ObjectiveLong-acting injectable (LAI) antipsychotics may improve treatment adherence by maintaining stable plasma drug concentrations and reducing relapse risk associated with inconsistent oral medication use. Although LAIs are widely used in adults with severe psychiatric disorders, their use in pediatric populations remains off-label, and evidence is limited. Aripiprazole, a partial dopamine D2 receptor agonist, has a favorable tolerability profile in adolescents, particularly regarding metabolic adverse effects and prolactin elevation.MethodsThis retrospective case series describes the clinical use of aripiprazole monohydrate LAI (AM LAI) in six adolescents aged 13-17 years with severe psychiatric conditions and poor adherence to oral treatment.ResultsTreatment with AM LAI was associated with improved adherence and clinical stabilization in most cases. Reductions in symptom severity and improvements in functional outcomes were observed during follow-up. No serious adverse effects were reported.ConclusionAM LAI appears to be a safe and effective off-label treatment option in high-risk adolescents with poor adherence to oral antipsychotics. This case series contributes clinically relevant real-world data to the limited literature on LAI use in pediatric psychiatry.
ObjectiveTo compare sleep quality, daytime sleepiness, and circadian rhythm characteristics across clinically defined chronic kidney disease (CKD) groups and to examine their relative contribution to global subjective sleep quality.MethodThis two-center, cross-sectional study enrolled 344 adults with CKD (response rate: 96.6%) from nephrology settings in Turkey. Participants were classified into three groups: mild-to-moderate CKD (KDIGO stages 2-3; n = 133), advanced CKD without dialysis (stages 4-5; n = 37), and dialysis-dependent CKD (stage 5D; n = 174). Sleep quality, daytime sleepiness, and circadian rhythm parameters were assessed using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Munich Chronotype Questionnaire (MCTQ). Hierarchical regression identified predictors of PSQI global scores.ResultsESS total scores were significantly higher in the dialysis-dependent group compared with both other groups (ε2 = 0.182, the only large effect size), whereas PSQI global scores were paradoxically lower in this group (adjusted P = 0.021). Biological chronotype (MSFsc) did not differ across groups. In hierarchical regression, ESS (β = 0.525) and dialysis-dependent status (β = -0.318) were the only significant predictors of PSQI global scores, with sleep-wake variables adding 24.3% explained variance beyond demographic and clinical factors.ConclusionsCKD-related sleep-wake burden is more prominently reflected in daytime sleepiness and social-circadian disorganization than in global subjective sleep quality. Assessment of daytime sleepiness may improve recognition of sleep-wake dysregulation in nephrology settings.
ObjectiveRapid Eye Movement sleep behavior disorder (RBD) is a parasomnia characterised by the loss of normal skeletal muscle atonia during REM sleep, leading to the enactment of dreams through complex motor behaviors such as talking, shouting, or violent movements that may result in injury. Emerging evidence suggests that antidepressants may be associated with RBD. This study reviewed the existing literature on the demographic and clinical features of patients with REM sleep behavior disorder (RBD) taking antidepressants, as well as the reported associations between antidepressant use and RBD.MethodsA comprehensive search strategy was implemented using the PRISMA for Scoping Reviews framework. Eligible study designs included cohort, cross-sectional, observational, randomised controlled trials, and case reports. Searches were conducted on Science Direct and PubMed for studies published between 1957 and 2025. Search terms included "REM sleep behavior disorder," "dream enactment behavior," "antidepressants," "SSRIs," "SNRIs," and "TCAs." The scoping review protocol was pre-registered on the Open Science Framework.ResultsTitle and abstract screening yielded 650 studies, with 16 studies meeting the inclusion criteria after full-text review. Data from 500 patients indicated a male predominance (70.2%), with a mean age of 53.9 years. Depression was the most common comorbidity (8 studies). SSRIs were most frequently associated with RBD (in 8 studies), followed by SNRIs (6 studies) and TCAs (6 studies).ConclusionAntidepressant-associated RBD is an emerging clinical concern requiring greater recognition and monitoring to enhance treatment outcomes. A clearer understanding of these relationships will ultimately improve risk stratification, patient counseling, and individualized treatment strategies in clinical settings.
ObjectiveOlanzapine is effective for schizophrenia but commonly causes metabolic dysregulation. This study examined whether adjunctive probiotic treatment was associated with short-term changes in composite insulin-resistance-related indices during olanzapine therapy.MethodsThis longitudinal secondary analysis included 84 patients with schizophrenia receiving olanzapine: 40 received adjunctive Bifidobacterium tetravaccine live tablets and 44 received olanzapine alone. The triglyceride-glucose index (TyG), triglyceride-glucose-body mass index (TyG-BMI), metabolic score for insulin resistance (METS-IR), single-point insulin sensitivity estimator (SPISE), and triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C) were assessed at baseline, Week 2, and Week 4. Baseline-adjusted linear mixed-effects models evaluated group × visit interactions and visit-specific contrasts. False discovery rate (FDR) correction and sensitivity analyses were applied.ResultsSignificant group × visit interactions were observed for TyG-BMI (P < 0.001; FDR <0.001) and SPISE (P = 0.005; FDR = 0.012), but not for TyG, METS-IR, or TG/HDL-C. At Week 2, TyG-BMI was lower in the probiotic group (adjusted difference, -16.76; 95% CI, -23.78 to -9.74; P < 0.001; FDR <0.001), whereas SPISE was higher (adjusted difference, 0.54; 95% CI, 0.16 to 0.93; P = 0.006; FDR = 0.016). No index differed significantly between groups at Week 4.ConclusionsAdjunctive probiotic treatment was associated with early favorable differences in TyG-BMI and SPISE, but these were not sustained at Week 4. TyG, METS-IR, and TG/HDL-C showed no significant primary-analysis effects. Larger, longer studies with direct insulin-based measurements are needed to determine reproducibility and clinical significance.
ObjectiveTo examine associations between gastrointestinal and hepatic diseases (GIHD) and long-term depressive symptom trajectories in older adults across diverse cultural and healthcare settings.MethodsLongitudinal data from four aging cohorts were harmonized: CHARLS (China), SHARE (Europe), HRS (United States), and KLOSA (South Korea), comprising 40,161 adults aged ≥60 years with 4-6 follow-up waves. Group-based trajectory modeling (GBTM) identified distinct depressive symptom trajectories. Multinomial logistic regression, adjusted for baseline depressive symptoms and covariates, estimated odds of trajectory membership. Random-effects meta-analysis with Hartung-Knapp correction pooled cohort-specific estimates. Inverse probability weighting (IPW) and E-values assessed robustness to confounding.ResultsThree trajectories were identified in all cohorts: Stable Low, Increasing Mild, and Stable High. After adjustment for baseline depressive symptoms, GIHD independently predicted Stable High trajectory membership (pooled OR = 1.73, 95% CI: 1.31-2.28; I2 = 21.2%). Upper gastrointestinal disorders showed exceptional cross-cultural consistency (pooled OR = 1.80, 95% CI: 1.69-1.92; I2 = 0%). Liver disease was significantly associated in CHARLS (OR = 2.64, 95% CI: 1.15-6.07) but not in KLOSA. Associations were consistent across sexes (P for interaction = 0.417). IPW confirmed robustness (CHARLS OR = 1.40; SHARE OR = 1.11), and E-values indicated resistance to unmeasured confounding (E-value = 1.97).ConclusionsChronic gastrointestinal conditions independently predict persistent severe depressive trajectories in older adults across four countries. The zero heterogeneity for upper gastrointestinal disorders suggests a gut-brain axis mechanism, supporting systematic depression screening in geriatric gastroenterology practice.
ObjectiveThis study explored the effects of adverse childhood experiences (ACEs) in older adults on long-term intrinsic capacity (IC) and trajectories of change in IC over 5 years from 2011 to 2015.MethodsA total of 2847 participants aged 60 years and older from the China Health and Retirement Longitudinal Study (CHARLS) were included in analyses. Twelve ACEs were retrospectively assessed by questionnaire in 2014. The number of ACEs was summed and categorized into 5 groups: 0, 1, 2, 3, and 4 or more ACEs. IC was assessed using a measure that examined five domains: locomotor, cognitive, sensory, vitality, and psychological.ResultsOverall, 87.4% of participants reported exposure to at least 1 of the 12 ACEs (Group 2) and 16.6% had experienced 4 or more ACEs (Group 5). Compared to participants without ACEs exposure (Group 1), those experiencing 1, 2, 3 and 4 or more ACEs (Groups 2-5) predicted worse IC (β = 0.085, 95% CI = -0.169 to -0.001, P < 0.05, to β = -0.44, 95 % CI = -0.54 to -0.34, P < 0.001, respectively across the four groups, demonstrating a dose-effect response. Three IC trajectories were identified (low-stable, moderate-stable, and high stable). Individuals with experience 2, 3 and 4 or more ACEs (Groups 3-5) predicted a significantly increased risk of moderate-stable and low-stable IC trajectories. In addition, physical abuse, household mental illness, domestic violence, bullying and parental disability was negatively related to IC and predicted an increased risk of moderate-stable and low-stable trajectory in long-term follow-up.ConclusionExposure to ACEs negatively impacts IC and predicts increased risk of moderate-stable and low-stable IC trajectory (vs. high stable) over time.
ObjectiveTo evaluate how specific psychiatric comorbidities relate to index length of stay (LOS), hospital costs, and in-hospital mortality during readmissions after HF hospitalization.MethodsA retrospective cohort study was conducted using the 2016-2022 Nationwide Readmissions Database. Adults with a principal HF diagnosis were included. Psychiatric comorbidities were depression, anxiety, bipolar disorder, schizophrenia/psychotic disorders, post-traumatic stress disorder (PTSD), and substance use disorder (SUD). Outcomes were index LOS, inflation-adjusted costs, and in-hospital mortality during readmissions within 30 days and up to 1 year after discharge. Survey-weighted multivariable models adjusted for demographics, socioeconomic factors, hospital characteristics, discharge disposition, and comorbidity burden; P ≤ 0.001 was prespecified as the level of statistical significance.ResultsAmong 31,886,859 weighted HF hospitalizations, psychiatric comorbidity was common. Anxiety was associated with longer LOS (β = 0.88 days; P < 0.001) and higher costs (β = $2779; P < 0.001) but there were no differences in 30-day or 1-year mortality. However, several diagnoses were associated with lower mortality, including depression (30-day OR = 0.86; 1-year OR = 0.86), bipolar disorder (0.66; 0.68), schizophrenia/psychotic disorders (0.68; 0.72), PTSD (0.73; 0.78), and SUD (0.87; 0.92) (all P < 0.001). Bipolar disorder showed the largest cost reduction (β = -$1320; P < 0.001) compared to HF patients without bipolar disorder.ConclusionPsychiatric comorbidity in HF is common. Anxiety is associated with increased hospital utilization, but is not associated with mortality, whereas several other diagnoses are associated with lower mortality. Costs were lower for depression and bipolar disorder. These diagnosis-specific patterns support targeted screening, early consultation, and integrated consultation-liaison care pathways during HF hospitalization.
ObjectivePsychiatric disorders are prevalent among heart failure (HF) patients and depression is a common psychiatric disorder. The benefit effect of dietary fiber on depression has been reported. We aimed to assess the association between dietary fiber intake and depressive symptoms.MethodA cross-sectional analysis was conducted of NHANES data collected 2005-2018 from adults ≥18 years with physician-diagnosed HF. Total and source-specific dietary fiber intake (g/day) was calculated from the average of two 24-hour dietary recalls using USDA's AMPM protocol. Age, sex, race, education, smoking status, diabetes, hypertension, renal function, and medication use were adjusted in analyses. Survey-weighted logistic regression models examined associations between fiber intake and depression (PHQ-9 ≥10), with adjustment for confounding variables. Sensitivity analyses examined modification by BMI categories (<25, 25-29.9, ≥30 kg/m2) and HF duration (≤5 vs >5 years).ResultsA total of 1041 participants were included, of which 188 (18.06%) with depression symptoms. High total dietary fiber intake (OR = 0.50, 95% CI: 0.29-0.86) and vegetable fiber intake (OR = 0.49, 95% CI: 0.25-0.97) were associated with the lower odds of depression in HF patients.ConclusionDepression is associated with vegetable fiber, but not with fiber from grains or fruits. Depression is less common in patients with HF who consume high levels of total dietary fiber and vegetable fiber.
ObjectiveIndividuals living with HIV are at increased risk for psychiatric disorders. In this pilot randomized clinical trial, the effects of probiotics on improving psychiatric symptoms among patients living with HIV was examined.MethodsA total of 50 patients living with HIV were randomly assigned to one of two groups: one group received a probiotic capsule. In contrast, the other received a placebo for 12 weeks, determined by a simple randomization method. Patients were evaluated at weeks 0, 4, 8, and 12 using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Simplified Nutritional Appetite Questionnaire (SNAQ), and the Pittsburgh Sleep Quality Index (PSQI).ResultsCompared to the control group, HIV patients in the intervention group receiving probiotics exhibited a significantly greater reduction in anxiety symptoms and greater improvement in appetite compared to those in the placebo group (time*group interaction: F (3, 144) = 6.63, P < 0.001 for anxiety symptoms; F (3, 144) = 18.74, P < 0.001 for appetite).ConclusionsProbiotics may be beneficial in alleviating anxiety symptoms and anorexia in persons living with HIV. Future studies in multicenter settings with larger sample sizes and extended follow-up periods are needed to replicate these results.
ObjectiveThis study conducted a comprehensive analysis of psychological and institutional factors that lead to the transformation of criminal behaviour in conditions of armed conflict, using the Russian-Ukrainian war as a case study.MethodThis research was based on qualitative analysis of secondary data. The study examined reports and analytical materials from international monitoring missions, including the United Nations, the Organization for Security and Co-operation in Europe, the Parliamentary Assembly of the Council of Europe, and Amnesty International. These sources were compared with theoretical approaches from criminal psychology and criminology in order to identify patterns in behavioural transformation under wartime conditions.ResultsThe findings demonstrate that the transformation of criminal behaviour occurs at 3 interconnected levels. First, the destruction or weakening of legitimate legal institutions in occupied territories creates an institutional vacuum and a state of anomie, which facilitates opportunistic crimes such as looting and organised criminal activity, including enforced disappearances. Second, among combatants there is a normalisation of violence supported by psychological mechanisms such as dehumanisation and moral disengagement, which contributes to systematic war crimes, including torture, sexual violence, and indiscriminate attacks. Third, changes occur in the behaviour of the civilian population, manifested in survival-related crimes, aggression caused by trauma, and forced criminalisation through collaboration with occupying authorities.ConclusionsThis report describes how armed conflict significantly alters patterns of criminal behaviour through the interaction of institutional collapse and psychological adaptation to violence. The results emphasise the need to incorporate psychological factors into post-war justice mechanisms and conflict-zone law enforcement strategies. They may also contribute to the development of post-war rehabilitation programs, improvements in transitional justice systems, and the training of peacekeeping personnel and law enforcement agencies operating in conflict environments.
