درمان

Purpose: This study aimed to compare the effectiveness of Compassion-Focused Therapy and Existential Therapy in reducing death anxiety and increasing illness acceptance among patients with cancer in remission. Methods and Materials: This applied study used a quasi-experimental pretest-posttest-follow-up design with a control group. The statistical population consisted of patients with common cancers in remission who referred to hospitals in Tehran during 2025–2026. Using purposive sampling, 45 eligible participants were selected and randomly assigned to Compassion-Focused Therapy, Existential Therapy, and control groups, with 15 participants in each group. Both intervention groups received eight 90-minute weekly sessions, while the control group received no psychological intervention. Data were collected using the Templer Death Anxiety Scale and the Acceptance of Illness Scale. The data were analyzed in SPSS version 26 using repeated-measures analysis of variance and Bonferroni-adjusted post hoc comparisons at a significance level of 0.05. Findings: Repeated-measures analysis of variance showed significant effects of time, group, and time-by-group interaction for death anxiety and illness acceptance (p < 0.001). Bonferroni comparisons indicated that both Compassion-Focused Therapy and Existential Therapy significantly reduced death anxiety and increased illness acceptance compared with the control group (p < 0.001). Compassion-Focused Therapy produced a significantly greater reduction in death anxiety than Existential Therapy (MD = 1.79, SE = 0.41, p < 0.001), whereas Existential Therapy produced a significantly greater increase in illness acceptance than Compassion-Focused Therapy (MD = 2.30, SE = 0.46, p < 0.001). The improvements were maintained at follow-up. Conclusion: Both Compassion-Focused Therapy and Existential Therapy were effective in improving psychological adjustment among patients with cancer in remission; however, Compassion-Focused Therapy was more effective in reducing death anxiety, whereas Existential Therapy was more effective in increasing illness acceptance.

هدف: این پژوهش با هدف مقایسه اثربخشی درمان مبتنی بر شفقت و درمان وجودی در کاهش اضطراب مرگ و افزایش پذیرش بیماری در بیماران مبتلا به سرطان در مرحله بهبودی انجام شد. روش‌ها و مواد: این مطالعه کاربردی با طرح نیمه‌آزمایشی پیش‌آزمون-پس‌آزمون-پیگیری با گروه کنترل انجام گرفت. جامعه آماری شامل بیماران مبتلا به سرطان‌های شایع در مرحله بهبودی بود که در سال‌های ۲۰۲۵ تا ۲۰۲۶ به بیمارستان‌های تهران مراجعه کردند. با استفاده از نمونه‌گیری هدفمند، ۴۵ شرکت‌کننده واجد شرایط انتخاب و به طور تصادفی در سه گروه درمان مبتنی بر شفقت، درمان وجودی و کنترل (هر گروه ۱۵ نفر) گمارده شدند. هر دو گروه مداخله، هشت جلسه هفتگی ۹۰ دقیقه‌ای دریافت کردند و گروه کنترل هیچ مداخله روان‌شناختی دریافت نکرد. داده‌ها با استفاده از مقیاس اضطراب مرگ تمپلر و مقیاس پذیرش بیماری جمع‌آوری شد. تحلیل داده‌ها با نرم‌افزار SPSS نسخه ۲۶ و با استفاده از تحلیل واریانس اندازه‌گیری مکرر و مقایسه‌های پس‌آزمون با اصلاح بونفرونی در سطح معناداری ۰٫۰۵ انجام گرفت. یافته‌ها: تحلیل واریانس اندازه‌گیری مکرر اثرات معنادار زمان، گروه و تعامل زمان و گروه را برای اضطراب مرگ و پذیرش بیماری نشان داد (p < 0.001). مقایسه‌های بونفرونی نشان داد که هر دو درمان مبتنی بر شفقت و درمان وجودی به طور معناداری اضطراب مرگ را کاهش و پذیرش بیماری را نسبت به گروه کنترل افزایش دادند (p < 0.001). درمان مبتنی بر شفقت کاهش معنادار بیشتری در اضطراب مرگ نسبت به درمان وجودی ایجاد کرد (MD = 1.79, SE = 0.41, p < 0.001)، در حالی که درمان وجودی افزایش معنادار بیشتری در پذیرش بیماری نسبت به درمان مبتنی بر شفقت داشت (MD = 2.30, SE = 0.46, p < 0.001). این بهبودها در مرحله پیگیری نیز حفظ شد. نتیجه‌گیری: هر دو درمان مبتنی بر شفقت و درمان وجودی در بهبود سازگاری روان‌شناختی بیماران مبتلا به سرطان در مرحله بهبودی مؤثر بودند؛ با این حال، درمان مبتنی بر شفقت در کاهش اضطراب مرگ و درمان وجودی در افزایش پذیرش بیماری اثربخشی بیشتری داشتند.

Purpose: This study aimed to phenomenologically explore clients’ lived experiences of the dialectic between success and failure in psychotherapy, with particular emphasis on interactional patterns, therapeutic alliance, and the relational processes underlying perceived therapeutic effectiveness or rupture. Methods and Materials: This qualitative study employed a descriptive–interpretive phenomenological design. The study population comprised individuals with prior experience of individual psychotherapy. Using purposive sampling with maximum variation in successful, unsuccessful, and ambivalent therapeutic experiences, 18 participants were recruited until experiential and thematic saturation was achieved. Data were collected through in-depth semi-structured interviews focused on clients’ perceptions of therapeutic interactions, relational safety, clinical responsiveness, treatment ruptures, and factors contributing to continuation or discontinuation of therapy. Interviews were transcribed verbatim and analyzed according to Colaizzi’s seven-step phenomenological method. MAXQDA software was used to organize, code, compare, and integrate the qualitative data and facilitate the development of overarching thematic structures. Findings: The analysis indicated that perceived therapeutic success emerged from an interconnected relational configuration characterized by a “liberating secure bond,” flexible clinical competence, unconditional acceptance, and empathic regulation of emotions. These processes strengthened clients’ sense of psychological safety, participation, trust, and agency and facilitated sustained therapeutic engagement. Conversely, perceived therapeutic failure was associated with technical rigidity, excessive dependence on inflexible protocols, authoritarian interactional patterns, and violations of client agency. The convergence of these relational disruptions progressively weakened the therapeutic alliance, intensified emotional exhaustion and alienation, and, in some cases, culminated in disengagement or premature termination. Conclusion: Psychotherapy appears to function fundamentally as an intersubjective encounter in which technical interventions become effective when embedded within clinical humility, relational flexibility, democratic collaboration, empathic responsiveness, and respect for clients’ dignity and autonomy.

هدف: این مطالعه با هدف کاوش پدیدارشناختی تجارب زیسته مراجعان از دیالکتیک میان موفقیت و شکست در روان‌درمانی، با تأکید ویژه بر الگوهای تعاملی، اتحاد درمانی و فرایندهای ارتباطی زیربنایی اثربخشی یا گسست ادراک‌شده درمان انجام شد. روش‌ها و مواد: این پژوهش کیفی با رویکرد پدیدارشناسی توصیفی-تفسیری انجام شد. جامعه پژوهش شامل افرادی بود که تجربه قبلی روان‌درمانی فردی داشتند. با استفاده از نمونه‌گیری هدفمند با حداکثر تنوع در تجارب درمانی موفق، ناموفق و دوسویه، ۱۸ نفر تا رسیدن به اشباع تجربی و تماتیک انتخاب شدند. داده‌ها از طریق مصاحبه‌های نیمه‌ساختاریافته عمیق که بر ادراک مراجعان از تعاملات درمانی، ایمنی رابطه‌ای، پاسخ‌دهی بالینی، گسست‌های درمانی و عوامل مؤثر بر ادامه یا قطع درمان متمرکز بود، گردآوری شد. مصاحبه‌ها به‌صورت کلمه‌به‌کلمه پیاده‌سازی و بر اساس روش هفت‌مرحله‌ای پدیدارشناسی Colaizzi تحلیل شدند. نرم‌افزار MAXQDA برای سازماندهی، کدگذاری، مقایسه و یکپارچه‌سازی داده‌های کیفی و تسهیل توسعه ساختارهای تماتیک کلان به‌کار رفت. یافته‌ها: تحلیل داده‌ها نشان داد که موفقیت ادراک‌شده درمانی از پیکربندی رابطه‌ای درهم‌تنیده‌ای ناشی می‌شود که با «پیوند ایمن رهایی‌بخش»، شایستگی بالینی انعطاف‌پذیر، پذیرش بی‌قیدوشرط و تنظیم همدلانه هیجانات مشخص می‌شود. این فرایندها حس ایمنی روان‌شناختی، مشارکت، اعتماد و عاملیت مراجعان را تقویت کرده و تداوم مشارکت درمانی را تسهیل می‌کنند. در مقابل، شکست ادراک‌شده درمانی با خشکی فنی، اتکای بیش از حد به پروتکل‌های غیرقابل انعطاف، الگوهای تعاملی اقتدارگرایانه و نقض عاملیت مراجع مرتبط بود. همگرایی این اختلالات رابطه‌ای به‌تدریج اتحاد درمانی را تضعیف کرده، فرسودگی هیجانی و بیگانگی را تشدید نموده و در برخی موارد به قطع ارتباط یا پایان زودهنگام درمان منجر شد. نتیجه‌گیری: به نظر می‌رسد روان‌درمانی اساساً به‌مثابه یک مواجهه بین‌ذهنی عمل می‌کند که در آن مداخلات فنی زمانی اثربخش می‌شوند که در بستر فروتنی بالینی، انعطاف‌پذیری رابطه‌ای، همکاری دموکراتیک، پاسخ‌دهی همدلانه و احترام به کرامت و خودمختاری مراجعان قرار گیرند.

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.

ABSTRACT Type 2 diabetes mellitus is a chronic metabolic disease with a rapidly increasing prevalence worldwide and is frequently accompanied by microvascular complications, particularly diabetic neuropathy. Diabetic neuropathy often presents with sensory symptoms such as pain, paresthesia, and numbness, which tend to worsen at night and may interfere with sleep quality. Disturbed sleep in patients with type 2 diabetes mellitus can adversely affect daily functioning, glycemic control, and overall quality of life. However, previous studies examining the relationship between diabetic neuropathy and sleep quality have reported inconsistent findings. This study aims to determine the relationship between the occurrence of diabetic neuropathy and sleep quality among patients with type 2 diabetes mellitus at RS Siti Khodijah Sepanjang. This study employed an analytical observational design with a cross-sectional approach. Data were collected using primary data from questionnaires and secondary data from medical records of patients with type 2 diabetes mellitus. Diabetic neuropathy was assessed based on clinical evaluation, while sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). The findings demonstrate an association between the occurrence of diabetic neuropathy and impaired sleep quality in patients with type 2 diabetes mellitus. Patients experiencing diabetic neuropathy tended to have poorer sleep quality, characterized by prolonged sleep latency, reduced sleep efficiency, increased sleep fragmentation, and shorter sleep duration. Diabetic neuropathy is associated with decreased sleep quality in patients with type 2 diabetes mellitus. These findings highlight the importance of considering sleep quality as part of comprehensive management in patients with diabetic neuropathy to improve overall health outcomes. Keywords: Type 2 Diabetes Mellitus, Diabetic Neuropathy, Sleep Quality, PSQI. ABSTRAK Diabetes melitus tipe 2 merupakan penyakit metabolik kronis dengan prevalensi yang terus meningkat dan sering disertai komplikasi mikrovaskular, salah satunya neuropati diabetik. Neuropati diabetik ditandai dengan gejala sensorik seperti nyeri, kesemutan, kebas, dan rasa terbakar yang umumnya memberat pada malam hari sehingga berpotensi mengganggu kualitas tidur. Gangguan kualitas tidur pada pasien diabetes melitus tipe 2 dapat berdampak negatif terhadap aktivitas harian, kontrol glikemik, dan kualitas hidup. Namun, hasil penelitian sebelumnya mengenai hubungan neuropati diabetik dengan kualitas tidur masih menunjukkan ketidakkonsistenan. Penelitian ini bertujuan untuk mengetahui hubungan antara kejadian neuropati diabetik dengan kualitas tidur pada pasien diabetes melitus tipe 2 di RS Siti Khodijah Sepanjang. Penelitian ini menggunakan desain observasional analitik dengan pendekatan cross-sectional. Data diperoleh dari data primer berupa kuesioner serta data sekunder dari rekam medis pasien diabetes melitus tipe 2. Kejadian neuropati diabetik dinilai melalui evaluasi klinis, sedangkan kualitas tidur diukur menggunakan Pittsburgh Sleep Quality Index (PSQI). Hasil penelitian menunjukkan adanya hubungan antara kejadian neuropati diabetik dengan penurunan kualitas tidur pada pasien diabetes melitus tipe 2. Pasien dengan neuropati diabetik cenderung mengalami kualitas tidur yang lebih buruk, ditandai dengan latensi tidur yang memanjang, efisiensi tidur yang menurun, fragmentasi tidur yang meningkat, serta durasi tidur yang lebih pendek. Terdapat hubungan antara kejadian neuropati diabetik dengan kualitas tidur pada pasien diabetes melitus tipe 2. Oleh karena itu, aspek kualitas tidur perlu dipertimbangkan dalam manajemen komprehensif pasien neuropati diabetik guna meningkatkan luaran kesehatan secara keseluruhan. Kata Kunci: Diabetes Melitus Tipe 2, Neuropati Diabetik, Kualitas Tidur, PSQI.

Health shocks—such as new diagnoses of chronic disease—can disrupt daily life and create potential “teachable moments” for behavioral improvement. Yet, existing evidence on post-diagnosis behavior change remains mixed and largely limited to high-income countries. This study addresses a major empirical gap by examining whether chronic disease diagnoses are associated with measurable within-person changes in health behaviors among middle-aged and older adults in Thailand, a rapidly aging middle-income society. We analyzed four waves (2015–2022) of the Health, Aging, and Retirement in Thailand (HART) survey. The analytic sample comprised adults aged ≥45 years with no baseline diagnosis of cancer, diabetes, or cardiovascular disease (N = 2,891; 9,577 person-wave observations). Self-reported physician-diagnosed conditions were used to construct disease-status indicators. Behavioral outcomes included smoking, current alcohol use, sufficient physical activity (≥150 minutes/week), normal body mass index (BMI) (18.5–23), and waist obesity (sex-specific cutoffs). Individual fixed-effects linear probability models with survey-wave fixed effects and adjustment for time-varying covariates (log income, activities of daily living [ADL] score, and marital status) estimated within-person associations, with standard errors clustered at the individual level. Disease-specific models and models including interactions with sex assessed heterogeneity. In pooled analyses, the disease-status indicator was not significantly associated with smoking, alcohol use, physical activity, BMI, or waist obesity. In contrast, a diabetes diagnosis was associated with a reduction of 3.6 percentage-point in current alcohol use, and both diabetes and cancer diagnoses were associated with reductions in frequent drinking. Models including interactions with sex suggested larger diagnosis-associated reductions in selected alcohol-use outcomes among men, although statistical evidence varied by outcome and disease type. Among middle-aged and older Thai adults, chronic disease diagnoses were associated with selective, rather than comprehensive, changes in health behaviors. Diagnosis alone is insufficient to support changes across multiple health behaviors, underscoring the need for structured post-diagnosis counselling, follow-up, and gender-sensitive secondary prevention in aging middle-income populations.

Abstract Subclinical depression among peacekeeping veterans remains understudied despite its prevalence and potential to progress to major depression. This study examined associations between deployment-related traumatic stressors and subclinical depressive symptoms in 2,258 Finnish peacekeeping veterans. Subclinical depression was measured using the Depression Scale (DEPS) and traumatic stressor exposure via a 16-item questionnaire. Frequent traumatic stressor exposure was associated with an increased risk of subclinical depression, with 5 out of 16 stressors showing significant associations. The strongest predictor was feeling powerless to help sufficiently within one’s role as peacekeeper, suggesting moral injury significantly contributes to the development of subclinical depression. These results highlight the importance of developing post-deployment screening to detect non-danger-based stressors and subclinical conditions that carry the risk of progressing into severe mental health disorders.

Eating disorders are complex mental health conditions that typically develop during adolescence or early adulthood and may have a significant adverse impact on both physical and mental health. The main types of eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder, all of which are characterized by altered eating behaviours and associated health problems (Robatto et al., 2024). Eating disorders may be associated with a range of psychological and somatic complications, including depression, anxiety, cardiovascular and endocrine disorders, as well as an increased risk of mortality (Mushtaq et al., 2023). The effects of these disorders may also manifest in the oral cavity. Therefore, in dental hygiene practice, particular importance should be placed on the early recognition of potential oral health changes, individualized assessment of the patient’s oral health status, and the selection of appropriate preventive measures. Dental hygienists may play an important role not only in the prevention of oral diseases but also in the early recognition of oral manifestations potentially associated with eating disorders and in encouraging patients to seek timely multidisciplinary professional care.

Background: Brief psychological treatment programmes in primary care are increasingly used to address common mental disorders (CMDs), yet patient outcomes remain heterogeneous. Routine symptom measures may help identify patients who are more or less likely to achieve clinically meaningful change and may support treatment planning within stepped-care systems. This study examined associations between baseline depressive and anxiety symptom severity predicted reliable improvement and reliable recovery following brief psychological treatment in a real-world primary care programme. Methods: This secondary analysis used routinely collected data from 512 adults treated in a real-world primary care psychological intervention programme. Participants were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) before and after brief psychological treatment. Baseline demographic and clinical variables, including age, sex, number of sessions, and PHQ-9 and GAD-7 scores, were examined according to reliable improvement and reliable recovery status. Logistic regression analyses examined associations between baseline variables and treatment outcomes. Results: Reliable improvement was observed in 73.6% of participants, whereas 53.3% achieved reliable recovery. Higher baseline anxiety severity was associated with reliable improvement (odds ratio [OR] = 1.16, 95% confidence interval [CI]: 1.08–1.23), whereas lower depressive severity predicted reliable recovery (OR = 0.92, 95% CI: 0.88–0.96). Fewer treatment sessions were associated with both reliable improvement and reliable recovery. Age and sex were not significantly associated with outcomes. Conclusions: Baseline anxiety and depressive symptom severity may be relevant for understanding variability in clinically meaningful outcomes following brief psychological interventions in primary care. Patients presenting with greater depressive symptom burden may benefit from closer monitoring and more intensive or extended treatment pathways within stepped-care models.

Abstract Court-Ordered Treatment (COT) is used to address treatment non-adherence and psychiatric readmission in individuals with serious mental illness (SMI), who are at risk for treatment non-adherence and recurrent psychiatric hospitalization. Evidence regarding clinical outcomes associated with COT remains mixed, partly due to differences in legal frameworks and program implementation. To compare psychiatric readmission, outpatient appointment attendance, and long-acting injectable (LAI) medication adherence during COT and during the year following COT expiration in Arizona’s public behavioral health system. This exploratory, retrospective chart review identified 94 patients placed on COT between 2020 and 2021. Paired within-subject analyses included 29 patients whose COT expired and who completed a full one-year follow-up after COT expiration. Outcomes during COT were compared with outcomes during the year after COT expiration. Among the 29 patients analyzed, psychiatric hospital admission rates rose significantly from 10.3% (3/29) during COT to 34.5% (10/29) post COT expiration ( p = .039). Missed psychiatric appointments increased from 24.1% (7/29) during COT to 37.9% (11/29) after COT expiration, but this change was not statistically significant (p =.219). Among 19 patients with complete LAI follow-up data, 1 missed at least one scheduled LAI dose during COT compared with 4 after COT expiration ( p =.250). In this exploratory cohort, psychiatric readmissions were less frequent during COT than during the year following COT expiration. Both missed outpatient appointments and LAI doses were also more frequent after COT expiration, although these differences were not statistically significant, and the small sample limited the ability to detect meaningful differences. These findings should be interpreted cautiously given the small, selected cohort and retrospective observational design. Larger prospective studies are needed to further evaluate outcomes following COT expiration.

Background: Spouses of persons with psychosis carry a distinct caregiving burden, but Indian studies often group them with other relatives. The study aims to assess anxiety and stress among spouses of persons with psychosis, examine their association with coping and family functioning, and explore differences by gender and marriage duration. Materials and Methods: In this cross-sectional analytical study, 80 spouses (32 men, 48 women) were recruited by purposive sampling at a tertiary psychiatric hospital in Goa. Anxiety and stress were measured with DASS-21 subscales, family functioning with the General Functioning subscale of the McMaster Family Assessment Device (FAD-GF), and coping with a 10-item researcher-constructed questionnaire. Results: Severe or extremely severe anxiety was reported by 95.0% of spouses, while 86.3% had moderate stress. Anxiety (ρ = 0.31, p = 0.005) and stress (ρ = 0.42, p < 0.001) were positively correlated with FAD-GF scores, indicating poorer family functioning with greater psychological distress. Coping scores were negatively correlated with anxiety (ρ = −0.27, p = 0.015) and FAD-GF scores (ρ = −0.30, p = 0.007), indicating that lower coping scores, defined as more frequent and effective coping, were unexpectedly associated with greater anxiety and poorer family functioning. The correlation between coping and stress was not statistically significant (ρ = −0.21, p = 0.062). Women reported higher anxiety than men (p = 0.047). Family functioning differed across marriage-duration groups (p = 0.036), although no pairwise differences remained significant after Bonferroni correction. Conclusion: Severe anxiety was very common among spouses and was associated with poorer family functioning. Because the design is cross-sectional, the sample is small and from one centre, and the coping scale is not validated, the findings show association only. Routine assessment of spouses and family-focused support are indicated. Keywords: Spouses; psychosis; anxiety; stress; coping; family functioning

Background Eating-related behavioural factors may contribute to the complexity of glycaemic management in type 2 diabetes mellitus (T2DM), but their relationships with treatment context remain insufficiently understood. This study examined hedonic hunger and eating-disorder symptom dimensions in relation to glycaemic control across different treatment regimens in adults with T2DM. Methods This cross-sectional study included 203 adults with T2DM attending an outpatient diet clinic in southeastern Turkey between March and September 2025. Participants were receiving oral antidiabetic medication only ( n = 108), insulin only ( n = 32), or combined oral medication plus insulin therapy ( n = 63). Hedonic hunger was assessed using the Power of Food Scale (PFS), and eating-disorder symptom dimensions using the 13-item Eating Disorder Examination Questionnaire–Short Form (EDE-Q-13). Anthropometric measurements, 24-h dietary recall data, fasting plasma glucose (FPG), and glycated haemoglobin (HbA1c) were obtained. Hierarchical linear regression was used to examine factors associated with HbA1c. Results HbA1c differed substantially across treatment groups and was highest in the insulin-only group ( p < 0.001). Several PFS subscales and EDE-Q-13 symptom dimensions also differed between groups, although their effect sizes were small. Selected PFS dimensions were weakly positively correlated with glycaemic indicators, whereas the EDE-Q-13 eating-restraint subscale and total score showed weak inverse correlations with HbA1c. In the fully adjusted model, insulin-only and combination therapy were associated with higher HbA1c compared with oral medication only, while body mass index (BMI) was inversely associated with HbA1c. Neither the PFS food available subscale nor the EDE-Q-13 total score remained independently associated with HbA1c. The final model explained 27.2% of the variance in HbA1c (adjusted r 2 = 0.230). Conclusion Treatment context was more strongly related to glycaemic status than the behavioural measures assessed, although modest differences in hedonic hunger and eating-disorder symptom dimensions were evident across treatment regimens. These findings suggest that eating-related behavioural characteristics may provide complementary information in nutritional assessment and should be interpreted alongside the broader clinical context of T2DM management.

Background: Patients with pulmonary tuberculosis (TB) undergoing treatment may experience poor sleep quality and fatigue, potentially affecting daily activities and quality of life. Objective: This study aimed to examine the relationship between sleep quality and fatigue levels among patients with pulmonary TB undergoing treatment. Methods: This observational analytic study employed a cross-sectional design. The study was conducted in April 2026 at Primary Health Center X, Deli Serdang Regency, Indonesia, involving 21 participants selected through total sampling. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while fatigue was measured using the Fatigue Severity Scale (FSS). Spearman's correlation test was planned with a significance level of α = 0.05. Results: According to the data presented in the manuscript, 14 participants (66.7%) had poor sleep quality, while 7 participants (33.3%) had good sleep quality. Moderate fatigue was the most frequent category, reported in 8 participants (38.1%), followed by severe fatigue in 7 participants (33.3%) and mild fatigue in 6 participants (28.6%). Cross-tabulation indicated that all participants classified as having severe fatigue belonged to the poor sleep quality group. Conclusion: The descriptive findings suggest a tendency toward greater fatigue among patients with poor sleep quality. However, the statistical significance of this relationship remains unconfirmed pending verification of the analysis using individual participant data

Background Stroke is a leading cause of disability worldwide and is frequently accompanied by psychological and functional impairments. Acceptance and Commitment Therapy (ACT), a third-wave behavioral intervention focusing on psychological flexibility, has been increasingly applied in stroke rehabilitation. Although previous reviews have suggested beneficial effects of ACT in stroke patients, whether these benefits persist in the short term after the intervention ends, and the certainty of the evidence, remain unclear. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261325108). Randomized controlled trials evaluating ACT in stroke patients were included. Pooled effects were calculated using random-effects models, with separate analyses for post-intervention and follow-up outcomes. Sources of heterogeneity were explored using subgroup analyses and meta-regression. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE framework. Results Twenty-two RCTs involving 1,975 participants were included. ACT may be associated with reductions in depressive symptoms (post-intervention: SMD = −1.32, 95% CI: −1.80 to −0.84; follow-up: SMD = −0.76, 95% CI: −1.07 to −0.45) and anxiety symptoms (post-intervention: SMD = −1.36, 95% CI: −1.90 to −0.82; follow-up: SMD = −0.51, 95% CI: −1.42 to 0.40, not significant); depressive symptoms remained statistically significant at follow-up. Heterogeneity was considerable for both outcomes at post-intervention ( I 2 = 93.68% for depression and 93.60% for anxiety), so the pooled estimates represent average effects across studies. ACT may also be associated with improvements in psychological flexibility, quality of life, and sleep quality; however, these outcomes were based on a limited number of studies and showed considerable heterogeneity ( I 2 = 74.68 to 92.26%), so they should be interpreted cautiously. However, no statistically significant effects were observed for activities of daily living, neurological function, or hope. ACT did not appear to increase dropout rates in the available studies ( K = 16; RR = 0.99, 95% CI: 0.58–1.69). Meta-regression analyses indicated that intervention duration may not be a significant moderator of treatment effects. The certainty of evidence ranged from very low to moderate, mainly due to risk of bias and inconsistency. Conclusion Acceptance and Commitment Therapy may be a useful adjunctive intervention for improving psychological outcomes in people with stroke. However, evidence for functional recovery remains insufficient. Future high-quality RCTs with standardized protocols, larger samples, and longer follow-up are needed to confirm the long-term effectiveness of ACT. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifer CRD420261325108.

Sleep and circadian disturbances in Alzheimer’s disease (AD) affect patients and caregivers, but clinical action depends on the syndrome, measurement, and outcome under consideration. This narrative review links sleep assessment to indication-based care while distinguishing symptomatic benefit, physiological target engagement, and disease modification. A purposive literature search was supplemented by targeted checks of PubMed-indexed and original publisher records through 4 October 2026. Selected studies are described by population, AD ascertainment, comparator, and measured endpoint rather than assigned formal evidence-certainty grades. Actigraphy characterizes behavioral rest–activity patterns; melatonin timing and temperature rhythms address endogenous circadian physiology under controlled conditions. Polysomnography and quantitative electroencephalography characterize respiratory events, sleep architecture, and oscillatory activity. These measurements inform different questions and do not independently assign AD etiology or cognitive-functional stage. Clinical priorities include confirmed obstructive sleep apnea, cognition-adapted insomnia care, irregular sleep timing, medication-related effects, parasomnias, limb symptoms, and excessive daytime sleepiness. Interpretation incorporates hypoxemia, treatment exposure, comorbidity, caregiver support, and competing diagnoses. Randomized sleep benefits remain distinct from observational cognitive associations or exploratory imaging and cerebrospinal fluid changes. Human and animal studies of arousal circuits, protein dynamics, inflammation, and fluid transport provide mechanistic context, with conflicting results interpreted according to the actual experimental endpoint. The review provides a clinically organized account of selected evidence, not a comprehensive treatment ranking. Sleep care and cognitive-etiologic assessment should proceed in parallel, with follow-up matched to patient function, safety, and the specific treatment goal.

This study evaluated the reliability and validity of a context-aware sleep holistic cycle gate algorithm and explored its potential for artificial intelligence (AI)-based personalized sleep management in digital health-care. A 6-week prospective observational study was conducted in 25 adults aged 20–65 years. Participants recorded daytime activities, eve-ning behaviors, presleep environmental factors, sleep outcomes, and feedback adherence using a mobile application. Five sleep-related indices were calculated, and a context-aware gate algorithm comprising five domains was applied. Reliability was assessed through internal consistency and reproducibility analyses, while validity was examined using correlations with sleep quality indicators and receiver operating characteristic curve analyses. Data completion and adherence rates were 80.3%±9.8% and 72.7%±11.6%, respectively. The sleep readiness index was positively correlated with subjective sleep quality (r=0.53, P<0.01). The algorithm demonstrated moderate predictive performance (area under the curve=0.73), with the environment and presleep gates showing the highest accuracy. Following personalized feedback, sleep onset latency decreased by 12.6%, and perceived sleep quality improved significantly (P<0.05). In conclusions, the context-aware sleep holistic cycle gate algorithm demonstrated acceptable reliability and validity for predicting sleep quality. These findings suggest that the proposed framework may serve as a foundational platform for the development of AI-driven personalized sleep management systems and future digital healthcare applications related to sleep rehabilitation and health promotion.

Background Digital mental health platforms routinely deliver self-administered symptom scales on the assumption that users with more severe symptoms are more likely to enter professional care. That assumption is rarely tested with linked participant-level data, and almost never in the Arabic-speaking Gulf. Objective To examine whether symptom severity at a user’s first self-assessment predicts booking a professional session within 90 days, across four symptom domains, on a Saudi commercial digital mental health platform. Methods Retrospective cohort analysis of 10,100 first assessments — depression, generalized anxiety, panic, and obsessive-compulsive scales — contributed by 5,524 unique users of the Talbinah platform and linked to demographic and session-booking records through a pseudonymous (SHA-256 hashed) user identifier. The primary outcome was any session booked within 90 days after the assessment. Severity was banded by the established cut-offs for the PHQ-9 and GAD-7, and by percentage of scale maximum for the panic and obsessive-compulsive measures, for which no severity thresholds are established. Per-scale multivariable logistic regression estimated adjusted odds ratios (aOR) for severity band (reference None/Minimal), adjusting for age, sex, and device type. Pre-specified sensitivity analyses used 30- and 180-day windows, an attended-session outcome, percentage-of-maximum banding applied to all four scales, and a subset with no prior booking (incident help-seeking). Reporting followed STROBE. Results Users were young (mean age 26.7 years, SD 8.1) and predominantly female (78.1%); 16.6% of first assessments were followed by a booking within 90 days. No severity band on any of the four scales was associated with higher odds of booking (severe vs None/Minimal: depression aOR 0.71, 95% CI 0.51–1.01; generalized anxiety 0.76, 0.49–1.16; panic 0.83, 0.52–1.31; obsessive-compulsive 1.01, 0.59–1.74). One severity contrast was statistically significant, in the opposite direction: moderate depression was associated with lower odds of booking (0.66, 95% CI 0.45–0.97). Older age (aOR ~1.2 per decade) and iOS device use (1.4–2.0) were associated with booking across scales. This absence of a positive severity–booking association was consistent across 30-, 90-, and 180-day windows, the attended-session outcome, and percentage-of-maximum banding; a nominal association for moderate anxiety seen under percentage banding did not persist with validated GAD-7 cut-offs. Estimates for the panic and obsessive-compulsive scales, which lack established severity thresholds, are exploratory. Conclusions On a Saudi digital mental health platform, greater self-reported symptom severity at first assessment was not followed by higher subsequent booking of professional care, consistently across specifications, and for moderate depression was associated with lower odds of booking; demographic and access-related attributes showed stronger associations with booking than symptom load did. Self-screening on its own appears insufficient as a pathway into care.