Adult attention-deficit/hyperactivity disorder (ADHD) is frequently accompanied by Cognitive Disengagement Syndrome (CDS), characterized by mental fogginess, slowed processing, excessive daydreaming, and reduced task engagement. This study compared the effects of cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) on self-reported ADHD and CDS symptoms in adults. In this randomized controlled trial, 60 adults meeting DSM-5 criteria for ADHD were assigned to CBT (n = 20), MBCT (n = 20), or a waitlist control group (n = 20). Outcomes were assessed at pretest, posttest, and two-month follow-up using the Persian version of the Barkley Adult ADHD Rating Scale–IV (BAARS-IV). Between-group posttest differences were examined using multivariate analysis of covariance (MANCOVA) controlling for baseline scores, and symptom changes over time were evaluated using repeated-measures analysis of variance. The analyses indicated significant between-group differences in self-reported ADHD/CDS symptoms following treatment. Both CBT and MBCT were associated with greater reductions in self-reported symptoms than the waitlist control group, with the most consistent improvements observed for inattention and CDS. Improvements in inattention and CDS were largely maintained at the two-month follow-up. Effects on hyperactivity and impulsivity were smaller. No statistically significant differences were detected between CBT and MBCT on the primary symptom outcomes. However, because the trial was not designed or powered as an equivalence or non-inferiority study, this finding should not be interpreted as evidence that the two interventions are equivalent. CBT and MBCT were each associated with greater reductions in self-reported ADHD and CDS symptoms than the waitlist control condition, particularly in attention-related and cognitive disengagement domains. No statistically significant differences were detected between the two active interventions; however, because the trial was not designed or powered as an equivalence or non-inferiority study, this finding should be interpreted as an absence of detected difference rather than evidence of comparable efficacy. Given the modest sample size, reliance on self-report outcomes, use of a waitlist control condition, and the single-group delivery of each active intervention, these findings should be regarded as preliminary and interpreted cautiously. The trial was prospectively registered in the Iranian Registry of Clinical Trials (IRCT20250927067383N1).
Suicidal behavior is common in schizophrenia, significantly worsens prognosis, and represents the leading cause of premature mortality in this population. Challenges in assessing suicide risk and implementing effective prevention strategies in individuals with schizophrenia pose major difficulties for clinicians and healthcare systems. This review aimed to summarize the key suicide risk factors and current preventive strategies associated with schizophrenia. A comprehensive narrative review of the literature was conducted. Electronic searches were performed in major biomedical databases, including PubMed/MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and the Cochrane Library, from database inception to June 2026. Relevant studies addressing suicide risk factors and preventive interventions in schizophrenia were selected according to predefined eligibility criteria. The review primarily relied on systematic reviews, meta-analyses, randomized controlled trials, large observational studies, and international clinical practice guidelines. Suicidal behavior in schizophrenia results from a complex interaction of clinical, neurobiological, genetic, and psychosocial factors. A comprehensive assessment of these factors may improve suicide risk assessment and guide individualized preventive strategies, while emerging artificial intelligence–based approaches may further support risk prediction in the future. Accordingly, a range of pharmacological and non-pharmacological preventive strategies can be implemented according to the individual’s clinical profile and suicide risk. Clozapine is the most extensively validated pharmacological treatment for reducing suicide risk in schizophrenia, although its use requires adherence to established clinical guidelines. Other pharmacological treatments may be considered in selected clinical situations. Non-pharmacological strategies are essential complements and include neuromodulation techniques, psychotherapy, and psychosocial intervention programs.
Abstract Background and Aim This study aimed to estimate the prevalence of multiple behavioral addiction risks among medical students and examine their shared and behavior-specific temperament and character correlates. Methods In this cross-sectional study, 385 medical students from a public university completed a sociodemographic data form, the Temperament and Character Inventory, the Patient Health Questionnaire-4, and validated measures of social media addiction, cyber pornography use, problem gambling, compulsive buying, food addiction, internet gaming disorder, and exercise dependence. Prevalence was estimated using scale-specific thresholds. Correlation and hierarchical regression analyses were performed to examine temperament and character correlates; regression models were adjusted for age, sex, and psychological distress. Results Threshold-based prevalence was 17.1% for social media addiction, 2.3% for high-risk cyber pornography use, 8.6% for problem gambling, 12.7% for compulsive buying, 9.6% for food addiction, 2.3% for internet gaming disorder, and 1.8% for exercise dependence. Females showed higher compulsive buying scores, whereas males showed higher scores for cyber pornography use, problem gambling, internet gaming disorder, and exercise dependence. Lower self-directedness emerged as the most consistent temperament and character correlate and was independently associated with higher social media addiction, compulsive buying, and internet gaming disorder scores after controlling for age, sex, and psychological distress. Behavior-specific associations were also observed: social media addiction was additionally associated with higher reward dependence and lower cooperativeness, compulsive buying with higher novelty seeking and self-transcendence, and exercise dependence with lower harm avoidance and higher self-transcendence. Conclusion Lower self-directedness was a recurring correlate of several behavioral addiction risks, whereas other temperament and character associations varied by behavior.
The relationship between menopausal hormone therapy (MHT) and the trajectory of cognitive function in midlife and later life remains one of the most consequential and contested questions in women’s health. The “critical window” or timing hypothesis posits that the cognitive consequences of exogenous estrogen depend on when therapy is initiated relative to the menopausal transition, and on which formulation, route, dose, and duration are used. After two decades of randomised trials and large pharmacoepidemiological cohorts, the evidence has matured but remains heterogeneous, and clinical guidance still varies widely across regions. We aimed to (i) systematically synthesise contemporary evidence on the effect of MHT on cognitive performance, mild cognitive impairment (MCI), and incident all-cause dementia or Alzheimer’s disease (AD); (ii) quantitatively examine effect modification by timing of initiation, formulation (estrogen-only versus estrogen plus progestogen), route (oral, transdermal, vaginal), and duration; and (iii) evaluate the methodological quality of the evidence base and identify clinically actionable recommendations. We searched PubMed/MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science from inception to 7 May 2026 for randomised controlled trials (RCTs), prospective cohort studies, nested case–control studies, and high-quality systematic reviews investigating MHT and cognitive or dementia outcomes. Two reviewers independently screened citations and extracted data; risk of bias was assessed with the Cochrane RoB 2 tool for RCTs and the Newcastle–Ottawa Scale for observational studies. Where ≥ 2 estimates per pre-specified subgroup were available, we pooled adjusted relative risks (aRRs), hazard ratios (HRs), or odds ratios (ORs) using inverse-variance random-effects meta-analysis with the DerSimonian–Laird estimator and report between-study heterogeneity using Cochran’s Q and Higgins’ I2. Pre-specified subgroups were defined by timing of initiation (< 5 years versus > 5 years from final menstrual period), formulation (estrogen-only versus combined estrogen–progestogen), route (oral, transdermal, vaginal), and duration (< 5 versus 5–9 versus ≥ 10 years). Of 7,271 records identified, 65 studies met the inclusion criteria for qualitative synthesis and 12 studies contributing 18 effect estimates were eligible for quantitative meta-analysis. The pooled aRR for any MHT use versus never-use on incident all-cause dementia was 1.06 (95
Abstract Background and objectives Methamphetamine use is increasing globally not only in developed countries but also in developing countries, including Egypt. The adverse impact of methamphetamine use (locally known as Shabu drug in Egypt) on psychiatric condition and cognitive functions has been described in previous studies, but limited evidence is available for abstinent users from prospective longitudinal studies especially in Egypt. The aim of this study was to assess the longitudinal changes in cognitive functions, anxiety, depression, and suicidality among methamphetamine users over 6 months of abstinence. Methods This prospective longitudinal study was conducted with baseline and two follow-up interviews every 3 months over 6 months of abstinence in 30 participants who were current or recent methamphetamine (shabu) users at baseline, in both the Inpatient and Outpatient Treatment Setting of the Neurology & Psychiatry Department, and Psychiatry, Neurology and Neurosurgery Centre in Tanta University Hospitals from July 2025 to December 2025. All patients underwent the assessment of socioeconomic data, assessment of patient’s level of depression by Beck depression inventory–II (BDI-II), the level of anxiety by generalized anxiety disorder-7 scale (GAD-7), the suicidal behaviour by Beck scale for suicidal ideation (BSSI) and assessment of cognitive functions by Montreal cognitive assessment (MoCA) test. Results The depression, anxiety and suicidality (assessed by previous measures) were significantly lower at T1 (after 3 months of abstinence) and T2 (after 6 months of abstinence) than T0 (baseline with recent methamphetamine use) ( P < 0.05) and were significantly lower at T2 than T1 ( P < 0.05). Regarding cognitive functions (assessed by Montreal cognitive assessment test, MoCA), the attention, naming, visual space/ executive function subscale scores and the total MoCA score were significantly higher at T1 and T2 than T0 ( P < 0.05) and was significantly higher at T2 than T1 ( P < 0.05). The language skills, and the memory and delayed recall subscale scores were significantly higher at T1 and T2 than T0 ( P < 0.05), with insignificant difference between T1 and T2. The abstract ability subscale score was significantly higher at T2 (6 months) than T0 (baseline) ( P < 0.05), with insignificant difference between T1 and T0. The orientation domain didn’t show statistical difference across three different time points of assessment. Conclusions Depression, anxiety, suicidal ideation and cognitive impairment were found to be high among current methamphetamine users, which showed significant improvement during 6 months of the methamphetamine abstinence.
Abstract Explanatory models are culturally shaped beliefs about health and illness that play a critical role in how individuals interpret their illness experiences, attach meaning to them, and decide on treatment options. This qualitative study explored how traditional leaders in Mokhotlong District, Lesotho, conceptualise depression, focusing on how they label it and its perceived causes. It also examined the influence of socio-demographic factors such as gender, age, and educational background on participants’ explanations to highlight commonalities and differences across groups. By offering culturally grounded perspectives, explanatory models provide contextually relevant explanations for understanding depression in Lesotho. Fourteen traditional leaders (11 men and three women) were recruited using purposive sampling. The findings indicate that shared cultural understandings shape traditional leaders’ conceptualisations of depression more strongly than demographic characteristics. Strengthening recognition of the biological dimensions of depression through culturally appropriate mental health literacy initiatives may foster a more comprehensive biopsychosocial understanding of depression.
Abstract Background Autism spectrum disorder (ASD) is a complex neurodevelopmental condition affecting approximately 1 in 100 individuals globally, characterized by persistent deficits in social communication and interaction, and restricted, repetitive behavioral patterns. No pharmacotherapy has demonstrated consistent efficacy for core ASD symptoms. Acupuncture, a central modality of traditional Chinese medicine (TCM), is increasingly used as an adjunctive intervention for pediatric ASD; however, prior meta-analyses have been substantially limited by methodological shortcomings including violation of effect-size independence assumptions, absence of prediction intervals, inadequate publication bias assessment, exclusive reliance on Chinese-language databases, and failure to apply contemporary Grading of Recommendations Assessment, Development and Evaluation (GRADE) standards. Objective To critically re-evaluate and comprehensively update the evidence base for acupuncture as adjunctive therapy for pediatric ASD through the largest synthesis to date, with robust variance estimation (RVE), prediction intervals, GRADE certainty assessment, and systematic moderator analyses. Methods Thirteen electronic databases (Cochrane Library, MEDLINE/PubMed, Embase, Allied and Complementary Medicine Database [AMED], Cumulative Index to Nursing and Allied Health Literature [CINAHL], PsycARTICLES, China National Knowledge Infrastructure [CNKI], Wanfang Data, VIP Database, Chinese Biomedical Literature Database [CBM], JAIRO, CiNii, and KoreaMed) were searched from inception through May 20, 2026, without language restrictions. Additional records were obtained through manual reference searching. The primary analysis used RVE with small-sample correction and within-study correlation ρ = 0.7 to properly handle multiple dependent effect sizes per study. Results Thirty-six unique RCTs contributing 56 effect sizes and involving 3,139 unique participants (5,189 total observations across both outcomes) met inclusion criteria. The pooled RVE estimate demonstrated a large standardized treatment effect: Hedges’ g = − 0.961 (95% confidence interval [CI]: − 1.120 to − 0.801; t = − 12.223, df = 35, P = 3.46 × 10⁻14), with a 95% prediction interval (PI) of − 2.329 to 0.408; I2 = 84.0%; τ2 = 0.381. Because the 95% PI includes zero and I2 exceeds 75%, the pooled point estimate should NOT be used for individual patient decision-making without explicit acknowledgment of this uncertainty. Five moderators were statistically significant after Bonferroni correction: outcome measure (Q = 40.458, P < 0.001), treatment duration (Q = 21.915, P < 0.001), intervention type (Q = 19.302, P < 0.001), publication period (Q = 85.879, P < 0.001), and diagnostic criteria (Q = 38.556, P < 0.001). GRADE assessment rated the primary outcome evidence as MODERATE quality (⊕ ⊕ ⊕ ○○). The adverse event rate was approximately 0.8%; no serious adverse events were recorded across 3,139 participants. Conclusions Moderate-quality evidence provides a conditional suggestion that acupuncture may reduce autism symptom severity as an adjunct to multimodal treatment in children. Extreme between-study heterogeneity, universal performance bias due to unblinded designs, exclusive reliance on Chinese RCTs, complete absence of sham controls, and substantive publication bias asymmetry significantly limit confidence and prevent definitive clinical recommendations. International, multicenter, sham-controlled RCTs with standardized protocols, biomarker endpoints, and long-term follow-up are urgently required to advance the field.
Abstract Attention-deficit/hyperactivity disorder (ADHD) is increasingly understood as a condition involving difficulties in cognitive, emotional, behavioural, and physiological self-regulation. Heart rate variability (HRV) has been proposed as a non-invasive index of autonomic regulation and vagal flexibility, but its interpretation in ADHD remains complex. This clinical perspective examines the relevance of HRV to autonomic dysregulation, emotional dysregulation, and treatment tolerability in ADHD. A narrative evidence synthesis was conducted using targeted searches of PubMed/MEDLINE, Embase, and PsycINFO, supplemented by manual screening of relevant reviews and empirical studies. Current evidence suggests that altered autonomic regulation may be present in some individuals with ADHD, particularly under cognitive, emotional, or stress-related demands. Reduced vagally mediated HRV appears more consistently in task-related contexts than during resting-state assessment, although findings remain heterogeneous across developmental stage, medication status, comorbidity, recording protocols, and HRV indices. Emotional dysregulation may represent one clinically meaningful pathway through which autonomic vulnerability becomes visible. On this basis, we propose a phenotype-informed autonomic framework that distinguishes patients with more evident hyperarousal, emotional reactivity, and treatment sensitivity from those with more compensated regulatory profiles. This framework is intended as a clinical and research concept rather than a diagnostic model. HRV should therefore not be regarded as a diagnostic biomarker or stand-alone guide for treatment selection. Future studies should use standardised HRV protocols, longitudinal designs, and careful clinical phenotyping to determine whether autonomic measures can improve assessment, treatment monitoring, or risk stratification in ADHD.
Abstract Background The war on Gaza has taken a heavy emotional burden on Palestinians and has also affected many Jordanians who feel closely connected through ties and constant exposure to the conflict. Understanding these psychological effects helps highlight the true human cost of the conflict and the need for meaningful support. Objective This study aims to evaluate the psychological impact of the Gaza war on Palestinians and Jordanians and to examine the levels of trauma-related psychological distress and associated factors. Methods From October 2023 to April 2024, a descriptive cross-sectional survey was implemented utilizing a web-based questionnaire distributed over social media platforms. The survey comprised socio-demographic questions and the Arabic version of the Impact of Event Scale-Revised (IES-R). In total, 977 valid responses were included in the final analysis (87.9% Jordanians, 12.1% Palestinians). Results The mean IES-R score was 46.18 ± 9.89, indicating a severe psychological impact, with 75.3% of participants reporting significant distress (IES-R ≥ 37). Palestinians reported a higher prevalence of severe distress (85.6%) while Jordanians reported a rate of 73.9%. Factors significantly associated with severe distress included female gender, residence in Palestine, a lack of prior exposure to war events, and the need for psychological support (all p < 0.05). These findings illustrate the significant psychological toll of the conflict and highlight vulnerable subgroups requiring targeted mental health interventions. Conclusion The Gaza conflict has caused enormous psychological distress for both Jordanians and Palestinians. Women are affected more than men by war due to lack of prior exposure. People suffering from severe distress must have access to psychological support services and this raises the need for availability of mental health service in conflict-affected areas. Researchers who study long-term psychological impacts of war need to identify resilience indicators in order to develop the best possible support strategies.
Internet Gaming Disorder (IGD) is becoming more common in Indonesia as a result of increased internet usage, which is associated with psychological and physiological dysfunctions, including stress system dysregulation and cognitive impairment. This study aimed to analyze the relationship between IGD, salivary cortisol levels, and eye saccadic movements as neurocognitive indicators. This was an observational-analytic, cross-sectional study conducted among students of SMP Negeri 18 Medan. Over 217 students screened, 60 participants were recruited using consecutive sampling and divided into IGD (n = 30) and control (n = 30) groups based on the Game Addiction Scale (GAS). Salivary cortisol samples were collected in the morning under fasting conditions, while eye saccadic movement was assessed using the error rate parameter. Data were analyzed using Mann–Whitney, Chi-square, and point-biserial correlation tests. Salivary cortisol levels were significantly higher in the IGD group compared with controls (p = 0.015). The proportion of saccadic errors was also significantly higher in the IGD group (p = 0.004). In addition, a moderate positive correlation was found between salivary cortisol levels and saccadic error rates in the IGD group (r = 0.443; p = 0.014). These findings suggest increased physiological stress responses and impaired inhibitory control among adolescents with IGD. Salivary cortisol levels and eye saccadic movement may have potential as objective markers in the assessment of IGD.
Abstract Background Physical education students face unique academic and performance-related demands that may increase vulnerability to psychological distress. Overexcitability (OE), a construct reflecting heightened psychological responsiveness, has been linked to emotional intensity and stress sensitivity, yet its relationship with anxiety among physical education students remains underexplored, particularly in conflict-affected contexts such as Palestine. Objective This study aimed to examine the relationship between overexcitability and anxiety among physical education university students in Palestine and to explore differences across demographic and academic characteristics. Methods A cross-sectional survey was conducted in August 2025 among 192 undergraduate physical education students enrolled in universities in the West Bank. Participants completed the Beck Anxiety Inventory (BAI) and Dabrowski’s Overexcitability Questionnaire (OEQ). Descriptive statistics, Pearson correlation analyses, t-tests, ANOVAs, and multiple regression analyses were performed to examine associations between overexcitability domains and anxiety. Results Overall overexcitability was significantly and positively correlated with anxiety ( r = 0.336, p < 0.001). All five OE domains: intellectual, emotional, sensory, imaginational, and psychomotor were significantly associated with higher anxiety scores. Female and younger students reported significantly higher anxiety levels. Students who were identified as gifted or talented athletes exhibited higher levels of overexcitability without corresponding reductions in anxiety. Despite elevated anxiety indicators, utilization of psychological counseling services was low. Conclusion The findings suggest that heightened overexcitability is associated with increased anxiety among physical education students, highlighting psychological intensity as an important vulnerability factor in this population. Athletic engagement alone may not be sufficient to buffer anxiety when overexcitability is high. These results underscore the need for targeted, culturally responsive mental health screening and interventions within physical education programs, particularly in contexts of chronic sociopolitical stress.
Abstract Introduction Substance Use Disorder (SUD) is a major public health concern globally, with unique epidemiological characteristics in different regions. This study aims to comprehensively describe the sociodemographic profile, substance use patterns, and personality traits of patients admitted for SUD treatment in Assiut University Hospital. Materials and methods A descriptive-survey design was employed at the Addiction Management Unit of Assiut University Hospital, Egypt, over one year. The study included 106 male patients with SUD, recruited via convenience sampling. Data collection utilized a custom Sociodemographic and Clinical Survey, Clinical Psychiatric Interview (DSM-5-TR), Symptom Checklist-90-Revised (SCL-90-R), Structured Interview for the Five-Factor Model of Personality (SIFFM), Addiction Severity Index (ASI), Urine Drug Screen (UDS), and serology testing. Statistical analysis utilized IBM-SPSS 26.0. Results The cohort had a mean age of 32.4 ± 8.3 years. predominantly rural (70.8%) and had low educational attainment (81.2%). Tobacco use was highly prevalent (89.6%). UDS revealed Amphetamines (48.1%) and Cannabinoids (45.3%) as the most detected substances, with nearly half (48.1%) being poly-substance users. Hashish use had the youngest mean age of onset (18.7 ± 4.6 years). SIFFM showed moderate scores across all five factors. ASI indicated high problem severity in drug/alcohol, psychiatric, family/social (87.7%), and employment (70.8%) domains. Conclusion The study reveals a distinct profile of young, rural, low-educated males with prevalent Amphetamine and Cannabinoid use, significant poly-substance use, and severe psychosocial impairment. These findings necessitate targeted, culturally sensitive prevention and treatment strategies for the region. Trial registration ClinicalTrials.gov, TRN: NCT05777200, Registration date: 27 February 2023.
Abstract Background Perinatal anxiety disorders are common yet understudied in low- and middle-income countries, particularly where sociocultural and economic stressors may elevate maternal vulnerability. This study assessed the prevalence and sociodemographic and psychosocial determinants of Mini International Neuropsychiatric Interview (MINI)-defined anxiety and related disorders among antenatal and postnatal women attending primary healthcare facilities in southwestern Nigeria. Methods A cross-sectional study was conducted among 406 women (203 antenatal; 203 postnatal) attending primary healthcare facilities. Sociodemographic, psychosocial, and clinical variables were assessed using a structured questionnaire. Anxiety and related disorders were diagnosed using the MINI. Chi-square tests and multivariable logistic regression were performed separately for antenatal and postnatal groups. Results The overall prevalence of MINI-defined anxiety or related disorders was 44.8%, with similar rates in antenatal (45.3%) and postnatal (44.3%) women. Among pregnant women, polygamous family structure (AOR = 3.90; 95% CI: 1.02–14.87) and low educational attainment (no formal/primary education: AOR = 5.47; 95% CI: 1.65–18.09) independently predicted anxiety disorders. In the postpartum group, younger maternal age (≤ 25 years: AOR = 3.32; 95% CI: 1.35–8.19) and low monthly income (≤₦20,000: AOR = 2.44; 95% CI: 1.37–4.33) were independently associated with anxiety disorders. Conclusions Perinatal anxiety disorders are highly prevalent in this Nigerian cohort. Distinct predictors emerged across the perinatal period, highlighting the need for stage-specific screening and interventions that address socioeconomic vulnerability and household structural factors.
Abstract Background In Malaysia, there is a gap between the rising prevalence of mental disorder and limited specialist resources. Mobile mental health (mHealth) apps have a potential to address the issue, but it is still uncertain how different diagnostic profile – GAD and MDD perceive and utilise the tools. This study examined awareness and attitudes towards mental illness and digital readiness between MDD and GAD patients. Methods A cross-sectional study design was used to examine baseline data from a pilot Randomised Controlled Trial conducted at the psychiatric clinic in Hospital Al-Sultan Abdullah (HASA), UiTM. 74 participants (38 with MDD and 36 with GAD) were recruited through consecutive sampling. Sociodemographic questionnaires, the PHQ-9, the GAD-7, and a validated mHealth application awareness and attitudes survey were administered. Chi-square and Fisher’s exact tests were used to determine differences in app usage and perceived barriers. Results Smartphone ownership was ubiquitous (100%), and over 88% in both groups were willing to adopt mHealth apps. However, the actual engagement in application use differed: GAD subjects were more likely to use mindfulness apps than MDD (50.0% versus 26.3%, P = 0.036). With respect to barriers, concern about privacy was more often present in GAD patients (66.7%) than MDD patients (44.7%) (P = 0.058). Although there was strong interest in the use of mHealth app, more than 60% of patients did not know where to find suitable apps for mental health intervention. Conclusions Although both cohorts are digitally literate and open to mHealth adoption, barriers to adoption are diagnoses-specific. Patients with MDD appears limited in using self-monitoring application due to motivational deficit related to their symptom severity, while fear of data exposure is the major source of barriers in GAD patients. Thus, a ‘one-size-fits-all’ approach may be insufficient, hence the need for a clinician-guided digital prescription to address the issue.
Abstract Background Little is known about sleep quality among healthcare workers (HCWs) in active conflict zones. Since October 2023, Gaza’s hospital workforce has endured continuous bombardment, severe resource shortages, and repeated displacement. This study evaluates sleep quality among frontline clinicians in Gaza and examines factors associated with sleep outcomes, including sociodemographic and work-related factors, psychological distress, and resilience. Methods A cross-sectional survey was conducted in August 2025 among physicians and nurses working in major government hospitals across the Gaza Strip. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), psychological distress with the Patient Health Questionnaire–4 (PHQ-4), and resilience with the Connor–Davidson Resilience Scale–10 (CD-RISC-10). Poor sleep was defined as a PSQI score > 5. Multiple linear regression analyzed factors linked to poor sleep. Additionally, a logistic regression model with poor sleep (PSQI > 5) as a binary outcome was used for sensitivity analysis. Results A total of 437 clinicians participated (52.5% female; 57.6% nurses). Poor sleep was highly prevalent (74.1%), with a mean Global PSQI of 7.98. Psychological distress was elevated (mean PHQ-4 = 6.54), and 58.6% reported scores indicating moderate or high distress. Resilience was in the moderate range (mean CD-RISC-10 = 23.94). Differences in PSQI by sex, profession, and department type were small (Hedges’ g 0.10–0.24). In adjusted models, psychological distress was independently associated with poorer sleep (β = 0.482, p < 0.001), whereas resilience was protective (β = −0.073, p < 0.001). Sensitivity analyses yielded consistent results. Conclusions Frontline clinicians in Gaza face widespread sleep disruptions amid ongoing conflict. Psychological distress is a key factor associated with poor sleep, whereas resilience confers some protective benefits. Ensuring safety and providing organizational and environmental support are essential. Interventions that enhance mental health support and foster resilience may help maintain clinician functioning and stabilize the health system during prolonged crises.
Abstract Background Schizophrenia isassociated with elevated incidence of type2 diabetes mellitus (T2D). Autoimmune responses targeting glutamate decarboxylase (GAD) may contribute to neurological disorders and diabetes development. Accordingly, the purpose of this research was to evaluate the clinical relevance of serum anti-GAD65 antibody level in patients with schizophrenia and T2D, compared with patients with schizophrenia without diabetes. Methods This study involved 60 patients with schizophrenia (30 patients with T2D and 30 patients without T2D). Levels of HbA1C with random blood sugar (RBS) were carried using commercial kits. Level of serum anti-GAD65 antibody was measured by using ELISA Bio Vendor GAD65 Assay Kit. Results Data showed substantial (p < 0.05) increases in HbA1C, RBS, and BMI among patients with schizophrenia and T2D Compared to patients with schizophrenia only. Serum anti-GAD65 antibody titer elevated in patients with schizophrenia and T2D (237.33 ± 9.49, p < 0.001) when compared with patients with schizophrenia only (193.11 ± 8.12), in females when compared with males of two groups, and in patients with schizophrenia (either with or without T2D) who received Olanzapine than those who received Clozapine. Additionally, the findings of the ROC curve showed that, with an AUC of 0.75, a cut-off value of 215 IU/ml, 80% sensitivity, and 70% specificity. Conclusion Serum anti-GAD65 antibody titers were significantly higher in patients with schizophrenia and T2D than in those with schizophrenia only, indicating strong association between anti-GAD65 and T2D in patients with schizophrenia.
Abstract Aim To assess the prevalence of Night Eating Syndrome and examine its association with depressive symptoms among medical students at the University of Babylon, Iraq. Methods A cross-sectional study was carried out at the College of Medicine, University of Babylon, from May 21 to June 21, 2025. A total of 359 medical students took part in the study by completing a self-administered questionnaire composed of three sections: sociodemographic characteristics, the Night Eating Diagnostic Questionnaire, and the Patient Health Questionnaire-9 to assess depressive symptoms (screening tool). Data were analyzed using SPSS version 26. Statistical significance was set at p less than or equal to 0.05. Results The mean age of students was 20.94 ± 1.67 years. Most of them (63.5%) had a normal body mass index (BMI), while 6.7% were obese. Full-syndrome Night Eating Syndrome was identified in 3.9% of students. Regarding depressive symptoms severity, 12.8% of participants exhibited moderate depressive symptoms, 6.1% had moderately severe depressive symptoms, and 5.8% had severe depressive symptoms. Night Eating Syndrome was significantly associated with depressive symptoms, male sex, smoking, and higher BMI (p < 0.05). Conclusion Night Eating Syndrome among medical students was relatively uncommon, yet it was significantly linked to depressive symptoms and unhealthy lifestyle behaviors. These findings highlight the need for further longitudinal research and may support consideration of screening approaches in future studies.
Abstract Background Apathy—a quantitative reduction of goal-directed activity—is among the most prevalent and disabling behavioral disturbances in neurodegenerative disease. Although traditionally treated as a non-specific neuropsychiatric symptom, accumulating evidence suggests that apathy reflects shared dysfunction of fronto-striatal motivation circuits and may operate as a transdiagnostic behavioral marker of brain disease, with implications for early detection, prognostication, and intervention. Objective To map the conceptualization, measurement, prevalence, neurobiology, prognostic significance, and treatment of apathy across major neurodegenerative diseases, and to identify priority gaps for psychological and behavioral science. Methods We conducted a scoping review following the Arksey and O’Malley framework as refined by the Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR. PubMed, Embase, PsycINFO, and the Cochrane Library were searched from inception to March 2026. Two reviewers independently screened 2,847 records at the title/abstract level, assessed 312 full-text articles, and charted data from 86 included studies using a structured extraction form. The selection process is presented in a PRISMA-ScR flow diagram (Fig. 1). Results Across diseases, pooled or representative prevalence estimates ranged from approximately 30% in MS and post-stroke cohorts to 49% in AD and up to 70% in bvFTD, with substantial variability driven by diagnostic instrument, disease stage, and care setting. Five conceptual frameworks dominated the literature: the Marin construct, the Levy–Dubois three-subtype model (cognitive, emotional-affective, auto-activation), the Robert et al. 2018 international consensus criteria, the Husain–Roiser transdiagnostic effort-based decision-making framework, and the Ismail Mild Behavioral Impairment (MBI) construct, which positions apathy as a prodromal marker of dementia. Neuroimaging consistently implicated anterior cingulate cortex, ventromedial and orbitofrontal cortex, ventral striatum, and their dopaminergic projections. Apathy independently predicted accelerated cognitive decline in AD and conversion from mild cognitive impairment to dementia, was associated with increased caregiver burden and reduced quality of life, and showed modest responsiveness to methylphenidate (Alzheimer’s disease) and to selected non-pharmacological strategies. Conclusions Apathy meets several criteria for a transdiagnostic behavioral marker: high prevalence, shared neurobiology, prognostic value, and partial treatment responsiveness. A psychology-informed research agenda—centered on dimensional measurement, ecologically valid behavioral tasks, and early-stage intervention—is needed to translate this construct into routine clinical practice and into preventive frameworks for cognitive decline.
Abstract Background Facial emotion recognition (FER) deficits constitute a clinically consequential dimension of schizophrenia, yet the contribution of specific executive function (EF) components, and whether this contribution varies between static and dynamic stimulus modalities, remains insufficiently understood, particularly outside Western samples. This study examined the relationships among inhibitory control, cognitive flexibility, central executive functioning, and the recognition of six basic emotions under both static and dynamic conditions in a Moroccan clinical sample. Methods Thirty-six patients with schizophrenia and 36 matched healthy controls completed the Stroop Color-Word Test, the Wisconsin Card Sorting Test (WCST), Baddeley’s Dual-Task Paradigm, and static and dynamic FER tasks. Symptom severity was evaluated using the Positive and Negative Syndrome Scale (PANSS). Analyses included Mann-Whitney U tests with Bonferroni correction, Spearman correlations with Holm-Bonferroni correction (66 tests), multiple regression with leave-one-out cross-validation (LOO-CV), and bootstrap mediation (5,000 resamples). Results Patients exhibited selective FER deficits for fear, surprise, and sadness under dynamic conditions (rrb = 0.89–1.00) but only for fear under static conditions. The dynamic–static performance gap was four times larger in patients than controls. Executive functions correlated significantly with dynamic (4 Holm-corrected) but not static emotion recognition. Inhibitory control predicted dynamic fear recognition (R² = 0.73; LOO-CV R² = 0.26, indicating overfitting). Preliminary mediation analyses (reported in Supplementary Material) raised the hypothesis that central executive functioning may partially account for the symptom severity–dynamic surprise recognition link; these results are underpowered and purely exploratory. Conclusions These findings provide preliminary evidence for a modality-specific model in which dynamic, but not static, emotion recognition is associated with executive function performance. The substantial discrepancy between standard and cross-validated R² underscores the need for replication with larger samples. The modality effect may partly reflect differential task difficulty rather than exclusively modality-specific processing demands (see Discussion). This is the first study to examine the EF–FER relationship across stimulus modalities in a Moroccan sample.
BackgroundSchizophrenia is a severe and persistent mental disorder that disrupts emotional, cognitive, and behavioral functioning, often leading to significant impairments in daily life. Adherence to treatment plays a central role in determining long-term clinical outcomes. As community-based mental health care increasingly emphasizes family involvement, caregiver-related psychological characteristics may influence patients' engagement with treatment and functional status.AimThis study aimed to examine the associations between caregivers' distress tolerance and perfectionism and patients' medication adherence and functional outcomes in schizophrenia.MethodsThis cross-sectional study included 80 clinically stable patients with schizophrenia and their 80 primary caregivers recruited from a psychiatry outpatient clinic between October 2024 and April 2025. Caregivers completed standardized measures assessing perfectionism and distress tolerance. Patients were evaluated using validated instruments measuring symptom severity, medication adherence, and psychosocial functioning. Correlation, logistic regression, and linear regression analyses were performed while controlling for relevant sociodemographic and clinical variables.ResultsPatients demonstrated moderate levels of functional impairment and medication adherence. Caregiver perfectionism was not significantly associated with patients' medication adherence. In contrast, higher caregiver distress tolerance, particularly the tolerance dimension, was independently associated with greater motivational adherence to medication. Regarding functional outcomes, caregiver perfectionism showed selective associations with patients' autonomy functioning, whereas caregiver distress tolerance was not significantly related to overall functioning.ConclusionOverall, the findings indicate that caregivers' emotional and personality-related characteristics may differentially relate to treatment engagement and specific functional domains. These results suggest that caregiver-focused psychological processes could be considered in family-based interventions aimed at improving adherence and functional outcomes in schizophrenia.
