Sanobar Jaka

Background: People living with dementia (PLWD) are at increased risk for medical complications, including urinary tract infections (UTIs), which are often presented atypically with delirium or behavioral changes. These atypical presentations frequently prompt psychiatric consultation and complicated medical management. As the aging population grows, understanding how dementia influences UTI-related outcomes is critical for C-L psychiatrists working at the interface of medicine and psychiatry. Methods: This retrospective cohort study used the 2021 National Inpatient Sample (NIS) to identify adult inpatients with a principal diagnosis of UTI. Patients were stratified by the presence of a comorbid dementia diagnosis. Multivariate logistic and linear regression models adjusted for demographic, clinical, and hospital-level covariates were used to examine associations between dementia and outcomes: in-hospital mortality (primary), length of stay (LOS), hospital charges, and discharge disposition (secondary). Adjusted models included available demographic, socioeconomic, comorbidity, and hospital-level covariates, including age, sex, race/ethnicity, median household income quartile by patient ZIP code, insurance type, Charlson Comorbidity Index, hospital region, urban hospital location, and hospital teaching status. Results: Among 295,494 hospitalizations for UTI, 78,990 (26.7%) involved patients with dementia. Compared to those without dementia, PLWD were significantly older (mean age 82.5 vs. 69.5 years), more likely to be female, and had greater comorbidity burden. Adjusted analyses revealed that dementia was linked to higher odds of in-hospital mortality (aOR: 1.28, 95% CI: 1.03–1.58), longer LOS (+0.93 days, p < 0.01), and increased hospital charges (+$3243.50, p < 0.01). Additionally, PLWD had lower odds of discharge to home (aOR: 0.53) and higher odds of discharge to skilled nursing facilities (aOR: 1.94). Conclusions: Among patients hospitalized with a principal diagnosis of UTI, comorbid dementia was linked with higher in-hospital mortality, longer length of stay, higher hospital charges, and lower likelihood of discharge home. These findings should be interpreted in the context of important limitations of administrative data, including residual confounding and inability to distinguish symptomatic UTI from asymptomatic bacteriuria.

Introduction: This study examined risk factors for schizophrenia spectrum disorder (SSD)-related hospitalization among children, adolescents, and transitional-age-youth (TAY). Methods: A cross-sectional analysis of the nationwide inpatient sample included 618,495 inpatients aged 6–24, divided into SSD and other psychiatric illness cohorts. Results: SSD accounted for 15% of psychiatric hospitalizations. Most SSD inpatients were ages 18–24 (91%), male (68.9%), and identified as Caucasian (37.7%) or African American (35.8%). Higher odds of SSD hospitalization were seen in TAY (OR=17.2), males (OR=2.5), African American (OR=2.8), and Hispanic (OR=2.06) individuals. Stimulant-related disorders (OR=1.36) and epilepsy (OR=1.24) increased risk, especially in children 6–11. Adolescents 12–17, cannabis-related disorders increased SSD hospitalization odds (OR=1.21). Conclusions: Children under 11 are more likely to be hospitalized for SSD due to stimulant-related disorders and epilepsy, while adolescents face higher risks linked to cannabis-related disorders, highlighting the need for targeted inpatient treatment.

Schizophrenia‐spectrum disorders are characterized by psychotic symptoms, including hallucinations, delusions, and disorganized thinking. Schneider’s first‐rank symptoms (FRS)—including thought broadcasting and experiences of external control—are clinically salient but not ergonomic and require careful differential diagnosis. The emergence of new‐onset psychosis in midlife, particularly in individuals without prior psychotic history, warrants a broad biopsychosocial evaluation. We present the case of a 47‐year‐old male with chronic major depressive disorder and complex developmental trauma who developed abrupt FRS‐like phenomena (prominently thought broadcasting) and auditory hallucinations following a period marked by (1) severe pneumonia with lung abscess, (2) escalating anxiety and depressive distress, (3) exposure to substances including reported synthetic cannabinoids (“Spice”) with a urine toxicology positive for amphetamines, and (4) neuromodulation via 20 sessions of transcranial magnetic stimulation (TMS). Concurrently, the patient experienced a severe psychosocial/legal stressor (investigation related to child sexual exploitation material), associated with profound shame and fear. Rather than attributing symptoms to a single trigger, this case highlights a convergence model—medical inflammation, substance toxicity, trauma‐related vulnerability, and acute legal stress—potentially disrupting cerebral homeostasis and precipitating psychosis and suicidality. Treatment included discontinuation of TMS, pharmacologic stabilization, and intensive psychotherapy, with partial remission of psychotic symptoms. There is a need for structured monitoring for emergent psychosis and multidimensional suicide risk in high‐risk patients receiving neuromodulation.

Background: Transcranial magnetic stimulation (TMS) is an emerging noninvasive treatment modality for various psychiatric disorders, but its applications in child and adolescent populations remain underexplored. This review aims to synthesize current evidence on the therapeutic potential of TMS in treating psychiatric conditions within this demographic. Methods: A comprehensive literature search was performed using PubMed and Google Scholar databases to identify studies published up to March 2025 that reported on the use of transcranial TMS in child and adolescent psychiatric disorders. Results: We found 32 published studies that included at least one type of TMS. TMS demonstrates potential as a safe and effective intervention for conditions such as depression, autism spectrum disorder, attention-deficit/hyperactivity disorder, obsessive–compulsive disorder, Tourette Syndrome, and childhood schizophrenia. However, the therapeutic outcomes vary significantly across conditions and protocols. Conclusions: TMS offers a promising, well-tolerated option for addressing psychiatric disorders in children and adolescents, but its application requires careful ethical and clinical consideration. To fully realize its potential, future research should focus on refining protocols, standardizing methodologies, and ensuring safety while expanding its use across diverse psychiatric conditions in younger populations.

Objective: To explore the incidence of alcohol use disorder (AUD) after bariatric surgery and the associated risk factors and specific manifestations of increased AUD risk, such as increased alcohol sensitivity and earlier symptom onset. Methods: This review adhered to PRISMA guidelines. Data were sourced from PubMed, Google Scholar, Cochrane, and Science.gov using search terms related to alcohol, bariatric surgery, and nutrition. Articles were screened based on inclusion and exclusion criteria: Inclusion criteria were English language articles published from 2013–present, availability in full text or open access, and adult patients (≥18 years) who had bariatric surgery. Exclusion criteria were non-English articles, articles written before 2013, unavailable full text or open access, articles that featured pediatric patients or patients who did not use alcohol or had bariatric surgery, and abstracts or opinion pieces. A final total of 11 studies were found. Data Extraction: Studies published from 2013 to the present that involved adult bariatric surgery patients with a history of alcohol consumption. Results: Findings suggest an elevated risk of AUD post-bariatric surgery, particularly following sleeve gastrectomy or Roux-en-Y gastric bypass surgery. There was strong evidence of increased alcohol sensitivity and AUD symptoms post-surgery, causing potential health effects. Conclusions: These results underscore the importance of comprehensive preoperative assessments and tailored interventions for bariatric surgery patients with AUD.

Background: The primary goal of our study is to assess the national US prevalence of autism spectrum disorder (ASD), along with its socio-demographic characteristics, severity, and co-occurring medical and psychiatric disorders, using data from the 2020–2021 National Survey of Children’s Health (NSCH). Methods: We analyzed 2020–2021 NSCH data to estimate the prevalence of ever-diagnosed and current ASD among 79,182 children and adolescents (3–17 years). Univariate and multivariate regression models were used to examine associations between medical and psychiatric co-morbidities, socio-demographic factors, and ASD severity. Results: Adolescents (11–17 years) and males were more likely to have ASD, with males comprising 78.7% of the ASD group. The mean age of the sample was 10.1 ± 4.6 years, and 3.2% had an ASD diagnosis. Children from lower-income households and those with caregivers who completed only a high school education were more likely to have ASD. Nearly 96.4% of children with ASD had at least one co-morbid condition. The most common neuropsychiatric co-morbidities were developmental delay (64%), behavioral and conduct problems (57.8%), and anxiety disorder (45.7%), while the most common medical conditions were allergies (32.4%), genetic disorders (26.2%), and asthma (12.6%). Gender disparities in ASD presentation were evident that females with ASD were more likely to experience vision problems, cerebral palsy, epilepsy, depression, and intellectual disability but had lower odds of ADHD and anxiety problems. Greater ASD severity was linked to higher odds of intellectual disability (OR: 5.8, p < 0.001), developmental delay (OR: 5.0, p < 0.001), epilepsy, Down syndrome (OR: 3.4, p < 0.001), vision problems (OR: 2.5, p < 0.001), and genetic disorders (OR: 2.3, p < 0.001). Conclusions: This study provides updated prevalence estimates of ASD and highlights the high burden of co-morbidities, emphasizing the need for comprehensive, multidisciplinary approaches in ASD management. Additionally, our findings emphasize gender differences in ASD presentation, which should be considered in future research and clinical practice to ensure more tailored diagnostic and intervention strategies.

Background: Tourette syndrome is a neurodevelopmental disorder characterized by multiple motor and vocal tics. Although Tourette syndrome is known to have various comorbidities, comprehensive data on its prevalence and associated conditions in a large, diverse population are limited. This study aimed to examine the prevalence of Tourette syndrome and its comorbidities in children aged 3 to 17 years using data from the 2021 National Survey of Children’s Health (NSCH). Methods: Data from 79,236 children aged 3–17 years were analyzed. The prevalence of Tourette syndrome was assessed, and its association with socio-demographic factors and comorbid conditions, including prematurity and low birth weight, was examined using univariate and multivariate logistic regression models. Results: The prevalence of Tourette syndrome was 0.3% among children aged 3–17 years, with higher rates in males (74%) and adolescents aged 11–17 years (74%). Prematurity and low birth weight were associated with higher rates of Tourette syndrome and its comorbidities. Neurodevelopmental conditions such as ADHD (49% in Tourette syndrome vs. 10.2% in non-Tourette syndrome), autism spectrum disorder (21% vs. 3.2%), and learning disabilities were significantly more prevalent among children with Tourette syndrome. Similarly, psychiatric disorders such as anxiety (60% vs. 11.3%) and depression (25% vs. 5%) were more common in the Tourette syndrome group. Immune-based conditions, including asthma and allergies, and physical health conditions such as diabetes and vision or hearing problems, were also significantly associated with TS. Conclusions: The study highlights the significant burden of comorbidities in children with Tourette syndrome, emphasizing the need for early diagnosis and comprehensive management strategies to address the multifaceted challenges faced by these children.

The Brazilian Journal of Psychiatry is the official publication of Brazilian Psychiatric Association (Associação Brasileira de Psiquiatria - ABP)

BACKGROUND Digital therapeutics (DTx), falling under the umbrella of Software as a Medical Device (SaMD), have swiftly progressed in tandem with broader technological innovations in healthcare. However, despite their increasing adoption in psychiatric treatment, there exists a notable research gap regarding a comprehensive evaluation of their regulatory frameworks, integration into healthcare systems, and clinical efficacy, especially concerning behavioral health conditions such as substance use disorders (SUD), insomnia, panic disorder, attention deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD). Rapid technological and regulatory changes further challenge the alignment of research with clinical practices. This study seeks to address this gap by thoroughly evaluating Food and Drug Administration (FDA) approved DTx, analyzing their clinical performance, regulatory adherence, and integration with traditional pharmacotherapy, and considering their potential to transform future psychiatric treatments. OBJECTIVE This study addresses the gap created by rapid technological and regulatory changes that challenge the alignment of research with clinical practices by thoroughly evaluating FDA-approved DTx, analyzing their clinical performance, regulatory compliance, and integration with traditional pharmacotherapy, and exploring their potential to transform future psychiatric treatments. METHODS A comprehensive review was conducted using key medical databases including PubMed, SCOPUS, Embase, and Web of Science, covering articles published up to January 2024. Search terms such as "digital therapeutics," "FDA-approved," and specific condition names (e.g., "ADHD," "SUD") were used. Exclusion criteria included non-English articles, studies without empirical data, and articles focusing solely on non-FDA-approved therapeutics. Sources like the FDA and the Digital Therapeutics Alliance were also consulted to focus on FDA-cleared digital therapeutics for behavioral health conditions. We evaluated these therapeutics' regulatory approvals, clinical outcomes, and healthcare integration, analyzing their effectiveness and limitations against traditional pharmacotherapy. RESULTS The analysis of nine different FDA-cleared digital therapeutics highlighted multiple benefits of DTx, including better treatment accessibility and the potential to reduce healthcare costs. For example, Somryst, a therapy grounded in Cognitive Behavioral Therapy (CBT) principles and designed for chronic insomnia, has demonstrated significant effectiveness; over 40% of its users have overcome chronic insomnia, and more than 60% experienced meaningful improvements without adverse events. However, digital therapeutics also face challenges such as limited provider adoption, inadequate insurance coverage, and high attrition rates among users. A study on internet-based CBT for depression found only 10.6% of participants fully engaged with the program, and a meta-analysis of mobile apps for depression revealed a corrected dropout rate of 47.8%. These findings indicate that while DTx show promise in improving certain clinical outcomes, they also exhibit discrepancies in effectiveness compared to traditional pharmacotherapy, particularly in more severe cases. CONCLUSIONS DTx show promise to enhance treatment accessibility and reduce associated risks, yet they face significant challenges including rigorous regulatory oversight, the development of comprehensive reimbursement models, and the imperative for solid clinical evidence. To facilitate mainstream integration, a concerted collaboration is necessary among developers, healthcare providers, regulators, and payers. The success of DTx and prescription digital therapeutics (PDTs) will ultimately hinge on their ability to demonstrate value convincingly, ensure patient safety, and integrate seamlessly into the existing healthcare ecosystem, thereby reshaping the treatment landscape for mental and behavioral health in the digital age.

Objective: Our study aims to examine the risk factors for comorbid psychosis in pediatric patients hospitalized for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and its impact on hospital outcomes. Methods: We conducted a cross-sectional study using the nationwide inpatient sample (NIS 2018–2019). We included 3,405 pediatric inpatients (age 6–17 years) with a primary discharge diagnosis of anti-NMDAR encephalitis. We used binomial logistic regression model to evaluate the odds ratio (OR) of variables (demographic and comorbidities) associated with comorbid psychosis. Results: The prevalence of comorbid psychosis in anti-NMDAR encephalitis inpatients was 5.3%, and majorly constituted of adolescents (72.2%) and females (58.3%). In terms of race, Blacks (OR 2.41), and Hispanics (OR 1.80) had a higher risk of comorbid psychosis compared to Whites. Among comorbidities, encephalitis inpatients with depressive disorders (OR 4.60), sleep-wake disorders (OR 3.16), anxiety disorders (OR 2.11), neurodevelopmental disorders (OR 1.95), and disruptive behavior disorders (OR 2.15) had a higher risk of comorbid psychosis. Anti-NMDAR encephalitis inpatients with comorbid psychosis had a longer median length of stay at 24.6 days (vs. 9.8 days) and higher median charges at $262,796 (vs. $135,323) compared to those without psychotic presentation. Conclusion: Adolescents, females, and Blacks with encephalitis have a higher risk of psychotic presentation leading to hospitalization for anti-NMDAR encephalitis. Identification of demographic predictors and comorbidities can aid in early recognition and intervention to optimize care and potentially reduce the healthcare burden.