The clinical management of a complex disorder such as schizophrenia remains a significant challenge worldwide. This disorder requires a comprehensive, integrated and personalized care that blends multiple approaches, and the real-world availability of multiple resources. We present here the first recommendations addressing the real-world comprehensive care for people with schizophrenia-spectrum psychoses across different approaches, clinical stages, and levels of available resources. The recommendations are based on a critical review of the scientific literature and a collaborative appraisal by numerous clinical academics actively treating people with schizophrenia worldwide, representing various countries and clinical settings, including those in the Global South. Experts by experience were also involved. Our recommendations indicate that the comprehensive care of schizophrenia should involve: a) early detection; b) measurement-based monitoring; c) pharmacological treatments; d) psychological interventions; e) psychosocial interventions (including supported employment, housing and education); f) management of somatic conditions; g) community care; h) inpatient care; i) peer support, self-help, and alternative healing methods; j) population-level prevention, and l) societal-level support. The overarching core recommendation is to implement evidence-based care that addresses disparities across high- to middle/low-resource settings, emphasizing early intervention (and prevention when possible), culturally-sensitive paradigms that leverage the local existing resources, and task-sharing models that involve non-professional health care workers and, if possible, traditional healers. In the future, we expect that scalable and resource-saving, evidence-based digital solutions will help extend and improve care quality and efficiency across all resource settings. However, none of this can be achieved without adequately focusing on and strengthening mental health funding, improving access to care, addressing social determinants of health, and recognizing that care for people at risk for or living with schizophrenia is uneven and in need of improvement across all settings.
Childhood abuse is still a prevalent problem in modern societies. Adolescents with a history of harm become increasingly susceptible to being bullied. One of the overlooked physical and mental damage seems centered around altered perception of one’s body such as muscle dysmorphia. This study assesses the correlation between abuse, bullying victimization and dysmorphia, taking into consideration the co-moderating role of mindfulness and social support among Lebanese adolescents. A convenient sample of 403 participants aged 15 to 18 was included in the study. Adolescents filled demographic questions as well as standardized questionnaires for childhood abuse (Child Abuse Self-Report Scale), bullying victimization (The Illinois Bully scale), muscle dysmorphia (Muscle Dysmorphic Disorder Inventory), social support (Multidimensional Scale of Perceived Social Support) and mindfulness (The Freiburg Mindfulness Inventory). Our results show a significant correlation between history of abuse and bullying in adolescents and pathological concerns over their body. We further illustrate that factors such as mindfulness and a network of support, although negatively correlating with the psychopathological concerns, do not mediate the relationship between abuse, bullying and dysmorphia. Inasmuch as participants with higher levels of mindfulness and social support report less victimization and dysmorphia, taken alone, they are not enough to curb the burden of childhood-induced distress in teens. Addressing this remains a major challenge to avoid long term worsening of physical and mental health during the sensitive developmental stages at school.
Introduction Hydrocephalus due to aqueductal stenosis is classically associated with neurological and cognitive symptoms. However, psychiatric manifestations, including psychotic episodes, remain underrecognized and poorly documented. Objectives We report the case of a patient with aqueductal stenosis whose psychiatric presentations revealed and recurred during the course of the disease. Methods We describe a 40-year-old male, with no family history of psychiatric or organic disorders, who initially presented in 2006 with a brief psychotic episode leading to the diagnosis of obstructive hydrocephalus by aqueductal stenosis. He underwent ventriculostomy with favorable outcome and significant improvement of psychiatric symptoms under olanzapine and valproate, discontinued after several months. The patient remained asymptomatic with good psychosocial functioning for almost two decades. In September 2025, he was admitted under involuntary hospitalization for acute psychomotor agitation and incoherent speech. Psychiatric evaluation revealed a well-systematized delusional syndrome with grandiose and persecutory themes, interpretative and intuitive mechanisms. Neurological examination showed no focal deficit, except for a sluggish left pupillary light reflex. Brain MRI confirmed stable obstructive supratentorial hydrocephalus with patent ventriculostomy. Results This case highlights the potential for recurrent psychotic manifestations in patients with long-standing hydrocephalus due to aqueductal stenosis, even in the absence of acute neurological deterioration. It underscores the need for systematic psychiatric monitoring in patients with obstructive hydrocephalus, particularly when initial presentation involves psychosis. The interplay between structural brain alterations and psychiatric vulnerability warrants further investigation. Conclusions Hydrocephalus by aqueductal stenosis can manifest with isolated or recurrent psychotic symptoms, sometimes preceding or persisting despite neurosurgical treatment. Clinicians should maintain a high index of suspicion and adopt an integrated neuropsychiatric approach in the long-term follow-up of these patients. Disclosure of Interest None Declared
Background Breast cancer in young women is a complex experience that goes beyond biomedical treatment, involves challenges in accessing healthcare, and has psychosocial and relational repercussions. Despite the growing recognition of these dimensions, qualitative studies exploring these experiences in the Brazilian context are still scarce. Thus, this study aimed to explore the psychosocial repercussions and challenges in accessing healthcare for young women who are breast cancer survivors in the Brazilian context.Methods A qualitative and descriptive study was conducted using individual semi-structured interviews, carried out via videoconference, between April and October 2025. The audio-recorded interviews were transcribed and analysed according to the Thematic Analysis proposed by Braun and Clarke.Results Participants included 14 young women (18-40 years old), who were diagnosed with breast cancer and had completed treatment within the last 5 years. Thematic analysis identified four main themes: (1) disease trajectory after cancer diagnosis; (2) tension between assistance and abandonment in the support network; (3) challenges in access to and response from health services; and (4) adjustment process to the disease.Conclusions Breast cancer in young women is a complex experience that goes beyond biomedical treatment, affecting emotional, relational and social dimensions.Implications for the Profession and/or Patient Care Our findings reinforce the need for integrated, age-sensitive, and person-centered care practices that recognize young women as active agents in the process of coping with and adapting to their disease.Impact The findings from your study have important clinical, social and policy-level implications, particularly for improving palliative and survivorship care among young women with breast cancer.Reporting Method The study followed the COREQ checklist.Patient or Public Contribution None.
Our study explored the mediating effect of sleep hygiene between morningness-eveningness preferences and psychological distress among a sample of Lebanese adults. A total of 948 Lebanese participants were enrolled in this cross-sectional study (mean age 26.93 ± 10.23 years). A self-administered survey was dispersed using the snowball sampling technique. The survey consisted of socio-demographic characteristics along with the following Arabic validated instruments: The Morningness-Eveningness Questionnaire (MEQ), the Patient-Health Questionnaire (PHQ-4), and the Sleep Hygiene Index (SHI). Statistical analysis was performed using SPSS v.27 with mediation analysis via PROCESS MACRO v.42 Model 4. Sleep hygiene fully mediated the relationship between morningness-eveningness preferences and psychological distress. Greater morningness preferences were significantly associated with better sleep hygiene (i.e. lower sleep hygiene scores). In turn, poor sleep hygiene (i.e. higher sleep hygiene scores) was significantly associated with higher psychological distress. The direct association between morningness and psychological distress was not statistically significant. Our study offered insight on important connections between sleep hygiene, morningness-eveningness preferences, and psychological distress within the Lebanese context. These results highlight the necessity of promoting healthy sleep behaviors and chronobiological awareness to improve mental health in this population.
