Psychiatria Danubina[JOURNAL]
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200 papers
THE INNER TYRANT AND THE LABYRINTH OF CONTROL: MEANING-MAKING AND IDENTITY CONSTRUCTION IN OBSESSIVE FUNCTIONING.
d'Errico I
Psychiatr Danub · 2025 Sep · PMID 40982823
In this paper I will bring some reflections from a post-rationalist constructivist phenomenological perspective on the Obsessive-Compulsive-Prone Style of Personality (tOCD), a style that can typically lead to an Obsessi...
In this paper I will bring some reflections from a post-rationalist constructivist phenomenological perspective on the Obsessive-Compulsive-Prone Style of Personality (tOCD), a style that can typically lead to an Obsessive-Compulsive Disorder (OCD), but not exclusively so.
LESSONS TO BE LEARNT FROM THE UNFORTUNATE CASE OF THE DEATH OF MOLLY RUSSELL.
Agius M, Agius M
Psychiatr Danub · 2025 Sep · PMID 40982822
In this article we describe the case of Molly Russell, whose suicide was caused by the on line content that she accessed while she was suffering from depression. We describe how this was brought about by the algorithms u...
In this article we describe the case of Molly Russell, whose suicide was caused by the on line content that she accessed while she was suffering from depression. We describe how this was brought about by the algorithms used in social media sites and the use of the internet to inappropriately call for help in depression instead of turning to human persons for help. We describe the legal measures taken to improve safety for young persons using the internet, and we advise the importance of educating young persons on proper use of the internet and proper understanding of its potential.
FOUR APPROACHES TO THE UNCONSCIOUS.
Bon OL
Psychiatr Danub · 2025 Sep · PMID 40982821
BACKGROUND: The concept of the unconscious has evolved across disciplines, originating in philosophy, hypnosis, and psychoanalysis, and later redefined through modern neuroscience and cognitive science. Whereas early mod...
BACKGROUND: The concept of the unconscious has evolved across disciplines, originating in philosophy, hypnosis, and psychoanalysis, and later redefined through modern neuroscience and cognitive science. Whereas early models primarily regarded it as a repository of repressed content, contemporary perspectives emphasize its adaptive, dynamic, multi-layered, and often non-pathological functions. SUBJECTS AND METHODS: This article provides a conceptual review of four major frameworks - psychoanalysis, Ericksonian hypnosis, cognitive sciences, and neuroscience. Through comparative analysis, it examines how each tradition conceptualizes unconscious processes and their relationship with conscious awareness. RESULTS: Despite divergent epistemologies, these approaches converge on several points: unconscious processes are real, influential, and often operate independently of conscious control. Each discipline contributes unique mechanisms - symbolic repression (psychoanalysis), therapeutic suggestion (hypnosis), automatic heuristics (cognitive science), and subcortical emotional circuits (neuroscience). Integration across these models reveals a layered topology of mind, encompassing dynamic, pre-reflective, and subliminal forms of unconscious activity. CONCLUSIONS: A comprehensive understanding of the unconscious requires interdisciplinary synthesis. Such integration offers not only theoretical coherence but also practical value in clinical settings, where unconscious processes manifest as symptoms, biases, or somatic expressions. The unconscious is no longer merely a hidden domain - it is central to mental functioning and human experience.
THE CLINICAL NOTION OF RESTLESSNESS AS A LINCHPIN FOR A FULL UNDERSTANDING OF THE BIPOLAR SPECTRUM.
Tavormina G, Franza F
Psychiatr Danub · 2025 Sep · PMID 40982820
Restlessness is the essence of the thymic disease of those who present a "mixed picture" in the bipolar spectrum of any form. Depressive suffering, always significant for the patient, never presents itself alone, but is...
Restlessness is the essence of the thymic disease of those who present a "mixed picture" in the bipolar spectrum of any form. Depressive suffering, always significant for the patient, never presents itself alone, but is always accompanied by a constant state of internal anxiety, restlessness with internal and muscular tension, depressive-irritable or depressive-apathetic-confused state, a sense of existential anguish that sometimes gives no hint of future prospects, and very frequent somatic symptoms associated with mood malaise. All this is summarized in the concept of "Restlessness".
A CHARTER "STIGMA IN THE MEDIA" FOR JOURNALISTS, AS A DECLARATION OF INTENT FOR RESPONSIBLE REPORTING ON MENTAL HEALTHCARE.
Catthoor K, Bouckaert F, Hert M … +2 more , Tecco J, Thys E
Psychiatr Danub · 2025 Sep · PMID 40982819
Stigma and discrimination against people with mental health problems remain prevalent, despite increasing global efforts to combat them. Organizations like the Lancet Commission and the WHO emphasize the media's crucial...
Stigma and discrimination against people with mental health problems remain prevalent, despite increasing global efforts to combat them. Organizations like the Lancet Commission and the WHO emphasize the media's crucial role in shaping public perception, advocating for responsible reporting and the involvement of individuals with lived experience. While some positive shifts in media portrayal have been observed (e.g., in prime-time TV series), negative representations, dehumanizing language, and the perpetuation of stereotypes persist across various media forms, including gaming and news. In Belgium, a specific incident involving stigmatizing media coverage led to the development of the "Stigma in the Media" charter. This charter provides guidelines for journalists. It stresses the importance of accurate information, appropriate terminology, respect for privacy and human dignity, and avoiding sensationalism. The charter aims to foster an empathetic and respectful media environment, promoting responsible discussions about mental health and encouraging positive societal change. Initial results suggest the charter is positively impacting media reporting on mental health in Belgium.
BEYOND POST-TRAUMATIC STRESS DISORDER (PTSD): STATE OF THE ART ON PSYCHOLOGICAL DISORDERS IN WHICH EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR) CURRENTLY SHOWS CLINICAL EFFICACY.
Lepri A
Psychiatr Danub · 2025 Sep · PMID 40982818
Eye Movement Desensitization and Reprocessing (EMDR) was originally developed as a treatment for post-traumatic stress disorder (PTSD), but its applications have expanded significantly in recent years. This narrative rev...
Eye Movement Desensitization and Reprocessing (EMDR) was originally developed as a treatment for post-traumatic stress disorder (PTSD), but its applications have expanded significantly in recent years. This narrative review explores the current state of evidence for EMDR's clinical efficacy across a spectrum of psychological disorders beyond PTSD. We examine findings from randomized controlled trials, systematic reviews, and meta-analyses - including the comprehensive systematic review by Scelles and Bulnes (2021) - that assess EMDR's impact on anxiety disorders, depression, obsessive-compulsive disorder (OCD), somatic symptom disorders, pain, addiction, and personality disorders. While the mechanism of action remains debated, empirical evidence suggests EMDR can yield outcomes comparable to or superior to established psychotherapies in certain contexts. A critical discussion is offered regarding the methodological limitations in existing studies and the importance of integrating EMDR within broader evidence-based treatment frameworks.
PROMOTING ADOLESCENT MENTAL HEALTH THROUGH SCHOOL-BASED LITERACY INITIATIVES: BEYOND THE STIGMA.
Litta A, Vacca A, Mino MV … +2 more , Franza F, Pastore F
Psychiatr Danub · 2025 Sep · PMID 40982817
BACKGROUND: Adolescent mental health has become an increasingly urgent concern, particularly in the aftermath of the COVID-19 pandemic. Mental Health Literacy (MHL) is emerging as a critical construct to promote psycholo...
BACKGROUND: Adolescent mental health has become an increasingly urgent concern, particularly in the aftermath of the COVID-19 pandemic. Mental Health Literacy (MHL) is emerging as a critical construct to promote psychological well-being, reduce stigma, and encourage the early recognition of psychological distress. METHODS: This study presents baseline data from a school-based pilot initiative conducted in a secondary school in Southern Italy. The aim was to assess students' knowledge beliefs, and attitudes toward mental health prior to implementing targeted educational interventions. A total of 85 fifth-year students (mean age = 17.7 years) completed the Italian version of the Mental Health Literacy Questionnaire - short form (MHLq-short), administered anonymously via an online platform. Statistical analyses included descriptive measures and non-parametric tests to explore the association between MHL scores and familiarity with mental health problems. RESULTS: Students who reported knowing someone with mental health issues exhibited a trend toward higher mental health literacy scores. In contrast, those who reported no such exposure or expressed uncertainty demonstrated lower average ranks, possibly reflecting limited awareness or emotional disengagement. CONCLUSIONS: These findings highlight the potential role of personal experience in shaping mental health literacy and reinforce the need for structured, school-based interventions. To our knowledge, this study represents the first application of the MHLq-short in Italy and supports its feasibility in identifying literacy gaps among adolescents. Future initiatives could aim to replicate and scale this model across diverse educational settings and inform national strategies to integrate MHL into school curricula.
WHY IS IT IMPORTANT TO STAGE CASES OF SCHIZOPHRENIA?
Agius M, Agius M, Grech A
Psychiatr Danub · 2025 Sep · PMID 40982816
In this article, we describe why we consider it important to stage cases of schizophrenia. Treatment in the three stages of Schizophrenia, that is: the At risk Mental State; the first episode and three year critical peri...
In this article, we describe why we consider it important to stage cases of schizophrenia. Treatment in the three stages of Schizophrenia, that is: the At risk Mental State; the first episode and three year critical period; and the phase of Chronic Schizophrenia is different. We also describe how MRI studies provide the view of anatomical changes which underpin the stages.
THE IMPACT OF SEX HORMONE LEVELS ON COGNITIVE FUNCTIONING IN WOMEN WITH SCHIZOPHRENIA - SCOPING REVIEW.
Krysta K, Tredzbor B, Martyniak E … +5 more , Kozmin-Burzynska A, Piekarska-Bugiel K, Wojnar R, Bies R, Krzystanek M
Psychiatr Danub · 2025 Sep · PMID 40982815
BACKGROUND: Cognitive impairment is a core and disabling feature of schizophrenia, with a profound impact on functional outcomes. Female patients often demonstrate better cognitive profiles than males, suggesting a poten...
BACKGROUND: Cognitive impairment is a core and disabling feature of schizophrenia, with a profound impact on functional outcomes. Female patients often demonstrate better cognitive profiles than males, suggesting a potential modulatory role of sex hormones. Estrogens, particularly estradiol, have been hypothesized to exert neuroprotective effects via modulation of neurotrophic, neurotransmitter, and inflammatory pathways. However, evidence regarding the relationship between sex hormone levels and cognition in schizophrenia remains scattered and inconclusive. METHODS: This scoping review synthesized evidence from clinical and preclinical studies examining the association between endogenous estrogen levels or estrogen-based treatments and cognitive functioning in women with schizophrenia. We included peer-reviewed literature addressing hormonal fluctuations across the menstrual cycle, menopause, and in response to antipsychotic treatment, with specific focus on estradiol and selective estrogen receptor modulators. RESULTS: Findings suggest that low estrogen levels may be linked to more severe negative symptoms and poorer cognitive performance in female patients. Studies investigating menstrual cycle phases report mixed results, while evidence from animal models indicates potential cognitive benefits of estrogenic compounds. Raloxifene has shown promise in mitigating cognitive deficits when administered during sensitive developmental periods. However, large-scale hormonal interventions in postmenopausal women have produced inconsistent results, likely due to differences in timing, dosage, and individual neurobiological context. CONCLUSIONS: Sex hormone levels, especially estradiol, appear to influence cognitive outcomes in women with schizophrenia, though findings are heterogeneous. Future research should address methodological inconsistencies and explore phase-specific, personalized hormonal strategies. A deeper understanding of hormonal-cognitive interactions may inform more effective, sex-sensitive treatment approaches in schizophrenia.
A DESCRIPTION OF ADDISON'S DISEASE, AND ITS NEUROPSYCHIATRIC MANIFESTATIONS COMPARING THE DISEASE AS IT IS NOW TO THE DISEASE AS EXPERIENCED BY SAINT ELIZABETH OF THE TRINITY IN 1906.
Agius M, Agius M
Psychiatr Danub · 2025 Sep · PMID 40982814
We describe Addison's disease, which is the disease caused by Adrenal Gland Insufficiency. Addison's disease is an uncommon endocrine disorder characterised by inadequate production of hormones, predominantly aldosterone...
We describe Addison's disease, which is the disease caused by Adrenal Gland Insufficiency. Addison's disease is an uncommon endocrine disorder characterised by inadequate production of hormones, predominantly aldosterone and cortisol, by the adrenal glands. This condition occurs due to damage to the adrenal cortex, the region responsible for hormone synthesis. Clinical manifestations of Addison's disease are often insidious and nonspecific, including symptoms such as myasthenia, persistent fatigue, unintentional weight loss, hypotension, and hyperpigmentation of the skin, especially in areas subjected to friction. A number of Neuropsychiatric manifestation, including Depression, and Psychosis can also occur. The aetiology is primarily autoimmune adrenalitis, where the immune system erroneously attacks and destroys adrenal cortical cells. Other aetiologies include infectious agents like Mycobacterium tuberculosis, which can infiltrate and impair the adrenal glands. Hemorrhagic damage to the adrenal cortex can occur secondary to severe stress, trauma, or coagulopathies. Additionally, metastatic neoplasms may involve the adrenal glands, leading to their destruction. Less frequently, genetic disorders such as adrenoleukodystrophy can compromise adrenal function by affecting both the cerebral white matter and adrenal cortex. Adrenal cortex damage can also result from adrenalectomy or the administration of medications that inhibit steroidogenesis. The pathophysiology of Addison's disease involves the disruption of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in cortisol deficiency, which is critical for regulating metabolism, immune function, and stress responses. Aldosterone deficiency leads to dysregulation of sodium and potassium homeostasis, causing hypotension and dehydration. Management of Addison's disease requires lifelong glucocorticoid and mineralocorticoid replacement therapy, typically with hydrocortisone or fludrocortisone, along with ongoing monitoring and dosage adjustments during periods of stress, illness, or surgical interventions. While describing Addison's Disease we describe the illness as experienced by Elizabeth of the Trinity, a Catholic Nun who suffered the illness in the early part of the Twentieth Century, whose illness is described from her letters and eyewitness accounts, taken for her beatification and canonisation findings. We describe how the illness it was viewed then, when it was seen as incurable, with great deficiencies in both diagnosis and treatment, and how the aetiology has changed over the years. Hence we show how the suffering endured by this person had both mental and physical aspects.
NEURODEVELOPMENTAL DISORDERS AND EATING DISORDERS: NEUROBIOLOGICAL CONNECTION.
Juli G, Juli R, Juli A … +1 more , Juli L
Psychiatr Danub · 2025 Sep · PMID 40982813
In the recent years, the co-occurrence of Neurodevelopmental disorders (NDDs) with Eating disorders (EDs) has gained increasing recognition, through multiple cross-sectional and longitudinal studies that demonstrated a s...
In the recent years, the co-occurrence of Neurodevelopmental disorders (NDDs) with Eating disorders (EDs) has gained increasing recognition, through multiple cross-sectional and longitudinal studies that demonstrated a significant overlap between these two conditions. This review aims to explore the neurobiological connections, the comorbidity and the shared pathways that relate these disorders, summarizing current findings.
POSSIBLE PREVENTION OF NEURODEVELOPMENTAL CONSEQUENCES OF VERTICAL HIV TRANSMISSION IN EARLY CHILDHOOD? A SYSTEMATIC REVIEW.
Muhigana J, Gasasira RA, Nicolis H
Psychiatr Danub · 2025 Sep · PMID 40982812
BACKGROUND: Children infected with the Human Immunodeficiency Virus (HIV) exhibit the lowest neurodevelopmental scores. Mother-to-child-transmission prevention include perinatally and early antiretroviral therapy (ART) a...
BACKGROUND: Children infected with the Human Immunodeficiency Virus (HIV) exhibit the lowest neurodevelopmental scores. Mother-to-child-transmission prevention include perinatally and early antiretroviral therapy (ART) although long-term effects of in utero exposure to ART on neurodevelopment remain unclear. It was difficult to determine whether these reported neurodevelopmental scores were a direct result of HIV. METHODS: A systematic search was conducted to identify the environmental and neurobiological factors associated with HIV infection and their impact on neurodevelopment. It was carried out across four electronic databases: Scopus, PubMed, ProQuest and Cochrane Database of Systematic Reviews. We selected 15 articles published between 2012 and 2024. RESULTS: Regarding ART, 4 articles reported a positive effect of ART regardless of the age of initiation and duration. We couldn't identify caregiver distress as a risk factor. CONCLUSIONS: Further research should include large cohort studies assessing long term consequences of ART exposition on children's neurodevelopment and impact of caregiver distress on child neurodevelopmental outcomes.
THE ROLE OF EMOTIONS IN THE RELATIONSHIP BETWEEN CHILDHOOD TRAUMAS AND CHRONIC PAIN IN ADULTHOOD: A SCOPING REVIEW.
Dieu CE, Briganti G
Psychiatr Danub · 2025 Sep · PMID 40982811
While the relationship between post-traumatic stress disorder (PTSD) and chronic pain is increasingly highlighted, the link between childhood traumas (CT) and chronic pain in adulthood remains underexplored. Yet, it is w...
While the relationship between post-traumatic stress disorder (PTSD) and chronic pain is increasingly highlighted, the link between childhood traumas (CT) and chronic pain in adulthood remains underexplored. Yet, it is well established that early adverse experiences (ACES) are more damaging than those experienced later in life due to ongoing neurological and psychological development. Furthermore, survivors of childhood traumas may develop more complex and multifaceted reactions than those observed in PTSD, potentially leading to Complex PTSD (CPTSD). A scoping review was conducted to explore the association between childhood traumas and chronic pain in adulthood, with a focus on identifying the psychological and biological mechanisms involved. Following PRISMA-ScR guidelines, 20 peer-reviewed articles were selected and thematically analyzed. Inclusion criteria covered empirical studies involving adult populations, published between 2005 and 2025. A strong association was found between cumulative ACEs and chronic pain, which supports the additional impacts of CPTSD compared to PTSD in chronic pain. Only three studies included focused on the specific impact of each CT and showed that emotional neglect and emotional abuse had the most persistent impact. Key mechanisms mainly included central sensitization, emotional dysregulation and affective disorders. Further studies are needed to investigate the differential impact of each childhood trauma type, including emotional neglect and abuse, and various pain conditions. These findings support the hypothesis of a specific emotional pathway from early adversity to pain chronification.
INAPPROPRIATE SEXUAL BEHAVIOR IN THE CONTEXT OF DEMENTIA AND NEURODEGENERATIVE DISORDERS: A REVIEW OF THE LITERATURE.
Sourdeau A
Psychiatr Danub · 2025 Sep · PMID 40982810
BACKGROUND: The increasing prevalence of neurodegenerative disorders in the context of global population aging, has led to a growing incidence of Behavioral and Psychological Symptoms in Dementia (BPSD). Among these, Ina...
BACKGROUND: The increasing prevalence of neurodegenerative disorders in the context of global population aging, has led to a growing incidence of Behavioral and Psychological Symptoms in Dementia (BPSD). Among these, Inappropriate Sexual Behavior (ISB) constitutes a particularly challenging and underrecognized issue for healthcare providers, patient and their family. Despite its clinical, ethical, and institutional implications, ISB remains insufficiently studied and poorly understood in the field of geriatric psychiatry. SUBJECTS AND METHODS: A literature review was conducted using publications from 2004 to 2024, identified across multiple databases (PubMed, Cochrane, Scopus, Cairn, Psychinfo). Search terms included: "sexuality in older adults," "dementia and sexuality," "sexual behavior disorders," and "affective, cognitive needs in geriatric psychiatry." RESULTS: Sexual expression persists as a fundamental human need in older adults, including those with dementia, yet it is frequently misinterpreted or pathologised. ISB in dementia may stem from multifactorial etiologies, including neuroanatomical changes, unmet emotional, relational needs, medication side effects, comorbid conditions, or pre-existing personality traits. Distinguishing ISB from paraphilic or deviant sexual behaviours necessitates a nuanced, individualised, and contextually informed assessment. Structured tools can aid in the systematic evaluation and monitoring of ISB. Management strategies should prioritise non-pharmacological interventions as first-line approaches. Pharmacological treatments are considered only in refractory cases. CONCLUSION: ISB in dementia demands a comprehensive, interdisciplinary, and person-centered approach. Greater clinical awareness, standardized diagnostic frameworks, and robust empirical research are urgently needed to inform effective and ethically sound interventions, ultimately improving patient and caregiver outcomes.
NEUROMODULATION IN PSYCHOGERIATRICS: EMERGING EVIDENCE AND FUTURE DIRECTIONS.
Elkrief L, Briganti G
Psychiatr Danub · 2025 Sep · PMID 40982809
Late-life mental illnesses, particularly treatment-resistant late-life depression, present a significant public health challenge due to complex interactions with medical comorbidity, polypharmacy, and neurocognitive diso...
Late-life mental illnesses, particularly treatment-resistant late-life depression, present a significant public health challenge due to complex interactions with medical comorbidity, polypharmacy, and neurocognitive disorders. Standard pharmacological treatments are often limited by efficacy and tolerability issues in this population. Neuromodulation has emerged as an essential therapeutic modality, offering targeted treatment that can circumvent systemic side effects. This narrative review provides a critical synthesis of the evidence for established neuromodulation techniques - Electroconvulsive Therapy (ECT), Repetitive Transcranial Magnetic Stimulation (rTMS), Transcranial Direct Current Stimulation (tDCS), and Vagus Nerve Stimulation (VNS) - and explores emerging approaches like Transcranial Focused Ultrasound (tFUS) within psychogeriatric populations. The application of these techniques is governed by a trade-off between efficacy, safety, and logistical burden. ECT remains the gold-standard for severe presentations, such as psychosis or catatonia, despite its cognitive risks. rTMS provides a powerful balance of efficacy and tolerability for non-psychotic TRD. tDCS and non-invasive VNS offer excellent safety profiles and potential for home-based administration, expanding access and showing promise for cognitive indications. While the clinical roles of these modalities are clarifying, the path forward requires addressing critical gaps. Future research must prioritize methodologically rigorous, geriatric-specific trials, the development of biomarkers to guide personalized treatment, and an unwavering focus on the ethical complexities of assessing capacity and obtaining informed consent. Integrating these imperatives will enable the field to deliver precise, effective, and patient-centered care for older adults.
DELIRIUM IN THE ELDERLY.
Briganti G
Psychiatr Danub · 2025 Sep · PMID 40982808
Delirium is a common and serious neuropsychiatric syndrome in older adults, characterized by acute and fluctuating disturbances in attention, awareness, and cognition. It is associated with multiple adverse outcomes, inc...
Delirium is a common and serious neuropsychiatric syndrome in older adults, characterized by acute and fluctuating disturbances in attention, awareness, and cognition. It is associated with multiple adverse outcomes, including increased mortality, functional decline, long-term cognitive impairment, and institutionalization. This review synthesizes current knowledge on the pathophysiology, risk factors, clinical presentation, diagnosis, prevention, treatment, and prognosis of delirium in elderly patients. Delirium arises from complex interactions between predisposing vulnerabilities (such as dementia, frailty, and sensory deficits) and acute precipitants (including infections, medications, surgery, and environmental stressors), resulting in a transient but often severe breakdown of cerebral function. Diagnostic tools such as the Confusion Assessment Method (CAM) and 4AT improve detection, though challenges remain in hypoactive presentations and in patients with underlying dementia. Multicomponent non-pharmacological interventions - focused on orientation, sleep hygiene, mobilization, hydration, medication review, and sensory support - are the most effective preventive and therapeutic strategies. Pharmacological treatment, primarily with antipsychotics, is reserved for severe behavioral disturbances and does not alter the course of the syndrome. Delirium is a clinical red flag indicating systemic decompensation and should prompt both acute management and structured follow-up to mitigate long-term consequences. Greater integration of delirium screening and prevention into hospital protocols is essential to improve care outcomes in this vulnerable population.
WHAT'S NEW IN PSYCHIATRY IN 2024-2025.
Zdanowicz N
Psychiatr Danub · 2025 Sep · PMID 40982807
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NO HEALTH WITHOUT MENTAL HEALTH: WHAT IT MEANS IN THE CONTEMPORARY WORLD.
Tecco JM
Psychiatr Danub · 2025 Sep · PMID 40982806
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PSYCHIATRY IN CONTEMPORARY WORLD: NO HEALTH WITHOUT MENTAL HEALTH.
Tavormina G, Franza F
Psychiatr Danub · 2025 Sep · PMID 40982805
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PSYCHIATRY IN CONTEMPORARY WORLD: THE ROLE OF PSYCHIATRIA DANUBINA.
Jakovljević M
Psychiatr Danub · 2025 Sep · PMID 40982804
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