Etomidate, traditionally an anesthetic agent, has recently emerged as a substance of misuse through the adulteration of e-vaporizers. Previous reports have raised concerns of associated adrenal dysfunction. In this case report, we describe two patients with a history of etomidate-laced vaporizer use who were incidentally found to have asymptomatic hypokalemia (serum potassium 2.9 mmol/L and 3.3 mmol/L) during outpatient evaluation. Both patients also presented with diffuse and palmer crease hyperpigmentation, a clinical sign frequently seen in adrenal dysfunction. Unlike previously reported cases presenting with neuromuscular weakness or adrenal crisis, this case report highlights subclinical manifestations of endocrine disruption associated with etomidate use. Early screening of asymptomatic hypokalemia in etomidate misuse is therefore important for clinicians treating this emerging group of patients, as this may facilitate timely investigation and prevention progression to severe adrenal complications.
Sexual functioning in trichotillomania and skin picking disorder
BackgroundThis study examines sexual functioning in adults with trichotillomania and skin picking disorder. To our knowledge, no study has examined sexual functioning in either of these disorders.Methods334 adults (mean age=30.21, SD = 8.23, 83.5% cisgender women, 67.6% sexually active with another person in the past month) were recruited from online Reddit communities. Participants completed surveys assessing demographics, sexual functioning, and current and lifetime pulling and picking severity. Comorbidities and treatment history were assessed via dichotomous variables. Sexual functioning was assessed via the Changes in Sexual Functioning Questionnaire – Short Form (CSFQ-14).Results27.1% (n=85) of the sample met criteria for sexual dysfunction. After controlling for relationship status, participants who rated their picking as currently at its worst had significantly lower scores on the Orgasm/Completion subscale. Sexual dysfunction, the total score, and subscales scores were not significantly associated with any current comorbidities or treatment variables.ConclusionsIt is difficult to compare rate of sexual dysfunction in adults with trichotillomania and skin picking disorder with the rate in the general population given the homogeneity of this study’s sample. However, worse skin picking symptoms appear to be associated with worse sexual functioning, particularly in the orgasm domain. Since severity of comorbidities was not assessed in this study, further research is needed to determine whether comorbid disorders have an effect on sexual functioning in this population.
Moral injury in animal care workers: prevalence, pathways, and phenomenology in a cross-sector sample
IntroductionMoral injury, the psychological harm resulting from events that violate one’s deeply held moral beliefs, has been extensively studied in military and healthcare populations but remains largely unexamined among animal care workers.MethodsThis cross-sectional survey of 291 animal care workers across six sectors (rescue, shelter, animal control, veterinary medicine, volunteer/foster, and other) provides the first empirical prevalence estimate of moral injury in this cross-sector population using a validated syndrome measure.ResultsFindings from the Moral Injury Outcome Scale (MIOS) indicate that 83.5% of participants endorsed at least one morally injurious experience pathway; most common was witnessing (63.9%), followed by being affected by others’ transgressions (38.5%) and direct participation (29.2%). Applying published caseness thresholds, 18.9% of the potentially morally injurious event (pMIE) endorsers met criteria for moral injury as a clinical syndrome and an additional 21.4% for moral distress (subclinical), with blended shame and trust violation presentations characterizing the majority (53.1%) of clinical cases. Patient Health Questionnaire-9 scores exceeded the clinical threshold for moderate depression (M = 10.96, SD = 6.27). One-way analysis of variance revealed significant sector differences in functional impairment, trust violations, and depression, with shelter workers reporting the highest levels across nearly all measures. The MIOS Shame subscale was more strongly associated with both depression (r = .646) and functional impairment (r = .343) than the Trust Violations subscale, which showed no significant relationship with functional impairment (r = .045, p = .456). Endorsement of the direct participation pathway was the only exposure pathway significantly associated with caseness classification, with 31.8% of direct participation endorsers meeting criteria for moral injury compared to 12.0% of non-endorsers (p < .001). A departure from standard MIOS administration presenting impact items to all participants revealed that a small number of pMIE non-endorsers met caseness thresholds despite actively denying exposure, raising questions about the comprehensiveness of current pathway categories.DiscussionThese findings identify moral injury as a prevalent and clinically significant occupational experience among animal care workers, with distinct shame-based and trust violation-based mechanisms in predicting functional decline and clinical severity, respectively. Implications for targeted intervention and organizational reform are discussed.
A connectome-based neural correlate of pediatric ADHD hyperactivity–impulsivity symptoms
BackgroundThis study examined the brain networks related to hyperactivity and impulsivity in children with Attention-Deficit/Hyperactivity Disorder (ADHD) and aimed to develop a resting-state functional connectivity marker that can predict symptom severity.MethodsA total of 44 children with ADHD (31 boys and 13 girls; mean age = 8.45 ± 1.52 years; range = 6–12 years) who met DSM-5 criteria were included. Resting-state fMRI data and clinical symptom scores were collected. Connectome-based predictive modeling (CPM) was used to predict hyperactivity–impulsivity symptoms based on whole-brain functional connectivity matrices. Symptoms were assessed using the SNAP-IV Parent and Teacher Rating Scales and the Conners Comprehensive Behavior Rating Scale. Model performance was tested with leave-one-out cross-validation and permutation testing.ResultsThe CPM model based on interregional functional connectivity successfully predicted hyperactivity–impulsivity symptoms (SNAP-IV parent and teacher ratings: r = 0.48, p = 0.001). The model also generalized well within the same dataset, as the selected functional connections significantly predicted hyperactivity–impulsivity scores on the Conners Parent Rating Scale (r = 0.49, p = 0.0009). Further analysis showed that stronger connectivity between the frontoparietal control network (FPN) and the dorsal attention network (DAN), and weaker connectivity between the FPN and the ventral attention network (VAN) and between the FPN and the somatomotor network (SMN), were related to symptom severity.ConclusionsWhole-brain functional connectivity is associated with hyperactivity–impulsivity symptoms in children with ADHD. The findings highlight the key role of FPN-related networks in these symptoms and provide a neural correlate that, pending further validation, represents a preliminary candidate for a neuroimaging marker.
Early biopsychological changes during masculinizing gender-affirming hormone therapy in AFAB transgender individuals: a 4-month prospective study
ObjectiveTransgender individuals frequently experience elevated levels of psychological distress, including anxiety and trauma-related symptoms. Gender-affirming hormone therapy (GAHT) has been associated with improvements in mental health and quality of life; however, early biopsychological changes occurring during the initial phase of masculinizing hormone therapy remain insufficiently understood. The present exploratory longitudinal study investigated early endocrine and psychological changes in transgender individuals assigned female at birth undergoing masculinizing GAHT.MethodsWe conducted a 4-month prospective observational study involving 30 transgender individuals assigned female at birth initiating masculinizing GAHT. Participants were assessed at baseline (prior to treatment initiation), after 2 months, and after 4 months of therapy. Hormonal parameters (estradiol, testosterone, prolactin) and psychological measures including anxiety (HAM-A), trauma-related symptoms (TSC-40), and quality of life (MANSA) were evaluated. Due to the exploratory character of the study and the relatively small sample size, analyses were performed primarily using non-parametric statistical methods, including repeated-measures analyses.ResultsDuring follow-up, expected endocrine changes were observed, including decreased estradiol levels and increased testosterone concentrations. These changes were accompanied by reductions in anxiety and trauma-related symptoms and by improvements in quality of life measures over time. Repeated-measures analyses demonstrated significant longitudinal improvements in psychological outcomes across follow-up assessments (p < 0.05). Exploratory associations between hormonal and psychological variables appeared more pronounced after 4 months of treatment, particularly for estradiol in relation to anxiety and quality of life. Earlier assessments demonstrated weaker and less consistent associations. Psychological improvements were not directly proportional to the magnitude of hormonal changes alone, suggesting that psychosocial and treatment-related factors may also contribute to early adaptation during GAHT.ConclusionEarly masculinizing GAHT in transgender individuals assigned female at birth was associated with favorable endocrine and psychological changes during the first 4 months of treatment. The findings support a complex and potentially time-dependent relationship between hormonal alterations and psychological adaptation during early transition. Given the exploratory nature and limited sample size of the present study, further longitudinal research with larger cohorts and comparison groups is needed to clarify the underlying biopsychological mechanisms of GAHT.
Medical innovation in LMICs: can India lead the way?
Nature Medicine, Published online: 17 June 2026; doi:10.1038/s41591-026-04499-z
With its biomedicine at an inflection point, India can seize the opportunity to scale up research and development at home and offer a distinct model of biomedical innovation for the global south.
CAR T cells take on precancers
Nature Medicine, Published online: 17 June 2026; doi:10.1038/s41591-026-04473-9
CAR T cell therapy can induce deep responses but also severe toxicities in patients with smoldering myeloma, an asymptomatic cancer precursor; given the potential risks and benefits, its success depends on careful patient selection.
Why large-scale randomized trials of live-attenuated shingles vaccination for dementia prevention are urgently needed
Nature Medicine, Published online: 17 June 2026; doi:10.1038/s41591-026-04474-8
In my view, we have never had as robust a body of evidence from observational data on an intervention for dementia as we do for live-attenuated shingles vaccination. Both a recent US National Institutes of Health expert workshop and an international expert consensus on Alzheimer’s disease drug repurposing identified large-scale randomized trials of shingles vaccination for dementia prevention as the crucial next step for the field.
STAT+: Is Abridge’s ‘patient centered’ claim a bridge too far?
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I cried reading about people’s shared moments with strangers at the bottom of last week’s edition of “We’re Here,” the community newsletter from Hank and John Green.
My colleague Eric Boodman’s stories usually make me cry as well, but his recent article about babies being born with congenital syphilis, which is usually totally preventable with penicillin from Pfizer, made me want to tear my hair out.
<![CDATA[Welcome back to another Psychiatric Times Insights series. In this episode titled, “The Switch Study: Why a New Mechanism Demands a New Approach,” David Walling, PhD, address the unmet clinical needs in schizophrenia treatment that motivated the development of the study evaluating the transition from atypical antipsychotics to Cobenfy?]]>