Cardiovascular diseases are one of the leading causes of death worldwide. Adherence to treatment is considered to be a key determinant of the effectiveness of therapy. Patient’s personality and other psychological characteristics play a regulating role in health behaviour but there is still no consistent evidence on their connection to the adherence to treatment.

The study aimed to determine the role of psychological factors regarding the adherence to treatment in patients with cardiovascular diseases.

Adherence was measured using the Questionnaire for Comprehensive Assessment of Treatment Adherence (Nikolayev et al. Clinical Pharmacology and Therapy 2018, 1 74-78). To provide a complex assessment of psychological factors we used the Short Health Anxiety Inventory (Salkovskis et al. Psychological Medicine 2002, 32 843-853; Pervichko, Shishkova. National Psychological Journal 2022, 2), the HEXACO Personality Inventory (Ashton, Lee. Personality and Social Psychology Review 2007, 11 150-166; Egorova et al. Issues of Psychology 2019, 5 33-49), the Defense Mechanisms Rating Scales (DMRS-SR-30; Di Giuseppe et al. Front. Psychiatry 2020, 11:870), and the Picture Frustration Test (Rosenzweig. Journal of Personality 1945, 14 3-23). The study was conducted from January 2024 to April 2024. The sample consisted of 42 male patients hospitalised with multiple cardiac pathology, whose average age was 49.40±7.71.

Patients with cardiovascular diseases mostly demonstrated middle level of the adherence to treatment (61.17±18.53%), twelve (30%) participants were defined as low-adherent, nine (22.5%) were high-adherent. The component of health anxiety known as vigilance to bodily sensations was found to be positively associated with the adherence to treatment (r=0.316, p=0.047). Conscientiousness was the only personality trait to demonstrate significant positive associations with the adherence (r=0.378, p=0.023). More interestingly, adherence to treatment appears to be positively associated with need-persistent and intropunitive frustration reactions (r=0.428, p=0.013; r=0.459, p=0.007) and negatively associated with extrapunitive frustration reactions (r=-0.409, p=0.004). Assessment of defense mechanisms reveals positive associations between overall defense maturity and adherence to treatment (r=0.388, p=0.021), indicating that low-adherent patients are more inclined to use less mature defenses.

Thus, adherence to treatment in patients with cardiovascular diseases is associated with greater vigilance to bodily sensations, conscientiousness, defense maturity, use of need-persistent and intropunitive frustration reactions and lesser use of extrapunitive frustration reactions.

None Declared

Promoting adherence to treatment is essential for increasing the effectiveness of therapy of the cardiovascular diseases. The role of defense mechanisms and frustration reactions of the cardiac patients in their adherence to treatment was not studied previously.

The aim of the research was to study the relationship between defense maturity and adherence to treatment in patients with cardiovascular diseases.

To measure the adherence to treatment the Questionnaire for Comprehensive Assessment of Treatment Adherence was used (Nikolayev et al. Clinical Pharmacology and Therapy 2018, 1 74-78). Defense mechanisms were assessed using the Defense Mechanisms Rating Scales (DMRS-SR-30; Di Giuseppe et al. Front. Psychiatry 2020, 11:870). The Picture Frustration Test was used to assess patients’ frustration reaction types (Rosenzweig. Journal of Personality 1945, 14 3-23). Structural equation modeling (path analysis method) was used for data analysis. The study was conducted from December 2022 to April 2023. The sample consisted of 42 male patients hospitalised with multiple cardiac pathology, whose average age was 49.40±7.7.

The majority of the patients in our sample demonstrated middle level of the adherence to treatment, with mean score being 61.17±18.53%. Twelve (30%) participants were defined as low-adherent and nine (22.5%) were defined as high-adherent. Assessment of frustration reactions showed that the adherence to treatment is positively connected with intropunitive and need-persistent reactions (r=0.428, p=0.013; r=0.459, p=0.007) and negatively connected with extrapunitive reactions (r=-0.409, p=0.004). What concerns defense mechanisms, the maturity of defenses appeared to be positively connected with the adherence to treatment (r=0,388, p=0,021). Using path analysis, we found only one theoretical model to be representative of the empiric data. The model constructed reveals indirect effect of the defense maturity on the adherence to treatment, mediated by the type of frustration reaction. The paths are positive, significant and equal 0.242 (χ2=1.871, p=0.171, CFI=0.947, RMSEA=0.176). Patients that use more mature defenses are more likely to give need-persistent reactions to frustration, hence, they have better adherence to treatment.

Thus, the results of our study demonstrate that defense maturity can be used as a predictor of the adherence to treatment in patients with cardiovascular diseases due to its role in determining the type of frustration reactions. More mature defenses allow patients to be more flexible in their reaction to the illness and its limitations that leads to higher adherence to treatment.

None Declared

Adherence to treatment plays a key role in the effectiveness of therapy of the cardiovascular diseases. Patient’s personality becomes an inevitable determinant of health behaviour influencing the way the patient reacts to the illness itself. The painful sensations, the need to adapt to the disease may be the cause of frustration in patients (Heszen-Klemens. Soc Sci Med 1987, 24 (5) 409-416). Hence, it is necessary to assess how the frustration reactions are connected with the adherence to treatment.

The aim of the research was to study the relationship between the frustration reactions and the adherence to treatment in patients with cardiovascular diseases.

The Picture Frustration Test (Rosenzweig. Journal of Personality 1945, 14 3-23) was used to assess frustration reactions of the patients. The Questionnaire for Comprehensive Assessment of Treatment Adherence was used to provide a complex evaluation of the adherence to treatment (Nikolayev, Skirdenko. Clinical Pharmacology and Therapy 2018, 1 74-78). The study was conducted from January 2024 to April 2024. The sample consisted of 42 male patients hospitalised with multiple cardiac pathology, whose average age was 49.40±7.71.

The average adherence to treatment of the patients with cardiovascular diseases in our sample was 61.17±18.53%, with twelve (30%) participants being defined as low-adherent and nine (22.5%) as high-adherent. What concerns direction of frustration reactions, low-adherent patients were more likely to exhibit extrapunitive reactions (H=7,760, p=0,021), whereas high-adherent patients demonstrated intropunitive reactions more often (H=6,062, p=0,048). More interestingly, there were significant differences in types of frustration reactions, with need-persistent reactions being more characteristic for the high adherent-patients (H=6,551, p=0,038). Intropunitive and need-persistent frustration reactions were associated positively with the adherence to treatment (r=0.428, p=0.013; r=0.459, p=0.007). Extrapunitive reactions were found to be negatively associated with the adherence (r=-0.409, p=0.004).

Our study was the first to consider the connection between the frustration reactions of the patients with cardiovascular diseases and their adherence to treatment. The results indicate that the way in which patients typically react to the frustration is connected with the way in which they handle limitations and requirements of the treatment process. When the patient is more likely to react to frustration in problem-solving manner, the chances are that their health behaviour will also lead to a sufficient adherence to treatment.

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The term brain fog is increasingly used by patients and researchers, but is poorly-defined. Understanding the symptom is important, as it is highly-prevalent, and linked to poor quality of life, and social and occupational disability. Furthermore, it is reported in a broad and seemingly unrelated set of conditions including COVID, menopause, hypothyroidism, traumatic brain injury (TBI), chronic fatigue syndrome (CFS/ME), fibromyalgia, and systemic lupus erythematosus (SLE). Transdiagnostic similarities may indicate common mechanisms or therapeutic targets, and opportunities for translation of research findings.

We aimed to review research characterising brain fog across diagnoses and summarise findings on phenomenology, definitions, objective cognitive measures, and neurobiological correlates. We aimed to highlight transdiagnostic commonalities and differences, and make recommendations on terminology and future research.

We conducted a narrative review of biomedical research into brain fog. We chose a non-systematic approach due to the fragmentary nature of the literature and our exploratory aims.

Brain fog is associated with cognitive symptoms - predominately difficulties with attention, memory, and language, contributing to a subjective “fog” or lack of “mental clarity”. It overlaps with fatigue, and psychiatric symptoms, including anxiety, depression, and dissociation. It is chronic but often transient or variable. There are many transdiagnostic similarities, but research conducting direct comparisons is lacking. We argue that transdiagnostic commonalities in brain fog must arise at one of 3 levels - ambiguous language, common cognitive mechanisms, or common neurobiology. Neurobiological correlates appear heterogenous. Objective cognitive findings are mixed, between mild deficits in attention and memory and no deficits. Evidence for correlation between subjective and objective symtpoms is mixed. Many studies find objective deficits are mediated by associated symptoms such as fatigue, depression, or anxiety.

We suggest researchers avoid the term brain fog in favour of clearly-defined terms where possible. While brain fog appears to refer to a broad range of phenomena, it captures a characteristic assocation of fatigue, cognitive and affective symptoms, and mild objective deficits across diagnoses. Brain fog appears to overlap substantially with mental fatigue. Further research is needed, including direct transdiagnostic comparisons. Measures should include high-precision cognitive batteries, as well as measures of affect (e.g., GAD / PHQ9), fatigue (e.g., FAS), and metacognition, to enable the role of non-cognitive factors to be assessed and compared across conditions.

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

This case presented highlights several key features of FND.

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

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

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

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

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

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

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

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

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

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

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Psoriasis is a chronic skin condition affecting 2-3% of the global population and is often associated with various comorbidities, including psychiatric disorders. The psychological burden of psoriasis is substantial and multifaceted. Patients frequently experience stigma, social isolation, and reduced self-esteem due to the visible and often disfiguring nature of the disease. These psychosocial stressors can precipitate or exacerbate psychiatric conditions such as anxiety and depression.

This study aims to identify the factors influencing psychopathological symptoms in patients with psoriasis, with a specific focus on the mediation role of physical and mental health on psychopathological distress in patient with psoriasis.

This observational study included 112 patients diagnosed with psoriasis. Dermatological and psychiatric evaluations were performed using Psodisk, the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the Symptom Checklist-90-Revised (SCL-90-R), and the 36-Item Short Form Health Survey (SF-36). Descriptive statistics, correlation analysis, mediation models were used for data analysis. To develop the mediation models, Psodisk subscales were used as independent variables, and the Global Severity Index (GSI) of SCL-90-R as the outcome variable; both physical (PCS) and mental (MCS) components of the SF-36 were used as mediators.

The sample consisted predominantly of middle-aged males (mean age 48.91 years). Females (p < 0.001), patients with arthritis (p < 0.05), and those leading a sedentary lifestyle (p < 0.05) exhibited higher scores for anxiety and depression. Psodisk subscales showed a significant correlation with psychiatric symptoms and QoL measures (p < 0.001). The mediation analysis revealed that the mental component of quality of life (MCS) had a statistically significant mediating effect in all models, being the only mediator for the effect of health, pain, and sleep domains of the Psodisk on GSI (p < 0.001; R2 = 0,2). Furthermore, when total Psodisk score was used as independent variable, MCS mediating effect on GSI was also significant (p < 0,001; R2 = 0,32) with a non-significant role of PCS.

This study highlights the complex relationship between psoriasis, psychiatric comorbidities, and QoL. Mediation analysis shows that mental component of quality of life can play a more significant mediating role than physical alterations in determining psychiatric symptoms in patients with psoriasis. All psoriasis patients, regardless of physical changes, should be considered at risk for developing psychiatric symptoms, and direct collaboration between general practitioners, dermatologists, and psychiatrists may be able to identify the most vulnerable patients and limit the onset of severe mental disorders.

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Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women of reproductive age, characterized by hyperandrogenism, oligomenorrhea/amenorrhea, and polycystic ovary morphology. PCOS can negatively impact sexuality due to physical issues like hyperandrogenism, metabolic syndrome, and infertility, as well as the psychological burden of the disease and associated mental health issues. Psychological resilience, defined as the ability to cope with stress and recover, is known to aid in managing physical illnesses and improve treatment outcomes. Although psychological resilience and sexuality are individually studied in relation to physical and psychological problems, research on their relationship, especially in PCOS, is limited.

This study aimed to explore the relationship between psychological resilience and sexual satisfaction in women with PCOS, comparing it with a healthy control group, and to identify factors affecting sexual satisfaction in PCOS patients.

70 women aged 18-40 with a PCOS diagnosis and 69 healthy controls matched for age and education participated in this study. Participants underwent a psychiatric interview according to the SCID-5 and completed the Sociodemographic Data Form, Psychological Resilience Scale for Adults (RSA), Hospital Anxiety and Depression Scale (HADS), Golombok Rust Inventory of Sexual Satisfaction (GRISS), and Arizona Sexual Experiences Scale (ASEX). Blood tests requested by the gynecologist were also documented for the PCOS group.

Women with PCOS exhibited lower psychological resilience than healthy controls, particularly in self perception area as shown in Table 1. They also reported lower sexual satisfaction with partners. No significant difference was found in masturbation frequency between the groups, nor was masturbation related to sexual satisfaction in either group. However, increased psychological resilience was associated with higher sexual satisfaction in both groups, with future perception area on the RSA significantly impacting sexual satisfaction. Examination of the relationship between RSA scores and GRISS and ASEX scores in women with PCOS is presented in Table 2 and Table 3.

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Psychological resilience, especially the future perception area, may play an influential role in sexual satisfaction. In light of these findings, it can be suggested that the treatment of PCOS should involve a multidisciplinary approach that includes mental health professionals. It is important to evaluate the sexual life of these women during follow-ups, provide psychoeducation, and adopt a hopeful approach. Considering factors that influence psychological resilience, interventions aimed at reducing risk factors and increasing protective factors could be anticipated to be important tools in preventing and treating sexual problems.

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Wilson disease is an autosomal recessive disorder that leads to defective copper metabolism. It manifests as neurologic, hepatic and psychiatric symptoms (Benhamla et al. Encephale 2007; 33(6):924–32). Through a case series of three family members, we emphasize the varied presentation of Wilson disease, and the need for investigation of metabolic causes of such symptoms especially in families with a history of consanguinity.

We aim to underscore the importance of considering metabolic causes of psychiatric symptoms, particularly when these symptoms cluster within families.

The cases are presented followed by an exploration of social context, gaps in existing literature, and suggestions for clinical practise.

Case 1: A 32-year-old male previously having received diagnoses of Treatment-Resistant Schizophrenia and Obsessive Compulsive Disorder over a period of 13 years presented with cognitive decline, delusions of persecution and reference, 2nd and 3rd person auditory hallucinations, preoccupation with cleaning and a significant decline in the ability to perform activities of daily living. Despite extensive psychiatric treatment, his symptoms worsened, raising suspicion for an underlying medical condition.

Case 2: A 16-year-old male, once a bright student, presented with progressive cognitive decline, poor working memory, social withdrawal, needing assistance with ADLs and sialorrhea for 2 years. These symptoms were initially misattributed to psychological stress and academic pressure, but the lack of response to treatment and worsening neurological signs of poor coordination raised suspicion for an organic cause. His eye exam was positive for Kayser Fleischer ring and his serum ceruloplasmin was below threshold level. This prompted a similar workup for his elder brother which was positive for Wilson disease.

Case 3: The mother of the aforementioned two patients, after witnessing her younger son’s decline, developed major depressive disorder with psychosis. Her symptoms started follwoing the stress of her children’s health problems and their lack of response to treatment.

Upon genetic counselling, the siblings of the first two patients revealed that they were both respectively engaged to be married to their first cousins and that their mother was adamant about these matches due to family traditions.

These cases underscore the need for a heightened suspicion of Wilson disease and other metabolic disorders in patients who belong to regions with high rates of consanguinity and have clustering of psychiatric disorders in their family. Further studies are needed to determine the true prevalence of Wilson disease in Pakistan which may be relatively high due to the common practise of cousin marriages (Zimbrean et al. Gen Hosp Psychiatry. 2014;36(1):53–62).

None Declared

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by a wide range of symptoms, including neurological and psychiatric symptomatology. Between 37 and 95% of SLE patients present psychiatric symptoms, which can appear at any point in the disease and may present in various forms, ranging from more common conditions like depression and anxiety to rarer manifestations such as psychosis and catatonia (Carrión-Barberà et al. Autoimmunity Reviews 2021;20:102780).

To describe the case of a patient who presented a SLE debut with catatonic symptoms and to review neuropsychiatric and specifically catatonic symptoms in SLE patients.

We present the case of a 32-year-old woman with no previous psychiatric history who was brought to our psychiatry emergency department (PED) for difficulties in language emission, only being able to babble for the last days. Approximately two weeks ago she had started to present anxiety, insomnia and catastrophic thoughts, so she consulted a psychiatrist who recommended starting escitalopram up to 15mg/d. In the next days she started to present difficulties of speech which worsened. Upon arrival, several diagnostic tests were performed including blood tests, CT scan, lumbar punction and electroencephalogram, showing no abnormalities. However, since the symptoms did not improve she was hospitalized for diagnostic affiliation.

During her hospitalization, more diagnostic tests were performed, including brain MRI and more exhaustive blood tests with autoimmunity profile, although the results were not available until several days later. Although the diagnosis was not yet clear and there were doubts among psychosis, neurologic functional disorder and organic mental disorder, several drugs were started including corticotherapy and olanzapine 15mg/d, venlafaxine up to 150mg/d and clonazepam 2.5mg/d with partial improvement of the symptoms, still showing motor retardation, blocking, perplexed gaze and mutism. In parallel, blood tests results emerged, showing high titre ANA antibodies, positive anti-double-stranded DNA and anti-Sm antibodies and decreased complement C3 component. With these findings, the diagnosis orientation was systemic lupus erythematosus (SLE).

Catatonia is a rare psychomotor syndrome that can be associated with SLE. Given its rarity, there still no standardized treatment for it in SLE patients, although some options have been proposed including, as in any other SLE manifestations, flare immunosuppressive at high doses and in these patients, the usual psychiatric management (Boeke et al. Psychosomatics 2018;59:523-530; Sundaram et al. Rheumatology Journal 2021;42:1461-1476) Clinicians should keep this in mind to correctly diagnose and treat these patients, since early identification of this syndrome and prompt treatment leads to a more favorable outcome.

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

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

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

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

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

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The surgical treatment process involves not only physical recovery but also the management of psychiatric and psychosocial issues. Psychiatric disorders can negatively affect postoperative recovery, complicate adherence to treatment and decrease the quality of life (Begum et al. World J Surg 2022; 46(6) 1408-1419).

This case series highlights less commonly encountered psychiatric conditions that arise after surgery and emphasizes the importance of considering how these conditions interact with pre-existing diseases during postoperative follow-up.

This case series examines three distinct cases of psychiatric disorders following surgical interventions:

Delusional disorder after hypophysectomy

Somatization disorder after cystoscopy

Psychotic depression following colostomy creation

Informed consent was obtained from all patients.

Case 1

A 62-year-old male patient diagnosed with hypophyseal macroadenoma underwent transsphenoidal hypophysectomy. Two months after surgery, he developed paranoid delusions, believing his wife was having an affair. Initially treated with aripiprazole 15 mg/day, the patient did not improve. His treatment was switched to risperidone 2 mg/day, resulting in resolution of his symptoms.

Case 2

A 58-year-old male with benign prostatic hyperplasia (BPH) developed persistent groin pain after cystoscopy. Despite urological treatment, the pain did not subside, and he was referred to algology for gabapentin, which was ineffective. Referred to psychiatry, he reported pain radiating to his back and arms, worsened by stress, and trouble sleeping due to his pain. Diagnosed with somatization disorder, he was treated with olanzapine 2.5 mg/day and cognitive interventions, which led to decreased pain.

Case 3

A 72-year-old male patient with rectal cancer, following abdominoperineal resection and colostomy creation, began consuming other people’s medications. He exhibited disorganized behavior and suicidal ideation, and was diagnosed with psychotic depression. Treated with olanzapine 5 mg/day and venlafaxine 75 mg/day, his disorganized behavior resolved during follow-up, and olanzapine was discontinued. He remains in remission on venlafaxine 75 mg/day.

This case series illustrates the diversity of psychiatric conditions that can arise after surgical interventions and emphasizes the importance of postoperative psychiatric monitoring. Although there is a lack of sufficient studies on this topic, a postoperative follow-up study conducted with a group of 200 patients found that the risk of developing anxiety after surgery was 31%, and the risk of developing depression was 56% (Basak et al. Int J Surg 2015; 23 18-22). Psychiatric symptoms can complicate physical recovery, affect adherence to treatment, and reduce quality of life. A multidisciplinary approach is essential to support both physical and psychological recovery, ultimately improving the overall health status of patients.

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The scientific literature recognizes the Gut-brain axis (GBA) as a crucial connection between gastrointestinal health and mental well-being. Patients with inflammatory bowel disease (IBD) are at a disproportionately higher risk of developing psychiatric disorders due to factors including gut dysbiosis and chronic inflammatory changes. Recent developments in artificial intelligence (AI) and machine learning, provide novel opportunities to predict the comorbid psychiatric outcomes in patients with IBD by analyzing complex datasets including but not limited to the gut microbiome and neuroimaging data.

This systematic review discusses the current evidence for AI-driven models to aid in the prediction of psychiatric disorders in IBD patients, with a focus on their performance and potential challenges around their clinical implementation.

A systematic search on PubMed, EMBASE, Scopus, and Cochrane databases, identified 28 studies utilizing AI-based models to examine gut microbiota and neuroimaging data in patients with IBD. Data extraction illuminated the following artifacts: classification thresholds (i.e. predictive), relevant supervised learning or deep learning modeling (e.g. random forest classifiers, convolutional neural networks, and unsupervised models like attention-based learning), sensitivity, specificity, accuracy, and both accuracy measures and AUC-ROC curve values.

A pooled analysis of the included studies demonstrated an estimated sensitivity of 81% (95% CI: 77-85%) and specificity of 78% (95% CI: 73-82%) to predict psychiatric disorders in patients with IBD with the highest predictive accuracy elicited by studies based on microbiome and neuroimaging data. Yun et al. (2024), for instance, demonstrated a predictive accuracy of 86% using microbiome profiles and structural brain imaging data while Fil et al. (2024) elucidated the positive correlation between gut dysbiosis and psychiatric symptoms based on microbial signature models. Additionally, the variability noted in the predictive performance of the models was found to be based on the patient population, quality of data, and machine learning strategy.

AI models present promising evidence in predicting psychiatric disorders in IBD patients by leveraging microbiome and neuroimaging datasets. Overall, the meta-analysis reports strong predictive strength with high sensitivity and specificity. Future work in this field should focus on the validation of these prediction models in various clinical populations, improving their generalizability and standardization to enable widespread use and integration in the field of personalized psychiatry, especially in patients with IBD.

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Handwriting is mainly a motor process involving an efficient level of motor organization lead-ing to fine coordination of movements, thus, children with developmental coordination disorder (DCD) are particularly affected with handwriting disorders.

We aimed to investigate handwriting disorders in DCD children in order to better understand the semiology of dysgraphia.

Data from 65 children aged 5 to 15 years (mean age 8.9 years, SD = 2.5) with DCD were collected on DSM-V criteria. They had no other medical or psychiatric condition and born full-term. They were assessed with handwriting testing and standardized assessments of neuropsychological, neurovisual, MRI and neuropsychomotor functions (NP-MOT neurodevelopmental battery), including muscular tone examination. Particular attention was paid to minor neurological dysfunctions (MND) which can be detected with the NP-MOT battery, such as a mild phasic stretch reflex (PSR).

Findings showed a high rate of visual perceptual motor, visuo-spatial, and visuo-constructional impairments (> 82%), visual pursuit disorders (93%) and 89% of handwriting disorders (HD, n=58). Among these HD, there are 83% of poor handwriting (PH) and 17% of dysgraphia (DysG). Moreover, we found in HD, 36% of PSR (with 29% in PH vs 70% in DysG) correlated to imbalance of axial tone (hyper-extension) associated with increase of neuropsychomotor disorders such as dissonance between spontaneous gestural, usual and psychosocial lateralities (P = 0.03), impairments of coordination between upper and lower limbs (P = 0.001), impairments of manual dexterity (P < 0.001), impairments of dynamic balance (P = 0.002), and dysdiadochokinesis (P < 0.001). Comparing PH and DysG groups, dysgraphia is associated to PSR (P = 0.04). 38% of abnormal MRI scans were heterogeneous and non-specific to the level of handwriting disorder and to PSR.

Dysgraphia appears to be a singular disorder as a comorbidity of DCD, which is significantly associated with a high incidence of motor impairments, suggesting a disturbance of the motor pathway (mild distal spasticity of the pyramidal corticospinal tract dysfunction). The presence of MND such as PSR highlights a mild impairment of the motor voluntary movement from the premotor cortex. PH appears primarily due to an immaturity of handwriting gesture consecutive to disorders of coordination programming in DCD.

Dysgraphia should be assessed not only with a simple handwriting test (legibility and speed) but completed with a developmental standardized physical neuropsychomotor examination assessing the presence of MND because to know the nature of the disorder is useful in clinical decision-making processes for handwriting remediation.

None Declared

In schizophrenia, depressive and negative symptoms often overlap, complicating the diagnosis. Symptoms such as lack of energy, anhedonia and association make the distinction difficult. A subjective state of sadness may indicate depression, while affective flattening is characteristic of schizophrenia. Other symptoms relevant to diagnosing depression include hopelessness, negative self-assessment, guilt, anxiety, and self-destructive thoughts.

This study, conducted over 6 months, aims to establish both the rate and the total number of patients with schizophrenia, suffering from depression to provide a better understanding of the clinical particularities of this type of comorbidity.

The research provided for a cross-sectional study to assess the incidence of depression among patients with schizophrenia hospitalized in the Clinical Psychiatric Hospital of Chisinau during the reference period. The Calgary depression scale for schizophrenia (CDSS) has been used as an evaluation tool to highlight the presence of depressive symptoms, while PANSS (negative symptoms) has been used, to measure their severity in schizophrenia. The data collection process involved structured questionnaires, semi-structured interviews with patients and clinical history analysis to obtain additional information.

The study included 155 women diagnosed with schizophrenia, aged between 18 and 55. Of these, 28.39% had more than two admissions during the year. Most of the patients included in the study (73.55%) suffered from F20.0, the rates of other forms of schizophrenia being: F20.1 (1.29%); F20.2 (14.84%); F20.3 (9.68%) and F20.9 (0.65%). According to the questionnaire applied to patients with different types of schizophrenia, it was observed that, 40.65% achieved a total score of more than 6 points on the CDSS scale (clinically significant depression) and 34.92% required repeated hospitalisation in the same year. Of those repeatedly admitted, 74.6% suffered from F20.0; 14.29% (F20.2) and 11.11% (F20.3), which probably could be a confirmation of the increased severity of the patient’s condition in case of comorbidity – schizophrenia-depression.

It can be assumed that the comorbidity of schizophrenia-depression negatively influences the social recovery process, but also the quality of life of patients; increases the risk of relapse. Patients with depression often experience higher rates of hospitalization because depressive symptoms can lead to emotional instability, cognitive impairments, undermining interpersonal relationships, social networking and reintegration. It is essential that mental health professionals identify and treat depression in patients with schizophrenia in order to increase their quality of life.

None Declared

Trichotillomania (TTM) and Major Depressive Disorder (MDD) are two psychiatric conditions that frequently co-occur, presenting a significant challenge for treatment due to their complex interplay. TTM involves repetitive hair-pulling, leading to noticeable hair loss and distress, while MDD is characterized by persistent low mood and loss of interest or pleasure leading to dysfunctionality.

This case report aims to discuss a case of a 21-year-old female with major depressive disorder and trichotillomania, management challenges, and the importance of a comprehensive, multifaceted therapeutic approach to address both disorders effectively.

A 21-year-old female college student and youth church leader presented with chronic hair-pulling and depressive symptoms. She had low self-esteem and a strong need for validation. Despite her responsibilities, she struggled with emotional distress exacerbated by family dynamics and her church role. Her symptoms were linked to self-esteem threats and feelings of inadequacy. She was diagnosed with Trichotillomania, Scalp, and Major Depressive Disorder.

Initial pharmacologic management was Fluoxetine 20mg/day up titrated to 40mg/day with no improvement hence shifted to Escitalopram 20mg/day and N-acetylcysteine 1200mg/day with noted significant improvement in symptoms. Non-pharmacologic strategies included supportive-expressive psychodynamic psychotherapy, cognitive-behavioral techniques, and family therapy. Psychoeducation, suicide safety planning, and an interprofessional approach with dermatology co-management were also integral.

Over the course of 15 therapy sessions, the patient demonstrated significant improvement in both her depressive symptoms and hair-pulling behavior. Her active engagement in therapy, combined with pharmacological support, facilitated better emotional regulation and a more cohesive sense of self. Her adherence to the treatment plan, along with the collaborative efforts of the interprofessional team, contributed to her positive outcomes.

This case highlights the significance of addressing both TTM and its comorbid conditions for effective treatment outcomes. The interplay between TTM and MDD underscores the need for comprehensive treatment plans incorporating pharmacological and psychotherapeutic approaches. Future practice should consider the benefits of an interprofessional approach for managing complex cases like this.

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Patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis (HD) are particularly susceptible to psychological disorders, such as anxiety and depression, which can significantly affect their quality of life and clinical outcomes. However, in spite of its prevalence, psychiatric comorbidity in this population remains under-recognized, contributing to worse health outcomes and increased mortality.

The primary aim of this study is to explore the prevalence of psychiatric comorbidities, particularly depression and anxiety, among HD and PD patients. Insights into the different psychological effects of different dialysis treatments are offered, emphasizing the importance of integrated mental and physical healthcare in improving patient outcomes.

A narrative review was carried out using PubMed and Google Scholar to identify relevant articles with the keywords “dialysis,” “psychiatry,” and “comorbidities.”

The review underscores the important burden of psychiatric disorders among dialysis patients. Studies suggest that depression may affect up to 50% of these individuals. Both HD and PD patients exhibit varying degrees of psychological distress, exacerbated by factors such as the invasiveness of dialysis, comorbid medical conditions (e.g., diabetes), and socioeconomic challenges. The evidence suggests that HD patients may experience an even more heightened psychiatric burden due to the more invasive nature of HD compared to PD, which imposes greater restrictions on daily activities. Psychiatric disorders in these patients are often underdiagnosed, leading to treatment non-compliance, increased hospital admissions, and elevated mortality rates. The findings stress the necessity of regular mental health screenings and the integration of psychiatric care into routine dialysis practice.

Psychiatric comorbidities are prevalent among dialysis patients, with HD patients exhibiting a greater psychological burden. This review highlights the urgent need for routine mental health screening and intervention within the dialysis care framework. The integration of mental health support into dialysis treatment protocols could lead to improved patient outcomes, fewer hospitalizations, and better treatment adherence. Future research should focus on developing customized mental health interventions that address the specific challenges faced by dialysis patients, thereby enhancing their quality of life and clinical outcomes.

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Attention-Deficit/Hyperactivity Disorder (ADHD) often coexists with insomnia. Challenges of ADHD, like racing thoughts and restlessness, can exacerbate sleep issues. Addressing both conditions concurrently is crucial for comprehensive treatment and improved quality of life.

The aim is to identify factors promoting insomnia in patients with ADHD.

The study is conducted on patients >18 years referred to the adult ADHD outpatient service of the Psychiatric Clinic of Ancona (Università Politecnica delle Marche, Italy). The Diagnostic Interview for ADHD in adults (DIVA 5.0) was used for diagnosis. Administered rating scales included Temperament Evaluation in Memphis, Pisa and San Diego (TEMPS-M), Coping Orientation to the Problems Experiences-new Italian version (COPE-NVI), Temperament and Character Inventory-Revised (TCI-R) and Insomnia Severity Index (ISI).

76% (n=170) of all screened patients were diagnosed with ADHD in adulthood. In our sample of ADHD subjects, those who have bipolar disorder in comorbidity tend to suffer more frequently from insomnia (χ²=4.290; p=0.038). A multivariate linear regression was observed between the ISI (R2=0.237; F(3,56)=13.150; p<0.001) and TEMPS-M cyclothymic temperament subscale (B=0.206; p=0.027), TCI-R responsibility subscale (B=-0.255; p=0.005), and TCI-R self-transcendence subscale (B=0.101; p=0.06). A logistic regression analysis was performed to ascertain the effects of all TCI-R, COPE-NVI, TEMPS-M subscales, on the likelihood of developing insomnia. The logistic regression model was statistically significant, ▫▫2(1)=4.539, p=0.033. The model explained 62.3% (Nagelkerke R2) of the variance in patients with ADHD and insomnia and correctly classified 76.7% of cases. Insomnia was significantly predicted by TEMPS-M irritable temperament subscale (exp(B)=1.272; p=0.003), TCI-R disorderliness subscale (exp(B)=0.628, p=0.004), TCI-R purposeful subscale (exp(B)=0.781, p=0.003), TCI-R social acceptance subscale (exp(B)=1.232, p=0.052), TCI-R compassion subscale (exp(B)=0.795, p=0.001) and TCI-R transpersonal identification subscale (exp(B)=1.268, p=0.002).

Findings suggest a link between ADHD patients with comorbid bipolar disorder and a higher incidence of insomnia. Personality traits such as cyclothymic temperament, low sense of responsibility, and high self-transcendence are significantly associated with insomnia in ADHD. The logistic regression model accurately predicted and identified key predictors for insomnia in ADHD patients, highlighting the substantial role of irritable temperament, rigidity in being orderly, low determination, high friendliness, low compassion, and high transpersonal identification. Understanding these associations is pivotal in developing targeted interventions and support strategies for individuals with ADHD prone to insomnia, emphasizing the intricate role of temperament and personality traits in sleep disturbances.

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Cluster headache (CH) and bipolar disorder (BD) are cyclic disorders with shared clinical aspects, e.g. disturbed sleep patterns, response to lithium and a tendency to use illicit drugs.

We investigated comorbidity of BD in patients with CH, prevalence of BD amongst CH family members, circadian aspects and use of illicit drugs.

Patients from the Leiden University Cluster headache neuro-Analysis program (LUCA) were screened cross-sectionally for BD online, using the Mood Disturbance Questionnaire (MDQ-NL) and Altman Self Rating Scale (ASRM-NL) and, if indicated, further evaluated with the Mini international neuropsychiatric interview (MINI). Circadian aspects were analyzed using the Circadian Type Inventory (CTI) and the Munich Chronotype Questionnaire (MCTQ).

The life-time prevalence of BD in patients suffering from CH was 6.5%. Patients with comorbid BD (CH+BD) were more likely to have family members with BD (standardized OR= 1.50, 95% CI=1.15;1.95, p=0.003) and were more likely to suffer from chronic CH (OR=3.05 95% CI=1.18;7.87, p=0.02) after adjustment for age and sex. They also more often used illicit drugs, compared to patients with only CH. Circadian type and chronotype did not differ between the two groups after adjustment for confounders.

There is a high prevalence of BD in CH patients. CH+BD patients are more likely to have a positive family history for BD. CH+BD patients are more likely to suffer from chronic CH and more often use illicit drugs. In clinical practice it is important to screen for BD when treating patients with CH.

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Nitrous oxide (N2O) was first discovered in 1772 by Joseph Priestley. Since its anesthetic properties were realized in 1844, it has been used in the medical and dental fields. Nitrous oxide is also known as “laughing gas” or “nos”.

Recent literature suggests that studying N2O is important, not only for understanding the pathophysiology of bipolar depression but also for exploring its potential as a treatment.

N2O is often used recreationally for its euphoric, anxiolytic, and dissociative effects.

To better understand the role of nitrous oxide, as well as its clinical implications.

A search was conducted in various databases, including PubMed.

N2O has two potential ways to help with bipolar depression. Firstly, it can block NMDA receptors which can be beneficial for mood stabilization. Secondly, it can widen blood vessels in the frontal brain regions which can improve blood flow and oxygenation.

Clinical studies have suggested the effectiveness of NMDA receptor antagonists in the treatment of depression. Among these studies, the use of ketamine has been a significant breakthrough in the treatment of depression.

Despite its medical uses, N2O has also gained popularity on a recreational level due to its relaxing, euphoric effects and its ability to provoke hallucinations. Unfortunately, recreational use of N2O can lead to various neuropsychiatric symptoms, such as emotional symptoms (mania, depression, anxiety), personality changes, aggressive behaviour, and psychotic symptoms.

Further research is needed to determine if N2O is beneficial in treating bipolar depression or if its use could lead to brain dysfunction (if taken recreationally).

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Chronic oral health issues, particularly periodontal disease, are significant contributors to systemic inflammation. Emerging evidence indicates that this inflammation can influence neurophysiological processes and contribute to psychiatric disorders, including depression and anxiety. Recent literature review has revealed that periodontal disease and depression share common biomarkers, such as lipopolysaccharide (LPS), C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol.

To elucidate the connection between poor oral health and psychiatric disorders through the lens of systemic inflammation and its neurophysiological impacts.

A comprehensive literature review was conducted using PubMed, PsycINFO, and Google Scholar, focusing on studies from the past decade that examine the relationship between periodontal disease, systemic inflammation, and psychiatric disorders. Key findings regarding the involvement of pro-inflammatory cytokines and their neurophysiological effects were synthesized.

The review highlighted that periodontal disease leads to elevated levels of pro-inflammatory cytokines. Such cytokines as CRP, IL-6, and tumor necrosis factor-alpha (TNF-α) can cross the blood-brain barrier, contributing to neuroinflammation and dysregulation of neurotransmitter systems. One significant effect is on serotonin metabolism, which is critical in the pathophysiology of depression. Pro-inflammatory cytokines can lead to reduced serotonin availability by upregulating genetic expression of serotonin transporters and increased serotonin metabolism. Given the interplay between inflammatory cytokines and neurotransmitter metabolism, the studies indicate that individuals with periodontal disease are more likely to exhibit depressive and anxiety symptoms, with neuroinflammation serving as a mediating factor.

Table 1: Impact of Pro-inflammatory Cytokines on Neurophysiological Processes

Systemic inflammation resulting from poor oral health significantly impacts neurophysiological processes associated with psychiatric disorders. These findings underscore the need for integrated healthcare approaches that consider both oral and mental health to mitigate the adverse effects of neuroinflammation on psychiatric well-being.

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