Background/Objectives: The initial systematic review of "Concurrent Disorder Management Guidelines. Systematic Review" assessed the quality of the concurrent disorders' clinical management guidelines in 2020, including the guidelines in the field from 2000 to 2020. Twenty-four guidelines were identified and assessed with AGREE II (Appraisal of Guidelines for Research and Evaluation). As dual disorder needs increased specifically among the younger population, requiring significant healthcare resources, more efficient approaches targeting complex concurrent disorders are essential. Since 2020, multiple new guidelines have been developed in response to new developments in the field of substance use disorder management. This systematic review update aimed to identify and appraise all new available concurrent disorder management guidelines to strategize the management of concurrent disorders, support better outcomes and further research directions. Methods: The review was registered, and protocol is available in the international register-PROSPERO. Literature searches were performed by two independent authors in electronic databases and the gray literature. The inclusion criteria were English language clinical management guidelines for adult concurrent disorders between 2020 and 2025. Sources that were not formal clinical guidelines, not addressed to physicians for adult age group, addressed to intellectual/developmental disability, or written in languages other than English were excluded. Results: The initial search resulted in 5003 records. A total of eight new guidelines were identified and assessed with AGREE II, highlighting the consistent gap in the evidence-based management recommendations. Conclusions: The appraised guidelines had similar quality to the 2020 findings, supporting dual or combined treatment; however, all guidelines had multiple domains not developed rigorously and with methodological limitations. Levels of complexity and staging of treatment were not considered in recommendations. Average domain scores were very low, with the lowest being applicability and editorial independence. Development of high-quality, rigorously developed, evidence-based guidelines, addressing staging, resource implications, and patient involvement is recommended as the evidence base remains underdeveloped.

Background/Objective: In recent years, epidemiological and clinical evidence has suggested an association between the use of second-generation antipsychotics (SGAs) and hyperglycemic complications: notably, diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS). However, the role of first-generation antipsychotics (FGAs) remains less well understood. To conduct a systematic review of evidence established in case reports (CRs) on adverse drug reactions, specifically DKA and HHS, associated with the use of both FGAs and SGAs in order to identify patterns that may inform clinical awareness and future research. Methods: Pertinent bibliographic databases (MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials (CENTRAL)) were searched using index phrases and keywords up until 17 October 2025. Eligible CRs discussed exposure to at least one US FDA-approved antipsychotic drug (APD) and assessed either DKA or HHS. Results: A total of 151 CRs were included in the systematic review (DKA, n = 121; HHS, n = 28; both conditions, n = 2). Patients aged 30 to 39 years accounted for the highest number of emergencies (n = 49, 32.5%), which occurred mostly in males (n = 108, 71.5%). The most common mental health diagnosis was schizophrenia (n = 77, 51%), followed by bipolar disorder (n = 26, 17.2%). Olanzapine was associated with the highest number of DKA cases (n = 53, 43.1%), followed by clozapine (n = 24, 19.5%). The average blood glucose at presentation was 842.8 mg/dL for DKA patients and 1252.8 mg/dL for HHS patients. The average hemoglobin A1c levels (HbA1c) were 11.5% and 12%, respectively, for these two conditions. Of the 12 reported fatalities, treatment with olanzapine was noted in four DKA cases and in one HHS case. Conclusions: This analysis provides additional evidence of an association between the use of atypical APDs and DKA or HHS. Clinicians should continue to monitor metabolic risk factors for these conditions, as well as educating patients about the prevention of acute diabetic complications.

Background/Objectives: Cortisol has become established as a relevant biomarker due to its association with various pathologies, including its potential utility in mental health research. However, regarding the techniques employed for its analysis, the available literature shows a certain degree of heterogeneity both in the methods used to obtain cortisol and in the analytical techniques employed for its measurement. This makes it difficult to compare results across specific populations, particularly in pregnant women, who experience metabolic and physiological changes characteristic of gestation. Therefore, the aim of this study was to describe the procedure for the extraction and analysis of cortisol in hair samples from pregnant women throughout gestation. Methods: Hair samples, three centimeters in length, were obtained from women during the first, second, and third trimesters of pregnancy. These samples underwent a standardized isopropanol washing step, followed by milling in a laboratory mill using zirconium balls of varying diameters. The resulting hair powder was then weighed and subjected to four incubation cycles using HPLC-grade methanol. Cortisol levels were detected using chemiluminescence immunoassay. Results: Mean hair cortisol levels were 4.1 μg/L (ng/mL) in the first trimester, 11.5 μg/L (ng/mL) in the second trimester, and 6.6 μg/L (ng/mL) in the third trimester. Conclusions: Standardizing the methodology for cortisol extraction improves the reproducibility of results and, in the long term, may support its incorporation into clinical practice as a useful tool for assessing cortisol levels in both pregnant women and the general population, since hair cortisol enables retrospective evaluation of its cumulative exposure over time, approximately on a monthly basis.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is often associated with cutaneous pain. The objective of this study was to evaluate the impact of cutaneous pain on the prevalence of anxiety, depression, quality of life (QoL) and stigmatization in patients with AD. Methods: A cross-sectional study was conducted on a group of 113 adults with AD (61% females; mean age 34.48 ± 13.20 years). The severity of AD was evaluated using the Eczema Area and Severity Index (EASI). The intensity of cutaneous pain in the past week was measured using a Numerical Rating Scale (NRS), a Short Form McGill Pain Questionnaire (SF-MPQ) and a Visual Analogue Scale (VAS). Psychosocial burden was evaluated using the Hospital Anxiety and Depression Scale (HADS), the Anxiety Generalized Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Dermatology Life Quality Index (DLQI) and the 6-Item Stigmatization Scale (6-ISS). Results: Individuals with AD who reported cutaneous pain in the past week scored significantly higher in HADS (p < 0.001), HADS-A (p < 0.001), HADS-D (p = 0.002), GAD-7 (p < 0.001), PHQ-9 (p < 0.001), DLQI (p < 0.001) and 6-ISS (p < 0.001) than the rest of the cohort. More individuals with cutaneous pain had anxiety (36 (48.0%) vs. 7 (18.4%), p = 0.002), depression (21 (28.0%) vs. 2 (5.3%), p = 0.006) and abnormal HADS scores (46 (61.3%) vs. 9 (23.7%), p < 0.001) compared to the rest of participants. Significant correlations were observed between all studied pain assessment tools and all studied psychometric assessments. Conclusions: The prevalence and severity of anxiety, depression, stigmatization, and impaired QoL are higher in adults with AD suffering from cutaneous pain compared to those without pain. This symptom is significantly associated with disease burden.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, which presents with painful nodules, abscesses and sinus tracts. Patients suffer from pain, drainage and worsening of mental health and quality of life. Treatment is often difficult. HS is typically associated with obesity and metabolic syndrome; thus, antidiabetics, especially GLP-1 agonists, present a potential therapy option. The aim of this review was to analyze the effects of GLP-1 agonists on patients with HS, including on their cardiovascular risk and quality of life. Methods: A literature search was conducted on Embase and PubMed, yielding 300 papers, of which 10 were used for this review. Results: HS patients using GLP-1 agonists showed improved clinical course with less pain and suppuration. Further, patients' quality of life and mental health improved and their cardiovascular risk was reduced. Inflammatory parameters showed no significant changes. Patients receiving a higher drug dose of GLP-1 agonists were more likely to show clinical improvement. A reduction in weight or BMI did not correlate with improvements in Hurley stage, pain or depression. Hence, HS patients could be treated with GLP-1 agonists. Conclusions: Therefore, whether patients' improvement is due to weight loss, or other mechanisms, i.e., GLP-1 agonists' anti-inflammatory properties, remains to be determined in further studies.

Background/Objectives: Hypothyroidism, including subclinical hypothyroidism, may affect mental health in children and adolescents through disturbances of neurotransmission and dysregulation of the hypothalamic-pituitary-thyroid and stress axes. Anxiety disorders are common in this population and frequently coexist with somatic symptoms overlapping those of hypothyroidism, complicating diagnosis and treatment. This study aimed to evaluate the association between levothyroxine treatment for hypothyroidism and the need for psychiatric interventions in children and adolescents with anxiety disorders. Methods: A retrospective cohort study was performed using data from the TriNetX global research network. Patients aged 5-18 years with diagnoses of hypothyroidism (ICD-10: E03) and anxiety disorders (ICD-10: F41) were included. Two propensity score-matched cohorts were analysed: patients treated with levothyroxine (n = 1861) and untreated patients (n = 1861). Outcomes included psychiatric hospitalisations, use of selective serotonin reuptake inhibitors and tricyclic-like antidepressants, frequency of psychiatric and psychotherapeutic consultations, and the occurrence of suicidal ideation and self-harm. Results: Levothyroxine treatment was associated with lower odds of SSRI use (OR = 0.58; p < 0.001), fewer psychiatric consultations (OR = 0.48; p < 0.001), and lower recorded use of psychotherapy (OR = 0.75; p = 0.029). Suicidal ideation and self-harm were recorded less frequently in the treated group (OR = 0.53; p = 0.001). No significant differences were observed in psychiatric hospitalisation rates. Use of tricyclic-like antidepressants was uncommon and did not differ significantly between groups. Conclusions: Among children and adolescents with comorbid anxiety disorders, levothyroxine treatment for hypothyroidism is associated with lower recorded utilization of certain psychiatric services and lower recorded rates of suicidal ideation and self-harm. Due to the retrospective design, causal inferences cannot be made, and the findings should be considered hypothesis-generating, requiring confirmation in prospective studies with standardised psychiatric outcome measures.

Background: Sjögren's disease (SjD) is a chronic systemic autoimmune disorder characterized by persistent exocrine gland inflammation, possible multi-organ involvement and a marked predominance of mid-life women. Beyond dryness and fatigue, patients report mood disturbances and cognitive complaints such as "brain fog", which affect daily functioning and quality of life. Objective: To summarize and critically synthesize the literature on depression, anxiety, cognitive function, personality traits and quality of life assessment in adults with SjD and to highlight clinically relevant gaps. Methods: We performed a narrative review (PubMed, Cochrane, Embase through June 2025) of studies on psychological outcomes, cognitive function and quality of life in adults with SjD. Results: Depression and anxiety were frequently observed: depressive symptoms were present in roughly one-third to nearly half of patients, while anxiety symptoms were reported by about one-third. Cognitive impairment (affecting memory, attention and executive function) was also frequently described, often alongside severe fatigue and sleep disturbance. Overall, quality of life was reduced in SjD, driven mainly by fatigue and emotional distress rather than by classic disease activity. Neuroimmune mechanisms (e.g., chronic systemic inflammation and cytokine signalling such as IL-6 and TNF-α) may contribute to affective and cognitive symptoms. Overall, the evidence base remains largely cross-sectional and heterogeneous. Conclusions: Psychiatric symptoms and cognitive complaints represent a substantial and clinically relevant burden in SjD. Routine screening and multidisciplinary management that includes psychological assessment and support may improve well-being, adherence and quality of life.

Background: Although the concepts of meteoropathy and meteosensitivity are not included in official classifications, such as the ICD-11 or DSM-5, they are increasingly being studied as potential symptom complexes linking weather variability to health status. The METEO-Q questionnaire, originally developed in Italy, has been adapted in Japan and Turkey, where it has demonstrated satisfactory reliability parameters, although the authors emphasized the need for further verification of the tool's temporal stability. The present study aimed to adapt METEO-Q to the Polish language and conduct a critical assessment of its factor structure, measurement invariance, and validity in clinical groups. Methods: This cross-sectional study involved 1128 adults: healthy individuals (n = 711), cardiac outpatients (n = 194), and subclinical group with diagnosed mental disorders (n = 223). Data from healthy participants were divided into a training sample (n = 426) for exploratory factor analysis (EFA) and a test sample (n = 285) for confirmatory factor analysis (CFA). Measurement invariance was assessed in the clinical groups. Validity was verified through correlations with a list of 21 symptoms and measures of anxiety and worry about climate change. Results: A two-factor model (meteoropathy and meteosensitivity) was better fitted to the data than a one-factor model, which is consistent with findings from Italian, Japanese, and Turkish studies. However, absolute fit indices in the test sample indicated significant model misfit [CFA: χ² (43) = 210.192, p < 0.001, RMSEA = 0.120, CFI = 0.927], suggesting the presence of local errors in the tool's structure. The reliability of the subscales was high (α from 0.86 to 0.93). Multi-group analyses suggested metric and scalar invariance. Patients with mental disorders obtained the highest scores, while cardiac outpatients reported a lower level of meteoropathy (M = 6.13) than healthy individuals (M = 7.24). Conclusions: METEO-Q demonstrates a stable two-factor structure and high internal consistency. The obtained RMSEA index (0.12), although indicative of some misfit, is similar to results obtained in other adaptations, such as the Japanese (RMSEA = 0.10) and the Turkish (RMSEA = 0.11), which suggests it is a consistent feature of this tool across different cultural contexts. Accordingly, the instrument is suitable for research purposes; however, its clinical application requires considerable caution and further work to optimize the model.

Uterine malformation represents a rare disease with a prevalence of up to 7% of the general population. Background/Objectives: Higher pregnancy complication rates have been reported in the literature; thus, in our study, we aimed to examine not only the obstetric complications encountered but also the psychological interventions and multidisciplinary approaches for parental counseling in our department in the context of preterm birth at the limit of viability. Methods: A retrospective pilot study was conducted on all the women in our department between 2010 and 2017 with congenital uterine malformations associated with infertility or pregnancy. In the study group, we included women with AUCs (n = 26), while the control group included pregnant women with normal uteri (n = 25) (total: n = 51), and then pregnancy complications were investigated. Results: Highly significant pregnancy complications were observed in the study group, the most important being preterm birth (p = 0.003) in comparison with the control group. Out of 26 patients with AUCs, only 14 gave birth to a live fetus compared to 22 out of the 25 with normal pregnancies, meaning that failure to give birth to a live newborn statistically significantly increased among the former group (p = 0.004). In terms of birth weight (p = 0.0001), Apgar score (p = 0.029) and intensive care unit admission (p = 0.0001), we observed significant differences between the newborns in the study group versus controls, with an impact on mental state that required psychological support. Conclusions: A clear correlation was observed in our study between uterine congenital malformations and pregnancy complications. The most common pregnancy outcome was premature delivery, with statistical significance. In addition, higher neonate admissions to the intensive care unit associated with lower Apgar scores were encountered compared with normal pregnancies. Appropriate parental counseling by obstetricians, neonatologists and psychologists could enhance pregnancy outcomes.

Objectives: Adolescent idiopathic scoliosis (AIS) may negatively affect both the quality of life of adolescents and the quality of life of their families (FQOL). Therefore, the analysis of objective and subjective determinants of FQOL in families of children and adolescents with AIS undergoing long-term conservative treatment becomes important and will allow for a better understanding of factors that may have a significant impact on the prognosis and clinical treatment outcomes. Methods: The analysis covered a total of 200 families of children and adolescents aged 7-18 from the Podkarpackie region (Poland). The medical history chart and the original physical examination card, as well as the Family Adaptability and Cohesion Scales (FACES III) and the Family Quality of Life Scale (FQOL), were used in this study. Results: Families of adolescents without AIS demonstrated significantly higher levels of family cohesion and adaptability compared with families of adolescents with AIS (p < 0.001). The mean overall FQOL score was significantly lower in the AIS group (75.33 ± 9.18) than in the control group (86.97 ± 7.91; p < 0.001, r_rb = 0.58). Multivariate analysis indicated that family adaptability was an independent predictor of FQOL in the AIS group, with higher adaptability associated with lower overall FQOL and reduced scores in parental functioning and emotional well-being domains. Conclusions: A long process of AIS treatment can cause crisis situations for patients and their families and influences both the physical and mental health of patients by changing their family's quality of life (FQOL). Early identification of families characterized by diminished cohesion and adaptability enables the integration of psychopedagogical support and family consultations into standardized care. Such a multidimensional approach may enhance therapeutic prognosis and accelerate the rehabilitation process.