Search Results (1,154)

Background/Objective: Transitioning towards plant-based dietary patterns is essential to improve health and reduce environmental impact. Hospitals represent a key setting to implement such dietary shifts, yet data on the availability of plant-based meals in healthcare institutions remain scarce. Methods: A cross-sectional survey was conducted across Dutch-speaking hospitals in Belgium to assess the meal plans and whether vegetarian or fully plant-based meal options were available for patients. Besides availability, the frequency and perceived barriers were assessed. Furthermore, the meal plans were analyzed to get an overview of the vegetarian and plant-based food options that were offered in different types of Belgian hospitals. Results: The availability of plant-based meal options was limited across hospitals. No meaningful differences were observed between general hospitals and other hospital types, including psychiatric, rehabilitation, and specialized hospitals. While plant-based fats and oils were widely available, key protein-rich plant foods such as legumes and minimally processed meat alternatives were rarely offered in all types of hospitals. Knowledge gaps among food service staff were observed, and structural barriers—including the need to accommodate diverse dietary requirements—were reported. Conclusions: Belgian hospitals currently underutilize the potential of vegetarian and plant-based nutrition to support patient health and sustainability goals. Strengthening institutional food environments by increasing the availability of nutritionally adequate plant-based meals represents a feasible and impactful strategy to align hospital practice with dietary guidelines and preventive healthcare priorities. Full article

Background/Objectives: Evidence suggests that AAIs may be useful to support the mental health of individuals with psychiatric diagnoses, but there is limited research on the efficacy of AAIs for patients hospitalized for the treatment of acute mental illness. Methods: A randomized controlled trial (RCT) design, where patients hospitalized for the treatment of mental illness (N = 60) were randomized into to one of three conditions: dog + handler intervention (AAI), handler only conversational control (CC), or usual care (UC), for 20 min per day for three days. Mood (Smiley Face Assessment Scale), Anxiety (State Trait Anxiety Scales) and Depression (Center for Epidemiological Studies) were the outcome measures. Linear Mixed Models with random intercepts were applied to compare changes in anxiety and mood between conditions pre/post daily intervention session and pre/post three-day intervention phase (days 2–4), and anxiety and depression were assessed from baseline to the day after intervention (days 1–5) (p < 0.01). Results: Mood and anxiety improved more for the AAI than for the CC or UC conditions. Females and people who did not live with a dog experienced similar improvements in mood in the AAI and CC conditions relative to UC, while males and people who live with a dog experienced greater improvement in the AAI condition. Depression decreased similarly in the AAI and CC conditions and both were significantly better than the UC condition. Conclusions: These results indicate that a dog + handler interaction is effective for reducing anxiety and depression and improving mood in adults hospitalized for the treatment of mental illness. Human handler-only visits did not consistently result in similar findings, indicating that there may be something unique and beneficial about the presence of the dog. Full article

Background and Clinical Significance: NMDAR autoimmune encephalitis is a rare but potentially life-threatening autoimmune disorder that can be hard to recognize initially because it has nonspecific symptoms. In the early phase of the disease, clinical presentation is often dominated by psychiatric symptoms, which can be misleading. A diagnosis is established by demonstrating specific anti-NMDA receptor antibodies, with cerebrospinal fluid analysis considered the most reliable diagnostic method. Timely initiation of immunomodulatory therapy, including corticosteroids, intravenous immunoglobulins, and therapeutic plasmapheresis, significantly improves disease outcomes, while second-line therapies are used in refractory cases. Case Presentation: A 21-year-old female patient (M.B.) was admitted to the Psychiatry Clinic at the University Clinical Center of Vojvodina due to the sudden onset of behavioral changes, including social withdrawal, absence of verbal communication, and unusual orofacial grimacing. During hospitalization, the patient was intermittently in a state of severe psychomotor agitation and poorly communicative, with pronounced orofacial dyskinesias and involuntary tongue movements. Anti-NMDA receptor autoantibodies were detected in both serum and cerebrospinal fluid, and the patient was subsequently transferred to the Intensive Care Unit of the Neurology Clinic. Due to the lack of an adequate clinical response to pulse corticosteroid therapy, six cycles of therapeutic plasmapheresis were performed. Following this treatment, significant clinical improvement was observed. Conclusions: Timely recognition of this condition and a multidisciplinary approach allow for early initiation of immunomodulatory therapy and significantly improve treatment outcomes. Full article

Spirituality and religiosity (S/R) are significant dimensions in mental health care and provide an important foundation for spiritual care, particularly in sociocultural contexts where religious beliefs are deeply embedded in personal and collective life. This study investigates the role of S/R in the treatment of psychiatric patients hospitalized in a private mental health clinic in southern Brazil. Using validated instruments—the Centrality of Religiosity Scale (CRS-10BR), the Brief-RCOPE-14, and the Inventory of Attachment to God (IAD-Br)—the study assessed religious centrality, coping strategies, and attachment styles to God among 100 participants. Based on CRS parameters, the sample was classified as predominantly “religious.” The findings revealed that most patients identified with some form of religion or belief in God, reported moderate to high levels of positive religious coping, and predominantly exhibited secure attachment patterns. Statistically significant correlations were observed between higher religiosity, greater use of positive coping strategies, and lower avoidance in the relationship with God. Despite these findings, spiritual and religious aspects were rarely addressed in clinical interactions. The findings are discussed through the lens of clinical bioethics, emphasizing the ethical relevance of spirituality and religiosity in psychiatric care and highlighting the relevance of developing practical approaches to spiritual care within a whole-person, patient-centered model. Full article

Background and Objectives: Treatment-resistant depression (TRD) is a major clinical challenge in the management of major depressive disorder (MDD). While pharmacogenetics has been suggested to be clinically useful in guiding antidepressant treatment, few studies have explored if and how pharmacogenes can be involved in TRD pathophysiology and its clinical outcomes. Material amd Methods: We explored the role of differences in metabolizer phenotypes, gene expression levels, and microRNAs of three key pharmacogenes (CYP2D6, CYP2C19, CYP2B6) in TRD pathophysiology and antidepressant response in a cohort of 300 patients with MDD from the PROMPT consortium. Results: CYP2D6 phenotype distribution did not differ significantly between TRD and non-TRD groups, but mRNA expression was significantly upregulated in TRD. Hsa-miR-26b-5p, a microRNA predicted to regulate CYP2D6, was significantly downregulated in TRD. For CYP2C19, intermediate metabolizers (IMs) were underrepresented in TRD versus non-TRD (IMs vs. normal metabolizers (NMs): χ² = 6.07, p = 0.019). microRNA hsa-let-7d-5p and hsa-miR-27a-3p, predicted to regulate CYP2C19, were significantly downregulated in TRD. No significant differences were found for CYP2B6. Conclusions: This study contributes valuable insights to the PROMPT project on how pharmacokinetic gene variants and their expression and regulatory mechanisms may influence antidepressant response and resistance in MDD. Full article

Introduction: Medical students are particularly susceptible to nutritional deficiencies and mental health problems due to intensive study demands, stress, and lifestyle factors. Vitamin D3, vitamin B12, and folate deficiencies have been implicated in mental well-being, although evidence remains inconsistent. Objective: To assess the prevalence of vitamin D3, vitamin B12, and folate deficiencies among medical students at the University of Warmia and Mazury in Olsztyn, and to explore associations between serum concentrations of these vitamins, lifestyle factors, and self-reported well-being. Materials and Methods: The study included 97 medical students. Serum vitamin concentrations were measured using electrochemiluminescence immunoassay. Well-being was assessed with the WHO-5 Well-Being Index. Group comparisons were performed using non-parametric tests, and a Poisson regression model was applied as an exploratory analysis to examine associations between selected lifestyle factors and well-being. Results: Vitamin D3 deficiency was observed in 78% of students, folate deficiency in 20%, and vitamin B12 deficiency in 8%. In unadjusted analyses, differences in serum vitamin D3 and vitamin B12 concentrations were observed between students with lower and higher self-reported well-being, whereas folate concentrations did not differ. However, after correction for multiple testing using the Benjamini–Hochberg procedure, none of these associations remained statistically significant. Exploratory regression analysis suggested that physical activity and gender may be associated with well-being, while no association with vitamin D3 supplementation was observed. Conclusions: Vitamin D3, vitamin B12, and folate deficiencies were common among medical students. Exploratory analyses suggested differences in vitamin D3 and vitamin B12 concentrations across well-being groups; however, these findings did not remain significant after correction for multiple testing and should be interpreted with caution. Overall, the results indicate that lifestyle-related factors, particularly physical activity, may play a more prominent role in student well-being than serum vitamin concentrations alone. Further longitudinal studies are required to clarify these relationships. Full article

Pediatric psychiatric emergency department (ED) visits have increased globally, yet many children do not receive timely outpatient follow-up. Although South Korea provides universal health coverage through its National Health Insurance (NHI), additional financial barriers may impede the continuity of mental health care. This study examined whether supplemental private insurance is associated with improved outpatient mental health follow-up after pediatric psychiatric ED visits within a universal coverage system. A retrospective cohort study was conducted at a tertiary children’s hospital in South Korea including 520 psychiatric ED visits (480 unique patients aged <18 years) from 2016 to 2024. The primary outcome was attendance at an outpatient mental health visit within 30 days of ED discharge. Multivariable logistic regression was used to assess the association between insurance type (NHI-only versus NHI plus supplemental private insurance) and follow-up, adjusting for age, sex, clinical presentation, and prior mental health care. Overall, 53.7% of patients attended a 30-day follow-up visit. Patients with supplemental private insurance had significantly higher follow-up rates than those with NHI alone (58.8% vs. 45.5%, p = 0.019). In adjusted analysis, supplemental private insurance was independently associated with increased follow-up (adjusted odds ratio 1.50, 95% confidence interval 1.10–2.05, p = 0.02). A significant interaction was observed between insurance type and prior mental health care (p_interaction = 0.03): the insurance effect was pronounced among patients without prior outpatient mental health treatment (45.6% vs. 38.8%) but negligible among those with prior treatment (71.9% vs. 72.5%). Prior outpatient mental health treatment (adjusted odds ratio 2.00, 95% confidence interval 1.30–3.10) and suicidal presentation were also significant predictors. Even within a universal health coverage system, supplemental private insurance is associated with better outpatient follow-up after pediatric psychiatric emergencies, particularly among patients new to the mental health system. Reducing financial barriers, expanding community-based mental health services, and strengthening care coordination are essential to ensure equitable continuity of care for all children. Full article

Background: The increasing use of advanced cardiac surgical therapies, particularly left ventricular assist devices (LVADs), has improved survival in patients with end-stage heart failure. However, the psychological burden associated with these therapies—especially depression and suicidality—remains underrecognized. Objectives: This narrative review synthesizes current evidence on the prevalence, underlying mechanisms, risk factors, screening strategies, and management of depression and suicidality in patients undergoing LVAD implantation and other advanced cardiac surgical interventions. Methods: A structured literature search of PubMed, Embase, and Scopus was conducted for studies published between 2020 and 2025 addressing depression, suicidal ideation, suicide attempts, and psychological distress in LVAD and advanced cardiac therapy populations. Results: Depression affects approximately 20–42% of patients with advanced heart failure, including those supported with LVADs, while suicidal ideation is reported in up to 12% of LVAD recipients, with higher rates of suicide attempts compared to other chronic disease populations. Risk factors are multifactorial and can be categorized into patient-related, disease-related, device-related, and psychosocial domains. Proposed mechanisms include neurohormonal dysregulation, systemic inflammation, and psychological processes such as loss of autonomy and existential distress. Although validated screening tools and multidisciplinary management strategies are available, their implementation in routine clinical practice remains inconsistent. Conclusions: Depression and suicidality represent significant and complex challenges in patients undergoing advanced cardiac therapies, particularly LVAD support. Systematic mental health screening and integrated, multidisciplinary care models are essential to improve patient outcomes. Future research should focus on longitudinal assessment, standardized suicide risk monitoring, and the development of targeted, evidence-based interventions for this vulnerable population. Full article

Although glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose co-transporter 2 inhibitors (SGLT2is) have demonstrated protective effects against chronic kidney disease, their impact on acute kidney injury (AKI) remains unclear. AKI and chronic kidney disease share overlapping clinical features but differ in pathogenesis and risk profiles. Previous analyses often grouped diverse agents into single categories, potentially concealing medication-specific renal risks. Given the widespread assumption of renoprotection, particularly among newer agents, there is a need to evaluate the comparative AKI risk of GLP-1RAs and SGLT2is at the individual drug and dose level. We performed a Bayesian network meta-analysis (NMA) following Cochrane-recommended methodology for safety-focused assessments. A systematic literature search across eight databases identified 67 randomized controlled trials (RCTs), including 199,877 participants. Eligible trials reported AKI outcomes or sufficiently explicit acute renal injury-related events associated with GLP-1RA or SGLT2i interventions. The primary outcome was the incidence of AKI; all-cause dropout was analyzed as a general tolerability measure. Odds ratios (ORs) with 95% credible intervals (CrIs) were calculated, and surface under the cumulative ranking curves (SUCRA) were used to estimate relative safety rankings. Only high-dose tirzepatide (10–15 mg/week) was associated with a significantly increased risk of AKI compared to controls (absolute risk difference: 0.28%; number needed to harm: 357). In contrast, lixisenatide, high-dose canagliflozin (300 mg/day), empagliflozin, and dapagliflozin were associated with reduced AKI risk. Risk rankings consistently identified high-dose tirzepatide as the most likely to induce AKI. Subgroup analyses excluding patients with baseline renal impairment yielded consistent results. High-dose tirzepatide may elevate AKI risk despite its metabolic benefits. Clinicians should assess renal vulnerability when prescribing GLP-1RAs or SGLT2is, particularly in patients with preserved kidney function. Further prospective trials are needed to clarify causal mechanisms and inform clinical decision-making. Full article

Background: Autoimmune encephalitis (AE) is an increasingly well recognized disorder in the past decade both in adults and in children, yet pediatric data are still limited. A full peripheral blood cell count is a routine examination that provides valuable information regarding the immune system. Thus, there are peripheral blood cell count (PBCC)-derived ratios that reflect systemic inflammatory activity and they have been associated with disease severity in adults: the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune–inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). Methods: This study is a retrospective chart review of children under 18 years diagnosed with definite or probable AE and treated in our institution from 1 January 2018 until 1 December 2025. Only patients with available PBCC results at the time of the first hospital admission after neurological/psychiatric symptom onset were included. An age-matched control group was created by selecting the results of PBCC of patients presenting for routine pediatric follow-ups with normal inflammatory and hematologic parameters. The group means were compared using an independent-samples t-test or the Mann–Whitney U test for non-normally distributed data. Analysis of the receiver operating characteristics curve (ROC curve) was conducted, followed by the area under the curve ROC curve (AUC). Results: A total of 45 children with AE and 150 controls were included in the study. Of these, 22 patients (49%) had probable AE and 23 patients (51%) had definite AE. The NLR, PLR, SII, SIRI and AISI values were significantly higher in AE patients compared with the controls, but the AUC values (~0.58–0.66) indicate poor-to-fair discriminative ability. Youden’s index-based cut-off values were associated with high specificity and modest sensitivity. The likelihood ratios in the range of 2–3 (LR+) and 0.6–0.7 (LR−) suggest weak rule-in capacity and limited rule-out utility. Conclusions: Our results suggest that at the time of the initial hospitalization, children with AE already show altered peripheral immune cell profiles compared to their age-matched peers. The high specificity and the low sensitivity of the inflammatory indices make them more suitable for supporting the AE diagnosis in suggestive clinical circumstances, but not for screening. These results represent a foundation for further investigation of the roles that these indices have both as diagnostic and prognostic factors for these children. Full article

Purpose: This retrospective study aimed to identify factors associated with postoperative cognitive dysfunction (POCD) in patients undergoing hepatectomy, with particular attention to liver disease-related characteristics and perioperative variables. A secondary aim was to develop a clinically applicable nomogram for individualized risk estimation in this population. Patients and Methods: A retrospective cohort study was conducted in 314 consecutive patients who underwent hepatectomy at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School between January 2023 and December 2024. Patients were included if they had complete clinical data and underwent preoperative and postoperative cognitive assessment. Exclusion criteria included preoperative cognitive impairment (Montreal Cognitive Assessment [MoCA] score < 26), preexisting neurological or psychiatric disorders, and in-hospital death within 72 h after surgery. POCD was defined as a decline of ≥3 points in the MoCA score from baseline to postoperative day 5. Clinical, surgical, nutritional, and perioperative variables were analyzed, and a nomogram was constructed based on the final multivariable logistic regression model. Results: The overall incidence of POCD was 27.4% (86/314). The final multivariable model included sarcopenia, preoperative hemoglobin < 120 g/L, Child–Pugh classification, alcohol consumption, operative duration, and pain score on postoperative day 1. The nomogram incorporating these variables showed good discriminative ability, with an area under the curve of 0.87 (95% CI: 0.83–0.92). Conclusions: In this retrospective cohort of patients undergoing hepatectomy, several perioperative clinical factors were associated with POCD. The proposed nomogram may serve as a practical tool for perioperative risk estimation and support more individualized management in higher-risk patients. Full article

Background/Objectives: Adolescents admitted for emergency psychiatric hospitalization frequently present with severe and heterogeneous psychopathology. In clinical practice, some adolescent inpatients appear to present a broader symptom pattern suggestive of emotional dysregulation. However, it remains unclear whether they can truly be distinguished in this population and whether they differ meaningfully from adolescents with predominantly depressive presentations. Methods: We conducted a retrospective cross-sectional chart review with subgroup analysis based on the medical records of patients aged 11–17 years hospitalized on an emergency basis at the Department of Child and Adolescent Psychiatry in Poznań, Poland, between January and December 2024. Patients were assigned either to an emotional dysregulation group, defined by affective dysregulation and behavioral dyscontrol, or to a depressive presentations group, comprising adolescents with depressive presentations who did not meet criteria for the emotional dysregulation profile. Broader clinical characteristics, adverse childhood experiences, and prior treatment history were compared between groups. Results: A total of 139 adolescents were included (85 in the emotional dysregulation group and 54 in the depressive presentations group). The median age was 13 years [Q1–Q3: 13–14] in the emotional dysregulation group and 14 years [Q1–Q3: 12.25–14] in the depressive presentations group; girls comprised 77.6% and 83.3% of the groups, respectively. The emotional dysregulation group more often presented with conflict-ridden relationships, a more frequent history of suicide attempts (72.9% vs. 50.0%, p = 0.006), and a higher number of suicide attempts (median 1 [Q1–Q3: 0–2] vs. 0.5 [Q1–Q3: 0–1], p = 0.012), as well as more frequent exposure to adversity-related experiences. Furthermore, this group had a higher number of previous psychiatric hospitalizations (median 1 [Q1–Q3: 1–2] vs. 1 [Q1–Q3: 1–1], p = 0.001) and a longer history of psychiatric treatment. In contrast, social withdrawal was more characteristic of the depressive presentations group. Conclusions: Routinely collected clinical records may capture a clinically meaningful subgroup of adolescents with a symptom profile suggestive of emotional dysregulation. Compared with the depressive presentations group, these adolescents showed greater interpersonal difficulties, more recurrent suicide attempts, greater adversity burden, and a longer history of psychiatric treatment. Further prospective studies using standardized measures are needed. Full article

Background/Objectives: A psychiatric consultation is a professional evaluation aimed at establishing a diagnosis, a prognosis, and developing a treatment plan. The objective was to assess psychiatric consultations (PCs) at the Community Mental Health Center (CMHC), Emergency Room (ER) and General Hospital (GH) to highlight differences across settings. Methods: With a retrospective design, we examined all PCs performed between 1 January 2024 and 31 December 2024 at the CMHC, ER and GH of Baggiovara in Modena. Descriptive statistical analysis and a multivariate logistic regression were performed. Results: We collected a total of 3174 PCs for 1801 patients, performed in the three settings: 52% in ER, 30% in CMHC and 18% in GH. In ER, PCs were most frequently requested for suicide risk (26%), psychomotor agitation (14%) and substance intoxication (14%). In CMHC, the most common diagnoses were depressive disorders (22%), acute anxiety (20%) and acute psychotic episodes (13%). In GH, consultations mainly addressed psychiatric symptoms associated with medical and eating disorders. The overall rate of psychiatric hospitalization after PCs was 16.2%, reaching 23.4% for consultations in ER. Discontinuation of pharmacological therapy was significantly associated with an increased risk of hospitalization (p < 0.001), which rose to 17% when therapy had been interrupted for more than one year. Conclusions: PCs at ER were the access point for most hospitalizations. Therapeutic discontinuation, acute psychosis and substance use represented the main predictors of hospitalization. Strengthening shared care pathways among CMHC, ER and GH represents an effective model of integration between hospital and community services, ensuring continuity of care. Full article

Background: Preterm birth is a significant early-life stressor associated with increased psychiatric vulnerability and long-term functional impairments in school-aged children. Objective: To compare behavioral–emotional outcomes and functional competence between school-aged preterm and term-born children, examining perinatal, cognitive, and socioeconomic predictors. Methods: 140 children aged 6–10 (70 preterm, 70 age-matched controls) were assessed using the Child Behavior Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ). Functional competence—defined as participation in daily activities, social interactions, and school performance—was examined alongside behavioral–emotional outcomes. Predictors included gestational age, birth weight, SES, and cognitive ability. Results: Preterm birth was associated with higher SDQ scores in emotional problems, hyperactivity, and peer problems. CBCL results showed lower total functional competence scores, specifically in activities, social participation, and school performance. Longer NICU stay predicted higher internalizing problems and lower social participation. Cognitive ability was linked to lower SDQ externalizing and internalizing scores. SES was not a significant predictor. Conclusions: Preterm birth and prolonged NICU hospitalization are linked to persistent behavioral–emotional and functional vulnerabilities. These findings underscore the need for early, integrated developmental monitoring within a preventive psychiatry framework to identify psychiatric vulnerability and support functional participation. Full article

Background: Delirium is a common neuropsychiatric syndrome among hospitalized patients and has been associated with increased short- and long-term mortality. However, data on long-term outcomes and prognostic significance remain limited, particularly in Middle Eastern populations. Methods: This prospective observational cohort study was conducted at a tertiary care hospital in Riyadh, Saudi Arabia. Adult patients admitted to medical, surgical, and intensive care units (ICUs) underwent standardized clinical neuropsychiatric assessment for delirium. Five-year follow-up data were obtained from electronic health records and phone follow-up with patients/caregivers. Clinical outcomes and survival were compared between patients with and without baseline delirium. Kaplan–Meier survival analysis assessed five-year survival, and Cox regression explored the association between delirium and time-to-death adjusting for medical/psychiatric morbidity. Results: Among 278 patients, 71 (25.5%) were diagnosed with delirium during initial hospitalization. At five years, 51 patients (18.3%) had died. Patients with delirium had higher mortality (35.2% vs. 12.6%, p < 0.001), reduced five-year survival, and greater cumulative ward and ICU stays. In Cox regression including 50 deaths with complete data, delirium at initial assessment was associated with a higher hazard of death during follow-up (HR 1.93, 95% CI 1.06–3.55). Older age per year (HR 1.02, 95% CI 1.00–1.04), kidney disease (HR 2.12, 95% CI 1.20–3.75), and psychiatric disorders (HR 2.16, 95% CI 1.17–3.97) were independently associated with a higher hazard of death. Conclusions: Delirium was associated with increased five-year mortality and adverse long-term clinical outcomes. These findings support the prognostic significance of delirium in hospitalized patients. Full article