Explore the vast range of titles available.

Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015;84(2):63–71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. However, only selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and antipsychotics were consistently also associated with persistent post-withdrawal disorders and potential high severity of symptoms, including alterations of clinical course, whereas the distress associated with benzodiazepines discontinuation appears to be short-lived. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.

Antidepressants are commonly prescribed for children and adolescents, but their discontinuation may result in withdrawal symptoms, though rarely described for this age group in the literature. Systematically examining the types and prevalence of withdrawal syndromes in children and adolescents in accordance with PRISMA guidelines is the aim of the present paper. A search of PubMed, Embase, Web of Science, and Cochrane Library was conducted from inception to December 2024. Inclusion criteria were: clinical populations; subjects aged 2–18; antidepressant discontinuation; assessment of withdrawal symptoms; randomized controlled trials (RCTs) or observational studies; rate/type of withdrawal symptoms. A total of 6227 citations were screened, leading to 12 studies, encompassing 690 participants aged 2–18 years, with eight RCTs and four observational studies. The analysis revealed common withdrawal symptoms across various antidepressant classes, predominantly affecting the central nervous and gastrointestinal systems. Symptoms such as nausea (14.6%–22.0%), headache (14.6%–15.0%), diarrhea (10.0%–22.0%), depression (10%), inner tension (44%), anxiety/worry (44%), and cough (33%) were frequently observed, especially after discontinuation of selective serotonin reuptake inhibitors. Such symptoms clustered in new withdrawal symptoms according to a diagnostic classification of withdrawal syndromes at discontinuation of antidepressants used in adults. Withdrawal symptoms and withdrawal syndromes following antidepressant discontinuation in children and adolescents are still neglected but pose significant clinical challenges, often resembling or exacerbating underlying conditions. Future research is needed, as well as a systematic assessment of these symptoms in the clinical realm (registered in OSF DOI: https://doi.org/10.17605/OSF.IO/GYQ9Z). Plain language summary Antidepressants are commonly prescribed for children and adolescents, but their discontinuation may result in withdrawal symptoms. Why was the study done? The clinical phenomenon of withdrawal symptoms after discontinuation of antidepressants has been rarely described in children and adolescents. The scientific literature was reviewed to sum up the available research findings on withdrawal symptoms after discontinuation of antidepressants in children and adolescents. What did the researchers do? The research team analyzed the existing scientific literature and extracted studies on withdrawal symptoms after discontinuation of antidepressants in patients aged 2-18 years. What did the researchers find? A total of 12 studies, encompassing 690 participants aged 2-18 years, were selected and their data were extracted. Based on them, common withdrawal symptoms in children and adolescents were identified, they encompass nausea, diarrhea, headache, anxiety, and cough, among the others. They were frequently observed especially after discontinuation of a specific class of antidepressants, namely Selective Serotonin Reuptake Inhibitors. What do the findings mean? This study identified a group of withdrawal symptoms in need of being evaluated in children and adolescents when they discontinue antidepressants. Clinicians can take advantage of this information in clinical practice to offer a global assessment to their young patients, which should thus include withdrawal symptoms after discontinuation of antidepressants.

Objective: We explored whether medical health workers had more psychosocial problems than nonmedical health workers during the COVID-19 outbreak. Methods: An online survey was run from February 19 to March 6, 2020; a total of 2,182 Chinese subjects participated. Mental health variables were assessed via the Insomnia Severity Index (ISI), the Symptom Check List-revised (SCL-90-R), and the Patient Health Questionnaire-4 (PHQ-4), which included a 2-item anxiety scale and a 2-item depression scale (PHQ-2). Results: Compared with nonmedical health workers (n = 1,255), medical health workers (n = 927) had a higher prevalence of insomnia (38.4 vs. 30.5%, p < 0.01), anxiety (13.0 vs. 8.5%, p < 0.01), depression (12.2 vs. 9.5%; p< 0.04), somatization (1.6 vs. 0.4%; p < 0.01), and obsessive-compulsive symptoms (5.3 vs. 2.2%; p < 0.01). They also had higher total scores of ISI, GAD-2, PHQ-2, and SCL-90-R obsessive-compulsive symptoms (p ≤ 0.01). Among medical health workers, having organic disease was an independent factor for insomnia, anxiety, depression, somatization, and obsessive-compulsive symptoms (p < 0.05 or 0.01). Living in rural areas, being female, and being at risk of contact with COVID-19 patients were the most common risk factors for insomnia, anxiety, obsessive-compulsive symptoms, and depression (p < 0.01 or 0.05). Among nonmedical health workers, having organic disease was a risk factor for insomnia, depression, and obsessive-compulsive symptoms (p < 0.01 or 0.05). Conclusions: During the COVID-19 outbreak, medical health workers had psychosocial problems and risk factors for developing them. They were in need of attention and recovery programs.

Background: Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used in medical practice. Their discontinuation has been associated with a wide range of symptoms. The aim of this paper is to identify the occurrence, frequency, and features of withdrawal symptoms after SNRI discontinuation. Methods: PRISMA guidelines were followed to conduct a systematic review. Electronic databases included PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017. Titles, abstracts, and topics were searched using a combination of the following terms: “duloxetine” OR “venlafaxine” OR “desvenlafaxine” OR “milnacipran” OR “levomilnacipran” OR “SNRI” OR “second generation antidepressant” OR “serotonin norepinephrine reuptake inhibitor” AND “discontinuation” OR “withdrawal” OR “rebound.” Only published trials in the English language were included. Results: Sixty-one reports met the criteria for inclusion. There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports. Withdrawal symptoms occurred after discontinuation of any type of SNRI. The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine. Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering. Late onset and/or a longer persistence of disturbances occurred as well. Conclusions: Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The results of this study challenge the use of SNRI as first-line treatment for mood and anxiety disorders.

Deep brain regions such as hippocampus, insula, and amygdala are involved in neuropsychiatric disorders, including chronic insomnia and depression. Our recent reports showed that transcranial alternating current stimulation (tACS) with a current of 15 mA and a frequency of 77.5 Hz, delivered through a montage of the forehead and both mastoids was safe and effective in intervening chronic insomnia and depression over 8 weeks. However, there is no physical evidence to support whether a large alternating current of 15 mA in tACS can send electrical currents to deep brain tissue in awake humans. Here, we directly recorded local field potentials (LFPs) in the hippocampus, insula and amygdala at different current strengths (1 to 15 mA) in 11 adult patients with drug-resistant epilepsy implanted with stereoelectroencephalography (SEEG) electrodes who received tACS at 77.5 Hz from 1 mA to 15 mA at 77.5 Hz for five minutes at each current for a total of 40 min. For the current of 15 mA at 77.5 Hz, additional 55 min were applied to add up a total of 60 min. Linear regression analysis revealed that the average LFPs for the remaining contacts on both sides of the hippocampus, insula, and amygdala of each patient were statistically associated with the given currents in each patient ( p  < 0.05–0.01), except for the left insula of one subject ( p  = 0.053). Alternating currents greater than 7 mA were required to produce significant differences in LFPs in the three brain regions compared to LFPs at 0 mA ( p  < 0.05). The differences remained significant after adjusting for multiple comparisons ( p  < 0.05). Our study provides direct evidence that the specific tACS procedures are capable of delivering electrical currents to deep brain tissues, opening a realistic avenue for modulating or treating neuropsychiatric disorders associated with hippocampus, insula, and amygdala.

Recent years have seen major developments in psychotherapy research that suggest the need to address critical methodological issues. These recommendations, developed by an international group of researchers, do not replace those for randomized controlled trials, but rather supplement strategies that need to be taken into account when considering psychological treatments. The limitations of traditional taxonomy and assessment methods are outlined, with suggestions for consideration of staging methods. Active psychotherapy control groups are recommended, and adaptive and dismantling study designs offer important opportunities. The treatments that are used, and particularly their specific ingredients, need to be described in detail for both the experimental and the control groups. Assessment should be performed blind before and after treatment and at long-term follow-up. A combination of observer-and self-rated measures is recommended. Side effects of psychotherapy should be evaluated using appropriate methods. Finally, the number of participants who deteriorate after treatment should be noted according to the methods that were used to define response or remission.

Illness representations explain the individual’s perception and processing of health-related information. In a chronic condition such as persistent pain, illness representations might influence treatment adherence and outcome. This study aims to exploratively identify illness representations of patients with chronic pain and their association to mental disorders and subjective distress. 95 participants admitted to an inpatient university clinic were included. Validated instruments were used to assess illness representations (IPQ-R), mental health disorders (PHQ-D), and subjective distress (PSQ). Sociodemographic data and scores for the instruments were first inspected descriptively. Correlation, regression, and mediator analyses were conducted. Analyses indicated that the distributions of the IPQ-R range toward higher values. In regard to mental disorders (PHQ-D) and subjective distress (PSQ), we found several significant correlations with subscales of the IPQ-R. A regression analysis showed the IPQ-R subscales personal control, emotional representation and sex (males) to be significant predictors of subjective distress measured with the PSQ (F (11,86)  = 11.55, p  < .001, adjusted R 2  = 0.545). Depression, anxiety, and stress syndromes (PHQ-D) significantly mediated the positive association between emotional representations (IPQ-R, predictor) and subjective distress (PSQ, outcome) with a total effect of c  = .005, 95% CI [.005; .129]. Illness representations play a significant role in evaluating patients’ subjective distress and mental health. It is advised to incorporate illness representations into standard protocols for psychological interventions to comprehend their influence on targeted therapeutic strategies, particularly those tailored for pain management.

Background The assessment of psychological well-being has been largely neglected in clinical settings, particularly in patients with systemic sclerosis (SSc), where the focus of clinical attention was mainly on symptoms. This is the first study in which the validity, reliability, and sensibility of two patient-reported outcome measures (PROMs) of psychological well-being, the five-item World Health Organization Well-Being Index (WHO-5) and the six-item version of the Ryff’s Psychological Well-Being Scales (PWB-6), have been tested according to clinimetric criteria to determine their current and potential clinical applications in SSc patients. Methods A cross-sectional study was conducted involving 219 patients with a diagnosis of SSc. Rasch and Mokken analyses were performed to assess the clinimetric properties of the two PROMs and determine their clinical utility. Results All items of WHO-5 and PWB-6 fitted the Rasch model, had an optimal scalability, and the dimensionality analyses yielded less than 5% of significant t -tests, thus indicating that the two PROMs were unidimensional measures. Person separation reliability indices revealed acceptable internal consistency and inspection of the person-item distribution map showed that WHO-5 and PWB-6 were reasonably well-targeted for use with SSc patients. Conclusions Findings indicate that WHO-5 and PWB-6 are valid indices of psychological well-being that may provide unique prognostic information and help researchers and clinicians tailor personalized treatment strategies. The two PROMs can be used jointly but for different clinical purposes. WHO-5 is particularly suitable to assess the degree of subjective vitality, a positive feeling of aliveness and energy that may help SSc patients cope with their illness. The PWB-6 can be used to identify unique experiences of psychological well-being that may help SSc patients not only cope with their feelings of loneliness and uncertainty but also experience a meaningful life despite the progression of disease. In clinical research and daily practice, the baseline and follow-up use of WHO-5 and PWB-6 may thus lead to a substantial improvement in the quality of care of patients with SSc. Given the cross-sectional design of the present investigation, future prospective studies are, however, recommended to further assess the predictive validity and prognostic utility of the two PROMs.

Background The care trajectory for patients with Persistent Somatic Symptoms (PSS) is complex due to variability in diagnoses and treatments, with differences across European healthcare systems. Existing findings predominantly come from individual Western European countries, and comparative studies are lacking. This study aimed to explore how healthcare systems are perceived to influence PSS courses across four European countries and how professionals view their respective systems regarding PSS. Methods We used semi-structured interviews to conduct a qualitative study with healthcare professionals from Germany, Italy, the Netherlands, and Poland. Sixteen participants were recruited purposively through international and national networks focusing on PSS, ensuring representation from primary care, secondary care medical specialists, mental health, and other healthcare fields. Results We found that the interaction of structural and interpersonal factors within the healthcare system influenced the course of PSS symptoms. Systemic barriers such as limited consultation times and issues in care pathways or insurance coverage were prevalent in Germany and the Netherlands, while access and trust issues were more prominent in Italy and Poland. Key improvements suggested included reimbursement and treatment eligibility for PSS, establishing collaborative care pathways, and sufficient consultation times. Additionally, enhancing professional-patient relationships and improving education for healthcare professionals and patients were identified as crucial steps. Conclusions The results show that although expertise is improving, current healthcare system structures prevent professionals from using them effectively. Therefore, systemic reforms and better professional training are needed to improve care for patients with PSS.