Histopathological analysis in type 1 diabetes presents challenges in achieving precise characterisation with cellular quantification from whole-slide images (WSIs). To ensure a comprehensive understanding of changes in endocrine cells, this study leveraged a pre-trained deep learning-assisted analysis workflow to enhance the understanding of histopathological features of type 1 diabetes development across pancreases from control, autoantibody-positive and type 1 diabetes organ donors. Three pancreatic sections (head, body and tail regions), stained for insulin (INS), glucagon (GCG) and CD3 by immunohistochemistry, were analysed from 32 autoantibody-negative control donors, 12 single-autoantibody-positive (sAAb+) donors, eight multi-autoantibody-positive (mAAb+) donors, six donors with recent-onset type 1 diabetes (0-1 years disease duration) and 19 donors with longstanding type 1 diabetes. Endocrine cell groups (i.e. clusters [<1000μm2] and islets [≥1000μm2]) were segmented by a pre-trained Segment Anything Model, followed by precise segmentation for INS+ and GCG+ cell regions within these structures using a QuPath pixel classifier. CD3+ cells located within a 20 µm periphery of each endocrine cell group were quantified. Ordinal regression was applied to assess disease stage-associated patterns in quantified predictors. The Kruskal-Wallis test was used to compare across the five donor groups. For pairwise comparisons, Wilcoxon rank-sum tests with Bonferroni correction were conducted. From a total of 231 WSIs from 77 donors, >82,000 islets and >26,000 clusters were analysed. In ordinal regression, fractional INS and GCG areas were the most significant predictors of type 1 diabetes progression. CD3+ immune cell infiltration in islets demonstrated a high association with type 1 diabetes progression. Infiltration in both islets and clusters peaked at disease onset before declining, suggesting that these structures are synchronised targets within the autoimmune process. Insulitic clusters were evident even prior to the onset of type 1 diabetes, underscoring the early involvement of these structures in the autoimmune process. The deep learning-powered approach enabled our study to include clusters of endocrine cells scattered throughout WSIs, providing precise quantitative evidence of cluster-level infiltration. The identification of autoimmune patterns in both islets and clusters, alongside the quantification of beta and alpha cells across donor groups and pancreatic regions, offers a more detailed understanding of type 1 diabetes pathogenesis. Our findings provide robust evidence of cluster-level infiltration even before type 1 diabetes onset, supporting early intervention efforts to preserve beta cells.
Franco Basaglia was a central figure in the Italian psychiatric reform of the 20th century, whose work radically challenged the institutional and biomedical foundations of psychiatry. His thought, rooted in phenomenology and existentialism, redefined the meaning of mental illness and the role of the psychiatrist within society. This paper aims to explore the revolutionary contributions of Basaglia to psychiatry and mental health care, emphasizing the socio-political, ethical, and philosophical dimensions of his approach. Through a historical and theoretical analysis, the article examines Basaglia's critique of psychiatric institutions, his redefinition of the concept of the person in care, and the political implications of his reformist project leading to Law 180 (1978). The discussion integrates philosophical sources and socio-political contexts to elucidate his notion of psychiatry as a "practice of freedom." Basaglia's thought transcended the clinical field, presenting psychiatry as an instrument of social change. By challenging exclusion and advocating for patients' rights and dignity, he aligned psychiatric reform with broader struggles for democracy and social justice. The paper highlights both the transformative potential and the later institutional neutralization of his legacy. Basaglia's vision remains profoundly relevant to contemporary debates on mental health, citizenship, and care ethics. Revisiting his work invites a rethinking of mental health care as a practice grounded in inclusion, human rights, and the recognition of subjectivity.
BACKGROUND: Mothers’ health-related quality of life (HRQoL) is frequently compromised when their neonates are admitted to neonatal intensive care units (NICUs), leading to psychological distress, sleep disturbances, and impaired maternal–infant bonding. These adverse experiences may be further intensified by neonatal clinical complications and maternal psychosocial vulnerabilities. Despite this, empirical evidence on HRQoL and its associated psychosocial and clinical determinants among Ethiopian mothers remains very limited. Therefore, this study aimed to assess mothers’ HRQoL and to identify the associated psychosocial and clinical factors among mothers of neonates admitted to NICUs in referral hospitals of the Amhara Regional State, Northwest Ethiopia. METHODS: A facility-based cross-sectional study was conducted from December 12, 2023, to March 15, 2024 among 636 mothers selected via systematic random sampling in the NICUs of selected referral hospitals. Health-related quality of life (HRQoL) was measured using the validated WHOQOL-BREF instrument, comprising 23 items in four domains. The mean score of each domain and the total HRQoL score (range 0–92) were calculated, with higher scores indicating better quality of life. Data were collected via structured interviews and hospital chart review. Simple and multiple linear regression analyses were conducted to identify psychosocial and clinical factors associated with HRQoL. RESULTS: A total of 651 eligible mothers were approached, of whom 636 participated, yielding a response rate of 97.7%. The overall mean (± SD) score of mothers’ health-related quality of life was 41.87 ± 3.47. The mean scores (± SD) for the physical, psychological, social, and environmental domains were 12.65 ± 2.09, 13.86 ± 1.99, 2.60 ± 1.04, and 13.72 ± 2.02, respectively. Factors significantly associated with mothers’ HRQoL included being married (β = 4.19; 95% CI: 3.02, 5.37), history of antenatal care follow-up at hospitals (β = -1.17; 95% CI: -1.99, -0.36), gestational age ≤ 34 weeks (β = -1.97; 95% CI: -3.21, -0.72), low birth weight (β = -1.15; 95% CI: -3.26, -1.06), receiving information about the neonate’s health status (β = 1.12; 95% CI: 1.03, 2.01), length of NICU stay (β = -0.24; 95% CI: -0.28, -0.04), and poor social support (β = -0.89; 95% CI: -1.40, -0.38). CONCLUSIONS: The findings of this study demonstrate that mothers whose neonates were admitted to the NICU experience reduced health-related quality of life. Therefore, to improve maternal quality of life, a range of effective interventions is needed, including strengthening social support and providing timely information about the health status of their neonates.
The potential to understand and treat psychiatric conditions will continue to develop but whether this will improve the lived experience of the majority of patients will depend on the political context. This is illustrated by personal reflections from the author looking back over a long career. Improvements have been vulnerable to changing economic and social models, and to the gaps between resources invested and levels of need. It is important that psychiatrists are aware of the socio-political environment, how it affects mental health needs, how it determines and limits the service that can be provided, and how it influences thinking and attitudes. Learning from the history of psychiatry can be helpful. Despite scientific advances, it is the author's view that psychiatry in the UK has faltered over the last two decades. She suggests that inadequate resources, the undermining effects of disparity of esteem between physical and mental health needs, and the toxic effects of moral injury in the workforce, have formed a vicious circle. Looking to the future, psychiatrists need to improve their understanding of these complicated dynamics, develop a clearer sense of their role, and a clearer vision of what good mental health services should look like.
Background/Objectives: Schizophrenia is one of the most extensively studied yet conceptually unstable disorders in the history of medicine and brain sciences. Since its formalization at the turn of the twentieth century, the disorder has been repeatedly redefined, reflecting changes in clinical observation, diagnostic philosophy, and neuroscientific models of brain function. The objective of this review is to critically examine the historical evolution of schizophrenia as a medical construct and to analyze how shifts in diagnostic systems have shaped the search for biological and molecular biomarkers. Methods: A narrative-historical review of the literature was conducted, integrating classical psychiatric texts, diagnostic manuals, and contemporary neuroscientific studies. Key milestones in the conceptualization of schizophrenia were analyzed alongside the development of biological hypotheses, including neurochemical, electrophysiological, neuroimaging, genetic, immunological, omics-based, and digital approaches. Emphasis was placed on identifying conceptual continuities, ruptures, and methodological limitations across historical periods. Results: The analysis reveals that the evolution of schizophrenia has been characterized by increasing diagnostic standardization accompanied by growing biological heterogeneity. While successive biological models have provided valuable insights into specific aspects of the disorder, none have yielded single, robust diagnostic biomarkers. Instead, findings consistently reflect partial overlaps between clinical phenotypes and biological signals, strongly influenced by historically derived diagnostic categories. Conclusions: The persistent absence of definitive diagnostic biomarkers for schizophrenia reflects not only technical limitations but also the historical construction of the disorder as a heterogeneous clinical category. Understanding this historical context is essential for interpreting current findings in brain sciences. Future research is likely to benefit from stratification-based, dimensional, and integrative frameworks that move beyond categorical diagnosis while preserving clinical relevance.
This article revisits a little-known lecture by René-Théophile-Hyacinthe Laennec (1781-1826), best known as the inventor of the stethoscope, focusing instead on his reflections on mental illness-what he termed vesanias. Delivered at the Collège de France in 1823, the lecture predates modern psychiatry and offers a rare, nuanced view of mental disorders at the crossroads of clinical medicine, philosophy, and Enlightenment moral thought. Laennec distinguishes between five types of mental illness-hallucinations, monomania, mania, dementia, and idiocy-while rejecting the reductionist views of his contemporaries who sought anatomical lesions as the sole cause. His classification emphasizes gradation, subjective experience, and the blending of pathology with normal human faculties such as imagination, emotion, and belief. He critiques the dominant anatomical paradigm, notably the views of Broussais, and advocates for a moral and observational approach to mental care. His views prefigure modern biopsychosocial models and anticipate concepts such as shared psychosis and dimensional spectra in psychiatry. By refusing to isolate madness from social, cultural, or historical contexts, Laennec offers a deeply human and still-relevant vision of mental illness-one that challenges us to rethink psychiatry beyond biological determinism and diagnostic rigidity.
Following the near-total destruction of mental health services during the Khmer Rouge regime (1975-1979), psychiatry in Cambodia underwent a gradual and resource-constrained revival from the early 1990s onward. This article traces the history of psychiatry in Cambodia from its early institutional foundations in the colonial period, through its collapse during the Khmer Rouge genocide, to its re-establishment and progressive institutionalization in the post-conflict era. Drawing on historical archives, policy documents, and published literature, the paper describes three main phases of development: initial reconstruction and training (1992-2000), expansion of services and education (2001-2015), and recent efforts toward institutionalization and specialization (2015-present). Particular attention is given to the interaction between western psychiatric models and Cambodian cultural frameworks of distress rooted in Buddhism, animism, and community-based healing practices. The article highlights the central role of international collaboration, nongovernmental organizations, and emerging local leadership in shaping psychiatric services, while also documenting persistent challenges including workforce shortages, uneven geographic distribution of care, limited inpatient capacity, and enduring stigma. By situating psychiatry within Cambodia's broader sociocultural and historical context, this review contributes to a transcultural understanding of mental health system reconstruction in post-conflict settings. It also underscores the importance of culturally responsive, community-oriented approaches for sustainable development.
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.
This paper examines the instrumentalisation of psychiatric procedures and the complicity of physicians and mental health professionals in the state-sponsored terror of Argentina's civil-military dictatorship (1976-1983). Hitherto, these episodes have remained largely underexplored in broader historiography, as have their implications for modern psychiatric ethics. Drawing on archival records, victim testimonies, and secondary sources, this paper outlines how mental health expertise and psychiatric institutions were implicated in the junta's campaigns to subjugate perceived "subversive" tendencies in Argentinian society. To that end, two case descriptions are used to illustrate distinctive modalities of abuse: (1) the "depersonalisation" and "brainwashing" of political detainees in Rawson Prison in Argentinian Patagonia, where psychiatrists and psychologists participated in experimental repression programmes; and (2) the transfer of torture-induced psychiatric patients to military-controlled hospitals, where coercive pharmacological interventions, electroconvulsive therapy, and further physical violence were inflicted. The analysis highlights psychiatry's function as a mechanism for direct torture and a legitimising veneer for political persecution. In doing so, it integrates previously fragmented materials into a unified analytical framework and situates psychiatric abuses within wider transnational patterns of repression characteristic of other Latin American dictatorships. Moreover, in the context of contemporaneous denialist narratives in Argentina and ongoing international instances of psychiatric abuse worldwide, the paper underlines the persistent vulnerability of ethical safeguards, reemphasising calls for proactive measures to protect against future human rights violations.
In this article, the complicated history of understanding and defining autism is presented. Descriptions of important contributors and studies that are not widely known or remembered are also included and incorporated into the historical timeline. The first descriptions of probable cases of autism date back to the 18th century, but at that time, the individuals were diagnosed with mental retardation or "silent madness." When the term autism was coined by Eugen Bleuler, it was related to the "inner world" to describe severe cases of schizophrenia. The first explicit description of autism, as we understand it today, was published in 1944 by Leo Kanner, who showed both similarities and differences between autism and childhood schizophrenia. Understanding the core problems related to autism took several decades. Groundbreaking studies conducted by Rutter et al. and Kolvin et al. determined that autism was separate from schizophrenia disorder 36 years after its official introduction (Diagnostic and Statistical Manual of Mental Disorders, Third Edition, in 1980). In 1988, Rutter and Schopler stated that autism had the most validated diagnosis in child psychiatry. However, each subsequent classification introduced major changes and was significantly different from the previous ones. The aim was to optimize the diagnosis and provide optimal care for affected individuals. Our knowledge of autism is broad, and there are still allegations concerning the quality of the currently applicable classifications. Given how many years it has taken and the various approaches that have been used to understand autism, it may indeed be one of the most mysterious disorders in humans. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The concept of "palliative psychiatry", which proposes a shift from curative goals to prioritizing quality of life for people with severe and persistent mental illness when remission seems unattainable, has been proposed to improve care for people with severe and persistent mental illness, yet service users' perspectives, particularly in the context of depression, are underexplored. The objective of this study is to explore how individuals with chronic depression understand and evaluate a concept of "palliative psychiatry". We conducted semi-structured interviews with 19 adults with chronic depression (age range 21-79 years; 63% women), many of whom had undergone intensive treatments such as electroconvulsive therapy or ketamine, recruited from three specialized wards in Berlin, Germany. Data were analyzed with thematic analysis, which is a systematic method for identifying, analyzing, and reporting patterns (themes) within qualitative data. Thematic analysis revealed two main thematic patterns with several subcategories. The two main thematic patterns were "benefits and risks" as well as "needs and wishes". Anticipated benefits included relief from perceived pressure to achieve remission and the avoidance of the psychological distress associated with repeated treatment failures. Risks included stigma linked to the term "palliative," fear of premature transition away from potentially curative care, and loss of hope. Concrete service users' needs and wishes included ongoing support without abandonment, care settings with a less institutional atmosphere, and transparent communication. Service users with chronic depression see benefits but also risks in a palliative orientation when curative goals appear unattainable, provided it does not imply therapeutic withdrawal. Potential future conceptual refinement of "palliative psychiatry" will require safeguards against premature categorization and careful terminology. Not applicable.
Cognitive reserve (CR) is a protective factor in first-episode psychosis (FEP), influencing cognitive, clinical, and functional outcomes. CR is shaped by a combination of genetic, clinical, and environmental factors, yet the extent of their respective contributions remains unclear. This study investigates the influence of polygenic risk scores (PRS), clinical and environmental variables on CR in FEP. A cohort of 174 individuals with non-affective FEP, aged 25.5 (SD=5.3), was analyzed. CR was assessed using a socio-behavioral proxy. PRS for educational attainment (PRSEA), intelligence (PRSIQ), cognitive performance (PRSCP), occupational attainment (PRSOA), physical activity (PRSPA), and schizophrenia (PRSSZ) were calculated. Age at onset, socioeconomic status, birth weight, and family history of psychosis were considered. Multiple regression models were employed to evaluate the impact of the different predictors on CR. PRSEA (p=0.002), age at onset (p=5.32x10-5), and family history of psychosis (p=0.001) emerged as the strongest contributors to CR. Higher PRSEA was associated with higher levels of CR, while earlier age at onset and positive family history were associated with lower CR. The model incorporating environmental, clinical, and genetic variables explained 17.7% of the variance in CR, and the one without PRS explained 13.5%. The inclusion of PRSEA in the model improved the explanatory power (Δadj.R2=0.042) and predictive accuracy (ΔRMSE=-0.288). These findings highlight the role of precision psychiatry in better understanding CR. Early identification of individuals with earlier onset, family history of psychosis, and lower genetic predisposition to educational attainment may help characterize those with lower CR.
Despite growing evidence related diet quality to depression, the extent to which the dietary risk factors proposed by the Global Burden of Diseases (GBD) are associated with depression at international level remains unknow. To address this gap, a harmonised protocol has been developed by the Global Burden of Disease Lifestyle And mental Disorder (GLAD) project and we aimed to contribute to the GLAD project by assessing associations between the 15 Global Burden of Diseases (GBD) dietary risk factors, and ultra processed foods (UPF) intakes-and recurrence of depressive symptoms (DepS) over 13 years of follow-up in the British Whitehall II study. Analyses carried out on 4099 participants with no prior history of DepS (73.6% men, mean age = 61.2; SD = 5.9 years) and available assessment of dietary exposures derived from Food-Frequency questionnaire in 2002/04. Recurrent DepS was defined as having DepS in at least two of the four repeated measurements between 2002-2004 and 2015-2016, with DepS assessed using the Center for Epidemiologic Studies Depression Scale (score ≥ 16) or use of antidepressants. After adjusting for sex, age and socio-economic status, results of logistic regression showed that each increase of 1 standard deviation of fruit consumption (228 g) and fibre intake (7.4 g) was associated with 17% and 15% lower odds of recurrent DepS respectively (ORfruit = 0.83, 95% CI 0.73; 0.95, ORfiber = 0.85, 95% CI 0.75; 0.96). These associations persisted after additionally adjusting for socio-demographics, health behaviours and health related factors, including prevalent cognitive impairment. Of the 16-GBD dietary factors, only fruit and fiber showed consistent associations with lower odds of recurrent depressive symptoms in the Whitehall II study.
Medical decision-making involves choosing from diverse - even oppositional - viewpoints to guide patient care. Critical psychiatry aims to improve psychiatric practice by providing alternative viewpoints on several topics: interrogating psychiatric concepts (for example, 'mental disorder'); flattening power differentials between professionals and patients; highlighting misuse of psychiatric authority; increased focus on social factors; scepticism about biological emphasis in psychiatry; using natural science methodologies and the 'medical model' in mental health; and critiquing the psychiatric evidence base, such as the effectiveness of medication and concern over pharmaceutical company influence. Critical psychiatry has helped identify and raise awareness about treatment-related adverse effects. Among concerns regarding current critical psychiatry are a reluctance to reconsider its positions when many of them are contradicted by the evidence, and promotion of views that can be used to justify reductions in services and welfare benefits for patients. Changes in leadership within critical psychiatry may help address these issues.
Internalizing disorders have been linked to alterations in default mode network (DMN) resting-state functional connectivity (RSFC). Given the increased risk of internalizing disorders in offspring of parents with a history of internalizing disorders, this study examined associations between parental depression and anxiety severity and adolescent DMN RSFC. Participants were 116 parent-adolescent dyads with youth between ages of 11-17 years. Structured diagnostic interviews and self-report questionnaires were completed by parents and adolescents to assess history and severity of internalizing disorders. Adolescents completed resting-state functional magnetic resonance imaging to determine the RSFC between regions of the DMN including the medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), and bilateral lateral parietal cortices (LPC). Analyses examined region-of-interest (ROI) to ROI RSFC, with bivariate correlations and linear regressions used to assess whether child age, sex, child internalizing symptoms, and parental internalizing symptoms were associated with child RSFC alterations. After controlling for child age, sex, internalizing symptoms, and in-scanner motion, increased parental depressive severity was associated with increased child RSFC between the PCC and right LPC. Child internalizing symptoms were also linked to decreased RSFC between the right LPC and the mPFC. This study is limited by its modest sample size relative to effect sizes for functional connectivity-phenotype associations, cross-sectional design, and a relatively homogeneous sample in terms of ethnicity, socioeconomic status, and parental sex. Results suggest that, among youth with a parental history of depression or anxiety, increased severity of parental depression is associated with altered offspring DMN RSFC.
The hospital at the Berlin-Hohenschönhausen remand prison of the Ministry for State Security (Stasi) occupied a special position among the prison hospitals in East Germany. Established in 1960, the hospital served not only medical but also operational-political functions within the investigative system. Drawing on a qualitative analysis of 800 prisoner medical files (20 per year), this paper contributes to ongoing debates on the politicization and potential abuse of psychiatry in the German Democratic Republic (GDR). The findings demonstrate that medical practice in the prison hospital was closely aligned with the interests of state security. Diagnoses such as "prison psychosis" were applied without clear clinical criteria and often had no therapeutic consequences for patients. Instead, treatment remained largely symptomatic and aimed at restoring prisoners' fitness for interrogation and trial. Psychotropic medications, particularly antipsychotics, were frequently used, in some cases in ways that suggest behavioral control rather than appropriate therapy. Evidence from selected cases indicates that pharmacological interventions may have contributed to the impairment of prisoners' cognitive and physical capacities, raising concerns about their use as a form of pharmacological torture. Das Haftkrankenhaus der Untersuchungshaftanstalt Berlin-Hohenschönhausen des Ministeriums für Staatssicherheit (Stasi) nahm unter den Haftkrankenhäusern in Ostdeutschland eine Sonderstellung ein. Das 1960 gegründete Haftkrankenhaus erfüllte innerhalb des Ermittlungsapparats nicht nur medizinische, sondern auch operativ-politische Funktionen. Auf der Grundlage einer qualitativen Analyse von 800 medizinischen Akten von Häftlingen (20 pro Jahr) leistet dieser Aufsatz einen Beitrag zu den laufenden Debatten über die Politisierung und den potenziellen Missbrauch der Psychiatrie in der Deutschen Demokratischen Republik (DDR). Die Ergebnisse zeigen, dass die medizinische Praxis im Haftkrankenhaus eng auf die Interessen der Staatssicherheit abgestimmt war. Diagnosen wie „Haftpsychose“ wurden ohne klare klinische Kriterien gestellt und hatten oft keine therapeutischen Konsequenzen für die Patienten. Stattdessen blieb die Behandlung weitgehend symptomatisch und zielte darauf ab, die Verhör- und Prozessfähigkeit der Häftlinge wiederherzustellen. Psychopharmaka, insbesondere Antipsychotika, wurden häufig eingesetzt, in einigen Fällen in einer Weise, die eher auf Verhaltenskontrolle als auf eine angemessene Therapie hindeutet. Belege aus ausgewählten Fällen deuten darauf hin, dass pharmakologische Interventionen möglicherweise zur Beeinträchtigung der kognitiven und körperlichen Fähigkeiten der Häftlinge beigetragen haben, was Bedenken hinsichtlich ihrer Verwendung als eine Form pharmakologischer Folter aufkommen lässt.
The present study examined whether self-stigma mediated the associations from inattention/impulsivity symptoms and suicide risk to psychological distress and quality of life (QoL) among individuals with schizophrenia. A longitudinal study was conducted comprising 241 individuals with schizophrenia who were recruited from daycare and outpatient units in Southern Taiwan. Eligible participants were adults (≥ 20 years) diagnosed with schizophrenia and enrolled in a daycare program or receiving regular outpatient follow-up. After providing informed consent, participants were interviewed to assess self-stigma, inattention and impulsivity symptoms, suicide risk, psychological distress, and QoL. Individuals with a history of moderate to severe substance use disorder (except tobacco use disorder) or head injury were excluded. Self-stigma mediated the relationships between inattention and impulsivity symptoms and both psychological distress and QoL among Taiwanese individuals with schizophrenia. More specifically, the indirect effect of inattention and impulsivity symptoms at Time 1 (T1) on each QoL domain (physical, psychological, social, and environment QoL at T3 through self-stigma at T2 was significant (β = - 0.05 to - 0.03, p < 0.05). The indirect effect on psychological distress at T3 was also significant (β = 0.06, 95% CI [0.01, 0.12], p = 0.019). In addition, self-stigma at T1 significantly predicted each QoL domain (β = - 0.19 to - 0.13, p < 0.001) and psychological distress at T3 (β = 0.24, 95% CI [1.94, 4.10], p < 0.001) through self-stigma at T2. The present study demonstrated the robust influence of self-stigma in increasing psychological distress and poor QoL in each specific domain, suggesting clinical approaches are needed for managing self-stigma, inattention and impulsivity symptoms, and suicide risk among individuals with schizophrenia. People with schizophrenia are likely to have inattention and impulsive behavior problems, which might cause difficulties in daily living because inattention and impulsive behavior problems may increase their self-stigma levels. However, no empirical evidence, especially longitudinal evidence, has been documented regarding the mediating roles of self-stigma in psychological distress and quality of life (QoL). Moreover, it is unclear if QoL is better to be examined using a global score or specific QoL domain score. Therefore, this study addressed the literature gap by testing the mediating role of self-stigma in the association of inattention/impulsivity with psychological distress and QoL (with global and specific domain scores comparison) over time.Employing a longitudinal design across three timepoints (3 months apart between each timepoint), people with schizophrenia completed questionnaires assessing their inattention/impulsivity, self-stigma, psychological distress, suicidality, and specific domains of QoL (including physical, psychological, social, and environmental QoL). Using robust analytical methods (i.e., structural equation modeling), higher levels of inattention and impulsivity led to stronger self-stigma, which in turn contributed to greater psychological distress and poorer QoL (in both global score and specific domains of QoL) later. Moreover, treating QoL using specific domains performed a better fit than treating QoL as a whole in the structural equation modeling, indicating that QoL needs to be considered for individual domain scores instead of summing them up. These findings suggest that reducing self-stigma may be a helpful way to improve psychological distress and specific domains of QoL for people living with schizophrenia.
Acne scars affect up to 95% of acne vulgaris (AV) patients. However, there is little clinical data to predict which patients are more prone to create scars. In this study, we aimed to evaluate the impulsivity, psychological distress, and quality of life in acne patients and factors related to acne scars. This study included 403 AV patients aged 18 years and older. The Global Evaluation Acne (GEA) Scale and the Global Scale for Acne Scar Severity (SCAR-S) were used to assess acne and scar severity. The patients completed a form that included epidemiologic data, such as smoking habits, alcohol consumption, acne characteristics, the Acne Quality of Life Instrument (AQLI), the Barratt Impulsivity Scale-11 Short Form (BIS-11-SF), and the Depression Anxiety Stress Scale-21 (DASS-21). Of the 403 acne patients, 56% (n = 226) had scars. The male sex, mean disease duration, and severity of acne were higher, and the age of acne onset was lower in the group with acne scars (p < 0.001, p = 0.030, p < 0.001, p < 0.001). Oily skin type was more frequent in patients with acne scars (p < 0.001), and Fitzpatrick skin types 3 and 4 were more frequent in patients with acne scars (p < 0.001, p < 0.001). Pruritus and postinflammatory hyperpigmentation were more frequent in the group with acne scars (p < 0.001, p < 0.001). The time from the first acne lesion to the beginning of treatment was longer in the group with acne scars (p < 0.001). The history of systemic drug, topical drug, and dermo-cosmetic product use for acne treatment was lower in the group with acne scars (p = 0.010, p < 0.001, p < 0.001, p < 0.001). The mean AQLI, BIS-11-SF, total DASS-21, depression subscale, and stress subscale scores were higher in the group with acne scars (p < 0.001, p < 0.001, p = 0.002, p = 0.007, p = 0.002). There was a negative correlation between scar severity score and the age of acne onset and a positive correlation between scar severity score and disease duration (p < 0.001, r = 0.16, p < 0.001, r = -0.3, respectively). There was a positive correlation between scar severity score and the mean AQLI, BIS-11-SF, total DASS-21, depression subscale, and stress subscale (p < 0.001, r = 0.2, p < 0.001, r = 0.16, p < 0.001, r = 0.16; p < 0.001, r = 0.17, p = 0.003, r = 0.15, respectively). Male sex, early onset of acne, prolonged acne duration, severe acne, delayed treatment, oily skin type, darker skin type, presence of pruritus, and higher impulsivity were associated with acne scars. The presence of scars had adverse effects on quality of life and psychoemotional status, such as depression and stress.
Studies suggest that forced hospitalizations adversely affect patient satisfaction and overall quality of life. This study aimed to evaluate the trends in involuntary admission rates in a psychiatric hospital and to examine the relationships between admission status and selected socio-demographic and clinical variables, as well as length of hospital stay. The study comprised all individuals involuntarily hospitalized at the Lower Silesian Centre of Mental Health in Wroclaw, Poland, between 2016 and 2022. The following data sources were used: a) Mental Health Protection Act (UoOZP) monitoring questionnaires from 2016 to 2022; b) statistical data on admissions and patient turnover; c) essential patient information available in the hospital's system. From 2016 to 2022, there was a significant increase in the proportion of individuals admitted involuntarily to the psychiatric hospital, rising from 15.64% to 22.21%. Factors linked to a higher probability of involuntary admission included: male gender, primary or secondary education, single status, an initial diagnosis of schizophrenia or other psychotic disorders, alcohol use disorders, or admission for observation. In contrast, factors associated with longer hospital stay included female gender, secondary or higher education, single status, admission under articles 23.1, (emergency admission), 28 (emergency admission following withdrawal of consent for treatment) and 29.1 (admission by request) of the UoOZP, non-scheduled admissions, a history of previous psychiatric hospitalizations, and a diagnosis of schizophrenia. Determining the predictors of involuntary admissions is essential for understanding the effects of compulsory treatment. Compulsory treatment has the potential to bring both advantages and disadvantages, which should be considered in decision-making regarding its application.
This article uses British drama film No Place for Jennifer (1950) to argue for the evidential value of staged content of real psychotherapeutic places (Institute of Child Psychology) and practices (Margaret Lowenfeld's World Technique). In the absence of 'real' documentary footage, discoveries of recreated therapeutic spaces within largely forgotten genre films can help reconstruct histories of the 'psy' sciences whilst offering insight into the contestations specific sites and practices provoked. Employing Baron's reformulation from 'documentary' to 'archival document', it demonstrates that content extracted from previously disregarded films can fill archival lacunas whilst expanding both 'what can be said' about the past and how it can be said.