Psychiatric Research Articles

Injury patterns of suicide attempts in the head and neck area-a retrospective analysis over 15years.

Suicide attempts may involve various parts of the body with different severity grades and therefore represent a multidisciplinary challenge. The head and neck region is highly vulnerable to severe self-inflicted injuries, yet literature on this topic remains limited. A retrospective analysis was performed of patients with suicide attempts in an Otorhinolaryngology (ORL) department of a tertiary referral hospital over a 15-year period. The aim of the study was to analyse their clinical course and injury patterns. 70 patients were included (m: 42/70; f: 28/70). The mean age at suicide attempt was 43.7 years. Women were significantly younger than men (p = 0.046). Seven injury types were differentiated: strangulation (44.3%), stabbing (17.1%), jumping from a height and firearm use (10.0% each), jumping in front of a moving vehicle and ingestion of acids/bases (7.1% each) as well as ingestion of pills (4.3%). Men were dominantly involved in strangulation (14/42; 33.3%) and stabbing (11/42; 26.2%), whereas women appeared with strangulation (17/28; 60.7%) and tablet ingestion (3/28; 10.7%). Men required ORL-specific surgical care significantly more often than women (43.9% vs. 7.1%; p < 0.001). Men chose "violent" methods more frequently than women (90.5% vs. 46.4%; p < 0.001). Women were more likely to receive psychiatric treatment (p = 0.0011). Violent suicide attempts were more common in males and therefore required more often surgical intervention. Soft attempts and psychiatric diagnoses were more often associated with female gender. Routine laryngoscopy is recommendedwithin 24h after the initial trauma.All individuals were successfully treated in an interdisciplinary setting and survived with moderate morbidity.

Suicide prevention inpatient group treatment-A treatment development and feasibility study.

One mainstay of psychiatric treatment for suicidal crises is inpatient psychiatric hospitalization. Despite the need to secure immediate safety and stabilization, inpatient treatment for acutely suicidal patients remains diagnosis-specific, which may fail to directly target and adequately manage suicidal behavior as a symptom and reason for admission or treatment. The post-discharge period is a high-risk period for repeat suicide attempts or death by suicide, but overburdened workforce and high patient turnover make it difficult to provide suicide-specific treatment. In response to this need, we developed the Suicide Prevention Inpatient Group Treatment (SPIGT), a four-module, group-based intervention, which provides evidence-supported concrete tools and psychoeducation to directly address suicidality. To assess feasibility and acceptability of implementation, the SPIGT was piloted on an inpatient psychiatric unit starting in 2016. Group participants were given optional, anonymous surveys after each module. Unit clinicians also completed optional, anonymous surveys to assess their attitudes towards the intervention. Results indicate that participants responded very favorably to each module, and that unit clinicians felt that the implementation of this intervention was feasible and acceptable. The SPIGT shows promise as a scalable suicide-specific, brief intervention, which addresses an unmet and critical need in suicide prevention.

Evaluating the value and risks of psychedelics for psychiatric medicine: a clinical perspective.

After a long period of obscurantism, a possible role of psychedelics in clinical practice has progressively become a tangible perspective during the last two decades. However, the resounding enthusiasm linked to such 'psychedelic renaissance' runs the risk to unduly minimize the possible hazards associated with these compounds, while expanding their alleged benefits to improbable panacea-like proportions. In order to avoid mystifying or demonizing the properties of 5-HT2a agonists on emotional grounds, this subject requires a strictly unprejudiced and cautious approach to the evidence. In this article, the authors attempted to comprehensively analyze the available literature to provide a balanced overview of the possible benefits of psychedelics in healthcare, taking into account their potential risks. To date, psychedelics have shown a therapeutic potential in a wide range of conditions, with a seemingly limited risk of inducing adverse reactions, including abuse and dependence, when administered in a controlled environment by specialized personnel. In any case, although several questions remain unanswered before drawing firm conclusions, further studies are needed to establish which conditions and subjects could benefit from psychedelics and which patients bear the greater risk of adversities.

Emotional processing as mechanism of change in brief good psychiatric management for borderline personality disorder: results of a randomized controlled trial

BackgroundBorderline Personality Disorder (BPD) is one of the most frequent, severe, mental conditions and is associated with a serious burden of disease. Treatment for patients with BPD involves structured psychotherapy. In addition and in order to improve access to care, psychiatric treatments are available. So far, it remains unclear if brief psychiatric intervention according to Good Psychiatric Management (GPM) produces a reliable effect on a variety of clinical outcomes. The assessment of mechanisms of change contributes to focus the treatment on the essential ingredients of change. The current study aims to demonstrate the emotional processing as a mechanism of change, assessed in an ecologically valid experimental context, of brief GPM.MethodsThe present two-arm randomized controlled study aims at testing the effects (i.e., reduction in borderline symptoms) and emotional processing as mechanism of change of a brief psychiatric treatment (10 sessions over 4 months), compared with treatment as usual. Participants are N = 76 patients with BPD who are either randomized to a 4 month GPM or a 4 month TAU without any BPD-specific content. All patients undergo assessments of borderline symptoms using ZAN-BPD and experiential enactment for assessment of emotional processing, at intake, 2 months and 4 months (discharge).ResultsThe effect of a brief version of GPM is not different from the effect of TAU on the total score of the ZAN-BPD at 4 month (d = 0.04). At the level of the secondary effects, GPM is more effective in reducing relationship problems on the ZAN-BPD sub-scale (F(1, 61) = 5.53; p = .022, d = 0.52), and in reducing impulsivity and social problems, and it increases treatment retention. Change in emotional processing between intake and month 2 mediates the reduction on the ZAN-BPD subscale relationship problems assessed between months 2 and 4, in an ecologically valid experimental context.ConclusionsOverall, brief GPM is not different from TAU in terms of reduction in borderline symptoms, but it may produce reduction in relationship problems between months 2 and 4 into the brief intervention. Change in emotional processing in an experimental context may function as mechanism of change of brief GPM. This study is in line with the top priority of establishing efficacy of brief interventions for BPD and proposes an evidence-based explanation for efficacy. These results should help disseminate brief psychiatric treatments for BPD, which contribute to reduce the societal burden related with BPD.Trial registrationClinical Trials NCT03717818 (date of registration of October 24th, 2018). Protocol number 2 from February 9th, 2018.

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.

Depression and anxiety levels in patients with hypertension and relationship with blood pressure control: A review of study design for psychiatric intervention protocol

Arterial hypertension, anxiety, and depression are common in Western and Eastern medicines, with each offering therapeutic instructions and proposals. Arterial hypertension has been identified as a harmful factor that causing cardiovascular diseases and increasing global mortality. Depression affects over 322 million people worldwide, with an overall incidence of 4.4%. In cases of hypertension, depression is observed in approximately 30% of patients when assessed using questionnaires and in approximately 21% when assessed psychiatrically. Anxiety and depression are risk factors for arterial hypertension. On the contrary, hypertension has been considered to cause anxiety and depressive symptoms. This could be attributed to the direct effects of high blood pressure (BP), side effects of antihypertensive drugs, or psychological reactions to the diagnosis of hypertension. An unhealthy lifestyle increases stress and BP levels. Therefore, controlling stress is a complementary therapy for hypertension. In this context, this study presents a protocol aimed at evaluating stress/depression levels as well as the quality of life in patients with hypertension and examining their correlation with BP control and target organ damage. In addition, we will assess the effect of subsequent psychiatric interventions in hypertensive patients with increased levels of depression/stress on BP control, treatment compliance, and quality of life after a follow-up period of 1 year.

Metabolic syndrome in adolescents with mental disorders: diagnostics, prevention and treatment

Over the past decades the prevalence of metabolic syndrome (MS) among adolescents has increased significantly. Psychiatric disorders and treatment with psychopharmacological drugs are among the risk factors for the development of MS. The risks of drug-induced metabolic disturbances in adolescents are higher than in adults. Conversely, potential reversibility of MS at its initial stages emphasizes the importance of early detection and treatment. The aim of this narrative review is to summarize the available data on the diagnostics, prevention and treatment of MS in adolescents with mental disorders. Medline and RSCI electronic databases were searched to identify relevant sources of information. Synthesis of information based on 157 publications demonstrates the lack of universally accepted criteria for the diagnosis of MS in adolescents and the limited data on effective preventive or therapeutic interventions. In this review the diagnostics of the components of MS and associated disturbances in adolescents are overviewed, pharmacological and nonpharmacological approaches to MS prophylaxis and treatment are discussed. The results of the reviewed studies reveal a number of factors contributing to the development and progression of MS (both unmodifiable and modifiable): genetic, systemic immune-inflammatory, environmental, pharmacological. Further exploration of these factors in adolescents with mental disorders, as well as the development of preventive and therapeutic strategies based on these factors, are important directions for future research.

Ayurveda and Mental Health: Integrative Perspectives on Neuro-Psychiatric Disorders

Ayurveda, the ancient Indian medical system, offers profound insights into mental health (Manas) by addressing the psychosomatic interface through an integrative model. As mental health disorders rise globally, exploring Ayurveda’s role in addressing psychiatric ailments, including anxiety, depression, and cognitive decline, is essential. This review delves into the Ayurvedic conceptualization of mental health, particularly the role of the Manas Doshas (Rajas and Tamas), Sattvavajaya (mind pacification), and Ojas (mental immunity). Emphasis is placed on the therapeutic role of Rasayana (rejuvenation), Panchakarma, psychotropic herbs, and compound formulations like Manas Mitra Vatakam and Smriti Sagara Rasa, and lifestyle modifications in mental health management. Furthermore, recent advances in the neuropsychopharmacology of Ayurvedic herbs, integration of Ayurveda with modern psychiatry, and research-backed evidence supporting these interventions are critically discussed.

Demographic and clinical characteristics of rural, regional, and metropolitan inpatients during psychiatric inpatient eating disorders treatment.

Eating disorders were previously considered less common in rural/regional areas. However, emerging research suggests that eating disorders may be more prevalent in these populations than initially recognized. We aimed to describe demographic/clinical characteristics of metropolitan compared to rural/regional inpatients during psychiatric inpatient eating disorder treatment at the Eating Disorders Unit (EDU), Austin Health in Melbourne, Australia. Retrospective review of patient files was undertaken for inpatients aged 18-65years who resided within the Body Image & Eating Disorders Treatment & Recovery Service (BETRS) catchment area and were admitted to EDU between 01/01/21 and 30/10/23. Regional/rural patients were on average 2.7years older and first diagnosed 3.5years later compared to metropolitan inpatients. These groups showed otherwise similar characteristics in relation to psychiatric/medical history. Available and accessible speciality eating disorders services in rural and regional areas are needed for early detection, prevention, and multidisciplinary management.

Is it still autism? The increasing broadening of the autism spectrum.

Clinical significance of a broad autism phenotype (BAP) seems to be increasingly supported by growing reports of high prevalence of subthreshold autism spectrum disorder (sASD) or autistic traits (AT) in various demographic samples, particularly in individuals with psychiatric conditions. We question this increasing extension of the autism spectrum and its potential negative consequences for clinical services, research, cultural attitudes, and resource allocation, as well as alternative explanations of what is currently attributed to sASD and AT. In modern psychiatry the diagnostic threshold is paramount and associated with a significant impairment of functioning, implying that symptom specificity is more relevant than sensitivity. Within a syndrome, symptoms have to be present together, with the parts related to and interconnected with the whole. Single autism symptomatic dimensions have low syndromic specificity and can be observed in many different mental disorders. For instance, communication problems may present in communication disorders, social-cognitive difficulties can be found in schizophrenia, and rigid and/or repetitive behaviors can be found in obsessive compulsive disorder. One alternative interpretation of AT and/or sASD relates to personality traits. For example, within the Big 5 Model, low openness is associated with a dislike of change and a narrow range of interests, low extraversion with social withdrawal and coldness, and low agreeableness with disinterest in others and disregard for their feelings. These risks of overreliance on non-specific aspects of autism are particularly likely to occur with screening checklists, self-assessment, or assessment by a lay interviewer with only limited expertise in clinical assessment.

The real-world association between digital markers of circadian disruption and mental health risks

While circadian disruption is recognized as a potential driver of depression, its real-world impact is poorly understood. A critical step to addressing this is the noninvasive collection of physiological time-series data outside laboratory settings in large populations. Digital tools offer promise in this endeavor. Here, using wearable data, we first quantify the degrees of circadian disruption, both between different internal rhythms and between each internal rhythm and the sleep-wake cycle. Our analysis, based on over 50,000 days of data from over 800 first-year training physicians, reveals bidirectional links between digital markers of circadian disruption and mood both before and after they began shift work, while accounting for confounders such as demographic and geographic variables. We further validate this by finding clinically relevant changes in the 9-item Patient Health Questionnaire score. Our findings validate a scalable digital measure of circadian disruption that could serve as a marker for psychiatric intervention.

Injuries from blank cartridge shots in suicide attempts within the South Korean military: a case series of five patients.

Blank cartridges are designed to produce the sound and gas flare of a gunshot without firing a bullet. However, blank cartridge shots (BCS) can still cause injuries ranging from minor to life-threatening. Within the South Korean military, most BCS-related injuries have occurred during suicide attempts. This study documents a case series of patients who sustained injuries from BCS during such attempts. We examined the medical records of Korean soldiers at a military trauma center between April 2022 and April 2024 who had sustained injuries from BCS during suicide attempts. The analyzed data included general characteristics, injury site, surgical and psychiatric interventions, and length of hospitalization. The case series included five patients between 19 and 20 years old (mean age, 19.6±0.55 years). Four of these patients sustained self-inflicted gunshot wounds to the submandibular area, while one targeted the right temporal area. Although initial vital signs and laboratory findings were unremarkable, computed tomography scans revealed injuries from projectile gas and gunpowder, including burns, subcutaneous emphysema, and major structural damage. Cases 1 and 2 required emergency surgery for foreign body removal and debridement. The average length of hospitalization was 35.2±12.11 days. Patients were first admitted to the trauma surgery department for BCS injury management, and then transferred to the psychiatry department for emotional support. The average stay was 15.6±15.87 days in trauma surgery and 19.6±14.99 days in psychiatry. This study highlights the consequences of BCS from suicide attempts in the South Korean military and provides valuable insights for medical personnel who may encounter patients with BCS injuries.

Peter Falkai: In order to understand the neurobiological origins of psychoses we need to understand the genetic underpinnings of brain plasticity and its modulation due to environmental risk factors

Peter Falkai stands as one of the world's leading authorities in psychiatric research, particularly in understanding the neurobiology of schizophrenia. As a Scientific Member of the Max Planck Society and Director and Head of the Hospital at the Max Planck Institute of Psychiatry since October 2024, he continues to advance our understanding of mental health disorders. His distinguished career spans over three decades, during which he has held multiple prestigious leadership positions, including President of the European Psychiatric Association (2021–2023) and current President of the World Federation of Societies of Biological Psychiatry. A member of the German Academy of Sciences Leopoldina, where he served as Senator of the Neurosciences Section, Prof. Falkai has been instrumental in shaping modern psychiatric research and treatment approaches. His groundbreaking work on brain plasticity and innovative treatment combinations has opened new pathways for understanding and treating psychotic disorders. As site spokesperson for the German Centre for Mental Health and former President of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology, he continues to bridge the gap between basic research and clinical application. In this Genomic Press Interview, Prof. Falkai graciously shares insights into his remarkable professional journey and personal life, offering readers a glimpse into the mind of one of psychiatry's most influential figures.

A unified understanding of the human mind — a neuroethical perspective

Abstract This article, titled “A Unified Understanding of the Human Mind - A Neuroethical Perspective,” examines the evolution of the concept of the human mind in Western thought and its integration with neuroscience, psychology, psychiatry, and relational dimensions. The author explores how the understanding of the mind has changed over time, influenced by shifts in philosophical paradigms, scientific advancements, and societal perspectives. The article traces the historical development of the mind’s concept, starting from ancient Greece, through influential thinkers like Plato and René Descartes, and progressing to contemporary perspectives. It highlights various philosophical and scientific approaches, including structuralism, functionalism, empiricism, and associationism, which have shaped our understanding of the mind. The article also delves into contemporary integration, where advancements in neuroimaging and the rise of holistic approaches offer a more nuanced understanding of the human mind. The author emphasizes the importance of the relational dimension and the interconnectedness of mental processes, the brain, and the external environment. This integrated perspective can benefit psychiatric treatment and psychological assessments by fostering a holistic approach to mental health. In conclusion, the article advocates for a multidimensional perspective that bridges subjective and objective aspects of human experience, offering promise for theoretical knowledge and practical applications in psychology, psychiatry, and neuroscience.

Comparison of Salivary Opiorphin in Burning Mouth Syndrome and Healthy Subjects and Its Correlation With Psychiatric Disorders

ABSTRACTObjectivesBurning mouth syndrome (BMS) is a chronic disease in which the patient experiences a burning sensation in the oral mucosa without any pathological cause. Opiorphin is a pentapeptide that prevents pain and can have an antidepressant effect. The aim of this study was to evaluate salivary opiorphin concentration in BMS and healthy subjects. In addition, opiorphin concentration in BMS patients before and after psychiatric treatment was compared and the association between burning severity and psychiatric scores with salivary opiorphin concentration was examined.Materials and MethodsThis cross‐sectional study included 28 BMS patients and 40 healthy individuals referred to the Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Mashhad, from September 2018 to August 2019. Patients with proven disease based on clinical and psychiatric examinations were included in the study. Unstimulated salivary opiorphin levels were assessed by ELISA. Statistical analysis was performed using SPSS version 24.ResultsSalivary opiorphin levels were significantly higher in BMS patients (2.16 ± 0.30 ng/mL) than in healthy subjects (1.80 ± 0.36 ng/mL) (p &lt; 0.001). Opiorphin levels in BMS patients increased insignificantly after psychiatric therapy (p = 0.212). In addition, there was no significant association between opiorphin levels and age, gender, menopause, burning severity, anxiety, and depression status.ConclusionsThe opiorphin concentration in saliva is higher in BMS patients than in healthy subjects. Most BMS patients also suffer from anxiety and depression.

‘Psychoanalysis for the Many’: Melitta Schmideberg's Work with Offenders in Psychoanalytic Free Clinics

In current histories of psychoanalysis, Melitta Schmideberg still lives under the shadow of her mother, Melanie Klein. If Schmideberg’s name is mentioned at all, it is in the context of the so-called Controversial Discussions that took place at the British Psychoanalytical Society in the early 1940s, in which Schmideberg directly questioned Klein’s views. In terms of psychoanalytic contributions, Schmideberg’s decades-long work with juvenile and adult offenders is barely mentioned. This article attempts to correct this imbalance by looking at Schmideberg’s innovations in offender therapy. Schmideberg understood that the available methods of psychoanalytic therapy (whether Freudian or Kleinian) would not suit patients she engaged with (antisocial, borderline and psychotic patients) and developed her own methodology of working with these groups. The article explores Schmideberg’s methods, while focusing specifically on the flexibility of the time, money and spatial frame, the role of reassurance, questions of transference as well as what she called ‘group therapy in reverse’. It also presents her virtually unknown work at the Association for the Psychiatric Treatment of Offenders, an institution she founded in the USA, and her thoughts on the role of class in the care system.

Affordances, mental health and psychiatry

This paper suggests that new directions in mental health and psychiatry are being driven by anomalies within epidemiology, mechanisms, and integration-based cognition. Three contrasting kinds of new work on mental disorder are critically discussed: enactive, ecological and active inference approaches, drawing from work by Varela, Gibson and Friston. These are detailed together with debates about their similarities and differences. All of these positions in fact make common use of ‘affordance’ as a core perception-action mechanism, suggesting promising options for new or enhanced psychiatric interventions. This leads to a critical review of the current state of knowledge on affordances, and their limitations, together with some suggestions as to how this approach might be applied in mental health and psychiatric practice.

Post-conditioning sleep deprivation facilitates delay and trace fear memory extinction

Trace and delay auditory fear conditioning involve different memory association strategies based on working memory involvement; however, their differences in long-term processing through sleep and extinction training remain unclear. While females often exhibit more persistent fear, complicating psychiatric treatment, most studies have primarily focused on how sleep affects initial recall in male mice. We investigated the three-way interaction between tests (trace vs. delay), sleep states, and sex during initial recall, extinction, and post-extinction remote recall. A six-hour post-conditioning sleep deprivation (SD) did not affect freezing behavior during the following day’s extinction training of delay fear memory. However, during post-extinction remote recall of delay fear memory, SD prevented spontaneous recovery in males and reduced persistent freezing in females. In contrast, SD rapidly facilitated extinction of trace fear memory. In summary, SD enhances extinction both in the short-term and long-term, depending on the conditioning protocol. These findings highlight the importance of long-term assessments to explore interactions among emotional memory, sleep, and sex differences, with implications for individualized mechanisms underlying post-traumatic stress disorder (PTSD) and its treatments.

TMS in the Kingdom of Denmark: an overview of current clinical practice

Purpose Repetitive TMS (rTMS) has been demonstrated to be an effective treatment of several neuropsychiatric disorders. Its safety and efficacy are well established, and multiple rTMS devices have been approved by both Conformitè Europëenne Mark and U.S. Food and Drug Administration. We aimed to survey TMS practice in Psychiatry in the Kingdom of Denmark and compare it with the international state of the art. Methods A survey of rTMS clinical practice in 2023 was sent to all general adult psychiatry departments practicing TMS in the Danish Realm (Denmark = 10, Faroe Islands = 0, Greenland = 0). Results Response rate was 100%. rTMS was available in 37% of psychiatric departments and 3 out of 5 Danish Regions. Admission criteria required a diagnosis of unipolar depression with a degree of treatment-resistance or unacceptable side-effects to antidepressant treatment. Common contraindications included: cochlear implants (100%), pacemaker and neurostimulators (80%), other ferromagnetic/implanted devices in head, neck, or thorax (70%), active substance misuse (60%), and electrolytic disturbances (50%). Three rTMS protocols were identified: 10 Hz rTMS delivered over the L-DLPFC, iTBS delivered over the L-DLPFC and 1 Hz rTMS delivered over the right-DLPFC. 383 patients were treated with TMS. Conclusions rTMS is unequally available in the public healthcare of the Kingdom of Denmark. Existing strategies for solving inequalities could address such issues. Unipolar depression was the only psychiatric disorder treated with rTMS in 2023. rTMS practice in the Danish Realm considers the use of evidence-based protocols and is consistent with recommendations from international expert guidelines.

Tracing Pharmaceuticals in Water Systems: Focus on Neurodegenerative and Psychiatric Treatments.

Pharmaceutical residues in aquatic ecosystems pose significant environmental and public health challenges. Identifying the presence and levels of these pharmaceuticals is crucial. This study developed an analytical method to detect pharmaceuticals used for Alzheimer's (AD) and Parkinson's (PD) disease, including psychiatric drugs and the stimulant caffeine, targeting 30 compounds. Optimized mass spectrometric and liquid chromatographic parameters enabled robust detection and quantification. The methodology was applied to 25 surface and wastewater samples. Twenty-one compounds were detected including eight psychiatric drugs, five metabolites (citalopram N-oxide, citalopram propionic acid, desmethylcitalopram, O-desmethylvenlafaxine, and 10,11-epoxycarbamazepine), and seven AD/PD pharmaceuticals along with caffeine. Nine compounds (apomorphine, benserazide, donepezil, didemethylcitalopram, carbidopa, norfluoxetine, galantamine, pramipexole, and safinamide) were not detected. Fluoxetine was found in all samples, and caffeine had the highest concentration at 76,991 ng/L, reflecting its high consumption. Concentrations ranged from 29.8 to 656 ng/L for caffeine, <MDL to 381 ng/L for psychiatric drugs, and <MDL to 37.1 ng/L for AD and PD pharmaceuticals in surface water. In wastewater, concentrations ranged from 140 to 76,991 ng/L for caffeine, <MDL to 5227 ng/L for psychiatric drugs, and <MDL to 206 ng/L for AD and PD pharmaceuticals. These findings highlight the critical need for comprehensive environmental monitoring.