During the pandemic of a new coronavirus infection in Russia, the number of patients with diagnosed depressive and anxiety disorders increased. Studies have shown a sharp increase in the number of respondents who recorded stress as a non-specific reaction to a sudden change in environmental conditions. Quality of life, encompassing physical, psychological, and social well-being, often correlates with individuals’ emotional and mental states.

The study aimed to examine the associations between quality of life and emotional states — specifically, depression, anxiety, and stress — in humanities students and people living with HIV.

Data were collected from January to July 2021 through a Google form. The sample comprised 35 humanities students from Russian universities and 59 HIV-positive patients. The WHOQOL-BREF assessed quality of life, while the DASS-21 measured levels of depression, anxiety, and stress. Both questionnaires have been adapted for Russian respondents.

We found that in the student group, depression was related to physical and psychological well-being (rs = -0.491, p < 0.01), self-image (rs = -0.552, p < 0.05) and microsocial support (rs = -0.550, p < 0.05), and anxiety with physical and psychological well-being (rs = -0.356, p < 0.05) and microsocial support (rs = -0.353, p < 0.05). In the patient group, physical and psychological well-being was associated with depression (rs = -0.309, p < 0.05) and anxiety (rs = -0.269, p < 0.05); self-perception was associated with depression (rs = -0.490, p < 0.01), anxiety (rs = -0.311, p < 0.05) and stress (rs = -0.361, p < 0.05); microsocial support — with depression (rs = -0.381, p < 0.01), anxiety (rs = -0.260, p < 0.05) and stress (rs = -0.322, p < 0.05); social well-being — with depression (rs = -0.360, p < 0.01), anxiety (rs = -0.426, p < 0.01) and stress (rs = -0.334, p < 0.05).

The study revealed distinct patterns in the relationship between life quality and emotional states across groups during the COVID-19 second wave in the Russian Federation. Among students, life quality, especially physical and psychological well-being, was associated with depression and anxiety but was notably independent of stress. Social well-being (including material security, health environment, leisure, and access to medical care) remained stable and unlinked to their emotional state. Among people living with HIV, almost all life quality domains correlated with depression, anxiety, and stress. This group displayed heightened vulnerability to emotional distress, affecting their self-perception, social interactions, and sense of security, thus underscoring the pandemic’s amplified impact on this group’s mental health.

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Self-report instruments assessing self-injurious thoughts and behaviors (STBs) are widely used, but their effectiveness and predictive validity vary.

This study aimed to synthesize findings from previous reviews and identify self-report instruments assessing suicidal thoughts and behaviors (STBs) in adults, followed by a network analysis to explore psychometric properties and inter-item relationships.

Systematic searches were conducted in MEDLINE/PubMed, EMBASE, and the Cochrane Database of Systematic Reviews, covering inception to July 2023, using terms like “suicide risk,” “self-report instruments,” and “psychometrics.” From 318 publications, 22 manuscripts were selected, including reviews, guidelines, and book chapters on STB instruments. Data were extracted under PRISMA guidelines, focusing on scale characteristics, predictive validity, item composition, and psychometric performance. Seven frequently cited scales (SPS, SSI, RFL, ASQ, SBQ-R, ACSS, and C-SSRS) were analyzed using Harmony, which uses NLP via Sentence-BERT to evaluate semantic similarity among items. A correlation matrix based on cosine similarity measured inter-item relationships, forming an undirected weighted graph analyzed with the Louvain community detection algorithm. Centrality measures (strength, betweenness, closeness) and questionnaire-based aggregation enabled scale comparisons. Additionally, Exploratory Graph Analysis (EGA) with the GLASSO model and Walktrap algorithm, assessed by the Total Entropy Fit Index (TEFI), explored network dimensionality and community structures.

Thirty-four scales were identified, with 35% having 1-10 items and 29% having 11-20 items. ASIQ and ASQ displayed high predictive validity (sensitivity: 96% and 96.9%, respectively). The Beck Scale for Suicide Ideation (SSI) had the highest strength centrality (68.1) and eigenvector centrality (0.871), while the CSSRS had the highest betweenness centrality (488.0). Four clusters were identified (Image 1) with a modularity score of 0.0838, indicating moderate cluster separation. The EGA (Image 2) confirmed a multidimensional structure, with an edge density of 0.667 and the Walktrap algorithm identified two main communities focused on cognitive and behavioral/protective aspects. The TEFI score of -3.778 indicated a multidimensional network structure.

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Image 2:

The findings underscore the need for multidimensional approaches to STB assessment. Key tools like the SSI and CSSRS are central, with future research recommended to enhance predictive validity and enable cross-cultural adaptation. To advance psychometric evaluation, future work will include a systematic review and meta-analysis following the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) protocol to assess these scales’ psychometric properties in depth.

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While several studies have investigated language disorders in individuals with Autism Spectrum Disorder (ASD), few have specifically examined formal thought disorder (FTD) symptoms, particularly in adults.

This study aims to assess FTD symptoms in adults with Level 1 ASD using the Thought and Language Disorder (TALD) scale and to analyze correlations between TALD scores and other neuropsychological dimensions.

The study included 23 adults with Level 1 ASD (16 males, 7 females). Inclusion criteria were: a diagnosis of Level 1 ASD and age between 18 and 50 years. Exclusion criteria included: presence of major psychiatric comorbidities, intellectual disability, and neurological disorders that could impair language abilities. A comprehensive evaulation was conducted using TIB, HAMD, PANSS, STAI-Y1 and Y2, TASIT (Parts 1, 2, and 3), Ekman Facial Expression Test, TAS-20, ADOS-2, RAADS, AQ, and EQ. Language and thought disorders were evaluated using the TALD scale. Statistical analyses were performed using SPSS software to examine correlations between TALD scores and other neuropsychological dimensions.

The study population had a mean age of 27.6 ± 8.22 years, comprising 16 men and 7 women. Total TALD scores showed no significant correlation with educational level (r = -0.028, p = 0.914). Results revealed a significant correlation between the total TALD score and the total TASIT-2 score (r = -0.679, p = 0.011). Additionally, the “manneristic speech” item correlated with paradoxical sarcasm on TASIT-2 (r = -0.620, p = 0.024) and with lie recognition on TASIT-3 (r = -0.633, p = 0.02). The total ADOS-2 score showed a strong correlation with the total TALD score (r = 0.607, p = 0.028) and with specific linguistic features, including verbigeration (r = 0.725, p = 0.005), pressured speech (r = 0.648, p = 0.017), clanging (r = 0.725, p = 0.005), echolalia (r = 0.725, p = 0.005), and concretism (r = 0.738, p = 0.004). Furthermore, TALD was predictive of higher ADOS-2 scores (β = 0.607, t = 2.53, r = 0.607, p = 0.028, R² = 0.368).

Our findings highlight specific FTD symptoms in adults with Level 1 ASD. The TALD scale proved to be a valuable tool, showing significant correlations with other neuropsychological domains. TALD scale also demonstrated a reliable predictive ability for higher ADOS-2 scores and distinct linguistic characteristics associated with ASD. TALD scale is proposed as a useful tool in clinical evaluations, providing additional insights beyond traditional diagnostic tools and showing independence from educational level.

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A 44-year-old woman with a history of migraine, ulcerative colitis, obesity, and hypertension. She experienced a depressive episode that resolved completely in 2013. Hospitalized in 2020 and 2021 for psychotic symptoms (auditory pseudo-hallucinations) resistant to treatment, requiring bilateral ECT (LOW05, dose titration up to 45% - 227 mC-) and initiation of clozapine. In October 2021, she was enrolled in a monthly ECT maintenance program, maintaining a period of euthymia without psychotic symptoms until September 2022. At that point, she began to present anxiety secondary to auditory perseveration: after an auditory stimulus, the patient verbalizes an echo of that sound outside her head, which lasts for hours or even days.

Perform a differential diagnosis between schizoaffective disorder (given the persistence of psychotic symptoms despite euthymia) and palinacusia. Additionally, monitor the patient’s progress and address the described psychopathology according to current scientific evidence.

Systematic review of the existing literature on the etiology, pathophysiology, and therapeutic approach to palinacusia. Clinical follow-up of the patient’s progression.

Various complementary tests are performed: normal blood tests (complete blood count, biochemistry, serologies, autoimmune markers, thyroid function). Clozapine levels: 315 ng/ml; norclozapine 189 ng/ml; ratio 1.6 (all within normal range). EEG: overload of slow activity over bilateral temporal regions. No postictal activity. MRI: slight cortico-subtemporal atrophic changes with a temporal predominance. No mesial sclerosis foci observed.

Since October 2023, different antiepileptic drugs have been trialed (topiramate, eslicarbazepine, and valproic acid). Additionally, the patient continues in a monthly maintenance ECT program (bilateral, LOW05, reaching a dose of 90%). As a result, the patient shows slow progress, with no remission of the described symptoms, although there is a temporary reduction in intensity (February 2024).

The term “palinacusia” was described by Jacobs in 1971 as auditory perseveration (following a trigger and with neutral content). It is associated with various etiologies, primarily convulsive phenomena, and it remains debated whether it is ictal or postictal. The temporal lobe’s GTS is typically affected. To date, it has been described in 43 patients, and only in two patients with psychosis. The case described began after treatment with ECT, which raises the possibility of its pathophysiological involvement (difficulty in postictal suppression capacity). Currently, after discontinuing ECT treatment in March 2024 due to the possibility that it was exacerbating the palinacusia, and after trialing the aforementioned antiepileptic drugs, no remission of symptoms has been achieved.

R. Ramallo Castillo Employee of: Internal medicine resident in the Andalusian Health System, M. Pérez Sosa Employee of: Specialist doctor in the Andalusian Health System, M. Vázquez Delgado Employee of: Specialist doctor in the Andalusian Health System, C. Sánchez Martínez Employee of: Internal medicine resident in the Andalusian Health System, J. M. Duro Garrido Employee of: Internal medicine resident in the Andalusian Health System

The Bible offers various insights into human struggles, including what can be interpreted today as mental illness. Although ancient texts do not explicitly refer to mental health using modern terminology, there are many accounts of emotional distress, depression, anxiety, and other psychological challenges. Throughout Scripture, several figures are portrayed grappling with deep sorrow, fear, and mental turmoil. These narratives provide spiritual reflections on suffering, healing, and divine intervention, shedding light on how biblical teachings have historically addressed human fragility.

To raises questions about how we can relate ancient wisdom to contemporary mental health issues, offering opportunities for spiritual growth, empathy, and care in our own lives.

A non-systematic review of the published literature was conducted using the Google Scholar database with the search terms “Bible” and “mental illness.” Articles were selected based on their relevance, and further information was obtained through direct consultation of biblical texts.

The prophet Elijah exhibits signs of reactive depression, triggered by stress after confronting the prophets of Baal and receiving a death threat from Jezebel (1 Kings 18:20-40). His symptoms—loss of appetite, isolation, low self-esteem, and hopelessness—are well-documented (1 Kings 19:3). God’s response (1 Kings 19:11-14) provides an example of care for depression, with affection, understanding, and patience.

James 5:15-18 references Elijah to highlight that depression can affect Christians, suggesting that illness, whether physical or spiritual, requires dialogue and support. James emphasizes God’s forgiveness, even if illness stems from sin, viewing depression as an organic condition in line with the holistic Jewish understanding. He advocates for confession and prayer as therapeutic (James 5:16), stressing that mercy triumphs over judgment.

Psalm 6:6-7 captures the deep despair of depression, showing the importance of seeking God amid mental anguish, which is often invisible to others.

The accounts of figures like Elijah and the reflections in Psalms demonstrate that conditions resembling modern definitions of depression and anxiety have long been acknowledged, albeit through the lens of ancient cultural and religious contexts. The compassionate care that God extends to Elijah, coupled with the guidance found in the New Testament, particularly in the book of James, underscores the importance of community and support in addressing mental health challenges.

By examining these stories, we gain a broader understanding of how faith communities have interpreted and coped with the complexities of mental illness - in light of their relationship with God.

These accounts present a holistic biblical view of depression, underscoring the need for empathy, spiritual care, and community support in mental health.

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Individuals who develop an Imposter Syndrome do not attribute objective successes to their own abilities and competences, but rather believe that they are not intelligent enough, and are sometimes convinced that they have deceived others. It is known that the Imposter Syndromehas various effects on health. In particular, it affects the mental health of the individuals affected. Although it is known that the manifestation of the Imposter Syndrome is higher in marginalized groups in academic fields. Whether the intersectionality of the relevant diversity domains and personal resources such as social support and belonging have an influence on the extent of the imposter phenomenon has not yet been investigated.

The aim of the study was to determine the association between imposter syndrome to the psychological well-being of supervisors and doctoral students in the doctoral process considering the mediating influence of experiences of discrimination, social support and belonging.

A six-month program was developed to accompany the promotion process. A total of seven groups were conducted from April 2024 to May 2025. At the beginning of the programme, baseline data was collected using The WHO-5 Well Being Questionnaire, the Sense of Belonging Questionnaire, the F-Sozu-6 Questionnaire, the Diversity minimal item set and the Clance Imposter Phenomenon Scale.

Preliminary data show that the Imposter syndrome is widespread among supervisors and doctoral students. Individuals who perceive themselves as belonging to multiple diversity domains tend to exhibit diminished psychological well-being, particularly when considering the intersectionality of these domains.

The findings of this study indicate that the Imposter syndrome should be addressed in an accompanying doctoral program with a focus on gender- and diversity aspects. Diversity domains, social support and sense of belonging should be considered more frequently in the development of academic career interventions.

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Communicating bad news is common in the health care sector, especially in emergency services. The importance of formal training in giving bad news in health care and the differences in the services provided by health care units in urban and rural contexts are well-documented in the literature. However, opportunities for clinicians to develop bad news communication skills provided by the distinct contexts of the health care unit in which they are included have rarely been studied. We assume that the communication of bad news is part of the service provided in emergency departments. Therefore, it can vary across rural and urban health care units.

This comparative cross-sectional study aims to test whether the location of the health care unit (rural vs. urban) has a significant impact on the communication of bad news by clinicians in emergency services.

Data will be collected through an online questionnaire based on the literature in two purposive samples of emergency health care professionals in rural and urban contexts. Qualitative and quantitative methods will be applied to analyze data regarding work features, situational context, experience, perceived knowledge and skills in providing bad news, and training needs and preferences.

Rural health care units serve populations with more health disparities and poorer outcomes than non-rural, and classically have shortage of emergency medicine trained physicians. In urban areas health units have larger and more differentiated teams. The results will be discussed in the light of the literature on discrepancies between rural and urban health care units, describing professional characteristics and experience in delivering bad news of the study participants. We expect to identify specific contextual factors associated with geographic location, institutional settings, and health professionals’ training in delivering bad news in emergency medicine.

The results of this study can aid to differentiate bad news communication trainers and health care unit managers in rural and urban areas (a) justifying the implementation of training programs, (b) adapting training programs to the audience, and (c) improving institutional facilities, practices, and policies to support adequate communication of bad news in emergency settings.

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Communicating bad news (CBN) in emergency medicine is a crucial and challenging aspect of clinical care. Emergency Health Care (EHC) operates in high-pressure, time-sensitive environments, where life-altering information must be communicated rapidly, leaving little time for careful preparation or consideration. The emotional, ethical, and psychological complexities of CBN in such settings necessitate effective communication strategies to mitigate the distress of patients, families, and healthcare providers. This literature review aimed to examine the key challenges and best practices associated with delivering bad news in emergency medicine.

This review aims to synthesize the literature with the main objectives of 1. identifying the challenges faced by emergency medical professionals in delivering bad news and 2. collect the best practices, general guidelines, specific protocols and communication models used in emergency settings.

A systematic review of the literature was conducted, focusing on peer-reviewed articles published between 2000 and 2023, using the keywords “comunicating bad news,” “emergency health care,” “communication in emergencies,” and “best practices for CBN.”. Articles were screened for relevance and rigor, and key findings were synthesized thematically.

The literature highlights several challenges: time constraints in EHC, lack of formal communication training, and emotional toll on both providers and recipients of the news. Emergency physicians often struggle to deliver bad news in a compassionate yet efficient manner, especially in the context of sudden or unexpected death. The best practices identified include the use of structured communication frameworks, such as the SPIKES protocol, which helps guide healthcare providers through the process. Multidisciplinary support, including involving social workers and counselors, was also emphasized as essential to alleviating the burden on both the physician and the patient. Furthermore, studies have revealed that when formal DBN training is implemented during residency, physician confidence and patient satisfaction improve significantly.

The review underscores the complexity of delivering bad news in emergency medicine. Incorporating structured communication protocols and formal training into medical education and emergency department practices is essential for improving patient outcomes and physician well-being. Future research should focus on evaluating the effectiveness of tailored CBN protocols and programs as well as interdisciplinary collaboration.

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Communicating bad news is a common occurrence in the healthcare sector, especially in emergency services. However, it is also recognized as one of the most stressful, uncomfortable and difficult moments. Clinicians may appear cold, exhibiting depersonalized communication, or feel detached and overwhelmed due to a lack of training in communicating bad news. Therefore, it is crucial to develop their skills in communicating bad news to improve their proficiency in these challenging situations.

The purpose of this study is to comprehend the specific needs of clinicians when delivering bad news to emergency patients, and to identify effective strategies for tailoring educational programs to the demands of emergency healthcare. Additionally, the study aims to identify differences and similarities across two geographic and cultural settings.

A group of emergency health professionals working in Portugal and Brazil were invited to participate in the study. We will collected sociodemographic data and performed a professional characterization. Participants will describe their experience and training in delivering bad news in emergency settings and preferences regarding methods and design of communication skills training. The evaluation included clinicians self-evaluate their knowledge, skills, and application of seven relevant skills (adapted from Breaking Bad News, Servotte et al 2019).

We expect clinicians from emergency health units in Portugal and Brazil to identify specific strategies applied when delivering bad news, and how theoretical knowledge and previous training imbed their sense of capability. Sociodemographic and professional characteristics are probable factors influencing clinicians’ self-perception of communicating bad news to emergency patients and families.

Breaking bad news can be challenging for clinicians due to the complexity of communication and the emotional intensity involved. This highlights the need for tailored training programs that are culturally adapted and focused on clinicians’ needs and preferences. Albeit speaking the same language differences in the healthcare setting (Portugal vs. Brazil) must be considered when designing educational interventions.

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The parental role is often central to the recovery process. For the 70% of people with Serious Mental Illnesses (SMI) who are or will become parents, the parental role is often central to their recovery process. Although a growing number of studies focuses on recovery in parents with SMI, little is known about the experienced influence of stigma on recovery within this specific group.

This systematic review aims to provide a deeper understanding of the interaction between various types of stigma, the parental role, and the recovery process in parents with SMI.

A systematic search was conducted in four online databases and the reference lists of included articles. Primary research studies of any design that included stigma- and recovery-related experiences among parents with SMI were included. Stigma-related experiences were categorized into six distinct types. The findings of included studies were inductively coded. Reflexive Thematic Analysis (RTA) was applied for the data-analysis.

A total of 25 studies were included, all of which identified various types of stigma related to the parental role. The data analysis of the interaction between the parental role, stigma, and recovery resulted in the conceptualization of six themes: (1) Loneliness and isolation; (2) Struggling with parental identity; (3) Protecting the children; (4) Not having the same rights and chances; (5) Lost in the system and (6) Overcoming stigma.

Parents with SMI experience stigmatization of their condition as well as stigmatization of their parental role. Stigmatization of the parental role can have a profound impact on their recovery process, since it limits or even restricts parents from fulfilling their parental role. In order to protect their parental role and family life, parents are hesitant to disclose their SMI and ask for help. As a result, parents and their families are hindered in receiving the needed (psychiatric) support. Since the parental role is central to the recovery process for parents with SMI, it is crucial for Mental Health professionals to pay specific attention to the stigma- and recovery-related factors associated with this role.

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Catatonia is a neuropsychiatric syndrome characterized by motor, behavioral, and autonomic disturbances, frequently associated with psychiatric disorders such as schizophrenia and mood disorders, but also manifesting in medical conditions like autoimmune encephalitis and epilepsy. Despite its prevalence, catatonia remains underdiagnosed and undertreated. Recent advances in neuroimaging, diagnostic frameworks, and therapeutic interventions have enhanced our understanding of the syndrome, contributing to improved clinical outcomes.

This abstract synthesizes recent developments in the diagnosis and treatment of catatonia based on research conducted from 2020 to 2024.

A systematic review of the literature published between 2020 and 2024 was performed using databases such as PubMed and Google Scholar. The search strategy included the terms “catatonia,” “diagnosis,” “treatment,” and “neuroimaging.” Relevant studies, case reports, and reviews focusing on diagnostic innovations, neuroimaging techniques, and therapeutic advances were included.

Advances in neuroimaging, particularly functional MRI, have revealed abnormalities in the frontoparietal cortex, basal ganglia, and cerebellum, offering insights into the neurobiological mechanisms underlying catatonia. Resting-state fMRI studies have demonstrated altered functional connectivity in these regions, facilitating differentiation between catatonia and other movement disorders. Diagnostic tools such as the Bush-Francis Catatonia Rating Scale (BFCRS) remain integral to clinical assessment.

Benzodiazepines, particularly lorazepam, continue to be the first-line treatment, while electroconvulsive therapy (ECT) is employed in treatment-resistant cases, especially in malignant catatonia marked by autonomic dysregulation. Emerging treatments, including NMDA receptor antagonists like memantine, have shown potential in refractory cases. Special considerations are required for populations with autism spectrum disorder (ASD) and neurodevelopmental conditions, where catatonia presents uniquely.

Recent findings underscore the importance of early diagnosis and timely intervention in catatonia. Advances in neuroimaging and novel therapeutic options have enhanced the management of this complex condition, opening new directions for research and clinical practice.

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Body dysmorphic disorder (BDD) consists of preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others, and which cause a great social deterioration. Its prevalence in aesthetic medicine is around 10 percent, and it is higher in women.

The overall objective of this systematic review is to gather integrated evidence to ascertain the prevalence of body dysmorphic disorder in an aesthetic medicine practice and its association with satisfaction with the results of the derived interventions.

An initial search of ScienceDirect, PubMed, PsycInfo, Cochrane, and CINAHL was conducted. In addition, scientific journal publications, book articles and clinical guidelines were used. The search terms were: “body image”, “eating disorder”, and “aesthetic medicine”. The search included results from January 2000 to January 2023, in Spanish and English.

The total number of participants in all studies was 3004. 42.86% of the studies were conducted between 2000 and 2009, while the rest were conducted from 2010 onwards. It has been observed that most patients with BDD seek non-psychiatric treatment for their perceived appearance defects. The result after an aesthetic intervention is that in most patients with BDD there is no improvement in the concern for the perceived body image defect, and they present greater dissatisfaction. A high number of patients with BDD are being overlooked in aesthetic medicine practice who should receive a combined medical and psychological intervention.

It is necessary to create protocols for an early diagnosis of body dysmorphic disorder in the aesthetic medicine practice which include a comprehensive approach.

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Corticosteroids are integral in treating various medical conditions across multiple specialties. However, they are known to induce psychiatric adverse effects, ranging from subtle mood changes and memory deficits to psychosis.

This review aims to explore the current literature on these effects, identifying risk factors and strategies for early intervention.

A non-systematized literature review was carried out on PubMed and Google Scholar. The following words were searched: (“corticosteroids” OR “steroids” OR “glucocorticoids”) AND (“psychiatry symptoms” OR “psychosis” OR “mood” OR “memory”).

Despite being recognized for their strong anti-inflammatory and immune-suppressing effects across various medical conditions, corticosteroid therapies frequently come with neuropsychiatric complications, the understanding of which is still limited. Although symptoms usually emerge within 3 to 4 days after starting corticosteroid treatment, they can manifest at any point, even after the therapy has been completed or stopped. Dosage is a significant risk factor, with high doses increasing the likelihood of psychosis. Depression is more prevalent among women. Additional risk factors include past psychiatric history, compromised blood-brain barrier, and hypoalbuminemia. However, some instances show beneficial outcomes, such as alleviation of depressive symptoms without triggering mania and improvements in cognitive function.

Early diagnosis and awareness are crucial in managing corticosteroid-induced psychiatric symptoms. Initial steps should involve tapering or discontinuing corticosteroids, supplemented by psychotropic medications if necessary.

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Attention-deficit/ hyperactivity disorder (ADHA) is recognized as a major public health issue, characterized as a persistent neurodevelopmental disorder that presents challenges in various aspects of life, often continuing into adulthood and frequently going undiagnosed.

This study aimed to explore the prevalence, types, participants knowledge and perceptions and demographic determinants of undiagnosed adult ADHD among undergraduate medical students in Pakistan.

This study conducted from July 2023 to December 2023. A nationwide cross-sectional study enrolled 342 undergraduate medical students who met the selection criteria. Data was collected through an online self-administered survey of three main parts, utilizing the WHO 18 questions Adult ADHD Self-Report Scale, Version 1.1 (ASRS-v1.1), to assess adult ADHD symptoms. Data analysis was carried out using SPSS ( version 26.0).

Out of 342 participants, 119 medical students, or 34.8%, were found to have adult ADHD. The most prevalent presentation was inattentive dominance, observed in 86 students (72.3%), followed by mixed dominance in 20 students (16.8%), and hyperactive dominance in 13 students (10.9%). There was a statistically significant (p < 0.05) association between individuals screening positive for adult ADHD and the presence of co-occurring psychological disorders (e.g., anxiety, depression) and a family history of psychiatric disorders (e.g., ADHD, generalized anxiety disorder, bipolar disorder). Additionally, these individuals believed that adults with adult ADHD could lead a normal life despite their condition. The type of ADHD was significantly associated with the use of medications for psychological disorders, with a notably higher usage among hyperactive dominants (5, 71.4%), and a significantly higher family history of GAD among mixed dominants (2, 10.0%).

This study uncovers a significant prevalence of undiagnosed adult ADHD and an inattentive dominance among medical students in Pakistan, highlighting the need for enhanced awareness and screening. These findings underscore the critical necessity for the implementation of ADHD screening programs.

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Smith-Magenis Syndrome (SMS) is a neurogenetic disorder caused by deletions on chromosome 17p11.2 or mutations in the RAI1 gene. It is characterized by intellectual disability, behavioral disturbances like aggression, impulsivity, self-injury, and sleep disruptions. A hallmark feature of SMS is inverted melatonin production, leading to daytime sleepiness and nighttime insomnia, which exacerbate behaviors. Traditional treatments, such as antipsychotics and SSRIs, often show limited effectiveness and can cause side effects, including metabolic syndrome, sedation, and extrapyramidal symptoms.

Lithium has emerged as a promising alternative to manage treatment-resistant behaviors in SMS. Known for its mood-stabilizing properties in bipolar disorder, lithium modulates dopamine and serotonin, reduces aggression, and promotes neuronal plasticity. However, lithium requires close monitoring due to the risks of nephrotoxicity, thyroid dysfunction, and its narrow therapeutic index.

This study explores lithium’s role in managing severe behavioral disturbances in SMS, especially in patients unresponsive to conventional treatments. The objectives are: (1) to review the literature on lithium’s efficacy and safety in SMS and similar neurodevelopmental disorders, and (2) to present a clinical case of a 25-year-old SMS patient treated successfully with lithium after antipsychotics and SSRIs failed.

A literature review was conducted using PubMed and Web of Science, focusing on articles published between 2013 and 2023 on lithium in SMS and related disorders. Additionally, the clinical case of a 25-year-old male with SMS, exhibiting aggression and self-injury, was documented. After other treatments failed, lithium was introduced with regular monitoring of serum levels, renal, and thyroid function throughout six months.

Literature supports lithium’s efficacy in reducing aggression and impulsivity in SMS. Lithium modulates dopaminergic and serotonergic systems, stabilizing mood and reducing disruptive behaviors. In the clinical case, the patient improved within two weeks of lithium therapy. Over six months, aggression and self-injury diminished significantly, with no adverse effects and stable renal and thyroid function.

Lithium is an effective option for SMS patients with treatment-resistant behavioral disturbances, particularly aggression and self-injury. It offers a valuable alternative to antipsychotics and SSRIs, enhancing emotional stability and quality of life. However, careful monitoring is required to prevent toxicity. Further research is needed to confirm lithium’s long-term safety and efficacy in SMS.

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Therapeutic adherence is defined by the World Health Organization as the degree to which the patient’s behavior corresponds to the recommendations agreed with the healthcare professional. Adequate adherence to pharmacological treatment is essential to achieve therapeutic objectives, but non-adherence rates are high, ranging between 10% and 92%.

To highlight the role of written communication/information provided to the patient in the adherence to treatment.

Non-systematic literature review.

Non-adherence limits therapeutic benefits, compromises the effectiveness of medications and increases the demand for healthcare, representing a major obstacle to the provision of care. One of the factors that contribute to non-adherence is the failure in communication between healthcare professionals and patients, especially with regard to providing clear information about medications.

Since patient educational interventions seem important and effective in improving medication adherence, it is pertinent to adopt more effective ways of communicating and adequately informing patients about the main aspects of the prescribed drugs. Such process can be assisted by written information leaflets.

In this context, studies have revealed that patients appreciate written information to help make decisions about whether or not to take a medication, manage medication intake and interpret symptoms. The benefits and side effects of drugs are generally important information for patients, especially if presented in a legible way, with understandable text, without large volume and without small font size used.

Written instructions can be a useful complement to information transmitted verbally by serving to increase the likelihood that important information can be presented, understood, accepted and remembered by the patient - studies show that patients who received written information better understood their medication, precautions, use instructions, associated side effects, and were more satisfied with the information received, which could contribute to greater therapeutic adherence.

There seems to be a consensus in the bibliography that written information should not replace verbal information. The latter remains a priority, but must be closely associated to written information so that, in combination, its beneficial effects can be enhanced.

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A compatriot who is declared insane and ends up chained in a mental institution is a new and unexpected character that appeared in Russian fiction during its heyday in the first half of the 19th century. The theme of “madness” followed by “chaining” is repeated in the influential works of Alexander Pushkin, Alexander Griboyedov, Alexander Voeikov and other outstanding writers of this period.

Find out: (1) How historically accurate was this persistent artistic image — was it merely a literary convention or a true reflection of the status quo? (2) Was the shackling of patients “the standard of care” in psychiatric institutions in Russia and Europe in the late 18th and first half of the 19th centuries?

A historiographical and comparative analysis was conducted, which allowed us to compare historical evidence and manuals on mental illness published in Europe in the period 1782-1845, as well as Russian professional literature on the history of psychiatry in Russia.

The artistic image of the “madman on a chain” largely corresponded to reality; moreover, in a number of cases, the horror of reality exceeded the artistic image.

By bringing the image of the patient in chains to the forefront, Russian fiction attracted public attention to the topic, which was one of the factors that contributed to the opening of a significant number of new psychiatric hospitals in Russia in the second half of the 19th century, with a more humane attitude towards psychiatric patients.

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Vladimir Chizh, who replaced Emil Kraepelin in the Department of Psychiatry at the University of Dorpat in 1891, counted no fewer than 30 characters with psychoneurological disorders in Dostoevsky’s works, beginning with the main character of “The Double,” written in 1846.

Try to answer the following questions: (1) Should a psychopathological analysis of a literary work include elements of the author’s psychobiography, psychopathological components of the author’s language, and can such work be carried out by one psychiatrist without the participation of a literary scholar? (2) What goals should such an analysis pursue? (3) Should the accuracy of the author’s description of the mental disorders present in the characters of his work be considered as a criterion for assessing the author’s artistic skill and the significance of the work as a literary and cultural phenomenon?

Taking Dostoevsky’s “The Double” as a starting point, the authors analyzed professional literature on the topic and conducted their own psychopathological and literary analysis of this literary work.

(1) psychopathological analysis without the participation of a literary scholar is always incomplete, since everything we learn about the hero of the work we learn through the language of the work. (2) the assessment of the quality of a work of art by a psychiatrist from the point of view of the accuracy of the description of psychopathological symptoms in a particular character leads to the fact that the ideal work of art becomes a well-written case history.

It is hardly correct to give a precise psychiatric categorization to persons whose behavior in a work of art is depicted as pathological. The author’s depiction of his hero’s pathological experiences has goals other than psychiatric ones and is conditioned by the general concept of the work.

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Notwithstanding the drastic reduction in the prevalence of catatonic symptoms in schizophrenia with the development of anti-psychotic treatment regimens since the 1950’s, a subgroup of patients still presents mostly such symptoms, associated with worse long-term prognosis.

Discuss the challenges surrounding the diagnosis and clinical management of patients with schizophrenia with catatonic symptoms.

In addition to describing a case report of a male with catatonic symptoms mimicking conversive disorder, research was undertaken in PubMed and other databases using the keywords “conversive disorder, “catatonia” and “schizophrenia”.

A 29-year-old male patient, a former Geology BA student followed by Psychiatry in our hospital for conversive symptoms – namely mutism and sudden episodes of motor paralysis with no changes in the neurological examination or imaging exams - and admitted twice for that reason in the prior 6 months, was brought to the ED by police after an attempted self-injury with a knife. The family reported for the past week sleep-wake inversion, social isolation, compulsive smoking, refusal to eat any homemade food, soliloquies, staring at the walls for no reason and, in the last 3 days, post its with messages such as “I sinned” or “I disappointed God”. In the ER, the patient engaged in mutism, with negativism in his posture. Considering the high suicide risk and the presence of psychotic symptoms, including persecutory, poisoning and mystical delusions as well as likely auditive-verbal hallucinatory activity, he was admitted again, this time in involuntary regime. To exclude secondary causes, both blood samples and imaging techniques (first head CT and later MRI) were ordered. The bloodwork revealed increased levels of CK without any other significant findings, and imaging techniques also had negative results. In the psychiatric ward, the patient engaged in selective mutism towards the medical team, likely in a context of persecutory delusions. Due to the prominence of negative symptoms and lack of adhesion to treatment, we choose to treat with intramuscular paliperidone and sertraline, 50 mg. With this treatment, the patient started feeding himself again, resumed a daily routine and ceased his mutism. Yet, he remained highly defensive psychopathologically, with very poor speech content and severe affective blunting. He was discharged with the diagnosis of schizophrenia and has been followed in outpatient visitations, remaining clinically stable.

Catatonic schizophrenia in its first presentation can be confused with conversive disorder, given the fact both may share movement disorders, in psychotic patients who collaborate very little with psychiatrists, requiring a careful combination of anamnesis, mental state examination and gathering of information with family members or others close to the patient.

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Autism spectrum disorder (ASD) and schizophrenia (SZ) are neurodevelopmental disorders that, although unfolding in different ways, can present with overlapping symptoms, both negative symptoms like deficits in social–emotional reciprocity and engagement (Trevisan et al. Front.Psych; 2020;11:548), and positive symptoms like delusions and hallucinations (Ribolsi et al. Front Psychiatry; 2022;13:768586).

To discuss the diagnostic challenges between ASD and SZ in patients presenting with both positive and negative symptoms.

In addition to describing a case report of a man with negative symptoms and presumptive psychotic symptoms, research was undertaken in PubMed and other databases using the keywords “autism spectrum disorder”, “schizophrenia” and “multiple sclerosis”.

A 26 year-old man was involuntarily admitted to the in-patient unit due to persecutory delusions, irritability, social isolation and cognitive symptoms. He had also been recently diagnosed with Multiple Sclerosis (MS). These symptoms had begun 5 years prior, intensifying over time, leading to the hypothesis of First Episode Psychosis, with a probable recent escalation secondary to the flairing up of MS. Through a detailed clinical history, we discovered that, in fact, the patient exhibited conduct changes since early adolescence: restricted and repetitive behavior, social isolation, reduced tolerance to opposition, cognitive rigidity, circumscribed interests and puerile contact. This lead to the development of great hostility towards his family members, whenever his wants weren’t met (most of them mismatched with reality), resulting in isolation from the family and the sending of aggressive messages and emails, even though his parents always tried to provide the patient with everything he wanted, explaining the assumption of persecutory delusions. Intramuscular risperidone and clozapine were initiated for irritability and cognitive symptoms, respectively, with minimal improvement in both, mainting however every other symptom described.

Despite the current distinction between ASD and SZ, they still share many similarities, increasing the difficulty of determining an exact diagnosis. We present a case with negative and cognitive symptoms, that can fit in both conditions, and positive symptoms that fit in SZ. It’s possible to understand that the delusions may not be primary, but secondary to social interpretation bias, common in ASD patients, and that part of the cognitive symptoms can be due to MS. The suboptimal response to antipsychotics also makes us lean more to the presence of ASD with temporary psychotic symptoms instead of a primary psychotic disorder.

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