We describe Addison's disease, which is the disease caused by Adrenal Gland Insufficiency. Addison's disease is an uncommon endocrine disorder characterised by inadequate production of hormones, predominantly aldosterone and cortisol, by the adrenal glands. This condition occurs due to damage to the adrenal cortex, the region responsible for hormone synthesis. Clinical manifestations of Addison's disease are often insidious and nonspecific, including symptoms such as myasthenia, persistent fatigue, unintentional weight loss, hypotension, and hyperpigmentation of the skin, especially in areas subjected to friction. A number of Neuropsychiatric manifestation, including Depression, and Psychosis can also occur. The aetiology is primarily autoimmune adrenalitis, where the immune system erroneously attacks and destroys adrenal cortical cells. Other aetiologies include infectious agents like Mycobacterium tuberculosis, which can infiltrate and impair the adrenal glands. Hemorrhagic damage to the adrenal cortex can occur secondary to severe stress, trauma, or coagulopathies. Additionally, metastatic neoplasms may involve the adrenal glands, leading to their destruction. Less frequently, genetic disorders such as adrenoleukodystrophy can compromise adrenal function by affecting both the cerebral white matter and adrenal cortex. Adrenal cortex damage can also result from adrenalectomy or the administration of medications that inhibit steroidogenesis. The pathophysiology of Addison's disease involves the disruption of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in cortisol deficiency, which is critical for regulating metabolism, immune function, and stress responses. Aldosterone deficiency leads to dysregulation of sodium and potassium homeostasis, causing hypotension and dehydration. Management of Addison's disease requires lifelong glucocorticoid and mineralocorticoid replacement therapy, typically with hydrocortisone or fludrocortisone, along with ongoing monitoring and dosage adjustments during periods of stress, illness, or surgical interventions. While describing Addison's Disease we describe the illness as experienced by Elizabeth of the Trinity, a Catholic Nun who suffered the illness in the early part of the Twentieth Century, whose illness is described from her letters and eyewitness accounts, taken for her beatification and canonisation findings. We describe how the illness it was viewed then, when it was seen as incurable, with great deficiencies in both diagnosis and treatment, and how the aetiology has changed over the years. Hence we show how the suffering endured by this person had both mental and physical aspects.

From time to time, tragic cases occur when patients with serious Mental illness commit homicide. We describe two cases which are in the public domain.These cases are not isolated incidents but part of a broader, systemic failure to provide sustained, assertive, and well-resourced community-based mental health care. It is crucial that the techniques of Assertive Outreach we have discussed are not only adopted in principle but also fully integrated into everyday practice, backed by proper funding, staff training, and institutional support. Without this commitment, we risk continuing the tragic cycle of preventable deaths, where both patients with severe mental illness and innocent bystanders pay the price for gaps in the system. By applying assertive outreach models effectively, we have the opportunity to change the trajectory of care, ensuring that vulnerable individuals receive the intensive, proactive support they need to remain stable, safe, and ultimately, to prevent such tragedies from happening again.

Here we discuss whether the type of love which is expressed as religious Catholics who want to offer their suffering in union with the suffering of Jesus Christ has the same neurological pathways as the usual pathways related to love, that is a neurological pathway linked with the the Reward System and based on Dopamine as the main neurotransmitter. We propose that this type of love is probably based on an input from the Mirror Neuron System, which is related to Empathy. and the Default Mode Network. We accept that there are different inputs for the different types of love but the main output in all cases is the release of Dopamine as a Neurotransmitter. We argue that, while all types of love have, as a final pathway, the release of Dopamine from the Reward system, the type of love which is associated with suffering in union with the suffering of Jesus Christ is related to inputs related to Empathy. and the identifying of the self. By highlighting this perspective, we underscore the importance of recognising and respecting the profound dignity of individuals who choose to engage with their suffering in this meaningful way.

In this article, we describe why we consider it important to stage cases of schizophrenia. Treatment in the three stages of Schizophrenia, that is: the At risk Mental State; the first episode and three year critical period; and the phase of Chronic Schizophrenia is different. We also describe how MRI studies provide the view of anatomical changes which underpin the stages.

In this article we describe the case of Molly Russell, whose suicide was caused by the on line content that she accessed while she was suffering from depression. We describe how this was brought about by the algorithms used in social media sites and the use of the internet to inappropriately call for help in depression instead of turning to human persons for help. We describe the legal measures taken to improve safety for young persons using the internet, and we advise the importance of educating young persons on proper use of the internet and proper understanding of its potential.

Accurate diagnosis of mood disorders, particularly depression and bipolar disorder, is essential for effective treatment planning and patient management. This article emphasizes the need for systematic symptom assessment and longitudinal analysis in facilitating the precise diagnosis and planning appropriate treatment interventions. By meticulously evaluating the symptomatology and delineating the longitudinal trajectory of the illness, clinicians can distinguish between unipolar depression and bipolar disorder, and therefore optimise patient outcomes. The article describes the inherent complexities in diagnosing mood disorders. It describes the overlapping symptomatology and diagnostic challenges. Through a comprehensive review of literature and clinical insights, it argues for a structured approach to symptom assessment, focusing on both the current presentation and also retrospective evaluation of illness progression. By elucidating the longitudinal trajectory of the illness, including the presence of episodes of high mood suggestive of bipolar disorder, clinicians can differentiate between mood disorders accurately. The article discusses the implications of accurate diagnosis on treatment planning and patient prognosis. A precise diagnosis enables clinicians to plan treatment strategies to the specific needs of the individual, including pharmacotherapy, psychotherapy, or both. By addressing the underlying mechanisms and trajectory of the illness, clinicians can implement targeted interventions which reduce the risk of misdiagnosis and which optimize therapeutic outcomes.

INTRODUCTION:Schizophrenia is a complex psychiatric disorder characterized by heterogeneous symptom trajectories that significantly impact patient outcomes. We believe that the study of the trajectories of Schizophrenia is useful in assessing treatment options and outcomes. While the Positive and Negative Syndrome scale is usually used on one occasion to measure symptoms at a single time, if measured repeatedly , the PANSS is also useful in measuring trajectories. In order to illustrate and promote this serial use, we have reviewed papers which describe the delineation of Trajectories of Symptoms in Schizophrenia based on PANSS scores. This review integrates findings from longitudinal studies focusing on the trajectories of positive symptoms, negative symptoms, the relation between positive and negative symptoms and cognition, soft neurological signs, and treatment response in schizophrenia. METHODS:Studies were identified from the PUBMED database .Studies included in this review employed diverse methodologies such as trajectory analyses, longitudinal assessments, and clinical trials. Data were extracted from a range of patient cohorts, including those with first-episode psychosis and chronic schizophrenia. RESULTS:Longitudinal studies consistently demonstrate variability in the trajectories of positive symptoms, with most patients experiencing early stable remission, though a subgroup exhibits persistent or fluctuating symptomatology. Negative symptoms, on the other hand, often show poor improvement over time, correlating with impaired social and neurocognitive functioning. Cognitive deficits also vary, with some domains showing improvement while others, such as logical memory, deteriorate in certain patient subgroups. The relationship between positive and negative symptom trajectories highlights their complex relationship, influencing overall functioning and treatment outcomes. Antipsychotic medications demonstrate varied responses across patient cohorts, with distinct trajectory patterns observed based on medication type and patient-specific factors such as co-morbid substance abuse and duration of untreated psychosis. CONCLUSION:Understanding the longitudinal trajectories of symptoms in schizophrenia is crucial for optimizing therapeutic strategies and improving patient outcomes. Personalised interventions tailored to individual symptom profiles and early clinical responses are recommended to enhance treatment efficacy and promote recovery. The PANSS scale can be used to delineate Trajectories of various symptom Groups in Schizophrenia.

We examine whether Sandra Sabattini, a young Medical Student who was beatified by Pope Francis in 2021 should be seen as a role model for medical students, and potentially seen as their patron saint. We examine the difference between Patron Saint and Role Model. We make the case that, given the importance of the Doctor-Patient Relationship, there is need for Medical Students to have a Role Model. We examine the environment, philosophy, and methodology in which Sandra Sabattini worked and we examine how she related to patients, based on Eyewitness accounts. We identify that Sandra worked in a holistic way and related to patients in a very personal way. Thus we conclude that Sandra Sabattini is indeed a useful role model for medical students, further, we note her ''pro-life'' philosophy.

In this paper we describe the physiology and endocrinology of the women's reproductive system as this refers to the function of the brain and the functioning of Oestrogen and Progesterone Receptors within the brain. We compare this to the description of woman's nature as described by the philosopher and psychologist Edith Stein, who has described the describing specific characteristics and behaviours of women, which fit woman for contributing to the professions as well as the family. We ask whether Stein's description of the characteristics of woman, is in fact consonant with the neuroscience which we have described. We conclude that these two concepts are consonant, in other words, the neuroscience of the female reproductive system and Edith Stein's characteristics of woman are not mutually exclusive and are two concepts which potentially support each other.

We review the development of clinical staging models of schizophrenia, which has developed as a logical extension of the Neuro-developmental theory of Schizophrenia. The staging approach, which involves assessing a disorder based on its severity, scope, progression, and characteristics, is gaining growing recognition in the fields of clinical psychology and psychiatry. We review the development of clinical staging models of schizophrenia, which has developed as a logical extension of the Neuro-developmental theory of Schizophrenia. The development of these clinical staging models should be based also on the neuroimaging dana, since this implies actual changes within the brain. There still are some difficulties with these models, but they are gradually providing both more logical ways of understanding the development of psychotic illness and more effective ways of treatment. The Models have contributed to research in several areas of psychiatry.

Depression is a common condition which causes serious of morbidity among the population. While treatment is often provided with pharmacological antidepressants and psychotherapy, many patients do not respond to such treatment, and therefore algorithms have been proposed to develop treatments for resistant depression. Transcranial Magnetic Stimulation is a relatively new form of treatment for depression, which appear to have a good safety profile and appear to be acceptable to patients. Other forms of Brain Stimulation, such as Electro-Convulsive therapy, have a more complex safety profile, and require anaesthesia. Still other forms of electrical stimulation of the brain, such as Vagus nerve Stimulation are invasive in nature. The position of a particular modality of treatment in the Algorithm for the treatment of Resistant Depression depends on a balance between effectiveness of treatment, side effect profile, acceptability to the patients, availability of treatment, invasiveness of treatment, and the possibility of combining it with other treatments. Here we assess the position of Transcranial Magnetic Stimulation in such an Algorithm for the treatment of Resistant Depression. Given its effectiveness and its relatively good side effect profile, we suggest that it could be used early in the treatment of depression, however its use may be limited by lack of necessary equipment. On the other hand, Electro-convulsive therapy must be reserved for much more resistant cases, because of the need for anaesthesia and muscle relaxants, as well as its side effect profile, even though it might be somewhat more effective than the other modalities. Further study of Transcranial Magnetic Stimulation and are warranted.

Depression is a common condition which causes serious of morbidity among the population. While treatment is often provided with pharmacological antidepressants and psychotherapy, many patients do not respond to such treatment, and therefore algorithms have been proposed to develop treatments for resistant depression. Transcranial Direct Current Stimulation is a relatively new form of treatment for depression, which appear to have a good safety profile and appear to be acceptable to patients. Other forms of Brain Stimulation, such as Electro-Convulsive therapy, have a more complex safety profile, and require anaesthesia. Still other forms of electrical stimulation of the brain, such as Vagus nerve Stimulation are invasive in nature. The position of a particular modality of treatment in the Algorithm for the treatment of Resistant Depression depends on a balance between effectiveness of treatment, side effect profile, acceptability to the patients, availability of treatment, invasiveness of treatment, and the possibility of combining it with other treatments. Here we assess the position of Transcranial Direct Current Stimulation in such an Algorithm for the treatment of Resistant Depression. Given its effectiveness and its relatively good side effect profile, we suggest that it could be used early in the treatment of depression, however its use may be limited by lack of necessary equipment. On the other hand, Electro-convulsive therapy must be reserved for much more resistant cases, because of the need for anaesthesia and muscle relaxants, as well as its side effect profile, even though it might be somewhat more effective than the other modalities. Further study of Transcranial Direct Current Stimulation is warranted.

Edith Stein has written a great deal about the nature of women and has advocated for the place of women in society and their place in the professions. We have written a series of papers describing the relationship between the findings of neuroscience and the differences between the female and male brains. Here we summarise how our knowledge of these differences underpin Edith Stein's view of the nature of women, and therefore validate Stein's particular view of feminism.

Mental trauma is a consequence of war. Here we consider whether the inflicting of such trauma, which could cause personality changes, should be considered a war crime in its own right, especially when it is civilians who are exposed to mental trauma. We make the argument based on a review of the development of personality disorders in persons exposed to mental trauma caused by war, and we make the argument that it is possible to demonstrate both physiological and anatomical changes in the brain of such persons, which could account for the observed behavioural and personality changes. Therefore we argue that deliberate exposure to Mental Health Trauma, for example by deliberate targeting of civilian areas with artillery, should be considered a war crime in its own right irrespective of whether the civilians receive physical trauma or not.

For several years now, the performing arts have been used to Educate about Mental Health Problems. An important aim is to eliminate stigma, which is a multifaceted concept which has several causes including shame and which is thought to act as a barrier to successful help seeking and engagement with support services by persons with mental health problems. There have been many art forms used, from One Man Shows, to films, Plays, Dance, or Singing. Recently Opera has been added to this collections of art form initiatives . We review the publications on how performing arts have been used to destigmatise mental health problems, including those in which an attempt has been made to measure the impact quantitatively. We then review Ciklu, a new Maltese Opera production which attempts to destigmatise Mental Health Problems, to show that it fits within the worldwide attempt to use performing arts to destigmatise Mental Health Issues.

That 'Childhood Adversity', which includes many traumatic events but in particular includes sexual abuse during childhood, can cause changes in the brain, such as the finding of a smaller hippocampus is well established by the observations of such persons as Thomas Frodl (2008, 2013). That traumatic events in adulthood can also cause both clinical symptoms such as Post Traumatic Stress Disorder, with equivalent shrinkage of the hippocampus (Smith 2005), is also well known. In this article we apply these neurological findings to the particular traumatic event of sexual abuse at any age, first to demonstrate that such abuse can indeed cause a number of mental illnesses, and hence to produce a model of how different forms of mental trauma may cause different mental illnesses. Next we describe human sexuality as a form of language, whereby feelings ranging from love to indifference to exercise of power to hatred can be expressed. We suggest that the expression of these feelings can give rise to positive feelings or to the mental illnesses we have mentioned. We emphasize how free choice is central to the 'messages' that we give to our partners through our sexuality - and therefore that we are responsible for those messages and their consequences. We point out therefore that inappropriate choices by the couple may lead to the consequent neurological changes and mental health symptoms we have mentioned. We finally analyse the act of sexual intercourse into a number of component functions (or consequences) including the Generative Function - that of producing another human person, the Choice Function - that of choosing the other person, the Language Function - that of communicating that choice to the other person and the Empowering Function- that of empowering the other person. We propose a model of human sexuality in which these four functions are linked together, so that in normal circumstances they work together in complete harmony, however, numerous circumstances of modern life can cause these four functions to operate asyncronously, thus leading to the neurological changes which we have mentioned above. These neurological changes are associated with the changes in hippocampal size which we have described above. Thus in our model, we have linked the Neurological changes of Trauma with factors relating to Choice, psychological concepts, and consequent symptomatology of illness. We do this in the context of a model of the Human Person in which mind and body are linked so that the human person can be understood as an 'Embodied Spirit', rather than the Cartesian Model. This concept goes back to the model of the Human Person of Aristotle, and was re-expressed in Medieval times by Aquinas and Augustine, and is congruent with Phenominology as expressed by Husserl and Stein. We have previously argued that such an 'Embodied Spirit' model of the Human Person is more congruent with modern neuroscience than a Cartesian Model (Agius 2017).

Objective Tinnitus is associated with a variety of cognitive, psychosocial and psychiatric disorders, and may contribute to suicidality. However, the prevalence of suicidal ideation (SI) in tinnitus populations has not previously been systematically reviewed. Method Medline, Embase and PsychInfo were searched in August 2020 to identify studies that assessed suicidal ideation in people aged 16 years and above with subjective tinnitus. Results Six cross-sectional studies were included, representing 7192 tinnitus sufferers across 4 countries. The pooled prevalence of suicidal ideation in tinnitus populations was 20.6 per cent (95 per cent confidence interval, 10.8-30.3 per cent; I-2 = 88 per cent). Two studies included a control population, in which the prevalence of suicidal ideation was significantly lower. The quality of included studies was variable. Conclusion It is not possible to arrive at any reasonable conclusion given the lack of quality studies, meaning the pooled prevalence should be interpreted very cautiously. Suicidal ideation may be more prevalent in tinnitus populations. Further large-scale epidemiological research investigating this relationship is needed, which may help psychiatric risk stratification.

Objective. Tinnitus is associated with a variety of cognitive, psychosocial and psychiatric disorders, and may contribute to suicidality. However, the prevalence of suicidal ideation (SI) in tinnitus populations has not previously been systematically reviewed. Method. Medline, Embase and PsychInfo were searched in August 2020 to identify studies that assessed suicidal ideation in people aged 16 years and above with subjective tinnitus. Results. Six cross-sectional studies were included, representing 7192 tinnitus sufferers across 4 countries. The pooled prevalence of suicidal ideation in tinnitus populations was 20.6 per cent (95percentconfidence interval, 10.8–30.3percent; I = 88percent).Twostudies includedacontrol population, in which the prevalence of suicidal ideation was significantly lower. The quality of included studies was variable. Conclusion. It is not possible to arrive at any reasonable conclusion given the lack of quality studies, meaning the pooled prevalence should be interpreted very cautiously. Suicidal ideation may be more prevalent in tinnitus populations. Further large-scale epidemiological research investigating this relationship is needed, which may help psychiatric risk stratification.