Psychiatry Int., Volume 5, Issue 4 (December 2024) – 23 articles

Interoceptive awareness is currently gaining considerable attention and is in an active phase of research, supported by a growing body of empirical evidence from diverse fields such as neurophysiology, cognitive neuroscience, mind–body therapies, psychiatry, and psychometrics. The aim of this study was to examine the relationship between interoceptive awareness, anxiety, and depression in Peruvian adults. A total of 414 participants residing in Lima, Peru, were included, with 85% being young adults aged 18–27 years (252 women = 61%; 162 men = 39%; age range = 18–64; M age = 23.4). The results indicated that the indirect effect of interoceptive awareness on depression through anxiety accounted for 61.7% of the mediation, while the direct effect of interoceptive awareness on depression accounted for 38.3%. In conclusion, the hypothesis that anxiety negatively mediates the relationship between interoceptive awareness and depression in Peruvian adults was confirmed. This research may have implications in clinical settings, particularly for the prevention and psychotherapeutic intervention of anxiety and depression, through the promotion of adaptive interoceptive awareness. Full article

State-of-the-art literature has been enhancing the significance of personality phenomena in Alzheimer’s dementia (AD). This study seeks to identify the relationships of current and premorbid traits and abnormal dimensions in AD. Five-factor model and axis II personality disorders are taken as references. This research was conducted with two groups, which were assessed using the NEO-FFI and PDQ-4+ in individual interview sessions. Current personality measure: AD Group (n = 44 female participants); premorbid personality measure: AD group informants (n = 40 related participants). Findings suggest that in terms of both premorbidity and current studies, the relevance of the dimensions neuroticism (high) and conscientiousness (low), are the most common explanations found in the personality disorder scales, DSM clusters, Appendix B and the global personality disorder index. These data are relevant for the assessment of personality phenomena in Alzheimer’s disease. Full article

The comorbidity between late-life depression and neurocognitive disorders (NCDs) in the elderly is a subject of increasing interest within the scientific and medical community. We conducted a narrative review of clinical studies focused on depression and NCDs, primarily covering articles published over the past 25 years. Compared with younger adults, depression in the elderly is often characterized by difficulties in expressing sadness, more pronounced somatic, anxiety, and psychotic symptoms, as well as a heightened risk of suicide and cognitive impairment. Depressive symptoms in the elderly may mimic NCDs, act as prodromal signs of future NCDs, or represent a clinical dimension of dementia. NCDs and late-life depression share specific clinical similarities, particularly at illness onset, emphasizing the importance of early differential diagnosis to guide the development of precise, integrated, and tailored interventions. Full article

Despite their higher risk of mental health conditions, migrants often face barriers to accessing mental health care. This systematic review aims to synthesize the evidence on interventions to improve mental health care access for migrants (protocol CRD42024556575). PubMed, Embase, PsycINFO, and CINAHL were searched for experimental and observational studies on this topic. A narrative summary and a meta-analysis of the study findings are presented, along with a GRADE quality assessment. Eighteen reports, accounting for 3285 migrants, were included in the final selection. There were six randomized controlled trials, nine non-randomized clinical trials, and three observational studies. The interventions consisted of psychoeducation (27.8%), digital tools (22.2%), outreach programs, counseling, peer support (each 11.1%), and miscellaneous approaches (16.7%). There was marked heterogeneity in the intervention structure and outcome measure across the studies. Nevertheless, all studies reported a positive effect of the interventions on mental health care access. Still limited by few studies providing data suitable for the pooled estimate, the meta-analyses found a significant effect in reducing stigma and improving mental health literacy. Overall, this review identified promising interventions for improving migrant mental health care access. Future research is needed to validate interventions that can be applied sustainably across different contexts and migrant populations. Full article

The COVID-19 pandemic crisis has increased the vulnerability and decreased the retention in treatment of patients receiving medication-assisted treatment (MAT). Therefore, the aim of the present study was to investigate the impact of COVID-19 on craving and quality of life (QoL) of MAT patients and to reveal the potential role of medication dose. Thus, 562 volunteers were divided into the control group (n = 100) comprising healthy volunteers without prior contact with substances of abuse, and into the experimental group (n = 462), which included patients receiving MAT, who were stratified into sub-groups of patients under methadone and buprenorphine. The groups were further divided into two sub-groups, based on whether the participants were infected by SARS-CoV-2 or not. The heroin craving questionnaire (HCQ), and the Nottingham health profile (NHP) instrument were used for craving assessment and QoL evaluation respectively. The MAT patients who were infected by SARS-CoV-2 had higher levels of craving compared to their non-infected counterparts, and COVID-19 restriction measures reduced QoL mainly of non-infected MAT patients. Furthermore, low craving and high QoL were largely associated with medium or low medication dose. It appears that focused interventions and modifications to medication doses could lead to better clinical outcomes of the MAT programs and relapse prevention. Full article

Although the Parenting Stress Index-Short Form (PSI-SF) is widely applicable, there has been a dearth of research on the psychometric properties and item wording effects associated with the cultural sensitivity of the instrument. This study investigated the psychometric properties, the factor structure, and the negative and positive item wording effects of PSI-SF for 96 Latinx parents of children with intellectual and developmental disabilities in the United States within exploratory structural equation modeling, and structural equation modeling-based generalizability theory frameworks. This study produces the following noteworthy findings. First, the ESEM bifactor model with negatively and positively phrased items best captured the theoretical frameworks underlying the structure of the PSI-SF. Second, adding method factors enhanced the model fits of all the factor models. Third, this study discovered several items with great proportions of method factors. This study recommended that the items with high proportions of method factors, which may likely be culturally insensitive to Latinx parents, be examined further and refined. With the use of accurately assessed PSI-SF scores, practitioners will be better able to support and empower Latinx parents of children with IDD and better meet their needs through the FIRME program, a parent advocacy initiative. Full article

The aim of this article is to present a new marker of the degree of self-representation unity, developed from the Rorschach test, to assess the strength or fragility of psychotic patients’ narcissistic foundations. The marker exhibited discriminative value when comparing a group of paranoid subjects (n = 25) to two other groups of schizophrenic (n = 26) and paranoid schizophrenic subjects (n = 30). This indicator also appears useful for assessing the positive effects on the narcissistic Ego in psychotherapy. Full article

Numerous studies have linked lower levels of serum cholesterol with heightened aggression, violent crimes, and violent deaths across diverse populations, including forensic psychiatric patients, criminals, and the broad public. Interestingly, this association appears to be more pronounced in men than in women. Conversely, findings regarding serum triglycerides present a more nuanced picture, with some studies indicating heightened aggression with elevated levels and others suggesting the opposite. However, most studies have neglected to examine this phenomenon in conjunction with psychological traits. Additionally, no prior research has explored the association between serum lipid levels and different types of aggression, e.g., reactive, instrumental, or appetitive. Considering these gaps, our study aimed to assess serum cholesterol and triglyceride levels upon clinic admission and correlate them with scores from the Appetitive and Facilitative Aggression Scale (AFAS), a self-rating questionnaire assessing reactive and appetitive aggression. We conducted our investigation on a cohort of 135 forensic psychiatric patients undergoing drug addiction treatment under Section 64 of the German Criminal Code. This provision offers a nearly unique opportunity worldwide for individuals who have committed crimes under the influence of drugs or in the context of their addiction to receive specialized treatment. Using non-linear Spearman correlation analyses, we observed an inverse relationship between serum concentrations of both cholesterol and triglycerides and AFAS appetitive violence scores but not for reactive aggression. Additionally, triglyceride levels exhibited an inverse association with the prevalence of violent crimes as an index crime. In conclusion, blood lipids may affect numerous areas of health and disease beyond what is currently known, offering a potential shift in how we understand their role in aggression. Full article

The occupational environment may affect one’s psychophysical health by leveraging both external workplace stressors and individual psychological responses. We developed a comprehensive questionnaire to assess occupational stress among postgraduate medical trainees, investigating both situational and personal aspects. Exploratory factor analysis was used to identify the constructs captured by the questionnaire, and reliability was assessed by estimating Cronbach’s alpha. Construct-specific scores were computed, and their correlation with established pre-validated scales (criterion validation) was assessed. Four factors—“stress”, “coping”, “empathy”, and “trauma”—explained 50% of data variability and demonstrated satisfactory overall internal consistency (Cronbach’s alpha = 0.76). Significant correlations were found between the “stress” score and the “emotional exhaustion” component of the Maslach Burnout Inventory (MBI) (r = −0.76), the “coping” score and the “positive attitudes” component of the Coping Orientation to Problems Experienced Inventory (COPE) (r = 0.46), and the “empathy” score with the “empathic concern” (r = 0.52), “fantasy” (r = 0.41), and “perspective taking” (r = 0.45) components of the Interpersonal Reactivity Index (IRI). No significant differences in scores were found in terms of gender or medical specialization. This study suggests that the SCOPE questionnaire may be a promising tool for assessing workplace stress and psychological responses among medical residents. Full article

The scientific literature focused on the categorization of therapists’ interventions in clinical sessions, and their effects on patients, is not very extensive and often autoreferential. The most relevant findings clearly show the eclecticism of clinicians, grounding only 10–14% of their interventions on the specific theoretical approach to which they belong. Despite that, a trans-theoretical systematization of clinical interventions is lacking. The present work aims to verify the feasibility of a trans-theoretical categorization of clinical interventions based on Dynamical Systems Research in psychotherapy (DSR). For this purpose, the authors present the results of three literature reviews. The first sections of this paper present the literature on the historical development of clinical interventions within the psychodynamic and cognitive-behavioral approaches. In the fourth section, the review of the DSR literature in psychotherapy and the systematization of clinical interventions according to such a unifying framework are introduced. Clinical interventions can be aimed at increasing the patient’s stability and flexibility, with the final objective of promoting H-L Synchronization and S-F Oscillations. The connections between the DSR-based categorization and the literature pertaining to the psychodynamic and cognitive-behavioral approaches are highlighted. Finally, in the conclusions, the limitations and potential developments of this scientific area are discussed. Full article

Suicidal behavior is an important public health problem often associated with psychological and biological factors. Understanding the role of biochemical markers, such as cholesterol and serotonin levels, may provide insight into the mechanisms underlying suicidal tendencies. This study aimed to investigate the relationship between lipid profile parameters, serotonin levels, and psychological status in individuals who had attempted suicide. Patients with suicidal attempts underwent a psychiatric evaluation and blood samples were taken to measure serotonin levels, total cholesterol, and lipid metabolism parameters. Psychological assessments included measures of depression, stress, and hopelessness; assessments of motivation; suicidal tendencies; and assessments of psychological and physical aspects of fear of death. The study found a significant positive correlation between serotonin and cholesterol levels (r = 0.6883, p < 0.0001). Lower levels of serotonin and cholesterol were associated with higher rates of depression and stress. These findings suggest that dyslipidemia may be associated with reduced serotonin function, which may contribute to the development of suicidal behavior. The study highlights the potential role of cholesterol and serotonin in the development of suicidal behavior, along with the mental status of patients. Evaluating the interaction of neurobiological and social–psychological factors provide an opportunity to search for peripheral biomarkers of suicide risk. Full article

Substance-induced psychosis (SIP) is an increasingly prevalent and complex condition that presents significant diagnostic and therapeutic challenges. With the rising use of novel psychoactive substances (NPSs) and potent traditional compounds like cannabis and cocaine, particularly among adolescents and young adults, understanding the mechanisms and clinical manifestations of SIP has become more critical. This review examines the psychopathological characteristics of SIP, focusing on the differentiation between substance-induced and primary psychotic disorders. Two key concepts are explored: Gaëtan de Clérambault’s “mental automatism”, which describes involuntary thoughts and sensations experienced as alien to the self, and the “twilight state” of consciousness, characterized by an altered perception of space, time, and social interaction. These phenomena are essential in understanding how substance use triggers psychotic processes and how SIP differs from endogenous psychosis. This review also highlights the clinical and phenomenological distinctions between acute and chronic psychotic episodes, emphasizing the potential transition from SIP to persistent psychosis, especially in cases of frequent and potent substance use. It discusses the diagnostic and therapeutic importance of recognizing specific psychopathological markers such as alterations in temporality, spatiality, and intersubjectivity. Understanding these features enhances the clinician’s ability to accurately differentiate SIP from primary psychotic disorders, which is often complicated by the widespread use of substances that may not be easily detectable in standard tests. This review concludes by advocating for a clinical–phenomenological approach to empathically engage with patients and provide a solid diagnostic framework for improved treatment strategies, particularly for those at risk of transitioning to chronic psychosis. Full article

This study investigates the impact of psychiatric interventions on occupational dysfunction in patients with major depressive disorder (MDD) and anxiety disorder (AD). Occupational dysfunction is a significant concern in these populations, severely impairing the ability to perform daily activities and fulfill work and social roles. This research seeks to evaluate how different psychiatric interventions, including pharmacotherapy and psychotherapy, affect patients’ occupational performance and overall quality of life. This study analyzed data from outpatients diagnosed with MDD and AD based on ICD-10 criteria. Participants were assessed before and after intervention using scales that measure anxiety, depression, and occupational task difficulty. Results demonstrated a significant improvement in patients’ ability to perform a wide range of tasks, including personal hygiene, work-related activities, and social engagement, following treatment. The study highlights the importance of a multidisciplinary approach, emphasizing that both pharmacotherapy and psychotherapy significantly contribute to reducing occupational dysfunction and enhancing quality of life. These findings underscore the need for tailored interventions that address the specific occupational challenges faced by individuals with MDD and AD, aiming for long-term functional recovery. Full article

The aim of this study was to assess the mental health situation of children and adolescents during a period of less strict COVID-19-pandemic-related measures after the first pandemic wave. This cross-sectional study was conducted in July 2021 by carrying out an online survey among children and adolescents (aged 10–18 years) from Halle (Saale), Germany (n = 233). The questionnaire measured important aspects of mental health among young people, namely health-related quality of life (HRQoL, using the self-report version of the KIDSCREEN-10), mental health problems in general (using the SDQ), depressive symptoms (using the CES-DC), and psychosomatic complaints (using the HBSC symptom checklist). In addition, other important health issues such as sleep behavior and related difficulties, disordered eating, and any positive consequences of the pandemic were addressed. The results were analyzed using descriptive statistics. A total of 223 children participated in the survey. About 69.7% of the participating children and adolescents had a high HRQoL, while 10.5% displayed abnormal results on the SDQ. There were indications of emotional problems in 16.5% of the participants based on the SDQ subscales. Almost 44% of the participants were screened as positive for depressive symptoms on the CES-DC, with girls and older adolescents being more likely to be affected. This also applied for psychosomatic complaints. Here, irritability was experienced at least once a week or more frequently by 58.9% of the children and adolescents. Although we had a small sample size, this study showed a high prevalence of mental health problems regarding the SDQ and HRQoL. However, our study population showed a better mental health than comparable studies conducted earlier in the pandemic. Depressive symptoms were still substantially higher than those in pre-pandemic data. We hypothesize that this might reflect the fact that there were a few COVID-19-related restrictions at the time when our survey took place. Based on these findings, we assume that the mental health of children and adolescents differed between different phases in the pandemic. Full article

Mental imagery is a cognitive ability that enables individuals to simulate sensory experiences without external stimuli. This complex process involves generating, manipulating, and experiencing sensory perceptions. Despite longstanding interest, understanding its relationship with other cognitive functions and emotions remains limited. This narrative review aims to address this gap by exploring mental imagery’s associations with cognitive and emotional processes. It emphasizes the significant role of mental imagery on different cognitive functions, with a particular focus on learning processes in different contexts, such as school career, motor skill acquisition, and rehabilitation. Moreover, it delves into the intricate connection between mental imagery and emotions, highlighting its implications in psychopathology and therapeutic interventions. The review also proposes a comprehensive psychometric protocol to assess mental imagery’s cognitive and emotional dimensions, enabling a thorough evaluation of this complex construct. Through a holistic understanding of mental imagery, integrating cognitive and emotional aspects, researchers can advance comprehension and application in both research and clinical settings. Full article

Background: Extreme promotion and prevention focus (foci) of the value need can lead to mental disorders due to a reinforcement mechanism between efficacy expectations (EEs) and behavioral intensity (BI) that then sets in. A reliable measurement instrument capturing the onset of this reinforcement could facilitate disorder prevention. Additionally, the needs for truth and control may also trigger mental disorders in extremes of their foci, though these foci lack conceptualization. Thus, designing foci for each need, we developed both an item pool to assess EEs and BI of all foci across all needs and a procedure for compiling group-specific scales from it to capture EE–BI correlations for preventive purposes. We examined both the overall suitability of the pool and of the procedure to compile those scales from it that are reliable, valid, and most probably capable of capturing the EE–BI reinforcement onset in a specific group (here, our calibration sample, N = 198, 77% female). Methods: All eligible scales from the item pool were tested for cubic EE–BI correlations (high majorities of the expected cubic shape indicated item pool suitability), and those yielding the most cubic relationships were assessed in nonlinear PLS structural equation modeling with regard to their significance, reliability, and validity. Results: The item pool and procedure were largely suitable, producing reliable, valid scales where EEs significantly predicted BI cubically. Conclusions: The item pool and the method for identifying group-specific scales mark an important step toward better risk group identification. Further studies are needed to determine their actual predictive relevance for mental disorders. Full article

Considering that research points to the discrepancy regarding the positive role of hedonia as opposed to eudaimonia in physical health, the aim of this study was to investigate the moderating effects of hedonia and eudaimonia on the relationship between stress and general mental health in young adults. A total of 328 participants took part in the study, 36.6% of whom were males, with ages ranging from 18 to 30, and a median age of 19 years (SD = 1.32). Questionnaires were used to measure well-being states, stress, and mental health. The results showed that hedonia moderated the relationship between low-stress conditions and general mental health. Eudaimonia, on the other hand, had a nonsignificant effect on the relationships tested. The findings indicate that an orientation toward pleasure may be the path to achieving mental health in the midst of stressful circumstances. Full article

Agitation is one of the most common and persistent behavioral and psychological symptoms among persons with dementia (PWD) in residential aged care facilities (RACFs). While most studies have explored the general impact of COVID-19 on the mental health and well-being of aged care residents, there has been limited research on the pandemic’s impact on agitation in dementia within RACFs. This knowledge is crucial to ensuring that RACFs are better equipped to handle future public health emergencies. Therefore, this retrospective cohort study investigates the impact of the pandemic on agitation incidents within 40 Australian RACFs. Using Python, we extracted agitation symptoms from nursing notes and compared the frequency and percentage of symptom occurrence pre-pandemic versus during-pandemic. Chi-square tests examined any significant change in the prevalence of dementia and agitation in dementia between the comparative groups and periods. Dementia prevalence dropped significantly during the second year of the pandemic, with a concurrent increase in early-onset dementia cases. Overall, agitation symptoms decreased by 20.1%, but six symptoms significantly increased: resisting (28.98%), wandering (11.78%), restlessness (3.19%), complaining (10.1%), arguing (2.36%), and outbursts (1.74%). Conversely, pacing decreased by 15.88% and speaking loudly decreased by 10.9%. Over half of the care recipients with dementia experienced agitation symptoms 2–5 times each year, increasing from 50.56% in 2019 to 58.28% in 2021. Despite the co-occurrence of symptoms such as falls, confusion, and weakness, there was no evidence to suggest that these comorbidities were specific to COVID-19; rather, they appeared to be prevalent even before the pandemic. Persons with agitation in dementia had a significantly higher death rate during the COVID-19 pandemic than otherwise. Full article

This study used bibliometric analysis to investigate the research on Attention-Deficit/Hyperactivity Disorder (ADHD) in pediatric populations between January 2014 and January 2024. The Scopus database is utilized to gather a diverse array of scholarly research on this complex ailment. Our objective was to compile a comprehensive dataset on understanding and managing ADHD by selecting specific terms such as “ADHD in Children”, “ADHD Treatment and Management”, and “Attention-Deficit/Hyperactivity Disorder”. We utilized the advanced analytical capabilities of Biblioshiny (bibliometrix R-package) and VOSviewer (VOSviewer version 1.6.19), within our methodological framework, to do network analysis. By conducting this analysis, we were able to examine patterns in publications, author affiliations, the geographic spread of research, and identify influential texts and developing research topics. The findings underscore the collaborative endeavors of medicine, psychology, and neuroscience in tackling the physiological and psychological aspects of ADHD, with a focus on interdisciplinary contributions. The extensive global impact of ADHD research is highlighted by the significant contributions made by countries including the United States, China, the UK, the Netherlands, and Canada. Our data indicates a notable shift towards holistic strategies that encompass socioeconomic, environmental, and behavioral aspects, alongside emerging practices like the utilization of non-invasive brain stimulation techniques in research. This bibliometric study offers a comprehensive view of ADHD research by identifying significant patterns and clusters of themes. It illuminates the shifts in scientific conversation over time and identifies areas that show potential for additional research. The study advocates for ongoing collaboration across various disciplines and nations, emphasizing the significance of innovative strategies to enhance the well-being of those affected by ADHD. Full article

The counseling needs of civilian war victims, particularly those not classified as refugees, have been largely neglected in academic counseling research. This study addresses this gap by conducting a rapid literature review to evaluate the current state of counseling services available to these individuals. Using Google Scholar and Web of Science, we identified and reviewed studies on counseling services for war veterans, refugees, and civilians in conflict zones. This review revealed a significant lack of structured counseling support for non-refugee civilian war victims, despite their high vulnerability. Findings indicate that while substantial efforts have been made to support refugees and veterans, the mental health needs of civilians who remain in conflict areas are often unmet, with existing services being sparse and inadequately documented. To address this issue, we propose a preliminary model that includes culturally sensitive counseling programs, training for local counselors, and international collaboration to provide sustainable support. This study highlights the urgent need for focused research and practical interventions to develop comprehensive counseling programs for these overlooked victims of war, and encourages researchers to address this critical gap in mental health services. Full article

Epilepsy is a critical neurological condition characterized by the disturbance of the excitatory neuron network, resulting in recurrent seizures. It is a serious health problem requiring intensive attention. The present study was designed to use bibliometric analysis to assess scientific research output on pharmacogenetics in epilepsy and drug-resistant epilepsy in Morocco during 1969–2024. The main objective of this study was to analyze scientific production and research development and to introduce available solutions to manage the elevating burden of epilepsy. The strategy approach comprised a suitable search scheme to collect publications related to epilepsy using the Scopus database. All the documents retrieved were analyzed to determine several parameters, including the number of publications annually, type of documents, institution and author productivity, and relevant sources. Studies on pharmacogenetics and drug-resistant epilepsy in Morocco are limited. The findings revealed that the number of articles has increased during the last decade. Publications remain scarce, especially on pharmacogenetics and drug-resistant epilepsy, and the most widely available publications include articles on epilepsy, seizures, mental illness, and anticonvulsant agents. Based on the search strategy, a bibliometric analysis identified potential subjects for further study. Consequently, research on epilepsy is essential to fully understand the condition, but it remains insufficient, and further studies are required, particularly on the pharmacogenetics of epilepsy. Full article

Globally, suicide mortality rates have decreased in this century; however, it has been reported that the decreasing trends of some subgroups were attenuated in the late 2010s. These tendencies are pronounced among adolescents. In this study, the temporal fluctuations of the age-standardized death rate of suicide (ASDR-suicide), crude mortality rate of suicide (CMR-suicide), and percentage of suicides per total deaths (PTD-suicide) among adolescents (10–24 years) in the global high-income and middle-income countries and in the Western Pacific Region (WPR) from 1990 to 2019, as well as the fixed effects of communication factors (penetration of cellular telephones and the Internet) on the ASDR-suicide/CMR-suicide/PTD-suicide of adolescents, were analyzed using the WHO Mortality Database. The male ASDR-suicide in global middle-income countries decreased, and those of males in global high-income countries and females in middle-income countries were unchanged, while the rate of other groups (males in the WPR and females in high-income countries and the WPR) increased. The ASDR-suicide of adolescent males in the WPR was almost equivalent to that of males in global high-income and middle-income countries in the 1990s but was higher than the rate in the 2010s. The ASDR-suicide of adolescent females in the WPR was consistently higher than that of females in global high-income and middle-income countries from 1990 to 2019, but the differences widened over time. The PTD-suicide of both males and females in middle-income countries was unchanged, whereas the PTD-suicide in global high-income countries and the WPR increased over time. The PTD-suicide in the WPR markedly increased by >40% in the late 2010s. The fixed effects of cellular telephone and Internet penetrations were negatively and positively related to adolescent suicide in the WPR, respectively. Therefore, these results suggest that, in this century, suicide prevention in adolescent health activities has been increasing in importance in the WPR compared with other regions. Full article