Gambling Disorder (GD) is the only behavioral addiction formally recognized by DSM-5-TR and ICD-11. Its prevalence has been increasing worldwide, driven by the expansion of online gambling, which enhances availability, anonymity, and exposure, leading to significant clinical, social, and economic consequences. High-income countries have already implemented surveillance and regulatory policies, but in Brazil data remain scarce and fragmented, hindering the design of prevention and care strategies. This gap justifies a comparative analysis between international and national evidence, aiming to inform both clinical practice and public health.

To review national and international evidence on GD, with emphasis on epidemiology, comorbidities, digital contexts, therapeutic strategies, and regulatory policies, highlighting implications for clinical practice and public health.

A narrative review was conducted using PubMed and the Virtual Health Library (BVS). PubMed search (“Gambling disorder” AND “Online gambling”, 2020–2025) yielded 820 results; after screening, 17 were included. BVS search (“apostas” OR “transtorno do jogo” AND “transtorno mental” AND “Brasil”) retrieved 6 results, with 3 included for historical relevance. Inclusion: articles in English or Portuguese on epidemiology, comorbidities, digital environments, interventions, or policies. Exclusion: duplicates, case reports, or unrelated topics. Two reviewers screened and analyzed the studies. Findings were organized into five thematic axes: epidemiology, comorbidities, digital/social environments, interventions, and policies. Findings were thematically saturated across the selected studies.

International evidence shows that 46.2% of adults gambled in the past year, with 1.41% meeting criteria for problem gambling and 8.7% at risk. Online casinos and slot machines carry the highest association with problematic gambling. In Brazil, video poker players appear especially vulnerable, though national data remain scarce. Women progress more rapidly to GD (“telescoping effect”), particularly in rapid-luck games. GD strongly co-occurs with depression, anxiety, substance use, eating disorders, and compulsive behaviors. Cognitive-behavioral therapy shows moderate efficacy, while digital tools (feedback, self-exclusion, limit setting) are promising but heterogeneous. Regulatory frameworks in Switzerland and the UK emphasize harm reduction (e.g., reverse withdrawal bans, marketing limits, monitoring systems).

GD is a multifaceted clinical and public health challenge. Priorities include national representative surveys, continuous harm surveillance, evidence-based digital therapies, regulation of gambling products and marketing, and multilevel policies addressing inequalities. In Brazil, the lack of representative data and specific regulations remains a critical barrier to prevention and care.

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Borderline personality disorder (BPD) and eating disorders represent two of the most severe psychiatric conditions associated with elevated suicide risk. When these conditions co-occur, clinical complexity increases substantially, amplifying suicidal behaviors and mortality rates. Understanding suicide risk in this group is crucial for developing effective prevention strategies and improving clinical outcomes.

This narrative literature review examines suicide risk in patients with comorbid borderline personality disorder and eating disorders, identifying risk factors, prevalence rates, and clinical implications to inform evidence-based prevention and treatment approaches.

This narrative literature review was conducted using PubMed, Embase, and PsychINFO databases from 2020-2025. Search terms included “borderline personality disorder,” “eating disorders,” “suicide,” and “comorbidity.” Studies were eligible if they: (1) examined suicide rates or risk factors, (2) included patients with comorbid BPD and eating disorders, and (3) were published in English or Portuguese.

Research demonstrates significantly elevated suicide risk in patients with comorbid BPD and eating disorders compared to either condition alone.

Studies indicate that 28.75% of individuals with BPD have attempted suicide, with comorbid eating disorders further increasing this risk.

Treatment-seeking populations with BPD and comorbid eating disorders show particularly high rates of self-harm and suicidal behaviors.

Contemporary research reveals that eating disorders, particularly bulimia nervosa, serve as independent risk factors for suicide regardless of psychiatric comorbidities. The combination of BPD and eating disorders creates a synergistic effect on suicide risk, driven by shared features such as impulsivity, emotional dysregulation, and self-destructive behaviors. Furthermore, the use of immature defense mechanisms, a common trait in BPD, significantly predicts suicide attempts in this population. Treatment complexity increases substantially in this population, requiring specialized integrated approaches addressing both conditions simultaneously. Several well-known mechanisms underlying BPD are also common in eating disorders, manifesting in both symptoms and interpersonal difficulties. These include poor awareness of affect, alexithymia, and perfectionism.

Patients with comorbid borderline personality disorder and eating disorders face substantially elevated suicide risk compared to either condition alone. The combination creates a synergistic effect on suicidal behaviors, requiring specialized assessment and intervention strategies. Early identification, comprehensive risk assessment, and integrated treatment approaches are essential for suicide prevention. Future research should focus on developing specific risk assessment tools and evidence-based interventions.

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Depression is one of the most prevalent psychiatric conditions among medical students, often driven by high academic demands, long study hours, and emotional burden. International studies suggest that LGBT students are at heightened risk, consistent with minority stress theory, which links stigma to worse mental health outcomes. However, results across settings are inconsistent, with some evidence pointing to resilience and protective community factors. In Brazil, comparative data on depressive symptoms in LGBT and heterosexual medical students are limited. Clarifying these patterns is crucial for tailoring mental health strategies to diverse student groups.

To compare depressive symptoms between LGBT and heterosexual medical students.

Cross-sectional study in a medical school in Sergipe (Brazil). A total of 142 undergraduates (7 gay/lesbian, 3 bisexual, 132 heterosexual; minimum sample=84; eligibility ≥18 years; informed consent obtained) completed a sociodemographic questionnaire and the Beck Depression Inventory. Depression levels were classified as minimal, mild, moderate, or severe. Analyses included Fisher’s exact test and ANOVA.

Minimal depression predominated in both groups. Among LGBT students, 80% scored in the minimal range, while none reached severe depression. Only 10% presented mild to moderate symptoms. Conversely, 21% of heterosexual students reported mild to moderate depression. Mean BDI scores were similar (6.8 versus 7.1; p=0.857).

Contrary to international literature, LGBT students did not show greater vulnerability to depressive symptoms. Heterosexual students presented more frequent mild to moderate symptoms, possibly related to gaps in social or family support. These results highlight the importance of addressing mental health broadly in medical education, considering protective and risk factors beyond sexual orientation. However, interpretations should be cautious, as the small LGBT subsample restricted statistical power and limited the generalizability of findings.

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Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are increasingly recognised as neurodevelopmental conditions that frequently co-occur in paediatric populations, presenting significant diagnostic challenges. Research indicates a high frequency of this comorbidity, with overlapping symptoms hindering diagnosis and co-occurrence associated with greater functional impairment in children. Since both disorders typically emerge in early development, focusing on paediatric populations is essential to ensure timely identification and intervention. Epidemiological data demonstrate considerable heterogeneity, highlighting the need to explicitly cite meta-analyses when reporting such rates. This highlights the need to clarify comorbidity and shared mechanisms in youth.

This systematic review examines current evidence regarding ADHD-ASD comorbidity prevalence, underlying aetiological mechanisms, and neurobiological foundations.

This literature review was conducted using PubMed databases and Virtual Health Library searches spanning 2020-2025, focusing on ADHD-ASD comorbidity. Search strategies employed “ADHD”, “autism spectrum disorder”, and “comorbidity” using Boolean operator AND. Studies met inclusion criteria if they: (1) included paediatric samples, (2) were published in English or Portuguese, and (3) addressed prevalence, aetiology, neurobiology, or therapeutic interventions. Exclusion criteria comprised case reports, editorials, and studies lacking mental health focus.

Autism spectrum disorder and ADHD represent neurodevelopmental conditions with prevalence rates of 1.5-2% and 5-9%, respectively, according to (Hatch et al. Psychol Sch 2022; 60:295-311). Comorbidity rates vary: 53-78% of children with ASD exhibit ADHD symptomatology, whilst 21% with ADHD display autistic traits. Both conditions demonstrate substantial heritability: ADHD shows 70-80% whilst ASD ranges 37-90%, with approximately 40% genetic overlap indicating shared mechanisms. Neuroimaging reveals overlapping dysfunction across attention networks and executive control systems. Children with both conditions experience greater functional impairments, higher anxiety, increased academic difficulties, and reduced therapeutic responsiveness. Environmental risk factors include maternal stress and toxin exposures. Effective approaches require comprehensive multimodal interventions combining behavioural and pharmacological therapies.

The substantial phenotypic and genetic overlap between ADHD and ASD necessitates integrated diagnostic frameworks recognising shared presentations and mechanisms. Given significant genetic convergence and overlapping neurobiological pathways, these conditions may be conceptualised as related spectrum disorders requiring specialised therapeutic approach. Comprehensive assessment and multimodal interventions remain essential for optimal outcomes.

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Impaired self-image plays a pivotal role in both eating disorders (EDs) and gender dysphoria. This association is shaped by stigma, neuroendocrine factors, functional impairment, and interpersonal dynamics. Although literature on EDs in LGBTQIA+ populations is scarce, existing studies consistently demonstrate high prevalence rates, particularly among transgender individuals. The Minority Stress Model posits that sexual and gender minorities are more susceptible to psychiatric disorders, including EDs, due to chronic exposure to stress and trauma.

To examine the correlation between eating disorders and gender dysphoria, explore patients’ self-image perception, and highlight the physical, psychological, and social impacts associated with this intersection.

An integrative literature review was conducted using LILACS, SCIELO, and PubMed databases. The search strategy included the descriptors: “Eating Disorder,” “Gender Dysphoria,” and “Body Image.” Additionally, the terms “Self-esteem” and “Mental Health” were used independently in both English and Portuguese. Boolean operators were not applied. A total of 108 articles were initially retrieved, and 23 full-text articles were selected for final analysis based on exclusion criteria: duplication, publication prior to 2020, and lack of relevance to the study’s objectives.

Findings indicate elevated rates of pathological eating behaviors and disordered eating symptoms among individuals with gender dysphoria. Several studies found that transgender youth are more likely to receive ED diagnoses compared to cisgender youth, although prevalence rates varied. These results suggest a strong association between gender identity incongruence and disordered eating behaviors.

Despite the limited number of studies on EDs within LGBTQIA+ populations, current evidence highlights a disproportionately high prevalence among transgender individuals. The intersection of social stigma, gender dysphoria, and the pursuit of unattainable body ideals increases vulnerability to EDs. These findings underscore the need for integrated and gender-sensitive mental health care approaches that address both psychosocial and identity-specific dimensions.

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Stigma in academic contexts extends beyond interpersonal discrimination, encompassing the degree of institutional recognition of diversity. Campus climate research highlights that policies, visibility, and support structures for gender and sexual minorities are central to equitable learning environments. In Brazilian medical schools, however, despite broader social progress in LGBT acceptance, formal institutional mechanisms, such as anti-discrimination regulations, diversity centers, or curricular inclusion, remain largely absent. Exploring how LGBT students perceive this gap between social acceptance and institutional invisibility is vital to guide reforms that strengthen equity and mental health.

To analyze perceptions of stigma, campus climate, and institutional diversity policies among medical students in a Northeastern Brazilian medical school.

Cross-sectional study with 142 students (7 gay/lesbian, 3 bisexual, 132 heterosexual; population=593; convenience sample; ≥18 years; informed consent obtained). Instruments: LGBT Campus Climate Scale and Perceived Social Support Scale. Analyses included descriptive statistics, Fisher’s exact test and ANOVA.

LGBT students reported high personal acceptance (78% felt respected by peers) and strong family support (74% agreement). Yet, institutional invisibility prevailed: only 20% of LGBT versus 22.7% of heterosexuals acknowledged anti-discrimination policies. No LGBT student identified resource centers or diversity activities. Moreover, 65% of LGBT respondents stated that faculty rarely addressed diversity in curricula, compared with 42% of heterosexuals (p=0.032).

The coexistence of social acceptance and institutional invisibility highlights a structural gap in medical education. Universities should formalize and disseminate diversity policies, establish support services, and integrate diversity into curricula, fostering equity and protecting student mental health. Findings should be interpreted with caution due to the perception-based design and single-center setting. Future multicenter studies across different Brazilian regions are warranted to capture cultural variations and strengthen the evidence base.

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Laughter is a biological and social reaction that fosters emotional connection, promotes well-being, and highlights the human side of our nature. Clown Therapy leverages laughter as a tool for humanizing care, transforming the often sterile and painful hospital environment into a space of creativity, connection, and therapeutic possibilities.

This study aims to explore the redefinition of non-conventional care practices and to examine how playful, humor-based therapies, such as Clown Therapy, can benefit mental health, particularly for psychiatry residents.

This is an experience report from a Psychiatry resident who incorporated Clown Therapy into her training as part of a medical project in 2019. The report evaluates the impact of this approach on her clinical practice, including patient interactions and personal development.

Clown Therapy significantly influenced the resident’s ability to adapt to psychiatric hospitalizations and the management of psychiatric diagnoses. The use of playful techniques resulted in improved patient rapport, lower levels of anxiety, depressive symptoms, and insomnia during the training period. Additionally, this approach enhanced the resident’s empathy in clinical consultations and fostered a more compassionate approach to psychiatric care.

The findings underscore the value of integrating non-pharmacological strategies, such as Clown Therapy, into psychiatric training and patient rehabilitation. This approach not only aids in the therapeutic relationship but also contributes to the mental well-being of both patients and healthcare providers.

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Forensic psychiatric hospitals are specialized institutions designated for the custody and treatment of individuals diagnosed with mental disorders who have committed criminal offenses and are deemed a risk to public safety. This often reinforces stigma, weakens therapeutic bonds, and complicates reintegration. In 2024, psychiatry residents in Alagoas, Brazil, trained in such a facility and later participated in the reintegration process following its closure, in line with national anti-asylum policies promoting community-based care.

To describe the experience of psychiatry residents during and after the closure of a forensic psychiatric hospital, emphasizing the role of humanized, multidisciplinary care and the importance of understanding legal, clinical, and social aspects involved in the treatment of individuals in conflict with the law.

Residents received supervised training at the forensic hospital alongside an interdisciplinary team. After the hospital’s closure, they joined the Evaluation and Monitoring Team for Therapeutic Measures Applied to People with Mental Disorders in Conflict with the Law (EAP), supporting the transition of patients to community-based services such as Psychosocial Care Centers (CAPS).

The hospital’s closure marked a shift from institutional to community care. Residents observed challenges related to stigma, treatment adherence, and the rebuilding of therapeutic alliances. Patients, often institutionalized for years, faced difficulties reintegrating into society. The experience highlighted the importance of continuous, interdisciplinary care and the psychiatrist’s role in promoting recovery, autonomy, and social inclusion.

This experience was transformative for psychiatric training. It deepened residents’ understanding of the intersection between mental health and the justice system and reinforced the value of a humanized, community-based approach. The transition from custodial care to reintegration underscored the need for long-term therapeutic support and respect for patients’ rights, aligning clinical practice with ethical and legal principles in forensic psychiatry.

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Minority stress theory states that exposure to prejudice and stigma increases vulnerability to mental health problems among LGBT populations. In higher education, and particularly in medical training, these risks intersect with academic stressors that already compromise student well-being. Yet, cultural and contextual factors, such as family cohesion and peer solidarity, can act as protective buffers. In Brazil, epidemiological data on LGBT medical students remain scarce, hindering the development of evidence-based inclusion policies. Assessing prevalence, perceived social support, and awareness of institutional protections is therefore essential to inform interventions in medical schools.

To estimate the prevalence of LGBT students and to assess perceived social support and awareness of institutional diversity policies.

Cross-sectional study conducted in a medical school in Aracaju (Brazil). A total of 142 undergraduates (population=593; calculated minimum=84; eligibility ≥18 years; informed consent obtained) completed a sociodemographic form, the Beck Depression Inventory, the LGBT Campus Climate Scale, and the Perceived Social Support Scale. Analyses included descriptive statistics, Fisher’s exact test/χ² and ANOVA.

Of 142 students, 7 (4.9%) identified as gay/lesbian, 3 (2.1%) as bisexual, and 132 (93.0%) as heterosexual. LGBT students reported higher social support, with 80% strongly agreeing they could rely on friends/family versus 62% of heterosexuals (p=0.041). Mean support scores were higher among LGBT (4.3 versus 3.9, p<0.05). Awareness of institutional policies was low in both groups: only 20% of LGBT and 22.7% of heterosexuals recognized anti-discrimination regulations. No student identified dedicated support centers or regular diversity activities.

Findings show resilience and robust support networks among LGBT students, challenging assumptions of universal vulnerability. Yet, institutional invisibility persists, underscoring the need for diversity policies, faculty training, and structured support services in medical schools. The single-site design, small LGBT subsample, and cross-sectional nature limit generalizability and prevent causal inferences, but results underscore the need for multicenter studies with longitudinal approaches.

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Psychotic disorders pose significant challenges for treatment adherence, particularly in resource-limited settings. In Brazil’s public health system (SUS), many patients face precarious living conditions, food insecurity, and limited social support, while depending entirely on the SUS for access to antipsychotics. Beyond structural barriers, the therapeutic relationship may play a decisive role in adherence. Psychiatrist Nise da Silveira argued that the “line-life” connecting people with schizophrenia to reality can be sustained through affective bonds with therapists and caregivers (O Mundo das Imagens, Imagens do Inconsciente).

To explore experiential insights from a specialized psychosis outpatient clinic within the SUS, emphasizing the role of affective bonds in fostering adherence, continuity of care, and clinical stabilization.

From March 2024 to February 2025, more than 100 patients with psychotic disorders were followed in a specialized outpatient clinic. Observational and reflective notes were collected on engagement, medication adherence, and therapeutic dynamics. Selected cases exemplify how affective connections between patients and clinicians influenced adherence, acceptance of treatment, and crisis management.

Adherence was frequently linked less to insight into illness or resource availability than to trust in clinicians. For instance, a patient with schizoaffective disorder, despite limited understanding of her condition, maintained adherence because of confidence in her physician. A patient with first-episode psychosis who had discontinued medication returned to the clinic and even agreed to hospitalization after developing trust with the medical team. Another patient with refractory schizophrenia regularly contacted his physician during crises to differentiate reality from delusion, underscoring the therapeutic role of affective reassurance. Despite limited socioeconomic resources, most patients achieved relative clinical stability, supported by continuous follow-up. Each patient is seen by the same physician throughout the year-long rotation, which strengthens therapeutic bonds, and some maintain contact with former doctors after transition, reflecting the enduring impact of these connections. Overall, affective engagement emerged as a key factor in adherence, reducing relapses, hospital readmissions, and treatment abandonment.

Within the constraints of Brazil’s public health system, affective bonds emerge as an indispensable tool in psychosis care. Consistent with Nise da Silveira’s perspective, therapeutic relationships grounded in empathy and trust may act as stabilizing forces, enabling adherence and improving outcomes where financial and structural resources are limited. These findings highlight the relevance of integrating the affective dimension into psychiatric practice, particularly in contexts of socioeconomic vulnerability.

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Social isolation (SI) is defined as the lack of social contact or support. Older adults have a higher risk of social isolation because of the changes in health and social relationships that can occur during ageing. Several studies have shown that SI is independently associated with poorer physical and mental health and worsened quality of life. However, limited evidence is available on SI predictors in old public housing populations.

To assess the risk of SI and dependency in Basic and Instrumental Activities of Daily Living (BADL; IADL) in a sample of older people living alone in public housing. To identify predictors of SI, namely whether ADL dependency is one of them.

As part of the ongoing “Porto Importa-se” project, this study included a sub-sample of older persons aged 70 years and over living alone in public housing communities in Porto City, Portugal. All participants were assessed with a comprehensive multidimensional assessment protocol, which encompassed the Barthel and Lawton Indexes (BADLs and IADLs dependency) and the Lubben Social Network Scale-6 (SI risk). Loneliness was measured with a categorical question. A multiple logistic regression model was performed to identify predictive factors for SI. Odds Ratio (OR) and its 95% Confidence Interval (95%CI) were calculated. A p<0.05 was considered statistically significant.

The final sample (n=716) was namely female (84%), with an average age of 80.4 years (SD=6.2). Around 36% presented a risk of SI, and 24% reported feeling lonely almost always to always. About 53% had moderate dependency on IADLs, and 11% dependency on BADLs. The proportion of participants dependent on BADLs and at risk of SI is more than double the proportion of cases considered not to be at risk (17%v.s.8%; p<0.001). Similarly, the proportion of cases considered to be severely dependent on IADLs and at risk of SI is about four times higher than the proportion of cases considered not to be at risk (13%v.s.3%; p<0.001). Based on the logistic regression model, severe dependence on IADLs (OR=5.16, 95%CI[2.37;11.24], p<0.001) and loneliness (OR=2.87, 95%CI[2.02;4.09], p<0.001) were significant predictors of the risk of SI. The model has a modest explanatory power (Nagelkerke R2=0.126).

The rate of SI found in this study aligns with the results reported in other studies with similar objectives. The identification of loneliness and dependence in ADL as predictors of SI also complies with previous studies. These results reinforce the importance of monitoring elderly people who find themselves alone and dependent on the fulfilment of their ADLs more closely.

This work was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020)

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Treatment-Resistant Depression (TRD) is commonly defined as an inadequate response to two or more antidepressant trials. The severity of TRD can be evaluated by means of the Maudsley Staging Method (MSM). The MSM consists of five domains including duration of the depression, symptom severity, number of treatment failures, augmentation therapy, and electroconvulsive therapy use. The Danish Medicines Council has suggested that the MSM could guide treatment decisions. However, the use of MSM in clinical practice is lagging and the evaluation of TRD in clinical practice has remained subjective and unstandardized.

To evaluate the use of MSM in clinical practice, we investigate the association between MSM scores and response to repetitive transcranial magnetic stimulation (rTMS) treatment, as measured by the 17-item Hamilton Depression Rating Scale (HAM-D17).

Patients with unipolar depression referred to six weeks of treatment with rTMS were consecutively invited to participate in the study. The study was a multi-center study with inclusion sites in Randers, Viborg, and Skejby, Denmark. Demographic information and clinical data were retrieved from the patient’s Electronic Health Record (EHR). The patients were assessed on the MSM within the first two weeks of the treatment. Ratings on the HAM-D17 and self-administered questionnaires including the depressive symptoms, side effects, and quality of life were completed on a weekly basis. Additionally, three side-effect interview assessments were conducted during the six weeks rTMS treatment. A power calculation estimated the inclusion of 65 patients.

Response is to be evaluated by means of the Spearman’s rank correlation coefficient (rho) between MSM score and HAM-D17. An adequate response is defined as a 50% decrease in the Hamilton score or below the threshold for remission.

Data collection is ongoing. As of September 2024, a total of 59 out of 65 participants have been recruited. Preliminary results will be presented at the EPA 2025 Congress.

A systematic assessment of TRD according to the MSM in clinical practice, holds promise for predicting treatment outcomes and guiding treatment decisions. Integrating MSM, for instance, during the recording of patient medical history, could enhance its practical utility in everyday clinical settings.

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Autism Spectrum Disorder (ASD) affects approximately 3% of children and adolescents in the U.S. This condition is increasingly prevalent worldwide and presents significant treatment challenges. Preliminary evidence suggests that cannabidiol (CBD) cannabis extracts may help manage ASD symptoms, but their efficacy and potential harms have not yet been systematically investigated.

To systematically review and meta-analyze the evidence from clinical trials investigating the efficacy and safety of CBD cannabis extracts in alleviating symptoms of ASD in children and adolescents.

We conducted a comprehensive search in MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials using MeSH terms including “Autism Spectrum Disorder,” “Cannabidiol,” “Cannabis,” “Child,” and “Adolescents.” No language or publication date restrictions were applied. The search was last updated on September 8, 2024. We included randomized, placebo-controlled trials on the efficacy or safety of CBD cannabis extracts in children and adolescents with ASD. For outcomes with limited study data, we used a fixed-effects model. The risk of bias in the included studies was evaluated using the Risk of Bias 2 tool.

Three studies met our criteria, comprising 276 participants (78.3% male; mean age 10.5 years, range 5 to 21). Interventions included orally administered CBD cannabis extracts, with tetrahydrocannabinol (THC) present in minimal amounts or in ratios of 9:1 to 20:1 CBD to THC. Dosages of CBD started at 1 mg/kg per day and were titrated up to 10 mg/kg per day. CBD cannabis extracts significantly enhanced social responsiveness (SMD = -0.75 [-1.08, -0.43], p < 0.01, I² = 17%), reduced disruptive behavior (SMD = -0.36 [-0.67, -0.06], p = 0.02, I² = 0%), and alleviated anxiety (SMD = -0.33 [-0.63, -0.03], p = 0.03, I² = 59%). CBD cannabis extracts also improved sleep quality, without reaching statistical significance (SMD = -0.19 [-0.49, 0.11], p = 0.21, I² = 0%). There was no significant difference in adverse effects between interventions and placebo (odds ratio = 2.11 [1.00, 4.46], p = 0.05, I² = 38%).

CBD cannabis extracts appear to provide meaningful benefits for children and adolescents with ASD, showing moderate improvements in social responsiveness and small yet notable reductions in disruptive behaviors and anxiety. They do not seem to significantly increase adverse effects compared to placebo, suggesting a favorable safety profile. These findings support the potential consideration of CBD cannabis extracts in ASD treatment plans. However, the review’s limitations include a small number of studies, limited sample sizes, and significant heterogeneity. Future research with larger, robust trials is needed to clarify the efficacy and safety of CBD cannabis extracts in managing ASD.

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In the last 50 years, obesity has become a leading cause of morbidity and decreased life expectancy, being associated with the development of cardiovascular disease, decreased mental health and overall decreased quality of life. The development of bariatric surgery as a treatment strategy in those in which attempts at conservative treatment yielded no satisfactory results has revolutionized treatment of refractory obesity. While short term gains in cardiovascular health are undeniable, long-term impact remains uncertain. More recently, there is emerging evidence of bariatric surgery being associated with de novo alcohol use disorder.

We aimed to study the possible correlation between bariatric surgery and alcohol use disorder, specifically the individual risk factors that may promote such outcome. Moreover, we aimed to evaluate which surgical procedures are more eliciting of alcohol use disorder.

We performed a literature review using the database MEDLINE and obtained 241 results using the query terms “bariatric surgery” and “alcohol”. Of these, we read all the summaries and subsequently selected 51 different scientific articles which we afterwards read in full. We then performed a literature review aiming to understand the maladaptive alcohol consumption patterns following bariatric surgery

Most studies report maladaptive alcohol use following bariatric surgery. Outstandingly, this consumption pattern develops only at later follow up stages, usually over 3 years after surgery. Furthermore, not all types of bariatric surgery appear to pose the same iatrogenic risk. Gastric bypass poses the highest risk of new onset alcohol misuse, in comparison to sleeve gastrectomy or gastric band surgery. It is not yet fully understood the mechanism behind this pattern of alcohol misuse following surgery, but common reasons have been identified, including different social interaction patterns, addiction transfer, ambivalence towards bodily changes, increased mental vulnerability and different body response to the effects of alcohol.

The screening of alcohol misuse before and after bariatric surgery is of paramount importance to decrease the surgical iatrogenic risk and improve outcomes. Further research should be developed in understanding what are the risk factors and mechanistic pathways for alcohol misuse following bariatric surgery. Also, it should be investigated whether the treatment of alcohol misuse disorder differs between patients submitted to bariatric surgery or not.

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The term cycloid psychosis was first introduced by Karl Kleist in 1926 to describe cases that did not meet the typical presentations of schizophrenia or manic-depressive illness. The concept was later developed by Karl Leonard, who proposed three distinct types of cycloid psychoses. Perris and Brockington established the first operational diagnostic criteria for the condition. Cycloid psychosis is characterized by its acute onset, brief duration, polymorphous and shifting symptomatology, a tendency for periodic recurrence, and full inter-episode recovery, with no residual functional impairment following the episodes. Despite its distinct characteristics, cycloid psychosis is not included in the current international psychiatric classification systems.

We aim to present a case report and conduct a literature review.

A narrative review of the literature was conducted, with data collected from the PubMed database. Only English-language studies published in peer-reviewed journals were included in the selection.

Case: A 35-year-old female patient has been presenting, over the last seven years, with episodes characterized by a sudden onset of agitation, acute anxiety (described by the patient as ‘an inexplicable sense of fear’), and frequently accompanied by persecutory delusions and auditory commanding hallucinations. Upon observation, the patient typically presents with confusion and perplexity and exhibits a lack of recollection of some previous events. Following the initiation of antipsychotic treatment, a complete recovery is always observed within a few days, with no residual symptoms remaining. In the most recent episode, the patient drove for a few hours to a different city from the one where she lives and had to ask for help from a fire department, as she felt lost and confused and had no memory of the previous events. According to reports from her family, the patient exhibited disorganized behavior, increased irritability, and a reduction in sleep duration during the week preceding the episode. The patient later acknowledged discontinuation of antipsychotic medication. These episodes occurred without any prior substance use, cognitive decline, or underlying medical conditions. The patient had no previous psychiatric complaints or family history of psychiatric disorders. Although the patient was a smoker, there was no history of substance or alcohol abuse. A comprehensive evaluation, including laboratory tests, imaging studies (head CT and brain MRI) and electroencephalography (EEG), revealed no abnormal findings. Considering the range of symptoms and characteristics observed in this clinical case, the patient meets Perris’s criteria for cycloid psychosis.

Our case report highlights that cycloid psychosis exhibits a distinctive symptom pattern and clinical outcome, which can support its validity as a nosological construct distinguishable from other disorders in classification systems.

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Obsessive-compulsive disorder (OCD) has an estimated prevalence of 1-2% and causes a significative reduction in functionality and quality of life with a high socioeconomic impact.

First and second line treatment includes serotonin reuptake inhibitors, clomipramine, antipsychotics augmentation strategy and cognitive behavioural therapy. It is ineffective in 20-60% of patients whose approach may include transcranial magnetic stimulation (TMS).

The aim of this study is to assess the effect of treatment with TMS on obsessive-compulsive, anxious, and depressive symptoms in patients with OCD.

A prospective observational study was conducted including all patients diagnosed with OCD who underwent TMS in our department since March 2023.

Our protocol targets the dorsolateral prefrontal cortex and includes a total of 25 sessions using the Food and Drug Administration approved parameters (20 Hz, 100% of the leg resting motor threshold, 50 trains of 2s duration, inter-train interval 20s, 2000 pulses per session). Before each session, symptom provocation is performed. TMS was performed using the Cool D-B80 coil and a MagPro stimulator.

Symptoms before and after treatment were assessed using the Yale Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D).

As of 01/09/2024, 21 individuals with OCD completed TMS treatment, 57% male, with a median age of 37 years (interquartile range (IQR) 17). The median duration of illness was 25 years (IQR 15), with 24% of patients having very severe OCD, 52% severe, and 19% moderate—all refractory to psychotherapeutic and pharmacological treatment.

There was a statistically significant reduction in Y-BOCS scores (pre-TMS median score 29 (IQR 6), post-TMS 21 (IQR 13), p=0.003), with 32% of patients achieving a complete response (Y-BOCS reduction ≥35%) and 5% a partial response (Y-BOCS reduction ≥25%). No correlation was found between the change in Y-BOCS scores and other variables such as age, duration of illness, and pre-TMS scores on Y-BOCS, HAM-A, and HAM-D.

Additionally, a statistically significant reduction was observed in HAM-A scores (pre-TMS median 20 (IQR 18), post-TMS 16 (IQR 11), p=0.026) and HAM-D scores (pre-TMS median 19 (IQR 17), post-TMS 15 (IQR 14), p=0.029).

No severe adverse effects were reported.

This study shows significant reductions in Y-BOCS, HAM-A, and HAM-D scores after TMS treatment, with many patients achieving complete or partial response. These findings align with previous research, suggesting TMS is an effective option for treatment-refractory OCD. The absence of severe adverse effects supports its safety.

In conclusion, this study adds to real-world evidence by demonstrating the efficacy and safety of TMS in a clinical setting. Continued data collection is crucial to identify predictors of response.

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