INTRODUCTION: Youth mental health is a growing concern, with reports of psychiatric diagnoses becoming increasingly prevalent. Among other factors, psychiatrization may inflate the observed prevalence by interpreting experiences previously understood as adversities inherent to human life as symptoms of psychopathology. The current study explores the pathologization of behaviors typical of adolescence by asking contemporary psychiatrists to diagnose and treat a character from a novel who is considered a prototypical teenager of the 19th century: Tom Sawyer. METHODS: A one-page vignette was distributed either in sealed envelopes or via email to 57 psychiatrists who had obtained their license for independent practice between 2021 and 2023 in the Czech Republic. In total, 47 psychiatrists took part, yielding an overall response rate of 82%. The number and frequency of diagnostic conclusions, prescribed medications, and recommended interventions are reported. RESULTS: Most respondents diagnosed the boy described in the vignette with a psychiatric disorder (94%; CI = 81-98%) and recommended an intervention within the healthcare system (89%; CI =76-96%). Two thirds (62%, CI = 46-75%) recommended pharmacotherapy: antidepressants (27%), antipsychotics (22%), stimulants (13%), and anxiolytics (2%); 68% (53-80%) recommended psychotherapy. Nonmedical interventions (e.g., counseling, social services) were recommended by 49%. CONCLUSIONS: The experiences of an adolescent boy, once interpreted as normative "adventures" in the 19th century, were recognized by newly certified psychiatrists as psychiatric disorder. These findings illustrate the extent of psychiatrization over time and suggest that expert diagnoses may substantially contribute to the overinterpretation of problems of living as psychiatric disorders.
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Amounting findings on maternal separation and early disturbed caregiving suggest that this type of early experience negatively influences socioemotional development and may be associated with behavioral and mental health problems in later life. Concerning previously published studies, we have assessed if maternal separation and disrupted caregiving before adoption in infancy could be related to heightened levels of dissociative symptoms and behavioral problems in middle childhood. We involved 30 children (sample S1) who had experienced maternal separation after birth and short-term institutional or foster care prior to adoption before 16.7 months of age. Based on the parents' reports, they had not experienced any other significant adversities by the time of evaluation. These children were compared to a control group of children who have lived with their biological mothers in complete families (sample S2; N = 25). Although the findings are correlational and not causal, they indicate that specific adverse experiences, maternal separation after birth, and relatively short disruptive caregiving prior to successful adoption in infancy could be associated with significantly heightened levels of dissociative symptoms and behavioral problems in school-aged children. Our data also contribute to the literature on child socioemotional development and the etiology of dissociative disorders.
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This report describes the case of a 31-year-old male lumberjack with severe self-inflicted injuries, including the amputation of both auricles and the penis, under the influence of cannabinoids, mitragynine, and 7-hydroxymitragynine. Emergency surgery was performed, and psychiatric evaluation revealed substance-induced psychosis. The patient's motivation for reconstructive penile surgery led to abstinence from the substance use and cooperation with treatment. Five months after hospitalization, successful penile reconstruction was completed. The patient remained abstinent and was engaged in regular psychiatric follow-ups, showing no signs of acute psychopathology. This case underscores the importance of using a multidisciplinary approach to manage severe self-harm behaviors, and highlights the critical role of patient motivation in achieving positive outcomes.
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- kazuistiky MeSH
Recent findings on stress and anxiety in attention deficit hyperactivity disorder (ADHD) suggest that specific processes related to brain developmental disorganization could create a vulnerable background that increases sensitivity to stress stimuli from the psychosocial environment. These basic neurodevelopmental processes are closely related to the developmental mechanisms of primitive functions and their integration or disintegration. In this context, the psychopathological processes that manifest in ADHD are linked to the mechanisms of disturbed inhibitory functions that may cause incongruent neural interactions ("neural interference") between the more primitive functions and the higher levels of attentional and cognitive neural processes. These disturbed developmental processes may also determine increased sensitivity to stressful experiences that, in ADHD cases, could lead to the manifestations of various psychopathological symptoms such as disturbed attentional and motor functions, anxiety, and depression, among other cognitive and affective disturbances. These findings, based on previous research, suggest novel framework and hypothesis on how this neurodevelopment-based increased sensitivity to stress stimuli could manifest in the etiopathogenesis of ADHD in its relationship with cognitive, affective, and motor deficits.
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INTRODUCTION: Virtual reality (VR) holds significant promise for psychiatric research, treatment, and assessment. Its unique ability to elicit immersion and presence is important for effective interventions. Immersion and presence are influenced by matching-the alignment between provided sensory information and user feedback, and self-presentation-the depiction of a user's virtual body or limbs. Discrepancies between real and virtual hands can affect the sense of presence and thus treatment efficacy. However, the precise impact of positional offsets in healthy individuals remains under-explored. This review assesses how various factors influence the detection thresholds for positional offsets in VR among healthy subjects. METHODS: A comprehensive database search targeted English-language studies on the detection thresholds of virtual hand positional offsets using head-mounted displays (HMDs) with specific tracking capabilities. Data on methodologies, participant demographics, and VR system specifics were extracted. RESULTS: Thirteen studies met the inclusion criteria, revealing significant variability in detection thresholds-from a few millimeters to 42 cm for linear shifts and from 2° to 45° for angular shifts. Sensitivity to these offsets was affected by hand movement direction and magnitude, hand representation realism, and the presence of distractions. VR system specifications, such as resolution and tracking accuracy, also played a significant role. Methodological issues included small sample sizes, inadequate demographic reporting, and inconsistent presence or avatar embodiment measures. CONCLUSION: The results highlight the need to consider identified influencing factors to maximize user presence in VR-based therapies. Variability in VR device capabilities also emphasizes the need for detailed reporting of device properties in research. The individual variability in offset detection further illustrates VR's potential as a tool for studying body ownership and multisensory integration.
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- systematický přehled MeSH
INTRODUCTION: Prenatal mental health problems are associated with morbidity for the pregnant person, and their infants are at long-term risk for poor health outcomes. We aim to explore how the SARS-CoV-2 pandemic affected the mental health of pregnant people in the United Kingdom (UK), and to further identify resilience factors which may have contributed to varying mental health outcomes. We also aim to examine the quality of antenatal care provided during the pandemic in the UK and to identify potential inadequacies to enhance preparedness for future events. METHODS: During June-November 2020, we recruited 3666 individuals in the UK for the EPPOCH pregnancy cohort (Maternal mental health during the COVID-19 pandemic: Effect of the Pandemic on Pregnancy Outcomes and Childhood Health). Participants were assessed for depression, anxiety, anger and pregnancy-related anxiety using validated scales. Additionally, physical activity, social support, individualized support and personal coping ability of the respondents were assessed as potential resilience factors. RESULTS: Participants reported high levels of depression (57.05%), anxiety (58.04%) and anger (58.05%). Higher levels of social and individualized support and personal coping ability were associated with lower mental health challenges. Additionally, pregnant individuals in the UK experienced higher depression during the pandemic than that reported in Canada. Finally, qualitative analysis revealed that restrictions for partners and support persons during medical appointments as well as poor public health communication led to increased mental health adversities and hindered ability to make medical decisions. DISCUSSION: This study revealed increased mental health challenges among pregnant individuals in the UK during the SARS-CoV-2 pandemic. These results highlight the need for reassessing the mental health support measures available to pregnant people in the UK, both during times of crisis and in general.
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OBJECTIVES: This study aimed to explore the relationship between plasma proteome and the clinical features of Major Depressive Disorder (MDD) during treatment of acute episode. METHODS: In this longitudinal observational study, 26 patients hospitalized for moderate to severe MDD were analyzed. The study utilized Liquid Chromatography with Tandem Mass Spectrometry (LC-MS/MS) alongside clinical metrics, including symptomatology derived from the Montgomery-Åsberg Depression Rating Scale (MADRS). Plasma protein analysis was conducted at the onset of acute depression and 6 weeks into treatment. Analytical methods comprised of Linear Models for Microarray Data (LIMMA), Weighted Correlation Network Analysis (WGCNA), Generalized Linear Models, Random Forests, and The Database for Annotation, Visualization and Integrated Discovery (DAVID). RESULTS: Five distinct plasma protein modules were identified, correlating with specific biological processes, and uniquely associated with symptom presentation, the disorder's trajectory, and treatment response. A module rich in proteins related to adaptive immunity was correlated with the manifestation of somatic syndrome, treatment response, and inversely associated with achieving remission. A module associated with cell adhesion was linked to affective symptoms and avolition, and played a role in the initial episodes and treatment response. Another module, characterized by proteins involved in blood coagulation and lipid transport, exhibited negative correlations with a variety of MDD symptoms and was predominantly associated with the manifestation of psychotic symptoms. CONCLUSION: This research points to a complex interplay between the plasma proteome and MDD's clinical presentation, suggesting that somatic, affective, and psychotic symptoms may represent distinct endophenotypic manifestations of MDD. These insights hold potential for advancing targeted therapeutic strategies and diagnostic tools. LIMITATIONS: The study's limited sample size and its naturalistic design, encompassing diverse treatment modalities, present methodological constraints. Furthermore, the analysis focused on peripheral blood proteins, with potential implications for interpretability.
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INTRODUCTION: In the Western world, more than one-third of the patients of productive age hospitalized for severe mental illness (SMI) are parents. Each of their offspring is exposed to several stressors related to their parent's illness and hospitalization, which puts them at an increased risk of developing mental health problems. In the Czech Republic, no statistics are currently available about the families of patients with SMI, inpatients who are parents, or data about their children (ages ≤18 years). Therefore, our research aim was to describe the prevalence of parenthood among hospitalized patients with SMI, assess the number of children and determine the extent to which offspring information was present in medical records. METHODS: Quantitative data from medical records (2,768 patients, aged 18-63 years, hospitalized for SMI between 2017 and 2020) from two large inpatient psychiatric facilities were examined. Parental information, demographic characteristics, number of children, and other available data were collected. RESULTS: The prevalence of parenthood among inpatients with SMI was 34.6%. Parenthood was most prevalent among female patients and patients with recurrent depressive and bipolar disorders. The total number of offspring in 957 patient-parents was 1781 (41.7% minors under the age of 18). Information on parenthood was available in 99.7% of cases; information on the age of offspring, custody, and sociodemographic situation varies, being included in 73% to 89.7% of the medical records (some details were more frequently recorded than others). DISCUSSION: The data obtained may help to better understand and address the specifics of these families and thus serve as a basis for the development of prevention programs.
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INTRODUCTION: This randomized, placebo-controlled, double-blind, parallel study aimed to evaluate the effect of 3-month supplementation of bovine colostrum (BOV-COL; 8x400 mg per day) on the outcomes of depression treatment in hospitalized patients with substance use disorder (SUD). The hypothesis is that BOV-COL supplementation as an add-on treatment results in favorable alternations in selected blood inflammatory markers or neurotransmitters, leading to better depression treatment outcomes compared with placebo (PLA). METHODS: Patients with a Minnesota Multiphasic Personality Inventory-2 score ≥60 points were enrolled. Twenty-nine participants (n=18 in the BOV-COL group and n=11 in the PLA group) completed the protocol. RESULTS: The mean Beck Depression Inventory-II score was significantly reduced after supplementation in both groups. However, the mean 17-point Hamilton Depression Rating Scale score was decreased in the BOV-COL group, but not in the PLA group. In the BOV-COL group, there was a reduction in interleukin (IL)-1, IL-6, IL-10, the IL-6:IL-10 ratio, IL-17, and tumor necrosis factor alpha (TNF-α), while in the PLA group only IL-6 decreased. Favorable alternations in the total count and differentials of white blood cell subsets were more pronounced in the BOV-COL. There were no changes in neurotransmitter concentrations. CONCLUSIONS: BOV-COL supplementation is a promising add-on therapy in patients with depression and SUD.
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