ABSTRACT Acquired hepatocerebral degeneration (AHD) is an uncommon neurological manifestation of chronic liver disease, most often associated with portosystemic shunting. The disorder is characterised by a combination of movement abnormalities, cognitive decline, and psychiatric disturbance. Manganese accumulation within the basal ganglia, secondary to impaired hepatic clearance, is considered the principal mechanism. The clinical overlap with more common neurodegenerative disorders frequently delays diagnosis. We describe a patient who presented with tremor, bradykinesia, and reduced facial expression in the context of compensated cirrhosis, whose neuroimaging findings were consistent with AHD. This case underscores the importance of considering AHD in patients with liver disease presenting with extrapyramidal or cognitive symptoms, as early recognition can alter management and improve outcomes.
ABSTRACT Brain tumors, particularly those involving the frontal and temporal lobes, may initially present with psychiatric manifestations such as mood disturbances, personality changes, cognitive impairment, or behavioral abnormalities. These atypical presentations frequently lead to misdiagnosis as primary psychiatric disorders, resulting in delayed diagnosis and treatment. Diagnostic difficulty is further increased by the overlap between psychiatric and neurological symptom profiles, limited access to early neuroimaging or neuropsychiatric assessment, and persistent clinical stigma. We conducted a narrative review of the literature (1990–2025) using PubMed, Embase, PsycINFO and Web of Science, focusing on adult patients initially diagnosed with psychiatric disorders who were later found to have underlying brain tumors. The reviewed evidence indicates that such misdiagnoses are often associated with delayed recognition of neurological disease, missed therapeutic windows, and increased morbidity. Contributing factors include cognitive bias in clinical reasoning, under‐recognition of subtle neurological signs, and systemic limitations in access to diagnostic imaging. Addressing these challenges requires a high index of suspicion in atypical psychiatric presentations, earlier use of neuroimaging, and a multidisciplinary approach integrating neurology, psychiatry, and neurosurgery. Improved clinical awareness, structured assessment pathways, and patient and caregiver education may further reduce diagnostic delays. Overall, early identification of brain tumors presenting with psychiatric symptoms is essential to improve prognosis, prevent irreversible neurological damage, and optimize functional outcomes.
ABSTRACT A frequent sleep issue called insomnia can lead to a number of disorders, including despair and anxiety. In order to cure insomnia, this study aims to evaluate the sedative effects of PRO in Swiss mice and use an in silico approach to look into the molecular processes at play. In our investigation, five mice were given oral PRO at doses of 2.5 and 10 mg/kg. The vehicle (NC) and diazepam (DZP), which serve as a positive allosteric modulator of the gamma‐aminobutyric acid A (GABA A ) receptor and a control, respectively, were used to measure the effects utilizing parameters including sleep duration and latency. Thiopental sodium (T‐Na) was employed in this instance as a sleep aid. Molecular docking experiments were also used to quantify PRO and DZP's binding capability to the GABA A receptor, which is linked to the sedative effect. The results show that PRO significantly affects mice's sleep patterns. PRO at 2.5 and 10 mg/kg extended sleep duration and reduced sleep latency in comparison to the NC. DZP (3 mg/kg) exhibited the greatest individual effect, even though PRO (10 mg/kg) and DZP combined further enhanced both measures, indicating a synergistic action. In the in silico investigation, PRO showed a significant binding affinity to the GABA A receptor with a docking score of −9.7 kcal/mol. It created several hydrophobic contacts and 11 hydrogen bonds with significant amino acid residues. PRO induces a sedative effect in mice primarily by modulating and activating the GABAergic neurotransmission system. We recommend more clinical research to validate PRO as a trustworthy sedative agent.
ABSTRACT Paradoxical reactions are uncommon consequences of benzodiazepine treatment. Despite the frequency of lorazepam use in acute psychiatric care, we are not aware of previous reports of paradoxical reactions to lorazepam in children and young people. We report here a case of such a reaction in a 16‐year‐old who presented to a local Accident and Emergency Department with acute psychiatric symptoms secondary to insomnia. We note that there are challenges to correctly identifying paradoxical reactions among children and young people in acute medical environments, where time pressures are acute. However, recognition is important for appropriate ongoing care, and related support for those working in these contexts may be beneficial.
ABSTRACT Functional and dissociative seizures (FDS), formerly known as psychogenic non‐epileptic seizures (PNES), closely mimic epileptic seizures but are not caused by abnormal epileptiform activity in the cerebral cortex. This resemblance poses significant challenges for accurate diagnosis and effective management. Misdiagnosis is common and often results in delayed appropriate treatment, thereby increasing the overall burden on patients. This review spotlights cutting‐edge strategies to distinguish FDS from epilepsy, emphasizing innovative diagnostics and holistic therapies to transform patient outcomes. A narrative review was conducted using systematic searches of PubMed, Scopus, and PsycINFO (2000–2025). Data on clinical features, diagnostics, comorbidities, and therapies were thematically synthesized to highlight challenges and guide clinical practice. FDS intricately blend neurological symptoms with psychological origins, making diagnosis challenging. Video‐EEG combined with psychiatric evaluation is essential. Treatment shifts focus from medication to psychological therapies, requiring multidisciplinary care. Education is a vital therapeutic tool in FDS management. By helping patients and families understand that FDS are real, treatable conditions—not fabricated—stigma is reduced, fostering acceptance. Establishing a strong therapeutic alliance based on empathy, transparency, and shared decision‐making turns treatment into a collaborative, motivating process, improving adherence and outcomes. FDS are complex, straddling neurology and psychiatry, with diagnostic and treatment challenges. Accurate diagnosis using video‐EEG and psychiatric evaluation is crucial to avoid mismanagement. Effective care demands multidisciplinary psychological treatments, patient education, and strong therapeutic alliances. Future research should enhance diagnostics and therapies through clinical trials and biomarker studies.
Isolated hypoglossal nerve palsy is rare, with neoplastic causes representing the most common etiology. We present an unusual case of metastatic breast cancer presenting with isolated hypoglossal nerve palsy during pregnancy. A 36-year-old primigravida at 17 weeks of gestation was admitted with progressive immobility, worsening back pain, and left-sided tongue deviation with hemi-atrophy. Laboratory investigations revealed hypercalcemia (corrected calcium 4.67 mmol/L) with suppressed parathyroid hormone levels. Imaging demonstrated skull base metastases involving the hypoglossal canal, hepatic metastases, and osseous metastases. Liver biopsy confirmed metastatic breast cancer (ER-positive, PR-positive, and HER2-negative). Following pregnancy termination, the patient commenced hormonal therapy with Goserelin and Anastrozole, with planned CDK4/6 inhibitor therapy. This case highlights the importance of considering metastatic disease in patients presenting with isolated cranial nerve palsies. The concurrent pregnancy created unique management challenges, requiring careful balance between maternal treatment needs and fetal considerations. Early recognition and multidisciplinary management are crucial for optimizing outcomes in such complex presentations.
Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS) is a rare multisystem mitochondrial disorder primarily caused by mutations in mitochondrial DNA. While it typically presents with stroke-like episodes, seizures, and lactic acidosis, recent evidence highlights a broader clinical spectrum, including neuropsychiatric manifestations such as psychosis. Although mutations in the MT-ND3 gene are primarily associated with Leigh syndrome, they have also been linked to MELAS-like presentations, underscoring the diagnostic complexity and the need for thorough genetic evaluation. We report the case of an 18-year-old Afghan female with a complex clinical history, including early-onset seizures, Wilms tumor treated with chemotherapy, progressive peripheral neuropathy, and recent-onset catatonia. Initial assessments suggested Charcot-Marie-Tooth disease; however, Whole mitochondrial genome sequencing identified a homoplasmic mitochondrial DNA variant in the MT-ND3 gene, designated according to standard mitochondrial nomenclature as m.10158 T > C (MT-ND3), which results in a missense amino acid substitution (p. Ser34Pro). Variant interpretation was conducted in accordance with ACMG/AMP guidelines adapted for mitochondrial DNA and was cross-referenced with MITOMAP and ClinGen mitochondrial expert panel classifications. Laboratory findings indicated lactic acidosis, elevated ammonia, and increased CPK levels. The patient responded rapidly to lorazepam for catatonia and showed functional recovery following the initiation of a mitochondrial cocktail and integrated neurorehabilitation. Although MELAS is most commonly linked to the m.3243 A > G mutation in MT-TL1, emerging reports associate MT-ND3 variants with a broader phenotypic spectrum, including neuropathy and psychiatric symptoms. Neuropsychiatric features are increasingly recognized in mitochondrial disorders and may precede classical neurological signs. Genetic testing and metabolic profiling are essential for accurate diagnosis, particularly in atypical cases or resource-limited settings. Treatment remains largely supportive, with variable responses to mitochondrial cocktails and symptomatic management. This case expands the phenotypic spectrum of MT-ND3-related mitochondrial encephalopathy with MELAS-like features, including catatonia and peripheral neuropathy, and highlights the clinical variability associated with pathogenic complex I-related mitochondrial DNA mutations. A multidisciplinary approach-including psychiatry, neurology, genetics, and rehabilitation-is crucial for managing these complex presentations.
Emotional intelligence (EI) has emerged as a critical determinant of psychological well-being, influencing individuals' capacity to manage stress, navigate social challenges, and regulate emotions. However, its role in shaping vulnerability to behavioral disorders-particularly eating disorders (ED) and Internet addiction (IA)-remains complex and underexplored. This study investigates the dual role of emotional intelligence as both a protective factor and a potential risk amplifier for eating disorder and compulsive Internet use among medical students. In this cross-sectional study, 400 clinical-stage medical students from the University of Medical Sciences in Northern Iran completed validated assessments of EI (Bradberry & Greaves), eating attitudes (EAT-26), and Internet addiction (IAT). Correlation and multiple regression analyses were conducted to evaluate the predictive value of EI subcomponents-well-being, self-control, emotionality, and sociability-on ED and IA symptoms. Higher total EI scores were significantly associated with lower ED symptoms (r = -0.45, p < 0.001). Regression analysis identified well-being and self-control as the strongest negative predictors of ED (R-2 = 0.36). Unexpectedly, EI was positively correlated with IA (r = 0.32, p < 0.001), with emotionality, well-being, and self-control positively predicting IA severity (R-2 = 0.24). Sociability did not significantly predict either outcome. These findings challenge the traditional view of EI as universally adaptive. While EI appears protective against disordered eating by enhancing emotional resilience and self-regulation, it may concurrently increase vulnerability to Internet overuse, potentially by facilitating online emotional engagement or avoidance behaviors. This paradox highlights the importance of dimension-specific, nuanced interventions in mental health and behavioral risk prevention among young adults.
This study aims to investigate expanded hematological data in multiple sclerosis (MS) and evaluate their association with disease severity. A total of 190 patients participated in the study. For this purpose, expanded hemocytometry data were compared between 120 patients diagnosed with MS and 70 healthy controls. Neurological deficit was assessed during the relapse period using the Kurtzke Expanded Disability Status Scale (EDSS), and patients were divided into two groups based on EDSS scores: mild (EDSS < 5) and moderate-severe (EDSS >= 5). The distribution width of the complexity of monocyte (Mo-WX) was significantly decreased in MS patients compared to the controls (p = 0.011). In contrast, dispersion of the lymphocyte-Y signal (Ly-WY; p = 0.017), dispersion of the Ly-Z signal (Ly-WZ; p = 0.021), and dispersion of the Mo-Z signal of monocytes (Mo-WZ; p = 0.049) were significantly increased in MS patients compared to the controls. Percentage of neutrophils (Ne%; p < 0.0001), percentage of monocyte (Mo%; p = 0.002), and percentage of immature granulocytes (IG%; p = 0.011) were higher in patients than in controls, whereas percentage of lymphocyte (lymphocyte%; p < 0.0001) and absolute lymphocyte count (lymphocyte#; p < 0.0001) were significantly lower. Furthermore, increasing EDSS scores were associated with higher dispersion of the neutrophil NE-SSC signal (NE-WX; p = 0.003), neutrophil% (p = 0.005), IG% (p = 0.014), and absolute IG count (IG#; p = 0.003), while lymphocyte% (p = 0.018) and reactive lymphocyte percentage (Re-Ly%; p = 0.016) were significantly reduced. We identified morphological changes in immune cells of MS patients that highlight unique immunological profiles and potential markers for MS. Further research and validation of these parameters may enhance their clinical significance by providing valuable insights for personalized treatment and diagnostic strategies in managing MS.
This case highlights a relapse of major depressive disorder in an elderly man following a flu-like illness, with clinical features and laboratory findings supporting a possible inflammatory contribution. It emphasises the relevance of the inflammatory theory of depression, especially in individuals with late-life depression and recent immune activation. The patient's response to a tailored pharmacological and behavioural intervention further supports the potential role of inflammation in both the pathogenesis and treatment resistance of depressive episodes. This case contributes to the growing clinical recognition that systemic inflammation may not only coexist with but also influence the trajectory of mood disorders.
Self-harm is a significant public health concern, particularly among young women, and is closely associated with psychiatric comorbidities and risky behaviors. This study aimed to compare the prevalence and contributing factors of self-harm among young women with and without substance use disorder (SUD). In this comparative cross-sectional study, 200 women aged 18 to 30 years were recruited from a drop-in center affiliated with the Welfare Organization, Mashhad, Iran. The sample included 100 women with clinically confirmed SUD and 100 age-matched healthy controls. Participants completed structured assessments regarding self-harm behaviors, educational level, depression, and anxiety. Self-harm was significantly more prevalent in the substance abuse group (61%) compared to the control group (23%) (p = 0.001). Women with substance abuse had lower educational attainment (85% had not completed high school vs. 50% in controls; p = 0.001), higher rates of moderate to severe anxiety (69% vs. 55%; p = 0.04), and elevated levels of depression (p = 0.015). Multivariate logistic regression revealed that substance abuse independently increased the risk of self-harm (adjusted OR = 5.05; 95% CI = 2.50-10.18, p < 0.001), even after controlling for education, depression, and anxiety. Notably, the association between substance abuse and self-harm was strongest in individuals with moderate to severe depression. Young women with SUD are at significantly increased risk of self-harm, particularly those with co-occurring depression and anxiety. These findings highlight the urgent need for integrated mental health and substance abuse interventions that address the complex interplay of psychological and behavioral factors.
Illness perception influences an individual's beliefs and coping mechanisms regarding their condition, impacting their overall well-being and ability to manage their health. This study investigated the effectiveness of Leventhal's model on illness perception in female patients with Multiple Sclerosis. This study was a randomized educational trial carried out in 2024 involving 60 female patients diagnosed with Multiple Sclerosis (MS). The samples were selected based on inclusion criteria and randomly divided into two groups: intervention (29 people) and control (31 people) using block randomization. The intervention group received education based on Leventhal's model, including cognitive and emotional dimensions, over 4 weeks, two online and eight offline sessions. During the research, no intervention was performed for the control group. Data were analyzed using SPSS with appropriate statistical tests, including Chi-square, Fisher's exact, independent t-tests and U-Mann-Whitney tests. In this study, Brief illness Perception Questionnaire (BIPQ) was used three times (before, after and 1 month after intervention). A repeated measures analysis of variance was performed to evaluate the changes. Furthermore, the Bonferroni's post hoc test was applied. The results indicated that before the intervention, the illness perception score significantly differed between the control and intervention groups (p = 0.005); however, this confounding effect was adjusted in the statistical analyses. Following the intervention and 1 month later, a significant difference was observed between the two groups in terms of the mean illness perception score (p = 0.0001). The changes in the mean illness perception score over time were statistically significant between the two groups (p = 0.0001). In the control group, the mean changes in the illness perception score at different time points were not significant. However, in the intervention group, the mean illness perception score significantly decreased after the intervention and 1 month later compared to the pre-intervention phase (p = 0.001). An education course focused on Leventhal self-regulation appears to enhance illness perception immediately following the intervention. Trial Registration: This study is registered as a clinical trial under the code IRCT20220703055351N3, with the registration date of February 11, 2024.
The beneficial effects of the ketogenic diet (KD) have been well demonstrated in children with convulsive disorders and epilepsy. Its potential therapeutic impact, primarily through limiting glucose availability to the brain, is currently being investigated in other neurological conditions such as Alzheimer ' s and Parkinson ' s diseases. Given the neuroprotective properties attributed to this dietary approach, the present study aimed to evaluate its effects in patients with traumatic brain injury (TBI). This randomized, double-blind clinical trial enrolled 20 adult patients with TBI admitted to the intensive care unit (ICU). Participants were randomly assigned to either the intervention or control group according to the inclusion criteria. The primary outcome was the induction of ketosis using the formulated KD. Secondary outcomes included mortality rate, duration of mechanical ventilation, and changes in the Glasgow Coma Scale (GCS). All patients in the intervention group who received the designed ketogenic formulation showed positive urinary ketone tests, confirming ketosis induction. There were no significant differences between groups in mortality rate or duration of mechanical ventilation. However, a significant improvement in GCS was observed within the intervention group between the first and last study days, although intergroup comparison showed no significant difference. The ketogenic diet may contribute to improved neurological recovery, as reflected by GCS impron some patients with TBI. Nevertheless, larger-scale studies are warranted to confirm its efficacy and safety in this population.
The Royal College of Psychiatrists' conference was held over four days in Liverpool, in July 2023, with world-renowned keynote speakers and key opinion leaders in mental health covering a wide range of topics. Joy Ogden reports here on some of the highlights of the conference.
The COVID-19 pandemic negatively impacted the mental health of people with emotionally unstable personality disorder (EUPD), with reports of maladaptive coping mechanisms, reduced mental health support and quality of life. In this study, the authors examine the impact of COVID-19 lockdown and post-lockdown period on acute psychiatric admission rates in an NHS Trust in people diagnosed with EUPD. In addition, the authors analyse whether patient profiles and the seasonal pattern of admission were impacted by COVID-19 in this population. The study highlights the need for preventative clinical care pathways with increased access and service responsiveness, adjusted to fit local needs at times of confinement policies and additionally more research into seasonal patterns of admission in those with EUPD.
There is a lack of high-quality evidence for pharmacological treatment options for Charles Bonnet syndrome and guidelines do not recommend any particular pharmacological option. Here, a case is presented of an older age male who developed complex visual hallucinations following stroke and central retinal artery occlusion (one after the other leading to loss of vision in both eyes), thus indicative of CBS secondary to vascular pathology. This case demonstrates a sustained progressive improvement in hallucinations in CBS following the initiation of acetylcholinesterase inhibitor, donepezil.
Olanzapine can have a better impact on negative symptoms of schizophrenia with reduced motor side effects compared to other atypical antipsychotics, according to some literature. Here, the authors describe a case of a woman with a diagnosis of schizophrenia who developed the rare side effect of bilateral pedal oedema while on oral olanzapine. The possible mechanism behind the condition and the clinical management measures taken to resolve the oedema is discussed.
The rare psychiatric phenomenon of catatonia has recently been decoupled from schizophrenia in the ICD-11 and DSM-V and is now a stand-alone syndrome. This article explores a complex case of catatonia in intellectual disability, considering a broad array of differential diagnoses for the underlying pathology. The authors also explore evolutionary theories of catatonia and consider the compounding factors resulting in delayed diagnosis and treatment.
Poststroke fatigue (PSF) is a common, underestimated sequel of stroke that affects the quality of life of patients. In this study, the authors investigate the prevalence of PSF in three equal groups: control, ischemic, and hemorrhagic stroke patients. Some of the multidimensional factors that predict PSF are examined, and the implications for improvement of stroke management are highlighted.
