The Autism Diagnostic Observation Schedule (ADOS) and its second edition (ADOS-2) have acquired a de facto “gold standard” status for reliably diagnosing autism in the United States, even though the developers themselves emphasize that the instrument should be used as part of a holistic, clinically driven developmental assessment. This narrative review is informed by diagnostic accuracy studies and the global mental health relevance of ADOS/ADOS-2 to lowand middle-income countries (LMICs) using Türkiye and the United States as point of contrast. We consider the benefits of ADOS/ADOS-2 —its contribution to standardized observation, cross-site comparability, and detailed phenotyping in research and complex clinical cases—as well as its limitations, including extensive training requirements, time-intensive administration, high kit costs, proprietary licensing, and tightly regulated translation policies. These factors substantially limit the practicality of routine ADOS/ADOS-2 use in LMICs and other resource-constrained settings, where most autistic children live. In the United States, ADOS/ ADOS-2 based assessments have become deeply integrated into specialty services and, in some regions, even informally mandated by insurers or school systems, with consequences for wait times, access, and equity. In Türkiye, autism is primarily diagnosed through clinical assessment by child and adolescent psychiatrists without formal requirements for ADOS/ADOS-2, which expands clinical autonomy but results in less standardization and weaker cross-site consistency. We argue that treating the ADOS/ ADOS-2 as a universal diagnostic “gold standard” is unachievable given the global public health resource constraints in LMICs. Autism diagnosis, service eligibility, and research, especially in such a poor resource setting will require scalable, open-access, and cost-effective tools for both routine care and population-level studies.
Background: Time perception, which has been conceptualized as a distinct sensory modality in some models, has been investigated in various psychiatric disorders. There is evidence suggesting impairments in time perception tasks among individuals diagnosed with schizophrenia and depressive disorder. This study aimed to examine the relationship between time estimation, production task performance, and both psychotic and depressive symptoms in patients with schizophrenia. Methods: A total of 50 patients diagnosed with schizophrenia and 50 healthy controls were administered structured time estimation and time production tasks at varying intervals. Additionally, the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS) were used for symptom assessment and correlational analyses. Results: In exploratory unadjusted analyses, significant group differences were observed at the 1-, 13-, and 32-second time estimation intervals. In the primary adjusted analyses controlling for age and smoking status, significant group differences remained at the 13-second and 32-second intervals. No significant group differences were observed for any time production interval. Conclusion: In this stabilized inpatient sample, patients with schizophrenia exhibited significantly greater time-estimation errors at the 13-second and 32-second intervals in the primary adjusted analyses, whereas time-production performance did not differ significantly from that of healthy controls. The absence of statistically significant associations with psychotic or depressive symptom scores suggests that timing performance may be partly independent of current symptom severity; longitudinal studies are needed to determine whether these abnormalities represent trait-like characteristics.
Background: Alzheimer’s disease (AD) is characterized as a network disconnection syndrome. Despite evidence implicating the cerebellum in cognitive network integration, its associated electrophysiological network topology dynamics across the AD continuum remain unexplored. Methods: We enrolled 34 healthy controls (HC), 40 patients with mild cognitive impairment (MCI), and 30 AD patients in this study. Cortical and cerebellar signals were recorded with a whole-brain EEG cap, and weighted functional connectivity networks were constructed using the phase-locking value (PLV). Graph theory was used to analyze network topological metrics across the AD continuum, focusing on cerebellar nodes. Topological metrics were correlated with neuropsychological scores, and networkbased statistics (NBS) identified differential connectivity patterns among groups. Results: Network changes were most prominent in the theta band, with additional alterations in the delta band. Both MCI and AD groups showed reduced small-world metrics, although small-world organization remained present. These groups also showed increased nodal centrality in the frontal, occipital and cerebellar regions (at CB1, CB2 and CBZ in MCI but only at CBZ in AD) but decreased in the central and temporal regions. NBS analysis identified selective theta-band reorganization of cerebellocortical connectivity. An inverted U-shaped relationship was found between cerebellar nodal centrality and neuropsychological scale scores. Conclusions: The cerebellar theta rhythm may be a key pattern involved in cognitive processing, and the topological changes of the cortical-cerebellar network may represent candidate electrophysiological network markers across different AD stages. These markers may reflect stage-related differences in cerebellar function, shifting from compensation in MCI to decompensation in AD.
Background: Sleep disorders are common in postmenopausal women and may contribute to cognitive decline. We investigated whether plasma biomarkers differentiate cognitive impairment (CI) in this population. Methods: In this cross-sectional exploratory study, we recruited 105 outpatients with insomnia disorder (79 women and 26 men) aged 45-60 years with insomnia symptoms (PSQI > 5, ISI > 7). Cognition was assessed using the Chinese Brief Cognitive Test (CBCT) and Auditory Verbal Learning Test. Postmenopausal women were classified as CI or non-CI based on CBCT criteria. Plasma glial fibrillary acidic protein (GFAP), neurofilament light chain, orexin A, total tau, and phosphorylated tau-181 (p-Tau) were measured using enzyme-linked immunosorbent assay. Associations with cognition and exploratory classification performance were examined using correlation and receiver operating characteristic analyses. Results: Postmenopausal women exhibited higher anxiety and poorer cognitive performance despite comparable insomnia severity. Among them (non-CI n=42; CI n=37), the CI group had higher plasma GFAP (14.82 vs. 12.42 ng/mL, P = .004) and p-Tau (1,002.18 vs. 918.27 pg/mL, P = .034). Biomarkercognition correlations were weak. GFAP showed the highest apparent performance among individual biomarkers (area under the curve, AUC = 0.672). The clinical information-adjusted model incorporating orexin A, GFAP, and p-Tau showed the highest apparent AUC among biomarker combinations (AUC = 0.755), although internally validated performance was more modest. Conclusions: Plasma GFAP and p-Tau, with potential incremental contribution from orexin A, may provide exploratory information for identifying cognitive vulnerability in postmenopausal women with insomnia disorder. These exploratory findings require validation in larger and independent cohorts.
Escitalopram, the S-enantiomer of racemic citalopram, is one of the most widely prescribed selective serotonin reuptake inhibitors (SSRIs) for the treatment of depressive and anxiety disorders. Owing to its high selectivity for the serotonin transporter (SERT) and its unique allosteric binding properties, escitalopram demonstrates pharmacological characteristics that distinguish it from other SSRIs. This narrative review provides an up-to-date evaluation of escitalopram, focusing on its mechanism of action, pharmacokinetic profile, clinical efficacy, tolerability, and safety. Evidence from randomized controlled trials and meta-analyses indicates that escitalopram produces significant antidepressant and anxiolytic effects, with symptom improvement often observed within the first one to two weeks of treatment. Neuroimaging studies further support its therapeutic activity by demonstrating dose-dependent SERT occupancy and normalization of fronto-limbic network dysfunction associated with mood regulation. In comparative studies, escitalopram yields favorable response and remission rates and exhibits better acceptability and tolerability relative to other antidepressant agents. Its pharmacokinetic properties—including predictable absorption, linear dose–concentration relationships, and limited cytochrome P450 interactions—contribute to its suitability for long-term use and polypharmacy. Escitalopram is generally well tolerated, with most adverse effects being mild and transient. Although sexual dysfunction, QT interval prolongation, and serotonin syndrome remain clinical considerations, its overall safety profile compares favorably with that of other SSRIs. In conclusion, current evidence supports escitalopram as a first-line pharmacological treatment for major depressive disorder and anxiety disorders. Its pharmacological specificity, consistent clinical efficacy, and favorable tolerability profile reinforce its central role in contemporary psychiatric treatment strategies.
Background: This study aimed to describe short-term clinical outcomes and tolerability associated with lurasidone-containing treatment regimens in adolescents hospitalized for bipolar depression. Methods: We retrospectively reviewed 28 adolescents aged 10–17 years who received lurasidone during admission to a university child and adolescent psychiatry unit between May 2024 and June 2025. All patients received at least one concurrent psychotropic treatment. Admission and discharge outcomes were assessed with the 17-item Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), and Clinical Global Impressions-Severity (CGI-S); CGI-Improvement (CGI-I), adverse events, and weight change were also recorded. Results: Mean length of hospital stay was 22.7 days. Among patients with complete paired data, HDRS scores decreased from 23.0 to 5.7 (n = 25), BDI scores from 27.7 to 7.6 (n = 25), and CGI-S scores from 5.9 to 2.1 (n = 28). At discharge, CGI-I was 1 (very much improved) in 3 patients and 2 (much improved) in 25 patients. No manic or hypomanic switch was documented. Mean weight change was +0.85 kg. The most frequent adverse events were nausea, headache, and akathisia; one patient required temporary treatment interruption for an acute oculogyric crisis, but no patient permanently discontinued lurasidone because of an adverse event. Conclusion: Clinical improvement was observed during hospitalization after lurasidone was introduced as part of multimodal treatment. Because the study was retrospective, uncontrolled, and universally involved polypharmacy, the independent contribution of lurasidone cannot be determined. Prospective controlled studies are needed.
Background: Antidepressant self-poisoning is a common form of intentional self-harm, and comparisons across antidepressant groups are complicated by differences in ingested dose and coexposures. Methods: This retrospective cross-sectional study reviewed emergency department presentations coded with International Classification of Diseases, 10th Revision (ICD-10) X61/X64 between 01 January 2023 and 15 May 2025. Among 15,160 screened records, 168 patients with documented antidepressant ingestion with self-harm/suicidal intent were included. Antidepressant exposures were classified by group and standardized using defined daily dose (DDD). Clinical presentation, serotonin toxicity based on the Hunter Serotonin Toxicity Criteria, management, and short-term outcomes were evaluated. Multivariable logistic regression was used to adjust for log-transformed DDD. Results: The median age was 27.0 years, and 66.7% of patients were female. Selective serotonin reuptake inhibitors (SSRIs) were the most frequently ingested antidepressants (79.8%). Symptomatic presentation occurred in 33.3% of patients and was more frequent in non-SSRI than in SSRI exposures 55.9% vs 27.6%; adjusted OR, 3.40; 95% CI, 1.55-7.43; P = .002). Serotonin toxicity was identified in 7.7% and was also more frequent in non-SSRI exposures (23.5% vs 3.7%; adjusted OR, 8.17; 95% CI, 2.45–27.26; P = .001). Serotonin toxicity was associated with intensive care unit (ICU) admission (53.8% vs 10.3%; P < .001). Conclusion: Non-SSRI antidepressant exposures were associated with greater short-term clinical severity than SSRI exposures. Because non-SSRI subgroups were small and heterogeneous, class-specific findings should be interpreted as exploratory. The early clinical pattern of toxicity may inform shortterm risk assessment.
Background: Functional somatic symptoms are common in children and adolescents and are often associated with anxiety and perceived stress. Mindfulness may be protective, but the mechanisms linking mindfulness to somatic symptom severity remain unclear. This study aimed to examine relationships between mindfulness, perceived stress, anxiety, and somatic symptom severity using a serial mediation model. Methods: This study included 55 children and adolescents, aged 10-18, diagnosed with anxiety disorders. Participants were recruited from a child psychiatry outpatient clinic. After semi-structured interview, self-report measures were administered, including Mindful Attention Awareness Scale, Perceived Stress Scale, Screen for Child Anxiety and Related Disorders, and Level 2 Somatic Symptoms Scale. Correlation, regression, and serial mediation analyses were conducted, controlling for age and sex. Results: Somatic symptom severity was negatively correlated with mindfulness and positively correlated with perceived stress and anxiety. Regression analysis indicated that higher anxiety and lower mindfulness were associated with somatic symptom severity, while perceived stress was not. Mediation analysis revealed a significant total indirect effect of mindfulness on somatic symptoms. Anxiety alone significantly mediated this relationship, whereas perceived stress did not act as an independent mediator. A significant serial mediation was identified: higher mindfulness was associated with lower perceived stress and lower anxiety, which were in turn associated with lower somatic symptom severity. Conclusion: Findings suggest that mindfulness is associated with lower somatic symptom severity both directly and indirectly, primarily through anxiety and sequentially through perceived stress and anxiety. Working with mindfulness and anxiety may be beneficial for youth presenting with somatic symptoms.
Background: Perioperative anxiety is common in women undergoing surgery for ectopic pregnancy and may aggravate pain and delay recovery. This trial evaluated whether evidence-based nursing combined with structured psychological intervention reduces perioperative anxiety compared with routine nursing in women undergoing conservative laparoscopic surgery for tubal ectopic pregnancy. Methods: In this single-center, parallel-group randomized controlled trial, 124 women with tubal ectopic pregnancy scheduled for non-emergency conservative laparoscopic surgery were enrolled by convenience sampling and randomly assigned 1:1 to a control group (routine perioperative nursing) or an experimental group (evidence-based nursing plus structured psychological intervention). The prespecified primary outcome was the between-group difference in State Anxiety Inventory (S-AI) score on the day of discharge. Secondary outcomes were postoperative pain (Visual Analogue Scale, VAS) and short-term recovery outcomes. Results: The day-of-discharge S-AI score was lower in the experimental group than in the control group (32.61 ± 4.45 vs 38.24 ± 2.62; mean difference −5.63, 95% CI −6.92 to −4.34; P < .001), with a significant group-by-time interaction (P < .001). VAS scores at 2, 6, 12, and 24 hours after surgery were lower in the experimental group (all P < .001). First ambulation time, length of hospital stay, antibiotic use time, and menstrual recovery time were shorter in the experimental group (all P < .001). Conclusion: Evidence-based nursing combined with structured psychological intervention was associated with lower perioperative anxiety and postoperative pain and with shorter short-term recovery outcomes in women undergoing conservative laparoscopic surgery for tubal ectopic pregnancy.
Background: Although aggression in bipolar disorder (BD) is more common during manic episodes, it may also occur during remission. This study examined the associations of impulsivity and somatoform dissociation with aggression and its subdimensions in euthymic patients with BD. Methods: The study included 67 patients diagnosed with BD type I according to DSM-5 criteria who had been in a euthymic state for at least two months. Participants completed a sociodemographic data form, the Barratt Impulsiveness Scale–11, the Somatoform Dissociation Questionnaire, and the Buss-Perry Aggression Questionnaire. Data were analyzed using correlation analysis, multiple linear regression, and hierarchical regression analyses. Statistical significance was set at P < .05. Results: Correlation analyses showed that somatoform dissociation was positively associated with total aggression (r = 0.28, P = .024) and hostility (r = 0.27, P = .025). While total impulsivity was not associated with total aggression, weak positive correlations were found with anger (P = .026). In regression analyses, somatoform dissociation significantly predicted total aggression (β = 0.30, P = .018), verbal aggression (β = 0.33, P = .011), and hostility (β = 0.29, P = .025). Impulsivity was not identified as an independent predictor, whereas somatoform dissociation significantly increased explained variance in hierarchical regression analyses (ΔR² = 0.08, P = .018). Given the exploratory nature of the analyses and the absence of correction for multiple comparisons, these findings should be interpreted cautiously. Conclusion: In euthymic patients with BD, aggression appears to be more consistently associated with somatoform dissociation than with impulsivity. Dissociative symptoms, particularly those related to verbal aggression and hostility, may represent clinically relevant domains for further assessment.
Background: This study aimed to evaluate health-related quality of life (HRQoL) and psychiatric outcomes in children and adolescents with supraventricular tachycardia (SVT) during the post-ablation follow-up period. Methods: This retrospective–prospective observational cohort study included pediatric patients who underwent successful catheter ablation for supraventricular tachycardia. Clinical and procedural data were collected retrospectively. Pre-ablation HRQoL data were obtained from either documented preprocedural assessments or caregiver recall when records were unavailable. Psychiatric interviews and post-ablation HRQoL assessments were conducted prospectively during a single follow-up evaluation. Results: A total of 59 pediatric patients participated in the follow-up evaluation and were included in the study; the median age was 13.0 years (Q1–Q3, 10.0–15.0). Depending on the HRQoL domain, paired preand post-ablation data were available for 53 or 54 participants. Follow-up scores for physical, emotional, social, and school functioning were higher than the retrospectively obtained pre-ablation reference scores (all p < .001; Bonferroni-adjusted significance threshold, p < .0125). At follow-up, at least 1 DSM-5 psychiatric diagnosis was identified in 18 participants (30.5%), most commonly anxiety and depressive disorders. Seven of these participants had 2 or more concurrent psychiatric diagnoses. Conclusion: Pediatric patients had higher HRQoL scores at post-ablation follow-up, and 30.5% met criteria for at least 1 psychiatric diagnosis. The HRQoL comparisons should be interpreted cautiously because baseline data were obtained from a combination of medical records and caregiver recall, informants were not fully standardized across assessment periods, and the exact interval between ablation and follow-up could not be reliably reconstructed.
Background: This study investigates the utilization of complementary and alternative medicine (CAM) practices, perceived benefits, and etiological beliefs among children and young adults with Autism Spectrum Disorder (ASD) and their families. Methods: This exploratory cross-sectional study included 136 participants (mean age 8.9 years; 72.8% male). Data were collected using questionnaires completed by parents regarding CAM utilization patterns, etiological beliefs, and primary information sources. To identify the predictors associated with the lack of parents’ perceived benefit from CAM methods, a logistic regression model was utilized, adjusting for selected clinical, sociodemographic, and informational variables. Results: A high prevalence of CAM use was identified, with 91.2% of participants reporting the use of at least one method. The most common practices were prayer (62.5%), vitamin/mineral supplementation (51.5%), and dietary supplements (44.1%). CAM preferences appeared to vary across developmental stages. Furthermore, logistic regression analysis revealed that child age was the only significant predictor for parents reporting no perceived benefit from CAM; each one-year increase significantly decreased the odds of perceiving no benefit (OR = 0.838; 95% CI, 0.762–0.921; P = .001). Sociodemographic variables and primary information sources did not significantly predict this outcome. Conclusion: CAM utilization is widespread and highly dynamic among families of children with ASD. The perceived lack of benefit is significantly associated with younger child age, likely reflecting unmet high expectations during the early post-diagnostic period. These findings highlight the psychosocial nature of CAM use and emphasize the crucial role of professionals in maintaining open dialogues to provide safe, cost-effective, and evidence-based guidance.
Background: A comprehensive investigation has been employed, focusing on the characteristics of adolescent depression with non-suicidal self-injury (NSSI) and its association with childhood trauma, inflammatory markers, and brain-derived neurotrophic factor (BDNF). Methods: Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria, 110 patients with first-episode depression aged 12-18 years old were recruited from the outpatient clinic over a 10-month period and were divided into a depression group with NSSI (57 patients) and a depression group without NSSI (53 patients). The scores of the childhood trauma questionnaire, Self-Rating Depression Scale, Self-Rating Anxiety Scale, and levels of BDNF and inflammatory factors were compared. Correlation analysis was performed to examine the relationship between the value of childhood trauma and variables such as anxiety, depression, BDNF, and inflammatory markers. Logistic regression was performed to analyze independent risk factors for NSSI. Results: 1) Instances of physical and emotional neglect, occurrences of sexual and emotional abuse, and levels of depression and anxiety in the NSSI group were significantly higher in comparison to the group without NSSI. Levels of interleukin (IL)-4 and IL-6 were higher, and BDNF was lower than in the group without NSSI. 2) Emotional abuse, sexual abuse, IL-4, and IL-6 were independent risk factors for NSSI in depressed adolescents. 3) Physical abuse and sexual abuse were correlated with IL-6 (r = 0.289, P = .029; r = -0.295, P = .026), emotional abuse and emotional neglect were correlated with the ratings on the Self-Rating Anxiety Scale (r = 0.330, P = .012; r = 0.299, P = .024). Conclusion: Inflammatory factors and BDNF levels in the cohort of adolescent depression patients with NSSI differed from those without NSSI, and different traumas have different effects on inflammatory factors. It was indicated that individuals in the NSSI group experienced more childhood trauma and more prominent inflammatory alterations, which may imply they are more prone to emotional dysregulation, requiring the need for timely and targeted intervention.
Background: Telomere length (TL), a biological marker of cellular aging, has been linked to several psychiatric disorders. Telomere length has been found to be shorter in bipolar disorder; however, the potential role of stress-related biological factors, such as cortisol, has not been fully clarified. This study aimed to investigate TL in bipolar I disorder (BD-I) and its relationship with clinical characteristics and serum cortisol levels. Methods: The study included 38 patients with BD-I and 32 age- and sex-matched controls. All patients were evaluated using the Hamilton Depression Rating Scale, Young Mania Rating Scale, and Clinical Global Impression. Telomere length and serum cortisol levels were measured from blood samples obtained from both groups. Results: A significant difference was observed in the TL between the patient and control groups (P .05). No relationship was found between cortisol level and TL. Telomere length was also not related to clinical variables such as the number of first episodes, presence of psychotic features, seasonal pattern, remission status, or history of hospitalization (P > .05). Conclusion: Patients with BD-I demonstrated shorter TL than healthy controls. The lack of association between TL, clinical features, and cortisol suggests that shorter telomeres may be related to BD-I itself. This is to our knowledge, this is among the first studies to investigate the relationship between cortisol levels and TL in BD-I. Further research is needed to clarify underlying mechanisms and the role of biological aging in bipolar disorder.
Background: This study aimed to examine how individuals with bipolar disorder (BD) in remission perceive time and how this perception is associated with their temperament and character traits. Methods: A total of 65 patients diagnosed with BD in remission, according to DSM-5 criteria, and 65 age- and gender-matched healthy controls were included. Remission was confirmed using the Hamilton Depression Rating Scale (HAM-D < 8) and the Young Mania Rating Scale (YMRS < 6). All participants completed the Zimbardo Time Perspective Inventory (ZTPI) and the Temperament and Character Inventory (TCI). Group differences were analyzed using independent samples t-tests, relationships among variables were assessed via correlation analysis, and multiple linear and logistic regression models were conducted to determine predictive factors. Results: The BD group exhibited significantly higher self-transcendence scores than the control group (P = .002). In the BD group, past-negative perspective was positively correlated with harm avoidance (r = 0.574, P= 0.001) and negatively with self-directedness (r = -0.586, P =.001). Present hedonism showed a strong positive correlation with self-transcendence (r = 0.595, P =.001). Linear regression analysis revealed that past-negative perception was significantly predicted by harm avoidance and self- directedness (R2 adj =0,60, P<.001). Logistic regression analysis indicated that higher self-transcendence scores significantly increased the risk of BD diagnosis (OR = 1.147, 95% CI [1.066-1.235], P<.001), while higher present-hedonism scores were associated with a decreased risk (OR = 0.933, 95% CI [0.879- 0.991], P =.023). Conclusion: These findings suggest that self-transcendence may represent a distinguishing personality characteristic in individuals with BD during remission. Although no causal interpretations can be made, the pattern of results indicates a potential association between self-transcendence and temporal- cognitive processes. Further research is needed to clarify the nature and clinical relevance of this relationship.
Major depressive disorder remains a leading cause of disability worldwide, and current antidepressants are limited by delayed onset and incomplete response. Building on advances driven by ketamine research, renewed interest has focused on classical serotonergic psychedelics-particularly psilocybin, N,N-dimethyltryptamine (DMT), 5-methoxy-DMT, and lysergic acid diethylamide (LSD)-which, under supervised conditions, can produce rapid and sometimes durable improvements in mood. This review synthesizes contemporary clinical evidence for classical psychedelics in depression and related disorders and evaluates key translational challenges, including small sample sizes, expectancy effects, and limitations in maintaining blinding in randomized controlled trials. We further evaluate mechanistic frameworks that move beyond an exclusively 5-HT2A receptor-centric framework. Classical psychedelics engage multiple serotonergic receptor subtypes and convergent intracellular signaling pathways that modulate glutamatergic neurotransmission, promote synaptic plasticity, and reorganize large-scale brain networks. Converging preclinical and clinical evidence implicates neurotrophic mechanisms- particularly brain-derived neurotrophic factor (BDNF)-tropomyosin receptor kinase B (TrkB) signaling-as contributors to sustained therapeutic effects. Although acute mystical-type experiences may enhance clinical response, emerging evidence suggests they are not strictly required, raising the possibility that plasticity-promoting mechanisms can be partially dissociated from hallucinogenic effects. We also consider peripheral contributions, including gut-brain axis interactions, that may influence treatment durability. Finally, we discuss safety considerations and future directions, emphasizing the need for rigorously designed trials of next-generation non-hallucinogenic psychoplastogens to improve safety, scalability, and long-term tolerability.
Background: Adolescent inpatients with mood disorders are at elevated risk for suicide, with cognitive factors, especially rumination, playing a crucial role. This study investigates the impact of depression and rumination on suicidal ideation in this demographic, paying particular attention to the mediating role of rumination subtypes. It is hypothesized that brooding, a subtype of rumination, significantly mediates the relationship between depression and suicidal ideation. Methods: This cross-sectional study evaluated 157 adolescent inpatients diagnosed with mood disorders. Suicidal ideation was measured using the Beck Suicide Ideation Scale (Chinese Version). The Patient Health Questionnaire-9 was employed to assess the severity of depressive symptoms, while rumination levels were gauged using the Ruminative Responses Scale. Statistical analyses included correlation, regression, and mediation analyses via the PROCESS macro v4.1 (Model 4) for SPSS to explore relationships among these variables. Results: Adolescents with suicide attempts exhibited significantly higher levels of depression, rumination, and suicidal ideation compared to those without such a history. A positive correlation emerged between suicidal ideation and both depressive symptoms and rumination. Notably, depressive symptoms and the subtype of rumination were significant predictors of suicidal ideation. Furthermore, brooding was found to partially mediate the relationship between depressive symptoms and suicidal ideation, accounting for 43.7% of the total effect. Conclusion: This study underscores the pivotal roles of depression and rumination, particularly the brooding subtype, in predicting suicidal ideation among adolescent inpatients with mood disorders. The findings highlight the importance of targeting rumination in suicide prevention strategies. This research offers valuable insights into the cognitive mechanisms underlying adolescent suicidality and supports the development of interventions that specifically address emotion regulation and maladaptive thinking patterns in this high-risk group.
Background: This study investigated the associations between eco-anxiety, anxiety, depression, and automatic thoughts, and tested whether automatic thoughts mediate the relationship of eco-anxiety with anxiety and depression. Methods: A cross-sectional survey was conducted with 319 medical students. Participants completed the Eco-Anxiety Scale, Hospital Anxiety and Depression Scale (HAD), and Automatic Thoughts Scale (ATS). Results: Eco-anxiety scores were significantly correlated with HAD-anxiety (r = 0.523, P < .001), HAD-depression (r = 0.296, P < .001), and ATS (r = 0.704, P < .001). In mediation analyses, ATS fully mediated the relationship between eco-anxiety and depression (indirect effect a & times;b = 0.180, standard error (SE) = 0.027), accounting for 83% of the total effect, while the direct effect was nonsignificant (c ' = -0.037, P = .258). For anxiety, ATS partially mediated the association (indirect effect a & times;b = 0.161, SE = 0.026), explaining 64.8% of the total effect, with the direct effect remaining significant (c ' = 0.088, P = .005). In multiple-mediator models, only the Giving Up/Helplessness subscale showed significant indirect effects for both depression and anxiety. Conclusion: This study suggests that eco-anxiety is present and clinically relevant in this young medical student sample and its association with anxiety and depression. Furthermore, a strong correlation between eco-anxiety and automatic thoughts was found, and the Giving Up/Helplessness subscale emerged as a specific cognitive phenotype. Interventions targeting automatic thoughts may be promising, although longitudinal studies are needed.
Background: To observe the sleep quality of patients with bipolar disorder (BD), analyze the possible causes of sleep disorders, and take targeted interventions, which are particularly necessary to improve the sleep quality of patients and promote the development of the disease. Methods: Between January 2022 and January 2024, 60 patients with BD were enrolled in the study, and sleep quality in all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). By comparing the general data of patients with and without sleep disorders, the influencing factors that may lead to poor sleep quality were analyzed. Results: The assessment results of the PSQI scale of 60 patients with BD showed that there were 40 patients with sleep disorders, which were included in the poor sleep quality group (PSQI >= 7); the average score of the PSQI scale was (15.25 +/- 1.03) points. There were 20 patients without sleep disorders who were included in the good sleep quality group; the average score of PSQI scale was (3.20 +/- 0.41) points. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), cortisol level and percentages of social support (low level), and coping style (negative coping) in the patients of poor sleep quality group were higher than those in the good sleep quality group (P 1, P = .017, .006, .014, .007, .005 respectively). Conclusion: Anxiety, depression, cortisol level, social support, and coping style are all related to the sleep quality of patients with BD. The SAS, SDS, cortisol levels, low social support, and negative coping style are risk factors for poor sleep quality.
Background: Rapamycin (RAPA) is an inhibitor of the mammalian target of rapamycin (mTOR) that may modulate neuropsychiatric conditions. The global prevalence of psychiatric disorders is increasing due to growing socioeconomic stressors. Despite the promising therapeutic indications of RAPA, the precise molecular mechanisms underlying the effects of RAPA on schizophrenia are unclear. This study investigates anti-schizophrenia mechanisms of RAPA using network pharmacology and molecular docking. Methods: Potential pharmacological targets of RAPA were identified by searching the SwissTargetPrediction, GeneCards, and Similarity Ensemble Approach databases. Schizophrenia- related targets were identified by searching GeneCards and Online Mendelian Inheritance in Man. Bioinformatics analysis (including analyses of protein-protein interaction networks and enrichment analyses) was conducted to identify core targets and signaling pathways. Molecular docking simulations were conducted to assess drug binding affinities to core targets. Results: Cross-referencing 4013 targets linked to schizophrenic pathology with 1954 RAPA-associated targets yielded 749 shared targets. Protein-protein interaction network analysis revealed the following core targets: interleukin-6 (IL-6), interferon-gamma, IL-10, IL-4, IL-2, IL-1 beta (IL-1B), tumor necrosis factor, IL-5, IL-17A, and IL-1A. Functional enrichment assessments revealed that signal transduction, positive regulation of transcription by RNA polymerase II, positive regulation of gene expression, and positive regulation of DNA-templated transcription are critical biological processes involved in RAPA antipsychotic effects. Pathway analysis revealed that the PI3K-AKT signaling cascade is a central mechanism mediating the effects of RAPA. Molecular docking simulations confirmed strong binding affinities between RAPA and the core targets. Conclusion: Rapamycin may modulate cytokine networks and PI3K-AKT/mTOR signaling pathways implicated in schizophrenia. These in-silico findings are hypothesis-generating and require experimental and clinical validation.
