Search Results (11,993)

Objectives: The aim of this study was to evaluate the effects of spinal cord stimulation (SCS) on pain, neuropathic symptoms, and other health-related metrics in patients with chronic painful peripheral neuropathy (PN) from multiple etiologies. Methods: A prospective single center observational longitudinal cohort study assessed SCS efficacy from April 2023 to May 2024, with follow-ups at 2, 4, 6, and 12 months in 19 patients suffering from the painful polyneuropathy of diverse etiologies: diabetic (DPN), idiopathic (CIAP), chemotherapy-induced (CIPN), and others. Patients were implanted with a neurostimulator (WaveWriter Alpha^TM, Boston Scientific Corporation, Valencia, CA, USA) and percutaneous leads targeting the lower limbs (T10–T11) and, if necessary, the upper limbs (C4–C7). Stimulation programming was individualized based on patient preference and best response. Assessments were performed before and after implantation and included pain intensity (VAS and DN4), neuropathic pain symptoms (NPSI and SF-MPQ-2), autonomic symptoms (SFN-SIQ and SAS), sensory and small fiber nerve injury (UENS), functionality (GAF), sleep (CPSI), global impression of change (CGI and PGI), and quality of life (EQ-VAS and EQ-5D). Intra-epidermal nerve fiber density (IENFD) via skin biopsy was also performed at baseline (diagnostic) and after 12 months to assess potential small fiber re-growth. Statistical analyses were conducted to determine the evolution of treatment success. Results: To date, 19 patients have undergone implantation and completed follow-up. SCS produced a significant consistent and sustained improvement in pain intensity by 49% in DN4 and 76% in VAS, in neuropathic pain symptoms by 73%, in autonomic symptoms by 26–30%, in the sensorimotor physical exam by 8%, in functionality by 44%, in sleep by 74%, and in quality of life (69% for EQ-VAS and 134% EQ-5D). Both clinicians and patients had a meaningful global impression of change, at 1.1 and 1.3, respectively. Distal intra-epidermal nerve fiber density improved by 22% at 12 months while proximal intra-epidermal nerve fiber density decreased by 18%. Conclusions: SCS is an effective therapy for managing various types of PN. Full article

Endometriosis is a widely spread disease that affects about 8% of the world’s female population. This condition may be described as a spread of endometrial tissue apart from the uterine cavity, but this process’s pathomechanism is still unsure. Apart from classic endometriosis symptoms, which are pelvic pain, infertility, and bleeding problems, there are neuropsychiatric comorbidities that are usually difficult to diagnose. In our review, we attempted to summarize some of them. Conditions like migraine, anxiety, and depression occur more often in women with endometriosis and have a significant impact on life quality and pain perception. Interestingly, 77% of endometriosis patients with depression also have anxiety. Neuroimaging gives an image of the so-called endometriosis brain, which means alternations in pain processing and cognition, self-regulation, and reward. Genetic factors, including mutations in KRAS, PTEN, and ARID1A, influence cellular proliferation, differentiation, and chromatin remodeling, potentially exacerbating lesion severity and complicating treatment. In this review, we focused on the aspects of sciatic and obturator nerve endometriosis, the emotional well-being of endometriosis-affected patients, and the potential influence of endometriosis on dementia, also focusing on prolonged diagnosis. Addressing endometriosis requires a multidisciplinary approach, encompassing molecular insights, innovative therapies, and attention to its psychological and systemic effects. Full article

The objective identification of depression using physiological data has emerged as a significant research focus within the field of psychiatry. The advancement of wearable physiological measurement devices has opened new avenues for the identification of individuals with depression in everyday-life contexts. Compared to other objective measurement methods, wearables offer the potential for continuous, unobtrusive monitoring, which can capture subtle physiological changes indicative of depressive states. The present study leverages multimodal wristband devices to collect data from fifty-eight participants clinically diagnosed with depression during their normal daytime activities over six hours. Data collected include pulse wave, skin conductance, and triaxial acceleration. For comparison, we also utilized data from fifty-eight matched healthy controls from a publicly available dataset, collected using the same devices over equivalent durations. Our aim was to identify depressive individuals through the analysis of multimodal physiological measurements derived from wearable devices in daily life scenarios. We extracted static features such as the mean, variance, skewness, and kurtosis of physiological indicators like heart rate, skin conductance, and acceleration, as well as autoregressive coefficients of these signals reflecting the temporal dynamics. Utilizing a Random Forest algorithm, we distinguished depressive and non-depressive individuals with varying classification accuracies on data aggregated over 6 h, 2 h, 30 min, and 5 min segments, as 90.0%, 84.7%, 80.1%, and 76.0%, respectively. Our results demonstrate the feasibility of using daily wearable-derived physiological data for depression recognition. The achieved classification accuracies suggest that this approach could be integrated into clinical settings for the early detection and monitoring of depressive symptoms. Future work will explore the potential of these methods for personalized interventions and real-time monitoring, offering a promising avenue for enhancing mental health care through the integration of wearable technology. Full article

Background and Objectives: Spinocerebellar ataxia (SCA) is a progressive neurodegenerative disease often accompanied by depression. This cross-sectional study investigated the prevalence of depression and the associated mental health factors in SCA patients. Material and Methods: Eleven Thai SCA patients completed questionnaires assessing depression, anxiety, inner strengths, perceived social support, personality traits and perceived stress. Results: Participants’ average age was 50.27 years old. The prevalence of depression was 27.27%. Depression scores were positively correlated with OI-anxiety score (r = 0.887, 95%CI 0.586 to 0.968), perceived stress (r = 0781, 95%CI 0.305 to 0.936) and personality traits including aggression (r = 0.73, 95% CI 0.197 to 0.920), activity (r = 0.651, 95%CI 0.052 to 0.893) and neuroticism (r = 0.80, 95% CI 0.351 to 0.942). Conversely, depression negatively correlated with inner strengths (r = −0.70, 95%CI −0.910 to −0.139) and perceived social support, particularly from family (r = −0.88, 95%CI −0.966 to −0.564). Conclusions: These findings highlight the need for comprehensive mental health assessment and intervention in SCA patients. Strengthening inner strengths, promoting social support, and managing negative mental health factors may improve quality of life for patients with SCA. Full article

Background and Objectives: This study aimed to identify asymptomatic brain lesions in patients with β-thalassemia major (TM) and sickle cell anemia (SCA) and evaluate the correlation of these lesions with factors such as splenectomy, thrombocytosis, and blood transfusions. Materials and Methods: A total of 26 patients with thalassemia major and 23 patients with sickle cell anemia were included. Ischemic lesions were categorized as lacunar, small vessel, or multifocal. Variables including age, years of education, presence and type of MRI-detected ischemia, smoking status, hemoglobin, hematocrit, platelet count, ferritin levels, vitamin B12 levels, fasting blood sugar, splenectomy status, chelation therapy, and hydroxyurea treatment were compared between the two groups. Results: The mean age was 27.33 years in the thalassemia major group and 32.65 years in the sickle cell anemia group (p = 0.010). No statistically significant difference was observed in the distribution of ischemia types between the groups (p = 0.303). The thalassemia major group had a lower mean hemoglobin level (8.37 g/dL) compared to the sickle cell anemia group (9.57 g/dL) (p = 0.003). Ferritin levels were significantly higher in the thalassemia major group (2018.92 ng/mL) than in the sickle cell anemia group (660.39 ng/mL) (p < 0.001). Conclusions: Although ischemic lesions were more frequently observed in patients with sickle cell anemia, the difference was not statistically significant. These findings emphasize the importance of ongoing surveillance and individualized management to mitigate cerebrovascular risks in both patient populations. Full article

Parental attitudes and peer victimization experiences in childhood influence anxiety. Depressive rumination is associated with these factors, but the interrelationship between them remains unclear. In this study, we hypothesized that “inadequate parental attitudes” and “peer victimization” experienced in childhood worsen “depressive rumination” and “state anxiety”, and that “depressive rumination” is an intermediate factor that worsens anxiety symptoms in adulthood. We verified this interrelationship by structural equation modeling. A cross-sectional questionnaire study was conducted on 576 adult volunteers, who gave written consent. Demographic data and scores from the Parental Bonding Instrument, Childhood Victimization Rating Scale, Ruminative Responses Scale, and state anxiety of State-Trait Anxiety Inventory Form Y were collected. Data were analyzed by multiple regression analysis and structural equation modeling. In the study models, inadequate parental attitudes (low care and high overprotection) and depressive rumination directly worsened anxiety. Inadequate parental attitudes and peer victimization experienced in childhood indirectly worsened anxiety via depressive rumination. Furthermore, inadequate parental attitudes experienced in childhood indirectly worsened depressive rumination via peer victimization in childhood. Our results indicate that depressive rumination influences the relationship between inadequate parental attitudes, peer victimization, and adulthood anxiety. Therefore, assessing the quality of parental attitudes and peer victimization experienced in childhood and depressive rumination may help to clarify the antecedents of anxiety and how to intervene effectively. Full article

Background: Anthrax is a serious disease caused by Bacillus anthracis (B. anthracis) with a very high mortality when the spores of B. anthracis are inhaled (inhalational anthrax). Aerosolized B. anthracis spores can be used as a deadly bioweapon. Vaccination against anthrax is the only effective preventive measure and, hence, the anthrax vaccine was administered to United States (and other) troops during the 1990–91 Gulf War. However, the anthrax vaccine is not harmless, and the anthrax vaccination has been linked to the occurrence and severity of Gulf War Illness (GWI), a debilitating Chronic Multisymptom Illness (CMI). We hypothesized that this is partly due to the combination of two factors, namely (a) the cytotoxicity of the antigen (anthrax Protective Antigen, PA) contained in the vaccine, and (b) the Human Leukocyte Antigen (HLA) genotype of susceptible vaccinees, reducing their ability to make antibodies against the cytotoxic PA. Method: Here, we tested this hypothesis by determining the association between severity of GWI symptoms in 458 GW veterans and the overall strength of the binding affinity of the PA epitopes to the specific six Human Leukocyte Antigen (HLA) Class II alleles carried by each individual (two of each of the HLA-II genes: DPB1, DQB1, DRB1), responsible for initiating the process of antibody production in otherwise immunocompetent individuals, estimated in silico. Results: We found that the severity of GWI symptomatology was negatively and significantly correlated with the strength of the predicted binding affinity of PA peptides to HLA-II molecules ($r=-0.356, p<0.001)$; the stronger the overall binding affinity, the weaker the symptoms. Since the binding of a peptide to an HLA-II molecule is the first and necessary step in initiating the production of antibodies, the findings above support our hypothesis that the severity of GWI symptomatology is partly due to a lack of HLA-II protection. Conclusions: Reduced HLA protection against the toxic anthrax vaccine may underlie GWI. Full article

The study of mitochondrial dysfunction has become increasingly pivotal in elucidating the pathophysiology of various cerebral pathologies, particularly neurodegenerative disorders. Mitochondria are essential for cellular energy metabolism, regulation of reactive oxygen species (ROS), calcium homeostasis, and the execution of apoptotic processes. Disruptions in mitochondrial function, driven by factors such as oxidative stress, excitotoxicity, and altered ion balance, lead to neuronal death and contribute to cognitive impairments in several brain diseases. Mitochondrial dysfunction can arise from genetic mutations, ischemic events, hypoxia, and other environmental factors. This article highlights the critical role of mitochondrial dysfunction in the progression of neurodegenerative diseases and discusses the need for targeted therapeutic strategies to attenuate cellular damage, restore mitochondrial function, and enhance neuroprotection. Full article

Introduction: Joint hypermobility (JH) is mobility beyond the normal range of motion. JH can be an isolated finding or a characteristic of a syndrome. Characteristics related to the sitting position with atypical body positions, such as sitting in splits (S), with the foot on the head (F), in W (W), in a concave shape (C), episodes of dislocations, and subluxations, suggest impacts on body mechanics since childhood, with damage to the conformation of the joints. Objectives: Identify preclinical signs of JH, in addition to Beighton Score (BS), through signs that are easily recognized early by pediatricians and family members to avoid possible joint deformities in the future. Methods: The medical records of 124 children (59.7% girls) between one and nine years old were analyzed. JH was assessed using the BS, a history of luxations/subluxations, and the concave (C), “W”, “splits” (S), and foot (F) on head sitting positions. Results: The concave sitting position was the most common, followed by W, F, and S in decreasing order. A total of 52.4% of the children had BS > 6, with a higher prevalence among girls (60.8%) compared to boys (40.0%); a difference statistically significant (p = 0.024, Fisher’s exact test). Thirty-two patients (27.4%) had luxations/subluxations with the higher scores. Conclusions: Sitting in S, F, W, and C positions are preclinical phenotypic characteristics of JH, easily identified by pediatricians and family members to prevent possible joint deformities. BS ≥ 6 is more frequently observed in all positions. The majority of the total sample has BS > 6, with a significant female gender influence. Among those with a history of occasional joint dislocations and subluxations, half of them have the highest BS scores. Full article

A significant proportion of patients who sustain a concussion/mild traumatic brain injury endorse persisting, lingering symptoms. The symptoms associated with concussion are nonspecific, and many other medical conditions present with similar symptoms. Medical conditions that overlap symptomatically with concussion include anxiety, depression, insomnia, chronic pain, chronic fatigue, fibromyalgia, and cervical strain injuries. One of the factors that may account for these similarities is that these conditions all present with disturbances in the optimal functioning of the autonomic nervous system and its intricate interactions with the endocrine system and immune system—the three primary regulatory systems in the body. When clinicians are working with patients presenting with persisting symptoms after concussion, evidence-based treatment options drawn from the literature are limited. We present a framework for the assessment and treatment of persisting symptoms following concussion based on the available evidence (treatment trials), neuroanatomical principles (research into the physiology of concussion), and clinical judgment. We review the research supporting the premise that behavioral interventions designed to stabilize and optimize regulatory systems in the body following injury have the potential to reduce symptoms and improve functioning in patients. Foundational concussion rehabilitation strategies in the areas of sleep stabilization, fatigue management, physical exercise, nutrition, relaxation protocols, and behavioral activation are outlined along with practical strategies for implementing intervention modules with patients. Full article

Background: To estimate the prevalence of co-occurring obsessive–compulsive disorder (OCD) with substance use disorder (SUD) in the general population. Methods: A comprehensive literature search was conducted on the prevalence of comorbid OCD and SUD in the general population using MEDLINE, PsycINFO, EMBASE and CINAHL. Using the keywords, relevant studies published between 1993 and 2021 were identified. These studies were analysed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and the guidelines for Meta-analysis for Observational Studies in Epidemiology. Results: Fourteen studies met the inclusion criteria and had a total combined sample size of 47,850 participants. The lifetime prevalence of any identified SUD in patients with OCD ranged between 4.3% and 62.4%. Among co-occurring OCD with AUD, prevalence ranged between 14.1% and 35.9%; cannabis use disorder and OCD, between 11.5% and 24.4%; and tobacco use disorder and OCD, between 15% and 23.1%. Alcohol was the commonest psychoactive substance used in most of the studies reviewed and the prevalence of co-occurring substance use was highest in males. Conclusions: In conclusion, this review highlights the variable prevalence of co-occurring SUDs in individuals with OCD, emphasizing that the association differs based on the type of substance. Overall, the prevalence rate of co-occurring OCD and SUDs underscores the need for further research on the relationship between these conditions and the development of effective treatment strategies that address both disorders concurrently. Full article

Concerning numbers of childhood behavior problems have been reported worldwide. Parenting interventions are considered one of the most effective early strategies to intervene with externalizing conduct. This protocol outlines a feasibility RCT that aims to implement a parenting intervention in Portugal and (a) test key feasibility parameters, (b) assess the fidelity and acceptability of the program, and (c) explore its effectiveness in childhood behavior problems, parenting skills, parental concern, and parental sense of competence. A double-blinded, two-arm feasibility RCT is described. The participants are the primary caregivers of children between the ages of two and eleven years old that identify difficulties in managing their child’s behavior. Families will be randomly assigned to an intervention arm and a waitlist control arm. Parents in the intervention arm will participate in the Being a Parent program (Portuguese version: Ser Pai & Ser Mãe), an eight-week group intervention. Outcomes will be assessed using quantitative and qualitative measures throughout three assessment periods (pre- and post-intervention, and follow-up). This study marks the first feasibility RCT of the Being a Parent program outside the UK. The findings will provide information on the global strength of this program. Challenges and clinical implications are also discussed. Full article

Background/Objectives: Health care workers are at greater risk for death by suicide compared to the general population and are less likely to seek assistance. More information about correlates of suicidality and treatment-seeking behavior are needed to reduce risk. Methods: The American Foundation for Suicide Prevention developed an Interactive Screening Program to identify and engage at-risk staff and trainees in health care settings. The study reports on the prevalence and demographic and clinical predictors of current suicidal thoughts, behaviors and mental health treatment at a single site (n = 5898) from 2009 to 2024. Results: The study found that 18.2% of respondents reported current suicidal thoughts and behaviors. These were more common among respondents who were younger, male, and who identified as a race/ethnicity other than non-Hispanic White. Suicidal thoughts and behaviors were more likely among those with higher PHQ-8 scores (OR = 1.23, p < 0.01) and those who endorsed maladaptive coping behaviors, hopelessness, loneliness, stress and nervousness (ORs 1.36–3.04, ps < 0.01). Current mental health treatment was more likely among women, non-Hispanic White respondents compared with Asian or Pacific Islander respondents, and nurses relative to physicians. Mental health treatment was also associated with higher PHQ-8 scores, lifetime suicide attempts, difficulty controlling eating and alcohol consumption, and recent feelings of anxiety, stress and nervousness. Conclusions: Findings suggest a continued need to identify and engage health care trainees and staff who are at risk for suicide and to establish new approaches to linking these individuals to resources or interventions aimed at reducing risk. The study identified male and/or Asian/Pacific Islander-identifying health care workers who reported intense loneliness and/or hopelessness, use of non-prescription drugs and recent suicidal thoughts and/or behaviors as high-risk individuals who may require enhanced methods of outreach, identification, acceptance and accessibility of treatment. Full article

In recent years, self-injury attempts have accounted for 46.2% of emergency room visits by teenagers and young adults. This study aimed to explore the prevalence of non-suicidal self-injury (NSSI) among Korean college students, compare the mean number of NSSI risk factors between those with a history of NSSI and a control group with no history of thoughts or experiences of self-injury, and identify which factors have a greater influence on NSSI. The participants consisted of 403 Korean college students aged 18–29 who were divided into a subject group with a history of NSSI (n = 198) and a comparison group (n = 205) with no history of NSSI. The Functional Assessment of Self-Mutilation (FASM), Childhood Trauma Questionnaire (CTQ-SF), Social Experience Questionnaire (SEQ), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7), Difficulties in Emotion Regulation Scale—16 item version (DERS-16), Experiences in Close Relationship Questionnaire-Revised (ECR-R), Rosenberg Self-Esteem Scale (RSES), Parents as Social Context Questionnaire-Kids (PSCQ-KA), and Barratt Impulsiveness Scale-11-Revised (BIS-11). The collected data were analyzed using SPSS 25.0. Before a regression analysis, a MANOVA was performed to examine the mean difference between groups of each dependent variable, and a multiple regression analysis was performed to confirm the influence. The mean difference in all risk factors in the subject group compared with the comparison group was found to be statistically significant, with an effect size of 0.8 or greater. As a result of examining the relative influence of each variable on NSSI, emotional dysregulation (t = 2.481, p = 0.014), anxiety (t = −2.109, p = 0.036), and adult attachment (t = 2.004, p = 0.046) were found to significantly influence NSSI (p = 0.05). These findings will serve as fundamental data for screening clients at risk of self-injury in counseling and treatment settings, in addition to providing preventive and therapeutic interventions. Full article

The assessment of negative symptoms in schizophrenia has advanced since the 2006 NIMH-MATRICS Consensus Statement, leading to the development of second-generation rating scales like the Brief Negative Symptom Scale and the Clinical Assessment Interview for Negative Symptoms. These scales address the limitations of first-generation tools, such as the inclusion of aspects that are not negative symptoms and the lack of assessment of the subject’s internal experience. However, psychometric validation of these scales is still in progress, and they are not yet recommended by regulatory agencies, thus limiting their use in clinical trials and settings. Complementing these traditional methods, remote digital phenotyping offers a novel approach by leveraging smartphones and wearable technology to capture real-time, high-resolution clinical data. Despite the potential to overcome traditional assessment barriers, challenges remain in aligning these digital measures with clinical ratings and ensuring data security. Equally important is patient acceptance, as the success of remote digital phenotyping relies on the willingness of patients to use these technologies. This review provides a critical overview of both second-generation scales and remote digital phenotyping for assessing negative symptoms, highlighting future research needs. Full article