Incels, or ‘involuntary celibates,’ are self-identified individuals who desire sexual or romantic relationships but struggle to find willing partners. This phenomenon is characterized by imposed social isolation and mental health morbidity manifesting as misogynist views, participation in online hate groups and in some cases, as aggressive actions.

This scoping review aims to understand the associated attitudes and behaviors, psychiatric comorbidities, and risk factors to optimally screen and manage patients with incel ideology who present to mental health clinics. It also explores the link between inceldom and violent tendencies, with a special focus on the mass shootings/murders caused by individuals who identified as incels.

We searched PubMed, PsycINFO, and Scopus using the keyword “incel,” yielding 310 studies. Exclusion criteria included non-English, irrelevant, or inaccessible studies. After removing duplicates (84 articles), we conducted abstract screening and full-text analysis, resulting in 46 studies being included as primary sources. Additional sources from: 1) open-source Google searches spanning incel forums, news articles, and blogs, and 2) references from primary sources increased the total to 124 studies (26 studies on incel linguistics and beliefs, 27 studies on history and evolution, 36 studies on incel violence, 23 studies on biopsychosocial pathophysiology, and 19 studies on psychiatric comorbidities). PRISMA-ScR guidelines were followed (Figure 1).

Incels are primarily young, socially isolated males who face economic and social challenges. They often exhibit significant psychiatric comorbidities—such as depression, anxiety, personality disorders, and suicidality—which, along with social influences, may exacerbate their propensity for violence targeting women and “normies” online and through mass homicidal incidents. Clinical management of incels includes an empathetic understanding of their misogynistic ideologies, pharmacological treatment for underlying psychiatric conditions, psychotherapy to combat extremist beliefs, and forensic assessment for trial competency.Image 1:

A comprehensive and multifaceted approach that includes integrated psychiatric care, legal evaluation, and targeted interventions is needed to address violence, psychiatric disorders, and extremist beliefs among Incels.

None Declared

Medication reconciliation (MedRec) is recognized as an important safety initiative by the World Health Organization (Accreditation Canada, ROP 2020 handbook). An initial audit at a Canadian Regional Hospital acute psychiatric unit revealed that 21/22 (95%) of inpatients had a documented admission Best Possible Medication History (BPMH). 15/21 (71%) contained at least one discrepancy, the most common type being omissions (10/17 total discrepancies, 59%). Documentation of ≥2 MedRec information sources was 4.8% (1/21). Stuijt et al. reported that 36–95% of admissions across six hospitals in the Netherlands had at least one MedRec discrepancy.

To improve the completeness, quality, and accuracy of admission MedRecs communicated to care providers for admitted psychiatric patients.

A quality improvement (QI) project was initiated with an initial audit, of all 22 patients on admission in a regional hospital acute psychiatric unit on a randomly selected day in June 2025. Data sources included admission MedRec forms and medical records. Primary process measures were proportion of patients with a documented MedRec; proportion of admission MedRec with documented ≥2 information sources (including patient/family/caregiver interviews), and the types and frequency of MedRec discrepancies. Prior to late September 2025, BPMHs were typically documented at the hospital using forms that did not include pre-populated provincial Drug Information System (DIS) medication lists. In late September 2025, a DIS MedRec form with a pre-populated DIS pre-admission prescribed medication list was implemented. Clinical team members received education on its use prior to the intervention’s implementation. Pre- and post-intervention data (June – August 2025 vs. November 2025 – January 2026) will be collected, and analyzed using run charts to identify trends or shifts in documentation rates, the frequency of documentation of at least two information sources, and discrepancy frequency.

Initial audit findings were shared with clinicians to highlight gaps in MedRec practices. Pre- and post-intervention data collection and analyses are ongoing to assess expected outcomes – increase in documentation rates, higher use of multiple information sources, and a reduction in MedRec discrepancies.

This audit represents an important first step towards improving MedRec accuracy and quality for psychiatric admissions at the hospital. Results will inform whether additional interventions or process refinements are necessary to achieve and sustain MedRec best practices at the hospital.

None Declared

Introduction: Non-communicable diseases (NCD) are usually chronic and result from a combination of genetic, physiological, environmental and behavioral factors. NCDs are increasingly recognised as significant contributors to morbidity and mortality in developing and developed countries. NCD risk factors can be thought of as variables associated with an increased risk of developing an NCD. NCD risk factor (NCDRF) screening has become prominent owing to the burden of NCDs. Major depressive disorders (MDD) and NCDs seem to share a bidirectional relationship. However data regarding NCDRF is biased towards severe mental illnesses.

This study was carried out to assess patients with MDD for NCDRFs.

Methods: The study protocol was approved by the Institute ethics committee and was carried out in patients attending the outpatient psychiatry clinic of a tertiary hospital in North India. 200 patients (120 males and 80 females) aged 18-69 years with a diagnosis of MDD (not severely depressed at time of assessment) were assessed for socio-demographic and clinical profile and NCDRFs derived from the WHO STEPS framework. Assessment included behavioral profiling, physical measurements and measurements of biochemical parameters. Data were analyzed.

The results indicated that patients with MDD had significant NCDRFs including current and lifetime tobacco and alcohol use, unhealthy dietary patterns, low levels of physical activity, obesity as indicated by body mass index and waist circumference, hypertension and deranged lipid profiles. Results were broadly comparable to epidemiological data in the general population that has been published elsewhere.

NCDRFs may contribute to increased morbidity and mortality seen in MDDs. Assessment of NCDRFs and modification of eligible risk factors should be included in the management of patients with MDD.

None Declared

Treatment-resistant depression is a major concern, though there has been significant advancement in antidepressant therapy. The therapeutic outcome for patients with depressive disorder is achieving a treatment response with remission. Predictions based on genetic markers may have the potential to increase the treatment response through a personalised approach. Norepinephrine neurotransmission is a major pathophysiological concern.

To investigate the association of single-nucleotide polymorphisms (SNPs) in the norepinephrine transporter (SLC6A2) as predictive pharmacogenetic biomarkers with antidepressant response in the Indian population, by comparing treatment responders and non-responders to SSRI/SNRI monotherapy.

Two hundred thirty-eight patients suffering from depressive disorder were selected and enrolled for this study. The patients were treated with SSRI/SNRI over a period of 3 months. Standardised questionnaires were used for assessment, including the severity of depression assessed by the Hamilton Depression Rating Scale (HDRS) and the Centre for Epidemiologic Studies Depression Scale (CES-D), social cognition assessment using SOCRATIS, and side effects evaluation with the UKU Side Effect Rating Scale. Genetic variations SLC6A2 with their SNPs (rs5569 and rs36029) were genotyped. The genetic data of the responders and non-responders were compared to evaluate the role of genetic variants in therapeutic outcome.

Out of the total patients, 136 (57.14%) showed a positive treatment response, with 32 (23.52%) achieving complete remission. Analysis of SNP rs36029 (A/G) revealed no significant association with responder/non-responder or remitter/non-remitter groups, nor with the eight most common side effects, except memory loss, which showed a significant (p = 0.029). For SNP rs5529 (G/A/C), the wild-type allele (G) was predominant among responders (56 patients, 37.3%), while mutant alleles A (19 patients, 12%) and C (1 patient, 0.7%) were less common. In non-responder groups, the G allele was less frequent (34 patients, 12.5%), with higher prevalence of A (29 patients, 17.3%) and C (11 patients, 7.3%). These findings suggest that mutant alleles, especially C, may reduce treatment efficacy. Notably, the NET rs5569 allele C has not been previously reported in the Indian population.Image 1:

This study suggests that while SNP rs36029 (A/G) showed no association with treatment response, it was significantly linked to memory loss. In contrast, SNP rs5529 (G/A/C) indicated that mutant alleles, particularly allele C—reported for the first time in the Indian population—may contribute to reduced antidepressant efficacy. Studies with larger samples are required to find out the genetic basis of antidepressant response in Indian patients.

None Declared

Virtual Reality Exposure Therapy (VRET), a promising integration of technology and psychotherapy, enables clinicians to safely use controlled simulations of traumatic environments for therapeutic processing. Traditional trauma-focused therapies often face developmental barriers, avoidance, or emotional overload, particularly in childhood trauma. VRET provides a structured, modifiable, clinician-guided setting that engages the sensory and emotional components of trauma while overcoming key limitations of conventional approaches.

We explore the therapeutic, neurobiological, and ethical foundations of VRET for childhood trauma through a narrative review, emphasizing how immersive environments can safely evoke traumatic memory reconsolidation and emotional regulation under clinician supervision. The review aims to identify key design principles for developmental appropriateness, therapeutic pacing, and trauma-informed safety in VRET.

A comprehensive literature search was conducted in PubMed, Scopus, and PsycNet using the keywords “Virtual Reality,” “Virtual Exposure Therapy,” “Childhood Trauma,” and “Adverse Childhood Events,” with no temporal or geographical restrictions. After removing duplicates, studies were screened by title and abstract; relevant English-language original and review articles were included. Non-English publications, commentaries, editorials, and opinion papers were excluded. Additional references were identified through citation screening of key studies and a targeted open-source Google search to capture conceptually relevant material.

Recent studies indicate that VRET reduces post-traumatic stress, anxiety, and dissociation while maintaining psychological safety. In a randomized trial (n=72) with childhood trauma, participants showed significant improvements in depressive and trauma scores (p < 0.05) sustained for three months. A second trial (n=44) with childhood sexual abuse replicated these findings but found no remission difference versus standard therapy. Beyond treatment, VR aids diagnosis by assessing stress reactivity, psychosis vulnerability, and maladaptive schemas, though ethical and neurodevelopmental effects on memory and resilience remain underexplored.

Virtual Reality Exposure Therapy holds transformative potential in childhood trauma care, enabling clinicians to safely simulate and recontextualize traumatic environments within a framework of trust and therapeutic containment. By bridging neuroscience, technology, and developmental psychology, VRET may accelerate trauma processing and resilience-building in ways previously unattainable in traditional talk-based therapy. Ethical oversight, individualized calibration, and clinician training will be essential to ensure safety and emotional integrity as this technology moves toward broader clinical implementation.

None Declared

Suicide is a leading cause of death in the psychiatric population. The existing modes of treatment (pharmacological and psychotherapeutic) for suicidality are effective but have longer onset, this delay causing a dangerous therapeutic gap in an acute crisis. We compare the two fast-acting treatments, the newer psychopharmacological agent Ketamine and well-established neuro-modulatory electroconvulsive therapy (ECT), for acute suicidality.

Comparing efficacy, safety and side effect profiles of Ketamine and electroconvulsive therapy through a scoping review and meta-analysis.

PubMed was searched on 15 January 2025 without temporal and geographical restrictions, using keywords ‘Ketamine’, ‘Electroconvulsive therapy’ and ‘Suicidality’ yielding 916 records. After duplicate removal, 895 remaining records were screened and 52 relevant original research or meta-analysis were included as primary records. Non-original, non-English, non-human and not relevant were excluded (843 records). Additional 50 secondary sources were retrieved from 1) references of primary sources and 2) targeted open-source Google search while drafting the manuscript. The final 102 articles were subdivided into 3 subsections (30- ketamine + 57- ECT+ 15- comparison of modalities) for analysis. PRISMA-ScR guidelines were followed (Figure 1) and 5 different meta-analyses were conducted using RevMan 5.4.1.

Ketamine demonstrated high potential as an anti-suicidal agent. Clinical trials with suicidality as primary outcome showed significant improvement in scores on clinical suicidal scales with ketamine, with standard mean difference (SMD) of -1.24 (95% CI [-1.79, -.068], Z = 4.34, p < 0.0001), but the heterogeneity was high (I2= 92%). Trials with suicidality as secondary outcome also showed significant improvement with SMD -0.79 ([-1.00, -0.57], Z= 7.28, p< 0.00001; I2= 0%) (Figure 2). The research in last 10 years demonstrate that the risk of suicide was significantly decreased by 22% with ECT (overall hazard ratio: 0.78, 95% CI [0.68, 0.90], Z = 3.52, p = 0.0004; I2= 0) (Figure 3). In psychopharmacological era, suicide and suicide attempt rates improved with ECT, with significant peto-odds ratio (OR) of 0.80 (95% CI [0.73, 0.88], Z = 4.85, p < 0.00001), but the heterogeneity was high (I2= 65%). Research from the shock therapy era was inconclusive with fallacious methodology. Ketamine has a rapid but short-lived effect with the side effects of dissociation, increased blood pressure, and nausea. In contrast, ECT requires multiple sessions, but a long-lasting impact, with cognitive side effects.Image 1:

Ketamine and ECT both have comparable efficacy in treating acute suicidality, despite different onset of action. The decision between ketamine and ECT should be individualized, guided by clinical urgency, patient preference, and contraindications.

None Declared

There is an increased recognition of the role of systemic inflammation, mediated through inflammatory markers like IL-6, CRP, in pathophysiology of psychiatric disorders like depression, schizophrenia and substance abuse. While bidirectional influence of chronic pain and psychiatric morbidity is also understood, large-scale, real-world estimates on this topic remain limited. We aim to bridge this gap through a cohort study using TriNetX.

To compare 5-year risk of major depressive disorder (MDD), suicidality, and substance use disorder (SUD) in chronic pain patients with high vs. low inflammatory biomarkers.

We used the TriNetX US Collaborative Network (71 health systems). Adults (≥18y) with chronic pain (ICD-10: G89.21, G89.28, G89.29, G89.4, M79.7) were stratified by inflammatory status using most-recent lab thresholds, each with ≥2 instances: high inflammation (ESR ≥20 mm/h [LOINC 4537-7], CRP ≥3 mg/L [1988-5], hs-CRP ≥3 mg/L [30522-7], or haptoglobin ≥200 mg/dL [4542-7]) vs. low (≤ these thresholds). Index was first date meeting pain + lab criteria; outcomes were assessed from day 1 to 5 years. Propensity-score matching (1:1) balanced demographics (642,785 per group post-match). We ran risk analyses excluding prior outcomes and Kaplan–Meier with log-rank tests and hazard ratios (Table 1)

After matching, MDD risk over 5 years was 19.2% in the high-inflammation cohort vs. 17.9% in low-inflammation (risk ratio [RR] = 1.074, 95% CI 1.064–1.083; HR = 1.162, 95% CI 1.151–1.174; log-rank p<0.001). Suicidality risk was 2.1% vs. 1.8% (RR = 1.170, 95% CI 1.141–1.199; HR = 1.247, 95% CI 1.216–1.279; p<0.001). SUD risk was 11.5% vs. 10.3% (RR = 1.112, 95% CI 1.100–1.125; HR = 1.188, 95% CI 1.174–1.203; p<0.001) (Table 2). Absolute risk differences were +1.3% (MDD), +0.3% (suicidality), and +1.2% (SUD).Image 1:

Among adults with chronic pain, elevated inflammatory biomarkers are associated with higher 5-year incidence of MDD, suicidality, and SUD. Findings support routine mental-health screening when inflammatory markers are elevated and motivate trials testing anti-inflammatory or immunomodulatory strategies alongside standard psychiatric care. Observational design and EHR limitations (measurement variability, residual confounding) apply.

None Declared

Psychedelic-assisted psychotherapy has re-emerged as a frontier of psychiatry, offering transformative potential for conditions resistant to conventional treatment. Personality disorders—particularly Borderline Personality Disorder (BPD)—are marked by affective instability, interpersonal dysfunction, and maladaptive relational patterns that often limit therapeutic progress. MDMA’s capacity to enhance empathy, reduce fear, and foster interpersonal trust may open a novel translational pathway for repairing disrupted attachment and self-structure in Cluster B disorders, integrating neurobiological, psychotherapeutic, and relational mechanisms within a unified model of healing.

To develop a conceptual and translational framework for the potential use of MDMA-assisted psychotherapy in Cluster B personality disorders, integrating neurobiological, psychotherapeutic, and ethical dimensions.

A comprehensive search was conducted across PubMed, Scopus, and PsycNet using the terms “MDMA,” “MDMA-assisted therapy,” and “personality disorders.” No temporal or geographical limits were applied. After removing duplicates, articles were screened by title and abstract. Eligible studies included peer-reviewed original and review papers in English. Non-English publications, editorials, and opinion pieces were excluded. Additional sources were identified by reviewing reference lists of primary studies and conducting a targeted open-source Google search to capture conceptually relevant material.

MDMA acts as an entactogen, enhancing empathy, interpersonal connection, and emotional openness through serotonergic, dopaminergic, and noradrenergic modulation. These mechanisms may help correct the emotional dysregulation, diminished empathy, and relational instability central to Cluster B pathology. Two cohort studies (n = 21; n = 55) reported improved functioning and reduced anxiety, depression, and suicidality following psychedelic interventions. Conceptual models of MDMA-assisted therapy highlight increased prosocial affect and relational attunement, while early BPD trial designs suggest benefits in emotional regulation, reduced avoidance, and stronger therapeutic alliance, though empirical evidence in Cluster B disorders remains limited.

MDMA-assisted psychotherapy may represent a promising adjunctive approach for Cluster B personality disorders by targeting deficits in attachment, trust, and emotion regulation. The proposed framework underscores the need for ethically grounded pilot trials, specialized therapist training, and robust safety monitoring. By bridging neurobiology and psychotherapy, MDMA-AT could advance integrative, relationally informed models for treatment-resistant personality pathology and encourage interdisciplinary collaboration within modern psychiatry.

None Declared

Suicide prevention training for educators is critical for early identification and intervention with at-risk youth.

To evaluates the effectiveness of a Gatekeeper Training (GKT) program towards suicide prevention awareness and self-efficacy among Public School Educators educators in Rajasthan, India.

The current study was planned as part of National Health related priority project funded by Indian council of Medical Research. An implementation study was carried out for government schools for Rajasthan, India where educators were invited to engage in gatekeeper training for enhancing suicide prevention knowledge and their perceived self-efficacy in improving student’s mental wellbeing. Quantitative outcomes included knowledge/awareness and self-efficacy scales, analysed with paired and independent t-tests and effect size calculations (Cohen’s d). Thematic analysis was conducted for open ended discussions captured throughout the sessions.

A total of 126 educators from urban Jodhpur schools participated (50.8% female; mean age = 43.8 years, mean experience = 16.7 years), Significant improvements were observed in both awareness (mean increase = 1.04, Cohen’s d = 0.615, p < 0.001) and self-efficacy (mean increase = 1.16, Cohen’s d = 0.524, p < 0.001), both reflecting medium effect sizes. The strongest gains were reported for identifying warning signs (d = 0.806, large effect) among at risk students. Male educators showed significantly higher post-intervention awareness (p = 0.024), self-efficacy (p = 0.001), and intervention acceptability (p = 0.040) than females. Implementation measures (acceptability, appropriateness, feasibility) scored high (≥85% of maximum). Qualitative themes revealed improved understanding of suicide as a process, enhanced empathy, and myth-busting of common misconceptions.

The gate keeper training program was well-received, feasible, and effective for public funded school educators. Male educators reported somewhat higher post-training gains as comapred to female educators. Thematic analysis highlighted increased sensitivity to warning signs and the importance of empathetic, private dialogue with at risk students realised among educators after training sessions.

None Declared

Depression often shows suboptimal outcomes with antidepressants, with ~66% response and ~37% remission after 6 weeks of treatment (MDD-1 India study). Renin–angiotensin–aldosterone system (RAAS) has been implicated in mood regulation through its effects on neuroplasticity, inflammation, and stress. While ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely prescribed for cardiovascular disease, their influence on antidepressant response and RAAS-related mechanisms remains underexplored.

To evaluate influence of ACEI/ARBs on antidepressant treatment response and correlate them with RAAS and depression related biomarkers.

This prospective observational study included patients with depression who were going to receive antidepressants for 6 weeks. They were divided into two groups: a. AD group: only antidepressants, b. AD+ACEI/ARBs group: antidepressants with ongoing ACEI/ARBs treatment for ≥ 3 months. Depression severity was assessed using Hamilton Depression Rating Scale (HDRS-17) at baseline and 6 weeks. Serum biomarkers (ACE, Ang II, Ang 1–7, renin, BDNF, cortisol) were quantified by ELISA, and gene expression (ACE, AT1R, AT2R, MasR) was analysed in peripheral blood by qRT-PCR. Safety of medications was evaluated through routine laboratory tests.

This study included 186 patients with depression (AD group: n=102; AD+ACEI/ARB group: n=64) and 20 healthy controls. Reduction in HDRS-17 score was greater within the AD+ACEI/ARB group (22.19 ± 7.15 to 10.61 ± 4.00) compared with AD group (21.97 ± 7.54 to 13.24 ± 6.50; p=0.001). Responder rate (≥ 50% reduction in HDRS score from baseline) was higher in AD+ACEI/ARBs (p=0.001) compared to AD group. At baseline AD+ACEI/ARB group had significantly lower serum ACE (p=0.022) compared to AD group. At 6 weeks of follow-up there was significant reduction in Ang II level (p = 0.002) in AD+ACEI/ARBs group compared to AD group. At baseline gene expression analysis showed upregulation of MasR (p = 0.022) and downregulation of ACE (p = 0.049) in the AD+ACEI/ARB group (with ≥ 3 months ACEI/ARB treatment) vs AD group. However, at follow-up there was no significant change among AD vs AD+ACEI/ARBs group in serum Ang 1–7, renin, BDNF, cortisol levels, and gene expression of AT1 and AT2 receptors.

Adjunctive ACEI/ARB therapy improves antidepressant treatment response, which may be ascribed to the modification of RAAS-related biomarkers. This was reflected through reduction in serum ACE and Ang II levels, downregulation of ACE and upregulation of MasR expression.

None Declared

GLP-1 receptor agonists (GLP-1RAs) reduce appetite, energy intake, and serum glucose levels by activating glucagon-like peptide-1 (GLP-1) receptors. They, potentially, act on the central and peripheral nervous system to reduce nerve damage, inflammation, and pain hypersensitivity. Fibromyalgia (FM) presents with neuropathic pain and small fiber neuropathy, resulting in significant opioid use, estimates range from 20-55%. We hypothesize that GLP-1RAs might prove to be opioid sparing, reduce acute care use, and increase the overall mental health quality in FM

Compare the pain-related medication burden, acute-healthcare use, and psychiatric outcomes in adult patients with comorbid FM and obesity utilizing GLP-1RAs vs. other anti-obesity pharmacotherapies in a cohort design

We conducted a retrospective, multi-network cohort study on the TriNetX Research Network. Adults (≥18 years) with an FM diagnosis (ICD-10-CM M79.7) and ≥12 months of data before and after the index drug initiation (GLP-1RAs) were eligible. The exposure was incident GLP-1RA initiation (semaglutide, liraglutide, exanatide, lixisenatide, dulaglutide, or tirzepatide) identified in EMR; the comparator was patients with FM without GLP-1RA exposure on a random outpatient visit. Propensity scores using demographics, BMI, type 2 DM, baseline pain score, PHQ-9/GAD-7 score, antidepressant/anxiolytic use, ED visits, and comorbidities (depression, anxiety, OSA, osteoarthritis). Primary outcome: Comparing any opioid fills. Secondary outcomes: Comparing neuromodulator/adjunct fills (duloxetine/ pregabalin/gabapentin/tizanidine), pain-related ED/hospital utilization, and symptom-burden proxies (PHQ-9 ≥10, GAD-7 ≥10, or pain NRS ≥4 where available). Analyses used measures of association, Kaplan-Meier, and number-of-instances. Patients with pre-window outcomes were excluded, and propensity score matching was applied (Figure 1).

After exclusions, opioid risk was lower with GLP-1RA vs comparator (risk 0.334 [7,574/22,686] vs 0.460 [13,690/29,767]; risk ratio 0.726, 95% CI 0.710-0.742). Opioid hazard was lower (HR 0.893, 95% CI 0.868-0.919; log-rank p<0.001). Opioid instances per patient were also lower (mean 1.34 vs 2.55; t=−22.35, p<0.001) (Figure 2). Neuromodulator/adjunct fills showed lower risk with GLP-1RA (0.246 vs 0.329; RR 0.748, 95% CI 0.732-0.765). A composite of pain-related ED/hospital outcomes favored GLP-1RA (risk 0.424 vs 0.494; RR 0.858, 95% CI 0.837-0.880) (Figure 3). Symptom-burden proxies were infrequent overall but nominally lower with GLP-1RA (RR 0.756, 95% CI 0.634-0.903).Image 1:

In a large national EHR network, GLP-1RA initiation among adults with FM and obesity was associated with clinically meaningful reductions in opioid exposure and other pain-related utilization over 6-12 months. Our findings support prospective evaluation of GLP-1RAs as adjuncts for FM care and opioid-sparing strategies.

None Declared

India has a complex relation with concepts of gender and sexuality. While a third gender or nature has been recognized since ancient time, India decriminalized homosexuality only in 2018, after waking up from its colonial hangover. Existing stigma in Indian society results in complex trauma and high psychiatric morbidity.

We explore the challenges faced, mental health struggles and resources available to the LGBTQ community through this narrative review. Additionally, we suggest adaptations to trauma and dissociation informed therapy to ideally support the Indian queer community.

We searched PubMed using keywords “LGBT India mental health”, “LGBT Trauma psychotherapy”, and “LGBT India”, yielding 174 studies. Inclusion Criteria: relevant English original or meta-analytic studies from India. Exclusion criteria: non-English, non-Indian, inaccessible studies. After duplicate removal, abstract screening and full text analysis, a total of 37 studies (6 studies- LGBT Statistics, 13 studies- struggles of LGBT Indian community, 11 studies- mental health impact, 9 studies- available resources, and 7 studies- trauma and dissociation informed therapy) were included for this narrative review (Figure 1).

Familial, communal and police violence against the LGBTQ+ still exists in India. Stigma, microaggressions, homophobia, re-traumatization in healthcare causes complex PTSD and other psychiatric disorders (Figure 2). Government, non-profit and community-based interventions are lacking. Individually-tailored, socially-sensitive trauma-informed therapy would be ideal for the Indian queer community. ‘Narrative exposure therapy’ creating culturally empowering narratives, ‘Mentalization-based therapy’ reducing internalized stigma, ‘Prolonged exposure group therapy’ building a support system, ‘Milan family therapy’ combating negative stigma and ‘somatic therapy’ reclaiming one’s body, would help adapt existing western trauma and dissociation informed therapy models for the LGBTQ+ population in India (Figure 3).Image 1:

By adapting a model of trauma informed therapy for the Indian LGBTQ+ community, we provide culturally and ethically sensitive recommendations for mental health professionals through this narrative review.

None Declared

Suicidality is a significant concern in patients living with chronic pain, with suicidal ideation reported in 18-50% of this population, and 5-14% attempting suicide. GLP-1 receptor agonists (GLP-1RAs) reduce pain hypersensitivity by acting on peripheral and central nervous systems through glucagon-like peptide-1 (GLP-1) receptors. GLP-1R–based anti-obesity/diabetes therapies, can potentially be useful in high-risk groups such as those with chronic pain, a research gap we aim to fulfill through this cohort study.

To compare 12-month risk of suicidality and related psychiatric/health-services outcomes among chronic-pain patients initiating GLP-1 therapies versus other anti-obesity medications (AOMs).

Retrospective cohort using TriNetX US Collaborative Network (72 HCOs). Adults (≥18) meeting a prespecified chronic-pain phenotype (ICD-10: G89.2x, G89.4, M79.7, chronic headache subtypes, vertebrogenic/other low-back pain, osteoarthritis subtypes) formed the base population. Exposure: GLP-1 agents (semaglutide, liraglutide, dulaglutide, exenatide, lixisenatide, tirzepatide); Comparator: non-GLP AOMs (orlistat, phentermine, bupropion, naltrexone, topiramate). Cohorts mutually excluded the other drug class. Index = first qualifying medication after pain documentation. Outcomes (12-month window, excluding prior outcome): suicidal ideation (R45.851), suicide attempt (T14.91*), any ED visit (CPT 99281–99285), and exploratory psychiatric outcomes (F32.9 depression, F41.9 anxiety, G47.00 insomnia, F11.20 opioid dependence). Propensity-score matching (1:1) balanced age, sex, ethnicity, type-2 diabetes, and BMI percentile.

After matching (N=501,736 per arm) (Table 1), GLP-1 initiation was associated with lower risk of:

Suicidal ideation: RR 0.19 (95% CI 0.17–0.20); HR 0.21 (0.19–0.22).

Suicide attempt: RR 0.13 (0.10–0.17); HR 0.15 (0.11–0.19).

Any ED visit: RR 0.77 (0.76–0.79); HR 0.86 (0.84–0.88). Exploratory outcomes were concordant: depression RR 0.18, anxiety RR 0.42, insomnia RR 0.48, opioid dependence RR 0.25 (all p<0.001) (Table 2).Image 1:

In adults with chronic pain, GLP-1 therapy versus other AOMs was associated with substantially reduced 12-month suicidality and reduced acute care utilization, with consistent reductions across psychiatric endpoints. These findings are hypothesis-generating and require confirmation with additional confounding control (e.g., baseline psychiatric burden), sensitivity analyses (new-user washout, early-risk windows), and prospective designs.

None Declared

Autism spectrum disorder (ASD) affects approximately 1 in 36 children globally, with limited evidence-based treatments addressing core symptomatology. The emerging regenerative medicine approaches using stem cell therapy have shown potential for modulating neuroinflammation and enhancing neuroplasticity in neurodevelopmental conditions. However, the clinical efficacy and safety profile of stem cell interventions for ASD remains uncertain.

This study aims to perform a systematic review and meta-analysis of clinical studies evaluating the efficacy and safety of stem cell therapy in children with autism spectrum disorder, as well as to identify optimal treatment protocols and patient selection criteria.

A comprehensive systematic review was conducted in accordance with the PRISMA guidelines across multiple databases (PubMed, Scopus, PsycINFO) on September 17, 2025, yielding a total of 1,698 records (Figure 1). After removing 399 duplicates, the remaining 1299 records were screened based on title, abstract, and full-text analysis. Inclusion criteria: (1) randomized controlled trials, controlled clinical trials, and open-label studies; (2) participants diagnosed with ASD using standardized criteria (DSM-5, ADOS, ADI-R); (3) stem cell interventions (mesenchymal stem cells, umbilical cord blood, neural stem cells); (4) standardized outcome measures. Exclusion criteria: preclinical studies, case reports, and non-English publications. Two independent reviewers conducted data extraction and quality assessment (Risk of Bias). Cochrane RevMan 5.4 was used for meta-analysis.

All 22 studies demonstrated the efficacy of stem cell therapy in the treatment of ASD. Autism Spectrum Disorder was diagnosed according to the DSM-5 TR criteria. The Childhood Autism Rating Scale (CARS), Autism Treatment Evaluation Checklist (ATEC), Vineland Adaptive Behavior Scales (VABS), Aberrant Behavior Checklist (ABC), and Pervasive Developmental Disorder Behavior Inventory T-score (PDDBI) were used to evaluate autism at various durations during clinical trials. A statistically significant overall improvement in ASD was seen post-treatment with stem cells, on meta-analysis, with a pooled standard mean difference (SMD) of -1.03 [95% CI (-1.23, -0.83), Z=10.03, p<0.00001] but with high heterogeneity (I2= 95%) (Figure 2). Few studies also found stem cell therapy to be more effective than placebo, with SMD of -4.99 [95% CI (-8.11, -1.88), Z=3.14, p=0.002] with low heterogeneity (I2=0%) (Figure 3).Image 1:

The existing literature exhibits the efficacy of stem cell therapy as a treatment for autism spectrum disorder. Further clinical trials of stem cells in varied geographical locations and minorities with ASD should be spearheaded to assess the efficacy in all populations. Existing protocols for the treatment of ASD should be modified to reflect our findings.

None Declared

Use of opioids peri-operatively, for both analgesia and anesthesia, is being highlighted negatively due to the opioid crisis in the United States. There is evidence that being exposed to opioids peri-operatively, alters neurobiology by disrupting the dopamine and serotonin pathways, through action on the hypothalamic-pituitary-axis, especially in the pliable adolescent brain. This can result in development of long term psychiatric comorbidity, opioid use disorder and consequent increased emergency healthcare visits.

To test whether perioperative opioid exposure after common adolescent procedures is associated with long-term psychiatric diagnoses, emergency department (ED) utilization, overdose, and indicators of opioid use treatment, when compared with non-opioid analgesia.

We conducted a retrospective cohort study on the TriNetX US Collaborative Network (71 health systems). Adolescents aged 12–19 undergoing common procedures (appendectomy, tonsil/adenoid, select orthopedic and dental procedures) were identified. The opioid cohort had a perioperative opioid use (−3 to +7 days around surgery); the comparison cohort had no perioperative opioid use. Key exclusions at baseline: prior opioid-related disorders (F11), any substance-use disorders (F10–F19), and chronic pain (G89.2). Outcomes (depression, anxiety, PTSD, sleep disorders, suicidal ideation/attempt, ED utilization, opioid poisoning/overdose, long-term opioid therapy [Z79.891], and MOUD/overdose-related medications [buprenorphine, methadone, naltrexone, naloxone]) were assessed from day 1 to 3,650 (~10 years) post-index. Propensity score matching 1:1 was performed on age, sex, and ethnicity; measures of association and Kaplan–Meier analyses were run on matched cohorts (Table 1).

After matching (n=77,810 per cohort), perioperative opioids were associated with higher risk of depression (RR 1.195, 95%CI 1.126–1.268), anxiety (RR 1.215, 1.168–1.264), sleep disorders (RR 1.296, 1.238–1.356), suicidal ideation/attempt (RR 1.121, 1.027–1.223), ED utilization (RR 1.187, 1.158–1.215), and opioid poisoning/overdose (RR 1.522, 1.049–2.208). Long-term opioid therapy (Z79.891) was not increased (RR 0.952, 0.820–1.104). Initiation of MOUD/overdose-related medications was markedly higher (RR 2.912, 2.572–3.298). Notably, PTSD diagnoses were lower in the opioid group (RR 0.581, 0.554–0.608). Kaplan–Meier results were directionally consistent for most outcomes (Table 2)Image 1:

In adolescents undergoing common procedures, perioperative opioid exposure was associated with small-to-moderate increases in long-term depression, anxiety, sleep disorders, suicidal ideation/attempt, ED utilization, and overdose, and a large increase in MOUD/overdose-related medication exposure. Findings support minimizing perioperative opioid exposure and proactive mental-health surveillance after surgery.

None Declared

Pseudologia fantastica (PF), also referred to as pathological lying in literature, consists of fantastically fabricated distortions with no apparent reason or personal gain. PF is not recognized as an independent clinical entity in the DSM-V, resulting in a diagnostic challenge and significant legal implications for competency assessment to stand trial.

Discuss demographics, intention and content of the fabrications, reaction on confrontation, psychiatric comorbidities and concurrent substance abuse associated with pseudologia fantastica through a systematic review and qualitative analysis.

We conducted a systematic search through 3 databases - PubMed, PsycINFO, and Scopus, to discuss the demographics, substance use, dynamics of the lies told by the patients with PF, and their psychiatric comorbidities. After applying inclusion and exclusion criteria for the title, abstract, and full-text assessments, we included a total of 34 articles consisting of 55 cases of PF in our final study. PRISMA guidelines were followed throughout (Figure 1).

A total of 55 cases from existing literature were selected and evaluated. Approximately 49% of pseudologues presented in their 3rd and 4th decade of life with a marked male predominance (72.73%). The three leading motives behind the fabrications seemed to be self-aggrandizing (38.18%), seeking attention (36.36%), and assumption of a sick role (29.09%). Exaggerations about life events (38.18%), education, and occupation (43.64%) closely followed health-related lies (67.27%) closely (Figure 2). Pseudologues assumed a different name/identity (32.73%), which posed serious legal ramifications. The most common psychiatric comorbidities associated with PF were cluster B personality disorders (25.45%), depressive disorders (16.36%), trauma/stress disorders (16.36%), and somatic and factitious disorders (14.55%) (Figure 3). Pseudologues also exhibited high suicidality (27.27%), with 16.36% attempting suicide. Substance abuse was also prevalent (30.91%), with significant alcohol use disorder (21.82%).Image 1:

PF puts considerable strain on employment, societal relationships, and legal and medical systems, and it is crucial to identify it early and empower physicians and law practitioners on best practices to manage the condition.

None Declared