Ekbom’s delusion as a prelude to Cotard’s syndrome, has not heretofore been described.

Case study: A 45-year-old woman with a past diagnosis of bipolar disorder with psychotic features was admitted, having been up all night conversing with spirits, proclaiming that she had made a deal with Satan. Convinced that her grandmother was possessed by the devil, she smashed her grandmother’s head with a two-by-four. Results: Mental Status Examination: self conversing with her eyes darting around the room. Poor hygiene. Behavior: guarded and withdrawn. Oriented x2. Speech: hyperverbal. Insight and judgment: poor. Mood: hostile, aggressive, and angry. Thought process disorganized, incongruent, and tangentiality. She was convinced she was infested with little black bugs crawling around her insides which had been placed there by the devil. After two days of olanzapine she reported the bugs were no longer present, but rather that she herself was dead and that her organs were decomposing, which persisted through the remainder of the hospitalization.

Neuroimaging abnormalities in Ekbom’s syndrome involve the striatum, basal ganglia (putamen and caudate nucleus), insular and cingulate cortices, cortex (prefrontal, right parietal, and temporal lobes), right lingual and orbitofrontal gyri, and thalamus. In Cotard’s syndrome, abnormalities have been identified in the striatum, frontal and temporal lobes, and right-sided and bilateral hemispheres. An overlap between the delusions exists in the striatum, inferior parietal, and temporal lobes. A single lesion in the nondominant inferior parietal lobe may cause both syndromes, due to its substantial interconnection with the temporo-limbic areas. Since the parietal lobe is also involved in somatosensory processing, peradventure distorted sensory perception with associated sensation of formication may have been the nidus for the delusional infestation as well as a nidus for the perception of thanatos habitus. Such misperception may have then been amplified into a delusion because of a hyperconnection between the parietal lobe and the limbic system. This may represent a variant of the two-factor hypothesis of delusions whereby a distorted sensory perception is then misrepresented in a delusion. Dysfunction of the right hemisphere, which normally acts to censor the left, allows the delusion to manifest. A single lesion of the inferior parietal lobule may be sufficient for both sensory distortions and loss of inhibition of delusional interpretation of distorted sensation by the frontal lobe, yclept the sensorialist hypothesis.

In those with monothematic delusions, the search for transient fluctuation in delusional states may be revealing.

No Funding

In the current educational environment of universities, students’ mental health issues are increasingly receiving attention. Anxiety disorder, as one of the common mental health problems, has brought many troubles to students’ learning and life. This study aims to explore the effectiveness of integrating the history of the socialist rule of law into ideological and political education in alleviating students’ anxiety disorders.

This study selects 1202 students from five different universities in a certain region as the research subjects, and they were randomly divided into an experimental group and a control group, with 601 students in each group. The experimental group adopts the ideological and political teaching mode that integrates the history of the socialist rule of law, while the control group adopts the traditional ideological and political teaching mode. Students’ anxiety symptoms before and after intervention were evaluated by using the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS); All results were statistically analyzed by using SPSS22.0 software.

The research results show that the experimental group of students showed significant improvements in anxiety levels, learning motivation, and satisfaction with ideological and political education; The anxiety level of students has decreased by about 30%, with a significant effect.

This study indicates that the integration of the history of the socialist rule of law has a positive effect on alleviating students’ anxiety disorders, providing a new path for ideological and political education in universities. It is recommended to further explore and improve this integration model in the future to meet the needs of more students.

Borderline personality disorder is a common psychological disorder, especially among college students. Red culture is an important historical and cultural aspect of China, with rich educational significance. Red culture identity education plays an important role in university education, but its effectiveness for students with borderline personality disorder has not been fully studied.

A total of 100 college students with borderline personality disorder were selected as experimental subjects and divided into two groups, respectively receiving art design education and routine education. Data were collected by the Stanford Acute Stress Response Questionnaire (SASRQ) and the 3-minute Delirium Diagnostic Scale (3D-CAM) and statistically analyzed using SPSS23.0 software.

The results showed that after participating in red culture identity education, the mental health status of students with borderline personality disorder was significantly improved. They exhibit higher emotional stability, self-confidence, and a sense of self-worth. At the same time, they are also more willing to express themselves and have a deeper understanding and identification with the core socialist values.

Art and design education can effectively improve the level of red cultural identity of college students with borderline personality disorder. The collaborative educational approach of art and design education can help college students with borderline personality disorder better adapt to the social environment, and enhance their mental health and self-development ability. Therefore, educational psychology should incorporate art and design education into the education plans of students with borderline personality disorders to promote the development of their red cultural identity.

Drug-induced movement disorders (DIMDs) form an important subgroup of secondary movement disorders, which despite conferring a significant iatrogenic burden, tend to be under-recognized and inappropriately managed.

We aimed to look into phenomenology, predictors of reversibility, and its impact on the quality of life of DIMD patients.

We conducted the study in the Department of Neurology at a tertiary-care centre in India. The institutional ethics-committee approved the study. We assessed 55-consecutive DIMD patients at presentation to our movement disorder clinic. Subsequently, they followed up to evaluate improvement in severity-scales (UPDRS, UDRS, BARS, AIMS) and quality of life (EuroQol-5D-5L). Wilcoxan-signed-rank test compared the scales at presentation and follow-up. Binary-logistic-regrerssion revealed the independent predictors of reversibility.

Fourteen patients (25.45%) had acute-subacute DIMD and 41 (74.55%) had tardive DIMD. Tardive-DIMD occurred more commonly in the elderly (age 50.73±16.92 years, p<0.001). Drug-induced-Parkinsonism (DIP) was the most common MD, followed by tardivedyskinesia. Risperidone and levosulpiride were the commonest culprit drugs. Patients in both the groups showed a statistically significant response to drug-dose reduction /withdrawal based on follow-up assessment on clinical-rating-scales and quality of life scores (EQ-5D-5L). DIMD was reversible in 71.42% of acute-subacute DIMD and 24.40% of patients with chronic DIMD (p=0.001). Binary-logistic-regression analysis showed acute-subacute DIMDs and DIP as independent predictors of reversibility.

DIP is the commonest and often reversible drug-induced movement disorder. Levosulpiride is notorious for causing DIMD in the elderly, requiring strict pharmacovigilance.

Slow release is a fundamental feature of long-acting injectable (LAI) antipsychotics. This property allows continuous drug exposure between dosing intervals. However, there can be a significant delay between giving the first LAI dose and achievement of efficacious plasma concentrations. This time period requires additional pharmacologic intervention. Until now, this delay was addressed with one of two strategies: 1) continuing with supplemental oral antipsychotic, or 2) giving more LAI up front (e.g. loading dose). A third strategy has now been developed to reduce the time needed for oral supplementation when starting the LAI aripiprazole lauroxil (AL) from 21days to 1day. A nano-crystalline milled dispersion of AL (ALNCD; brand name ARISTADA INITIO™) was formulated by reducing the AL particle diameter from micron-size particles to nanometer- sized particles. ALNCD has faster dissolution and a shorter half-life than AL and is designed to be used as a single injection along with a single oral aripiprazole dose of 30mg as a 1-day alternative to the 21days of oral aripiprazole supplementation. Here we provide an overview of the new 1-day initiation regimen for starting AL treatment, and demonstrate the relative contributions of each of its components.

A blinded, randomized, phase 1, pharmacokinetic (PK), and safety study compared the 1-day initiation regimen with the 21-day oral aripiprazole regimen. A combination of observed data, and population pharmacokinetic model–based simulations were used to plot plasma aripiprazole concentrations of single doses of ALNCD, 30mg oral aripiprazole, and AL, individually, and all three combined.

The PK profiles of the 1-day and 21-day initiation regimens (both in conjunction with either 441mg or 882mg doses of AL) were comparable, with therapeutically relevant aripiprazole levels achieved within 4days of treatment initiation. The safety profile of the 1-day initiation regimen was similar to the 21-day initiation regimen, and consistent with that of AL. Aripiprazole concentration–time profiles demonstrated that each component delivered aripiprazole to the systemic circulation at different time periods, with the 30mg dose of oral aripiprazole predominant in the first week, followed by ALNCD, and then AL.

The 1-day initiation regimen is well-tolerated and a suitable alternative to 21days of oral aripiprazole supplementation for starting AL. Each component of the 1-day initiation regimen, together with AL, is necessary to provide continuous coverage from treatment initiation until the next regularly scheduled AL injection.

Funding Acknowledgements: This study was funded by Alkermes Inc.

Pharmacogenomic testing has emerged to aid medication selection for patients with major depressive disorder (MDD) by identifying potential gene-drug interactions (GDI). Many pharmacogenomic tests are available with varying levels of supporting evidence, including direct-to-consumer and physician-ordered tests. We retrospectively evaluated the safety of using a physician-ordered combinatorial pharmacogenomic test (GeneSight) to guide medication selection for patients with MDD in a large, randomized, controlled trial (GUIDED).

Patients diagnosed with MDD who had an inadequate response to ≥1 psychotropic medication were randomized to treatment as usual (TAU) or combinatorial pharmacogenomic test-guided care (guided-care). All received combinatorial pharmacogenomic testing and medications were categorized by predicted GDI (no, moderate, or significant GDI). Patients and raters were blinded to study arm, and physicians were blinded to test results for patients in TAU, through week 8. Measures included adverse events (AEs, present/absent), worsening suicidal ideation (increase of ≥1 on the corresponding HAM-D17 question), or symptom worsening (HAM-D17 increase of ≥1). These measures were evaluated based on medication changes [add only, drop only, switch (add and drop), any, and none] and study arm, as well as baseline medication GDI.

Most patients had a medication change between baseline and week 8 (938/1,166; 80.5%), including 269 (23.1%) who added only, 80 (6.9%) who dropped only, and 589 (50.5%) who switched medications. In the full cohort, changing medications resulted in an increased relative risk (RR) of experiencing AEs at both week 4 and 8 [RR 2.00 (95% CI 1.41–2.83) and RR 2.25 (95% CI 1.39–3.65), respectively]. This was true regardless of arm, with no significant difference observed between guided-care and TAU, though the RRs for guided-care were lower than for TAU. Medication change was not associated with increased suicidal ideation or symptom worsening, regardless of study arm or type of medication change. Special attention was focused on patients who entered the study taking medications identified by pharmacogenomic testing as likely having significant GDI; those who were only taking medications subject to no or moderate GDI at week 8 were significantly less likely to experience AEs than those who were still taking at least one medication subject to significant GDI (RR 0.39, 95% CI 0.15–0.99, p=0.048). No other significant differences in risk were observed at week 8.

These data indicate that patient safety in the combinatorial pharmacogenomic test-guided care arm was no worse than TAU in the GUIDED trial. Moreover, combinatorial pharmacogenomic-guided medication selection may reduce some safety concerns. Collectively, these data demonstrate that combinatorial pharmacogenomic testing can be adopted safely into clinical practice without risking symptom degradation among patients.

Myriad Neuroscience/Assurex Health

The psychological problems of college students are the focus of social concern and hot discussions. Influenced by the epidemic, college students’ study, life and employment have been affected to a certain extent. Schools should strengthen mental health education to improve college students’ ability to resist pressure and help students improve their ability to adapt to society. Positive psychology can help students improve their mental health by guiding their mental activities and tapping their own strengths. In the process of using positive psychological knowledge to intervene with college students, self-help incentive training and personality cultivation can help students understand their own mental health problems. Therefore, in the psychological health education of colleges and universities, we can consider taking these two methods to carry out psychological intervention on college students, so as to improve the students’ ability to withstand pressure.

In the experiment, 360 college students who meet the requirements were randomly selected in colleges and universities through a questionnaire survey as the research objects of mental health problems. There are 187 boys and 173 girls, with an average age of (20 ± 2) years. The 360 college students were randomly divided into the intervention group and the control group, 180 in each. The intervention group used positive psychological thinking for psychological intervention, while the control group did not take any psychological intervention measures. The Perceived Stress Scale (PSS) was selected as the test scale of college students’ compressive capacity, and SPSS23.0 was used to analyze the score results.

The score of the PSS scale is shown in Table 1. It can be seen from the table that after the intervention group received the psychological intervention, their problem-solving and rationalization abilities were significantly improved (P < 0.05), and their withdrawal emotions were significantly reduced (P < 0.05).Table 1.

PSS score

The results show that after the intervention of positive psychology, the psychological pressure resistance of college students has been significantly improved, which helps to improve the level of mental health of college students, so as to better solve many psychological problems caused by the epidemic.

At present, the social economy is in a period of fast-paced change in China, with various modes of production and life evolving and emerging. The transfer of agricultural land is the transformation of the utilization mode of the main factors of production in rural areas, and it is one of the contents of the social and economic reform in rural areas. In 2021, the area of rural land transfer is up to 3.7×1011 m2 in China, an increase of 4.3% over the previous year. 1,239 counties (cities, districts) and 18,731 townships have established agricultural land management rights transfer centers to provide services such as policy consultation, information release, and contract signing for both sides of the transfer. Farmers are the subjects of agricultural land management and transfer. Their behaviors are affected by their psychology to some extent. In the long-term, dynamic, and gradual process of agricultural land transfer, it is particularly important to respect farmers’ wishes, pay attention to farmers’ psychology, and guide farmers’ behavior. However, only a few written contracts were signed. Most are verbal agreements of spontaneous or collective land transfers. The verbal agreements auto-execute to some extent within certain limits. The goals of farmers in farmland transfer are diversified, and their cognition, willingness and psychological identity affect the performance of the contract and the effect of transfer.

The psychological contract of agricultural land transfer can be defined as the transferor and transferee of agricultural land transfer. Through a certain psychological suggestion mode, through the subjective cognition and understanding of the rights and obligations of both parties, rather than the direct explicit expression, a contract relationship of rights and obligations is formed. The party awarding contract and the contractor are the subjects of agricultural land transfer. Therefore, the subjects of the psychological contract of agricultural land transfer include farmers, village collectives and enterprises, all of whom have equal status, forming their own psychological contracts. The forming process of the psychological contract of agricultural land transfer includes four steps. Step one is cognition and judgment. Both parties to the transfer are aware of and judge their own rights and obligations based on external environmental information and their own circumstances. Step two is psychological expectations. Before information is transmitted, both sides of the transmission transform cognition and judgment into psychological expectations. The third step is to convey psychological expectations. Both sides of transfer transmit psychological expectations by means of direct patterns, such as oral form and written form, and implicit ways, such as perception and comprehension. Step four is the formation of the psychological contract. Both sides of transfer reciprocally admit information of psychological expectations transmitted in implicit ways, forming psychological contracts. If they can’t come to an agreement on psychological contracts, a new four-step cycle is entered.

The forming of the psychological contract of agricultural land transfer is shown in Figure 1. First, farmers’ behavior background, such as the experiences of land lease and transfer, the targets of land transfer and education, has an effect on the building of psychological contracts and its type. On the one hand, the farmers who have the experience of land transfer and get high benefits from it are much more motivated than those who don’t have that experience or ever have dissension while transferring. On the other hand, the targets of transfer and the education level of farmers affect the type of psychological contracts. Second, Farmers’ subjective norms, mainly reflected in the difference in folk customs, will form various communication modes and take different measures to deal with breaching contracts while transferring. Third, farmers’ behavior cognition reflects in their comprehension of the capability of executing contracts, including bargaining power, decision-making level and managing modes of the rent. The ability of behavior cognition and control of farmers has a positive influence on their behavior intention and happened.

According to the above results, in order to promote the reposeful transfer and orderly development of agricultural land, the following suggestions are proposed: The first is to improve the agricultural land transfer policy system, establish and improve the institutional environment for agricultural land transfer, create conditions for the establishment of farmers’ behavioral psychological contracts in the process of agricultural land transfers, and guide farmers to establish relationship psychological contracts. The second is to improve the market system, properly cultivate and develop agricultural land transfer intermediaries, reduce transaction costs, and reduce the probability of farmers’ psychological contracts being broken. The third is to guide farmers to establish a positive agricultural land transfer psychology based on their resource endowments such as labor force quality and cultural quality, and encourage farmers to make agricultural land transfer decisions such as subcontracting, leasing, reselling, and interchanging.Figure 1.

Psychological contracts of agricultural land transfer forming

Postpartum depression (PPD), now referred to as perinatal depression, is a prevalent and debilitating mood disorder that reduces health-related quality of life (HRQoL) and psychosocial functioning. Esketamine, which is efficacious in adults with treatment-resistant depression and individuals with depression and suicidality, is also analgesic in pain management during childbirth labour. Herein, we investigate the efficacy of prophylactic esketamine in reducing the incidence of PPD.

We performed a systematic review (i.e., PubMed, Scopus, and Ovid databases; inception to January 22, 2024) of randomized controlled trials that investigated the use of esketamine for PPD. We delimited our search to studies that prespecified the prevention of PPD with esketamine as the primary outcome. A meta-analysis was performed on PPD incidence rates using a random effects model.

Our analysis consisted of seven studies that met our eligibility criteria. We found that esketamine was significantly associated with a decreased incidence of PPD diagnosis within one week of childbirth (OR = 0.30, 95% CI = [0.15, 0.60], p = 0.0047). We also observed that esketamine was significantly associated with a decreased incidence of PPD diagnosis between 4 to 6 weeks post-delivery (OR = 0.33, 95% CI = [0.18, 0.59], p = 0.0034).

Our results indicate that esketamine may have preventive antidepressant effects during the postpartum period. The aforementioned points have both mechanistic and clinically meaningful implications for the treatment of PPD.