Bilateral vocal fold immobility is a rare, often delayed complication of head and neck radiotherapy that is not well described in the literature. This study aimed to characterise its timing and clinical course.

Patients from 2016 to 2024 with prior head and neck radiotherapy, a diagnosis of bilateral vocal fold immobility and no residual disease were reviewed. Data included demographics, tumour site, radiotherapy type/dose, chemotherapy, interval to bilateral vocal fold immobility, airway intervention, nutrition route and mobility recovery.

Twelve patients (10 male, 2 female; median age 65.8 years) were identified. Glottic (4, 33.3 per cent) and nasopharyngeal (3, 25 per cent) tumours were the most common. Most (11, 91.7 per cent) received intensity-modulated radiotherapy (median dose 68 Gy); eight had chemoradiation. Median time to bilateral vocal fold immobility was 7.5 years. Seven required tracheostomy (two decannulated); eight needed percutaneous gastric tubes. No patients recovered mobility.

Bilateral vocal fold immobility following radiotherapy is rare, delayed, often irreversible, and frequently requires tracheostomy and enteral nutrition.

This study aimed to evaluate the epidemiological characteristics, incidence trends and survival outcomes of nasopharyngeal carcinoma from 2000 to 2021.

A retrospective analysis of 10,419 NPC cases from the SEER database (2000–2021) was conducted. Incidence rates were calculated per 100,000 population. Joinpoint regression assessed trends, and Kaplan–Meier and Cox regression evaluated survival.

Most patients were male (68.9 per cent) and White individuals (51.2 per cent), with 49.5 per cent presenting at a regional stage. Males were more likely to present with distant disease than females (72.2 per cent vs. 27.8 per cent; p < 0.001). Nasopharyngeal carcinoma incidence was higher in males (0.8/100,000) and Asian populations (1.87/100,000). Overall incidence declined (average annual per cent change: –0.8 per cent; p = 0.002). Median survival was 79 months, longer in females (90) and Asian populations (118). Distant disease predicted higher mortality (hazard ratio 1.71; p < 0.001). Nasopharyngeal carcinoma was the leading cause of death (43.6 per cent).

Males and Asian populations had higher nasopharyngeal carcinoma incidence. Female sex and Asian race predicted better survival, while distant-stage disease increased mortality.

Global epidemiological research suggests that approximately 1% of the global population is affected by schizophrenia, with 2 to 3% experiencing obsessive-compulsive disorder (OCD). Additionally, a noteworthy proportion of individuals with schizophrenia also exhibit comorbid OCD. This overlap often complicates differential diagnosis, especially as many schizophrenia patients display obsessive and/or compulsive symptoms akin to those seen in OCD.

This literature review is designed to examine how frequently schizophrenia and OCD co-occur and to summarize the treatments reported in various studies.

A comprehensive literature review was carried out focusing on the co-occurrence and treatment of schizophrenia and OCD. This review involved an extensive search of scientific publications, selecting articles pertinent to the subject from databases such as Scopus and PubMed using keywords like “schizophrenia and OCD” and “schizophrenia and OCD treatment,” yielding over 1500 articles from 1988 to 2024. Additional sources included Google Scholar and various grey literature sources. After applying specific exclusion criteria, 44 recent articles were selected that addressed the frequency of co-occurrence and the treatment modalities used for schizophrenia and OCD. These articles were categorized by country, frequency of co-occurrence, and treatment methods.

The review revealed that roughly 14.5% of individuals with schizophrenia also suffer from OCD. Among treatments, Clozapine was commonly associated with the worsening of OCD symptoms, while Haloperidol showed better tolerability. Other antipsychotic medications like Olanzapine, Risperidone, and Quetiapine were noted to either aggravate existing OCD symptoms or initiate the onset in some cases. In contrast, some antipsychotics, such as Amisulpride and Aripiprazole, helped reduce symptom severity. Non-pharmacological treatments, particularly Cognitive Behavioral Therapy (CBT), have proven effective in reducing symptom severity with favorable outcomes noted in numerous cases. The integration of pharmacological and psychotherapeutic strategies is generally recommended to maximize therapeutic outcomes, underscoring the potential of combined modalities in treating OCD.

Our literature review investigated the prevalence of comorbidity between schizophrenia and obsessive-compulsive disorder (OCD), as well as the pharmacological and non-pharmacological treatments utilized. The significant overlap between these disorders highlights the complexity of managing patients with these co-occurring conditions, underscoring the need for systematic screenings and integrated treatment approaches.

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Non-adherence to prescribed medications in schizophrenia is a primary factor leading to relapse and repeated hospitalizations, posing a significant challenge in psychiatric care. Understanding and enhancing medication adherence is crucial for improving outcomes in schizophrenia treatment.

This study aimed to estimate the prevalence of medication non-adherence among schizophrenia patients and to explore the impact of depression and other sociodemographic factors on adherence levels. Recognizing these influences is essential for developing targeted interventions to improve patient outcomes.

A cross-sectional analysis was conducted involving 350 individuals with schizophrenia, encompassing both outpatients and inpatients. A comprehensive questionnaire was employed to collect data on sociodemographic characteristics, clinical history, and therapeutic interventions.

To assess medication adherence and depressive symptoms, the study utilized the Medication Adherence Rating Scale (MARS) and the Calgary Depression Scale for Schizophrenia (CDSS), both of which are validated tools designed for psychiatric evaluations.

Data analysis revealed that 21.3% of the participants exhibited poor medication adherence as measured by MARS. Further statistical testing using a logistic regression model identified employment status and level of depression as significant predictors of non-adherence.

Patients who were unemployed and those exhibiting higher scores on the CDSS indicating more severe depressive symptoms were more likely to be non-compliant with their medication regimen (p=0,001). This highlights the intricate relationship between mental health symptoms and treatment adherence.

The results of this study illuminate the importance of considering depression and employment status when addressing medication adherence in individuals with schizophrenia. These factors play a pivotal role in the adherence behavior and overall treatment outcomes of patients.

Emphasizing comprehensive care that includes management of depression alongside routine antipsychotic treatment could enhance adherence and improve the prognosis for individuals living with schizophrenia. Ongoing research is needed to further elucidate the pathways that influence medication adherence and to develop strategies that effectively address these challenges.

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Studies in the general population and those based on clinical assessments of individuals with schizophrenia have shown a high degree of overlap between schizophrenia and substance-related disorders.

The prevalence of substance abuse throughout life is so common that the likelihood of a specific link inevitably arises. Various hypotheses have been proposed to explain the high comorbidity between schizophrenia and substance abuse, making these patients challenging to manage due to potential pharmacological interactions between the substances they consume and neuroleptic medications.

To explore the nexus between nicotine dependence and schizophrenia through a case report and a review of the literature.

We discuss a 40-year-old divorced man, father of one daughter, unemployed, with a history of psychiatric follow-up in private care for seven months before admission for untreated schizophrenia, and polyaddiction to substances including tobacco, cannabis, and cocaine.

He was transferred to our facility for management of behavioral disorders and aggression with a refusal of oral treatment. The patient had been incarcerated in France for four years for assault with a bladed weapon. He was admitted to our emergency psychiatric service with his brother due to arson within his residence where he lives alone. Upon admission, the patient was well-oriented in time and space, with neglected hygiene, easy contact, neutral facial expressions, sad mood, blunted affect, motor instability, and a dissociative syndrome: irrelevant responses, tangential speech, and persecution delusions without a specific persecutor, confirming his behavioral disorder and trivializing it with impaired judgment and no suicidal ideations.

The patient was hospitalized and underwent a complete blood test and ECG, both of which returned normal results, and was treated with olanzapine 10 mg/day and chlorpromazine 200 mg/day. During his hospitalization, he made several attempts to start fires within the ward, explaining his actions as a constant desire to inhale smoke to relieve discomfort, and he experienced a craving for smoke. After a month in our facility, and following the resolution of the dissociative and delusional syndromes, we scheduled a leave for the patient to assess clinical improvement. Upon returning from leave, the patient expressed multiple persecutory delusions towards family members who prevented him from starting a fire in his garden, which he considered necessary for his well-being.

Comorbidity between addiction and schizophrenia is very common in our social context, and management should be simultaneous, without neglecting the importance of family support.

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Medical students often harbor entrenched and somewhat negative views towards psychiatry, which can impact their interest in pursuing this specialty and pose challenges to recruitment efforts.

To assess whether exposure to clinical placements in psychiatry can positively shift medical students’ perceptions and influence their career decisions towards this field.

This study employed a “before/after” longitudinal design over an eight-month period involving 5th-year medical students who were starting their 4-week psychiatric rotation. Evaluations were carried out at the beginning and end of the internship using a comprehensive questionnaire that covered sociodemographic details, clinical exposure, and students’ career inclinations towards psychiatry. The questionnaire also explored various reasons influencing their specialty choice, aiming to identify shifts in perspective directly attributable to their internship experience.

A total of 41 students (n=41) participated in the study. There was a notable positive shift in attitudes towards psychiatry observed at the conclusion of the internship. At the start of the rotation, only 29% of students considered choosing psychiatry as a potential career path. By the end of the internship, this figure had increased to 49%. This substantial increase underscores the transformative potential of direct, immersive experiences in altering career considerations among medical students.

Consistent with the literature, the results of this study demonstrate the positive impact that clinical placements in psychiatry can have on medical students’ attitudes towards the specialty and their subsequent choice of it as a career path. This improvement highlights the critical role that such internships play not only in enhancing educational outcomes but also in shaping the future workforce in psychiatry. It is evident that integrating robust psychiatric placements into medical training programs is essential for nurturing an informed, motivated, and committed next generation of psychiatrists. Our findings support the continued advocacy for and expansion of these experiential learning opportunities within medical curricula to foster a deeper understanding and appreciation of psychiatry.

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Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops when a person is exposed to death, perceives a threat to their safety, or witnesses a traumatic event, either personally or vicariously. It is a condition that affects over 70% of adults who have experienced trauma at least once in their lives. What happens in the case of individuals who have attempted suicide? Do they also frequently develop PTSD?

To determine if individuals who have attempted suicide are at risk of developing PTSD as a result of their suicide attempt. If such a connection is proven, what therapeutic measures could be proposed to prevent the onset of this disorder?

This is a descriptive study using a survey of patients at the Department of Psychiatry D at RAZI Hospital, who have made one or more suicide attempts during the year 2023.

20 patients (80%) exhibited a moderate to severe depressive episode at the time of their suicide attempt. The average number of suicide attempts was 1.53. The methods used for the suicide attempts included medication ingestion, observed in 15 patients (60%), phlebotomy in 4 (16%), jumping from a height in 2 (8%), hanging in 2 (8%), and ingestion of toxins in 2 (8%). 14 patients (56%) required hospitalization in a medical unit following the suicide attempt. 9 out of 25 patients (36%) developed PTSD according to DSM-5 criteria.

A significant proportion of suicide attempt survivors may develop PTSD related to the suicide attempt. PTSD related to a suicide attempt could serve as a viable target for assessment and intervention to improve quality of life and reduce the risk of future suicide among individuals who have attempted suicide. However, more studies are needed to evaluate the risk of PTSD in this population.

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Social deficits are a significant impairment in adult ASD, leading to difficulties in socio-emotional cognition, communication, and relationships. Effective social skills interventions are crucial during the transition to adulthood. The UCLA PEERS® (Program for the Education and Enrichment of Relational Skills) for young adults is a prominent and well-researched intervention, implemented in over eighty countries and translated into numerous languages. This program includes concurrent sessions for young adults and their parents, aiming to improve social skills and reduce ASD-related social issues

The current study aimed to test the effectiveness of a culturally adapted Persian -translated version of PEERS® for young adults with ASD without intellectual disabilities.

Three psychiatrists and two psychologists underwent PEERS® training and translated the manual into Farsi, adapting it culturally for Iran. Twenty-four young adults with ASD and their parents participated in the study, randomly assigned to a treatment group or a control group. Inclusion criteria were males aged 18-30 years with an ASD diagnosis, predominant social difficulties, motivation to participate, and a family member acting as a social coach. Exclusion criteria included intellectual disability, major psychiatric conditions, and significant verbal or literacy difficulties.

Participants attended 16 weekly 90-minute group sessions, covering topics like conversations, humor, electronic communication, dating etiquette, conflict management, and bullying. Sessions were led by a PEERS-certified psychologist and an assistant behavioral coach. Weekly meetings were held to align session content and address potential issues.

The culturally adapted Persian -translated version of PEERS® was perceived as beneficial by young adults with ASD and their caregivers, improving social skills and quality of life. However, quantitative measures did not show significant changes, indicating a need for further refinement and investigation to achieve measurable improvements in social functioning.

While qualitative feedback indicates that both young adults with ASD and their caregivers found the caregiver-assisted social skills intervention to be beneficial in improving social skills and overall quality of life, the quantitative measures did not show significant changes. This suggests that while the intervention may have positive perceptual impacts, further refinement and investigation are needed to achieve measurable improvements in social functioning.

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Virtual testing can reduce cost and burdens, as well as increase access to clinical care. Few studies have examined the equivalency of virtual and in-person administration of standardized measures of executive functioning in children. During the COVID-19 pandemic, we utilized virtual administration of the Delis-Kaplan Executive Function System, Color-Word Interference Test (DKEFS-CW) in our ongoing longitudinal research study exploring outcomes in children clinically recovered from concussion compared to never-concussed peers. In the current study, we explore the equivalence of scores obtained via in-person and virtual administration of the DKEFS-CW in youth recovered from concussion and never-concussed controls.

Participants included 112 youth ages 10-18 (Mage=14.05 years, SD=2.296; 53.5 % Male) who completed the DKEFS-CW in-person (n=63) or virtually (n=49) as part of their involvement in the parent study. Of these, 38 were recovered from concussion (Mdays since injury— 91.21, SD=88.91), and 74 were never-injured controls. Virtual administration was done via Zoom by presenting digital scans of the DKEFS stimulus book using the screen-sharing function. Participants set up and joined the Zoom call from a secondary device (cell phone) that was set in a stable position to provide a view of their screen, mouse and keyboard setup. Group (in-person vs remote) differences in DKEFS-CW scores were examined using independent-samples t-tests for all subtest conditions (color naming, word reading, inhibition, and inhibition/switching). T-tests/chi-square tests were used to examine between-group differences in demographic variables (i.e., age, sex maternal education, IQ, concussion history). Demographic variables that were significantly different by group were then included as covariates in ANCOVA models examining the effect of administration context on performance.

There were no significant differences in DKEFS-CW scaled scores between those who were administered the measure in-person or virtually (Color Naming: Min-person=10.78, Mvirtual=10.08, t(110)=1.634, p=.105; Word Reading: Min-person=11.25, Mvirtual=10.92, t(110)=.877, p=.382; Inhibition: M in-person= 11.70, Mvirtual=11.24, t(110)=1.182, p=.240; Inhibition/Switching: Mi n-person= 11.29, Mvirtual=10.82, t(110)=1.114, p=.268). There were no significant between-group differences in concussion history, sex, maternal education or IQ. However, those who were administered the DKEFS-CW in-person (Mage=13.55) were significantly younger than those who were administered the measure virtually (Mage=14.69), t(110)=-2.777, p=.006. After controlling for age, there remained no significant relationship between administration context (in-person vs. virtual) and DKEFS-CW performance for any subtest condition (Color Naming: F(1,30)=.016, p=.889; Word Reading: F(1,76)=.655, p=.421; Inhibition: F(1,30)=.038, p=.847; Inhibition/Switching: F(1,30)=.015, p=.902).

The recommended practice for remote administration of DKEFS-CW is to have test stimuli presented flat on a table by a trained facilitator present with the examinees. Here, we provide preliminary evidence of equivalence between DKEFS-CW scores from tests completed in-person and those completed virtually with stimuli presented on a computer screen. Future studies are needed to replicate these findings in clinical populations with greater variability in executive function. Some clinical populations may also require more in-person support. Likewise, future studies may examine the role of trained facilitators or caregivers in the virtual testing process.

Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent, inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature.

We aimed to investigate the risk of suicide among refugees in Sweden and Norway according to their sex, age, region/country of birth and duration of residence.

Each suicide case between the age of 18-64 years during 1998 and 2018 (17,572 and 9,443 cases in Sweden and Norway, respectively) was matched with up to 20 population-based controls, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide.

The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI: 0.5-0.6) and 0.3 (95% CI: 0.3-0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI: 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age.

The findings of almost similar suicide mortality advantages among refugees in two host countries may suggest that resiliency and culture/religion-bound attitudes could be more influential for suicide risk among refugees than other post-migration environmental and structural factors in the host country.

No significant relationships.

The corticotropin-releasing hormone receptor 2 (CRHR2) gene encodes CRHR2, which is an important element in the hypothalamic-pituitary-adrenal physiologic response towards stress culminating in hyperglycemia, insulin resistance, mood disorders and depression (MDD). CRHR2-/- mice are hypersensitive to stress, and the CRHR2 locus in humans has been linked to type 2 diabetes (T2D) and MDD.

Several variants in the CRHR2 gene have been reported in patients with bipolar disorder, post-traumatic stress disorder, and T2D, but variants in the gene have not been investigated in families with T2D and MDD.

We genotyped 212 Italian families with T2D and MDD. We tested 17 SNPs in the CRHR2 gene using two-point parametric-linkage and linkage-disequilibrium (LD) analysis with the following models: dominant with complete-penetrance (D1), dominant with incomplete-penetrance (D2), recessive with complete-penetrance (R1) and recessive with incomplete-penetrance (R2).

We detected linkage to and/or LD with: MDD for 3 SNPs/D1, 2 SNPs/D2, 3 SNPs/R1, and 3 SNPs/R2; and, T2D for 3 SNPs/D1, 2 SNPs/D2, 2 SNPs/R1 and 1 SNP/R2. Two independent SNPs were comorbid. Interestingly, the variants linked to or in LD with MDD had in general higher statistical significance level than the variants linked to T2D, despite that the families were primarily ascertained for T2D.

Our study shows for the first time that the CRHR2 gene which encodes CRHR2 is in linkage to and linkage disequilibrium with MDD and T2D, thereby contributing, in families with T2D, to both disorders and underlying the shared genetic pathogenesis of their comorbidity

No significant relationships.

Refugees, especially minors, who often have experienced traumatic events, are a vulnerable group regarding poor mental health. Little is known, however, of their risk of suicidal behaviour as young adults.

We aimed to investigate the risk of suicidal behaviour for young adult refugees who migrated as minors. The moderating role of education and history of mental disorders in this association was also investigated.

In this register linkage study, all 19-30-year-old Swedish-born (n = 1,149,855) and refugees (n = 51,098) residing in Sweden on December 31st, 2009 were included. The follow-up period covered 2010-2016. Cox models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). The multivariate models were adjusted for socio-demographic, labour market marginalisation and health-related factors.

Compared to Swedish-born, the risk of suicide attempt was lower for all refugees (HR 0.78, 95% CI 0.70-0.87), and accompanied refugee minors (HR 0.77, 95% CI 0.69-0.87), but estimates did not differ for unaccompanied refugee minors (HR 0.83, 95% CI 0.62-1.10). Low education and previous mental disorders increased the risk of suicide attempt in both refugees and Swedish-born, with lower excess risks in refugees. Findings for suicide were similar to those of suicide attempt.

Young adult refugees have a lower risk of suicidal behaviour than their Swedish-born peers, even if they have low educational level or have mental disorders. Young refugees who entered Sweden unaccompanied do not seem to be equally protected and need specific attention.

No significant relationships.