Adverse childhood experiences (ACE) have a significant negative impact on health. ACEs lead to more pronounced trait anxiety, among others, which serves as a basis for various mental and somatic symptoms. Recent findings suggest that the fact that individuals with more ACEs also have more maladaptive metacognitive beliefs may contribute to the development of these symptoms.

We aim to study the possible mediating role of maladaptive metacognitive beliefs, resulting from adverse childhood experiences, on trait anxiety.

Data was collected online, anonymously, in a non-clinical population of adults over 18 years of age. The sample consisted of 304 subjects (84.21 % women, 15.79 % men). The applied questionnaires included a demographic questionnaire, the Adverse Childhood Experiences Questionnaire 10 item version, the Meta-Cognitions Questionnaire, and the Spielberger Trait Anxiety Questionnaire. The system of correlations between the examined variables was explored using structural equation modeling (SEM). The study was carried out with ethical approval and in accordance with the Declaration of Helsinki.

Our results confirm that ACEs have a significant impact on all the measured dimensions of maladaptive metacognitive beliefs. The direct effect of ACEs on adult trait anxiety is also significant. The results of the study on indirect effects support the joint mediating role of the five metacognitive dimensions. The strongest significant mediating effect was found for the uncontrollability and dangerousness of negative beliefs about worry. Both the direct and indirect effects of cognitive self-consciousness on adult trait anxiety are negative, which means that the more the cognitive self-consiousness is characteristic of someone, the lower the degree of trait anxiety in adulthood is.

Our results confirm the mediating effect of metacognitive beliefs on trait anxiety in the context of adverse childhood experiences, which points to the importance of further research on metacognition among the population that suffered early adversities. One of the limitations of the study roots in online data collection: the examined sample is not representative. Moreover, to extend the results, it is recommended to repeat the study on a clinical population. This would enable us to compare our results with those of the clinical population, which could provide further important results in the field of metacognition and adverse childhood experiences.

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Disturbances in the hypothalamic-pituitary-thyroid (HPT) and hypothalamic-pituitary-adrenal (HPA) axes have been frequently reported in treatment resistant depressed patients (TRDs). So far, the effects of intermittent theta-burst stimulation (iTBS) treatment—a form of repetitive transcranial magnetic stimulation (rTMS) technique—on the activity of the HPT and HPA axes are poorly understood.

The present study aimed to evaluate the effects of iTBS sessions, applied to the left dorsolateral prefrontal cortex, in TRDs with abnormal chronobiological HPT functioning at baseline (BL) possibly associated with hypercortisolemia.

The ∆∆TSH test (i.e., the difference between the thyrotropin response to protirelin tests [∆TSH] performed at 8 AM and 11 PM on the same day) and the dexamethasone suppression test (DST) were performed in 12 TRDs and 14 healthy hospitalized control subjects (HCs). To be enrolled in this study, patients had to show at BL reduced ∆∆TSH values (i.e., < 2.5 mU/L) and a score of 18 or greater on the 17-item Hamilton Rating Scale for Depression (HAMD-17). Post-DST cortisol maximum (CORmax) serum level in excess of 120 nmol/L defined DST non-suppression (i.e., hypercortisolemia)—6 TRDs were DST non-suppressors at BL. After 10 and 20 iTBS sessions the ∆∆TSH test and the DST were repeated in all inpatients. A positive clinical response was defined by a final HAMD-17 score ≤ 8.

Compared to HCs, ∆∆TSH values were lower in TRDs at BL (p < 0.00001), and remained reduced after 10 and 20 iTBS sessions (p < 0.001 and p < 0.02 respectively). Post-DST CORmax levels were higher in TRDs than in HCs at BL (p < 0.01), but were comparable to those of HCs after 10 and 20 iTBS sessions. Responders (n = 5) were characterized by 1) a normalization of their ∆∆TSH values after 20 iTBS sessions (whereas after 10 iTBS sessions ∆∆TSH values were still reduced compared to HCs [p < 0.05]), and 2) a normality of post-DST CORmax levels at BL—while after 10 and 20 iTBS sessions post-DST CORmax levels were decreased compared to HCs (p < 0.006 and p < 0.03 respectively). Non-responders (n = 7) showed 1) no significant change in their ∆∆TSH values which remained lower than those of HCs at each assessment (all p < 0.001), 2) while increased post-DST CORmax levels found at BL (p < 0.0008 vs. HCs) normalized from the 10th iTBS session.

The present pilot study suggests that successful iTBS treatment can restore the chronobiological activity of the HPT axis. Although iTBS may increase glucocorticoid receptor signaling, baseline hypercortisolemia could negatively impact subsequent response to iTBS treatment.

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Patients undergoing electroconvulsive treatment (ECT) may display an acute confusional state, often characterized by transient disorientation, inattention, memory and cognitive deficits.

In this retrospective medical chart naturalistic study, we sought the determine whether white mater lesions and brain atrophy associate with the emergence of confusion during ECT treatment and preliminary results are presented herein

Medical charts of 24 consecutive inpatients with depression admitted to a psychogeriatric ward and subjected to bilateral frontotemporal ECT were examined retrospectively for patient and clinical characteristics. Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) scores at admission and hospital discharge were retrospectively collected. Available brain Magnetic Resonance Imaging (MRI) scans were graded for lesions (white matter hyperintensities, WMH), parietal, temporal and global brain atrophy

In this pilot study of mostly elderly patients, 50% displayed signs of confusion. All patients improved substantially, as indicated by MMSE and GDS scores, irrespectively of whether they experienced transient confusion during ECT. Preliminary results indicate that WMH are unrelated to the emergence of confusion. Instead, brain atrophy, and in particular temporal lobe and mostly frontal lobe atrophy associated with confusion

In our sample of elderly inpatients with depression subjected to bilateral ECT, preliminary results of this pilot study indicate that brain atrophy, as evidenced by MRI scans, appears as a predictor of post-ECT confusion. Moreover, the Pasquier scale, and specifically the scale sub-scores regarding brain atrophy in the frontal and temporal sulci, could prove useful in helping the clinician estimate the probability of ECT-related confusion during ECT treatment

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Electroconvulsive therapy (ECT) is an evidence-based treatment for difficult-to-treat depression, in which an electrical stimulus is applied via right unilateral (RUL) (Fig 1) or bitemporal (BT) electrodes (Fig 2). Current guidelines recommend to start ECT with RUL placement, except for cases where rapid response is needed. BT ECT has the reputation of exerting a stronger and faster antidepressive effect, but is associated with more pronounced cognitive side effects, as compared to RUL ECT. Recent studies, however, suggest comparable outcomes. In patients responding to ECT, most of the improvement in depressive symptom severity is witnessed early in the treatment course. In case of non-response, it is common practice to switch from RUL to BT electrode placement, although scientific evidence is lacking. As an answer to this research gap, the ChaT-trial was designed: a randomized controlled trial (RCT) to address which treatment strategy (either continue RUL ECT or switch to BT ECT) speeds up recovery with the least impact on cognitive function, in case of early non-response after 4 ECT sessions.

1. 1) To compare the antidepressant efficacy and cognitive effects of continuing RUL ECT vs switching to BT ECT.

2. 2) To assess group and subject-specific trajectories of depressive symptom severity and neurocognitive performance during the acute ECT course and up to 3 months post-treatment.

This multi-center double-blind RCT includes adult patients with a uni- or bipolar depression. In case of non-response (<50% decrease of IDS-CR score (Inventory of Depressive Symptomatology-Clinician Rated)) after 4 sessions of brief-pulse high-dose RUL ECT, patients are randomized to either continue RUL ECT, or switch to brief-pulse moderate dose BT ECT until remission. Depressive symptoms are assessed by IDS-CR, Psychotic Depression Assessment Scale (PDAS) and CORE assessment of psychomotor change. An extensive neuropsychological test battery is used to assess different domains of cognitive functioning, e.g., autobiographical memory using the Colombia University- Autobiographical Memory Interview Short- Form (CU-AMI-SF)(Fig 3).

Our hypotheses are: (1) continuing RUL ECT is non-inferior to switching to BT ECT in terms of depressive symptom severity, and (2) continuing RUL ECT is superior to switching to BT ECT in terms of cognitive side effects.

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The ChaT-trial is the first RCT comparing antidepressant efficacy and cognitive effects of continuing RUL ECT with switching to BT ECT in case of early non-response during an acute ECT-course. The results may optimize clinical decision making, speeding up recovery, while minimizing cognitive side effects.

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Most patients show temporary impairments in clinical orientation (i.e., orientation in person, place, and time) after electroconvulsive therapy (ECT)-induced seizures. It is unclear whether postictal reorientation is related to electroencephalography (EEG) restoration. This tentative relationship may shed light on mechanistic aspects of reorientation after ECT.

To study whether postictal EEG restoration after an ECT-induced seizure is related to recovery of clinical orientation in the cognitive domains person, place and time.

We performed a longitudinal study in ECT patients and collected continuous postictal EEGs. Postictal EEG restoration was estimated by the evolution of the normalized alpha/delta ratio (ADR). Recovery of orientation in the cognitive domains of person, place, and time was assessed using the Reorientation Time (ROT) questionnaire. In each cognitive domain, a linear mixed model was fitted to investigate the relationship between ROT and postictal EEG restoration. In these models, other (ECT-)parameters including seizure duration, use of benzodiazepines and electrode placement were included.

In total, 272 ictal and postictal EEG recordings of 32 patients were included. In all domains, longer ROT was associated with slower postictal EEG recovery. Longer seizure duration and use of benzodiazepines were related to longer ROT in all domains. Increased total charge of the ECT-stimulus was associated with increased ROT in place and age was positively associated with ROT in time.

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We show a relationship between restoration of the postictal EEG and clinical reorientation in person, place and time after ECT-induced seizures. This indicates that clinical reorientation probably depends on gradual cortical synaptic recovery. Increased seizure duration and the use of benzodiazepines were also related to increased ROT values. Longer seizures and use of benzodiazepines may induce longer postictal synaptic depression.

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An increased risk of suicide has been reported by psychiatric patients, including schizophrenia1. Numerous evidence suggests alterations in the grade of pro-inflammatory impact on suicidal behavior2, and this relation has been shown in patients with mood or anxious disorders3,4. However, the grade of inflammation impact suicidal behavior in patients with schizophrenia has hardly been investigated.

Identify peripheral blood biomarkers of suicidal behavior in patients with schizophrenia, including inflammatory and lipid profile parameters.

Secondary analysis of a cross-sectional study. Sample: 254 patients with schizophrenia, aged 18-72. Assessments: ad-hoc demographic and clinical questionnaire, PANSS, CDS, CAINS, PSP. Inflammatory and lipid parameters: C-reactive protein (PCR), interleukin 6 (IL-6); high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceridaemia (TG). Statistical analysis: Correlations, T Student, U Mann-Withney and lineal regression.

Mean age: 40.49 (13.10). Men: 64.2%.

No statistically significant differences were found between patients with suicide attempts and those without in any of the inflammatory or lipid parameters (p>0.05). However, differences were found in terms of suicide attempts (yes/no) in the PANSS negative (T=-2.217; p=0.028) and PANSS general psychopathy (T=-4.224; p< 0.001), in depressive symptoms (T =-6.967; p< 0.001), and the MAP subscale of the CAINS (T= -3.741; p<0.001).

Among patients with suicide attempts (n=42; 16.52% of the sample) (mean=1.90; sd=1.73; Range:1-7), statistically significant correlations were found with PCR (r=0.309; p=0.046), but not with cytokines and lipid parameters. On the other hand, no correlations were found with age, sex, length of illness, and any of the clinical scales.

A multiple linear regression was performed considering the number of suicide attempts as the dependent variable and as independent variables, age, sex, and those that were significant in the bivariate analysis (PCR).

A predictive model was found that explains 9.60% of the variance of number of suicide attempts (F = 4.224; p < 0.001). The variable that entered the model was PCR (β= 0.309; p=0.046).

The increase in inflammation (manifested by the elevation of PCR) is related to an increase in the number of suicides. On the contrary, no correlations were found with lipid parameters or interleukins.

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There are several arguments supporting the inflammatory hypothesis in schizophrenia (SCZ). Among the inflammatory markers, beta-2- microglobulin (β2M) is associated with abnormalities in neurogenesis and cognitive impairment described in (SCZ).

The objectives of our study were to evaluate the level of β2M in a group of patients compared with a control group and to investigate the sociodemographic, clinical, and environmental factors associated with elevated β2M levels

We conducted a cross-sectional in outpatients with SCZ. We collected patients sociodemographic, environmental, and clinical data. We assessed psychopathology with the PANSS. We measured serum β2M concentration.

We included 30 patients with SCZ compared with 20 controls. Patients mean age was 40,23±10,66. The mean level of β2M was 1,98 ± 0.42 mg/L for patients and 1.65±0.56 mg/L for control group. The difference was significant between the patient group and the control group (p<10-3). No environmental or clinical factors have been associated with β2M levels other than smoking status (p=0.046).

Further research with larger samples investigating the different stages of SCZ especially early psychosis would be needed to confirm the relevance of this biomarker in SCZ.

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In this research, we investigate how Aberrant Salience (AS), Psychotic-Like Experiences (PLEs), and anxiety are interlinked in both healthy individuals and subjects with psychotic disorders. AS is a trait contributing to a susceptibility to psychosis and anxiety, while PLEs are subclinical states often leading to psychosis. We hypothesize that AS impacts the occurrence and severity of PLEs, which in turn influences anxiety.

The goal is to offer a more nuanced understanding of the risk factors leading to psychotic disorders and to shed light on anxiety psychopathogenesis in healthy and psychotic populations.

We used self-reported questionnaires like the Aberrant Salience Inventory (ASI), Community Assessment of Psychic Experiences (CAPE), and Symptom Check List-90-revised (SCL-90-R). Data analysis included descriptive statistics and mediation analysis, adjusting for age, gender, and education. Controls were sourced through convenience and snowball sampling, while out-patients diagnosed with Schizophrenia Spectrum Disorder, Bipolar Disorder with psychotic features, or Major Depression with psychotic features were recruited from Florence University Hospital.

A total of 207 participants were included, with 163 controls and 44 patients. Descriptive statistics are shown in Table 1. Mediation analysis showed that PLEs frequency acted as a mediator between AS and anxiety only in the control group (Figure 1), not in patients (Figure 2).Table 1.

Descriptive statistics - Mean ± Std. Deviation.

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PLEs triggered by AS led to anxiety in the control group but not in psychotic patients. The discrepancy could be due to reduced novelty and awareness of experiences in the patient group. This may affect how bodily responses to PLEs are perceived and suggests the need for specialized treatment approaches for anxiety in these two groups.

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Current guidelines for managing antipsychotic-induced hyperprolactinemia recommend the use of aripiprazole, either as a substitute or in combination with the primary antipsychotic. However, there have been reported cases of exacerbated psychotic symptoms when introducing aripiprazole after chronic treatment with another antipsychotic.

We present a case of a patient with unspecified schizophrenia spectrum disorder receiving amisulpride, who developed worsened psychotic symptoms following the introduction of aripiprazole to treat hyperprolactinemia. We also review this phenomenon and its clinical management in the literature.

Clinical case report and brief literature review.

Ms. G, a 54-year-old woman diagnosed with unspecified schizophrenia spectrum disorder, was on amisulpiride 400mg/day and had remained asymptomatic for months. During a follow-up, she complained of mastalgia and had a prolactin level of 71.7 ng/mL. Following clinical guidelines, aripiprazole was added at 10mg/day. Within a month, anxiety and sleep disturbances escalated, followed by the reappearance of psychotic symptoms. Aripiprazole was discontinued, amisulpride reinstated, achieving stability. Subsequently, hyperprolactinemia was managed using metformin.

Antipsychotic-induced hyperprolactinemia is common, especially with first-generation antipsychotics, causing various symptoms in both genders. Long-term consequences may include weight gain, reduced bone density, and potentially increased breast cancer risk, among others.

Aripiprazole is an atypical antipsychotic with a partial agonist effect on dopamine D2 and D3 receptors. This means that aripiprazole will act as a functional D2-antagonist under hyperdopaminergic conditions, but a functional D2-agonist under hypodopaminergic conditions. This property of aripiprazole may contribute to counteract ‘prolactin-raising’ agents, acting as a D2 agonist, potentially reducing prolactin rise.

Chronic use of presynaptic D2/D3 antagonist (amisulpiride) might create a hypodopaminergic environment and hypersensitivity to dopamine agonists, possibly explaining worsened symptoms with aripiprazole introduction.

To prevent adverse outcomes when adding or switching to aripiprazole, gradual reduction of the previous antipsychotic (amisulpride) and high-dose aripiprazole initiation (30-40 mg/day) can help.

Antipsychotic-induced hyperprolactinemia is a serious issue that deserves our attention. While aripiprazole is recommended by several guidelines to treat it, introducing it to patients on chronic antipsychotic treatment may lead to a worsening of psychotic symptoms. Caution is recommended when combining aripiprazole with potent D2 receptor blockers. To mitigate this effect, gradual dose reduction of the previous antipsychotic and high-dose aripiprazole initiation are crucial.

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Antipsychotic medications are essential for managing psychiatric disorders, offering symptom relief and improved functioning. However, their use carries potential risks. Vigilant monitoring and patient engagement are crucial when initiating antipsychotics.

To explore whether comprehensive discussions with patients concerning the benefits and risks of antipsychotics are taking place, and whether baseline investigations are performed before initiation of antipsychotics as per NICE guidelines.

This retrospective study focused on admissions to a male acute ward between March 1 and May 31, 2023. Data from electronic patient records included demographics, Mental Health Act (MHA) status, psychiatric diagnoses, medical co-morbidities, documentation of medication benefits / side effects discussions with patients, medication information provision, as well as baseline investigations involving weight, height, waist/hip circumference, pulse, blood pressure, blood glucose, HbA1c, lipid profile, prolactin levels, movement disorder assessment, nutritional status, diet, physical activity, and ECG.

Among 23 admitted patients, 15 were newly initiated or reintroduced to antipsychotics, with 14(93.3%) admitted under the MHA. Primary diagnoses included Paranoid Schizophrenia (33.33%), Unspecified Non-Organic Psychosis (20%), Bipolar Affective Disorder (20%), and others. Medical comorbidities were observed in 10(66.7%), notably type 2 diabetes (40%). Among initiates, 6(40%) were new to treatment, while in 9(60%) it was re-initiated.

Within the 15-patient group, discussions on treatment benefits engaged 11(73.3%), while 4(26.7%) lacked complete documentation. Only 6(40%) had discussions about side effects. Metabolic side effects were discussed with 3(20%), extrapyramidal effects with 2(13.33%), while 4(26.7%) had general side effect talks. Patient information leaflets were given to 5(33.3%) patients. Baseline measurements: 12(80%) had weight/height, 4(26.7%) waist/hip, and 14(93.3%) pulse/blood pressure assessed. Blood tests were declined by 4(26.7%). Baseline glucose, HbA1c, lipids, and prolactin were assessed in 8(53.3%), 10(66.7%), 9(60%), and 8(53.3%) patients respectively. Nutritional status was assessed in 13(86.7%), movement disorders in 1(6.7%), and physical activity in 1(6.7%). All 15(100%) patients were offered ECGs, although 5(33.3%) declined.

Adherence to NICE guidelines for baseline investigations and risk/benefit discussions prior to antipsychotic initiation was low, apart from ECGs, weight/height, pulse/blood pressure, assessment of nutritional status, and discussions about antipsychotics’ benefits. Implementing effective monitoring and patient engagement to mitigate potential side effects, is crucial to facilitating the safe and efficient utilisation of antipsychotics.

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Limited information is available regarding the clinical features, optimal treatment and prognosis of Paranoid Personality Disorder (PPD) and Delusional Disorder (DD). This is partly due to the low prevalence of cases and poor patient insight. The difference between DD and PPD has been questioned in the literature, as some studies have described them as a continuum, highlighting the role of specific personality traits in the transition to clinical delusions.

Nonadherence to pharmacological treatment is one of the most challenging aspects. This further leads to relapses, increased use of emergency psychiatric services, psychiatric admissions, longer periods of hospitalization, and an increased cost of illness to healthcare systems.

The primary goal of this study is to compare the differences between DD and PPD in terms of medication adherence, relapses, lost to follow-up, and costs. Other aims of this study are to analyze the differences in these variables between patients who are adequately adherent and patients who are not

An observational, retrospective, and multicenter descriptive epidemiological study was conducted. Patients were selected from four public departments of psychiatry in Madrid, providing an area of roughly one million people. All patients were older than 18 years-old, diagnosed with DD or PPD from 2005 to 2022. Data were extracted from electronic medical records and from electronic prescribing program used in the public health system.The study was approved by the Hospital Fundación Jiménez Díaz Ethics Committee.

1227 individuals diagnosed with DD (974 patients,79,3%) or PPD (253 patients, 20.61%). 23.81% (232 patients) of the DD-group did not take out the prescribed medication of the pharmacy, and 16.6% (42 patients) of the PPD-group were considered non-adherent.

Adherent patients had greater follow-up (4.02 vs 2.89 years) and shorter hospital stays (5.15 vs 8.6 days, p<0.05) compared to non-adherent patients. DD patients doubled the average hospitalization stay compared to the PPD group (6.7 vs 2.96 days, p<0.01).

Regarding costs: DD had higher hospitalization costs than PDD (1164 vs 488 euros per year) and higher total costs than PDD (2180 vs 1528 euros per year, p<0.05). The costs were also higher in non-adherent than in adherent patients (2570 vs 1895 euros per year, p<0.05)

Our sample of 1227 DD and PPD patients followed from 2005-2022 is, to our knowledge, one of the largest collected to date. We found sociodemographic and clinical differences between the DD and the PPD group. We also found differences between adherent and non-adherent patients, highlighting that non-adherence is associated with longer mean stay of hospitalization and more costs, both hospitalization and total direct healthcare costs. We have also found association between non-adherence and risk of psychotic relapse.

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Psychotic patients often require pharmacological treatment, which may prove ineffective, leading to treatment-resistant psychosis necessitating the use of clozapine. However, the emergence of side effects can result in discontinuation, potentially triggering a relapse of psychotic symptoms. One significant side effect is antipsychotic-induced weight gain which, over time, can lead to adverse metabolic events. Recent translational research is evaluating the impact of prenatal factors on the metabolic outcomes of psychotic patients, using a surrogate marker of the intrauterine milieu such as birth weight (BW).

We aim to evaluate the changes in leptin, adiponectin, and insulin levels in patients with treatment-resistant psychosis who initiate clozapine treatment due to persistent psychotic symptoms.

Subjects older than 18 years with a diagnostic of a major mental disorder and initiating clozapine were enrolled in this 18-months longitudinal study. Neurohormones levels, including leptin, adiponeptin, and insulin were measured at baseline, 8 and 18 months during follow-up. Statistical analysis were conducted by using a fixed-effects model.

A total of 23 subjects initiating clozapine were evaluated during the initial mandatory 18-week period. Neurohormones, specifically leptin and adiponectin, were measured at three time points: baseline, 8 weeks, and 18 weeks. The changes in leptin levels were significantly associated with birth BW with sex differences, being inversely correlated only in females. Adiponectin was significantly associated with BW, being inversely correlated in males. Conversely, there was no observed association between insulin levels and BW.

Our findings highlight the significance of prenatal factors in influencing the subsequent evolution of neurohormones in individuals initiating clozapine treatment. This suggests that subjects with lower BW tend to exhibit elevated neurohormone values, emphasizing the role of prenatal events in this context.

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Isaiah Berlin’s (1948) exploration of the self-searching of Russian thinkers includes studies of the writers – Tolstoy and others (now – Russian-language texts of the school reader). These studies refute a widespread misconception about the relations between Russian writers and thinkers: namely, that in Russia literature and radical thought form two distinct traditions related only by mutual hostility. The works of Tolstoy, Dostoevsky, Karamzin, Leskov, Ostrovsky, and of minor novelists too, are penetrated with a sense of their own time, of this or that particular social and historical milieu and its ideological content, to an even higher degree than the ‘social’ novels of the west. The personal characteristics of suicide victims, heroines of Russian literature, along with the gender aspects, deserve attention in suicidal behavior (SP) focus.

To study personal characteristics of suicide victims, heroines of fiction.

Qualitative analysis of selected Russian-language texts of the school reader.

At the dawn of literature, we have seen fiery heroines and tremulous victims in the arms of death. Аs psychology approach was developed, and we get acquainted with the tragiс backstory. Psychotypes of suicides are exaggerated and overlapped. «Hysterical»: manipulative, frigid nymphomaniac (e.g., Anna Karenina). «Freedom-loving rebel» (i.e., Katerina reincarnations from A. Ostrovsky) in conditions of excessive regulation. «She-Devil, or Rebel Without a Cause». The obsession with death turns into a criminal and a victim (e.g., «Lady Macbeth of the Mtsensk» by N. Leskov, Turgenev’s Susanna or Klara Milich). The image of a vindictively furious («velvet and tiger claws») woman descends to the Victorian view of female self-will. «Mimosa» is a sensitive, dreamy person, unable to resist the hardships of life, dependent (dies with her beloved, objection). In suicide, the strength of weakness is the outcome of a humiliating life (e.g., Karamzin’s «Poor Liza», «A Gentle Creature» by F. Dostoevsky. The meaning of suicides is the following: a call (to compassion, salvation), a «cry for help», atonement for one’s (imaginary) – someone else’s (by proxy) guilt, and release from encumbrance.

Fiction and life are united by emotionally unstable characters and/or depression as markers of unsatisfactory resilience. The cultural diversity of gender patterns and interpretations of SP challenges the essentialist view that «femininity» and marriage are protective factors. SP patterns illustrate and complement the explanatory concepts of SP. The inner world of suicidal people is fascinating and contributes to the evidence-based optimism in the «patient-centric» crisis care model.

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Decision-making is a complex process, and little is known about the various elements that comprise it. Recent literature on neurocognitive deficits in patients with a history of suicidality has highlighted that impaired (non-adaptive) decision-making is one of the most consistent deficits in individuals with a history of suicidality.

This study aims to systematically review the available evidence on decision- making capacity in depressed patients with a history of suicide attempts.

A systematic search was conducted in PubMed, Psycnet, Elsevier and Scopus with additional searching through bibliographic references. This search was performed until the 31st of August 2022 and provided information on decision-making capacity in relation to suicidality and depression.

The literature review provided 377 references, the titles and abstracts of which were reviewed for relevance to this study and the entry criteria set. The review of the title and abstract of these studies resulted in 50 articles that were potentially relevant to the study topic and a further review was then conducted to re-examine the selected studies and articles, which resulted in the final selection of 20 studies. The outcome measure used by the majority of studies as a measure of decision-making ability was the IOWA Gambling Task (IGT), in which the performance of patients with a history of depression and self-harm in most studies was significantly worse than that of healthy controls. Some methodological characteristics of the studies included in this review complicated the interpretation of the results, such as the sample size and characteristics of each study.

Decision-making ability shows alterations in patients with a history of suicidality and depression, confirming the findings of previous studies. Furthermore, an impaired or dysfunctional decision-making ability may potentially be a predictor of suicidal behaviour in patients with depression, a possibility that could be a reason for further research in this field, both in the context of investigating predictors and in developing appropriate treatments for these patients.

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Food insecurity has become a growing burden within a global context where climate change, catastrophes, wars, and insurgencies are increasingly prevalent. Several studies have reported an association between suicidal behaviors (i.e., suicide ideation, plans, and attempts) and food insecurity. This meta-analytic review for the first time, synthesized the available literature to determine the pooled prevalence of suicidal behaviors among individuals experiencing food insecurity, and examined the strength of their association.

To determine the pooled prevalence of suicidal behaviors among individuals experiencing food insecurity, and examine the strength of their association.

Databases (Ovid, PubMed, Web of Science, and CINAHL) were searched using the appropriate search term from inception to July 2022. Eligible studies reporting the number/prevalence of suicidal behaviors among individuals experiencing food insecurity or the association between food insecurity and suicidal behaviors were included. The pooled prevalence of suicidal behaviors was determined using the random-effects model. The review was registered with PROSPERO (CRD42022352858).

A total of 47 studies comprising 75,346 individuals having experienced food insecurity were included. The pooled prevalence was 22.3% for suicide ideation (95% CI: 14.7-29.9; I2=99.6%, p<0.001, k=18), 18.1% for suicide plans (95% CI: 7.0-29.1; I2=99.6%, p<0.001, k=4), 17.2% for suicide attempts (95% CI: 9.6-24.8; I2=99.9%, p<0.001, k=12), and 4.6% for unspecified suicidal behavior (95% CI: 2.8-6.4; I2=85.5%, p<0.001, k=5). There was a positive relationship between experiencing food insecurity and (i) suicide ideation (aOR=1.049 [95% CI: 1.046-1.052; I2=99.6%, p<0.001, k=31]), (ii) suicide plans (aOR=1.480 [95% CI: 1.465-1.496; I2=99.1%, p<0.001, k=5]), and (iii) unspecified suicide behaviors (aOR=1.133 [95% CI: 1.052-1.219; I2=53.0%, p=0.047, k=6]). However, a negative relationship was observed between experiencing food insecurity and suicide attempts (aOR=0.622 [95% CI: 0.617-0.627; I2 = 98.8%, p<0.001, k=15]). The continent and the countries income status where the study was conducted were the common cause of heterogeneity of the differences in the odds of the relationships between experiencing food insecurity and suicidal behaviors - with North America and high-income countries (HICs) having higher odds. For suicide attempts, all non HICs had a negative relationship with food insecurity.

There is a high prevalence of suicidal behaviors among individuals experiencing food insecurity. Initiatives to reduce food insecurity would likely be beneficial for mental wellbeing and to mitigate the risk of suicidal behaviors among population experiencing food insecurity.

The paradoxical finding of suicide attempts having a negative relationship with food insecurity warrants further research.

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In Hungary, in contrast to most other countries, suicide deaths increased significantly during the first year of the COVID-19 epidemic (March to December 2020). Globally, the burden of emergency care in the healthcare system tended to decrease during the first period of the epidemic.

Our research aimed to evaluate the changes in the number of intentional suicide attempts by violent and non-violent means during the first two years of the epidemic, compared to the trend before March 2020 in the Budapest metropolitan area and Pest County.

We analyzed psychiatric assessment reports of self-poisoning patients admitted to Péterfy Hospital’s Emergency Department and Clinical Toxicology from Jan 2019 to Dec 2021 to estimate non-violent suicide attempt trends. We analyzed patient data for violent suicide attempts treated at Dr. Manninger Jenő Trauma Centre from 2016-2021, focusing on trends during the first two years of the pandemic. Negative binomial regression estimates were used for interrupted time series analysis with Prais-Winsten regression, controlling for time and seasonal and autoregressive effects. We used change-point detection to examine the leveling of trends. The Institutional Review Board approved the research in both institutions. Approval numbers: 08-2022 (Péterfy Hospitaly) and 19-2021 (Traumatology Center).

The number of male non-violent suicide attempts decreased by 16.6% compared with the pre-epidemic period (p<0.001). A similar and significant decrease was observed in females and in the total population (Image 1). The female and total population trends, i.e., the decrease, were reversed by August 2020, and the male trends were reversed by October 2020. The total number of patients treated for violent suicide attempts increased significantly (p<0.05) during the first two years of the pandemic (Image 2). There was a slight increase in violent attempts in men and a small decrease in women, but these changes are not statistically significant.

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We hypothesize that those who tried to end their life through non-violent drug use were less inclined to seek assistance because they were concerned about being hospitalized during the COVID-19 outbreak. The surge in violent attempts is striking, as it correlates with the rise in suicide fatalities documented in Hungary during the initial year of the outbreak. Our data was obtained from two prominent public hospitals in Budapest, enabling us to conduct a more concentrated and thorough examination of the circumstances in the capital.

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Suicidal thoughts and behaviors (STB) are a serious public health problem. Suicide prevention programs have been established over the years, but many people who are suicidal do not seek treatment, and when they do, they end up in low-threshold sectors such as the Emergency Department in general hospitals. Previous studies about STB at the ED are mostly narrative, rather than a date-driven approach and limited in sample size .

This study describes the prevalence and evolution over time of suicidal ideation (SI) and suicidal attempts (SA) in terms of sociodemographic, clinical and service use variables of the psychiatric patient referred to the Emergency Department of the University Hospital Gasthuisberg (Leuven, Belgium) over a 20 year period.

During a 20 year period (2002-2022), all patients with a psychiatric referral to the Psychiatric Emergency Department (PED) of the University Hospital Gasthuisberg (Leuven) were included (N˜18.000). We use descriptive statistics to summarize the data set, focusing on STB in terms of sociodemographic, clinical and service use variables.

Around 1/10 patients presents with SA; another 1/5 with SI. Despite several reforms, SI and SA have remained relatively stable over the years. Notably, there is a higher prevalence of referrals for females in both SI and SA compared to males. However, there has been a notable increase in male SA cases over time. In the age group 36-49, both sexes exhibit the highest percentages of SI and SA cases, with exception for women in SI, where the age category 18-25 has the most referrals. Approximately one-third of male patients referred with STB have never accessed outpatient care, underscoring a critical gap in mental health services for this demographic.

Despite several reforms in mental health care, the PED remains a major entry point into mental healthcare for large proportions of STB patients.

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Alcohol and sedative substance use disorders are escalating global public health challenges. Lebanon has grappled with multiple crises, including economic, healthcare, and social issues.

This study aimed to assess the correlates of the alcohol and sedative substance use risk scores with sociodemographic and clinical factors, including sleep disorders, chronotype, anxiety, and depression.

A cross-sectional study was conducted among the Lebanese population using several validated scales to assess the risk of alcohol and sedative substance use, including the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Other tools evaluated chronotype, sleep, and mood disturbances. Bivariate and multivariable analyses were then performed, taking the alcohol and sedative scores as dependent variables.

A total of 646 participants were included. Multivariate analysis revealed positive and significant correlations between higher ASSIST-alcohol scores and personal history of alcohol abuse (B=4.61), family history of prescription substance abuse (B=1.763), psychiatric disorders (B=2.898), and worse Insomnia Severity Index scores (Beta=0.14). Conversely, ASSIST-alcohol scores negatively correlated with weight (B= -0.39) and morning chronotype (B=-0.084). Positive correlations were identified between higher ASSIST-alcohol scores and personal history of illicit substance abuse (B=2.834), prescription substance abuse (B=2.252), sleep quality (B=0.130), and sleep severity (B=0.082), while negatively correlating with cigarette smoking (B=-0.038).

This study elucidates the role of several predisposing factors to alcohol and sedative use disorders in Lebanon, including history of substance abuse, psychiatric disorders, sleep disorders, and chronotype. These findings advocate, in particular, for the integration of sleep disorder assessment and management into addiction rehabilitation programs.

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The expression Binge Drinking (BD) refers to dysregulated alcohol consumption, characterized by the intake of large quantities of alcohol, regardless of their nature, consecutively in a limited period of time. BD is a significant public health problem in many European countries, including Italy. According to data from the Istituto Superiore di Sanità, dated 2020, over 4 million Italians exhibit episodic excessive alcohol consumption (compared to 2019 data, there was an increase of approximately 5,3%).

This study aims to examine alcohol consumption habits in the Italian population, evaluating psychopathological correlations that can explain its diffusion.

Between January and May 2023, an anonymous online questionnaire was randomly sent to the general population. Alongside with tests to evaluate psycho-social features, to estimate the presence of alcohol abuse or dependence the AUDIT scale (Saunders et al. Addict Abingdon Engl. 1993; 88:791–804) was used. It included two specific questions to frame the phenomenon of BD (Cranford et al. Alcohol Clin Exp Res. 2006; 30:1896–905). No other study conducted in Italy has so far used the aforementioned validated questions.

The sample consists of 308 people (189 F, 119 M), with an average age of 32 years (sd 14). The AUDIT indicates a state of chronic alcohol consumption in 11,7% (95% confidence interval 8,5%-15,7%), of the recruited sample, positively correlating with the element of impulsivity (p<0,005) confirming what has already been reported in literature. BD prevalence reaches 56% (M 57%, F 55%) without any significant correlation with impulsivity, personality disorders, emotional dysregulation, or sensitivity to rejection. Among university students the prevalence of BD exceeds 70% (95% confidence interval 60%-76%), with a number of drinks reported for a single occasion reaching up to 25 units and a reported number of binge episodes, in a two-week span, ranging from 2 to 10.

Despite possible biases, this study raises the relevant issue of the extremely high prevalence of BD disorder, which is particularly alarming in light of the numerous issues related to the behavior itself. A direct correlation with reduced school performance, an increase in risky sexual behavior, and an increase in cases of drunk driving have been evaluated. Considering these consequences, it is of primary importance on a medical, but even more social level, to best characterize this phenomenon in such a way as to be able to implement awareness-raising and prevention interventions.

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Suicidal behaviors are frequently observed among patients with substance use disorder, including suicidal ideation (SI) (1). Alcohol use disorder (AUD) is one of the most prevalent addictions and may be related to suicidal behaviors (2,3). However, the association between AUD and SI requires a deeper analysis which includes several clinical features observed among AUD patients.

To analyze the clinical characteristics and features associated with lifetime SI among patients who had AUD.

This is a cross-sectional study performed in an outpatient center for addiction treatment in patients seeking for treatment who met the criteria for AUD between 01/01/2010 and 12/31/2021. Patients were evaluated with an ad-hoc questionnaire and the European Addiction Severity Index (EuropASI), SI was evaluated using the item for SI in EuropASI.

From a potential sample of n=3729 patients, only n=1082 (73.8% males; mean age 42.82±12.51) met inclusion criteria and had data for the current analysis. Lifetime SI was present in 50.9% of the AUD patients. Several clinical features were related to SI, including: sex differences, any type of lifetime abuse, polyconsumption, benzodiazepine use disorder, any psychiatric diagnosis aside from SUD, and higher addiction severity according to the EuropASI.

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SI among AUD patients is related to several clinical features which indicate a higher addiction severity, more polyconsumption, and a higher prevalence of psychiatric comorbidities. These findings may contribute to the understanding of suicidal behaviors in AUD patients but it is required further investigations, including longitudinal studies.

REFERENCES

1 Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-445. doi:10.1016/j.psychres.2017.09.021

2. MacKillop J, et al. Hazardous drinking and alcohol use disorders. Nat Rev Dis Primers. 2022;8(1):80. doi:10.1038/s41572-022-00406-1

3.Darvishi N, et al. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis [published correction appears in PLoS One. 2020;15(10):e0241874]. PLoS One. 2015;10(5):e0126870. doi:10.1371/journal.pone.0126870

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