Search Results (107)

Background/Objectives: Bipolar II disorder is frequently misdiagnosed as unipolar depression, particularly when depressive symptoms predominate and hypomanic features are subtle or overlooked. This case study describes a patient initially treated for postpartum depression who later developed antidepressant-induced hypomanic symptoms, leading to the correct diagnosis of bipolar II disorder. The objective is to illustrate diagnostic complexities and highlight the value of an integrated treatment approach. Methods: Clinical assessment included standardized mood rating scales, structured interviews, functional evaluations, and monitoring of sleep and physical health indicators. Treatment combined mood-stabilizing pharmacotherapy with cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), psychoeducation, and interpersonal and social rhythm therapy (IPSRT). Lifestyle interventions targeted sleep hygiene, physical activity, and stress management. Results: The diagnosis of bipolar II disorder was supported by the emergence of hypomanic symptoms following antidepressant treatment. The integrated therapeutic plan resulted in sustained mood stabilization, normalization of sleep patterns, improved occupational and social functioning, and reductions in depressive and hypomanic symptom scores. Physical health indicators, including body mass index, also improved. Conclusions: This case underscores the importance of comprehensive assessment and careful interpretation of antidepressant response in suspected bipolar presentations. A multimodal treatment approach integrating medication, psychotherapy, and lifestyle modification contributed to significant clinical improvement and may serve as a model for managing complex bipolar II presentations. Full article

Antiretroviral therapy (ART) adherence behavior is heterogeneous among adolescents and young adults (AYAs) with HIV and influenced by individual and interpersonal psychosocial factors. The primary objective of this study is to characterize ART adherence phenotypes and psychosocial symptom clusters, as related to ART adherence and HIV viral load suppression. This analysis included 60 AYAs with HIV enrolled in an ART adherence support clinical trial. Self-reported ART adherence at baseline, 12-weeks, and 24-weeks was used to define four ART adherence phenotypes: consistently high adherence (YY), early-only adherence (YN), late-only adherence (NY), and consistently low adherence (NN). Symptom clusters were empirically derived from baseline psychosocial measures, including adherence self-efficacy, ART knowledge, HIV stigma, psychological distress (depression, anxiety, trauma), and social support. Linear mixed-effects models were used to examine psychosocial symptom outcomes at three timepoints (baseline, 12-weeks, and 24-weeks) and across groups with different adherence or viral load phenotypes. Using hierarchical clustering, four distinct clusters were identified, underscoring heterogeneity of psychosocial symptoms and patterns of ART and viral suppression. Findings from this analysis are among the first known characterizations of ART adherence phenotypes and psychosocial symptom clusters among AYAs with HIV. Heterogeneity in clusters underscores the need to examine other factors, such as resilience, not captured in the present study. Overall, these study findings contribute to improved understanding of the multi-level psychosocial influences of ART adherence and viral load suppression. Full article

Background: Sexual dysfunction (SD) is a common yet under-recognized consequence of traumatic brain injury (TBI), with significant implications for physical health, psychological well-being, interpersonal relationships and social reintegration. Although TBI research has largely focused on cognitive, motor and behavioral outcomes, the impact of SD remains insufficiently addressed in both clinical practice and rehabilitation programs. Objectives: This review aims to synthesize current evidence on the prevalence, mechanisms and management of SD following TBI, while emphasizing the importance of gender-sensitive and multidisciplinary approaches to care. Methods: A narrative review was conducted by searching PubMed, Scopus and Web of Science for English-language articles published between 2000 and 2025 using combinations of the following keywords: traumatic brain injury, sexual dysfunction, neuroendocrine dysfunction, psychological sequelae and rehabilitation. Priority was given to peer-reviewed clinical studies, systematic reviews and expert consensus guidelines that addressed neurological, endocrine, cognitive, psychological and social aspects of SD in TBI survivors. Exclusion criteria included case reports with insufficient clinical detail and non-peer-reviewed sources. Articles were screened for relevance to both pathophysiological mechanisms and therapeutic strategies. Results: The etiology of post-TBI SD is multifactorial, involving direct neurological injury, hypothalamic–pituitary dysfunction, emotional and cognitive impairments, as well as psychological challenges such as stigma and relationship strain. Men and women may present distinct symptom profiles; for instance, men more frequently report erectile dysfunction and hypogonadism, whereas women more commonly experience challenges with arousal, lubrication and psychological stress. Effective interventions include pharmacotherapy, hormone replacement therapy, psychotherapy and rehabilitative approaches designed to restore intimacy and quality of life. Optimal outcomes are achieved through multidisciplinary collaboration among neurology, endocrinology, psychiatry, psychology and rehabilitation medicine. Conclusions: Sexual dysfunction should be recognized as a critical component of TBI sequelae rather than a secondary concern. Routine screening, gender-sensitive assessment and the integration of individualized, multidisciplinary care pathways are essential to improving patient outcomes. Advancing clinical awareness and standardization in this area holds the potential to significantly enhance the holistic recovery and reintegration of TBI survivors. Full article

Background/Objectives: Gestalt therapy traditionally opposes categorical diagnostic labelling due to its fundamental inconsistency with phenomenological and process-oriented ontology. However, this epistemological rigour can limit integration with structured evidence-based interventions for complex personality organizations such as Borderline Personality Disorder (BPD). Despite the evidence base for DBT and Schema Therapy in treating BPD, these approaches may inadvertently minimize the lived phenomenological experience and organismic wisdom central to recovery. Meanwhile, Gestalt therapy’s anti-diagnostic stance limits its integration with structured evidence-based protocols. This paper proposes a hybrid theoretical model that addresses this gap by integrating the clinical epistemology of Gestalt therapy with Linehan’s biosocial theory of Dialectical Behaviour Therapy (DBT) and schema-focused interventions, while preserving the core principles of Gestalt. Methods: we present a model of theoretical integration that draws on Gestalt contact theory, the four modules of DBT (mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness) and the experiential techniques of Schema Therapy. The integration focuses on the dialectic of acceptance and change, which mirrors Gestalt’s paradoxical theory of change. The proposed framework preserves the non-protocol dimension of Gestalt therapy while incorporating the pragmatic utility of DBT and Schema Therapy. Results: key conceptual contributions we propose include: (1) theorizing the “Draft Self” as the object and subject of therapeutic work, (2) integrating mindfulness and grounding as embodied processes within live Gestalt experiments, (3) activation techniques to explore the identity fragmentation endemic to BPD. Conclusions:his integration offers a coherent, embodied, and process-oriented framework for understanding and treating BPD that validates patients’ lived experience, mobilizes evidence-based interventions, and opens up meaningful intertheoretical dialogue. Full article

Dog parents have a strong attachment to their pets and treat them as children. Similarly to the guilt experienced by the parents of human children, dog parents feel guilty when they have to travel or work long hours and leave their dogs at home alone. This study examined the empathic tendencies among dog parents and how they are related to dog parent guilt and other mental health symptoms. A sample of 332 dog owners from the United States, stratified by age and sex, was recruited for this study. The sample comprised 168 female and 164 male participants. The Guilt About Dog Parenting Scale (GAPS-D), Depression Anxiety and Stress Scale-21, Interpersonal Reactivity Index, and Dog Anthropomorphism Scale were administered via an online survey. Demographic variables, such as age, sex, race, education level, household income, relationship, and parental status, were also collected. Data were analyzed using descriptive statistics, correlation, and linear regression. As predicted, this study found that empathic tendencies in dog parents are related to guilt, anthropomorphizing, and mental health symptoms. This is the first study to examine empathetic tendencies among dog parents in relation to dog parent guilt. Researchers, educators, social workers, mental health professionals, and veterinarians should inform and educate pet owners about dog parent guilt. This will increase the knowledge of professionals, organizations, and pet owners suffering from such guilt. Cognitive behavior therapy (CBT) may offer a promising approach for helping pet parents identify, normalize, and better understand their thoughts, feelings, and behaviors related to empathic and anthropomorphic tendencies. By addressing these cognitive patterns, CBT could potentially help reduce associated feelings of guilt, depression, anxiety, and stress. Full article

Background. Living with a stoma entails profound changes in a person’s life, affecting physical, psychological, and social well-being. Patients often face challenges related to body image, interpersonal relationships, and self-esteem. A stoma can impair quality of life, trigger feelings of shame and limit freedom of movement. Objectives. To assess the subjective perception of quality of life and related psychophysical consequences in individuals with an intestinal stoma. To evaluate the level of perceived support from healthcare professionals involved in the care pathway. Methods. This is a descriptive observational study conducted through the administration of an online questionnaire. The sample includes 189 adult patients with an intestinal stoma. Results. Data analysis revealed that participants aged ≥65 years and those with a permanent stoma reported higher quality of life scores compared to younger individuals or those with a temporary stoma. An inverse correlation emerged between quality of life and perceived stress (p < 0.001); in particular, pain and social embarrassment were strongly associated with higher levels of stress. The enterostomal therapy nurse was identified as a key figure in the care pathway (70.4%). Conclusions. The findings highlight the need for person-centered care that addresses not only clinical aspects but also emotional and relational dimensions. Enhancing the role of trained professionals, such as enterostomal therapy nurses, and promoting targeted educational interventions may contribute to improving the quality of life in patients living with a stoma. Full article

Virtual Reality (VR) is a useful educational tool in healthcare, allowing students to practise and improve practical skills. In speech therapy (ST), the need to revise academic curricula to adapt them to university contexts and integrate them into advanced clinical practices has highlighted the need to analyse the use of VR in this sector. The objective of this scoping review was to investigate whether research has considered using VR to support ST students’ training and highlight potential gaps in the literature. The study followed the JBI methodology for scoping reviews and was reported according to PRISMA-ScR guidelines. A protocol to conduct the current review was developed and registered on the Open Science Framework. The articles considered were retrieved from databases specialising in healthcare, computer science, and education, and were enhanced by results found with the help of AI-based tools. No constraints were applied and all study types were considered. Fourteen studies were included in the review and analysed under four core subjects: VR technology, ST context, training purposes, and main outcomes and assessment methods. The VR types identified in the studies were grouped into four categories, i.e., non-immersive VR (6/14, 42.9%), immersive VR (5/14, 35.7%), non-specified VR type (2/14, 14.3%), and semi-immersive VR (1/14, 7.1%). Most studies (5/14, 35.7%) focused on clinical skills acquisition, others addressed communication and interpersonal collaborative skills (3/14, 21.4%), while the remaining focused on person-centred care and awareness, clinical interviewing or reasoning skills, and performance knowledge (2/14 each, 14.3%). VR is still in its early stages in ST education. Some recent studies suggest VR supports students’ communication, interdisciplinary, and clinical skills. Although still limited in the context of ST education, the increasing affordability and ease of development of VR, along with its growing use in other healthcare fields, suggest that its underuse might be due to institutional barriers and lack of standardised frameworks. Overall, the findings suggest that VR offers promising support for experiential and skills-based learning. Full article

Background/Objectives: Positive psychology interventions (PPIs) may enhance well-being in individuals with severe psychiatric conditions (SPCs), yet little is known about individual differences in treatment response. Methods: We conducted a secondary analysis of a single-blind, parallel-group randomized controlled trial. A total of 119 adults receiving outpatient mental health care were randomized to an 11-week multicomponent PPI plus treatment as usual (PPI + TAU) or TAU alone. A priori demographic and baseline clinical variables (e.g., age, gender, education, diagnosis, symptom severity) were tested as predictors and moderators of six well-being outcomes. Moderation analyses were conducted using the PROCESS macro (version 4.1) for SPSS version 29.0, with simple slopes explored for significant interactions. Analyses followed an intention-to-treat approach. Results: Individuals who were unemployed, had a diagnosis within the psychosis spectrum, or exhibited high interpersonal sensitivity showed improvements in well-being irrespective of the treatment modality received. Older patients, those attending more weekly therapy sessions, and individuals with less somatization, hostility, or life satisfaction levels responded particularly well to the specialized PPI + TAU treatment. While several interactions were significant at p < 0.01, none remained significant after Bonferroni–Holm correction. Nevertheless, the patterns were consistent and theoretically grounded. Conclusions: Individual characteristics may influence the effectiveness of PPIs in SPC populations. Identifying predictors and moderators can inform more personalized interventions. The findings warrant replication. Trial registration: ClinicalTrials.gov, NCT01436331. Full article

Background/Objectives: Borderline Personality Disorder (BPD) involves emotional dysregulation, interpersonal instability and impulsivity. Although treatments have advanced, evaluating the latest innovations remains essential. This rapid review aimed to (1) identify and classify recent therapeutic innovations for BPD, (2) assess their effects on clinical and functional outcomes, and (3) highlight research gaps to inform future priorities. Methods: Employing a rapid review design, we searched PubMed/MEDLINE, PsycINFO, and Embase for publications from 1 January 2019 to 28 March 2025. Eligible studies addressed adult or adolescent BPD populations and novel interventions—psychotherapies, pharmacological agents, digital tools, and neuromodulation. Two independent reviewers conducted screening, full-text review, and data extraction using a standardised form. Results: Sixty-nine studies—predominantly from Europe and North America—were included. Psychotherapeutic programmes dominated, ranging from entirely novel models to adaptations of established treatments (for example, extended or modified Dialectical Behavior Therapy). Pharmacological research offered fresh insights, particularly into ketamine, while holistic approaches such as adventure therapy and digital interventions also emerged. Most investigations centred on symptom reduction; far fewer examined psychosocial functioning, mortality, or social inclusion. Conclusions: Recent innovations show promise in BPD treatment but underserve the needs of mortality and societal-level outcomes. Future research should adopt inclusive, equity-focused agendas that align with patient-centred and recovery-oriented goals, supported by a coordinated, integrated research strategy. Full article

Compassion Focused therapy (CFT) is designed to reduce shame (internal and external) and self-criticism while enhancing the three flows of compassion (compassion to others, from others, and for the self). This systematic review evaluated the effectiveness of CFT on these core theoretical constructs in adult clinical populations. A systematic search of three databases (2000–2024) identified 21 studies (N = 450) meeting the inclusion criteria. The studies were narratively synthesised, and quality was assessed using the EPHPP tool. Consistent improvements in self-compassion (g = 0.23–4.14) and reductions in self-criticism (g = 0.29–1.56) were reported. Reductions in external shame were also observed (g = 0.54–1.22), though this outcome was examined in fewer studies. Limited and inconsistent evidence was found for internal shame and interpersonal compassion flows (compassion to and from others), with only a small number of low- to moderate-quality studies addressing these outcomes. Follow-up effects were rarely assessed, and comparator groups were limited. Most interventions were group-based and of variable methodological quality, with frequent selection bias, small sample sizes, and limited demographic diversity. Overall, CFT shows promise for targeting self-directed processes in clinical populations, though stronger evidence is needed to understand its effects on relational components of compassion. Future research should adopt standardised measures, improve methodological rigour, and recruit more diverse samples. Full article

Background: Stigma associated with tuberculosis (TB) continues to undermine patient well-being, treatment adherence, and public health goals and objectives. This study aims to systematically review the literature to identify and synthesize TB stigma reduction interventions published between 2015 and 2025. Methods: Following the PRISMA guidelines, we conducted a comprehensive literature search across PubMed, Scopus, Science Direct, ProQuest, and Google Scholar. Eligible studies included those with qualitative, quantitative, and mixed-methods designs that focused on interventions related to TB-related stigma. We categorized the studies into three groups: (1) intervention development studies, (2) TB treatment programs with stigma reduction outcomes, (3) stigma-specific interventions. Data extraction and quality appraisal were conducted independently by two reviewers using the Mixed Methods Appraisal Tool (MMAT). Results: A total of 15 studies met the inclusion criteria. Five studies focused on co-developing stigma interventions, which incorporated multi-level and multicomponent strategies targeting internalized, enacted, anticipated, and intersectional stigma. Two studies assessed TB treatment-related interventions (e.g., home-based care, digital adherence tools) with incidental stigma reduction effects. The remaining seven studies implemented stigma-targeted interventions, including educational programs, video-based therapy, peer-led support, and anti-self-stigma toolkits. Interventions addressed stigma across individual, interpersonal, institutional, community, and policy levels. Conclusions: This review highlights the evolution and diversification of TB stigma interventions over the past decade. While earlier interventions emphasized education and support, recent strategies increasingly integrate peer leadership, digital platforms, and socio-ecological frameworks. The findings underscore the need for comprehensive, contextually grounded interventions that reflect the lived experiences of people affected by TB. Full article

Borderline personality disorder (BPD) is a complex and heterogeneous condition characterized by emotional instability, impulsivity, and impaired regulation of interpersonal relationships. This narrative review integrates findings from recent neuroimaging, neurochemical, and treatment studies to identify core neurobiological mechanisms and highlight translational potential. Evidence from 112 studies published up to 2025 is synthesized, encompassing structural MRI, resting-state and task-based functional MRI, EEG, PET, and emerging machine learning applications. Consistent disruptions are observed across the prefrontal–amygdala circuitry, the default mode network (DMN), and mentalization-related regions. BPD shows a dominant and stable pattern of hyperconnectivity in the precuneus. Transdiagnostic comparisons with PTSD and cocaine use disorder (CUD) suggest partial overlap in DMN dysregulation, though BPD-specific traits emerge in network topology. Machine learning models achieve a classification accuracy of 70–88% and may support the tracking of early treatment responses. Longitudinal fMRI studies indicate that psychodynamic therapy facilitates the progressive normalization of dorsal anterior cingulate cortex (dACC) activity and reductions in alexithymia. We discuss the role of phenotypic heterogeneity (internalizing versus externalizing profiles), the potential of neuromodulation guided by biomarkers, and the need for standardized imaging protocols. Limitations include small sample sizes, a lack of effective connectivity analyses, and minimal multicenter cohort representation. Future research should focus on constructing multimodal biomarker panels that integrate functional connectivity, epigenetics, and computational phenotyping. This review supports the use of a precision psychiatry approach for BPD by aligning neuroscience with scalable clinical tools. Full article

Background: Borderline personality disorder (BPD) is a severe psychiatric condition characterised by emotional instability, impulsivity, interpersonal dysfunction, and self-injurious behaviours. Despite growing clinical interest, the neuropsychological mechanisms underlying these symptoms are still not fully understood. This review aims to summarise findings from neuroimaging, psychophysiological, and neurodevelopmental studies in order to clarify the neurobiological and physiological basis of BPD, with a particular focus on emotional dysregulation and implications for the treatment of adolescents. Methods: A narrative review was conducted, integrating results from longitudinal neurodevelopmental studies, functional and structural neuroimaging research (e.g. FMRI and PET), and psychophysiological assessments (e.g., heart rate variability and cortisol reactivity). Studies were selected based on their contribution to understanding the neural correlates of BPD symptom dimensions, particularly emotion dysregulation, impulsivity, interpersonal dysfunction, and self-harm. Results: Findings suggest that early reductions in amygdala volume, as early as age 13 predict later BPD symptoms. Hyperactivity of the amygdala, combined with hypoactivity in the prefrontal cortex, underlies deficits in emotion regulation. Orbitofrontal abnormalities correlate with impulsivity, while disruptions in the default mode network and oxytocin signaling are related to interpersonal dysfunction. Self-injurious behaviour appears to serve a neuropsychological function in regulating emotional pain and trauma-related arousal. This is linked to disruption of the hypothalamic-pituitary-adrenal (HPA) axis and structural brain alterations. The Unified Protocol for Adolescents (UP-A) was more effective to Mentalization-Based Therapy for Adolescents (MBT-A) at reducing emotional dysregulation compared, though challenges in treating identity disturbance and relational difficulties remain. Discussion: The reviewed evidence suggests that BPD has its in early neurodevelopmental vulnerability and is sustained by maladaptive neurophysiological processes. Emotional dysregulation emerges as a central transdiagnostic mechanism. Self-harm may serve as a strategy for regulating emotions in response to trauma-related neural dysregulation. These findings advocate for the integration of neuroscience into psychotherapeutic practice, including the application of neuromodulation techniques and psychophysiological monitoring. Conclusions: A comprehensive understanding of BPD requires a neuropsychologically informed framework. Personalised treatment approaches combining pharmacotherapy, brain-based interventions, and developmentally adapted psychotherapies—particularly DBT, psychodynamic therapy, and trauma-informed care—are essential. Future research should prioritise interdisciplinary, longitudinal studies to further bridge the gap between neurobiological findings and clinical innovation. Full article

Background: Several studies document the importance of communicative abilities for children’s development. Especially in recent years verbal communication in preschool children with developmental language disorder (DLD) has been studied, relying heavily on statistical analysis, outcome measures, or/and parents’ reports. Purpose: This explorative study investigates the effects of speech therapy on the development of language and verbal communication skills in preschool children with DLD within their peer group in a day-to-day setting using objective video-documentation. Hypothesis: Speech therapy leads to improvement of language, communication, and possibly to concurrent development of both language and verbal communication skills in preschool children. Methods: Preliminary prospective study to assess language and verbal communications skills of nine preschool children (seven boys, two girls, 4–6 y) with DLD in a speech therapy kindergarten using video recordings over a one-year therapy period. The communicative participation of the members of the peer group was assessed and included the verbal address (Av) and the ratio of “verbal address/verbal reaction” (Av/Rv). Results: The investigation results in evidence for two outcome groups: One group with suspected preferential verbal communication disorders (n = 4) was characterised by a high Av/Rv value, meaning they were scored to have a normal or high verbal address (Av) and a low verbal response (Rv) (predominantly interpersonal communication related disorder). This group showed minimal changes in the short term but demonstrated improvement after 5 years of schooling; thus, pedagogical activities seemed to be particularly effective for these children. The second group showed a balanced Av/Rv ratio (predominantly language related disorder) (n = 5); but after five years they demonstrated a partial need for special school support measures. This group may therefore particularly benefit from speech therapy. Conclusions: The present study clearly shows that even with speech-language therapy, the linguistic ability of DLD-disturbed children does not necessarily develop simultaneously with their communication ability. Rather, the investigations provide evidence for two groups of preschool children with DLD and communication disorder: One group demonstrated a predominantly verbal communication related disorder, where pedagogical intervention might be the more important treatment. The second group showed predominantly DLD, therefore making speech therapy the more effective intervention. In this study, all children expressed their desire to communicate with their peers. To the authors’ best knowledge, this is the first study determining the ability to communicate in a preschool cohort with DLD using characterisation with video documentation in a follow-up for 1 year. Full article

Background and Objectives: Acceptance and commitment therapy (ACT) enhances psychological flexibility by fostering acceptance of thoughts and emotions, promoting mindfulness practices, and encouraging engagement in value-based actions. These processes have been associated with improvements in mental health and social functioning, with accumulating evidence supporting ACT’s efficacy across various psychiatric disorders. This systematic review aimed to evaluate current evidence on ACT interventions for reducing psychiatric symptoms and enhancing social functioning and interpersonal relationships in adults with psychiatric conditions. Materials and Methods: A comprehensive search was conducted across PubMed, Web of Science, the Cochrane Library, and Embase for studies published between 2014 and 2024. The review protocol was registered on the Open Science Framework (OSF; registration ID: 2ZAGT). Results: Seventeen studies met the inclusion criteria; however, the evidence base remained fragmented, with most psychiatric diagnoses represented by only one or two studies. The reviewed studies exhibited several methodological limitations, including small sample sizes, lack of randomization and blinding, high risk of bias, reliance on subjective outcome measures, and inadequately designed or absent control groups. Despite these limitations, ACT was associated with beneficial effects in conditions such as post-traumatic stress disorder (PTSD), insomnia, psychosis, and autism spectrum disorder, particularly in reducing experiential avoidance, enhancing mindfulness, and promoting long-term improvements in emotional regulation and life satisfaction. Conclusions: Due to the limited number of studies per diagnosis, significant methodological weaknesses, and the lack of high-quality controlled trials, this review cannot provide strong evidence for the efficacy of ACT in improving social functioning among adults with psychiatric disorders. The heterogeneity and overall low quality of the available literature highlight the urgent need for further large-scale well-controlled studies. Full article