Psychiatria Danubina最新文献

Late-life mental illnesses, particularly treatment-resistant late-life depression, present a significant public health challenge due to complex interactions with medical comorbidity, polypharmacy, and neurocognitive disorders. Standard pharmacological treatments are often limited by efficacy and tolerability issues in this population. Neuromodulation has emerged as an essential therapeutic modality, offering targeted treatment that can circumvent systemic side effects. This narrative review provides a critical synthesis of the evidence for established neuromodulation techniques - Electroconvulsive Therapy (ECT), Repetitive Transcranial Magnetic Stimulation (rTMS), Transcranial Direct Current Stimulation (tDCS), and Vagus Nerve Stimulation (VNS) - and explores emerging approaches like Transcranial Focused Ultrasound (tFUS) within psychogeriatric populations. The application of these techniques is governed by a trade-off between efficacy, safety, and logistical burden. ECT remains the gold-standard for severe presentations, such as psychosis or catatonia, despite its cognitive risks. rTMS provides a powerful balance of efficacy and tolerability for non-psychotic TRD. tDCS and non-invasive VNS offer excellent safety profiles and potential for home-based administration, expanding access and showing promise for cognitive indications. While the clinical roles of these modalities are clarifying, the path forward requires addressing critical gaps. Future research must prioritize methodologically rigorous, geriatric-specific trials, the development of biomarkers to guide personalized treatment, and an unwavering focus on the ethical complexities of assessing capacity and obtaining informed consent. Integrating these imperatives will enable the field to deliver precise, effective, and patient-centered care for older adults.

Chronic diseases represent one of the most pressing global health challenges, with increasing prevalence due to aging populations and lifestyle-related factors. In recent decades, clinical psychology has played a pivotal role in understanding and managing the psychological aspects of chronic illnesses. This paper aims to synthesize current research on the bidirectional relationship between psychological factors and chronic disease progression, emphasizing recent advances in theoretical models, empirical findings, and clinical interventions. Defensive functioning, alexithymia, and psychological flexibility emerge as crucial dimensions. A greater use of mature defense mechanisms appears to be linked to better psychosomatic well-being, while reliance on immature defenses is associated with increased anxiety-depressive symptoms and a more negative perception of health. Similarly, higher levels of alexithymia are connected to greater psychological distress and reduced interoceptive awareness. In contrast, psychological flexibility shows a protective role, promoting better mental health and adaptive functioning. These findings highlight the need to deepen our understanding of the psychological underpinnings of chronic illness, especially through approaches that account for individual differences in emotional regulation and coping. While existing research has offered promising directions, the field would benefit from longitudinal studies and the systematic inclusion of psychological variables in chronic care pathways. Integrating such perspectives may support more comprehensive and person-centered interventions, improving both clinical outcomes and patients' subjective experiences.

Background: Patients with psychotic disorders often have low levels of physical activity, and there's limited data on implementing exercise programs and systematically evaluating physical health among inpatients. This study, conducted in a closed psychosis unit, aimed to explore the feasibility of a 1-hour weekly walk activity, alongside assessing self-esteem.

Subjects and methods: From February 7 to July 11, 2025, patients at the Gaudi unit in Mons, Belgium, specializing in psychotic disorder care, were offered participation in a weekly supervised walk. Out of 64 evaluated inpatients, eligible individuals could choose between a 3 km or 5 km circuit. The study also planned to assess self-esteem using the Rosenberg Self-Esteem Scale (RSES) and to conduct qualitative analysis upon admission.

Results: Over 24 weeks, the average walk participation rate was 59.86% (255 out of 426 possible participations). Most preferred the 3 km circuit (75.69%), while fewer chose the 5 km (14.9%) or the 8 km combination (9.41%). However, comprehensive assessments (RSES, qualitative evaluation) were only offered to 12 of the 64 patients. Only 6 completed the qualitative evaluation, and 10 completed the RSES. This low assessment completion rate suggests the evaluations might be too challenging for this population.

Conclusion: Implementing a weekly walk activity in a closed psychosis unit is feasible. Nevertheless, integrating a study protocol for comprehensive physical and psychological assessments proved challenging. Future projects would require adapting assessment methods to be more realistic for this setting.

Background: Depression is a common disabling disease. Self-efficacy has been identified as a key factor in the prognosis of depression, as it influences how affected individuals cope and manage depressive symptoms.

Subjects and methods: This study aims to gain a deeper understanding of the factors that contribute to the development of personal self-efficacy by using a framework inspired by the Research Domain Criteria (RDoC). A total of 41 adult inpatients meeting DSM-5 criteria for major depressive disorder were assessed on a comprehensive battery of measures spanning emotional, cognitive, and social domains.

Results: Multiple linear regression analyses revealed that trait emotional intelligence and particularly its well-being and self-control subscales, was the most robust predictor of self-efficacy. Satisfaction with social support emerged as a secondary contributor.

Conclusions: These findings underscore the importance of targeting emotional intelligence and social support in therapeutic interventions for depression, suggesting that fostering adaptive emotion regulation and enhancing perceived support may bolster patients' confidence in their ability to manage depressive challenges.

Background: Cognitive impairment is a core and disabling feature of schizophrenia, with a profound impact on functional outcomes. Female patients often demonstrate better cognitive profiles than males, suggesting a potential modulatory role of sex hormones. Estrogens, particularly estradiol, have been hypothesized to exert neuroprotective effects via modulation of neurotrophic, neurotransmitter, and inflammatory pathways. However, evidence regarding the relationship between sex hormone levels and cognition in schizophrenia remains scattered and inconclusive.

Methods: This scoping review synthesized evidence from clinical and preclinical studies examining the association between endogenous estrogen levels or estrogen-based treatments and cognitive functioning in women with schizophrenia. We included peer-reviewed literature addressing hormonal fluctuations across the menstrual cycle, menopause, and in response to antipsychotic treatment, with specific focus on estradiol and selective estrogen receptor modulators.

Results: Findings suggest that low estrogen levels may be linked to more severe negative symptoms and poorer cognitive performance in female patients. Studies investigating menstrual cycle phases report mixed results, while evidence from animal models indicates potential cognitive benefits of estrogenic compounds. Raloxifene has shown promise in mitigating cognitive deficits when administered during sensitive developmental periods. However, large-scale hormonal interventions in postmenopausal women have produced inconsistent results, likely due to differences in timing, dosage, and individual neurobiological context.

Conclusions: Sex hormone levels, especially estradiol, appear to influence cognitive outcomes in women with schizophrenia, though findings are heterogeneous. Future research should address methodological inconsistencies and explore phase-specific, personalized hormonal strategies. A deeper understanding of hormonal-cognitive interactions may inform more effective, sex-sensitive treatment approaches in schizophrenia.

Both somatic and psychiatric abnormalities are not uncommon among politicians. Clinical insights may help to understand their suboptimal decisions and behavior. If a leader is psychotic while other functions are more or less intact, he or she can preserve abilities to remain in a position of power. Grave consequences occur when paranoid ideas persist in a dictator, so that delusions are put into life. Some people suffering from paranoid personality disorder are belligerent against delusional goals. Governments in democracy are more transparent; therefore, it is less probable that power would be kept by mentally abnormal individuals. In the author's opinion, there is danger of a large-scale war thanks to paranoid ideation in Vladimir Putin. Arguments in favor of this hypothesis are discussed here. More expert opinions are needed. In his childhood, Putin was a victim of maltreatment. Reportedly, child abuse statistically predicts psychosis and some other mental disorders. Putin formulated the aims of his military operation, one of them being protecting Russian-speakers from genocide. It is known that ethnic Russians have not undergone genocide. Apparently, this idea is delusional. Many people subscribe to delusions at large. Besides, there is a hypothesis that Putin has hubris syndrome. In conclusion, mental derangements in politicians should be diagnosed by psychiatrists on the basis of language and behavior.

Background: Recent studies suggest an overlap and mutual influence between Anorexia Nervosa (AN) and psychotic symptoms, with the anorexic voice proposed as a clinically significant marker within this spectrum. This cross-sectional observational study aimed to assess the prevalence and characteristics of psychotic symptoms, focusing on the anorexic voice, in patients with AN. Secondary objectives included exploring associations with dissociation, body image disturbance (BID), sociodemographic and clinical factors.

Subjects and methods: Forty-three patients were recruited from specialized outpatient and inpatient Services. Anamnestic history was collected, participants completed psychometric assessments, including Positive and Negative Syndrome Scale (PANSS), Brown Assessment of Beliefs Scale (BABS/BABS-A), Eating Disorder Examination (EDE-Q), Eating Disorder Inventory (EDI-3), Body Uneasiness Test (BUT), Body Shape Questionnaire (BSQ), Symptom Checklist-90 Revised (SCL-90-R), Dissociative Experience Scale (DES/A-DES), Community Assessment of Psychic Experiences (CAPE-42), Multidimensional Assessment of Interoceptive Awareness (MAIA).

Results: The anorexic voice was significantly associated with clinically relevant dissociation, not with BID. Subthreshold psychotic symptoms were common and significantly linked to body dissatisfaction, eating psychopathology and dissociation. Psychoticism was associated with BID, higher psychiatric comorbidity (especially personality and anxiety disorders), lower ideal BMI and greater general psychopathology. Adolescents showed higher levels of persecutory ideation, interpersonal alienation and general psychopathology.

Conclusions: Psychotic-like symptoms are highly prevalent in AN. The anorexic voice appears more closely related to dissociative processes than psychotic phenomena. Conversely, BID may play a significant role in the onset of predominant ideation about body shape and weight. Larger longitudinal studies are needed to clarify these relationships and their prognostic implications.

Background: Nutritional psychiatry is gaining recognition as a complementary approach to improving mental health. Although evidence supports the role of diet and nutraceuticals in psychiatric care, little is known about their integration into clinical practice by mental health professionals. This study investigates the knowledge, attitudes, and use of nutritional strategies among Italian psychiatrists and psychologists.

Methods: A cross-sectional survey was administered to 110 mental health professionals to assess their knowledge of nutritional psychiatry and the practical application of dietary interventions.

Results: Most participants reported discussing nutrition with patients and using dietary strategies, though inconsistently. Psychiatrists were more frequently engaged in nutritional counseling and in preventive strategies for somatic comorbidities. The Mediterranean diet emerged as the most commonly recommended model. Gender differences were noted, with female psychiatrists reporting significantly higher self-rated knowledge.

Conclusions: Italian mental health professionals show growing interest in nutritional psychiatry, yet its routine adoption remains limited by gaps in training and institutional support. Clear guidelines, accessible education, and interdisciplinary collaboration - including with dietitians - are essential to foster its integration into psychiatric care.