Treatment and management for difficult-to-treat depression are challenging, especially in a subset of patients who are at high risk for relapse and recurrence. The conditions that represent this subset are recurrent depressive disorder (RDD) and bipolar disorder (BD). In this context, we aimed to examine the effectiveness of maintenance transcranial magnetic stimulation (TMS) on a real-world clinical basis by retrospectively extracting data from the TMS registry data in Tokyo, Japan.

Data on patients diagnosed with treatment-resistant RDD and BD who received maintenance intermittent theta burst stimulation (iTBS) weekly after successful treatment with acute iTBS between March 2020 and October 2023 were extracted from the registry.

All patients (21 cases: 10 cases with RDD and 11 cases with BD) could sustain response, and 19 of them further maintained remission. In this study, maintenance iTBS did not exacerbate depressive symptoms in any of the cases, but may rather have the effect of stabilizing the mental condition and preventing recurrence.

This case series is of great clinical significance because it is the first study to report on the effectiveness of maintenance iTBS for RDD and BD, with a follow-up of more than 2 years. Further validation with a randomized controlled trial design with a larger sample size is warranted.

Visual release hallucinations are perceptual disturbances that occur in individuals who have experienced vision loss. Almost 50 million people worldwide are believed to experience visual release hallucinations, yet they are profoundly underdiagnosed. Although first described within the Charles Bonnet syndrome, the paradigm underlying this syndrome precludes their consideration in many populations, such as those with underlying psychiatric illness or dementia. Consequently, visual release hallucinations have rarely been studied in patients presenting with psychosis. We conducted a scoping review to determine whether visual-release hallucinations occur in psychotic patients.

The PubMed research database was searched from inception through April 2023. Cases were collected reporting on psychotic patients experiencing suspected visual release hallucinations. Individual treatment courses and responses were extracted.

Thirteen cases compiled from 11 different studies were summarized to provide baseline characteristics and overall trends in treatment response. Most patients did not remit from pharmacological management alone. All patients who received reafferentation therapy remitted, though many were not candidates. Almost half of the patients did not achieve remission.

Visual release hallucinations can manifest in psychosis and may contribute to treatment-resistant psychosis among psychiatric populations. A shift in our understanding of visual release hallucinations may aid their recognition in psychotic patients by shifting the focus toward visual release features. Recognizing release features among patients with hallucinatory conditions may open new treatment avenues for managing patients with psychosis. A preliminary screening index for visual release features is provided to support this shift.

The COVID-19 pandemic impacted mental health across different groups, including healthcare workers (HWs). To date, few studies focused on potential positive aspects that may follow the exposure to the pandemic. We investigated the prevalence of posttraumatic stress disorder (PTSD) in Italian HWs and whether posttraumatic growth (PTG) dimensions affected the risk of suicidal ideation (SI) during the first COVID-19 wave.

An online self-report survey was conducted between April and May 2020. Sociodemographic data, information about COVID-19-related stressful events, Impact of the Event Scale-revised, and Post-Traumatic Growth Inventory-Short Form (PTGI-SF) scores were collected and compared between participants. Patient Health Questionnaire-9 scores were also collected to assess SI through item 9. Multivariate logistic regression was used to assess the relationship between PTGI and SI.

Among 948 HWs, 257 (27.0%) reported a provisional PTSD diagnosis. The median PTGI-SF score was 24. Participants reporting PTSD symptoms had higher scores in the Spiritual change, Appreciation of life, and New possibilities domains, and in the total PTG scale. A total of 100 HWs (10.8%) screened positive for SI. Improvements in Relating to others domain of PTGI-SF (odds ratioOR: .46; 95% confidence interval: .25–.85) were associated with lower odds of SI.

COVID-19 pandemic has been indicated as a risk factor for SI, also among HWs. PTG may have a protective role on suicide risk. Improvements in Relating to others domain reduced odds of SI, consistently with the role of loneliness and lack of connectedness with others in enhancing suicidal risk.

Sleep disturbance and impulsivity are key components of mood vulnerability in bipolar disorder (BD), but few studies have assessed the association between these two symptoms among patients with BD.

Forty-seven euthymic patients with bipolar I disorder (BDI) or bipolar II disorder (BDII) and 58 age- and sex-matched healthy controls were enrolled in this cross-sectional study. Trait impulsivity was measured using the Barratt Impulsiveness Scale Version 11 (BIS-11), which yielded 3 second-order factors: attention, motor, and non-planning. Subjective sleep quality was assessed using the self-reported Pittsburgh Sleep Quality Index (PSQI). General linear models (GLMs) were used to assess the associations between subjective poor sleep and trait impulsivity with multiple testing corrections.

Patients with BD scored higher in BIS-11 and PSQI than healthy controls. PSQI total scores positively correlated with BIS-11 total scores, while sleep disturbance and daytime dysfunction were associated with attentional impulsiveness after controlling for covariates. Participants with higher PSQI total scores (>10) had higher scores in BIS-11 total, attention, and non-planning than those with low PSQI scores (≤5).

These findings support the hypothesis that poor sleep quality might lead to impulsivity and add to the growing evidence that improving sleep quality may be a therapeutic target for patients with BD.

Tending to patients with a diagnosis of borderline personality disorder (BPD) is a challenging task for clinicians due to stigma and differences in opinion within the psychiatric community. Various symptoms of BPD including affective instability, mood reactivity, and extremes of idealization are associated with challenging emotions toward patients with BPD. This observational research study utilized an adaptation of the 37-question Attitude to Personality Disorder Questionnaire (APDQ) to assess the attitudes of clinicians toward patients with BPD.

This questionnaire was distributed to 139 clinicians including psychiatry attendings, psychiatry residents, registered nurses, nurse practitioners, social workers, recreation and art therapists, and psychologists who worked with patients diagnosed with BPD on an inpatient unit. Responses of participants were compared based on occupation, gender, and duration of years worked on an inpatient psychiatric unit.

Results show that individuals employed in occupations under the “other health professionals” category had more positive transference (which included feelings of respect toward BPD patients along with feelings of closeness and warmth) toward patients with BPD, and nurses had an increased total score for lack of valid difficulties compared with other health professionals. When grouping by gender and duration of year spent working on an inpatient unit, there were no significant differences in the response toward patients with BPD in affective situations.

Clinical implications are discussed, as well as the need for training to help improve staff attitudes toward this patient population.

Scientific literature has highlighted the link between autism spectrum disorder (ASD) and anxiety disorders, but few studies have delved into the relationship between ASD and panic-agoraphobic disorders. The aim of this study is to investigate the relationship between autism spectrum and panic-agoraphobic symptoms, examining whether and which autistic domains are predictive of the presence of specific panic-agoraphobic symptoms.

Forty-five adult subjects with ASD and 50 healthy controls (HCs) were evaluated through the Structured Clinical Interview for DSM-5, Research Version and assessed with the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Panic-Agoraphobic – Short Version (PAS-SV) questionnaires. Statistical analyses included Mann–Whitney U test, chi-square test, and a set of linear and logistic regression analyses.

The PAS-SV total and domain scores were significantly higher in the ASD group than in the HC group. A higher AdAS total score appeared to be predictive of a higher PAS-SV total score. The AdAS domain Restricted Interests and Rumination would increase the risk of obtaining higher PAS-SV total and domain scores. Conversely, the AdAS Spectrum domain Inflexibility and Adherence to Routine would predict lower total PAS-SV score.

This study revealed a greater representation of panic-agoraphobic symptoms in adults with ASD, as well as an increased risk of showing such symptoms in the presence of significant autistic traits. Restricted interests and ruminative thinking emerged as predominant risk factors for panic-agoraphobic manifestations.

Sleep pattern alteration is a core feature of bipolar disorder (BD), often challenging to treat and affecting clinical outcomes. Suvorexant, a hypnotic agent that decreases wakefulness, has shown promising results in treating primary insomnia. To date, data on its use in BD are lacking. This study evaluated the efficacy and tolerability of adjunctive suvorexant for treatment-resistant insomnia in BD patients.

Thirty-six BD outpatients (19 BDI, 69.4% female, 48.9 [±15.2] years) were randomized for 1 week to double-blind suvorexant (10–20 mg/day) versus placebo. Then, all subjects who completed the randomized phase were offered open suvorexant for 3 months. Subjective total sleep time (sTST) and objective total sleep time (oTST) were assessed.

During the randomized control trial (RCT) phase, an overall increase in the oTST emerged, which was statistically significant for the Cole–Kripke algorithm (p = 0.035). The comparison between the suvorexant and placebo groups was limited by significant differences between measurements at baseline. During the open phase, no significant improvement was detected relative to either sTST and oTST. No adverse events nor major intolerances were reported.

Efficacy results are inconsistent. During the RCT phase, only a small increase in the objective oTST emerged, while during the open phase, no significant improvement was detected. While this is the first ever study of suvorexant in BD-related insomnia, the limitation of the small sample and the high rate of dropouts limits the generalizability of these findings. Larger studies are needed to assess suvorexant in treating BD-related insomnia.

Conventional treatment methods have limited effectiveness in addressing late-life depression (LLD) that does not respond well. While a new approach called priming repetitive transcranial magnetic stimulation (rTMS) has shown promise in treating depression in adults, its effectiveness in LLD has not been explored. This study aimed to investigate the impact of priming rTMS on LLD.

This study investigated the effectiveness of priming rTMS in 31 patients with LLD who did not improve after an adequate trial of antidepressants. Patients were randomly assigned to receive either active priming rTMS or sham priming rTMS. Active priming rTMS was delivered over the right dorsolateral prefrontal cortex for 10 sessions, lasting 31 minutes each, over a period of 2 weeks.

The group receiving active priming rTMS demonstrated greater improvements in scores on the Hamilton Rating Scale for Depression (p < 0.037; partial η2 0.141) and the Geriatric Depression Rating Scale (p < 0.045; partial η2 0.131) compared to the sham priming group, with a mild effect size. At the end of the second and fourth weeks, the priming rTMS group achieved a response rate of 50%, while the sham priming group had response rates of 26.7% and 6.7%, respectively. No adverse effects requiring intervention were observed.

Priming rTMS is well-tolerated for the treatment of LLD and not only reduces the severity of depression but also maintains the achieved response over time.

Hoarding disorder studies are primarily based on persons who seek treatment and demonstrate good insight. The aim of the present study is to evaluate whether there are differences between community and treatment-seeking samples of individuals with hoarding disorder (HD).

Fourteen people with HD from the community and twenty treatment-seeking people with HD were assessed by a battery of instruments to evaluate HD features and other associated characteristics.

Compared to the treatment-seeking sample, the HD community sample was older, had poorer insight, and had a lower prevalence of comorbid obsessive-compulsive disorder (OCD). There were no differences in gender, education, presence of psychiatric comorbidities, quality of life, and hoarding behavior characteristics between the samples. The final logistic regression model with the Dimensional Obsessive-Compulsive Scale (DOCS) as the single predictor of treatment-seeking status was statistically significant, indicating that it was able to distinguish between the two samples. The model explained between 20.7% and 27.9% of the variance of subjects, and correctly classified 67.6% of cases.

Our results indicate that there appear to be few differences between the treatment-seeking and community samples of individuals with HD. The presence of comorbid OCD in treatment-seeking groups seems to be more frequent than in HD community samples.

People with mental illness are overrepresented throughout the criminal justice system. In Italy, the Judicial Psychiatric Hospitals are now on the edge of their closure in favor of small-scale therapeutic facilities (REMS). Therefore, when patients end their duty for criminal behaviors, their clinical management moves back to the outpatient psychiatric centers. Elevated risks of rule-violating behavior are not equally shared across the spectrum of psychiatric disorders. To broaden the research in this area, we analyzed sociodemographic, clinical, and forensic variables of a group of psychiatric patients with a history of criminal behaviors, attending an outpatient psychiatric service in Milan, focusing on substance use disorder (SUD).

This is a cross-sectional single center study, conducted from 2020. Seventy-six subjects with a history of criminal behaviors aged 18 years or older and attending an outpatient psychiatric service were included. Demographic and clinical variables collected during clinical interviews with patients were retrospectively retrieved from patients’ medical records. Appropriate statistical analyses for categorical and continuous variables were conducted.

Data were available for 76 patients, 51.3% of them had lifetime SUD. Lifetime SUD was significantly more common in patients with long-acting injectable antipsychotics therapy, a history of more than 3 psychiatric hospitalizations, and a history of previous crimes, particularly economic crimes. Additionally, this last potential correlation was confirmed by logistic regression.

Data emerging from this survey provide new information about offenders with lifetime SUD attending an Italian mental health service. Our preliminary results should be confirmed in larger sample sizes.

War participation risks mental disorders. Ukrainian combatants in Anti-Terrorist Operation/Joint Forces Operation since 2014 receive psychiatric care. Some show unique symptoms, not fitting recognized disorders, termed post-combat delayed response (tension) syndrome. The aim of this study was to establish diagnostic criteria and develop a scale of differential diagnosis of post-combat delayed response (tension) syndrome.

This was a clinical retrospective study conducted on the basis of Zaporizhzhia Military Hospital and Zaporizhzhia and State Medical University, Ukraine, in the period from 2015 to 2021. Combatants of Ukraine—members of Anti-Terrorist Operation/Joint Forces Operation were involved in the study. In total, 426 male combatants were surveyed from whom those suffering from post-traumatic stress disorder (n = 24), neurasthenia (n = 35), and post-combat delayed response (tension) syndrome (n = 46) were selected.

The key symptoms of post-combat delayed response (tension) syndrome were selected and ranked in order of their differential diagnostic value. The diagnostic scale for post-combat delayed response (tension) syndrome was developed, which consists of 12 points.

The received anamnestic information is important for classifying patients at risk of post-combat delayed response (tension) syndrome.

Dextromethorphan/bupropion (DXM/BUP) received Food and Drug Administration (FDA) approval for the treatment of adults with major depressive disorder (MDD) in August 2022. This combination is not known to have abuse liability and is not currently scheduled by the Drug Enforcement Administration (DEA). Notwithstanding, dextromethorphan is a drug of abuse. Herein, we sought to determine whether DXM/BUP has alcohol and/or substance misuse liability.

We evaluated spontaneous reports of terms such as “alcohol problem, alcoholism, alcohol abuse, substance dependence, substance use disorder (SUD), substance abuse, drug dependence, drug use disorder and drug abuse” in the FDA Adverse Event Reporting System (FAERS). The FAERS is a spontaneous reporting database of adverse events submitted to the FDA.

We performed a comparative assessment of the alcohol and/or substance misuse liability of DXM/BUP since its market authorization in August 2022, using acetaminophen as the control. Dextromethorphan served as the upper-bound reference point. Our findings showed that, since August 2022, dextromethorphan had a significant reporting odds ratio (ROR) for “drug abuse.” In contrast, DXM/BUP did not have a significant ROR for any of the categories of alcohol and/or substance misuse evaluated. Limitations of our findings derive largely from the limitations of the FAERS and its data capture method.

The absence of alcohol or substance misuse reported to the FAERS with DXM/BUP accords with the lack of evidence of abuse liability prior to FDA approval and its non-scheduling by the DEA.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor outcomes in Parkinson’s disease (PD) but may have adverse long-term effects on specific cognitive domains. The aim of this study was to investigate the association between total electrical energy (TEED) delivered by DBS and postoperative changes in verbal fluency.

Seventeen PD patients undergoing bilateral STN-DBS were assessed with the Alternate Verbal Fluency Battery (AVFB), which includes phonemic (PVF), semantic (SVF), and alternate verbal fluency (AVF) tests, before surgery (T0) and after 6 (T1) and 12 months (T2). Bilateral TEED and average TEEDM were recorded at T1 and T2. For each AVFB measurement, changes from T0 to T1 (Δ-01) and from T0 to T2 (Δ-02) were calculated.

At T1, PVF (p = 0.007) and SVF scores (p = 0.003) decreased significantly. TEED measures at T1 and T2 were unrelated to Δ-01 and Δ-02 scores, respectively. However, an inverse, marginally significant association was detected between the TEEDM and Δ-01 scores for the AVF (p = 0.041, against an αadjusted = 0.025).

In conclusion, the present reports provide preliminary evidence that TEED may not be responsible or only slightly responsible for the decline in VF performance after STN-DBS in PD.

Cognitive and psychiatric symptoms are frequently reported after SARS-CoV-2 infection, but their interplay has been only partially explored. We investigated frequency and severity of psychiatric symptoms in patients with persistent cognitive complaints after COVID-19.

We conducted a cross-sectional study. Neurologists assessed 101 patients reporting cognitive symptoms after COVID-19. Patients were invited to fill a screening battery with self-reported psychometric scales (Depression Anxiety Stress Scales-21, Impact of Event Scale-Revised, Insomnia Severity Index). Patients scoring above validated cut-offs in ≥1 scale were referred to psychiatrists who administered the Mini-International Neuropsychiatric Interview (M.I.N.I.), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scales and asked to complete the Personality Inventory for DSM-5-Brief Form (PID-5-BF).

Out of the 57 referred patients, 38 (64.4%) accepted to undergo the psychiatric examination. Among these, 18 (47.4%) were diagnosed with adjustment disorder (23.7%), anxiety disorder (10.5%), major depressive disorder (7.9%), and post-traumatic stress disorder (2.6%). Pharmacologic treatment before post-COVID condition (present in 12 patients, 31.6%) was associated with a score above cut-off on the HAM-A and HAM-D scales. A longer duration of untreated psychiatric illness after COVID-19 was associated with worse scores on the same scales. Patients with a higher PID-5-BF total score had a higher probability of receiving a psychiatric diagnosis.

Almost half of patients with post-COVID-19 conditions reporting cognitive symptoms were found to suffer from a psychiatric condition after psychiatric evaluation. The application of a psychiatric screening in a population suffering from long-term effects of COVID-19 can lead to early diagnosis and timely treatment.

In VIVRE (NCT04448431), vortioxetine was associated with significantly higher rates of symptomatic and functional remission, better daily and social functioning, and greater treatment satisfaction than desvenlafaxine in patients with major depressive disorder (MDD) and partial response to selective serotonin reuptake inhibitor (SSRI) therapy. This analysis further explored the relative improvement in patient functioning with vortioxetine versus desvenlafaxine.

VIVRE was a randomized, double-blind study of vortioxetine (10 or 20 mg/day) versus desvenlafaxine (50 mg/day) in adults with MDD and partial response to initial SSRI monotherapy. Mean percentage changes from baseline to week 8 in Functioning Assessment Short Test (FAST) total and domain scores were analyzed by treatment group in the overall population and in working patients.

In the overall population, the mean reduction in FAST total score from baseline after 8 weeks of treatment was 37.2% in vortioxetine-treated patients versus 31.8% in desvenlafaxine-treated patients (P = 0.04). Significantly greater improvements versus desvenlafaxine were seen in vortioxetine-treated patients for FAST autonomy, cognitive functioning, and interpersonal-relationships scores (all P < 0.05). In working patients, the mean reduction in FAST total score from baseline at week 8 was 38.7% versus 32.1% in the vortioxetine and desvenlafaxine groups, respectively (P = 0.04). Significant correlations were seen between absolute changes in patient functioning, and those in depression severity and health-related quality of life.

Vortioxetine was significantly better than desvenlafaxine in improving overall functioning as well as daily, social, and cognitive functioning in patients with MDD with inadequate response to prior SSRI therapy.

To describe and compare the prevalence of psychosocial and psychiatric disorders among veterans with multiple sclerosis (MS) and a propensity-score-matched group of veterans without MS, and to identify sociodemographic and clinical characteristics associated with comorbid psychosocial and psychiatric problems among veterans with MS.

Data were linked and extracted from the Veterans Affairs (VA) Homeless Operations Management and Evaluation System and the Corporate Data Warehouse. The total sample comprised 27,342 veterans in the VA healthcare system between January 1, 2022, and June 30, 2023, who met eligibility criteria for an MS diagnosis (n=13,671) and 1:1 propensity-score-matched sample of veterans who did not have MS (n=13,671). MS diagnosis, substance use disorder (SUD), mental illness, and homelessness were defined using standard ICD-10 codes. Covariates included sex, age, Charlson Comorbidity Index (CCI), and VA service-connected disability rating.

A higher prevalence of mental illness among veterans with MS (33%) was found compared with those without MS (31%). Multivariable logistic regression models indicated MS was negatively associated with diagnoses of alcohol use disorder, stimulant use disorders, posttraumatic stress disorder, and schizophrenia/schizoaffective disorder but positively associated with diagnoses of cannabis use disorder and major depressive disorder. MS was not significantly related to homelessness. Disparities in psychosocial and psychiatric disorders among veterans with MS are described.

This study provides novel insights regarding rates of homelessness, SUD, and mental illnesses among veterans with MS. Interdisciplinary approaches to identification and management of mental illness, SUD, and homelessness among veterans with MS are critically needed.