Abstract Aripiprazole is recommended as a first-line treatment for Tourette syndrome but has been associated with new-onset impulse control disorders, including pathological gambling, as highlighted by a 2016 Food and Drug Administration safety warning. Gambling disorder has rarely been reported in patients with Tourette syndrome receiving aripiprazole. We report a 43-year-old man with schizoaffective disorder and comorbid childhood-onset Tourette syndrome. Gambling behaviour began after an aripiprazole dose increase, persisted for about 12 months, and was diagnosed roughly 1.5 years after aripiprazole was started. Within weeks of tapering, gambling ceased and did not recurred over a 5-year follow-up. To our knowledge, this is the first reported case of gambling disorder as a possible adverse drug reaction to aripiprazole in a patient with comorbid Tourette syndrome. We hypothesise that partial D2/D3 agonism on an already sensitised dopaminergic system could have contributed; this remains speculative. Long-term monitoring of such patients should be considered.
Abstract Background Suicide is a serious public health issue and the leading non-accidental cause of death among adolescents in Spain. Although a previous suicide attempt is the strongest risk factor for a new attempt, studies focused specifically on adolescent reattempters remain scarce. This study aims to identify modulating factors for suicide reattempts in a clinical adolescent population following an index attempt, using network analysis. Methods We recruited a total of 287 adolescents aged 12 to 17, treated in emergency services after a recent suicide attempt. Data collection involved structured clinical interviews and validated self-report questionnaires assessing sociodemographic, psychopathological, and behavioral variables. Our network analysis explored significant correlations (r ≥ 0.2) between variables and their relative influence on suicidal behavior, with a particular focus on reattempts (1-year follow-up). Results Variables related to emotional and behavioral difficulties, childhood trauma, and depressive symptoms were the most central and influential within the network. In contrast, suicide reattempts and their frequency appeared as peripheral nodes with no significant direct associations. Emotional abuse was associated with a higher total number of suicide attempts, and the Self-Awareness of Mental Health intervention was linked to a longer time before reattempt. Conclusions This study highlights the complexity of suicide reattempt risk factors in adolescents, emphasizing the importance of indirect interactions rather than isolated predictors. Incorporating standardized self-report tools may enhance clinical assessment and prevention strategies. Through network analysis, this research offers an innovative perspective to understand the multivariate nature of suicide risk in adolescent populations.
Abstract Background Worldwide, the increasing trend of young people experiencing mental health challenges constitutes a major public health concern. There is a need for preventive and mental health-promoting initiatives targeting youths. This study examines the effectiveness of headspace Denmark – a nationwide counseling service for 12- to 25-year-olds – at 6-month follow-up. Methods The study was a quasi-experimental trial. 12- to 25-year-olds who had participated in counseling sessions in headspace were matched with a comparable control group, using propensity score matching. Survey data, collected at baseline and at 6-month follow-up, were linked to national register data. Outcome measures were well-being, loneliness, self-efficacy, life satisfaction, and health-related quality of life. Linear regression was used to test differences between the two groups. Subgroup analyses were conducted. Post-hoc Population Attributable Fractions (PAFs) were estimated to describe the effect sizes at the population level. Results The inclusion period was 14.5 months from September 2022. Follow-up data were collected until mid-August 2024. The number of participants in the intervention group was 1,362. In the control group was 3,192. A statistically significant difference between the groups was observed for well-being at 6-month follow-up (Cohen’s D = 0.11; p = 0.018). The estimated PAF was 4%, assuming a prevalence of low well-being in the target group of 70% and the intervention reaching 80% of the target group. Conclusions headspace had an effect on participants’ well-being. Based on the estimated PAF, headspace can play a crucial role in early health promotion and disease prevention among young people in Denmark.
Contemporary psychiatry suffers from an epistemological impoverishment that weakens its capacity to encounter the intricacy of human suffering. Because psychopathological conditions are intrinsically ambiguous, contradictory, and affectively charged, psychiatric training cannot rely exclusively on rational-conceptual language and rigid operational categories. This article advances the claim that residents in psychiatry must also be trained in psychiatric poetics, that is, a paradoxical and poetic language and mode of thinking. Utilizing a hermeneutic approach, we analyze the structural role of language in psychiatric education and clinical care. We examine how human existence is fundamentally constituted through language and evaluate the epistemological limitations of purely standard diagnostic frameworks. We demonstrate that the rich and paradoxical language of psychiatric poetics is not aesthetic ornamentation, but a disciplined clinical capacity to tolerate ambiguity, hold contradictions together, and remain responsive to the existential texture of patients’ lives. Poetic language operates as a rigorous epistemological instrument, an ethical stance, and an essential clinical skill that enables clinicians to access the pre-reflective density of human lived experience. Because psychiatry deals directly with human forms of existence, it necessarily depends upon forms of expression that are adequate to the complexity of living. Integrating poetics into psychiatric education provides an indispensable framework to restore depth, ethical responsiveness, and diagnostic precision to contemporary clinical practice.
Abstract:INTRODUCTION:: The non-benzodiazepine anxiolytic etifoxine is hypothesized to act as a neurosteroidogenic agent via the 18-kDa translocator protein. In a placebo controlled design, we compared its steroidogenic effects with those of alprazolam. Abstract:METHODS:: In a double-blind within-subject design, healthy male participants (N=29) received etifoxine (150 mg/d), alprazolam (1.5 mg/d), and placebo in randomised order for 5 days. Pregnenolone expression and cortisol expression were assessed at the end of each treatment in the morning, and at four time points in the afternoon. Thrombocyte 18-kDa translocator protein expression was measured in the morning. Abstract:RESULTS:: Analysis of morning samples revealed higher 18-kDa translocator protein expression (χ 2=7.41 and p=0.025) after etifoxine intake compared to alprazolam intake (p=0.025). Both alprazolam and etifoxine were associated with lower pregnenolone levels (p<0.005). The 18-kDa translocator protein did not mediate the medication effects on pregnenolone (average causal mediation effects for etifoxine vs. placebo contrast: p=0.276). Afternoon measurements showed that alprazolam reduced cortisol (χ 2=66.76, p<0.001), and that both alprazolam and etifoxine reduced pregnenolone levels (χ 2=31.75, p<0.001). State anxiety was only marginally lowered by medication (p=0.092), and no biological markers-cortisol, pregnenolone, or 18-kDa translocator protein-predicted anxiety ratings (all p > 0.40). Abstract:CONCLUSIONS:: We confirmed the effects of benzodiazepines on cortisol and pregnenolone levels in healthy male participants. Etifoxine administration was associated with a decrease in peripheral plasma pregnenolone. Taken together, however, plasma pregnenolone levels do not seem to reflect etifoxine binding to 18-kDa translocator protein and central anxiolytic mechanisms in humans.
