Clozapine is the gold standard for treatment-resistant schizophrenia. In the setting of malignancy with concurrent anti-cancer agent use, clozapine use may be of increased concern. Clozapine cessation holds its own risks. This study aims to systematically review all cases of concurrent pharmacotherapy with clozapine and anti-cancer agents and analyze the psychiatric and physical health outcomes. PubMed, EMBASE, CINAHL, and PsycINFO databases were searched from inception to February 2025. Descriptive statistics and narrative analysis of the included cases occurred. There were 53 cases of clozapine use with anti-cancer agents, with a male to female ratio of 1.7:1 and a mean age of 45.0 years. In 30 cases, clozapine was continued without interruption, and in additional 16 cases, clozapine was recommenced after a period of interruption. In cases with clozapine interruption or discontinuation, 90% noted significant deterioration in mental state despite alternative antipsychotic treatments. There were 34 cases of neutropenia, mostly (94%) in the setting of cytotoxic chemotherapy, with low rates of neutropenic complications. The successful continuation of clozapine with anti-cancer agents can occur, although risk-benefit analysis taking into account individual, clozapine, psychiatric, and physical health factors is required. Consideration of prophylactic neutropenia protective measures should form part of the discussion with the individual and their family.

This chapter discusses the Dutch Law on Compulsory Mental Healthcare (Wvggz), which aims to strengthen the autonomy of patients with severe mental disorders by recognizing that coercive measures can be used not only to prevent harm, but also to restore autonomy. This approach challenges the traditional notion that coercive measures inherently undermine autonomy. The chapter also explores the unintended consequences of the law, such as increased bureaucracy. We argue that while the Wvggz introduces valuable ideas, its practical implementation has highlighted the challenges of translating legislative goals into effective practices.

Anosognosia, a term that denotes a lack of insight into one’s own condition, is a defining characteristic of many psychotic illnesses. As a result, generations of psychiatrists have pursued a paternalistic approach to care. Yet in the past century, the overall trend in patient care has been toward autonomy. What does it mean to respect the autonomy of patients whose lack of insight may bring them harm? This chapter will explore these questions through each of the four principles generally employed in bioethical analysis: beneficence, nonmaleficence, justice, and autonomy. Each will have an illustrative case study and explore how anosognosia can further complicate already perplexing ethical scenarios.

Parkinson’s disease, the second most prevalent neurological disorder, is a multisystem neurodegenerative disease characterized by both motor and non-motor symptoms. Transcranial direct current stimulation (tDCS) is a non-invasive brain neuromodulation technique that has been shown to be effective in some neurological conditions and for some clinical outcomes. To evaluate the efficacy of tDCS combined with gait training in Parkinson’s disease, compared to placebo, absence of treatment, conventional therapy, or other therapies. A systematic review and meta-analysis were performed in accordance with the PRISMA guidelines and registered in PROSPERO CRD42024542552. The literature search was conducted in PubMed, CINAHL, SPORT Discus, Web of Science, Scopus, MEDLINE, and Academic Search Ultimate (EBSCO) databases up to May 2024, limited to trials from the last 10 years. A total of 600 articles were identified; 9 were included in the systematic review and 8 in the meta-analysis. Significant intra-group changes were observed, but in the meta-analysis, no significant differences were seen between tDCS + gait training and tDCS placebo + gait training, although variables such as motor function slightly favored the combination (MD = −0.49; 95% CI [−1.55; 0.57], I2 = 0%). The combination of tDCS and gait training could provide significant motor benefits in terms of gait speed, functional mobility, cadence, motor function, quality of life, 6MWT, coordination and dynamic balance, flexibility, and stretch resistance in patients with Parkinson’s disease, but not in a more effective way than the same training without stimulation.

Schizophrenia is a severe and disabling psychiatric illness that profoundly affects a person’s ability to think clearly, perceive reality, manage emotions, and engage in daily activities. While antipsychotic medications have long been the cornerstone of treatment, debates persist around their long-term use and potential impacts on brain structure and function. In our review, we examine whether antipsychotic medications improve or worsen long-term outcomes in schizophrenia, particularly when treatment is refused or discontinued. Drawing from randomized controlled trials, large-scale observational studies, forensic outcome data, international guidelines, and neuroimaging research, the findings demonstrate that sustained antipsychotic treatment significantly reduces relapse, improves functional outcomes, and may protect against neurobiological deterioration. In contrast, untreated or inconsistently treated psychosis is associated with higher relapse rates, treatment resistance, cognitive decline, and progressive brain changes. While treatment must be personalized and compassionate, the cumulative evidence supports the critical role of early and continuous antipsychotic use in preserving health, autonomy, and long-term recovery for individuals living with schizophrenia.

Continuous glucose monitoring (CGM) has revolutionized diabetes management by providing real-time data on blood glucose fluctuations. Unlike traditional methods, CGM systems offer continuous feedback, enabling individuals to better regulate glucose levels in response to lifestyle factors such as diet, exercise, and stress. This technology has been shown to improve glycemic control and stabilize HbA1c levels. Beyond its primary role in diabetes management, emerging research highlights the relationship between metabolic health and mental wellbeing. Glucose dysregulation has been implicated in mood instability, and fluctuations in blood glucose levels may directly influence emotional states. Notably, some researchers have proposed reclassifying major depressive disorder (MDD) as “Metabolic Syndrome Type II” due to shared pathophysiological mechanisms involving glucose homeostasis and inflammation. Given these connections, CGM technology may offer mental health benefits by promoting glucose stability. For individuals with diabetes who also experience psychiatric conditions such as MDD or generalized anxiety disorder (GAD), CGM use may contribute to improved mood regulation and reduced psychiatric symptoms. By addressing both metabolic and mental health concerns, CGM holds promise as a valuable tool in enhancing overall wellbeing. Further research is warranted to explore the full potential of CGM in supporting mental health outcomes in individuals with metabolic disorders.

Melatonin is an easily accessible, widely used drug for sleep issues, disrupted sleep–wake cycles, and jet lag, available in a variety of forms and dosages. Melatonin is also used in hospital settings to promote sleep onset, particularly in elderly patients, as a circadian rhythm regulator. Despite the popularity of melatonin, it is not approved by the US Food and Drug Administration (FDA). This creates ambiguity surrounding its proper usage for optimum results, including dosage and time of administration. The objective of this article is to shed light on the best timing to administer melatonin. Melatonin is a hormone that our body naturally produces to regulate our biological clock. Even though our body has a built-in “sleep system,” many people still suffer from chronic sleep disorders such as insomnia. Melatonin has also proved to help prevent delirium in hospitalized patients due to its circadian rhythm regulatory effects. The elderly are at risk of developing insomnia because as one ages, melatonin production decreases. The most convenient solution for insomnia is to take melatonin supplements. To optimize the effects of melatonin supplements, proper dosage and timing must be considered. Additionally, patients who are oppositional to bedtime, which is known as bedtime resistance, are typically more willing to go to bed following melatonin administration. Melatonin administration at around 6 PM (1–2 hours before bedtime) is optimal to regulate sleep cycles of patients, and it can help with bedtime resistance. This should be the standard of care in all hospitals, nursing homes, and at home.

Two vesicular monoamine transporter 2 (VMAT2) inhibitors, valbenazine and deutetrabenazine, are approved for the treatment of tardive dyskinesia (TD), a persistent and potentially disabling movement disorder associated with prolonged exposure to antipsychotics and other dopamine receptor blocking agents. Since their initial approval in 2017, new formulations and doses for both medications have become available, including a sprinkle capsule for valbenazine and a once-daily tablet for deutetrabenazine. In light of these new therapeutic options, a comprehensive scoping review was conducted to consolidate the current knowledge about these medications. Both valbenazine and deutetrabenazine are safe and effective in treating TD. However, as they are different drugs, one objective of this review is to describe their pharmacology and pharmacokinetics. Another objective is to summarize the similarities and differences as to how these medications are prescribed, specifically in terms of their warnings and precautions, their use in special populations, and recommendations for dosing when taken with concomitant medications. Results from double-blind, placebo-controlled clinical trials are presented, along with post hoc analyses that provide benchmarks for clinical relevance (eg, effect size, number needed to treat, minimal clinically important difference). As most patients with TD will require ongoing treatment, findings from long-term studies provide evidence for the safety and effectiveness of these medications.

Sexsomnia is an arousal disorder in which abnormal sexual behaviors and experiences (such as masturbation, sexual intercourse, loud sexual vocalizations) are manifested during NREM sleep and are followed by amnesia upon awakening from these episodes. Both behavioral and pharmacological interventions are available for management of these manifestations, but no clinical trials have been performed to determine their effectiveness or guide clinical management. The aim of this review and case report is to describe the effectiveness of Cognitive Behavioral Therapy for sexsomnia (CBT-S) in a 27-year-old male whose chief complaint was sexual behavior 2 to 3 nights per week. The initial clinical assessment yielded diagnoses of sexsomnia, insufficient sleep syndrome, and snoring. The components of CBT-S used in this case included sleep extension, sleep hygiene, and relaxation therapy (diaphragmatic breathing with autogenic training) employing client-centered Motivational Interviewing. The patient reported no recurrence of sexsomnia events during the first month of therapy, but experienced 1 recurrence between the third and sixth months of follow-up, which was likely triggered by sleep deprivation and following alcohol consumption. No further recurrence of sexsomnia events was reported while maintaining adequate adherence to therapy. As is the case for insomnia, CBT represents a viable therapeutic option for the management of sexsomnia.

Psychoactive substances, known for their acute impact on perception and cognition, are gaining attention for their potential therapeutic applications. Many of these substances are plant-derived with deep-rooted histories of use in non-medical contexts, where they have been viewed as either tools for social cohesion or sources of discord, depending on cultural and societal contexts. This review explores psychoactive substances; psychedelics, cannabis, and stimulants, in a legitimized medical context, focusing on the ethical considerations shaping research and the regulatory and prescribing challenges involved in translating these compounds into viable clinical treatments. It highlights the diverse voices; Indigenous, philosophical, psychiatric, and using communities advocating for careful consideration of their broader implications. Key issues include navigating the blurred boundaries between therapeutic benefit and potential misuse, ensuring rigorous scientific methodologies, and addressing the sociopolitical factors shaping public perception and policy. The article emphasizes the need for evidence-based frameworks that balance innovation with patient safety and calls for approaches that recognize the social and commercial determinants of health, extending ethical considerations beyond merely prescribing. By critically assessing the promise and limitations of repurposing these substances, the article contributes to the ongoing discourse on their role in contemporary psychiatric practice.

The menopausal period in women is characterized by neuroendocrine alterations, which is in part mediated by the reduction in circulating estrogen. During this transition, many perimenopausal and menopausal women experience sleep disturbances and increased susceptibility to sleep-related disorders. Sleep disruptions are partially attributed to nighttime vasomotor symptoms (VMS), which exacerbates the insomnia risk in the menopausal woman. Converging data implicate the orexin system in the pathophysiology of insomnia and VMS, particularly through regulation of arousal, thermoregulation, and sympathetic outputs. Estrogen decline due to menopause is postulated to modulate orexin signaling, thereby heightening sympathetic drive and thermoregulatory instability. Given this potential mechanistic framework, orexin receptor antagonists, notably dual orexin receptor antagonists (DORAs), have been proposed as alternative menopausal therapeutics. Herein, we aim to examine preclinical, translation, and clinical literature assessing the therapeutic potentials of DORAs as a nonhormonal intervention for the mitigation of insomnia and VMS in midlife women.