Search Results (136)

Background: Although menstrual cycle-based training has attracted increasing attention in endurance sports, research has predominantly focused on ergometric parameters. However, the subjective perspectives and lived realities of athletes remain relatively underexamined. Accordingly, this study aimed to explore performance perceptions and self-regulatory experiences of female endurance athletes within real-life training and competitive contexts. Methods: Qualitative semi-structured interviews were conducted with twelve female endurance athletes (ages 18–42) across triathlon, running, swimming, cycling, and skiing. Data were analysed inductively using descriptive thematic analysis in MaxQDA. Results: Six themes emerged related to menstrual cycle experiences: body awareness and cycle-related perceptions; the influence of expectations and self-efficacy on perceived performance; heterogeneous approaches to cycle-based training; training and recovery adjustments; the ambivalent role of digital tracking tools; and communication openness and barriers. Overall, cycle-based training was applied inconsistently and served more as a framework for interpreting physical symptoms than as a means of optimising performance. Conclusions: In this sample of endurance athletes, cycle-related effects on performance and symptom perceptions were primarily shaped by biopsychosocial factors rather than physiological considerations alone. The menstrual cycle supported self-regulation, but rigid interpretations may risk reinforcing negative expectancies. These insights extend existing work by foregrounding athlete-centred, flexible approaches over deterministic training models. Full article

Sexual interactions are complex human exchanges that are further complicated in the digital domain. This is because the introduction of technology to sexual interactions has prompted change in not only sexual activity but also communication pertaining to consent. Challenges have emerged in defining, interpreting, and communicating sexual consent within a digital context. Accordingly, it is critical to understand how sexual consent is understood and communicated within digital contexts. Herein, the literature concerning digital sexual consent was reviewed and critically analyzed. This narrative review describes digital sexual consent practices, as well as critically analyzes the literature pertaining to sexual consent to identify similarities and differences between in-person and digital consent practices. It is suggested that digital sexual consent should be viewed as a subset of sexual consent rather than a separate sexual consent practice. Future directions pertaining to research and application are discussed. Full article

Background/Objectives: Chronic alcohol use accelerates biological and cognitive aging, yet it remains unclear how cognitive aging progresses during abstinence in alcohol use disorder (AUD). It is also unknown to what extent this follows models such as accelerated aging or the age-related decline as proposed by the vulnerability hypothesis. This study examined age-related changes and cognitive recovery during abstinence in patients with AUD. Methods: A total of 197 clinically admitted patients, referred for detoxification and extensive neuropsychological examination, were included. Neuropsychological testing was administered in the second and sixth week of admission using well-normed instruments. Using both multi-assessment and cross-sectional data, relationships between age and normed cognitive outcome scores were examined. Results: After six weeks of abstinence, age-related deviations were observed for perceptual reasoning (PRI), verbal comprehension (VCI), and short-term memory (SMI) but not for ten other cognitive indices. During admission, age significantly influenced the change in belonging to a specific recovery category. Each additional year of age reduced the odds of showing no cognitive impairment by 5% and reduced the odds of cognitive recovery by approximately 4%, compared to non-improvers. Conclusions: Age-related influences appear limited to specific cognitive functions and do not follow a uniform or easily interpretable pattern. Perceptual reasoning seems negatively affected after age 60 for participants with six weeks of abstinence. Older participants showed a reduced likelihood of cognitive recovery and a reduced likelihood of having no cognitive problems at all. The findings do not support accelerated aging and are still too weak to be considered evidence for the vulnerability hypothesis. Implications for future research are discussed. Full article

Background/Objectives: Antisocial personality disorder (ASPD) is strongly associated with violence, substance use, criminal behavior, and elevated suicide risk. Although inflammatory and metabolic dysregulation have been implicated in severe psychiatric disorders, the biological correlates of impulsivity, aggression, and suicide risk in forensic ASPD populations remain unclear. This study aimed to investigate whether routine hematological, inflammatory, and metabolic parameters are associated with these clinical features. Methods: This cross-sectional study included 57 male individuals diagnosed with antisocial personality disorder (ASPD) who had committed crimes and were referred to the Forensic Psychiatry Department of Elazığ Fethi Sekin City Hospital in Turkey by the court, and 56 age-matched healthy controls. Participants completed standardized assessments of impulsivity (BIS-11), aggression (BPAQ), and suicide probability (SPS). Hematological indices, inflammatory markers, and routine biochemical parameters were analyzed. Group comparisons, correlation analyses, and multivariable logistic regression were performed. Results: Compared with age-matched controls, individuals with ASPD showed markedly higher impulsivity, aggression, and suicide probability, alongside substantially higher rates of substance use, imprisonment history, and suicide attempts (all p < 0.001). Hematological and inflammatory analyses revealed lower red blood cell (RBC) counts and elevated mean corpuscular volume (MCV), red cell distribution width (RDW), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and CRP–albumin ratio (CAR) in the ASPD group (all p < 0.05). Biochemical profiling showed reduced glucose, total protein, albumin, HDL, ALT, and vitamin B12 levels, with increased uric acid levels in ASPD (p < 0.05). Multivariable analysis indicated that being married and having higher education were protective against ASPD, whereas higher uric acid and CAR levels were associated with increased risk. Conclusions: The findings indicate that criminal offenders with ASPD show increased inflammatory markers and altered hematological and biochemical profiles. Routine blood parameters, combined with psychometric assessments, may help identify individuals at higher behavioral risk and support early risk stratification in forensic psychiatric settings, although causal relationships cannot be inferred from this cross-sectional study. Full article

Background: Psychiatrists operate at the interface of clinical care, legal frameworks, and governmental power, where external pressures and insufficient safeguards can potentially engender ethical vulnerabilities. Supranational instruments and wider professional standards notwithstanding, the extent to which national-level psychiatric associations articulate protections against torture and abusive practices in their ethical codes remains underexplored. Methods: A cross-sectional documentary audit was conducted of all 145 World Psychiatric Association (WPA) Member Societies, representing ≈250,000 psychiatrists globally. National-level psychiatric ethical codes were located via systematic web searches and examined for clauses specifically referencing torture or analogous abuses and for any associated enforcement procedures. Results: Only nineteen (13.1%) WPA Member Societies maintained publicly accessible ethical codes, with ten (6.9%) containing explicit provisions proscribing torture and associated abuses. These predominantly originated from high-income countries or jurisdictions with documented histories of human rights violations. Most codes invoked broad principles without directly addressing such abuses, and fewer than half delineated any enforcement mechanisms. Conclusions: Gaps persist in ethical governance and human-rights safeguards amongst WPA Member Societies. Although beneficence and non-maleficence provide moral foundations for psychiatric practice, generic commitments alone may prove inadequate under duress. Strengthening anti-torture prohibitions within national-level psychiatric codes could therefore help support ethical resilience and accountability in situations of institutional or political coercion. Full article

(1) Background: Post-arrival screening for infectious diseases is routinely offered to newly arrived refugees in Denmark, including tests for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis. This study aimed to examine the cascade of care following positive screening results in a local cohort of refugees in Denmark, with a focus on subsequent clinical management, follow-up, and outcomes. (2) Methods: This retrospective cohort study included 1506 newly arrived refugees of all ages and countries of origin. All were offered a post-arrival infectious disease screening in Denmark. Clinical records were reviewed to assess progression through the cascade of care, including referral, evaluation, follow-up, and clinical outcomes among individuals with positive screening results. (3) Results: Of the 1506 screened refugees, 33 (2.2%) had at least one positive screening result. Among the 15 individuals with detectable hepatitis B surface antigen, six (43%) attended regular follow-up, while eight (57%) were lost during the cascade of care. Two participants screened positive for HCV antibodies; both underwent initial clinical evaluation, but their subsequent care trajectories differed due to repeated non-attendance or undocumented reasons. Only one participant with non-specific syphilis antibodies completed follow-up in accordance with national guidelines. One participant was diagnosed with HIV and successfully linked to care. (4) Conclusions: The prevalence of screened infectious diseases in this local Danish refugee cohort was low and consistent with findings from comparable settings. Although post-arrival screening facilitates the identification of infectious diseases, substantial loss to follow-up occurred after initial diagnosis, limiting the effectiveness of follow-up and treatment. These findings highlight the need for targeted, interdisciplinary strategies addressing organisational, social, and individual barriers to improve continuity of care following screening. Full article

Background/Objectives: Incarcerated people experience high rates of trauma, psychological distress, and social marginalization. Yoga has been introduced in prisons as a trauma-sensitive mind–body practice, yet its rehabilitative contribution remains uncertain. This systematic review aimed to synthesize evidence on the feasibility and effectiveness of yoga interventions delivered in correctional settings. Methods: Following PRISMA guidelines and a preregistered PROSPERO protocol, we searched PubMed, PsycINFO, Cochrane CENTRAL, and Scopus for peer-reviewed publications from May 2012 to November 2025. Eligible studies involved structured yoga interventions for incarcerated populations and reported psychological, behavioral, or institutional outcomes. Two reviewers independently performed screening, data extraction, and quality appraisal using the Mixed-Methods Appraisal Tool (MMAT). Results: Ten studies reported in twelve publications and involving 1815 incarcerated individuals met the inclusion criteria. Interventions included Hatha-based protocols, Krimyoga, trauma-informed approaches, and multicomponent programs. Across randomized, quasi-experimental, and pre–post designs, yoga was feasible and acceptable. Reported benefits included reduced psychological distress, negative affect, anger, and trauma-related symptoms, as well as improved mood, self-regulation, and mindfulness. Evidence specific to women and girls was limited, but the available trauma-informed and gender-responsive studies suggested potential reductions in post-traumatic stress, depression, and anxiety, alongside increases in self-compassion. One large quasi-experimental cohort found lower reincarceration rates among yoga participants, although institutional outcomes were otherwise limited. Evidence was constrained by small samples, heterogeneous intervention formats, short follow-up, and variable outcome measures. Conclusions: Yoga appears to be a promising adjunct to rehabilitation in correctional settings. However, methodological limitations prevent firm conclusions. Larger, well-controlled studies with standardized outcomes and longer follow-up are needed to clarify effectiveness and support integration into correctional health and rehabilitation policy. Full article

Introduction: Paternal filicide is a rare and complex form of intrafamilial homicide, frequently associated with underlying psychopathology, interpersonal conflict, and psychosocial stressors. While maternal filicide has been more extensively studied, cases involving fathers—especially those employing multiple homicidal methods—remain significantly underrepresented in the forensic literature. This paper presents an unusual case of paternal filicide involving combined lethal methods, contextualized through a narrative review of comparable cases. Methods: A comprehensive forensic-pathological and psychiatric investigation was conducted following the homicide of an 8-year-old boy, killed by his father through a combination of asphyxiation and stabbing. A narrative literature review was performed using PubMed, Scopus, and Google Scholar, focusing on case reports and case series concerning paternal filicide. Particular attention was paid to homicidal methods, motivational dynamics, psychiatric comorbidities, and post-crime behavior. Results: The child’s body was found concealed in a building, in a bed storage drawer, with packing tape tightly wrapped around the mouth and nose and a kitchen knife embedded in the neck. No defensive wounds were observed, suggesting a sudden and unopposed assault, likely facilitated by the victim’s trust in the perpetrator. Autopsy findings revealed signs of asphyxiation and three stab wounds to the chin, neck, and thorax, involving vital structures such as the thyroid cartilage and heart. The father was found in a state of acute alcohol intoxication and subsequently convicted of intentional homicide. The motive appeared to be revenge-related, stemming from a highly conflictual marital separation. The literature review confirmed the predominance of retaliatory motives, frequent substance use, and post-crime suicidal behavior. However, the use of combined homicidal methods and the concealment of the body were found to be exceedingly rare. Conclusions: This case, combined with the literature review, highlights the need for deeper scientific exploration of paternal filicide. Comprehensive forensic and psychiatric assessments are essential to identify recurring situational patterns, motivational profiles, sociocultural contexts, and psychiatric vulnerabilities. These findings are critical not only for post-crime evaluations but also for the development of interdisciplinary prevention strategies targeting early warning signs and high-risk family dynamics. Full article

Background: Ultramarathon running represents an extreme physiological and metabolic challenge. Despite its growing popularity among recreational and competitive runners, evidence-based guidance for nutrition, energy balance, and recovery remains limited. Understanding metabolic response and hormonal regulation during such events is crucial for improving athletes’ health and performance. Methods: This prospective observational study examined participants of the 2024 TorTour de Ruhr^® (100 km, 160.9 km, and 230 km). Pre- and post-race assessments included body composition, energy intake and expenditure, metabolic and hormonal biomarkers (leptin, ghrelin, insulin, glucagon, irisin, creatine kinase muscle type (CKM), lactate dehydrogenase (LDH)), and continuous glucose monitoring (CGM). Blood and saliva samples, bioimpedance analysis, and validated symptom questionnaires (General Assessment of Side Effects (GASE)) were used. Results: Of the 43 ultra runners (16 women, 27 men), 39 finished the race: 19 participants of the 100 km group, 8 of the 160.9 km group, and 16 of the 230 km group. Mean energy deficit was 6797 kcal (range: 417–18,364 kcal) with carbohydrate-dominant fueling (79%). Significant reductions in leptin and insulin and increases in ghrelin, glucagon, CKM, and LDH were observed, indicating disrupted energy homeostasis and muscle damage. The 230 km subgroup showed the greatest changes. Gastrointestinal and musculoskeletal symptoms increased post-race, aligning with biomarker patterns. Conclusions: Ultramarathon participation induces profound disturbances in metabolic and structural integrity, regardless of race distance. These findings underline the importance of developing individualized nutritional and recovery strategies and highlight the need for future research to investigate how energy deficit and macronutrient composition interact to influence metabolic strain and post-race recovery. Full article

Background: Germany provides a worldwide almost unique legal framework for offenders with substance use disorders through § 64 of the German Criminal Code, mandating a two-year multimodal therapy including an in-house clinical treatment period followed by a reintegration phase with gradually reduced supervision. During this phase, lapses are often concealed, with synthetic cannabinoids (SCs) serving as a potential tool due to limited detection in routine screenings and heterogeneous monitoring practices across forensic psychiatric clinics. Methods: This study compared two forensic hospitals, Guenzburg and Kaufbeuren, over a ten-year period, from 2014 to 2024, to evaluate monitoring strategies. While Kaufbeuren applied a case-dependent testing approach, including unannounced urine screenings, Guenzburg introduced a stricter regime in 2019, combining mandatory hair analysis three months into reintegration with unannounced broad-spectrum screenings including SCs. Results: Among the 527 patients included in this study, significantly more tests were conducted in Guenzburg after 2022. The different approach between hair vs. urine analysis produced a seven-fold higher detection rate of SC use compared to Kaufbeuren. Across both clinics, however, SC-positive patients shared similar features. They were younger at first conviction, more frequently under substitution treatment, and more likely to have committed violent offenses. A history of violence quadrupled SC-positive odds, while time since leave as such increased odds by 0.1% per day. Conclusions: In conclusion, these results underscore the effectiveness of standardized long-term SC monitoring using hair analysis and the predictive role of a history of violence in the context of SC-relapse. Full article

Zinc (Zn²⁺) is a trace element essential for its catalytic, antioxidant, and immunomodulatory roles extending to synaptic signalling in the central nervous system. In this narrative review, we aim to offer the reader evidence linking perturbations of the Zn²⁺ homeostasis, including deficiency, excess, or transportation anomalies, to neuropsychiatric conditions such as Alzheimer’s disease (AD), Parkinson’s disease (PD), autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD). A targeted, unsystematic PubMed search followed by an extensive pearl-growing strategy was applied to further augment study selection based on the extensive expertise of study authors. Overall, most of the evidence currently available suggests a modest benefit for a Zn²⁺ supplement of around 25–30 mg/day as an augmentation to MDD treatment, with potential benefits of smaller magnitude in paediatric ADHD. Evidence for perturbations of Zn²⁺ as a biomarker of risk for these neuropsychiatric disorders remains unconvincing. The role of Zn²⁺ supplements in the treatment of the selected conditions remains largely unknown due to the lack of specific, randomised controlled trials conducted to explore their efficacy. The long-term safety, optimal doses for specific applications, and the exploration of possible biomarkers to stratify patient selection to identify the optimal candidate for Zn²⁺ supplements remain unanswered questions. Full article

Background/Objectives: The Commission d’examen des troubles mentaux (CETM), under Quebec’s Tribunal Administratif du Québec, reviews individuals found not criminally responsible on account of mental disorder (NCRMD). These hearings seek to balance public safety with reintegration, guided largely by treatment team recommendations. Despite the CETM’s central role in forensic psychiatry, limited empirical data exist on how its decisions align with clinical advice and which dynamic risk factors influence outcomes. This study aimed to (1) profile the CETM’s 2023 caseload, (2) evaluate concordance between CETM dispositions and treatment team recommendations, and (3) examine clinical, social, and legal factors associated with decision-making. Methods: We conducted a retrospective review of 1721 judgments issued by the CETM in 2023, retrieved from the publicly accessible Société Québécoise d’information juridique (SOQUIJ) database. Eligible cases included annual NCRMD review hearings, excluding trial fitness assessments and repeated hearings within the same year. A structured coding grid documented sociodemographic, administrative, legal, and clinical information, with emphasis on dynamic risk factors such as treatment adherence, substance use, and recent aggression. Descriptive analyses summarized population characteristics and concordance between clinical recommendations and CETM decisions. Results: The cohort was predominantly male (85%) with a mean age of 41 years. Psychotic disorders were the most frequent primary diagnoses (76%), frequently accompanied by substance use and antisocial traits. Most patients (79.6%) had prior psychiatric hospitalizations, while 25.5% had prior incarcerations. Nearly half displayed recent aggression or non-compliance. Treatment teams most often recommended conditional discharge (55%), followed by detention with conditions (21%) and unconditional release (19%). CETM decisions aligned with recommendations in 83.6% of cases; when divergent, rulings were more restrictive (8.6%) than permissive (4.6%). Conclusions: This study provides the first large-scale profile of Quebec’s CETM. High concordance with clinical teams was observed, but restrictive decisions were more frequent in cases of disagreement. The findings underscore the importance of incorporating standardized risk assessment tools to enhance transparency, consistency, and balance in forensic decision-making. Full article

Simulation is widely used in healthcare, with VR simulation replacing physical scenarios with virtual ones. Participants observe based on predefined learning objectives and reflect on them during debriefing sessions. De-escalation is recommended as the first-line response to potential aggression in mental healthcare. Staff in secure mental health units frequently face aggression, and training may enhance de-escalation skills. The study aimed to explore staff experiences with VR simulation as a supplement to physical simulation for de-escalation and examine differences between those with and without prior physical simulation experience. The study involved 58 frontline staff in a Norwegian high security secure mental health department. Twelve simulations were conducted, followed by a post-simulation questionnaire. Data was analyzed using thematic analysis and appropriate statistical analyses. Departmental and data protection approvals were obtained, and participation was based on informed consent. Two themes emerged: (1) enhances situational understanding, and (2) lack of training for action readiness. Participants rated the simulation highly on most questions and perceived VR simulation as a valuable supplement to physical simulation. Those without prior simulation experience were more satisfied with the VR scenario (mean difference = 0.421, 2-sided 95%CI = 0.036–0.807, t = 2.188, p = 0.033), learned more from the VR simulation (mean difference = 0.725, 2-sided 95%CI = 0.045–1.406, t = 2.136, p = 0.037), experienced VR scenario which was more applicable to clinical work (mean difference = 0.645, 2-sided 95% CI = 0.161–1.128, t = 2.674, p = 0.010), and reflected that the VR simulation increased their experienced safety (mean difference = 1.133. 95%CI = 0.478–1.788, t = 3.468, p = 0.001). Greater benefits were yielded from the VR simulation for those without prior simulation experience than those with previous experience. Further studies are recommended. Full article

Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and continuity of care. Nevertheless, risk governance gaps persist for high-complexity patients, imposing a disproportionate legal and clinical burden on mental health professionals. This group includes individuals who refuse treatment despite meeting criteria for compulsory admission, patients at elevated risk with substantial management complexity, and offenders with a current or suspected psychiatric disorder. Methods: We conducted a comparative legal and policy review across seven jurisdictions (Italy, England and Wales (UK), France, Germany, Spain, the United States, and Canada) to map frameworks for involuntary treatment, forensic services, CTOs (or equivalents), and community-based risk management. We also extracted procedural safeguards, duration and renewal limits, and interfaces with forensic services. Results: CTOs are available in five of the seven jurisdictions (England and Wales, France, Spain, the United States, and Canada) but are absent in Italy and Germany. We propose a three-pillar framework: (1) enforceable outpatient measures, including CTOs; (2) Forensic Psychiatry Units within Local Health Authorities; and (3) oversight boards with judicial, clinical, and social representatives. These components aim to redistribute responsibility, ensure continuity of care, and provide proportional oversight within a least restrictive, graduated system. Conclusions: When narrowly targeted, time limited, and paired with robust safeguards and service-quality standards, CTOs can support adherence and continuity for patients who repeatedly disengage from care. For Italy, integrating this instrument within the three-pillar framework and under independent oversight could strengthen patient rights and public safety, reduce revolving-door admissions, and improve outcomes. Full article