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This study aimed to examine the relationship and differences between healthy eating, orthorexia nervosa tendencies and early maladaptive schemas. A cross-sectional online survey was conducted on a sample of Hungarian adults. One thousand twelve participants completed measures assessing healthy orthorexia, orthorexia nervosa tendencies, perceived stress, and early maladaptive schemas. Structural equation modeling was used to determine the relationships among the variables. Results indicated significant associations between orthorexia nervosa tendencies and specific early maladaptive schemas, particularly unrelenting standards and defectiveness/shame schemas. Additionally, age, perceived stress, and BMI were found to be associated with orthorexia nervosa tendencies and healthy orthorexia. The findings suggest that early maladaptive schemas, especially those related to perfectionism and low self-esteem, may contribute to the development and persistence of high orthorexia nervosa tendencies. More research is necessary to examine these relationships and their potential therapeutic implications. Level V, descriptive cross-sectional study. We all hold deep-rooted beliefs about ourselves that influence our thoughts, feelings and behaviors. One type of belief, called „early maladaptive schemas,” can develop during childhood if basic emotional needs are not met. Since previous research has shown that these schemas contribute to the development of anorexia and bulimia nervosa, we examined whether they also play a role in orthorexia nervosa tendencies. Although orthorexia nervosa is not formally recognized as a distinct diagnosis within current classification systems, its characteristic symptoms, such as strict adherence to extreme dietary rules, eating only foods considered „healthy”, and feeling of shame following dietary violations, can lead to significant distress and impairments in affected individuals. Our findings indicate that individuals with orthorexia nervosa tendencies are more likely to display stronger activation of the unrelenting standars schema, characterized by the pursuit of excessively high personal standards, as well as the defectiveness/shame schema, which reflects pervasive beliefs of inadequacy or unworthiness. The unrelenting standards schema was also linked to healthy eating habits, while the defectiveness/shame schema was only associated with orthorexia nervosa tendencies, suggesting a possible role in the disorder. We also observed some unexpected results: healthy eating habits were positively related to perceived stress, whereas orthorexia nervosa tendencies were negatively related to it. This pattern may reflect the challenge in determining when healthy eating transitions into maladaptive behavior, and may also suggest that individuals with orthorexia nervosa tendencies might experience positive emotions as a result of strict routines and control.

Benzodiazepines are a class of tranquilizers that, like prescription opiates, are commonly subject to abuse. Abusers of benzodiazepines commonly malinger to sustain access to these prescriptions from their health care providers by creating and enhancing medically necessary conditions requiring treatment with benzodiazepines. Such behavior may involve displays of unrelenting extreme anxiety that are resolved only by the administration of benzodiazepines. Typical substance abuse behaviors also include noncompliance with treatment, lack of self-care, and lack/failure of counseling. Three cases underwritten for life expectancies in legal matters provide insight as to what kinds of benzodiazepine abuse behaviors can arise, given the conditions and resources available. For life underwriters and medical directors, such benzodiazepine abuse behaviors can serve as an underwriting red flag at time of application. Signs and symptoms of additional substance abuse, such as alcohol and prescription opiates, are likely to be found among those who abuse benzodiazepines and can serve as underwriting red flags.

Fibromyalgia is characterized by widespread musculoskeletal pain, fatigue, disturbances in cognitive and emotional functioning. Cognitive impairment (so-called "fibrofog") is increasingly recognized as a central feature of fibromyalgia. However, its relationship with psychological traits and personality dimensions remains insufficiently explored. This study aimed to examine the interaction between cognitive performance, emotional states, and personality traits in individuals diagnosed with fibromyalgia. This descriptive pilot study involved 10 female outpatients diagnosed with fibromyalgia according to the criteria of the American College of Rheumatology. Participants underwent a comprehensive assessment including neuropsychological, psychological, personality, and motor evaluations. Instruments used included the Young Schema Questionnaire, the State-Trait Anxiety Inventory, the Beck Depression Inventory, the Brief COPE questionnaire, and a battery of cognitive and motor tests. Statistical analyses were conducted using Spearman's rank correlation coefficient. The most frequently observed maladaptive personality schemas were self-sacrifice (80%) and unrelenting standards (70%). Trait anxiety was present in 80% of participants, and depressive symptoms were reported by 90%. While short-term and long-term memory were generally preserved, 80% of participants showed deficits in divided attention, and 40% demonstrated impaired mobility under dual-task conditions. Significant correlations were found between anxiety and cognitive flexibility, as well as between coping strategies and working memory performance. Patients with fibromyalgia exhibit a complex cognitive-emotional profile characterized by attentional deficits, maladaptive personality traits, and elevated psychological distress. These findings emphasize the importance of multidimensional assessment and suggest that interventions targeting personality schemas and coping mechanisms may improve cognitive and functional outcomes in this population.

Patients experiencing pregnancy complications have died after being denied emergency medical treatment in states with restrictive abortion laws even where the laws ostensibly allow pregnancy termination when necessary to save a patient's life. For patients experiencing miscarriage, premature rupture of membranes, placental abruption, severe hypertensive disorders, ectopic pregnancy, and other conditions, a treating physician's decision about whether their condition qualifies as an emergency under state law can mean the difference between life and death. Physicians who treat obstetric emergencies report being torn between delivering evidence-based care and protecting themselves from criminal prosecution. This article frames physician decision-making about emergency abortion within the larger institutional context in which those decisions arise, providing a taxonomy of the myriad hospital policies that impact physicians who treat obstetric emergencies. It evaluates these institutional procedures' efficacy with respect to the dual goals of protecting pregnant patients' health and limiting providers' exposure to legal risk. The article concludes that the optimal institutional approach grants full deference to physicians' clinical judgment while also providing robust institutional support in the form of comprehensive legal guidance and guaranteed legal representation for physicians who are prosecuted for making good faith medical judgments. It calls upon hospitals to re-commit to their primary mission of providing high quality patient care, and to dedicate resources to supporting physicians who deliver evidence-based care despite unrelenting legal and political pressures.

Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD), a sensory hyperactivity condition, involves a broad range of undesired, unrelenting dysesthesia(s), including genital arousal, hard flaccid syndrome, and sleep-related prolonged erection. PGAD/GPD is associated with significant, negative psychosocial consequences, including suicidal ideation. In 2021, the International Society for the Study of Women's Sexual Health developed a process of care for biopsychosocial management of PGAD/GPD in women. This article reviews the management of PGAD/GPD in all genders. A consensus guideline for management of PGAD/GPD in all genders was developed based on the understanding that this complex condition may be triggered by multiple pathophysiologic factors. The International Consultation for Sexual Medicine identified co-chairs to organize a consensus committee on PGAD/GPD and select an expert multidisciplinary panel. They reviewed literature, basic science, and clinical data, using a modified Delphi method to reach a consensus on the background, diagnostic procedures, and therapeutic options. PGAD/GPD occurs in women and men with similar prevalences, from which we can infer that a substantial number of individuals are adversely affected by PGAD/GPD. While sensory hyperactivity is perceived as located in the genito-pelvic region, symptoms can originate from any of 5 regions: region 1, the end organ; region 2, the pelvis/perineum; region 3, the cauda equina; region 4, the spinal cord; and region 5, the brain. The experts reviewed region-based pathophysiologic triggers, diagnostic procedures, and biopsychosocial treatment strategies based on the location of the trigger(s). Psychological and medical treatments should be performed concomitantly. Although PGAD/GPD is associated with significant morbidity, it is still underrecognized by healthcare practitioners. It is strongly recommended that individuals of all genders be safely and effectively managed following the process-of-care diagnostic algorithm that systematically examines the 5 regions to localize the dysesthesia trigger(s). The algorithm emphasizes using psychological and medical interventions in parallel throughout the process, with interventions based on the location(s) of the identified trigger(s).

Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD) involves chronic, unrelenting arousal and dysesthesia of the genito-pelvic region. In 2012, Komisaruk and Lee identified a high incidence of sacral Tarlov cysts in patients with PGAD/GPD, prompting development of a multidisciplinary diagnostic and treatment algorithm. This study reviews surgical outcomes for patients with PGAD/GPD in whom a Tarlov cyst was identified as the symptomatic driver. A retrospective review of prospectively collected data was conducted on patients with PGAD/GPD who underwent Tarlov cyst excision and imbrication from 2017 to 2023. The diagnostic algorithm included neurogenital testing, sacral MRI, and assessment for pelvic or end-organ triggers.When one or more cysts were suspected as the etiology, a targeted diagnostic injection with anesthetic and steroid confirmed the diagnosis.Operative reports, imaging, and pre/postoperative clinic visits were reviewed to assess complications, readmissions, reoperations, and symptom changes. Outcomes were measured using the Patient Global Impression of Improvement (PGI-I), Oswestry Disability Index (ODI), Sexual Distress Scale-Revised (SDS-R), and Visual Analog Scale (VAS) for back pain. Nineteen patients (mean age 45.5 ± 15.9 years) with an average follow-up of 18.2 ± 10.5 months were included. Fourteen patients (73.7%) reported postoperative improvement on the PGI-I: 2 "very much better," 9 "much better," 3 "little better," and 5 with no improvement. No patients reported worsening symptoms. All were discharged the same day, with no cerebrospinal fluid leaks, wound issues, or cyst recurrences. Oswestry Disability Index improved from 32.9 to 28.4, SDS-R from 30.9 to 26.8, and Visual Analog Scale back pain from 4.8 to 3.2. Symptomatic Tarlov cysts can contribute to PGAD/GPD and associated sexual dysfunction. Early detection with a structured diagnostic algorithm support accurate patient selection and safe, effective surgical treatment, offering meaningful symptom relief for appropriately selected patients.

Family caregivers in low- and middle-income countries (LMICs) provide the lion's share of care for their relatives with severe mental health conditions amid vast treatment gaps. Yet, their lived experiences are not adequately explored. This systematic review synthesizes evidence on the lived experiences, priorities and needs of these caregivers across diverse LMIC settings. We analyzed 76 articles identified across nine databases. Data were synthesized using thematic analysis. The synthesis identified five themes: (1) the journey to understanding, (2) familial commitment to care, (3) the unrelenting burden of caregiving, (4) Forging resilience: strategies of enduring care and (5) voiced needs and priorities. The early attempts to understand the illness take the family on a journey from initial uncertainty to experiential learning. Familial commitment to care is often rooted in moral obligation and system neglect, but this sustained effort leads to an immense caregiving toll. The burden is profoundly gendered, disproportionately affecting women, who commonly face isolation and burnout. Caregivers often navigate pervasive, multidimensional stigma that restricts the entire family's social and economic future. Despite these challenges, resilience is fostered through faith, peer support and active inclusion of the person in family routines. Caregivers urgently prioritized mental health services that offer knowledge about the illness, active and respectful involvement in treatment planning, practical caregiving skills and support groups. The pressing need for economic support was also expressed. This review underscores the need for global mental health endeavors to recognize and respond to unsupported family caregiving. Family focused interventions have the potential to modify the home environment in ways that support recovery for the person and alleviate many of the caregiving challenges faced by the family. Alongside this, initiatives are needed to address economic precarity and facilitate social inclusion of the family unit.

Antimicrobial resistance (AMR) is a worldwide health crisis challenging existing antibiotics, leading to increased mortality. Since their discovery in the early twentieth century, antibiotics have transformed medicine and saved countless lives. But today, the worrying increase in antibiotic resistance casts a shadow over the discovery of antibiotics. The abuse and overuse of antibiotics has led to the unrelenting adaptability of microbes, which is the cause of this global issue. With particular attention on ciprofloxacin (CIP), 2nd generation fluoroquinolones work by preventing DNA gyrase and topoisomerase IV from performing their vital functions, which include transcription, recombination, replication, and condensed DNA remodeling. Numerous researchers have developed CIP derivatives that are promising treatments, but factors such as overuse, multiple drug therapy, and misuse contribute to widespread resistance along with different side effects. So, to overcome such problems, diverse strategies to enhance CIP efficacy are examined, including synthetic approaches such as hybridization, Mannich reaction, and oxidation, aiming to modify the structure of CIP and create novel compounds with potentially enhanced biological activities, improved efficacy, or reduced side effects, which happens as a result of chemical and physical changes, typically involving one or more reactions. Along with this, nanotechnology for drug delivery and synergistic combinations with aminoglycosides, tobramycin, or azithromycin, antimicrobial peptides (AMPs) and monoclonal antibodies (mAbs) offer potential to combat multidrug-resistant strains. This review provides insights into potential breakthroughs necessary to overcome AMR challenges and advance effective emerging synthetic and delivery approaches for antibacterial treatments. Overall, we have compiled different emerging strategies to develop CIP derivatives with the aim of discovering new and more effective ways to combat drug-resistant infections.

Positive aspects of caregiving (PAC) are assumed to protect against caregiver suffering, but evidence is lacking. Two studies examined this assumption through testing the reciprocal causality between PAC and burden/depression, and exploring the mechanisms linking these constructs. MethodsIn Study One, 99 dementia caregivers were interviewed six months apart. In Study Two, 45 caregivers provided 620 diaries across eight weeks. In Study One, baseline burden predicted increased depressive symptoms, whereas baseline depressive symptoms predicted less PAC. Although burden was unrelated to PAC concurrently, burden was found to strengthen PAC after depression was controlled for (statistical suppression). Contrary to prevailing assumption, PAC predicted neither burden nor depression. In Study Two, 213 of the 620 diaries contained narratives linking burden to PAC. Supporting the PAC-enhancing role of burden, four mechanisms were extracted using thematic analysis, describing unrelenting caregiving stress enriching the significance of their work and pressuring them to learn, to push beyond boundaries, and to transform thinking. Chronic hardship may be a breeding ground for positive meanings, yet also increasing depression, undermining positivity. Consequently, burden has a direct positive effect, but an indirect negative effect via depression, on PAC. A conceptual model depicting such complex dynamics is proposed.

Idiopathic pulmonary fibrosis (IPF) is the prototypical fibrosing interstitial lung disease, characterised by its unrelenting progressive course and poor prognosis. The incidence of IPF is rising and is becoming a major public health concern. Debilitating dyspnoea and respiratory failure results. Death occurs on average 3-5 years from the time of diagnosis. Clearer understanding of the pathobiology of the condition continues to advance and although we may now better understand disease mechanisms, our therapeutic approach remains limited. In the UK, only two treatments are licensed for IPF, and both can only slow the process down. An ideal silver bullet would halt and ideally reverse established fibrosis. New therapies are showing promise; however, lung transplant remains the only treatment that can substantially increase both duration and quality of life. Here we will provide a comprehensive overview of IPF to summarise definitions, epidemiology, mechanisms, diagnostics, and management.

To explore survivors' perspectives and experiences of psychological detachment while living with a stoma. A qualitative descriptive study was conducted. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. A total of 15 semi-structured interviews were conducted between February 2024 and May 2024. The phenomenological method proposed by Colaizzi was used to analyze the data. Four major themes emerged from the analysis: (1) Trapped in the Persistent Impact of Dual Traumas: Struggles with Adaptation; (2) Trapped by the Unrelenting Burden of Stoma Care: A Cycle of Powerlessness; (3) Trapped by the Shackles of a Stigmatised Identity: The Dilemma of Social Reintegration; and (4) Divergent Pathways of Detachment: Navigating Between Immersion and Transcendence. Within the main themes, eight subthemes were formulated. This study thoroughly explored and elucidated the psychological detachment experiences of colorectal cancer survivors with a stoma, revealing its key role in mental health recovery and psychosocial rehabilitation and informing clinical interventions. The study suggests that healthcare staff should guide survivors in drawing a clear boundary between stoma care and their personal life, encourage any correction of erroneous social cognition, and promote the positive development of psychological detachment among survivors. This study explored the challenges of psychological detachment in stoma survivors, identifying key barriers like trauma, care burden, role misconceptions, and varying detachment levels. The findings can guide healthcare providers in supporting survivors' mental well-being and inform better survivorship care strategies. There was no patient or public contribution.

Myalgic encephalomyelitis (ME), commonly known as chronic fatigue syndrome (CFS), is a long-lasting neurological disease. The cause of ME remains uncertain, characterized by unrelenting or recurring fatigue not alleviated by rest. In recent times, CFS incidence has been on the rise annually, showing a tendency towards younger sufferers. Especially post-COVID-19, its prevalence has surged, posing a significant threat to 21st-century health. CFS symptoms are intricate and diverse. Patients typically endure extreme fatigue lasting over six months, accompanied by physical and neuropsychiatric symptoms like sore throat, muscle/joint pain, anxiety, and distress. These severely disrupt daily life and work, heightening illness risks and financial strain. With the unknown etiology, current treatments have limited success and may induce psychological issues such as anxiety and depression. This paper delivers an extensive and thorough overview of the latest developments in the studies concerning the pathogenesis, diagnostic standards, and therapeutic approaches for chronic fatigue syndrome. Integrating and assessing the existing knowledge body related to this field systematically, we aim to facilitate continuous research and gain a deeper understanding of this complex medical problem whose mechanism remains largely unknown. Moreover, valuable insights and practical recommendations for future related treatments and research are also provided.

Diabetes distress (DD) is a phenomenon that highlights the emotional strain of having diabetes and the unrelenting demands of this illness; DD is very high and known in a poorly studied area of South Asia. This review is based on evidence published since 2023 and provides an enhancement of the 2023 South Asian Federation of Endocrine Societies (SAFES) recommendations. A 2025 systematic review and meta-analysis found pooled prevalence of type 2 diabetes distress of 85% in Pakistan, 42% in India and Bangladesh and 25% in Sri Lanka with emotional burden turning out to be the prevailing domain. The predictors of increased distress are always female gender, low socioeconomic status, prolonged period of the disease, comorbidities and poor glycemic control. Qualitative research indicates that South Asian patients are distressed due to family strain, out-of-pocket expenditure compelling them to decide whether to purchase the drug or not and fragmented health systems that isolate mental and physical health care. Cultural factors such as gendered roles in care giving, limited resources in the household budget and lack of social support increase emotional load and limit self-management. Clinicians can deal with diabetes distress by screening with validated measures and including short-term psychosocial counseling with diabetes visits, simplifying regimens to minimize hypoglycemia, addressing social support shortfalls and promoting care that is gender-sensitive and affordable. The review can guide South Asian clinicians to identify, evaluate and act on diabetes distress in resource limited, culturally diverse environments which will in turn enhance the glycemic and quality of life outcomes.

BACKGROUND Fungal endocarditis constitutes up to 3% of diagnosed infective endocarditis cases, and Histoplasma spp. cause approximately 10% of fungal endocarditis cases. Histoplasma infection occurs through inhalation of spores typically found in contaminated soil. The clinical forms are variable, ranging from asymptomatic to fatal presentations. Asymptomatic individuals may develop reactivated disease years after the primary exposure. Most cases of histoplasmosis are confined to the pulmonary system. In rare instances, fungal elements disseminate to the heart valves, where destructive injury occurs. CASE REPORT A 59-year-old woman presented with vascular bypass occlusion, 2 months after aortobifemoral bypass for aortoiliac occlusive disease. She reported severe, unrelenting nausea and vomiting; a large aortic valve mass was detected on transthoracic echocardiography. Bacterial endocarditis was initially suspected, but cultures were unrevealing. Follow-up microbial cell-free DNA testing identified Histoplasma capsulatum and low-level Streptococcus mitis/oralis, prompting further evaluation for disseminated histoplasmosis. Bone marrow biopsy showed Histoplasma negativity according to polymerase chain reaction. The patient subsequently underwent aortic valve replacement, and pathology confirmed fungal elements consistent with H. capsulatum. Gram and acid-fast bacilli staining of the aortic valve yielded negative results. CONCLUSIONS Fungal endocarditis carries substantial morbidity and is challenging to diagnose due to its nonspecific presentation over time and the absence of standardized blood culture protocols. Treatment options include surgical valve replacement and targeted antifungal therapy. This case underscores the diagnostic difficulties associated with fungal endocarditis, particularly in the context of negative cultures and a history of travel to endemic areas, when microbial coinfection cannot be definitively excluded.

This study examined relationships between Early Maladaptive Schemas (EMS), emotion regulation, coping styles, and psoriasis outcomes in Istanbul, Turkey. Participants included 100 psoriasis patients (ages 25-45) and 107 healthy controls. Data were analyzed using structural equation modeling. Psoriasis patients scored significantly higher on six schemas: Emotional Deprivation, Approval Seeking, Pessimism, Self-Sacrifice, Punitiveness, and Unrelenting Standards (Cohen's d = 0.42-0.89). They also demonstrated greater emotion regulation difficulties and reduced adaptive coping. Mediation analyses revealed that maladaptive emotion-focused coping fully mediated relationships between EMS and quality of life deterioration (β = .11, 95% CI (.04, .19]) and psoriasis severity (β = .08, 95% CI [.02, .15]). Pessimism and Punitiveness schemas, impulse control difficulties, and maladaptive emotion-focused coping predicted general psychological symptom severity (measured by validated scales) (R2 = .46). Findings suggest maladaptive emotion-focused coping as a key mechanism linking schemas to psoriasis outcomes, supporting integrated dermatological and psychological interventions.

The unrelenting progression of Parkinson's disease (PD) leads to severely impaired quality of life, with considerable variability in progression rates among patients. Identifying biomarkers of PD progression could improve clinical monitoring and management. Radiomics, which facilitates data extraction from imaging for use in machine learning models, offers a promising approach to this challenge. This study investigated the use of multi-modality imaging, combining conventional magnetic resonance imaging (MRI) and dopamine transporter single photon emission computed tomography (DAT-SPECT), to predict motor progression in PD. Motor progression was measured by changes in the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor subscale scores. Radiomic features were selected from the midbrain region in MRI and caudate nucleus, putamen, and ventral striatum in DAT-SPECT. Patients were stratified into fast progression vs. slow progression based on change in MDS-UPDRS in follow-up. Various feature selection methods and machine learning classifiers were evaluated for each modality, and the best-performing models were combined into an ensemble. On the internal test set, the ensemble model, which integrated clinical information, T1WI, T2WI and DAT-SPECT achieved a ROC AUC of 0.93 (95% CI: 0.80-1.00), PR AUC of 0.88 (95%CI 0.61-1.00), accuracy of 0.85 (95% CI: 0.70-0.89), sensitivity of 0.72 (95% CI: 0.43-1.00), and specificity of 0.92 (95% CI: 0.77-1.00). On the external test set, the ensemble model outperformed single-modality models with a ROC AUC of 0.77 (95% CI: 0.53-0.93), PR AUC of 0.79 (95% CI: 0.56-0.95), accuracy of 0.68 (95% CI: 0.50-0.86), sensitivity of 0.53 (95% CI: 0.27-0.82), and specificity of 0.82 (95% CI: 0.55-1.00). In conclusion, this study developed an imaging-based model to identify baseline characteristics predictive of disease progression in PD patients. The findings highlight the strength of using multiple imaging modalities and integrating imaging data with clinical information to enhance the prediction of motor progression in PD.