This systematic review and meta-analysis examined the effects of probiotics on major depressive disorder (MDD). MEDLINE, EMBASE, PsycINFO, Web of Science, Cochrane Library, ProQuest Dissertations and Theses A&I, and Google Scholar were searched for randomised controlled trials published from inception to 1 March 2025 that compared changes in validated depression rating scale scores among patients diagnosed with MDD who received either probiotics or placebo. Standardised mean differences (SMDs) were calculated using random-effects models; subgroup analyses and meta-regression were performed to identify potential moderators of heterogeneity. In total, 13 studies involving 710 patients with MDD were included in the analysis. The pooled SMD was 0.38, favouring probiotics use. Between-study heterogeneity was moderate, with an I2 of 42.8%. Subgroup analyses and meta-regression identified no significant moderators of the SMD. Probiotics appear to reduce depressive symptoms, but factors contributing to heterogeneity remain uncertain.
OBJECTIVE:To determine the prevalence and associated factors of depression, anxiety, and stress among pharmacy students at the University of Phayao, Thailand. METHODS:Undergraduate students aged ≥18 years majoring in pharmaceutical care at the University of Phayao in northern Thailand during the 2024 academic year were invited to participate in an online survey. Demographic and academic data were collected using a self-administered questionnaire. Mental health was assessed using the Thai version of the Depression, Anxiety and Stress Scale. Outcomes were dichotomised as present (at least moderate severity) or absent (normal/mild) for regression analyses. RESULTS:Of 470 undergraduate pharmacy students, 296 completed the questionnaire, yielding a response rate of 58.0%. Overall, 41.9%, 53.7%, and 34.1% of participants reported having depressive symptoms, anxiety, and stress, respectively; 64.2% experienced at least one mental health problem, and 23.3% reported comorbid depression, anxiety, and stress. The three mental problems were positively correlated (r = 0.48-0.52, all p < 0.001). Independent factors for depression were parental separation (adjusted odds ratio [aOR] = 10.80), high self-imposed pressure (aOR = 7.71), untreated mental health problems (aOR = 53.81), sleep deprivation (aOR = 2.92), lecture-based class (aOR = 4.08), and academic workload (≥4 assignments) [aOR = 3.22]. Independent factors for anxiety were commuting by private car (aOR = 2.07), compulsory participation in student clubs (aOR = 9.26), many problems with peers or partner (aOR = 3.48), sleep deprivation (aOR = 2.28), and lecture-based class (aOR = 2.52). Independent factors for stress were living with a partner (aOR = 13.20), living with family (aOR = 3.26), low support from peers or partner (aOR = 10.63), moderate problems with lecturers (aOR = 88.75), high self-imposed pressure (aOR = 18.61), self-study (aOR = 7.12), project-based learning (aOR = 3.13), and examinations (aOR = 3.60). Notably, sleep deprivation was inversely associated with stress (aOR = 0.19), suggesting potential confounding effects or adaptive coping mechanisms. CONCLUSION:Depression, anxiety, and stress are prevalent among pharmacy students, particularly during preclinical years. These psychological disorders are associated with a combination of individual vulnerability, interpersonal dynamics, health behaviours, and excessive academic workload. Proactive mental health screening, integrated care, and reforms to foster supportive learning environments that promote sustained well-being and resilience among students are recommended.
OBJECTIVES:To develop a decision-aid leaflet to support decision making on antipsychotic formulation in patients with schizophrenia hospitalised for acute symptoms. METHODS:The decision-aid leaflet was developed in accordance with the International Patient Decision Aids Standards and the Ottawa Personal Decision Guide. Usability and readability assessments were conducted among 16 patients with schizophrenia and 51 psychiatric healthcare professionals. Additionally, shared decision making incorporating the decision-aid leaflet was implemented in three patients with schizophrenia. RESULTS:The decision-aid leaflet met all qualifying and certification criteria, as well as 20 of the 23 quality criteria of the International Patient Decision Aids Standards. All three patients with schizophrenia who underwent the shared decision-making process agreed that the leaflet provided sufficient information to guide their decisions regarding changes in antipsychotic formulations. CONCLUSION:A decision-aid leaflet was developed to support decision-making regarding changes in antipsychotic formulations among patients with schizophrenia hospitalised in an acute-care ward. The leaflet appears feasible for use in clinical practice.
OBJECTIVES:To evaluate the effects of magnesium supplementation as an adjunct to fluoxetine on serum brain-derived neurotrophic factor (BDNF) levels and cognitive function in patients with depression. METHODS:Outpatients aged 18 to 50 years diagnosed with depression who were receiving fluoxetine treatment at various hospitals in Makassar, Indonesia, between July and August 2025 were invited to participate. Participants were randomly allocated to either the control group, which received fluoxetine therapy alone for 6 weeks, or the treatment group, which received fluoxetine therapy plus 350 mg of oral magnesium supplementation once daily for 6 weeks. Patients were assessed at baseline and 6 weeks. BDNF levels were measured using peripheral venous blood samples. Serum BDNF concentrations (in pg/mL) were quantified using an enzyme-linked immunosorbent assay kit. Cognitive function was assessed using the validated Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina). RESULTS:In total, 40 participants were randomly allocated to either the control group (n = 20) or the treatment group (n = 20). Both groups had significant improvements in MoCA-Ina scores from baseline to week 6 (both p < 0.001), but the improvement was greater in the treatment group (4.8 vs 1.35, p < 0.001), particularly in the domains of attention (from 2.90 to 4.05, p < 0.001) and memory (from 2.25 to 3.85, p < 0.001). At week 6, scores were significantly higher in the treatment group in the domains of attention (4.05 vs 3.10, p = 0.002), memory (3.85 vs 2.70, p < 0.001), and orientation (5.75 vs 5.05, p < 0.001). Although improvement in MoCA-Ina scores was greater in the treatment group, change in serum BDNF levels between groups was not significant (60.59 vs -29.01 pg/mL, p = 0.584). Changes in serum BDNF levels were more strongly correlated with changes in MoCA-Ina scores in the treatment group (ρ = 0.667, p = 0.001) than in the control group (ρ = 0.483, p = 0.031). CONCLUSION:Magnesium supplementation as an adjunct to fluoxetine was associated with greater improvement in cognitive function than fluoxetine alone in patients with depression. Changes in serum BDNF levels were positively associated with cognitive improvement, particularly in the treatment group. These findings suggest a role for magnesium in enhancing cognitive recovery, possibly through modulation of neuroplasticity-related pathways.
OBJECTIVE:To determine the level of post-traumatic growth (PTG) and its association with coping strategies among individuals with major depressive disorder (MDD). METHODS:Patients aged ≥18 years with a diagnosis of MDD who had received treatment for at least 1 year (to ensure adequate time for the development of PTG) and could understand Bahasa Malaysia were invited to participate. Lifetime exposure to potentially traumatic events was assessed using the Malay version of the Life Events Checklist for DSM-5. Coping strategies were assessed in three domains (problem-focused coping, emotion-focused coping, and avoidant coping) using the Malay version of the 28-item Brief Coping Orientation to Problems Experienced. PTG was assessed in five domains (new possibilities, relating to others, personal strength, spiritual change, and appreciation of life) using the Malay version of the 10-item Post-Traumatic Growth Inventory-Short Form (PTGI-SF). RESULTS:In total, 122 patients with MDD (mean age, 35.5 years) were included in the analysis. On average, participants reported lifetime exposure to 7.08 traumatic events. The mean PTGI-SF score was 32.65, indicating a moderate level of PTG. The PTGI-SF score was positively correlated with the problem-focused coping strategies of active coping, planning, and instrumental support, as well as the emotion-focused coping strategies of positive reframing, acceptance, religious coping, emotional support, and venting. In contrast, all avoidant coping strategies showed no significant correlations with the PTGI-SF score, except for behavioural disengagement and self-blame. In the final model of hierarchical multiple linear regression analysis, problem-focused coping (β = 0.341, p = 0.002), emotion-focused coping (β = 0.234, p = 0.037), and age (β = 0.218, p = 0.005) remained significantly associated with PTG, explaining 36.6% of the variance. Trauma exposure, psychotherapy, and avoidant coping were no longer associated with PTG after adjustment for covariates. CONCLUSION:Among patients with MDD, PTG reflects adaptive cognitive and emotional processing rather than the absence of symptoms. Problem-focused and emotion-focused coping strategies were associated with higher levels of PTG.
OBJECTIVES:To develop a Satir model-based health literacy programme for individuals with stable schizophrenia and evaluate its effects on health literacy, health behaviours, relapse prevention, and key metabolic indicators. METHODS:The study comprised three phases: (1) situation analysis and health literacy survey in 972 outpatients with stable schizophrenia, (2) programme development and validation by five experts, and (3) a 12-week quasi-experimental pilot study in 24 outpatients with stable schizophrenia. Outcome measures included health literacy, health behaviours, relapse prevention behaviours, and metabolic indicators. RESULTS:In total, 15 men and nine women (mean age, 43.0 years) with stable schizophrenia completed the programme. After intervention, health literacy significantly improved (d = 0.56, p = 0.012), particularly in the accessing domain (d = 0.93, p < 0.001), while improvements in the understanding (d = 0.41, p = 0.055), appraising, and applying domains were not significant. Health behaviours also significantly improved (d = 0.61, p = 0.006), with a trend towards improved dietary habits (p = 0.051). Relapse prevention behaviours also significantly improved (d = 0.54, p = 0.015), particularly in the early warning sign monitoring domain (d = 0.45, p = 0.038). Triglyceride levels significantly decreased by a mean of 47.29 mg/dL (r = 0.59, p = 0.025), while HDL cholesterol significantly increased by a mean of 4.83 mg/dL (d = 0.69, p = 0.003). CONCLUSIONS:The Satir model-based health literacy programme is feasible for rehabilitation in patients with stable schizophrenia. By fostering personal responsibility and intrapersonal restructuring, the programme empowered patients towards active self-regulation. Addressing the internal 'iceberg' is essential for sustainable metabolic health and recovery in schizophrenia.
Research on recovery after first-episode psychosis remains difficult to compare and synthesise because definitions and outcome measures vary widely, contributing to highly heterogeneous recovery rates (approximately 13.5%-57.0%) and limiting understanding of illness trajectories, determinants of long-term outcomes, and cross-national differences. This perspective describes a protocol for an international Delphi study aiming to establish a clear, operational, and globally applicable definition of recovery after psychosis and to identify a core outcome set for psychosis research. A multidisciplinary steering committee will develop an initial statement framework informed by an umbrella review of recovery definitions, outcomes, and prior consensus-oriented work. We will recruit approximately 60 international panellists, including mental health professionals, and experts with lived experience, with broad representation across regions (North America, Europe, Australia, and the Global South). The Delphi process will include three online rounds, with a minimum retention target of 70% across rounds, and consensus will be determined using prespecified thresholds (consensus ≥75% agreement; emerging consensus 70%-74% with limited dissent; final consensus ≥75% on binary items). Minority positions will be documented and reported. Results will be disseminated via a workshop and peer-reviewed publication to support standardisation of recovery definitions and outcomes and improve comparability and interpretability across psychosis research.
OBJECTIVES:To compare the prevalences of mental health problems, substance use, and suicidal ideation between first-year and final-year medical students. METHODS:First- and final-year medical students at ESIC Medical College and Hospital, Faridabad, Haryana, India, were invited to participate in a survey using consecutive sampling. The 21-item Depression, Anxiety and Stress Scale (DASS-21) was used to assess depression, anxiety, and stress. The 10-item Drug Abuse Screening Test was used to assess drug use during the previous 12 months. The 10-item Alcohol Use Disorders Identification Test was used to evaluate alcohol consumption patterns, drinking behaviours, and alcohol-related problems. The six-item Fagerström Test for Nicotine Dependence was used to assess frequency of use, compulsion, and level of nicotine dependence. The four-item Suicidal Behaviour Questionnaire-Revised was used to assess suicidal thoughts and behaviours. RESULTS:Of 160 medical students approached, 20 declined to participate; 140 (70 each from the first and final years) were included in the analysis. Most students were single (90.0% among first-year students and 58.6% among final-year students). Students who were in a relationship had lower DASS-21 scores than those who were single (32.8 vs 40.6, p = 0.03). The mean DASS-21 score was higher among first-year students than among final-year students (41.6 vs 35.7, p = 0.07). However, final-year students had higher proportions of hazardous-to-dependent alcohol use (14.3% vs 1.4%, p = 0.004), moderate-to-severe drug use (17.1% vs 1.4%, p = 0.006), and smoking during the previous year (37.1% vs 7.1%, p < 0.001). Overall, 20.0% of first-year students and 15.7% of final-year students had a high risk of suicidal behaviour. DASS-21 scores were moderately correlated with Drug Abuse Screening Test scores in both first-year students (r = 0.43, p < 0.001) and final-year students (r = 0.37, p < 0.001), as well as in both first-year students (r = 0.43, p < 0.001) and final-year students (r = 0.37, p < 0.001), as well as Suicidal Behaviour Questionnaire-Revised scores in both first-year students (r = 0.41, p < 0.001) and final-year students (r = 0.44, p < 0.001). In binary logistic regression, higher DASS-21 scores predicted both high-risk suicidal behaviour (adjusted odds ratio [OR] = 1.06 per unit, p < 0.001) and moderate-to-severe drug use (adjusted OR = 1.08 per unit, p = 0.001). Final-year students had higher odds of moderate-to-severe drug use (adjusted OR = 23.70, p = 0.032), independent of psychological distress. Older age predicted high-risk suicidal behaviour (adjusted OR = 1.65 per year, p = 0.017). CONCLUSION:Medical students in an Indian hospital experience a high burden of psychological distress. Although first-year students exhibit greater emotional distress, final-year students demonstrate a higher prevalence of substance use, which may reflect maladaptive coping behaviours. Early, continuous, institution-based mental health interventions are needed.
Clozapine has been used for treatment-resistant aggression across a range of psychiatric diagnoses. We aimed to comprehensively review the effectiveness of clozapine in the management of aggression. We searched PubMed, Web of Science, Cochrane Library, PsycINFO, and MEDLINE up to 8 June 2025. Full-text articles examining the effects of clozapine on aggression and violence in psychotic and non-psychotic disorders were included. In total, 75 papers were included; 49 papers focused on patients with schizophrenia and consisted of randomised controlled trials (n = 9), registry studies (n = 3), prospective pre-post studies (n = 8), prospective comparative studies (n = 6), retrospective studies (n = 21), and case series (n = 2). The remaining 26 papers primarily consisted of case series and focused on patients with non-psychotic disorders, including autism spectrum disorder (n = 4), conduct disorder (n = 3), intellectual disability (n = 5), personality disorders (n = 6), dementia (n = 6), and mixed diagnoses (n = 2). All studies showed reductions in violence and aggression associated with clozapine, particularly in treatment-resistant cases. Clozapine may also offer benefits in selected non-psychotic conditions. Further research is needed to clarify the role of clozapine as a transdiagnostic treatment for aggressive behaviour associated with mental illness.
OBJECTIVES:To identify associations between drug use and both self-esteem and psychological hardiness among adolescents in northwestern Syria. METHODS:Adolescents from various schools in northwestern Syria and Azaz were invited to participate. Participants were assessed for beliefs and attitudes towards drug use (using the Beliefs and Attitudes of Substance Abuse Inventory [BASAI]), psychological hardiness (using the Psychological Hardiness Scale), and self-esteem (using the Rosenberg Self-Esteem Scale). RESULTS:In total, 230 male and 161 female adolescents aged 11 to 15 years (n = 124) or 16 to 19 years (n = 267) were included in the analysis. BASAI scores were higher in male adolescents than in female adolescents (39.7 ± 8.7 vs 37.7 ± 6.8, p = 0.016) and in those aged 16 to 19 years than in those aged 11 to 15 years (40.0 ± 8.3 vs 36.6 ± 6.8, p < 0.001). BASAI scores were inversely correlated with self-esteem (r = -0.304, p < 0.001) and psychological hardiness (r = -0.451, p < 0.001) scores. Psychological hardiness was a significant predictor of BASAI scores (β = -0.404, B = -0.210, p < 0.001), whereas self-esteem was not (β = -0.090, B = -0.168, p = 0.094). CONCLUSION:Psychological hardiness is a potential predictor of drug use among adolescents with positive beliefs and attitudes towards substance use. The association may be stronger among male adolescents and high school students.
OBJECTIVES:To determine associations between impulsivity and peripheral inflammatory ratios in patients with borderline personality disorder (BPD). METHODS:Consecutive patients aged ≥18 years with a diagnosis of BPD who presented to the Institute of Mental Health and Neurosciences Kashmir, India, between November 2024 and June 2025 were invited to participate. Recent self-harm was recorded. A blood sample (3 mL) was collected from each patient; levels of white blood cells, neutrophils, lymphocytes, monocytes, platelets, and erythrocyte sedimentation rate were recorded. The neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio were calculated. BPD symptomatology was assessed using the self-report Borderline Personality Questionnaire (BPQ). Impulsivity was assessed using the self-report Urgency, Premeditation, Perseverance, Sensation Seeking-Impulsive Behaviour Scale, short version (UPPS-S). RESULTS:In total, 26 women and seven men (mean age, 21.2 years) were included in the analysis. Of these, 17 reported recent self-harm and the remaining 16 did not; the two groups did not differ significantly in terms of peripheral inflammatory ratios. In Pearson correlation analysis, MLR showed a trend towards correlation with the UPPS-S (r = 0.338, p = 0.055) and BPQ (r = 0.324, p = 0.066). In multivariate regression analysis, MLR remained associated with the UPPS-S (β = 0.460, p = 0.017) and BPQ (β = 0.358, p = 0.056). CONCLUSION:Although patients with BPD with or without recent self-harm did not differ significantly in terms of peripheral inflammatory ratios, the specific association between higher MLR and greater impulsivity suggests that immune abnormalities are linked to impulsivity in BPD.
This perspective synthesises current evidence on the association between soft drink consumption and depression, with emphasis on the gut microbiome as a potential mediating mechanism. PubMed, Scopus, and Google Scholar were searched using the following terms: 'soft drinks', 'sugar-sweetened beverages', 'carbonated beverages', 'soda', 'depression', 'depressive symptoms', 'mental health', 'gut microbiome', 'microbiota', and 'gut-brain axis'. Peer-reviewed original articles published in English between January 2000 and October 2025 were included if they involved human participants of any age (sample size ≥50 for observational studies), assessed soft drink or sugar-sweetened beverage consumption, and measured depression diagnosis, depressive symptoms, or depression severity. Associations between soft drink consumption and increased depression risk were consistently shown across multiple study designs and populations. Evidence for artificially sweetened beverages was less consistent and suggested potentially distinct, non-sugar-related pathways. A multicentre cohort study of 932 participants revealed that soft drink consumption predicted the major depressive disorder diagnosis (odds ratio = 1.081), with stronger effects in women (odds ratio = 1.167). Eggerthella partially mediated the soft drink-depression association, explaining approximately 4% of the association. Soft drink consumption is associated with increased depression risk through multiple biological pathways involving inflammation, metabolic dysregulation, and gut microbiome alterations. Modest effect sizes suggest the involvement of multiple interconnected mechanisms. Public health interventions to limit sugar-sweetened beverage consumption are recommended to improve physical and mental health. Healthcare providers should consider dietary assessment and counselling as part of depression prevention and treatment strategies.
OBJECTIVE:This study aimed to investigate spiritual well-being as a predictor of successful ageing among community-dwelling older adults in the Xiashan District of Zhanjiang, Guangdong, China. METHODS:Older adults aged ≥60 years who had a score of ≥10 on the Mini-Mental State Examination were recruited from eight community health service centres in the Xiashan District of Zhanjiang, Guangdong, China between August and December 2024. Participants were assessed using the Successful Ageing Inventory, Spiritual Well-Being Scale, Barthel Index, Mini-Mental State Examination, and Social Support Rating Scale. RESULTS:In total, 147 men and 279 women aged 60 to 95 years were included in the study. Predictors of successful ageing were having a religious belief (β = 0.10, p = 0.04), having completed primary school (β = 0.11, p = 0.08), middle/high/vocational high school (β = 0.18, p = 0.01), or junior college or college and above (β = 0.21, p < 0.01) education, having better spiritual well-being (β = 0.25, p < 0.01), and having higher levels of social support (β = 0.14, p = 0.01). The model explained 23% of the variance, indicating a moderate fit. CONCLUSION:Spiritual well-being, educational attainment, religious belief, and social support are key determinants of successful ageing among community-dwelling older adults in the Xiashan District of Zhanjiang, Guangdong, China.
OBJECTIVES:To explore the effect of two sessions of high-definition transcranial direct current stimulation (HD-tDCS) at a 30-minute interval on depressive and other non-motor symptoms in patients with Parkinson's disease (PD). METHODS:Consecutive patients aged ≥18 years with mild-to-moderate idiopathic PD who had depressive symptoms, were right-handed, had no or mild cognitive impairment, and were receiving stable doses of anti-Parkinsonian drugs for at least 1 month were invited to participate. Participants were randomly assigned to either the active-first or sham-first group. Intervention consisted of two sessions (separated by a 30-minute interval) of 20-minute anodal stimulation targeting the left dorsolateral prefrontal cortex. Participants were assessed at baseline and 1 week after intervention using the Montgomery-Asberg Depression Rating Scale, Montreal Cognitive Assessment, Movement Disorder Society Unified Parkinson's Disease Rating Scale Parts 1 to 3, and EuroQol 5-Dimension 5-Level Scale. Adverse effects of HD-tDCS and any subjective change in emotional state were assessed immediately after intervention. Subsequently, participants crossed over to the alternate group after a 1-week washout period. Participants were asked after each session to guess the type of stimulation received. RESULTS:In total, 25 patients were included in the analysis. Significant time × group interactions were observed for Montgomery-Asberg Depression Rating Scale (p = 0.02), Montreal Cognitive Assessment (p < 0.01), Movement Disorder Society Unified Parkinson's Disease Rating Scale Part 1 (p = 0.02), Part 2 (p < 0.01), Part 3 (p < 0.01), and EuroQol 5-Dimension 5-Level Scale (p = 0.05). Common adverse effects included itching and burning sensations at the stimulation site. Subjective mood change was reported by 72% of participants in the active group and 48% of those in the sham group. The active and sham groups did not differ significantly in terms of correct identification of the stimulation type (96% vs 20%, p = 0.18). CONCLUSION:Two-session HD-tDCS at a 30-minute interval targeting the left dorsolateral prefrontal cortex is a safe, well-tolerated, and potentially effective intervention for depressive and cognitive symptoms in patients with mild-to-moderate PD.
OBJECTIVES:To evaluate the effectiveness of magnesium supplementation as an adjunct to fluoxetine therapy for improving depressive symptoms and serum serotonin levels in patients with depression. METHODS:Consecutive patients aged 18 to 45 years who had been prescribed fluoxetine therapy for new-onset or chronic depression were recruited between November 2024 and February 2025 at the outpatient psychiatry clinic of Wahidin Sudirohusodo General Hospital and three affiliated hospitals in Makassar, Indonesia. Participants were randomised in an alternating sequence to receive either fluoxetine 20 mg/day alone or in combination with oral magnesium supplementation 250 mg/day. Outcomes were assessed at baseline and week 6. The severity of depressive symptoms was assessed using the Hamilton Depression Rating Scale (HDRS). Blood samples were collected to measure serum serotonin levels. RESULTS:In total, 32 women and 8 men who received either fluoxetine alone (n = 20) or in combination with magnesium (n = 20) were included in the analysis. Both groups showed significant reductions in HDRS total score from baseline to week 6 (p < 0.001), but changes in serum serotonin level were not significant in either group. The reduction in HDRS total score was greater in the intervention group than in the control group (-6.35 vs -2.80, p < 0.001), particularly in the domains of mood and insomnia. The median reduction in HDRS total score was greater in the intervention group than in the control group (-6 vs -2, p < 0.001). The group effect remained significant (F(1,30) = 33.51, partial η2 = 0.528, p < 0.001) after adjustment for baseline HDRS score and demographic covariates, indicating a large effect size. CONCLUSION:Magnesium supplementation as an adjunct to fluoxetine therapy improves HDRS total score in patients with depression.
We review the literature regarding repurposed medications for major depressive disorder (MDD). Preclinical and clinical research on repurposed medications for MDD was reviewed, including agents that modulate the dopaminergic, glutamatergic, and GABAergic systems; enhance neurotrophic signalling; and reduce neuroinflammation, as well as nutraceuticals. Telmisartan, statins, celecoxib, valproic acid, pregabalin, metformin, pioglitazone, ketamine, dextromethorphan-bupropion, aripiprazole, and modafinil show effectiveness in the treatment of MDD, as do nutritional supplements such as vitamin D, zinc, selenium, and spermidine. Mechanisms include neurotransmission modulation, neuroplasticity promotion, and neuroinflammatory cascade suppression. However, the current evidence is limited by a lack of large-scale randomised controlled trials and insufficient mechanistic characterisation. Drug repurposing leverages proven safety profiles while reducing development costs and time. Nonetheless, clinical studies are needed to confirm effectiveness, elucidate mechanisms, and specify their incorporation into clinical practice.
OBJECTIVES:To examine the associations between cytomegalovirus (CMV) infection and mental health among the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, plus) population in India. METHODS:Members of the LGBTQIA+ community with no history of organ transplantation, immunocompromising conditions, or active infections were recruited from healthcare and community organisations in West Bengal and Delhi National Capital Region, India, using purposive sampling. The presence and severity of depression and anxiety symptoms were evaluated using the 21-item Beck Depression Inventory and 21-item Beck Anxiety Inventory, respectively. Psychological distress and well-being were assessed using the 12-item General Health Questionnaire. Pain perception was rated using the Numerical Pain Rating Scale. Blood samples were collected for detection of CMV-specific IgG and IgM antibodies. RESULTS:In total, 180 individuals from the LGBTQIA+ community aged 22 to 56 (mean, 37) years were included in the analysis. CMV IgM antibody titres were correlated with depression (r = 0.527, p < 0.001), anxiety (r = 0.503, p < 0.001), pain (r = 0.275, p < 0.001), and general health (r = -0.445, p < 0.001). Similarly, CMV IgG antibody titres were correlated with depression (r = 0.368, p < 0.001), anxiety (r = 0.415, p < 0.001), pain (r = 0.359, p < 0.001), and general health (r = -0.359, p < 0.001). CONCLUSION:CMV antibody titres are associated with depression, anxiety, well-being, and pain and may play a role in mental health issues in the LGBTQIA+ population.
OBJECTIVES:To quantitatively synthesise evidence from randomised controlled trials (RCTs) on the efficacy and safety of risperidone augmentation in children and adolescents with attention deficit hyperactivity disorder (ADHD) and comorbid disruptive behaviour disorders (DBDs). METHODS:PubMed, EMBASE, and Scopus were searched for studies published from inception to 14 February 2025 using combinations of the following terms: ADHD, DBD, risperidone, aggression, and RCTs. Included studies were RCTs that evaluated the efficacy and/or safety of risperidone as an adjunct to optimise stimulant therapy in individuals aged 6 to 12 years diagnosed with ADHD and comorbid DBDs. The primary outcome was change in aggression from baseline to post-intervention, measured using standardised scales, between the risperidone and placebo groups. Secondary outcomes included the tolerability of risperidone in terms of weight gain and increased serum prolactin levels. RESULTS:Three studies involving individuals aged 6 to 12 years with a dual diagnosis of ADHD and DBDs were included in the analysis. The overall sample size was 279, with 144 in the risperidone group and 135 in the placebo or active control (stimulant) group. Individuals receiving risperidone augmentation showed improvement in aggression (standardised mean difference [SMD] = -0.79, p < 0.001), greater weight gain (2.1 vs 0.5 kg, SMD = 0.22, p = 0.06), and higher serum prolactin levels (28.5 vs 2.3 ng/mL, SMD = 1.40, p < 0.001). CONCLUSION:Risperidone augmentation reduces aggression and oppositional symptoms in children and adolescents with ADHD and comorbid DBDs. Nonetheless, risperidone is associated with risks of weight gain, elevated serum prolactin, and metabolic syndrome.
OBJECTIVES:This pilot study aimed to evaluate the frequency and characteristics of involuntary autobiographical memories (IAMs) elicited with or without audio word stimuli among healthy participants. METHODS:Healthy participants were recruited via convenience sampling and were randomly assigned to perform a task that assesses the frequency and characteristics of IAMs with or without word stimuli. Recorded characteristics included modality, event date, valence, presence of simultaneous thoughts, and trigger. Visual and auditory vividness, believed accuracy, and spontaneity of the IAM were rated on a scale ranging from 1 (not at all) to 7 (extremely). RESULTS:In total, 26 healthy participants were randomly assigned to either the no-stimuli group (n = 12) or the word-stimuli group (n = 14). The no-stimuli and word-stimuli groups recalled 75 and 99 IAMs, respectively. For participant-level comparisons, there was no significant group difference. For memory-level comparisons, there was no significant difference between groups in terms of IAM frequencies, modality type, valence, and simultaneous thoughts, as well as auditory vividness, visual vividness, and spontaneity. However, compared with the no-stimuli group, the word-stimuli group recalled more IAMs from the day of the assessment and fewer from the past month (p = 0.039), reported fewer internally and more externally triggered IAMs (p < 0.001), with lower believed accuracy (p = 0.006). CONCLUSIONS:Retrieval conditions could affect the recency, trigger, and accuracy of IAMs. These findings are largely consistent with the literature and support the use of audio stimuli to elicit IAMs.
