Tag: Therapy

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Integrating cognitive-behavioral training with immersive virtual reality intervention in ADHD: a case report

IntroductionAttention-Deficit/Hyperactivity Disorder (ADHD) is a condition characterized by persistent patterns of inattention and/or hyperactivity-impulsivity. This case highlights the potential benefit of integrating Immersive Virtual Reality (IVR) with cognitive-behavioral therapy (CBT) in the rehabilitation of a child with ADHD. It contributes to emerging evidence by showing how a combined approach may simultaneously target executive, attentional, and motor domains within a single intervention.Case presentationAn 8-year-old child with deficits in sustained and selective attention, impaired executive functioning (including planning and working memory), impulsivity, and difficulties in motor regulation, as revealed during baseline assessments, impacting daily functioning. The patient was diagnosed with combined-type ADHD and underwent a 12-week CBT intervention, followed by integrated IVR-CBT intervention targeting executive functions and self-control, once a week for 12 weeks. The intervention was conducted using the CAREN (Computer Assisted Rehabilitation Environment), an immersive virtual reality platform integrating multisensory input and interactive tasks to promote cognitive and motor engagement. Post-intervention assessments showed improvements in sustained and selective attention, planning, working memory, and balance. There was also an increase in involvement and a reduction in impulsivity.ConclusionThe findings support the hypothesis that immersive, embodied interventions targeting both executive and sensorimotor processes may represent a promising novelty adjunctive rehabilitation approach. Further studies are needed to evaluate efficacy, generalizability, and to confirm these findings in larger samples. This case report was prepared in accordance with the CARE Guidelines.
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Quitting smoking is hard. A Medicare change may push doctors to give more help

Pretty much everyone who cares about public health agrees that it’s a good idea to help people quit smoking, the No. 1 cause of preventable death in the U.S. Doctors may soon get some extra encouragement to lend a hand, thanks to proposed changes in Medicare’s physician fee schedules.

Physicians who offer counseling on quitting cigarettes or other tobacco products during visits with patients would get a 19% increase in reimbursement, according to a few paragraphs buried in the 1,592-page document released this week. The same adjustment would also apply to assessments of, and interventions for, alcohol and substance misuse during doctors’ visits.

“Given the evidence supported role these services play in preventing and managing chronic disease […] we believe that valuation should more accurately reflect the clinical intensity and work associated with these time-based services,” the proposal from the Centers for Medicare and Medicaid Services explains. Comments on the proposal are due Sept. 14. 

“The prioritization of cessation as a service is long overdue, and we’re very excited about it,” said Anne DiGiulio, the American Lung Association’s senior director of nationwide tobacco cessation and health policy.

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<![CDATA[Learn how clinicians manage bipolar disorder in women who may become pregnant—safer meds, contraception counseling, and relapse prevention.]]>
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Pharmacotherapy, acupoint stimulation, and psychotherapy for perimenopausal women with anxiety, depression, and panic disorder: a systematic review and network meta-analysis of randomized controlled trials

BackgroundPerimenopausal women frequently experience physiological and psychological symptoms, including anxiety, depression, and panic disorders, mainly due to declining ovarian function and hormonal changes. Current options include pharmacotherapy, acupoint stimulation (AcuStim), and psychotherapy (psych), but their comparative efficacy and safety remain controversial.ObjectiveThis network meta-analysis (NMA) systematically compared pharmacotherapy, AcuStim, and psychotherapy for perimenopausal anxiety, depression, and panic disorder, assessing clinical efficacy, adverse events (AEs), and changes in the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Kupperman Index (KI), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Index (PSQI), and serum hormone levels.MethodsWe searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed from inception to June 14, 2026, for randomized controlled trials (RCTs). A Bayesian NMA was performed, and the Surface Under the Cumulative Ranking Curve (SUCRA) was calculated.ResultsThe study included 131 RCTs, encompassing 11457 perimenopausal women diagnosed with emotional disorders. These trials evaluated three distinct treatment strategies. The NMA showed that the highest SUCRA probabilities were observed for drug_psych across HAMD (SUCRA = 92.4%), KI (SUCRA = 97.9%), SDS (SUCRA = 94.5%), PSQI (SUCRA = 98.1%), and follicle-stimulating hormone (FSH) (SUCRA = 96.1%) reduction and estradiol (E2) (SUCRA = 0.1%) elevation; for AcuStim_psych (SUCRA = 93.7%) in HAMA reduction; for psych (SUCRA = 98.9%) in SAS reduction; for drug_AcuStim in clinical efficacy (SUCRA = 9.0%) and luteinizing hormone (LH) reduction (SUCRA = 100%); and for control (SUCRA = 65.5%) in safety outcomes. In pharmacotherapy subgroup analyses, antidepressants (ADs)_Traditional Chinese medicine (TCM) ranked highest for HAMD (SUCRA = 87.2%) and safety (SUCRA = 82%), ADs_antipsychotics (AP) (SUCRA = 97.5%) for HAMA, and ADs_hormone replacement therapy (HRT) (SUCRA = 10.2%) for clinical efficacy.ConclusionPharmacological, acupoint stimulation, and psychological interventions each demonstrated therapeutic benefits for perimenopausal women with emotional disorders. Combination therapies generally showed more favorable efficacy across multiple psychological and endocrine outcomes than single-modality interventions, while no single treatment strategy was consistently superior across all outcomes. These findings may provide evidence to support individualized treatment selection according to patients’ clinical characteristics and therapeutic goals.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261340530.
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Why affirming trans identities can be critical for suicide prevention counseling

Specialized counseling services for LGBTQ+ youth will return to the 988 Suicide & Crisis Lifeline by the end of the year, the Trump administration confirmed last month. But young people looking to “press 3” for that support may encounter an altered experience, as federal health officials want to ensure the services comply with President Trump’s executive order last year that essentially denies the existence of transgender and nonbinary identities. 

The Trump administration shuttered the LGBTQ+ youth specialty services last July, but soon after, a congressional appropriations bill directed $33.1 million toward reinstating the line. The law indicates that services should support all LGBTQ+ youth. 

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Fragile self, mechanical world: mechanistic delusions and ego fragility in schizotypal–affective spectrum disorder—a CARE case report

Categorical nosological systems frequently fall short when confronted with patients whose presentations cross established diagnostic boundaries. We report M.S., a 44-year-old Brazilian man involuntarily admitted to a psychiatric inpatient unit who presented with systematized persecutory ideation of mechanistic–technological content (chip implantation, satellite-based surveillance), structural ego fragility, absent insight, and progressive social and occupational deterioration. While prior diagnoses of bipolar disorder and provisional schizophrenia had been considered, neither fully captured the clinical complexity. Psychopathological-dimensional analysis, grounded in phenomenological observation and contemporary psychopathological theory, suggests three potentially interacting axes: (1) structural ego fragility (Ich-Schwäche), potentially arising from impaired early attachment and deficient relational learning; (2) a relational causality deficit replaced by concrete–mechanistic reasoning; and (3) limbic hyperactivation that appears to sustain an anxiety–perplexity–paranoia feedback loop. These converge on a schizotypal–affective spectrum formulation. Laboratory investigations identified severe dyslipidemia and marked hyperandrogenism (total testosterone 1,367 ng/dL), the latter potentially associated with limbic hyperactivation, though causality cannot be established from a single cross-sectional measurement. Psychometric assessment (BPRS-18) at admission yielded a total score of 43, with suspiciousness (5) and unusual thought content (5) as dominant items. During a seven-day inpatient course, a multimodal thymic strategy—risperidone, lithium carbonate, and structured psychotherapy—produced attenuation of paranoid reactivity, improved family engagement, and the spontaneous resumption of guitar playing from day 3, as a functional correlate of behavioral stabilization. The patient was discharged with a referral for a three-monthly paliperidone palmitate long-acting injectable. The pharmacological response retrospectively supports the dimensional formulation and illustrates the heuristic value of psychopathological analysis grounded in ego structure, causal reasoning, and affective dysregulation as a complementary approach to categorical nosology in complex psychotic–affective presentations.