BACKGROUNDIllness anxiety disorder, also known as hypochondriasis, is characterized by excessive worry about having or developing a serious medical condition and has rarely been associated with delusional disorder.CASE SERIES PRESENTATIONTwo middle-aged patients with illness anxiety disorder gradually developed somatic-type delusional disorder. The first, a 45-year-old woman, had a two-and-a-half-year history of health-related fears involving her throat — an ulcer for six months, a cyst for one year and a tumor for one year. She initially showed improvement with fluoxetine over two months, but after discontinuing the medication for three months, developed a fixed delusion that she had throat cancer, accompanied by aggression and poor self-care. She responded to risperidone within three weeks, though symptoms relapsed after discontinuing the treatment at six months. The second patient, a 45-year-old man with anxious traits and a family history of psychosis, had a five-year history of concerns about having a gastric ulcer and liver failure despite repeated normal medical evaluations. He subsequently developed a delusional conviction of liver failure for three months and showed improvement within two weeks with cariprazine treatment. He remained stable for four months but relapsed after stopping the treatment. Upon restarting cariprazine, he achieved sustained remission for six months.CONCLUSIONThe factors leading to the transition of illness anxiety-related ideas into delusions require further study in the context of poor treatment adherence. It is equally important to distinguish delusional disorder from hypochondriasis, particularly in patients with poor or absent insight.

This article introduces the Bipolar Tensile Model, a neurosemiotic and integrative framework for understanding Autism Spectrum Disorder (ASD). The model reinterprets ASD not as a collection of deficits, but as the outcome of an unresolved tension between two complementary hemispheric cognitive modalities: symbolic-sequential and corporeal-perceptual. In typical development, these modalities are dynamically harmonized through an extended interhemispheric network, comprising the Default Mode Network, major cerebral commissures (corpus callosum, anterior and hippocampal), and the cerebellum.In ASD, the instability of this mediating system disrupts proprioceptive integration and generates polarized cognitive configurations, such as operational rigidity, sensory disorganization, and repetitive behaviors. Proprioception is understood not as a peripheral sensory channel, but as a semiotic regulator of interhemispheric coherence and embodied self-awareness.Drawing on a narrative synthesis of clinical, neuropsychological, and neurophysiological literature — and supported by representative clinical cases — the model highlights how interhemispheric disconnection and proprioceptive instability interact to shape atypical developmental patterns. It proposes compensatory adaptation, including local hyperconnectivity and symbolic overcompensation, as central mechanisms in the formation of ASD profiles.By integrating insights from semiotics, systems neuroscience, and embodied cognition, the Bipolar Tensile Model provides new perspectives on diagnosis, clinical interpretation, and individualized therapeutic approaches, with particular attention to the early identification of proprioceptive dysfunction and the design of integrative rehabilitation protocols.

BACKGROUNDChronic and recurrent dermatophytosis (CRD) might affect mental health morbidity as well as the quality of life of patients, although it has not been conclusively proven.AIMTo study the quality of life and mental health burden in patients with CRD as compared to those presenting with first-episode superficial dermatophytic infection (SDI).METHODSThe study included patients aged over 18 years with CRD or with first-episode SDI. Quality of life was assessed using the Dermatology Life Quality Index (DLQI), mental health morbidity — using the 12-item General Health Questionnaire (GHQ12) and the Hospital Anxiety and Depression Scale (HADS) defined as the HADS-A (anxiety) and the HADS-D (depression).RESULTSA total of 166 patients were examined: 104 with CRD and 62 with first-episode SDI. CRD patients had significantly poorer quality of life, especially in the “extremely large score category” as compared with SDI. The DLQI domains of “symptoms and feelings” and “daily activities” were the worst affected (in all cases p<0.05). In multivariate logistic regression analysis, body surface area involvement and HADS-A emerged as significant predictors of CRD.CONCLUSIONCRD patients had greater deterioration in mental health (HADS-A) as compared to patients with first-episode superficial dermatophytosis.

BACKGROUNDAutism Spectrum Disorder (ASD) is a complex neurodevelopmental condition with a globally increasing prevalence. Early detection is crucial for effective intervention, yet current diagnostic methods often result in delays. Emerging research suggests that prenatal biomarkers, including structural anomalies detectable via ultrasound, may offer opportunities for earlier identification.AIMTo synthesize current evidence on prenatal ultrasound-detectable anomalies associated with ASD and assess their potential as early predictors.METHODSA comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar for studies published between 2007 and 2025. Keywords included “autism spectrum disorder”, “prenatal ultrasound”, “fetal anomalies”, “preeclampsia”, “neurodevelopment” and “biomarkers”. Priority was given to recent and high-quality studies, including systematic reviews and large cohort analyses. The selected articles were read in full, and their key findings were summarized in a narrative form. The synthesis focused on describing the scope of the existing evidence, the prenatal ultrasound findings reported in relation to ASD, and on highlighting recurrent patterns or notable differences between studies.RESULTSSeveral studies report associations between ASD and prenatal anomalies such as ventriculomegaly, increased biparietal diameter, hyperechogenic kidneys, and congenital heart defects. However, these findings are not specific to ASD and show inconsistent predictive performance. Sensitivity and specificity vary widely across studies, and ethical concerns about overdiagnosis and disparities in access to care persist.CONCLUSIONPrenatal ultrasound may contribute to early ASD risk identification but lacks the accuracy required for standalone diagnosis. Integrating ultrasound findings with genetic and postnatal data, along with standardized protocols and further research, is essential to improve its predictive value and clinical application.

[This corrects the article DOI: 10.17816/CP15553.].

BACKGROUNDHypothyroidism, a common thyroid disorder, is typically associated with affective and cognitive symptoms. However, up to 15% of patients may also present psychotic symptoms, which represents a relatively rare and poorly understood manifestation. Existing literature on this condition consists primarily of isolated case reports, which describe short courses of antipsychotic treatment. In contrast, the present case illustrates a prolonged and more complex trajectory, contributing to a better understanding of the psychiatric presentations of hypothyroidism and their management.CASE PRESENTATIONWe report the case of a 42-year-old man hospitalized for violent behavior toward others and overt psychotic symptoms in untreated hypothyroidism. Tests revealed elevated thyroid-stimulating hormone levels of 34.925 mIU/L. Clinical evaluation confirmed significant psychiatric disturbance necessitating inpatient care. A diagnosis of secondary psychotic disorder due to hypothyroidism was established. The patient required prolonged antipsychotic treatment, and an initial attempt to discontinue treatment was unsuccessful. A second withdrawal attempt made several months later was successful, with full recovery and complete remission of symptoms. This remission was maintained despite recurrent thyroid-stimulating hormone level elevation, while thyroxine hormone levels remained within the normal range.CONCLUSIONThis case illustrates the importance of ruling out non-psychiatric medical causes in the differential diagnosis of psychiatric symptoms. It also highlights the need for individualized treatment plans and sustained follow-up, particularly in rare and poorly understood conditions for which no formal guidelines or standardized management protocols exist.

BACKGROUNDAnxiety disorders are the most common mental disorders, yet only about a quarter of affected individuals receive treatment. This necessitates the development of high-technology care approaches, including virtual reality.AIMTo analyze mental imagery associated with psychological safety and inner comfort to optimize the selection of relaxation content for virtual reality.METHODSParticipants completed standardized questionnaires: the Social Readjustment Rating Scale, the Well-being, Activity, Mood questionnaire, and a Safe Place interview. Statistical analysis included significance testing and one-way analysis of variance. Descriptions of safe places underwent qualitative analysis to identify the frequency of key semantic categories.RESULTSA total of 192 respondents (18–82 years) were stratified into three age groups: 18–39 (n=97), 40–49 (n=55), and 50 years and older (n=40). Age was negatively correlated with overall stress levels and positively correlated with emotional well-being. The highest stress levels were in the 18–39 age group. For safe place imagery, most descriptions (68.2%) were of natural landscapes, followed by urban motifs (22.9%); intrapsychic and spiritual symbols accounted for 8.9%. Within natural landscapes, water-related images were most frequent (39.5%). The image of a confined personal space was 2.4 times more common in participants aged 50 years and older.CONCLUSIONThe highest distress levels were observed in individuals under 40, indicating a greater need for relaxation interventions. Across all age groups, images of water associated with a safe place, while participants aged 50 years and older more frequently preferred personal spaces. The identified semantic categories can form a basis for thematic catalogs in virtual relaxation libraries.

BACKGROUNDDespite theoretical concepts about the key role of perfectionism in the formation of the symptoms of anorexia nervosa (AN), the aspects of the mutual influence between body mass index (BMI), perfectionism, and body image in patients with AN remain insufficiently studied or contradictory. Studying integrative cognitive processes, such as metacognition, may reveal new mechanisms of perfectionism’s influence on the clinical manifestations of AN.AIMThe assessment of the moderating effect of metacognition on perfectionism associated with BMI and body image in patients with AN.METHODSA cross-sectional study was conducted involving patients with AN who were undergoing inpatient treatment. Perception of one’s own body was assessed using the Body Image Questionnaire. Perfectionism was assessed using the Multidimensional Perfectionism Scale. The level of metacognition of patients was assessed using the Metacognition Assessment Scale-Abbreviated, which evaluates Self-reflectivity, Understanding the other’s mind, Decentration, and Mastery (the ability to develop adaptive strategies for coping and behaviour regulation). BMI was also recorded.RESULTSA total of 130 patients were examined. At a Mastery score of ≥4 higher perfectionism scores were associated with an increase in BMI, and at a Mastery level of ≤1 a higher level of perfectionism was associated with decreasing of BMI. Even with minimal Self-reflectivity scores (≥2), the negative effect of perfectionism on body image was evident. Body image disturbance was positively correlated with perfectionism. No correlations were found between BMI and perfectionism and between BMI and body image disturbance.CONCLUSIONThe effect of perfectionism on body image disturbance and BMI in patients with AN depends on the magnitude of Self-reflectivity and Mastery. The obtained data indicate the necessity of incorporating psychotherapy aimed at the development of metacognition in patients with AN.