Major Depressive Disorder (MDD) is a significantly debilitating and prevalent mental condition, that appears to be influenced by various biological and environmental factors and possess substantial risks for physio-psychological functioning. Considering these adverse implications, various psychotherapeutic interventions have surfaced, in which Cognitive Behavioral Therapy (CBT) and Psychodynamic Therapy (PDT) stand out as the most prominent, non-pharmacological treatment approaches in adults with MDD. To assess these assumptions, the current study implemented a Systematic Literature Review (SLR) to investigate treatment effectiveness of CBT and PDT to MDD, on adult population. Results concur with previous literature, indicating that both approaches from their own accords exhibit relatively similar beneficial outcomes as psychotherapeutic treatments to MDD, with the sole notable difference being the longevity of the effects. These assumptions may indirectly implicate that CBT tends to provide fast, yet not as enduring effects, whereas PDT although could necessitate a longer timeframe to exhibit results, might produce effects of relatively greater duration. Several implications concerning remission and response rates, treatment effectiveness, relapse, and probable biases in interventional literature are thoroughly discussed.
Background: Young adults are making career decisions in a labour market shaped by technological change, economic instability and the growing use of artificial intelligence. AI is often discussed as a source of disruption and anxiety, yet it may also support exploration by helping users identify emerging, hybrid and less visible career pathways. This study examined career uncertainty, openness to non-obvious careers and receptivity to AI-supported career exploration among young adults. Methods: An exploratory cross-sectional survey design was used. The sample consisted of 80 respondents aged 18-24 years. The questionnaire examined career certainty, fear of making the wrong career decision, perceived labour-market awareness, knowledge of less prominent career options, openness to skills-based career discovery and interest in digital, interactive, gamified and AI-supported career exploration tools. Data were analysed descriptively through frequencies, percentages and exploratory cross-tabulations; open-ended responses were reviewed thematically. Results: More than half of the participants reported uncertainty about their professional future (53.75%) and fear of making the wrong career decision (56.25%). Nearly half (46.25%) felt inadequately informed about current career options, and only 28.75% reported familiarity with less prominent career paths. At the same time, interest in guided discovery was high: 86.25% wanted to discover career options they would not have considered independently, and 90.00% wanted to learn about professions connected to their existing skills. Receptivity to interactive formats was also strong, with 76.25% willing to use a scenario-based digital tool and 83.75% preferring an interactive experience over a classic test. Interest in AI-supported personalised insight was positive but more cautious (56.25%). Conclusions: In this exploratory sample, career uncertainty coexisted with a strong interest in discovering non-obvious and skills-related professional pathways. AI-supported tools may contribute to this process when they are transparent, interactive and designed to support reflection rather than to automate career choice. The findings support cautious development of AI-assisted career exploration as a decision-support resource, not as a substitute for human career guidance.
Artificial intelligence is increasingly used in career guidance through chatbots, recommender systems, predictive analytics and interactive platforms. These tools may improve access and personalisation, but career guidance is not a neutral information service. It can influence how people understand their skills, their future options and their sense of agency. This article provides a narrative review and normative analysis of recent academic, professional and regulatory sources on AI-assisted career guidance. The discussion focuses on opportunities, risks and ethical boundaries, with particular attention to human oversight, personal data, fairness, transparency and the distinction between career discovery and career decision-making. The literature suggests that AI can expand access to guidance, support lifelong learning, connect users with changing labour-market information and make exploration more interactive. At the same time, the evidence base remains uneven. Important risks include biased or outdated data, privacy and secondary use of personal data, hallucinated or weakly verified outputs, narrow recommendation loops, automation bias and the possible weakening of the human relationship in guidance. Concluding, ethical AI in career guidance requires more than enthusiasm for innovation. It requires explainable outputs, data minimisation, quality control, practitioner involvement, user contestability, AI literacy and clear human responsibility. The article argues that the most important boundary is the line between career discovery and career decision. AI systems that help users explore possibilities may be valuable; systems that substantially determine educational or employment outcomes require stricter governance and human oversight.
The caregiving profession represents a relatively overlooked and under-researched domain, characterized by a complex interplay of intense positive and negative emotions. These experiences can become especially challenging when caregivers support vulnerable populations within the demanding environment of boarding houses. The aim of this qualitative study is to explore and gain a deeper understanding of the lived experiences of caregivers employed in a boarding house that supports adults diagnosed with autism and schizophrenia. Data were collected through semi-structured interviews conducted with six caregivers employed at a boarding house in Athens, Greece. The method of analysis employed was Interpretative Phenomenological Analysis (IPA), which integrates the principles of phenomenology, idiographic approach, and the concept of double hermeneutics. The analysis of the interviews identified three interconnected themes. The first theme illuminated the negative emotions and daily challenges encountered by caregivers, with particular emphasis on self-blame and feelings of pity directed toward the patients. These challenges brought to light the second theme, which centered on the coping mechanisms employed by caregivers, focusing on the emotional support from peers and colleagues, alongside the cultivation of meaningful relationships with patients. The third theme uncovered an additional dimension of the caregiving profession, revealing the positive psychological impact of the caregiver’s role. This theme specifically explored the personal fulfillment derived from patients’ progress and well-being, as well as an enhanced sense of gratitude fostered by the recognition of life’s challenges. Collectively, the findings offered a comprehensive portrayal of the full spectrum of caregivers’ emotional experiences, providing valuable insights into the working conditions within the mental health field.
Background: Intimate partner violence (IPV) constitutes a major public health and human rights issue worldwide, with well-documented psychological consequences including posttraumatic stress, depression, and impaired interpersonal functioning. Despite increasing awareness of IPV in Greece, empirically evaluated psychosocial interventions for women survivors—particularly accessible online group programs—remain limited. Empowerment-oriented, trauma-informed interventions have been suggested as promising approaches for supporting survivors’ recovery, enhancing self-efficacy, and fostering posttraumatic growth. Methods: The present pilot study evaluated the preliminary effectiveness of A New Beginning – Learning to Care for Myself, a structured online psychoeducational group intervention developed by W.I.N. Hellas for women survivors of IPV. The program was delivered through 15 weekly sessions and was grounded in cognitive-behavioral, systemic, and trauma-informed principles aimed at increasing awareness of abusive dynamics, reducing self-blame, strengthening emotional regulation, and promoting empowerment. Twenty-one women survivors of domestic violence (aged 19–58 years; M = 41.81, SD = 9.84) participated in the study. Participants completed measures assessing posttraumatic stress symptoms (PCL-C), help-seeking attitudes and minimization of abuse (MHSS), and posttraumatic growth (PTGI-SF) before and after the intervention. Given the small sample size and non-normal distributions, nonparametric analyses were conducted, including chi-square tests and Wilcoxon signed-rank tests. Results: The proportion of participants meeting the clinical cutoff for probable PTSD decreased from 28.6% pre-intervention to 14.3% post-intervention, although this change was not statistically significant. No significant differences were observed in most help-seeking attitudes. In contrast, significant improvements were observed in key domains of posttraumatic growth. Participants reported a significant increase in perceived personal strength (z = –2.71, p = .007) and relational intimacy with others (z = –2.31, p = .021). Trends toward improvement were also observed in appreciation of life and perceived ability to face difficulties. These findings suggest that participation in the intervention was associated with meaningful gains in psychological empowerment and relational functioning. Conclusions: Although reductions in PTSD symptoms and changes in help-seeking attitudes were limited, the intervention demonstrated promising effects in enhancing posttraumatic growth among women survivors of IPV. The observed increases in personal strength and relational intimacy highlight the potential value of empowerment-focused psychoeducational group programs delivered in online formats. Given the exploratory nature of the study and its methodological limitations—including small sample size and absence of a control group—future research should employ larger samples, controlled designs, and longitudinal follow-ups to further examine the effectiveness and sustainability of such interventions. Nevertheless, the findings provide preliminary evidence supporting the feasibility and potential psychological benefits of structured online empowerment interventions for IPV survivors in the Greek context.
Selective mutism (SM) is a rare childhood disorder characterized by a persistent failure to speak in certain social situations, such as school, despite the ability to speak in others, like at home. Although earlier theories explained SM through psychodynamic perspectives focused on trauma and family dynamics, current classifications in the DSM-5-TR place it within anxiety disorders. However, research suggests that SM is a complex and multidimensional condition that cannot be explained by anxiety alone. Using Engel’s biopsychosocial model, the essay highlights how biological, psychological, and social factors interact in the development of SM. Biological influences include genetic vulnerabilities, auditory processing differences, temperament traits such as shyness, and familial psychopathology. Psychological mechanisms involve fear of negative evaluation, behavioral inhibition, social withdrawal, and high rates of comorbid anxiety disorders, particularly social anxiety. Social factors include overprotective or controlling parenting styles, parental anxiety, family conflict, stressful life events, and environmental transitions such as starting a new school. Several theoretical frameworks, including the “unsafe world” model, polyvagal theory, and attachment theory, help explain how perceptions of safety and emotion regulation influence speech behavior. Evidence indicates that early intervention is important, with cognitive-behavioral and behavioral therapies—often combined with family and school support—showing the strongest effectiveness in improving speech and reducing anxiety in children with SM.
Introduction: Obsessive–Compulsive Disorder (OCD) is a chronic psychiatric disorder with significant implications for functioning and quality of life. Beyond cognitive and biological approaches, contemporary theoretical perspectives emphasize the role of interpersonal factors and protective mechanisms in understanding the psychopathology of OCD. The present study aimed to investigate the relationship between attachment styles and psychological resilience and their association with obsessive–compulsive symptomatology in an adult Greek population. It was hypothesized that insecure attachment styles (avoidant and fearful), but not secure attachment, would be associated with higher levels of obsessive–compulsive symptoms, and that insecure attachment styles and lower psychological resilience would significantly predict obsessive–compulsive symptom levels. Method: The sample consisted of 109 adults (74 women, 35 men) who completed the Experiences in Close Relationships–Revised Scale (ECR-R), the Obsessive–Compulsive Inventory–Revised (OCI-R), and the Connor–Davidson Resilience Scale (CD-RISC). Data were analyzed using analyses of variance and multiple linear regression analyses. Results: The findings indicated that insecure attachment styles (avoidant and fearful) were associated with higher levels of obsessive–compulsive symptoms. Moreover, both insecure attachment styles and reduced psychological resilience emerged as statistically significant predictors of obsessive–compulsive symptom levels. Conclusions: The results underscore the importance of interpersonal attachment patterns and psychological resilience in the understanding and clinical treatment of OCD, highlighting the need for comprehensive therapeutic interventions that incorporate these factors.
Background: Family Constellations are widely recognised for their experiential impact but face challenges regarding empirical validation, standardisation and replication. The practice’s subjective nature often limits its integration into evidence-based clinical frameworks. Aims: This study aimed to explore the effects of a Standardised Family Constellation Exercise within a virtual setting, focusing on adults who had experienced parentification. The goal was to assess whether a structured and replicable approach could elicit therapeutic effects and meaningful personal insights. Method: Ten Greek-speaking adults aged 18–45, with no prior exposure to constellation work, participated in the process through the Delightex Edu platform. The intervention included structured resolution sentences and symbolic visualisations targeting the systemic burden of parentification. A qualitative design with Thematic Analysis was used to examine participant experiences. Results: Six core themes emerged: (1) the Burden of Responsibility as a Psychosomatic Experience, (2) Revival of the Child Role, (3) the Power of Resolution Sentences, (4) Ambivalence – Guilt – Letting go, (5) Identity and Role Renegotiation, and (6) the Therapeutic Value of Visualisation. Conclusion: Findings suggest that a Standardised Family Constellation Exercise can reliably evoke profound emotional reactions, facilitate the symbolic resolution of the parentification burden, and support shifts in participants’ self-concept and family role dynamics. Despite limitations such as sample size and the researcher’s dual role, there is therapeutic potential of structured constellation methods as accessible, trauma-informed interventions within clinical settings.
As mobile beings, it is important to maintain spatial information about our surroundings in everyday life. Neuroscience suggests the existence of two types of frames of reference in spatial memory: egocentric and allocentric representation. The former encodes the location of an object in relation to one’s body, while the latter encodes the location in relation to the external environment. Spatial reference frames (RFs) play a critical role in spatial memory, allowing the storage of information to be organized into different coordinate systems. In general, in egocentric RFs, the locations of objects are encoded relative to the location-label of the main subject, while in allocentric RFs, they are encoded relative to each other or relative to landmarks in the environment. Egocentric representation is mainly innate, while allocentric representation derives mainly from acquired experience; thus, egocentric representation dominates in the early years of life, while allocentric representation gains ground during development. The underlying neural processes for egocentric and allocentric RFs appear to be at least partially overlapping. Taking together the findings, we may suggest that the dynamic connectivity of the spatially distributed network, rather than the activity of a single brain region, is critical for accurate recall spatial cognition. Also, the extent to which a spatially distributed memory network can rapidly exchange information is critical for the efficiency of its functional output. Interesting aspects of involvement of spatially tuned neurons in the understanding of domains of social cognition have been recently proposed. Furthermore, it is worth exploring the way in which ‘the self’ is experienced and navigated in new technological and AI environments. As we now live in a new digital era, the following questions arise: How do we perceive “presence” in human-AI interactions? Also, how can egocentric and allocentric representations produce social and cognitive maps in these technological environments?
Phenomenology of the Self for trauma patients, we think, is based on conscious and pre reflective data of experience. Conscious data are linked to thought/behavioral symptoms in trauma patients, while pre-reflective data concern consciousness alterations, cognitive disorders and long-term memory deficits in line to the neurobiological explanation of experience. In this presentation, we are asking about the use of empirical questionnaires in mental health services following the thesis of front-loaded phenomenology. We claim that questionnaires based on front-loaded phenomenology can display qualitative, conscious and pre reflective, data in the most effective way. They’ll be a useful tool for clinical evaluation and cooperation with trauma patients.
This study introduces the PsychoBioDynamic Management (PBDM) model, a novel human-centered management framework that integrates emotional intelligence, lifestyle balance, and biological self-regulation as determinants of managerial effectiveness. Traditional management theories (Classical, Neo-Classical, and Modern) have been criticized for neglecting the biological and emotional dimensions of human behavior in organizational contexts. Addressing this gap, the PBDM model conceptualizes managerial performance as a function of psychobiological equilibrium, proposing that a manager’s empathy, self-regulation, and health-related lifestyle directly affect the well-being and job satisfaction of subordinates. A cross-sectional empirical study was conducted with 458 participants from Greek organizations, including 228 managers and 230 subordinates. The managers’ PBDM profiles were constructed using the Wong and Law Emotional Intelligence Scale (WLEIS) to measure empathy and self-regulation, and a bio-behavioral lifestyle questionnaire assessing factors influencing key hormonal biomarkers (e.g., cortisol, oxytocin). Employees’ job satisfaction was measured through the Employee Satisfaction Inventory (ESI). Statistical analysis using Pearson correlation and Kruskal–Wallis tests revealed a significant positive relationship between the managerial PBDM profile and employee job satisfaction (r = 0.173, p < 0.05). Moreover, higher levels of PBDM applicability were associated with significantly greater employee satisfaction (x²(2) = 7.490, p = 0.024). The findings support the hypothesis that managerial emotional and biological balance enhances organizational homeostasis by promoting employee satisfaction and well-being. The study concludes that focusing on the manager’s psychobiological health and emotional competencies offers a powerful, evidence-based strategy for improving management effectiveness and resilience in modern organizations. The PBDM approach thus establishes a new interdisciplinary paradigm, bridging management science, psychology, and biology, and positioning management as a biologically modulated process essential for sustainable organizational harmony.
Adoption is conventionally framed as a statutory mechanism for child protection; however, adoptive parents’ perspectives reveal it to be a far more complex psychosocial process defined by continuous meaning-making, resilience, therapeutic caregiving, and pervasive uncertainty. This study presents a qualitative exploration of the narratives of twenty-seven adoptive parents. Using semi-structured interviews subjected to thematic analysis, the research examines how parents negotiate the semantic density of adoption as both rupture and repair, and as an intervention that reconfigures family identities. The analysis identifies three interconnected domains. First, parents conceptualise adoption as a paradoxical act that simultaneously embodies altruism, loss, and continuity. Second, experiences of pre-adoption preparation highlight asymmetrical power relations and experiences of inadequacy within professional systems. Third, post-placement life emerges as a site of ongoing negotiation, where parental identity, attachment, and the child’s evolving sense of self are intertwined with service navigation, open contact dilemmas, and the sustained effort required to maintain family bonds. Findings illuminate adoption as a dynamic, reparative and unfinished process rather than a definitive resolution. They underscore the need for reforms in training, policy, and support services that acknowledge the complexity of adoptive parenthood. Specifically, the study argues for support structures that prioritise emotionally attuned accompaniment and trauma-informed approaches, enabling families to adapt to evolving challenges and fostering resilience across the life course.
Background: The HEALTH-IQ project addresses critical gaps in quality, equity, and gender responsiveness in Greece’s healthcare system. Persistent challenges—including fragmented services, inadequate quality standards, and inequitable access—limit progress toward universal health coverage. This national initiative, aligned with Sustainable Development Goals and WHO standards, seeks to establish a standardized framework for quality assessment that incorporates evidence-based strategies, gender-sensitive indicators, and rights-based policies. Methods: A comprehensive situational analysis, guided by the WHO Gender, Equity, and Human Rights (GER) framework, explored gender disparities in healthcare access, utilization, and outcomes. The study combined desk reviews of scientific literature, policy documents, statistical reports, and grey literature with mapping exercises to identify systemic barriers. Data were examined with a focus on vulnerable and marginalized groups, including migrants, low-income populations, LGBTQ+ individuals, people with disabilities, older adults, and rural residents, considering intersecting determinants such as socioeconomic status, geography, and discrimination. Results: Seven priority indicators were developed to measure gender equity and service quality: gender gaps in healthcare access, life expectancy, gender-based violence and related services, mental health access, work-life balance impacts on women’s health, public expenditure on gender-sensitive services, and accessibility for women from vulnerable groups. Additional indicators were proposed for future research, including cancer screening rates, maternal mortality, healthcare workforce gender distribution, gender pay gaps, chronic disease prevalence, and pandemic impacts. Findings revealed significant data limitations, particularly in gender-disaggregated and intersectional statistics, hindering effective monitoring and intervention. Conclusions: Integrating gender and rights perspectives into healthcare measurement and governance is essential to achieving equitable, high-quality services in Greece. This requires embedding gender-sensitive indicators in health information systems, training providers to address implicit bias, and designing inclusive policies responsive to the needs of diverse populations. Community engagement and culturally competent care are critical for empowering underserved groups and improving service uptake. By institutionalizing these approaches, the HEALTH-IQ project offers a replicable model for rights-based health reform, positioning Greece as a leader in equitable health system quality and ensuring that universal health coverage is both inclusive and sustainable.
This research study examined the experience of deinstitutionalization amongst a group of 24 long-term residents of a psychiatric hospital in Athens, Greece. Participants varied in age and gender, but all suffered from schizophrenia. The main issue this study explored was what was the notion of “asylum” for these patients. For them, “asylum” revolved around five basic axes 1) having friends and social network, creating a sense of acceptance, 2) trust in stuff and treatment, 3) financial security, 4) absence of abuse, 5) stress-free daily routine. From the patients’ interviews, four different interpretations of “asylum” as a typology were developed: for one group the mental hospital was perceived as offering “permanent asylum”, and was even perceived as a “home”; for a second group, the mental hospital offered “temporary asylum”, since their familial home could no longer offer them “asylum”, until their next transfer to a Community Care Units (CCU); for a third group, the mental hospital offered “temporary asylum” during periods of serious relapses that patients experienced while in CCUs; for a fourth group of patients, the CCUs offered “permanent asylum”, indicating a successful transition to a community.
Memory is a significant cognitive process shaped by both internal self-regulatory mechanisms and external psychological stimuli. Previous research has discovered that trauma is associated with memory difficulties while poor sleep quality impairs both retrospective and prospective memory. On the other hand, metacognitive dysfunction is associated with increased cognitive complaints and poor self-monitoring of memory performance. The present study explored whether psychological trauma, sleep quality and metacognitive dysfunction predict memory discrepancies in a non-clinical population. While these variables have been extensively researched separately, this research represents the first known attempt to examine them combined within a single predictive model. The research explores how these interrelated factors contribute to everyday difficulties by using cognitive, clinical and neuropsychological frameworks. 130 participants completed four validated self-report measures that assess trauma exposure (International Trauma Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), metacognitive beliefs (Metacognition Questionnaire-30) and memory function (Prospective and Retrospective Memory Questionnaire). All predictor variables were standardized, and a multiple regression analysis was conducted to assess their contributions to memory outcomes, either individually or combined. The overall model was statistically significant and accounted for 30.5% of the variance in memory performance (R2 = .305, p
This study examined the effect of emotional stimuli on working memory and face recognition efficiency. Additionally, it examined the interplay of depressive symptoms with the performance of participants. Participants were randomly assigned to watch a positive, negative or neutral video and complete a digit span task and a face recognition task before and after being exposed to the stimuli. Results from repeated measures MANOVA indicated a significant main effect of stimuli on both tasks, with participants assigned to the positive condition having a drastically higher performance on both tasks in comparison to the negative and neutral conditions. No significant effect of time and time x stimuli was found. However, although depressive symptoms did not significantly affect performance on both tasks, participants who had the highest BDI scores exhibited lower performance that in contrast to participants of the other two conditions. These findings further prove the interplay between emotion and cognitive functions, as well as suggest that individuals with higher depressive symptoms may be more susceptible to negative stimuli which leads to a decrease in their performance. Implications and recommendations for future studies are discussed.
Declarative memory, that is, the recall of conscious memories from long-term memory, can involve either details of a previous experience (episodic memory) or general knowledge about the world (semantic memory). Research shows that episodic memory is enhanced when the level of emotional arousal elicited by a stimulus is sufficient to engage the amygdala, regardless of the positive/negative nature (valence) of the emotion. However, studies on the effect of emotional arousal on semantic memory are very limited and inconsistent. The present study examined the simultaneous effect of high positive arousal on episodic and semantic recall in 47 young Greek adults. Seven high-arousal positive images and seven low-arousal neutral images were used. Each image was paired with one episodic and one semantic question. Participants were asked to answer these with “true/false/don’t know” in a computer program that recorded the precise reaction times of correct responses. The mean response times were analyzed using a 2×2 factorial repeated-measures ANOVA, revealing a significant main effect of Memory (p
This paper explores the profound transformation of intellectual property (IP) law in response to emerging technologies such as Artificial Intelligence (AI), the Internet of Things (IoT), blockchain, and the Metaverse. It highlights the challenges posed by automated creation, decentralized environments, and global digital networks, which disrupt traditional legal frameworks and raise complex questions of authorship, ownership, and enforcement. AI systems can autonomously generate creative works—music, code, literature—without human intervention, challenging the legal requirement of human authorship. Similarly, IoT devices collect and transmit data that may contain copyrighted content, often without clear legal attribution. The document emphasizes the need to revise national and European legislation to accommodate AI-generated works and content distributed via IoT. The Metaverse introduces new forms of trademarks and digital assets, such as avatars, motion marks, and virtual goods, requiring expanded legal definitions and cross-border enforcement mechanisms. Blockchain is presented as a transformative tool for IP management, offering secure timestamping, automated licensing via smart contracts, and enhanced transparency. However, limitations such as scalability, legal recognition, and conflicts with data protection laws (e.g., GDPR) are acknowledged. Patent’ law is also under pressure, as AI-generated inventions challenge the notion of mental conception and inventorship. Landmark cases such as Thaler v. USPTO and DABUS illustrate the global legal divide on whether AI can be recognized as an inventor. The paper calls for international harmonization and the development of sui generis legal frameworks. Trademark law faces similar disruptions, with AI and IoT altering consumer behavior and brand interaction. While AI enhances enforcement and market monitoring, it also raises risks of unintentional infringement and undermines the traditional concept of the “average consumer.” In conclusion, we advocate for coordinated international regulation, technological integration (e.g., blockchain for IP certification), and digital literacy. It stresses the strategic value of IP in the digital economy and the need to balance innovation with legal protection through continuous adaptation.
Introduction: Adolescent depression is a prevalent disorder with significant physiological and psychological consequences that often persist into adulthood. Despite the use of pharmacological and psychological treatments, these interventions may be limited in their efficacy for some individuals. Therefore, researchers and clinicians are actively investigating novel, safe, and low-side-effect therapies. Repetitive transcranial magnetic stimulation (rTMS) and exercise are emerging as synergistic rehabilitation methods targeting neuroplasticity in adolescents. This narrative review aims to examine the current evidence on the use of rTMS and exercise as rehabilitation approaches for adolescent depression and to explore their combined potential in targeting neuroplasticity as a theoretical model. Methods: A comprehensive search was conducted on PubMed (MEDLINE) using specific keywords to identify studies exploring rTMS and exercise interventions, both individually and in combination, for adolescents with depression. Systematic reviews and meta-analyses were included to examine the mechanisms targeted by these therapeutic approaches, their efficacy, safety, and feasibility. Additionally, studies in adult populations were reviewed to explore the combined intervention model. Results: Both rTMS and exercise modulate neuroplasticity-related mechanisms such as Brain-Derived Neurotrophic Factor, Insulin-Like Growth Factor 1, Vascular Endothelial Growth Factor, and other neurotrophic factors, leading to antidepressant effects. rTMS is an effective, safe, and adaptable method for improving depressive symptoms in adolescents, while exercise improves depressive symptoms through physiological and psychosocial pathways. However, there is a notable lack of studies combining these interventions. Limited studies in adults suggest that the combined use of rTMS and exercise, targeting neuroplasticity, is feasible, safe, and may enhance clinical outcomes compared to either intervention alone. Conclusion: rTMS and exercise appear to be promising approaches for alleviating depressive symptoms in adolescents, particularly in cases where pharmacological and psychological treatments are insufficient. Their synergistic effect on neuroplasticity supports the need for further studies combining these interventions. Future research should focus on randomized controlled trials to assess the efficacy, safety, compliance, side effects, and protocol requirements tailored to this developmentally sensitive population within ethical and legal frameworks.
Background: Bipolar disorder (BD) is a complex and often misdiagnosed psychiatric condition associated with high morbidity, suicidality, and functional impairment. Early identification of risk factors is critical for improving clinical outcomes, particularly in settings with limited access to mental health services. Aim: This study aimed to identify psychosocial, neurodevelopmental, and behavioral predictors of BD symptomatology using a multidimensional assessment model. Methods: A cross-sectional study was conducted with 590 participants recruited from the outpatient psychiatric clinics of the 414 SNEN Military Hospital in Athens, Greece. Participants completed the CISQ-90 psychometric inventory and a structured questionnaire covering psychosocial, demographic, and behavioral variables. Statistical analyses included Spearman correlations, multiple regression models, and structural equation modeling (SEM). Results: Significant predictors of BD included maternal history of mental illness, comorbid ADHD, perinatal complications, male gender, and left-handedness. Unexpectedly, parental divorce was negatively associated with BD, potentially reflecting protective effects in high-conflict households. Social support emerged as the strongest protective factor, with higher levels significantly predicting lower BD symptomatology. Financial stressors (e.g., low income, loan default) contributed modestly. Substance use and suicidality showed the highest predictive value, with BD mediating the relationship between substance use and suicidal ideation. Conclusions: The findings underscore the importance of adopting a multilevel diagnostic approach to BD that incorporates familial, neurodevelopmental, psychosocial, and behavioral factors. Enhanced screening and early intervention strategies targeting at-risk populations, particularly those with neurodevelopmental vulnerabilities and reduced social support, may help reduce diagnostic delays and improve treatment outcomes.
