Although heightened anxiety associated with social interaction or evaluation is the core diagnostic criterion for social anxiety disorder (SAD), there is growing evidence that SAD is characterized by more pervasive reactivity beyond social situations. We employed Ecological Momentary Assessment (EMA) to describe the affective dynamics and emotional reactivity to daily events in a community-based sample of adults with SAD compared with other anxiety disorders, and controls without anxiety or mood disorders.

A sample of 236 adults with a lifetime diagnosis of SAD (n = 53), other anxiety disorders (n = 120), and no mood or anxiety disorder (n = 63) based on comprehensive diagnostic interviews answered brief electronic interviews that assessed daily life events and mood and anxiety symptoms four times a day for two weeks. Linear mixed models were used to quantify reactivity to daily life events.

Persons with SAD had higher average levels of sad and anxious mood than those with other anxiety disorders or controls. Irrespective of comorbid mood disorders, people with SAD also demonstrated significantly greater decreases in both sad and anxious mood following positive events, and a greater increase in anxious mood following negative, particularly non-social events.

Our findings regarding pervasive reactivity beyond the social context in people with SAD confirm the need for broader conceptualization of this disorder as well as expansion of interventions beyond the social context. This work also demonstrates the utility of EMA as a powerful tool to track individual variability and reactivity in daily life that can inform etiology, treatment and prevention.

Functional Neurological Disorder (FND) is a well-recognised disorder that is seen by both neurology and psychiatry services. It is an unconscious disorder that may involve motor or sensory neurological symptoms, classically ascribed to underlying psychological distress, the aetiology of which can sometimes be difficult to ascertain.

This case presented highlights several key features of FND.

Presentations can involve pain and may evolve to involve multiple locations that may not follow a neuroanatomical distribution.

There may be initial reluctance of the patient or family to accept the diagnosis.

These can be difficult cases but there is potential for improvement with multidisciplinary support.

Inclusion of the patients’ perspective of going through the diagnostic process, in this case, gives a unique perspective of being a patient with this disorder,

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A young female presented to the emergency department with acute onset severe right facial pain, subjective facial swelling, minor ptosis of the right eyelid and headache. Symptoms evolved over the next week to include speech disturbance, right shoulder pain, and reduced sensation in her right arm. After initial extensive negative work, it was felt that the patient most likely had a functional neurological disorder and underwent multidisciplinary treatment. The patient represented four months later after a minor fall at work with re-emergence of the right arm and facial pain associated with speech disturbance. Relapsed functional neurological disorder (FND) was diagnosed. A multidisciplinary team (MDT) approach with neurology, liaison psychiatry, speech and language therapy (SALT), physiotherapy and psychotherapy was instituted resulting in the resolution of symptoms. FND is a common disorder in which clinicians receive limited training. This case highlights a complex presentation of FND including “pseudoptosis”, a rarely seen functional symptom, and how MDT input led to symptomatic improvement. Relapse of FND is not uncommon, sometimes after minor physical or psychological stress or trauma. There is hope to improve symptoms when this happens. Our review also includes the patient’s perspective of going through the FND diagnosis.

Functional Neurological Disorders are common and greater training in and understanding of these disorders is important.

Symptoms that are rarely functional such as ptosis, do not exclude FND.

FND can be a difficult diagnosis for patients and families to accept, but accepting the diagnosis is key to appropriate treatment and recovery

An MDT approach incorporating neurology, psychiatry, physiotherapy, psychology, speech and language therapy and occupational therapy provides the best opportunity for recovery.

Early diagnosis and multi-disciplinary treatment can aid recovery, reduce the development of further disability and reduce healthcare utilisation and costs.

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Major Depressive Disorder (MDD) is a neuropsychiatric condition whose neurobiological characteristics include alterations in brain plasticity, modulated by Brain Derived Neurotrophic Factor (BDNF). In animal models, Environmental Enrichment promotes neuroplasticity and reduces depressive-like behaviors. It has been proposed to measure the level of Enriched Environment (EE) as a protective or risk factor for the development and severity of MDD using the EE Indicator (EEI).

Determine the relationship between the level of EE and serum levels of BDNF in participants with MDD and healthy controls.

Treatment-free MDD patients and controls were recruited, who underwent an analysis of their LES, clinical factors, and serum BDNF levels.

25 participants were recruited, of which 6 participants with MDD and the same number of controls were selected in a paired manner, who were divided into two groups:

medium and low EE. Although no differences were found between the concentration of BDNF between the groups, positive correlations were observed between social EE and BDNF, as well as negative correlations between this same domain with the Hamilton scale score for depression and the presence of this condition. No differences were found in the EE groups classified by total score between the cognitive, social and physical domains; But when breaking them down, it was observed that the sum between cognitive and social EE has a positive correlation with the serum concentration of BDNF (p=0.0451).

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The level of EE is potentially modulating the presence and severity of MDD at a clinical level, but it can also influence at a neuroplastic level through promoting or limiting the concentration of BDNF.

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The month of Ramadan, a sacred period in the Islamic calendar, is a time of fasting, prayer, and reflection for millions of Muslims worldwide. While the effects of fasting on physical and mental health have been extensively studied, there has been little focus on its specific impact on sexual life, particularly in the Tunisian context.

The aim of our research was to study the opinions of Tunisians regarding their sexual behavior during the month of Ramadan.

This was a retrospective, descriptive, and comparative study conducted through an online survey among Tunisian adults. Data collection was carried out via a self-administered online questionnaire during Ramadan 2024, from March 21 to April 4, 2024. Two reminders were sent and the anonymity of the responses was guaranteed.

Our study included 130 Tunisian adults with a mean age of 28.69 years. The majority of our population resided in urban areas (98.5%), 43.8% were single where 29.2% were in a relationship and both genders were equally represented (53.1% female, 46.9% male). The majority of participants identified as heterosexual (89.2%). During Ramadan, 78.5% of participants fasted, and 77.7% believed sexual activity was permissible during this period. Overall, 44.6% of participants felt that fasting had a negative impact on sexual behavior, 30.7% on sexual desire, and 26% on sexual performance. More than 70% reported that fasting influenced their sexual behavior, primarily in a negative way (44.6%). Among those who perceived an impact (n=93), changes were mostly noted in the timing (77.7%) and frequency of sexual activities (75.5%). Furthermore, 72.3% of participants reported that fasting influenced their sexual desire, with 40.9% perceiving this influence positively. Behavioral factors were identified as the most common cause of these changes (52.1%), followed by religious reasons (27.7%) and societal factors (11.7%). Significant gender differences were observed, with women being more affected by religious factors (p=0.02), while men were more influenced by behavioral factors (p=0.03). Women also reported a significantly greater impact on the frequency of sexual activity compared to men (p=0.012) and perceived a more significant negative impact of fasting on sexual performance compared to men (p=0.06).

Our study indicates that Ramadan fasting significantly affects the sexual lives of Tunisians, driven by sociocultural, religious, and physiological factors. This highlights the need for culturally sensitive sexual education and targeted health policies to ensure accessible and inclusive care during Ramadan.

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In certain cultures psychological suffering is expressed with more somatic symptoms. Besides, they tend to describe more often hallucinations and other forms of perception problems.

To describe and warn about the risks of misdiagnose when culture is not an element considered in the diagnosis.

Descriptive methodology based on practice and observation.

In the last year MSF has been working in more than 40 countries such as South Sudan and Chad with local and refugee populations. The teams have provided treatment to people with anxiety, trauma related and depressive disorders. However, we have also treated many people with hallucinations in the context of trauma, forced displacement. Several patients presented sudden, abrupt symptoms such as fear, insomnia, anxiety, and hallucinations. These hallucinations are often related to the potential traumatic event, to the witness of violence or displacement. When it appears accompanied by flashbacks, hypervigilance, and other PTSD symptoms it may be considered as PTSD with psychotic like symptoms. But other times these hallucinations seem to be more linked to a depressive episode or adjustment disorder. We have witness several cultures where hallucinations are very common during grief processes. The main risks of a misdiagnose of psychosis is the mistreatment.

On another note, it is known that migrant and refugee status are associated with a higher prevalence of psychosis. Using the cultural lenses, should we question these findings? Is there maybe a bias or misdiagnosis in some of these research?

Not all people with sensory perceptual alterations can be diagnosed with psychosis. A proper diagnose that is adapted to the culture of the person is essential for a good quality treatment.

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Galonal increases gamma-aminobutyric acid (GABA) neurotransmission in the brain by having a modulatory effect on neuronal GABAA-receptors (GABAA-R). The presence of functional GABAA-R on the surface of immune cells, in particular T-lymphocytes, which mediate modulation of the cell’s functional activity has also been described. Chronic alcohol use is associated with significant T-lymphocytes dysregulation within the adaptive immune system. It suggests that synthetic GABAA-R ligand Galonal, similar to its effects on neuronal cells, may cause modulation of the functional activity of the lymphocytes, thereby influencing the intensity of the immune response.

Considering the fact that GABAA-R proved to be the molecular targets of ethanol on the immune and nervous cells, we investigated behavior and immunomodulatory effects of the artificial GABA receptor ligand Galonal during long-term alcohol exposure to find new perspective pharmacological substances in the treatment of alcoholism.

Galonal (100 mg/kg) was administered in mice with 6-month 10% ethanol exposure (suspension of 1% starch mucus intragastrically) for 10 days, after which animal’s alcohol consumption, behavior and immune parameters were estimated.

After the course of Galonal administration a decrease in alcohol motivation and stimulation of exploratory behavior have been established in long-term alcoholized mice. An increase in the humoral immune response was also recorded, assessed by the absolute and relative numbers of AFC, to a level characteristic of healthy animals of the corresponding age. Significant stimulation of the cellular immune response, estimated by the DTH reaction and lymphocytes proliferative activity was also registered.

Galonal demonstrated positive neuroimmunomodulation effect during long-term alcohol exposure, therefore, its promising for clinical use in the treatment of alcoholism.

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Depression significantly affects patients with chronic kidney disease (CKD), with prevalence rates reaching up to 39% among those on hemodialysis, and is often overlooked in screening. This study aims to assess the PHQ-9’s effectiveness in Omani dialysis patients, potentially improving early detection and mental health care integration.

The objectives of this study are as follows: 1) To assess the sensitivity, specificity, positive predictive value and negative predictive value of the PHQ-9 in detecting depression among Omani renal dialysis patients at Al Seeb and Bausher dialysis units from October 2023 to January 2024. 2) To evaluate the psychometric properties of the PHQ-9, including the optimal cut-off score, internal consistency, and criterion validity, in Omani renal dialysis patients by January 2024

This cross-sectional study was conducted from October 1, 2023, to January 31, 2024, at two renal dialysis centers in Muscat, focusing on adults aged 18 and older who had undergone dialysis for at least three months. Data collection included a sociodemographic questionnaire, the Patient Health Questionnaire (PHQ-9) for depression symptoms, and the Structured Clinical Interview for DSM-5 (SCID-5) for psychiatric evaluation, with all ethical standards adhered to and Institutional Review Board approval obtained. Data analysis utilized MedCalc® software, with statistical significance set at p < 0.05, and the diagnostic accuracy of the PHQ-9 evaluated through ROC curve analysis.

The study included 209 patients with Chronic Kidney Disease (CKD), averaging 48.43 years, with demographics summarized in Table 1. The Patient Health Questionnaire-9 (PHQ-9) effectively screened for Major Depressive Disorder (MDD), achieving an AUC of 0.87, as illustrated in Figure 1, with an optimal cutoff score of 9, sensitivity of nearly 78%, and specificity of about 85%. Additional metrics are detailed in Table 2, confirming the PHQ-9’s overall accuracy of 83.25% in identifying depression, highlighting the importance of clinical evaluation for diagnosis.

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This study provides strong evidence for the validity and reliability of the PHQ-9 as a depression screening tool for Omani dialysis patients, emphasizing the need for culturally sensitive approaches in screening. It suggests adjusting cutoff scores to enhance diagnostic accuracy, with significant implications for clinical practice in Oman and similar regions. Healthcare professionals are urged to consider cultural factors when implementing screening protocols to improve patient care. Future research should broaden the validation of the PHQ-9 across other regions in Oman and the Middle East, examining how linguistic and educational differences may affect its effectiveness.

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Previous studies have indicated a potential increase in risks of mental disorders among the offspring of mothers with depressive disorders. However, the association between maternal exposure at different developmental periods, including the period around pregnancy, and the offspring’s risk for adverse mental health outcomes remain unclear. Additionally, there is a lack of studies controlling for potential confounding by familial factors.

To determine the association between the timing of maternal depression around pregnancy and the risk of mental disorders among the offspring.

Population-based cohort study using linkage from Swedish national registers including 4,051,192 live singleton births in 1973-2010. Individuals were followed from age 3 until the first date of mental disorders diagnosis, emigration, death or 31 December 2013. We included the following diagnoses: depression, postpartum depression, neurotic disorders, stress-related disorders, alcohol use disorders, drug use disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disability, behavioural disorders (child-/adolescent-onset), schizophrenia, other psychotic disorders, bipolar disorders, eating disorders, personality disorders, and others. Timing of maternal depression was defined as the earliest date of diagnosis or antidepressant dispensation around pregnancy, categorised into ‘1 year before conception’, ‘during pregnancy’, and ‘1 year after childbirth.’ Hazard ratios (HR) were estimated using Cox regression, adjusting for potential confounders. We also stratified the associations by age at follow up and birth year. To account for familial confounding, comparison was also made within full siblings.

In the population-based analysis, maternal depression was associated with a higher risk of overall mental disorder diagnosis in offspring in all three time periods, although the association tends to be stronger during the first year before conception (HR 1.90, 95% CI 1.78-2.03) and somewhat attenuated afterwards (HR during pregnancy 1.77, 95% CI 1.69-1.84; HR 1 year after childbirth 1.68, 95% CI 1.57-1.79; Figure 1). However, the associations were attenuated to null in the sibling analysis (HR overall mental disorders 1 year before conception 0.94, 95% CI 0.83-1.07; during pregnancy 1.08, 95% CI 0.98-1.17; 1 year after childbirth 1.00, 95% CI 0.88-1.13). Similar patterns were observed in most mental disorder diagnoses (Figure 1), across age at diagnosis (Figure 2), and birth year (Figure 3).

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While maternal depression before, during, and after pregnancy is predictive for the offspring’s mental health development, the link is likely driven by shared familial genetic and environmental factors.

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This research explores the intricate relationship between coping strategies, perceived stress levels, and life satisfaction among female medical professionals. The medical field is known for its rigorous demands, and understanding how lady doctors manage stress and its impact on their overall life satisfaction is crucial. While previous studies have shed light on stress-related issues in medical undergraduates, there is a significant gap in research focused on the well-being of practicing female doctors.

The objectives of this study are to investigate the relationship between coping behaviors and stress levels among lady doctors, assess the role of coping behaviors in shaping life satisfaction, explore the connections between coping behaviors, life satisfaction, and stress, and analyze the influence of demographic factors such as age and marital status on coping life satisfaction, and stress perception.

This study utilizes a quantitative research design and a purposive sample of lady doctors from government hospitals in Pakistan. Key measures include the COPE Inventory to assess coping behaviors, the Satisfaction with Life Scale to gauge life satisfaction, and the Perceived Stress Scale to measure stress levels. These tools allow for a comprehensive examination of the intricate interplay between these variables. SPSS 21 was used to analyze the data.

Results indicated that Coping is negatively correlated with Stress (r = -.29, n = 100, p = 0.05) meaning that higher coping strategies are associated with lower stress levels. Similarly, Coping is positively correlated with Life Satisfaction (r = .36, n = 100, p = 0.05) indicating that higher coping strategies are associated with higher life satisfaction. Likewise, Stress is negatively correlated with Life Satisfaction (r = -.22, n = 100, p = 0.05), suggesting that higher stress levels are associated with lower life satisfaction. Also, there is a statistically significant difference in coping between Single and Married individuals (t = 2.2, df = 36.6, p = 0.03), with Single individuals showing higher coping scores.

The findings of this study provide valuable insights into the psychological well-being of female medical professionals in Pakistan. This research contributes to the broader discourse on the well-being of healthcare professionals, shedding light on the unique experiences of female doctors in a challenging healthcare environment. Ultimately, it aims to inform policies and practices that support the psychological resilience and job satisfaction of female doctors, ensuring they can continue providing high-quality healthcare services to their communities.

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The COVID-19 pandemic has placed immense psychological pressure on healthcare workers (HCWs) worldwide. In addition to the physical risks of infection, HCWs have faced high levels of anxiety due to their proximity to the virus, overwork, and the challenges of providing care in an ever-evolving environment. These psychological effects are expected to persist well beyond the initial phase of the pandemic.

This study explores the long-term impact of COVID-19 on both anxiety and depression among HCWs and identifies the main contributing factors.

This cross-sectional study was conducted among HCWs infected with SARS Cov-2 between January and August 2022. Sociodemographic and professional data were extracted from participants’ medical records. Anxiety and depression were evaluated using the GAD-7 (Generalized Anxiety Disorder) and PHQ-9 (Patient Health Questionnaire) scales, respectively, through phone interviews conducted at least one year after their last COVID-19 infection

This study included a total of 184 healthcare workers (HCWs). The mean age of the participants was 41.93 years (± 8.6), with 95.1% being over 30 years old. Women comprised 81.4% of the cohort, and the majority of participants were nurses (45.7%), followed by administrative staff (20.1%). The median occupational seniority was 16 years. Notably, 28.3% of HCWs were employed in COVID-19 wards. Anxiety symptoms were reported by 92.9% of participants, with 17.3% experiencing mild anxiety, and 38.5% severe anxiety. Depression was prevalent in 69.1% of HCWs, with 27.2% presenting mild symptoms, and 24.5% experiencing moderate to severe depression. Female HCWs and those aged over 40 were significantly more likely to report symptoms of anxiety and depression (p < 0.001). Furthermore, HCWs with pre-existing conditions, such as diabetes, as well as those directly exposed to COVID-19 patients, exhibited significantly higher anxiety and depression scores. Nurses demonstrated particularly elevated levels of psychological distress, especially those working in COVID-19 wards.

The COVID-19 pandemic has had a profound and lasting psychological impact on healthcare workers, with anxiety and depression levels remaining elevated long after the acute phase of the crisis. This study emphasizes the need for targeted psychological support interventions. Addressing the mental health needs of HCWs is crucial not only for their well-being but also for ensuring the ongoing efficacy and resilience of the healthcare workforce in times of crisis. Further research is warranted to explore long-term impacts and effective strategies for mental health support in this population.

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The presence of borderline personality disorder (BPD) in cancer patients can be a risk factor for adherence to oncological treatment.

To analyze problems related to adherence to treatment of patients with borderline personality disorder (BPD) in comorbidity with gynecological cancer.

Clinical histories and subsequent interviews of patients (“A” and “B”), both 25 years of age. “A” with a diagnosis of Cervical Cancer in 2022, without adherence to treatment, irritable, unmotivated, with emotional instability in her relationships, chronic emptiness, impulsivity, risky sexual behaviors, self-harm, and suicidal thoughts. B, diagnosed with endometrial cancer in January 2023, presents treatment adherence with extreme fear of abandonment, irritability, anhedonia, anxiety, low self-esteem, impulsivity, and suicidal ideas. Both receive psychotherapy at the Psychooncology and Palliative Care clinic. Scales from the General Health Questionnaire (GHQ-28) and McLean Screening Instrument for Borderline Personality Disorder were applied.

Anxiety, lack of control, and rebellion manifested A’s lack of adherence. B’s “adherence” is redefined as separation anxiety, currently deposited in her partner and the oncology team. They evoked physical and sexual violence experienced since childhood and drug abuse, which influenced her anger and attitude towards cancer treatment for being “captives” of the disease. Thus, she denied A her dependency needs and B her fear of her partner’s abandonment and her suicidal thoughts.

Internal conflicts are expressed through self-destructive behavior: addressing her fears allowed her to continue treatment. Psychotherapy limited his judgment, cognitive, and reasoning lapses. They mentalized stories of abuse, early violence, and behaviors that limited their quality of life before and after cancer, improving their treatment adherence.

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Lithium is used as a first-line treatment in perinatal bipolar disorder. Lithium is almost exclusively renal eliminated without undergoing metabolization. Renal changes associated with pregnancy are responsible for alterations in lithium pharmacokinetics that may impact lithium efficacy and toxicity in mother. Characterization of the trajectory of lithium disposition during the perinatal period (previous year of pregnancy, pregnancy and first year postpartum) is necessary to monitoring and dose adjustments to prevent bipolar symptom recurrence while minimizing adverse effects.

To characterize the disposition of lithium during the perinatal period ant to evaluate whether changes in serum lithium concentration are consistent with changes in renal function (creatinine).

Women treated with lithium carbonate and referred to the perinatal psychiatry out-patient clinic of a single tertiary university hospital (November 2006 -December 2018), were evaluated for eligibility to participate in this retrospective observational cohort study (HCB/2020/1305). The basis of this study was all samples analysed in the same laboratory for lithium during perinatal period obtained at steady-state and predose. Serum creatinine concentrations measurements were also extracted. Lithium concentrations were determined by means of an AVL 9180 electrolyte analyzer based on the ion- selective electrode (ISE) measurement principle. Detection limit (LoD) was 0.1 mEq/L and limit of quantification (LoQ) 0.2 mEq/L. Serum creatinine concentration was determined by molecular absorption spectrometry. Detection limit (LoD) was 0.10 mg/dL, and the limit of quantification (LoQ) was 0.15 mg/dL Linear mixed models were used to analyze lithium and creatinine serum concentrations.Time points extractions and lithium dose were included as fixed effects, while the individual mother was included as a random effect to account for repeated measurements.

In total, 1260 lithium and 1174 creatinine serum concentration measurements from 109 pregnancies of 95 women were available. Dose-ajusted serum lithium concentrations (C/D ratio) decreased and average of 23.9% and 27.6% during the first and second trimesters respectively, increased slightly in the third trimester but remained 16.9 % below the prconception time (reference period) and increased postpartum 11% . Serum creatinine concentration evidenced a similar longitudinal pattern during pregnancy (decreased 20%, 26.1% and 22.3% in first, second and third trimester respectively) and also decreased postpartum 4.3%.

We recommend monitoring lithium and creatinine serum concentration once every 4 weeks until 34 weeks of pregnancy, then weekly until delivery, followed in postpartum at day 2±1, (bi-)weekly during the first month, monthly until 6 months postpartum and then every 3-4 months to ensure adequate lithium dosing.

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Women generally have a later age of onset, and may therefore have a more favourable course of psychotic illness than men regarding psychopathology. Little is known about a broader range of outcomes, including well-being and recovery, and about the influence of age of onset.

This study examines longitudinal sex-related and age of onset-related differences in well-being and recovery of people with a psychotic disorder with long illness durations.

Routine outcome monitoring data (2012-2021) of n=3843 patients were used. Well-being (quality of life and personal recovery) and recovery (clinical and societal recovery and psychosocial functioning) were assessed. Latent class growth analysis (LCGA) was performed to assess whether classes with different trajectories of well-being and recovery could be identified. Classes were related to sex and (early/late) age of onset of psychosis (EOP/LOP).

LCGA identified five classes with varying combinations in levels of well-being and recovery, which were stable over time. Sex, age of onset and the combination of these two were significantly related to class membership. Women and individuals with LOP were more prevalent in better functioning classes than men and individuals with EOP.

This study showed sex differences in long-term recovery patterns of psychosis. Not only women but also individuals with LOP had a higher chance of better well-being and recovery, while men with EOP were at risk for worse outcomes. Taking these sex differences into account when deciding on policy and treatment protocols for individual patients might provide better mental health care to people with psychosis.

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