There has been limited study to date into the specific patient factors that influence decisions about an individual's need for high-security psychiatric care. Admission to high-security services requires careful assessment and consideration to ensure patients receive the least restrictive care justified, and those who are most likely to benefit from it are admitted. This retrospective case-control study describes the demographic, clinical and risk characteristics of referrals made to the State Hospital in Scotland during a 12-month period, and delineates differences between referrals that were accepted and rejected for admission. It updates the methods of a previous study undertaken at the State Hospital. Six variables differentiated rejected and accepted referrals in univariate analyses. Multivariate logistic regression found that a model with only the individual's age, whether they were prescribed antipsychotic medication at the time of referral, and whether they had a history of violent convictions, best predicted referral outcome. The findings support the conclusion that it is not only an individual's risk of violence or the severity of their mental illness in isolation, but the combination of these factors that is deemed to necessitate high-security care within a stratified forensic mental health system.

This study aimed to determine the prevalence and associated factors of depressive symptoms, poor sleep, and life quality among patients with systemic sclerosis (SSc).

This was a cross-sectional study including 120 SSc patients. Demographic and clinical data were obtained. The Short Form Health Survey 36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), and short form of the Beck Depression Questionnaire were used to evaluate life quality, sleep quality, and self-reported depressive symptoms, respectively. The obtained data were analyzed to identify the demographic and clinical risk associations for depressive symptoms, poor sleep, and life quality.

Of 120 participants, 108 patients (90%) were female. The mean age was 42.23 years, and the mean disease duration was 13.58 years. Most of the patients were married, unemployed, or housekeepers. Most of them had moderate economic conditions and tertiary education. The total scores of the SF-36 and PSQI questionnaires were 93.25±3.7 and 9.02±4.51, respectively, which showed good life quality but poor sleep quality. The prevalence of depressive symptoms was 44.16% (n=53), and most of them had mild to moderate depressive symptoms. The factors that correlated with life quality were occupational status and cough. The factors that negatively correlated with sleep quality were the presence of digital ulcers, cough, and dysphasia. The presence of cough, dyspnea, and gastroesophageal reflux disease was associated with depressive symptoms.

Our study showed a high prevalence of poor sleep quality and depressive symptoms among SSc patients. We found that gastrointestinal symptoms, respiratory symptoms, and digital ulcers affected patients' life quality, sleep quality, and mental status. Our results also demonstrated that depression was correlated with poor sleep quality, and they were both risk factors for diminished life quality. Identification of these factors would help to make pharmacological and non-pharmacological interventions to improve the quality of life and sleep in SSc patients.

ObjectivesEncouraging interest in specialist practice in psychiatry is a key aim of both public psychiatric practice and medical student training. We describe the ongoing development and benefits of an accredited trainee position in academic psychiatry based in public mental health services and a graduate medical school. This is discussed in the context of relevant research evidence on psychiatry training and fostering interest in psychiatry.ConclusionsThe benefits of an accredited trainee position in academic psychiatry extend beyond the skills gained by the trainee, with flow on effects to medical student teaching, attraction to the local training scheme, and fostering a broader culture of academic engagement and activity. The challenges include maintaining funding for a position over nearly two decades, balancing specialist training requirements with clinical and academic service, and also tailoring the roles for the different interests and skills of academic trainees.

Fatigue is a symptom that has been described among adult patients with congenital heart disease (CHD), but the prevalence and impact of fatigue on the patient's daily life has been poorly studied. This study (i) examines the prevalence of fatigue in patients aged over 40 years with moderately complex or complex congenital heart disease compared to controls and (ii) explores the relationship between fatigue, heart disease complexity, clinical characteristics and self-reported New York Heart Association Functional Class (self-reported NYHA class).

The Multidimensional Fatigue Inventory (MFI-20) was applied in 166 patients with moderately complex CHD or complex CHD (44 % females, median age 55.3 years, IQR 47.6-64.8) along with 89 controls (43 % female, median age 54.0, IQR 46.0-65.9). MFI-20 measured general fatigue, physical fatigue, mental fatigue, reduced motivation and reduced activity.

Physical fatigue (severe to very severe) was more common in complex CHD compared with moderately complex CHD (25 % vs. 52 %, p = 0.006). Complex CHD was associated with severe to very severe physical fatigue (odds ratio 3.1 (95 % CI 1.1-9.1). Patients with complex CHD had higher levels of self-reported NYHA class than patients with moderately complex CHD. All dimensions of fatigue were positively associated with self-reported NYHA class.

Patients over the age of 40 with complex CHD were three times more likely to report severe to very severe physical fatigue and reported higher levels of self-reported NYHA class than patients with moderately complex CHD. This highlights the importance of considering CHD complexity in clinical practice.

This study investigates the characteristics and typologies of family cohesion and adaptability among individuals diagnosed with Internet Addiction Disorder (IAD), and explores the associations between these family dynamics and levels of depression and anxiety. The findings aim to inform the theoretical underpinnings of family-based therapeutic interventions for IAD.

A cross-sectional survey design was adopted, employing four well-validated instruments: the Young Diagnostic Questionnaire for Addiction, the Family Cohesion and Adaptability Scale, the Depression Scale, and the Anxiety Scale. The sample comprised 150 individuals diagnosed with IAD from the outpatient department of the Second People's Hospital of Hunan Province, and a control group of 150 age- and gender-matched individuals without IAD. Statistical analyses, including independent sample t-tests and Pearson correlation analyses, were conducted using SPSS version 27.0.

(1) Compared to the control group, individuals with IAD reported significantly lower scores in both actual intimacy and actual adaptability, as well as in ideal adaptability, on the FACES scale (all P < 0.001). Dissatisfaction scores for both intimacy and adaptability were significantly higher in the IAD group (P < 0.002). The predominant family typologies identified in the IAD group were disengaged (49.3%) and rigid (80.0%). (2) Levels of depression and anxiety were significantly elevated in the IAD group compared to the control group (P < 0.001). (3) Actual and ideal scores of family intimacy and adaptability were negatively correlated with depression and anxiety scores in the IAD group (P < 0.05).

The findings highlight the necessity of a dual-focused intervention strategy. Preventive programs should prioritize individuals exhibiting lower levels of family cohesion and adaptability, with an emphasis on educating parents about the crucial influence of family dynamics on child development and providing guidance on improving the home environment. Concurrently, attention to the mental health of children is essential. Early identification and intervention for symptoms of depression and anxiety may help prevent the escalation of comorbid conditions such as Internet Addiction Disorder and emotional dysregulation, thereby enhancing the effectiveness of therapeutic outcomes.

Natural interventions for sleep disturbances, such as saffron extract, are gaining scientific and clinical interest. This 3-arm, randomized, double-blind, placebo-controlled trial examined the effect of a standardized saffron extract (Safr'Inside™) on sleep, stress, and other associated psychological outcomes in 165 adults reporting moderate insomnia.

Participants received 30 mg, 20 mg saffron extract, or placebo for 4 weeks. The primary endpoint was the change in insomnia symptoms (Athens Insomnia Scale, AIS). Secondary outcomes were the Single-Item Sleep Quality Scale (SQS), Perceived Stress Scale (PSS), Patient Health Questionnaire-4 (PHQ-4), Positive and Negative Affect Schedule (PANAS), Epworth Sleepiness Scale (ESS), and World Health Organization Quality of Life (WHOQOL). Analyses followed an intention-to-treat (ITT) approach, with per-protocol (PP) confirmation.

Among 150 completers, saffron extract led to a greater reduction in insomnia symptoms (AIS) than the placebo (between-group adjusted mean difference β = -0.95 [95 % CI: -1.79, -0.11], P < .05). In secondary analyses, sleep quality (SQS) improved significantly after 3 weeks and was sustained at week 4 in both saffron groups compared to placebo (30 mg vs placebo: β = 0.82 [95 % CI: 0.22, 1.41], P = .004; 20 mg vs placebo: β = 1.02 [0.43, 1.62], P < .001). Perceived stress (PSS) was significantly reduced with 30 mg or 20 mg saffron extract compared to placebo (30 mg vs placebo: β = -1.87 [95 % CI: -3.23, -0.53], P = .01; 20 mg vs placebo: β = -1.89 [95 % CI: -3.22, -0.52], P = .04). Some improvement in psychological symptoms (PHQ-4) was also observed with 30 mg saffron extract compared to placebo (β = -0.79 [-1.40, -0.18], P = .03). All other measures showed no significant differences. No serious adverse events occurred.

Four weeks of 20 or 30 mg saffron extract may reduce insomnia and stress in middle-aged adults. Future research should assess longer interventions and explore which subgroups benefit most from saffron extract.

Hepatitis B Virus (HBV) is a major global public health concern, with chronic infection affecting physical, psychological, social and work functioning, often leading to depression, anxiety, and stress. However, tailored online psychological interventions remain limited. This pilot randomized controlled trial aimed to evaluate the feasibility, acceptability and efficacy of a culturally-adapted four-week mobile cognitive-behavioral intervention for reducing depression, anxiety, and stress levels among individuals with HBV in China. Thirty-seven HBV-positive participants (age 18-65) with moderate to severe depression, anxiety or stress were recruited through an online platform. Participants were randomly assigned to an intervention group (n = 19) or waitlist control (n = 18). The intervention included animated psychoeducation, interactive exercises, and weekly feedback from trained clinical psychology graduates. Primary outcomes-depression, anxiety, and stress-were assessed weekly (T0-T4), while secondary outcomes-fatigue, cognitive flexibility, and post-traumatic stress-were measured at baseline (T0) and post-intervention (T4). Results showed that the intervention was feasible, with no serious adverse events reported. Participants in the intervention group completed an average of 43.2 % of the program and reported high satisfaction with it. Intention-to-treat repeated-measures ANOVA indicated significant improvements in depression and anxiety for both groups but found no significant differences between groups in primary or secondary psychological outcomes. This pilot study underscores the need to refine intervention content and delivery methods. Larger trials are needed to evaluate the efficacy of online psychological interventions for individuals with HBV and to explore strategies for enhancing engagement and adherence.

Understanding trends in opioid-related hospital utilization is crucial for informing public health policies; however, existing research is often limited in scope and methodology. This study provides national estimates from 2016 to 2021, emphasizing the variability in trends across different opioid categories and subpopulations.

This study employed a repeated cross-sectional analysis using data from the National Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS). Analyses were performed in two periods: 2016-2019 and 2019-2021 (during the COVID-19 pandemic). Outcomes included rates of opioid-related diagnoses and three types of opioid use disorder-related clinical events: nonfatal opioid overdose, injection drug use-related acute infection, and substance abuse treatment. Further analyses were conducted by opioid category (e.g., heroin and synthetic opioids as a proxy for fentanyl), as well as subgroup analyses based on predefined demographic characteristics, including age, sex, race/ethnicity, socioeconomic status, and geographic location.

Between 2016 and 2019, in the NIS, there was a significant decrease in the rate of opioid-related diagnoses (relative change: -5.4%, 95% Cl: -9.4 to -1.3), nonfatal opioid overdose (-18.4%, -21.7 to -15.0), and substance abuse treatment (-25.1%, -45.9 to -4.3). Conversely, the rate of injection drug use-related acute infection increased significantly (14.4%, 7.3-21.4). In the NEDS, the rates of these outcomes did not change significantly. Notable variations were observed; for instance, in the NIS, the rate of nonfatal synthetic opioids as a proxy for fentanyl overdose increased by 21.1% (11.6-30.5), and heroin-related adverse event or poisoning increased by 51.8% (16.8-86.8) among adults aged 65-84. Between 2019 and 2021, in both the NIS and NEDS, the rate of nonfatal opioid overdose increased significantly (NIS: 8.1%, 3.5-12.7; NEDS: 24.8%, 11.5-38.0), in the NIS, a significant increase was found in the rate of injection drug use-related acute infection (relative increase: 8.2%, 1.2-15.1), while the rates of the other outcomes did not change significantly. Significant variations were also identified; for example, in the NIS, the rate of nonfatal opioid overdose did not show significant change among females, non-Hispanic whites, and adults with higher socioeconomic status.

The significant variability in opioid-related hospital utilization trends among U.S. adults underscores the need for careful consideration in the design of future policies, especially during crises. Management strategies should be tailored to specific subpopulations, opioid categories, and OUD-related clinical events to maximize success rates.

Taishan Scholars Program of Shandong Province-Pandeng Taishan Scholars.

The aim of the present study was to test whether the occurrence of psychosomatic syndromes in patients with systemic sclerosis (SSc) may influence psychopathological distress and well-being.

A total of 276 outpatients with SSc were consecutively enrolled. Mental disorders were assessed using the Mini-International Neuropsychiatric Interview (MINI), while psychosomatic syndromes were assessed using the Semi-Structured Interview for Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R-SSI). Psychological distress and well-being were assessed using the Mental Pain Questionnaire (MPQ), the Symptom Questionnaire (SQ), the Psychological Well-Being (PWB) scales, the 5-item World Health Organization Well-Being Index (WHO-5), the Euthymia Scale (ES), and the Pictorial Representation of Illness and Self Measure (PRISM). Latent Class Analysis (LCA) was performed on the 14 items of the DCPR-R-SSI. The LCA solution identified two distinct latent patient groups with distinct clinical profiles: LC1, comprising 255 patients (92.4%), and LC2, comprising 21 patients (7.6%).

DCPR-R allostatic overload, demoralization, irritable mood, type a behavior, and alexithymia primarily discriminated between the two distinct latent groups of patients. The probabilities of observing these syndromes were higher among the patients belonging to the LC2 group. Depression was found to be associated with belonging to the LC2 group, as well as with higher scores on the MPQ and the SQ scales for depression, anxiety, anger-hostility, and somatization (p < 0.05). In addition, lower scores were observed on the PWB scales for environmental mastery, positive relationships with others, purpose in life, and self-acceptance, as well as on the WHO-5, ES, and PRISM measures of feeling at peace (p < 0.05).

Psychosomatic syndromes may help define distinct clusters among patients with SSc, reflecting specific clinical profiles that should be considered during patient assessment and when proposing tailored interventions.

With the widespread use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in managing diabetes and obesity, the occurrence of GLP-1 RA-induced cholecystitis and cholelithiasis has raised increasing concern among healthcare professionals.

This study extracted adverse event reports of GLP-1 RA-induced cholecystitis and cholelithiasis from the FDA Adverse Event Reporting System database, covering Q1 2004 to Q2 2024. Disproportionality analysis methods, including the reporting odds ratio, proportional reporting ratio, and Bayesian confidence propagation neural network, were employed to identify associations between GLP-1 RAs and these AEs. The analysis focused on the five most commonly prescribed GLP-1 RAs, evaluated at both high-level term and preferred term levels.

A total of 1,829 reports were identified in which GLP-1 RAs were listed as the primary suspect drug, involving 1,651 patients. All three signal detection methods indicated a positive signal between GLP-1 RAs and these conditions. The majority of cases occurred in patients aged 45 years and older, with a significantly higher prevalence in females. The median onset time of GLP-1 RA-induced cholecystitis and cholelithiasis was 182 days, with variations observed across different drugs, genders, and age groups.

This study provides a comprehensive pharmacovigilance analysis of GLP-1 RA-induced cholecystitis and cholelithiasis, offering valuable insights into the prevention and management of these AEs.