Scopolamine is a muscarinic receptor antagonist and is widely utilized as a “memory-loss model.” However, its impact across different memory and attention tasks and using different modes of administration has yet to be clearly evaluated. This systematic review and meta-analysis investigates the effect of scopolamine, across all routes of administration and across different dosages, on memory and attention performance in healthy humans (PROSPERO ID: CRD42024531634).

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched (on 20 April 2024) for studies that utilized scopolamine and assessed memory and/or attention. Random-effects meta-analyses were conducted across a range of memory and attention tasks using “Comprehensive Meta-Analysis,” Version 3, to evaluate differential pharmacological effects on cognitive tasks between the scopolamine and placebo groups.

Forty-six studies fulfilled the inclusion and exclusion criteria. Scopolamine negatively impaired performance on all memory tasks (immediate memory, delayed recall, digit span, Buschke selective reminding task, and recognition memory) and led to slower reaction times for three of the five attention tasks examined (choice reaction time, simple reaction time, and rapid visual information processing) compared to placebo. Scopolamine’s negative effect on memory and attention was greater with injectable (e.g., intramuscular, intravenous, and subcutaneous) compared to non-injectable routes of administration (e.g., intranasal, oral, and transdermal).

This study supports the use of scopolamine as a “memory-loss model,” particularly when given by an injectable route of administration. Future clinical trials should evaluate the bioavailability of scopolamine across different routes of administration to ensure therapeutic benefits outweigh any potential adverse cognitive effects.

It is widely known that people with a severe and persistent mental illness (SPMI) are more at risk of poor physical health outcomes because of disparities in healthcare access and provision. Less is known about the quality of end-of-life (EoL) care in people with SPMI who have a life-limiting disease.

A comprehensive and systematic literature search in PubMed, Embase, Web of Science, Scopus, and CINAHL electronic databases (from inception to November 2023) was conducted, without language restriction, for reviews on EoL care and/or palliative sedation for people with SPMI and a life-limiting disease. A critical appraisal of the selected reviews was performed. Data were analyzed according to the four principles of biomedical ethics.

Ten reviews were included. These show that people with SPMI are at risk of suboptimal EoL care. Stigma among healthcare professionals, lack of integrated care policies, absence of advanced care planning, and insufficient expertise and training in palliative care of psychiatrists have been identified as key challenges to the provision of adequate EoL care for people with SPMI. No data were found about palliative sedation.

To optimize palliative and EoL care for SPMI patients with a life-limiting disease, a policy of coordinated and integrated mental and physical healthcare is needed. Moreover, education and training initiatives to reduce stigma and discrimination among all healthcare workers and to enhance palliative care skills in psychiatrists should be offered. Finally, more research is needed on EoL particularly on palliative sedation for people with SPMI and a life-limiting disease.

Catatonia in psychotic patients presents unique challenges. While antipsychotics are the cornerstone of schizophrenia treatment, their use in catatonic patients is sometimes discouraged for fear of worsening the signs. Reports on the successful use of second-generation antipsychotics have been published. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to describe the outcomes of antipsychotic-treated catatonic events.

We searched Medline and Web of Science databases from 2000 to 2023 using search terms including “catatonia” and “antipsychotic agents” for all original peer-reviewed articles, including clinical trials, observational studies, and case-reports. We included antipsychotic-treated catatonic events and extracted data on patient characteristics, pharmacological context, agent involved, and treatment outcomes for each antipsychotic trial.

After screening 6,219 records, 79 full-text articles were included. Among them, we identified 175 antipsychotic trials (in 110 patients). Only 41.1% of the patients benefited from a previous benzodiazepine trial. Antipsychotic use was considered beneficial in 60.0% of the trials, neutral in 29.1%, and harmful in 10.9%. Trials tended to be reported as beneficial for amisulpride, clozapine, and risperidone, equivocal for aripiprazole and olanzapine, and mostly detrimental for haloperidol and quetiapine. Psychotic disorders were the most common underlying etiology (65.8%).

Antipsychotics could be an option in the treatment of catatonia in psychotic patients. However, with few exceptions, we found non-beneficial outcomes with all second-generation antipsychotics in varying proportions in this largest review to date. Although olanzapine is widely used, it is associated with mitigated reported outcomes.

The prevalence of alcohol use disorder among older adults is increasing, with this population being particularly vulnerable to alcohol’s detrimental effects. While knowledge of preventative factors is scarce, physical activity has emerged as a potential modifiable protective factor. This study aimed to examine associations between alcohol consumption and physical activity in a large-scale, multi-national prospective study of the older adult population.

Longitudinal data from the SHARE study on physical activity, alcohol consumption, demographic, socioeconomic, and health variables, were analyzed in older adults. Individual-level data were examined using logistic regression models. Both cross-sectional and longitudinal models were calculated to account for potential latency in the association between physical activity and alcohol consumption.

The study included 3133 participants from 13 countries. Higher physical activity levels were significantly associated with higher alcohol consumption in cross-sectional (p = 0.0004) and longitudinal analyses (p = 0.0045) over a median follow-up of 6 years. While the presence of depressive symptoms and higher educational attainment were associated with higher alcohol consumption, female sex and persons with lower perceived health showed lower frequency of alcohol consumption. Additionally, the country of residence also proved to be a relevant factor for alcohol consumption.

Higher levels of physical activity showed an association with higher alcohol consumption in older adults. Future research should investigate whether this association is causal and underpinned by neurobiological, social, or methodological factors.

Depression affects twice as many women as men. Risk factors for depression certainly impact this difference, but their strong interconnectedness challenges the assessment of standalone contributions. Network models allow the identification of systematic independent relationships between individual symptoms and risk factors. This study aimed to evaluate whether the extended networks of depressive symptoms, cognitive functions, and leisure activities in like-sex twins differ depending on gender or zygosity.

Twins, including 2,040 women (918 monozygotic and 1,122 dizygotic) and 1,712 men (730 monozygotic and 982 dizygotic), were selected from the Danish Twin Registry for having, along with their like-sex co-twin, completed measures of depressive symptoms, cognition, and leisure activities (physical, intellectual, and social). Network models were estimated and compared at three levels: co-twins to each other within groups defined by gender and zygosity; monozygotic to dizygotic twins within the same gender, and between genders.

No significant differences were observed when co-twins were compared to each other, regardless of the pair’s zygosity or gender, nor when monozygotic twins were compared to dizygotic twins within gender. However, the gendered networks differed significantly in global strength, structure, and partial correlations between specific depressive symptoms and risk factors, all indicating stronger connectedness in women relative to men.

Environmental factors appear to best explain between-gender network differences. Women’s networks showed significantly stronger associations both among depressive symptoms and between depressive symptoms and risk factors (i.e., decreased cognition and leisure activities). Longitudinal research is needed to determine the causality and directionality of these relationships.

Impairment in both psychosocial functioning and neurocognition (NC) performance is present in bipolar disorder (BD) yet the role of sex differences in these deficits remains unclear. The present systematic review and meta-analysis examined whether males and females with BD demonstrate differences in psychosocial functioning and NC performance.

The Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases were systematically searched from inception until November 20, 2023.

Twenty studies published between 2005 and 2023 with a total sample size of 2286 patients with BD were included. A random effects meta-analysis revealed a statistically significant result with a small effect (SMD = 0.313) for sex differences in verbal learning and memory as well as visual learning and memory (SMD = 0.263). Females outperformed males in both domains. No significant sex differences were observed for any other NC outcome or psychosocial functioning. High heterogeneity and differences in assessment scales used should be considered when interpreting these findings, given their potential impact on results.

Future research should adopt a more homogenous, standardized approach using longitudinal designs to gain a clearer insight into sex differences in this population. This approach so may increase the use of preventative therapeutic options to address the difficult clinical challenge of reaching cognitive and functional recovery.

Antidepressants are essential in managing depression, including treatment-resistant cases. Public perceptions of these medications, shaped by social media platforms like X (formerly Twitter), can influence treatment adherence and outcomes. This study explores public attitudes toward antidepressants through sentiment and topic modeling analysis of tweets in English and Spanish from 2007 to 2022.

Tweets mentioning antidepressants approved for depression were collected. The analysis focused on selective serotonin reuptake inhibitors (SSRIs) and glutamatergic drugs. Sentiment analysis and topic modeling were conducted to identify trends, concerns, and emotions in discussions across both languages.

A total of 1,448,674 tweets were analyzed (1,013,128 in English and 435,546 in Spanish). SSRIs were the most mentioned antidepressants (27.9% in English, 58.91% in Spanish). Pricing and availability were key concerns in English tweets, while Spanish tweets highlighted availability, efficacy, and sexual side effects. Glutamatergic drugs, especially esketamine, gained attention (15.61% in English, 25.23% in Spanish), evoking emotions such as fear, sadness, and anger. Temporal analysis showed significant increases in discussions, with peaks in 2012 and 2021 for SSRIs in Spanish, and exponential growth from 2018 to 2021 for glutamatergic drugs. Emotional tones varied across languages, reflecting cultural differences.

Social media platforms like X provide valuable insights into public perceptions of antidepressants, highlighting cultural variations in attitudes. Understanding these perceptions can help clinicians address concerns and misconceptions, fostering informed treatment decisions. The limitations of social media data call for careful interpretation, emphasizing the need for continued research to improve pharmacovigilance and public health strategies.

Attention deficit/hyperactivity disorder (ADHD) prevalence has increased in the last 10 years, most likely due to increased recognition by clinicians. Even so, an issue with under-diagnostics may persist. Historically ADHD has been described as a male-dominant disorder. However, recent evidence shows that ADHD prevalence is similar between the sexes, but that the related impairment or symptomatology might vary. This study estimated the prevalence of undiagnosed ADHD symptoms (pADHD) and explored the sex-stratified symptomatology and associations with self-perceived health-related quality of life (HRQL) and experience of depressive symptoms.

This was done in a unique cohort of 50,937 healthy blood donors – individuals who successfully maintain regular commitments despite potential ADHD symptoms. ADHD symptoms were estimated using the Adult ADHD Self-Report Scale (ASRS), health-related quality of life (HRQL) measured using mental and physical component scores (MCS/PCS) estimated based on a 12-item Short-Form Health Survey (SF-12) with a higher score indicating better HRQL, and depressive symptoms were measured using Major Depression Inventory (MDI) with higher score indicating more depressive symptoms.

In total, 3% were classified with pADHD (sex ratio 1:1). pADHD was associated with reduced MCS and PCS, and increased MDI score. Males scored on average higher on inattentive symptoms compared to females, whereas females scored on average higher on hyperactive-impulsive symptoms. Individuals scoring high on the combined inattentive and hyperactive-impulsive ADHD symptom presentation were most likely to be impaired in terms of higher MDI scores and lower PCS when compared to non-ADHD controls.

In conclusion, ADHD symptoms are common in this seemingly healthy and undiagnosed population. Symptom presentations differ between sexes and the type of presentation seems to impact the association with depressive symptoms and level of reduced HRQL.

Adolescents with psychiatric disorders are at increased risk of suicide, with insomnia, depression, and social-personal factors playing pivotal roles. This study investigates the interplay between these factors in a sample of adolescent psychiatric inpatients in Italy, with a particular focus on their association with suicide attempts.

We conducted a cross-sectional study on 95 adolescent inpatients (54 suicide attempters, 41 non-attempters) to explore their sociodemographic and clinical variables, including insomnia, depression, and social-personal factors as history of bullying. Logistic regression analyses and Pearson’s correlations were used to identify significant predictors of suicide attempts and their interrelations.

Suicide attempters were predominantly female (90% vs. 75%, p = 0.04) and more likely to have a family psychiatric history (83% vs. 63%, p = 0.04), a history of bullying (26% vs. 9%, p = 0.01), and insomnia (79% vs. 53%, p = 0.01). Depression was strongly associated with suicide attempts (96% vs. 70%, p = 0.01), while physically active adolescents were significantly less likely to attempt suicide (27% vs. 53%, p = 0.01). Insomnia and depression were highly correlated (r = 0.94, p = 0.02), emphasizing the critical role of the former in emotional dysregulation. Behavioral factors, such as physical inactivity and bullying, emerged as additional key contributors to suicidal behavior.

This study highlights the multifaceted nature of suicide risk in adolescent psychiatric inpatients, with sleep disturbances, depression, and behavioral factors playing central roles. These findings underscore the need for integrated interventions targeting sleep, emotional regulation, and behavioral vulnerabilities to mitigate suicide risk.

There is increasing evidence that childhood Attention-Deficit Hyperactivity Disorder (ADHD) elevates the risk of later Bipolar Spectrum Disorder (BD). However, it remains unclear whether different trajectories of ADHD symptoms confer differential risk for BD.

Data from the Avon Longitudinal Study of Parents and Children were available from 7811 children at age 8 years, 7435 at 10, 6798 at 13, and 1217 at 21–23 years. ADHD symptoms were assessed at 8, 10, and 13 years with the Development and Well-Being Assessment. Clinically significant hypomanic symptoms (CSHS) at 21–23 years were assessed using the Hypomania Symptom Checklist (HCL-32). Group trajectories of ADHD and its subtypes were estimated using latent class growth analysis. The prospective associations between different ADHD trajectories and CSHS were tested using logistic regression analysis.

Persistently high, increasing, remitting, and persistently low ADHD symptom trajectories were identified for the three ADHD-related categories. Individuals with persistently high and increasing levels of ADHD symptoms had increased odds of CSHS compared to persistently low class. Sensitivity analyses validated these results. In separate analyses, persistently high levels of hyperactivity and inattentive, and increasing levels of inattentive symptoms were also independently associated with CSHS.

Young people with a longitudinal pattern of high and increasing ADHD symptoms are at higher risk for developing CSHS in young adulthood compared to individuals with low symptom patterns. These two trajectories in childhood and adolescence may represent distinct phenotypic risk profiles for subsequently developing BD and be clinically significant targets for prevention and treatment of BD.

Increasing daylight exposure might be a simple way to improve mental health. However, little is known about daylight-symptom associations in depressive disorders.

In a subset of the Australian Genetics of Depression Study (N = 13,480; 75% female), we explored associations between self-reported number of hours spent in daylight on a typical workday and free day and seven symptom dimensions: depressive (overall, somatic, psychological); hypo-manic-like; psychotic-like; insomnia; and daytime sleepiness. Polygenic scores for major depressive disorder (MDD); bipolar disorder (BD); and schizophrenia (SCZ) were calculated. Models were adjusted for age, sex, shift work status, employment status, season, and educational attainment. Exploratory analyses examined age-stratified associations (18–24 years; 25–34 years; 35–64 years; 65 and older). Bonferroni-corrected associations (p < 0.004) are discussed.

Adults with depression reported spending a median of one hour in daylight on workdays and three hours on free days. More daylight exposure on workdays and free days was associated with lower depressive (overall, psychological, somatic) and insomnia symptoms (p’s<0.001), but higher hypo-manic-like symptoms (p’s<0.002). Genetic loading for MDD and SCZ were associated with less daylight exposure in unadjusted correlational analyses (effect sizes were not meaningful). Exploratory analyses revealed age-related heterogeneity. Among 18–24-year-olds, no symptom dimensions were associated with daylight. By contrast, for the older age groups, there was a pattern of more daylight exposure and lower insomnia symptoms (p < 0.003) (except for 25–34-year-olds on free days, p = 0.019); and lower depressive symptoms with more daylight on free days, and to some extent workdays (depending on the age-group).

Exploration of the causal status of daylight in depression is warranted.

Medication-induced dystonia (MID) is a movement disorder (MD), characterized by involuntary sustained or intermittent muscle contractions, causing abnormal, often repetitive, movements, postures, or both. Although MID is commonly associated with the use of antipsychotics, it also occurs with many other medications widely used in clinical practice.

A systematic literature search (from inception to November 2023), using the PubMed and Embase databases, was conducted without language restriction for articles reporting on MID in people without pre-existing MDs, and this for all potentially relevant non-antipsychotic medications. A narrative synthesis of the available evidence was undertaken.

MID is common (1 to 10%) with certain antiemetics. Selective serotonin reuptake inhibitors and the antiepileptics valproate, carbamazepine, and lamotrigine are rarely (0.01 to 0.1%) or very rarely (<0.01%) associated with MID. All other medications are very rarely (<0.01%) associated with MID or have a risk that cannot be precisely estimated. The actual rate of dystonic reactions with most non-antipsychotic agents remains unknown, owing to misdiagnosis and underreporting in the scientific literature. In general, MID seems to occur more often in children and adolescents, even with a single low dose, and with polymedication. In most cases, MID is acute in onset (occurring within hours to days) and involves the head and neck.

Although MID is most common with dopamine receptor-blocking antiemetics, many other medications may also produce dystonic reactions, particularly in children and adolescents. Although such incidents remain rare, there are indications that MID is underreported for many classes of medications.

Living with major depressive disorder (MDD) reduces life expectancy, with respiratory disease being a significant threat. However, evidence on respiratory disease in this population has not yet been meta-analyzed.

This meta-analysis examines respiratory disease prevalence and odds ratio (OR) in patients with MDD and treatment resistant depression (TRD). A systematic literature search was conducted, with a snowball search of reference and citation lists. Inclusion criteria covered studies in MDD and TRD patients with confirmed diagnoses of respiratory diseases (asthma, chronic obstructive pulmonary disease [COPD], pneumonia, lung cancer, and tuberculosis), comparing with a control group when possible.

From 4,138 retrieved articles, 15 (including 476,927 individuals with MDD, 50,680 with TRD, and 1,108,979 control group) met the inclusion criteria. In MDD patients, COPD prevalence was 9.0% (95% CI: 3.8–19.6%), asthma 8.6% (95% CI: 5.7–12.8%), and pneumonia 2.5% (95% CI: 2.2–2.9%). In TRD patients, COPD prevalence was 9.9% (95% CI: 4.2–21.9%) and asthma 10.9% (95% CI: 10.7–11.2%), but meta-analysis limited to those diseases showed no significant relative risk differences. Compared to the general population, individuals with MDD had significantly higher rates of COPD (OR 1.79, 95% CI: 1.49–2.16), even higher in younger populations (1.85 [95% CI: 1.74–1.97]) and more prevalent in women.

This first meta-analysis on this topic shows that MDD is associated with an increased risk of respiratory illness compared to the general population. The prevalence of asthma doubles the mean described in the general population worldwide, and in COPD, women and younger people are at particular risk. Prevention policies are urgently needed.