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Patients with implantable cardioverter-defibrillators (ICDs) are vulnerable to psychological distress, including posttraumatic stress disorder (PTSD). Impaired sleep is a hallmark of PTSD, and may also act as a risk factor that maintains or exacerbates PTSD, yet this relationship has not been examined in ICD recipients across different ages. We assessed 422 patients with ICD or cardiac resynchronisation therapy with defibrillator (CRT-D) who completed the Pittsburgh sleep quality index (PSQI) and post-traumatic diagnostic scale (PDS). 44.2% of patients showed impaired sleep (PSQI > 5). A multiple linear regression model showed that poorer sleep was associated with greater PTSD severity, and this association weakened with increasing age (interaction β = − 0.002, 95% CI [− 0.004, − 0.001], p  = 0.008), indicating stronger effects in younger patients. Exploratory component analyses identified daytime dysfunction (β = 0.351, 95% CI [0.212, 0.490], p  < 0.001) and sleep disturbance (β = 0.345, 95% CI [0.126, 0.564], p  = 0.002) as the components most strongly linked to PTSD symptoms. These findings support that routine sleep screening is an important component of comprehensive ICD care, identifying clinically relevant sleep disturbance associated with PTSD symptom severity and underscoring sleep as a meaningful and modifiable treatment target.

•Putamen vessel distance mapping via high-resolution 7T ToF angiography.•Higher CSVD severity predicts increased mean vessel distance in putamen.•Greater vessel distance associates with prolonged arterial transit time.•Right-putamen vessel distance associates with lower global cognitive performance. In cerebral small vessel disease (CSVD), compromised arterial supply to the deep gray matter contributes to cognitive decline. While CSVD frequently involves lenticulostriate arteries supplying the putamen, the functional consequences of altered putaminal vascular architecture remain unclear. We hypothesized that a less homogeneous arterial network in the putamen is associated with impaired perfusion and worse cognitive performance in CSVD. We enrolled 16 CSVD patients with cerebral microbleeds and 21 age‑matched controls (mean age 71 years; 38 % female). High-resolution 7 T time‑of‑flight angiography was used to segment all visible intraputaminal vessels. For each voxel in the putamen, the distance to its nearest segmented vessel was computed to generate a vessel distance map; the mean vessel distance reflects the homogeneity of the arterial network. Putaminal perfusion was quantified via multi‑inversion time pulsed arterial spin labeling (ASL) at 3 T, and CSVD severity was scored on clinical 3 T MRI. All participants completed a comprehensive neuropsychological battery to derive a global cognition composite score. Linear regression revealed that higher CSVD MRI scores predicted larger mean vessel distance, reflecting a sparser arterial network, in both the right (B = 0.12, β = 0.42, p = 0.010) and left putamen (B = 0.13, β = 0.43, p = 0.014). Across all participants, increased vessel distance was also associated with prolonged arterial transit time in the right (B = 0.044, β = 0.50, p = 0.009) and left putamen (B = 0.042, β = 0.49, p = 0.009). Finally, in a multivariable linear regression adjusting for demographics, vascular risk factors, and CSVD severity, greater vessel distance in the right putamen was associated with lower global cognitive performance (B = –1.26, β = –0.34, p = 0.012). This study demonstrates the impact of an impaired arterial network in the putamen on blood supply and cognitive function across the continuum of CSVD.

Illness perceptions (IP), as measured by the Brief Illness Perception Questionnaire (BIPQ), and adverse childhood experiences (ACE) have been shown to affect the physical and psychological well-being in different patient populations. However, little is known about IP and ACE in patients with an implantable cardioverter-defibrillator (ICD). Our objectives were to investigate the dimensional structure and to evaluate correlates of the BIPQ in ICD patients. 423 patients with an ICD were prospectively recruited. We conducted a principal component analysis to determine the dimensional structure of the BIPQ. Associations between ACE, other sociodemographic and clinical variables, and IP were analysed using a multivariable linear regression. We identified a two-factor structure (I = Consequences, II = Control) of the BIPQ. Among others, a higher number of ICD shocks in the past (0.21, 95% CI = 0.01–0.41, p = 0.036), low physical activity (-2.16, 95% CI = -4.37 to -0.37, p = 0.045), more frequent ACE (0.56, 95% CI = 0.08–1.22, p = 0.030), ICD shock-related concerns (0.75, 95% CI 0.62–0.89, p < 0.001), and primary ICD indication (-2.29, 95% CI -4.47 to -0.11, p = 0.039) were significantly associated with more threatening IP. The identification of those variables might lead to more precise interventions targeting maladaptive IP in this vulnerable patient population.

Inferior frontal sulcal hyperintensities (IFSH) observed on fluid-attenuated inversion recovery (FLAIR) MRI have been proposed as indicators of elevated cerebrospinal fluid waste accumulation in cerebral small vessel disease (CSVD). However, to validate IFSH as a reliable imaging biomarker, further replication studies are required. The objective of this study was to investigate associations between IFSH and CSVD, and their potential repercussions, i.e., cognitive impairment and depression. We prospectively recruited 47 patients with CSVD and 29 cognitively normal controls (NC). IFSH were rated visually based on FLAIR MRI. Using different regression models, we explored the relationship between IFSH, group status (CSVD vs. NC), CSVD severity assessed with MRI, cognitive function, and symptoms of depression. Patients with CSVD were more likely to have higher IFSH scores compared to NC (OR 5.64, 95% CI 1.91–16.60), and greater CSVD severity on MRI predicted more severe IFSH (OR 1.47, 95% CI 1.14–1.88). Higher IFSH scores were associated with lower cognitive function (-0.96, 95% CI -1.81 to -0.10), and higher levels of depression (0.33, 95% CI 0.01–0.65). CSVD and IFSH may be tightly linked to each other, and the accumulation of waste products, indicated by IFSH, could have detrimental effects on cognitive function and symptoms of depression.

Background: Polyneuropathies (PNP) are a broad field of diseases affecting millions of people. While the symptoms presented are mostly similar, underlying causes are abundant. Thus, early identification of treatable causes is often difficult. Besides clinical data and basic laboratory findings, nerve conduction studies are crucial for etiological classification, yet limited. Besides Magnetic Resonance Imaging (MRI), high-resolution nerve ultrasound (HRUS) has become a noninvasive, fast, economic and available tool to help distinguish different types of nerve alterations in neuropathies. Methods: We aim to describe typical ultrasound findings in PNP and patterns of morphological changes in hereditary, immune-mediated, diabetic, metabolic and neurodegenerative PNP. Literature research was performed in PubMed using the terms ‘nerve ultrasound’, neuromuscular ultrasound, high-resolution nerve ultrasound, peripheral nerves, nerve enlargement, demyelinating, hereditary, polyneuropathies, hypertrophy’. Results: Plenty of studies over the past 20 years investigated the value of nerve ultrasound in different neuropathies. Next to nerve enlargement, patterns of nerve enlargement, echointensity, vascularization and elastography have been evaluated for diagnostic terms. Furthermore, different scores have been developed to distinguish different etiologies of PNP. Conclusions: Where morphological alterations of the nerves reflect underlying pathologies, early nerve ultrasound might enable a timely start of available treatment and also facilitate follow up of therapy success.

Background While several studies in cerebral amyloid angiopathy (CAA) focus on cognitive function, data on neuropsychiatric symptoms (NPS) and lifelong mental activities in these patients are scarce. Since NPS are associated with functional impairment, faster cognitive decline and faster progression to death, replication studies in more diverse settings and samples are warranted. Methods We prospectively recruited n  = 69 CAA patients and n  = 18 cognitively normal controls (NC). The number and severity of NPS were assessed using the Alzheimer’s Disease (AD) Assessment Scale’s (ADAS) noncognitive subscale. We applied different regression models exploring associations between NPS number or severity and group status (CAA vs. NC), CAA severity assessed with magnetic resonance imaging (MRI) or cognitive function (Mini-Mental State Examination (MMSE), ADAS cognitive subscale), adjusting for age, sex, years of education, arterial hypertension, AD pathology, and apolipoprotein E status. Mediation analyses were performed to test indirect effects of lifelong mental activities on CAA severity and NPS. Results Patients with CAA had 4.86 times (95% CI 2.20-10.73) more NPS and 3.56 units (95% CI 1.94–5.19) higher expected NPS severity than NC. Higher total CAA severity on MRI predicted 1.14 times (95% CI 1.01.-1.27) more NPS and 0.57 units (95% CI 0.19–0.95) higher expected NPS severity. More severe white matter hyperintensities were associated with 1.21 times more NPS (95% CI 1.05–1.39) and 0.63 units (95% CI 0.19–1.08) more severe NPS. NPS number (MMSE mean difference − 1.15, 95% CI -1.67 to -0.63; ADAS cognitive mean difference 1.91, 95% CI 1.26–2.56) and severity (MMSE − 0.55, 95% CI -0.80 to -0.30; ADAS cognitive mean difference 0.89, 95% CI 0.57–1.21) predicted lower cognitive function. Greater lifelong mental activities partially mediated the relationship between CAA severity and NPS (indirect effect 0.05, 95% CI 0.0007-0.13), and greater lifelong mental activities led to less pronounced CAA severity and thus to less NPS (indirect effect − 0.08, 95% CI -0.22 to -0.002). Discussion This study suggests that NPS are common in CAA, and that this relationship may be driven by CAA severity. Furthermore, NPS seem to be tied to lower cognitive function. However, lifelong mental activities might mitigate the impact of NPS in CAA.

Background: Psycho-oncological support (PO) is an effective measure to reduce distress and improve the quality of life in patients with cancer. Currently, there are only a few studies investigating the (expressed) wish for PO. The aim of this study was to evaluate the number of patients who request PO and to identify predictors for the wish for PO. Methods: Data from 3063 cancer patients who had been diagnosed and treated at a Comprehensive Cancer Center between 2011 and 2019 were analyzed retrospectively. Potential predictors for the wish for PO were identified using logistic regression. As a novelty, a Back Propagation Neural Network (BPNN) was applied to establish a prediction model for the wish for PO. Results: In total, 1752 patients (57.19%) had a distress score above the cut-off and 14.59% expressed the wish for PO. Patients’ requests for pastoral care (OR = 13.1) and social services support (OR = 5.4) were the strongest predictors of the wish for PO. Patients of the female sex or who had a current psychiatric diagnosis, opioid treatment and malignant neoplasms of the skin and the hematopoietic system also predicted the wish for PO, while malignant neoplasms of digestive organs and older age negatively predicted the wish for PO. These nine significant predictors were used as input variables for the BPNN model. BPNN computations indicated that a three-layer network with eight neurons in the hidden layer is the most precise prediction model. Discussion: Our results suggest that the identification of predictors for the wish for PO might foster PO referrals and help cancer patients reduce barriers to expressing their wish for PO. Furthermore, the final BPNN prediction model demonstrates a high level of discrimination and might be easily implemented in the hospital information system.

Inferior frontal sulcal hyperintensities (IFSHs) on fluid-attenuated inversion recovery (FLAIR) sequences have been proposed to be indicative of glymphatic dysfunction. Replication studies in large and diverse samples are nonetheless needed to confirm them as an imaging biomarker. We investigated whether IFSHs were tied to Alzheimer’s disease (AD) pathology and cognitive performance. We used data from 361 participants along the AD continuum, who were enrolled in the multicentre DELCODE study. The IFSHs were rated visually based on FLAIR magnetic resonance imaging. We performed ordinal regression to examine the relationship between the IFSHs and cerebrospinal fluid-derived amyloid positivity and tau positivity (Aβ42/40 ratio ≤ 0.08; pTau181 ≥ 73.65 pg/mL) and linear regression to examine the relationship between cognitive performance (i.e., Mini-Mental State Examination and global cognitive and domain-specific performance) and the IFSHs. We controlled the models for age, sex, years of education, and history of hypertension. The IFSH scores were higher in those participants with amyloid positivity (OR: 1.95, 95% CI: 1.05–3.59) but not tau positivity (OR: 1.12, 95% CI: 0.57–2.18). The IFSH scores were higher in older participants (OR: 1.05, 95% CI: 1.00–1.10) and lower in males compared to females (OR: 0.44, 95% CI: 0.26–0.76). We did not find sufficient evidence linking the IFSH scores with cognitive performance after correcting for demographics and AD biomarker positivity. IFSHs may reflect the aberrant accumulation of amyloid β beyond age.

Schizophrenia spectrum disorders (SSD) are associated with increased risks of criminal behavior, especially if mediated by factors such as substance use. However, it remains unclear whether these factors retain their predictive relevance once broader social and systemic conditions are considered. To date, comparisons between forensic (FPP) and general psychiatric (GPP) SSD patients that systematically test the weight of these factors in complex contexts are scarce. We sought to evaluate whether established clinical risk factors for criminal behavior hold explanatory power once embedded in wider contextual frameworks. Group membership was used as a proxy for such forensic trajectories. A retrospective study was conducted using data from 740 patients (370 FPP, 370 GPP) diagnosed with SSD receiving treatment at one institution in Switzerland. Several machine learning algorithms were tested. Gradient Boosting emerged as the most suitable model. Performance metrics such as balanced accuracy, area under the curve (AUC), sensitivity, and specificity were used for model evaluation. Key predictive variables were ranked based on their influence. Gradient Boosting achieved a balanced accuracy of 77.5% and an AUC of 0.85 (analysis excluding item 'olanzapine-equivalent dose at discharge', which was identified as a potential downstream marker of institutional placement; primary model with all items: 81.6% and 0.88, respectively), outperforming other algorithms in discriminating between the groups. Notable predictors of a forensic-psychiatric course included social isolation across life span and limited mental health care system integration, while psychopathology did not emerge as a relevant predictor. When comprehensively comparing forensic and general psychiatric SSD patients, social isolation, antipsychotic dosage, and mental health system integration emerge as the primary discriminators, overshadowing well established risk factors. Preventing forensic pathways in SSD requires strengthening social networks and system integration, marking a paradigm shift away from symptom-centered risk models. •Patients with Schizophrenia spectrum disorder might engage in criminal behavior.•Psychopathology is insufficient to explain the differences of forensic patients.•Machine learning revealed system integration as the key differentiating factor.•Clinical implications extend beyond symptom control to health system integration.

Empirical evidence on psychological factors associated with somatic symptom disorder (SSD) is scarce so far, but could provide a better understanding of the psychological embeddedness of SSD. The current study targeted this research gap. This cross-sectional study included 1536 participants of an inpatient psychosomatic unit between 2018 and 2024. A set of different self-report questionnaires was applied to evaluate SSD, depression and anxiety, narcissism, alexithymia, overcommitment, effort-reward imbalance (ERI), and burnout. A hierarchical multivariable binary logistic regression, applying a multiple imputation (MI) model considering missing data and a complete case model, was used to analyse associations between positive SSD screening and these psychological factors. Complementary analyses were conducted to further assess associations with the self-report questionnaires' subscales. 547 (35.6%) participants indicated a diagnosis of SSD. In the final MI model, alexithymia (OR 1.02, 95% CI 1.01–1.03), narcissism (1.06, 1.03–1.08), and ERI (1.76, 1.10–2.82) were significantly associated with a higher risk for positive SSD screening. Complementary analyses revealed significant associations with the alexithymia subscales difficulty identifying feelings (1.08, 1.01–1.15) and difficulty describing feelings (0.96, 0.92–0.99), the narcissism subscales threatened self (0.97, 0.94–0.99) and hypochondriac self (1.25, 1.15–1.35), and the burnout subscales emotional exhaustion (1.07, 1.01–1.13) and cynicism (0.94, 0.90–0.98). Positive SSD screening was common in the observed population. Future studies may strive to unravel the mechanisms linking SSD potentially with alexithymia, narcissism, ERI, and burnout. A deeper understanding of the relationship between these psychological factors' subscales and SSD might be a key element in this endeavour. •547 (35.6%) participants indicated a diagnosis of somatic symptom disorder (SSD).•Personality traits and work-related stress were linked to positive SSD screening.•These findings could improve diagnosis and treatment in individuals at risk for SSD.