Objective: The etiology of suicidal thoughts and behaviors (STBs) is complex, multifactorial, and difficult to predict, which limits suicide prevention efforts. The biopsychosocial model of suicide suggests that risk for suicidal ideation, attempts, and death by suicide emerges through the interplay of biological, psychological, and social factors. Yet, these factors are often studied in isolation and assessed inconsistently in practice, making it difficult for researchers and clinicians to appreciate their combined impact in suicide risk assessment and prevention.Method: Charlotte Wells' film Aftersun was examined through the lens of the biopsychosocial model of suicide. Cinematic depictions of important risk factors for STBs, including adverse childhood experiences, shame, social disconnection, financial difficulties, and alcohol use, were integrated with empirical evidence to illustrate how these factors may interact to influence suicide risk.Results: This analysis identifies several empirically supported risk factors for STBs depicted in Aftersun and illustrates how their co-occurrence may increase vulnerability to death by suicide. The film provides a useful example of how suicide risk may be shaped not by any single factor, but by the accumulation and interaction of multiple biological, psychological, and social vulnerabilities.Conclusion: Aftersun provides trainees, clinicians, and researchers with an accessible illustration of the multifactorial nature of suicide and the importance of considering interacting biopsychosocial risk factors during assessment and prevention efforts.
ObjectiveThis study sought to identify independent factors influencing short-term treatment responses in schizophrenia, covering both positive and negative symptoms, and developed a validated nomogram prediction model. Method: The study examined clinical data from 446 schizophrenia patients diagnosed between 2019 and 2023, focusing on health status, admission vital signs, and initial lab results. Participants were split into training and validation groups (6:4 ratio) and classified as improvers or non-improvers based on a ≥ 30% symptom score reduction. LASSO and multivariable logistic regression analyzed the data, with a nomogram illustrating the prediction model. The Bootstrap method generated the ROC curve, and the AUC was calculated. Calibration and clinical decision curves evaluated the model's discrimination, calibration, and clinical utility. Results: The study involved 446 schizophrenia patients, divided into 267 for training and 179 for validation. Of these, 122 improved in psychiatric symptoms, while 324 did not. Key factors linked to improvement- gender, age, smoking, LDL, homocysteine, and folic acid, were identified using LASSO and logistic regression. These factors formed a predictive model, visualized with nomograms. The model's performance, tested with 1000 Bootstrap iterations, had a C-index of 0.7817. ROC analysis showed an AUC of 0.814 for the training group and 0.7863 for the validation group. Conclusion: Gender, age, smoking habits, LDL, homocysteine, and folic acid independently influence the improvement of psychiatric symptoms in schizophrenia. Predictive models using these factors are effective and clinically valuable, with the resulting nomogram serving as a practical tool for evaluating potential symptom improvement in patients.
OBJECTIVE:Neuroplasticity refers to the tendency of the nervous system to change structurally and functionally due to experience. The adult visual cortex was historically presumed rigid and unchangeable. However, recent research has identified residual neuroplasticity in the visual cortex extending into adulthood, which may be mediated by environmental factors including visual deprivation. Eagleman and Vaughn proposed the Defensive Activation Theory (DAT) in 2021, which posits a role for rapid eye movement sleep (REMS)-related dreaming in preventing neuroplastic loss of visual function during the extended periods of visual deprivation that occur during sleep. METHOD:We reviewed research examining the extent of visual cortical plasticity across the human lifespan and the roles of sleep and dreaming regarding this neuroplasticity, providing further discussion of the DAT and potential areas for future investigation. CONCLUSION:Neuroplasticity in adulthood can contribute to functional outcomes, and sleep appears to play a role in mediating this neuroplasticity.
OBJECTIVE:Medical cannabis use is often motivated by somatic or affective concerns, and both are common among older adults. Protective behavioral strategies (PBS) are known to mitigate adverse outcomes associated with substance use. Goals of this study were to examine how somatic and affective use motives relate to use of PBS, cannabis use, and symptoms of cannabis use disorder. METHOD:The sample included 471 participants age 55+, recruited through social media, who self-reported legal medical cannabis use. Measures included cannabis use motives, subjective cannabis use patterns, the Protective Behavioral Strategies for Marijuana Scale (PBSM), Cannabis Use Disorder Symptoms questionnaire, Cannabis Use Disorder Identification Test-Revised (CUDIT-R). RESULTS:Both a measurement and a hypothesized model fit the data well (RMSEA = .036, CFI = .981, c2 = 112.57). Somatic use justifications were associated with greater PBS use, less cannabis use, and lower CUDIT scores. Affective use justifications were associated with less PBS use, more cannabis use, and higher CUDIT scores. Indirect pathways linking both somatic and affective use justifications with CUDIT score through PBS were statistically significant. CONCLUSIONS:Findings indicate that somatic justifications for cannabis use among older adults are associated with use of protective behaviors that reduce the risk for CUD symptoms, while affective motives suggest higher risk for CUD symptoms. These findings support the common practice of referring older adults with mental health concerns for conventional treatment, including evidence-based psychotherapy. Training in PBS use may mitigate escalation of CUD symptoms in this vulnerable population, and future research should examine that hypothesis.
OBJECTIVE:Although the relationship between childhood maltreatment (CM) and obsessive-compulsive disorder (OCD) is well known, no studies to date have examined the potential mediating roles of thought-action fusion (TAF) and schizotypal traits in the relationship between CM and OCD. In this study, we investigated whether TAF and/or schizotypal traits mediate the association between CM subtypes and OCD. METHOD:This study was conducted in 83 patients (18-65 years) with OCD. Participants completed Yale Brown Obsessive-Compulsive Scale (YBOCS) Childhood Trauma Questionnaire-Short Form (CTQ-SF), Thought-Action Fusion Scale (TAFS), and Schizotypal Personality Questionnaire-Brief (SPQ-B). Descriptive, correlational, and mediation analyses were used to determine the extent of the relationship between CM and OCD. RESULTS:The YBOCS scores showed significant correlations with SPQ-B total and SPQ-B interpersonal traits. Positive correlations were found between the YBOCS scores and emotional abuse, physical abuse, and emotional neglect. Emotional abuse was associated with cognitive, perceptual, and disorganized traits and TAF subscales. Emotional neglect was significantly associated with SPQ-B total, interpersonal, and cognitive-perceptual traits, as well as TAF likelihood-self. The mediation analysis indicated that the SPQ-B total significantly mediated the relationship between emotional abuse and emotional neglect and the YBOCS total. CONCLUSIONS:Contrary to expectations, neither moral nor the likelihood dimensions of TAF were significantly associated with OCD severity. As hypothesized, the indirect effects of emotional abuse and emotional neglect on OCD through total schizotypy were significant. Clinicians treating individuals who develop new or worsening OCD following maltreatment exposure should consider the role of schizotypal traits for treatment.
