Hormone replacement therapy (HRT) for transgender men involves various formulations of testosterone, each exhibiting unique pharmacokinetic profiles and emotional impacts. A comprehensive understanding of these variations is crucial for optimizing treatment outcomes and managing side effects effectively.

This study aims to elucidate the differential emotional effects associated with various testosterone formulations used in HRT for transgender men.

A comprehensive literature review was conducted using databases such as PubMed, Scopus, and Web of Science. The review focused on four primary testosterone administration methods: intramuscular and subcutaneous injections, transdermal patches and gels, oral testosterone, and implantable pellets. Key metrics evaluated included pharmacokinetics, emotional effects, and nature of side effects.

The review identified distinct pharmacokinetic profiles and emotional responses associated with each testosterone formulation:

Intramuscular and Subcutaneous Injections: These methods showed peak testosterone levels within 24-48 hours, followed by a decline over one to two weeks. Emotional effects included mood elevation and increased energy during the peak phase, with potential irritability or anxiety. The trough phase was marked by mood swings and depressive symptoms, particularly before the next injection. Side effects such as acne and libido changes peaked shortly after injection and decreased before the subsequent dose.

Transdermal Patches and Gels: These methods maintained consistent blood testosterone levels, resulting in stable mood and emotional states with reduced mood swings. Initial therapy adaptation caused mild mood changes, and side effects were primarily localized to skin irritation at application sites.

Oral Testosterone: Testosterone undecanoate offered stable testosterone levels with consistent mood regulation. Gastrointestinal side effects were common, and emotional stability varied based on absorption rates and adherence to dosing schedules.

Implantable Pellets: These provided the most stable testosterone levels over several months, leading to very stable emotional states with minimal mood fluctuations. Side effects included localized reactions such as discomfort or infection at the implantation site, with minimal systemic side effects.

The choice of testosterone formulation significantly impacts the emotional well-being of transgender men undergoing HRT. Intramuscular and subcutaneous injections were associated with emotional fluctuations tied to hormone peaks and troughs, while transdermal, oral, and implantable methods provided more stable hormone levels and emotional states. Regular monitoring and individualized modifications are crucial to optimizing physiological and emotional outcomes and enhancing the quality of life for transgender men.

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Lifestyle factors are being increasingly studied in bipolar disorder (BD) due to their possible effects on both course of disease and physical health.

The aim of this study was to jointly describe and explore the interrelations between diet patterns, exercise, pharmacological treatment with course of disease and metabolic profile in BD.

The sample consisted of 66 euthymic or mild depressive individuals with BD. Clinical and metabolic outcomes were assessed, as well as pharmacological treatment or lifestyle habits (diet and exercise). Correlations were explored for different interrelations and a factor analysis of dietary patterns was performed.

Adherence to the Mediterranean diet was low, seen in 37.9% of the patients and was positively associated with perceived quality of life. The amount of exercise was negatively associated with cholesterol levels, with 32.8% of participants rated as low active by International Physical Activity Questionnaire. There was a high prevalence of obesity (40.6%) and metabolic syndrome (29.7%). Users of lithium showed the best metabolic profile. Interestingly, three dietary patterns were identified: “vegetarian,” “omnivore” and “Western.” The key finding was the overall positive impact of the “vegetarian” pattern in BD, which was associated with reduced depression scores, better psychosocial functioning, and perceived quality of life, decreased body mass index, cholesterol, LDL and diastolic blood pressure. Nuts consumption was associated with a better metabolic profile.

A vegetarian diet pattern was associated with both, better clinical and metabolic parameters, in patients with BD. Future studies should prioritize prospective and randomized designs to determine causal relationships, and potentially inform clinical recommendations.

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Infertility can have a profound impact on couples, causing emotional distress and negatively affecting sexual well-being. In Tunisia, it contributes to over 20% of divorce cases due to relationship strain. Despite its significance, research on the influence of infertility on sexual experiences, particularly gender differences, remains limited.

This study aims to evaluate the effects of infertility on sexual health of Tunisian infertile couples and to compare these effects between men and women.

We conducted a cross-sectional study involving sexually active infertile couples who had been under follow-up for at least one year at a specialized Assisted Reproductive Technology center in Tunis. Each participant completed closed-ended questions regarding their sexual experiences following the infertility diagnosis, including the frequency of sexual intercourse, preferred types of sexual activities, sexual positions believed to enhance conception, and overall sexual rhythm. The Arizona Sexual Experiences Scale (ASEX) was used in Arabic to assess sexual function.

A total of 60 infertile couples participated in the study. The average age of women was 35.07 ± 4 years while the average age of men 41.1 ± 6 years. Regarding sexual intercourse frequency, 35% of women (n=21) and 27% of men (n=16) reported a decrease, with no significant gender difference (p=0.426).

Infertility did not significantly alter preferences for sexual practices, as 78% of women (n=47) and 85% of men (n=51) reported no changes. Vaginal penetration was the predominant activity for both sexes (100%), while mutual masturbation was engaged in by 68% of women and 72% of men. Oral sex was reported by 57% of women and 53% of men, with no significant gender differences (p>0.05).

In terms of sexual positions, 48% of women and 50% of men favored specific positions to enhance conception, with no significant differences (p=0.995). However, 48% of women and 64% of men adhered to a calendar-based rhythm, with women perceiving this regimen as more detrimental to spontaneity (p=0.038 and p=0.041).

Sexual dysfunctions were significantly more common in women, with a prevalence of 28% compared to only 5% in men. Desire disorders were the most commonly reported sexual dysfunction for both genders. Women exhibited significantly higher rates of physical and psychological arousal problems, as well as orgasmic disorders (p<0.05).

Screening for sexual dysfunction in infertile couples is essential not only for improving sexual health but also for providing tailored psychological support that considers gender differences. By identifying and addressing these issues, healthcare providers can enhance the overall well-being of couples dealing with infertility challenges.

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Sleep disturbances are common among individuals with bipolar disorder (BD) and may be present even during euthymic phases and significantly impact illness course and quality of life. This preliminary analysis is part of BEGIN (The Bipolar Exposome-Gene Interaction Naturalistic study.

Here, we analyze the relationship between subjective sleep disturbances and various lifestyle and environmental factors in BD patients.

Eighty-seven patients diagnosed with BD (Mean age = 50.7 years, SD = 13.6; 44.7% female; Mean BMI = 26.9, SD = 4.61) all in a three-month euthymic phase, were recruited. At baseline, participants completed lifestyle questionnaires covering diet, light exposure, and time spent indoors, alongside assessments of clinical history and circadian rhythms using the BRIAN scale. Sleep quality was assessed through the Pittsburgh Sleep Quality Index (PSQI, with a cutoff >5 for sleep problems) and the Epworth Sleepiness Scale (ESS, with a cutoff >10 indicating excessive daytime sleepiness). Sociodemographic, clinical, and environmental factors were compared between BD patients with and without sleep disturbances.

Based on ESS scores, patients with excessive daytime sleepiness had significantly higher overall circadian rhythm disruptions, as indicated by the BRIAN total score (p = 0.049). A negative correlation emerged between excessive daytime sleepiness and age at first hospitalization (r = -0.36, p = 0.003). Disrupted eating patterns, reflected in the BRIAN eating subscale, also correlated with excessive daytime sleepiness (r = 0.27, p = 0.027). Based on PSQI scores tobacco smoking was positively associated with poor sleep quality (r = 0.42, p = 0.013), while more time spent with artificial light from electronic devices (r = -0.29, p = 0.019), and less time spent indoors (r = 0.39, p = 0.001) correlated with worse sleep quality. Patients experiencing poor sleep also showed less consistency in social routines (BRIAN social score, p = 0.028).

These preliminary findings suggest that sleep disturbances in BD patients may be intricately linked to lifestyle and environmental factors, such as circadian rhythm disruptions, smoking, and exposure to artificial light. These results highlight the importance of considering environmental and lifestyle modifications to support sleep quality in BD. Future longitudinal analyses will be essential to clarify causal pathways and develop targeted interventions that address circadian and lifestyle factors in managing BD.

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People with unbearable psychiatric suffering and a chronic death wish are a subgroup of patients with Severe and Persistent Mental Illness (SPMI; Moureau et al., FiP 2023; 14:1094038). They suffer from at least one, but usually multiple psychiatric disorders, in a chronic course, resulting in severe limitations in psychosocial functioning (Woods et al., CJP 2008; 53 725-736.). Their chronic death wish is rooted in their struggle with life and death and diminished perspective on the alleviation of their suffering. They are at risk for suicide and/or are eligible to request euthanasia as legislated in Belgium. Reakiro is a Belgian pilot project and a drop-in, care and expertise centre developing tailored mental healthcare for this target population in addition to continued care as usual.

To describe psychological and existential characteristics, care needs, experienced changes and the correlations between these variables in 107 consecutive Reakiro patients who agreed to participate in this study.

The Beck Scale for Suicide Ideation (BSSI), Dutch Empowerment Scale (DES), Herth Hope Index (HHI), Meaning In Life Measure (MILM), Existential Concerns Questionnaire (ECQ), Outcome Questionnaire-45 (OQ-45) and the Change Questionnaire (CQ) were administered combined with an assessment of their life and death wish and of how they experience the care in Reakiro.

The BSSI (M = 21.78, SD = 8.48), DES (M = 113.39, SD = 20.42), HHI (M = 24.15, SD = 5.40), MILM (M = 5.39, SD = 1.50), ECQ (M = 62.13, SD = 12.10) and OQ-45 (M = 98.93, SD = 20.50) show heightened levels of suicidality, existential anxiety and symptomatology and lowered levels of hope, meaning in life and empowerment, compared to other psychiatric and non-clinical samples. Longer trajectories in Reakiro were correlated with heightened hope and lowered symptomatology, but not with suicidality. The preliminary CQ-analysis revealed 31 participants reporting positive changes in their relation to life and death, to self and others and to hope and future; 8 participants reported negative changes in their relation to life and death.

The results depict a concrete profile of the severity of the suffering and suicidality in these patients. The mixed-methods design reveals a major group that does not report any change and suffers greatly, but also a minor group that reports positive changes and even lowered suicidality. Clinical implications for psychiatric healthcare professionals will be discussed.

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Pseudodementia presents with symptoms resembling dementia but with cognitive dysfunction improving after depression treatment. Dementia is a progressive, irreversible disorder causing impairment in multiple cognitive domains and daily activities. In the elderly, depressive disorders can manifest as pseudo-forgetfulness due to deterioration of attention functions, while cognitive decline and behavioral changes in dementia may mimic depression. Distinguishing between elderly depression and dementia is challenging because depression often co-occurs with cognitive impairments, and dementia frequently presents with depressive symptoms.

This case report aims to highlight the importance of differential diagnosis in cognitive impairments among the elderly by presenting a case where frontotemporal dementia insidiously developed on a background of pseudodementia.

A 62-year-old woman with a recent history of treatment for depressive symptoms exhibited a gradual decline in planning abilities and behavioral changes over time. Following a non-suicidal jump attempt, she was admitted to the psychiatric ward for diagnostic clarification and treatment. A thorough evaluation of her socio-demographic data, family history, and medical and psychiatric history was conducted.

The patient’s initial complaints began after a psychosocial stressor, including headaches, depressed mood, loss of interest, sleep disturbances, attention difficulties, and increasing forgetfulness. Struggling with daily tasks led her to consult neurology, where age-appropriate atrophy was observed. She was prescribed migraine medication and metformin. Referred to psychiatry, she received sertraline with a preliminary diagnosis of depressive disorder but missed follow-up due to limited social support. Over the next five months, she developed reduced planning abilities, behavioral changes, aimless wandering, inappropriate mood shifts, weakness, and significant functional decline. After a non-suicidal jump attempt, she was admitted to psychiatry. Observations revealed persecutory thoughts and agitation. MRI showed pronounced frontal lobe atrophy inconsistent with her age. Diagnosed with frontotemporal dementia, she was discharged on olanzapine 5 mg and donepezil 10 mg.

This case demonstrates how confounding factors in dementia can adversely affect clinical progression, emphasizing the importance of social support and regular follow-up for accurate diagnosis and treatment. In patients with irregular follow-ups and low social support, conditions like dementia can have dramatic and irreversible courses. Therefore, performing differential diagnosis for dementia in elderly patients with depressive symptoms and reassessing dementia etiologies during follow-ups are vital.

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Depression is one of the most important medical and social problems in old age due to its high prevalence (10-25%) and a significant increase in the burden on social services and medical institutions. A diverse combination of biological factors of aging contributes to the polymorphism of clinical manifestations of late-life depression.

Study of the clinical features of depressed patients of late age of three identified neurobiochemical models of energy, antioxidant and glutamate metabolism.

The study material consisted of 52 hospitalized patients (40 women and 12 men) aged 60-86 years with a depressive episode of recurrent depressive disorder, bipolar affective disorder and a single depressive episode (ICD-10). The patients were examined by clinical, psychometric, biochemical and statistical methods. Before starting therapy, psychometric assessments were performed using the Hamilton Anxiety and Depression Rating Scales and the Mini-Mental Status Examination. On the same day, the activity of enzymes of energy (cytochrome c oxidase - CO), antioxidant (glutathione reductase - GR and glutathione S-transferase - GST) and glutamate (glutamate dehydrogenase - GDH) metabolism enzymes in blood platelets was determined in patients.

In patients with a decrease in energy and antioxidant metabolism (↓GR, GST, HD and ↑GDH), there was a predominance of shallow apathetic depression of a “seasonal” nature with the presence of mild cognitive impairment, a later age of manifestation, and a high incidence of cerebrovascular pathology. Patients with “disharmonious” metabolism (↓ GR, GST, GD and ↑ CO) were characterized by an early onset of the disease, its longer duration, more severe and complex depression with a pronounced anxiety component. Patients with a conditionally “normal” metabolism were more likely to experience typical melancholy depression and the lowest incidence of severe cerebrovascular pathology.

The relationship has been established between the clinical features of late-life depressions and changes in the activity of enzymes of energy, antioxidant and glutamate metabolism. It was revealed that the type of metabolism with “reduced” and “disharmonious” activity of these enzymes corresponds to the parameters of late and early manifesting depression. Thus, the clinical heterogeneity of late-life depression is closely related to different neurobiochemical types of metabolism.

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