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Opioid use disorder (OUD) has reached epidemic proportions, with many countries facing high levels of opioid use and related fatalities. Although currently prescribed medications for OUD are considered lifesaving, they inadequately address negative affect and cognitive impairment, resulting in high relapse rates to nonmedical opioid use even years after drug cessation (protracted abstinence). Evidence supports the notion that ketamine, an anesthetic and rapid-acting antidepressant drug, holds promise as a candidate for OUD treatment, including the management of acute withdrawal somatic symptoms, negative affect during protracted opioid abstinence, and prevention of retaking nonmedical opioids. In this review, we comprehensively discuss preclinical and clinical research that has evaluated ketamine and its metabolites as potential novel therapeutic strategies for treating OUD. Furthermore, we examine evidence that supports the relevance of the molecular targets of ketamine and its metabolites in relation to their potential effects and therapeutic outcomes in OUD. Overall, existing evidence demonstrates that ketamine and its metabolites can effectively modulate pathophysiological processes affected in OUD, suggesting a promising therapeutic role in the treatment of OUD and the prevention of return to opioid use during abstinence.

Background: Pedophilia remains a challenging area of study due to its sensitive nature and the ethical considerations surrounding research involving individuals with deviant sexual interests.

Objective: The aim of this review was to systematically explore and present the current research status on biomarkers in pedophilia. The focus was on biomarkers that may support the diagnostic process, treatment evaluation and assessment of risk and recidivism of pedophilia.

Methods: Based on literature searches [MEDLINE, EMBASE, Scopus, APA PsycNet, Google Scholar], a scoping review was applied between January and March 2024, including studies in adults diagnosed with pedophilia, published within the last decade.

Results: A total of 39 studies were included in the study sample. These encompassed only male participants. Biomarkers associated with pedophilia were identified and categorized as following: genetic/epigenetic and neuroendocrinal, physiological, cognitive/behavioral, and neuroimaging/neurofunctional. Results indicated the presence of cognitive deficits or impairments, especially in memory and executive functions, significant structural and functional brain differences in neuroimaging, with evidence of altered connectivity, volume reductions, and abnormal brain activation patterns. Physiological biomarkers revealed altered physical traits, attentional control, and sexual arousal patterns in pedophilia, with neural responses suggesting dysfunction in prefrontal cortex and error processing areas. Lastly, genetic and neuroendocrine studies suggested a potential link between epigenetic alterations in the serotonergic and testosterone systems, with lower testosterone levels and signs of prenatal androgen exposure observed in pedophilic individuals.

Conclusions: This review mapped the existing state of the art data in biomarkers in pedophilia, also supporting the existence of promising biological systems implicated in the pathophysiology of pedophilia, thus emphasized the need for further research in the field.

Systematic review registration: https://osf.io/8v9wn, identifier https://doi.org/10.17605/OSF.IO/8V9WN.

Objectives: Emerging evidence suggests that post-traumatic stress disorder (PTSD) may increase susceptibility to autoimmune diseases, including SLE. PTSD-related immune dysregulation is hypothesized to heighten vulnerability to autoimmunity. This systematic review sought to evaluate the relationship between PTSD and the risk of developing SLE, as well as explore potential shared genetic predispositions.

Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analysis statement (PRISMA) guidelines, a systematic review of PubMed and Scopus databases was conducted up to 1 January 2025. Search terms included 'post-traumatic stress disorder' AND 'SLE' OR 'systemic lupus erythematosus'. Included were full-text original articles assessing the PTSD-SLE relationship, while systematic and narrative reviews, case reports and studies with fewer than 10 patients were excluded. Genetic overlap between PTSD and SLE was analysed using genes identified by genome-wide association study.

Results: From 24 identified studies, 7 met the inclusion criteria, comprising 5 prospective cohort studies, 1 retrospective cohort and 1 case-control study. Across 11 614 SLE patients, 1325 (11.4%) had comorbid PTSD, predominantly females in USA-based studies. All studies demonstrated a positive association between PTSD and SLE, with three reporting at least a 2-fold increased risk of SLE in PTSD patients. Depression and anxiety were common comorbidities in PTSD-SLE patients (n = 2 studies). Genetic analysis did not reveal significant common genetic variants between the two conditions.

Conclusion: PTSD is strongly associated with an increased risk of developing SLE. These findings underscore the need for further investigation into PTSD-induced immune dysregulation and its role in autoimmunity. Early PTSD intervention may mitigate the risk of developing SLE.

Background: The impact of potential environmental influences, like temperature changes and latitudinal gradient, has not been investigated in depth in psychiatric diseases. The aim of this project was to investigate the association of geographical latitude and temperature with the prevalence of psychiatric disorders.

Methods: Linear regression analysis was performed for 201 countries by analyzing average annual temperatures and age-standardized rates (prevalence) of seven major psychiatric entities. A systematic review was also performed, investigating if these correlation data were supported by published original studies.

Results: Linear regression analysis showed a significant correlation between average annual temperatures and age-standardized rates (p < 0.0001) for three psychiatric disorders: anorexia, autism, and schizophrenia. Systematic review analysis showed that the prevalence of autism and schizophrenia is potentially influenced by geographic and climatic factors. However, no published data were identified to support the findings for anorexia.

Conclusion: These preliminary findings underscore the complexity of interactions between environmental, genetic, and socioeconomic factors for psychiatric diseases. The association between temperature and prevalence of psychiatric diseases needs further investigation to reveal any unknown epidemiological factors that contribute to disease pathogenesis.

Introduction: Effective management of suicidality and impulsivity in hospitalized psychiatric patients is vital for improving outcomes and ensuring safety. Psychiatric patients, especially those with schizophrenia, exhibit higher tendencies towards aggressive and suicidal behaviours. This study aims to explore sex-specific associations between lipid profiles, impulsivity, and suicidality among psychiatric inpatients.

Methods: A total of 158 psychiatric inpatients (92 men and 66 women) were assessed using the Barratt Impulsiveness Scale, the Columbia Suicide Severity Rating Scale, and the Karolinska Interpersonal Violence Scale. Serum lipid levels (total cholesterol, LDL, HDL) were obtained from fasting blood samples.

Results: Among men, higher total cholesterol and LDL were positively correlated with impulsivity (LDL and BIS-11 total score: rho =.308, p =.006). In women, higher HDL was associated with lower suicidality (HDL and lifetime suicide attempt frequency: rho = –.374, p =.021). Regression confirmed LDL predicts impulsivity in men (R squared =.265, p =.031), and HDL, LDL, age, and BMI explain 52 percent of suicidality variance in women (R squared =.523, p =.0006).

Conclusion: Elevated LDL may indicate higher impulsivity in men, while low HDL suggests higher suicide risk in women. Lipid monitoring could enhance risk assessment in psychiatric care.

Background: Genetic testing in psychiatry has gained attention, raising questions about its application and impact. Understanding stakeholders’ perspectives, including healthcare providers and patients, is vital for informed policy development. The aim of this systematic review was to focus on the perceptions and concerns of patients and healthcare workers in psychiatry regarding the use of genetic testing.

Methods: We conducted a systematic review following PRISMA guidelines, for the period 1/2/2014, to 1/1/2024, via PubMed and Embase databases identifying 50 articles in total. After excluding duplicates (n = 12), 38 articles went through screening. After careful full-text article assessment for eligibility and applying the inclusion and exclusion criteria, only fifteen (n = 15) of the articles were included.

Results: Among 15 selected studies involving 3,156 participants (2,347 healthcare professionals; 809 patients), thematic analysis identified four primary themes: Organizational-implementation concerns, Ethical Considerations, Concerns on changes in clinical praxis, and Legal implications. Despite these concerns, seven out of eleven studies indicated that healthcare workers viewed genetic testing in psychiatry positively. Patients’ perspectives varied, with two of the four studies reflecting positive attitudes. No pervasive negative sentiment was observed.

Conclusion: Our review highlights the multidimensional perspectives of healthcare professionals and patients surrounding the application of genetic testing in psychiatry. These considerations need to be addressed to facilitate the implementation of genetic testing in clinical praxis in psychiatry. Further research is needed for validation of the results and to guide policies and clinicians in the integration of genetic testing into mental healthcare practice.

Background: Chronic and acute inflammation of the mucosa-associated lymphoid tissue have been positively linked to the development of psychiatric disorders in observational studies. However, it remains unclear whether this association is causal. In the present study, we investigated this association, using as proxies genetically predicted tonsillectomy, appendectomy and appendicitis on psychiatric disorders including major depressive disorder (MDD), schizophrenia (SCZ), bipolar depression (BD) and anxiety (ANX) via a two-sample Mendelian randomization (MR) analysis.

Methods: Genetic association summary statistics for tonsillectomy, appendectomy and appendicitis were sourced from FinnGen Consortium, comprising data from 342,000 participants. Genetic correlations between all exposures and outcome were calculated with Linkage Disequilibrium Score (LDSC) Regression analysis. MR estimates were then calculated to assess their impact on the risk of developing psychiatric disorders. Sensitivity analysis was employed to test for any directional pleiotropy.

Results: Our results suggest that there is no direct causal association between tonsillectomy, appendectomy or appendicitis with a heightened risk for development of psychiatric disorders. The robustness of the results of the main MR analysis was further confirmed with additional sensitivity analyses. However, a moderate inverse genetic correlation was observed between tonsillectomy and MDD traits (r_g=-0.39, p-value (P)=7.5x10^-5).

Conclusion: Our findings provide, for the first time, evidence that there is no causal association between tonsillectomy or appendectomy on subsequent vulnerability of developing psychiatric disorders. Future studies using larger sample size GWAS should focus on unraveling the confounding factors and mediators to investigate this relationship further.

Background: The Republic of Cyprus has recorded the greatest increase in suicide mortality among Eastern Mediterranean countries, with an average annual increase of 5.1% in 2000-2019.

Aims: To investigate trends in suicide mortality rates between 2004 and 2020 in the Republic of Cyprus, with a focus on age, gender and suicide methods.

Method: Suicide deaths (ICD-10 taxonomy, including 'undetermined' code) and population denominators were obtained from the National Mortality Registry and Statistical Office, respectively. Directly standardised (European Standard) mortality rates were calculated for four gender and age groups. Annual change was estimated using Poisson regression models with interaction terms to assess differential trends over different time periods.

Results: There were 560 suicide deaths; these were four times more frequent in men, and approximately 80% were classified as 'violent' for both genders. The male suicide rate doubled from 4-5 to 9-10 per 100 000, mostly before 2012, representing a 9% annual change (rate ratio = 1.09, 95% CI 1.03, 1.15; P = 0.002). From 2013, the trend reversed (effect modification P < 0.001) with a 4% annual decrease (95% CI -9%, 1%). Declines were not uniform across all age groups; rates in males aged 45-64 years continued to rise, surpassing the previously high rate in males aged 25-44 years. Rates in females declined from 4-5 per 100 000 to 2-3 over the study period. Overall, the male-to-female suicide rate ratio was 5.33 (95% CI 3.46, 8.19) in 2017-2020, compared with 2.73 (1.88, 3.95) in 2004-2008.

Conclusion: Although suicide rates remain relatively low, the gender differential has widened in the Republic of Cyprus. Further analysis of trends in relation to unemployment and other socioeconomic indicators is warranted.

Background: There is limited evidence on the association between cognitive function, psychotic symptoms and doses of antipsychotics in adults under compulsory psychiatric care.

Aims: We assessed (a) the degree of cognitive impairment in adults involuntarily hospitalised for compulsory psychiatric care and (b) correlation of Montreal Cognitive Assessment (MoCA) score with psychotic symptoms, polypharmacy and prescription of high-dose antipsychotics.

Method: This was a nationwide, cross-sectional study, conducted at the only referral state hospital for compulsory psychiatric care in Cyprus (December 2016-February 2018). Τhe MoCA was applied for the assessment of cognitive functioning. The Positive and Negative Syndrome Scale (PANSS) was applied for the assessment of psychotic symptoms.

Results: The sample comprised 187 men and 116 women. The mean MoCA score was 22.09 (reported scale range (RSR): 3-30); the mean PANSS general symptoms subscale score was 49.60 (RSR = 41-162). The participants who reported positive psychiatric history (mean 21.71, s.d. 5.37), non-adherence to pharmacotherapy (mean 21.32, s.d. 5.56) and prescription of high-dose antipsychotics (with medication prescribed as needed: mean 21.31, s.d. 5.70; without medication prescribed as needed: mean 20.71, s.d. 5.78) had lower mean MoCA scores compared with those who reported negative psychiatric history (mean 23.42, s.d. 4.51; P = 0.017), adherence to pharmacotherapy (mean 23.10, s.d. 6.61; P = 0.003) and no prescription of high-dose antipsychotics (with medication prescribed as needed: mean 22.56, s.d. 4.90; without medication prescribed as needed: mean 22.60 s.d. 4.94; P = 0.045-0.005), respectively. Mean MoCA score was mildly and inversely associated with total PANSS score (r = -0.15, P = 0.03), PANSS general (r = -0.18, P = 0.002) and PANSS negative (r = -0.16, P = 0.005) symptoms subscales, respectively.

Conclusions: Our findings support the evaluation of cognitive functioning in adults under compulsory psychiatric care via the MoCA tool, with focus on those prescribed high-dose antipsychotics, with positive mental health history and non-adherence to pharmacotherapy.