搜索结果：Comprehensive psychiatry

In psychiatry, tensions have often arisen between biological and social approaches, despite their interconnection. Social psychiatry has evolved alongside changing understandings of mental health and its ties to broader social and geopolitical determinants. Global factors such as economic inequality, migration, and social exclusion are increasingly recognized as key influences on mental health outcomes. Nonetheless, challenges like stigma, lack of access, and resource limitations persist. The Biopsychosocial Model remains central to social psychiatry, offering an integrated framework that considers biological, psychological, and social dimensions. This comprehensive perspective ensures that interventions target not only symptoms but also contextual factors contributing to mental illness. The future of social psychiatry will be shaped by heightened awareness of social determinants, particularly amid global crises like war or COVID-19. Consistent application of the biopsychosocial model in clinical settings is essential. Policy advocacy focused on housing, employment, and inclusive care-alongside cultural sensitivity and the use of digital tools-will be vital. Moreover, enhancing psychiatric education and fostering interdisciplinary collaboration will be key to addressing social determinants across all levels of mental health care.

Esketamine, the S-enantiomer of ketamine, has emerged as a rapid-acting antidepressant with unique mechanisms. This narrative review synthesizes current evidence on its clinical applications, safety, and regulatory status based on peer-reviewed literature published between January 2000 and March 2024, searched in PubMed, Web of Science, and the Cochrane Library. Esketamine exerts its effects primarily through noncompetitive antagonism of N-methyl-D-aspartate receptors, leading to rapid modulation of glutamatergic signaling and neuroplasticity. In anesthesia, it provides effective sedation with minimal respiratory depression. In psychiatry, intravenous and intranasal esketamine have demonstrated rapid antidepressant effects in treatment-resistant depression, with response rates of 50% to 70% within 24 hours. However, long-term safety data remain limited, and concerns persist regarding dissociative symptoms, cognitive impairment, and abuse potential. Regulatory approvals vary: the Food and Drug Administration approved intranasal esketamine for treatment-resistant depression in 2019, while European and Asian countries have adopted differing restrictions. Esketamine represents a paradigm shift in depression treatment, but its use requires careful patient selection, monitoring, and risk management. Future research should focus on head-to-head comparisons with other rapid-acting interventions, long-term outcomes, and integration into stepped-care models.

Depression poses a major global health challenge, highlighting the urgent need for valid animal models to elucidate its pathogenesis and develop novel treatments. This review offers a comprehensive characterization and validation of an original rodent model of depression induced by chronic exposure to variable-frequency ultrasound (20-45kHz), termed the ultrasound model (US-model). We hypothesize that this model uniquely recapitulates a state of "information uncertainty", providing a highly relevant framework for studying depression amid modern urban environments. Based on extensive experimental data collected over 10 years (2013-2024), the model has been systematically evaluated using three key criteria for validity. First, the US-model demonstrates face validity, recapitulating core behavioral abnormalities such as anhedonia, behavioral despair, social withdrawal, anxiety, and cognitive deficits. Second, its construct validity is supported by the faithful reproduction of key pathophysiological mechanisms, including monoamine system dysfunction, impaired neuroplasticity, neuroinflammation, oxidative stress, and hypothalamic-pituitary-adrenal (HPA) axis hyperactivity. Finally, the model exhibits strong predictive validity, showing sensitivity to various established classes of antidepressants (e.g., fluoxetine, clomipramine), novel compounds (e.g., vindeburnol, neuropeptides), electroconvulsive therapy, and agents with antioxidant or anti-inflammatory properties. Compared to classic models, the US-model may offer several potential advantages such as a relatively high degree of standardization and an arguably more ethical profile, as it is less invasive. In conclusion, the US-model of depression represents a reliable and reproducible tool to investigate the pathogenesis of affective disorders and screen new therapeutic agents.

In recent years, sports psychiatry and psychotherapy has developed rapidly. Under the umbrella of the International Society for Sports Psychiatry (ISSP), the first international consensus statement on sports psychiatry was recently published. Fields of sports psychiatry were identified. In the field of competitive and elite sports, the end of a sports career is a vulnerable phase. The end of a sports career can lead to an increased prevalence of psychiatric symptoms and disorders. This is illustrated using the case of a cross-country skier. The interactions between success, mental health, stress, training and overload are presented. In this context, a treatment with the Synergetic Navigation System (SNS) for digitized real-time monitoring is presented, considering the interaction of the various factors. Symptoms of overtraining were apparently helpful in treating somatoform autonomic dysfunction. The pre-treatment proved helpful when the athlete returned for treatment years later due to depression at the end of his career. To set a standard of service and a direction for future development in the field of sports psychiatry and psychotherapy, it is necessary to define typical and problematic issues to develop common approaches. The end of a career is an important issue in competitive and elite sports, and one in which athletes need support, recommended with integration into mental health care and prevention concepts. At the end of a sports career thorough and comprehensive preparation for post sport life is highly recommended. An "Exit Health Examination" including mental health exploration and "After Career Consultations" could be beneficial.

Neuroimaging presents us with an in-depth understanding about brain structure and function, yet the data complexity poses significant analytical challenges. Current frameworks suffer from issues such as scalability, poor integration with traditional statistics and a need for a programing background, which hinder researchers from focusing on neuroscience questions. To address these limitations, we present BrainInsights, an integrated and automated GUI-based pipeline ecosystem designed to facilitate the analysis of multi-modal or multi-parametric neuroimaging data in a flexible way. The framework comprises three core tools: MARIA (MAgnetic Resonance Imaging data Analysis and inspection tool) for data inspection and hypotheses testing, ML Pipeline for automated feature selection and model construction, and ML DaViz for model evaluation and bio-signature generation. Deployed as a singularity container, the system ensures reproducibility and scalability across computing environments. We validated BrainInsights using diverse datasets, including multi-parametric MRI studies of Anorexia Nervosa, Crohn's disease, and Rheumatoid Arthritis. Specifically, the framework distinguished young Anorexia Nervosa patients from controls with a balanced accuracy of 65%, while in the PreCePRA trial, it predicted Rheumatoid Arthritis treatment response with a balanced accuracy of up to 95.4% using functional pain markers. The results demonstrate the ability of the framework to achieve high separation of subgroups and treatment success and additionally bridge hypotheses-driven statistical analysis with data-driven machine learning analysis. By enabling interpretability tools like SHAP, BrainInsights empowers researchers to move beyond "black-box" modeling to uncover stable, biologically plausible bio-signatures. Ultimately, this framework aids in accelerating the translation of complex neuroimaging data into meaningful clinical insights.

Executive functions (EFs) are meta-cognitive abilities that orchestrate goal-directed behavior (i.e., set-shifting, working memory, and inhibitory control). Despite their strong genetic composition, the development of EFs is shaped by environmental exposures - as maternal distress, perinatal hypoxia, household dysfunction, neglection - which have varying degrees of impact depending on the duration or severity of the exposure, sensitive neurodevelopmental periods, and individual resiliency. Furthermore, they are negatively affected by aging and psychiatric, neurologic, and inflammatory diseases. MicroRNA dysregulation interferes with normal brain development and function and has been associated with various neuropsychiatric disorders; however, its effects on EFs remain unclear. Therefore, in this review we focus on the evidence regarding microRNA changes and their effects on EFs. We performed a systematic search from inception until October 2023 of four databases of human and animal studies. The results are presented narratively. Moreover, we conducted a bioinformatics analysis using experimental mRNA targets of the candidate microRNAs, as well as assessed the risk of bias of the included studies. We found 46 studies (23 in humans, 22 in animals, and one in both). The studies evaluated mild cognitive impairment, psychiatric disorders, and healthy aging. Gene mutations in MIR137 were associated with decreased EF performance, whereas MIR885 gene methylation was associated with increased executive functioning. Mutations in the genes of enzymes relevant for microRNA biosynthesis also impacted EFs. In the revised literature, the microRNAs that were consistently reported as dysregulated in two or more samples in relation to variations in EFs were miR-148a-3p for humans; miR-155, miR-30e, and miR-384-5p for rodents; and miR-132, miR-146a-5p, miR-148-3p, miR-181a-5p, miR-190b, miR-31, miR-501-3p, and miR-9-5p for both humans and rodents. The suggested regulatory pathways behind EFs included changes in neurogenesis, neurodevelopment, and synaptic plasticity/signaling. Changes in the various steps of microRNA biogenesis - such as mutations in the genes coding for microRNAs, reduced availability of relevant processing enzymes, or dysregulation of microRNA expression - are potentially associated with changes in EFs. Future research is required to better understand these associations in relation to developmental stage, diagnosis, disease severity, and the degree of the microRNA dysregulation.

Introduction: According to the Alzheimer Society of Canada, over 770,000 people in Canada are living with dementia. This number is expected to rise to nearly 1 million people by 2030. Although the provision of team-based interprofessional assessment in gerontological care is critical for the early detection and prevention of dementia, its planning and delivery can be a challenge. In Saskatchewan, previous assessments have identified significant gaps between actual and best practices in dealing with this medical condition. The emergence of Geriatric Services Resource Teams (GSRTs), which apply an innovative, team-based model to improve the diagnosis and care of older adults with complex health practices, can be proven beneficial in this regard. The purpose of this study is to compare the efficacy of the care provision process between a GSRT and a traditional medical care channel (i.e., primary health) with respect to dementia patients. Methods: A retrospective patient chart review was conducted by collecting data from a large Primary Care practice (n = 90) and the GSRT in Regina (n = 75). Collected data included information on patient demographics and treatment, and the diagnosis process itself. Results: While demographic characteristics between patient groups were similar, significant differences (p < 0.05) were found in the involvement of pharmacy and other healthcare professionals, prescriptions for memory loss, and in who made the diagnosis. Moreover, although the dementia diagnosis was usually made first in Primary Care, further clarification of the type of dementia, counseling of diagnosis, review of medication, and assessment of functions and social supports were better managed in the GSRT group. Discussion: The use of Geriatric Services Resource Teams is a relatively new concept in Saskatchewan. As these teams are established, initial results show that their role in complex care management has beneficial outcomes for dementia patients.

Objective: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication impairments, restricted interests, and repetitive behaviors. The etiology of ASD is complex, involving genetic and environmental factors. The HECT (Homologous to the E6-AP Carboxyl Terminus) family protein E6-associated protein (E6-AP), encoded by the UBE3A gene, is an ubiquitin ligase implicated in neurological disorders, including Angelman syndrome (AS) and potentially ASD. Dysregulation of E6-AP, influenced by environmental factors such as human papillomavirus (HPV) E6 protein, may contribute to neurodevelopmental abnormalities. Method : This review synthesizes current literature to explore the potential link between HPV E6 protein and E6-AP dysfunction in the context of ASD. We analyzed 32 peer-reviewed studies, including 12 original research articles, 10 reviews, and 10 meta-analyses, retrieved from PubMed and Google Scholar, focusing on E6-AP's roles in ubiquitin-mediated signaling pathways, its dysregulation in neurodevelopmental disorders, and the impact of HPV E6 on E6-AP function. Results: E6-AP is critical in regulating signaling pathways associated with tumorigenesis and neurodevelopment. Dysregulation of E6-AP, potentially induced by HPV E6, has been implicated in AS and, to a lesser extent, ASD. As visually demonstrated in Figure 1, these complex relationships between HPV, neurodevelopmental disorders, and E6 protein underscore the need for cross-disciplinary research. Current findings indicate that HPV E6 may disrupt E6-AP's ubiquitin ligase activity, potentially contributing to neurodevelopmental impairments observed in ASD. Conclusion: The potential link between HPV E6 and E6-AP dysfunction underscores a novel avenue for understanding environmental contributors to ASD. Given the complexity of ASD, further research is essential to elucidate E6-AP's role and to develop targeted therapeutic strategies. This review highlights the need for studies investigating HPV-related mechanisms in ASD to advance effective interventions and support systems.

Hyperonirism, or "epic dreaming," is an emerging clinical phenomenon characterized by excessive, vivid, and continuous dream activity associated with non-restorative sleep and daytime fatigue. Despite historical descriptions, it remains poorly defined and unrecognized by current nosological systems. We describe four patients assessed in expert sleep and psychiatry centers, presenting with persistent complaints of excessive dream activity not attributable to nightmares, REM sleep behavior disorder, or medication-induced parasomnias. Comprehensive clinical, psychiatric, and sleep evaluations, including polysomnography and actigraphy, were conducted. All patients described excessive, vivid, and intrusive dream activity occurring with high frequency and perceived as disproportionate to normal dreaming. This "dream overflow" was consistently linked to non-restorative sleep and persistent daytime fatigue, with additional complaints including reduced attention, cognitive inefficiency, and emotional distress. The phenomenological complaint was strikingly similar. Importantly, patients clearly differentiated this experience from nightmares, as dream content was not necessarily negative but continuous, vivid, unrelenting, and mentally exhausting. Psychiatric comorbidities such as depression, anxiety, or insomnia were frequent, yet insufficient to explain the hyperonirism. Objective sleep investigations were largely normal, underscoring the gap between subjective experience and conventional sleep measures. This case series supports the characterization of hyperonirism disorder as a distinct clinical entity at the crossroads of sleep medicine and psychiatry. We propose preliminary diagnostic criteria encompassing both nocturnal and diurnal dimensions. Recognition of hyperonirism disorder may improve clinical assessment of dream-related complaints and stimulate research into its neurobiological mechanisms and therapeutic management.

Conversational AI offers scalable mental health support, with large language models (LLMs) enabling personalized interactions. Human-centered design is critical in this domain, yet a comprehensive synthesis from this perspective is lacking. This review maps conversational AI research in mental health across the patient journey and develops a human-centered taxonomy to guide future design. Following PRISMA guidelines, we conducted a comprehensive search across fifteen multidisciplinary databases. We systematically analyzed the literature across six dimensions: research foci, mental disorder types, target populations, AI technologies, data sources, and evaluation metrics. A consensual taxonomy research method was employed to develop a human-centered design framework. Of 10,293 identified records, 677 studies met the inclusion criteria. Analysis reveals a marked increase in publications since 2020, predominantly from computer science (449 studies), followed by medicine (148) and social sciences (80). Research is skewed toward detection (23%) and intervention (66%) stages, with prevention (8%) and maintenance (3%) receiving less attention. Mood, anxiety, and stress-related disorders are the most investigated conditions. LLMs have emerged as the predominant AI technology, particularly within intervention and maintenance stages. Data sources continue to rely heavily on text-based inputs, with multimodal approaches still limited in adoption. Evaluation metrics vary significantly by discipline, reflecting limited cross-disciplinary integration. Through thematic synthesis, we developed a human-centered taxonomy comprising four primary dimensions: Emotional Sensitivity to Users, User-Centric Interaction Design, Human-AI Collaboration and Capability Enhancement, and Ethics and Accountability, with a total of thirteen sub-dimensions. This review provides a comprehensive, human-centered mapping of conversational AI research in mental health across the patient journey. Critical gaps remain in stage coverage, disorder diversity, population inclusivity, multimodal data integration, and interdisciplinary evaluation. The proposed taxonomy offers a structured framework to align AI development with human-centered principles, fostering empathetic, ethical, effective, and equitable mental health support.

Objective: Autism Spectrum Disorder (ASD) is a genetically heterogeneous neurodevelopmental condition involving multiple genes. This study aimed to comprehensively review the genetic landscape of ASD in the Iranian population, identifying gene variants associated with increased risk, to facilitate improved diagnosis and targeted interventions. Method : A systematic review and meta-analysis were conducted on genetic association studies of ASD in Iran up to August 2025. Comprehensive searches were performed in PubMed, Scopus, Web of Science, and Persian databases using relevant keywords. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools. Meta-analyses were carried out using Review Manager software, assessing heterogeneity and publication bias. Protein-protein interaction networks were constructed via STRING and analyzed with Cytoscape to identify key hub genes and enriched neurodevelopmental pathways. Results: In this study, genes RORA, MTRR, MTR, Reelin, VDR, VMAT1, ACE I/D, MOCOS, HOTAIR, ANRIL, RIT2, MMP-9, GRM7, FOXP3, and GRIN2B showed significant associations with the occurrence of autism. Findings reinforce associations between multiple gene polymorphisms, especially RORA rs4774388 and MOCOS rs594445, with the risk of ASD. Conclusion: This systematic review and meta-analysis emphasize the multifactorial genetic contributions to ASD in the Iranian population, highlighting key risk loci and neurodevelopmental pathways. The findings underscore the importance of integrating genetic, epigenetic, and environmental factors for understanding ASD etiology and developing population-tailored diagnostic and therapeutic strategies. Future studies employing larger cohorts and multi-omics approaches are warranted to further elucidate the complex genetic architecture of ASD in diverse ethnic groups.

Personal digital health technologies (DHTs) enable real-time monitoring of physiological metrics and behavioral data, including heart rate variability (HRV), supporting analysis of pregnancy-related conditions and personalized care throughout the perinatal period. While recent studies demonstrate the utility of personal DHTs in tracking pregnancy-related symptoms, they often rely on aggregate statistical methods that overlook individual variability. This study aims to compare aggregate and individual-level analyses of DHT data for pregnancy-related conditions, using the comprehensive BUMP (Better Understanding the Metamorphosis of Pregnancy) dataset to highlight the importance of individual variability and data heterogeneity. We analyzed wearable and self-reported data from 256 participants enrolled in the BUMP study (January 2021 to May 2022), including HRV, sleep, and fatigue measured via Oura Rings and smartphone surveys. Individual-level (N-of-1) trajectories were evaluated and compared with aggregate results to uncover personal and collective trends. A statistical method was developed to assess the influence of adverse events and severe symptoms, while case studies explored confounding and modifying factors underlying heterogeneity. Comprehensive statistical analysis included the coefficient of determination, Kolmogorov-Smirnov tests, likelihood ratio tests, and Welch t tests, with interindividual variability flagged based on high-variability thresholds. Substantial interindividual variability was observed across all features. Only 4.76% (12/256) of participants exhibited an HRV inflection at the aggregate week-33 inflection point, with a coefficient of variation of 14.24%. The median value of the gestational week in individual fatigue troughs was 23 (IQR 8; range 8-38) weeks, differing from aggregate estimates. Distributional comparisons showed no statistically significant differences in individual-level model fit (R&#xb2;) by pregnancy complications or age (P values ranging from .06 to .99 across all model fit comparisons). Case studies further highlighted both intraindividual and interindividual differences, emphasizing the importance of considering external factors, such as adverse events and severe symptoms. Our findings show that aggregate wearable data often fail to generalize across populations, oversimplifying pregnancy-related physiological and subjective changes. This simplification can obscure individual trajectories, leading to generalized insights that may not reflect many pregnant women's experiences. Our results highlight the impact of heterogeneity on pregnancy outcomes, emphasizing the need to move beyond one-size-fits-all models and leverage DHT for personalized care.

Patients' digital access to their personal health data is becoming increasingly common worldwide. However, medical documentation often contains technical language and sensitive information, which can lead to potential misunderstandings and distress among patients. These issues may be particularly impactful in mental health contexts. Large language models (LLMs) offer a promising approach by transforming clinician-generated health notes into language that is more patient-centered, nonmedicalized, and empathetic. However, risks related to accuracy and clinical safety have not been adequately investigated in psychiatry. This study aimed to qualitatively analyze the errors introduced by LLMs when transforming notes written by psychiatrists into patient-facing formats. It also highlights the implications for clinical communication and patient safety. Clinical notes (n=63) written by 19 psychiatrists in an outpatient treatment setting were collected, anonymized, and translated from German to English by humans. OpenAI GPT-3.5 Turbo was used to develop a preprompt that transformed these notes into a patient-centered, lay-readable form through an iterative process. Three psychiatrists qualitatively analyzed the LLM-revised documentation using Kuckartz content analysis. They compared the preconversion and postconversion notes to systematically identify and categorize LLM-induced errors. Five categories of clinically relevant errors were identified: (1) clinical misinterpretations, particularly in critical assessments such as suicidality, where nuanced terminology was oversimplified or inaccurately represented; (2) attribution errors, where behaviors or roles within family dynamics or interactions were incorrectly attributed to different individuals; (3) content distortion errors, which were characterized by speculative additions, emotional exaggerations, and inappropriate contextual assumptions; (4) abbreviation and terminology errors, which resulted from inaccurate expansions of medical abbreviations and terms; and (5) structural and syntax errors, which resulted in ambiguity, particularly when the original notes were brief or bulleted. Despite significant improvements in the readability and overall linguistic fluency of the converted notes, these errors occurred. LLMs have the potential to transform psychiatric notes into patient-friendly formats. However, critical errors remain prevalent and can impair clinical judgment, understanding of patient circumstances, clarity of medication regimens, and interpretation of clinical observations. To safely integrate artificial intelligence-generated documentation into psychiatric care, clinician oversight and targeted model refinement are essential. Future research should explore strategies to mitigate these errors, assess their comprehensive clinical impact, and incorporate patient and provider perspectives to ensure robust implementation.

Suicide is a leading cause of maternal mortality, yet there are currently no evidence-based perinatal suicide prevention programs. Given the risk of serious outcomes if undetected or inadequately treated, the goal of this study was to further understand the screening and treatment experiences of individuals with perinatal suicidal thoughts and behaviors (STBs). Qualitative data were generated from in-depth interviews with 13 individuals primarily from the United States who experienced perinatal suicidality at least 6 months prior to participation. Thematic analysis was used to examine the experiences of participants with respect to screening and treatment of perinatal STBs. Regarding screening, three major themes were identified: (1) gaps in comprehensive/routine screening for STBs (e.g., infrequent screenings or non-specific to suicide), (2) attitudes toward disclosure of STBs (resulting in omission of symptoms or downplaying of severity), and (3) importance of follow-up after screening. Three themes influenced participants' treatment experiences: (1) providers' engagement in care, (2) shared decision-making between provider and patient, and (3) impact of perinatal-specific treatment programs. Findings from this study highlight critical gaps in screening for and treatment of perinatal STBs. Implementing routine screening and comprehensive follow-up and improving treatment experiences are essential for improving the care of individuals with perinatal STBs and reducing maternal mortality.

Adolescents and young adults (AYA) aged 15-24 in Tajikistan have the lowest comprehensive knowledge of HIV compared to other AYA in Eastern Europe and Central Asia; however, little research has explored what sources of HIV information they utilize. We conducted a qualitative study with 36 AYA in Dushanbe, grouped by gender and age. Participants engaged in participatory activities and discussions over two sessions. We conducted thematic analysis and identified three main themes: (1) school-based HIV education was limited and technical, leaving practical knowledge gaps; (2) social networks often spread inaccurate, stigmatizing information; and (3) AYA preferred professional sources but had limited access, relying instead on potentially inaccurate sources like social media. Tajik AYA lack information sources which empower them with accurate information and build their capacity to engage in preventive behaviors. Educational efforts must move beyond knowledge enhancement to address social and structural barriers to information sharing regarding HIV.

To develop an evidence-based, consensus-driven service model for the identification, assessment and treatment of tic disorders in children and young people (CYP) in England, addressing the absence of dedicated pathways and national clinical guidance. Two-stage consensus study comprising a Delphi survey, expert/patient and public involvement (PPI) review and regional stakeholder workshops. UK healthcare and community settings relevant to tic disorder assessment and management (primary care, neurodevelopmental services, child and adolescent mental health services). Stage 1: UK-based clinicians, researchers and practitioners with expertise in tic disorders (Delphi panel; n=49; 98% retention across rounds). Stage 2: regional stakeholders including clinicians, commissioners, service managers, third-sector representatives and parents/carers (n=36). Eligibility required relevant professional or lived experience; no exclusions applied beyond this criterion. Identification of a consensus-based component of a best-practice service model for tic disorders and barriers and facilitators to implementation across regional pathways. The Delphi process generated consensus on 40 core components, refined to 43 following expert and PPI review. Agreed features included referral criteria, comprehensive assessment, psychoeducation, behavioural interventions, pharmacological options and integrated cross-service working. Stakeholder workshops highlighted key implementation challenges, including workforce training, funding constraints and coordination across neurodevelopmental and mental health services, informing practical adaptations to the model. This consensus-informed service model provides structured, UK-specific guidance to support earlier identification, appropriate intervention and improved care coordination for CYP with tic disorders. Future research should assess real-world implementation and impact. The model offers actionable recommendations for referral pathways, intervention provision and service configuration. Adoption may reduce diagnostic delays, minimise misdiagnosis and strengthen collaboration between primary, neurodevelopmental and mental health services, leading to improved outcomes for CYP with tic disorders.

IntroductionFinancial toxicity (FT) is more prevalent among rural-dwelling cancer survivors who also face greater cancer care-related travel burdens. We sought to examine how FT and travel burdens may pose dual burdens for cancer survivors, and assess their effects on care experiences and subsequent cost-coping strategies.MethodsRapid qualitative analysis of semi-structured interviews with rural-dwelling cancer survivors who screened positive for FT per the COmprehensive Score for financial Toxicity (COST) measure. Our analysis was structured around three inductive themes: rural-dwelling patients' experiences of cancer treatment while navigating FT, patient perceptions of travel burdens undertaken in the course of accessing cancer care, and perceived implications of both FT and travel burdens for care on HRQoL.ResultsThe (n = 12) participants in our study were mostly women, with a median age of 60.1. The median COST score was 9.5, indicating a high degree of FT, and the median round-trip travel distance was 25.6 miles. Participants reported cost-coping strategies to reduce travel-associated costs, such as "stacking" appointments to reduce travel costs and taking advantage of non-medical assistance offered by health systems' financial assistance programs (e.g., gas cards). Participants also reported shared burdens with caregivers who also shouldered costs.ConclusionsEstimates of travel distances to cancer care likely understate travel burdens, because they do not capture the frequency of appointments and their associated indirect and opportunity costs for cancer survivors experiencing FT. Financial assistance for cancer survivors should be responsive to the dual and cumulative financial and travel burdens of cancer care. Rural-dwelling cancer survivors are more likely to experience Financial Toxicity (FT) in tandem with greater cancer care-related travel burdens. This qualitative study sought to examine how FT and travel burdens may pose dual burdens for cancer survivors, and assess their effects on care experiences and subsequent cost-coping strategies. We conducted semi-structured interviews with (n = 12) participants sampled from the Lessening the Impact of Financial Toxicity (LIFT) study, an intervention that screened for FT and provided site-based financial navigation services and supports. Interview participants were mostly women, with a median age of 60.1. The median COmprehensive Score for financial Toxicity (COST) score was 9.5, indicating a high degree of FT, and the median round-trip travel distance was 25.6 miles. Participants reported cost-coping strategies to reduce travel-associated costs, such as &#x201c;stacking&#x201d; appointments to reduce travel costs and taking advantage of non-medical assistance offered health systems&#x2019; financial assistance programs (e.g., gas cards). Participants also reported shared burdens with caregivers who also shouldered costs. Concomitant caregivers- or cancer survivors who were also caregivers- were especially in need to supports to mitigate the dual burdens of cancer care-related FT and travel burdens.

Palliative care (PC) patients and families have diverse psychosocial needs. Support in this context is multidimensional. A tiered support framework could enable PC professionals to address these needs effectively. This study presents part of a research initiative to develop and evaluate a tiered model of psychosocial support in PC for adult patients. The current phase of the project focuses on enhancing the preliminary model in cancer care. The objective was to assess how PC patients and professionals would develop the applicability of the framework. A qualitative study using participatory research events with the World Caf&#xe9; method was conducted. Participants were recruited in collaboration with a cancer centre and professional and patient societies. The eligible participants were patients with metastatic cancer and professionals with experience in caring for them. The SWOT analysis facilitated data collection and, with the Consolidated Framework for Implementation Research, guided abductive analysis. Five research events, onsite and online, with 44 participants (10 patients and 34 professionals) were conducted. From the perspectives of patients and professionals, the strengths and opportunities of the framework's applicability lie in the quality and delivery of care, while the weaknesses and threats lie in its comprehensiveness, resources, care delivery, and skills. To improve applicability, the framework's description should be refined, and factors like care quality, systemic issues, environment, individuals, implementation, and collaboration need consideration. The evaluated model demonstrates potential to improve care quality, service implementation, and organisational development for delivering psychosocial support in cancer PC. Our results provide justification and valuable information for further development. Implementation will require leadership and understanding of complex systems from all involved. The framework may offer structure for professionals to provide adequate support to patients and their families. It is essential to ensure a well-managed implementation of the framework.

Background: Polysubstance use, particularly the combination of opioids and stimulants, represents a growing public health concern due to its high risk of severe multisystem complications and mortality. Here, we present a case illustrating the lethal synergy of opioid-stimulant co-use. Methods: A 37-year-old male with chronic Hepatitis C and documented polysubstance use reported recent use of fentanyl, cocaine, methamphetamine, and cannabis. He presented with generalized weakness, left lower limb pain, tense edema, and anuria. Clinical assessment included monitoring of vital signs, physical examination, capillary blood gas analysis, extended laboratory panels (muscle and cardiac enzymes, electrolytes, and coagulation parameters), urinalysis, and Doppler imaging. Management over five days included intravenous hydration, diuretics, urinary alkalinization, electrolyte correction, anticoagulation, metabolic and vitamin therapy, hemodialysis, and comprehensive supportive care. Results: Laboratory evaluation revealed massive rhabdomyolysis (peak CK 161,050 U/L), severe hyperkalemia (K+ 8.4 mmol/L), metabolic acidosis, acute kidney injury with oligoanuria, and left-sided deep vein thrombosis. Despite intensive multidisciplinary interventions, the patient's repeated refusal of ongoing treatment critically contributed to a fatal outcome. Conclusions: This case underscores the high mortality risk associated with opioid-stimulant co-use and the crucial impact of treatment refusal. Clinicians and public health stakeholders should recognize the rapid progression of multisystem dysfunction in polysubstance users and prioritize early, aggressive interventions combined with patient engagement strategies to mitigate fatal outcomes.