The impact of chronotype on alertness and performance at work in healthcare professionals (HPs) has been hypothesized. The relation between chronotype and work-related quality of life (WRQOL) remains to be investigated.

Our aim was to investigate the impact of the chronotype on WRQOL in HPs.

A cross-sectional, monocentric, observational study was conducted at the military hospital of Tunis in September 2025, including HPs (nurses, nursing assistants, physiotherapists, anesthesiologists, radiology technicians, and ward supervisors). Inclusion criteria were: HPs who had obtained professional qualification certificates and agreed to participate in the study. Exclusion criteria were retired HPs, refresher HPs, and student HPs; HPS with less than 6 months of work experience; or HPs missing more than one month of work due to illness, marriage, maternity, or other reasons. Chronotype of participants was determined through the Horne-Ostberg questionnaire (HOQ). Evaluation of WRQOL was obtained using the “Work-related quality of life-2” (WRQOL-2) scale and its subscales.

We included 106 participants from 22 departments. Sex-ratio was 1.2 and median age was 33.5 years (IQR=15). Nurses represented 84.5% of participants. Median WRQOL-2 in our cohort was 3.25 (IQR=0.92) with low to very-low WRQOL accounting for 30.2% of cases (n=32). Participants with an evening type chronotype had significantly lower total WRQOL-2 score compared to morning type (median=2.8 (IQR=0.8) vs 3.7 (IQR=1.2), p=0.002). A negative correlation was found between morning type participants and WRWOL-2 subscores, including job career satisfaction (p=0.044) and stress at work (p=0.049).

Our study found that evening-type healthcare professionals reported significantly lower work-related quality of life (WRQoL-2) scores compared to morning types, aligning with previous research. Misalignment between chronotype and work schedules can lead to increased strain and reduced job satisfaction. Negative correlations between morningness and WRQoL-2 subscores were observed, consistent with findings by Honkalampi et al. (2022).

These results underscore the importance of considering chronotype in scheduling to optimize healthcare workers’ well-being and performance.

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Borderline personality disorder (BPD) carries a high burden of suicidality. Clarifying how childhood adversity, attachment insecurity and dissociation relate to suicidal ideation, attempts and death in adults with BPD is essential for targeted prevention, yet evidence remains fragmented.

To quantify associations between early trauma, attachment insecurity and dissociation with suicidal ideation, attempts and death in adults with BPD; to examine subgroup differences (clinical vs community settings; comorbidity); and to explore mediation where reported.

Comprehensive searches of MEDLINE/PubMed, Embase, PsycINFO and Web of Science in adults with BPD. Eligible designs: observational/longitudinal studies and systematic/narrative reviews; findings synthesised narratively (no meta-analysis). PRISMA flow: 1,196 records; 862 after deduplication; 147 full texts; 26 included (16 observational, 6 reviews, 4 longitudinal); 121 excluded (non-BPD 41%, <18 years 29%, no suicidality 21%, other 9%). Across included studies, mean age 29-36 years; 69-74% female; 78% clinical, 22% community.

Aggregated descriptively from included studies and recent reviews: adult BPD prevalences were ideation 74% (69-82%), attempts 56% (48-66%), deaths 4% (2-6%); inpatients typically showed +18-25 percentage points (pp) vs outpatients. Early trauma in 70-85% of patients; multiple exposures approximately +12-22 pp for attempts vs single/none; emotional abuse/neglect +15-28% for ideation. Attachment insecurity >70%; secure <30% and protective (attempt rates lower by 25-40%); where tested, secure attachment mediated ~10-20% of the trauma-suicidality association. Dissociation moderate-severe in 60-75%; associated with +18-30% ideation and with self-harm (non-suicidal self-injury); for attempts, differences vs low dissociation approximately +8-15 pp; longitudinal signals indicated elevated 6-12-month risk at higher dissociation. Subgroups (where reported): age <30 years +8-12 pp for attempts; comorbid major depressive disorder +20-30 pp.

In BPD, early trauma, attachment insecurity and dissociation are key correlates of suicidal vulnerability, with measurable effects of ~10-30 pp on risk indicators. Clinical pathways should implement standardised screening (ACEs/CTQ, attachment measures, DES) and trauma-informed, attachment-focused and mentalisation-based elements alongside dialectical behaviour therapy (DBT).

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Nutrition is increasingly recognized as mental health determinant, influencing onset, course, and treatment of mental disorders through biological mechanisms (nutrients, metabolism, inflammation, gut microbiota) and psychosocial pathways. Yet structured integration of nutrition professionals and interventions into mental health care remains limited.

Nourishing Minds aimed to strengthen this integration through participatory workshops in Germany and Finland.

In 2025, two workshop series were delivered in mental health clinics in Augsburg, Germany, and in Kuopio, Finland. Content was tailored to local needs. German sessions introduced foundational concepts and co-designed basic interventions. Finnish sessions addressed more advanced approaches, including integration of nutrition professionals into care pathways. Interactive methods, including World Cafés, supported reflection, experience exchange, and the development of actionable strategies.

In Germany, participants reported that nutrition currently plays a marginal role in mental health care despite rising patient demand. Some wards already offer small initiatives such as cooking groups. However, integration is hindered by rigid meal plans, unclear responsibilities, constraints in space and resources, and gaps in expertise. Nevertheless, interest in expanding activities was high. During the World Café, participants co-designed four concrete project ideas targeting awareness, multi-professional collaboration, and better use of existing infrastructure. Finnish workshops focused on advanced models of integrating nutrition professionals; analysis is ongoing.

Participatory workshops proved effective in generating context-sensitive strategies and mobilizing stakeholder commitment. Findings suggest that successful integration of nutrition into mental health care requires cross-disciplinary collaboration, clear role definitions, and institutional flexibility to adapt to local resources.

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Youth depression represents a growing burden in rural and Indigenous communities, where access to mental health services is scarce. There is an urgent need for scalable, culturally adapted, and community-based models to improve detection and care.

To evaluate the feasibility and effectiveness of the MAP-PSI (Primary Care and Psychiatry Model), a telemedicine-based intervention designed to reduce depressive symptoms among youth aged 15–25 in marginalized settings.

A quasi-experimental pre-post study was conducted (March 2023 – March 2025) in Ciudad Fernández, San Luis Potosí, Mexico. The intervention combined: (1) bilingual psychoeducation, (2) brief cognitive-behavioral therapy (CBT), and (3) psychiatric care via telemedicine. Screening instruments included the PHQ-9 and KAP questionnaires. A total of 1,057 youth were screened, and 400 received stepped-care based on symptom severity. Data were analyzed using non-parametric tests (Wilcoxon, Mann-Whitney U).

Analysis of the results showed a 60% average reduction in depressive symptoms across modalities (p < .001). Also, 25 cases of suicidal ideation were successfully treated, and 34,224 school absence days were prevented (84% reduction). Moreover, the intervention reached over 1,500 youth with >85% adherence and high community acceptability. The pilot implementation achieved a 98% reduction in out-of-pocket expenses. This pilot study involved 67 bilingual community health promoters who were trained and certified.Image 1:

The MAP-PSI model proved to be a culturally relevant, cost-effective, and feasible strategy for youth depression in underserved regions. Its stepped-care, telemedicine-supported approach has strong potential for replication in other low-resource settings. Further studies with controlled designs are warranted to evaluate long-term outcomes.

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Electroconvulsive therapy (ECT) is a cornerstone of treatment for severe depression, suicidality, and catatonia. Anesthetic choice directly influences seizure threshold, seizure quality, hemodynamic stability, and ultimately therapeutic efficacy. Cardiovascular comorbidity amplifies these challenges. For psychiatrists, acquiring fluency in anesthetic principles contributes to safety, tolerability, and quality outcomes.

To review anesthetic agents used in ECT and clarify how pharmacological selection intersects with treatment efficacy and patient safety.

Narrative educational review of psychiatric, anesthetic, pharmacologic literature (2010–2025), focus on four mainstay agents showcasing the effect on hemodynamics, cardiac function, and therapeutic seizure characteristics.

ECT anesthetics differ substantially in both neuropsychiatric and cardiovascular profiles (Table 1):

Methohexital is the gold standard: it lowers seizure threshold, sustains adequate seizure duration, and provides remarkable hemodynamic stability in the majority of patients. However, its dose-dependent negative inotropy can become significant in patients with advanced heart failure.

Etomidate preserves cardiac output and reliably produces long seizure durations, often yielding higher efficacy in treatment-resistant depression. Downsides include temporary adrenal suppression, especially in the context of frequent treatments and limited availability outside North America.

Propofol blunts hypertensive surges and provides rapid emergence, though slower than methohexital. It raises seizure threshold and shortens seizure duration. Hemodynamic effects include vasodilation leading to lower systemic vascular resistance and some negative inotropy, making it less suitable in patients with heart failure.

Ketamine prolongs seizure duration and augments sympathetic tone, occasionally improving mood acutely. Yet its indirect sympathetic activation may be destabilizing in patients with arrhythmias or advanced coronary disease.Table 1.

Psychiatrists who understand anesthetic pharmacology can better anticipate treatment trajectories and maintain treatment efficacy and safety, especially in patients with cardiovascular comorbidities. Education in anesthetic-psychiatric intersections within the psychiatric curriculum would benefit safe ECT therapy in cardiac patients.

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Fictional narratives can be powerful educational tools in psychiatry, allowing exploration of sensitive themes without breaching confidentiality. We present “Ash,” a fictional character whose developmental history and psychological trajectory mirror common clinical patterns of complex trauma, depressive collapse and existential recovery.

Our objective was to demonstrate how a detailed fictional case vignette can serve as an innovative teaching tool in psychiatry, illustrating the psychodynamic and existential processes involved in complex trauma, depressive collapse and recovery of meaning.

We developed a detailed fictional case vignette drawing on psychoanalytic, existential and phenomenological concepts and analysed Ash’s life history, emotional landscape and adaptation to illustrate key psychodynamic mechanisms and potential teaching applications for psychiatry trainees.

Ash, once a devoted and perfectionistic youth, discovers he was betrayed and effectively “sold” to an imperial institution. This revelation precipitates a severe depressive episode characterised by anhedonia, loss of purpose and existential despair. Over time he shifts from striving for external validation to cultivating curiosity, endurance and authentic presence.

The analysis identified three interconnected processes: (1) betrayal and early attachment trauma leading to perfectionism and over-investment in an institution; (2) depressive collapse and existential despair following discovery of betrayal; and (3) gradual reconstruction of meaning and authentic identity through curiosity and acceptance. These processes parallel patterns observed in real clinical settings and provide a framework for teaching resilience and existential recovery.

Fictional case vignettes such as Ash’s can enrich psychiatric education by safely demonstrating complex themes—attachment trauma, identity collapse, resilience and existential recovery—beyond traditional diagnostic frameworks. Integrating creative narratives into training may foster empathy, conceptual flexibility and deeper understanding of patient experiences.

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Pain management remains a major challenge in perioperative medicine. Hypnosis has emerged as a promising alternative, capable of modulating pain perception, reducing anxiety, and improving the overall perioperative experience for patients.

To evaluate the perioperative benefits of hypnosis in the context of parietal urological surgery.

This was a randomized, controlled, single-blind clinical trial conducted among patients scheduled for parietal urological surgery under general anesthesia in the urology operating room at Sahloul University Hospital of Sousse, over a four-month period (February to May 2025). The patients included in the study were randomly assigned to two groups of 15 patients each: Intervention group (Group I): patients who received a session of self-hypnosis immediately before anesthetic induction. Control group (Group C): patients who underwent general anesthesia without hypnosis. Postoperative pain and anxiety were assessed using the Visual Analog Scale (VAS) every 4 hours during the first 48 hours.

Preoperative anxiety VAS was 7.74 ± 1.19 in group I and 7.33 in group C (p = 0.423). Postoperatively, pain intensity decreased progressively in both groups. Mean VAS scores were comparable between groups I and C at all time points, except at H24, where the mean VAS was 0.06 ± 0.25 in group I and 0.73 ± 0.79 in group C (p = 0.007), showing a significant reduction in pain in the hypnosis group. Postoperative anxiety was overall lower in the hypnosis group, with significant differences observed at H4 (p = 0.048), H8 (p = 0.006), and H24 (p = 0.005).

These findings suggest a beneficial effect of hypnosis, as it significantly reduces both postoperative pain and anxiety, thereby improving the overall recovery experience after surgery.

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Tardive dyskinesia, or TD, is a drug-induced movement disorder, linked with long-term use of dopamine receptor blockers. TD imposes a substantial healthcare burden, with higher hospitalization and emergency visits, higher medical costs, and increased psychiatric and physical comorbidities.

This study aims to identify drugs associated with TD risks beyond established agents such as metoclopramide using the FDA Adverse Event Reporting System (FAERS) database, which is a public, quarterly-updated, spontaneous reporting system for adverse drug events.

TD reports were extracted from the FAERS database (Q1 2004 to Q4 2024). Four disproportionality methods were appllied to identify statistically significant TD risk signals. Sensitivity analyses utilizing adjusted RORs (aRORs) were conducted for drugs with ≥20 reports and a significant signal. Multivariable logistic regression analysis was employed to identify risk factors influencing reporting probability. Time-to-onset (TTO) was calculated from treatment initiation to event onset and analysed descriptively with median and Weibull shape parameters (WSP), and presented by Kaplan–Meier cumulative-incidence curves.

We identified 9,390 TD reports involving 399 drugs. Antipsychotics dominated the top 3 most frequently reported drugs: aripiprazole (n=2099), quetiapine (n=1121), and risperidone (n=910). Disproportionality analysis identified statistically significant TD signals for 57 drugs: antipsychotics (n=27, 47.4%), antidepressants (n=13, 22.8%), psychostimulants (n=4, 7.0%), and others (n=13, 22.8%). Sensitivity analyses confirmed significant positive aRORs for all evaluated agents. The strongest signals were observed for brexpiprazole (aROR=899.7) and cariprazine (aROR=732.6) among antipsychotics, fluoxetine (aROR=43.3) among antidepressants, and benztropine (aROR=467.3) among other classes. Age significantly influenced reporting risk; the effect of sex varied by drug, with higher risk in females for duloxetine and benztropine, and in males for citalopram and fluoxetine. TTO was shortest in patients aged<19 years (median=155.5 d). Second-generation antipsychotics (median = 421.0 d) and first-generation antipsychotics (626.0 d) exhibited longer TTOs than antidepressants (median=246.0 d). Weibull analysis indicated early-failure patterns for risperidone, olanzapine, lurasidone, haloperidol, and fluoxetine, while all other analyzed agents followed a random failure pattern over time.

Our findings underscore significant TD risk associated with a broad pharmacologic spectrum, particularly with antipsychotics and antidepressants, and reveal distinct TTO profiles by drug class. These data support the need for individualized, long-term monitoring of TD risk during neuropsychiatric treatment.

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Forensic psychiatry is an interdisciplinary field that combines psychiatry, medicine, and law. It treats patients with severe mental disorders who have committed criminal offenses and integrates therapeutic care with legal responsibilities. Understanding how these patients perceive their crimes is essential for effective treatment, risk management, and rehabilitation.

The aim of this study was to analyze how forensic psychiatric patients currently perceive their committed crimes, and to investigate how these attitudes are associated with the type of offense, psychiatric diagnosis, treatment history, and duration of hospitalization.

The study included all forensic psychiatric inpatients at the Department of Forensic Psychiatry “Dr. Vlado Jukić”, Psychiatric Hospital Vrapče, Zagreb. Data on sociodemographics, diagnoses, treatment history, and criminal code articles were collected, with focus on patients’ most recent statements about their crimes: acknowledges crime as part of illness, acknowledges crime but does not think it was due to the illness, amnesia, and denial. Statistical analyses included descriptive summaries, cross-tabulations, Fisher’s exact tests, and non-parametric tests for group comparisons.

The study included 71 forensic psychiatric patients (59 men, 12 women). Most were diagnosed with schizophrenia spectrum disorders (84.5%) while smaller groups had organic, affective, substance use, or other diagnoses. Regarding attitudes toward their crimes, 40.8% acknowledged without linking to illness, 32.4% denied, 19.7% acknowledged as illness-related, and 7.0% reported amnesia. Violent offenses dominated, with threats (33.8%) and homicide (22.5%) accounting for over half of cases. A significant association was found between crime type and crime attitude (p=0.0048): homicide was more often seen as illness-related, while threats were acknowledged without illness. No significant link was found between diagnosis and attitude. There was no significant association between diagnosis and attitude (p=0.410), although descriptively, patients with organic disorders acknowledged the crime without linking it to illness, while patients with schizophrenia spectrum disorders expressed all four attitudes.

This study shows that forensic psychiatric patients differ in how they perceive their crimes. Some acknowledge the offense as part of their illness while others admit it without linking it to illness, deny it altogether, or report amnesia. These attitudes were significantly associated with the type of offense, which suggests that patients’ subjective views could be shaped by the nature of the crime itself. Understanding these perspectives is important for clinical management, risk assessment, and rehabilitation planning in forensic psychiatry.

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Solitude, understood as the pleasant experience of being alone, can represent a positive and meaningful aspect of life. It may be a source of autonomy, creativity, or personal growth. However, the motivations underlying solitude differ among individuals and may be shaped by personality functioning (PF). While some are drawn to solitude for self-determined reasons like self-reflection or growth, others may be motivated by non-self-determined motives such as anxiety or withdrawal tendencies, particularly relevant in the context of impaired PF.

The study aimed to examine motivational patterns for solitude in individuals with varying levels of PF, with a focus on those experiencing impaired functioning.

A total of 1736 participants (1248 women, mean age 37.42 ± 12.14; 152 with severe/extreme PF impairment), divided into five levels of PF (from none to extreme), completed the Motivation for Solitude Scale–Short Form. Analyses included ANOVA to examine group differences and K-means clustering to identify motivational profiles related to solitude.

Differences in motivations have emerged, where individuals with more impaired PF were more likely to endorse anxiety-driven motivations for spending time alone. Additionally, four motivational clusters with two interconnected main dimensions have been identified: 1) solitude motivated by anxiety and discomfort when around others, and 2) solitude driven by the pursuit of self-reflection, or intrapersonal contact. Subgroups have been identified, and among those driven by anxiety, a subgroup also valued self-reflection and connection, while another did not. Similarly, among individuals without anxiety toward others, one subgroup emphasized self-reflection and connection over the other.

The findings demonstrate that the solitude motivations of people with and without impaired PF are not uniform but are driven by the presence or absence of anxiety, and by valuing self-reflection and connection. For those with impaired personality functioning, anxiety-driven solitude was more common, but even then, half of them were able to use and value the solitude for self-reflection, creativity, and connection. The findings suggest a potential for promoting self-reflection and other self-determined drivers while being alone among those who do not yet value it, which could support their mental health and personal development.

This study has been supported by the Czech Science Foundation under grant nr. 24-10889S.

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Sex differences in schizophrenia (SZ) are well-documented in terms of age of onset, symptoms, and treatment response. However, sex is often treated as a covariate rather than a primary variable of interest. Continuous “sex-scores” have been proposed to quantify the “maleness/femaleness” of multiple traits, as a complement to biological sex.

We aimed: i) to compute brain sex-scores in healthy individuals (HC) and SZ patients and; ii) to examine the association of brain sex-scores with SZ symptoms.

In Sample A (215 males, 211 females HC), sex effect coefficients were obtained for 34 cortical regions (Desikan-Killiany atlas) through linear regressions of cortical thickness (CT) and surface area (SA). In Sample B (237 SZ patients), individual-level CT and SA values were summed and weighted by the sex effect coefficients obtained from Sample A to compute sex-scores ranging from 0 (maximum maleness) to 1 (maximum femaleness). We assessed correlations between sex-scores and Positive and Negative Syndrome Scale (PANSS) in SZ patients, separately for males and females.

CT sex-scores showed significant correlations with PANSS-Negative symptoms in females (r2 =-0.4; pFDR=0.017). In males, CT sex-scores were associated with PANSS-Positive symptoms (r2=-0.18; pFDR=0.033) and general psychopathology (r2=-0.24; pFDR=0.009).

Our data suggest that lower CT sex-scores (associated with greater maleness) are related to more severe symptoms, highlighting the importance of considering sex-related variability in a quantitative manner. Then, sex-scores emerge as a useful tool to study sex- and gender-related variability in the neurobiology and clinical expression of schizophrenia.

ISCIII project-PI20/01002, grant-FI21/00093-NH, grant-CP20/00072-MFV co-funded by ERDF/ESF; AGAUR-2021SGR01475; Beca Santander-Estades formatives Espanya i estranger 2024 doctorands UB-NH; Beca de Recerca Bàsica de l’Acadèmia 2025.

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Depression, anxiety, and insomnia represent the most prevalent psychiatric comorbidities in cancer populations, significantly impacting quality of life, treatment adherence, and survival outcomes. These conditions are increasingly recognized as complex neurobiological phenomena rather than simple psychological reactions to cancer diagnosis.

To synthesize current evidence on the epidemiology, pathophysiology, assessment approaches, and treatment interventions for depression, anxiety, and insomnia in oncologic populations, providing evidence-based insights for clinical practice and research.

Comprehensive review of recent meta-analyses, systematic reviews, and clinical guidelines published between 2023-2025. Key databases included PubMed, EMBASE, and major oncology journals. Priority was given to large-scale meta-analyses and evidence-based clinical practice guidelines from major oncology organizations.

Global meta-analysis of 135,015 cancer survivors from 31 countries revealed prevalence rates of 23.7% for depression, 24.4% for anxiety, and 34.1% for sleep disorders. Pathophysiological mechanisms involve immune-inflammatory processes, hypothalamic-pituitary-adrenal axis dysregulation, and neurotransmitter alterations. Validated screening tools include Hospital Anxiety and Depression Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Insomnia Severity Index. Evidence-based treatments demonstrate strong efficacy: Cognitive Behavioral Therapy shows moderate to large treatment benefits for depression and anxiety, while Cognitive Behavioral Therapy for Insomnia shows very large improvements in sleep quality and duration. Mindfulness-based interventions receive strong American Society of Clinical Oncology recommendations. Pharmacological approaches favor selective serotonin reuptake inhibitors as first-line agents.

Psychiatric comorbidities in cancer require systematic screening and evidence-based treatment. The high prevalence rates underscore the need for integrated psycho-oncology care. Future directions include personalized medicine approaches and prevention-focused interventions targeting inflammatory pathways.

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Socioeconomic status (SES) affects cognitive functioning and life outcomes. Most research focuses on objective indicators such as income, education, or occupation. Less is known about subjective socioeconomic status (SSS), i.e., people’s perception of their social position, which may also influence executive functioning, particularly in North African populations.

This study examined whether subjective socioeconomic status is associated with executive performance in a Tunisian sample.

A total of 151 healthy adults from Tunis (Age: M = 39.49; SD = 13.18; Range = 19-74) were recruited. Participants were categorized into three subjective socioeconomic groups (low, low-middle, and high-middle/high) using the MacArthur Subjective Socioeconomic Status Scale. The original design included four groups, but the high-middle and high categories were merged due to the small number of participants in the highest group. Executive functioning was assessed across four domains: inhibition (Stroop, Hayling), cognitive flexibility (Verbal Fluency, Modified Card Sorting Test), working memory (Digit Span, Corsi Block Tapping), and behavioral regulation (BRIEF questionnaire).

ANOVA analyses showed significant differences between groups for both cognitive and behavioral executive processes. Participants in the high-middle/high group consistently outperformed those in the low and low-middle groups across inhibition, flexibility, and working memory tasks, with shorter execution times and fewer errors. They also reported stronger behavioral control and emotional regulation on the BRIEF compared to the low-middle group. These differences remained significant when controlling for intelligence, but not when controlling for objective SES, education, or income.

These findings suggest that subjective socioeconomic status relates to executive functioning, though its effects are intertwined with objective socioeconomic indicators. This study contributes to understanding how socioeconomic perceptions and realities jointly influence cognition in North African populations. Further research may help guide interventions to support cognitive and mental health in individuals facing socioeconomic disadvantage.

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Effective communication between community mental health services and general practitioners (GPs) is crucial for maintaining patient safety, ensuring continuity of care, and coordinating follow-up interventions. Both NHS England and the Health Service Executive (HSE) in Ireland provide clear guidance on timely communication following assessments. According to the NHS Standard Contract (2022), outcome letters from outpatient or community assessments should be sent within 10 working days. Similarly, the HSE’s National Clinical Programme for Mental Health (2020) recommends that communication with referring GPs should occur as soon as possible, ideally within 7 to 14 calendar days. Delays in this process can result in fragmented care, increased risk, and avoidable deterioration in mental health conditions.

To evaluate whether GP letters following initial mental health assessments were sent within 14 days, in line with HSE/NHS guidelines.

This retrospective audit included 20 patients who were personally assessed by the auditor at CMHT Swords – Orange Team, North Dublin Mental Health Services, between 13 January and 13 July 2025. Patients included in the audit were those seen for an initial mental health assessment during the specified time frame. Follow-up reviews or emergency consultations where GP communication was not required were excluded. For each case, the audit recorded the date of assessment, date of GP letter dispatch, and the number of calendar days between assessment and communication. Timeliness was categorized into three groups: letters sent within 7 days, between 8–14 days, and beyond 14 days.

A total of 20 patients were included, all of whom had been assessed by the auditor during the audit period. Of these, 15 patients (75%) had GP letters sent within 7 calendar days of assessment, meeting and exceeding the optimal standard. An additional 4 patients (20%) had letters sent between 8 to 14 days, thus remaining compliant with the HSE and NHS benchmark of ≤14 days. Only 1 case (5%) breached the recommended timeframe by exceeding 14 calendar days. Overall, 95% of cases achieved compliance with national communication standards. Notably, 75% of cases were communicated within just one week, demonstrating an efficient and proactive documentation process.Image 1:Image 2:

The audit demonstrates high compliance with national standards for timely GP communication following initial CMHT assessments. Continued use of structured templates and weekly review of delayed cases can support full compliance.

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Generalized Anxiety Disorder (MDD) is a disabling mental condition, with a prevalence in women twice than men. Despite the implementation of precision and gender medicine, little data are currently available on gender differences in GAD.

Purpose of this study is to identify gender differences in clinical features and outcomes of patients affected by GAD to implement individualized treatment strategies.

A cross-sectional, retrospective study was conducted. Medical records of GAD patients from three mental health services were reviewed, and socio-demographic and clinical variables were extracted. Continuous and qualitative variables were compared according to gender respectively by unpaired t-tests and chi-square tests (with odds ratio-[OR] calculation where appropriate).

The total sample included 243 patients (162 women and 81 men). Female patients compared to males resulted: to be more frequently married or in partnership (61.7% versus 44.4%; χ2=8.68, p=0.03), to have less frequently cannabis use disorder before GAD onset (0.6% versus 7.4%; χ2=13.71, p=0.01), to have less frequently alcohol use disorder after GAD onset (0.6% versus 6.2%; χ2=13.68, p<0.01), to have more frequently committed attempted suicides (4.9% versus 0.0%; χ2=4.14, p=0.05), to present more often a history of obstetrical complications (low birth weight or preterm birth) (5.5% versus 0.0%; χ2=4.14, p=0.03; OR=1.54).

The results of this study support gender-specific medicine with personalized treatments for males and females with GAD. Males are more likely to engage in substance abuse, while females are more likely to engage in self-harm. Specific psychoeducational interventions should be planned, and pharmacotherapy should be chosen based on their interactions with substances of abuse or their anti-suicidal efficacy. The results of this study need to be confirmed by future research.

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Superoxide dismutases (SODs) are key antioxidant enzymes that neutralize superoxide radicals. Mammals express three isoforms: SOD1, SOD2, and SOD3. SOD1, a cytosolic copper-zinc enzyme encoded on chromosome 21q22, detoxifies reactive oxygen species. The gene has five exons and four introns, with notable variants including a 50 bp promoter Ins/Del and the +35A/C (rs2234694) polymorphism, both linked to various clinical conditions. Their role in synthetic cannabinoid use disorder (SCUD), however, remains unexplored. We hypothesize that these SOD1 variants may influence susceptibility to SCUD.

This study aims to investigate the relationship between clinical features of SCUD and two genetic variants of the SOD1 gene: the +35A/C (rs2234694) and the 50 bp insertion/deletion (Ins/Del) polymorphisms. Specifically, we sought to compare the genotype distributions of these polymorphisms between patients with SCUD and healthy controls, and to explore their potential associations with clinical characteristics.

This case-control study included 168 patients with SCUD and 150 age- and sex-matched healthy controls. The SOD1 rs2234694 (+35A/C) and 50-bp insertion/deletion (Ins/Del) polymorphisms were analyzed using PCR-RFLP. For the +35A/C variant, DNA samples were amplified under standard PCR conditions, digested with HhaI, and visualized on agarose gel: AA (278 bp), AC (278, 207, 71 bp), CC (207, 71 bp). The 50-bp Ins/Del variant was amplified with specific primers and separated on a 3.5% agarose gel: Ins/Ins (297 bp), Ins/Del (297, 247 bp), Del/Del (247 bp).

Significant differences were found in the distribution of the SOD1 50-bp Ins/Del polymorphism, with the heterozygous I/D genotype more frequent in SCUD patients than controls (p < 0.05). No significant differences were observed for the +35A/C (exon 3/intron 3) polymorphism in terms of genotype or allele frequencies. Analysis of clinical parameters—including age at onset, disorder duration, polysubstance abuse, inpatient treatment, violent behavior, suicide attempts, psychotic symptoms, family history, and substance use frequency—showed no associations with genotype, except that patients with the AA genotype of +35A/C had a significantly higher prevalence of family psychiatric history (p < 0.05).

Our study suggests that the SOD1 50-bp Ins/Del heterozygous (I/D) genotype may confer a potential disadvantage, as it was significantly more frequent in SCUD patients. The Del allele has been linked to decreased promoter activity of SOD1, which may reduce ROS detoxification and impair oxidative stress regulation. Given the strong interaction between ROS and DNA, this polymorphism could influence genome integrity and contribute to individual susceptibility to SCUD.

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Post-Traumatic Stress Disorder (PTSD) in children is a complex condition that may go beyond the typical symptoms of re-experiencing, avoidance, and hyperarousal. Traumatic experiences can manifest through somatic or conversion symptoms, reflecting nonverbal expressions of distress. Repeated trauma exposure also increases the risk of comorbid anxiety disorders, such as panic disorder, highlighting the need for a comprehensive, trauma-informed approach.

Post-Traumatic Stress Disorder (PTSD) in children and adolescents can present with a wide range of symptoms, including somatic complaints, dissociation, and functional neurological symptoms. We report a clinical case that highlights the link between cumulative trauma and conversion disorder in a pediatric patient.

M.N., an 11-year-old boy, was referred to child psychiatry after developing progressive tetraplegia over a two-month period, with no abnormalities found on medical investigations. His parents reported a history of physical assault by a classmate five months earlier, followed by loss of consciousness and initial trauma-related symptoms. Shortly afterward, the patient began experiencing falls with unresponsiveness, worsening to complete immobility. On admission, he was bedridden, emotionally labile, reported generalized pain and vertigo, and showed marked avoidance and re-experiencing symptoms suggestive of PTSD. The clinical picture also revealed features consistent with conversion disorder.

Following parental guidance and the introduction of SSRIs, the patient gradually recovered motor function and verbalized another traumatic experience: the murder of a neighbor, which had occurred a year earlier. He described vivid flashbacks involving visual, olfactory, and emotional triggers, and persistent fear of being killed in the same way. This second trauma had been previously unrecognized. His presentation combined both PTSD symptoms and functional neurological symptoms, reflecting a complex interaction between psychological trauma and somatic expression.

This case underscores the importance of recognizing conversion disorder as a possible expression of PTSD in children, especially when symptoms are disproportionate or medically unexplained. It also highlights that multiple traumatic events, not a single one, often underlie such presentations. A comprehensive, trauma-informed approach is essential.

None Declared

Anxiety disorders represent one of the most prevalent mental health conditions in adulthood, often associated with significant impairment in daily functioning and well-being. Standard treatments include pharmacological and cognitive-behavioral approaches, but additional behavioral interventions may enhance outcomes. Behavioral Relaxation Training (BRT), grounded in Applied Behavior Analysis (ABA), focuses on the systematic acquisition of relaxation postures and breathing patterns, offering a direct behavioral strategy to reduce physiological arousal and anxiety symptoms.

This study aimed to investigate the efficacy of BRT in reducing anxiety symptoms and improving relaxation behaviors in adults diagnosed with anxiety disorders, using a controlled experimental design.

A multiple baseline design across three caregivers was employed to demonstrate experimental control. Each participant engaged in structured BRT sessions designed to teach and generalize relaxation postures and regulated breathing. Outcome measures included the Behavioral Relaxation Scale (BRS) as a direct behavioral index of relaxation, alongside standardized clinical instruments such as the Hamilton Anxiety Rating Scale (HAM-A) and the Clinician-Administered PTSD Scale (CAPS), following procedures described in previous research (Lundervold et al., 2013).

Findings revealed consistent reductions in anxiety severity and significant improvements in relaxation behavior across all participants. Decreases in HAM-A and CAPS scores paralleled improvements in BRS performance, indicating both subjective and behavioral gains. Treatment effects were maintained at follow-up, supporting the stability of outcomes over time.

Preliminary evidence suggests that BRT, when embedded within an ABA framework, represents an effective behavioral intervention for adults with anxiety disorders. The approach promotes emotional regulation, reduces physiological tension, and complements existing therapeutic models. Further studies with larger samples are warranted to strengthen the empirical base and explore generalization across broader clinical populations

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Medical students are exposed to high academic pressure, emotional stress, and intense cognitive demands, conditions that may contribute to dysfunctional eating patterns, including food addiction. This condition is associated with dysregulation of the dopaminergic reward system and may lead to strategies to control appetite and weight, such as the use of appetite-reducing medications, often without adequate indication or monitoring.

To estimate the prevalence of food addiction among medical students and investigate whether the use of appetite-reducing drugs is associated with this condition.

A cross-sectional study was conducted with medical students from a college in the state of São Paulo, Brazil. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) and a structured questionnaire on the use of appetite-reducing drugs were applied. After ethics approval, data were analyzed using descriptive statistics and association tests (Chi-square and Fisher’s exact test) to examine relationships between food addiction, sex, and medication use.

A total of 546 students participated; 70.9% were women and 89.7% were aged 18–25 years. Most reported being white (89.9%) and enrolled in their first undergraduate degree (88.1%). Appetite-reducing drug use was reported by 30.2%, mainly lisdexamfetamine (11%), semaglutide (7.5%), and methylphenidate (7.1%). Food addiction was identified in 10.6% of students, with 5.3% classified as severe. Women were 2.29 times more likely to present food addiction (OR = 2.29; 95% CI = 1.09–4.81; p = 0.028). Students who used appetite-reducing drugs had a higher likelihood of food addiction (OR = 2.88; p < 0.05).

There was a high prevalence of appetite-reducing drug use among medical students, and this group showed a significantly higher rate of food addiction, suggesting the use of pharmacological strategies to control eating behavior. Food addiction was more frequent among women. These findings reinforce the need for targeted nutritional education, psychological support, and monitoring of appetite-reducing medication use among medical students to encourage healthier coping strategies and prevent disordered eating behaviors.

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Social media platforms have become central to communication and networking among healthcare trainees. However, their excessive use may lead to addictive behaviors that compromise professional performance.

To assess the association between social media addiction and professional performance.

A cross-sectional study was carried out in 2025 among 429 residents across four Tunisian medical faculties. Social media addiction was assessed using the Bergen Social Media Addiction Scale (BSMAS), while work performance was measured by the Individual Work Performance Questionnaire (IWPQ). Comparative analyses between addicted and non-addicted residents were conducted.

Social media addiction was observed in 25.6% of residents. Addicted residents demonstrated significantly poorer performance across all IWPQ dimensions. Task performance was lower (2.31 ± 0.80 vs. 2.68 ± 0.77, p<0.001), contextual performance was reduced (2.62 ± 0.82 vs. 2.86 ± 0.80, p=0.007), and counterproductive behaviors were higher (2.72 ± 0.91 vs. 2.40 ± 0.78, p=0.001). Overall performance scores were significantly lower among addicts (2.73 ± 0.49 vs. 3.04 ± 0.48, p<0.001).

Social media addiction exerts a pronounced negative effect on work performance. These results underline the importance of addressing social media overuse in residency programs to protect both professional efficiency and quality of patient care.

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