BACKGROUND The "Montreal syndrome" is an emerging urban stress-related condition charac-terized by rage and anxiety triggered by the sight of construction cones, partic-ularly prevalent in Montreal, Canada. This case represents the first medically do-cumented instance of conophobia-induced road rage. CASE SUMMARY A 52-year-old man experienced an episode of intense anger and impulsive driving after encountering a series of orange traffic cones near his home. The event inc-luded verbal aggression, a traffic violation, and lingering emotional distress. He reported no prior psychiatric history, and imaging confirmed that a coincidental scalp mass was a benign lipoma, ruling out organic causes. The episode led to sym-ptoms consistent with adjustment disorder with mixed emotional features, without meeting criteria for intermittent explosive disorder. This case illustrates how environmental stressors in urban settings can provoke atypical behavioral responses in otherwise mentally healthy individuals. The "Montreal syndrome" defined by conophobia, avoidance, mood disturbance, and impulsive behavior, offers insight into how chronic urban disruption may impact public mental heal-th. The phenomenon is further contextualized alongside other city-named syn-dromes such as Stockholm and Florence syndromes. CONCLUSION The "Montreal syndrome" underscores the psychological impact of urban infra-structure. This case highlights the need for clinicians to recognize novel forms of situational distress and for urban planners to consider the mental health con-sequences of the built environment.

BACKGROUND:Auditory verbal hallucinations (AVH) are among the most disabling symptoms of schizophrenia and often persist despite treatment. Virtual reality-assisted therapies (VRT) are a new generation of relational interventions for AVH, but comparative evidence against active interventions is currently lacking. OBJECTIVE:This study aimed to assess whether VRT (9 sessions) is superior to a short course of cognitive behavioral therapy targeting AVH (CBT; 9 sessions) in reducing AVH in individuals with treatment-resistant schizophrenia. METHODS:In this assessor-blind, parallel-group randomized controlled trial conducted from 2019 to 2026 at an academic center in Montreal (Canada), adults with schizophrenia or schizoaffective disorder and persistent AVH were either referred by their healthcare team or self-referred. A total of 136 participants were randomized 1:1 to VRT or CBT, stratified by gender and clozapine use status. Both nine-session interventions targeted maladaptive beliefs and relationships with voices and were administered by trained psychotherapists. The predetermined primary outcome was the evolution of AVH severity over time, measured at baseline, post-treatment, and 3 months post-therapy with the auditory hallucination subscale of the Psychotic Symptoms Rating Scale. Secondary outcome notably included the general psychotic symptomatology measured using the Positive and Negative Syndrome Scale. Linear mixed‑effect models tested time‑by‑treatment interactions. Psychotherapy sessions and assessments were conducted primarily in person, with CBT being occasionally delivered via videoconference during the COVID-19 pandemic. RESULTS:Participants had a mean age of 40.3 years, 63% were male, and 57% received clozapine. Intention‑to‑treat analyses (VRT n=67; CBT n=69) showed a significant time‑by‑treatment interaction favoring VRT (p=0.013) with a moderate effect size at 3 months post-therapy (d=0.614). Both therapies showed significant within-group improvements in the primary outcome, with large effect sizes for VRT (d=0.81 post-therapy and d=1.17 at 3 months) and moderate for CBT (d=0.58 post-therapy and d=0.39 at 3 months). While there were no between-group differences for secondary outcomes, within-group improvements were observed in psychotic symptoms, emotional regulation, and voice acceptance for both therapies, while VRT also reduced maladaptive beliefs about voices and improved self‑esteem. CONCLUSIONS:VRT outperformed a targeted short course of CBT in reducing persistent AVH for up to three months after the intervention in a North American population with treatment‑resistant schizophrenia. Improvements were also seen in some secondary outcomes, such as general psychotic symptomatology, and those were similar for both interventions. Overall, these findings support VRT's value as a personalized and clinically effective intervention. CLINICALTRIAL:ClinicalTrials.gov [NCT04054778].

Objective People in acute crisis who seek psychiatric emergency services are clearly in great distress and likely already show signs of chronic stress. But how can we best measure chronic stress physiologically? Our study aims to assess allostatic load (AL), the "wear and tear" on biological systems that we can measure using different biological marker called biomarkers. Method We aim to assess biological and psychosocial dimensions related to psychiatric symptom changes among psychiatric emergency patients repeatedly evaluated at four-time points: (T1) 48-hours upon admission, (T2) end of hospitalization (about 2 weeks later), (T3) external follow-up (about 2 months), and (T4) 1 year later. We expect that (1) AL at T1 will distinguish psychiatric conditions, (2) higher AL will predict symptom trajectories over time, and (3) that combinations of modifiable risk and protective factors (e.g. health-related behaviors, psychosocial experiences) will boost or buffer these associations. We acquired funding in order analyze hair, saliva, and blood samples that have already been collected as part of the Signature Biobank that offers measures at T1 (N=1,984; 40% women; mean age 41 with a range from 18-81) as well as at T2 (n=685), T3 (n=606), & T4 (n=370). Results In the proposed project, we acquired funding to analyze biobanked tissues to index AL among all PEP and 149 healthy controls. Among subsamples with T2, T3, and T4 measures, we will assess prospectively changes in AL and psychiatric symptoms trajectories simultaneously. Conclusion From admission to remission, the study of psychiatric emergency patients is a unique opportunity to assess extreme profiles that can help refine precision medicine. The Signature Biobank will provide unique insights on the biological signatures of psychiatric conditions and changes over time while also providing unique knowledge and training opportunities for years to come supported by a transdisciplinary team.

Background Cognitive impairment, commonly known as "brain fog," is a persistent symptom in individuals recovering from COVID-19. Characterized by difficulties in memory, attention, and executive function, subjective cognitive complaints (SCC) significantly affect daily activities and quality of life. These complaints often do not correlate with objective cognitive assessments, necessitating reliable self-report tools. Aim and Objectives This study aimed to assess SCC in post-COVID-19 individuals using the Subjective Scale to Investigate Cognition in Emirates (SSTIC-E), a validated adaptation of the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS). The objectives were to determine SCC prevalence, explore associations with COVID-19-related clinical factors, and assess correlations with demographic and vaccination factors. Methodology A cross-sectional study of 210 participants (126 with mental health follow-up and 84 controls) assessed SCC using the SSTIC-E. Data on COVID-19 history, quarantine duration, vaccination status, and post-COVID-19 symptoms were collected. Statistical analyses were performed to examine relationships between SCC and clinical variables. Results The SSTIC-E showed high internal consistency (Cronbach’s alpha = 0.951). Participants were classified into three cognitive groups: good (35.3%), medium (25%), and poor (39.7%). Higher SCC scores were linked to longer quarantine and symptoms like anosmia. Conclusion This study highlights the prevalence of SCC in post-COVID-19 individuals and the importance of validated tools like the SSTIC-E for early identification and intervention.

The objective of this case report is to present a clinical challenge encountered by a patient followed at the Institut universitaire en santé mentale de Montréal (IUSMM) Psychotic Disorders Program: the coexistence of Ekbom syndrome and schizophrenia. Schizophrenia and Ekbom syndrome (delusional parasitosis) are 2 distinct psychiatric entities, yet they share similarities regarding delusional conviction, lack of insight, and response to antipsychotic treatment. Ekbom syndrome can occur as a primary delusional disorder or as a secondary manifestation within the context of schizophrenia. The American Psychiatric Association's DSM-5 criteria distinguish schizophrenia by the presence of multiple psychotic symptoms and greater functional impairment, whereas Ekbom syndrome is defined by a single, systematized somatic delusion, often manifesting outside of psychiatric contexts and accompanied by less pervasive negative symptoms.

Plain language summaryWhy similar scale names can create confusion in schizophrenia researchThis letter responds to comments about our recent meta-analysis on subjective cognitive complaints in schizophrenia using the SSTICS scale. One study included in the analysis used a Norwegian scale with a similar acronym (SACCS), highlighting a broader problem in the field: several cognitive complaint scales have very similar names despite being different instruments. We repeated the analyses after excluding this study, and the results remained almost unchanged. This suggests that the overall conclusions of the meta-analysis are robust. The discussion also highlights the importance of clearer scale nomenclature and transparent reporting in future systematic reviews and cross-cultural research.

Objectif Les personnes en situation de crise aiguë qui sollicitent les services d’urgence psychiatrique manifestent une détresse psychologique sévère et présentent probablement des signes physiologiques de stress chronique. Toutefois, comment mesurer au mieux le stress chronique ? Notre étude vise à évaluer la charge allostatique (CA), c’est-à-dire l’ « usure » des systèmes biologiques que nous pouvons mesurer à l’aide de différents marqueurs biologiques appelés biomarqueurs. Méthode Dans ce protocole utilisant les données de la Biobanque Signature, nous souhaitons évaluer les dimensions biologiques et psychosociales liées aux changements des symptômes psychiatriques chez les patient(e)s consultant à l’urgence psychiatrique. L’évaluation sera faite à 4 moments consécutifs : (T1) 1-4 jours après leur admission à l’urgence ; (T2) à la fin de leur hospitalisation (en moyenne 2 semaines plus tard) ; (T3) lors d’un suivi en consultation externe (en moyenne 2 mois plus tard) ; et (T4) environ 1 an plus tard. Nous prévoyons que : 1) la CA à T1 permettra de distinguer différents troubles psychiatriques ; 2) une CA plus élevée permettra de prédire l’évolution des symptômes au fil du temps ; et 3) que la combinaison de facteurs de risque et de protection modifiables (p. ex. les comportements liés à la santé, les expériences psychosociales) renforcera ou atténuera ces associations observées. Nous avons obtenu un financement conséquent des IRSC afin d’analyser les échantillons de cheveux, de salive et de sang, prélevés et conservés par la Biobanque Signature. Cette analyse constituera des mesures à T1 ( N = 1984 ; 40 % de femmes ; âge moyen de 41 ans, avec une fourchette allant de 18 à 81 ans) ainsi qu’à T2 ( n = 685), T3 ( n = 606) et T4 ( n = 370). Résultats Le projet proposé permettra d’indexer la CA chez les patient(e)s et les 149 participant(e)s témoins sans trouble psychiatrique récent. Parmi les sous-échantillons avec des mesures T2, T3 et T4, nous évaluerons simultanément, de manière prospective, les changements de la CA et les trajectoires des symptômes psychiatriques. Conclusion De l’admission à la rémission, l’étude des patient(e)s en urgence psychiatrique est une occasion unique d’évaluer des profils extrêmes qui peuvent contribuer à des approches de médecine de précision. La Signature Biobanque apportera des données uniques sur les signatures biologiques des troubles psychiatriques et leur évolution dans le temps, tout en offrant des possibilités de connaissances uniques et renforcement des capacités pour les années à venir, avec le soutien d’une équipe transdisciplinaire.

Suicidal ideation (SI) is common among patients presenting to psychiatric emergency departments (EDs), yet its association with longer-term clinical and functional outcomes remains insufficiently understood. This study examined trajectories of functional disability, depressive and anxiety symptoms, and alcohol misuse among patients with mood and anxiety disorders according to SI at ED presentation.Data were drawn from a prospective cohort of 261 adults with mood and anxiety disorders presenting to a psychiatric ED and followed for 12 months. Linear mixed-effects models examined longitudinal outcomes according to baseline SI, adjusting for sociodemographic, clinical, and psychosocial factors. A secondary analysis examined longitudinal associations between time-varying SI and depressive symptoms.Baseline SI was associated with greater functional disability and more severe depressive and anxiety symptoms throughout follow-up, but not with alcohol misuse. Time-by-SI interactions were nonsignificant for all outcomes, indicating similar trajectories regardless of baseline SI. Depressive and anxiety symptoms improved over follow-up, whereas functional disability increased at discharge before stabilizing, and alcohol misuse decreased only at 12 months. Poor sleep satisfaction, chronic physical illness, and higher impulsivity were associated with poorer outcomes. Male sex and religious or spiritual coping were associated with lower functional disability and/or fewer depressive and anxiety symptoms. Older age was associated with lower alcohol misuse. Time-varying SI was associated with depressive symptoms at both within- and between-person levels.SI at psychiatric ED presentation may identify patients with sustained clinical and functional burden despite similar patterns of change over time, supporting comprehensive assessment and post-discharge monitoring alongside suicide-risk assessment.

Les hallucinations à contenu sexuel, en particulier cénesthésiques et orales, sont rarement décrites dans la littérature psychiatrique malgré leur potentiel de détresse et d’impacts sur le suivi thérapeutique. Nous rapportons le cas d’une femme de 51 ans présentant un ensemble complexe de symptômes psychotiques, incluant des hallucinations cénesthésiques à contenu de « relations sexuelles orales forcées », accompagnées d’hallucinations multimodales (gustatives, visuelles, auditives, olfactives) ainsi que d’une méfiance prononcée envers les soignants. À notre connaissance, en l’état actuel de la littérature scientifique explorée dans Medline et Google Scholar, aucune entité nosographique autonome correspondant à un « délire de fellation » ( fellatio delusion ) n’est reconnue, et ni le DSM-5-TR ni la CIM-11 ne décrivent de syndrome spécifique centré sur ce contenu. De telles manifestations s’intègrent davantage dans le cadre d’un sous-type rare et sévère d’hallucinations sexuelles ou somatiques au sein de troubles psychotiques constitués, le plus souvent du spectre schizophrénique, doivent être soigneusement distinguées du phénomène d’incubus, une parasomnie liée à la paralysie du sommeil, caractérisée par une sensation de pression corporelle et des hallucinations pouvant inclure une composante sexuelle. Nous discutons de la sémiologie, du diagnostic différentiel, des défis thérapeutiques, des implications éthiques et déontologiques, et de l’adaptation du suivi clinique, particulièrement en lien avec le genre des cliniciens impliqués.

Background The Healthy Minds Study (HMS) Questionnaire is an assessment tool that examines mental health, service awareness and help-seeking behaviour (including stigma and knowledge) among university students.Aims A shortage of tools specifically designed to cater to student populations has resulted in limited data from Arabic-speaking countries on mental health in university students. Our study aimed to describe the prevalence of mental health symptoms, service awareness, stigma and help-seeking attitudes among medical students at the United Arab Emirates (UAE) University.Method We conducted a cross-sectional survey of 87 medical students at the UAE University, using the HMS Questionnaire.Results A total of 73.6% reported at least mild depressive symptoms (Patient Health Questionnaire-9 (PHQ-9) >= 5), 35.8% met criteria for probable major depression (PHQ-9 >= 10), 46% screened positive for anxiety, 11.5% reported non-suicidal self-injury, 9.2% reported seriously thinking of suicide, 13.8% reported symptoms of an eating disorder, 8.1% agreed that they would think less of a person who has received mental health treatment and 69% agreed that most people would think less of a person who has received mental health treatment.Conclusions We found a high prevalence of mental health difficulties and a reluctance to report and seek help for mental health difficulties among medical students in the UAE, which may be associated with a negative perceived public stigma.

Background Hallucinations with sexual content, particularly cenesthetic and oral hallucinations, are rarely reported in the psychiatric literature despite their significant potential for distress and impact on therapeutic engagement. Case presentation We describe a 51-year-old woman presenting with a complex psychotic picture, including cenesthetic hallucinations experienced as "forced oral sexual acts," associated with multimodal hallucinations (gustatory, visual, auditory, and olfactory) and marked mistrust toward healthcare providers. Differential diagnosis A review of the literature using MEDLINE and Google Scholar found no recognized autonomous nosographic entity corresponding to a "fellatio delusion," and neither the DSM-5-TR nor the ICD-11 describes a syndrome specifically centered on this content. Sexual-themed delusions in psychotic disorders are categorized by their general content rather than by specific sexual acts such as fellation. These manifestations are better conceptualized as a rare and severe subtype of sexual or somatic hallucinations within established psychotic disorders, most commonly schizophrenia spectrum disorders, and must be differentiated from the incubus phenomenon, a parasomnia occurring during sleep paralysis. Treatment Management required an integrated and adaptive therapeutic approach addressing psychotic symptoms, patient distress, and relational challenges within the clinical team. Outcome and follow-up Clinical follow-up highlighted the importance of tailoring care to ethical, relational, and gender-sensitive considerations in the therapeutic setting. Discussion This case underscores the need for careful phenomenological assessment, accurate differential diagnosis, and ethically informed clinical adaptation when managing rare and distressing sexual hallucinations in psychotic disorders.

OBJECTIVES:This study aimed to investigate the shared and distinct activation patterns between a hallucination capture task and a task consisting of exposure to an avatar representing the participants' most distressful auditory verbal hallucination (AVH) (Avatar task).Methods: Twenty participants with schizophrenia and persistent AVHs were recruited. During an fMRI session, they performed the Avatar task and the hallucination capture task. Whole-brain analyses were performed for each task. The potentially shared and distinct activations between tasks were examined using a region of interest (ROI) approach. To avoid inflating the number of brain regions tested, we selected as ROIs brain regions involved in language (left inferior frontal gyrus), emotional processing (amygdala) and social cognition (dorsomedial prefrontal cortex). RESULTS:We found that participants with AVHs exhibited significant activation in the left inferior frontal gyrus during the hallucination capture task. In contrast, they showed significant activation in the left amygdala and the left dorsomedial prefrontal cortex during the Avatar task. Conjunction and disjunction analyses produced similar results. CONCLUSIONS:The exposure to the AVH avatar specifically activated regions involved in emotional processing and social cognition, suggesting that the Avatar task is relevant for exploring the neural mechanisms involved in dialogical therapies for AVH.

Background: Subjective cognitive complaints, or neurocognitive insight, reflect to patients' awareness of cognitive functioning. In schizophrenia, these complaints show inconsistent links with objective cognition, psychiatric symptoms, and illness insight. The Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), a validated self-report tool developed in Canada and used internationally, enables a homogeneous synthesis. Objective: This meta-analysis examined whether subjective complaints measured with the SSTICS are associated with objective cognition, psychiatric symptoms, and illness insight, and reviewed its factorial structure. Method: We conducted a meta-analysis following PRISMA guidelines. Systematic searches of PubMed, Web of Science, and Google Scholar identified studies using the SSTICS in psychiatric populations. Eligible studies compared patients to healthy controls and/or examined correlations with cognition, symptoms, or illness insight or conducted factor analyses of the SSTICS domains. Results: Twenty-five studies (N = 3,205) met criteria. Schizophrenia patients reported more cognitive complaints than controls (d = 0.746). No significant correlation emerged with global objective cognition (r = 0.105). Complaints were unrelated to positive, negative, or general symptoms but showed a moderate association with depressive symptoms (r = 0.300) and a small one with illness insight (r = 0.155). Factor analyses consistently identified 3 domains: memory, attention, and daily living. Conclusions: SSTICS-based complaints are substantial in schizophrenia but largely dissociated from objective cognition, reflecting impaired neurocognitive insight. Instead, they are more strongly linked to depressive symptoms, suggesting complaints reflect emotional distress rather than actual deficits. Findings support refining SSTICS subscales and extending investigations to other psychiatric populations.