To evaluate the effectiveness of a sequential dual-track learning intervention that combined a simulation-based motivational interviewing (MI) workshop with online practice learning in enhancing psychiatric mental health nurses' (PMHNs') knowledge, confidence, and performance in MI for medication adherence. A parallel cluster-randomized controlled trial was conducted in four psychiatric hospitals. Participants were allocated to experimental or control groups. The intervention consisted of an 8-hour simulation-based MI workshop followed by a four-month online practice learning phase. Outcomes-MI knowledge, confidence, and skill performance-were assessed at baseline (T0), immediately after the workshop (T1), and after online practice learning (T2). Changes over time were analyzed using repeated-measures analysis of variance. In total, 107 PMHNs completed all three assessments (experimental = 52; control = 55). The sequential dual-track learning intervention produced significant group-by-time effects for knowledge (F (2, 210) = 4.96, p = .011), confidence (F (2, 210) = 4.63, p = .011), and skill performance (F (2, 210) = 41.20, p < .001). The experimental group showed substantially greater gains than the control group at T1, and these gains were observed at T2, with no significant T2-T1 differences despite a small decline in mean skill scores. The sequential dual-track learning intervention, integrating a simulation-based MI workshop with online practice learning, effectively improved PMHNs' MI knowledge, confidence, and skill performance for medication adherence and provides a flexible, scalable model for evidence-based continuing education in psychiatric nursing. ClinicalTrials.gov, NCT06004492 (August 16, 2023).
Background Cognitive symptoms after SARS-CoV-2 infection, often described as "brain fog," remain difficult to measure objectively and are biologically heterogeneous. DNA methylation may provide a stable, blood-accessible layer of information linking post-COVID immune remodeling, biological aging, and neuropsychiatric vulnerability. We re-analyzed GSE247869, a whole-blood Illumina MethylationEPIC dataset from individuals sampled six months after COVID-19 infection, to identify age-associated methylation signals with translational relevance. The present analysis was designed to characterize age-associated methylation within this post-COVID cohort, not to establish a COVID-19-specific signature or biological age acceleration. Methodology This was a cross-sectional analysis of a single post-COVID cohort, with 94 samples included in the age models and no COVID-19-negative comparator included in the analyzed model. Processed beta values were aligned to metadata, converted to M-values, and modeled at each cytosine-phosphate-guanine (CpG) using ordinary least squares with age and sex as predictors. Differentially methylated positions were corrected by Benjamini-Hochberg false discovery rate (FDR). CpGs were mapped to genes using robust annotation and Illumina manifest fallback. Gene-level signals were integrated using a multi-evidence prioritization score that incorporated statistical strength, effect size, multi-CpG support, direction consistency, known epigenetic-clock membership, and curated pathway membership. Results Within this cohort, the analysis identified 3,467 age-associated CpGs at FDR < 0.05, with an overall hypomethylation bias but focal hypermethylation at canonical aging loci. In total, 11 of 12 reference clock CpGs were recovered, including ELOVL2, FHL2, TRIM59, EDARADD, ASPA, and PDE4C. The strongest exploratory signal was enrichment of glutamatergic/N-methyl-D-aspartate (NMDA) genes, including GRIN1, GRIN2C, GRIN2D, GRM1, GRM5, and SLC17A7. GRIN1 and GRIN2C had high integrated evidence scores and showed age-associated hypermethylation. The prioritized genes mapped interpretively to glutamatergic synapse, calcium signaling, and cAMP signaling pathways, although these complete KEGG pathways were not tested as formal enrichment categories. Conclusions This re-analysis recovered established age-associated CpGs and identified age-associated methylation enrichment near glutamatergic/NMDA genes within this post-COVID cohort. It cannot determine whether these signals are specific to COVID-19 infection, reflect accelerated biological aging, or relate to cognitive symptoms because no COVID-19-negative comparator or symptom-level cognitive phenotyping was included in the present analysis. The glutamatergic finding is hypothesis-generating, particularly because the curated set was small and no independent replication cohort was analyzed. Future longitudinal and case-control studies integrating GRIN1/GRIN2C methylation with cognitive and inflammatory phenotyping are needed. Glutamatergic and calcium-signaling pathways may be evaluated in appropriately designed mechanistic and intervention studies, including but not limited to hypotheses related to the Cheung Glutamatergic Regimen, only after independent validation and careful safety evaluation.
Emerging evidence suggests a critical link between micronutrient deficiencies and mental health. This study investigated the relationship between serum levels of Magnesium (Mg), Iron (Fe), Zinc (Zn), and Selenium (Se) and the severity of depression among adults in the Sukkur region of Pakistan. A comparative cross-sectional study was conducted with 215 participants (105 males, 110 females). Depression severity was assessed using the PHQ-9 instrument, and serum mineral levels were measured using Photometric techniques. Following baseline analysis, a targeted interventional phase was initiated with 40 severely depressed participants, who received a one-month regimen of mineral supplements. Statistical analysis was performed using ANOVA-Tukey and Pearson correlation (p < 0.05). Baseline results revealed a significant inverse correlation between mineral concentrations and depression severity, with the strongest correlations observed for Magnesium (r = -0.771) and Selenium (r = -0.735). Gender-stratified data showed that females generally possessed lower mineral stores, particularly within the severe depression category (Mg: 1.50 ± 0.21 mg/dL). Following the four-week supplementation period, a statistically significant reduction in mean symptom scores was recorded; mean PHQ-9 scores decreased by approximately 50%, falling from "Severe" (~ 18.5) to "Mild" (~ 8.5) levels. This psychological recovery mirrored the significant restoration of serum mineral levels, with Magnesium rising from 1.26 ± 0.01 to 2.23 ± 0.02 mg/dL and Zinc increasing from 46.45 0.53 to 76.95 ± 0.88 µg/dL. The findings confirm that mineral depletion is strongly associated with the severity of depression. The significant attenuation of depressive symptoms observed during the exploratory targeted supplementation phase suggests the potential value of nutritional therapy as a supportive adjunct or secondary intervention strategy for Major Depressive Disorder (MDD).
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Contemporary psychiatry increasingly recognises the importance of person-centred, recovery-oriented, and biopsychosocial approaches to care. Yet these frameworks do not fully resolve the methodological question of how clinicians should investigate patients' lived experience in ways that inform ethical psychiatric practice. This paper argues that phenomenology should be understood not merely as a humanistic supplement to psychiatry, but as a methodological foundation for ethically responsible clinical practice. A conceptual analysis drawing on phenomenological psychopathology, philosophy of medicine, and clinical ethics is used to examine how attention to lived experience informs psychiatric understanding, therapeutic engagement, and ethical decision-making. Phenomenology contributes a disciplined method of inquiry into subjective experience. It complements diagnostic classification and neurobiological explanation by clarifying how illness reorganises the patient's lived world. A comparative clinical illustration demonstrates how phenomenological inquiry can deepen psychiatric assessment without replacing conventional diagnosis. This enriched understanding strengthens autonomy, informed consent, shared decision-making, diagnostic humility, and psychiatric education. Phenomenology does not require psychiatry to abandon diagnostic reliability, neuroscience, or evidence-based treatment. Rather, it provides a method through which psychiatry can more fully realise ethical commitments it already recognises. Attending to lived experience should therefore be regarded as a professional obligation within psychiatric practice.
The issue of psychiatric workforce renewal is no longer merely a human resource problem; it lies at the intersection of professional identity, training structure, and the organizational logic of the healthcare system. International medical education literature describes professional identity formation as a gradual process of socialization in which the novice physician progresses from performing professional tasks to internalizing the vocation itself. This process is strongly influenced by the clinical learning environment, the presence of role models, structured reflection, the gradual transfer of responsibility, psychological safety, and whether the resident is truly able to practice the chosen specialty. A specific challenge in Hungarian psychiatry is that the process of becoming a psychiatrist is often constrained by systemic pressures that lead to blurred professional boundaries, distortion of training, increased risks to patient safety, and erosion of professional self-identity. The aim of this paper is to examine the educational and organizational conditions necessary for psychiatry to become an attractive and sustainable career choice again. The article is based on a synthesis of the international literature on professional identity formation, Hungarian research on psychiatric professional identity, and a qualitative case-based analysis. Orv Hetil. 2026; 167(29): 1142-1151. A pszichiátriai utánpótlás kérdése ma már nem pusztán humánerőforrás-probléma, hanem a szakmai identitás, a képzési struktúra és az ellátórendszer szervezeti logikájának közös metszete. A nemzetközi orvosképzési irodalom a szakmai identitás kialakulását fokozatos, szocializációs folyamatként írja le, amelyben a kezdő orvos a szakmai tevékenység végzésétől a hivatás belsővé tételéig jut el. E folyamatot döntően befolyásolja a klinikai tanulási környezet, a példaképek jelenléte, a strukturált reflexió, a felelősség fokozatos átadása, a pszichológiai biztonság, valamint az, hogy a rezidens valóban a választott szakmáját gyakorolhatja-e. A magyar pszichiátria sajátos nehézsége, hogy a pszichiáterré válás folyamata gyakran olyan rendszerterhelések közé szorul, amelyek a kompetenciahatárok elmosódásához, a képzés torzulásához, a betegbiztonsági kockázatok növekedéséhez és a szakmai önazonosság eróziójához vezetnek. A jelen közlemény célja annak bemutatása, hogy milyen képzési és munkaszervezési feltételek szükségesek ahhoz, hogy a pszichiáteri hivatás újra vonzó és hosszú távon vállalható pályává váljon. A szöveg a nemzetközi szakmai identitásfejlődés-szakirodalom, a hazai pszichiáteridentitás-kutatás és kvalitatív rezidensi tapasztalatok szintézisére épül. Orv Hetil. 2026; 167(29): 1142–1151.
Trichobezoar is a rare but clinically significant cause of gastrointestinal obstruction, typically affecting adolescent females with underlying psychiatric or neurodevelopmental conditions. We report an unusual case of synchronous gastric and duodenal trichobezoar in a 17-year-old female with autism spectrum disorder (ASD) whose guardian denied trichotillomania or pica, highlighting the diagnostic and surgical challenges this presentation poses. The patient presented with a three-week history of diffuse abdominal pain, nausea, and bilious non-bloody emesis. Abdominopelvic CT with contrast demonstrated a continuous large mass in the stomach and duodenum, interpreted as bezoars. Pain was rated 6/10 at presentation, predominantly in the upper quadrants. Diagnostic endoscopy confirmed a trichobezoar at the proximal stomach blocking passage into the pylorus. The patient underwent open exploratory laparotomy with gastrotomy for excision of the gastric trichobezoar and proximal jejunum enterotomy for excision of a second trichobezoar drained from the distal duodenum. The bowel and stomach were closed with running PDS sutures and Lembert reinforcement. Estimated blood loss was 5 cc. The patient was extubated and transferred to the pediatric acute care unit (PACU) in stable condition. This report underscores the importance of considering trichobezoar in adolescent females with neurodevelopmental disorders presenting with upper gastrointestinal symptoms, even in the absence of a reported history of hair ingestion. Multidisciplinary surgical and psychiatric follow-up is essential to prevent recurrence.
Gambling in older adults represents an emerging but still underrecognized mental health concern. Although gambling participation is increasingly observed in later life, the specific psychological, social, cognitive, and biological factors associated with gambling-related problems in older adults remain insufficiently characterized. A systematic review was conducted in accordance with PRISMA guidelines. Empirical studies involving adults aged ≥55 years with Gambling were identified through searches of Web of Science, PubMed/MEDLINE, Scopus, PsycNET, ClinicalTrials.gov, and WHO ICTRP from January 15 to June 15, 2025. From 40,263 identified records, 35 studies met the inclusion criteria. The included studies, published between 2000 and 2025, primarily investigated gambling behaviors, severity, psychosocial correlates, and associated mental health outcomes in older adults. Commonly identified correlates to gambling-related problems included loneliness, reduced social support, financial difficulties, male gender, stressful life events, and early gambling initiation. Gambling was frequently reported as a recreational activity but could become maladaptive when used as a strategy to regulate negative emotions or cope with social isolation. Psychiatric comorbidity, particularly depression and anxiety, was frequently observed in clinical and high-risk samples. Evidence regarding psychological interventions remains limited but suggests potential benefits. Current evidence highlights substantial gaps in age-specific assessment and targeted interventions. Future studies should prioritize tailored psychological interventions addressing loneliness, emotional regulation, cognitive distortions, and life transitions in later adulthood.
Attention-deficit/hyperactivity disorder (ADHD) and language/reading difficulties frequently co-occur. The extent of shared genetic architecture remains incompletely defined. We investigated genome-wide overlap between ADHD and four core skills: word reading, nonword reading, spelling, and phoneme awareness. We integrated genome-wide association study (GWAS) summary statistics from the Psychiatric Genomics Consortium for ADHD (38,691 cases; 186,843 controls) and from the GenLang Consortium for language-related traits (n = 13,633-33,959). We performed linkage disequilibrium score regression (LDSC) to estimate genetic correlations and stratified LDSC to identify enriched genomic annotations. Cross-trait meta-analyses were conducted using MTAG and CPASSOC to identify cross-trait association signals. Mendelian randomization (MR) was applied to assess potential directional relationships. Genome-wide genetic correlations were negative and significant between ADHD and each reading- and language-related trait (word reading rg = -0.35, p = 1.35 × 10-16; nonword reading rg = -0.28, p = 2.15 × 10-9; spelling rg = -0.38, p = 1.03 × 10-15; phoneme awareness rg = -0.28, p = 2.64 × 10-6). Partitioned heritability analysis using S-LDSC showed significant enrichment after Benjamini-Hochberg false discovery rate correction (BH-FDR), concentrated in conserved or constrained annotations such as Genomic Evolutionary Rate Profiling and phastCons. Cross-trait analyses (MTAG and CPASSOC) identified loci associated with ADHD and each skill, 6 for word reading, 7 for spelling, 7 for phoneme awareness, and 4 suggestive loci for nonword reading (dual-method p < 5 × 10-6); several map near neurodevelopmental genes including DCC, MEF2C, and ST3GAL3. Bidirectional MR findings were consistent with a potential directional contribution of ADHD genetic liability to poorer reading/language performance, with no clear evidence supporting the reverse direction under standard MR assumptions. ADHD and language/reading abilities share a substantial polygenic overlap with convergent signals in neuronal regulatory annotations. These genome-wide findings support a transdiagnostic framework linking attention and literacy-related skills, while indicating that causal and clinical interpretations should remain cautious given the modest effect sizes and limited variance captured by current GWAS resources.
Borderline Personality Disorder (BPD) is a severe psychiatric condition frequently associated with Substance Use Disorder (SUD), with high rates of comorbidity and poor clinical outcomes. Impulsivity and emotional dysregulation are core features shared by both disorders, suggesting common underlying mechanisms. However, less is known about the role of additional factors-such as alexithymia, coping strategies, and quality of life in contributing to dual diagnosis and SUD severity in individuals with BPD. This study aims to: (1) examine the clinical and demographic variables in a sample of patients with BPD comorbid with SUD, in comparison with a group of patients with BPD alone, and (2) identify clinical and psychopathological factors related to the presence of SUD and severity of SUD symptoms in the whole sample (BPD with and without SUD). Seventy-five outpatients diagnosed with BPD were recruited and divided into two groups: BPD with comorbid SUD (n = 43) and BPD without SUD (n = 32). Diagnoses were established using SCID-5-CV and SCID-5-PD. Participants were assessed using validated instruments measuring BPD severity (BPDSI-IV), impulsivity (BIS-11), alexithymia (TAS-20), coping strategies (CISS), addiction vulnerability and severity (ABQ), quality of life (SAT-P), and functioning (SOFAS). Group differences were analyzed using chi-square and ANCOVA. Hierarchical logistic and linear regressions were conducted to identify factors associated with the SUD presence and severity. Patients with BPD and SUD were more frequently male and showed earlier BPD onset, greater symptom severity, higher impulsivity, higher vulnerability to addiction, greater alexithymia, and more use of task-oriented coping strategies. Logistic regression showed that impulsivity and vulnerability to SUD were significantly associated with comorbid SUD, while alexithymia reduced the effect of gender. Motor impulsiveness independently contributed to the presence of dual diagnosis. Linear regression analyses indicated that alexithymia and impulsivity were variables most strictly associated with SUD severity, jointly explaining approximately 60% of the variance. Specifically, difficulty describing feelings and externally oriented thinking contributed to a greater SUD severity. Impulsivity and alexithymia appear to be key transdiagnostic factors underlying both the presence and severity of SUD in individuals with BPD. These findings highlight the importance of targeting deficits in emotional processing and impulse control in clinical interventions to improve outcomes in this clinical population.
Informed consent is a cornerstone of modern medicine, yet the extent to which patients truly understand surgical information in the perioperative setting remains uncertain, particularly among older and vulnerable populations. Orthopaedic surgery represents a particularly challenging context, as trauma pathways are often characterized by urgency, pain, and emotional stress, whereas elective procedures allow greater opportunity for structured communication. To assess real-time patient comprehension of surgical informed consent immediately before orthopaedic surgery and to compare understanding between elective and trauma pathways. We conducted a prospective observational study at a single tertiary referral hospital in Northern Italy between January 2023 and December 2024. Approximately 870 adult orthopaedic surgical patients were screened for eligibility. After exclusion of patients with cognitive impairment, severe psychiatric illness, language barriers, refusal to participate, or incomplete questionnaires, 750 consecutive patients were included in the final analysis (460 elective, 290 trauma). All patients had received standard preoperative explanations and completed institutional informed consent procedures. In routine clinical practice, consent discussions generally involved both an orthopaedic resident and the supervising attending surgeon. Comprehension was assessed immediately before transfer to the operating room using a brief standardized four-item tool evaluating understanding of the planned procedure, risks, benefits, and therapeutic alternatives. Responses were independently categorized as absent, vague/partial, or adequate. Overall, 488 patients (65.1%) demonstrated absent comprehension, 188 (25.1%) vague or partial comprehension, and only 74 (9.9%) adequate comprehension. Trauma patients showed significantly lower overall comprehension than elective patients, with fewer patients demonstrating at least partial comprehension (28.3% vs. 39.1%; p = 0.003). Adequate comprehension remained low in both groups (8.3% vs. 10.9%; p = 0.30). Older age and lower educational attainment were associated with poorer comprehension in exploratory analyses. Mean questionnaire completion time was 3.5 ± 1.2 min. Despite repeated explanations and signed consent forms, most patients entered the operating room without meaningful understanding of the planned procedure, risks, benefits, or alternatives. The observed deficit was present in both elective and trauma settings, suggesting a systemic limitation of routine consent processes rather than solely a physician-specific communication issue. Informed consent in orthopaedic surgery frequently fails to ensure patient comprehension. Consent should be reframed as a dynamic verification process rather than a purely administrative requirement, incorporating structured communication pathways, simplified language, and teach-back-based strategies tailored to both elective and trauma settings.
Yoga has gained widespread acceptance as a complementary health practice. However, adverse events related to yoga have not been systematically evaluated for the purpose of developing evidence-based safety guidelines. This study systematically reviews published case reports and case series of yoga-associated adverse events (YAEs), categorizing their clinical features, associated yoga practices, and treatment outcomes to inform safer yoga practice. A comprehensive search was conducted in MEDLINE/PubMed, Scopus, and Web of Science from database inception through April 2025, supplemented by Google Scholar and hand-searching of reference lists. We included peer-reviewed case reports and case series in any language with English abstracts that described one or more adverse events temporally or causally linked to yoga practice. Two authors independently screened records and extracted study identifiers, patient demographics, yoga style and technique, affected systems, management, and outcomes; a third author validated all entries, and two additional authors assessed methodological quality using the Joanna Briggs Institute checklists. Eighty-four adverse events from 70 studies were identified, affecting 7 physiological systems: musculo-skeletal (34 cases, 40%), ophthalmological (16, 19%), neurological (10, 12%), cardio-respiratory (12, 14%), psychiatric (6, 7%), nasopharyngeal/gastrointestinal (4, 6%) and dermatological (2, 2%). The most frequently implicated practices were headstand (sirsasana; 15 cases, 18%) and forceful pranayama (8, 10%). Bikram, Ashtanga and Hatha yoga were the styles most often reported in association with adverse events. Patients' ages ranged from 15 to 90 years, and 60% were female. Fifty-four percent had pre-existing vulnerabilities. Complete recovery occurred in 40% of cases, partial recovery in 27%, and one individual had no recovery. Although YAEs are uncommon, they can result in significant morbidity, particularly in individuals with underlying risk factors. Systematic pre-practice screening, tailored instruction, and targeted instructor training are essential to mitigate risk and promote safe yoga practice. Please cite this article as: Sharma S, Bhandari SS, Malhotra V, Kuppusamy M, Kumar S, Dhakal M. Yoga and its risks: A systematic review of adverse events reported in case reports and case series. J Integr Med. 2026; Epub ahead of print.
Chronic alcohol use and stress are major risk factors for psychiatric disorders, frequently disrupting emotion regulation and behavioral inhibition. Yet, many individuals exposed to alcohol or stress do not develop pathology, highlighting the need to identify mechanisms that confer vulnerability or resilience. Using a conditioned inhibition paradigm, we examined how prior alcohol intake and acute stress shape fear- and reward-related behavioral control. Male and female Long Evans rats underwent either intermittent two-bottle alcohol access or water-only control conditions, followed by exposure to an acute stressor or non-stress context. Animals then completed cue discrimination and conditioned inhibition training, after which corticolimbic tissue was processed for parvalbumin, somatostatin, and protein kinase C-δ (PKCδ) immunohistochemistry. Stress exposure delayed discrimination learning across groups, but all subjects ultimately distinguished reward, fear, and inhibitory cues. However, when an inhibitor cue was presented concurrently with a fear cue, females with combined alcohol and stress histories failed to suppress fear responses, unlike all other groups. Across conditions, subsets of animals displayed either resilient or non-resilient behavioral profiles, which were linked to distinctive interregional correlations of parvalbumin- and PKCδ-expressing interneurons within the corticolimbic network. These findings reveal how alcohol and stress interact to disrupt inhibitory control over fear, particularly in females, and show that resilience is associated with coordinated shifts in interneuron network organization. Our conditioned inhibition approach provides a sensitive framework for parsing the neural substrates of vulnerability and resilience across fear and reward systems.
Unpartnered heterosexual women constitute a significant demographic within nursing home populations, yet their sexuality remains largely understudied. Although recent healthcare policies and research focus on improving residents' sexual wellbeing, they often reflect heteronormative assumptions, for instance by prioritizing life-long sex for heterosexual monogamous couples. While the heteronormativity of nursing home spaces has been highlighted in critical gerontological approaches that draw on LGBTQ+ lived experiences, its structuring of heterosexual women's lived experiences remains under-researched. This paper explores this gap through the stories of two heterosexual women living in dementia or psychiatric care units in a Belgian nursing home, both with a history of sex work. Embedded in a wider study using in-depth interviews, talking group sessions, and participant observation, it examines their experiences, desires, and imagination of sex and how these are entangled within the nursing home space. It reveals notions of later life sex and desire that extend beyond frameworks focused on activity or performance, to include imagination as a meaningful dimension. Moreover, the women's imageries of alternative relationships, spaces, and strategies for evading the discomforts of institutional life emerge as disruptors of heteronormative assumptions. Through this analysis, we expand understandings of women's heterosexuality in later life beyond heteronormativity and beyond binaries of desexualization and successful ageing. We underscore the value of intersectional and Critical New Materialist lenses that center on embodiment and practices within (imagined) space, rather than focusing primarily on heterosexual identity. These perspectives illuminate textured lived experiences that contribute to diversified understandings of sexual wellbeing in later life.
Quiet quitting, a passive disengagement involving minimal work effort, has surged post-pandemic amid workloads, burnout, and undervaluation, particularly in healthcare. Despite their critical role in health management, public health specialists in Türkiye often face role ambiguity and limited administrative authority, potentially fostering 'quiet quitting'-a state of passive disengagement. The aim of this study is to evaluate quiet quitting attitudes and identify associated factors among public health specialists in Türkiye. A cross-sectional online study was conducted from August 1 to September 30, 2024, targeting 601 Ministry of Health public health specialists. A simple random sample of eligible public health specialists was invited to participate in an online survey, and 241 completed a questionnaire comprising a Personal Information Form (sociodemographics, work characteristics, satisfaction) and the Quiet Quitting Attitude Scale (QQAS). The questionnaire was pilot-tested, and informed consent was obtained. Chi-square, Student's t, ANOVA, Mann-Whitney U, Kruskal-Wallis, post-hoc analyses, Logistic and linear regression were applied in the evaluation of the data. Of the participants, 18.2% viewed the future of public health in Türkiye as very hopeful or hopeful, 34.5% considered changing their specialty, 38.2% wanted a transfer from their current province, and 27.8% considered resigning. In the logistic regression model (QQAS ≥ 103), being aged 40 years or older, absence of an administrative position (OR = 6.73, 95% CI: 3.20-14.16), perceiving specialty training as incompatible with the field, a hopeless outlook on the specialty's future (OR = 9.56, 95% CI: 3.17-28.82), and desires for transfer and resignation were independently associated with higher quiet quitting attitudes. In the linear regression model, the same factors were significant, with the addition of 4-6 years of specialist experience and dissatisfaction with the public health specialty. Marital status, presence of psychiatric illness, and total medical experience were significant in univariate analyses but did not retain independent associations in the multivariate models. Quiet quitting attitudes among public health specialists were associated with professional hopelessness and role-education mismatch. These findings suggest that targeted institutional efforts to better align job descriptions with specialist training and to improve career outlooks may help sustain workforce engagement.
Cardiovascular disease (CVD) is the leading cause of premature mortality in bipolar disorder (BD). While lithium is a first-line mood stabilizer, its long-term cardiovascular safety profile remains debated, with conflicting evidence regarding potential toxicity versus protective effects. This study aimed to evaluate the association between lithium use and incident CVD risk in claims-based cohort of patients with BD. We conducted a claims-based longitudinal cohort study using the Beijing Medical Claim Data for Employees (BMCDE) database from 2010 to 2017. Patients newly diagnosed with BD were categorized into lithium and non‑lithium user groups. Inverse probability weighting (IPW) was applied to control for baseline confounding. Weighted Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident CVDs, including ischemic heart disease (IHD) and stroke. The study included 2945 patients (mean age 44.5 years) with a mean follow-up of 3 years. Lithium use was associated with a significantly lower risk of overall CVD (HR = 0.38; 95% CI 0.18-0.78) and specifically IHD (HR = 0.20; 95% CI 0.06-0.67). No significant association was found for stroke (HR = 0.69; 95% CI 0.27-1.75). Subgroup analyses revealed that this lower risk was most pronounced among older individuals, males, and those with pre-existing cardiovascular risk factors. Lithium use is associated with a reduced risk of incident CVDs, particularly IHD, in patients with BD. These findings suggest that lithium may confer dual psychiatric and somatic benefits, supporting its continued utility in high-risk populations.
Psilocybin is a serotonergic psychedelic drug with emerging therapeutic applications, yet its actions under glutamatergic dysfunction, and relevance to schizophrenia and associated psychiatric disorders, remain unclear. We examined the acute and long-lasting effects of psilocybin (1 mg/kg, intraperitoneal) on behavioral and neural outcomes in the metabotropic glutamate receptor 5 (mGlu5) knockout (KO) mouse model of schizophrenia. The mGlu5 KO mice displayed psilocybin-induced hyperlocomotion, whereas wild-type (WT) mice did not. Additionally, male mGlu5 KO mice showed an amplified psilocybin-induced head-twitch response (HTR) compared with WT males, consistent with sex-dependent enhancement of 5-HT2A receptor-mediated signaling. Acute psilocybin increased c-Fos expression in the claustrum of WT but not KO mice, suggesting intact mGlu5 signaling is required for psilocybin-evoked claustral recruitment. Psilocybin did not alter anxiety-like behavior in the light-dark box and increased immobility time in the Porsolt test. Strikingly, psilocybin produced a sustained normalization in prepulse inhibition (a measure of sensorimotor gating) in female KO mice, evident nine days after treatment. Together, these findings indicate that disrupted mGlu5 signaling amplifies acute responses to psilocybin and reveals a sex-dependent long-term effect on sensorimotor gating. These results refine understanding of glutamatergic-serotonergic interactions and motivate further work evaluating psilocybin across schizophrenia-relevant endophenotypes.
Structural brain changes and immune-metabolic alterations are widely reported in post-COVID condition (PCC), particularly among patients with depressive symptoms. Alterations in gray matter volume (GMV) and dysregulation of the peripheral kynurenine pathway have each been described independently in PCC; however, potential interactions remain unclear. This observational case-control study investigated associations between GMV and peripheral kynurenine-pathway metabolites in patients with PCC compared to unimpaired individuals who recovered after COVID-19. The analysis is based on a sub-cohort from a multicentre, population-based study of individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between October 2020 and April 2021. We compared 43 patients with PCC (age: M = 47.63 (SD = 13.01), 74.4% female) to 27 age- and sex-matched fully recovered controls (age: M = 47.44 (SD = 10.39), 77.8% female) on average 156 weeks after SARS-CoV-2 infection. GMV was assessed using isotropic T1-weighted magnetic resonance imaging (MRI) data (normalized to total intracranial volume, age, and sex). We analyzed the relation of normalized regional GMV to serum kynurenine-pathway metabolites (kynurenine, kynurenic acid, quinolinic acid, kynurenic/quinolinic acid ratio). Additionally, in patients with PCC, GMV and kynurenine-pathway metabolites were tested for correlations with the severity of depressive symptoms. No significant group-level differences in GMV were observed. Clinical case status moderated the association between the peripheral kynurenic acid/quinolinic acid ratio and GMV of the right cingulate gyrus and right parietal lobe. Post-hoc analyses showed a positive association in PCC. Furthermore, within the PCC group, 60.5% showed depressive symptoms according to the Patient Health Questionnaire-9, and larger bilateral hippocampal volumes were significantly associated with greater depressive symptom severity. None of the kynurenine pathway metabolites were significantly associated with depressive symptom severity. Our findings may indicate that the peripheral kynurenine metabolism is associated with GMV in PCC, suggesting the presence of facilitated immune-brain interactions. The association between higher hippocampal GMV and depressive symptom severity in PCC-associated depression points to a distinct neurobiological mechanism.
Symptoms of insomnia affect over half of patients with advanced cancer and frequently co-occur with other conditions, particularly pain. Effective and well-tolerated treatments are needed. This study compared acupuncture and massage therapy for insomnia symptoms with comorbid pain and examined the relationship between sleep and pain. Data were drawn from a multicenter pragmatic randomized clinical trial comparing acupuncture and massage therapy for pain in advanced cancer. Among 300 participants, 234 with baseline insomnia (ISI ≥ 8) were included. Participants received 10 weeks of treatment with follow-up to 26 weeks. Insomnia symptoms were measured using the Insomnia Severity Index (ISI). Linear mixed-effects models evaluated longitudinal changes. Responder analyses defined ISI responders as ≥8-point reduction or ISI <8, and pain responders as ≥30% reduction in Brief Pain Inventory (BPI) severity at week 10. Both acupuncture and massage significantly improved ISI scores at week 10 (-3.86 and -3.83; both p<0.0001) with no between-group differences (p=0.91). ISI responder rates were similar (35.1% vs 33.3%), while BPI responder rates were higher (48.0% vs 62.9%). Pain responders had greater improvements in insomnia at week 10 (Δ=-2.97; p=0.0003), though attenuated by week 26. Insomnia responders showed greater reductions in pain at week 10 and 26 (both p<0.0001). Acupuncture and massage improved insomnia in patients with advanced cancer. Sleep and pain showed a bidirectional relationship, supporting integrative approaches targeting symptom clusters.
Despite abundant evidence linking hyperglycemia to stroke, its heterogeneous effects across stroke etiologies and lesions remain unclear. We examined the associations between admission glycated hemoglobin (HbA1c) levels and stroke subtypes, lesions, and functional outcomes. Adults with acute ischemic stroke admitted between 2016 and 2020 were analyzed using a Japanese nationwide registry. Patients were grouped by admission HbA1c (<6.0%, 6.0-6.9%, 7.0-7.9%, and ≥ 8.0%). Stroke subtypes were determined using the Trial of Org 10,172 in Acute Stroke Treatment criteria. Lesion was categorized as cerebral cortex, basal ganglia/corona radiata, thalamus, brainstem, or cerebellum. Unfavorable outcome was defined as discharge modified Rankin Scale (mRS) >2 for patients with premorbid mRS ≤2, or higher discharge mRS than premorbid mRS for others. Associations were assessed using multivariable mixed-effects logistic regression analysis. Among 13,569 patients, HbA1c was <6.0% in 7001 (51.6%), 6.0-6.9% in 4201 (31.0%), 7.0-7.9% in 1264 (9.3%), and ≥ 8.0% in 1103 (8.1%). Higher HbA1c levels were associated with a greater proportion of large artery atherosclerosis (adjusted OR for HbA1c ≥8.0% vs <6.0%, 1.40; 95% CI, 1.19-1.65) and lower proportion of cardioembolism (0.63; 0.50-0.79). Elevated HbA1c levels were associated with higher prevalence of brainstem lesions (2.35; 1.82-3.02) and lower prevalence of cerebral cortex and basal ganglia/corona radiata lesions, even after adjusting for stroke subtype. Unfavorable outcomes were more common in patients with higher HbA1c levels (overall, 1.56; 1.31-1.85), particularly in those with large artery atherosclerosis and cardioembolism. Higher admission HbA1c levels were associated with a higher proportion of large artery atherosclerosis and a lower proportion of cardioembolism, with a higher proportion of brainstem lesions and a lower proportion of cortical and basal ganglia/corona radiata lesions, and with worse functional outcomes.