Search Results (827)

Burn injuries are increasingly recognized as chronic conditions with enduring physical, psychological and social consequences that extend beyond acute survival. This narrative review synthesizes and interpretatively discusses recent evidence on health-related quality of life (HRQoL) in adult burn survivors, focusing on recovery patterns following discharge. Persistent physical sequelae—particularly chronic pain, pruritus, contractures and scarring—remain major determinants of reduced HRQoL, mainly mediated by functional limitation and self-perception. Psychological morbidity is common, with high rates of depression, anxiety and post-traumatic stress disorder, particularly early after injury, although post-traumatic growth may also emerge. Social reintegration, including return to work, is often delayed or incomplete and is influenced by injury severity, mental health status and social support. Recovery trajectories are nonlinear: the greatest improvements occur within the first six months, followed by slower gains up to 18–24 months, after which many patients fail to reach population norms. Pain and psychological symptoms may persist for years. Overall, these findings support a multidisciplinary, longitudinal approach to burn care, emphasizing early risk stratification and rehabilitation to optimize individualized recovery. In this narrative review, we aim to outline the main dimensions of long-term quality of life, with a particular focus on the temporal dynamics of recovery patterns. Full article

This study aimed to examine the relationship between post-traumatic stress symptoms following cryptocurrency loss and early maladaptive schemas in physicians. This cross-sectional study was conducted using a relational screening model and included 94 physicians across Türkiye who reported financial loss in cryptocurrency markets between 15 April and 15 July 2022. Data were collected online using a sociodemographic information form, the Young Schema Questionnaire–Short Form 3, and the Impact of Event Scale-Revised. Participants with an Impact of Event Scale–Revised total score of 33 or higher were classified as having elevated IES-R symptoms, reflecting elevated event-related distress according to a screening cutoff rather than a clinical diagnosis of PTSD. Eighteen participants (19.1%) were classified into this group. While no significant differences were found in age, marital status, employment status, or investment duration, the proportion of savings allocated to crypto was higher among participants with elevated IES-R symptoms. The elevated IES-R symptom group had higher scores in Failure, Pessimism, Dependence/Enmeshment, Punitiveness, Defectiveness, and Vulnerability to Harm, and additional correlation analyses showed that the IES-R total score was positively associated with Pessimism, Punitiveness, Dependence/Enmeshment, and Failure after false discovery rate correction. However, in the exploratory logistic regression analysis, none of these variables independently predicted elevated IES-R symptom status. These findings suggest that cryptocurrency loss may represent not only a financial stressor but also a significant experience associated with post-traumatic stress symptoms and maladaptive schema patterns in physicians. Full article

Post-Traumatic Stress Disorder (PTSD) is a prevalent and costly mental health condition characterized by symptoms such as hyperarousal, avoidance, and re-experiencing. While machine learning (ML) approaches have shown promise in detecting PTSD-related physiological patterns, most validation efforts rely on computational metrics rather than real-world user perceptions. This study evaluates the perceived precision of a smartwatch-based ML tool designed to detect PTSD hyperarousal events using heart rate and activity data. The tool, previously developed using XGBoost 1.0.0, was deployed in a 21-day naturalistic study with 12 participants diagnosed with PTSD. Quantitative results showed a median perceived precision of 65.27%, with substantial variability across participants. A Mann–Kendall trend analysis revealed a significant increase in perceived precision over time for most participants, suggesting calibration of trust. Qualitative findings indicated high usability, general trust in the system, and acceptance of false positives, though concerns about notification design and battery life were noted. The results highlight the importance of incorporating user-centered, real-world validation into the evaluation of ML-based mental health monitoring tools. This work provides preliminary evidence supporting the feasibility of wearable-based PTSD monitoring and underscores the role of perceived precision in technology adoption and sustained use. Full article

Background and Objectives: This study aimed to examine the level of depression in children who had undergone pediatric liver transplantation and to evaluate the potential role of liver enzymes as biomarkers of depression. Materials and Methods: The study was conducted with 50 pediatric liver transplant recipients followed at the Liver Transplantation Institute of İnönü University, and data were collected through face-to-face interviews. The Personal and Transplant Information Form, Child Revised Impact of Event Scale, and Patient Health Questionnaire–Depression were used as data collection tools. In addition to descriptive statistics, Student’s t-test, Mann–Whitney U test, correlation analyses, and regression analyses were performed. Results: The median PHQ-9 score was 1.00 (Q1–Q3: 0.00–5.00), indicating generally low levels of depression. A significant positive correlation was found between CRIES and PHQ-9 scores (r = 0.414, p < 0.01). In contrast, no consistent significant associations were observed between liver enzyme levels and depression scores in multivariate analyses, although bilirubin showed a modest negative correlation with PHQ-9 scores. In the multivariate analysis, although the overall regression model was not statistically significant, the CRIES score showed an individual association with PHQ-9 scores within the model (B = 0.117, p = 0.037). Conclusions: Liver enzymes cannot be considered strong biomarkers of depression in pediatric liver transplant recipients; however, post-traumatic stress symptoms may be an important clinical indicator for assessing psychological adjustment. Full article

Post-traumatic stress disorder (PTSD) remains inadequately treated by existing pharmacological and psychological interventions, prompting growing interest in psychedelic-assisted psychotherapy. Although randomised controlled trials have evaluated several psychedelic agents for PTSD, to our knowledge, no prior PTSD-specific synthesis has quantitatively examined multiple agent classes within a single review framework. This systematic review and meta-analysis searched PsycINFO, CINAHL, Embase, MEDLINE, and clinical trial registries to identify RCTs of psychedelic-assisted psychotherapy for PTSD. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and random-effects meta-analyses were conducted for efficacy outcomes; safety and therapeutic protocols were synthesised narratively. Eleven RCTs involving 358 participants met inclusion criteria, evaluating MDMA, ketamine, and cannabidiol, of which eight contributed to meta-analyses. MDMA-assisted psychotherapy demonstrated a significant moderate-to-large reduction in PTSD symptom severity with negligible heterogeneity, and participants were significantly more likely to achieve clinical response and loss of PTSD diagnosis. The pooled effect for ketamine was small and non-significant, and a single cannabidiol trial showed no clear benefit. All agents were generally well tolerated. MDMA-assisted psychotherapy showed a promising efficacy signal for PTSD symptom reduction, although safety data were heterogenous and remain insufficient for strong comparative conclusions. Evidence for ketamine and cannabidiol remains too limited to support clinical implementation and it is noted that the current evidence base is dominated by MDMA trials. Further adequately powered trials with standardised outcomes and direct comparative studies across agents are needed. Full article

Background/Objectives: Clinical childbirth in high-income countries is increasingly shaped by standardised routines that do not always accommodate individual preferences. In Germany, approximately one in eight pregnant persons experiences clinically significant childbirth-related post-traumatic stress disorder symptoms, with pregnant persons facing language or health-literacy barriers being at particular risk of inadequate preference integration. Methods: This paper presents the conceptual foundation and proposed study design for FAIR-Birth, an interdisciplinary initiative to develop and feasibility-test a mobile application supporting Advance Birth Planning (ABP) embedded within midwifery-led antenatal care. The intervention combines four elements: transfer of the Advance Care Planning concept to antenatal care, a domain-restricted Large Language Model (LLM) supporting multilingual preference articulation, integration of the resulting ABP document into midwifery-led continuity of care, and iterative adaptation. Following the updated MRC framework, this study will employ a sequential mixed-methods design encompassing systematic review, participatory instrument development, Delphi consensus on the knowledge base, iterative technical development with usability testing, and a feasibility study across two perinatal centres in Bavaria. Results/Conclusions: FAIR-Birth is expected to generate a content-validated ABP instrument, a domain-restricted multilingual LLM dialogue system, and an evaluated application prototype. The work corresponds to the development and feasibility phases of the MRC framework; effectiveness questions are reserved for a planned subsequent randomised controlled trial. Full article

Background/Objectives: Extant data suggest that the Stellate Ganglion Block (SGB) is effective for posttraumatic stress disorder (PTSD). Clinical data from a large healthcare system are lacking. We report data from a clinical project in the Veterans Health Administration. Methods: Retrospective data of PTSD and anxiety for 579 patients who received one or more SGBs were analyzed on the full sample and on those who had complete data using general linear models. Results: Receiving the first SGB provided a 36% and 30% reduction in PTSD symptom scores at 1-week and 1-month post-SGB, respectively. Those who received 2–4+ SGBs showed lower pre-SGB PTSD symptom scores and trends for lower scores at 1-week and 1-month post-SGB. Overall, 78% and 71% of patients had a reliable (Δ ≥ −5 points) change and 68% and 60% had a clinically meaningful (Δ ≥ −10 points) change in PTSD symptom scores from pre-SGB to 1-week and 1-month post-SGB, respectively. There were clinically meaningful reductions for anxiety in 51.5% and 48.3% at 1-week and 1-month post-SGB, respectively. Conclusions: These data corroborate existing data about the benefit of SGB for PTSD and anxiety and are unique in showing an association between repeat SGBs and lower PTSD symptoms at subsequent baseline. Full article

Exposure to blast waves without kinetic, penetrating, thermal, or toxic components causes a distinct form of traumatic brain injury, termed primary blast-induced TBI (pbTBI). Clinical manifestations of pbTBI span a wide spectrum, ranging from life-threatening intracranial hemorrhage, hyperemia, and delayed cerebral edema to mild and transient neurological symptoms without detectable structural abnormalities on routine imaging. At the mild end of the spectrum, symptoms after a single exposure may resolve quickly, yet repeated exposures—even at very low levels, termed “subconcussive”—can develop into post-concussive syndrome (PCS) or persistent post-concussive symptoms (PPCS) in a subset of individuals. Despite extensive studies, the molecular pathobiology linking primary blast exposure to delayed and sometimes chronic neurobehavioral deficits remains incompletely understood. A mechanistic framework connecting blast-wave physics to biomechanics to biological vulnerability may therefore help define exposure hazards, interpret clinical symptomatology, and guide diagnostic and therapeutic development. This review summarizes the physics of primary blast waves, the resulting biomechanical responses, and candidate biological substrates, emphasizing structures and interfaces with distinct acoustic impedances across anatomical, tissue, cellular, and molecular scales. We synthesize evidence supporting the hypothesis that the cerebral vasculature and endothelial cells represent critically vulnerable substrates of primary blast-wave injury, in part because the vascular tree constitutes the brain’s largest and most widely distributed interface between compartments with different acoustic impedances. Across experimental and human studies, endothelial stress, vascular injury, and downstream neuroinflammation emerge as convergent molecular responses to primary blast exposure. Temporal dynamics are central to understanding pbTBI because many blast-induced processes unfold in sequential phases. These observations support conceptualizing pbTBI as a condition characterized by prominent cerebrovascular injury of varying severity with secondary consequences for neuronal signaling, network function, and behavior. Within this framework, cerebrovascular and neurovascular unit (NVU) dysfunction provides a parsimonious bridge between primary blast-wave exposure and chronic symptom trajectories, where vascular pathology may offer more accessible therapeutic targets than neuronal injury. Key knowledge gaps include identifying which physical component(s) of the blast are most injurious, establishing biologically meaningful dose–response relationships at molecular and physiological levels, and defining windows of vulnerability during recovery that are relevant to repeated exposures. Addressing these gaps is essential for refining safety protocols, improving diagnostic specificity through mechanism-informed biomarkers, and developing evidence-based molecular and vascular therapeutic targets for pbTBI-associated conditions. Progress will require integrating waveform-aware dosimetry with longitudinal physiological and molecular monitoring across both preclinical and human cohorts. Such integration offers a practical path toward translating blast physics into actionable medical guidance for prevention, triage, and recovery management. Full article

Background/Objectives: Survival rates after pediatric liver transplantation have improved substantially over recent decades, yet the psychiatric consequences for recipients remain a concern that warrants closer attention. We sought to map the psychiatric symptom burden across multiple domains in this population and to determine which symptom clusters carry the greatest impact on health-related quality of life (HRQOL). Materials and Methods: Fifty liver transplant recipients between the ages of 8 and 18 were enrolled at a single center. Children and their parents completed four psychiatric measures—the CBCL, CDI, SCARED, and CRIES-13—alongside the parent-proxy PedsQL to capture HRQOL across physical, emotional, social, and school functioning domains. Correlations between instruments were calculated, and linear regression was used to determine which psychiatric variables independently predicted PedsQL Total scores. Results: Across all psychiatric measures, higher symptom scores were associated with lower HRQOL, with school functioning recording the lowest absolute PedsQL domain score, while emotional functioning demonstrated the strongest and most consistent inverse correlations with all psychiatric symptom measures across instruments. CBCL Total (r = −0.607), SCARED Total (r = −0.557), and CRIES-13 Total (r = −0.548) scores all correlated meaningfully with overall HRQOL. When entered into multivariable analysis, anxiety symptoms measured by the SCARED (β = −0.295, p = 0.032) and post-traumatic stress symptoms measured by the CRIES-13 (β = −0.400, p = 0.004) stood out as the two independent predictors of worse PedsQL Total scores. Conclusions: Even in medically stable recipients, anxiety and post-traumatic stress symptoms were independently associated with lower daily functioning scores and overall quality of life. These findings suggest that routine psychosocial screening and trauma-informed approaches may warrant integration into post-transplant care protocols, and that prospective, adequately powered studies are needed to confirm and extend these associations. Full article

Background: Non-invasive respiratory supports (High-Flow Nasal Oxygen, HFNO; Continuous Positive Airway Pressure, CPAP; Non-Invasive Ventilation, NIV) are frequently used in Acute Hypoxemic Respiratory Failure (AHRF). However, the experience of assisted breathing may profoundly affect patients’ psychological balance, particularly during acute critical illness and subsequent rehabilitation. Aims and objectives: This longitudinal study investigated the psychological burden associated with non-invasive respiratory support use in patients with COVID-19-related AHRF, exploring changes in psychological functioning from acute hospitalization (RICU/ICU) (T0) to follow-up, conducted at a mean of 6.0 ± 3.1 months after respiratory rehabilitation (T1). Methods: Fifty-two patients (mean age = 66.9 ± 9.17 years) were assessed at T0 and T1. Standardized measures evaluated anxiety, psychological distress, post-traumatic stress symptoms, depression, and resilience, in relation to perceived illness severity and subjective experience of non-invasive respiratory support. Results: During acute care, patients reported high levels of fear and anxiety related to illness severity and uncertainty. The experience of non-invasive respiratory support, often perceived as a marker of critical condition, was associated with increased fear and anxiety (t(14) = 2.79, p = 0.014) compared to the recovery phase, leading to feelings of loss of control and diminished psychological well-being (t(17) = 2.35, p = 0.031). However, resilience significantly improved over time (t(16) = −4.78, p < 0.001). Conclusions: Non-invasive respiratory support may represent a psychologically demanding experience, often perceived as challenging to patients’ sense of safety and control. Encouragingly, psychological adaptation and resilience can improve during rehabilitation. Integrating structured psychological support within respiratory rehabilitation pathways may promote recovery and restore psychological balance in patients requiring assisted ventilation. Full article

This study examines the relationship between Sudanese audiences’ exposure to digital media coverage of the civil war and their psychological immunity and post-traumatic stress disorder (PTSD) symptoms while also investigating the mediating role of psychological immunity. Data were collected through an online survey from a sample of 774 Sudanese respondents residing both inside and outside Sudan. The findings indicate a relatively high level of exposure to digital news coverage, particularly through social media platforms such as Facebook, reflecting the growing centrality of digitally mediated news environments in conflict reporting. The results also reveal moderate levels of psychological immunity and relatively high levels of PTSD symptoms, especially in the hyperarousal dimension. Statistical analysis shows a negative association between media exposure and psychological immunity, and a positive association between exposure and PTSD symptoms, with psychological immunity partially mediating this relationship. Beyond these findings, this study highlights important implications for journalism practice and media responsibility. The intensity and emotional nature of digital war coverage raise critical concerns regarding ethical news production, the circulation of distressing content, and the potential psychological impact on audiences. These findings underscore the need for more responsible digital journalism practices, including content moderation, trauma-sensitive reporting, and the promotion of media literacy, in order to mitigate the potential harm associated with repeated exposure to crisis-related news content. Full article

The relationship between stress and Parkinson’s disease is regarded as complex and multifaceted, although a direct causal link has not yet been conclusively proven. One prevailing hypothesis is based on the activation of the hypothalamic–pituitary–adrenal (HPA) axis and the consequent elevation of glucocorticoid levels. Prolonged exposure to these hormones may exacerbate oxidative stress, thereby rendering the dopaminergic neurons within the brain’s subcortical structures more susceptible to degeneration. Furthermore, stress may intensify neuroinflammation through the activation of microglia—a mechanism that could constitute a significant factor in the pathogenesis of Parkinson’s disease. Another important concept concerns the direct interaction of stressors with the dopaminergic system. Physiological and psychological stress can alter dopaminergic transmission by affecting both the synthesis and release of dopamine, as well as the sensitivity of dopamine receptors. Severe or chronic stress may contribute to the disruption of dopaminergic mechanisms and accelerate the onset of clinical symptoms in predisposed individuals. Furthermore, many researchers draw attention to the role of stress-induced aggregation of α-synuclein—a key protein implicated in the pathogenesis of Parkinson’s disease. Clinical data suggest a highly probable link between post-traumatic stress disorder and an increased risk of developing Parkinson’s disease, although these findings remain inconclusive. It is possible that stress acts not as a primary cause, but rather as a modifying factor that interacts with genetic predisposition, accelerating or triggering neurodegenerative processes. The aim of our narrative review was to examine these concepts and discuss possible directions for future research into the interaction between stress and Parkinson’s disease. Full article

Trauma-related autobiographical memories can manifest as involuntary, vivid, emotionally charged intrusions that perpetuate avoidance, negative emotions, and functional impairment. While these memories are central to post-traumatic stress disorder (PTSD), they also occur across diagnoses and are often reported in depressive disorders, including treatment-resistant depression (TRD). Although trauma-focused psychotherapies are effective, their routine implementation can be limited by dropout, residual symptoms, and difficulty engaging patients with severe depression, dissociation, or complex comorbidities. Intranasal esketamine is an approved rapid-acting treatment for TRD and has been hypothesized to create transient conditions that may facilitate psychotherapeutic work on traumatic memories. This narrative review synthesizes clinical and translational evidence on ketamine and esketamine for PTSD and trauma-related symptoms, with particular attention to the distinction between intravenous ketamine studies, intranasal esketamine data, and studies combining these compounds with psychotherapy. Currently, the most robust evidence in this area comes from three randomised trials of intravenous ketamine for PTSD. In contrast, data on intranasal esketamine and psychotherapy-combination approaches are mainly from pilot studies, retrospective analyses, or case reports. We additionally propose a pragmatic, feasibility-oriented protocol integrating intranasal esketamine with a structured traumatic-memory intervention for TRD patients with clinically relevant trauma-memory symptoms. The novelty of the proposal does not lie in claiming efficacy, but in specifying a standardised imagery rescripting module and predefining two timing hypotheses. The proposal targets patients with TRD with relevant trauma-memory symptoms, and it embeds the intervention within existing esketamine-care infrastructure. Overall, the available literature supports mechanistic plausibility and preliminary feasibility more than clinical efficacy. The evidence base remains small, heterogeneous, and largely uncontrolled, and controlled studies are needed before efficacy claims can be made. Full article

Daylight Saving Time (DST) creates abrupt, externally imposed circadian disruptions that can impair sleep regulation, hormonal balance, cognitive performance, and emotional stability. Although these effects are known in the general population, individuals with chronic mental illness, whose circadian systems are often intrinsically dysregulated, may face increased neuropsychological consequences. This comprehensive review synthesizes evidence from chronobiology, psychiatry, neuroscience, and population health to examine how DST-related circadian misalignment impacts cognitive functioning, mood regulation, suicidality risk, and symptom exacerbation across psychological disorders such as depression, anxiety disorders, bipolar disorder, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, and psychotic disorders. Following the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines, a search of PubMed, PsycINFO, Scopus, and Google Scholar was conducted to identify studies published from 2000–2026 examining DST, circadian rhythm disruption, neuropsychological outcomes, and chronic mental illness. Empirical, theoretical, and mechanistic studies were included to ensure comprehensive synthesis. Across conditions, DST, particularly spring forward transitions, is associated with increased sleep disturbance, impaired executive functioning, reduced attention and working memory, heightened emotional reactivity, increased depressive symptoms, elevated risk of manic episodes, and short-term increases in suicidality. Neurobiological mechanisms include altered melatonin secretion, cortisol dysregulation, Hypothalamus Pituitary Axis (HPA-axis) activation, and clock-gene desynchrony. DST may function as a modifiable negative environmental influence capable of affecting neuropsychological functioning in vulnerable populations. These findings underscore the need for clinical awareness, preventive strategies, and policy reconsiderations, including calls to eliminate seasonal time changes. Standardizing DST-related research outcomes and expanding longitudinal, multi-site studies will be essential for advancing this emerging field. Full article

Background: Posttraumatic stress disorder (PTSD) in ages 3–18 is associated with disturbances in attention, working memory, processing speed, and executive control, as well as persistent difficulties in affect regulation. These neuropsychological vulnerabilities might interfere with learning, peer relationships, and the consolidation of age-appropriate developmental skills. Methods: We conducted a narrative review informed by a structured literature search in PubMed, Scopus, PsycINFO, Embase, EBSCOhost, Web of Science, and Google Scholar. English-language publications from 1990 to 2025 were considered if they examined (1) neuropsychological outcomes of trauma exposure or PTSD in youth and/or (2) interventions with potential to modify neurocognitive or affective functioning, including trauma-focused cognitive behavioral therapy (TF-CBT), mindfulness-based interventions, cognitive rehabilitation strategies, and biofeedback/neurofeedback. Results: Across study designs, trauma exposure and PTSD in youth are consistently linked to impairments in attentional control and executive functioning, with downstream effects on everyday memory and academic performance. Neurobiological studies commonly implicate altered reactivity within amygdala-centered threat circuits and reduced top-down modulation by prefrontal networks, although findings vary with trauma type, developmental stage, and comorbidity. TF-CBT remains the best-supported intervention for pediatric PTSD symptoms; however, neurocognitive outcomes are measured less frequently. Mindfulness-based programs show promise for strengthening attention and emotion regulation when carefully adapted for trauma-exposed youth. Neurofeedback and targeted cognitive rehabilitation represent emerging approaches with preliminary evidence, but the literature remains heterogeneous. Conclusions: An intervention strategy that combines symptom-focused trauma therapy with explicit targeting of executive control, memory processes, and affect regulation may represent a developmentally informed clinical framework for trauma-exposed youth. Future trials need to incorporate standardized neuropsychological endpoints and examine moderators that inform treatment matching. Full article