Mapping moral injury: Development and feasibility of the Clinical Interview for Moral Injury—military version (CIMI-M)

Experiences of bullying can have significant psychological consequences, including an increased risk of social anxiety. This study aimed to examine changes in social anxiety following Virtual Reality Social Exposure (VRSE) among bullying victims. A one-group pretest–posttest design without a control group was employed with 12 participants. The intervention consisted of three gradual exposure sessions in virtual environments representing social situations. Social anxiety was measured before and after the intervention, and the data were analyzed using the Wilcoxon Signed-Rank Test. The results indicated a statistically significant decrease in social anxiety scores following the intervention (p = 0.002), with a reported effect size of 0.974. These findings suggest that VRSE may be a promising approach for reducing social anxiety among bullying victims. However, the absence of a control group and the small sample size limit conclusions regarding its effectiveness and safety. Further studies with larger samples, control groups, and systematic safety assessments are needed.

Stress arising from academic, professional and financial demands is common among students and young professionals, and the coping methods within easiest reach, such as listening to music, do not always suffice. This paper presents a survey-driven design for a virtual reality (VR) gadget that combines selectable immersive natural environments, environment-matched sound therapy and heart-rate biofeedback for short relaxation sessions. An online questionnaire completed by 24 respondents, mostly college students, supplies the user requirements. Among those who answer the relevant items, 65.2% report daily stress, 73.9% name academic or job pressure as the main cause, and 47.8% state that a busy schedule prevents regular yoga or meditation. Music is the most common coping method (63.6%). Asked about a 10–15 minute VR relaxation session described as free of side effects, 83.3% answer “yes, definitely” and 8.3% answer “maybe” if the price is under Rs. 5000. The findings yield design requirements, a system architecture, a session workflow and a protocol for comparing the gadget with guided breathing, meditation and relaxing music. That comparison is planned, not yet carried out: the prototype has not been tested with users, and the paper makes no claim of clinical effectiveness.

Mental health services are constantly evolving with the gradual introduction of functionalized care, which means medical intervention has become more focused on a particular clinical area or stage of the illness. This has progressed to having designated teams for inpatient psychiatry. Usually, psychiatrists manage their patients both in outpatient and inpatient settings while working in a particular geographical area or sector. Moving away from this model to a functionalized inpatient setting, where other psychiatrists take care of their patients, is seen as a breach in continuity of care. In this context, it was intended to review the current literature for the experience of clinicians and patients in these sectorized (medical continuity) or functionalized models of psychiatric inpatient care. A narrative review of the current literature from multiple databases was conducted. The results suggested that there are positive and negative observations in both models. It appeared that neither met the expectations of patients nor clinicians. Patients preferred to be seen by the same consultant in community and inpatient settings, but clinical outcomes were not significantly different in the two models. The functionalized care was mostly medical continuity rather than multidisciplinary. Any changes in the care models may be driven by local facilities and issues. There is a need to improve the quality of care through existing models before any changes. More studies are needed to improve the evidence on the effectiveness of these service models.

Background: Patients recovering from craniotomy in the Intensive Care Unit (ICU) are at risk of hemodynamic changes related to stress responses, neurological impairment, pain, and environmental stimuli. A combination of music therapy and hand massage may help maintain hemodynamic stability in these patients. Objective: To describe the application of combined music therapy and hand massage to support hemodynamic stability in post-craniotomy patients in the ICU. Methods: This evidence-based nursing intervention was implemented with three post-craniotomy patients admitted to the ICU of Abdul Wahab Sjahranie Regional General Hospital, Samarinda. The intervention consisted of 15 minutes of instrumental or classical music followed by 15 minutes of effleurage hand massage. Systolic and diastolic blood pressure, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO₂) were measured before and after each intervention. The intervention was conducted over three days, with each patient’s clinical changes monitored. Results: The case study findings indicated greater stability in blood pressure, MAP, HR, RR, and SpO₂ following the intervention. Conclusion: Combined music therapy and hand massage may be a safe, non-pharmacological intervention to support nursing care and maintain hemodynamic stability in post-craniotomy patients. Further research is needed to assess its effects on other outcomes, including biochemical changes.

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia in which the normal muscle atonia of REM sleep is lost, and patients act out their dreams.Serotonergic antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are a recognized trigger, but in psychiatric patients the nocturnal behaviors are easily attributed to stress or to the primary illness.We report the case of a 46-year-old man with schizoaffective disorder, depressive type, maintained on aripiprazole 15 mg daily, who was started on escitalopram 10 mg at bedtime (day one); the dose was reduced to 5 mg on day 77.Around day 430, about 14 months after starting escitalopram and while taking 5 mg, he began to walk in his sleep and act out his dreams, including punching movements and, on one occasion, walking while holding a clothing iron, with no recollection on waking.The episodes occurred late in the night, with his eyes closed, two to three times a month and were accompanied by sleep paralysis and daytime sleepiness.His mental status examination and routine blood tests were unremarkable.He declined polysomnography and brain imaging, so a diagnosis of probable RBD, possibly associated with escitalopram, was made on clinical grounds; a non-REM parasomnia could not be excluded.On day 616, escitalopram was stopped and clonazepam 0.5 mg at bedtime was started at the same time.The episodes had stopped by day 665.Clonazepam was discontinued on day 772, and at the latest follow-up on day 1962 there had been no recurrence.Because clonazepam was started when escitalopram was withdrawn, the improvement cannot be attributed to stopping escitalopram alone, although the absence of recurrence after clonazepam was discontinued supports a role for the antidepressant.Clinicians who prescribe serotonergic antidepressants should take a sleep history from patients and their bed partners, arrange polysomnography where it is available, and review the suspected drug.