Psychiatric Research Articles

Clinicians' Knowledge, Attitudes, and Practices Regarding the Management of Functional Gastrointestinal Disorders With Neuromodulators and Psychological Treatment.

Little is known about the practical clinical application of neuromodulators and psychiatric treatments in patients with functional gastrointestinal disorders (FGIDs). We investigate the knowledge, attitudes, and practices of Korean clinicians regarding the use of neuromodulators and psychiatric treatments for FGIDs. This prospective, online, cross-sectional study was conducted between May and August 2022. A questionnaire regarding the knowledge, attitude, and practice of neuromodulators and psychiatric treatments for FGIDs was developed and administered to primary care clinicians and gastroenterologists in university hospitals in Korea. Overall, 451 clinicians from primary (n = 179, 39.7%), secondary (n = 113, 25.1%), and tertiary (n = 159, 35.3%) hospitals participated in the survey. Most of them considered that neuromodulators (98.7%) and psychiatric treatment (86.5%) were required for patients with FGIDs. However, approximately one-third of them did not prescribe neuromodulators, mainly due to unfamiliarity with the drugs, and only one-quarter considered psychiatric referral. Compared to gastroenterologists at university hospitals, primary care clinicians' prescriptions had a lower rate (87.2% vs 64.2%, P < 0.001) and shorter duration of neuromodulator. The psychiatric referral rate was lower for primary care clinicians than for gastroenterologists at university hospitals (19.0% vs 34.2%, P < 0.001). Knowledge, attitude, and practice levels regarding neuromodulators and psychiatric treatment among clinicians are inhomogeneous, and a knowledge gap exists between primary care clinicians and gastroenterologists at university hospitals. Encouraging ongoing education for Korean clinicians regarding the appropriate use of neuromodulators and psychiatric treatments in patients with FGIDs is suggested.

Mental health symptoms and treatment for common mental disorders among sexual minority immigrants in Sweden – a national population-based study

Abstract Background Although sexual minorities are at greater risk of poor mental health, less is known about mental health among dual minority statuses individuals based on sexual orientation and migration status. The current study investigated disparities in mental health symptoms and psychiatric treatment for common mental disorders among Swedish-born and immigrant heterosexuals and sexual minorities. It further explored the role played by interpersonal and social stress in explaining these disparities. Methods Participants (n = 104,652) were drawn from the Swedish Public Health Survey in 2018. Six groups were compared based on sexual orientation (heterosexual, sexual minority) and migration status (Swedish-born, European-born, non-European). The survey was complemented with information on psychiatric treatment from nationwide registries. Odds ratios were calculated using logistic regression. Results Compared to Swedish-born heterosexuals, Swedish-born and non-European sexual minorities had the greatest risk of mental health symptoms (odds ratios [OR]=2.20, 95% confidence intervals [CI]: 1.89-2.57, and OR = 2.10, 95% CI 1.34-3.29, respectively). Swedish-born sexual minorities had greater risk of psychiatric treatment (OR = 2.58, 95% CI 2.20-3.01), while non-European heterosexuals had lower risk (OR = 0.61, 95% CI 0.52-0.72). No differences in psychiatric treatment was found for non-European sexual minorities (OR = 0.82, 95% CI 0.46-1.48). Interpersonal and social stress factors mediated the associations between migration status and mental health symptoms and psychiatric treatment differently depending on sexual orientation. Conclusions No excess risk of mental health symptoms was found among sexual minority immigrants compared to their Swedish-born counterparts. Key message • Non-European sexual minority immigrants’ risk of mental health symptoms was equally high to the risk among Swedish-born sexual minorities, but they received less psychiatric treatment.

Social inequalities in the prevalence and treatment of depressive symptoms in Czechia

Abstract Background Depressive symptoms are associated with achieved socioeconomic status (SES) in men and women. The aim of the analysis is to verify this association between severity of depressive symptoms and socioeconomic status in the Czech context. Another aim is to examine the use of psychiatric and psychological treatment among men and women. Methods The data come from the 2019 European Health Interview Survey (EHIS). The Patient Health Questionnaire (PHQ-8) was used to measure the symptoms and severity of depressive symptoms among respondents. Participants were aged 20 and above and resided in households. Binary logistic regression was used to test the relationship for using of treatment and depressive symptoms. Results The weighted prevalence of mild depressive symptoms is determined to be 10.5% (8.0 % in men; 12.8% in women), with severe depressive symptoms recorded at 3.1% (2.6% in men; 3.7% in women) within the Czech population. The psychiatric or psychological treatment is utilized by 3.8% (2.8% in men; 4.7% in women) of the Czech population. Respondents with severe depressive symptoms (37.4%) use care the most, followed by those with mild symptoms (11.9%), and the least by those with none (1.6%). Individuals with tertiary education utilize treatment the most among respondents with moderate and severe depressive symptoms. Respondents differ in the utilization of treatment; however, after stratifying the model only for respondents with mild or severe depressive symptoms, these respondents do not differ in the utilization of treatment. Conclusions SES level is reflected differently in the prevalence and severity of depressive symptoms for men and women. But no difference was found in the use of psychiatric or psychological care in men and women. A treatment gap was found for depressive symptoms in the Czech population. Key messages • The results confirmed the relationship between the utilization of care and depressive symptoms. • It was revealed that respondents did not differ in the utilization of care after the stratification.

1.O. Scientific session: Trans &amp; Gender-Diverse Individuals’ Mental &amp; Behavioral Health Risks &amp; Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

Gender identity differences in age of first mental health diagnosis: A population-based study of childhood and adolescence

Abstract Introduction Gender minority (GM; i.e., trans, non-binary, and other gender diverse) individuals have an increased risk of mental health disorders, but few studies have explored disparities using population-based samples or the age of onset of this risk. Objectives The aim of the current study was to identify the age at which the gender identity disparity in physician-assessed psychiatric diagnosis and treatment for common mental health disorders can be first identified in a population-based sample linked to national health care registries. Methods All individuals aged 16 to 25 (n = 18,793) participating in the nationwide probability-based Swedish National Public Health Survey in 2018, 2020, or 2021 were included in the analyses. This sample could be linked to mental health care treatment history data in nationally comprehensive health care registries starting at age 8 years old. Results Individuals reporting a GM identity in adulthood were seven times more likely to having been diagnosed with depression and/or anxiety and about five times more likely to having been diagnosed with a neurodevelopmental disorder during childhood or adolescence compared to individuals with a cisgender identity. GM individuals’ increased likelihood of being diagnosed with depression and/or anxiety was significantly elevated from age 13, while their neurodevelopmental disorder diagnosis risk was significantly elevated from age 10, compared to cisgender individuals. Conclusions The results from this study are the first population-based evidence to show that GM individuals are more likely to be diagnosed and treated for mental health disorders early during childhood and adolescence compared to cisgender individuals. The early emergence of this increased risk requires further inquiry into causes of these early disparities. It also suggests a potential benefit of interventions that facilitate social belonging and inclusion and reduce stressors related to societal expectations of gender.

Qualitative analysis of blood from patients engaging in deliberate self‐harm: Differences between prescribed and detected drugs

AbstractBackgroundWhile drugs are sometimes taken during deliberate self‐harm (DSH), no study has attempted to analyze drugs in the blood of DSH patients and compare them with prescribed medications or other drugs. In this study, drugs were analyzed from the blood of DSH patients, and the detected, prescribed, and suspected drugs were documented.MethodsPatients who practiced DSH and were transferred to the emergency sites of Fukuoka University Hospital between April 2021 and September 2022 participated in the study. Psychiatrists assessed information such as the history of psychiatric treatment and recent methods of DSH, as well as prescribed drugs within 1 month of presenting to the hospital. Blood samples were analyzed using LC–MS/MS. Participants were divided into groups according to whether or not they were prescribed psychotropics within 1 month.ResultsFifty‐five patients were enrolled in the study. Forty had been prescribed psychotropics within 1 month of hospital admission. However, non‐prescribed drugs (NPD) were detected in 42 of the 55 participants (76%). The detection of NPD was significantly high among patients with overdose of medications and OTC drugs (p = 0.036), but NPD were also detected in patients who engaged in other methods (n = 14), and in patients without prescribed medication (n = 10).DiscussionThis is the first study focused on the drug analysis of blood from patients engaging in DSH. Approximately 80% of the DSH patients in this study had taken NPD, revealing a large discrepancy between prescribed medications and those detected in the blood.

Thoughts on Self-Harm in Polish Pregnant and Postpartum Women During the Pandemic Period

Background: The risk of depression during pregnancy and postpartum is high and has intensified during the COVID-19 pandemic. The aim of this study was to estimate the risk of depressive disorders and self-harm thoughts in the third trimester of pregnancy and the first week postpartum in the pandemic period. Methods: This study involved a total of 317 pregnant and postpartum women. The risk and severity of depressive disorders and the prevalence of self-harm thoughts in women during the perinatal period were assessed using EPDS. Results: Pregnant women were significantly more likely to have higher EPDS scores compared to postpartum women. Mild depressive symptoms were reported by 22.08% of pregnant women and 17.18% of postpartum women, and severe symptoms were observed in 25.97% of pregnant women and 16.56% of postpartum women. Thoughts of self-harm were reported by 11.69% of pregnant women and 17.79% of postpartum women. Self-harm thoughts were significantly more common among pregnant women: multiparous women, pregnant women who received psychiatric treatment before pregnancy, those diagnosed with depressive disorders, those who suffered from prolonged periods of anxiety and sadness, and those lacking a supportive person. Among postpartum women, there were statistically significant differences in the prevalence of self-harm thoughts for place of residence, education, type of occupation, number of pregnancies, course of pregnancy, and presence of a supportive person. Conclusions: The increased prevalence of depressive symptoms and self-harm thoughts related to the COVID-19 pandemic highlights the urgent need for screening among pregnant women and the implementation of clinical interventions.

Involuntary commitment and medical education on mental health diseases across Europe

Abstract Background Psychiatric diseases are projected to become one of the greatest contributors to the global burden of disease by 2030, already presenting as one of the principal causes of DALYs lost in Europe. Given the particular nature of psychiatric disorders, national legislatures have been enacted by each European country regarding the possibility of involuntary psychiatric treatment. As practical implementations vary greatly from country to country, we wish to analyse how different attitudes to involuntary treatment affect health outcomes, so as to propose a uniform guideline for European medical practitioners. We also wish to analyse whether medical education targeted at communication with psychiatric patients has an effect on involuntary treatment rates and general mental well-being. Methods We conducted a systematic review on PubMed to identify studies pertaining to how legislature on involuntary commitment varies between European countries, as well as to what extent it is utilised. We also looked at the extent of medical education on psychiatric diseases. Results Preliminary results show that involuntary hospitalisation rates vary greatly within Europe, with certain countries being almost 20 times more likely to utilise such measures than others, notwithstanding similar mental illness prevalence. Results do not seem correlated to legislation types. Conclusions Given the vastly different use of involuntary commitment, a more standardised European approach should be implemented, especially in sight of the growing prevalence and burden of disease of psychiatric illnesses. Furthermore, an often-overlooked aspect of medical education is how to understand and communicate effectively with patients dealing with mental diseases: we advocate for continuous education, regardless of medical specialty. Key messages • Involuntary hospitalisation rates vary greatly across Europe, but the effects of this phenomenon have been poorly studied. We propose a more unified approach to maximise the efficacy of such a law. • We advocate for a more thorough education of health professionals on mental illnesses, regardless of medical specialty, in sight of the growing prevalence of such diseases.

Community mental health care in Croatia: Mobile team for psychosocial support in the community

Abstract The Republic of Croatia has initiated numerous reforms in the mental health care system in the community. Within the framework of EU JA Implement, a mobile team was formed to provide interventions in the community, that is, in the homes of persons discharged from psychiatric hospitals. The mobile team was formed during 2023. The team includes: one psychiatrist, leader and coordinator of the mobile team, three graduate nurses, a case manager, a social worker, three experienced experts who are employed in the team as peer workers, and one social pedagogue and psychologist. The wider composition of the team includes a psychiatrist who provides outpatient psychiatric treatment, who is familiar with the individual recovery plan and, if necessary, participates in the development of the plan. The goal of establishing a mobile team is to implement an individual recovery plan in the community, that is, in the patient’s home, using biopsychosocial interventions, with the aim of better and faster recovery of the user and inclusion in the community, as well as prevention of rehospitalization and disability. Before the patients home visits, the experts in the team were trained. 15 patients were included in the pilot project, with whom 96 home visits or interventions were carried out in the time period from the establishment of the team to April 2024. As a result of the effectiveness of the pilot project, in 2024, in accordance with the Strategic Framework for the Development of Mental Health until 2030, the Republic of Croatia adopted a new network of health institutions, within which 30 mobile psychiatric teams and 24 psychological teams at the primary level of health care are planned. Empowerment of users, engagement of people with experience in the implementation of interventions, increase in mental health literacy of the population and destigmatization are additional results of the implementation of mental health protection in the community through JA impleMENTAL.

Patient Experiences of Patient-Initiated Brief Admission in Psychiatric Care: A Systematic Review.

Patient-initiated brief admission (PIBA) is an innovative psychiatric care intervention that gives patients the autonomy to initiate a short admission (approximately 1-3 days) to psychiatric inpatient care. This intervention is structured around a mutual agreement between the patient and their care provider that outlines the specific structure and content of their care. Unlike regular psychiatric admissions, healthcare professionals do not review the patient's decision for admission during PIBA. Similar interventions have been developed globally to reduce the need for long inpatient admissions and compulsory care by enhancing patient autonomy, promoting active participation in care, and empowering patients to recognise early signs of mental health deterioration. The objective of this systematic review was to explore the experiences of PIBA among individuals with mental health disorders. A systematic review was conducted using qualitative articles sourced from the PubMed, CINAHL, and PsycINFO databases. A total of thirteen original articles were included in the review, encompassing 186 patients. Research demonstrates that PIBA significantly impacts patients' care experiences in various ways. Access to PIBA gives patients the opportunity to take a break from daily stressors, which has proven significant in interrupting the cycle of worsening symptoms and negative thoughts. Furthermore, when the care environment is characterised by trust and respect, patients experience an increased sense of freedom, which contributes to a more effective recovery process. PIBA provides patients with a sense of safety and offers the possibility of a more functional daily life. Healthcare professionals'attitude and care provision also significantly influences patients' experiences. Central to a positive patient experience are a warm reception, attentiveness, and active listening. PIBA can not only change patients' perceptions of healthcare but, more importantly, fosters a transformative view of themselves as active participants in their own well-being. Knowledgeable healthcare professionals are crucial for the successful implementation of this intervention. By offering dignity and warmth alongside safety, PIBA addresses a critical gap in patient mental health care.

Advancing ketamine in the treatment hierarchy for refractory depression.

Evidence indicates that ketamine is highly effective, has a lower side effect profile and is better tolerated compared to many augmentation strategies for refractory depression. This, combined with data on psychiatric treatment outcome mediators, suggests that earlier intervention with ketamine could improve outcomes for patients suffering from refractory depression.

Ketamine. The Story of Modern Psychiatry's Most Fascinating Molecule.

Ketamine. The Story of Modern Psychiatry's Most Fascinating Molecule.

IEHT vs. Regular Treatment - Are there Differences between the Two forms of Treatment in the Retrospective Course with regard to Individual Objective and Subjective Outcome Variables?

This retrospective follow-up study over one year (after discharge from the index treatment), compares the effects of inpatient-equivalent home treatment (IEHT) and regular psychiatric treatment using subjective and objective quality indicators. Using a 1:1 matching of cohorts (diagnosis, age, gender, number of previous treatments and severity of illness), 732 IEHT patients were assigned to a comparison group. Outcome data was taken from the routine data of the clinic database and the in-house basic documentation. In the subjective quality measure, patients and practitioners in regular psychiatric treatment reported a significantly higher improvement in condition. In terms of the objective quality measure, the number of further inpatient treatment days in the observation period, the two groups did not differ significantly, which can be interpreted as encouragement for the use of this new, increasingly established form of treatment.

A War of D’s: DRESS or Dengue?

Background: Dengue fever can present with symptoms that mimic drug-related reactions, especially in patients with complex medical histories, such as those with bipolar disorder on multiple medications. Case details: We report a 62-year-old female with a known history of bipolar disorder who was admitted with altered mental status, vomiting, and a rash. Given her psychiatric treatment, there was an initial concern for a drug-related reaction. Investigations: Through investigation was conducted. Results revealed a positive serology for dengue fever, alongside leukopenia and thrombocytopenia. Discussion: This case highlights the diagnostic challenge of differentiating between adverse drug reactions and infectious diseases like dengue in patients on multiple medications. Conclusion: Clinicians must maintain a high index of suspicion for tropical diseases like dengue, particularly in patients with complex comorbidities. This case underscores the importance of comprehensive evaluations in emergency settings and the need for a broad differential diagnosis approach.

Is the Treatment Worse than the Disease?: Key Stakeholders’ Views about the Use of Psychiatric Electroceutical Interventions for Treatment-Resistant Depression

Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat psychiatric conditions. For depression therapy, PEIs include both approved treatment modalities, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), and experimental neurotechnologies, such as deep brain stimulation (DBS) and adaptive brain implants (ABIs). We present results from a survey-based experiment in which members of four relevant stakeholder groups (psychiatrists, patients with depression, caregivers of adults with depression, and the general public) assessed whether treatment with one of four PEIs (ECT, rTMS, DBS, or ABIs) was better or worse than living with treatment-resistant depression (TRD) and then provided a narrative explanation for their assessment. Overall, the prevalence of many narrative themes differed substantially by stakeholder group—with psychiatrists typically offering different reasons for their assessment than non-clinicians—but much less so by PEI modality. A large majority of all participants viewed their assigned PEI as better than living with TRD, with their reasons being a mix of positive views about the treatment and negative views about TRD. The minority of all participants who viewed their assigned PEI as worse than living with TRD tended to express negative affect toward it as well as emphasize its riskiness, negative side effects, and, to a lesser extent, its invasiveness. The richness of these narrative explanations enabled us to put in context and add depth to key patterns seen in recent survey-based research on PEIs.

Challenging Involuntary Treatment and Confinement in Canada Through the United Nations Convention on the Rights of Persons with Disabilities (CRPD)

The Convention on the Rights of Persons with Disabilities (CRPD) came into force in 2008. People with disabilities, including people with psychosocial disabilities, were instrumental to its development. Article 12 and Article 14 of the CRPD, which respectively affirm the universal legal capacity and right to liberty of persons with disabilities, were viewed as key victories by disability rights movements. These provisions are particularly important for people with psychosocial disabilities who are routinely subjected to human rights violations through psychiatric detainment and involuntary treatment authorized under domestic mental health legislation in many states. We aim to advance discourse surrounding the CRPD and its development by centring mad peoples’ voices and individuals with lived experience through a literature review and interviews with key disability rights advocates. Using Canada as a case study, we critically examine the implementation of the CRPD and the need to align mental health acts with our international human rights obligations. We argue that forced psychiatric interventions violate the rights of persons with psychosocial disabilities and cause inherent harm. There is an urgent need to move towards new paradigms of care that promote the dignity and autonomy of people with psychosocial disabilities.

Exploring transferability in psychiatric interventions: a conceptual framework.

The growing significance of generalization in psychiatric interventions stems from the need for effective and applicable treatments across diverse populations and settings. Addressing psychiatric disorders involves navigating the complex interplay of biological, cognitive, and behavioral factors, making it crucial to assess the transferability of interventions beyond controlled environments. To tackle this challenge, we propose a novel conceptual framework, the FIELD model (Function, Implement, Ecology, Level, and Durability). This model offers a comprehensive exploration of generalization by considering the function and tools used in interventions, the ecological contexts of their application, the various levels of impact, and the durability of effects over time. In this study, we explore the dimensions of the FIELD model, emphasizing the role of assessment tools as valuable indicators and the significance of effect sizes in quantifying the transfer of training effects. The FIELD model stands as a tool to enhance our understanding of psychiatric interventions, providing a systematic and nuanced approach to evaluate their generalization across diverse scenarios.

Polygenic liabilities and treatment trajectories in early-onset depression: a Danish register-based study.

The clinical course of major depressive disorder (MDD) is heterogeneous, and early-onset MDD often has a more severe and complex clinical course. Our goal was to determine whether polygenic scores (PGSs) for psychiatric disorders are associated with treatment trajectories in early-onset MDD treated in secondary care. Data were drawn from the iPSYCH2015 sample, which includes all individuals born in Denmark between 1981 and 2008 who were treated in secondary care for depression between 1995 and 2015. We selected unrelated individuals of European ancestry with an MDD diagnosis between ages 10-25 (N = 10577). Seven-year trajectories of hospital contacts for depression were modeled using Latent Class Growth Analysis. Associations between PGS for MDD, bipolar disorder, schizophrenia, ADHD, and anorexia and trajectories of MDD contacts were modeled using multinomial logistic regressions. We identified four trajectory patterns: brief contact (65%), prolonged initial contact (20%), later re-entry (8%), and persistent contact (7%). Relative to the brief contact trajectory, higher PGS for ADHD was associated with a decreased odds of membership in the prolonged initial contact (odds ratio = 1.06, 95% confidence interval = 1.01-1.11) and persistent contact (1.12, 1.03-1.21) trajectories, while PGS-AN was associated with increased odds of membership in the persistent contact trajectory (1.12, 1.03-1.21). We found significant associations between polygenic liabilities for psychiatric disorders and treatment trajectories in patients with secondary-treated early-onset MDD. These findings help elucidate the relationship between a patient's genetics and their clinical course; however, the effect sizes are small and therefore unlikely to have predictive value in clinical settings.

Radicalisation in adolescents: mental health considerations for violent extremism.

To outline current understanding and recommended mental health and psychiatric considerations for radicalisation and violent extremism among adolescents. Overview of recent research regarding violent extremism in adolescents and relationships with mental illness and other psychosocial determinants. Relevant international and Australasian research is outlined, with an emphasis on adolescents. Psychiatric considerations, intervention and policy implications will be explored. Adolescents who become radicalised form a heterogenous group with complex, multifaceted needs from mental disorder, familial, societal and/or environmental contributions. Thus, assessment and management need to be individualised. Mental health clinicians working with at-risk and radicalised adolescents should maintain a high index of suspicion for mental illness (particularly psychosis and depressive disorder) and neurodevelopmental disorder. Identified psychiatric conditions warrant prioritised mental health treatment. There may be a relationship between specific psychopathology and certain ideological beliefs and behaviours. Radicalised adolescents pose challenges with risk of serious harm to others, presentation complexity, multifactorial contributors and associations with varied psychopathology. All adolescents at risk of radicalisation or who are radicalised, should receive comprehensive mental health assessment and prompt assertive treatment of identified psychiatric conditions.

Cognitive Behavioral Therapy in Cardiovascular Disease.

The influence of cognitive behavioral therapy (CBT) and its modalities on various neuropsychiatric conditions is herein explored together with their impact on specific cardiovascular (CV) diseases (CVD). A comprehensive review of the literature was undertaken via the PubMed, Scopus and Google Scholar on the above relevant topics. The focus was on large randomized controlled trials and meta-analyses. Among the various neuropsychiatric disorders, depression and anxiety commonly occur in CVD patients, frequently eluding clinician's attention. This reciprocal liaison may incur higher rates of morbidity/mortality, through physiological and behavioral mechanisms. Multimodal psychiatric interventions, using medications and psychotherapies, such as CBT, seem promising. Such mindfulness-based interventions have the potential to be an efficacious complementary strategy to address psychological stress in CVD patients. As the cost of CBT is relatively low, such a supportive approach for stress management provides high patient acceptability, with a positive impact on improving quality of life, by promoting CV health and mitigating CV complications. There is ample evidence of a reciprocal liaison between heart and mind. Several CV risk factors are strongly affected by diseases of the mind, and the clinical course of various CVDs is influenced by affective or other psychiatric disorders. CBT and relevant mindfulness-based interventions have a significant supportive role in patients with various CVDs by targeting CV risk factor(s) or the underlying specific CVD and by identifying and addressing psychosocial issues. In this direction, various CBT interventions can provide the means to favorably influence both CV risk factors and CVDs.