Alexithymia presents a reduced ability to identify, express, and describe one's own emotions. In medical professionals, alexithymia is associated with increased burnout and substance use, as well as reduced altruistic behavior. Our aim was to examine the association between alexithymia and different sociodemographic, psychological, and somatic parameters among medical students. Participants included 186 third- and sixth-year students of the Faculty of Medicine in Belgrade, Serbia. Data were collected through an online survey, composed of 1) a general questionnaire (sociodemographic data, education satisfaction, grade point average, presence of psychological and somatic disorders), 2) Twenty-Item Toronto Alexithymia Scale, 3) Patient Health Questionnaire-9, and 4) Beck Anxiety Inventory. Third-year students had significantly higher rates of alexithymia compared with sixth-year students. Negative correlation was found between alexithymia and educational satisfaction ( r = -0.276**) and alexithymia and grade point average ( r = -0.186*). A positive correlation was found between alexithymia and depression ( r = 0.424**) and alexithymia and anxiety ( r = 0.338**). The negative impact of alexithymia on educational satisfaction and psychological health is pronounced in the population of medical students, indicating a need for preventive programs aimed in medical schools.

This study aimed to determine the mediating role of emotion regulation difficulties in the correlation between mindfulness and psychological resilience. This study was conducted with a total of 119 patients diagnosed with major depression. Data were collected with Personal Information Form, Mindfulness Scale, Emotion Regulation Difficulties Scale, and Psychological Resilience Scale. The study participants reported moderate levels of mindfulness and emotion regulation difficulties, and above-average levels of psychological resilience. It was found that there was a moderately negative correlation between mindfulness and emotion regulation difficulties (r = -0.553, p < 0.001), as well as between psychological resilience and emotion regulation difficulties (r = -0.429, p < 0.001). A moderately positive correlation was determined between mindfulness and psychological resilience (r = 0.344, p < 0.001). Emotion regulation difficulties fully mediated the correlation between mindfulness and psychological resilience. These findings will guide the development of interventions aimed at enhancing mindfulness, emotion regulation skills, and psychological resilience in depression treatment.

Rituals represent a prominent human behavior in different contexts such as daily routines, life cycle stages, and psychopathology, for example, obsessive compulsive disorder (OCD) where they are referred to as compulsions. OCD compulsions differ from habitual behaviors and stereotypies regarding their formal features: acts repetition, the addition of nonfunctional acts, and attentional focus on basic motor units. This study aims to categorize OCD compulsions based on the motor patterns of acts repetition and inclusion of nonfunctional acts. We analyzed 28 video-recorded OCD compulsions; we adopted a cluster analytic model to identify distinct patterns within the data and determine cluster characteristics. Our findings revealed a moderate negative covariance between nonfunctionality and repetitiveness, indicating that as nonfunctionality increased, repetitiveness decreased. Three distinct clusters in OCD rituals were identified according to the motor pattern: "idiosyncratic rituals," characterized by strong incorporation of nonfunctional acts; "iterative rituals" showing high repetitiveness; and "routines," with minimal repetition and limited inclusion of nonfunctional acts. These motor patterns highlight evolutionarily conserved behavioral strategies aimed at coping with conditions of environmental unpredictability. The findings might allow fine-grained discrimination of ritual compulsions and help target personalized interventions.

Lifetime history of suicide attempts is associated with inflammatory mechanisms, severity of depressive symptoms, and childhood trauma. This cross-sectional study enrolled 54 suicide attempters and 154 nonsuicide attempters. All individuals were assessed through a questionnaire, a structured clinical interview, scales, anthropometric measures, and laboratory biomarkers. Individuals with a history of lifetime suicide attempts showed significant positive correlations regarding soluble tumor necrosis factor receptor 1 and severity of depressive symptoms (p = 0.013), interleukin-1 receptor antagonist and severity of depressive symptoms (p = 0.04), and absenteeism from work and childhood physical abuse (p = 0.012). Suicide attempters also experienced more childhood trauma (sexual abuse, physical abuse, emotional abuse, emotional neglect, and physical neglect) compared with nonsuicide attempters. IL-4 levels were significantly lower in individuals who attempted suicide than in nonsuicidal individuals. Lifetime suicide attempts in major affective disorders were associated with childhood trauma and proinflammatory and anti-inflammatory cytokines.

We aim to study Adverse childhood experiences' (ACEs') association with cognitive decline during adulthood. We reviewed data on subjective cognitive decline (SCD) for those ≥45 years of age. Logistic regression analysis, odds ratio, and 95% confidence interval (CI) assessed the association between ACEs and SCD. We analyzed an adult survey (N = 3900, mean age: 60.9 years, male: 46%). The most common ACE reported was household substance abuse (22.4%), followed by parental divorce/separation (20.9%). The prevalence of SCD in those having at least one ACE was higher than those without any (16.5% vs. 8.1%, p < 0.001). SCD positively correlated with the number of ACEs (p < 0.001). The odds of SCD increase in proportion to the increase in the number of ACEs experienced. These findings should be replicated in a larger population while controlling for confounding factors.

This study investigates the role of family and social relationships in cases of attempted suicide in China. Studies, mostly analyzing data from developed countries, have indicated that interpersonal relationships are important predictors of suicidal behaviors. This study's data were derived from a case-control study in China. Family relationships included relationships with spouses, parents, and parents-in-law. Poor family and social relationships were significantly associated with increased risk of attempted suicide in women and men. Depression and social support significantly mediated the association between interpersonal relationship and attempted suicide. Poor relationship with spouse was significantly associated with an elevated risk of attempted suicide. Relationship with parents-in-law was also significantly associated with attempted suicide in women, whereas family relationships played a more important role than social relationships in suicidal behaviors, especially in men. The findings imply that suicide prevention in China could be conducted from the perspective of improving family relationships, especially husband/wife and parents/daughters-in-law relationships.

The presence of specific craniofacial deviations may be evidence of abnormal early brain development in bipolar disorder (BD). This study aimed to compare mandibular morphology in patients with BD versus nonpsychiatric controls using panoramic radiography. A total of 215 recorded images, 70 patients with BD and 145 controls, were evaluated. Seven mandibular parameters of the ramus height (RH), condylar height (CH), gonial angle (GA), antegonial angle (AGA), antegonial notch depth (AND), ramal notch depth (RND), and bigonial width (BGW) were measured in a blinded manner. Group analysis was conducted separately for males and females. The univariate comparisons showed increased values in RH, CH, AND, RND, and BGW and decreased values in GA in males with BD compared with male controls. In addition, females with BD had higher RH, CH, RND, and BGW values in comparison to female controls. The differences were statistically significant. Data from multivariate analyses revealed that increases in RH and BGW values in both sexes were significant predictive variables that distinguished patients with BD from controls. Moreover, deeper AND was the most prominent predictor that distinguished male patients with BD from male controls. The identification of subtle changes in mandibular measurements is consistent with the notion of impaired neurodevelopment in BD.

Sexual violence is associated with posttraumatic stress disorder (PTSD), but relatively less research has explored whether it is associated with hazardous drinking. PTSD symptoms may indirectly influence the association between sexual violence and hazardous alcohol use. This association may be moderated by gender. The aim of the current study was to cross-sectionally test whether sexual violence is indirectly associated with hazardous drinking through PTSD symptoms and explore whether gender moderates this association. Hypotheses were tested among 631 adults (Mage = 38, 56% men, 78.6% White) with probable PTSD and hazardous drinking who completed online self-report surveys. Results indicated sexual violence, compared with other trauma types, was associated with more severe hazardous drinking. There was a significant indirect effect of PTSD symptoms in this association. There was no evidence of a moderating effect of gender. PTSD symptoms may drive hazardous drinking among sexual violence survivors. Results also underscore associations between sexual violence and alcohol use, regardless of gender. Future work should continue to investigate these associations prospectively.

Volunteers who respond to disasters play a crucial role in disaster management. However, their indirect exposure to traumatic events during their duties can adversely affect their mental health. The aim of the study was to determine the correlation among trauma centrality, coping self-efficacy, and posttraumatic growth and trauma centrality as possible mediator role in this relationship. A total of 112 disaster volunteers participated. The data were collected with a Demographic Form, the Centrality of Events Scale, the Post-Traumatic Growth Scale, and the Coping Self-Efficacy Scale. Disaster volunteers exhibited above average event centrality, high levels of posttraumatic growth, and coping self-efficacy. A positive correlation was identified among trauma centrality, posttraumatic growth, and coping self-efficacy, with trauma centrality playing a full mediating role. This study will be instrumental in better understanding the posttraumatic processes of disaster volunteers and in strengthening coping capacities, guiding the implementation of preventive and protective psychosocial interventions.

The research is based on interpretive phenomenological analysis and the interview method. The sample involved 100 secondary school students from five to nine grades and eight physical education teachers. All participants studied the proposed physical education program in-person for one academic semester, as well as studied the program online for one academic semester. It was found that online learning was viewed unfavorably by 87% of teachers. However, 65% of participants admitted that learning opportunities were limited, and they experienced difficulties with appropriate lesson content, equipment, and space to foster a positive learning environment and a productive working context. In addition, marginalization occurred as parents and students paid more attention to other subject areas except for physical education. The research suggested that the majority of teachers (89%) were looking forward to full-time and face-to-face physical education training because they lacked personal relationships and interaction with their students.

This study investigated the prevalence and risk factors of probable posttraumatic stress disorder (PTSD), depression, and complicated grief among 529 adults residing in a container city, 4 months after the 2023 earthquakes in Türkiye. Participants were assessed using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the Hamilton Depression Scale, and the Inventory of Complicated Grief. The prevalence rates of probable PTSD, depression, and complicated grief were 21.4%, 15.9%, and 64.7%, respectively. Logistic regression analyses indicated that PTSD was significantly associated with the loss of a loved one, fear of future earthquakes, and decreased perceived life control. Similarly, depression was associated with being trapped under debris, experiencing fear during the earthquake, and reduced perceived life control. These findings suggest that individuals presenting these risk factors warrant closer follow-up for potential psychological issues. Additionally, the impact of fear related to the earthquake and the role of perceived life control emerge as crucial considerations for psychological interventions.

This study aimed to investigate anxiety, depression levels, and emotional/behavioral problems of children and adolescents while being treated in the COVID-19 unit. The present study included 50 children who were COVID-19 positive, aged 7-18 years, and 50 age- and gender-matched healthy controls. The sociodemographic data form and Revised Child Anxiety and Depression Scale-Child Version (RCADS-C) were applied to all children, and all families were asked sociodemographic data form, Revised Child Anxiety and Depression Scale-Parent Version (RCADS-P), and Strengths and Difficulties Questionnaire (SDQ). There was no significant difference between the patient and control groups in terms of anxiety, depression levels, and emotional/behavioral problems. The conduct problems subscale score of SDQ in the patient group was found to be significantly lower than the control group (p = 0.037). Separation anxiety subscale scores of RCADS (p = 0.034) and the rate of accompanying companions (p = 0.01) in the patient group were found to be significantly higher in preadolescents than in adolescents. In conclusion, this study demonstrated that children and adolescents who were COVID-19 positive were not different from healthy children in terms of anxiety and depression levels, and emotional and behavioral problems in the acute period during inpatient treatment.

The participation of military personnel in operations like the Anti-Terrorist Operation (ATO)/Joint Forces Operations (JFO) can lead to significant psychological trauma, potentially resulting in posttraumatic stress disorder (PTSD). Understanding the effectiveness of psychotherapy in treating PTSD among ATO/JFO participants is crucial given its profound impact on personal relationships, life scenarios, and overall well-being. This study evaluates how acceptance and commitment therapy can alleviate PTSD symptoms and enhance well-being in Ukrainian military personnel with combat-related PTSD. The main research method was a psychological experiment, and the case study method was used as an auxiliary research method. The study revealed the following: combatants in the ATO/JFO who have been diagnosed with PTSD should be classified as persons with disabilities due to certain limitations in their life activities, namely, the inability to control their behavior, and difficulties in work and communication. This study proves that cognitive-behavioral psychotherapy has a clear advantage in overcoming PTSD in the military, as it allows transforming psychological trauma into posttraumatic growth. Attachment and acceptance therapy, a form of behavioral therapy, has emerged as one of the most effective treatments for PTSD. It focuses on diagnosing and addressing the psychological consequences of war by analyzing the connections among cognition, affect, and behavior. Given the protracted nature of PTSD, the practical significance of the study is to develop effective psychotherapeutic interventions for the expected recovery of ATO/JFO participants affected by combat operations.

Insomnia and anxiety symptoms are independent clinical variables involved in suicidal ideation in psychiatric inpatients. In this article, we investigated the relationship among insomnia severity, severity of anxiety symptoms, and suicidal ideation in a sample of psychiatric inpatients with severe mental disorders. We used a mediation model considering insomnia severity as the possible mediator of the relationship between anxiety severity and suicidal ideation. We administered the Columbia Suicide Severity Rating Scale, the Insomnia Severity Index, and the Hamilton Anxiety Rating Scale to 116 consecutive inpatients to the psychiatric unit of Sant'Andrea Hospital in Rome. The effect of anxiety symptoms was mediated by insomnia severity; patients who perceive higher anxiety symptoms were more likely to experience higher levels of insomnia and, thus, higher suicidal ideation intensity. Results showed the importance of assessing and treating both insomnia and anxiety in clinical practice.

This comprehensive study delves into the escalating issue of nonchemical addictions, spurred by technological advancements. It thoroughly examines psychological factors and intervention strategies for these addictions, focusing on their development, influence on human behavior, and psychocorrection processes. Aiming to discover effective methods for correcting and preventing addictive behavior, the study incorporates a theoretical analysis of existing scientific approaches, characterizing various nonchemical addictions such as Internet and gadget use, gambling, and others. It scrutinizes the origins, proliferation, and interplay of these addictions with an individual's psychoemotional state, lifestyle, and external environment, underscoring the destructive nature of addiction on physiological, emotional, and social levels. A key component of the research is an empirical investigation among teenagers, a highly susceptible group, to assess gadget addiction levels, causative factors, and impacts. This research not only elucidates the essence and variety of nonchemical addictions and their correlation with mental health but also provides valuable insights into prevention and overcoming strategies. The practical significance of this study lies in its potential application for recognizing addiction signs and formulating effective management programs.

The problem of paranoid disorders is widespread and difficult to diagnose due to the many mental symptoms that a person often perceives as character traits. Passion for work, the so-called pathological workaholism, harms not only the suffering person but also all the people around them, affecting their quality of life and disrupting social and family ties. The purpose of study was to determine the level of pathological workaholism and its main symptoms. The objectives of the study included interviewing respondents and identifying the correlation between the level of workaholism and mental manifestations, and finding differences in the manifestations of workaholism in men and women. For this purpose, 78 people were examined, including 38 women and 40 men. All participants worked as middle managers in multinational companies. The aim was to identify people with pathological workaholism among the participants using the "Work Addiction Risk Test" questionnaire. Among managers, a high degree of predisposition to workaholism was diagnosed. We found that women have a strong tendency to be fixated on work, and as a result, they have increased rumination anxiety. Regardless of gender, managers who took part in the study showed a pronounced manifestation of paranoid and obsessive-phobic disorders, depression, and asthenic manifestations. Regarding the relationship between neurotic symptoms and a tendency to workaholism, a high correlation was observed ( p < 0.05). The results of this study may be useful for specialists to develop means of preventing and effectively treating paranoid workaholism, as a disease that is increasingly having a negative impact on society.

Schizophrenia is a debilitating mental health disorder that imposes profound economic, societal, and personal burdens. The negative symptoms of schizophrenia ( i.e. , blunted affect, alogia, anhedonia, asociality, and avolition) are highly prevalent and pervasive in the psychotic disorder and pose significant resistance to available treatment options. Traumatic childhood experiences are strongly linked with the risk of developing schizophrenia. Most prior studies have primarily focused on positive symptoms of schizophrenia ( e.g. , hallucinations and delusions), whereas less attention has been given to negative symptoms. The current study investigated the relationship between childhood trauma ( i.e. , physical abuse, sexual abuse, and emotional abuse and neglect) and negative symptoms in a sample of schizophrenia outpatients and healthy controls ( n = 159 participants, including 99 patients with schizophrenia). The observations from the current study revealed that schizophrenia patients experienced a significantly greater degree of childhood trauma and negative symptoms than the control individuals. The results of the current study also indicated that more severe experiences of total childhood trauma ( i.e. , summation of all trauma types), physical abuse, and emotional neglect may increase the risk of schizophrenia patients reporting negative symptoms. However, childhood sexual and emotional abuse was found to have no impact on the degree of negative symptoms experienced by schizophrenia patients. Implications and limitations of the current study are discussed. In conclusion, we found that the severity of overall childhood trauma, physical abuse, and emotional neglect may play an important role in increasing the likelihood of schizophrenia patients reporting negative symptoms.

Patients with psychiatric disorders often have foreshortened lives, attributed both to "natural" medical and "unnatural" external causes of death such as suicide, homicide, and accident. Many deaths are foreseeable due to circumstances linked to patients' psychiatric disorders. These can include illness-associated disparities, adverse treatment effects, lack of self-care, and behaviors stemming directly from psychopathological processes. Whereas some of these processes contribute indirectly to patients' causes of death, others are more directly consequential, causing patients to "die from" their psychiatric disorders. Some patients manifest likely fatal trajectories that may lead to "end-stage" psychiatric disorders. Palliative approaches may optimize their quality of life and potentially alter these trajectories, but patients with psychiatric disorders are less likely to receive optimal end-of-life care. Although assuring a "good death" can be challenging, systematic efforts can assist in providing patients with psychiatric disorders deaths with dignity rather than indignity.

As a nonpharmacological method for cognitive rehabilitation, older adults with mild cognitive impairment (MCI) may benefit from Baduanjin exercise (BE), a moderate-intensity aerobic exercise. This meta-analysis was conducted to determine if BE is effective in enhancing cognitive performance in older adults with MCI. Using a combination of topic phrases and free words, systematic searches were executed in nine databases. Review Manager 5.4 was used to retrieve and statistically evaluate the data. Fourteen randomized controlled studies comprising 994 individuals aged ≥60 years were included in the meta-analysis. BE enhanced the general cognitive performance in individuals with MCI as measured by the Montreal Cognitive Assessment (standardized mean difference [SMD] = 2.56; 95% confidence interval [CI], 2.17, 2.96; p < 0.001). The level of memory decline (Wechsler Memory Scale; SMD = 12.46; 95% CI, 8.36, 16.57; p < 0.001), executive function (Trail Making Test; SMD = -7.08; 95% CI, -11.21, -2.94; p < 0.001), and frailty (Edmonton Frailty Scale; SMD = -0.97; 95% CI, -1.30, -0.64; p < 0.001) were all improved with BE for older adults with MCI. This study presented a therapeutic practice guide for using BE for cognitive rehabilitation in older adults. BE notably improves cognitive function in older adults with MCI and can be an excellent nonpharmaceutical therapy option.

A good physician-patient relationship is essential for the delivery of quality health care and is associated with better health outcomes. This study explored the association between patients' object relations and the physician-patient relationship. Primary care patients (n = 72) and physicians (n = 21) participated in the study. Patients' early memories were obtained prior to their medical visit and were coded with the Social Cognition and Object Relations-Global Method (SCORS-G). Patients and physicians independently rated the quality of the physician-patient encounter. Results indicated that object relations (SCORS-G Cognitive-structural and Self factors) incrementally predicted physician-patient relationship ratings, as rated by the patient, above and beyond psychological distress, somatization, and level of physician training. Patient education, psychological distress, and level of physician training predicted physician ratings of the medical encounter. The authors discuss the discrepancy between physician and patient ratings as they relate to patients' object relations.

The psychopathological manifestations associated with substance use, including induced psychotic experiences, are increasingly relevant but not well-understood within the medical community. Novel psychoactive substances and potentiated old compounds like cannabis and cocaine have emerged as a global concern, especially among adolescents and young adults. Transition rates from substance-induced psychosis (SIP) to persistent psychosis are significant, particularly in cases of cannabis-induced psychosis. Scientific inquiry into induced psychotic phenomena has revealed differences between SIP and primary psychotic disorders, highlighting the risk factors associated with each. The concept of exogenous psychosis, including its toxic variant known as lysergic psychoma, provides valuable insights into the role of external factors in psychosis development. A phenomenological approach characterizes this disruption in perception as a shift in temporal and spatial dimensions, leading to auditory and visual hallucinations. The "twilight state" of consciousness plays a crucial role in the transition from substance use to psychosis, with implications for spatiality, intersubjectivity, and temporality. This complex path to psychosis challenges traditional diagnostic models and underscores the need for a more nuanced understanding of substance-induced psychopathological experiences.

The purpose of this study was to determine the influence of knowledge and beliefs on beneficial behaviors and dementia risk scores. A online survey was conducted among Chinese community residents over 18 years old. Multivariate logistic regression was used to identify the impact of knowledge and beliefs on dementia risk scores and beneficial behaviors. The respondents were 760 adults (mean age = 47.6 years, 60.8% female). Knowledge and beliefs were associated with cognitive activities (knowledge, odds ratio [OR] = 1.04; beliefs, OR = 1.17) and dementia risk scores (knowledge, OR = 0.95; beliefs, OR = 0.82). Additionally, lower perceived susceptibility (OR = 1.68; 95% CI, 1.04 to 2.72) and higher perceived benefits (OR = 0.68; 95% CI, 0.57 to 0.80) were associated with lower dementia risk scores. Knowledge and beliefs can promote beneficial behaviors and reduce dementia risk. In particular, perceptions of dementia susceptibility and benefits should be enhanced, which will greatly reduce dementia risk in the general public.

The aim is to identify the causes of physical and emotional health disorders in men in terms of intimate interaction with partners, as well as how they can be prevented. The research used comparison, analysis, statistical methods, and surveys. The need for people to discover and study sexual health issues in the modern world in order to support not only the physical, but also the psychological aspects of their body, as well as the impact of lifestyle on this process, is shown. The research was conducted to better understand all diseases that are based on the deterioration of the psycho-emotional state of men, which leads to sexual disorders. A more detailed study of this topic will allow to better select treatment for patients and find different approaches to the problem in the future.

COVID-19 survivors complained of the experience of cognitive impairments, which also called "brain fog" even recovered. The study aimed to describe long-term cognitive change and determine psychosocial factors in COVID-19 survivors. A cross-sectional study was recruited 285 participants from February 2020 to April 2020 in 17 hospitals in Sichuan Province. Cognitive function, variables indicative of the virus infection itself, and psychosocial variables were collected by telephone interview. Univariate logistic regression and Lasso logistic regression models were used for variable selection which plugged into a multiple logistics model. Overall prevalence of moderate or severe cognitive impairment was 6.3%. Logistic regression showed that sex, religion, smoking status, occupation, self-perceived severity of illness, sleep quality, perceived mental distress after COVID-19, perceived discrimination from relatives and friends, and suffered abuse were associated with cognitive impairment. The long-term consequences of cognitive function are related to multiple domains, in which psychosocial factors should be taken into consideration.

This study evaluated the impact of a direct-to-consumer (DTC) marketing video designed to educate the public about patients' rights to evidence-based mental health care (EBMHC). Participants ( N = 632) were randomly assigned to an active DTC video condition, a control video condition, or a control condition without a video. Participants who watched the DTC video ( vs . both control conditions) had significantly greater knowledge of patients' rights to EBMHC. Further, individuals who watched the DTC ( vs . control) video reported significantly greater comfort with accessing care and perceived their assigned video as significantly more culturally sensitive. However, participants who watched the DTC video were not significantly different from both control conditions on self-report measures of self-efficacy in working with a provider, likelihood of asking a provider about one's rights, treatment-seeking intentions, and self-stigma. Findings suggest the potential for a DTC video to promote knowledge of EBMHC, though its impact on help-seeking perceptions and intentions was less promising.

The controversies surrounding the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases have generated significant debate across the psy-sciences. This debate has been further fueled by the launch of the Research Domain Criteria as a framework to facilitate advances in neuroscientific research, a renewed emphasis on dimensional models of psychopathology, currently exemplified by the Hierarchical Taxonomy of Psychopathology, and development of the Psychodynamic Diagnostic Manual by the psychodynamic community. In this article, we provide a clinical overview of recent debates surrounding categorical and dimensional approaches to psychiatric diagnosis, offer a critical assessment of proposed alternatives, and discuss how clinicians can navigate a plurality of diagnostic frameworks. Our discussion emphasizes that diagnostic frameworks need to be contextualized within the process of a comprehensive clinical evaluation, and their advantages and disadvantages should be understood in relationship to the theoretical orientations and practical needs of clinicians.

The study was set out to establish the potential for psychotherapy to effect improvements in patients with narcissistic personality disorder (NPD). Eight patients with NPD who improved in treatment were identified. Consensus clinician/investigator diagnostic scores from before and after the psychotherapies were retroactively established on the Diagnostic Interview for Narcissism (DIN) and the Diagnostic Statistic Manual for Psychiatric Disorders, 5th Edition (DSM-5) Personality Disorder Section II criteria. Psychosocial functioning (work or school, romantic relationships) before and after the psychotherapies was retroactively evaluated as well. At the completion of the therapies after 2.5 to 5 years, all patients had improved, no longer met DIN or DSM-5 criteria for NPD, and showed better psychosocial functioning. Symptomatic improvements were associated with large effect sizes. In conclusion, changes in NPD can occur in treatment after 2.5 to 5 years. Future research should identify patient characteristics, interventions, and common processes in such improved cases that could help with development of treatments.

The DSM-III symptomatic criteria for major depression (MD) were derived from those proposed by Feighner and colleagues in 1972, which closely resembled those published by Cassidy in 1957. I here present a counter-factual history in which Feighner carefully read a key reference in Cassidy, a large 1953 follow-up study by Campbell of depressed patients with detailed tables of depressive signs and symptoms. In this alternative timeline, the Feighner criteria for MD were modified by Campbell's results, which then changed DSM-III and subsequent MD criteria sets. The historical pathway to the current DSM MD criteria was contingent on a range of historical events and could easily have been different. This story is not meant to criticize DSM MD criteria that perform well. Rather, it suggests that these criteria represent a useful but fallible set of symptoms/signs that index but do not constitute MD and therefore are not to be reified.

Wolfram syndrome 1 (WS1) is a rare, autosomal recessive neurodegenerative disorder characterized by diabetes insipidus, insulin-dependent diabetes mellitus, optic atrophy, and deafness resulting from loss-of-function genetic variants in the WFS1 gene. Individuals with WS1 manifest a spectrum of neuropsychiatric disorders. Here, we report a pediatric case of WS1, which stemmed from a novel biallelic WFS1 loss-of-function genetic variant. The individual initially presented with obsessive-compulsive disorder, which was successfully managed by fluvoxamine. After 2 months, the child manifested excessive daytime sleepiness. Clinical evaluation and sleep recordings revealed a diagnosis of narcolepsy type 2. Excessive daytime sleepiness was improved with methylphenidate. To the best of our knowledge, this is the first report of narcolepsy in WS1, which possibly arose during a progressive neurodegenerative process. We emphasize the need for in-depth screening for neuropsychiatric phenotypes and sleep-related disorders in WS1, for clinical management, which significantly improves the quality of life.