out to people around them.” The study indicates the critical role of addressing family and social stigma in trans women’s coping throughout their gender-affirmation. Furthermore, the study unveils a striking finding that efforts to facilitate trans women’s coping throughout their gender-affirmation extend beyond the purview of mental health professionals. It reveals that these efforts have dimensions that concern the entire healthcare system, the legal system, social security, labor, and working conditions.

The study highlights the importance of psychosocial support and improved access to these services to bolster trans women’s coping mechanisms throughout their gender-affirmation, with particular emphasis on the specific periods identified above. The psychosocial support for trans women should encompass not only them but also extend to their families, significant others, and the community in which they live, adopting a holistic approach.

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Perinatal disorders occur in 25% of childbearing women. Postnatal depressive symptoms (PDS) have been widely studied, whilst PDS usually overshadows bonding disorder (BD) in clinical practice and research. BD includes mild disorders, such as delay, ambivalence or loss of maternal emotional response, and severe disorders, such as pathological anger or rejection of the child (Brockington et al., Arch Womens Ment Health 2006; 9(5) 243-251).

To estimate the prevalences of PDS and BD in mothers during the six months after birth.

Women and their male partners aged ≥ 18, without delivery and neonatal complications, were recruited at the Maternity Ward in a public hospital in Madrid, during 2021-2022. Data was collected at immediate puerperium (T0), sixth week (T1), fourth month (T2), and sixth month (T3). The last observation carried forward (LOCF) was used. An Ad hoc Socio-Demographic questionnaire was used. To determine the presence of PDS and BD, respectively, there were used the Edinburgh Postnatal Depression Scale (EPDS), cut off ≥ 11 (Ascaso-Terrén et al., Med Clin (Barc) 2003; 120(9) 326-329) and Postpartum Bonding Questionnaire (PBQ), cut off ≥ 13 for BD, and ≥ 18 for severe BD (Torres-Giménez et al., Span J Psychol. 2021; 24, e47, 1-9).

1502 couples were recruited at T0. The main characteristics of female participants were: mean age 34.1 years, 53.9% married, 54.1% primiparous, 27.8% migrants, 67.3% university degree or higher, 83.2% employed, 14.8% financial difficulties, 4.9% smoking during pregnancy and, 21.7% c-section. At T0, the prevalences of PDS were 13.0% of mothers, 10.5% of fathers, and 3.5% of both parents. Applying LOCF, 874 women responded to the questionnaires at some timing during the follow-up. The results were divided into two groups (see Table 1 and Table 2) depending on whether they presented PDS at T0. In mothers with PDS at T0, PDS and BD rates eventually decrease at T3. In the other group, while BD rates decrease at T3, a slight increase in PDS presentation at T3 is observed.Table 1.

LOCF of mothers with PDS at T0

Depressive symptoms and impaired bonding could have different severity and timing during the postnatal period. More research on bonding disorder is needed to clarify more accurately the psychopathological features that distinguish it from postnatal depression to provide more targeted treatment that will also reduce the associated stigma of childbearing difficulties.

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Research into early interventions following a first episode of psychosis (FEP) has enabled a focused approach on prognostic-modifying factors. Among these, poor medication adherence contributes to relapse, as well as cognitive and functional deterioration. Several studies report discontinuation rates of oral antipsychotics (OAPs) after FEP at 70%, regardless of the prescribed OAP. The early introduction of long-acting injectable antipsychotics (LAIAs) could present an alternative.

This study aims to review the efficacy of LAIAs in the early stages of psychosis and compare the most relevant international guidelines on this topic.

Methodology: A non-systematic literature review using the keywords “long-acting injectable” and “first episode psychosis,” limited to articles published in English and Portuguese in the last 10 years from the PubMed®/MEDLINE® database, and clinical practice guidelines on psychosis, schizophrenia, and FEP from NICE, APA, and RANZCP.

Despite frequent selection biases (such as reserving LAIAs for patients with worse prognostic factors), significant benefits of LAIAs over OAPs in preventing hospitalization and relapse during the early phases of psychosis are consistently reported. LAIAs reduce non-adherence due to forgetfulness or reduced insight, while their different pharmacokinetics minimize withdrawal symptoms, drug interactions, and fluctuations in plasma concentration, enhancing tolerability. No second-generation LAIA was found to be clearly superior in terms of efficacy. Various guidelines recommend offering this treatment option early, favoring an informed and collaborative decision-making process. However, despite documented benefits in robust studies, they do not consider LAIAs as a first-line treatment.

Discussion/Conclusions: Significant variations in the proportion of patients on LAIAs across countries suggest that factors other than efficacy may influence its use. Greater understanding of these factors could help identify potential barriers to optimal implementation. New evidence may prompt a review of the guidelines.

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Breast cancer is one of the most common cancers in women. Depression and anxiety affect not only health behaviors and treatment adherence but also cancer recurrence. Several studies have demonstrated that psychosocial interventions improve both mood symptoms and survival in breast cancer patients.

Psychodynamics plays a significant role in psychological distress and maladaptive behaviors. Therefore, psychoeducation focusing on patient dynamics can offer more individualized and tailored intervention. This study investigated the impact of psychodynamic-oriented psychoeducation for early-stage breast cancer patients on both psychological distress and disease trajectory, compared to those receiving standard cancer treatment only.

Psychodynamic-oriented psychoeducation aims to provide guidance on managing psychological distress during cancer treatment, based on clinical and psychodynamic assessments of patients. A trained psychiatrist delivered this 60-minute intervention at least once within one-week post-mastectomy. The study included early-stage breast cancer patients (AJCC stages 0-IIIA) who underwent mastectomy at Kyungpook National University Hospital (KNUH) and Kyungpook National University Chilgok Hospital (KNUCH) between 2008 and 2015, excluding those with prior cancer history. Participants were divided into two groups: control (standard treatment) and treatment (standard treatment plus psychodynamic-oriented psychoeducation). Outcomes measured included breast cancer recurrence, disease-free survival, and psychological assessments using the Hospital Anxiety and Depression Scale (HADS) and Experiences in Close Relationships-Modified 36 (ECR-M36) at baseline and 12 months post-intervention in the treatment group. Propensity score matching was used to control for recurrence-related factors.

The median follow-up was 72.6 months. Recurrence rates were comparable between control and treatment groups (control vs. treatment: 9.0% vs. 8.3%, p=0.763). In a subanalysis of recurrent cases, the treatment group showed longer disease-free survival (51.3 vs. 32.5 months, p=0.038). (Table 1 and Figure 1) HADS scores showed no significant difference at 12 months, while ECR-M36 showed significant decreases in total and anxiety subscale scores at 12 months (p<0.05). (Table 2)

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This study, unique in integrating psychodynamic principles into psychoeducation, showed improvements in attachment-related anxiety and longer disease-free survival, specifically among recurrent cases, suggesting the potential benefits of this approach for certain breast cancer patients. Further research is needed to identify which patients might benefit most from this intervention.

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Nonadherence in transplantology stands for a not cooperating patient in terms of taking medication, having the laboratory, and imaging tests taken, missing appointments, not following dietary and lifestyle recommendations related to smoking tobacco, drinking alcohol, and other high-risk behaviours. Factors of not following therapeutic recommendations in patient after liver transplantation are high costs, psychiatric disorders, convictions regarding harmfulness of the immunosuppressive medicine and its side effects as well as rejection episodes, infections, stress related to suffering from a chronic disease and inadequate social support.

The aim of this study was to assess the adherence to therapeutic recommendations in patients after liver transplantation including the level of depression, anxiety, degree of acceptance of the disease and social support.

Study was carried out among 112 respondents after liver transplantation. The Delphi method was used and the following standardised tools were used: ISSB, AIS, BDI, STAI X-1 and X-2 as well as a questionnaire form regarding sociodemographic data.

An average level of adherence to therapeutic recommendations was on an average level (6.8±1.85). A statistically significant positive correlation between disease acceptance and following therapeutic recommendations was observed (r = –0.20, t = –2.040; p = 0.044). The adherence to recommendations increased with growing disease acceptance. Six factors were distinguished from the analysed predictors which in a relevant way influenced the level of adherence to therapeutic recommendations in the group of patients after liver transplantation. Regression model consisting of six independent variables explains 55% of variation of the dependent variable (r2corrected= 0,55, F(6, 98) = 22.127; p<0.001). Such positive factors include always following recommendations (β = –0.23; p = 0.002) and seeking various sources of information (β = –0.34; p<0.001), while negative ones constituted of illness duration (β = 0.18; p = 0.008), experiencing side effects (β = 0.40; p<0.001), suffering from concomitant diseases (β = 0,40; p<0,001).

Patients who have accepted their disease constitute a group that adheres to therapeutic recommendations to a lesser extent.

The main factors affecting adherence to therapeutic recommendations are the search for other sources of information and declarative adherence to therapeutic recommendations. Negative predictors- duration of disease, experiencing adverse effects of treatment, and comorbidities.

The way in which a physician communicates to the patients after liver transplantation the information about the results indicating that the medications were taken irregularly significantly more often influenced not following therapeutic recommendations which might suggest an unintended non-adherence.

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Tardive dyskinesia (TD) is an iatrogenic disorder characterized by a range of movement abnormalities, described as irregular, stereotyped, and choreiform caused by exposure to antipsychotics. This condition can lead to significant or disabling symptoms that affect quality of life. However, the exact mechanism underlying TD remains unclear. Pharmacotherapy of TD includes cholinergic drugs, benzodiazepines, antioxidants, amantadine, propanolol, botulinum toxin, whereas the non-pharmacotherapy approach includes modified electroconvulsive therapy and deep brain stimulation. We successfully treated a chronic schizophrenia patient with comorbid TD using Aripiprazole and botulinum toxin after trying calcium channel blockers in association with Aripiprazole and vitamin E.

To determine the effects of calcium channel blocker drugs (Amlodipine) for treatment of neuroleptic-induced tardive dyskinesia in people with schizophrenia, and the efficiency of botulinum toxin in treating induced tardive dyskinesia.

Through a case report and a literature review, our work aims to study antipsychotics induced tardive dyskinesia and its pharmacotherapy especially the use of calcium channel blocker and botulinum toxin in association with Aripiprazole.

A 22 years male, diagnosed with schizophrenia since the age of 16 years, with one hospitalization. The evolution of his disease was marked by the development of a tardive dyskinesia, cervical and brachial movements disorders with rapid worsening in few months, the patient was treated with olanzapine oral administration. During his follows-up, his tardive dyskinesia disn’t resolve despite switching the incriminated antipsychotic to Aripiprazole, lowering the dose since he was on complete remission. we added benzodiazepines and vitamin E to his treatment, before trying the calcium channel blocker for two months, with no improvement, on the contrary a worsening was noted using the Unified Dyskinesia Rating Scale. The aggravation of the movements was a reason for the patient attempted suicide, after this late incident we chose to try the botulinum toxin injections. His tardive dyskinesia was spectacularly improved within the fisrt injections.

Antipsychotic drugs are known to cause a variety of adverse effects, including tardive dyskinesia. Hence the importance of knowing the pharmacotherapy and non-pharmaco- therapy to manage this effect, through this case report where it tardive dyskinesia got treated after using botilinum toxin injections with a spectacular improvement in its Unified Dyskinesia Rating Scale. In our case, we had no response after adding calcium channel blocker .The effects of calcium channel blockers for antipsychotic-induced tardive dyskinesia are unknown, and it use is still limited.

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Work-related hand injuries (WRHI) can have profound impacts on an individual’s physical capabilities, and these injuries often carry long-term consequences that extend beyond physical impairment. Upon returning to work, victims may face challenges in performing occupational tasks and daily activities.

This study aims to assess the quality of life in workers who have suffered WRHI after returning to their professional activities.

We conducted a cross-sectional study among victims of WRHI in the private sector after returning to work, from January 2021 to December 2022. Sociodemographic and professional data were collected along with characteristics of the WRHI. Quality of life was assessed using the Short Form-12 (SF-12) score, which evaluates both physical and mental health components (PCS-12 and MCS-12). The Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) score was used to measure the functional disability of the hand. Job satisfaction and pain level were auto-evaluated with a scale of 0 to 10.

We included 126 workers, 88.1% of whom were male, with a mean age of 41.3 ± 10.6 years. Tobacco and alcohol use were reported by 42.9% and 9.5% of participants, respectively, while caffeine consumption was noted in 57.9%. The most represented sectors were metallurgy (22.2%) and the chemical industry (16.7%). The median job satisfaction after the accident was 6 (IQR [5; 8]). In 61.9% of cases, the dominant hand was affected. Both rehabilitation sessions and surgical treatment were required for 69% of participants. The median pain level was 5 (IQR [4; 7]), and 47.6% of participants reported sleep disorders following the accident.

The median Quick DASH score was 34.1 (IQR [13.1; 50.6]), and the median Quick DASH work module score was 43.8 (IQR [25; 68.8]). The mean PCS-12 score was 39.5 ± 7.6, while the mean MCS-12 score was 46.8 ± 11.4. The PCS-12 score was significantly associated with caffeine consumption (p = 0.03), alcohol consumption (p = 0.03), rehabilitation sessions (p = 0.029), and sleep disorders (p < 0.001). It was also significantly correlated with pain level (p = 0.005; r = -0.247), Quick DASH score (p < 0.001; r = -0.4), and the Quick DASH work module (p < 0.001; r = -0.44).

The MCS-12 score was significantly associated with job satisfaction (p = 0.008; r = 0.237), Quick DASH score (p = 0.003; r = -0.265), the Quick DASH work module (p = 0.012; r = -0.23), and sleep disorders (p = 0.012).

Work-related injuries, particularly hand injuries, pose significant challenges to both the professional and personal lives of those affected. Addressing these challenges is crucial to ensuring a successful return to work and social reintegration.

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11 years old, Syrian, he arrives alone in Italy after disembarking in Lampedusa, coming from Libya where he reports having stayed for a year. He is assigned to a community by the Juvenile Court of Catania.

A few days later, he exhibits multiple episodes of chest pain, difficulty breathing, drooling, muscle rigidity and tremors, and in the most severe case, he is taken to the emergency room and then hospitalized in pediatric neuropsychiatry.

Diagnosis ICD 10: Dissociative disorders (Code F44); Post-traumatic stress disorder (Code F53.1). Trazodone hydrochloride (60 ml) is prescribed, 5 drops three times a day.

Care of the person and resolution of symptoms through psychotherapeutic management by the “Medicina delle Migrazione e delle Emergenze Sanitarie” of ASP 3 Catania (Italy).

Hypnosis combined with virtual reality, a technique already experimented with by the writer, the procedure consists of: trance induction; awakening; application of the visor; re-induction of the trance through conditioning, simultaneously with the departure of the virtual stimulus; continuous feedback with peripheral device. The stimulus situations transmitted by the viewer have as object setting such as: Abstract: lights, colors, geometric shapes; Concrete: naturalistic and aquatic landscapes, animals, guided tours, etc.

He is a good hypnotic subject, responds well and after initial disorientation, benefits from psychotherapy, showing a slow but continuous improvement in behavior: anxiety progressively decreases, oppositional and rebellious behavior in the community wanes, conduct at school becomes appropriate where there were previously conflicts, sleep changes from disturbed to regular, and he interacts positively with adults and peers.

Marked interference is noted via phone from the family of origin, urging him to go to Germany where a half-sister resides (the procedure is feasible but very complex), leading to a resurgence of symptoms and feelings of guilt in the minor, who perceives himself as unable to meet the demands of his relatives.

During Ramadan (he is Muslim), there are difficulties with concentration and lack of energy due to the lack of food and water, leading to a temporary delay in the work.

In an advanced phase of treatment, the minor categorically refuses to come to the clinic, probably due to being mocked by peers in the community, and it is decided to discontinue the sessions, especially since the work had progressed effectively and there was already an intention to gradually discontinue it.

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It is believed that the use of hypnosis combined with virtual reality represents an appropriate treatment for post-traumatic stress disorder (PTSD), as it reduces anxiety, strengthens the ego, accelerates the process of change, and directs life in a positive direction.

The Juvenile Court has granted family reunification in Germany, and at present, the minor is awaiting departure.

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Obsessive-compulsive disorder (OCD) affects 1-3% of the population and is the fourth most debilitating psychiatric disorder. OCD characterised by persistent obsessions and compulsions in the ICD-11 is more common in students, with rates often exceeding 3-4% in medical students. Effective mental health services and interventions are critical in supporting these students.

Creating an online mindfulness-based intervention for Cardiff University medical students to engage with remotely. Evaluating the effectiveness of the intervention in reducing OCD symptoms.

Medical students at Cardiff University’s School of Medicine, including those in intercalation years, were invited to fill out an online survey using Microsoft Forms. This included self-report measures such as the Beck Depression Inventory-II (BDI-II), the State-Trait Anxiety Inventory (STAI), and the Obsessive-Compulsive Inventory-Revised (OCI-R). Recruited participants completed a two-part intervention based on Acceptance and Commitment Therapy (ACT). The course was designed on the Xerte platform and used reflective tasks, interactive elements, and embedded videos. The intervention was developed with MyMedic, the Medical School’s mental health service. Participants completed the same online survey and a feedback form post intervention. Responses were analysed for changes in OCI-R scores.

Thirty-two students completed the pre-intervention survey. Six students met the study’s inclusion criteria. A significant positive relationship was found between OCI-R scores (minus hoarding) and BDI-II scores (χ² (3, N=32) = 10.745, p=0.01) (Figure 1). Three participants revealed reduced OCI-R (minus hoarding), STAI, and BDI-II scores after the intervention (Figure 2). The intervention was rated highly for usefulness and relevance, but neutral for interactivity. The embedded videos were deemed useful, and the module was thought-provoking.

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This study found an 18% prevalence of OCD among medical students. The ACT-based skills course which emphasises psychological flexibility and mindfulness resulted in a significant reduction in the OCI-R. ACT could be a useful tool for university support services, potentially complementing or replacing CBT. Integrating such interventions into medical curricula may provide more comprehensive support and reduce wait times for mental health services.

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Extrapyramidal side effects due to antipsychotics is very common but antidepressants being the causative factor is very less studied. Among antidepressants escitalopram is the most commonly reported. SSRI’s most commonly cause extrapyramidal side effects than other antidepressants. The major theories are changes in chemical, anatomical and physiological perspectives of neurological system. Reported cases shed light that akathisia occurs most commonly followed by dystonia, parkinsonism and tardive dyskinesia states in antidepressant induced extrapyramidal side effects. Desvenlafaxine (o desmethyl venlafaxine) inhibits reuptake of dopamine, serotonin and norepinephrine. EPS occurs due to inhibitory effect of serotonin on dopaminergic pathway in striatum. Females suffer from it more commonly than men. Increasing age in women,CYP2D6 inhibition by concomittently used drugs can increase the risk. SNRI’s less frequently cause EPS than SSRI’s.Although desvenlafaxine is very well tolerated this rare side effect increases noncompliance and chances of suicide. Drug induced parkinsonism also predicts future chances of parkinsonism. Usage of desvenlafaxine sometimes present to the emergency department as dystonia causing panic among care givers of the patients.

To determine desvenlafaxine’s role in causing extraPyramidal side effects

We report here 8 cases of desvenlafaxine induced extrapyramidal side effects. All follow up cases of depression coming for follow up to dept of psychiatry IMS & Hospital who were on desvenlafaxine was analysed.the patients developong extrapyramidal side effects were detected and detailed evaluation and appropriate management was done for those specific cases..all these cases were collected over a period of last 4 years.

In our case series we bring into light rare occurences of extrapyramidal side effects due desvenlafaxine. 5 out of 8 cases were females.most of the symptoms of developed within 5 days of starting the medicine.4 of these cases resulted in secondary parkinsonism, 3 of them resulted in akathisia and one resulted in acute dystonia post adminstration of desvelafaxine. The average dose of desvenlafaxine in all the cases were within 50-100mg. When after extrapyramidal side effects desvenlafaxine was withdrawn replacement with mirtzapine, escitalopram, sertraline or duloxetine was used instead of it resulting in good symptom reduction of primary illness.

Extrapyramidal symptoms with desvenlafaxine is extremely rare. In our case series we highlighted the importance of a keen eye to check for Extrapyramidal side-effects even with the administration of Antidepressants. Future reasearch is needed to find predictors and exact mechanism of action for the same.

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Autism spectrum disorder (ASD) and schizophrenia (SZ) are neurodevelopmental disorders that, although unfolding in different ways, can present with overlapping symptoms, both negative symptoms like deficits in social–emotional reciprocity and engagement (Trevisan et al. Front.Psych; 2020;11:548), and positive symptoms like delusions and hallucinations (Ribolsi et al. Front Psychiatry; 2022;13:768586).

To discuss the diagnostic challenges between ASD and SZ in patients presenting with both positive and negative symptoms.

In addition to describing a case report of a man with negative symptoms and presumptive psychotic symptoms, research was undertaken in PubMed and other databases using the keywords “autism spectrum disorder”, “schizophrenia” and “multiple sclerosis”.

A 26 year-old man was involuntarily admitted to the in-patient unit due to persecutory delusions, irritability, social isolation and cognitive symptoms. He had also been recently diagnosed with Multiple Sclerosis (MS). These symptoms had begun 5 years prior, intensifying over time, leading to the hypothesis of First Episode Psychosis, with a probable recent escalation secondary to the flairing up of MS. Through a detailed clinical history, we discovered that, in fact, the patient exhibited conduct changes since early adolescence: restricted and repetitive behavior, social isolation, reduced tolerance to opposition, cognitive rigidity, circumscribed interests and puerile contact. This lead to the development of great hostility towards his family members, whenever his wants weren’t met (most of them mismatched with reality), resulting in isolation from the family and the sending of aggressive messages and emails, even though his parents always tried to provide the patient with everything he wanted, explaining the assumption of persecutory delusions. Intramuscular risperidone and clozapine were initiated for irritability and cognitive symptoms, respectively, with minimal improvement in both, mainting however every other symptom described.

Despite the current distinction between ASD and SZ, they still share many similarities, increasing the difficulty of determining an exact diagnosis. We present a case with negative and cognitive symptoms, that can fit in both conditions, and positive symptoms that fit in SZ. It’s possible to understand that the delusions may not be primary, but secondary to social interpretation bias, common in ASD patients, and that part of the cognitive symptoms can be due to MS. The suboptimal response to antipsychotics also makes us lean more to the presence of ASD with temporary psychotic symptoms instead of a primary psychotic disorder.

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Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that affects the central nervous system (NP-SLE) in approximately 30-40% of patients, with psychosis being one of the less common yet very serious manifestations, occurring in about 2-3.5% of cases. Diagnosing psychosis in SLE can be challenging, requiring careful integration of medical history with appropriate complementary tests (immunological, CSF, neuroimaging…) while considering other possible differential diagnoses.

To highlight the importance of considering this condition (as well as other rare causes of neuropsychiatric involvement) in patients presenting with atypical psychotic symptoms accompanied by cognitive and behavioral disturbances.

Presentation of a clinical case and literature review.

A 69-year-old female presents with a complex medical history, including melanoma, meningioma, and cerebral microangiopathy. Since 2019, prolonged activated partial thromboplastin time (aPTT) and lupus anticoagulant have been observed. In 2020, she developed neurological symptoms such as blurred vision, diplopia, dizziness, and instability. In December 2022, she consults for depressive symptoms and memory problems. June 2023, she was admitted to Psychiatry ward for a psychotic episode characterized by poorly structured and apparently fluctuating delusional symptoms. There was also evident disorganization, confusion, incoherent behavior, memory deficits, and functional decline. During the hospitalization, her condition initially worsened, with bizarre behaviors fluctuating, requiring mechanical and pharmacological restraint on several occasions. Blood tests showed bicitopenia (leukopenia and thrombocytopenia), along with renal insufficiency. Antiphospholipid syndrome was confirmed. Subsequently, her delusional symptoms remitted, and she was discharged. A second scheduled admission in internal medicine followed for diagnostic clarification during which SLE (ANA+, SSA, SSB, anti U1RNP, anti Sm D, and anti-DNA+) and antiphospholipid syndrome were confirmed. Hydroxychloroquine and anticoagulation (Sintrom) were initiated.

She currently remains under follow-up in both Internal Medicine and Psychiatry with functional, cognitive, and emotional improvement, allowing for the reduction of antipsychotic and antidepressant medication without relapse. A cognitive decline has been ruled out by the dementia unit.

In the case of SLE and its neuropsychiatric manifestations (NP-SLE), there are no specific markers, making detailed medical history, thorough screening, and differential diagnosis essential. Appropriate use of complementary tests and close coordination with other medical specialties are crucial, requiring a multidisciplinary and holistic approach.

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