Psychiatry International

The first postpartum year presents threats to the mental health of birthing parents and obstacles to accessing care. Digital mental health interventions (DMHIs) hold potential to increase postpartum mental healthcare access. However, DMHIs tend to promote limited engagement particularly when they are self-guided (when they do not involve contact with a provider). Yet, given that provider support is a limited resource, a balance must be struck between accessibility and intervention intensity (i.e., involving more human contact). Towards achieving this balance, this analysis seeks to identify characteristics that are associated with a reported preference for a human-guided introduction to digital resources aimed at promoting postpartum mental health. In a sample of largely White, non-Latinx, employed, married, and graduate school-educated individuals, multivariate logistic regression revealed that age (p = 0.0095), level of postpartum functioning (p = 0.0057), depression symptoms (p = 0.0099), and anxiety symptoms (p = 0.03) were associated with guide preference. Specifically, more anxious or lower-postpartum-functioning individuals were more likely to report preferring a guide while older or more depressed individuals were less likely to report preferring a guide. These findings can inform clinical recommendations surrounding who is most likely to engage with, and thus benefit from, exclusively self-guided DMHIs during the postpartum period. Full article

Introduction: A positive association between Internet usage time and Internet addiction among adolescents and adults has been frequently reported; however, studies of working adults focusing on weekdays and holidays are limited. Therefore, this study aimed to elucidate the association between Internet usage time and psychometric tests among working adults in their 30s, focusing on weekdays and holidays. Methods: A total of 129 workers aged 30–39 years participated in this study. Participants completed a questionnaire and interview regarding psychometric tests, including Internet usage time, Internet addiction tendency, smartphone addiction tendency, depression tendency, and personality traits. A correlation analysis focusing on differences between weekdays and holidays was conducted. Results: The scores on Internet addiction scales are weakly positively correlated with holiday Internet usage time. The scores of smartphone addiction scales are also weakly positively correlated with the holiday Internet time. No correlation was found between weekdays Internet usage time and scores on Internet addiction scales. Conclusions: Internet usage time during holidays is associated with Internet addiction tendency among the working adult samples. Holiday Internet usage time could be a useful indicator of risk of Internet addiction. Our pilot findings provide clues to the mental health affected by the Internet, especially among adults. Full article

Aggressive behaviors of people with dementia pose a significant challenge to employees in nursing homes and aged care facilities. Aggressive behavior is a result of psychomotor agitation in dementia (BPSD). Globally, psychotropic interventions are the preferred treatment for BPSD. However, it is still unclear which psychotropic should be prescribed. The purpose of this systematic review is to compare pharmacological interventions for psychomotor agitation and psychosis symptoms. Method: The studies were extracted from databases, such as PubMed, OVID, and Cochrane, with a date restriction from 2000 to present, and in English. PRISMA steps were used to refine the extracted data. The RCTs extracted for this systematic review compared active ingredient medications to one another or to a placebo. Results: PRISMA was used to assess all selected trials comprehensively. Four trials are being conducted on quetiapine, two on haloperidol, one on olanzapine, three on risperidone, one on brexpiprazole, one on pimavanserin, and two on aripiprazole. Compared to typical antipsychotics, quetiapine showed tolerable adverse effects and did not worsen parkinsonism. Psychosis symptoms and behavioral improvements can be improved with haloperidol. Among elderly patients with psychosis, risperidone reduces angriness, paranoia, and aggression, as well as improves global functioning. As compared with other antipsychotics, aripiprazole provides a lower risk of adverse effects and demonstrated improvement in agitation, anxiety, and depression associated with psychosis. While olanzapine improves hostile suspiciousness, hallucinations, aggression, mistrust, and uncooperativeness, it worsens depression symptoms. Psychosis was treated effectively with pimavanserin without adverse effects on motor functions. Psychosis symptoms are well tolerated by brexpiprazole, but insomnia, headache, and urinary tract infections are common side effects. Conclusions: In this systematic review, we provide an overview of how to choose the correct antipsychotics and dosages for the management of BPSD and emphasize the importance of safe and conservative use of these drugs. Full article

Sexual dysfunctions are common among females with common mental health conditions, such as anxiety and depression. However, discussion on this topic remains taboo in many cultures, including India. Worldwide, the Female Sexual Function Index (FSFI) is the most used tool to evaluate sexual functioning in females. Researchers across the globe attempted to translate and validate this scale in native languages (e.g., Japanese and Spanish); however, such translations are not available in Hindi. Strikingly, although there is literature informing us about the regional validation process of this scale, little has been discussed about qualitative nuances of the process of translation, the expert panel discussion, and cognitive interviewing during pilot testing. The lack of such procedural qualitative data limits the replicability of such translations in different cultures; furthermore, it can adversely influence the parameters of the validation study. Hence, the current study was conducted to highlight the process of Hindi translation of the FSFI and illustrate the challenges faced at various stages of translation and testing. The study was conducted in the multidisciplinary hospital of Central India by involving five translators, five expert panel discussants, and 15 patients with common mental health conditions or their caregivers. The significant findings of the current work include the requirement of semantic and grammatical changes and rephrasing of the sentences for improving comprehensibility and applicability in the Indian population (during the panel discussion). Additionally, it informed us to use alternate or more than one word to capture a concept, including English words written in Hindi (during preliminary pilot testing). Critical roadblocks were inadequate awareness of the issues, lack of typical/comprehensive terminologies to capture the ideas, and significant stigma attached to the subject. Full article

Background: Major Depressive Disorder is a leading cause of disability worldwide and one of the most common disorders in the United States. Contributors to an individual’s risk for experiencing depressive disorders include individual and social factors. Although the social determinants of health (SDOH) are conditions that contribute to healthy functioning, health outcomes, and quality of life, it is unclear to what extent adverse SDOH experiences are associated with self-reporting depressive disorder (DD). Methods: Data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey of noninstitutionalized U.S. adults, was employed in this study. Lifetime diagnosis of DD was self-reported among survey participants who also completed the Social Determinants of Health optional module within 17 participating BRFSS states and entities. Rao-Scott chi-square analysis was used to determine the association of individual and SDOH measures with DD. Results: The prevalence of DD among participating states was 19.85%. Among respondents, significant proportional differences were observed for each SDOH indicator regarding DD status. However, significant differences in health insurance coverage were not observed. Conclusion: Survey respondents with a lifetime diagnosis of DD experienced adverse SDOH conditions in greater proportion than individuals not reporting DD. Individual and community-based approaches to address the contextual influences of depressive disorders should be aggressively implemented. Full article

Background: There is clear evidence showing an increase in mental health symptoms along with an increased demand for mental health services since the start of the COVID-19 pandemic. Objective: This study aimed to determine the rates of elevated anxiety symptoms in children during the COVID-19 pandemic in the state of Qatar. It also explored any correlated factors. Method: A cross-sectional, questionnaire-based study with 199 participants (children aged 6–16 years) consulting a dental care center. We used the original English version as well as a previously validated Arabic version of the Parent Spence Children’s Anxiety Scale to measure anxiety symptoms. Results: A total of 29.6% (n = 59) of our sample met the respective elevated cut-off score for overall anxiety disorder. The largest group among the children was elevated levels of physical injury fears 37.6% (n = 75), followed by Social Phobia 36.1% (n = 72). Younger children showed significantly higher scores for total anxiety, separation anxiety, physical injury fears, and generalized anxiety score. Among the gender groups, females reported significantly higher scores of General anxiety disorder. When comparing natives to expatriates, expatriates showed higher scores for total anxiety, physical injury fears score, social phobia score, and generalized anxiety. Conclusions: Overall, this study shows increased rates of clinically elevated anxiety symptoms in children during the COVID-19 pandemic in the state of Qatar. Younger children, females, and expatriates were more vulnerable to the psychological impact of the COVID-19 pandemic. This study highlights the specific psychological vulnerability of this population group during major health crises like the current pandemic. Full article

Miscarriage or perinatal loss constitutes one of the most important emotional stressors a woman can experience and can be associated with bereavement. This mourning is a way of adapting and coping with the circumstances. However, inadequate management of this process can lead to the development of complicated grief and psychopathologies such as anxiety, depression, and post-traumatic stress disorder. The aim of this systematic review was to evaluate the prevalence of psychopathology (anxiety, depression, and post-traumatic stress disorder) in women with a history of miscarriage or perinatal loss in the year prior, and to compare these results with women without this history. A peer review was conducted in PubMed, Cochrane, Scopus, and Web of Science databases. We included (1) articles that included women of any age who had had a miscarriage or perinatal loss in the year prior, and (2) articles with a longitudinal cohort design with a comparison group of women without a history of miscarriage or perinatal loss. After the screening process, three articles met these inclusion criteria and were included in this study. Psychopathology in women after miscarriage or perinatal loss was higher than in the control groups. In addition, it was observed that these psychopathologies gradually decreased over the first year from the loss. In conclusion, abortion and perinatal loss pose a risk factor for the development of psychopathology. Therefore, we emphasize the importance of implementing a mental health plan for these women. Full article

This study aims to analyze the main and most recent forms of gambling and related psychopathological disorders, also proposing psychological clinical recommendations. From November 2022 to February 2023, we searched the databases of PubMed, Web of Science, Health & Medical Collection, Elsevier Journal, and Springer for relevant studies performing different searches through different search strings. New forms of gambling are mostly related to new technological tools, such as the Internet, smartphones, social media, or electronic machines. The prevalence of online gambling affects all demographic groups, although 35–44-year-olds appear to have the largest share. Online gambling can lead to addiction, financial hardship, and mental health problems. It has also been statistically significantly associated with high levels of Gambling disorder, high levels of depression and anxiety, poor overall mental health, and alcohol use. Furthermore, it has been noted that online gamblers are more likely to engage in high-risk gambling behaviors and have a higher prevalence of comorbid mental disorders. The review highlights the need for continued research on the impact of new forms of gambling and the development of effective prevention and treatment strategies. Further research is needed to better understand the complex relationship between new forms of gambling and the development of gambling disorders. Full article

The study of wording and its impact on medical practice is key for the training of future physicians. Negative, imprecise, and disrespectful terms are still widespread in the medical field and contribute to the stigmatization of people in treatment, which ultimately limits their access to care. In this study, we explore the feasibility and acceptability of a method to investigate medical students’ perceptions of wording and stigma. This method involves a questionnaire that medical students complete after having read a clinical vignette. One of the two versions of the vignette is made available, which only varies in the way the patient is referred to (“substance abuser” vs. “having a substance use disorder”). Medical students from the University of Lausanne between their first and sixth year were contacted via the university’s mailing lists. They were randomly exposed to one of the two versions of the vignette and responded to the questionnaire online. This exploratory study shows that it is feasible and acceptable to assess the influence and perceptions of stigmatizing terminology among students through a vignette-based questionnaire comparing two wording options. In line with the initial study, we find trends in favor of the non-stigmatizing terminology; however, beliefs are widely held about the need for judicial “punishment” to address consumption behavior. No statistically significant differences are found between the two groups. The study of wording and its impact on access to care is a crucial issue which seems necessary to integrate into pre-graduate training. It permits the deconstruction of prejudices related to medical knowledge and offers perspectives for intervention and research to improve the right to health, which includes the fundamental right to access to care. Full article

This quasi-experimental study aimed to investigate how rational emotive behavior therapy (REBT) works in Indonesian outpatient settings, especially in the context of the COVID-19 pandemic. This study evaluated depression, anxiety, and sleep among 60 Atma Jaya Hospital patients (public and private) using several assessment tools (PHQ-9, GAD-7, and PSQI). The majority of participants were under 40 (53.3%), female (58.3%), married (56.6%), and working formally (65%), with either high school or diploma/bachelor’s level education (86.6%). After six REBT therapy sessions, significant improvements were evident in anxiety, depression, and sleep quality scores (p < 0.001). Participants showed improvements in anxiety and depression during the third and sixth sessions; and in sleep quality during the sixth session. These findings suggest that REBT-based interventions are effective in public and private outpatient settings, highlighting the importance of psychotherapy and cross-division collaboration in the Indonesian healthcare system. Full article

Intolerance of Uncertainty (IU) is described as the tendency to avoid uncertain states and exhibit negative responses to uncertain situations on cognitive, emotional, and behavioral levels. It is considered a transdiagnostic cognitive bias that plays a role in developing and maintaining psychopathology. The Intolerance of Uncertainty Scale-12 (IUS-12) has proven to be a sound measure of intolerance of uncertainty with excellent validity and reliability. Although research has supported a two-factor structure of IUS-12, most recent studies also suggest a bifactor model. The present study examines the factorial structure, validity, and reliability of the Greek version of IUS-12 with a sample of 959 university students (66.6% female) aged 19.63 years (SD = 3.20). Confirmatory Factor Analysis showed that although the two-factor solution adequately fit the data, the bifactor model better fit with IU total as an underlying one-factor. Internal consistency and validity were excellent for the total IUS-12 and Prospective and Inhibitory Anxiety subscales. Our findings support recent findings concerning the factorial structure of IUS-12 and the scale’s psychometric qualities in a Greek undergraduate sample. We expect that future research with clinical samples will confirm the screening and clinical utility of IUS-12. Full article

Lying is seemingly common in daily life, but it is scarcely researched despite its possible relevance to understanding a range of pathological behaviors and associated deception. Our aim was to investigate whether the acceptability of lying might indicate other personality constructs by analyzing a variety of questionnaire responses collected from a cross-sectional sample (n = 138). Total scores for lying acceptability were moderately associated with Machiavellianism and with functional impairment due to lying at work, in social settings, and at home. Scores for these tests were not closely associated with problematic usage of the internet, self-esteem, or religious activity/religiosity. Three distinct groupings produced by a multidimensional scale informed us of how lying might be better understood as an explanatory mechanism for compulsive behaviors. We also noted possible avenues for future research into the acceptability of lying and deception. Full article

When investigating the feelings of caregivers to patients with T1DM, parental stress, anxiety, and depression are found to be most prevalent, especially in the diagnostic phase and in the first months after diagnosis. In this pilot study, we research various significant elements regarding the well-being of mothers with children between 10 and 15 years of age with a chronic condition. The study focuses on a period of at least three years after the child’s diagnosis. The aims of the study are to describe our sample’s levels of satisfaction (SWLS) and subjective happiness (SHS) and to evaluate possible associations. A sample of 40 mothers was offered a series of assessment tools about psychological skills that could play a role in improving mothers’ well-being: the use of specific coping mechanisms (CISS), the methods of narrating the experience of life with a son/daughter with diabetes, the sense of coherence (SOCS 29), health parameters vs. child’s disease (HbA1c, CBCL), and socio-demographic, such as education and work. The most significant associations with respect to subjective happiness are with the sense of coherence, as a unitary value and as distinct factors, and with task-oriented coping. Sense of coherence is also associated with satisfaction. Full article

Background: The association between personality and life outcome has been widely studied in Western countries, and one might question whether the association exists in China. The official documentation from the Twenty-Six Histories of Imperial China, which presents life-long data on the social elite, may offer a convenient way to realize this effort. Meanwhile, a possible association might help identify competent personalities and offer treatment hints for personality disorders or other psychiatric deviations worldwide. Methods: Based on these historical records (about 618–1911 AD) on 18 social elite groups with long longevity (Macrobian group) and 30 with normal lifespans (Control group), we assessed personality traits/facets using the revised NEO Personality Inventory (NEO-PI-R) and destiny using the Destiny Evaluation Questionnaire (DEQ). Results: Compared to the Controls, the Macrobian group scored higher on the DEQ’s Health and Destiny in General and lower on the NEO-PI-R traits Openness to Experience and Extraversion and facets such as Openness to Fantasy, Openness to Aesthetics, Openness to Feelings, Excitement-Seeking, and Self-Consciousness. In the Macrobian group, the Trust and Compliance facets predicted the DEQ’s Family and Marriage and Social Relationships aspects, respectively; Conscientiousness and its facets Dutifulness, Self-Discipline, and Competence predicted Family and Marriage, Career Achievement, and Destiny in General, respectively; and the Self-Consciousness facet predicted worse performance in Career Achievement, Family and Marriage, and Social Relationships and the Depression facet of Destiny in General. In the Control group, Openness to Feelings positively and Anxiety negatively predicted Health. Conclusions: Less self-focused attention and more interdependence between individuals were beneficial to several aspects of individual destiny in Imperial China, which might be profound for the individual career development and clinical treatment of personality disorders in contemporary society. Full article

The Alice in Wonderland Syndrome (AIWS) is an unusual and uncommon condition that falls under the umbrella of neurology and psychiatry. It is characterized by the presence of complex perceptual and visual discord. Additionally, there are visual hallucinations that are multi-dimensional. This syndrome was first described by John Todd in the 1950s, and it was loosely based on the book Alice in Wonderland. A man in his 30s arrived at his doctor’s appointment with a chief complaint of a pounding cluster headache that lasted over a full day. In addition, he mentioned that there was an aura preceding his headaches. The pain was so intense, it was debilitating him from routine activities. Before the headaches, he explained that he would sense bizarre physical and visual behaviors. During these episodes, he explained that things around him appeared distorted and of various sizes. Things in his room appeared to be more distant than they really were and larger in size (macropsia and micropsia). He described the fingers on his right hand to be much smaller compared to his left hand (micropsia). Objects around him were deformed and distorted (metamorphopsia). His symptoms lasted 45 minutes. He did not suffer from any previous headaches or hallucinations. He was a healthy man with a clean bill of health as per his medical records. Upon examination, the attending physician described the patient as alert, oriented to time and place, and under no obvious distress. All labs performed returned normal including a 10-panel drug test. These were tested to see if he was under the influence of any narcotic, stimulant, or other substances. The physician prescribed 500 mg of valproic acid to take daily. Three months later during his follow-up, he mentioned his symptoms had subsided but were still present. His dose was again increased to 1000 mg/day, eventually stopping all further symptoms from surfacing. He has not had another episode in three months. The Alice in Wonderland Syndrome is known to be associated with headaches with preceding auras. It is common in the pediatric and adult populations. In this paper, I introduce a case of a patient who displays migraines with preceding auras, indicative of AIWS. Full article

Catatonic syndrome is frequently observed over the course of severe mental disorders and general medical conditions, but when catatonia occurs in psychiatric patients with co-morbid medical or neurologic conditions, diagnosis and management may be challenging. Several medical conditions may cause catatonia in psychiatric patients, but some, such as brain injury, infections, hyponatremia and critical illness, may be most relevant in this population. Alongside appropriate etiologic treatment, benzodiazepines and electroconvulsive therapy in refractory cases are effective and safe, and may resolve catatonic syndrome rapidly. When newly-onset psychotic symptoms in catatonic patients with established psychotic disorders occur, delirium should be suspected and appropriately managed. An extensive clinical and laboratory diagnostic workup to determine the underlying etiology of catatonic syndrome should be carried out. In cases of acute multi-morbidity, the exact cause of catatonic syndrome in psychiatric patients may be unclear. It is recommended to avoid antipsychotic drugs in acutely catatonic patients, because they may exacerbate the catatonic symptoms. The akinetic type of catatonia should be differentiated from hypoactive delirium, as treatments for these syndromes differ substantially. When a psychiatric patient presents with symptomatology of both catatonia and delirium, treatment is particularly challenging. Full article