The phenomenon of substance use disorders (SUDs) presents extremely complex etiopathogenesis with intermingled psychological, social, economic, and biological factors. Therefore, the prophylactic and therapeutic approach is multidimensional and should involve targeting all the aforementioned variables. However, it is frequently difficult to separate these factors and construct specific strategies to mitigate their direct negative effects, so caution is needed when formulating recommendations for this population, starting from guidelines for case management and finishing with optimization of healthcare policies. Based on the lack of good practices approved at the national level in Romania for the prevention and treatment of SUDs, this article suggests a draft for such an instrument that could help both clinicians and decisional factors with attribution in healthcare and drug abuse prevention. The methods used in this article are (1) a literature review of studies, guidelines, and other reviews focused on specific aspects of drug abuse/dependence and (2) expert opinions derived from clinical and administrative experience. The results are formulated as recommendations, scored according to the GRADE system, and grouped into three categories: (1) preventative measures for SUDs, (2) secondary prophylaxis, (3) therapeutic and other SUD-targeted interventions. In conclusion, the need for guidelines and policies focused on the prevention and treatment of SUDs, especially in vulnerable populations, is an unmet need in our country. The suggested algorithm in this paper tried to bridge the gap between the available literature dedicated to SUDs, practical experience, and future policies in the healthcare of patients with SUDs.
A multinodular and vacuolating neuronal tumor (MVNT) is a rare non-malign central nervous system tumor. The cerebral cortex of young to middle-aged adults is affected and seizures and focal neurological deficits could reveal it. Despite being considered a low-grade tumor, MVNT can be challenging to diagnose and manage due to its histopathological similarities to other neuronal tumors. The limited number of reported cases makes it difficult to establish definitive guidelines for treatment and follow-up. Given the relatively recent discovery of MVNT, there is a need for further research to better understand its pathogenesis, optimal treatment and long-term strategies. Furthermore, studying MVNT can contribute to the broader understanding of brain tumor biology and the intricacies of tumor heterogeneity. This paper explores the challenges and perspectives surrounding MVNT to improve clinical decision-making and patient outcomes. Based on the present narrative review, advancements in diagnostic technologies have shown promise in addressing the challenges associated with diagnosing MVNTs. Liquid biopsy is an innovative and non-invasive diagnostic tool that analyzes biomarkers to provide information about tumors, and radiomics is a method that extracts quantitative data from medical images to provide detailed insights into tumor characteristics. Such innovative diagnostic technologies are important because they have the potential to significantly improve the current diagnostic landscape for MVNTs, allowing for earlier detection, accurate classification, and personalized treatment strategies.
Delirium is associated with lower quality of life, increased healthcare costs, longer hospitalizations, and worse prognosis when detected in patients who are already confronted with a severe and invalidating disease, like the major neurocognitive disorder (MND). In order to identify the most evidence-based interventions that could be included in case management for patients with both delirium and MND, this narrative review explored three electronic databases (Pubmed, Cochrane, and Web of Science/Clarivate) for primary and secondary sources dedicated to this topic. All papers published in English between the inception of each database and September 2024 were screened for relevant data on pharmacological and non-pharmacological therapies targeting delirium. The results supported the use of a multicomponent approach as the first line of treatment, mitigating the precipitating factors, and only as a second line, the use of pharmacological instruments. There is a lack of validated therapies targeting specifically the delirium superimposed on MND, most of the recommendations being extrapolated from studies with delirium in the general population or in elderly patients with different organic diseases. Further studies are required to investigate the specifics of delirium in patients with MND and potential strategies focused on neurobiological mechanisms instead of just clinical manifestations.
There is a potential lateralization of vegetative influences at the cerebral level. We sought to understand the impact of these influences in the setting of ischemic stroke. We conducted a prospective study on 110 who presented with acute ischemic stroke (symptom onset maximum 24 hours before admission). We investigated correlations between stroke subtype, insular location or lateralization, stroke severity, hospital mortality, and the dynamic of enzymes (Tn, TnT, CK, CK-MB). We demonstrated that a higher cardiac enzyme value is associated either with stroke severity or with a higher risk of death in the short term, this growth being a marker for a more severe prognosis of a large stroke rather than an independent cause of mortality. Cardiac monitoring in the acute phase of ischemic stroke can prevent cardiac morbidity and mortality, which is why it is important to identify patients at high risk of heart complications after stroke.
More and more research in recent years has focused on neurogenesis and neuroplasticity. The hippocampus is a key location of adult neurogenesis. Because this part of the brain is regulated by environmental variables, it must be mentioned the therapeutic potential for neurodegenerative illnesses and brain injuries. Furthermore, this information challenges the historical concept of a static brain and tries to demonstrate its flexibility, adaptability, and possibility for regeneration. Those mechanisms which are found in a variety of mammalian species, including humans, are important when it comes to adaptive learning and memory, thus providing insights into cognitive well-being and mental health. The discovery of the brain's dynamic nature represented by new neurons, marks a shift in the field of neurology with far-reaching potentials. This paper highlights the significant potential of adult neurogenesis when it comes to clinical applications such as Alz-heimer’s disease.
The primary objective of this narrative review is to evaluate the most frequently recommended structural and functional imaging methods in managing epilepsy cases as effectively as possible from a neurologist’s perspective. This review examines the background of current practice, from the beginnings of neuroimaging by computer tomography to the newly introduced methods and their combination, which helps diagnose and monitor these patients. The neuroimaging investigations required for the presurgical evaluation of patients with epilepsy are presented, and recommendations for specific MRI protocols are provided. The clinical use of functional imaging methods is also considered, and correlations between clinical aspects and specific imaging methods are explored, based on the retrieved data in the literature. In conclusion, this review emphasizes using functional and structural imaging methods, guided by clinical evidence, for better therapeutic management in patients with epilepsy.
The assessment of suicide risk is a highly debated topic in the literature due to the complex interplay between social, psychological, cultural, and biological factors that contribute to the pathogenesis of self-harm. There is no unanimously accepted predictive model of suicide and no widely recognized evidence-based algorithm for psychiatric and psychological evaluation in clinical and non-clinical populations for early detection of self-harm. Therefore, this narrative review is focused on identifying the validated clinical instruments that may contribute to the construction of a possible screening and monitoring plan for suicide risk in military and civilian populations. Four electronic databases were searched (PubMed, CINAHL, Google Scholar, and Clarivate/Web of Science) for relevant reports on psychometric tools for detecting suicide risk published between the inception of each archive and January 2025. Seventeen instruments dedicated to the measurement of suicide and suicide-related aspects were reviewed, as well as three tools for the evaluation of depression severity that include specific items for assessing self-harm. The advantages and vulnerabilities of each instrument were assessed, and the particular features of using these tools in the military population were also explored. In conclusion, although a large number of validated instruments for the assessment of suicide risk exist, it is not possible to recommend the use of a single tool, either for clinical and nonclinical populations or for military and civilian personnel. The endeavor of finding an algorithm for the assessment of suicide risk is still far from reaching its end, as new psychometric instruments and possibly a new paradigm for the phenomenon of self-harm are sorely needed.
Clinical research is the cornerstone of the progress recorded in psychiatry in the last six decades, or of what is called the psychopharmacological revolution. Regardless of the stage of clinical research, there are sensitive ethical and legal aspects that may appear during this process, and such challenges have to be acknowledged in order to preserve its scientific value, integrity, and centered-on-the-patient-wellbeing core principles. Also, adequate strategies focused on preventing the risk of ethical misconduct and litigation have to be found to avoid a loss of trust in the results of clinical research, to protect vulnerable populations from abuse, and to ensure a legally stable environment for investigators. In order to explore these practical problems, a narrative review was performed through a search in PubMed and Google Scholar databases. The main ethical risks detected in clinical research were related to errors in the methodology of obtaining informed consent, monitoring the participant's safety during the clinical trial, and falsifying collected data. Several famous cases of ethical misconduct were found and analyzed, and methods to decrease the risk of the re-appearance of such problems have been listed. In conclusion, this review is an invitation to explore the complexity of the methodology of clinical research and its ethical and legal risks, as well as to find new ways to mitigate the possibility of such risks related to the research process.
Background. Primary headaches are comprised of three big categories: migraines (with or without aura), the third most common and the 6th most disabling disease worldwide, tension-headaches, and trigeminal autonomic cephalalgias, each with different, complex, and not completely understood pathophysiological, clinical, and neuroimagistic characteristics. Structures like the brain stem, hippocampus, or hypothalamus have been depicted as being the main triggers of these types of headaches, which have a significant impact on the quality of life. Methods. We performed a broad literature review on primary headaches from January 2016 to June 2023, analyzing the latest scientific updates and emphasizing the pathophysiological and neuroimagistic characteristics. Results. We provide a concise review of the main neuroimaging studies that help in differential diagnosis between several types of primary headaches. Conclusions. It is difficult to approach the pathophysiology of these three primary headache categories. Keeping in mind that neuroimagistic methods are rapidly developing (especially in the MRI sphere), the most important endpoint of future studies will be to establish a reliable distinction system for all these types of cephalalgias, thus updating the protocols and guidelines. Currently, imaging studies are indicated only in certain circumstances.
Erectile dysfunction (ED) has an intricate pathogenesis, with organic and psychosocial factors contributing to the shaping of its clinical manifestations and functional impairment. ED disrupts not only an individual’s sexual life but may also contribute to impairments of self-esteem, social functioning, quality of life, overall well-being, mood, etc. The assessment process and therapeutic interventions should be adequate to the specific profile of each patient, therefore an interdisciplinary approach is usually recommended, in order to find the vulnerability factors, recent triggers, psychiatric and organic comorbidities or causes, and elements that contribute to maintaining the sexual dysfunction, such as lifestyle factors, interpersonal conflicts, or inadequate sexual education. This narrative review explores the evidence-based approaches to structured psychiatric, psychological, and therapeutical assessment in patients with ED, and the most validated psychosocial treatments available. The results support the use of recognized diagnostic criteria within DSM-5TR and ICD-11, together with structured instruments (scales, questionnaires, and inventories), in a multidisciplinary approach. The cognitive model and cognitive-emotional model of ED support the initiation of cognitive-behavioral therapy in these patients. Other interventions, like the PLISSIT model, sexual therapy, couple therapy, and sexual-focused psychoeducation are also supported by evidence. In conclusion, ED requires a combined, psychiatric, psychologic, psychotherapeutic, and organic-oriented assessment, with the purpose of tailoring the treatment to the patient’s particularities.
The assessment of coping mechanisms in patients diagnosed with oncological diseases is essential for mental health specialists, who have to design the most appropriate case management strategy for comorbid mood disorders, anxiety disorders, adjustment disorders, and other psychiatric conditions that may be detected in this vulnerable population. The adequate treatment of these disorders is important for the preservation of mental health status, quality of life, and overall functionality in patients diagnosed with cancer. Coping mechanisms modulate the vulnerability toward psychiatric disorders, but they also have an impact on treatment adherence, which is an important factor correlating with prognosis. Appraisal-focused, problem-focused, emotion-focused, and occupation-focused coping represent the most well-defined strategies patients use when confronted with a stressful life situation, like a diagnosis with potentially vital consequences. Maladaptive coping strategies may also be identified in these patients, e.g., withdrawal from reality, including complete or partial denial of the disease, substance abuse, behavioral addictions, refusal of the recommended treatment, etc. The psychotherapeutic approach in patients with oncological diseases should include an initial evaluation of the coping strategies used either currently or in the past stressful conditions, an assessment of all the psychosocial resources the patients have (e.,g., support group, professional insertion, hobbies), and screening for mood and anxiety disorders that may have been triggered by the cancer diagnosis. Consequently, within the psychotherapeutic framework, a trained specialist can enhance the role of adaptive coping strategies and highlight the disadvantages of dysfunctional ones. This process may possess a favorable impact on treatment adherence, mental health status, and quality of life in patients with cancer.
Nutritional interventions in the field of psychiatry have been explored more intensively in the last two decades, but definitive conclusions based on the retrieved data in the literature about the efficacy of this therapeutic approach are difficult to formulate. This observation has multiple explanations, e.g., these therapeutic interventions are very heterogenous, cohort studies usually enroll different psychiatric populations or healthy subjects with minor psychiatric symptoms, nutritional supplements or special diets are commonly recommended as add-ons to the pharmacological interventions (thus making it difficult to differentiate the impact of each therapy on the outcomes), placebo-controlled randomized studies are still very few, etc. Therefore, a narrative review focused on the main challenges reported during the research in the field of nutritional psychiatry (NP) may be useful for clinicians interested in strategies to augment the efficacy of pharmacological treatments or to find new solutions with low risk of adverse events in patients with organic comorbidities or multiple concomitant medications. Data about the efficacy and tolerability of nutritional interventions explored for psychiatric disorders were searched in four electronic databases (PubMed, Cochrane, Clarivate/Web of Science, and EMBASE). Omega-3 polyunsaturated fatty acids supplementation, healthy diet interventions, folate and vitamin B12, S-adenosyl-L-methionine, N-acetyl cysteine, vitamin B1 and B6, vitamin D, minerals, psychobiotics, inositol, and herbal products were the main interventions identified, and their demonstrated efficacy was quite heterogenous, while their tolerability and safety were good. Therefore, NP is a domain of research that may benefit from more good-quality and longer-duration trials, in order to verify the effectiveness of such augmentation strategies to the already validated treatments.
The conundrum of post-psychotic depression (PPD) is still present in the psychiatric literature, for more than a century since it was first described by Mayer-Gross. After a short existence in the DSM-IV and ICD-10, this nosological construct was excluded from newer versions of the mental disorders classifications. Therefore, an exploratory analysis of the PPD concept was considered useful both from clinical and theoretical perspectives. There is a high prevalence of depressive symptoms in patients with schizophrenia spectrum disorders (SSD) and, although not all of them represent cases of PPD, they are considered risk factors for suicide. The arguments and contra-arguments for/against PPD were reviewed, and the potential pharmacological interventions for this disorder were analyzed. The explored evidence indicates that PPD is worth further investigation, and in order to differentiate it from schizoaffective disorder, negative symptoms of SSD, or depressive manifestations within the acute psychotic episodes, clearly defined criteria should be found. The use of validated scales, like the Calgary Depression Scale for Schizophrenia and the InterSePT Scale for Suicidal Thinking, is recommended for the initial assessment of depression and suicidal risk in patients with SSD, but also for their monitoring during the acute and maintenance phases. Besides the administration of combined, antidepressant and antipsychotic treatment, the use of clozapine, and the recommendation to initiate treatment for SSD with atypical antipsychotics whenever possible, there is a dearth of studies exploring specific interventions for PPD. Future studies are expected to address the validity of the nosological construct of PPD and the most adequate therapeutic and prophylactic interventions in patients with SSD.
Neurocognitive disorders are extremely invalidating psychiatric disorders with chronic courses and significant negative impacts over all areas of cognitive functioning and behavioral activity. Although extensive research on these progressive neurodegenerative disorders has been conducted, pathogenetic treatments with long-term significant benefits are yet controversial. From a clinical perspective, there is an acute need to find therapeutic strategies that could delay cognitive impairment in patients diagnosed with Alzheimer’s disease (AD), vascular dementia (VaD), Lewy body dementia (LBD), etc. Also, slowing the transition from mild cognitive impairment (MCI) to clinically significant AD is another important clinical aspect, with a major impact on the patient’s daily functioning, quality of life, and caregivers’ burden. Acetylcholinesterase inhibitors (AChEI) are still the first line of treatment in AD patients, and they are also administered in the case of VaD or Parkinson’s dementia. Various nootropics have been studied in this population, as add-on agents. Highly purified animal tissue extracts (HPATE) are administered in patients with neurocognitive disorders due to their neurotrophic properties, but many questions remain unanswered regarding their pharmacodynamic characteristics. These extracts may be added to AChEI to enhance their pro-cognitive effect, but evidence to support the superior efficacity of this association versus AChEI monotherapy is mainly derived from low-to-medium quality clinical trials. In conclusion, HPATE may be a useful add-on to first-line pro-cognitive agents in AD and VaD, but larger trials with better methodology are needed. In particular cases, however, HPATE may be of significant interest for patients with mild-to-moderate AD, based on results from clinical practice.
Cannabinoids' usefulness in the treatment of neurological disorders (epilepsy, and various neurodegenerative diseases, such as Multiple Sclerosis and Alzheimer's Disease) has been demonstrated in a growing number of studies. Of the 11 known general types of natural cannabinoids, the focus has been mainly directed at cannabidiol (CBD) due to its specificity in stimulating cannabinoid receptors and the low rate of side effects, as well as on Δ (9)-tetrahydrocannabinol (Δ9-THC). The natural and synthetic analogs of CBD have been described as a potential treatment in neurological diseases, as they showed their therapeutic benefits in reducing the seizures from epilepsy and their neuroprotectivity in neurodegenerative diseases. First and foremost, CBD's neuroprotective properties are due to its capacity to act as an endogenous cannabinoid receptor agonist. Second, CBD enhances neuroprotection by interacting with many signal transduction pathways mediated indirectly through cannabinoid receptors. CBD also reduces the hyperphosphorylation of glycogen synthetase kinase 3 (GSK-3) induced by the buildup of Amyloid β in the physiopathology of Alzheimer's disease.
During the COVID-19 pandemic, neuropsychiatric disorders have been diagnosed both in the acute phase, and in the aftermath of this disease. Inpatients, as well as outpatients recently diagnosed with mild, moderate or severe forms of Coronavirus infection have reported neuropsychiatric manifestations with variable duration, symptoms that could be directly or indirectly related to the viral pathogenic agent. Patients who are recovering from the acute phase of COVID-19 also may exhibit various psychopathological manifestations, during the so-called “post-COVID-19 syndrome” or “long COVID-19 syndrome”. Explanations regarding the onset of this type of clinical manifestations and the SARS-CoV-2 infection are extremely diverse, ranging from biological factors (e.g., direct central nervous system viral activity, cerebral hypo- oxygenation, high level of inflammatory response) to psycho-social stressors (e.g., isolation, fear of death, anxiety related to possible somatic complications or sequelae). Objectives: The primary objective of this article was to analyze psychiatric manifestations in patients with acute COVID-19 disease and in patients during post-COVID-19 phase. The secondary objective was to propose a conceptual framework for the evaluation and treatment of these patients. Methods: Patients included in this analysis were screened positive for COVID-19 infection in the last 6 months before their first psychiatric examination. These patients were further evaluated to detect any personal history of psychiatric disorders, somatic comorbidities, or significant concomitant pharmacological treatments. Specific scales for the measurement of symptoms severity and functional impairment were administered in all patients. Results: Five patients were included in this analysis, one during the acute phase of COVID-19 infection, and four patients were evaluated after the complete remission of this disease. Hyperactive delirium, mild neurocognitive disorder, major depressive episode, panic disorder with agoraphobia, or acute psychotic disorder were the main diagnoses in these patients. All patients received adequate treatment and they were monitored using psychological scales until symptoms remission or stabilisation. Conclusions: Psychosocial stressors, neurobiological changes, systemic inflammatory reaction, and individual vulnerability factors may contribute to a diathesis- stress model for psychiatric disorders onset within the acute phase or after the remission of acute manifestations in COVID- 19-diagnosed patients.
Medical personnel is constantly exposed to a variety of stressful events, starting from work overloading, to threats to one's own health or personal integrity, disruptions in personal relationships due to high stress in the professional environment, continuous need to keep in touch with the advances of medical science and therapeutic guidelines etc. Structured evaluation of work-related stress disorders (WRSD) is important both for screening purposes in a vulnerable population like the medical personnel, and for the monitoring of the overall status evolution during individual or organizational interventions. Beside burnout syndrome, major depressive episodes, anxiety disorders, acute stress reactions, posttraumatic stress reactions, substance use disorders, adjustment disorders are also included in the category of WRSD. A specific instrument has been designed for the purpose of screening for WRSD in this specific population, i.e. the Work-related Stress Inventory for Medical Personnel, structured as a 20 items, self-administered instrument (WRSIMP-20). This inventory evaluates three main dimensions- (1) mood symptoms and somatic equivalents, (2) work and professional environment- related discomfort, and (3) interpersonal relationship-associated distress. The results of online administration of WRSIMP- 20 in 81 health care workers and 52 individuals not related in any way to health care professions (control group) were consistent with the premises, as this inventory has been proven valid for the targeted population. Larger trials and test-retest evaluation are needed in order to complete the psychometric properties of WRSIMP-20, but this instrument seems promising in the detection of individuals vulnerable to WRSD.
Isolation and quarantine during the Covid-19 pandemic affected the lifestyle and daily functioning of the population around the world, leading to social, psychological, and economic changes which further multiplied the stress related to the threat of coronavirus contagion by adding financial, relational, academic, professional and mental health vulnerabilities. To assess the impact of isolation and quarantine over the quality of life in the Romanian population, we conducted a Web-based survey focused on the evaluation of stress level, perception of lifestyle changes, communication patterns, mental health, major concerns, perception of one’s future, but also on the preferred coping strategies that people have used to deal with the isolation stress. The answers were collected during one month and the results for the first 2 weeks of quarantine/isolation were compared with the results after one month of such regimen. Several recommendations based on the survey results analysis were formulated regarding possible strategies for decreasing the impact of stress factors over the general population and specific, vulnerable groups.
A unique approach to the treatment of posttraumatic stress disorder (PTSD) is difficult to support, because of the complexity and heterogeneity of this pathology. Multiple evidence-based guidelines for PTSD treatment exist, elaborated by prestigious institutions around the world, but a certain level of the inconsistency of their recommendations appears when these sources are compared with each other. Therefore, a review of current guidelines and extraction of the most supported by evidence recommendations is considered important for clinical practice, due to the need to approach such complex cases as PTSD-diagnosed patients in a stepwise manner. Structured monitoring of the clinical status during the treatment is also an important and rather neglected aspect of the case management in PTSD, and the necessity of follow-up visits for efficacy and tolerability should be taken into consideration. Psychotherapy (especially cognitive- behavioral oriented therapies and eye movement desensitization and reprocessing therapy) is supported by evidence as a first-line approach, as well as certain antidepressants, like the selective serotonin reuptake inhibitors and venlafaxine. Many second-line pharmacological agents and psychotherapies are also available, but there is an obvious need for more pragmatic trials with PTSD patients.
Background: A large number of augmentation agents have been tried in patients with schizophrenia spectrum disorders, because negative and cognitive symptoms are difficult-to-treat with current pharmacological agents, and because the high percentage of treatment-resistant cases requires new therapeutic solutions. Inflammation is one of the supposed pathophysiological mechanisms in schizophrenia; therefore, antibiotics have been explored as add-on agents. No systematic review or meta-analysis about the efficacy of antibiotics in psychotic disorders has yet been conducted. Objectives: To assess if the use of antibiotics as add-on to current antipsychotic treatment may improve core symptoms of schizophrenia spectrum disorders, global clinical status, overall functionality, and if this augmentation strategy is well tolerated. Methods: A systematic literature review was conducted, including papers published between 1980 and 2018, which have been found in the main electronic databases (PubMed/MEDLINE, CINAHL, NCBI, Embase, Thomson Reuters/Web of Science). The keyword search strategy was formulated using the following paradigm: „schizophrenia spectrum disorders”/ „schizophrenia”/ „schizo-affective disorder”/ „schizophreniform disorder”, AND „antibiotics”/ all the names of currently marketed antibiotics classes. This review was registered to PROSPERO database with the protocol number CRD42019119152. Results: Based on reviewing the selected trials regarding the efficacy of antibiotics over core symptoms of schizophrenia, only two agents were detected – minocycline and D-cycloserine. Minocycline as add-on to antipsychotic treatment was associated with mixed results, while regarding the efficacy of d-cycloserine either no significant difference, or superiority to placebo over negative and cognitive symptoms was reported. Minocycline had an overall effect over the clinical impression that was not distinguishable from placebo, although there was one trial supporting the efficacy of this antibiotic. The impact of minocycline over the global functioning when added to antipsychotic in patients with schizophrenia was mixed, with one positive and one negative trial (moderate to high quality designed trials). D-cycloserine had no significant impact over global clinical status or patients’ overall functionality. Conclusion: From all the data reviewed and hierarchized resulted that larger trials are needed in order to confirm the efficacy of antibiotics as add-on to antipsychotics over negative and cognitive symptoms of schizophrenia spectrum disorders.
Opioid use disorder is a worldwide challenge for an increasing number of patients, and still the therapeutic options presented in clinical guidelines for this condition are very few. The first line pharmacological therapies for opioid use disorder continue to be opioid agonists as substitution treatment, but the need to find new treatments without the effect of prolonging opioid dependence become more and more obvious. This systematic review presents the most supported by evidence pharmacological agents that can be used as monotherapy for opioid use disorder patients (i.e., naltrexone, extended release/implant and oral formulation), or as adjuvants to substitution therapy (e.g. olanzapine for aggressive behaviours, memantine or dextromethorphan for reducing inflammatory processes related to opioid use). More good quality data derived from larger, well designed trials are needed in order to find solid recommendations for non-opioid agonists in the treatment of opioid use disorder.
Several problems related to coagulation dysfunctions induced by selective serotonin reuptake inhibitors (SSRIs) were reported in literature, as serotonin is widely distributed in the human organism and it has significant contribution in various vascular and hematologic regulatory mechanisms. First, a systematic review has integrated main results from the field of SSRIs and anticoagulants pharmacologic interactions. Secondly, a retrospective analysis was performed, based on the medical charts of hospitalized patients diagnosed with SSRI-treated depressive disorders, who also received concomitant anticoagulant treatment with acenocoumarol. Platelet count, prothrombin time, activated partial thromboplastin time, and bleeding time were monitored during hospitalization and their values before and after SSRI initiation treatment were compared.
Treatment resistant schizophrenia (TRS) is a severely disabling disorder, which decreases dramatically the quality of life and overall functionality, while it increases the rate of hospital admissions and overall healthcare costs. The main objective of this research was to evaluate the risk factors for TRS in a group of patients based on a retrospective analysis. The secondary objective was to design an algorithm for initial evaluation in patients with schizophrenia, in order to detect the candidates at risk for developing TRS. Medical charts and consultation records of all patients aged between 18 and 30, diagnosed with TRS, evaluated during 1-year in our department, were selected for analysis. The most significant risk factors for TRS found in univariate model were younger age at schizophrenia onset, male gender, living in rural areas, co-morbid drug dependence, lower therapeutic adherence, and premorbid personality disorder. Marginally significant were higher Positive and Negative Syndrome Scale (PANSS) scores at previous admissions, higher scores on PANSS negative symptoms sub-scale, and lower educational background. In the multivariate model, TRS was still significantly predicted (p<0.05) by younger age at the disease onset, addictive co-morbidity, and lower therapeutic adherence. An algorithm based on these risk factors is suggested, based on (a) structured PANSS evaluation using SCI-PANSS and Informant Questionnaire for PANSS, (b) a scale for the detection of co-morbid drug dependence (i.e. Inventory of Drug Taking Situations, IDTS), (c) an interview for detecting premorbid personality disorders (i.e. Structured Clinical Interview for DSM IV – Axis II Disorders, SCID-II), and (d) Treatment Satisfaction Questionnaire for Medication (TSQM) for therapeutic adherence monitoring. Also, the inclusion of several pharmacogenetic parameters (at least CYP450 2D6 panel for detection of poor/ultrarapid metabolizers) could be useful when establishing an adequate therapeutic management, and may help in decreasing the rate of non- response due to variations in antipsychotics plasma levels.
Patients with schizophrenia are frequently diagnosed with addictive comorbidities, and data in the literature support a 10 to 70% prevalence of this dual diagnosis. Nonetheless, substance use disorders can be missed during the initial interview with a psychotic patient, if the clinician is focused only on the more obvious manifestations. Therefore, using psychometric scales and structured interviews in patients with schizophrenia is strongly encouraged because the case manager will base his/her therapeutic decisions on quantifiable data about these patients’ symptoms and functional status. Clinical management in dual diagnosis cases must address both conditions simultaneously, as the delay in the initiation of substance withdrawal treatment may hinder the recovery from a psychotic episode. An important issue is represented by the potential pharmacologic interactions between drugs administered for schizophrenia and those targeting substance withdrawal and substance dependence. Other important aspects refer to (1) the therapeutic adherence, which can influence the prognosis of both conditions, (2) the negative impact of residual psychotic symptoms and substance-related disorders over the patient quality of life and daily functioning, (3) the necessity to integrate variables like the patient’s specific needs, lifestyle, and psychological resources in the therapeutic decision. These clinical vignettes are focused on clinical, biological, psychometric, and pharmacological dimensions, supporting the formulation of treatment recommendations based on monitoring both psychiatric and biological profiles.
Late-life major depression is a high-incidence and difficult-to-treat affective disorder. Diagnosis of major depression in old age could also could be a challenge, due to aspects like (1) there is a higher vulnerability to the stigma of depression in this population, (2) hypochondriac ideation and somatic symptoms are the main symptoms, while depressive disposition or anhedonia are under-reported by such patients, (3) differential diagnosis includes various organic diseases, but also several psychiatric disorders, like neurocognitive disorders, organic affective disorders, drug induced affective disorders etc. Reduction of social relationships caused by retirement and loss of spouse and friends, as well as a decrease of personal income could precipitate or maintain depressive disorders during late-life. Quality of life in patients diagnosed with depressive major disorders is a rarely monitored parameter, although its importance for case management could not be overemphasized. A reduction of life quality correlates with a poorer functional prognosis, persistence of neglected residual symptoms, low adherence to treatment plan etc.
Matching drugs with anxiolytic properties- but without the potential of inducing dependence or abuse- with clinical manifestations of various affective disorders is a very important challenge for psychiatrists. Although the first line of pharmacologic treatment for anxiety disorders remains antidepressants with serotoninergic properties, calcium channel alpha-2-delta ligands are adjuvant agents which could be useful for augmenting antidepressant agents’ clinical effects. Unfortunately, calcium channel alpha-2-delta ligands efficacy and tolerability are not very well known, due to a lack of large scale, randomized, placebo-controlled trials focused on psychiatric disorders. Data regarding pregabalin and gabapentin pharmacology and clinical effects are reviewed and conclusions with pragmatically impact based on the discovered evidence are formulated accordingly.
Loneliness is receiving more and more attention for being an important psychosocial contributor to the deterioration of quality of life, psychological well-being, onset of mental health disorders, but also to the increased mortality and morbidity, through the mediation of general health problems and suicide. While studies on the impact of loneliness in the civilian population have been steadily increasing in number over the past decade, research on the same phenomenon in military settings has progressed at a comparatively slower pace. This article is a two-stage analysis of the perceived lack of social connectedness among active-duty and former military personnel, including (1) a conceptual exploration and literature review based on searches in three electronic databases (PubMed, Google Scholar, and Web of Science/Clarivate), and (2) a pragmatical set of recommended strategies to reduce the impact of loneliness in these populations. Based on the review of 42 primary and secondary sources, the paper explores the prevalence, risk and protective factors, characteristics, and consequences of loneliness, with particular attention to various minorities, female military personnel experiencing motherhood during active duty, civilian spouses of deployed service members, and other significant subgroups. Recommended directions of interventions are threefold, i.e., screening for loneliness and its risk factors, initiation of prophylactic strategies and therapeutic interventions targeting this phenomenon in vulnerable categories. In conclusion, further research on loneliness in both active and former military personnel is strongly warranted, given its significant consequences for multiple dimensions of health and overall functioning.
Mental health stigma (MHS) among military personnel requires a complex approach, as it is influenced by ethical challenges and organizational norms distinct from those in civilian milieus. Stigmatization encompasses multiple dimensions -including social, self, anticipated, cultural, and structural stigma- that must also be examined within military settings. This article presents a conceptual analysis of key research directions in the field of MHS, based on a literature review conducted across three electronic databases (PubMed, Google Scholar, and Clarivate/Web of Science), from the inception of each database up to June 2025. The review focuses on active-duty service members and veterans, and identified six major domains involving MHS: (1) structural stigma within military contexts, (2) risk factors and consequences associated with MHS, (3) self-stigma among active-duty personnel and veterans, (4) the role of military healthcare providers in mitigating stigma, (5) military sexual trauma and its relationship to stigma, and (6) interventions aimed at decreasing MHS among military personnel. Although relevant primary and secondary studies were identified across these domains, significant research gaps remain, particularly in the last three areas. Addressing MHS in military populations is essential not only for improving quality of life, psychological well-being, and daily functioning, but also for maintaining combat readiness, unit cohesion, and peer acceptance.
The therapeutic landscape for multiple sclerosis has evolved markedly in recent years, with an expanding arsenal of disease- modifying therapies offering clinicians more tools to manage the disease. This progress presents both opportunities and complexities, as treatment decisions increasingly require individualized strategies balancing efficacy, safety, and long-term outcomes. While current therapies effectively reduce inflammation and delay disease progression, they fall short in halting neurodegeneration, highlighting a critical unmet need. Treatment paradigms range from escalation strategies prioritizing safety to early high-efficacy approaches aimed at aggressive disease control. Data increasingly support early initiation of high-efficacy DMTs in patients with poor prognostic indicators, but concerns over long-term safety and tolerability remain. Shared decision-making, informed by patient preferences and evolving evidence, is central to modern MS care. The future is promising, with new therapies in advanced stages of research, which seek to exceed the limits of current therapy, to act in a targeted manner, limiting both inflammation and neurodegeneration, for better control of disease activity, with an improved safety profile.
Bereavement constitutes a shared environmental exposure that may result in distinct psychopathological outcomes, including prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). The objective of this research was to construct a transdiagnostic conceptual model for interpreting bereavement-related pathologies that integrates core psychopathological data. A structured conceptual synthesis of the literature was conducted, focusing on diagnostic, epidemiological, pathophysiological, clinical, and therapeutic findings related to PGD and associated disorders. Shared and disorder- specific mechanisms were identified and mapped across diagnostic categories in order to construct an integrative framework. The proposed model suggests that bereavement-related psychopathology can be conceptualized as a spectrum of partially overlapping syndromes organized around three principal domains: attachment dysregulation and separation distress (PGD), trauma- and threat- processing abnormalities (PTSD, acute stress disorder, adjustment disorder), and depressive-cognitive vulnerability (MDD). This framework provides a clinically relevant perspective on the relationship between grief-, trauma-, and depression-related disorders following loss. More research is needed to empirically validate this model, but at a theoretical level, it can serve as an orienting aid for mapping bereavement-related diagnoses and treatments.
Background: Behavioral addictions (BAs), including gambling disorder, gaming disorder, problematic pornography use, compulsive sexual behavior, and problematic internet use, have received increasing attention because of their potential impact on mental health, occupational functioning, and military readiness. Objectives: To identify military-specific risk factors, clinical and operational consequences, barriers to detection and treatment, and gaps in prevention strategies related to BAs among active-duty personnel and veterans, and to propose a framework for prevention and early intervention. Methods: A narrative evidence synthesis was conducted using studies evaluating BAs in military and veteran populations, and data were extracted regarding prevalence, risk factors, psychiatric comorbidities, functional outcomes, help-seeking barriers, and intervention approaches. Findings were analyzed thematically to identify common patterns across different BAs and to inform the development of a military-specific prevention framework. Results: Evidence consistently indicated that military personnel and veterans are at increased risk of confronting multiple vulnerability factors for BAs, including trauma exposure, deployment-related stress, social isolation, boredom, sleep disruption, risk- taking tendencies, and barriers to help-seeking. Gambling disorder and problematic gaming were the most extensively studied conditions and were associated with depression, anxiety, posttraumatic stress disorder, substance use disorders, suicidality, impaired occupational functioning, financial difficulties, and reduced operational readiness. Also, emerging evidence suggests similar associations for problematic pornography use, compulsive sexual behavior, and problematic internet use. Across studies, stigma, concerns about career repercussions, and limited awareness of available services represented important obstacles to treatment engagement. Conclusions: BAs represent an under-recognized challenge to military health and force readiness, while the available evidence supports implementing integrated prevention strategies that include routine screening, psychoeducation, commander training, confidential referral pathways, and early intervention programs. A comprehensive military-specific framework targeting behavioral addictions may improve individual well-being while reducing operational and organizational consequences.
