Background: Road traffic accidents (RTAs) present a significant public health problem and economic burden. The aim of the study was to determine mental health outcomes and health-related quality of life (HRQOL) of RTA victims 6 months following a road trauma and factors associated with mental and physical components of HRQOL; Methods: A cohort of 200 RTA victims was followed during a 6-month period and a wide range of sociodemographic, health-related, RTA-related, injury-related, psychological and victim-related factors associated with the HRQOL scores were explored using multiple regression analyses; Results: Lower physical component summary score was associated with pre-existing chronic disease, self-perceived life threat, surgical treatment, amnesia following an RTA, permanent pain, increase in pain intensity or frequency and depression symptoms (p < 0.05); lower mental component summary score was associated with irreligiousness, rehabilitation procedure, depression symptoms, anxiety symptoms, permanent pain and increase in medication use (p < 0.05); Conclusions: HRQOL measurement after an RTA should provide holistic assessment of physical, mental and social consequences throughout an extended period of recovery. Together with evaluation of predictors of poorer HRQOL and recovery, this could enable an individual approach to individual needs of RTA victims.
(1) Background: Communication barriers may complicate forensic psychiatric assessment of deaf or hard-of-hearing individuals. (2) Methods: This retrospective descriptive case series reviewed 450 unique adults with institutional and forensic psychiatric records at a high-security hospital in Iasi County, Romania (2015–2025). Six individuals (N = 6; 6/450, 1.33%) met the record-based criteria for profound bilateral hearing loss with severe speech or spoken-language impairment. No examination was performed specifically for the study. (3) Results: Four of six individuals had documented congenital or prelingual profound bilateral hearing loss, and two had profound bilateral coexisting conductive and sensorineural hearing-loss components. Four had no formal schooling, and two had partial compulsory schooling; all six lacked documented standardized sign-language competence. Initial records did not document effective communication access or audiological confirmation, and psychiatric formulations were inconclusive or changed over time. Forensic discernment was recorded as absent in 5/6 individuals (83.3%). (4) Conclusions: Communication limitations may have contributed to assessment uncertainty alongside educational, cognitive, psychiatric, and social factors. The series does not confirm misdiagnosis, causation, or population prevalence.
Mental health is shaped by multiple psychological, social, cultural, and spiritual factors. This narrative review aimed to synthesize the available evidence on the relationship between spirituality, religiosity, and mental health across the lifespan, with particular emphasis on psychological well-being, coping, resilience, and help-seeking behaviors, while considering both beneficial and potentially adverse associations. A narrative review was conducted using PubMed, Scopus, and Web of Science databases. Studies published between 2000 and 2026 were screened according to predefined eligibility criteria. A total of 52 publications, including quantitative and qualitative studies, systematic reviews, meta-analyses, and narrative reviews, were included. The evidence was synthesized according to three life stages (childhood and adolescence, adulthood, and older adulthood), with an additional section examining help-seeking behaviors and access to mental health care across the lifespan. The reviewed evidence identified both beneficial and adverse mental health outcomes in relation to spirituality and religiosity. Beneficial outcomes included lower levels of depression, anxiety, substance use, and suicidal behaviors, as well as higher levels of resilience, emotional support, and life satisfaction. In contrast, negative religious coping and spiritual struggles were associated with higher levels of depression and anxiety, as well as delayed help-seeking behavior. Overall, the findings varied across study designs, populations, and cultural contexts. Spirituality and religiosity can influence mental health in both positive and negative ways throughout life. Understanding these relationships may help support more sensitive and individualized approaches to mental health care.
Trace amines (TAs) are endogenous biogenic amines present at low concentrations in the brain and were historically considered byproducts of monoamine metabolism. The discovery of trace amine-associated receptors (TAARs), a family of G protein-coupled receptors, has redefined their physiological and pharmacological relevance. TAAR1 regulates dopaminergic, serotonergic, and glutamatergic signaling and is increasingly implicated in neuropsychiatric disorders. Preclinical studies show that TAAR1 agonists normalize dopaminergic function and improve cognitive deficits in schizophrenia models. Early clinical evidence suggests potential antipsychotic efficacy with a favorable extrapyramidal and metabolic safety profile. However, the failure of subsequent phase III trials to meet their primary efficacy endpoints highlights the need to identify responsive patient subgroups, optimize trial design, and clarify the clinical settings in which TAAR1 agonism may provide the greatest therapeutic benefit. In depression, TAAR1 activation produces antidepressant-like effects in preclinical models, whereas findings in anxiety are variable and context-dependent. TAAR1 may also modulate reward-driven feeding and metabolic parameters. Mechanistically, TAAR1 agonists differ in their effects on dopamine transporter function and monoaminergic neuron activity, indicating that their pharmacological effects are compound-specific rather than class-wide. These properties distinguish TAAR1-targeting compounds from classical D2 receptor antagonists and may underlie their clinical profile. Further translational studies are required to confirm their efficacy across symptom domains and establish long-term clinical benefit.
Background: Problematic gaming has been linked to reduced well-being, but associations between student life satisfaction and gaming-related risk among students remain relatively untested. This pilot cross-sectional study applied the Japanese version of the Gaming Disorder Scale for Adolescents (GADIS-A) on an exploratory basis to a university student sample to examine gaming-related risk classifications and their associations with gaming time and student life satisfaction. Methods: In December 2021, 320 university students in Aichi, Japan, completed an anonymous online survey including the Japanese GADIS-A and five student life satisfaction items. Participants were classified using operational criteria based on the previous GADIS-A scoring framework: gaming disorder (GD), elevated symptoms, and problem frequency. Prevalence estimates were based on the full sample, whereas logistic regression analyses were restricted to current gamers (gaming time > 0 h; n = 244). Results: In the full sample, 35 students (10.9%) met the operational criteria for GD, and 106 (33.1%) had elevated symptoms. Among current gamers, longer gaming time was associated with increased incidence of GD, elevated symptoms, and problem frequency. Conversely, better student life satisfaction was associated with decreased incidence of GD. Conclusions: These results indicate that student life satisfaction may help explain gaming-related risk among university students. Follow-up longitudinal and psychometric studies are required.
Parents of children with autism spectrum disorder (ASD) and other communication-related conditions may experience substantial emotional demands, yet depressive symptoms have been underexamined in Greek families. This exploratory cross-sectional study assessed depressive symptoms in 164 Greek parents using the Greek-language Beck Depression Inventory-II (BDI-II). Of the participants, 117 reported having a child with ASD, and 47 reported having a child with another communication-related condition. Mean BDI-II scores were significantly higher among parents of children with ASD than among parents of children with other communication-related conditions (17.65 vs. 9.36; Welch’s t(140.19) = 5.73, p < 0.001, Cohen’s d = 0.80). This association remained significant after adjustment for parent-reported functional-speech status and available parent characteristics (B = 8.27, 95% CI [4.73, 11.80], p < 0.001). Parent-reported functional-speech status was also associated with the distribution of BDI-II symptom-severity categories (exact p = 0.002); however, the continuous-score difference and adjusted association for absence of functional speech were not statistically significant (p = 0.086 and p = 0.080, respectively). These findings suggest that parent-reported ASD status was more consistently associated with depressive-symptom severity than functional-speech status in this exploratory sample. Cross-sectional design, convenience sampling, parent-reported child characteristics, and limited measurement of potential confounders warrant cautious interpretation.
Mood disorder symptoms represent an important but understudied mental health concern among physicians in Romania, with potential implications for quality of life and suicide risk. This cross-sectional study included 104 medical doctors. Validated self-report instruments were used to assess depressive symptoms, manic and cyclothymic symptoms, bipolar risk, suicidal behaviour, and quality of life. Pearson correlation analyses and multiple linear regression models were conducted to examine associations and identify predictors of quality of life and suicide risk. Overall, 33% of participants screened positive for depressive symptoms, 21% for manic symptoms, 71% for cyclothymic symptoms, 12% for suicide risk, and 2% for bipolar risk. Depression, cyclothymia, and suicide risk were negatively correlated with quality of life, whereas manic symptoms showed a positive association. In multivariate analyses, cyclothymia predicted poorer quality of life (β = −0.43, p < 0.001) and manic symptoms seemed to predict better quality of life (β = 0.26, p = 0.008), while depressive symptoms uniquely predicted greater suicide risk (β = 0.24, p = 0.048). These findings indicate a high prevalence of mood disorders among Romanian physicians and suggest distinct patterns linking mood symptoms to quality of life and suicide risk. The results highlight the importance of early identification, stigma reduction, and targeted mental health interventions to support physician well-being and healthcare system sustainability.
Background: Artificial intelligence (AI)-driven conversational systems are increasingly capable of simulating empathy, adapting to individual users, and fostering emotional bonds that blur the boundary between tool and companion. This scoping review maps the extent and nature of published evidence regarding psychological mechanisms underlying emotional reliance on AI chatbots and associated mental health implications. Methods: Conducted in accordance with PRISMA-ScR guidelines, we systematically searched PubMed/MEDLINE, PsycINFO, Web of Science, Scopus, and IEEE Xplore from database inception to March 2026. Two independent reviewers screened records and extracted data using the PCC (Population, Concept, Context) framework. Thematic synthesis was performed to map evidence across psychological, clinical, and developmental domains. Results: Of 1847 records identified, 46 studies met inclusion criteria. Key themes included: (1) the ELIZA effect as a foundational mechanism of human–AI attachment, with documented cases of severe dependency including fatal outcomes; (2) anthropomorphization and artificial intimacy fostered by adaptive, personalized AI design; (3) proposal of Generative AI Dependency (GAID) as a conceptual framework mapping onto behavioral addiction components, pending empirical validation; (4) particular vulnerability of adolescents and lonely individuals to exclusive affective bonds with AI; and (5) potential erosion of human relational capacities, empathy development, and tolerance for interpersonal complexity. Significant gaps were identified in longitudinal research, validated screening tools, and intervention protocols. Conclusions: Emotional reliance on AI represents an emerging clinical phenomenon with addiction-like features requiring specific diagnostic frameworks, evidence-based interventions, and ethical design guidelines. Future research should prioritize longitudinal studies examining developmental impacts and neurobiological investigations of AI-mediated reinforcement mechanisms.
Early parental loss may increase depression risk among orphaned university students, yet evidence from low- and middle-income countries such as Thailand remains limited. This cross-sectional study examined depressive symptoms and their associations with attachment insecurity, resilience, inner strength, and perceived social support among 226 Thai university students aged ≥20 years who had lost one or both biological parents before age 18. Participants completed validated Thai versions of the Outcome Inventory–Depression subscale, the Experiences of Close Relationships–Revised 10-item version, the 9-item Resilience Inventory, the Inner Strength-Based Inventory, and the revised Thai Multidimensional Scale of Perceived Social Support. Multiple linear regression identified factors associated with depressive symptoms. The mean depression score was 6.62, with no significant difference between single and double orphans. Attachment anxiety (β = 0.176, p = 0.002) was significantly and positively associated with depressive symptoms, whereas resilience (β = −0.322, p < 0.001), inner strength (β = −0.192, p < 0.003), and perceived social support (β = −0.156, p = 0.022) were significantly and negatively associated with depression. In contrast, attachment avoidance (β = 0.110, p = 0.068) did not reach statistical significance. Among orphaned students, depressive symptoms were more closely linked to psychosocial factors than to the specific type of parental loss (single vs. double orphanhood).
Introduction: Nurses in hospital settings frequently experience anxiety, which may adversely affect both their psychological well-being and professional functioning. In this context, Professional Quality of Life (ProQoL) and Meaning in Life are recognized as key factors influencing nurses’ mental health outcomes. Aim: The aim of the present study was to explore the level of anxiety among nursing personnel in hospital settings and to assess its association with ProQoL and Meaning in Life. Materials and Methods: A cross-sectional study was conducted in a convenience sample of 200 nursing personnel in a public hospital. Data were collected using the Zung Self-Rating Anxiety Scale (SAS), the Professional Quality of Life Scale-5 (ProQoL-5), and the Meaning in Life Questionnaire (MLQ) which also included characteristics of nursing personnel. Results: Anxiety levels were low to mild (39.8 ± 8.7). ProQoL dimensions indicated moderate to high Compassion Satisfaction (35.5 ± 7.3) and moderate levels of Burnout (27.6 ± 5.7) and Secondary Traumatic Stress (26.5 ± 6.1). Regarding Meaning in Life, participants reported high levels of Presence of Meaning (27.1 ± 4.8) and moderate levels of Search for Meaning (21.7 ± 6.7). A statistically significant negative correlation was observed between anxiety and Compassion Satisfaction (r = −0.532, p < 0.001), as well as between anxiety and Presence of Meaning (r = −0.387, p < 0.001). In contrast, anxiety was positively correlated with Burnout (r = 0.652, p < 0.001) and Secondary Traumatic Stress (r = 0.534, p < 0.001). In the multivariable analysis, the self-rating of daily work experience score was associated with increased anxiety levels by 0.9 units for each unit increase (95% CI: 0.2 to 1.7, p < 0.011). Compassion Satisfaction was associated with a decrease in anxiety by 0.4 units (95% CI: −0.6 to −0.2, p < 0.001), while Burnout and Secondary Traumatic Stress were associated with an increase in anxiety by 0.5 (95% CI: 0.2 to 0.8, p < 0.001) and 0.4 units (95% CI: 0.2 to 0.6, p < 0.001), respectively. Conclusions: Self-rated daily work experience, Burnout, and Secondary Traumatic Stress were positively associated with anxiety, whereas Compassion Satisfaction was negatively associated with anxiety. These results illustrate the importance of targeted interventions aimed at reducing anxiety, strengthening ProQoL, and promoting Meaning in Life to support nursing personnel’s well-being.
Background: Mental health is the main factor of the overall quality of life of both individuals and the community. In contemporary society, mental health is gaining more and more significance, although there is still an insufficient level of awareness among people about what factors can affect our mental health and why it is of such importance for daily functioning. Material: The research used an anonymous questionnaire created by a team of doctors from the Clinic for Psychiatry in Novi Sad with the aim of assessing how the ongoing social situation in Serbia affects the mental health of the population. Results: It was shown that there is a statistically significant link between levels of feeling tense and following the news about the ongoing protests. The research has shown that there are statistically significant differences in emotional response in relation to gender and age resulting from the current situation. A statistically significant association between sleep problems and the use of anxiolytic therapy has been proven. Most of the respondents declared that the current situation in which we live has a negative impact on mental health. Conclusions: The results of the research indicate that social circumstances in Serbia significantly affect the psychological functioning of the population.
Background: Hospitalization and incarceration are distinct institutional experiences, but both may involve reduced autonomy, externally regulated routines, uncertainty, restricted privacy, and disruption of meaningful social relationships. This systematic review examined shared and setting-specific psychological outcomes and associated factors across the two environments. Methods: PubMed, Scopus, Web of Science and the Cochrane Library were searched from database inception to 30 January 2026. Of 1149 identified records, 22 studies met the eligibility criteria. Methodological quality was assessed using the Mixed Methods Appraisal Tool 2018, and findings were synthesized narratively because substantial clinical and methodological heterogeneity precluded meta-analysis. Results: Ten studies examined incarcerated populations and twelve examined hospitalized populations. Across incarceration studies, reported estimates ranged from 14.9% to 72.6% for depressive symptoms or mood disorders and from 23.3% to 77.8% for anxiety symptoms or disorders. Across hospitalization studies, corresponding estimates ranged from 5.1% to 41.0% and from 5.8% to 60.0%, respectively. These ranges reflect heterogeneous screening instruments, diagnostic procedures, populations, and outcome definitions and were not statistically pooled. In both settings, poorer psychological outcomes were associated with reduced perceived control, disrupted routines, uncertainty, limited social support, and individual vulnerability. Setting-specific factors included prison climate, coping style, shame, and sentence-related circumstances in incarceration, and illness severity, functional impairment, prognostic uncertainty, isolation precautions, and prolonged or repeated admission in hospitalization. Findings concerning exposure duration were inconsistent in both settings. Conclusions: Hospitalization and incarceration should not be regarded as psychologically equivalent. Nevertheless, they may share experiential conditions associated with distress, particularly when autonomy, privacy, predictability, and social connectedness are reduced. Because the evidence was heterogeneous and predominantly observational, causal conclusions and direct quantitative comparisons cannot be made.
(1) Background: Depression, anxiety, and diabetes-related distress commonly coexist in adults with diabetes and may contribute to cumulative psychosocial burden. This study examined the prevalence of multi-psychosocial burden and its association with chronic diabetes-related complications. (2) Methods: A cross-sectional study was conducted among 172 adults with diabetes using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Diabetes Distress Scale. Multi-psychosocial burden was defined as the presence of at least two positive psychosocial conditions. Sociodemographic and clinical data were collected through structured assessment and medical record review. (3) Results: The mean age was 58.3 ± 10.4 years, and 57.6% were female. Overall, 16.9% of participants met criteria for multi-psychosocial burden. Chronic diabetes-related complications were present in 47.7% of participants. Each additional chronic complication was independently associated with higher odds of multi-psychosocial burden (adjusted OR 1.92, 95% CI 1.21–3.05; p = 0.005). The prevalence of multi-psychosocial burden increased from 8.9% among participants without complications to 37.9% among those with two or more complications, demonstrating a dose-dependent pattern. (4) Conclusions: Chronic complication burden was independently associated with concurrent psychosocial conditions in adults with diabetes, supporting the importance of routine psychosocial screening in patients with chronic complications, while future longitudinal studies are needed to clarify causal pathways.
Gambling disorder (GD) is associated with severe psychosocial impairment, impulsive dyscontrol, affective instability, and increased suicidal risk. Pharmacological options remain limited, particularly for patients whose presentation is dominated by transdiagnostic dimensions such as impulsivity, emotional dysregulation, and suicidal vulnerability. Lithium may be relevant because of its anti-suicidal properties and potential effects on affective instability and behavioral dyscontrol. We describe a 40-year-old man with sports-betting-related GD who presented after a suicidal crisis in the context of financial collapse and marital conflict. He entered a structured multimodal program including psychiatric care, lithium carbonate, individual psychotherapy, psychoeducational and self-help groups, family intervention, and social support. During multimodal treatment, which included lithium carbonate titrated to 600 mg/day, the patient was observed to show progressive affective stabilization, remission of suicidal ideation, reduced gambling urges, and sustained abstinence, with one brief lapse that was rapidly contained. Psychometric reassessment showed selective improvement across gambling-related and functional domains, including reduced functional impairment and markedly reduced gambling-related cognitive distortions; however, global psychopathological distress remained substantially stable, and the GPQ subtype shift was interpreted only descriptively. Although causal inference is limited by the single-case design and multimodal treatment context, this case raises the hypothesis that lithium may have contributed, within a multimodal intervention, to the stabilization of core vulnerability dimensions in selected GD presentations, particularly impulsivity, affective dysregulation, and suicidality.
Background/Objectives: Suicide remains a major public health concern, with over 700,000 deaths annually worldwide. Current risk assessment is limited by the tendency of at-risk patients to deny suicidal ideation, with denial rates of approximately 50% among ideators and up to 78% among inpatient suicide decedents. Methods: This proof-of-concept study investigated whether deep learning applied to patient speech could distinguish psychiatric inpatients admitted following a recent suicide attempt from patients with severe depression without documented suicidal ideation. A multi-scale two-dimensional convolutional neural network with residual connections and spatial attention (Multi-Scale CNN) was trained on mel-spectrograms generated exclusively from patient speech extracted by automatic speaker diarization followed by manual verification. The dataset comprised recordings from 88 psychiatric inpatients (59 suicide attempters and 29 patients with severe depression without suicidal ideation). Model performance was evaluated using repeated patient-level stratified five-fold cross-validation, ensuring complete separation of participants between folds. Additional female-only, exploratory male-only, and repeated sex-matched analyses were performed to evaluate the potential influence of sex imbalance. Results: Repeated patient-level five-fold cross-validation yielded a mean classification accuracy of 72.7 ± 6.4% with a mean ROC-AUC of 0.824 ± 0.054, a sensitivity of 88.3 ± 9.5%, and a specificity of 41.3 ± 25.0%. Female-only analysis maintained good discriminative performance (ROC-AUC 0.866 ± 0.123), whereas repeated sex-matched analyses produced lower performance (ROC-AUC 0.621 ± 0.156), indicating that sex imbalance contributed to, but did not fully explain, the observed discrimination. The male-only analysis was considered exploratory because of the limited number of male patients in the depression group. Conclusions: These findings support the feasibility of voice-based patient-level analysis as a complementary objective approach for suicide risk assessment. Although the study remains exploratory because of the limited sample size and the absence of external validation, the revised validation strategy and sex-controlled analyses provide a substantially more robust estimate of model performance. Further multicenter prospective studies are required before clinical implementation.
Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security professionals and examine their associations with PTSD symptoms and general psychological distress. Methods: A cross-sectional online survey was conducted with Portuguese police/security professionals (N = 644). Latent class analysis (LCA) was applied to 17 indicators of potentially traumatic events coded as directly experienced or witnessed, derived from the Life Events Checklist for DSM-5. PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and general psychological distress was assessed using the Brief Symptom Inventory. Exploratory receiver operating characteristic (ROC) analyses examined whether counts of proximal traumatic events could approximate the LCA-derived classes. Results: A three-class solution was identified, comprising low proximal exposure (37.3%), moderate proximal exposure (40.7%), and high proximal/cumulative exposure (22.0%) classes. The classes reflected a graded cumulative pattern of exposure across traumatic event categories, rather than clearly distinct qualitative configurations defined by specific event types. Higher exposure classes were associated with progressively higher PTSD symptoms and psychological distress, and these associations remained significant after adjustment for sociodemographic and occupational variables. Exploratory receiver operating characteristic (ROC) analyses showed that a simple count of proximal traumatic event categories closely approximated the empirically derived class structure within the present sample. However, the resulting thresholds are sample-specific, exploratory, and should not be interpreted as validated screening cutoffs. Conclusions: Proximal traumatic exposure among police/security professionals appears to follow a graded cumulative structure associated with increased PTSD symptoms and psychological distress. The person-centered analysis provided an empirical test of whether exposure was organized according to qualitatively distinct event configurations or primarily along a cumulative gradient. In this sample, cumulative exposure burden emerged as the dominant organizing dimension. The count-based approximation requires external validation before any screening or decision-making application can be considered.
Background: Access to substance use disorder (SUD) treatment remains a concern in Brazil, particularly among socioeconomically disadvantaged populations affected by cocaine and crack-cocaine use. Community-based services such as the HUB de Cuidados em Crack e Outras Drogas (HUB) in São Paulo aim to engage vulnerable individuals but often face a “revolving door” pattern of repeated admissions. Evidence on predictors of readmission in community-based support services, particularly gender differences, remains limited. This study examines gender-specific predictors of readmission to the HUB within 12 months and changes in clinical characteristics over time. Methods: This is a retrospective observational design study. Records from all individuals who sought treatment for their alcohol and/or drug use in HUB between June 2024–2025 were analysed (number of records = 13,645; number of service users = 6528). This timeframe refers to the study period during which data were collected. Results: Among 6528 service users, most were men (92.6%), with higher readmission rates than women (53.4% vs. 38.6%). Homelessness and synthetic cannabinoid use predicted readmission for both genders. Among men, younger age, substance use patterns, and greater clinical severity were associated with readmission. Among women, recent crack-cocaine use was linked to lower readmission. Over time, men showed worsening substance use and clinical indicators, while women showed reduced stimulant use but increased psychotic symptoms and help-seeking. Conclusions: The “revolving door” pattern of repeatedly entering and leaving services without continuity of care is common in community-based support services like HUB. Risk profiles differ between men and women. The limited predictors identified for women suggest that routine clinical assessments may overlook important social and structural vulnerabilities. These findings highlight the need for gender-sensitive approaches that account for distinct emotional and cognitive pathways and the service needs of men and women.
There is growing evidence on the use of pitolisant for the treatment of residual excessive daytime sleepiness (EDS) in adults with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing pitolisant to a placebo in adults with OSA and residual EDS despite CPAP use. The primary outcome was a change in subjective sleepiness measured on any validated scale. Secondary outcomes included all-cause discontinuation and treatment-emergent adverse events (TEAEs). A random-effects model was used to calculate standardized mean differences (SMDs) and pooled Log risk ratios (Log RRs). Three RCTs (N = 721) were included. Pitolisant significantly reduced Epworth Sleepiness Scale scores (SMD = −0.90, 95% CI = −1.29 to −0.50; low certainty). There were no significant differences between pitolisant and a placebo for all-cause discontinuation (Log RR = −0.27, 95% CI = −1.60 to 1.06; low certainty) or TEAEs (Log RR = 0.04, 95% CI = −0.19 to 0.27; low certainty). The most common adverse events reported while using pitolisant were headache and insomnia. These findings show emerging potential for pitolisant as a therapeutic option in this population. Future studies should include larger sample sizes and objective measures of sleepiness.
This article proposes a general integrative model focusing on psychological control and psychological reserve. The former refers to internal psychological control and external psychological control. Internal psychological control refers to the management of physiological processes associated with arousal and panics. Here, the concept of internal psychological control is differentiated into two components: cognitive control/executive function and self-control/emotional regulation. External psychological control refers to the sense the person has of being able to manage, have agency in, and otherwise not be overwhelmed by the external context in which one is adapting functionally. Here, the concept of external psychological control is differentiated into two major sub-components: managing reactivity to external events, such as to daily stressors or extreme events, e.g., natural disasters, and proactively taking steps to have agency in and using predictive processing to adjust to context by mitigating the probability of experiencing overwhelming events. Psychological reserve refers to the fluid state reservoir of mental, cognitive, emotional, motivational, and stress management/coping space that is available for use in confronting ongoing and new stressors, challenges, or difficulties. Here, this article differentiates psychological reserve into phases of depletion and recovery. This article examines prior work on psychological control and reserve, demonstrating how they can be understood or modified based on the present sub-component differentiation of the concepts involved. The revised model is applied to understanding psychotherapeutic change mechanisms, a biopsychosocial model of the mechanisms, an integrated functional adaptational model, posttraumatic stress disorder, a unified model for psychotherapy and psychology generally, and clinical recommendations.
Disclosing a schizophrenia diagnosis presents significant ethical dilemmas due to stigma, caregiving burdens, and cultural norms. This study explored psychiatrists’ ethical considerations when disclosing this diagnosis to family members in Indonesia. Using a qualitative phenomenological approach, we conducted in-depth interviews with eight psychiatrists at a single-site private psychiatric hospital in Jakarta. Data underwent inductive thematic analysis. Four themes emerged: (1) preparing for truth-telling by assessing family readiness, roles, and cultural beliefs; (2) negotiating clinical uncertainty and emotional pacing through staged disclosure; (3) balancing ethical duties of honesty and patient confidentiality against safety risks and severe stigma; and (4) extending disclosure into continuous care via psychoeducation and crisis support. Overall, psychiatrists approach diagnostic disclosure not as a single declarative act, but as an ethically negotiated, relational, and continuous process. While practices like staged disclosure preserve therapeutic alliances, they require critical reflection to avoid paternalism. Adopting culturally responsive, family-inclusive approaches is essential to strengthen the ethical delivery of psychiatric diagnoses and ensure continuing care.
