Psychological factors, including personality and temperament show an association with various somatic conditions and may also influence perioperative analgesic requirements. Understanding the role of psychological factors could help personalise pain management, improving well-being of patients and reducing postoperative complications. Affective temperaments (AT) have previously been associated with course and characteristics of several somatic conditions, but have not been studied in this context.

We aim to investigate the association between ATs and postoperative analgesic needs in a prospective study.

In our ongoing study we plan to enroll 350 women awaiting non-obsetrical, non-oncological gynecological surgery. Type of surgery and anesthesia are standardized. Psychological evaluation is carried out at three timepoints: 5 days preoperatively (ATs, anxiety, depression, pain catastrophizing)? 24 hours postop (amount and quality of pain experienced, anxiety, depression, current pain catastrophizing); 7 days postop (same as before, plus length of stay and quality of life). Tools include TEMPS-A (ATs), STAI-S and T (anxiety), PHQ9 (depression), PCS (pain catastrophizing) and BPI (pain experience and QoL). Intraoperative vital parameters and opioid use are also observed, as well as the use of postoperative analgesic medications. Statistical associations between pain and psychological factors are analysed using MANOVA, regression, correlation and path analysis.

Currently we are at 50% of our data collection (N=175). At this stage of our research we already have significant preliminary results. Apart from psychological factors, age has a negative predictive effect on pain experienced on day 1 (p<0.001, stβ=-0.327, R2=0.14) and also predicts the effectiveness of painkillers on day 1 (p=0.006, stβ=0.036). When controlled for age ATs also predict pain experienced on day 1: anxious scores predict amount of pain experienced (p=0.049, stβ=0.283), whereas higher dysthymic scores predict smaller amount of pain experienced (p=0.006, stβ=-0.382). Preoperative anxiety and pain expectations do not seem to predict pain, but pain expectations predict how pain effects overall mood (postop day 1 p=0.002, stβ=0.227 and day 7 p=0.035, stβ=0.226). Postop day 7 pain is less influenced by the investigated factors, but state anxiety on postop day 1 predicts postop pain on day 7 (p=0.028, stβ=0.251).

Our study may help in clinical practice to identify patients who are likely to experience more postoperative pain. While age is a significant negative predictor of early and late postoperative pain, when controlling for age, ATs seem to be sensitive predictors of early postoperative pain experience, whereas other investigated factors have a less direct effect on pain experience. Further data analysis with more complex models is needed after data collection is finished.

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Contemporary global crises, including Climate Change/CC, has increased the interest in Future Anxiety/FA. As an emotional response to the anticipation of threats in the distant rather than proximal future, FA is broader than worry, which generally focuses on particular issues and fluctuates depending on specific circumstances.

To analyze the psychometric properties of the Portuguese versions of Dark Future Scale (DFS; Zaleski et al. 2019), composed of 5 items to evaluate FA; and Climate Change Worry Scale (CCWS; Stewart 2021), a 10-items measure of proximal worry about CC; to explore whether they evaluate distinct or overlapping constructs.

590 adults (64.6% women; mean age=34.40±16.18) answered DFS, CCWS (preliminary), Climate Change Distress and Impairment Scale/CC-DIS and Pro-Environmental Behaviours Scale/PEBS. Exploratory Factor Analysis (EFA; with a subsample of n=290) and Confirmatory Factor Analysis (CFA; n=300) were performed. DFS and CCWS structures tested with CFA were based on previous EFA results, including a model combining items from both scales.

DFS: CFA evidenced the good fit of the unidimensional model, χ2/df=3.314, CFI=.995, TLI=.990, GFI=.989, RMSEA=.060, p<.001; alfa=.91.

the unidimensional model (similar to the one found in the original version) (χ2/df=2.076; CFI=.982; TLI=.970; GFI=.965; RMSEA=.0590; p<.001; a=.90) and the two-factors model, with F1 composed of 6 items related to CC concerns and F2 of 4 items related to perceived interference (χ2/df=2.561; CFI=.973; TLI=.956; GFI=.956; RMSEA=.0611; p<.001; aF1=.75, aF2= .89) presented good fit.

the 2-factor model, with each scale being one factor (χ2/df=2.312; CFI=.962; TLI=.951; GFI=.928; RMSEA=.065; p<.001) and the 3-factor model, where CCWS divides into 2 factors (χ2/df=2.248; CFI=.964; TLI=.954; GFI=.926; RMSEA=.063; p<.001) resulted in good fit. FA correlated with CCWSTotal/F1/ F2 (r>.25). Correlations with CCDIS were r=.36 for FA and r<.55 for CCWSTotal/F1/F2; only CCWS total and dimensional scores correlated with PEB (r>.45) (all p<.001). When predicting CCDIS, FA adds 4% (R change, p<.001) to the variance explained by CCWS dimensions (R2=49.7%). Only CCWSConcerns (b=.345) but not CCWSInterference predicted PEB.

DFS and CCWS Portuguese versions have adequate validity and reliability. Their moderate correlation and the validity of the measurement models tested suggest that they evaluate distinct constructs. FA seems more maladaptive than CCW: although it increments CC-DIS prediction, it does not correlate with PEBS. The same applies to CCWSInterference, which emphasizes that the CCWS two-factor structure may be useful to delimit CCW’s normal/pathological nature. We intend to use these scales in an ongoing research project on psychological factors associated with CC mitigation and adaptation.

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Although childbirth represents a positive experience for most mothers and fathers, it can also be potentially traumatic when it endangers the life of the mother or the baby. In more severe cases, it can even develop into Post-Traumatic Stress Disorder (PTSD) postpartum. Studies indicate birth-related PTSD impacts around 17% of postpartum parents. This condition includes intrusive symptoms, hyperactivation, avoidance behaviors, and negative changes in mood and cognition, significantly impacting the mother-baby bond and the family’s well-being.

The authors pretend to raise awareness of postpartum PTSD.

The authors did a non-systematic review of the current literature.

The etiology of postpartum PTSD is multifactorial and results from the combination of pre-birth risk factors (depression during pregnancy, fear of childbirth, medical complications during pregnancy, history of trauma or sexual abuse, history of mental disorders), factors during childbirth (subjectively experienced negative childbirth, obstetric complications, and severe maternal morbidity), and postpartum factors (postpartum depression, maternal complications after childbirth, or maladaptive coping mechanisms). The risk factors related to childbirth appear to be independent of neonatal complications, with the latter constituting an additional stressor factor. Psychological trauma during childbirth and postpartum PTSD, despite having a significant impact on families, are often not recognized in maternity services, hindering timely intervention. Currently, there are no recommended treatments to prevent or mitigate postpartum PTSD. However, there is some evidence of the benefits of prenatal and postnatal interventions, such as early identification of risk factors for postpartum PTSD and postnatal counseling.

The studies suggests that women should be assessed for negative traumatic birth experiences and PTSD, to allow targeted observation for psychopathologies and therapeutic interventions. Further research is needed with larger sample sizes, validated and reliable clinical interviews to assess PTSD.

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Chronic Fatigue Syndrome (CFS) is marked by physical and cognitive fatigue, as well as increased susceptibility to fatigue. While the precise causes of CFS remain unclear, there is growing interest in the role of the stress response system in its development.

Given that early adverse experiences might affect one’s ability to handle stress effectively, the aim of this study was to examine whether such early life events could predispose patients with CFS to higher self-reported stress levels when confronted with psychosocial stressor.

76 patients with CFS and 45 healthy controls (HC) underwent the Maastricht Acute Stress Test (MAST) to induce stress. Subjective stress levels were assessed before, during and after the task. The Childhood Trauma Questionnaire (CTQ) was used to retrospectively evaluate abusive and neglectful experiences in childhood

Patients with CFS reported significantly higher levels of subjective stress at all stages of the MAST compared to HC (main effect of group; p<0.0001). Additionally, CFS patients had higher CTQ scores than HC (p=0.04). Within patients, higher levels of childhood trauma was associated with higher levels of self-reported stress (p = 0.0047) throughout the MAST. The results of the link are visualized in the attached figure.

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Patients with CFS experience heightened stress levels during a validated stress-inducing task compared to HC. Furthermore, a history of greater childhood abuse and neglect is associated with increased stress levels later in life, potentially contributing to the development of CFS.

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Infertility is a significant source of emotional stress for couples worldwide. In Tunisia, it affects approximately 15 to 20% of couples of reproductive age. Studies indicate that women experience higher rates of depression (35% vs. 15%) and anxiety (52% vs. 28%) compared to men, largely due to cultural pressures. For these reasons, understanding these gender differences in coping mechanisms is essential.

To analyze the coping styles of infertile couples and identify gender differences in coping mechanisms to inform tailored psychological support.

We conducted a cross-sectional study involving couples undergoing infertility treatment at a specialized Assisted Reproductive Technology center inTunis. The participants provided information related to socio-demographic data. Coping strategies were assessed using the Brief Cope scale administred in the Tunisian dialect. These strategies were classified into three categories: problem-focused, emotion-focused, and avoidant coping.

A total of 60 infertile couples participated in the study. The average age of men was 41.1±6 years, while the average age of women was 35.07±4 years. Among them, 68% resided in urban areas, and 73% were from a middle socioeconomic background. Educationally, 47% of women held a university degree, compared to 17% of men. Approximately half of the women were unemployed, while 52% of men were employed.

Problem-focused coping emerged as the most frequently utilized strategy (5.93±1.02), followed by emotion-focused coping (5.32±0.82) and avoidant coping (3.95±0.70).

Women significantly employed problem-focused and emotion-focused strategies more than men (p=0.017; p<0.01). They also scored higher in emotional support, expression of feelings, active coping, planning, and religious coping (p<0.05; p=0.01). Conversely, men displayed a greater inclination towards acceptance, distraction, and substance use.

In conclusion, addressing gender-specific coping strategies is essential for providing effective psychological support to infertile couples. Healthcare professionals should promote problem-focused coping to help couples actively manage their challenges.

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The differentiation between somatic and psychiatric disorders presents a significant challenge in clinical practice due to overlapping symptomatology and complex etiologies. This abstract proposes an integrated approach utilizing laboratory tests and neuroimaging techniques to enhance diagnostic accuracy and improve patient outcomes. Somatic disorders, characterized by physical symptoms with identifiable organic causes, often mimic psychiatric conditions, leading to misdiagnosis and inappropriate treatment. Laboratory evaluations play a crucial role in ruling out medical conditions that may present with psychiatric-like symptoms. Thyroid function tests, vitamin B12 level assessments, and screening for infections are vital in this process. Routine blood tests further aid in detecting systemic conditions contributing to psychiatric presentations. Neuroimaging techniques offer visual insights into brain structure and function, facilitating the differentiation between psychiatric and neurological conditions. Structural imaging modalities like MRI and CT scans can reveal abnormalities such as tumors or lesions. Functional imaging, including PET and SPECT scans, assesses cerebral metabolism and blood flow, identifying anomalies associated with specific psychiatric disorders. Integrating laboratory tests with neuroimaging significantly enhances diagnostic precision. In suspected dementia cases, for instance, laboratory tests can exclude metabolic or infectious causes, while neuroimaging can identify characteristic patterns of Alzheimer’s disease or vascular dementia. This combined approach ensures a thorough evaluation, reducing misdiagnosis and facilitating targeted treatment strategies. Clinical studies have demonstrated the efficacy of this integrated approach in improving diagnostic accuracy for conditions like major depressive disorder and bipolar disorder. Functional neuroimaging has also proven instrumental in distinguishing between psychiatric disorders and neurological conditions such as epilepsy. Despite its advantages, this approach faces challenges, including cost, availability, and the need for standardized interpretation protocols. Future directions include advancements in neuroimaging accessibility, research into novel biomarkers, and the integration of artificial intelligence for enhanced diagnostic accuracy and personalized treatment planning. In conclusion, integrating laboratory tests with neuroimaging represents a significant advancement in the differential diagnosis of somatic and psychiatric disorders. This comprehensive approach facilitates accurate diagnosis, ensuring patients receive appropriate and effective treatment, ultimately leading to improved patient outcomes.

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Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that significantly affects children’s behaviour, attention, and academic performance. While the impact of maternal smoking during pregnancy on ADHD risk is well-established, emerging research suggests that paternal smoking may also contribute to this risk. However, the relationship between paternal tobacco use and ADHD remains underexplored, with existing studies presenting mixed results.

This systematic review and meta-analysis aim to clarify the extent of this association and provide a comprehensive assessment of the evidence available.

All relevant studies in CINAHL, Embase, PsycINFO, PubMed, Scopus, and Web of Science databases were searched from inception until 15 March 2024. Both conventional and cumulative meta-analyses were conducted. Pooled odds ratios with 95% confidence intervals (CIs) were calculated using a random-effects model. The heterogeneity among studies was assessed using the I2 test, and the presence of small study effects was evaluated using funnel plots and Egger’s test. Sensitivity and subgroup analyses were also performed.

Twenty observational studies involving over 294, 236 study participants from 16 different countries were included. We found that paternal smoking was associated with a 22% increased risk of ADHD in children (RR=1.22, 95% CI: 1.12, 1.33). The observed association has remained stable since 2014, with minimal fluctuations in effect sizes and their corresponding 95% CIs. Our subgroup analysis revealed that this association is only evident among studies that did not account for maternal smoking (OR=1.23, 95% CI: 1.10, 1.38, n=8), while no increased risk of ADHD was found in studies that adjusted for maternal smoking (OR=1.14, 95% CI: 0.98, 1.33), suggesting that maternal smoking may confound the observed association.

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Paternal smoking may increase the risk of ADHD in children. Future studies should focus on maternal and paternal comparisons to disentangle the independent and combined effects of parental smoking on ADHD risk in children.

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Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics. Individuals with gender dysphoria frequently face social as well as psychoaffective difficulties that can impede their well-being and quality of life.

The aim of this study were to assess the impact of gender dysphoria among young medical trainees on their psychological health in terms of stress, anxiety and depression.

A cross-sectional, descriptive, and analytical study was conducted with a Tunisian population of young medical trainees, during the period of time from October 1, 2023, to January 31, 2024. Data were collected using a questionnaire created with GOOGLE FORMS including an information sheet and two psychometric assessment tools : the Depression, Anxiety, and Stress Scale (DASS-21) and the gender identity/gender dysphoria questionnaire for adolescents and adults (GIDYQ-AA) asssessing subjective, somatic, social, and sociolegal aspects.

A total of 111 participants took part in this study. Their median age was 28 years. They were single in 56.6% of cases, with a male-to-female ratio of 0.56.

The prevalence of depression, anxiety, and stress was 53.2%, 59.5%, and 34.2%, respectively.

Median scores of depresssion, anxiety and stress were 10 (IQR =[2–18]), 8 (IQR =[4–14]) and 10 (IQR =[6–20]), respectively.

The overall median score on the GIDYQ-AA scale was 4.85 (IQR =[4.77–5.0]). The social dimension had the lowest median score at 4.88 (IQR=[4.55–5.0]) while the median score of the subjective dimension was 4.92 (IQR=[4.69-5.0]). Somatic and socio-legal median scores were 5.0 (IQR=[5.0–5.0]).

The score for the subjective dimension of the GIDYQ-AA was negatively correlated with anxiety (p=0.04) and stress (p=0.04) scores.

The psychological vulnerability of young medical trainees may be exacerbated by intrapsychic conflicts which may be related to their gender identity. It is essential to identify and consider the psychological factors associated with gender dysphoria in the care pathway of these individuals, through appropriate psychiatric evaluation and support in order to better guide therapeutic decisions regarding sex reassignment.

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The cognitive model of psychosis suggests that psychotic symptoms may arise due to biases in information processing. Cognitive biases such as jumping to conclusions (JTC), belief inflexibility (BI), selective attention to threat (AT), and external attribution (EA) are dysfunctional ways of thinking in which distortions are observed in data collection, processing and interpretation. Cognitive biases are known to be associated with the occurrence of positive psychotic symptoms, but evidence for the influence of other cognitive processes on this relationship remains lacking.

This study aimed to examine the relationship between cognitive biases and psychotic symptoms in schizophrenia spectrum disorders and the cognitive factors hypothesized to influence this relationship, such as intolerance of uncertainty and insight.

65 patients with schizophrenia spectrum disorder were included. Sociodemographic data form, Davos Assessment of Cognitive Biases Scale (DACOBS), Intolerance of Uncertainty Scale (IUS) Anxiety Sensitivity Index-3 (ASI-3), and Beck Cognitive Insight Scale (BCIS) Positive and Negative Syndrome Scale (PANSS) and Beck Anxiety Inventory were applied. Ethics committee approval was obtained (no: 2023-40). Statistical analysis was performed with SPSS 25.

The mean age of the participants was 39.27 ± 12.21 years. 63.1% were male (n: 41) and 36.9% (n: 24) were female. Disease duration was 16.95 ± 12.80 years. Hierarchical regression analysis determined that PANNS positive scores were predicted by DACOBS external attribution subscale and IUS, ASI-3 and BCIS scores had a moderator effect (F: 3.51 p<0.001).

Our results showed that external attribution bias is the only cognitive bias associated with positive psychotic symptoms. Intolerance of uncertainty and anxiety sensitivity also play a role in the prediction of positive psychotic symptoms. Targeting intolerance of uncertainty and anxiety sensitivity with cognitive interventions may be useful in the treatment of positive psychotic symptoms in schizophrenia spectrum disorders.

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Clinical practice involves many stress factors for nursing students. Stress in clinical practice causes positive or negative outcomes for students. Students show physical, emotional and behavioural reactions to stress. Therefore, progressive muscle relaxation and breathing exercises with music can be a method that students can easily learn and apply, reducing stress and negative bio-psycho-social responses.

This study aimed to examine the effects of progressive muscle relaxation and breathing exercises accompanied by music on the stress levels of undergraduate nursing students and their bio-psycho-social responses to stress.

This randomized controlled study was conducted at a university in Turkey with ethics committee approval. A total of 154 undergraduate nursing students were randomized, 77 in the intervention group and 77 in the control group. 44 of the students were sophomores, 52 were third-year students, and 58 were fourth-year students. Progressive muscle relaxation and breathing exercises were applied to the intervention group for six weeks with music. No intervention was applied to the control group during the research period. Research data were collected using the Personal Information Form, the Perceived Stress Scale for Nursing Students, and the Biopsychosocial Response Scale for Nursing Students. The scales were applied to the intervention and control groups before the exercises, at the end of the six-week exercises, and two weeks after the exercises ended. Data were collected between October 2022 and January 2023. Shapiro-Wilk test was used in the analysis of normality of data; Independent Samples t-test, Dependent Samples t-test, and Analysis of Variance were used in the analysis of variables.

In the pre-test measurements of the groups, it was found that there was no significant difference in terms of the students’ stress levels in clinical practice and bio-psycho-social response scores (p>0.05). In the post-test and follow-up measurements, it was seen that the stress and bio-psycho-social response scores were significantly lower in the intervention group than in the control group (p<0.05). There was also a significant group*time interaction between the groups in terms of stress and bio-psycho-social response scores (p <0.05).

The findings showed that the intervention helped students reduce their stress levels and negative bio-psycho-social responses to stress, and the effects were found to be sustained in the short term. These positive results are promising in the use of progressive muscle relaxation and breathing exercises with music as an effective and easy method to reduce the stress level and negative physical, emotional and behavioral responses to stress in the clinical practice of undergraduate nursing students.

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Fatigue is one of the most significant factors impairing functionality in patients with multiple sclerosis (MS). Research has demonstrated that psychological factors, in addition to neurobiological ones, play a crucial role in fatigue among MS patients. Previous research has demonstrated that emotional neglect and emotional abuse are associated with fatigue in patients with MS (Pust et al. Front Psychiatry 2020; 11:811). While the role of emotion dysregulation as a mediator between adverse childhood experiences and long-term effects of childhood trauma has been studied, this relationship has not been previously examined in patients with MS.

This study aims to investigate the association between adverse childhood experiences and fatigue and to examine the mediating effect of emotion dysregulation in patients with MS.

Patients with MS followed in the Neurology Outpatient Clinic at Marmara University, who were evaluated during their clinical examination to be cognitively competent and without any physical disabilities that would prevent them from completing the forms, were included in the study. Adverse childhood experiences were assessed using the expanded version of the Childhood Trauma Questionnaire (CTQ-33), emotion dysregulation was measured by the 16-item Difficulties in Emotion Regulation Scale (DERS-16) and fatigue was evaluated using the Fatigue Severity Scale. The impact of CTQ subscale scores on fatigue and the mediating role of emotion dysregulation were analyzed using SPSS with Process Macro v4.2.

A total of 119 patients completed the survey, with a mean age of 37.45 years, and 71.4% of the participants were women. Emotional abuse and emotional neglect were associated with fatigue in patients with MS. The effect of emotional abuse on fatigue was mediated by emotion dysregulation, with the total effect being 0.81 (95% CI [0.04, 1.58]), the direct effect -0.12 (95% CI [-0.86, 0.63]), and the indirect effect 0.93 (95% CI [0.50, 1.55]). Similarly, the relationship between emotional neglect and fatigue was also mediated by emotion dysregulation, with the total effect being 0.66 (95% CI [0.10, 1.22]), the direct effect -0.05 (95% CI [-0.60, 0.49]), and the indirect effect 0.71 (95% CI [0.39, 1.10]). These results indicate that emotion dysregulation fully mediates the effects of both emotional abuse and emotional neglect on fatigue in patients with MS.

Our findings indicate that the link between fatigue severity and emotional neglect or abuse in MS patients is fully mediated by difficulties in emotion regulation. Consequently, it is suggested that interventions aimed at enhancing emotion regulation strategies may potentially mitigate the effects of adverse childhood experiences on MS-related fatigue. Further research, especially focused on intervention strategies, is needed in this area.

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Burnout is a pervasive issue among psychiatry residents, with long-term consequences for both individual well-being and the quality of care provided to patients. The role of emotional competencies, including emotional regulation, self-awareness, and mentalization, is increasingly recognized as critical in mediating burnout outcomes, according to the job demands-resources model of burnout.

The study objective was to investigate predictors of burnout and burnout correlates in a sample of psychiatry trainees.

This study examines longitudinal data from the QASP project (Questionnaire and Assessment of Stress and Performance in psychiatry residents), which also aims to assess the relationship between emotional exhaustion, depersonalization, and personal accomplishment in medical residents across multiple centers in Italy. Using a mixed longitudinal model, we explored predictors of burnout and its correlates, in particular mentalization deficits, emotional dysregulation, and attachment insecurity.

The study involved 827 psychiatry residents enrolled across different psychiatry training programs in Italy, enrolled in two waves: 2022 and 2023. To date, 351 follow-up assessments were retrieved. Emotional exhaustion showed a rapid increase during the early years of residency, then stabilizing in later years (Figure 1).

The results also indicated a strong relationship between increased exposure to violence and elevated burnout dimensions. However, coping strategies were observed to evolve and refine during residency training, with psychiatry trainees displaying a shift from avoidance to problem-focused approaches over time. Residents were also more likely to report less attachment insecurity after one year of training (Longitudinal Mixed Models - Figure 2).

Interpersonal competencies, sustained by mentalization skills, were observed as following a coupled longitudinal trajectory with burnout, so that an increase in interpersonal competencies was associated with a lower elevation in burnout dimensions (Figure 3).

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Our findings suggest that enhancing emotional personal and interpersonal competencies could mitigate burnout, improve training outcomes, and potentially increase later workforce retention among psychiatry trainees. These results underscore the need for interventions targeting emotional competencies and mentalization during psychiatric training, such as focused clinical supervisions by senior staff members. Such interventions could enhance residents’ resilience, promote effective coping mechanisms, and ultimately improve the quality of psychiatric care.

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Precision of language in neuropsychiatry is vital for the accurate understanding of complex psychopathological phenomena. Many expressions used in psychiatry, especially those of German origin, reflect nuanced descriptions of patient behaviors, cognitive impairments, and emotional states that are not easily captured by modern terms. These linguistic tools provide a window into the intricate dynamics between the mind and body, helping clinicians interpret and navigate the subtleties of neuropsychiatric conditions.

This review aims to explore how specific expressions in neuropsychiatry, derived from clinical German terminology, contribute to a deeper understanding of patient experiences and enhance the precision of clinical assessment. By examining these linguistic elements, the paper seeks to illustrate their relevance in diagnosing and treating neuropsychiatric disorders, particularly where conventional language falls short.

Through a conceptual analysis, this review delves into the historical development and clinical application of several key terms originating in German psychiatry. Terms such as “Gegenhalten,” which describes paradoxical resistance in catatonia, and “Weltschmerz,” a term encapsulating existential despair, are examined within clinical contexts. The review also discusses other terms such as “Mitgehen,” referring to automatic obedience, and “Vorbeireden,” which highlights disorganized speech patterns. The review draws upon classical psychiatric literature and modern clinical observations to demonstrate how these terms inform diagnosis and treatment strategies.

The use of these specific linguistic constructs offers neuropsychiatrists valuable insights into the subjective experiences of patients, often highlighting behaviors and emotional states that would be otherwise overlooked. For example, “Gegenhalten” allows for the differentiation of motor dysfunction in catatonia, while “Weltschmerz” provides a unique framework for understanding a type of depression that transcends typical diagnostic boundaries. Similarly, “Vobeirreden” aids in the recognition of cognitive disorganization, and “Mitgehen” underscores deficits in volitional control. These terms provide clinicians with greater clarity and precision in diagnosis and therapeutic approaches, bridging the gap between patient experiences and clinical evaluation.

This review underscores the importance of language in the accurate interpretation of neuropsychiatric disorders. It demonstrates how these terms enrich the diagnostic process and offer deeper clinical insights into patient behaviors and symptoms. The nuanced language of neuropsychiatry not only enhances understanding but also serves as a tool for more targeted and effective interventions. Ultimately, this approach encourages clinicians to consider the broader impact of linguistic precision in both diagnosis and treatment planning.

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Methadone is typically administered as a racemic mixture of two enantiomers (50% Dextro, 50% Levo methadone) and is used for chronic pain management and as maintenance therapy for opioid dependence. Levomethadone, when used alone, shows similar efficacy but with fewer side effects, particularly a safer cardiac profile with less QTc prolongation. In maintenance therapy for heroin dependence, the effective dosage of levomethadone ranges from 40 to 70 mg per day.

Our case concerns a 42-year-old patient who has struggled with substance abuse since the age of 17. Admitted to the Psychiatric Unit of Cesena Hospital for a reduction of Lormetazepam (previously consuming 80-100 mg/day), he was found to be taking 200 mg of levomethadone daily. This dosage is typically administered for pain management rather than as maintenance therapy for heroin dependence. Although the man was consistently consuming high doses of psychoactive medications, exceeding the ranges commonly reported in the literature, he did not exhibit significant adverse effects or signs of sedation during his hospital stay. This observation led us to consider the possibility of a genetic alteration in cytochrome enzymes that could enable ultra-rapid drug metabolism.

During the hospital stay, it was possible to safely reduce the benzodiazepine therapy by switching from oral lormetazepam to intravenous diazepam and subsequently to oral diazepam.The patient also underwent a pharmacogenetic test that analyzes the polymorphisms of 60 different enzymes using cells obtained from saliva.

In the reported case, the use of L-Methadone has allowed over the years a full control of withdrawal symptoms and cravings from opioid drugs, a greater compliance with treatment and a lower risk of general and cardiological side effects than racemic methadone administered in equivalent therapeutic doses in past years.

It has also been made possible, through in-patient treatment, to carry out a progressive withdrawal from Lormetazepam in total safety.

Pharmacogenetic testing targeting CYP3A4 and CYP2B6 enzymes did not reveal significant alterations, contradicting our initial hypothesis.

The originality of this case is basically due to the lack in the literature about clinical cases treated with such a high dose of Levomethadone (200 mg/day) as substitution therapy for opioid addiction and to the investigation of the salivary pharmacogenetic testing to eventually support the hypothesis that the patient could be a rapid or ultrarapid metabolizer.

Moreover, we have sought to clarify the correct use of levomethadone in individuals at high risk of death due to conditions that may increase the risk of Torsades de Pointes.

The pharmacogenetic analysis excluded rapid metabolism, suggesting a role for P-glycoprotein (PGP) in influencing the absorption of methadone and the variability of plasma concentration.

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While the relationship between social anxiety disorder SAD and various sociodemographic factors has been explored, there is a notable gap in research examining the prevalence of SAD in visually impaired individuals. Vision loss could influence social interactions and thus may alter the typical presentation or severity of social anxiety.

This study aims to compare self-esteem and social anxiety disorder (SAD) levels between visually impaired and sighted individuals and to explore the relationship between social anxiety and various sociodemographic factors.

A case-control study was conducted from March to June 2017 in Riyadh, Saudi Arabia, involving 62 participants (24 visually impaired and 38 sighted). Participants completed a demographic form, the Liebowitz Social Anxiety Scale (LSAS), and the Rosenberg Self-Esteem Scale (RSES). Data analysis included descriptive statistics, t-tests, and ANOVA to compare psychological outcomes between groups.

The mean age of visually impaired participants was significantly higher than that of sighted participants (24±2.8 vs. 22.4±2.2 years, p=0.013). No significant differences were observed between the two groups in terms of gender, marital status, or education level. The RSES scores indicated no significant difference in self-esteem between visually impaired and sighted individuals (18.13±2.66 vs. 17.42±2.04, p=0.244). Similarly, LSAS scores did not significantly differ between the two groups (32.63±24.19 vs. 36.68±22.68, p=0.506).

The findings suggest that visually impaired individuals do not have significantly different levels of self-esteem or social anxiety compared to their sighted peers, indicating that visual impairment may not directly contribute to lower self-esteem or higher social anxiety. Future research should involve larger, more diverse samples and longitudinal studies to further explore these relationships.

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In research, recruitment challenges are common and lead to delays and reduce sample size and power. People with schizophrenia are often described as hard to reach and retain in research, and in particular, studies targeting people with chronic comorbidities such as diabetes, meet difficulties related to recruitment.

This study aims to describe challenges and strategies to recruitment of Danish adults with schizophrenia and type 2 diabetes to a cross-sectional survey study about psychosocial health and support.

The recruitment process was tracked in a register where all relevant information was synthesized systematically. This included information on how eligible participants were identified and invited for the study and reasons for declining. Two recruitment strategies were applied for recruiting participants to complete a questionnaire: 1) Through mental health professionals in psychiatric outpatient clinics in Region Zealand, Denmark, and 2) Through phone calls to eligible participants. Descriptive analyses of the recruitment data were conducted.

Three types of challenges were found and described: 1) Identifying eligible participants, 2) Challenges with having mental health professionals to recruit, and 3) Participants’ lack of ability to complete a questionnaire. The challenges were met by several practical approaches: 1) Identifying eligible participants though electronic health records and medication types, 2) Inviting participants through phone calls, and 3) Letting participants receiving help for completing the questionnaire from a care coordinator, family/friend or researcher when needed. Approximately 15% of all eligible participants declined to take part, which indicate high willingness to participate.

Exploring different types of challenges was important for understanding the actual difficulties in recruitment, for using approaches to meet the challenges, and for detecting the high willingness to take part.

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Manic episodes, a defining feature of bipolar disorder, are often triggered by significant psychosocial stressors. In Tunisia, marriage carries deep religious, societal, and familial significance, creating considerable pressure that may act as a precipitating factor for the onset of bipolar disorder. This case series presents three patients who experienced their first manic episode in the immediate aftermath of their wedding.

To highlight the role of marriage as a significant trigger for the first manic episodes in patients with no previous psychiatric history, within the specific socio-cultural context of Tunisia.

These case reports were compiled through clinical observations and interviews with the patients and their families. All three cases involved newlywed males who developed manic symptoms shortly after marriage, requiring hospitalization.

• - Case 1: A 30-year-old male with no personal or familial psychiatric history presented with manic symptoms 5 days after his wedding. Symptoms included expansive mood, irritability, insomnia, grandiose and persecutory delusions, hyperactivity, and logorrhea. He was hospitalized and treated with lithium and risperidone. After 3 weeks, he was discharged and has remained symptom-free for 1 month.

• - Case 2: A 33-year-old male with a paternal history of schizoaffective disorder developed mania the day after his wedding, following alcohol use and sleep deprivation. His symptoms included psychomotor agitation, destruction of objects, verbal aggression, logorrhea, tachyphemia, delusions of grandeur and persecution, insomnia, and hyperactivity. He was treated with clonazepam, lithium and haloperidol. Clonazepam was discontinued before discharge, and haloperidol after 3 months. He had been episode-free for 3 years, then he had a manic episode and was hospitalized for 2 weeks. Now he’s been symptom-free for 2 months

• - Case 3: A 31-year-old male with no personal or familial psychiatric history presented with manic symptoms 7 days after his wedding, including insomnia, expansive mood, grandiose delusions with auditory hallucinations (he believed God told him to have a son who would be the next prophet), hyperactivity, and logorrhea. He was treated with diazepam, lithium, and risperidone. He was discharged after 4 weeks, with diazepam discontinued before discharge and risperidone after 6 months. He has remained episode-free for 1 year.

These cases highlight the significant cultural pressures surrounding marriage in Tunisia, which can serve as a potent trigger for manic episodes in individuals without prior psychiatric history. Early identification and intervention with antipsychotics and mood stabilizers proved effective in all cases. These findings emphasize the importance of psychiatric vigilance in similar socio-cultural settings to manage the onset of bipolar disorder in response to life stressors.

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Neuroimaging studies show that schizophrenia is linked to reduced grey and white matter volumes and increased cerebrospinal fluid. Cannabis use, a widely known risk factor for psychosis, is associated with poorer clinical outcomes, although the mechanisms underlying this association remain unknown.

This study aims to explore the effect of cannabis use on brain volumes in individuals with a first episode of psychosis, comparing users and non-users.

A cross-sectional study with 207 participants was conducted at the Cantabria Early Psychosis Intervention Program (ITPCan) in Santander, Spain, from January 2020 to July 2024. Clinical, sociodemographic, and cannabis use data were collected. Structural magnetic resonance imaging (sMRI) scans were obtained using a Philips 3.0T MRI machine with T1-weighted sequences. Voxel-based morphometry (VBM) analysis was conducted using the CAT12 toolbox to assess relative volume measures of white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF), accounting for individual differences.Statistical analyses were performed by SPSS 23.0, with a significance of 0.05, including mean comparisons and multivariate analysis of covariance controlling for age, sex, and educational level.

Out of the total sample, 106 patients underwent sMRI, including 44 men and 62 women, with an average age of 36.9 years. In terms of education, 47.2% had achieved basic level, while 52.8% had higher education. Regarding cannabis-related variables, 28 participants (26.5%) were identified as users; the average age of initiation was 17.1 years, with consumption occurring around 6.5 days per week and 6. 7 joints per day.

Non-user group showed slightly higher mean CSF and WM volumes compared to users (CSF=18.65 vs. 17.56; WM=36.49 vs.35.99), but these differences did not reach statistical significance (p= 0.154; p = 0.265). In contrast, cannabis users showed a significantly greater relative mean GM volume (46.37 vs. 45.12, p = 0.037). However, these differences did not reach statistical significance after adjusting for age, sex, and education.

Cannabis use is associated with greater GM volumes among individual with a first episode of psychosis. However, these differences did not remain significant after adjusting for age sex and education. GM differences could largely be attributed to the age disparity between both groups, with cannabis users being significantly younger than non-users (27 vs. 40.8 years).

Further research into the underlying mechanisms and long-term studies are needed to provide a clearer understanding of how cannabis use affects brain structure over time.

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The number of elderly people requiring social and health care support in the last years of life is constantly increasing. The consequence is a significant increase in the number of guests in assisted nursing homes. The elderly patient, collaborating with healthcare professionals, becomes the protagonist of the entire care process. The places and times of care, together with the lived experience and the emotions felt, are just some dimensions of humanization, dignity of care and dignified care. This recognition of the patient experience within the definition of quality of care is associated with better clinical outcomes and patient safety. Patient Reported Experience Measures (PREM) are psychometrically validated questionnaires returned directly by patients and aim to provide a standardized assessment of individual care experiences.

Assess the emotionality, dignity, depressive symptoms of the elderly patient without significant psychiatric disorders at the time of admission to a place of care.

Sixty-seven elderly subjects (28 F, 38 M) were recruited in some elderly residential facilities (total mean age (yrs)(±SD): 75.64 ±5.96)

age ≥ 65 years; MMSE ≥20; absence of overt diagnosis of psychiatric or neurodegenerative disorders (evaluation with SCID-5-CV). All patients were given a PREM questionnaire at the beginning and during the care pathway. All patients were administered at baseline (T0), after 6 months (T1) and after 1 year (T2) the following evaluation rating scales:

• - Mini-Mental State Examination (MMSE) (only T0); Patient Dignity Inventory (PDI); Geriatric Depression Scale (GDS); Global Assessment of Functioning (GAF); Quality Life Index (QLi)

The data were statistically analyzed with the EZAnalyze 3.0 software for the Excel platform.

Tables 1 and 2 show the results obtained with each scale analyzed. On the PDI scale, the ANOVA results indicate that at least two of the repeated measures differed significantly [Mean scores ± Std. Dev: (T0) 63.388 ± 22.042; (T1): 57.313 ±21.159; (T2): 49.985 ±17.418]. The data obtained with the GDS scale showed no variation during the observational period. Although the differences were not statistically significant, the data indicate that no increases in depressive symptoms were observed. I results obtained with the QLi showed that the ANOVA results indicate that at least two of the repeated measures differed significantly [Mean scores ± SD: (T0) 3.358 ± 1.164; (T1): 6.075 ±1.222; (T2): 6.657 ±1.213]. Similar results were observed with the GAF scale.

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Intervention programs that allow older residents to express their emotions and observations are not only beneficial for corporate welfare, but also promote a sense of empowerment and involvement. Our small observational study has shown that these programs can significantly improve residents’ quality of life and protect against the onset of depressive symptoms.

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