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RationaleThe regular consumption of very small doses of psychedelic drugs (known as microdosing) has been a source of growing media and community attention in recent years. However, there is currently limited clinical and social research evidence on the potential role of microdosing as therapies for mental and substance use disorders.ObjectivesThis paper examined subjective experiences of microdosing psychedelics to improve mental health or to cease or reduce substance use, and examined sociodemographic and other covariates of perceived improvements in mental health that individuals attributed to microdosing.MethodsAn international online survey was conducted in 2018 and examined people’s experiences of using psychedelics for self-reported therapeutic or enhancement purposes. This paper focuses on 1102 respondents who reported current or past experience of psychedelic microdosing.ResultsTwenty-one percent of respondents reported primarily microdosing as a therapy for depression, 7% for anxiety, 9% for other mental disorders and 2% for substance use cessation or reduction. Forty-four percent of respondents perceived that their mental health was “much better” as a consequence of microdosing. In a multivariate analysis, perceived improvements in mental health from microdosing were associated with a range of variables including gender, education, microdosing duration and motivations, and recent use of larger psychedelic doses.ConclusionsGiven the promising findings of clinical trials of standard psychedelic doses as mental health therapies, clinical microdosing research is needed to determine its potential role in psychiatric treatment, and ongoing social research to better understand the use of microdosing as self-managed mental health and substance use therapies.

Participants from an outpatient treatment program for cognitive disorders have been offered bridging measures because of limited access to the outpatient clinic during a Covid-19-caused lock-down. The aim of this study was to assess perceived stress, acceptance, and appreciation of the measures among patients and their caregivers compared to the previous bridging measure. Forty participants were offered treatment in person or online depending on their cognitive performance level. To evaluate acceptance, data collected from clinical routine was incorporated into a treatment observation. The evaluation of bridging measures by 25 participants was positive. Perceived stress was moderate to high among participants and has increased significantly compared to previous special treatment. Perceived stress in older patients had increased over the course of the pandemic. Bridging measures represented a treatment alternative and may offer previously untapped potential for location-independent psychosocial treatments in order to ameliorate both the patients’ and their caregivers’ convenience.

The reconceptualization of addiction as a neurobiological disease has gained significant traction over recent decades, informed by advances in neuropharmacological and neuroimaging research [...].The reconceptualization of addiction as a neurobiological disease has gained significant traction over recent decades, informed by advances in neuropharmacological and neuroimaging research [...].

Niemann-Pick disease type B (NPD-B) is a rare lysosomal storage disorder characterized by residual activity of acid sphingomyelinase (ASM). While functional inhibitors of ASM (FIASMAs) are widely prescribed as psychotropic medications, they may pose a particular risk to patients with NPD-B by further reducing the already impaired enzymatic function. Here, we report the case of a 20-year-old male with genetically confirmed NPD-B who experienced rapid clinical deterioration following the administration of zuclopenthixol, a drug not previously associated with FIASMA activity. Within 48 hours of treatment initiation, the patient developed profound lethargy and markedly elevated creatine kinase (CK) levels of up to 22,000 U/L, consistent with rhabdomyolysis. Symptoms resolved quickly after discontinuation of zuclopenthixol. In vitro experiments using a radioactive [ 1 4 C]-sphingomyelin assay in Jurkat cells demonstrated that zuclopenthixol dose-dependently inhibited ASM activity by up to 71.5%. Zuclopenthixol had not previously been recognized as a FIASMA and might therefore have been considered a rational choice for treating patients with NPD-B. Our findings challenge this assumption by identifying zuclopenthixol as a potent inhibitor of ASM activity. This novel insight is of high clinical relevance, given the frequent use of antipsychotics in the management of neuropsychiatric symptoms in lysosomal storage disorders. We propose that zuclopenthixol and other potential FIASMAs be carefully re-evaluated for use in this vulnerable patient population.

Background The interactions between unemployment and mental health are complex. However, broad and current epidemiological data about the mental health status of unemployed individuals in Germany are scarce. This study aimed to evaluate the prevalence rates of mental disorders and work ability among all unemployed people who underwent socio-medical assessment by the Federal Employment Agency (FEA). Methods Socio-medical assessments between 2016 and 2021 were taken from the FEA database and analyzed regarding sociodemographic characteristics, mental disorders and work ability. Standard descriptive statistics were used to analyze the data. Results A total of 4,249,028 unemployed individuals were assessed. Of these, 2,213,048 persons (52.1%) had at least one psychiatric diagnosis (mean age 40.6 ± 13.5 years, 51.7% female). Mood disorders (53.9%), neurotic, stress-related and somatoform disorders (43.9%), as well as substance use disorders (15.3%) showed the highest prevalence rates among mental disorders and accounted for about 80% of all psychiatric diagnoses. About 40% of them were evaluated to be able to work full time. Conclusions Psychiatric morbidity among unemployed people is high. However, a significant proportion of them was assessed to be able to return to the labor market. Therefore, close collaborations between unemployment agencies and mental health care institutions as well as specific re-integration programs including supported job placement and vocational training, long-term job coaching as well as integrated mental health care are required in order to improve mental health status, prevent further chronification, avoid labor market exit, and increase employment rate.

Non-pharmacological interventions are increasingly recognized as first-line therapies for managing dementia symptoms alongside pharmacologic strategies. Among these, therapy gardens and horticultural interventions have emerged as promising adjunctive approaches. This pilot study aimed to evaluate the effects of a six-month dementia-friendly therapy garden intervention on psychological well-being, specifically depression levels, and to determine whether baseline dementia severity predicts treatment success. The study was conducted in a real-world setting, with a final sample of 28 dementia patients. Unlike previous studies, this intervention incorporated multimodal stimulation, including sensory, motor, and cognitive elements. Results indicated a significant reduction in depression, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) after six months of intervention ( p  <.05). However, depression scores assessed using the Hamilton Depression Rating Scale (HAM-D) showed only a trend toward improvement but did not reach statistical significance. No improvements were observed at the three-month mark, suggesting that sustained engagement is necessary for measurable benefits. Cognitive function, as assessed by dementia severity, did not show significant improvement, and dementia severity at baseline was not a significant predictor of treatment response. These findings underscore the potential of dementia-friendly therapy gardens to provide meaningful psychological benefits by significantly reducing depression over time. Notably, even individuals with more advanced dementia benefited, challenging the prevailing notion that non-pharmacological interventions are primarily effective in early disease stages. These results highlight the need for further research on the long-term effects and mechanisms underlying garden-based interventions in dementia care.

Background: Sexualized substance use (SSU) describes the use of psychotropic substances in the context of sexual activity. Less is known about the role of sexualized substance use among individuals with substance use disorders (SUD) and its effect on the course of the disorder, e.g., regarding relapses after abstinence. Methods: A convenience sample of individuals undergoing SUD rehabilitation in Germany was surveyed. A questionnaire asked about SSU, sex as a risk factor for relapse, and the importance of sexuality in treatment. Results: N = 490 (30.1% female) participated; 55% of men and 63% of women reported SSU, and 56.5% of heterosexual and 82.9% of homosexual men reported SSU (p < 0.017; r = 0.20). Stimulant users are more likely to report SSU than alcohol (p < 0.001) and sedative users (p < 0.001; r = 0.296 and r = 0.261). Furthermore, 15% of women and 18% of men consider sexual activity a risk factor for relapse; homosexual men (65%) consider it significantly more often than heterosexual men (14%), while 41.2% of heterosexual women and 55% of homosexual women consider it a factor. Additionally, 27.4% of heterosexual and 69.4% identified sexuality as an important topic for therapy, while 19.8% of heterosexual women, 30% of homosexual women, 13.5% of heterosexual men, and 47.2% of homosexual men reported that sexuality had been addressed in their therapy. Conclusions: SSU was reported by individuals with a SUD who were undergoing rehabilitation treatment. Furthermore, patients consider sexual activity as a potential risk factor for relapse, with this being particularly the case for stimulant users. The topic of sexuality is highly important for patients and should, therefore, be given greater consideration in therapy in the future.

Background As 700,000 people per year commit suicide worldwide, improvements in suicide prevention and the prediction of suicide attempts or suicide in clinical care are mandatory. This systematic review aims to examine heart rate (HR) and heart rate variability (HRV) as risk factors for the development of suicidal thoughts and behaviour in clinical and non-clinical populations. Methods and analysis The systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA). We will retrieve relevant literatures across the following databases: PubMed, PsycINFO, Cochrane Library and Web of Science. Additionally, we will manually search the reference lists of all relevant articles. If studies are published or translated in English and measure HRV or HR and suicidal thoughts or behaviour, they will be included. Two reviewers will independently complete the article selection, data extraction and risk of bias ratings. A third reviewer will resolve disagreements. Tabular and narrative synthesis will be done accordingly and a risk of bias assessment will be conducted by the QUIPS (Quality In Prognosis) tool. Discussion This systematic review will present evidence from which conclusions can be made regarding the relationship between HRV and HR and suicidal thoughts and behaviour. By identifying risk factors associated with suicidality and differentiating between factors for suicidal thoughts versus behaviour, this review will potentially contribute theoretically to our understanding of the causal factors involved in influencing increasing levels of suicidality. Ethics and dissemination This is a systematic review of published literature and thereby ethical approval was not sought. Results will be disseminated through conferences and publications in relevant peer-reviewed journals. Strength and limitations of this study The results will have important implications for risk prediction for suicidal thoughts and behaviour. The protocol follows the PRISMA guidelines (Page et al.,BMJ 372:n71,2021). Thus, two reviewers will perform data extraction and risk of bias evaluation separately. We will exclude non-English translated or published studies, which might be a limitation and bias against non-English-speaking countries. Systematic review registration PROSPERO registration number: CRD42023460068

Background: Psychological parameters related to alcohol dependence (AD) affect patients’ behavioral and cognitive control, decision making, impulsivity and inhibitory control. People with AD often have a chronic course with a relapse to dependent substance use even after extensive treatment. This study investigated whether the psychological parameters of patients with AD predict (a) premature termination of treatment, and/or (b) relapse into consumption of alcohol from admission until 6 weeks after discharge from an inpatient rehabilitation treatment. Methods: Participants: Alcohol-dependent patients consecutively admitted for a duration of about three months to inpatient rehabilitation treatment in a hospital specialized in substance use disorders. Craving (OCDS-G) and impulsivity (BIS-11; UPPS) were assessed with computerized questionnaires. Attentional bias and inhibitory control were measured with two computer-based experiments (dot-probe task; stop-signal task (SST)). Investigations were conducted at entry (T1); after 6 weeks (T2); and during the last two weeks of the inpatient treatment (T3). Some N = 128 patients finished the first, N = 102 the second and N = 83 the third assessments. Outcome variables were discontinuation of treatment and abstinence or relapse until follow-up 6 weeks after discharge; participants were contacted via telephone. Results: None of the variables are associated with discontinuation of treatment. Poor inhibitory control (SST) and high craving (OCDS-5) levels, measured at T1, are significantly associated with relapse. Higher impulsivity (UPPS) measured at T2 and T3 is significantly associated with relapse. Exploratory analyses showed that older age, longer inpatient treatment duration and time spent in abstinence before rehabilitation treatment were significantly associated with a reduced risk of relapse. Conclusions: Psychological parameters, craving and impulsivity levels did not predict relapse to a high degree. It is assumed that discontinuation of treatment and relapse may be associated with different issues, such as social context, and individual motivation levels. In contrast, the length of both abstinence before admission and of inpatient treatment were significantly associated with abstinence; it is here suggested that recovery time duration may be an underestimated influencing factor regarding relapse in AD patients.

Background/Objectives: According to a diathesis–stress model for the development of mental illness, it is assumed that, in addition to pre-existing individual vulnerability, the occurrence of acute strains is an etiological factor. The SARS-CoV-2 pandemic was a collective massive stressor, which could predispose to a first manifestation of a mental disorder or the exacerbation of a pre-existing mental disorder. The aim of this study was to investigate the effects of the pandemic on the cohort of patients admitted to hospital during the first year of the pandemic. Methods: Patients admitted to inpatient treatment in a university psychiatric hospital in an urban region from April 2020 to March 2021 were interviewed using a systematic questionnaire assessing individual stress factors in the context of the pandemic. On the basis of the interview, clinical practitioners rated the influence of the pandemic on the admission. Results: Six hundred and forty-five patients were interviewed. Only 6.4% showed a strong influence of the pandemic on inpatient admission. This group was characterized by a comparatively high level of socioeconomic functioning. Additionally, the majority of this group had a pre-existing mental disorder. Conclusions: For the majority of patients, the pandemic had only a minor influence on their hospitalization; only for 6.4% was a high impact of the pandemic reported. We hypothesize that this group’s higher socioeconomic functioning in addition to a pre-existing mental disorder made them vulnerable to pandemic-associated limitations. These data confirm a complex diathesis–stress model for the development of mental illness in the context of an acute collective stressor.