Sexual minority individuals face unique challenges in mental and sexual health, emotion regulation, and well-being. Although understanding the complex dynamics among these variables in the context of diverse sexual orientations and gender identities is crucial to supporting and tailoring comprehensive interventions, limited research has investigated their overlapping relationships and intersections.

The current study aims to examine the connections between mental health, sexual health, emotion regulation, and well-being among sexual minority and heterosexual individuals in Israel. The main purpose was to provide a comprehensive understanding of the unique challenges sexual minority individuals face.

The study included 465 participants, 324 (70%) were identified as heterosexual individuals and 119 (26%) as sexual minority individuals. Various variables were assessed using an online anonymous questionnaire, including mental health (anxiety, depression, suicide ideation, substance use disorder), sexual health (sex-related distress, problematic pornography use, compulsive sexual behavior disorder), emotion-regulation, and well-being. Between-group differences were analyzed using Mann-Whitney U tests. Network analysis was conducted to examine the centrality and edges of relationships between variables within each group.

Significant differences were found between the heterosexual and sexual minority groups across the measured variables. Sexual minority individuals reported higher levels of psychopathology, lower sexual health, as well as lower levels of emotion regulation and well-being compared to heterosexual individuals. Network analysis revealed that the number of diagnosed psychopathologies and depression were central nodes in the sexual minority group, while sexual functioning played a central role in the heterosexual group. The sexual minority group’s network showed less stability, suggesting distinct subpopulations within this group.

This study contributes to understanding the unique mental and sexual challenges sexual minority individuals face and the intersections between mental health, sexual health, emotion regulation, and well-being. These findings highlight the importance for mental health professionals to acknowledge and address these connections, emphasizing the need for tailored psychosocial interventions that integrate sexual health.

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The subtle, subjective nature of basic symptoms (BS) has often led to doubt regarding their clinical significance.

We therefore examined the prevalence, clinical significance and course of BS over three years in a large sample (N = 2684) of 16- to 40-year-old residents of the Swiss canton of Bern (response rate: 64%). At follow-up, persons with a lifetime risk symptom at baseline were compared with control subjects (N = 834; response rate 66%). Fourteen criteria-relevant BSs were assessed by trained clinical psychologists over the telephone, along with information on symptomatic ultra-high-risk symptoms, mental disorders and functioning.

At baseline, 18% of the participants reported any lifetime BS, 10% had still experienced one in the three months prior to the interview. In general, BS were rare, and only 2% of the participants met any BS criteria, which was significantly associated with non-psychotic mental disorders (OR = 5) and especially with functional deficits (OR = 16). At follow-up, five individuals had developed psychosis, one with BS criteria and three more with BS at baseline. In addition, 95% of the participants no longer met the BS criteria, while 3% reported new BS criteria.

Although BS are not rare phenomena in the community, they rarely persist and rarely occur frequently enough to meet the requirements of the risk criteria. Furthermore, they do not appear to occur randomly, but are restricted to a subpopulation of vulnerable individuals – possibly occurring in times of stress and/or low mood and functional difficulties in these individuals.

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Neurological soft signs (NSS) are subtle sensory and motor deficits linked to neurodevelopmental disorders, schizophrenia, and thyroid disorders (TH). TH are essential for neurodevelopment and the modulation of the proinflammatory response. Indeed, a growing body of evidence suggests that thyroid function is altered in individuals with schizophrenia spectrum disorders (SSD).

We aimed to evaluate the relationship between TH, NSS, and psychopathology in individuals with schizophrenia.

Opportunistic recruitment took place at the 3rd Department of Psychiatry at AHEPA University General Hospital of Thessaloniki, Greece. Inclusion criteria were an SDD diagnosis and age above 18 or below 65 years. Patients were excluded if they had a history of neurological or other somatic disorder, a history of substance abuse, an IQ estimate <70, and if they were pregnant, or on treatment with glucocorticoids and/or thyroxin. Clinical symptomatology was assessed using the Positive and Negative Syndrome Scale (PANSS), and NSS were assessed using the Neurological Evaluation Scale (NES; Greek version). Blood samples were drawn after an overnight fast to measure serum levels of TSH, fT4, and fT3. We used the t-test to compare differences between sex and the Pearson correlation to test for correlations between PANSS scores, NES scores, and TH (R statistical software version 4.3.2).

A total of 73 patients (31 female) with SSD were included [mean age 41.2 (SD 11.6) years]. TSH and fT4 levels were significantly higher in females, p<0.0005 and p=0.020, respectively. fT3, but not fT4 or TSH, was negatively correlated with age (r=-0.479, p<0.001). A negative correlation between NES total score and fT4 (r=-0.416, p=0.014) was only found in males. Serum fT3 levels exhibited no significant correlation with NES scores but the PANSS negative subscore was negatively associated with fT3 (r=-0.471, p<0.001).

Our study suggests that TSH and fT4 abnormalities are more prevalent in females with SSDs. Moreover, it appears that with increasing age, the likelihood of hypothyroidism increases. Interestingly, in individuals with SSDs, lower fT4 levels predicted NSS severity but only in males, and lower fT3 levels predicted an increase in negative symptoms. Hypothyroidism has been reported to cause damage to the central nervous system and has been associated with increased apoptosis and altered expression of cerebellar neurons leading to impairment in motor function. In this sense, restoring fT3 and fT4 levels might have a positive effect on negative symptoms and NSS severity (in males), respectively. However, antipsychotic medication may affect TH levels in SSDs. Thus, future studies should examine a larger sample of drug-naïve individuals with SSDs, followed-up longitudinally in time to infer causality.

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Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked genetic enzymopathy that impacts 4.9% of the population, with greater prevalence among Mediterranean, East Asian, and African populations. G6PD deficiency results in levels of nicotinamide-adenine dinucleotide phosphate (NADPH) and glutathione (GSH) that are insufficient for maintaining the balance of oxidation-reduction in the body. This results in elevated production of reactive oxygen species (ROS), oxidative stress on proteins and lipids, damage to DNA, and potential activation of chemokine and cytokine pathways by astrocytes and microglia. We propose that these direct and indirect effects of G6PD deficiency are associated with development of ADHD.

This study investigated the association between G6PD deficiency and Attention Deficit/Hyperactivity Disorder (ADHD).

The study involved 7,473 G6PD-deficient patients and 29,892 matched case-controls (selected at a 1:4 ratio) from a cohort of 1,031,354 within the Leumit Health Services database. Clinical characteristics were analyzed using Fisher’s Exact Tests for categorical variables and Mann-Whitney U tests for continuous variables.

The average age of patients was 29.2 ± 22.3 years, with 68.7% being male. The mean follow-up duration was 14.3 ± 6.2 years. Individuals with G6PD deficiency showed a significant 16% higher risk of being diagnosed with ADHD (Odds Ratio (OR) = 1.16 [95% CI, 1.08-1.25], p < 0.001) on follow up. Furthermore, G6PD deficiency was associated with a 30% greater likelihood of seeking care from adult neurologists (OR = 1.30 [95% CI, 1.22-1.38], p < 0.001) and a 12% higher probability of consulting adult psychiatrists (OR = 1.12 [95% CI, 1.01-1.24], p = 0.048). The use of stimulant medications among G6PD deficient individuals was 17% higher for methylphenidate class drugs (OR = 1.17 [95% CI, 1.08, 1.27], p < 0.001), and use of amphetamines elevated by 16% (OR = 1.16 [95% CI, 1.03, 1.37], p = 0.047).

This study establishes a significant association between G6PD deficiency and an increased risk of ADHD diagnoses. These findings suggest potential opportunities for the development of culturally sensitive interventions.

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Subutex abuse in Tunisia is a phenomenon that is becoming more and more frequent and the management of which is not obvious due to the development of this substance in parallel markets.

Our objective was to assess the patient’s Subutex use and initially assist with withdrawal, followed by achieving abstinence.

We followed the case of a patient in the psychiatric unit B at the Razi hospital, for depressive symptoms and having a problem of misuse of Subutex for 4 years, in a difficult family and social context.

Patient follow-up was done over a one-year period with weekly consultation sessions at the beginning to assess the situation. Although withdrawal was done after a few weeks, it was essential to maintain this abstinence, using psychotherapy based on CBT done over 7 sessions.

During the study period, the patient violated abstinence only once in a family conflict.

The patient’s response to our management has reinforced the hope of being able to treat addiction to Subutex despite the severity of his condition and family and social instability.

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Psychologically, traumatic incidents often involve physical injuries that threaten a person’s survival and sense of security. After a sudden health problem or other kind issues, hospital admission can be an experience that negatively affects psychological health and recovery, often including symptoms of post-traumatic stress disorder, anxiety, and depression. Nurses who spend a longer time with patients can determine the initial changes in individuals and play a crucial role in the decision-making process.

This systematic review aimed to investigate the effect of nurse-led interventions in reducing post-traumatic stress disorder symptoms in inpatients.

In this review, we investigated studies from Pubmed, Cochrane Library, Medline (OVID), Scopus, Web of Science, CINAHL, Dergipark and TR Dizin (a directory) databases that met the inclusion criteria. The methodological quality of the studies was assessed using the Cochrane Risk of Bias 1 tool. This study was performed based on the Guidelines of Systematic Reporting of Examination presented in the PRISMA checklist. The search protocol has been registered at the PROSPERO International Prospective Register of Systematic Reviews.

This systematic review included seven studies with a total sample size of 736 inpatients (intervention group: 350 participants; control group: 345 participants). The meta-analysis revealed that nurse-led interventions showed no statistically significant impact on post-traumatic stress disorder symptoms (SMD: -4,08, Z = .79, p = .43), anxiety (SMD: .28, Z = .18, p = .86) and depression (SMD: -.60, Z = .87, p = .38) in inpatients.

Out of seven studies, five of them indicated that these interventions were not effective in reducing PTSD symptoms while in two studies, the interventions were found to be effective in alleviating PTSD symptoms. To effectively reduce or prevent post-traumatic stress symptoms in inpatients, it is recommended to integrate a comprehensive range of therapeutic, evidence-based practices into clinical settings, facilitated by a multidisciplinary team approach within a educative and collaborative working environment.

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Lithium enjoyed its first golden age between 1965 and 1990, but interest in the molecule has not waned, on the contrary, the last 20 years have seen a veritable renaissance in lithium publications. This literature is fuelled by the ongoing exploration of lithium’s unique mood-stabilizing, anti-suicidal and neuroprotective properties, a panoply of properties never before observed in a single molecule. In spite of this, the literature describes little use of lithium, despite ample evidence of its benefits.Our study points the perceptions and misperceptions of lithium and their effects on it use in our hospital.

To study and identify the perceptions and misperceptions of doctors at Ar-razi Hospital about lithium, and thus discuss both of efficacy and safety misperceptions through a litterature review. This study will have as a first objective to correct these mispercetions in order to promote a proper care of our patients.

This is a descriptive study. Data collection was carried out on 50 psychiatrists and trainees. By using an online and handout forms focusing on physicians perceptions and misperceptions of the efficacy and safety of lithium at Ar-razi Hospital in Salé. Jamovi 2.3 was used for data entry and statistical analysis.

our study results were resumed in 2 images. Image 1 is a table that shows the status of our professionnals and also their use of lithum as first or second molecule.

image 2 resumes efficacy perceptions of lithium among our psychiatrists and trainees.

although many other results will be shown by text:

• - 58% thinks that Lithium should not be used in women of childbearing age due to teratogenic risk

• - 73% have the perception that Lithium should be avoided in elderly patients suffering from a lack of efficacy data and safety concerns.

• - 53% thinks that other thymoregulators are safer and should be systematically used in women of childbearing age with bipolar disorder instead of lithium.

• - 84% acclaim that lithium treatment is stopped because of it security profile, when 44% of them thinks that hypothyroidism is prevalent as a secondary effect and causes treatment stop.

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Our study finds that our hospital professionnals have many misperceptions about lithium, especially about it security, which may affect the treatment plan for many patients. This study and it discussion throught the litterature review will change these perceptions, furthermore give the patients a proper care.

Disclosure of new knowledge is essential to refute misconceptions about lithium and enable patients to access its unique therapeutic constellation.

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Theoretical analysis of the problem of anticipatory competence in adolescents with mental disorders highlights its insufficient study as an integral ability that contributes to their adaptation in society and the prevention of deviant behavior.

To identify and study the relationship between anticipatory consistency and deviations in adolescents with mental disorders.

The study involved 25 adolescents aged 12-14 (6A00.0, ICD-11) attending an educational institution for children with disabilities. The following methods were used: the “Test of Anticipatory Solvency” by V.D. Mendelevich, the “Test of Propensity for Deviant Behavior” by E.V. Leusa and A.G. Solovieva, and the “Study of Anticipatory Solvency in Adolescents” by A.I. Akhmetzyanova and T.V. Artemyeva.

Adolescents with mental disabilities exhibit varying degrees of motor clumsiness and difficulty judging distance in visual space. They struggle to predict the consequences of their actions and are not always able to foresee conflict situations in social settings, nor respond adequately in such interactions, which often leads to the development of antisocial behavior. The majority of adolescents with mental disorders (56% of the subjects) exhibit a situational predisposition to delinquent behavior, indicating a tendency to put their own norms and values in conflict with those of the group. Correlation analysis revealed a statistically significant relationship between personal-situational anticipatory consistency and the scale of delinquent behavior (r=0.416).

The findings of this study can be useful to practitioners working with adolescents with mental disorders, helping them to plan and organize corrective interventions that consider the development of this essential skill. Anticipatory competence is one of the factors necessary for successful socialization and the prevention of deviant behavior in adolescents.

This paper has been supported by the Kazan Federal University Strategic Academic Leadership Program (PRIORITY-2030).

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Aging leads to a progressive deterioration at the communicative level. The identification of language impairment in older adults could help to prevent or slow down the development of a possible neurocognitive disorder.

To evaluate psychopathological manifestations in language and communication by means of a psychopathological evaluation protocol in a control group of subjects matched by age and sex to a group of people with mild cognitive impairment.

The sample consists of twenty healthy older adults (75% female, 25% male) with mean age of 84.15 years (SD = 6.81). A descriptive and observational study was carried out. Subjects of both sexes between 70 and 95 years of age, with absence of possible cognitive impairment, were included. The Mini-Cognitive Examination was used to assess cognitive performance, the PRESEEA interview was used to obtain the speech sample and a psychopathological assessment protocol.

Increasing age is associated with greater intensity of language impairment (R2 = .02, p = .047). In the MEC-35 total score, the control group shows a significantly higher performance than the patient group (F = 49.11, p < .001). A negative correlation appears between the total score of psychopathological manifestations and the variables ‘educational level’ (R2 = .23, p = .029) and ‘socioeconomic level’ (R2 = .33, p = .007).

Anomia, perseverations, disintegrated language, concretism and paragrammatism are possible early indicators of cognitive impairment. The elaboration and application of both assessment protocols and speech therapy intervention programs in older adults may improve communication skills.

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Supervision is recognized as having a vital role in the professional development of psychotherapists. The way it is implemented has a direct impact on the quality of the educator’s learning process, as well as on the quality of psychotherapy provided to clients. Supervision is a complex and dynamic practice, requiring supervisors to conceptualize the thoughts, feelings and behavior of their educators and the educator’s clients, as well as selective attention to the complexly layered interpersonal dynamics between clients, educators and themselves.

Emphasizing the possibility of the appearance of difficulties and their aspects and increasing awareness of these concepts can greatly help supervisors and educators in the formation of ways and approaches that can facilitate better communication and the formation of a more professional relationship as significantly influencing the main result of the quality of psychotherapy and the process of professional development.

During the training of mental health professionals, it is crucial to ensure that the supervision process is carried out according to a legal, ethical and competent approach, such as informed consent and a supervision contract, and it is necessary to take into account elements such as supervisor and educator competencies, awareness of the challenges of diversity and multiculturalism, personal and professional boundaries, multiple contexts of relationship between supervisor and educator, evaluation and feedback. Through the supervisor’s dilemmas, ambiguities in the perceptions of supervision educators, success is reflected through the analysis of personal contribution, of unconscious interpersonal and developmental dynamics, and access to one’s own limits.

The importance of clinical supervision is evidently recognized by almost all licensing boards and accrediting bodies for the mental health professions, requiring that educators receive psychotherapeutic, clinical supervision as part of their training, and ongoing supervision is often necessary to maintain professional licensure. An integrative approach of incorporating innovative research results, as well as consolidating them with already established factors, is key in leading psychotherapeutic training, research, supervision, as well as the client’s treatment itself towards increased effectiveness. A significant contribution to the literature would be enabled by future research dealing with issues of difficulties in supervision through the prism of educators.

This paper focuses on understanding the significance of the supervision process thorugh the theoretical perspective, approaching the concept of difficulties by the prism of supervisors and educators, and the practical implications of successful supervision.

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Burnout among mental health professionals poses a significant threat to personal wellbeing, patient care, and healthcare systems. Addressing this challenge aligns with the broader mission of the European Academy of Neurology (EAN) to promote brain health not only for patients but also for clinicians. This presentation highlights education, collaboration, and systemic interventions, integrating neurological and psychiatric perspectives.

This initiative stems from the EAN Task Force for Wellbeing (TFW), in collaboration with the European Psychiatric Association (EPA). A multipronged strategy was designed to enhance awareness, build resilience, and foster systemic reforms:

1. - Educational Media: A podcast series exploring burnout’s conceptualization, its neurobiological and psychological aspects, gender disparities, and practical solutions.

2. - Interactive Webinars: Interdisciplinary sessions combining insights from neurology and psychiatry, showcasing evidence-based strategies and technological innovations.

3. - Public Debates: Open forums to engage professionals across career stages, raising awareness and encouraging action to tackle burnout.

These initiatives were supplemented by systematic reviews, case studies, and suggestions of novel tools to monitor mental health and stress factors.

The combined educational and intervention efforts yielded significant outcomes:

1. - Advancing Brain Health for Clinicians: Awareness initiatives emphasized the vital link between clinician brain health and professional resilience

2. - Skill Development and Resilience: Practical strategies for time management, mentorship, and self-care were disseminated through case studies and interactive discussions.

3. - Collaborative Solutions: Webinars and public debates highlighted shared challenges and fostered interdisciplinary advocacy for systemic reform.

Burnout is not just an individual issue but a systemic challenge requiring collective action. By prioritizing clinician brain health as a mission, the EAN and EPA collaboration provides a unifying framework to tackle burnout. Educational initiatives bridged the gap between theory and practice, while public debates fostered community engagement and systemic advocacy. Interdisciplinary collaboration underscored the shared nature of burnout and the need for unified, brain-health-centric strategies.

Promoting wellbeing through education, collaboration, and innovative tools aligns with the broader goal of achieving brain health for clinicians. These initiatives provide a sustainable pathway to counteract burnout and foster a resilient and thriving workforce. Continued investment in education, public discourse, and systemic reform is essential to realizing this mission.

burnout, brain health, wellbeing, education, interdisciplinary collaboration, neurology, psychiatry, systemic reforms

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Parent-focused interventions are an important part of the treatment plan for children with Attention-deficit/hyperactivity disorder (ADHD). Minority families tend to be less involved in psychosocial treatments and are more likely to discontinue the intervention. The Haredi community in Israel is a cultural-religious minority of 1.2 million people

We aimed to assess the feasibility and potential efficacy of culturally adapted psychosocial programs for attention-deficit/hyperactivity disorder (ADHD) within the Haredi community in Israel.

This was an open-label non-randomized study conducted within the Haredi community in Israel between 2018 and 2021. The participants (N=265) were parents of children aged 8-12 years who had been diagnosed with ADHD or exhibited ADHD symptoms. Three culturally adapted programs were compared: 1. A program involving only the parents (N=46), 2. A program involving both children and parents (N=155) and 3. Only recorded video lectures with no interaction (N=38). Parents completed questionnaires to assess their self-efficacy using the Parenting Self-Efficacy tool (TOPSE) and their child’s ADHD symptom severity, using the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) both before and after the intervention.

The programs demonstrated high feasibility. Of 335 referrals, 265 parents were recruited. Participation rates differed significantly between the video lectures program (60%) and the two interactive programs (80%, p<0.001). A significant interaction was found between time and program type for both parental efficacy (F(2,213)=5.65, p=0.004) and for ADHD symptomatology (F(2, 213)=5.65, p=0.004). Post hoc analysis revealed that the video lectures program showed no benefit, whereas both interactive programs (parents-only and parent-child) exhibited improvement in parental self-efficacy and reduction in reported ADHD symptom severity.

Despite certain limitations, this study suggests that culturally adapted psychosocial programs for ADHD in the Haredi community are feasible and that including an interactive component is crucial for effectiveness.

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Nicotine replacement therapy, particularly nicotine gum, is an effective tool for smoking cessation but may lead to dependence in 6-9% of long-term users. This report presents two patients with prolonged nicotine gum dependence, exploring individualized treatment strategies and their outcomes.

To evaluate two personalized treatments for nicotine gum dependence: one using transdermal nicotine patches with psychosocial support, and the other using bupropion with psychosocial support.

Patient A, a 67-year-old retired technician with a history of anxiety, depression, and past alcohol and benzodiazepine dependence (both in remission), began smoking at 16 (20 cigarettes a day) and quit at 35 due to Leriche Syndrome, switching to 20 pieces of 2 mg nicotine gum daily. In a four-week program, he transitioned to nicotine patches with a gradual dose reduction, alongside psychosocial support. Patient B, a 61-year-old social worker with a history of depression, smoked 40 cigarettes daily until quitting at 51 due to COPD, then developed a long-term dependence on 30 pieces of 4 mg gum. Fifteen days before admission, she abruptly discontinued using nicotine gum. She presented to the program seeking support and strategies for managing cravings, and her treatment focused on psychosocial interventions and medication adjustments.

Both patients successfully achieved abstinence and improved functioning. Patient A transitioned from nicotine gum to nicotine patches, starting at 40 mg daily, reducing to 25 mg after six weeks, and then to 15 mg before discontinuation. Throughout the treatment period, the patient successfully maintained abstinence. Psychological assessments showed stable mood and satisfactory remission. One week into the treatment, patient B reported difficulties in maintaining abstinence after abruptly stopping nicotine gum during a COVID-19 infection. She began experiencing increased depressive symptoms and nervousness, leading to an increase in bupropion (which she used prior to enrolling in the program) dose from 150 mg to 300 mg daily. Active participation in group therapy helped her manage cravings and control anxiety, preventing relapse.

Two distinct approaches, one using nicotine patches and the other pharmacological support, both highlighted the importance of psychosocial support in achieving nicotine gum dependence cessation. Nicotine patches, with their slower absorption, are less rewarding and reduce long-term dependence risk. Despite patient B’s initial struggles after abrupt cessation, the combination of increased bupropion and active therapy participation helped manage cravings and anxiety. Both cases highlight the importance of individualized care and comprehensive psychosocial interventions for sustained nicotine abstinence.

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In the digital era, online dating platforms have emerged as a prominent means for establishing social relationships. While these platforms facilitate connections, they also introduce a distinct form of external validation through likes, matches, and compliments. Despite their popularity, researchs on the psychological effects of this validation on users are limited.

This study aimed to reveal the profile of dating platforms users and assess whether these platforms foster a dependence on external validation and affect operator’s self-esteem

A cross-sectional study was shared via social media and online forums. In addition to socio demographic and work related variables, it comprised an evaluation of dependency on external validation through a series of targeted questions, and explored its relationship with the use of dating platform. The Rosenberg Self-Esteem Scale was used to assess participants’ self-esteem, with a score below 31 indicating low self-esteem.

The study included 55 participants aged between 19 and 40 years, with a mean age of 26.27. The gender distribution was nearly equal, with 49.1% male (n=27) and 50.9% female(n=28). Most participants (54.54%) were single, and 40% reported using dating apps primarily for casual dating and entertainment.

Among applications users, 46.7% engaged with the platforms several times a week, while 20% used them daily. Furthermore, 53.7% of users plan to continue using them.

Regarding external validation, 64.4% reported that receiving validation motivated them to use the applications more frequently, while 56.2% indicated they would adjust their behavior based on feedbacks. Additionally, 47.1% felt influenced by compliments, and 58.9% reported that criticism and rejection affected them negatively.

According to the Rosenberg Self-Esteem Scale, 33.3% of users exhibited low self-esteem and 28.5% of users reported that dating applications had a negative impact on their self-esteem. Notably, no significant correlation was found between dating applications’ usage and self-esteem (p = 0.53 > 0.05).

This study highlights a reliance on external validation among online dating users, suggesting that these platforms may encourage behaviors driven by the need for approval. This underscores the importance of further research into the psychological effects of such dependence.

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Doctors Without Borders works in humanitarian settings. In these settings, we have observed a notable movement away from first generation medications such as haloperidol towards second-generation antipsychotics, where these medications are available. We began to question whether the evidence clearly justified this and decided to contribute to the evidence.

To assess the clinical benefits and harms of haloperidol compared to olanzapine for people with schizophrenia and schizophreniaspectrum disorders.

Searched the Cochrane Schizophrenia study-based register of trials, screened the references of all included studies. We contacted relevant authors of trials for additional information where clarification was required or where data were incomplete. The register was last searched on 14 January 2023.

We didn’t find a statistically significant difference between haloperidol and olanzapine in global state (RR 0.84, 95% CI 0.69 to 1.02), nor in relapse (RR 1.42, 95% CI 1.00 to 2.02). Haloperidol resulted in an increase of extrapyramidal side effects compared to olanzapine (RR 3.38, 95% CI 2.28 to 5.02). For weight gain, there may be a large reduction in the risk with haloperidol compared to olanzapine (RR 0.47, 95% CI 0.35 to 0.61). Haloperidol may result in an increase of leaving the study early compared to olanzapine (RR 1.99, 95% CI 1.60 to 2.47).

Overall, the certainty of the evidence was low to very low for the main outcomes in this review, making it difficult to draw reliable conclusions. There is no clear difference between haloperidol and olanzapine in terms of global state and relapse. Different side effect profiles were noted. These findings should contribute to continue using haloperidol and olanzapine.

Many studies did not use equivalent doses of the two medications when they were compared. Most studies used comparatively higher doses of haloperidol compared to olanzapine.

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Bipolar disorder (BD) is a complex mental health condition characterized by alternating periods of depression and mania, affecting millions worldwide. Despite its prevalence, the use of antidepressants, widely prescribed for unipolar depression, remains debated in the context of bipolar depression due to concerns about mood destabilization, mania induction, rapid cycling, and long-term efficacy and safety. This ambiguity underscores the critical need for a comprehensive analysis to guide clinical practice. This review aims to evaluate the efficacy, safety, and long-term outcomes of antidepressant use in bipolar disorder.

Assess the safety and efficacy of antidepressants in bipolar disorder. Optimize treatment options to help reduce the global burden of bipolar disorder and address a major gap in understanding regarding the role of antidepressants in treating bipolar disorder.

A systematic review of 35 studies, including 18 randomized controlled trials (RCTs), 14 cohort studies, and 3 meta-analyses published between 2010 and 2023, was conducted. Studies were selected based on predefined inclusion and exclusion criteria, focusing on antidepressant efficacy, safety, and long-term effects in BD patients. Data extraction and synthesis followed rigorous methodological protocols. The extracted data were then analyzed to identify trends, themes, and contradictions in the literature.

The use of antidepressants in bipolar disorder should be highly individualized, balancing potential benefits against risks. Clinicians must exercise caution, particularly regarding the risk of mania induction. This review found that antidepressants, especially when combined with mood stabilizers, demonstrated moderate efficacy in treating bipolar depression. Outcomes varied significantly across studies; while some patients benefited from antidepressant use, others experienced increased risks, such as rapid cycling and mania induction. There is a lack of conclusive long-term safety data, highlighting the need for personalized treatment approaches to mitigate risks.

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The role of antidepressants in bipolar disorder treatment remains contentious due to variability in outcomes and safety concerns. A personalized treatment approach, incorporating mood stabilizers, is recommended. This literature review concluded it is essential to balance the benefits and risks. Therefore, a combined treatment regimen with mood stabilizers is recommended. Further research, particularly longitudinal studies, is necessary to establish more definitive, evidence-based guidelines for treating bipolar depression with antidepressants.

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Mood disorders with mixed features, characterized by the concurrent presence of manic and depressive symptoms, represent a complex and significant area in psychiatric research. Historically, the recognition of such mixed states traces back to ancient Greek scholars, with evolving understanding through the 19th century. This evolution reflects substantial contributions from early thinkers to modern psychiatric frameworks.

1. 1. To trace the historical development of the concept of mixed mood states from ancient Greece to the 19th century.

2. 2. To analyze the contributions of key figures such as Areteo of Cappadocia, Wilhelm Griesinger, Jean-Pierre Falret, Emil Kraepelin, and Wilhelm Weygandt in shaping the understanding of mixed states.

3. 3. To evaluate the impact of Kraepelin’s and Weygandt’s work on contemporary classifications of mood disorders.

A historical review of primary and secondary sources, including classical texts and psychiatric literature, was conducted. The analysis focused on the contributions of significant historical figures, examining their theories and classifications of mood disorders. Key publications, such as Kraepelin’s treatises and Weygandt’s monographs, were scrutinized to assess their influence on modern psychiatric nomenclature.

The study highlights the foundational observations of mixed mood states by ancient Greek scholars, particularly Areteo, who first proposed that mania and melancholia were facets of the same condition. The 19th-century revival of interest in these states saw important contributions from Griesinger and Falret, with Kraepelin’s systematic framework in his 1899 treatise integrating mixed states into a unified concept of manic-depressive insanity. Weygandt’s 1899 monograph further refined the understanding of mixed states, reflecting a collaborative intellectual effort with Kraepelin.

The historical evolution of mixed mood states demonstrates a significant advancement in psychiatric theory. Kraepelin’s comprehensive framework, supported by Weygandt’s detailed analysis, laid the groundwork for contemporary classifications of mood disorders. Recognizing the collaborative nature of these developments underscores the importance of shared intellectual contributions in the advancement of psychiatric science.

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Mental illness remains a significant issue globally, often accompanied by challenges related to stigma, stereotypes, and prejudice. In Albania, research exploring societal perceptions and the acceptance of mental illness and psychiatric treatment is limited. Understanding these views is crucial for improving mental health care and reducing stigma.

The aim of this study was to evaluate the perception and prejudice toward mental illness in the Albanian population, with a focus on stigmatization, acceptance, and attitudes toward psychiatric treatment.

Data collection was carried out through a self-administered online questionnaire distributed to the general population in Albania. A total of 326 questionnaires were analyzed. The study population included individuals born and residing in Albania. The data was processed using the statistical program IMB SPSS v. 23.

The sample showed a significant gender disparity, with a female-to-male ratio of 2.7:1. The majority of respondents were aged 21 to 40 years and had higher education. Religious individuals also showed high participation. While respondents acknowledged high levels of stigma in society, they expressed personal openness toward maintaining relationships with individuals with mental illness and integrating them into society. Despite this, there was a general lack of knowledge regarding mental illness, and confidence in the quality of mental health services in Albania was low. Psychiatrists were recommended for severe cases, though psychologists were preferred for treating depression. The most favored treatment approach was a combination of medication and psychotherapy.

The findings suggest that while there is an awareness of societal stigma toward mental illness in Albania, individuals personally express supportive attitudes toward integration and treatment. However, a gap in knowledge about mental illness and skepticism toward mental health services highlights the need for public education and improvements in the healthcare system. The preference for combined treatment reflects an evolving view on comprehensive care.

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The Flemish Association of Psychiatry developed due care guidelines for medical assisted dying in cases of severe and unbearable psychiatric suffering, which were adopted by the Order of Physicians. In principle, there are therefore more than enough well-known recommendations on how to handle a request for termination of life from a patient with psychiatric issues.

Nevertheless, occasionally something goes wrong due to misinterpretation of the legal criteria or due to careless actions by the consulting or performing physician.

In 2010, a female patient died by euthanasia because of unbearable mental suffering, which was unacceptable for her family. The family decided to initiate a court case to have the inaccuracies in the decision-making process and the execution of the euthanasia evaluated by a judge. In 2020, three involved doctors, including a psychiatrist, were prosecuted for this euthanasia. An analysis of the court case and the media coverage of this case will be discussed.

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Clozapine, traditionally prescribed for treatment-resistant schizophrenia, has shown potential for off-label use, particularly in affective and personality disorders characterized by severe impulsivity, nonsuicidal self-injury (NSSI), and suicidality (Delgado et al 2020, Journal of psychiatric research, 125, 21-27). Emerging evidence suggests that clozapine’s unique pharmacodynamic profile (serotonergic activity and high affinity for D4R, α1R, H1R) may contribute to reducing aggression and impulsivity and offer therapeutic benefits for borderline personality disorder (BPD). This is particularly relevant given the high suicide risk in BPD patients, with an estimated annual rate up to 10%, 50 times higher than the general population. Despite this, current treatment guidelines for BPD typically limit pharmacological interventions in favor of psychotherapeutic approaches (Pascual JC et al Int Clin Psychopharmacol. 2010, 25(6), 349-55). However, clozapine’s ability to modulate impulsivity and emotional dysregulation could provide a valuable adjunct in the treatment of this complex disorder.

To evaluate the efficacy of clozapine in reducing impulsivity, emotional dysregulation, and suicidality in patients with BPD.

The study cohort consisted of 47 patients (29 women) with a mean age of 28 years (IQR: 22-44), all diagnosed with BPD resistant to previous pharmacological treatments. Clozapine was introduced after a comprehensive risk-benefit assessment. At baseline, 96% of patients were taking mood stabilizers or anticonvulsants, 87% were taking SSRI/SNRI antidepressants, 81% were taking antipsychotics, and 66% were taking other medications such as benzodiazepines or gabapentinoids. Clinical assessments using the RIPoST-40, MOAS, and Columbia scales were administered at baseline, one week (T1), one month (T2), and three months (T3). Data were analyzed using repeated measures ANOVA and Friedman’s test with significance set at p<0.01 after Bonferroni correction.

Significant reductions in all scores were observed at T3: RIPoST-40 scores decreased by 40.15% (p<0.0001), MOAS by 58%(p<0.0001), Columbia Scale scores by 70.20% (p<0.0001). At month 3, clinical response, defined as a ≥50% reduction in scores, was achieved by 11% of patients on the RIPoST-40, 70% on the MOAS, and 94% on the Columbia Scale.

Clozapine demonstrated significant reductions in impulsivity, emotional dysregulation, and suicidality in patients with BPD, with rapid improvements observed within the first week and sustained through 3 months. These findings suggest that clozapine, in combination with psychotherapy, may be an effective treatment strategy for the most severe symptoms of BPD. Further prospective studies with larger cohorts are needed to validate these preliminary results and to assess the long-term safety and efficacy of clozapine in this population.

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