Mental Disorders Research Articles

Study protocol and preliminary baseline characteristics of a VA multi-site, mixed methods, randomized controlled study evaluating supported employment provided to veterans with opioid use disorder

Opioid Use Disorder (OUD) is a pervasive and devastating public health crisis that continues to take a heavy toll on individuals and communities across the United States. In 2021, approximately 473,000 veterans misused opioids in the past year. In the context of their military service and post-service life, Veterans with OUD often encounter unique barriers to recovery, including the reintegration into civilian society and the pursuit of stable, meaningful employment. The path to recovery from OUD is inextricably linked to the restoration of a stable and purposeful life, a fact underscored by the interplay of substance use, mental health, and employment outcomes. These factors necessitate a comprehensive approach to treatment that extends beyond mere pharmacological interventions. One such approach is Individual Placement and Support (IPS), a well-established evidence-based practice that focuses on supporting individuals with severe mental illness in their pursuit of competitive employment. The primary objective of this manuscript is to describe a two-arm, multi-site RCT designed to rigorously evaluate the efficacy of IPS when provided to veterans with OUD and provide the baseline demographics and characteristics of the participants who have enrolled to date. The central hypothesis guiding this research is that IPS can significantly improve vocational, psychosocial, and treatment outcomes of veterans in recovery from OUD, ultimately leading to a more successful reintegration into civilian life. Our study is timely as the VA has expanded IPS services to veterans with SUD this past year. Thus, this study is one of the first to examine IPS in a subpopulation of veterans with a SUD and may provide actionable data to support sustainment of IPS with this population.

Client experiences of a task-shifting supported self-management intervention for depression in Vietnam

BackgroundThe global burden of mental illness is substantial, with depression impacting close to 300 million people worldwide. This has been exacerbated within the context of the COVID-19 pandemic. Yet, in many low- and middle-income countries including Vietnam, there is a substantial treatment gap, with many requiring mental health care unable to access it. Task-shifting is an evidence-based approach that seeks to address this gap by utilizing non-specialist providers to provide care. While there is a large body of literature exploring task-shifting, there is little that explores the client experience. This paper describes the facilitators and barriers impacting the client experience of a task-shifting supported self-management (SSM) intervention for depression in Vietnam. SSM involves a client workbook and supportive coaching by non-specialist providers.MethodsThis paper is situated within a randomized controlled trial that demonstrated the effectiveness of the SSM intervention in adult populations across eight provinces in Vietnam. Semi-structured interviews were conducted with a convenience sample of clients (recipients of the intervention) with depression caseness as measured by the Self-Report Questionnaire-20 depression screening measure, and providers (non-specialist “social collaborators”) to explore SSM’s acceptability and factors influencing participation and adherence. This paper presents the qualitative findings from an analysis of the interviews, focusing on the client perspective. Qualitative descriptive methods and thematic analysis were used.ResultsForty-five clients were interviewed. Sub-themes reported for the facilitators and benefits for the client experience of the SSM intervention were client-provider relationship building and family and community connections. Sub-themes reported for the barriers were clients’ responsibilities, clients’ health conditions, and consequences of stigma.ConclusionsDue to challenges with sustaining and scaling up the in-person SSM intervention in Vietnam, the research team has pivoted to delivering the SSM intervention digitally through a smartphone-based app adapted from SSM, with direction from the Government of Vietnam. Findings from this study suggest that while digital interventions may support accessibility and convenience, they may neglect the critical human contact component of mental health care. Ultimately, a model that combines digital delivery with some form of human contact by a support person may be important.

Intuitive eating predictors and outcomes in people with severe mental illness participating in a lifestyle intervention.

People with severe mental illness (SMI) are at higher risk of preventable diseases than the general population; poor diet contributes to heightened risk. Adaptive approaches designed to improve intuitive eating may improve dietary behaviours in people with SMI. Aims of this study were to investigate predictors of, and assess the impact of a nutrition program on, intuitive eating in people with SMI. This was a retrospective analysis of an exercise and nutrition program for people with SMI. The primary outcome was intuitive eating assessed using the Intuitive Eating Scale 2 (IES2); psychological distress was measured using the Kessler-6 scale. Regression analyses were conducted on baseline data; change in intuitive eating was assessed using Wilcoxon tests. A total of 93 participants had complete data for regression analyses, and 32 completed pre/post-assessments. The most common mental health diagnosis was psychotic disorder (35%); 74% had BMI > 25 kg/m2. The regression model significantly predicted total IES2 score and three intuitive eating domains. Body mass index (BMI) was negatively associated with these outcomes (β = -0.234 to -0.248; p < 0.05). Both BMI and psychological distress were negatively associated with body-food choice congruence (B-FCC), and only B-FCC was improved at post-intervention. Higher BMI and psychological distress were associated with lower intuitive eating in people with SMI. Nutrition interventions may improve B-FCC in people with SMI. SO WHAT?: Given the interrelatedness of BMI and psychological distress with psychosocial stressors, nutritional interventions should be implemented alongside holistic approaches to improve health equality.

Spirituality in logotherapy and existential analysis by Viktor Emil Frankl

A proper image of man forms the basis of all kinds of practice – educational, medical, pastoral – including psychotherapeutic practice. What, then, constitutes the constitutive element of this image? In search of the answer to this question, Logotherapy, created by Viktor Emil Frankl, was examined. The key dimension of human existence in Logotherapy is the spiritual dimension. Starting with a general characteristic of Logotherapy as a psychotherapeutic approach, a detailed analysis of the spiritual dimension in this context was conducted, outlining its various manifestations against the backdrop of broader philosophical assumptions on which Frankl constructed the foundations of his theory. The theoretical aspects were related to examples from case studies described by Frankl and his contemporary followers. The aspect of spiritual unconsciousness, distinct from the unconscious in the psychoanalytic sense, was also discussed. Based on the analyses conducted, it was concluded that the spiritual dimension of human existence constitutes an inalienable and fundamental way of being, even if that dimension is unconscious or, to use Frankl’s terminology, even if it is “walled off,” for example, due to mental illness. The spiritual dimension itself is not subject to illness, which creates a hopeful area for psychotherapeutic work and serves as a source of resources manifested, for instance, in the so-called “power of the spirit’s resistance.” The extraordinary potential of Logotherapy lies in the connection between the spiritual dimension and meaning, which, according to Frankl, is the strongest motivating factor. The spiritual dimension directs us to something greater than ourselves – to the meaning that awaits realization. The more the spiritual dimension is a governing dimension, the more a person is integrated around this dimension, the easier it is for them to perceive the unique call to meaning that permeates all life circumstances and continually offers itself anew.

Prescribing of antipsychotics for people diagnosed with severe mental illness in UK primary care 2000-2019: 20-year investigation of who receives treatment, with which agents and at what doses.

Contemporary data relating to antipsychotic prescribing in UK primary care for patients diagnosed with severe mental illness (SMI) are lacking. To describe contemporary patterns of antipsychotic prescribing in UK primary care for patients diagnosed with SMI. Cohort study of patients with an SMI diagnosis (i.e. schizophrenia, bipolar disorder, other non-organic psychoses) first recorded in primary care between 2000 and 2017 derived from Clinical Practice Research Datalink. Patients were considered exposed to antipsychotics if prescribed at least one antipsychotic in primary care between 2000 and 2019. We compared characteristics of patients prescribed and not prescribed antipsychotics; calculated annual prevalence rates for antipsychotic prescribing; and computed average daily antipsychotic doses stratified by patient characteristics. Of 309 378 patients first diagnosed with an SMI in primary care between 2000 and 2017, 212,618 (68.7%) were prescribed an antipsychotic between 2000 and 2019. Antipsychotic prescribing prevalence was 426 (95% CI, 420-433) per 1000 patients in the year 2000, reaching a peak of 550 (547-553) in 2016, decreasing to 470 (468-473) in 2019. The proportion prescribed antipsychotics was higher among patients diagnosed with schizophrenia (81.0%) than with bipolar disorder (64.6%) and other non-organic psychoses (65.7%). Olanzapine, quetiapine, risperidone and aripiprazole accounted for 78.8% of all antipsychotic prescriptions. Higher mean olanzapine equivalent total daily doses were prescribed to patients with the following characteristics: schizophrenia diagnosis, ethnic minority status, male gender, younger age and greater relative deprivation. Antipsychotic prescribing is dominated by olanzapine, quetiapine, risperidone and aripiprazole. We identified potential disparities in both the receipt and prescribed doses of antipsychotics across subgroups. To inform efforts to optimise prescribing and ensure equity of care, further research is needed to understand why certain groups are prescribed higher doses and are more likely to be treated with long-acting injectable antipsychotics compared with others.

Practice Resource for Reproductive Psychiatry/Women's Mental Health in Forensic Psychiatry Practice.

This practice resource seeks to describe salient problems within reproductive psychiatry (also known as women's mental health) for the practice of forensic psychiatry. Understanding is critical and can help combat gender bias in such evaluations. Forensic psychiatric evaluations in the criminal realm, including evaluations related to neonaticide, infanticide, filicide, child abuse, and kidnapping by cesarean, require an understanding of reproductive psychiatry. Civil forensic evaluations requiring knowledge about reproductive psychiatry include parenting evaluations and risk assessments in the postpartum. Similarly, forensic psychiatrists performing a treatment role within corrections or forensic hospitals recognize the importance of understanding mental illness in pregnancy and postpartum, lactation, mother-baby units, and forced separation or custody loss. In addition to menstruation, pregnancy, and postpartum, specific concerns that bear consideration within reproductive forensic psychiatry include the periods of girlhood and menstruation. Finally, eating disorders and substance misuse bear additional attention in this group.

Screening of the key genes and signaling pathways for schizophrenia using bioinformatics and next generation sequencing data analysis

Schizophrenia is thought to be the most prevalent chronic psychiatric disorder. Researchers have identified numerous proteins associated with the occurrence and development of schizophrenia. This study aimed to identify potential core genes and pathways involved in schizophrenia through exhaustive bioinformatics and next generation sequencing (NGS) data analyses using GSE106589 NGS data of neural progenitor cells and neurons obtained from healthy controls and patients with schizophrenia. The NGS data were downloaded from the Gene Expression Omnibus database. NGS data was processed by the DESeq2 package in R software, and the differentially expressed genes (DEGs) were identified. Gene ontology (GO) enrichment analysis and REACTOME pathway enrichment analysis were carried out to identify potential biological functions and pathways of the DEGs. Protein-protein interaction network, module, micro-RNA (miRNA)-hub gene regulatory network, transcription factor (TF)-hub gene regulatory network, and drug-hub gene interaction network analysis were performed to identify the hub genes, miRNA, TFs, and drug molecules. Potential hub genes were analyzed using receiver operating characteristic curves in the R package. In this investigation, an overall 955 DEGs were identified: 478 genes were remarkably upregulated and 477 genes were distinctly downregulated. These genes were enriched for GO terms and pathways mainly involved in the multicellular organismal process, G protein-coupled receptor ligand binding, regulation of cellular processes, and amine ligand-binding receptors. MYC, FN1, CDKN2A, EEF1G, CAV1, ONECUT1, SYK, MAPK13, TFAP2A, and BTK were considered the potential hub genes. The MiRNA-hub gene regulatory network, TF-hub gene regulatory network, and drug-hub gene interaction network were constructed successfully and predicted key miRNAs, TFs, and drug molecules for schizophrenia diagnosis and treatment. On the whole, the findings of this investigation enhance our understanding of the potential molecular mechanisms of schizophrenia and provide potential targets for further investigation.

Psilocybin increases emotional empathy in patients with major depression.

Empathy plays a crucial role in interpersonal relationships and mental health. It is decreased in a variety of psychiatric disorders including major depression. Psilocybin, a promising candidate for treating depression, has been shown to acutely increase emotional empathy in healthy volunteers. However, no study has investigated this effect and its relevance for symptom improvement in a clinical population. This study examines the enduring effects of psilocybin-assisted therapy on empathy in depressed patients using a randomized, placebo-controlled design. Fifty-one depressed patients were randomly assigned to receive a single dose of psilocybin (0215 mg/kg body weight) or a placebo embedded in a 4-week psychological support intervention. Empathy was measured using the Multifaceted Empathy Test at baseline and 2 days, 1 week, and 2 weeks after substance administration. Changes in empathy were compared between treatment conditions. Patients who received psilocybin showed significant improvements in explicit emotional empathy driven by an increase in empathy towards positive stimuli compared to the placebo group for at least two weeks. This study highlights the potential of psychedelics to enhance social cognition in individuals living with depression and contributes to a better understanding of the psychological mechanisms of action of psychedelics. Further studies are necessary to investigate the interaction between social cognition and clinical efficacy.The trial is registered on clinicaltrials.gov (Identifier: NCT03715127) and KOFAM (Identifier: SNCTP000003139).

Modern Psychiatry: from Theory to Practice

In this review scientific papers published on eLibrary, PubMed, Google Scholar were searched and analyzed for all time till 2024 year on the problem of neuropsychiatry, translational neuro-science, biomarkers. The issues of precision psychiatry and targeted therapy of mental disorders are considered. The ways of bridging the gap between theoretical and practical (clinical) psychiatry are discussed.

The Role of Pharmacogenetic Testing in Overcoming Pseudoresistance and Hyperprolactinemia in a Patient with Schizophrenia (Case Report)

Schizophrenia is a chronic mental disorder. It is treated with antipsychotics, which have a high risk of adverse drug reactions. Approximately 20-30% of patients with schizophrenia remain resistant to psychopharmacotherapy. Determining the individual predisposition to the response to antipsychotics and antipsychotic-induced adverse drug reactions development is possible using pharmacogenetic testing. Purpose is to present the role of pharmacogenetic testing in optimizing antipsychotic therapy. Materials and methods: The peripheral blood of patients was genotyping using real-time polymerase chain reaction. Results: This case report is about a 30- year-old female patient with paranoid schizophrenia, which had a long history of low effectiveness and poor tolerability of antipsychotics. The treatment was complicated by the pituitary microadenoma presence. According to the PGx results, the patient has a “poor transporter” phenotype, which also explains the high risk adverse drug reactions developing and therapeutic resistance while taking P- glycoprotein substrates antipsychotics. For the treatment, the antipsychotic brexpiprazole was selected, which did not have the P-glycoprotein substrate properties. It made possible to achieve paranoid schizophrenia remission and hyperprolactinemia correction. Conclusion: This case report demonstrates that wider implementation of pharmacogenetic testing into real clinical practice could help significantly improve the efficiency and safety of antipsychotic therapy.

Long-term ambient air pollution and the risk of major mental disorder: a prospective cohort study.

Long-term ambient air pollution and the risk of major mental disorder: a prospective cohort study.

The use of new psychoactive substances among young adults in Romania

Background and objectives. The consumption of new psychoactive substances (NPS), particularly among young people, remains a significant public health issue. The principal objective of this study was to identify the incidence and prevalence of NPS use among young people in Romania and the impact of the consumption on their mental health. Materials and methods. A cross-sectional study was conducted on a sample of 231 Romanian participants on March-April 2023. Data were collected through an online questionnaire and analyzed using GraphPad and Excel statistical software. Results. The prevalence of NPS use was 38.10% within the sample The analyzed data indicated an increased incidence of NPS use among male participants. Notably, most respondents who reported NPS use were students, accounting for 23.38% of users. Among the total of 88 NPS users, 22.68% consumed synthetic cannabinoids, 14.09% bath salts, and 13.75% used mephedrone. Less frequently consumed substances included synthetic opioids, methamphetamines, synthetic piperazines, Salvia divinorum, and MDPV. A significant proportion of users reported severe psychiatric symptoms including psychosis, depression and anxiety. Among non-users, awareness of the side effects of NPS influenced over half of them to avoid such substances. Conclusions. NPS use impacts predominantly young people. Organizing prevention and information campaigns about the implications of NPS use and its immediate harmful effects could help reduce its prevalence among young individuals.

The prevalence of burnout and coping strategies among Palestinian health professionals: a cross sectional study

IntroductionDuring times of conflict, healthcare personnel face a heightened vulnerability to experiencing psychological problems such as burnout. The impact of conflict or wars on mental health professionals in Palestine and their strategies for managing these problems are currently not recognized. This study sought to assess the prevalence of burnout symptoms and coping strategies among healthcare workers in Palestine, in the context of the ongoing conflict and political violence.MethodsThe study utilized a cross-sectional research design. Self-reported questionnaires, including the shortened version (9 items) of The Maslach Burnout Questionnaire and Brief COPE scales, were used to gather data. The relationship between the research variables and burn symptoms was investigated using Chi-squared test, Student’s t-test, Mann–Whitney, and Analysis of variance and multi-regression.ResultsA total of 713 participants were recruited. The prevalence rates were as follows: burnout—(72.9%), emotional exhaustion (44.2%), depersonalization (9.8%), and low personal accomplishment (72.2%). The multivariate analysis found that those who worked more than 16 h per day and those who had 1–15 years of job experience were more likely to had emotional exhaustion. Active coping, substance use, informational support, and emotional support all reduced the likelihood of burnout while behavioral disengagement and self-blame increased the possibility of experiencing burnout. Finally, substance use decreased emotional exhaustion, increased depersonalization and enhanced personal accomplishment.ConclusionThe findings revealed a high prevalence of burnout among health professionals during wartime and political violence. As a result, health professionals are vulnerable to mental problems during political violence and they need immediate assistance in enhancing their mental wellbeing through psychological support, and comprehensive training in stress management.

Features of mental state and reproductive function in dynamics inmentally ill women with infertility

Women suffering from a mental disorder are faced with the problem of pregnancy and the realisation of their reproductive rights throughout their lives. The presence of a mental disorder largely determines the onset, course and outcome of pregnancy. A deterioration in mental health is often accompanied by an impairment of menstrual and reproductive function, and an improvement contributes to their recovery.Objective: to analyse individual indicators of reproductive function in women with various mental disorders and infertility in dynamics according to the follow-up data.Material and methods. The study included 120 women with various mental disorders and infertility, who were observed for 2 years by a psychiatrist and a gynaecologist on the background of treatment of the existing disorders.Results. In 70% of cases, mentally ill women have primary infertility, with idiopathic infertility predominating (63.3%), especially in the context of secondary infertility (77.8%; p&lt;0.05). Treatment of infertility by gynaecologists and mental disorders by psychiatrists leads to the normalization of the menstrual cycle and the onset of pregnancy. Pregnancy is usually accompanied by obstetric and somatic complications (fetal growth retardation and miscarriage, placental disorders, hypertension, oedema, lipid metabolism disorders, gestational diabetes mellitus). Reproductive function is impaired mostly in patients with schizophrenia and affective disorders, they account for 80.8% of observed infertility. Fertility is lowest in patients with paranoid schizophrenia: pregnancy occurred in 12.9% of patients, none of them gave birth. In schizoaffective disorder, 43.75% of women became pregnant, but only 20% gave birth. In bipolar affective disorder (BAD) type I, pregnancy occurred in 87.5% of patients (of which 57.1% resulted in a childbirth), in bipolar disorder type II – in 43.75% (of which 42.8% resulted in a childbirth), and in recurrent depressive disorder – in 60% (of which 50% resulted in a childbirth). In these disorders, the duration of infertility correlates with the duration of the disease (p&lt;0.05). In neurotic disorders, fertility suffers to a lesser extent: pregnancy with recovery or significant improvement of the mental condition occurred in 75–100% of cases, but only 66.7% of cases resulted in a child birth. Childbirth was mainly performed by caesarean section.Conclusion. Reproductive function in mentally ill women depends largely on the type of mental disorder, the characteristics of its course, the efficacy of psychopharmacotherapy, the quality of remission and the degree of social and family adaptation, which must be taken into account in the diagnosis and treatment of infertility.

Unveiling the subconscious: How sexual dreams reflect and intensify mental problems

AbstractBackgroundSexual dreams represent a largely underexplored domain of human experience, particularly concerning their prevalence, frequency, and potential relationship with mental health conditions. Understanding this interplay may provide insights into the psychological and physiological effects of dream content.AimsTo investigate the prevalence, frequency, and impact of sexual dreams among individuals with and without mental health diagnoses and to evaluate the associations between sexual dream frequency, post‐dream symptoms, and mental health status.Materials &amp; MethodsThe SLEEP Study surveyed 301 female‐identifying adults in the United States using an online questionnaire. The questionnaire assessed the frequency and content of sexual dreams, as well as post‐dream symptoms such as anxiety, increased heart rate, and muscle tension. Logistic regression and Pearson correlation analyses were conducted to examine relationships between sexual dream frequency, mental health diagnoses, and post‐dream symptoms.Results99.67% of participants reported experiencing sexual dreams, with 45.2% identifying them as frequent. A significant association was observed between frequent sexual dreams and mental health diagnoses (OR = 1.83, p = 0.018). While post‐dream symptoms such as anxiety and physical tension were common, their correlations with mental health treatment were weak and not statistically significant (p = 0.061).DiscussionThe findings suggest that frequent sexual dreams may serve as a psychological stress indicator, particularly in individuals with mental health conditions. However, the weak correlation between post‐dream symptoms and mental health treatment highlights the need for further investigation into the mechanisms underlying these associations.ConclusionFrequent sexual dreams could provide valuable insights into psychological stress and mental health. Incorporating dream patterns into mental health assessments may enhance clinical understanding and interventions. Further research involving diverse populations and experimental methodologies is required to these relationships and their broader implications.

Associations Between Food Security, Housing and Health in South Australia.

Food security is becoming increasingly difficult to achieve for many households. Research has shown that food insecurity is associated with socioeconomic disadvantage, including housing pressures, and may contribute to poor health outcomes. There is lack of data on these associations in the South Australian setting, where food security is not consistently monitored. A population health survey was administered to South Australian participants in April 2023. Descriptive analysis was conducted on data regarding food insecurity, housing circumstances, chronic and mental health conditions. Multivariate logistic regression analysis was performed to assess associations between food security and health outcomes. From a sample of 3002 participants, 16.4% reported low and very low food security. These participants tended to be renting, facing housing cost pressures, and lacking infrastructure to store and prepare food. When controlling for confounders, food insecurity was found to be associated with increased likelihood of having at least one chronic condition, mental health condition, and decreased overall wellbeing. Food security is itself a determinant of health. Regular monitoring of theprevalence of household food insecurity and addressing the structural factors influencing food affordability and availability are required. Further research on its links to health outcomes is warranted. SO WHAT?: Evidence-based action to address food insecurity will become more pressing as the crises of cost-of-living, housing, health system pressures and environmental disasters converge.

An initial grounded theory of how young people with mental health problems experience and are affected by fictional representation

ABSTRACT Young people with mental health problems (MHPs) are increasingly exposed to representations of MHPs within fiction, but little is known about this process. This study used grounded theory to develop a preliminary understanding of how 16- to 25-year-olds with MHPs experience and are affected by fictional media representation of MHPs. Fourteen individual interviews were conducted with nine young people. The developed theory suggests that fiction was experienced as a reflection on participants’ own reality, a process made up of two key stages, identification with fiction and transferring beyond fiction, whereby the representative portrayals led to both helpful and harmful impacts. Such effects seemed to depend on both personal context and the nature of the fiction. Findings are discussed in terms of relevant theory and outcomes for wellbeing, with study limitations and implications for practice and research considered.

An innovative model of behavioral healthcare for older adults with serious mental illness, substance use disorders, and dementia.

Older adults with serious mental illness (SMI) experience higher rates of medical comorbidities, mortality, hospital readmissions, and total healthcare spending when compared with Medicare beneficiaries without SMI. Although telehealth provides an opportunity to overcome barriers to behavioral healthcare access, older adults face unique challenges when accessing and utilizing telehealth services. We present Author Health's care model, which integrates virtual-first behavioral health care with an interdisciplinary approach to health-related social needs (HRSN) screening and intervention in older adults. We launched an innovative behavioral healthcare delivery model in collaboration with primary care for Medicare Advantage recipients with SMI, substance use disorders (SUD), and dementia. All patients completed an intake with an MD/NP and were offered screening for HRSN at entry using the Accountable Health Communities HRSN tool. Primary diagnosis was assigned and categorized into SMI/SUD/dementia and non-SMI. Logistic regression was used to quantify the odds of food, housing, and transportation insecurity explained by SMI/SUD/dementia versus non-SMI behavioral health conditions. A total of 2301 patients completed an intake from January 2023 to March 2024. Moderate/severe depression (40%) was the most common primary target condition at intake, followed by dementia/Alzheimer's disease (12%) and bipolar disorder (5%). The rates of housing insecurity, food insecurity, and transportation insecurity were 27%, 30%, and 21%, respectively. Within our sample of Medicare Advantage participants in Florida, patients with SMI/SUD/dementia were 1.42 times (p < 0.05) and 1.58 times (p < 0.01) more likely to report housing insecurity and food insecurity, respectively, when compared with those with mild/moderate behavioral health conditions. Author Health provides a blueprint for behavioral health services that remove barriers and provide tenacious, consistent, and whole-person virtual-first behavioral health care tailored to the unique needs of older adults. Our sample of Medicare Advantage participants in Florida suggests SMI/SUD/dementia may be a predictor for HRSN independent of socioeconomic status and race/ethnicity.

Race/Ethnicity, Acculturation, Mental Health Stigma, and Counseling Use among U.S. College Students

Race/Ethnicity, Acculturation, Mental Health Stigma, and Counseling Use among U.S. College Students

Clinical characteristics of adrenal crisis in 371 adult patients with glucocorticoid-induced adrenal insufficiency

BackgroundGlucocorticoid-induced adrenal insufficiency (GIAI) is a hypothalamic-pituitary-adrenal (HPA) axis dysfunction caused by long-term use of exogenous steroids. Adrenal crisis (AC) is an acute complication of GIAI and one of the reasons for the increased risk of death. This study aims to analyze the clinical characteristics of GIAI patients with AC and explore the related risk factors.MethodsClinical data of adult GIAI patients treated at our hospital between January 1, 2014, and December 31, 2023 were included. The demographic characteristics, clinical characteristics, laboratory tests and comorbidities of the patients were collected. Univariate and multivariate regression analyses were used to explore the variables related to the occurrence of AC, and prediction models were constructed.Results51 patients (13.75%) developed AC during hospitalization. Mortality was significantly higher in patients with AC than in those without AC. Multivariate logistic regression analysis showed that infection, psychiatric symptoms, serum sodium, albumin, neutrophil-lymphocyte ratio (NLR) and eosinophil-lymphocyte ratio (ELR) were independent risk factors for AC. Among the prediction models constructed by machine learning algorithms, logistic regression model had the best prediction effect.ConclusionThis study investigated the clinical characteristics of AC in GIAI patients. NLR and ELR may be effective predictors of AC in GIAI patients, and combined with other clinically significant indicators, an effective prediction model was constructed. Logistic regression model had the best performance in predicting AC in GIAI patients.