Search Results (468)

Schizophrenia is a severe and complex psychological disorder characterised by psychosis, affecting approximately 20 million people worldwide, with its prevalence on the rise. It is hypothesised to arise from a multifactorial aetiology involving a complex interplay of genetic predisposition and environmental risk factors. The exact cause of schizophrenia remains unknown. There are significant interactions between genetic and environmental factors, making it a condition of great significance. Both pharmacological and non-pharmacological therapies are available to manage the various symptoms associated with this condition. Antipsychotic drugs are the primary pharmacological approach, addressing both the positive and negative symptoms of schizophrenia. However, their use has sparked controversies due to potential side effects and long-term consequences, necessitating individualised treatment plans. Non-pharmacological therapies, on the other hand, provide an alternative approach, focusing on reducing anxiety and fear and empowering patients to regain control over their lives. In this scientific review, an extensive analysis of existing research has been conducted to evaluate the efficacy and safety of antipsychotic drugs and non-pharmacological therapies for schizophrenia. Their impact on positive and negative symptoms as well as socio-economic implications have been assessed. Beyond treatment efficacy, this review also addresses broader societal aspects, emphasising the need for patient-centred mental healthcare services that consider individual differences and preferences. The review highlights the importance of a multidimensional translational approach to schizophrenia management and advocates for accessible mental healthcare services to cater to the unique challenges faced by individuals with schizophrenia. By considering advantages and disadvantages, we support the implementation of tailored treatment plans to optimise patient outcomes and overall societal well-being. A holistic translational approach to schizophrenia management, incorporating medical, psychological, and societal support systems is essential for improving the quality of life for individuals living with schizophrenia. Full article

Background/Objectives: Pediatric migraine is a prevalent neurological disorder that significantly impacts children’s quality of life, academic performance, and social interactions. Unlike migraines in adults, pediatric migraines often present differently and involve unique underlying mechanisms, making diagnosis and treatment more complex. Methods: This review discusses the clinical phases of pediatric migraine, key trigger factors, sex- and age-related differences, and the role of childhood maltreatment in migraine development. We also discuss episodic syndromes such as cyclic vomiting syndrome, abdominal migraine, benign paroxysmal vertigo, and benign paroxysmal torticollis, along with comorbidities such as psychiatric disorders, sleep disturbances, and epilepsy. Results: The underlying pathophysiological mechanisms for pediatric migraines, including genetic predispositions, neuroinflammation, and gut microbiota dysbiosis, are summarized. Current therapeutic strategies, including conventional and emerging pharmacological treatments, nutraceuticals, and non-pharmacological approaches, are evaluated. Non-pharmacological strategies, particularly evidence-based lifestyle interventions such as stress management, diet, hydration, sleep, exercise, screen time moderation, and cognitive behavioral therapy, are highlighted as key components of migraine prevention and management. The long-term prognosis and follow-up of pediatric migraine patients are reviewed, emphasizing the importance of early diagnosis, and tailored multidisciplinary care to prevent chronic progression. Conclusions: Future research should focus on novel therapeutic targets and integrating gut–brain axis modulation, with a need for longitudinal studies to better understand the long-term course of pediatric migraine. Full article

Osteoarthritis (OA) is a chronic and debilitating joint disease characterized by progressive cartilage degeneration for which no definitive cure exists. Conventional management approaches often rely on fragmented and poorly coordinated pharmacological and non-pharmacological interventions that are inconsistently applied throughout the disease course. Persistent controversies regarding the clinical efficacy of chondroprotective agents, frequently highlighted by pharmacovigilance agencies, underscore the need for a structured evidence-based approach. Emerging evidence suggests that synchronizing pharmacotherapy and exercise regimens with circadian biology may optimize therapeutic outcomes by addressing early pathological processes, including low-grade inflammation, oxidative stress, and matrix degradation. Recognizing the influence of the chondrocyte clock on these processes, this study proposes a ‘prototype’ for a novel framework that leverages the circadian rhythm-aligned administration of traditional chondroprotective agents along with tailored, accessible exercise protocols to mitigate cartilage breakdown and support joint function. In addition, this model-based framework emphasizes the interdependence between cartilage chronobiology and time-of-day-dependent responses to exercise, where strategically timed joint activity enhances nutrient and waste exchange, mitigates mitochondrial dysfunction, supports cellular metabolism, and promotes tissue maintenance, whereas nighttime rest promotes cartilage rehydration and repair. This time-sensitive, comprehensive approach aims to slow OA progression, reduce structural damage, and delay invasive procedures, particularly in weight-bearing joints such as the knee and hip. However, significant challenges remain, including inter-individual variability in circadian rhythms, a lack of reliable biomarkers for therapeutic monitoring, and limited clinical evidence supporting chronoexercise protocols. Future large-scale, longitudinal trials are critical to evaluate the efficacy and scalability of this rational integrative strategy, paving the way for a new era in OA management. Full article

Parkinson’s disease (PD) is a progressive neurodegenerative disorder, with pharmacological treatments predominantly focusing on dopaminergic therapies. In the early stages of PD, symptoms may also be alleviated through non-pharmacological interventions. One such non-invasive technique is electroencephalogram neurofeedback (EEG NFB), which has shown promising results in improving the cognitive and motor functions of PD patients. The aim of our study was to assess the existing evidence, identify key trends and determine potential opportunities for future research in the field of EEG NFB for PD. This analysis explores the impact of EEG NFB on motor deficits in PD and identifies key factors for the successful implementation of EEG NFB as evidenced in the literature. The synthesis includes findings from five relevant studies, including one case study, one pilot study and three randomized controlled trials. Study selection followed the PICO framework to ensure relevance and rigor. The results suggest a correlation between sensorimotor rhythm (SMR) and beta rhythms, with increases in SMR (13–15 Hz) and beta (12–15 Hz) rhythms linked to improvements in balance, mobility and stability in PD patients. However, limitations such as small sample sizes, brief intervention durations and lack of follow-up warrant a cautious interpretation. Future research should prioritize robust protocols, larger samples and extended neurofeedback training to fully assess EEG NFB’s potential for PD management. Full article

Background: Opioid analgesic therapy has been traditionally used for pain management; however, the variability in patient characteristics, complexity in evaluating pain, availability of treatment within facilities, and U.S. physicians overprescribing opioids have contributed to the current opioid epidemic. Despite large research efforts investigating the patterns of postsurgical pain management and influencing factors, it remains unclear how these overall trends vary across the varying sizes and available resources of academic hospitals, community hospitals, and outpatient surgery centers. The primary aim of this scoping review was to examine the patterns of contemporary postoperative pain management across healthcare settings, including academic medical centers, community hospitals, and outpatient surgery centers. Specifically, this study investigates how prescription practices for opioids, NSAIDs, and acetaminophen are influenced by patient demographics, including sex, race, gender, insurance status, and other social determinants of health (SDoH), to inform equitable and patient-centered pain management strategies. Methods: This study utilized The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and was used as a reference checklist. The Arksey and O’Malley methodological framework was used to guide the review process. To ensure comprehensive coverage, searches were conducted across three major databases: PubMed, Embase, and Cochrane Library. Results: A total of 43 eligible studies were retained for analysis. The highest reported Healthy People 2030 category was Social and community context (n = 39), while the highest reported category of SDoH was age (n = 36). A total of 34 articles listed sex and age as SDoH. Additional SDoH examined were race/ethnicity (n = 17), insurance (n = 7), employment (n = 1), education (n = 4), and income (n = 1). This review suggests that there are significant gaps in the implementation of institution-specific, patient-centered, and equitable pain management strategies, particularly in academic hospitals, which our findings show have the highest rates of opioid and NSAID prescriptions (n = 26) compared to outpatient surgical centers (n = 8). Findings from our review of the literature demonstrated that while academic hospitals often adopt enhanced recovery protocols aimed at reducing opioid dependence, these protocols can fail to address the diverse needs of at-risk populations, such as those with chronic substance use, low socioeconomic status, or racial and ethnic minorities. Conclusions: Findings from this review are expected to have implications for informing both organizational-specific and nationwide policy recommendations, potentially leading to more personalized and equitable pain management strategies across different healthcare settings. These include guidelines for clinicians on addressing various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. Full article

Metabolic syndrome (MetS) is an association of risk factors that share insulin resistance (IR), exerting a super cumulative effect on the risk of developing cardiometabolic diseases. Lifestyle optimization is a key element in the prevention and non-pharmacological therapy of MetS. Certain studies have concluded that some dietary patterns could be more beneficial as an adjunctive treatment for MetS. Fasting mimicking diet (FMD) is a form of periodic fasting in which caloric intake is restricted for 5 days each month. It has been studied for its beneficial effects not only in patients with neoplasia and neurodegenerative diseases but also for its effects on IR and metabolism. In this narrative review, the effects of FMD in patients with MetS were analyzed, focusing on its impact on key metabolic components and summarizing findings from human studies. FMD has demonstrated beneficial effects on MetS by reducing BMI and waist circumference, preserving lean mass, and improving the metabolic profile. Moreover, individuals with a higher BMI or a greater number of MetS components appear to derive greater benefits from this intervention. However, limitations such as high dropout rates, small sample sizes, and methodological constraints restrict the generalizability of current findings. Further large-scale studies are needed to confirm these effects and establish FMD as a viable non-pharmacological strategy for managing MetS. Full article

With FDA-approved devices, left atrial appendage (LAA) occlusion has emerged as a well-established and rapidly growing approach to stroke prevention in patients with non-valvular atrial fibrillation. These devices are indicated for use in patients who are at increased risk of stroke and systemic embolism, as determined by CHA₂DS₂-VASc scores, and are suitable for anticoagulation therapy, with an appropriate rationale for seeking a non-pharmacologic alternative. This includes patients who may be unsuitable for long-term anticoagulation due to contra-indications. These devices, generally consisting of a nitinol-framed structure with a circular cross-section, are positioned within the LAA to obstruct the ostium, effectively preventing the thrombus from embolizing the brain. The initial clinical data from pivotal trials and observational registries indicated no strong correlation between peri-device leaks (PDLs) and adverse events. However, recent studies have shown that PDLs are associated with a higher risk of thrombo-embolic events, leading to renewed interest in managing PDLs. This paper reviews the occurrence of PDLs after percutaneous LAA occlusion using current FDA-approved devices, highlighting the need for non-circular occluders to better-accommodate the inherent variability in LAA anatomy. It also compares the benefits and limitations of emerging approaches still under investigation, focusing on addressing PDLs. Full article

Background/Objectives: Perimenopause, impacting 80–90% of women, encompasses a range of vasomotor, urogenital, cognitive, and psychiatric symptoms associated with the fluctuation and gradual reduction of gonadal hormones. Moreover, the onset or worsening of sleep disturbances is prevalent during the menopausal transition. This narrative review seeks to elucidate the pathogenetic processes behind sleep disturbances during perimenopause and the main therapeutic options. Methods: The electronic databases PubMed, Scopus, Google Scholar, Web of Science, and Embase were queried for publications up to May 2024. Longitudinal, observational, case–control, and cross-sectional studies, as well as reviews and meta-analyses, were included in the review in order to explore the prevalence of sleep disorders during perimenopause, the pathogenetic mechanisms underlying the association between menopausal transition and sleep disorders, and the available non-pharmacological and pharmacological treatment options. Results: Sleep disturbances are common among perimenopausal women and include insomnia, sleep-related breathing disorders, and movement disorders. Fluctuations in estrogen and progesterone affect sleep quality, while vasomotor symptoms can disrupt sleep. Circadian changes, decreased melatonin production, and physiological changes associated with aging and mood disorders further exacerbate sleep disturbances. Conclusions: Managing sleep disorders in perimenopause requires an individualized approach, considering the multifactorial nature of these disturbances and providing background knowledge about the relationship between reproductive hormonal changes and sleep. Non-pharmacological treatments should be considered the first-line therapy; hormone therapy or non-hormonal pharmacological treatments can be considered according to the patients’ specific needs and risk factors. However, there is still a lack of standards on the appropriate management and treatment of sleep disorders in perimenopause. Full article

Background: Contrast therapy (CT) is a non-pharmacological treatment that alternates between cryotherapy and thermotherapy. It helps reduce VAS pain, improve joint ROM, enhance function, alleviate muscle soreness, and manage swelling, while also improving blood circulation. This scoping review summarizes recent studies on its use for musculoskeletal injuries (e.g., exercise-induced muscle damage, ankle sprain), degenerative conditions (e.g., osteoarthritis), and painful disorders (e.g., complex regional pain syndrome), assessing its healing potential compared to other conservative therapies. Methods: PubMed, Scopus, and Cochrane Library were searched to identify relevant publications. Articles were selected using the following inclusion criteria: randomized controlled trials, written in English, published between 2004 and 2024, and addressing the use of CT in the management of musculoskeletal painful conditions. Results: Data from 7 articles and 303 patients with musculoskeletal painful conditions treated with CT were included. There was considerable heterogeneity in terms of treatment protocols, with significant differences in the application method, duration, sequence of individuals in each hot/cold cycle, total treatment time, and the pathologies studied. Nevertheless, all studies showed an improvement in the patients’ initial clinical conditions. Conclusions: This review highlights the lack of guidelines for the clinical use of CT in musculoskeletal painful conditions. The heterogeneity of the studies reviewed (different clinical scores, follow-up periods, data, and samples) makes the results imprecise. In addition, the modest quality of the trials does not allow the authors to draw clear conclusions about the effectiveness of CT compared with other therapies. Full article

Hypoxic-ischemic encephalopathy (HIE) is a common cause of significant neonatal morbidity and mortality. The stronghold of the treatment for moderate-to-severe HIE is therapeutic hypothermia (TH) which provides a neuroprotective effect. However, it also is associated with pain and stress. Moreover, neonates with HIE are subjected to a significant number of painful procedures. Untreated pain during the early neonatal period may entail future challenges such as impaired brain growth and development as well as impaired pain sensitivity later in life. Hereby, the provision of adequate sedation and alleviation of pain and discomfort is essential. There are currently no universally accepted guidelines for sedation and pain management for this patient population. In this review, we highlight non-pharmacologic and pharmacologic methods currently in use to provide comfort and sedation to patients with HIE undergoing TH. Full article

Synovitis–acne–pustulosis–hyperostosis–osteitis (SAPHO) syndrome is a rare disease characterized by a sterile inflammatory osteitis and/or arthritis associated with a wide range of dermatological manifestations, such as acne, palmoplantar pustulosis, and psoriasis. This review, providing up-to-date knowledge on this disease, aims at informing researchers and clinicians to help them program future studies in order to improve patients’ care. Due to the vast clinical heterogeneity that characterizes this disease, SAPHO syndrome has received various names; among these, chronic recurrent multifocal osteomyelitis represents the most used one. The various nomenclatures in use also reflect different approaches to its management. Indeed, considering the world-wide distribution and the vast onset age (from children to late adulthood), in addition to the multiform clinical presentation, its diagnosis and treatment are often challenging for clinicians. In this review, we provide valuable insights on SAPHO syndrome, delving into its many aspects: epidemiology, pathogenesis, clinical presentation, diagnosis, and classification. Most importantly, this paper addresses the continuously changing treatment panorama of this disease, from established drugs to newly introduced ones. Furthermore, a peculiar focus regards nonpharmacologic approaches, including traditional Chinese medicine, the apheresis technique, and surgery. Similarly, this review also discusses patients’ lifestyle, including quality of life. To improve SAPHO syndrome’s management, different knowledge gaps should be filled, such as its current epidemiology and pathogenesis. In turn, perfected knowledge in these fields could also advance research in therapy. Full article

Introduction: Type 2 diabetes is a significant health concern in the 21st century, and its prevalence continues to rise despite efforts to promote preventive lifestyle changes. This increase has led to higher economic burdens, prompting the search for non-pharmacological methods to manage glucose levels. Objective: To assess the effects of flaxseed consumption on biochemical markers (glucose, glycated hemoglobin, total cholesterol, and triglycerides) in adult patients with Type 2 diabetes in Oaxaca, Mexico. Materials and Methods: Participants were recruited and randomized into clinical trials between April and June 2023, and the study protocol was approved by a Human Research Ethics Committee. Results: Consuming 16 g of flaxseed daily for three months led to a significant decrease in glucose, total cholesterol, and triglyceride levels (p < 0.001) in Type 2 diabetes patients in the intervention group (n = 82). Belonging to the control group (n = 84) was correlated with presenting higher levels of glycated hemoglobin (Spearman’s Rho 0.640; p < 0.001), higher levels of glucose (Spearman’s Rho 0.352; p < 0.001), total cholesterol (Spearman’s Rho 0.796; p < 0.001), and triglycerides (Spearman’s Rho 0.700; p < 0.001). Conclusions: A daily intake of 16 g of flaxseed is an effective supplementary treatment for adult Mexican patients with Type 2 diabetes, as evidenced by reduced levels of glycated hemoglobin, glucose, cholesterol, and triglycerides in the intervention group. Potential implications for clinical practice: Healthcare providers may consider recommending flaxseed in the diets of patients with obesity, prediabetes, or Type 2 diabetes to improve glucose and lipid metabolism and overall metabolic health. Full article

Background: Dementia with Lewy bodies (DLBs) often presents with neuropsychiatric symptoms (NPSs), yet the role of hyperglycemia, a common cause of delirium in older adults, as a contributing factor remains under-recognized. This article aims to explore the relationship between hyperglycemia and NPSs. Methods: We report the case of a 71-year-old male with DLBs and type 2 diabetes mellitus (T2DM) who experienced worsening NPSs closely associated with periods of hyperglycemia. Initial pharmacological and nonpharmacological interventions were insufficient, prompting adjustments to insulin therapy and dietary modifications to stabilize blood glucose levels. Results: Improved glycemic control resulted in a clinically significant reduction in NPSs. Conclusions: This case suggests a potential link between hyperglycemia and NPSs in DLB patients, emphasizing the importance of maintaining glycemic control in managing NPSs. Although the exact mechanisms remain incompletely understood, adopting a holistic framework for brain health could offer a comprehensive approach to cognitive care. Further studies are needed to elucidate the biological pathways involved, validate these findings in larger populations, and develop evidence-based clinical guidelines. Full article

Idiopathic pulmonary fibrosis (IPF) is a relatively common progressive fibrotic interstitial lung disease associated with significant morbidity and mortality. The available medications for IPF only slow down the disease process, with lung transplantation the only option for a cure. Non-pharmacological therapies are significant adjuncts that can improve symptom burden and quality of life with minimal or no side effects. Supplemental oxygen can improve exercise capacity and the sensation of dyspnea in a significant portion of patients with resting or exertional hypoxemia and has been supported by several professional societies. Pulmonary rehabilitation is a comprehensive program that includes education and therapeutic exercises to improve patient stamina and strength. It is one of the few interventions that have been shown to produce a meaningful increase in a patient’s exercise capacity, but its wide adoption is limited by availability, especially in rural areas. Sleep optimization with supplemental oxygen and positive airway pressure therapy should actively be investigated for all patients diagnosed with IPF. Although gastroesophageal reflux control with non-pharmacological means is still controversial as an intervention to reduce the rate of lung function decline, it can help control reflux symptoms and improve cough intensity. IPF patients should be educated on the importance of balanced nutrition and the potential benefits of screening for lung transplantation. Palliative medicine can help with symptom control and should be considered for all patients regardless severity, but especially in those in the later stages of disease. Full article

Chronic stress significantly influences the pathogenesis of headache disorders, affecting millions worldwide. This review explores the intricate relationship between stress and headaches, focusing on the dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis and autonomic nervous system (ANS). Persistent stress could lead to neuroinflammation, increased pain sensitivity, and vascular changes that could contribute to headache development and progression. The bidirectional nature of this relationship creates a vicious cycle, with recurrent headaches becoming a source of additional stress. Dysregulation of the HPA axis and ANS imbalance could amplify susceptibility to headaches, intensifying their frequency and severity. While pharmacological interventions remain common, non-pharmacological approaches targeting stress reduction, such as cognitive-behavioral therapy, biofeedback, and relaxation techniques, offer promising avenues for comprehensive headache management. By addressing the underlying stress-related mechanisms, these approaches provide a sustainable strategy to reduce headache frequency and improve patients’ quality of life. Full article