Background Multiple studies have reported olfactory deficits (OD) in schizophrenia (SCZ). However, the OD in SCZ may differ from the loss of smell known to occur in patients with other neurodegenerative disorders. We reviewed the clinical and neurobiological correlates of OD in SCZ reported in controlled published studies. Methods Using search engines, including PubMed, Medline databases, and Google Scholar, we used keywords including schizophrenia, psychosis, olfaction, and olfactory deficits, and collated the clinical and biological correlates previously reported in controlled studies of OD. Results 17 publications were identified over the past 30 years. We identified the following correlates: (1) OD is associated with severity of negative symptoms and verbal memory impairment, (2) OD are present in medication naïve patient groups, (3) odor identification tends to be worse in male SCZ patients, (4) OD tends to be worse in the left nostril, and (5) deficits persist despite improvement in psychotic symptoms with antipsychotic therapy. Discussion OD in SCZ appears to be a trait present before the onset of psychosis, not related to treatment, present in a subtype, mostly males, and is more impaired in the left nostril than the right. Further studies are warranted to exploit OD as a biomarker.
Background Long-acting injectable buprenorphine (LAI-BUP) is safe and effective, however is underutilized. Little is known regarding how buprenorphine prescribers view LAI-BUP, and which medication attributes they prioritize when selecting opioid use disorder (OUD) treatment.Methods Secondary analysis of a national, cross-sectional survey of U.S. physicians prescribing buprenorphine for OUD. Respondents reported OUD caseload, LAI-BUP use, and importance of medication attributes (eg, efficacy, safety, ease of prescribing, administrative requirements). Providers were categorized as no LAI-BUP use or, among LAI-BUP prescribers, Low vs High use by a median split. Group comparisons used chi-square (or Fisher's exact) tests for categorical variables and Jonckheere-Terpstra tests for ordinal responses.Results Among 125 respondents, 39 (31.2%) reported no LAI-BUP use. The remaining 86 (68.8%) were split evenly into Low and High use groups (n's = 43). LAI-BUP use did not differ meaningfully by specialty, region, or practice setting. Greater LAI-BUP use was reported by providers with larger OUD panels. Ratings of medication attributes were uniformly high.Conclusions LAI-BUP remains underused, with uptake highest among clinicians managing larger OUD caseloads. Measured attitudes toward medication attributes did not explain these differences. Future work should assess clinic workflow, staffing, reimbursement, and REMS burden, testing targeted implementation strategies using mixed-methods trials.
Background Autonomic dysfunction is a potentially life-threatening condition that is frequently underrecognized in psychiatric and neuropsychiatric settings. Failure to identify autonomic features may delay diagnosis and appropriate management, leading to increased morbidity. Objective To illustrate the diagnostic and clinical relevance of autonomic dysfunction in psychiatric patients through representative clinical cases encountered on the consultation-liaison psychiatry service. Methods We report the clinical presentations of 4 patients evaluated on the consultation liaison service at a tertiary care center in Lebanon between July 2023 and December 2025, through a retrospective chart review. Each case highlights a distinct neuropsychiatric syndrome in which autonomic dysfunction played a central role in diagnosis and management. Results The cases included autonomic dysfunction associated with neurodegenerative disease, malignant catatonia, benzodiazepine withdrawal, and Neuro-Sweet Syndrome. For each syndrome, we summarize the causes, recommended investigations, and treatment approaches, offering a practical framework for psychiatrists. Conclusion This overview highlights the importance of evaluating autonomic dysfunction in specific psychiatric populations to guide timely and targeted interventions.
Empirical research on religion, spirituality, and mental health has expanded in recent decades, with a subset examining neurobiological correlates using electroencephalography (EEG). This scoping review synthesizes studies exploring associations between religious belief and practice, EEG findings, and psychiatric relevance. A literature search of MEDLINE, Embase, and Web of Science identified studies involving human participants, EEG measures, and quantitative assessments of religiosity. Sixteen studies published between 2009 and 2024 and conducted primarily from North America and Europe met inclusion criteria. Considerable heterogeneity was observed across EEG paradigms and religiosity measures. Across studies, religiosity was associated with differences in EEG indices related to error monitoring, emotional salience, cognitive control, and resting-state activity. Several studies interpreted these patterns as consistent with reduced distress or enhanced resilience, although standardized psychiatric symptom measures were infrequently employed, limiting direct clinical inference. Methodological diversity precluded definitive quantitative synthesis. Current evidence suggests that religiosity is associated with distinct EEG patterns relevant to cognitive and emotional processes implicated in psychiatric functioning. However, methodological heterogeneity and limited direct measurement of psychiatric outcomes constrain clinical inference. Greater standardization of religiosity measures and incorporation of validated psychiatric outcome measures are needed to clarify these relationships.
Background Oral antipsychotics are often continued after long-acting injectable (LAI) antipsychotics are established, which can push total exposure into high-dose antipsychotic therapy (HDAT). We evaluated this practice across two outpatient pathways. Methods Observational service evaluation of consecutive adults with psychotic disorders prescribed antipsychotics. LAI and oral use were recorded at baseline (t0). At 3 months (t3), we extracted the active regimen, concurrent dose burden (concurrent defined daily dose index [cDDD]), oral overlap (LAI+oral), and whether the regimen exceeded a prespecified study high-dose threshold (cDDD>1.5). Hospitalisation history was analysed with negative binomial regression. Results N = 58. At t3, 41/58 (70.7%) received an LAI and 22/58 (37.9%) had LAI+oral overlap; all overlap regimens exceeded the prespecified study high-dose threshold. Overlap was linked to higher cDDD. Higher cDDD, but not LAI status, was associated with more lifetime psychiatric hospitalisations. Conclusions At a standard 3-month review, continued oral overlap during LAI treatment was a simple marker of high-dose, high-burden prescribing and may serve as a practical audit checkpoint. This study did not assess whether overlap observed at month 3 persisted at later time points. Routine cDDD calculation and a clear stop/review plan for overlap may strengthen outpatient prescribing safety.
Background Uncertain is whether patients who present for outpatient psychiatric care seek treatment for all of their diagnosable disorders or only for the primary concern that prompted treatment initiation. The aim of the present study was to identify which psychiatric disorders motivate patients to seek treatment. Methods Three thousand eight hundred psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV. For patients with more than one disorder, the diagnoses were assigned as principal or additional according to the DSM-IV convention of whether it was the patient’s stated primary reason for presenting for treatment. For all current disorders, patients were asked if the symptoms of each diagnosed disorder were a reason (or one of the reasons) for seeking treatment. Results Of the 5846 diagnoses that were not the principal reason for seeking treatment, patients expressed a desire for treatment for 78.2%. For all disorders except substance use disorders, the majority of patients wanted treatment when the condition was an additional diagnosis. Conclusions Patients’ desire for treatment of comorbid disorders varied across disorders. Possible explanations for why patients do not wish to receive treatment for all disorders present at the time of the initial evaluation are discussed.
Objective: This study aimed to evaluate the effectiveness of intensive inpatient trauma-focused cognitive behavioral therapy (II-TF-CBT) and to describe key features of this treatment approach in adolescents with post-traumatic stress disorder (PTSD) following sexual abuse. Methods: Between 2021 and 2025, 54 adolescents hospitalized for PTSD related to sexual abuse were evaluated, and 48 received the II-TF-CBT protocol. Psychiatric diagnoses were established according to DSM-5 criteria. Symptom severity was assessed using the Children's Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, and the National Stressful Events Survey-PTSD Short Scale (Child Version). Outcomes included changes in PTSD symptom severity and diagnostic remission at discharge. Results: The median age at abuse was 12.5 years (IQR = 7), and the median age at hospitalization was 16 years (IQR = 2). Prolonged abuse occurred in 39.5% of cases, incest in 25%, and penetrative abuse in 64.6%. The median number of treatment sessions was 23 (range = 10-56). II-TF-CBT significantly reduced PTSD symptoms (F = 80.311, P < 0.0001), and no patients met PTSD diagnostic criteria at discharge. Depressive disorders were the most common comorbidity (91.7%), with depressive symptom severity significantly decreasing after treatment (P < 0.0001). Conclusion: II-TF-CBT is an effective inpatient intervention for adolescents with complex PTSD related to sexual abuse, including cases with severe trauma characteristics and psychiatric comorbidities.
Background The perinatal period represents a phase of increased psychiatric vulnerability, yet the factors linked to severe mental illnesses (SMIs) diagnosed during pregnancy or postpartum remain unclear. This study sought to identify associated and predictive factors of depression, bipolar disorder, and schizophrenia-related disorders diagnosed during pregnancy vs postpartum, with or without psychiatric comorbidity, in women seeking psychiatric care.Methods Using a retrospective cohort design, data from 927 women who accessed specialized perinatal psychiatric services in Quebec City (Canada) were analyzed. Poisson regression models examined psychiatric, sociodemographic, medical, and obstetric correlates of perinatal SMIs.Results Distinct profiles emerged according to diagnosis timing, disorder type, and comorbidity. During pregnancy, associated factors included being single, absence of prior psychotropic use, musculoskeletal conditions, and cluster C personality disorders. Past postpartum psychosis predicted bipolar disorder diagnosed during pregnancy. In the postpartum period, key correlates included history of anxiety or (hypo)manic symptoms, somatic-related disorder, suicidal behavior, absence of previous psychiatric diagnosis, and no new diagnosis during pregnancy. Foreign nativity and lack of psychotropic treatment were linked to depression across both periods.Conclusions Results highlight period-specific and shared factors underlying perinatal SMIs. Their identification may improve early detection and targeted interventions for maternal mental health.
Background ADHD evaluations are increasingly common in outpatient psychiatric settings, yet diagnostic accuracy remains challenging due to nonspecific, overlapping symptoms with other conditions. This study examined how childhood adversity/trauma exposure (ACEs) and current posttraumatic stress disorder PTSD symptoms influence childhood and adult inattention, impulsivity, and hyperactivity symptom reporting among adults undergoing ADHD evaluation.Methods Clinical data from 264 adults referred for ADHD evaluation administered the Clinical Assessment of Attention Deficit-Adult (CAT-A), Adverse Childhood Experiences (ACE) Questionnaire, and PTSD Checklist for DSM-5 (PCL-5) were analyzed. Linear regressions examined the influence of ACEs and PTSD symptoms on ADHD symptom reporting in childhood and adulthood.Results ACEs significantly predicted retrospective childhood ADHD symptoms, particularly inattention and impulsivity, but not current symptoms. Conversely, active PTSD symptoms predicted impulsivity, but not other ADHD symptoms in adulthood. Neither ACEs nor PTSD symptoms predicted hyperactivity. ACEs were more associated with retrospective childhood symptom reporting, while current PTSD symptoms were more relevant for adult symptom reporting.Conclusions Both childhood adversity and active PTSD symptoms influence self-reported ADHD symptoms-especially inattention and impulsivity-while self-reported hyperactivity appears unrelated to early adversity or trauma-related symptoms. These results highlight the importance of incorporating trauma history and multi-method assessment in ADHD evaluations.
Methods Two former policemen hospitalized for evaluation and treatment of complaints of depression showed marked deficits in speech latency, fluency and word finding. Both had multiple cognitive deficits following traumatic brain injury (TBI) that ended their careers several years prior. They showed no response to antidepressants or electroconvulsive therapy. Oral methylphenidate 10-20 mg twice daily was then given for depression.Results Methylphenidate did not affect mood or cognitive function but improved speech to be within normal range. The patients then complained copiously about longstanding frustrations and disempowerments following traumatic brain injury.Conclusions By rapid mitigation methylphenidate illuminated aphasia following traumatic brain injury. Searches found no previous report of methylphenidate decrease of aphasia following traumatic brain injury.
Background Despite an increased interest in Facebook addiction (FA) research over the past 10 years, few data are available in Cameroon. This study aimed to determine the prevalence and determinants of FA, and its relationship to depression among students in a government university. Methods A cross-sectional study was conducted in 9 institutions of the University of Douala. A total of 1133 students completed a self-administered survey including sociodemographic data, Facebook use patterns, Bergen Facebook Addiction Scale (BFAS), and Beck Depression Inventory II (BDI II). BFAS >18 was defined as FA, depression was defined as a BDI II >= 10. Data were analyzed using SPSS (R) 28.0. Results The mean age was 22.5 +/- 3.7 years with 53.5% of female. Prevalence of FA and depression were 14.5% and 52.1% respectively. Independent Predictors of FA were multiple daily logins, virtual friends <200, and daily use >= 4 hours. Female students, medical school, teachers' training college, and PhD/equivalent were significantly associated to depression. FA was positively correlated to depression severity (r = 0.26; rho = 0.25; P < 0.001). Conclusion Facebook addiction is common, and often associated with depression among students at the University of Douala, highlighting the need for mental health interventions.
Introduction Suicide among military personnel poses a significant threat to both individual well-being and organizational readiness. This study aimed to develop a structured suicide prevention educational package based on the Gatekeeper model tailored for military duty and career personnel in the Islamic Republic of Iran Army.Methods A qualitative study using the Delphi approach was conducted in 2022-2023. Participants were 20 mental health experts including psychiatrists and psychologists, working in army hospitals across Tehran, selected via purposive sampling. Semi-structured interviews were conducted across three Delphi rounds until theoretical saturation and consensus were reached. Data were analyzed using MAXQDA software.Results A total of 130 open codes were extracted from initial interviews, which were refined into 10 core thematic categories and one central theme: a gatekeeper-based educational intervention. These themes included psychological traits of gatekeepers, suicide risk factors in military settings, warning signs, appropriate and harmful gatekeeper actions, referral protocols, and system-level improvements.Conclusion The resulting package equips military commanders and personnel with the competencies to recognize, engage, and refer at-risk individuals. This model offers a scalable and evidence-informed approach for suicide prevention within military institutions.
Background Comorbid substance use disorder (BD-SUD) is common among individuals with bipolar disorder (BD) and is associated with worse clinical outcomes. This study compares differences in medication adherence, adherence barriers, and symptom severity of individuals with BD-SUD based on diagnostic status (current, past, or none).Methods This interim analysis utilized screening and baseline data from a 12-month randomized controlled trial comparing adherence interventions among poorly adherent individuals with BD. Patients were recruited from public mental health settings and met strict diagnostic and symptom criteria.Results From the study sample (N = 129; Mage = 42.18; SDage = 13.04), no significant sociodemographic differences were found. Individuals with BD and current substance use disorder reported significantly higher rates of problematic substance use and motivation to reduce such use compared to the other groups. No other differences were found.Conclusions Comorbid substance use disorder is common among individuals with bipolar disorder and often associated with poor outcomes. In this baseline, cross-sectional analysis, minimal differences were observed across varying BD-SUD status. Longitudinal analyses will be important for clarifying whether adherence and related outcomes differ over time across BD-SUD groups.
