Cognitive and behavioral features associated with lower intellectual functioning can overlap with psychotic symptom presentations, increasing the risk of misattribution in acute psychiatric settings where diagnostic overshadowing is common. We present a 45-year-old woman with a long-standing diagnosis of schizophrenia who experienced recurrent hospitalizations and prolonged antipsychotic exposure without sustained benefit. Her presentation had been consistently interpreted within a psychotic framework due to reports of "voices," social withdrawal, fears regarding her family's safety, and impaired self-care. During an inpatient admission marked by minimal response to treatment, an individualized assessment incorporating cognitive profiling with the Wechsler Abbreviated Scale of Intelligence-Second Edition (WASI-II) revealed a pattern of functioning suggestive of mild intellectual impairment. Integration of these findings with longitudinal observation prompted reformulation of her symptoms. Her reported "voices" were reconceptualized as an internally generated negative self-talk in the context of her cognitive profile, rather than a psychotic process. Guided by the clinical presentation and cognitive profile of the patient, treatment was modified to prioritize antidepressant therapy and psychosocial interventions, alongside gradual tapering of antipsychotic medication. This approach was associated with improved engagement, increased participation in therapy, and reduced distress. This case highlights the value of individualized cognitive assessment in complex presentations, supporting more targeted, person-specific care and reducing unnecessary pharmacologic exposure, ultimately improving both individual outcomes and healthcare system efficiency.
Grief and loss are common among individuals with serious mental illness, yet little research has characterized these experiences in the context of obsessive-compulsive disorder (OCD). The present study described the development and validation of the Loss and OCD Symptoms Scale (LOSS), comprising a Checklist of loss experiences and a Severity scale of emotional, cognitive, and behavioral reactions to loss, among 509 individuals with OCD. Common loss experiences preceding OCD onset included traumatic events (e.g., illness/injury, transportation accidents), life transitions (i.e., moving), death of loved ones (including pets), and estrangement from important relationships; and common loss experiences following OCD onset included relationship strain and loss of ability to complete routine activities, career/academic opportunities, sense of self, and perceived mental health functioning. One-hundred percent of participants endorsed grief and loss reactions, highlighting their universality among individuals with OCD. Factor analyses supported five distinct reactions: Grief (99.5% endorsed), Prevention (95.9% endorsed), Etiology (85.1% endorsed), Coping (79.9% endorsed), and Self-Blame (74.5% endorsed). These subscales and total scores demonstrated strong internal consistency, test-retest reliability, and convergent validity with measures of mental illness-related loss, functional impairment, depressive symptoms, suicidal ideation, hopelessness, and resilience. Findings support the LOSS as a reliable and valid measure of grief and loss in the context of OCD.
Self-disclosure of psychiatric diagnostic status or mental health challenges can be a complex yet socially important process that has potential to result in a range of both positive and negative outcomes. However, few studies have comprehensively investigated mental health-related self-disclosure within the context of OCD. In the present cross-sectional study, N = 205 adults who self-identified as having an OCD diagnosis completed a survey battery assessing OCD disclosure experiences and related mental health variables, including OCD-related shaming experiences, internalized OCD-related stigma, OCD symptom severity, and quality of life. Results revealed that participants engaged in substantial OCD-related disclosures (M lifetime disclosures = 19.3), with the most common recipients being close friends, healthcare providers, parents, and romantic partners. The most commonly endorsed reasons for disclosure involved improving shared understanding within relationships, providing an explanation for the individual's behavior, and receiving emotional support. Outcomes of, and recipient reactions to, disclosure were mostly positive (i.e., understanding, supportive, empathetic, or validating), but some negative reactions were also noted (i.e., dismissive, judgmental, rude, etc.). Results of ordinal regression models revealed that increased quality of life was positively associated with increased quality of disclosure when controlling for other relevant study variables, while OCD-related shaming was associated with worse quality of disclosure. However, these findings were modest in magnitude. This study highlights the integral role of interpersonal processes for individuals with OCD, and points to the importance of fostering optimal disclosure outcomes as potential avenues for reducing stigma and improving quality of life.
Background Post-traumatic stress disorder (PTSD) is a prevalent psychiatric condition, yet no current assessment approach, whether clinician interview or self-report, incorporates objective physiological measurement. The absence of a validated biomarker is a fundamental gap. Methods We evaluated smartphone-based pupillometry (Senseye Diagnostic Tool, iPhone) in 38 trauma-exposed veterans in an intensive outpatient program. Pupil-to-iris ratio (PIR) was measured during pupillary light reflex (PLR) and affective image viewing (AIV) tasks across treatment and follow-up visits (96 PLR, 88 AIV sessions; same-day PCL-5, BDI-II, BAI). Continuous, hierarchical, and within-person mixed-effects regressions isolated PTSD-specific variance and tested within-person symptom tracking. Results Constriction PIR correlated with PCL-5 severity (R2 = 0.109, p = 0.001), concentrated in avoidance (R2 = 0.171) and negative alterations in cognitions/mood (R2 = 0.224, both p < 0.001) rather than arousal. After adjusting for demographics and comorbidity, PTSD clusters explained an additional 16.4% of variance (p < 0.001), about seven times the comorbid contribution. Dark Mean PIR was elevated in PTSD + sessions (p = 0.019). Within-person, participants' own PCL-5 changes tracked concurrent changes in Dark Mean PIR (beta = 0.0024, p = 0.006) and Constriction PIR (beta = 0.0014, p = 0.031), independent of BDI-II and BAI. AIV trended similarly but was not significant. Conclusions Smartphone pupillometry shows promise as an objective, physiologically grounded approach to PTSD assessment. These proof-of-concept findings show that the biomarker captures PTSD-specific variance independent of comorbid psychopathology and tracks within-person symptom change. Validation in larger, more diverse samples is required to establish clinical utility.
Objective: To delineate the neuropsychological endophenotypes driving alcohol and substance use vulnerability among freelance professional artists, examining the interplay of personality dysregulation, intellectual capacity, and gender-moderated pathways. Method: We conducted a deep clinical phenotyping of 42 freelance professional artists in Mexico (50% women; mean age = 28.5). We integrated standardized measures of personality pathology (MMPI-2), intelligence (WAISIV), and alcohol risk (AUDIT) using Mexican population norms. Data were analyzed via hierarchical regression and two-step cluster analysis. Results: Alcohol risk was predicted by traits of low behavioral control (social responsibility; (3 = -0.28) and high self-perceived addiction potential ((3 = 0.59), whereas WAIS-IV intelligence indices exerted no universal protective or risk effects. Critically, gender moderated risk expression: hypomania and trauma-related externalizing traits strongly predicted AUDIT scores in men (r = 0.47) but not in women (r = 0.14), who exhibited more internalizing profiles. Cluster analysis identified three etiologically distinct endophenotypes: a high-risk disinhibited profile (62.5% male) characterized by unconventional thought, executive deficits (working memory), and severe alcohol misuse; a high-resource impulsive profile with superior intelligence but elevated hypomania; and a regulated profile (66.7% female) exhibiting high social responsibility and minimal risk. Conclusion: Substance use vulnerability in the freelance creative workforce is driven by personality dysregulation and executive functioning deficits rather than intellectual capacity or creative talent per se. Identifying these gender-specific, trauma-informed endophenotypes provides a critical background for personalized medicine, enabling tailored therapeutic interventions that move beyond generic addiction protocols.
This study aimed to analyze Brazilian version of the PHQ-8 measurement invariance in subgroups, while considering gender and/or work. We conducted a methodological study with 4,170 individuals. We applied multi-group confirmatory factor analysis, alignment models, and variations in model fit indices. PHQ-8 demonstrated (uni)dimensional equivalence for all the groups assessed. We identified total instrument invariance for the work groups (workers and non-workers), partial (almost total) invariance for the gender groups (men and women), and the intersection of gender and work (working women and men, and non-working women and men). There were no invariance violations for the item intercepts, which enabled the construct assessed by the instrument to be mapped and the extracted means compared. PHQ-8 is invariant across gender and/or work groups. Thus, it is interchangeable and may be used to diagnose and compare depression.
Mental health symptoms often present as complex and difficult to organize into coherent treatment strategies. Instead of focusing primarily on diagnostic labels, the FPMT helps identify patterns in how individuals regulate stress, thoughts, and self-experience. The framework describes four broad regulatory patterns that may contribute to psychiatric symptoms and provides a structured screening workflow to support clinical evaluation and treatment planning. The FPMT is designed to complement, not replace, standard psychiatric assessment and diagnostic procedures. The framework is particularly relevant to non-invasive neuromodulation modalities such as repetitive transcranial magnetic stimulation (rTMS).
Purpose: This study aims to assess the relationship between stress, academic performance, and personality traits among Egyptian medical students. Participants and Methods: A cross-sectional survey was conducted among 470 medical students. Participants completed three validated instruments: the Big Five Inventory-20 (BFI-20) to assess personality traits, the Perceived Stress Scale (PSS-10), and the Perceived Academic Performance Scale. Data were analysed using Spearman's correlation and multiple linear regression. Results: Neuroticism was a significant positive predictor of stress levels (beta = 0.80, p < 0.001), indicating that students with higher neuroticism experienced higher stress. Conscientiousness positively predicted academic performance (beta = 0.70, p < 0.001). Notably, Openness was weakly but significantly correlated with increased stress (r = 0.18, p < 0.001). Age negatively predicted academic performance (beta = -0.65, p < 0.001), suggesting that younger students tended to perform better academically. Conclusion: Personality traits, particularly neuroticism and conscientiousness, appear to influence stress and academic outcomes among medical students. These findings underscore the importance of accounting for individual personality differences in the development of academic and mental health support programs, particularly in high-stress educational settings.
Objective: To explore the characteristics and prevalence of interpersonal stressors prior to suicide in individuals with personality disorders compared to individuals without personality disorders. Methods: Records at the Office of the Chief Coroner of Ontario were reviewed to identify suicide decedents with personality disorders (n = 105) and without personality disorders (n = 5183) in Toronto, Ontario (1998-2020). Coroner charts were coded for demographic data, interpersonal stressors, mental health history, and other suicide-related characteristics. Chi-square comparisons were conducted to examine stressors, and all other suicide-related characteristics associated with suicide across both groups. Results: Suicide decedents with personality disorders (M = 38.4 years +/- 14.6, 48% female, 90.5% single) had higher interpersonal conflict than those without personality disorders (OR: 1.72, 95% CI [1.09-2.71]). Other interpersonal stressors, including a recent relationship breakup were not different between groups. Additional analyses showed that the personality disorder group was younger, and had a greater proportion of females, single individuals, and those with previous suicide attempts. Conclusion: Our results demonstrated that those with personality disorders had a higher prevalence of interpersonal conflict, but not other interpersonal stressors prior to suicide compared to those without personality disorders. Suicide decedents with personality disorders were primarily in low-risk demographic groups (i.e., females and younger people).
The identification of objective, scalable markers of socio-emotional behavior represents a major challenge in pediatric mental health diagnostics. Few approaches exist to reliably and objectively quantify social reciprocity and negative emotional states, which characterize many psychiatric and neurodevelopmental conditions, including anxiety, depression, obsessive-compulsive disorder, and autism. Advances in computer vision, natural language analytics, and psychophysiology enable fine-grained, objective measurement of socio-emotional behavior along these transdiagnostic dimensions, yet their application to youth remains limited. This article presents multimodal affective computing as an innovative approach with the potential to quantify objective markers of psychiatric and neurodevelopmental conditions in adolescents. The Affective Computing in Youth Psychopathology (ACES) study is a multi-site investigation designed to develop and validate novel behavioral and physiological markers of socio-emotional functioning across autistic and non-autistic youth with or without anxiety or depression. The study combines a standardized experimental battery to elicit spontaneous emotional and social behavior with a clinical battery to capture diagnostic status and clinical characteristics. By integrating clinical assessments and experimental paradigms with advanced multimodal phenotyping, ACES seeks to identify transdiagnostic markers of social and emotional behavior during adolescence, a critical window for the emergence of many psychiatric conditions. We describe the rationale, design, and analytic framework of ACES, highlighting how innovative affective computing technologies can provide objective and scalable assessment tools that ultimately advance precision psychiatry.
There is limited research examining the perspectives on the use of genetic testing in psychiatric care among individuals of non-European ancestry. Adults with obsessive-compulsive disorder (OCD) of Latin American ancestry (n = 1,513) completed a survey assessing their interest in receiving genetic testing for OCD, their level of comfort with disclosing this information, views on the use of genetic testing to inform reproductive decisions, and their concerns about stigma and discrimination. Most participants indicated they would be interested in learning their genetic liability for OCD; however, their level of comfort with sharing this information varied. Participants also reported high levels of mental health stigma and experiences with discrimination based on their OCD. Taken together, findings suggest there is interest among the Latino community to engage with genetic testing should it become available; however, there also are concerns that must be addressed to ensure responsible and ethical implementation in this population.
Background: Immune system activation has been implicated in the pathophysiology of psychiatric disorders. Pro-inflammatory cytokine elevations, including interleukin-6 (IL-6), have been reported in bipolar disorder (BD), although results are mixed. Elevated IL-6 has been associated with symptom severity, poor treatment response, and may be influenced by single nucleotide polymorphisms (SNPs). This ancillary study examined IL-6 SNPs in treatment-resistant bipolar depression (TRBDD) to assess their relationship with inflammatory modulation and treatment outcomes. Methods: This secondary analysis was derived from a 10-week, double-blind, randomized, placebo-controlled trial of escitalopram (ESC) plus celecoxib (CBX) versus ESC plus placebo (PBO) in 43 patients with TRBDD. Plasma IL-6 was measured at baseline and week 8 by ELISA. Genome-wide genotyping identified two SNPs on the IL-6 promoter (rs1800795, rs1800796). Associations between genotype, IL-6 expression, and treatment response were assessed using multiple regression and ANCOVA. Results: At baseline, mean IL-6 levels were elevated in TRBDD compared to healthy controls (p = 0.007). No significant correlation was observed between baseline IL-6 and either SNP. For rs1800795, IL-6 levels differed across genotypes (CC: 1.21, GC: 1.99, GG: 1.48 ng/ml). Patients with the G allele showed lower Hamilton Depression Rating Scale (HAMD) scores in the CBX arm, suggesting greater treatment response. For rs1800796, the sample was skewed toward the CC genotype, limiting interpretation; however, higher IL-6 levels and improved outcomes with CBX were observed in CC carriers. Conclusions: Although limited by sample size, these findings suggest IL-6 polymorphisms may influence inflammatory profiles and antidepressant response in TRBDD, with CBX augmentation showing potential benefit.
Parkinson's disease (PD) is the second most common neurodegenerative disorder of aging, and the most common movement disorder. Approximately one-third of patients with PD are treated with antipsychotic drugs. Prolonged exposure carries a significant risk of tardive dyskinesia (TD), characterized by involuntary movements that classically involve the oral-buccal-lingual region but may affect any muscle group. Although Repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (left-DLPFC) is FDA-cleared treatment for treatment-resistant depression, evidence for its use in primary motor symptom modulation is limited. We present the case of a 66-year-old woman with major depressive disorder (MDD), PD, essential tremor, and TD who experienced profound benefits across all conditions following rTMS. After an initial course, she reported a 40-50% reduction in Parkinsonian motor symptoms, decreased TD, and remission of depression and essential tremor. A second course was administered to address residual TD, resulting in its resolution along with patient-reported 90-100% improvement in Parkinsonian tremors, gait instability, masked facies, and speech impairment. To our knowledge, this is the first documented case in which rTMS over the left-DLPFC produced sustained near-extinction of PD motor symptoms and subsequent resolution of TD. These findings highlight the therapeutic promise of rTMS beyond mood disorders and underscore the need for systematic investigation of its efficacy in PD and TD.
Objective: The COVID-19 pandemic exacerbated youth mental and behavioral health challenges in the United States, disproportionately impacting minoritized groups. Few studies examine how intersecting social determinants jointly shape these outcomes, particularly in underserved regions. This study applied an intersectional framework to assess pandemic-related changes and identify highest-risk strata. Methods: We applied a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy model to emergency department data (2010-2022) to estimate pre- and post-pandemic prevalence of depression, anxiety, self-harm, and attention-deficit/hyperactivity disorder among youth (ages 5-26) in western North Carolina (WNC) (n = 934,938) and statewide (n = 11,973,484). Intersectional strata were defined by COVID-19 period, sex, race/ethnicity, insurance type, and age. Predicted prevalence identified highest-risk strata for each outcome and region. Results: Lowest-risk strata were consistently pre-COVID, elementary-aged children with self-pay insurance, often male and from minoritized racial/ethnic groups. Highest-risk strata for depression and anxiety were post-COVID, young adult females with insurance across multiple racial/ethnic groups, with prevalence up to 11.9% (depression) and 12.9% (anxiety) in WNC. For self-harm, post-COVID adolescent females with insurance had the highest risk, with slightly higher prevalence in WNC (1.5%) than NC (1.4%). ADHD showed distinct patterns, with highest prevalence among male adolescents with Medicaid (7.1% in WNC, 11.4% statewide). Conclusions: Intersectional analysis revealed both shared and region-specific disparities. WNC showed higher toprisk prevalence for depression, anxiety, and self-harm, while statewide strata showed higher ADHD risk. Findings support regionally tailored prevention strategies, including rural workforce expansion, culturally responsive care, and standardized diagnostic practices.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and Lithium carbonate are widely prescribed drugs for type 2 diabetes mellitus and bipolar disorder, respectively. The pharmacokinetic interaction between these commonly prescribed drugs has not yet been documented in the literature, despite their extended clinical usage. Here, we present a clinical case in which Lithium carbonate and Tirzepatide administration was temporally associated with Lithium toxicity. We discuss potential mechanisms including volume-depleting gastrointestinal effects leading to dehydration affecting lithium renal clearance, and elevating serum lithium levels. Finally, we propose clinical recommendations and guidelines including frequent monitoring of Li levels and renal function markers in patients who are prescribed GLP-1 RAs and lithium concurrently.
