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Abstract Lithium's well-documented efficacy in preventing suicide over the long term prompts consideration of its potential for more rapid antisuicidal effects. However, evidence supporting such acute efficacy is limited. Weighing against its possible rapid benefits are significant concerns regarding lithium's side-effect profile – particularly toxicity, renal impairment, and weight gain – and the often necessary delay in achieving therapeutic levels. Moreover, the multifaceted nature of suicidality complicates identifying short-term outcomes and disentangling lithium's effects on suicidal thoughts from broader reductions in depressive symptoms. While lithium may remain invaluable for some high-risk patients in emergency settings, its routine use as a rapid-acting agent for acute suicidality is currently not well supported.

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Abstract Psychedelics are a group of psychoactive substances that produce complex and subjective changes to consciousness and carry unique safety considerations. There is a growing body of work investigating the use of psychedelics in mental health treatment alongside increasing socio-cultural and political acceptance. This rapid evolution has prompted corporations to fund psychedelic clinical trials, leading to a potential rise in conflicts of interest in relevant studies and publications. However, the body of evidence for the safety and efficacy of psychedelic-assisted psychotherapy is early. There is concern regarding the introduction of bias in psychedelic clinical trials and the selective reporting of results amidst and beyond corporate involvement. At a crucial time in psychedelic drug reform, this paper explores the safety concerns associated with psychedelics, the potential influences of financial stakeholders on safety outcome reporting and the importance of balanced science communication in maintaining public health and safety.

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Abstract Neuroscience-based nomenclature (NbN) is a proposal to provide a nomenclature based on neuroscience and pharmacology instead of the old disease-based classification. The NbN is based on the mechanism of action and pharmacological target and aims to assist in rational prescription, to reduce stigma, and to increase treatment adherence. Currently, the NbN is endorsed by many psychiatric associations, has been adopted by several relevant journals, and is included in major psychiatry textbooks. Therefore, it is important that the NbN is known to psychiatrists.

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Abstract Objective Although research has shown that mood and anxiety disorders manifest disturbed emotion regulation, it is unclear whether anxiety disorders differ from each other in terms of their emotion regulation strategies. In the present study, we investigated whether patients with anxiety disorders present different affective styles. Methods We assessed the affective styles of 32 obsessive-compulsive disorder (OCD) patients, 29 social anxiety disorder (SAD) patients, 29 panic disorder (PD) patients, and 20 healthy controls using the Affective Style Questionnaire (ASQ). A multivariate analysis of covariance (MANCOVA) was conducted to compare affective styles across groups (OCD, SAD, PD, and control), while controlling for depression, anxiety symptoms, and age. Results The MANCOVA revealed a significant, small-medium, main effect of diagnostic group on affective styles. The planned contrasts revealed that OCD and SAD patients reported significantly lower scores for “tolerance” (ASQ-T) compared to the healthy controls. There were no differences between the PD group and healthy controls. Conclusion Our findings provide evidence that individuals with OCD and SAD have difficulty tolerating strong emotions existing in the present moment in an open and non-defensive way.

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Abstract Objective: Children grow up spending most of their time within the family social environment, where they can experience stressful situations such as marital conflict, a non-cohesive environment, parental alcohol use disorder, parental depression, and other parental mental health issues. All these factors are associated with children's developmental delays. We aimed to conduct a scoping review on associations between family stress and family resilience and child development delays to examine familial conditions associated with child development. Methods: We conducted a scoping review of observational studies published from January 2000 to July 2023 and indexed in the MEDLINE and LILACS databases. We included observational studies that assessed history of exposure to violence and behavioral or emotional symptoms or mental health problems among children aged 4-12. Data were independently extracted using a structured form. Results: Database searches identified 12,990 unique records. A total of 43 articles were included in the review. Three main findings emerged: (1) parental mental health problems, especially depressive symptoms in mothers, were associated with child developmental delays and mental health problems; (2) better parenting practices and a cohesive home environment were positively associated with child development; and (3) vulnerable social environments (e.g., poverty and housing insecurity) may be linked to child mental health problems. Conclusion: The studies reviewed show that promoting better family dynamics and increasing family cohesion, as well as improving parenting abilities, are beneficial to children's socioemotional development and prevention of child mental health problems. Moreover, increasing family and children's resilience improves the quality of life within family units.

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Abstract Objective Despite previous literature, the superiority of second-generation antipsychotics (SGAs) relative to first-generation antipsychotics – especially haloperidol – on cognitive management in schizophrenia is still controversial. Thus, we aimed to compare the effects of haloperidol versus SGAs on the cognitive performance of individuals with schizophrenia or related disorders. Methods We conducted an updated systematic review and nine pairwise meta-analyses of double-blinded randomized controlled trials published up to October 30th, 2022, using MEDLINE, Web of Science, and Embase. Results Twenty-eight trials were included, enrolling 1,932 individuals. Compared to SGAs, haloperidol performed worse on cognitive composite (mean difference [MD] −0.13; 95% confidence interval [95%CI] −0.33 to −0.03), processing speed (MD −0.17; 95%CI −0.28 to −0.07), attention (MD −0.14; 95%CI −0.26 to −0.02), motor performance (MD −0.17; 95%CI −0.31 to −0.03), memory and verbal learning (MD −0.21; 95%CI −0.35 to −0.08), and executive function (MD −0.27; 95%CI −0.43 to −0.11). In contrast, there were no significant differences between SGAs and haloperidol on working memory (MD 0.10; 95%CI −0.08 to 0.27), visual learning (MD 0.08; 95%CI −0.05 to 0.21), social cognition (MD 0.29; 95%CI −0.30 to 0.88), and visuoconstruction (MD 0.17; 95%CI −0.04 to 0.39). Conclusion Haloperidol had poorer performance in global cognition and in some cognitive domains, but with small effect sizes. Therefore, it was not possible to conclude that haloperidol is certainly worse than SGAs in the long-term cognitive management of schizophrenia.

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Abstract Objective: Recent guidelines on depressive disorders suggest a combination of antidepressants and psychotherapy in case of moderate to severe symptomatology. While cognitive behavioral therapy (CBT) and interpersonal therapy (ITP) are the most investigated interventions, psychodynamic psychotherapies have been less explored. The aim of this paper is to systematically review literature data on the efficacy of short-term psychodynamic psychotherapy (STPP) in combination with antidepressants in the treatment of depressive disorders, focusing on both short and long-term results and on potential moderators that could influence its effectiveness. Methods: This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched were PubMed, Ovid, Scopus, and Cochrane Library, from inception to August 2023. Results: Adding STPP to medications in the first 6 months of treatment did not influence remission rates, but did improve acceptability, work adjustment, interpersonal relationships, social role functioning, hospitalization rates, and cost-effectiveness. After 12 months, a significant difference in remission rates arose, favoring combined therapy. From a long-term perspective, adding STPP to pharmacotherapy reduced the recurrence rate by almost 50%. STPP has proven to be more effective in longer depressive episodes, in more severe depression, and in patients with a history of childhood abuse. However, STPP had no impact on major depressive disorder (MDD) with comorbid obsessive-compulsive disorder (OCD). Conclusions: Combining STPP with antidepressants appeared to be helpful from both short-term and long-term perspectives. Still, there are few rigorous studies with large samples and further research is needed to identify which subgroups of patients may benefit more from STPP.

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Abstract Objective: There is growing concern about the occurrence of burnout syndrome in university students worldwide. This systematic review aimed to estimate the prevalence of burnout syndrome and its associated factors among health sciences students (HSS) in Spain. Methods: Five databases (MEDLINE/PubMed, PsycINFO, EMBASE, Dialnet and MEDES) were searched up to January 5, 2023, adhering to PRISMA guidelines. Quantitative studies reporting the prevalence of burnout syndrome among HSS in Spanish universities were considered. The reference lists of the selected studies were hand searched. Data were extracted from peer-reviewed articles. Results: Twenty-six studies were included with a total of 14,437 HSS. Most studies included nursing students (k = 11), followed by medicine students (k = 8), psychology students (k = 5), dental students (k = 2), physiotherapy students (k = 1) and pharmacy students (k = 1). Overall, study quality was fair. The most widely used instrument was the Maslach Burnout Inventory. The mean prevalence of burnout was 35.3% (k = 11 studies). However, rates varied widely between studies, which may be due to methodological differences. Inconsistent associations were found with gender and year of study. The relationship of burnout with academic and mental-health related variables was consistent across studies. Personal attributes, such as higher resilience, are likely protective against burnout. Conclusion: Burnout appears to be prevalent among HSS in Spain, and may be affected by academic, mental health and personality factors. Identifying risk and protective factors for burnout could help to develop preventive and management strategies to ultimately reduce its negative consequences in this population. Systematic review registration: PROSPERO (CRD42023387460).

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Abstract Objectives We investigated relationships between the triarchic model of psychopathy, coping styles, and externalizing and internalizing symptoms, and verified the mediating effect of coping styles. Methods Participants were 957 adults who answered the Triarchic Psychopathy Measure (TriPM), the Inventory of Depression and Anxiety Symptoms Expanded Version (IDAS-II), and the Crime and Analogous Behavior Scale (CAB). Results Data were analyzed using four path analyses to test our hypotheses, indicating each triarchic trait is differently associated with psychological symptoms and coping styles. We also observed preferences for some coping styles affecting the association between triarchic traits and psychological symptoms. Conclusion Our findings suggest that coping styles only affect the interaction between boldness and distress, as well as between boldness and fear, indicating that specific coping strategies can account for variations in distress and fear linked to boldness.

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Abstract Objectives Death anxiety (DA) is a predictor of exacerbation of both physical and psychological symptoms of chronic diseases. Therefore, having short and easy-to-apply instruments to assess the presence of DA and adopting a multidisciplinary approach to address it are important. This study analyzes the psychometric properties of the Death Anxiety Scale (DAS), originally developed by Donald Templer, in a Colombian population of adult patients diagnosed with a chronic disease. Methods The original instrument was linguistically, conceptually, and culturally adapted to Colombian Spanish to be subsequently administered to 301 adult patients with chronic diseases. Results The exploratory factor analysis revealed a three-factor structure, which explained 47% of variance. Internal consistency was demonstrated (Cronbach’s alpha: 0.71; McDonald’s omega: 0.76; Guttman’s lambda 6 [G6]: 0.74; greatest lower bound: 0.54). A correlation coefficient of 0.64 was found between the total score of the DAS and the Beck Anxiety Inventory (BAI). Conclusion When comparing the results with the versions of the DAS in Spanish from Mexico and Spain, variability in the psychometric properties was observed. Language cannot therefore be assumed to be a guarantee of the reliability and validity of the instrument.

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Abstract Objective: Cardiovascular patients experience various psychological problems due to the conditions caused by their disease, making it worse if left untreated. The purpose of the current study was to evaluate the effects of acceptance and commitment therapy (ACT) on distress, emotion regulation, and self-compassion in patients with cardiovascular disease. Methods: This study was a randomized clinical trial with pre-test, post-test, and 2-month and 4-month follow-up periods accompanying a control group and an experimental group. Patients filled out questionnaires at four stages; a Depression, Anxiety, and Stress Scale (DASS-21), an Emotion Regulation Questionnaire (ERQ), and a Self-Compassion Scale (SCS). The experimental group underwent a treatment protocol based on ACT. Data were then analyzed using SPSS-25 with repeated measures analysis of variance (ANOVA). Results: ACT significantly reduced depression, anxiety, and stress, enhanced self-compassion, and improved emotion regulation in cardiac patients. Between-subjects (group) partial Eta squared (η²) for depression, anxiety, stress, reappraisal, suppression, and self-compassion were 0.61, 0.64, 0.66, 0.62, 0.66, and 0.65, respectively. Treatment efficacy was maintained at the 2-month and 6-month follow-up visits. Conclusion: The results of this study suggest that treating cardiac patients’ psychological problems in an ACT-focused manner may have an impact on how well they respond to their treatment.

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Abstract Objective: Major depressive disorder (MDD) is a global concern due to its widespread prevalence and morbidity. It is crucial to identify protective factors in high-risk individuals, including those with a familial predisposition, maltreatment history, and socioeconomic vulnerabilities. Methods: We assessed a high-risk subsample within a young adult population cohort (n = 791; mean age = 31.94 [standard deviation {SD} = 2.18]) across three waves, using multiple regression models to analyze higher education, feeling supported, spirituality, psychotherapy access, higher socioeconomic status, involvement in activities, cohabitation, and family unity in waves 1 and 2 and their association with MDD resilience at wave 3. Results: In the high-risk group, MDD incidence was 13.7% (n = 24). Paternal support had a protective effect on MDD incidence (odds ratio [OR] = 0.366; 95% confidence interval [95%CI] 0.137 to 0.955; p = 0.040) and suicide attempt risk (OR = 0.380; 95%CI 0.150 to 0.956; p = 0.038). Higher resilience scores were also protective (OR = 0.975; 95%CI 0.953 to 0.997; p = 0.030), correlating with reduced Beck Depression Inventory (BDI) (r = 0.0484; B = −0.2202; 95%CI −0.3572 to −0.0738; p = 0.003) and Montgomery-Åsberg Depression Rating Scale (MADRS) scores (r = 0.0485; B = −0.2204; 95%CI −0.3574 to −0.0741; p = 0.003). Conclusion: Our paper emphasizes reorienting the MDD approach, focusing on positive prevention strategies. It highlights the crucial role of fathers in family-based interventions and in promoting resilience in high-risk populations.

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Abstract Objective In recent decades, there have been considerable advances in treatment and prevention of acute ischemic stroke (IS). However, even after treatment, approximately two-thirds of patients with IS have some degree of disability that requires rehabilitation, along with an increased likelihood of developing psychiatric disorders, particularly depression. The objective of this study was to determine the predictors of post-stroke depression in a 6-month period in patients with IS. Methods Ninety-seven patients with IS without previous depression were included in the study. The study protocol was applied during hospitalization and at 30, 90, and 180 days after hospital discharge. A binary logistic regression was then conducted. Age, sex, marital status, occupation, educational level, thrombolysis, National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) score, Barthel Index (BI), and Mini-Mental State Examination (MMSE) score were included as independent variables. Results Of the 97 patients, 24% of patients developed post-stroke depression. In the longitudinal follow-up, an mRS score of > 0 was the lone significant predictor of development of depression (odds ratio [OR] = 5.38; 95% confidence interval [95%CI] 1.25-23.12; p < 0.05). Conclusion Our results showed that in patients without previous depression, functional impairment of any degree is associated with a 5-fold greater chance of development of depression in the first 6 months post-stroke compared to patients without functional impairment.

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Abstract Objective Ketamine and esketamine have both shown significant antidepressant effects in treatment-resistant depression (TRD) and conflicting evidence suggests that dissociation induced by these drugs could be a clinical predictor of esketamine/ketamine's efficacy. Methods This study is a secondary analysis of data from a two-center, randomized, controlled trial. Participants were randomly assigned 1:1 to receive an IV infusion of either esketamine (0.25 mg/kg) or racemic ketamine (0.50 mg/kg) over 40 minutes. Dissociative symptoms were assessed using the Clinician-Administered Dissociative State Scale (CADSS) 40 minutes following the beginning of the infusion. Variations in depression scores were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), which was administered before the intervention as a baseline measure and 24 hours, 72 hours, and 7 days following infusion. Results Sixty-one patients were included in the analysis. Examining CADSS scores of 15 or below, for every 1-point increment in the CADSS score, there was a mean change of −0.5 (standard deviation [SD] = 0.25; p = 0.04) of predicted MADRS score from baseline to 24 hours. The results for 72 hours and 7 days following infusion were not significant. Since the original trial was not designed to assess the relationship between ketamine or esketamine-induced dissociation and antidepressant effects as the main outcome, confounding variables for this relationship were not controlled. Conclusion We suggest a positive relationship between dissociation intensity measured with the CADSS and the antidepressant effects of ketamine and esketamine 24 hours after infusion for CADSS scores of up to 15 points.

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Abstract Objective Medical students are a population at increased risk for anxiety due to their demanding schedule and concerns about potential stigmatization, which often discourage them from seeking help. It has been reported that the coronavirus disease (COVID-19) pandemic worsened this issue by restricting social interaction and mobility. An innovative method has been developed to address this problem, known as the asynchronous Digital Cognitive Education Gadjah Mada Anxiety Intervention for Medical Students (DCE GAMA-AIMS). Compared to traditional therapy, this modality can be accessed independently without the guidance of a therapist. The objective of this study was to compare the effectiveness of DCE GAMA-AIMS compared to therapist-guided brief cognitive behavioral therapy (bCBT) for reducing anxiety scores. Methods A non-blinded randomized clinical trial (RCT) was conducted with 66 medical students. The participants were equally divided into two groups, an intervention and a control group. The intervention group was given DCE GAMA-AIMS, while guided bCBT was administered to the controls. The data obtained were analyzed using independent t tests and analysis of variance (ANOVA). Results The application had a significant effect, reducing anxiety scores from the 2nd week (M Taylor Manifest Anxiety Scale [TMAS] = 18) to the 8th week (M TMAS = 13). A faster and more significant improvement was observed in the intervention group from the 1st to the 2nd week compared to the controls, who began to improve in the 4th week. Furthermore, the intervention group had larger effect size (1.32) compared to the control (0.79) from the 1st to 8th weeks. Conclusion Asynchronous DCE GAMA-AIMS and guided bCBT both reduced TMAS scores in medical students with anxiety, but DCE GAMA-AIMS yielded a larger effect size.

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Abstract Objective Lifestyle Medicine comprises six domains: diet, substance use, physical activity, stress management, social connection, and sleep. The comprehensive assessment of lifestyle is challenging, but the Short Multidimensional Inventory on Lifestyle Evaluation (SMILE) was developed to fill out this gap. In this paper, we describe the development and the psychometric properties (internal consistency, concurrent and convergent validity) of a shorter version of the SMILE among university students. Methods Data from a cross-sectional study including 369 students from 10 Brazilian universities were used. Considering a theoretical nomological net, we performed exploratory factor analysis (EFA) to obtain the most parsimonious, interpretable, and good-fitting model. Results The final model was called U-SMILE, comprised 24 items, and presented acceptable internal consistency (Cronbach's α = 0.73, McDonald's ω = 0.79). To evaluate the concurrent validity of the U-SMILE, we compared it to the original SMILE and found a high correlation between the instruments (Spearman's r = 0.94). Furthermore, we evaluated convergent validity by examining the U-SMILE correlation with the Patient Health Questionnaire (PHQ-9) (Spearman's r = −0.517), and Generalized Anxiety Disorder Questionnaire (GAD-7) (Spearman's r = −0.356), two validated instruments to screen for depression and anxiety, respectively. Conclusion Our findings suggest that the U-SMILE is a valid instrument for assessing lifestyle among university students. We recommend that the use of U-SMILE to evaluate overall lifestyle scores rather than individual domain scores. Finally, we discuss the importance of clarifying the definitions of lifestyle and related constructs in future research.

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Abstract Objective One of the most popular ways to meet new people in the modern world is through dating apps. However, their use may facilitate casual sexual encounters and quick partner changes, both of which are associated with endangering sexual health in different populations. The objective of this study is to describe the use of mobile dating apps among undergraduate students at a major Brazilian public university and investigate its associations with sexual risk behaviors and sociodemographic factors. Methods This is a cross-sectional study based on a web survey. The link for participation was made available to students enrolled in undergraduate courses at the eight units of Universidade de São Paulo, Campus Ribeirão Preto. Use of dating apps, sociodemographic/behavioral profile, and sexual risk behaviors were among the variables studied. The distribution of app users was calculated for each variable of interest, and prevalence ratios (PRs) were used for comparisons. PRs were reported with 95% confidence intervals (95%CI). Results A total of 487 students participated, with 32.9% reporting using dating apps. Male participants were more likely to use apps. Use of dating apps was associated with having multiple sexual partners and risky behaviors such as smoking, alcohol consumption, and substance abuse. Conclusion It is critical to describe the pattern of app use by undergraduate students and understand its influence on sexual health in order to avoid stigmatizing users. Additionally, this information can be helpful to guide the creation of strategies for using these apps as resources to promote health, such as through sharing information regarding sexual health.