Antonia Ioana Vasile

Background: Medication adherence is a major determinant of treatment effectiveness in psychiatric care and is influenced by patients’ attitudes toward medication and beliefs about treatment. Objective: This study aimed to evaluate medication adherence, drug attitudes, and beliefs about medicines, and to examine their relationships in the study population. Methods: A total of 300 participants were assessed using the Medication Adherence Rating Scale (MARS), Drug Attitude Inventory-10 (DAI-10), and Beliefs about Medicines Questionnaire (BMQ-General and BMQ-Specific). Descriptive statistics, independent-samples t-tests, Pearson correlation analyses, and multiple linear regression were performed. Results: The mean DAI-10 score was 3.57 ± 3.44, indicating an overall positive attitude toward medication, although 27.33% of participants had neutral or negative attitudes. The mean MARS score was 6.27 ± 2.24, suggesting moderate adherence. Mean BMQ-General and BMQ-Specific scores were 21.70 ± 5.81 and 31.64 ± 6.13, respectively. Significant gender differences were found across all scales. DAI-10 was positively correlated with MARS, while BMQ-General was negatively correlated with MARS. Multiple regression showed that DAI-10, BMQ-General, and BMQ-Specific significantly predicted MARS scores, explained 30.8% of variance after adjustment. Conclusions: Medication adherence was moderate and was significantly associated with treatment attitudes and beliefs about medicines. The findings support multidimensional assessment and targeted interventions addressing both positive attitudes and negative medication beliefs.

Background/Objectives: Thyroid dysfunction is frequently associated with mood and anxiety disorders, yet the directionality and diagnostic specificity of this relationship remain debated. Although numerous studies have examined major depressive disorder (MDD) and bipolar disorder (BD) separately, comparative data including generalized anxiety disorder (GAD) and accounting for non-thyroidal illness (NTI) effects remain scarce. This study aimed to evaluate thyroid function and its correlation with affective symptom severity across MDD, GAD, and BD in an inpatient cohort. Methods: Eighty-eight hospitalized patients with MDD, GAD, or BD were included in the study (MDD = 30, GAD = 30, BD = 28). Serum levels of TSH, FT4, and FT3 were measured 24–48 h after admission to minimize the influence of NTI. Psychiatric assessment included the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Scale (HAM-A), and Young Mania Rating Scale (YMRS). Between-group differences were analyzed using ANOVA, and associations between thyroid parameters and symptom severity were examined using correlation and regression analyses. Results: ANOVA revealed that patients with MDD had significantly higher TSH levels compared with those with GAD and BD (p < 0.01). MDD patients also showed a higher prevalence of subclinical hypothyroidism (33.3%) than patients with GAD (13.3%) and BD (7.1%), as well as a higher prevalence of overt hypothyroidism (13.3%) compared with GAD (0%) and BD (7.1%). TSH levels correlated positively with MADRS scores (r = 0.45, p < 0.05) and HAM-A scores (r = 0.38, p < 0.05), particularly within the MDD group. In BD, FT4 and FT3 levels were elevated and positively correlated with YMRS scores (FT4: r = 0.30, p < 0.05; FT3: r = 0.42, p < 0.05). In regression analysis within the MDD subgroup, both hypothyroidism and male sex were independently associated with higher MADRS scores, indicating greater depressive symptom severity. Conclusions: These findings suggest diagnosis-specific patterns of thyroid dysfunction among psychiatric inpatients. Higher TSH levels and increased rates of hypothyroidism were most prominent in MDD and were associated with greater depressive and anxiety symptom severity, whereas elevated FT4 and FT3 levels in BD were associated with manic symptom severity. The results support systematic thyroid screening in depressive admissions, hormone-informed monitoring in bipolar disorder, and a more integrated endocrine–psychiatric approach to clinical care.

Aim: We assumed that patients would present during the pandemic with more advanced, more disseminated, and more symptomatic forms of colon cancer. Materials and methods: We did a retrospective observational study that analyzed the database of the General Surgery Department of a tertiary care center in Romania, analyzing information about the patients from their clinical charts. The study was conducted on 204 patients diagnosed with colon cancer, subdivided into the pre-pandemic group (2019) and the pandemic group (2020). The ages varied between 27 and 95 years old, male and female. We measured: age, gender, year of admission, tumor localization, admission reasons, colon cancer emergencies, post-operative colon cancer complications, endoscopic tumor characteristics, histopathologic result, concomitant colonoscopy finding, presence and sites of metastases, and discharge status. Results: The number of presentations was lower in the pandemic year, but non-significant. During the pandemic, patients presented more with abdominal bloating, infiltrative tumors, multiple metastases, especially peritoneal metastases, indicating a more advanced local disease. As for colon cancer emergencies, inferior digestive hemorrhage occurred more frequently, consistent with more locally aggressive tumor behavior. Conclusions: During the pandemic, more patients presented with more oncologically advanced forms of colon cancer, but the cancer-related in-hospital mortality was not influenced. While the pandemic did not increase overall emergency presentations or short-term mortality, it was associated with delayed diagnosis and a higher burden of locally advanced and metastatic colon cancer at presentation.

Pregnancy is considered a relative contraindication for thrombolysis. Moreover, mechanical thrombectomy should be considered for pregnant patients, as it would be indicated in non‑pregnant patients. The present study describes the clinical case of a 29‑year‑old female full‑term pregnant patient who presented to the emergency room with a sudden onset symptomatology characterized by pronunciation disorder and motor impairment in the right arm with numbness at the same level, and with a National Institutes of Health Stroke Scale score of 7 points. The patient presented in the revascularization window, and the series of acute medical interventions were as follows: Clinical examination, native head computed tomography (CT) scan, emergency cesarean section, CT angiography of the cerebral arteries, and, eventually, mechanical thrombectomy. A brain MRI revealed a hyperintense lesion in diffusion sequence with low apparent diffusion coefficient correspondence at the frontal level of the left side, affecting the middle and precentral gyrus. A transesophageal ultrasound revealed a small patent foramen ovale with a risk of paradoxical embolism score of 8 points. Usual thrombophilia laboratory test results were negative; however, a homozygous methylenetetrahydrofolate reductase gene mutation and a heterozygous positive plasminogen activator inhibitor‑1 gene mutation were detected. On the whole, the present case report emphasizes the importance of evaluating inherited genetic thrombophilia and PFO in young patients suffering a stroke. Moreover, the need for the psychological and psychiatric evaluation for possible reactive depression, anxiety and burnout in young patients suffering a stroke, and particularly in the peripartum period, is highlighted.

Diagnosis in stroke patients is based mainly on clinical and radiological findings; therefore, there is a need for serological markers that can orient the clinician. Copeptin is a new blood marker for diagnosis and prognosis in several neurological conditions, such as ischemic stroke, hemorrhagic stroke, aneurysmal subarachnoid hemorrhage, and multiple sclerosis. The aim of our study was to highlight the diagnostic value of copeptin in differentiating between stroke subtypes and stroke mimics. We performed a literature review by searching the PubMed and Scopus databases for papers with the following keywords: “stroke AND copeptin AND differential”. The PRISMA criteria were used. We identified 29 papers that met the criteria. We analyzed only original research articles, excluding reviews and only including those in English. Some studies did not find any significant differences between cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage, but one study demonstrated significant correlations. All studies agreed that copeptin levels can help in differentiating stroke patients from stroke-free patients. Copeptin levels were correlated with prognostic scales For stroke mimics, copeptin levels were extremely broad and for vestibular disorders; it was shown that a normal level of copeptin excludes stroke. Copeptin is a new blood marker that can help clinicians in the acute neurological field. It may help in diagnosing stroke, in differentiating between stroke subtypes and stroke mimics, and in evaluating the prognosis of these patients, but further studies are needed.

We tried to synthesize the possibilities of predicting the response to clozapine treatment, which can significantly improve the efficacy of the active substance and reduce adverse reactions, and how the active substance acts at the D1 dopaminergic receptors D2, D3, D4, and D5, muscarinic M1, M2, M3, and M5, and the histamine and alpha 1 adrenergic receptor, as well as how it contributes to increased cerebral blood flow, the effect on ribosomal protein S6 function, or the effect on kynurenine 3-monooxygenase function. Clozapine is one of the most effective antipsychotics, and there is potential to improve performance by combining it with different compounds to limit adverse effects or by augmenting it with other antipsychotics (amisulpride, paliperidone), other active substances with different properties (minocycline, N-acetylcysteine, memantine), or alternative therapies (electroconvulsive therapy, repetitive transcranial magnetic stimulation). There are also significant steps in optimizing clozapine efficacy by predicting treatment response, which could be determined by testing the following: plasma levels of clozapine N-oxide and N-desmethylclozapine, serum levels of neurotrophins and glutamate, genetic testing, the polygenic risk score, morphometry, or even the identification and accurate determination of persistent negative symptoms.

Psychomotor agitation is a behavioral and emotional symptom frequently seen in demen-tia patients. Vascular dementia has few options for treating non-cognitive symptoms such as agitation and psychotic symptoms. We present the case of a 71-year-old male who presented in the revascularisation window for confusional syndrome and te-trameric ataxia. The examination revealed: psychomotor agitation, dyscromatopsia, selfdisorientation, temporal and spatial disorientation, complex visual hallucinations with Capgras syndrome, facial agnosia, and akinetopsia. Brain CT revealed top of the basilar artery thrombosis which was treated with mechanical thrombectomy and in-traarterial thrombosis. Brain imaging revealed constitutive lesions in the occipital lobe, parahippocampal, the lingual gyrus, in the paramedian pontine level, and a cerebellar lesion. The patient developed strategic infarct dementia with severe psychomotor agitation. As a therapeutic approach, the heroic combination that diminished the agitation was: Olanzapine and Levomepromazine (two sedative neuroleptics), Valproate (thymostabiliser), and Diazepam. We emphasize the need for heroic treatment options for severe psychomotor agitation and psychotic agitation in patients with cardiovascular risks such as stroke. In this case, we present our beneficial results with Olanzapine and Levomepromazine. We highlight the need for extensive treatment guidelines for se-vere cases of psychomotor agitation.

Introduction: Pro-arginine vasopressin consists of three peptides: arginine-vasopressin, neurophysin II, and copeptin. AVP is released by the neurohypophysis in response to increased plasma osmolality, decreased blood volume and stress. Copeptin has the advantage of being stable ex vivo and easy to measure. New data show the importance of copeptin in ischemic stroke and its complications.Methods: We present a literature review that highlights the importance of copeptin as a biological marker for stroke. We searched the Pubmed and Scopus databases for papers with the following keywords: “stroke AND copeptin.” PRISMA criteria were used.Results: We identified 332 papers that met the criteria. We excluded analyzed reviews, systematic reviews and meta-analyses. 31 articles resulted. The number of patients included in the analyzed studies varied between 18 and 4,302. Copeptin is a marker that associated with clinical stroke severity, infarct volume, short-term and long-term functionality and mortality and adds prognostic value to the previously used scales. It may reflect the effectiveness of revascularization therapy. Copeptin is a biomarker that can help predict post-stroke complications such as: cerebral edema and hemorrhagic transformation.Discussion: Copeptin is a novel and promising biomarker for evaluating cerebrovascular diseases. Because it is considered a non-specific biomarker, it is not yet used routinely and it cannot replace the clinical examination. However, combined with other clinical or paraclinical parameters, it can increase the accuracy of the diagnosis.

Introduction: Strobe training is a form of visual training where the athlete has to practice during intermittently dark conditions. Strobe training improves visual, perceptual, and cognitive skills, which will enhance athletic performance. Strobe training can influence multiple training components in climbing: psychological, tactical, physical, and technical training.Materials and methods: The study was conducted on 17 elite climbers from Romania (10 male and 7 female), representing the entire National Youth Climbing Team. The research group was divided into a control group (n = 8) and an experimental group (n = 9). The used instruments were the Cognitrom battery (for cognitive skills, such as spatial skills and reactivity), the Witty SEM system (for motor-cognitive skills, such as cognitive agility, visual processing speed, and visual memory), and the International Rock Climbing Research Association (IRCRA) performance-related test battery for climbers (climbing-specific motor skills). The experimental group had 20 strobe training sessions, which took place during one calendar year, as an additional session to their climbing schedule done with their principal trainer. The strobe session was once a week, depending on the periodization of the macrocycle (preparatory, competitional, and transition periods). The control group and the experimental group had similar climbing training sessions during the 1-year macrocycle in terms of intensity and volume of their training.Results: Strobe training improved on-sight performance (d = 0.38) and red-point performance (d = 0.36). Strobe training improved the majority of cognitive skills [all spatial skills (d = 1.27 for mental image transformation;d = 1.14 for spatial orientation;d = 1.59 for image generation) and simple reaction time (d = 0.99)]. Strobe training improved all motor-cognitive skills (d = 0.16 for visual memory;d = 1.96 for visual memory errors;d = 1.39 for visual processing speed;d = 1.94 for visual processing errors;d = 1.30 for cognitive agility). Strobe training improved many climbing-specific parameters (flexibility and upper body strength) (d = 0.44 andd = 0.47 for flexibility parameters;d = 0.50 to 0.73 for upper body strength parameters).Discussion: Strobe training is an effective training method for enhancing performance that should be used on more experienced climbers. It acts more on spatial skills, rather than on reactivity skills, developing the visual-motor coordination system. Strobe training has greater effects on climbers aged below 16 years, as youth athletes rely more on visual input compared to adults. The improvement in climbing-specific variables was due to the additional climbing session done weekly. Strobe training acts more on the cognitive component of training than on the motor component of training in climbing.

Electroconvulsive therapy (ECT) is an efficient therapeutic resource for psycho-pharmacotherapeutic resistant forms of depression. ECT is a form of electrical brain stimulation involving the induction of a controlled seizure, clinically similar to an epileptic seizure, that is initiated in the prefrontal region of the brain and spreads to the cortex and subcortex, including the diencephalic structures. This is achieved by creating a transcranial electric field and synchronously depolarizing neuronal membranes. The mechanisms of action of ECT are not yet fully understood, but several hypotheses have been proposed to explain how it affects the brain: neurotransmitter changes, neuroplasticity, network connectivity, endocrine system regulation and changes in regional cerebral blood flow and regional metabolism.