Latest Articles

Fabrication or Fact? Navigating Ethical and Clinical Challenges in Diagnosing Factitious Disorder

Sophia Dane Fraga^1*, Christopher Johnson-Harwitz¹, Elizabeth Badalov¹, Ahmad Shobassy²

¹University of Michigan Medical School, Ann Arbor, MI, USA

²Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

Background: Factitious disorder (FD) is a complex psychiatric condition characterized by deliberate falsification or induction of symptoms to assume the role of a patient, driven by internal psychological needs rather than external rewards. Despite its rarity, FD poses significant diagnostic and ethical challenges in clinical practice.

Methods: This paper explores the nuances of diagnosing and managing FD through two contrasting case studies, underscoring the risks of both overdiagnosis and underdiagnosis.

Results: The first case details a patient with a history of multiple hospitalizations and symptom exaggeration, ultimately revealing a clear pattern of factitious behavior. Despite accumulating evidence, clinicians hesitated to assign the FD diagnosis due to ethical concerns and fear of damaging the therapeutic relationship. This avoidance resulted in repeated iatrogenic harm, violation of ethical principles such as non-maleficence, and delayed psychiatric intervention. In contrast, the second case describes a patient who was prematurely labeled with FD in the absence of sufficient evidence, leading to delayed care for a genuine medical condition and a breakdown in trust with the healthcare system.

Conclusion: These cases highlight the need for a deliberate, evidence-based, and ethically sound approach when considering a diagnosis of FD. Clinicians must balance the imperative to avoid harm with the duty to promote patient well-being through honest communication and appropriate treatment. Non-confrontational approaches, while preserving rapport, may inadvertently reinforce deceptive behaviors or delay psychiatric care for patients with FD. Ultimately, diagnosing FD responsibly requires clear evidence to support clinical suspicion, awareness of unconscious bias, and the use of standardized communication strategies to ensure that patients receive compassionate and appropriate care.

Beyond Acceptance: Utilizing Empathy to Diagnose and Treat Internalized Homophobia in LGBTQ+ Clients

Eli Sharon

School of Government & Society, Family Studies, The Academic College Tel Aviv-Yaffo, Israel

Faculty of Health Professions, Ono Academic College, Israel

This article asserts that effective therapy with LGBTQ+ clients should evolve beyond basic "gay friendly" practices to require deeper clinical engagement. It argues that therapists can actively cultivate precise empathy, which is predicated on a more detailed familiarity with the client's unique experiences, particularly those shaped by internalized homophobia. This skillful approach involves refining a therapist's cognitive complexity and utilizing relevant diagnostic tools to accurately diagnose and treat the often-subtle, debilitating impact of minority stress. Ultimately, this targeted, empathetic strategy is vital for establishing and strengthening the therapeutic alliance.

Mini-Review: A Superior Treatment for Clozapine-induced Sialorrhea

Ai-Li W. Arias^1,2,3,5*, Michael A. Cummings^1,2,3,5, George J. Proctor^1,3,4,5

¹Department of Psychiatry and Neuroscience, University of California, Riverside, CA, USA

²Department of Psychiatry & Human Behavior, University of California, Irvine, Neuropsychiatric Center, Orange, CA, USA

³Psychopharmacology Resource Network, Clinical Operations Division, California Department of State Hospitals (DSH), Sacramento, CA, USA

⁴Department of Psychiatry, Loma Linda University School of Medicine, Loma Linda, CA, USA

⁵Department of State Hospitals - Patton, Patton, CA, USA

Clozapine is the only antipsychotic with demonstrated efficacy for treatment-resistant schizophrenia and mania, and aggression, suicide, or psychogenic polydipsia related to schizophrenia. Sialorrhea, a common adverse effect, is frequently a barrier to clozapine treatment. Anticholinergic agents have limited efficacy and increase risk for constipation, bowel impaction, or ileus. Interval injection of select salivary glands with botulinum neurotoxin (BT) has proven to be a superior alternative treatment for clozapine-induced sialorrhea (CIS). This mini-review describes the viability and logistics for establishing a successful botulinum treatment clinic, including adequate staff, training, educating treatment providers about the availability and effectiveness of botulinum treatment for sialorrhea, and development of a clinic protocol (e.g., procedural elements and relevant rating scales). Finally, botulinum treatment was determined to be cost-effective. Evidence for botulinum treatment of CIS includes Level I data.

Stress experiences among older Chinese immigrants in Canada during the COVID-19 pandemic: A qualitative study

Ziyu Su¹, Lixia Yang^1*, Haoran Dong¹, Xindi Wang¹, Lu Wang², Minhui Yang³, Sepali Guruge⁴

¹Department of Psychology, Toronto Metropolitan University, Toronto, Canada

²Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, Canada

³Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

⁴Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada

This study investigates the stress experiences and coping strategies among older Chinese immigrants in Canada during the COVID-19 pandemic. Data was collected through focus group interviews and analyzed using the Transactional Model of Stress and Coping (TMSC). The results showed that participants (N=25; 14 female, 11 male; age 65 and above) faced three main sources of stress during the pandemic: personal life disruption (e.g., hindered family reunions and financial pressure), emotional distress (e.g., fear, uncertainty, and distress), and structural obstacles (e.g., travel restrictions and anti-Chinese discrimination). In addition, participants reported generally three types of coping styles: cognitive coping (e.g., maintaining a positive mindset and redefining risks), behavioural coping (e.g., adhering to the pandemic prevention regulations and maintaining daily activities), and social coping (e.g., participating in online social activities and establishing mutual assistance networks). The results call for culturally sensitive policies and measures in future public health crises to address the specific stressors and coping resources of older immigrants.

Evaluating the Impact of Multidisciplinary Care on Opioid Use Disorder: A Retrospective Study of Buprenorphine/Naloxone-Assisted Treatment in a Family Medicine Residency

Sally Mukatash Pauls^1*, Aubrey Baccari², Brian Henriksen²

¹Department of Pharmacy, Lutheran Hospital of Indiana, Fort Wayne, Indiana, USA

²Fort Wayne Medical Education Program, Fort Wayne, Indiana, USA

Background: Medications for Opioid Use Disorder (MOUD) with buprenorphine/naloxone improves opioid-use-disorder (OUD) outcomes, yet sustaining engagement is challenging. Pharmacist integration within MOUD teams enhances safety and adherence. We evaluated a pharmacist-augmented MOUD model embedded in a family-medicine residency clinic.

Methods: Adults with OUD treated between October 2020 and July 2024 formed a retrospective cohort. Eligibility required ≥ 1 clinic visit; polysubstance use excluded. Descriptive statistics summarized cohort characteristics; single-sample t-tests compared local outcomes with a published physician–pharmacist trial (Wu et al.). Variables included demographics, psychiatric comorbidities, induction site, Clinical Opiate Withdrawal Scale scores, urine drug screens (UDS), visit cadence, and retention rate.

Results: Fourteen of 30 screened patients met criteria (50% male; mean age 43 y). A clinical pharmacist participated in all MOUD visits. Induction was on-site for 78.6%, and 85.7% had ≥ 1 psychiatric comorbidity. Negative-UDS consistency was 85.7% versus 95.1% in Wu et al. (p = 0.21). The retention rate was 35.7% versus 88.7% in Wu et al. (p < 0.0001) but lay within the wider U.S. range of 19–64%. Two patients (14.3%) achieved remission after a median of six visits; three (21.4%) remained engaged ≥ 3 months.

Conclusions: Embedding pharmacists in a residency-based MOUD program yielded high medication adherence and UDS consistency comparable to collaborative-care trials, but retention lagged. Enhanced behavioral-health integration and provider continuity may bolster long-term engagement while preserving pharmacist-driven safety benefits.

Minds in Crisis: How the AI Revolution is Impacting Mental Health

Keith Robert Head

LMSW, Master^'s in Social Work (MSW), West Texas A & M University, USA

Master of Business Administration (MBA), Bottega University, USA

The rapid rise of generative AI systems, particularly conversational chatbots such as ChatGPT and Character.AI, has sparked new concerns regarding their psychological impact on users. While these tools offer unprecedented access to information and companionship, a growing body of evidence suggests they may also induce or exacerbate psychiatric symptoms, particularly in vulnerable individuals. This paper conducts a narrative literature review of peer-reviewed studies, credible media reports, and case analyses to explore emerging mental health concerns associated with AI-human interactions. Three major themes are identified: psychological dependency and attachment formation, crisis incidents and harmful outcomes, and heightened vulnerability among specific populations including adolescents, elderly adults, and individuals with mental illness. Notably, the paper discusses high-profile cases, including the suicide of 14-year-old Sewell Setzer III, which highlight the severe consequences of unregulated AI relationships. Findings indicate that users often anthropomorphize AI systems, forming parasocial attachments that can lead to delusional thinking, emotional dysregulation, and social withdrawal. Additionally, preliminary neuroscientific data suggest cognitive impairment and addictive behaviors linked to prolonged AI use. Despite the limitations of available data, primarily anecdotal and early-stage research, the evidence points to a growing public health concern. The paper emphasizes the urgent need for validated diagnostic criteria, clinician training, ethical oversight, and regulatory protections to address the risks posed by increasingly human-like AI systems. Without proactive intervention, society may face a mental health crisis driven by widespread, emotionally charged human-AI relationships.

Depression in Youth: Investigating the Impact of Obesity, Inflammation and Sleep: A Narrative Review

Angela Trombley^1*, Paul Trombley^2,3

¹Assistant Professor, Western Carolina School of Nursing, Cullowhee, NC, USA

²Diplomate of the American Board of Pediatrics, USA

³Diplomate of the American Board of Psychiatry and Neurology in Child and Adolescent Psychiatry, USA

Background: Depressive disorders in children and adolescents have been associated with lifelong health implications and risk factors. Concurrently, rates of depression, overweight and obesity in pediatrics have markedly worsened since the COVID-19 pandemic. Sleep and inflammation have also been described as altered in depressive and overweight or obese status, suggesting an intertwined relationship. This clinical practice review examines these intertwined roles while exploring health care disparities, holistic care, and interdisciplinary approaches.

Methods: The methodology of this review followed a narrative format by examining and summarizing trends related to pediatric depression with existing literature and expert synthesis.

Results: Selected articles provided a broad overview of key concepts contributing to a deeper understanding of research topics. Relevant clinical insights into the complex and interwoven concepts of pediatric depression, obesity, and inflammation answered the research question by informing clinical practice with a culturally sensitive, holistic, and integrated health care approach.

Conclusions: Significant findings underscored the need for healthcare providers to understand the complex relationships between depression, obesity, inflammation, and sleep, to avoid healthcare disparities and risk for negative lifelong consequences. This article is intended for all the disciplines involved in the care of pediatric populations.

The Association between Mental Health and Stressful Life Events among Undergraduate Students in Cyprus: A Descriptive Correlational Study

Sokratis Sokratous^1*, Giorgos Alexandrou¹, Rafailia Zavrou¹, Elena Rousou¹, Nikolas Sokratous², Maria Karanikola¹

¹Department of Nursing, Cyprus University of Technology, Limassol, Cyprus

²General Oncology Hospital of Kifisia – Saints Anargyroi, Greece

Background: Previous studies have indicated a causal link between stressful life experiences and mental health. However, little is known about the impact of the frequency and seriousness of recent stressful life events on clinical mental discomfort among university students. This study explored the mental health status of undergraduate students in Cyprus. It examined the association between the number and severity of stressful life events and clinical symptoms of mental distress.

Methods: This was a cross-sectional, descriptive, correlational study conducted using convenience sampling, with a total of 1,500 undergraduate students participating. Descriptive statistics for sociodemographic characteristics, mental distress symptoms, and life events of the participants were calculated and expressed in frequencies, mean values, and standard deviations. One-way analysis of variance and independent sample t-tests were conducted to compare the General Health Questionnaire – 28 (GHQ-28) subscales with groups based on the number of events and total score in Life Events Scale for Students (LESS).

Results: After adjusting for sociodemographic characteristics using logistic regression analysis, gender remained the only variable significantly associated with mental distress symptoms before and after controlling for stressful life events, with women being 1.6 times more likely to report clinical levels of distress than men (95% CI: 0.98–2.46). However, a statistically significant association was observed between gender and mental distress symptoms. Specifically, women had a higher level of mental distress than men.

Conclusion: Individual characteristics, stress, negative life events, and psychological distress were interconnected. Collaboration among teachers, students, parents, and mental health professionals is essential to create a supportive and nurturing school environment.

Person-Centered Health Services Research: Policy Implications

John S. Lyons^1*, Olga A. Vsevolozhskaya²

¹Center for Innovation in Population Health, Department of Health Management and Policy Administration, College of Public Health, University of Kentucky, Lexington, KY, USA

²Center for Innovation in Population Health, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA