Purpose:To discuss the relationship between autism and gender dysphoria (GD), and their co-occurrence with transgender identity, and to raise awareness of the specific needs of individuals with autism spectrum disorder (ASD) in gender-confirming clinics. PubMed, Scopus, Medline, and EBSCO databases were reviewed. Only peer-reviewed English-language articles were considered eligible. Priority was given to meta-analyses and original articles presenting quantitative results published within the last five years; For some unreplicated studies this period was extended. The databases were searched using the keywords: "ASD" and "GD", "autism spectrum" and "transgender", "autism spectrum" and "gender dysphoria". Views:An increasing number of studies show that ASD is overrepresented in people with GD as well as in gender-affirming secondary care clinics. This trend is observed in both young people and adults. People with overlapping diagnoses face higher anxiety, depression, risk of self-harm and the feeling of being a minority within a minority. Sensory disorders from ASD may cause difficulties in achieving gender congruence, while social communication deficits may delay the diagnosis of transgenderism. Conclusions:Transgenderism is more common among the ASD population than among neurotypical individuals. The reasons for this correlation are unclear, but they may be found in the theory of mind, extreme male brain theory, cerebral cortex structure, and cognitive inflexibility. Practitioners need training to uphold the dignity and autonomy of patients with comorbid transgender and autism spectrum diagnoses, enabling shared decision-making in treatment process and in co-defining the goals of therapy.
Purpose: Lafora body disease (LBD) is a rare autosomal recessive progressive myoclonic epilepsy characterized by neurodegeneration due to an intracellular accumulation of poorly branched polyglucosan inclusions. Effective pharmacological management remains challenging due to the risk of druginduced exacerbation of symptoms and adverse interactions. Case description: We present the case of an 18yearold male with intractable seizures, myoclonus, and cognitive regression. Electroencephalogram showed frequent generalized polyspike discharges, and histopathology confirmed Lafora bodies. The patient was initially prescribed a broad polypharmacy regimen including sodium valproate, carbamazepine, phenytoin, and phenobarbitone - leading to detrimental pharmacokinetic and pharmacodynamic interactions, worsening his neurological status. A stepwise revision with withdrawal of contraindicated agents and rational introduction of levetiracetam, clobazam, and perampanel improved seizure control and alertness. Comment: This case highlights the hazards of unstructured polypharmacy in LBD and stresses the need for individualized pharmacotherapy. Novel diseasemodifying options like metformin, targeting glycogen metabolism, offer future therapeutic potential in altering disease trajectory.
Purpose:To report a novel NOTCH3 pathologic variant in a family presenting CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, OMIM #125310). Case description:Two affected sisters with dementia and ischemic stroke (only the proband) in their medical history, and the pro- band's daughter with migraine without aura underwent clinical and imaging evaluations. Magnetic resonance imaging revealed typical CADASIL lesions in both sisters. Next-generation sequencing and targeted Sanger sequencing were performed to link the phenotype to a variant in the NOTCH3. Comment:Sequencing data revealed a likely pathogenic variant in the NOTCH3 gene. Using ACMG guidelines, the variant was classified as likely pathogenic. We have described a new likely pathogenic NOTCH3 missense variant c.1675T>G p. (Cys559Gly) and linked it to the CADASIL phenotype, confirming the predictions of genetic analyses. We particularly emphasize co-occurring central vascular lesions in patients with migraine, which may be de facto caused by pathogenic NOTCH3 variants.
Purpose:This study aimed to examine the relationship between health literacy (HL) and health anxiety (HA) among young women and to evaluate how variations in HL influence anxiety and related health outcomes. Methods:A cross-sectional survey was conducted with 245 women aged 18-45 years attending the Prof. Dr. Cemil Taşcıoğlu City Hospital Training and Research Family Health Center. The questionnaire included 13 sociodemographic items, the 14-item Health Literacy Scale, and the 18-item Health Anxiety Inventory. Higher scores reflected higher levels of literacy or anxiety. Data were analyzed using SPSS 25, with p < 0.05 considered statistically significant. Results:Of 245 participants, 66.8% were married and 61.2% had children. Higher education was associated with higher HL, whereas lower education, obesity, chronic disease, and regular medication use were associated with lower literacy scores (p < 0.05). HA was negatively correlated with the level of education and HL but positively correlated with the number of doctor visits. Conclusions:HL increases with the level of education, while HA decreases. Enhancing HL in primary care settings may help reduce health-related anxiety and unnecessary healthcare use among young women.
Purpose: This study aimed to evaluate the local impact of implementing the Mental Health Center (MHC) model in the Malbork and Sztum counties in 2024. The analysis focused on comparing patient numbers, types of services provided, and diagnostic patterns before and after the introduction of the MHC. Methods: A retrospective quantitative analysis was conducted using data from psychiatric outpatient clinics and the psychiatric day ward for 2023 (pre-reform) and 2024 (post-reform). Variables included the total number of patients, individuals initiating psychiatric treatment, service types, and the most frequently recorded ICD-10 diagnoses. Results: In 2024, the total number of patients increased by 12.9%, while the number of individuals initiating psychiatric care rose by 49.8%. The overall number of services grew by 22.4%, with the most notable increases observed in psychotherapy sessions (+230.5%) and initial diagnostic assessments coded as Z03. Psychological consultations declined by 15.5%. The newly established psychiatric day ward showed a consistent upward trend in utilization. There was a shift in the distribution of diagnoses, with a rise in F41.2 and F43.2 cases, and the emergence of F00.1 among the most commonly assigned. Conclusions: In summary, our findings indicate that implementation in the Malbork and Sztum counties of the Mental Health Center model was associated with enhanced accessibility, earlier diagnosis, improved coordination, and a more comprehensive approach to psychiatric care. These outcomes are consistent with the guiding principles of Poland's mental health reform and align with previous national evaluations, underscoring the practical value of community-based mental health services.
Purpose: Adolescents studying in special education centres are a group at particular risk of suicidal behaviour. The aim of this cross-sectional study was to identify risk/protective factors associated with suicide attempts among students aged 12-19 years (N = 1730) who attended Youth Sociotherapy Centres (YSC) and Youth Correctional Centres (YCC) in Poland. Methods: Auditory self-administered surveys were conducted as part of school lessons with procedures in place to ensure anonymity and confidentiality of the data. Hierarchical linear regression was used to analyse the relationship between the frequency of suicide attempts and a set of risk and protective factors. Results: The results indicate that the risk factors identified as associated with the frequency of suicide attempts were depressive symptoms, sensation-seeking tendencies and having experienced violence and cyberbullying from peers. Among the risk factors confirmed only for boys were the ongoing use of medication for stomach ache, and also listening to music in leisure time. In turn, the risk factors that were confirmed only among girls were domestic conflicts/violence and the use of medicine for negative emotional states. Playing computer games appeared to be a protective factor, but only for boys; no protective factors were identified for girls. Conclusions: Preventive efforts should be aimed at early identification of youth at risk of depression, peer or domestic violence as well as training YSC/YCC staff in brief interventions addressed to young people at risk of suicide.
Purpose:Dentists' communication skills are a vital component of facilitating the provision of better health information for patients, and meeting their needs and expectations. High levels of stress, anxiety, and depression - caused by work pressure, non-cooperative patients, and financial issues - may be associated with dentist-patient communication. This study assessed communication skills and their relationship with depression, anxiety, and stress among dental students. Methods:This cross-sectional study involved 210 third year and above dentistry students at Ahvaz Jundishapur University of Medi-cal Sciences, Ahvaz, Iran, in 2024. The participants were selected using a census sampling method. They all completed the Queendom Communication Skills Test-Revised (CSTR) and the Depression, Anxiety and Stress Scale - 21 Items (DASS-21). Statistical analysis was performed using SPSS 27. Results:The mean (± SD) communication skills score was 104.20 ± 13.17. The logistic regression model revealed that anxiety and depression were positively associated with some components of communication skills, including emotional control, listening skills, and the ability to receive and send messages. In contrast, the level of stress was only associated with assertive communication. Conclusions:The results indicated a high level of communication skills among the dental students. However, it is recommended that interventions be designed, especially to improve depression and anxiety, and to examine their impact on enhancing communication skills.
Purpose: Differentiating between Alzheimer's disease (AD), vascular dementia (VaD), and mixed dementia (MD) remains a major clinical challenge, as overlapping symptoms and comorbid pathologies limit the diagnostic value of screening tools. The Addenbrooke's Cognitive Examination III (ACE-III) offers a multidomain assessment and may support differential diagnosis. Methods: The study included 138 Polish patients with mild dementia (46 AD, 46 VaD, 46 MD), matched for age, sex, and education, and diagnosed based on current clinical criteria. Group comparisons were conducted using the Kruskal-Wallis test with Dunn-Bonferroni post hoc analyses. Results: Total ACE-III scores did not differ significantly between the groups. Significant effects were observed only in the Memory domain, where VaD patients scored higher than both AD and MD, who did not differ from each other. Subtest analyses confirmed group differences in episodic memory tasks. Only Serial 7 Subtraction (Attention) and Letter Fluency differentiated between groups, with AD patients outperforming VaD patients. Within the Visuospatial domain, only Dot Counting differentiated between groups (AD > MD > VaD). The Language domain showed no group effects. Conclusions: While total ACE-III scores have limited diagnostic value, domain-and subtest-level analyses reveal distinct cognitive profiles supporting differential diagnosis. VaD is marked by preserved episodic memory but impaired attention and executive tasks, AD by severe episodic memory deficits, and MD by an AD-like profile with vascular contributions. Domain-focused interpretation of ACE-III may enhance diagnostic accuracy in clinical practice.
Purpose: The aim of this study is to present a case of delayed encephalopathy after acute carbon monoxide (CO) poisoning in a 29-year-old female patient, and to discuss the applied treatment strategies. Case description: A 29-year-old female patient was admitted to the Toxicology Department due to acute CO poisoning. Improvement was achieved following oxygen therapy, including hyperbaric oxygen therapy (HBOT). After 38 days, a decline in cognitive and functional status was observed. The patient was re-hospitalized in the Neurology Department, where delayed encephalopathy after acute CO poisoning (DEACMP) was diagnosed. Pharmacological treatment proved ineffective. Comprehensive therapy was applied in the Rehabilitation Department, including cognitive, motor, and speech therapy, along with hyperbaric oxygen therapy. This approach led to a significant improvement in the patient's neurological status. Comment: DEACMP is a serious complication that may occur after asymptomatic CO exposure or following transient clinical improvement. In the presented case, HBOT proved an effective treatment modality, both in the acute phase and during the management of long-term neurological sequelae.
Purpose: Exposure to traumatic events and having symptoms of post-traumatic stress disorder (PTSD) are both risk factors for the development of addictions. The aim of the study was to determine the links between trauma and the intensity of eating and shopping behaviors and identify the predictors of eating and shopping addiction. The number of traumatic events experienced and PTSD symptoms were used as the indicators of trauma. Methods: The study was conducted online. The participants were 90 women aged 22-56 years (M = 33.9; SD = 8.93) who completed four standard measurement tools and a survey developed for the purpose of the study. Results: The results indicate that eating behaviors are positively associated with symptoms of PTSD but are not linked to the number of traumatic events an individual has experienced. In turn, the shopping behaviors analyzed are associated with the number of traumatic events experienced indirectly, but not with PTSD symptoms. Conclusions: PTSD is a risk factor for eating addiction, and the number of events experienced indirectly increases the risk of shopping addiction. There is a need for prevention programs aimed at reducing the risk of behavioral addictions by equipping people with skills that can help them cope with traumatic events.
Purpose: Numerous mental health disorders in childhood and adolescence typically begin during the early-to-middle years of childhood. Due to insufficient evidence in the Middle East, we reported the mental health profile of childhood and adolescence in the Kurdistan Region. Methods: In this retrospective cross-sectional study, we included 852 cases of children and adolescents from the Child and Adolescent Mental Health Center in Duhok City in the Kurdistan Region of Iraq, for ten years between 2015 and 2024. Results: The mean value of age of the patients, aged 2-22 years, was 10.97 (SD: 4.31 years). The study found that 23.19% of the children had failed at school. The majority of the patients were from nuclear families (99.76%) and had 6-10 family members, followed by those who had 3-5 (40.33%). The study showed that 19.10% of the children have a family history of psychiatric disorders. The most common types of mental disorders among children were those of psychological development (69.25%) and neurotic, stress-related, and somatoform disorders (11.27%). The delivery types of the patients were normal vaginal delivery (74.19%), followed by cesarean section (22.58%) and difficult labor (3.23%). Preschool children were more likely to have normal medical conditions (20.51%) than other age groups (p = 0.0334). The patients with a family history were more likely to have mental disorders (95.68% vs. 90.43%; p = 0.0319) and neurodevelopmental disorders (94.62% vs. 87.57%; p = 0.0216). Conclusions: The most common types of psychiatric disorders in children were neurodevelopmental disorders and neurotic, stress-related, and somatoform disorders, and were linked to a family history of mental disorders.
Purpose: This study aimed to investigate the associations between depression, childhood infections, stressful life events, and multi ple sclerosis (MS) in the Polish population. By exploring these relationships, the study seeks to provide deeper insight into the inter play of psychological, immunological, and environmental factors in the context of MS. Methods: A retrospective case control study was conducted involving 210 Polish participants. All subjects completed the Beck Depression Inventory, Recent Life Changes Questionnaire and an original survey that gathered data on demographic and socioeco nomic characteristics, family medical history, and past illnesses, including childhood infections. Statistical analyses included both univariate and multivariate logistic regression models. Results: Compared to controls, individuals with MS were significantly more likely to have been diagnosed with depression (odds ratio [OR] = 3.06; 95% confidence interval [CI]: 1.645.70). They were also significantly less likely to report a history of certain childhood infections, including strep throat (OR = 0.39; 95% CI: 0.220.69), tonsillitis (OR = 0.35; 95% CI: 0.190.67), pharyngitis (OR = 0.44; 95% CI: 0.250.78), rubella (OR = 0.56; 95% CI: 0.320.98), and frequent episodes of fever (OR = 0.31; 95% CI: 0.180.56). Conclusions: Individuals with MS were approximately three times more likely to experience depression than healthy controls, underscoring the importance of psychological assessment and support in MS management. While the study provides insights into childhood infections and cumulative stress, it is important to note that its retrospective design may limit the generalizability of the findings.
Purpose: This case study presents an unusually severe variant of Capgras syndrome involving multiple imposters, which is consi dered a rare presentation. Case description: A 37year old male with schizophrenia exhibited complex delusional misidentification involving his parents, siblings, and ex spouse, whom he believed had each been replaced by hundreds of different imposters. These imposters were diffe rentiated by subtle physical and behavioral features. The delusional system extended to include persecutory beliefs involving secret organizations and supernatural entities. This elaborate form of serial substitution, rarely reported in the literature, reflects a highly systematized psychotic process and highlights the breadth of misidentification phenomena. Clinical assessment supported a diag nosis of schizophrenia with prominent delusional misidentification. Comment: The case adds to the growing recognition of how Capgras syndrome can manifest in atypical and exaggerated forms, raising important questions about the underlying neurocognitive and affective mechanisms driving these beliefs. Awareness of such presentations is crucial for accurate diagnosis and conceptual understanding.
Purpose:The article presents a case of invasively treated stroke in a patient with heart failure (HF) and implanted left ventricle assist device (LVAD), and risk factors suspected as the reasons behind the stroke. Case description:A 58-year-old patient with HF supported with LVAD, with atrial fibrillation (AF) and rapid heart rate, was admitted to intensive cardiac care unit due to episodes of AF falsely detected by implantable cardiac defibrillator as ventricular fibrillation (VF), provoking unnecessary defibrillator discharges and episodes of real VF in consequence. Twelve hours after admission, the patient displayed symptoms of stroke and was treated with mechanical thrombectomy of the occluded right middle cerebral artery, with good results. Comment:The treatment for stroke in a patient with multiple risk factors, who needed antithrombotic therapy due to LVAD, presented a significant challenge. Fortunately, timely diagnosis of stroke enabled quick invasive treatment with good results.
Purpose:The purpose of this study is to discuss current applications of artificial intelligence (AI) in psychiatry and the ethical issues involved. It also aims to identify the need for further research and collaboration between researchers, clinicians, and technology developers to safely and effectively implement AI in the care of patients with mental disorders. Views:The application of AI in the diagnosis and treatment of mental illnesses is a promising direction for modern psychiatry, but it involves many ethical challenges. AI is being used in a variety of areas, such as early disease detection, personalization of treatment and monitoring the progress of therapy. Examples include recognizing patterns in patient data, detecting the early stages of neurodegenerative diseases, and using digital games and mobile apps to treat mental disorders such as depression and anxiety disorders. Despite the growing role of AI, there are a number of controversies related to the lack of empathy its use brings to patient in patient interactions, the threat to data privacy, and the opacity of decision-making processes in AI algorithms. Ethical challenges also include the risk of over-reliance on technology and the reduced role of human specialists in psychiatry. Conclusions:The application of AI in psychiatry comes with opportunities as well as serious ethical challenges. Ensuring the transparency of algorithms, protecting patients' privacy and clearly defining responsibility for decisions made with the support of AI remain crucial. Only a responsible approach to these issues will allow the full potential of AI to be realized without compromising basic ethical values.
Purpose:Neuroimaging and biological predictors of response to electroconvulsive therapy (ECT) are still being sought, so as to enable a full understanding of its therapeutic effects. The present study aims to determine the role of functional near-infrared spectroscopy (fNIRS) as a potential predictor of response to treatment with and efficacy of ECT. Views:Each of the currently used neuroimaging methods has its limitations; however, the advantages of fNIRS provide a starting point for the widespread use of this method in the assessment of ECT. Studies using fNIRS for measurement have shown that prior to undergoing ECT depressed patients have a bilaterally lower frontal oxyhaemoglobin response to cognitive tasks compared to healthy subjects. After ECT, there is a change in oxyhaemoglobin (oxy-Hb) values compared to pre-treatment ones. However, the results regarding changes in oxy-Hb values obtained by different groups of investigators were not consistent. Conclusions:Higher oxy-Hb values are achieved in healthy subjects than in patients. Apart from that, oxy-Hb values in patients are altered after ECT. For this reason the use of fNIRS can be an objective assessment of its therapeutic effect on patients. However, for fNIRS to become a biomarker for ECT treatment, studies need to be conducted on a larger patient population, considering the time since the last ECT and various disease entities.
Purpose:Adolescent drug abuse is a growing global public health concern, with early onset linked to a variety of harmful effects. This study examines the long-term mental, physical, social, and legal implications of adolescents' illicit drug usage, with an emphasis on psychiatric illnesses and risks associated with demographic factors such as cultural background and socioeconomic status. Methods:A retrospective descriptive study was conducted at the "Ali Mihali" Psychiatric Hospital in Vlora, Albania, using clinical data spanning 10 years (2014-2024). The study comprised 312 individuals with a history substance use that began during adolescence (12-18 years). Patients were assessed using structured psychiatric interviews and standardized evaluation tools, including the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI-II), and Young Mania Rating Scale (YMRS). Data on mental, medical, and legal histories were obtained from the hospital. Results:The study found a significant rise in early-onset substance use, with cannabis being most commonly used, followed by cocaine and heroin. The average age at the initiation of use ranged from 12 to 18 years, with 34.5% starting at 18. Psychiatric problems, including psychotic disorders (56.4%), bipolar disorder (21.8%), and personality disorders (17.9%) were observed. Physical health concerns were present in 39.7% of patients, including liver disease, respiratory issues, and infectious diseases (hepatitis, HIV). Moreover, 14.4% of patients had experienced legal issues, including drug trafficking and domestic violence. Conclusions:Early drug misuse has long-lasting impacts on mental health, physical health, and social integration, according to this study. It highlights the necessity of all-encompassing, multisectoral approaches to prevention, early intervention, and rehabilitation.
Purpose:The aim of this study was to analyze the relationship between religiosity and health-related attitudes during the COVID-19 pandemic, including views on sanitary restrictions and vaccination. The study also examined the impact of anxiety levels on these attitudes, as well as preferred coping strategies among religious and non-religious individuals. Methods:The study was conducted online on a non-representative sample of 700 individuals, of whom 289 provided complete responses. A proprietary questionnaire, the Fear of COVID-19 Scale (FCV-19S), and the Mini-COPE inventory were used. Statistical analyses were performed using the χ2 test and Student's t-test (p < 0.05). Results:Religiosity was not significantly associated with adherence to preventive measures but was associated with greater skepticism toward restrictions in places of worship and vaccinations. Higher anxiety levels were associated with more frequent compliance with sanitary guidelines, regardless of degree of religiosity. Religious individuals were more likely to use coping strategies based on faith and social support, while non-religious ones more often relied on avoidance and helplessness strategies. Conclusions:Religiosity may serve a protective role in coping with pandemic-related stress but can also be associated with a lower acceptance of preventive measures. Anxiety emerged as a significant motivator for following recommendations, regardless of religious beliefs. These findings underscore the importance of addressing both emotional and spiritual factors in health communication strategies during epidemiological crises.
Purpose:As some addictive behaviors increased during the COVID-19 pandemic, we have attempted to identify their risks and protective factors against them. In this research, we have investigated the relationship between the fear of COVID-19 and addictive behaviors and the role of general and COVID-19-specific sense of control, attitude to vaccination, and earlier recovery from COVID-19. Methods:A total of 511 individuals aged 18-79 participated in the online survey. Women comprised 71.29% of the sample, men 27.93%, and 0.79% (n = 3) declined to provide information on their gender. Participants completed questionnaires assessing substance-related and substance-dependent behaviors, general and COVID-19-specific locus of control, fear of COVID-19, and attitudes toward vaccination. Moderation and mediation analyses were conducted. Results:Fear of COVID-19 was associated with increased internet, social media, and marijuana use. Lower sense of control (both general and COVID-19-specific) was associated with an increased severity of various addictions. A COVID-19-specific sense of control mediated the relationship between fear and addictive behaviors, particularly for women. Conclusions:This study highlights the impact of fear and sense of control on addictive behaviors during the COVID-19 pandemic. Promoting a sense of control may mitigate the risk of addiction in the face of pandemic-related stress. Public health efforts should address the potential for long-term consequences of addictive behaviors exacerbated by such global health crises, as similar challenges may arise with future outbreaks.
