Abstract Background: Staff attire may influence patient perceptions of staff in healthcare settings. However, little is known about how this applies to psychiatric services. To address this gap, we examined whether different types of attire influence patient approval of staff in psychiatric settings. Methods: Adult patients receiving treatment in the Psychiatric Services of the Central Denmark Region were invited to participate in an electronic survey. Respondents were randomly allocated to one of five groups shown photographs of a: I. Doctor wearing personal clothes, II. Doctor wearing white coat over personal clothes, III. Doctor wearing white coat over scrubs, IV. Nurse wearing personal clothes, or V. Nurse wearing scrubs. Each participant answered seven ‘approval’ question items on a Likert-like scale (range 0–10) covering competence, credibility, empathy, trustworthiness, willingness to follow recommendations, willingness to approach the staff member and perceived professionalism. Composite approval scores were compared across the doctor and nurse groups, respectively, using pairwise t -tests. Results: Of the 9310 eligible patients, 1431 (15.4% response rate) completed the full questionnaire. Mean composite approval scores (range 0–70) were highly similar and did not differ statistically significantly across the doctor groups (I. 52 ± 14, II. 53 ± 14 and III. 52 ± 14, respectively; all p ≥ 0.244), nor between the nurse groups (IV. 52 ± 14 and V. 52 ± 15, respectively; p = 0.826). Conclusions: In this randomised survey experiment, approval ratings were highly similar across psychiatric staff attire. Given this apparent parity, and the advantages in terms of hygiene and correct identification of staff, we believe that more consistent use of uniforms should be considered.
Abstract Background: Bipolar disorder (BD) is marked by recurrent mood episodes and functional impairment. Growing evidence implicates mitochondrial dysfunction, oxidative stress, and metabolic disturbances as important to its pathophysiology, affecting neuronal signalling, synaptic plasticity, and inflammatory pathways. Aims: This review synthesises current evidence linking energetic metabolism to BD, integrates neuroimaging and peripheral biomarker findings, and discusses emerging therapeutic strategies targeting mitochondrial and metabolic dysfunction. Methods: A systematic search following PRISMA guidelines was conducted across PubMed, MEDLINE, EMBASE, Scopus, and Cochrane Library using ‘bipolar disorder’, ‘energetic metabolism’, and ‘mitochondria’. Inclusion criteria comprised peer-reviewed human studies, original research, and meta-analyses; paediatric, non-English, dietary, genetic, or comorbidity-focused studies were excluded. Additional manual searches targeted biomarker-specific studies. Results: Evidence consistently shows impaired oxidative phosphorylation, reduced ATP and phosphocreatine, altered NAD + /NADH ratios, and increased oxidative and inflammatory markers in BD. Neuroimaging demonstrates reduced PCr/ATP ratios, elevated lactate, and decreased TCA cycle intermediates, indicating cerebral energy deficits. Peripheral biomarkers: including decreased ETC complex activity, increased MDA and 8-OHdG, altered purinergic enzymes, and elevated mtDNA reflect systemic bioenergetic stress. Emerging interventions targeting mitochondrial cofactors (creatine, CoQ10, carnitine, NAC), metabolic strategies (ketogenic diet), and immunomodulatory or purinergic pathway modulators show promise. Conclusions: Emerging evidence suggests that systemic bioenergetic dysregulation may contribute to the pathophysiology of BD. Integrating mitochondrial, metabolic, and inflammatory biomarkers with neuroimaging may enable biologically informed patient stratification and precision therapeutics aimed at restoring energetic homeostasis. Large, standardised multicenter studies are required to translate these findings into clinical practice.
Abstract The article presents a historical overview of the mechanisms of lithium action. In the 19 th century, the prevalent mechanism of lithium was attributed to the uric acid diathesis of depression. Following John Cade’s introduction of lithium into modern psychiatry in 1949, research in the second half of the 20th century focused on lithium’s effect on electrolyte metabolism and membrane transport, the cyclic nucleotide and phosphatidylinositol (PI) systems, and glycogen synthase kinase-3β (GSK-3β) activity. Also, during this time, research on lithium’s effects on neurotransmitters and its antiviral activity was initiated. The new data on lithium mechanisms in the 21 st century have been obtained from in vitro studies and molecular-genetic research. The last decades have also brought lithium findings related to new pathogenic hypotheses of bipolar disorder, such as low-grade inflammation, mitochondrial dysfunctions, biological rhythms, brain-derived neurotrophic factor, telomere length, and a new purinergic hypothesis. For the mechanisms of lithium in mood disorders, they may be connected with a correction of pathophysiological abnormalities underlying the illness or considered as markers of prophylactic lithium response. Among the mechanisms discovered in the 21 st century, lithium’s inhibition of GSK-3ß and/or PI has been shown to play an essential role in most of them. In recent decades, there has also been an increasing interest in the mechanisms underlying lithium’s neuroprotective and anti-dementia properties. Here, the most important seems to be the inhibition of GSK-3ß.
Abstract Objective: In recent years, artificial intelligence (AI) and its applications have become a compelling topic in psychiatry. This study aimed to investigate whether the AI chatbot ChatGPT is useful for patient education by evaluating the quality, reliability, and readability of its responses to patient questions about repetitive transcranial magnetic stimulation (rTMS). Methods: Twenty-five frequently asked questions about rTMS were separately queried to ChatGPT-4 with no follow-up questions. Responses were reviewed by three psychiatrists by using the Global Quality Scale (GQS), DISCERN tool, and Journal of the American Medical Association (JAMA) Benchmark Criteria. Readability was evaluated by the Flesch-Kincaid Grade Level and the Gunning Fog, Coleman-Liau, and Simple Measure of Gobbledygook Indexes. Results: Overall, the quality of ChatGPT responses was moderate to good, with a mean GQS score of 3.69. The mean DISCERN score was 35.33, which is considered poor, and the JAMA Benchmark Criteria score was 0 for all questions. The mean readability score was high (mean grade level, 10.98). Conclusion: Our results show that ChatGPT responses to patient questions about rTMS are of acceptable quality and usefulness. However, the reliability and accuracy of the responses are limited, and a high reading level is required to understand them. Although ChatGPT can support patient education about rTMS, it should be used with caution and under guidance from healthcare professionals.
Abstract Background: In this cross-sectional analysis, we examined associations between socioeconomic status (SES), body mass index (BMI), inflammation, diet, and cognitive performance. While low SES is associated with lower cognitive scores, the present study investigated whether these variables – specifically BMI, inflammatory biomarkers, and dietary intake – statistically mediate this relationship. Methods: The final sample included 109 young adults (mean age = 21.31; 65% female; 45% white). Analyses utilized a comprehensive neuropsychological battery, including the NIH Cognitive Toolbox and Kaufman Brief Intelligence Test, alongside biomarkers of inflammation (Interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α)), and self-reported dietary intake via the National Cancer Institute’s Diet History Questionnaire – Third Edition. A pre-registered analysis using bootstrapped standard errors across 5,000 bootstrapped replications in ‘lavaan’ tested whether (i) associations between SES and executive functioning and episodic memory were statistically mediated by a higher BMI and (ii) associations between BMI and executive functioning and episodic memory were statistically mediated by elevated inflammation and sugar or fat intake. Results: BMI did not account for the association between SES and cognition; however, BMI, fat intake, and sugar intake were inversely correlated with cognitive functioning. Sugar intake mediated the association between BMI and cognition, though this finding was not significant after adjusting for covariates. Inflammation did not mediate the relationship between BMI and cognition. Conclusions: These results provide support for a link between BMI and cognitive performance and preliminary evidence of a mediating role of sugar intake. Further longitudinal and experimental research is needed to extend these findings and characterize underlying mechanisms.
