Case Report: Subacute combined degeneration misdiagnosed as a primary affective disorder: diagnostic pitfalls and clinical red flags

BackgroundSubacute combined degeneration (SCD) of the spinal cord is a progressive neurological disorder caused by vitamin B12 deficiency. When initial symptoms present as nonspecific fatigue, dizziness, and affective distress, the condition is frequently misattributed to primary psychiatric disorders. This “diagnostic overshadowing” leads to critical delays in administering definitive therapy, risking irreversible axonal damage.Case presentationA 39-year-old male presented with a nine-month history of progressive paresthesia, dizziness, and emotional distress. Initial medical workups (including brain CT and EEG) were unremarkable, leading to a diagnosis of Somatic Symptom Disorder and anxiety. Despite treatment with multiple psychotropic agents, his condition deteriorated, eventually manifesting as lower limb weakness and significant gait ataxia. Subsequent evaluation at a tertiary center revealed absent patellar reflexes and impaired vibratory sensation. Psychometric testing (SCL-90) showed a high somatization factor (3.00). Investigations confirmed a critically low serum vitamin B12 level (<37 pmol/L) and characteristic longitudinally extensive T2-weighted hyperintensities in the dorsal columns from C3 to T12. Following intramuscular and oral vitamin B12 replacement, supplemented by escitalopram for residual distress, the patient achieved significant recovery. At five-month follow-up, he was fully ambulatory with near-normalization of psychometric scores.ConclusionThis case illustrates the risk of misinterpreting organic neurological deficits as psychogenic somatization. A discrepancy between subjective psychiatric complaints and emerging objective neurological signs-such as absent reflexes or ataxia-should trigger an immediate search for underlying organic etiologies and the initiation of targeted treatment.

Early Intervention to Prevent Development of PTSD in Burn Survivors and Their Caregivers

Conditions: Posttraumatic Stress Disorder; Burns; Traumatic Injury; Acute Stress Disorder; Trauma and Stressor Related Disorders; Trauma and Stress Related Disorders; Stress Disorder; Stress Disorders, Post-Traumatic; Stress Disorders, Traumatic; Stress Disorders, Traumatic, Acute; Relationship, Social

Interventions: Behavioral: Promotion of Emotional Disclosure for Burns (PoED-B); Behavioral: minimally Enhanced Usual Care control (mEUC)

Sponsors: University of Southern California; Los Angeles General Medical Center; National Institute of Mental Health (NIMH)

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RFK Jr. presents $700 million in mental health funding, but experts say grants aren’t new

The Trump administration on Wednesday said it was announcing $700 million in “new funding” for mental health and addiction programs, with an emphasis on combating homelessness resulting from severe, untreated mental illness. 

But behavioral health experts instantly cast doubt on the claim, identifying the $700 million not as new funding but as the long-awaited release of existing grants that Congress had previously authorized and that the federal government already planned to spend. 

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OLE Identified as a Potential Alzheimer’s Therapy Targeting Microglia

A research collaboration between investigators from the Spanish National Research Council (CSIC), the Miguel Hernández University of Elche (UMH), and the École Polytechnique Fédérale de Lausanne (EPFL) has identified a molecule that may could be a new approach to treating Alzheimer’s disease (AD) by restoring the protective functions of microglia, immune cells found in the brain. The findings, published in Cell Death & Disease, said the molecule N-oleoyl-Leucine (OLE), which is derived from the Alzheimer’s disease-associated gene PM20D1, was shown to reduce amyloid pathology, improve cognition, and promote neuroprotection.

“One of the most significant findings is that we have identified a molecule capable of restoring microglia’s protective function,” said senior author José Vicente Sánchez Mut, PhD, principal investigator at the Functional Epi-Genomics of Aging and Alzheimer’s Disease laboratory at the Institute for Neurosciences, a joint CSIC-UMH center. “In Alzheimer’s disease, these cells become progressively impaired. Our results suggest that this process can be reversed, pointing to new therapeutic and research avenues to counteract the disease.”

In recent years, there has been a surge of research into microglia’s role in AD. As the researchers noted, genetic risk variants associated with AD are enriched in regions that regulate microglial function, and microglial gene-expression programs have been shown to be altered during disease progression. As the disease advances, microglia proliferate and accumulate around amyloid plaques, but lose their ability to maintain tissue homeostasis and clear amyloid beta (Aβ). At the same time these immune cells take on inflammatory and neurotoxic characteristics.

PM20D1 has been identified recently as a risk gene in the development of AD. It is a quantitative trait locus associated not only with Alzheimer’s disease but also with diabetes, obesity, and other disorders. People exhibiting lower PM20D1 expression have a higher risk of developing metabolic disorders and Alzheimer’s disease. Other prior research studies also showed that PM20D1 overexpression in mouse models reduced amyloid levels and cognitive deficits, making it a potentially fruitful area for additional study.

PM20D1 encodes a secreted enzyme that regulates the conjugation of fatty acids with amino acids, generating compounds known as N-acyl amino acids (NAAA). OLE is one of these amino acids and was selected for further investigation because PM20D1 activity in living organisms appears to favor its production and because OLE levels are strongly correlated with PM20D1 expression in both humans and mice.

“There is increasing evidence of microglia participation in Alzheimer’s disease (AD), which incentives their modulation to intercept the disease,” the researchers wrote. “Here, we describe a new mechanism by which the recently AD-associated Peptidase M20 Domain Containing 1 (PM20D1) instructs microglia to tackle AD.”

To evaluate OLE’s therapeutic potential, the team first tested it in genetically engineered Caenorhabditis elegans worms that produce beta-amyloid, where they showed that OLE treatment reduced protein aggregation and improved mobility. The researchers then administered OLE to APP/PS1 mouse models of AD for three months. Again, the mice demonstrated better performance in memory tests and showed reductions in amyloid plaque burden.

A cellular analyses found that microglia were the cells most responsive to OLE treatment.

“Single-cell analysis allowed us to determine that microglia were the cells that responded most strongly to the treatment,” said first author Victoria Pozzi, PhD, a postdoctoral researcher working in the Sánchez Mut lab. “From there, we observed that the compound helped these cells move toward beta-amyloid plaques and better contain the damage associated with the disease.”

The study also found that OLE increased Aβ chemotaxis and clearance in cultured microglia. In neuronal cultures exposed to Alzheimer’s-related stressors, OLE enhanced cell survival, indicating that the molecule may have direct neuroprotective effects in addition to its effects on immune cells.

The team believes OLE may function as a disease-modifying therapy by altering microglial behavior and reducing amyloid-associated damage, but because OLE was administered systemically in their experiments, more work is needed to determine whether its primary effects occur in microglia or whether it acts independently on multiple cell types. They also plan to investigate whether other N-acyl amino acids have therapeutic potential and whether OLE can influence tau pathology and neurodegeneration.

The post OLE Identified as a Potential Alzheimer’s Therapy Targeting Microglia appeared first on Inside Precision Medicine.

A Shared Vision for Children and Young People: Advancing Partnership and Impact at SNF Nostos 2026

As the Stavros Niarchos Foundation (SNF) celebrates 30 years of visionary philanthropy, leaders from across sectors and around the world will gather at SNF Nostos 2026 (June 21–28) at the Stavros Niarchos Foundation Cultural Center (SNFCC) in Athens, Greece. There, they will explore bold ideas and practical solutions for building a better future. The Child Mind Institute is honored to participate in this milestone anniversary celebration, grateful for SNF’s longstanding partnership and commitment to advancing child and adolescent mental health globally.

Throughout the SNF Nostos 2026 week, the Child Mind Institute and the SNF Global Center for Child and Adolescent Mental Health will contribute to conversations examining how youth mental health intersects with some of today’s most pressing challenges, including education, technology, equity, and workforce development. These discussions will bring together diverse perspectives united by a shared belief that meaningful progress requires collaboration across disciplines, sectors, and borders.

During the panel, “SNF’s Global Health Initiative (GHI): Focus on Mental Health”, SNF co-president Andreas Dracopoulos will join founding president and medical director of the Child Mind Institute, Harold S. Koplewicz, MD, senior vice president of Global Programs Giovanni Abrahão Salum, MD, PhD, and other international experts to explore how sustainable support for mental health can strengthen communities and improve outcomes for children and young people worldwide. The discussion will highlight approaches that are locally led, evidence-based, and designed to meet the unique needs of diverse communities.

In addition, the SNF Global Center and its Global Youth Advisory Council (GYAC) will come together, in-person, for the first time to lead two conversations focused on advancing collaborative and community-driven approaches to mental health:

  • Strengthening Mental Health Systems through Cross-Country Partnerships: Case Studies from Greece, South Africa, Brazil, and Mozambique
  • Youth Voices Driving Digital Innovation in Mental Health Interventions

These conversations aim to highlight how countries and communities are building stronger systems of support through local leadership, meaningful youth participation, and innovative approaches to care.

Members of the SNF Global Center at the Child Mind Institute’s Global Youth Advisory Council (GYAC)

Building on the momentum of the SNF Global Center’s inaugural Global Summit on Youth Mental Health in 2025 and the ongoing work of the GYAC, SNF Nostos 2026 will also spotlight the critical role young people play in shaping the future of mental health. Across the week, youth leaders will share perspectives on how lived experience, community engagement, and innovation can help create more responsive and effective systems of support.

Additionally, a landmark Evidence-to-Policy Review examining what it means to navigate adolescence in an increasingly digital world will be presented.  Commissioned by the Prime Minister of Greece and developed through the Child and Adolescent Mental Health Initiative (CAMHI) in Greece, the youth-led report brings together the latest evidence, youth perspectives, and a roadmap for how governments, institutions, and communities can better support young people in Greece and beyond.  Having started in Greece, CAMHI has since expanded into additional core hubs in South Africa and Brazil, as well as partnerships across multiple low- and middle-income countries.  We look forward to seeing the positive impacts this expansion will make on youth mental health globally.

Finally, as a special part of the celebration, the Child Mind Institute is proud to share a video reflecting on our transformative partnership with SNF, and the exceptional changes made possible through the SNF Global Center for Child and Adolescent Mental Health. Over the past six years, we have worked together to expand access to care, strengthen mental health systems, support local leaders, and elevate youth voices across communities around the world.

“What we share with the Stavros Niarchos Foundation, is that we both believe that every child, everywhere, deserves mental health.”

Dr. Harold S. Koplewicz

SNF Nostos 2026 is a celebration of what becomes possible when people unite around a shared purpose. With humanity at the core, SNF Nostos 2026 will serve as a reminder that sustained progress begins with people — especially youth, families, communities, and the leaders committed to supporting them. Together, we can build a world where every child counts.

The post A Shared Vision for Children and Young People: Advancing Partnership and Impact at SNF Nostos 2026 appeared first on Child Mind Institute.

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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.