Planning and problem solving across multiple psychiatric disorders in young adults.

Anxiety disorders and obsessive-compulsive disorder constitute a significant burden at both individual and societal levels, owing to their high prevalence rates and substantial functional impairment. One of the central factors in the chronification of these disorders is the use of maladaptive coping strategies that individuals develop in an attempt to manage their symptoms. This study examines the maladaptive coping strategies observed in panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder from a transdiagnostic perspective. It further aims to situate these strategies within the Research Domain Criteria framework, which shares conceptual coherence with the transdiagnostic approach. The reviewed literature indicates that although maladaptive coping strategies reduce anxiety in the short term, they serve to maintain psychopathology over the long term through negative reinforcement cycles. Transdiagnostic analysis reveals that threat appraisal and interpretation biases, intolerance of uncertainty, perseverative cognition, and emotional avoidance emerge as shared mechanisms across disorders. Maladaptive coping strategies may be conceptualized not merely as disorder-specific clinical presentations, but as distinct phenotypic expressions of underlying transdiagnostic mechanisms. The findings of this review are expected to contribute to the identification of maladaptive coping strategies and to inform the development of transdiagnostic treatment protocols.

Sleep disturbances in anxiety disorders: State of the art and management.

This study examined whether playing soccer in high school was associated with higher rates of mental health problems in early to middle adulthood. Longitudinal cohort study. The National Longitudinal Study of Adolescent to Adult Health ("Add Health") databases were analyzed. There were 221 individuals (53.8% women) who participated in high school soccer (without participating in football) and 2388 (67.2% women) who denied participating in soccer or any contact sports during high school. N/A. This study includes longitudinal data from individuals assessed at Wave I (n = 6503; median age = 15), Wave III (median age = 22), Wave IV (median age = 29), and Wave V (n = 4196; median age = 38). We compared those who played soccer with those who did not engage in contact sports on several mental health outcomes. When comparing those who played high school soccer with those who did not play contact sports, there were no differences in the proportion who had a lifetime diagnosis of depression, lifetime diagnosis of anxiety or panic disorders, suicidal ideation in the past year, psychological counseling in the past year, or current depressed mood at Waves III, IV, or V (all P-values > 0.05). In addition, we matched soccer players to control participants on biologic sex, race, and educational attainment to control for potential confounds; the results were similar and nonsignificant. Individuals who played soccer in high school did not have an increased rate of mental health difficulties at multiple follow-up time points during early to mid-adulthood.

The current research was made to investigate the effect of an intervention program based on CBT on coping with stress and psychological well-being in persons with panic disorder. This research was conducted between May 2021 and July 2022 in a training and research hospital and a university hospital as quasi-experimental design with two-site comparison research with a pretest-posttest and control group. The research's participants were 105 persons with panic disorder (54 in the control group and 51 in the experimental group). The Descriptive Features Form, the Psychological Well-being Scale (PWS), and the coping with stress scale (CSS) were utilized to gather data. The persons in the experimental group performed eight sessions (one session per week) of CBT-based intervention program in the form of group training, and no training was performed on the persons in the control group. The variation between the PWS and the CSS pretest total mean score and the posttest total mean score of the persons in the experimental group was statistically significant (p < 0.05). CBT-based intervention program can be utilized as an effective psychosocial intervention to enhance coping with stress and promote psychological well-being in persons with panic disorder.

This study explores processes of change for individuals who responded to low-intensity Cognitive Behavioural Therapy (CBT) for depression, Generalised Anxiety Disorder (GAD), or panic disorder. Routinely collected data from NHS Talking Therapies for Anxiety and Depression (TTad) services (N = 11, 396, 69.2% female) were analysed using network analyses. Nine Gaussian graphical models (GGMs) were conducted: for each disorder, across three time phases (assessment to start-of-treatment; start to mid-point of treatment; mid-point to end-of-treatment). Each GGM included 19 nodes, based on PHQ-9, GAD-7,and NHS TTad phobia scores, using residuals as indices of change for each node. Networks of symptom change were largely similar. Estimated network matrix similarity ranged between r = .74 and r = .91 across disorders, with depression and GAD networks more similar to each other than to panic disorder. Networks varied over time within the same disorder, more so for panic disorder (r = .61-.63) than GAD (r = .86-.90) or depression (r = .87-.93). There were close links between changes in worry-related items and feeling nervous or anxious, and between depressed mood and anhedonia across all networks, as well as links between sleep disturbance, appetite, trouble relaxing and irritability. Findings suggest shared patterns of co-change across anxiety and depression. There is a potential indication that therapy may work by leveraging existing natural change mechanisms rather than by creating entirely new patterns of symptom interaction. Networks also show associations between symptom changes specific to certain disorders at certain points in therapy.

Melasma is a hyperpigmentation disorder primarily affecting the face in reproductive-age women, with significant psychological impact [1]. A 2018 study reported stress exacerbated melasma in 54% of patients; depressive disorder (42%) and adjustment disorder (26%) were the most common psychiatric comorbidities [2]. Tranexamic acid (TXA), an anti-fibrinolytic synthetic lysine analog, started being used to treat melasma in 1979 and has been shown to significantly decrease the Melasma Area and Severity Index (MASI) in oral, injectable, and topical routes, as well as in combination with other melasma treatments [1, 3]. Reported side effects are mild and transient (injection pain, erythema, pruritus, urticaria, hyperpigmentation, hypertrichosis, gastritis, and hypomenorrhea), but psychiatric effects remain poorly documented [4, 5]. Given the efficacy of TXA treatment for melasma, the risk of developing psychiatric comorbidities as a result of treatment was hypothesized to be decreased. Utilizing the TriNetX database, the association between TXA use in melasma treatment and the rates of various psychiatric comorbidities was investigated via a multicenter cohort study. The International Classification of Diseases 10th Clinical Modification (ICD-10-CM) billing code L81.1 was searched on the TriNetX database in August 2025 to anonymously identify cases of melasma patients treated with TXA and propensity score-match them to patients not treated with TXA. This resulted in the inclusion of 21,525 patients in each cohort; no exclusions were performed. Demographics, including age, gender, race, and ethnicity, were collected (Table 1). Furthermore, psychiatric comorbidities (depression, anxiety, social anxiety, suicide attempt, sexual dysfunction, nicotine dependence, alcohol abuse, bipolar disorder, schizophrenia, and panic disorder) were collected by searching for their respective ICD-10-CM billing codes and assessed using risk ratios (RRs) and 95% confidence intervals (CIs) via Wald's method (Table 2) for each cohort. Per TriNetX data dissemination guidelines, groups with participant counts < 10 were suppressed. Patients diagnosed with melasma and treated with TXA had statistically significant decreased risks of depression (RR 0.708, CI 0.661–0.759, p-value < 0.0001), anxiety (RR 0.772, CI 0.729–0.818, p < 0.0001), nicotine dependence on cigarettes (RR 0.612, CI 0.541–0.693, p < 0.0001), alcohol abuse (RR 0.757, CI 0.628–0.913, p = 0.0034), and schizophrenia (RR 0.572, CI 0.468–0.699, p < 0.0001). However, the risk ratios of social anxiety (RR 0.773, CI 0.468–1.277, p = 0.3138), suicide attempt (RR 1.001, CI 0.417–2.404, p = 0.9983), sexual dysfunction not due to a substance or a known physiological condition (RR 0.916, CI 0.644–1.303, p = 0.6256), bipolar disorder (RR 0.851, CI 0.661–1.096, p 0.2112), and panic disorder (RR 0.965, CI 0.83–1.122, p = 0.6444) were statistically insignificant. The findings of this study demonstrate that TXA may decrease the risk of psychiatric comorbidities in melasma patients. This, in combination with TXA's alleviation of the physical effects of melasma as demonstrated in the literature, supports the overall satisfaction patients have with TXA treatment for melasma. Therefore, TXA should continue to be recommended to patients with melasma, especially those who are at risk of being affected by psychiatric comorbidities. Limitations of this analysis include the possibility of missing data from the TriNetX database because of using ICD-10-CM billing codes to identify melasma patients and their psychiatric comorbidities, which may not have been complete. Patients may have underreported their psychiatric comorbidities due to the sensitivity of those diseases. Furthermore, the severity of melasma and the method of TXA administration were not documented, which could have influenced risk ratios. This study only provides indirect evidence of mental benefit from TXA, based on diagnostic codes rather than direct patient-reported outcomes. While TXA has been shown to diminish pigmentation, long-term longitudinal studies of melasma patients throughout therapy are required to clarify whether psychological improvement is proportionate to pigmentation reduction and to assess long-term consequences. We gratefully acknowledge TriNetX Database for their contributions, without whom this research would not have been possible, and for making the participant data (and/or samples and/or cohort) examined in this study available. IRB approval status: This study was considered by our IRB to be nonhuman research and thus is exempt from review. Previous publishing or presentation: No prevalence data from this database has been previously published. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Panic disorder (PD) exhibits marked clinical heterogeneity, and individual differences in autistic traits may contribute to variability in symptom severity and treatment course. This study examined whether autistic traits are associated with panic severity and agoraphobic avoidance during pharmacological treatment. In this retrospective observational study, 41 adults with DSM-5-diagnosed PD receiving guideline-based pharmacotherapy were followed over six months. Symptom trajectories were assessed using the Panic Disorder Severity Scale (PDSS) at baseline, one month, and six months, while autistic traits were measured using the Autism Spectrum Quotient (AQ) at the six-month visit. Linear mixed-effects models and repeated-measures ANCOVA examined associations between autistic traits and symptom burden while adjusting for age and sex. PDSS total and agoraphobia scores declined significantly over time (p <.001). Higher AQ total scores were associated with greater overall PD severity (p = .043) and more pronounced agoraphobic avoidance (p = .015) across assessments. Exploratory analyses indicated that attention switching and social skills were associated with overall severity, whereas reduced imagination was specifically linked to agoraphobic severity. Age was independently associated with agoraphobic severity but not with overall panic severity. No significant Time × AQ interactions were observed, indicating comparable symptom improvement across trait levels during the six-month treatment period. These findings suggest that elevated autistic traits are associated with persistently higher symptom burden during treatment without altering pharmacological response.

Dynamic changes in metacognitive mechanisms and symptoms during the attention training technique: Insights from ecological momentary assessment.

Panic disorder is among the most common mental disorders, characterised by recurrent, unexpected panic attacks that are highly distressing and further lead to pervasive anxiety about future attacks and maladaptive behavioural changes. Existing pharmacological and psychological treatments often fail to produce lasting improvement, and relapse is common. Neither antidepressants, the current first-line drug treatments, nor benzodiazepines exert their actions sufficiently rapidly to head off panic attacks between the initial indications of panic symptoms and the fully developed panic attack. Therefore, there is a clear need for new pharmacological compounds, particularly those that could be administered at the first warning signs of an impending panic attack, to disrupt its genesis. Here we discuss the acid-sensing ion channel (ASIC) as a therapeutic target and the potential of amiloride, an ASIC antagonist administered via nasal spray, for rapid access to the brain, as a compound with potential to fill this need. We summarise relevant preclinical studies, including a demonstration of nebulised amiloride's ability to normalise responses to carbon dioxide, a panicogenic, brain-acidifying agent. Following existing safety, stability and pharmacokinetic studies, clinical trials are needed to test the efficacy of this compound in individuals with panic disorder and/or recurrent panic attacks.

Research in the mental health field has focused on exploration and implementation of digital interventions both in research and society. However, demographic and mental health factors that may influence engagement with research on such interventions have not been explored. This study aims to investigate the relationship between demographics, signs of mental disorders, and interest in participating in an intervention study. Using data collected in the Swedish arm of the World Health Organization’s World Mental Health International College Student (WHO-WMH-ICS) initiative (n = 9140), we conducted a multinomial logistic regression to assess relationships between these factors. Older age, as well as female and non-binary gender identities, were factors significantly associated with increased interest in the intervention study. Treatment flags, indicating fulfilment of criteria for possible mental disorder diagnosis, were significantly associated with clear interest (“yes” response) in intervention research for five of the 15 treatment flags: depression, general anxiety, social anxiety, panic disorder and self-harm. Possible interest (“maybe” response) was also indicated for four of these, excluding general anxiety. These findings may facilitate a better-informed approach to recruiting student participants for treatment research, enhancing unbiased recruitment practices, reducing treatment gaps, and increasing engagement in digital intervention studies for improved mental health.

Different anxiety types demonstrate overlapping clinical features while retaining distinct characteristics, often leading to diagnostic challenges. Existing diagnostic approaches predominantly rely on symptom-based criteria, which may result in ambiguity. The identification of biomarkers is essential for elucidating the metabolomic mechanisms underlying anxiety, thereby informing improved diagnostic and therapeutic strategies. We conducted a Mendelian randomization (MR) study, utilizing data from genome-wide association studies (GWAS) on plasma metabolites and three anxiety types. The study meticulously evaluated instrumental variable, as well as heterogeneity, horizontal pleiotropy, and directionality, supplemented by sensitivity analyses. Initial MR analysis identified common risk metabolites across the three anxiety subtypes. Subsequent sensitivity analyses revealed five specific generalized anxiety disorder (GAD) risk markers, including 3-hydroxy-2-ethylpropionate (OR = 1.248, PIVW = 0.012) and the glutarate (C5-DC) to salicylate ratio (OR = 1.314, PIVW = 0.007). Among social anxiety disorder (SAD) risk markers, 5-hydroxyhexanoate (OR = 1.005, PIVW = 0.010) was unique. Potential panic disorder (PD) risk metabolites were identified as arabitol/xylitol (OR = 1.002, PIVW = 0.011), 2-hydroxy-3-methylvalerate (OR = 1.002, PIVW = 0.008), and the AMP to phosphate ratio (OR = 1.003, PIVW = 0.004). Protective factors for GAD included X-17354 (OR = 0.739, PIVW = 0.023) and the salicylate to citrate ratio (OR = 0.754, PIVW = 0.010). This study highlights potential metabolomic pathways involved in the shared and distinct clinical features of GAD, SAD, and PD. These findings suggest novel biomarkers for developing targeted treatments for anxiety disorders.This study investigates the causal relationship between plasma metabolites and three common types of anxiety disorders using MR analysis. Our findings propose a novel direction for utilizing metabolites as biomarkers in the diagnosis and treatment of anxiety disorders.

Anxiety is a common disorder characterized by excessive fear, tension, and physical symptoms, such as sweating and palpitations. There are approximately 16.6 % of patients worldwide affected by anxiety disorders, which have been classified as panic disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, obsessivecompulsive disorder, and phobias. The amygdala plays a central role in regulating fear, anxiety, and aggression, particularly when influenced by trauma or heredity, which can contribute to the development of anxiety disorders. Another contributing factor is oxidative stress, characterized by reduced antioxidant levels and increased cellular damage. Neurotransmitters, such as serotonin, norepinephrine, and Gamma-Aminobutyric Acid, are critical in controlling anxiety. Anxiety also usually involves imbalances, in particular, low levels of serotonin and high norepinephrine. N-Methyl-D-aspartate and Cholecystokinin brain receptors are involved in long-term fear memory encoding, suggesting potential new targets for treating this condition. Although conventional pharmacological treatments such as benzodiazepines and selective serotonin reuptake inhibitors are effective, they are often associated with side effects, dependency, and limited long-term efficacy. In recent years, plant-based bioactive compounds have gained attention as potential alternatives or adjunct therapies for managing anxiety disorders, and they act in Gamma-Aminobutyric Acid modulation and monoamine regulation. Anxiety can be treated through herbal medicine using ethnopharmacology.

Magnetic Resonance (MR) is a medical imaging technology where magnetic fields are used to make internal images of body organs to help medical practitioners visualise them for therapeutic and diagnostic purposes. Although MRI is a relatively safe procedure, the patients may go through significant anxiety or claustrophobia from having to lie down in a confined space for prolonged periods of time during the imaging procedure. The study explored the prevalence of claustrophobia amongst patients visiting the AgaKhan University Hospital. The study specifically aimed to determine if pre-exposure to an MRI machine would reduce fear and anxiety during MRI examinations in the radiology department of Aga Khan University Hospital, and whether age is more susceptible to fear and anxiety during MRI examinations. The study adopted a cross-sectional research design. The study targeted patients aged between 18-60years. Based on the Cochran formula, 140 participants were chosen. A questionnaire was used to assess patients undergoing the MRI procedure and participants with panic disorder. This study used SPSS version 28 to analyse data. The data was presented in tables. The study found that the prevalence of claustrophobia amongst patients visiting the radiology department at Aga Khan University Hospital for MRI examination was 42.9%. Those who had been exposed to MRI scans before had higher odds of having claustrophobia (1.071) than those who had not been exposed before (0.833). In addition, those aged 18-20 years and above 50 years had higher odds of being claustrophobic. Based on the findings, the study recommends that health professionals conducting MRI examinations should be prepared to assist the young and old patients, who were found to have a higher prevalence of claustrophobia as compared to middle-aged individuals.

Love is a losing game: The experience of romantic love in social anxiety disorder.

Anxiety in the youth today has reached to an alarming situation where feelings of fear, worry and uneasiness have converted into excessive and persistent restlessness, confusion and loss of clear identity to emerge as an confident individual. This has triggered their physical, emotional, academic and behavioural patterns into identifiable disorders i.e Generalized Anxiety Disorder, Phobias, Panic Disorder and Social Anxiety Disorder. Loss of interest in studies, unbalanced aggression, suicide are some unwelcome outcomes of these disorders. Indian and Foreign scales are available for identifying symptoms. Yet, while working with adolescents from Indian schools and colleges, there emerged a need to have scale for career, academic, behavioural and personal anxiety can be measured as to formulate a comprehensive anxiety score in order to design interventions accordingly. AAS (Adolescent Anxiety Scale) was conceptualized and designed as an answer for the required need. It is a questionnaire having 25 items which were obtained after going through the various stages of making a standardized scale. On sample size of 150 students, AAS scores were correlated with TMAS (Tailors Manifest Anxiety Scale). AAS and TMAS were found significantly correlated (r=0.690, p &lt; 0.001), suggesting the Adolescent Anxiety Scale has convergent validity with TMAS.

Medical Student Syndrome (MSS) is often understood as a manifestation of illness anxiety disorder where medical students misinterpret benign symptoms as signs of a serious illness. Current explanations rely heavily on psychological factors; however, these fail to capture the systemic reasoning errors that underly MSS. This paper proposes a mixed model: that MSS results from a combination of the Bayesian reasoning failure of base rate neglect and psychological stressors. An observational cross-sectional study of medical students was conducted $$\left(n=112\right)$$. Participants completed an anonymous survey assessing self-reported MSS, responses to medical diagnostic scenarios modelled on Kahneman and Tversky’s “librarian or farmer” problem, and prioritisation of diagnostic reasoning components. Descriptive statistics and categorical analysis of qualitative responses were performed. A history of MSS was reported by 56.3% of participants. Diagnostic accuracy was low for both medical scenarios (48.3% correct for differentiating between stroke and migraine; 33.3% for differentiating between pheochromocytoma and panic disorder) and the Bayesian reasoning task (41.1% correct). 71% of students who answered medical questions incorrectly also failed the Bayesian task, suggesting a shared underlying process. 14% of students with a history of MSS answered both questions correctly. Students ranked pathophysiology and symptoms of the presenting complaint as most important in diagnosis, and epidemiology as the least important (mean rank = 8.8/9). Self-analysis of errors showed that most students attributed their mistakes to poor probabilistic reasoning rather than a lack of knowledge. The findings support the explanation of MSS as partially a statistical reasoning error rather than a purely psychological condition. Training in Bayesian reasoning, integration of epidemiology into diagnostic teaching, and diversification of assessment formats may mitigate MSS and enhance diagnostic accuracy for medical students.

Anxiety disorders, encompassing generalized anxiety disorder, social anxiety, panic disorder, and specific phobias, are pervasive mental health conditions associated with significant distress and functional impairment. A comprehensive search was conducted from July 2024 to December 2025 across PubMed, Scopus, and Embase from inception to the present. According to the document on metabolomic markers in disorders of anxiety, these disorders arise from a complex interaction of genetic, neurobiological, and psychosocial factors. Key challenges in managing anxiety disorders include accurate diagnosis and distinguishing anxiety symptoms from overlapping medical conditions such as asthma, atrial fibrillation, and hyperthyroidism. The present investigation is narrative review. It provides an informative, valuable narrative review of the history, abnormalities, and roles of neurotransmitters—norepinephrine, serotonin, dopamine, and GABA—and the involvement of brain structures such as the amygdala and limbic system, which underscore the neurobiological basis of anxiety. Current treatments concentrate on a combination of Selective serotonin reuptake Inhibitors (SSRIs), serotonin-nor-epinephrine reuptake Inhibitors (SNRIs), and benzodiazepines, alongside cognitive behavioural remedy (CBT). However, these approaches are not universally effective, and issues such as drug dependency and side effects remain critical obstacles. Emerging research in metabolomics offers potential for identifying biomarkers that could improve diagnostic accuracy and treatment personalization. Integrating metabolomic insights with traditional and complementary therapies may enhance treatment outcomes. Addressing these multifaceted challenges requires interdisciplinary collaboration to advance research and develop tailored, effective strategies for managing anxiety disorders in diverse patient populations. Keywords: Anxiety, Anxiety disorders, Metabolomic markers, Biomarkers

Patients who undergo cardiac transplantation or implantation of LVADs are significantly affected by mental health disorders and substance use problems, which can negatively impact their compliance and quality of life. There is a paucity of research regarding mental health and substance abuse disorders in the post-LVAD implant/ cardiac transplant population. This narrative review will focus on the knowledge gaps </P> Methods: A qualitative review was performed by conducting a literature search using PubMed and Google Scholar. Adults 18 years and older with LVAD or cardiac transplant were included. The keywords used were anxiety, depression, mood disorder, panic disorder, PTSD, adjustment disorder, and eating disorders in LVAD patients, and anxiety, depression, mood disorder, panic disorder, PTSD, and adjustment disorder in heart transplant patients. No geographical parameters were used in the search. All papers retrieved were reviewed qualitatively, and relevant information obtained was synthesized to arrive at the results and conclusions presented in this review. </P> Results: This narrative review showed that anxiety, depression, mood disorder, panic disorder, PTSD, adjustment disorder, and eating disorder exist in patients undergoing advanced surgical therapies (durable LVADs and cardiac transplantation). Most of the relevant studies are retrospective chart analyses done in single centers. Incidence and prevalence vary widely. </P> Discussion: This review highlights the importance of mental health surveillance in patients undergoing LVAD and cardiac transplantation to enhance outcomes by improving behavioral health and compliance. </P> Conclusions: There are no granular guidelines to address psychosocial evaluation in this population. The current literature does not help to distinguish any differences mechanical support would have on the psychology of these patients as compared to cardiac transplantation. Knowledge gaps exist in risk assessment and risk stratification of patients, which need further investigation.

Post-orgasmic Illness Syndrome Masquerading as Panic Disorder: Diagnostic Challenges and Successful Restoration of Sexual Health