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Metronidazole, a widely used antimicrobial agent, has been associated with rare neuropsychiatric adverse effects, including antibiotic-induced mania (antibiomania). We report the case of a 46-year-old woman with a history of bipolar disorder type I, previously triggered by antidepressant treatment, who presented with an acute onset of a manic episode with psychotic features following prolonged metronidazole treatment. The patient had remained euthymic and medication-free for approximately nine years prior to this episode. Metronidazole was discontinued upon admission, and appropriate psychiatric treatment was initiated. Manic and psychotic symptoms resolved completely within three days, supporting a probable causal association. This case highlights the potential of metronidazole to induce manic episodes, particularly in individuals with a predisposition to mood disorders, and aims to discuss the possible underlying mechanisms through which metronidazole may contribute to the development of mania.
Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder characterized by repeated upper airway obstruction during sleep, leading to poor sleep quality, excessive daytime sleepiness, and reduced psychosocial functioning. Obesity is a major risk factor that increases both the likelihood and severity of OSA, further affecting physical and mental health. Although continuous positive airway pressure (CPAP) is the standard treatment, alternative non-pharmacological approaches such as Pilates and myofunctional therapy may provide additional benefits. This study aimed to evaluate the effectiveness of combining Pilates and myofunctional therapy in improving sleep quality and psychosocial well-being in an individual with obesity-associated OSA. A case study was conducted in a clinical rehabilitation setting involving a 45-year-old male diagnosed with moderate OSA (Apnea-Hypopnea Index = 25) and obesity (BMI = 34 kg/m²). The participant completed an 8-week intervention program consisting of Pilates and myofunctional therapy, each performed for 30 minutes, three times per week. Outcome measures included the Pittsburgh Sleep Quality Index (PSQI) and the Short Form-36 (SF-36), which assessed physical health, mental health, and vitality. Pre- and post-intervention scores were compared. Post-intervention results demonstrated improvements in both sleep quality and quality of life. The PSQI score decreased from 7 to 4. SF-36 scores improved in physical health (55 to 68), mental health (48 to 62), and vitality (60 to 68). The participant also reported reduced daytime sleepiness, better mood, enhanced social interaction, and increased confidence. The findings suggest that combining Pilates and myofunctional therapy may be a useful non-pharmacological strategy to improve sleep and psychosocial outcomes in individuals with obesity-associated OSA.
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The aim of this study was to compare eating disorders (EDs) symptoms, traumatic experiences, family functioning and emotional regulation between Croatian and German bulimia nervosa (BN) female patients. The study included a total of 192 participants; 50 Croatian BN female patients ranging from 15 to 25 years old, treated at University Hospital Center Zagreb, and 55 German BN female patients between 20 and 45 years old, treated at University Hospital Ulm. Croatian control group consisted of 50 subjects, and German control group consisted of 37 subjects that are matched with participants of clinical groups by to the essential characteristics. Participants were asked to fill out EDI-2, ETISR-SF, FAD and DERS. We obtained differences between Croatian and German BN female patients in age range and in multiple clinical scales. After controlling for the age variable, we found no statistically significant difference between groups in ED symptoms on EDI-2, nor in family functioning with respect to FAD. The Croatian participants showed more traumatic experiences on the ETISR-SF (General trauma, Physical punishment) and German participants showed more difficulties with emotional regulation on DERS (Awareness), whereas higher levels of exposure to General trauma (OR=.25; 95% CI =.09-.70; p<.01) and Physical punishment (OR=.06; 95% CI=.01-.37; p<.01) increased the odds for participant to be categorized as part of the Croatian group, while lack of emotional Awareness (OR=7.07; 95% CI=1.33-37.05; p<.05) increases the odds for participant to belong to the German group. The Croatian group exhibited more traumatic experiences, whereas German participants demonstrated greater lack of emotional awareness. On the whole, we found no statistically significant difference between Croatian and German BN female patients in ED symptoms as neither in family functioning.
The novel coronavirus disease (COVID-19) emerged at the end of 2019 and has since affected Türkiye as well as the rest of the World. The main purpose of this study is to examine the effects of social isolation measures during the COVID-19 epidemic on education perceptions, anxiety levels, sleep quality, and physical activity levels of healthcare students, as well as the relationship between anxiety with sleep quality and physical activity level. The cross-sectional and descriptive study was conducted between May and June 2020. The sample consisted of 457 physiotherapy, nursing, and occupational therapy students aged 18-41. Before to starting the survey, electronic consent was obtained from all participants. The data were collected through the Google Forms web survey platform using the convenience sampling method. The demographic information form, Beck Anxiety Inventory, Pittsburgh Sleep Quality Inventory, and Rapid Assessment of Physical Activity were used to collect data. The data were analyzed using the Statistical Package for Social Sciences (SPSS) for Windows 22 (IBM SPSS Inc., Chicago, IL) at a significance level of 0.05. The majority of students expressed concerns regarding the insufficiency of distance education (82.5%). Over half (53.39%) of the study participants reported experiencing mild, moderate, and severe anxiety. In addition, students exhibited poor sleep quality (67.5%) and low levels of physical activity (61.1%). A statistically significant positive correlation was found between the total scores of the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Index (r = 0.425, p < 0.001). Healthcare students were concerned about distance education during the first wave of the pandemic. Universities should provide all students with guidance on mental health and encourage them to perform more physical activity. Moreover, different methods and techniques should be developed for applied science during distance education.
This narrative review examines the neuropsychopharmacological effects of Aronia melanocarpa (black chokeberry), focusing on its potential in the prevention and treatment of neuropsychiatric disorders such as anxiety, depression, and cognitive decline. A comprehensive literature search across Web of Science, Scopus, and Google Scholar identified 29 original studies, based on in vitro, animal, and human research. Findings demonstrated that Aronia melanocarpa, rich in polyphenols like anthocyanins and proanthocyanidins, exerts cognitive-enhancing, anxiolytic-like, and antidepressant-like effects. These outcomes are mediated by mechanisms involving antioxidant activity, modulation of neurotransmitter systems, inhibition of monoamine oxidases, reduction of neuroinflammation, modulation of gut microbiota, and upregulation of brain-derived neurotrophic factor (BDNF). Animal models of Alzheimer's disease and stress-induced disorders, along with human clinical trials, corroborated these effects. The review underscores the therapeutic promise of Aronia melanocarpa nutraceuticals in neuropsychiatric health and highlights the need for further clinical validation.
To evaluate the level of insight into illness in patients with schizophrenia and its associations with demographic factors, clinical symptoms, executive functions, and selected metabolic parameters. This cross-sectional study included 60 outpatients diagnosed with schizophrenia according to DSMIV criteria. Participants were divided into two groups based on the median score of the Self-Appraisal of Illness Questionnaire (SAIQ): preserved insight (n=30) and impaired insight (n=30). Positive symptoms were assessed with the Positive Symptoms Rating Scale (PSRS), negative symptoms with the Brief Negative Symptom Assessment (BNSA), executive functions with the Wisconsin Card Sorting Test (WCST) and Wechsler-Bellevue Intelligence Scale-II (WB-II) subscales. Metabolic parameters included body mass index (BMI), systolic and diastolic blood pressure, and waist circumference. Statistical analysis was performed using t-tests, ANOVA, Pearson correlation, and multiple linear regression (p<0.05). Patients with impaired insight exhibited significantly higher positive (PSRS: 28.5±4.2 vs 18.3±3.1; p<0.001) and negative symptoms (BNSA: 35.2±5.6 vs 22.1±4.0; p<0.001), poorer executive performance (WCST total score: 45.6±8.9 vs 68.4±7.2; p<0.001), higher BMI (28.7±3.4 vs 24.5±2.8; p<0.01), and elevated blood pressure values. SAIQ total score negatively correlated with positive (r=-0.62; p<0.001) and negative symptoms (r=-0.58; p<0.001), illness duration (r=-0.45; p<0.01), and positively with years of education (r=0.48; p<0.01) and WCST score (r=0.52; p<0.001). Regression analysis showed that negative symptoms (β=-0.41; p<0.001) and executive dysfunction (β=-0.35; p<0.01) were the strongest independent predictors of poor insight (R²=0.62). Impaired insight in schizophrenia is strongly associated with greater psychopathological burden, neurocognitive deficits (especially executive dysfunction), and metabolic disturbances. These findings support the implementation of integrated therapeutic strategies targeting insight, cognition, and cardiometabolic health to improve long-term outcomes.
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Cognitive stimulation in older adults can improve cognitive performance and help reduce the risk of developing cognitive decline. To analyze the effectiveness of computerized cognitive stimulation (CCS) on memory, attention, processing speed, and problem-solving in cognitively healthy older adults (OA). The sample consisted of an intervention group (IG = 47, M = 76.02, SD = 3.37 years) subjected to 42 CCS sessions using Lumosity software three times per week, and a control group (CG = 52, M = 74.12, SD = 2.86 years) from the community, who did not receive any intervention. Both groups were medically evaluated and assessed using the Modified Mini-Mental State Examination (MMSEm), the Photo Test (PT), the Clock Test (CT), and the Trail Making Test (TMT A and B), before and after training. At baseline, significant intergroup differences favored the CG in all cognitive tests (MMSEm: d = 0.92; TMT-A: d = 1.12; TMT-B: d = 1.14; PT: d = 0.55; CT: d = 0.50). Despite these disparities, post-intervention analysis showed significant improvements in the IG across all domains except the CT (t = -1.43, p = ns), with large effects in MMSEm (d = 0.86) and moderate effects in PT, TMT-A and B. CCS improved the cognitive performance of the evaluated older adults, demonstrating its feasibility and relevance as a digital strategy for cognitive health.
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Nomophobia is a psychological condition characterized by an individual's fear of being disconnected from smartphone connectivity. Nomophobia Questionnaire (NMP-Q) is the most used self-reported measure to assess nomophobia across the globe. Therefore, the present study aimed to assess the factor structure, reliability, and validity of NMP-Q among Indian undergraduate college students. Using a cross-sectional design, our study employed an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), where data was collected from three centres across India. EFA was carried out to obtain factor structure and check the internal consistency among items. CFA was carried out to test the factor structure of NMP-Q. Convergent and discriminant validity were tested using bivariate correlation analysis. Exploratory factor analysis showed that the questionnaire has good internal consistency (Cronbach's alpha reliability coefficient= 0.952) with a three-factor pattern matrix. CFA explained three-factor structure which deemed to be the most tenable comprising of 20 items. NMP-Q fits good on almost all indices (CMIN/df= 3.01, CFI= 0.94, RMSEA=0.07, TLI=0.93, IFI=0.93) for the three-factor structure. Moderate to excellent associations were noted for the convergent (r=0.770) and divergent validity (r=-0.972) respectively. The NMP-Q demonstrated scores below 64 as no nomophobia; from 64-79 for mild nomophobia; 80-95 for moderate nomophobia and >95 indicated severe nomophobia for our population. The Nomophobia Questionnaire (NMP-Q) is a valid, accurate and reliable instrument that can measure nomophobia in the Indian youth population.
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Treatment adherence improves the quality of life and functional outcomes in patients with bipolar disorder (BD) by supporting effective disease management and fostering the development of self-esteem and self-efficacy. This study aimed to determine the effect of Adherence Therapy (AT) on medication adherence (MA), self-efficacy, and self-esteem in patients diagnosed with BD. This randomized controlled study was conducted with patients diagnosed with BD admitted to the psychiatry outpatient clinic of an Application and Research Hospital in Türkiye. The participants were randomly assigned to either an intervention group (n = 31), who received AT individually, or a control group (n = 30), who continued with their routine outpatient clinic follow-up. Data were collected using the Patient Descriptive Questionnaire, the Morisky Medication Adherence Scale (MMAS), the Self-Efficacy Scale (SES), and the Coopersmith Self-Esteem Inventory -Adult Form (CSEI). There was a significant difference in the MMAS scores, which assess MA, between the intervention and control groups after the AT intervention (p < 0.01). Logistic regression analysis revealed that participants in the intervention group had a significantly lower likelihood of poor MA than those in the control group (OR = 0.060; p < 0.01). An increasing trend was observed in the SES scores of the intervention group; however, this difference was not statistically significant. The CSEI scores increased significantly in the intervention group, but no significant difference was found between the groups. The AT administered to patients with BD played a role in increasing patients' adherence to treatment. The results of this study suggest that it is important for mental health professionals to use evidence-based strategies to improve patients' MA.
The aim of this paper is to contribute to the increased understanding of research methods on meditation as a tool for preventing and improving mental health by addressing the key challenges that research faces. Different definitions of meditation have been analyzed, and the complexity of the phenomenon, as well as the problems in conceptualization, have been highlighted. It has been emphasized that comparing the results of research is complicated by the fact that meditation encompasses a wide range of practices that differ in techniques, goals, and expected outcomes. A solution to this problem is the operationalization of the type of meditation being investigated and the standardization of protocols. In addition to this, meditators represent a diverse group of individuals who differ in experience, motivation, and characteristics. Therefore, it is essential to track the characteristics of the participants closely and, when conducting quantitative research, stratify the sample according to relevant characteristics. Repeated measurements do not always yield the same results, which is attributed to numerous methodological shortcomings and a lack of a theoretical framework. The successful outcomes of meditation are often determined in various ways, so it is necessary to define measurable outcomes that are specific to the research goals. Given the difficulty of quantifying the subjective experiences resulting from meditation practice, it is beneficial to combine qualitative and quantitative measurements. Due to the complexity of the meditation phenomenon, research should be interdisciplinary, incorporating knowledge and insights from psychology, philosophy, anthropology, neuroscience, biology, sociology, and comparative studies of cultures and religions. More high-quality, qualitative, and interdisciplinary research is needed to understand better the process of meditation and its impact on mental processes, personality, and behavior, and subsequently to improve its application in the field of mental health.
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Loss and bereavement may precede mood episodes in bipolar disorders (BD). When a loved one dies, this is a stressful life event with a negative connotation that can trigger the onset of symptoms of both polarities (depressive or manic) of BD or lead to the emergence of the first mood episodes. Even though the relationships between death and depression are better known in the literature and clinical practice, the associations between bereavement and (hypo-)mania are less clear. To date, information on "funeral mania", also called "grief mania" or "bereavement mania", is rather limited, remaining in fact an underestimated topic. Aiming to draw more attention to this overlooked issue, the purpose of this mini-review is to update the knowledge currently available on this topic. We reviewed the existing literature exploring the possible associations between bereavement and the onset of a (hypo-)manic episode, both a first or recurrent episode, supporting the role of loss events as a potential risk factor for BD progression. Our findings emphasize the positive association between the loss of a loved one and (hypo-)manic symptoms in bipolar disorders, although no prospective studies have assessed the impact of these life events on the course of (hypo-)mania in a large sample. We recommend the clinical assessment of this association, in order to provide patients with BD with the most adequate and prompt treatments.