PURPOSE:Spirituality and religiosity have repeatedly been discussed as potential psychosocial resources that may influence recovery in chronic or life-threatening illnesses. Evidence in surgical settings, particularly within neurosurgery, is scarce and inconsistent. This study investigated whether daily spiritual experiences - as measured by the Daily Spiritual Experience Scale (DSES) - are associated with postoperative outcomes in patients undergoing lumbar spine surgery. METHODS:In this prospective observational study, patients scheduled for lumbar decompression or fusion surgery completed the DSES preoperatively. Clinical and patient-reported outcomes (pain intensity, Oswestry Disability Index (ODI), Short Form 36 (SF-36), Beck Depression Inventory II (BDI-II), State-Trait Anxiety Inventory (STAI) were assessed before and three months after surgery. Correlation analyses explored associations between spirituality and postoperative functional and psychological recovery. In addition, an exploratory hierarchical regression analysis was performed for postoperative back pain. RESULTS:The 115 patients, 56 (48.7%) male and 59 (51.3%) female, showed statistically significant improvements across all postoperative measures compared to baseline. An initial unadjusted analysis revealed a weak association (p = .048) between DSES scores and postoperative back pain. However, this finding did not remain statistically significant after correction for multiple testing and was not confirmed in the hierarchical regression model. No associations emerged between DSES scores and functional or psychological outcomes at three months. CONCLUSION:Within this exploratory study, spirituality was not associated with and did not emerge as an independent predictor of patient-reported outcomes. The findings suggest that spirituality and religiosity in this context may reflect individual coping styles rather than determinants of short-term clinical recovery.
Abstract Background Youth mental health systems worldwide face increasing demand, workforce shortages, and fragmented pathways to care. Addressing these challenges requires approaches that extend beyond specialist clinical treatment to incorporate prevention, participation, education, and recovery-oriented support. While Recovery Colleges are increasingly established within adult mental health services, their youth-adapted counterparts commonly referred to as Discovery Colleges remain underexplored within youth mental health systems research. This narrative review synthesises emerging literature to examine the conceptual foundations, developmental adaptations, and potential system-level role of Discovery Colleges within youth mental health care. Methods A narrative review approach was employed to synthesise emerging literature on Discovery Colleges and related recovery-oriented educational initiatives. Peer-reviewed publications, programme descriptions, and implementation reports were analysed to examine the defining principles, developmental relevance, organisational characteristics, and system-level implications of Discovery Colleges within youth mental health contexts. Results The synthesis identified four interrelated conceptual domains characterising Discovery Colleges: (1) recovery-oriented learning models and developmental adaptation; (2) mechanisms of engagement and participation; (3) organisational and professional implications; and (4) cross-sector positioning within youth mental health ecosystems. The findings suggest that Discovery Colleges can be conceptualised as developmentally responsive and recovery-oriented learning environments operating at the intersection of education, community support, and mental health care. The review further highlights important tensions relating to implementation, safeguarding, fidelity, sustainability, and cross-sector integration. Conclusions Discovery Colleges may represent a promising recovery-oriented innovation within youth mental health systems by reframing mental health support as a collaborative, participatory, and educational process rather than solely a clinical intervention. However, the current evidence base remains limited and largely exploratory. Further empirical, developmental, and implementation-focused research is required to evaluate their effectiveness, sustainability, and long-term contribution to integrated youth mental health systems.
Ziel dieser Studie war es, ärztliche Perspektiven auf das Reduzieren und Absetzen (R A) von Antidepressiva (AD) und Antipsychotika (AP) zu untersuchen. In zehn systematischen Interviews und einer Fokusgruppe mit ambulant tätigen Psychiater*innen aus Berlin und Brandenburg wurden Unterschiede in Einschätzungen, Beratungspraktiken und Entscheidungsmuster erfasst und anschließend mittels MAXQDA induktiv ausgewertet. R A wird bei AD häufiger initiiert, da depressive Patient*innen als einsichtiger und therapietreuer gelten. Im Gegensatz dazu schätzen Psychiater*innen das Rückfallrisiko und die Folgen des Absetzens von AP höher ein, was zu einer Zurückhaltung beim R A führt. Strukturelle Hürden, unklare Leitlinien und fehlende nicht-medikamentöse Alternativen erschweren das R A insbesondere im Fall von Psychosen. Für das gemeinschaftliche R A von AP und AD braucht es klare Leitlinien, Wissenstransfer und bessere psychosoziale Versorgungsangebote – vor allem für Patient*innen mit Psychosen.
Substance use disorders (SUD) involving ketamine, cocaine, and alcohol present significant clinical challenges, often characterized by high relapse rates and limited pharmacological options. This case report details a 30-year-old male with a five-year history of severe polysubstance dependence, including daily intranasal ketamine use (2-3 g/day), cocaine, and alcohol, comorbid with recurrent depressive disorder. Despite conventional psychiatric treatment, the patient experienced severe cravings and sought ibogaine-assisted treatment. The patient underwent a structured 13-day residential program in Mexico, receiving an 800 mg ibogaine HCl flood dose (10.1 mg/kg), followed by two supplementary booster doses of 300 mg (3.8 mg/kg) under continuous medical and ECG monitoring. Following treatment, the patient reported an immediate cessation of cravings for all substances. Over approximately 17 months of follow-up including a medically supervised fractionated ibogaine intervention approximately 11 months after the initial treatment, serial toxicology and psychometric assessments were consistent with continued abstinence from ketamine, cocaine, alcohol and other previously misused substances, and significant improvements in depression (PHQ-9: 0-3), anxiety, and quality of life (WHOQOL-BREF: 55 to 71). This report represents the first longitudinally documented case of sustained abstinence in severe ketamine use disorder following ibogaine treatment, supported by serial toxicology and standardized psychometric outcomes. It adds objective, time-resolved evidence to a literature that has largely focused on ibogaine for opioid use disorder, and it highlights ketamine use disorder as a specific target for future controlled trials. The therapeutic outcome is hypothesized to arise from ibogaine's unique polypharmacology. This includes acute NMDA antagonism, which may disrupt compulsive circuits, as well as noribogaine's (the principal long-acting metabolite of ibogaine, with an elimination half-life of approximately 28-49 hours) kappa opioid receptor agonism and serotonin transporter inhibition, which stabilize reward pathways. Additionally, enhanced neuroplasticity via GDNF/BDNF expression may facilitate long-term behavioral changes. This case provides rare, rigorously documented evidence for ibogaine's potential in treating chronic ketamine dependence and highlights the urgent need for controlled clinical trials within regulated frameworks to further investigate its safety and efficacy.
BACKGROUND:Uro-oncology is moving toward precision medicine, driven by high-dimensional longitudinal data from imaging, pathology, molecular profiling, and follow-up. However, clinical decision-making often relies on static risk scores that cannot fully capture individual disease dynamics. Digital twins aim to integrate multimodal patient data and to provide patient-specific, dynamically updated simulation models, thereby enabling "what-if" testing of interventions. OBJECTIVE:How is a medical digital twin defined, which data foundation is available in uro-oncology, and which clinical use cases can be envisaged? METHODS:This work comprises a narrative review including a description of the digital twin concept, a structured presentation of multimodal data (laboratory parameters, imaging, pathology, omics, long-term outcomes), and an overview of representative published applications (e.g., tumor growth reconstruction, virtual pathology, surgical 3D twins). RESULTS:Current digital twin research in uro-oncology largely represents partial digital twins (e.g., tumor progression models, virtual assessment, patient-specific 3D surgical planning). Potential clinical value of digital twins includes dynamic risk stratification, individualized treatment planning, and adaptive follow-up strategies. Major limitations relate to data quality, interoperability, external validation, interpretability, data privacy, and regulatory requirements for clinical deployment. CONCLUSION:Digital twins have the potential to enable a new era of predictive precision medicine in uro-oncology. Progress toward clinically actionable digital twins requires multimodal architectures, rigorous monitoring, and seamless integration into clinical workflows under robust governance and regulatory frameworks.
