Depression among medical students in Tunisia:Prevalence and associated factors

BACKGROUND Medical school is known for its lengthy process,which is both physically and emotionally draining.Students’mental balance would shrink as they progress in their medical training.A systematic review and meta-analysis reported that the prevalence of depressive symptoms among medical students remained relatively constant at 27.2%.AIM To assess the prevalence of depressive symptoms among Tunisian medical students and evaluate its associated factors.METHODS This is a descriptive cross-sectional study that was carried out in the second semester of the academic year 2017/2018,between April 2018 and July 2018 among 1138 medical students.Data were collected using a socio-demographic questionnaire and the Beck Depression Inventory-II(BDI-II).RESULTS Sixty-four percent(n=728)of the participants had depressive symptoms,of which 266(23.4%)met the criteria for mild,271(23.8%)for moderate,and 191(16.8%)for severe depressive symptoms.Female gender,low socio-economic level,smoking habits and history of mental disorder,performing leisure and physical activities,satisfaction toward a career choice,and happiness perception were the main prognostic factors for depression among medical students.Although academic grades may not be considered a prognostic factor,final-year students appeared to be less depressive than their colleagues.CONCLUSION These findings give insight into mental health issues and comorbidities among Tunisian medical students.It is a hopeful request for decision-makers and academic authorities to set serious measures and draw effective interventions to minimize the currency of psychological distress among this subpopulation.

Clinical value of ankle flexion and extension exercises combined with a psychological intervention in knee osteoarthritis

BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients.AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living(ADLs)of patients with KOA.METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022,including 54 patients receiving routine treatment,care and psychological intervention(control group)and 62 patients additionally treated with ankle flexion and extension exercises(research group).The two groups were comparatively analyzed in terms of psychological status(Self-rating Anxiety/Depression Scale,SDS/SAS),ADLs,knee joint function(Lysholm Knee Scoring Scale),pain(Visual Analog Scale,VAS),fatigue(Multidimensional Fatigue Inventory,MFI),and quality of life(QoL;Short-Form 36 Item Health Survey,SF-36).RESULTS After evaluation,it was found that the postinterventional SDS,SAS,VAS,and MFI scores in the research group were significantly reduced compared with the baseline(before the intervention)values and those of the control group,while the postinterventional Lysholm,ADL and SF-36 scores were markedly elevated.CONCLUSION Therefore,ankle flexion and extension exercises are highly effective in easing negative psychological status,enhancing ADLs,daily living ability,knee joint function and QoL,and relieving pain and fatigue in KOA patients,thus warranting clinical promotion.

ABCB9 polymorphism rs61955196 is associated with schizophrenia in a Chinese Han population

BACKGROUND Schizophrenia(SCZ)is a complex disease which can be affected by both genetic and environmental factors.Prenatal famine exposure may cause changes in DNA methylation levels of genes.Meanwhile,maternal nutrition during pregnancy is a pivotal environmental factor in the development of SCZ.DNA methylation may be an intermediate factor mediating exposure to famine during pregnancy and SCZ,and DNA methylation quantitative trait loci might serve as a promising tool for linking SCZ and prenatal famine.AIM To analyze the association between prenatal famine exposure and SCZ risk in Northeast Han Chinese through analysis of DNA methylation related loci.METHODS A total of 954 Han Chinese from Northeast China were recruited,including 443 patients with SCZ and 511 healthy controls.The participants were further divided into famine(born in 1960-1962)and non-famine(born in 1963-1965)groups to investigate the effect of prenatal famine exposure.Four single-nucleotide polymorphisms(SNPs)selected according to the relevant literature were genotyped,namely,rs11917047 in PTPRG,rs2239681 in IGF2,rs3842756 in INSIGF,and rs61955196 in ABCB9.DNA were extracted from peripheral blood samples,and the genotypes of these SNP loci were detected using the improved Multiple Ligase Detection Reaction multiple SNP typing technique.The associations of the DNA methylation related SNPs with SCZ risk and prenatal famine,and their interactions were analyzed using logistic regression analysis and generalized multifactor dimensionality reduction(GMDR)software.RESULTS Based on the sequencing data,genotype distributions and allele frequencies of the four selected SNPs were determined.All genotype frequencies of the four SNPs in the healthy control group were tested for deviation from Hardy-Weinberg equilibrium(P>0.05).Logistic regression analysis showed that rs61955196 was significantly associated with SCZ risk in the log-additive model[odds ratio(OR):1.22;95%confidence interval(CI):1.01-1.48;P=0.040].We also found that the rs61955196 allele was related with an enhanced risk of SCZ(G>C,OR:1.22;95%CI:1.01-1.47;P=0.042).However,no associations were observed between rs11917047,rs2239681,or rs3842756 and SCZ risk.Under the optimal genetic model,no significant association of famine with the four SNPs was seen.Though the gene–gene interactions between rs2239681 and rs61955196 were found in GMDR analysis,none of the gene-gene interactions and gene-famine interactions were associated with the risk of SCZ.CONCLUSION Our study suggested that rs61955196 in ABCB9 is associated with SCZ susceptibility in Northeast Han Chinese,providing insight into genetic effects on SCZ.

Childhood maltreatment and suicide ideation: A possible mediation of social support

BACKGROUND Existing literature suggests a positive link between childhood maltreatment(CM)and suicide ideation(SI).Nevertheless,whether social support significantly mediates this association remains unknown.AIM To investigate whether social support significantly mediates the association between CM and SI.METHODS In this cross-sectional study of 4732 adolescents from southwest China,we intended to discuss the association between CM and multiple types of SI.In addition,the mediation of major types of social support in this association was also investigated.A self-administrated questionnaire was used to collect the data.A series of multivariate logistic regression models were employed to estimate the association between different types of CM,social support,and SI.The possible mediation of social support in the association between CM and SI was assessed using the path model.RESULTS Based on the cutoffs for subscales of Childhood Trauma Questionnaire,928(19.61%),1269(26.82%),595(12.57%),2337(49.39%),and 3067(64.81%)respondents reported physical abuse,emotional abuse,sexual abuse,physical neglect,and emotional neglect,respectively.Among all the social sources,parental support presented as a significant mediator in the association between emotional maltreatment,both abuse and neglect,and all three types of SI:1-wk,1-year,and lifetime.Parental social support mediated 5.31%and 29.23%,4.80%and 24.50%,and 7.04%and 44.42%of the overall emotional abuse-SI and emotional neglect-SI associations,respectively.CONCLUSION Our findings suggest that improving parental social support might be effective in preventing suicidal risk related to childhood emotional maltreatment in adolescents.

Does COVID-19 related symptomatology indicate a transdiagnostic neuropsychiatric disorder?-Multidisciplinary implications

The clinical presentation that emerges from the extensive coronavirus disease 2019(COVID-19)mental health literature suggests high correlations among many conventional psychiatric diagnoses.Arguments against the use of multiple comorbidities for a single patient have been published long before the pandemic.Concurrently,diagnostic recommendations for use of transdiagnostic considerations for improved treatment have been also published in recent years.In this review,we pose the question of whether a transdiagnostic mental health disease,including psychiatric and neuropsychiatric symptomology,has emerged since the onset of the pandemic.There are many attempts to identify a syndrome related to the pandemic,but none of the validated scales is able to capture the entire psychiatric and neuropsychiatric clinical presentation in infected and non-infected individuals.These scales also only marginally touch the issue of etiology and prevalence.We suggest a working hypothesis termed Complex Stress Reaction Syndrome(CSRS)representing a global psychiatric reaction to the pandemic situation in the general population(Type A)and a neuropsychiatric reaction in infected individuals(Type B)which relates to neurocognitive and psychiatric features which are part(excluding systemic and metabolic dysfunctions)of the syndrome termed in the literature as long COVID.We base our propositions on multidisciplinary scientific data regarding mental health during the global pandemic situation and the effects of viral infection reviewed from Google Scholar and PubMed between February 1,2022 and March 10,2022.Search inclusion criteria were“mental health”,“COVID-19”and“Long COVID”,English language and human studies only.We suggest that this more comprehensive way of understanding COVID-19 complex mental health reactions may promote better prevention and treatment and serve to guide implementation of recommended administrative regulations that were recently published by the World Psychiatric Association.This review may serve as a call for an international investigation of our working hypothesis.

Psychiatric hospitalization during the two SARS-CoV-2 pandemic waves:New warnings for acute psychotic episodes and suicidal behaviors

BACKGROUND The subsequent waves of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)pandemic have represented a dramatic health emergency characterized by significant consequences on mental health.Diachronic variations in the incidence rates of acute relapse of psychiatric disorders may represent significant"sentinel events"for assessing the mental health response to an unprecedented stressful event.AIM To investigate the variation in psychiatric hospitalization rates and differences in sociodemographic and clinical-psychopathological peculiarities at Bologna"Maggiore"General Hospital Psychiatric Ward(GHPW)between the first two waves SARS-CoV-2 pandemic and the same periods of the previous 3 years.The secondary purpose of the study was to suggest a diachronic response pathway to stress by reporting additional literature data on coping strategies.METHODS This observational and retrospective study collected information on admission to the GHPW at the"Maggiore"Hospital in Bologna in the index periods defined as follows:the first period between February 24,2020 and April 30,2020(first epidemic wave)and the second period between October 8,2020,and January 7,2021(second pandemic wave).Absolute numbers and proportion of admitted patients,their sociodemographic and clinical-psychopathological characteristics were compared with the same parameters recorded in the two same periods of the previous 3 years.No strict inclusion or exclusion criteria were provided in the data collection to collect information on all patients requiring acute psychiatric hospitalization.RESULTS During the first wave,there was a significant reduction in hospitalization rates,although there was a simultaneous increase in compulsory hospitalizations and the acute relapse of schizophrenia spectrum and other psychotic disorders.During the second wave,hospitalization rates reached those recorded during the same period of the previous 3 years,mainly due to the rise of bipolar and related disorders,depressive disorders,anxiety disorders,trauma-and stressor-related disorders and suicidal behaviors.CONCLUSION The coping strategies adopted during the first wave of the SARS-CoV-2 pandemic protected the vulnerable population from the general risk of clinical-psychopathological acute relapse,even if they increased the susceptibility to run into schizophrenia spectrum and other psychotic disorder relapses.In the medium-long term(as in the second pandemic wave),the same strategies do not play protective roles against the stress associated with the pandemic and social restriction measures.Indeed,during the second wave of the SARS-CoV-2 pandemic,an increase in total hospitalization rate,suicidal behaviors and the incidence rate of bipolar and related disorders,depressive disorders,anxiety disorders,trauma-and stressorrelated disorders was observed.

Abnormalities of electroencephalography microstates in patients with depression and their association with cognitive function

BACKGROUND A growing number of recent studies have explored underlying activity in the brain by measuring electroencephalography(EEG)in people with depression.However,the consistency of findings on EEG microstates in patients with depression is poor,and few studies have reported the relationship between EEG microstates,cognitive scales,and depression severity scales.AIM To investigate the EEG microstate characteristics of patients with depression and their association with cognitive functions.METHODS A total of 24 patients diagnosed with depression and 32 healthy controls were included in this study using the Structured Clinical Interview for Disease for The Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition.We collected information relating to demographic and clinical characteristics,as well as data from the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS;Chinese version)and EEG.RESULTS Compared with the controls,the duration,occurrence,and contribution of microstate C were significantly higher[depression(DEP):Duration 84.58±24.35,occurrence 3.72±0.56,contribution 30.39±8.59;CON:Duration 72.77±10.23,occurrence 3.41±0.36,contribution 24.46±4.66;Duration F=6.02,P=0.049;Occurrence F=6.19,P=0.049;Contribution F=10.82,P=0.011]while the duration,occurrence,and contribution of microstate D were significantly lower(DEP:Duration 70.00±15.92,occurrence 3.18±0.71,contribution 22.48±8.12;CON:Duration 85.46±10.23,occurrence 3.54±0.41,contribution 28.25±5.85;Duration F=19.18,P<0.001;Occurrence F=5.79,P=0.050;Contribution F=9.41,P=0.013)in patients with depression.A positive correlation was observed between the visuospatial/constructional scores of the RBANS scale and the transition probability of microstate class C to B(r=0.405,P=0.049).CONCLUSION EEG microstate,especially C and D,is a possible biomarker in depression.Patients with depression had a more frequent transition from microstate C to B,which may relate to more negative rumination and visual processing.

Effect of emotion management and nursing on patients with painless induced abortion after operation

BACKGROUND With an estimated 121 million abortions following unwanted pregnancies occurring worldwide each year,many countries are now committed to protecting women’s reproductive rights.AIM To analyze the impact of emotional management and care on anxiety and contraceptive knowledge mastery in painless induced abortion(IA)patients.METHODS This study was retrospective analysis of 84 patients with IA at our hospital.According to different nursing methods,the patients were divided into a control group and an observation group,with 42 cases in each group.Degree of pain,rate of postoperative uterine relaxation,surgical bleeding volume,and postoperative bleeding volume at 1 h between the two groups of patients;nursing satisfaction;and mastery of contraceptive knowledge were analyzed.RESULTS After nursing,Self-Assessment Scale,Depression Self-Assessment Scale,and Hamilton Anxiety Scale scores were 39.18±2.18,30.27±2.64,6.69±2.15,respectively,vs 45.63±2.66,38.61±2.17,13.45±2.12,respectively,with the observation group being lower than the control group(P<0.05).Comparing visual analog scales,the observation group was lower than the control group(4.55±0.22 vs 3.23±0.41;P<0.05).The relaxation rate of the cervix after nursing,surgical bleeding volume,and 1-h postoperative bleeding volumes were 25(59.5),31.72±2.23,and 22.41±1.23,respectively,vs 36(85.7),42.39±3.53,28.51±3.34,respec tively,for the observation group compared to the control group.The observation group had a better nursing situation(P<0.05),and higher nursing satisfaction and contraceptive knowledge mastery scores compared to the control group(P<0.05).CONCLUSION The application of emotional management in postoperative care of IA has an ideal effect.

Correlation of preoperative inflammatory factors and emotional disorders with postoperative delirium in patients with craniocerebral trauma

BACKGROUND Traumatic brain injury(TBI)imposes a substantial societal and familial burden due to its high disability and fatality rates,rendering it a serious public health problem.Some patients with TBI have poor treatment outcomes and are prone to postoperative delirium(POD),which affects their quality of life.Anxiety has been linked to increased POD incidence in some studies,while others have found no correlation.AIM To investigate the correlation of POD risk factors,preoperative inflammatory factors,and mood disorders in patients with TBI.METHODS We retrospectively collected data on the treatment of 80 patients with TBI from November 2021 to September 2023.Patients were grouped as POD and non-POD,according to their POD status,and the general data of the two groups were compared.Inflammatory factor levels were detected preoperatively,and the Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were used to investigate the risk factors associated with POD in these patients.Logistic regression was used to identify the independent risk factors.RESULTS Twenty-one patients(26.25%)developed POD,including 7,10,and 4 cases of the excitatory,inhibitory,and mixed types,respectively.There were 59 cases(73.75%)in the non-POD group.Compared with the non-POD group,the POD group had a significantly higher proportion of patients with low Glasgow Coma Scale(GCS)scores before admission,unilateral mydriasis,preoperative hemorrhagic shock,intraventricular hemorrhage(IVH),and postoperative hyperglycemic hyperosmolar disease(P<0.05).In the POD group,interleukin-6(IL-6),human tumor necrosis factor-α(TNF-α),myeloperoxidase levels,HAMA,and HAMD scores were higher than those in the non-POD group(all P<0.05).Logistic multivariate analysis showed that GCS score at admission,IVH,IL-6,TNF-α,HAMA,and HAMD were independent risk factors for POD in patients with TBI(P<0.05).CONCLUSION Low GCS score at admission,IVH,elevated IL-6 and TNF-α,other inflammatory indicators,anxiety,and depression,can increase the risk of POD in patients with TBI after surgery.

Correlation between cognitive impairment and metabolic imbalance of gut microbiota in patients with schizophrenia

BACKGROUND The gut microbiome interacts with the central nervous system through the gutbrain axis,and this interaction involves neuronal,endocrine,and immune mechanisms,among others,which allow the microbiota to influence and respond to a variety of behavioral and mental conditions.AIM To explore the correlation between cognitive impairment and gut microbiota imbalance in patients with schizophrenia.METHODS A total of 498 untreated patients with schizophrenia admitted to our hospital from July 2020 to July 2022 were selected as the case group,while 498 healthy volunteers who underwent physical examinations at our hospital during the same period were selected as a control group.Fluorescence in situ hybridization was employed to determine the total number of bacteria in the feces of the two groups.The cognitive function test package was used to assess the score of cognitive function in each dimension.Then,the relationship between gut microbiota and cognitive function was analyzed.RESULTS There were statistically significant differences in the relative abundance of gut microbiota at both phylum and class levels between the case group and the control group.In addition,the scores of cognitive function,such as attention/alertness and learning ability,were significantly lower in the case group than in the control group(all P<0.05).The cognitive function was positively correlated with Actinomycetota,Bacteroidota,Euryarchaeota,Fusobacteria,Pseudomonadota,and Saccharibacteria,while negatively correlated with Bacillota,Tenericutes,and Verrucomicrobia at the phylum level.While at the class level,the cognitive function was positively correlated with Class Actinobacteria,Bacteroidia,Betaproteobacteria,Proteobacteria,Blastomycetes,and Gammaproteobacteria,while negatively correlated with Bacilli,Clostridia,Coriobacteriia,and Verrucomicrobiae.CONCLUSION There is a relationship between the metabolic results of gut microbiota and cognitive function in patients with schizophrenia.When imbalances occur in the gut microbiota of patients,it leads to more severe cognitive impairment.

Hypomanic/manic switch after transcranial magnetic stimulation in mood disorders:A systematic review and meta-analysis

BACKGROUND Nowadays there is an increasing use of transcranial magnetic stimulation(TMS)both in neurological and psychiatric fields.After Food and Drug Administration approval of TMS for the therapy of treatment-resistant depression,TMS has been widely used in the context of mood disorders(MD).However,growing reports regarding the possibility of developing hypomanic/manic switch(HMS)have generated concern regarding its use in MDs.AIM To investigate the actual risk of developing HMS due to TMS in the treatment of MD.METHODS We led our research on PubMed,Scopus and Web of Science on March 22,2020,in accordance to the PRISMA guidelines for systematic review.Only double blind/single blind studies,written in English and focused on the TMS treatment of MD,were included.A meta-analysis of repetitive TMS protocol studies including HMS was conducted using RevMan 5.4 software.The assessment of Risk of Bias was done using Cochrane risk of bias tool.This protocol was registered on PROSPERO with the CRD42020175811 code.RESULTS Twenty-five studies were included in our meta-analysis:Twenty-one double blind randomized controlled trials(RCT)and four single blind-RCT(no.of subjects involved in active stimulation=576;no.of subjects involved in sham protocol=487).The most frequently treated pathology was major depressive episode/major depressive disorder,followed by resistant depression,bipolar depression and other MD.The majority of the studies used a repetitive TMS protocol,and the left dorsolateral prefrontal cortex was the main target area.Side effects were reported in eight studies and HMS(described as greater energy,insomnia,irritability,anxiety,suicidal attempt)in four studies.When comparing active TMS vs sham treatment,the risk of developing HMS was not significantly different between conditions.CONCLUSION Applying the most usual protocols and the appropriate precautionary measures,TMS seems not to be related to HMS development.

Uncertainty following an inconclusive result from the BRCA1/2 genetic test:A review about psychological outcomes

BACKGROUND An inconclusive result from BRCA1/2 genetic testing indicates that a genetic variant of uncertain significance is detected.This case constitutes the majority of genetic test results,but studies specifically addressing the psychological adjustment of people with inconclusive results are scarce.AIM To examine psychological outcomes of receiving an uninformative BRCA1/2 test result.METHODS PubMed,PsychInfo,and Cochrane Central Register of Controlled Trials were screened for studies focusing on distress,anxiety,and depression levels in individuals with inconclusive genetic test results.This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.RESULTS Studies on psychological outcomes of inconclusive BRCA1/2 focused on general and specific distress,anxiety,and depression.Overall,they produced mixed results.These inconsistent findings are probably due to the uncertainty caused by this type of result,that may also influence the decisions of individuals about surveillance and prophylactic options,reducing their compliance.In addition,this review highlights specific risk and protective factors that affect psychological adjustment in individuals with an inconclusive genetic testing result.CONCLUSION Individuals with inconclusive genetic test results need specific educational programs and support to better understand the meaning of their results in order to be able to make decisions about surveillance and prophylactic options.

Biomarkers in schizophrenia:A focus on blood based diagnostics and theranostics

Identifying biomarkers that can be used as diagnostics or predictors of treatment response(theranostics) in people with schizophrenia(Sz) will be an important step towards being able to provide personalized treatment. Findings from the studies in brain tissue have not yet been translated into biomarkers that are practical in clinical use because brain biopsies are not acceptable and neuroimaging techniques are expensive and the results are inconclusive. Thus, in recent years, there has been search for blood-based biomarkers for Sz as a valid alternative. Although there are some encouraging preliminary data to support the notion of peripheral biomarkers for Sz, it must be acknowledged that Sz is a complex and heterogeneous disorder which needs to be further dissected into subtype using biological based and clinical markers. The scope of this review is to critically examine published blood-based biomarker of Sz, focusing on possible uses for diagnosis, treatment response, or their relationship with schizophreniaassociated phenotype. We sorted the studies into six categories which include:(1) brain-derived neurotrophic factor;(2) inflammation and immune function;(3) neurochemistry;(4) oxidative stress response and metabolism;(5) epigenetics and micro RNA; and(6) transcriptome and proteome studies. This review also summarized the molecules which have been conclusively reported as potential blood-based biomarkers for Sz in different blood cell types. Finally, we further discusses the pitfall of current blood-based studies and suggest that a prediction model-based, Sz specific, bloodoriented study design as well as standardize blood collection conditions would be useful for Sz biomarker development.

First 150 years of catatonia:Looking back at its complicated history and forward to the road ahead

Karl Ludwig Kahlbaum(1828-1899)was the first to conceptualize and describe the main clinical features of a novel psychiatric illness,which he termed catatonia in his groundbreaking monograph published 150 years ago.Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course,a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions.In his classification system,Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox(schizophrenia)disease entity.Because of the substantial influence of Kraepelin’s classification,catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century.However,with the advent of the psychopharmacotherapy era starting from the early 1950s,interest in catatonia in both clinical practice and research subsided until the early 2000s.The past two decades have witnessed a resurgence of interest in catatonia.The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition,marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions.The introduction of an independent diagnostic category termed“Catatonia Not Otherwise Specified”significantly stimulated research in this field.The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.

Research progress on the mechanism of exercise against depression

The substantial global health burden of depression encourages the development of innovative and broadly effective interventions.This paper aimed to examine recent advancements by which exercise works as an antidepressant and recommends optimal types and quantity of exercise as supplemental therapies in treating depression.Sedentary behavior and low physical activity significantly influence the onset of depression.Being an effective treatment option,exercise can significantly reduce depression risk.Exercise exerts antidepressant effects as it modulates neurotransmitters,neuroplasticity,the immune system,and hormone levels.Effective exercise forms include yoga,strength training,and walking/jogging.Tailored exercise regimens that consider individual preferences and tolerability can improve outcomes.Regular exercise enhances general well-being and reduces depressive symptoms.Additional research is needed to understand the complex basis of exercise's effects on depression.Exercise is a cost-effective and accessible intervention for depression management that needs additional exploration.Thus,customized exercise programs,as per each patient’s needs,are essential for their successful implementation clinically.

Clinical, scientific and stakeholders’ caring about identity perturbations

In this editorial we comment on the article by Zhang et al published in the recent issue of the World Journal of Psychiatry.We focus on identity diffusion,identity perturbations,their origin and developmental pathways.This is an upcoming problem in the society as not only school children are affected.Adolescents and young people suffer from uncertainty in gender identity,in self-image,migration effects due to chronic crises caused by war,pandemic disruptions or climate change.We show how such chronic uncertainty can be cared for,treated,and contained.The key is affective holding,reflection and to provide adequate affective mentalizing in a close concomitant way.These key features also depend on ambient conditions,such as psychotherapeutic care.In a qualitative interview study carried out in a cyclical research design with a comparative analysis on the basis of thematic coding using Grounded Theory Methodology we found institu-tionalized defenses in health policies.Professionals request better training and adequat academic knowledge as well as research into unresolved areas for improvement of the ambient conditions for adequat development of the self.Practice points for further clinical and scientific development are given and discussed.

Investigation of contemporary college students’mental health status and construction of a risk prediction model

BACKGROUND Due to academic pressure,social relations,and the change of adapting to independent life,college students are under high levels of pressure.Therefore,it is very important to study the mental health problems of college students.Developing a predictive model that can detect early warning signals of college students’mental health risks can help support early intervention and improve overall well-being.AIM To investigate college students’present psychological well-being,identify the contributing factors to its decline,and construct a predictive nomogram model.METHODS We analyzed the psychological health status of 40874 university students in selected universities in Hubei Province,China from March 1 to 15,2022,using online questionnaires and random sampling.Factors influencing their mental health were also analyzed using the logistic regression approach,and R4.2.3 software was employed to develop a nomogram model for risk prediction.RESULTS We randomly selected 918 valid data and found that 11.3%of college students had psychological problems.The results of the general data survey showed that the mental health problems of doctoral students were more prominent than those of junior college students,and the mental health of students from rural areas was more likely to be abnormal than that of urban students.In addition,students who had experienced significant life events and divorced parents were more likely to have an abnormal status.The abnormal group exhibited significantly higher Patient Health Questionnaire-9(PHQ-9)and Generalized Anxiety Disorder-7 scores than the healthy group,with these differences being statistically significant(P<0.05).The nomogram prediction model drawn by multivariate analysis includ-ed six predictors:The place of origin,whether they were single children,whether there were significant life events,parents’marital status,regular exercise,intimate friends,and the PHQ-9 score.The training set demonstrated an area under the receiver operating characteristic(ROC)curve(AUC)of 0.972[95%confidence interval(CI):0.947-0.997],a specificity of 0.888 and a sensitivity of 0.972.Similarly,the validation set had a ROC AUC of 0.979(95%CI:0.955-1.000),with a specificity of 0.942 and a sensitivity of 0.939.The H-L deviation test result was χ^(2)=32.476,P=0.000007,suggesting that the model calibration was good.CONCLUSION In this study,nearly 11.3%of contemporary college students had psychological problems,the risk factors include students from rural areas,divorced parents,non-single children,infrequent exercise,and significant life events.

New-onset depression after hip fracture surgery among older patients:Effects on associated clinical outcomes and what can we do?

BACKGROUND Hip fracture in the elderly is a worldwide medical problem.New-onset depression after hip fracture has also received attention because of its increasing incidence and negative impact on recovery.AIM To provide a synthesis of the literature addressing two very important questions arising from postoperative hip fracture depression(PHFD)research:the risk factors and associated clinical outcomes of PHFD,and the optimal options for intervention in PHFD.METHODS We searched the PubMed,Web of Science,EMBASE,and PsycINFO databases for English papers published from 2000 to 2021.RESULTS Our results showed that PHFD may result in poor clinical outcomes,such as poor physical function and more medical support.In addition,the risk factors for PHFD were summarized,which made it possible to assess patients preoperatively.Moreover,our work preliminarily suggested that comprehensive care may be the optimal treatment option for PHFDs,while interdisciplinary intervention can also be clinically useful.CONCLUSION We suggest that clinicians should assess risk factors for PHFDs preoperatively,and future research should further validate current treatment methods in more countries and regions and explore more advanced solutions.

Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease:A metaanalysis

BACKGROUND Recently,the efficacy of cognitive behavioral therapy(CBT)-based intervention on health outcomes in patients with coronary heart disease(CHD)has been recognized in randomized controlled trials(RCTs),but no comprehensive systematic review has been conducted.To address this research gap,our study aimed to evaluate whether comprehensive CBT-based interventions positively affect health outcomes in CHD patients.It was hypothesized that CBT-based interventions are effective in:(1)Reducing depression,anxiety,and stress symptoms;(2)Reducing body mass index,blood pressure,and lipid levels;and(3)Improving quality of life,and exercise endurance.AIM To verify the effectiveness of CBT-based interventions on CHD patients through a meta-analysis of previous publications.METHODS Relevant RCTs published in English were obtained by searching electronic databases,including PubMed,Embase,Cochrane Central Register of Controlled Trials,Scopus,and Proquest,with the retrieval time from inception to August 2020.The primary outcomes were psychological factors(depression,anxiety,and stress symptoms),physiological factors(body mass index,blood pressure,blood lipids).The secondary outcomes included quality of life and exercise endurance.We used Review Manager 5.3 to conduct the meta-analysis and used the Physiotherapy Evidence Database tool to evaluate the quality of studies.RESULTS A total of 22 RCTs comprising 4991 patients with CHD were included in the systematic review and meta-analysis.The main analysis revealed that CBT-based intervention can reduce depression symptoms:-2.00[95%confidence interval(CI):-2.83 to-1.16,P<0.001];anxiety symptoms:-2.07(95%CI:-3.39 to-0.75,P=0.002);stress symptoms:-3.33(95%CI:-4.23 to-2.44,P<0.001);body mass index:-0.47(95%CI:-0.81 to-0.13,P=0.006);and improve physical functioning:3.36(95%CI:1.63 to 5.10,P=0.000)and mental functioning:6.91(95%CI:4.10 to 9.73,P<0.001).Moreover,subgroup analysis results showed that CBT-based interventions were more effective for symptoms of depression and anxiety in CHD patients when individual,as opposed to group treatment,and psycho-education,behavioral and cognitive strategies were applied as the core treatment approaches.CONCLUSION CBT-based interventions are effective treatment strategies for CHD patients,significantly improving their symptoms of depression,anxiety and stress,body mass index,and health-related quality of life.

Self-reported and behavioural impulsivity in anorexia nervosa

AIM To examine how self-reported and behavioural impulsivity are related in anorexia nervosa(AN).METHODS Twenty-four females with AN and 25 healthy controls(HC) participant in the study.Self-reported impulsivity was assessed with the Barratt Impulsiveness Scale(BIS-11).The scale yields three second-order factors:Attentional,motor and non-planning.Behavioural impulsivity was investigated with the continuous performance test(CPT),a computer-based task of sustained attention in which numbers are flashed briefly on screen and participants are required to click the mouse when the same number appears consecutively.The rate of commission and omission errors can be used a measure of behavioural imulsivity.RESULTS AN participants self-reported increased attentional [AN:20.67(3.64),HC:13.88(2.91),P = 0.001] and reduced motor impulsivity [AN:11.55(2.28),HC:14.08(2.78),P = 0.002].The rate of omission or commission errors on the CPT did not differ between groups(P > 0.05).BIS-11 and CPT measures did not significantly correlate,but attentional impulsivity was related to negative mood states in AN(depression:r = 0.52,P = 0.010,anxiety:r = 0.55,P = 0.006,stress:r = 0.57,P = 0.004).CONCLUSION The discrepancy between self-reported and behavioural impulsivity are discussed in terms of perfectionism in AN.Furthermore,it is suggested that improving negative mood states may resolve this inconsistency in AN.