Nightmares are a hallmark of post-traumatic stress disorder (PTSD), yet pharmacological treatments remain limited. Here we conducted a multicenter, double-blind, randomized, placebo-controlled trial to evaluate the efficacy and safety of dronabinol (BX-1; Δ9-tetrahydrocannabinol (THC)) for PTSD-related nightmares. Adults with PTSD and recurrent nightmares were randomly assigned to receive dronabinol (2.5-15 mg) or placebo, once daily before bedtime, for 10 weeks. The primary endpoint was change from baseline to week 10 in the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV) B2 item assessing nightmare frequency and intensity. A total of 171 patients underwent randomization (mean age, 37.9 ± 12.8 years; 79.3% female), with 87 assigned to dronabinol and 84 to placebo. At week 10, reduction in CAPS-IV B2 scores was significantly greater with dronabinol than with placebo (between-group difference -1.50; 95% confidence interval -2.28 to -0.71; Cohen's d = 0.65; P < 0.001). Adverse events occurred in 78 patients (89.7%) receiving dronabinol and 64 (77.1%) receiving placebo. Treatment discontinuation due to adverse events occurred in five (5.7%) and six (7.2%) patients, respectively. Serious adverse events occurred in seven patients (8.0%) receiving dronabinol and in none receiving placebo. This trial provides evidence that dronabinol reduces the frequency and intensity of PTSD-related nightmares, although long-term efficacy and safety require further evaluation. ClinicalTrials.gov: NCT04448808 .

Mental disorders represent a growing global burden, with particularly large treatment gaps in low- and middle-income countries such as Brazil. Educational initiatives like Mental Health First Aid (MHFA) seek to improve mental health literacy and reduce stigma among lay populations. This pilot study evaluated the feasibility, applicability, and preliminary findings of a Brazilian-adapted MHFA-informed program based on culturally adapted Brazilian MHFA guidelines. A total of 124 employees from three workplaces (two non-profit organizations and one private company) were allocated into intervention and control groups according to institutional operational feasibility, participant registration order, and workplace scheduling demands. The Brazilian-adapted MHFA-informed program consisted of five 1-hour sessions covering depression, psychosis, suicide, trauma, and alcohol-related problems; the control group received Ministry of Health educational materials. Outcomes included attitudes toward mental illness (EMO-56) and perceived stigma (PDDQ), assessed at baseline (T1) and post-intervention (T2). No significant group differences were observed, although both groups showed improvements over time, particularly in the Policy and Structural Assistance dimension (p<0.001). Participants with higher baseline knowledge demonstrated more pronounced improvements over time, and those with self-reported mental illness exhibited more positive attitudes and less stigma. These findings support the feasibility and cultural applicability of a Brazilian-adapted MHFA-informed program in workplace settings. Although limited by sample size and participant attrition, the study highlights the potential relevance of culturally adapted psychoeducational interventions for promoting mental health knowledge and reducing stigma in Brazilian contexts. Future controlled studies with larger samples are needed to further evaluate these approaches.

Smartphone addiction is an increasing mental health concern among university students, yet the emotional coping correlates related to this association remain insufficiently understood. This issue is strategically important in Chinese higher education because university students represent a large digitally embedded population facing academic, developmental, and psychosocial pressures. This study examined the cross-sectional associations among elevated addiction-like smartphone use, emotional coping strategies, mental health symptoms, and gender among Chinese university students who met the SAS-SV screening threshold.

Guided by stress-coping theory, this study used convenience recruitment followed by criterion-based screening. A total of 2,401 students from two public universities in China completed the Smartphone Addiction Scale-Short Version (SAS-SV) screening procedure, and 1,276 students who met the SAS-SV screening threshold were included in the final analysis. Elevated addiction-like smartphone use was assessed using the SAS-SV, mental health symptoms using the Kessler Psychological Distress Scale (K10), and emotional coping strategies using the Emotion Regulation Questionnaire (ERQ), including reinterpretation strategy and suppression strategy. Direct and indirect statistical associations were tested using partial least squares structural equation modelling (PLS-SEM). Measurement invariance was evaluated before gender-based multigroup analysis.

Smartphone addiction was positively associated with mental health symptoms (β = 0.748, t = 55.524, p < 0.001), suppression strategy (β = 0.357, t = 12.075, p < 0.001), and reinterpretation strategy (β = 0.214, t = 7.230, p < 0.001). Suppression strategy showed a positive indirect association between smartphone addiction and mental health symptoms, whereas reinterpretation strategy showed a negative indirect association. The model explained 66.2% of the variance in mental health symptoms. Gender did not significantly moderate the direct pathway, but the indirect pathway through reinterpretation strategy was significant among male students only.

The findings identify theoretically meaningful cross-sectional associations among smartphone addiction, emotional coping strategies, and mental health symptoms. Suppression and reinterpretation strategies showed different patterns of association with mental health symptoms, suggesting that emotional coping strategies may be relevant targets for future longitudinal and intervention research. As the data were collected at a single time point, the observed relationships cannot support causal inference and should instead be interpreted as associations.

Special interests are a highly prevalent feature of autism spectrum conditions (ASC) and have long been described primarily from a deficit-oriented perspective. More recent work has pointed to their potential as psychological resources, yet systematic evidence and direct comparisons with non-autistic groups remain limited. The present study examined the significance of special interests for well-being, self-related aspects and emotion regulation in autistic adults, as well as negative consequences and stigma. Furthermore, we directly compared the likelihood of engaging in special interests versus seeking social contact across a range of emotional contexts. A total of 182 participants (60 autistic and 122 non-autistic) completed an online survey on multiple aspects of their (special) interests and measures of social anxiety and self-esteem. Autistic individuals reported a stronger role of special interests in emotion regulation and as a source of learning and knowledge, while also experiencing greater stigma and negative consequences compared with non-autistic participants. Autistic participants further showed a higher likelihood of relying on their interests as a coping strategy in negative and exhausting situations, highlighting their particular relevance for emotion regulation. Our findings emphasize the unique functions of special interests in autism and point to their therapeutic potential as adaptive resources.Lay AbstractMany autistic people have special interests - topics or activities they pursue with great passion. We asked autistic and non-autistic adults how meaningful their interests are and how they use them in different emotional situations. Autistic people reported that interests are especially helpful for coping with stress and regulating emotions, and that they are an important source of learning and knowledge. On the other hand, autistic individuals also experienced more stigma and negative reactions from others than non-autistic individuals. Our findings show that special interests are an important source of well-being and should be recognized as a valuable resource in autism.

Alanine, commonly found in meaty foods and popular as a sports supplement, has interactions with neurotransmitters and brain energy supply, but its impact on mental health remains uncertain. This two-sample Mendelian randomisation (MR) study aimed to investigate causal associations of plasma alanine with major mental disorders-depression, bipolar disorder, schizophrenia, anxiety, and attention-deficit hyperactivity disorder (ADHD) and to further explore sex-specific associations using available data, considering potential sex disparity. We utilised genetic variants from the UK Biobank to predict plasma alanine (N = 115,074) and obtained their genetic associations with depression (N _cases = 194,180 and N _controls = 521,663), bipolar disorder (N _cases = 46,418 and N _controls = 563,769), schizophrenia (N _cases = 52,017 and N _controls = 75,889), anxiety (N _cases = 19,529 and N _controls = 212,855), and ADHD (N _cases = 46,418 and N _controls = 402,606) from genome-wide association studies (GWASs) in the Psychiatric Genomics Consortium (PGC) and FinnGen Biobank. MR estimates were primarily derived using the inverse variance weighted (IVW) method, with weighted median, MR-Egger, and MR-RAPS applied as sensitivity analyses. MR-PRESSO was used to detect pleiotropy and outliers. Genetically predicted alanine was nominally associated with a lower risk of schizophrenia overall (OR 0.88, 95% CI: 0.79-0.99) and in males (OR 0.88, 95% CI: 0.77-0.99), which were not significant after multiple testing. No association was detected in females (OR 0.92, 95% CI: 0.80-1.05). There was no evidence linking plasma alanine to depression, bipolar disorder, anxiety, or ADHD. These findings suggest that alanine might have an inverse association with schizophrenia, which may be more evident in males, but has no psychiatric side effects on other mental disorders. Replication in larger studies is warranted.

The transition to survivorship for prostate cancer (PCa) patients is a complex and multifaceted process, influenced by physical, emotional, and social challenges. This study aimed to explore the process of transition to survivorship in PCa patients, identifying challenges, coping strategies, and contextual influences affecting adaptation to life after treatment.

A grounded theory approach was used for this qualitative study. Data were collected through semistructured interviews with 15 PCa patients, 3 spouses, and 4 healthcare providers. Participants were selected through purposive and theoretical sampling to ensure diverse perspectives. Data analysis followed the constant comparative method, guided by Corbin and Strauss's grounded theory framework.

The transition to survivorship in individuals with PCa was described as a complex, forward-moving process influenced nonlinearly by contextual factors. The main concern was the "threat to the integrity of life," stemming from "embodied disruption," "persistent uncertainty," and "psychological erosion." The core category, "striving for survival through the storm," captured the main response, encompassing "adaptive coping efforts" and "reclaiming normal life." Contextual factors such as "personal resources and constraints" and "relational and healthcare support" significantly shaped the process. Ultimately, patients described achieving a "relative restoration of normal life."

Transition to survivorship in PCa patients was dynamic and nonlinear, and was influenced by recovery, psychological adaptation, and support.

Nurses can facilitate this transition by recognizing patients' main concerns, supporting coping strategies, and addressing contextual barriers. Tailored interventions that strengthen perceived support and recovery efforts can enhance adaptation and quality of life for PCa survivors.

To analyze the prevalence and factors associated with e-cigarette (EC) use among adolescents aged 13-17 in Brazil, and to describe the pattern of polytobacco/nicotine product use.

This is a cross-sectional study using data from 159,245 students from the 2019 National School Health Survey (PeNSE). The prevalence of EC use and combined use with other products (conventional cigarettes, hookah, and others) was estimated. The association with sociodemographic variables, mental health, and other substance use was analyzed through multivariate logistic regression, calculating adjusted Odds Ratios (aOR) and their 95% confidence intervals (95% CI).

The prevalence of EC use in the last 30 days was 2.82% (95%CI 2.62-3.04). Polytobacco use was significant, with dual use (EC + conventional cigarette) found in 8.56%. The combined use of all smoked products was 14.83%, and quadruple use (EC + conventional + hookah + straw) reached 14.04%. After adjustment, the factors associated with higher odds of EC use were: alcohol consumption (aOR=3.94), having friends who smoke in their presence (aOR=2.53), regular tobacco use (aOR=2.22), other drug use (aOR=2.04), feeling lonely (aOR=1.25), feeling sad (aOR=1.24), and having parents who smoke (aOR=1.17).

E-cigarette use among Brazilian adolescents is associated with mental health factors, social influences, and the concomitant use of alcohol and other drugs. The polytobacco use is a worrying reality among these adolescents. The findings highlight the need for public policies that articulate tobacco control with mental health initiatives and strategies for preventing alcohol/other drug use.

The objective of the study was to estimate the magnitude, associated factors, and risk-factor population attributable fractions (PAFs) for Diabetes Mellitus (DM) among adults living in Brazilian state capitals, according to sex. This was a cross-sectional study using data from a sample of 32,111 adults aged 18 years or older who participated in the 2019 National Health Survey. Poisson regression and PAFs estimation were used to assess the associated factors and their contributions to prevalent cases of DM, respectively. The prevalence of DM was 7.7% (7.2% in men and 8.0% in women). In the total sample, the Poisson model showed a direct association between DM and female sex, age >60 years, no formal education, physical inactivity during leisure time, self-reported hypercholesterolemia and hypertension, overweight, and obesity. An inverse association was observed for binge drinking. Mixed-race and black race/skin color, as well as leisure-time physical inactivity, were factors associated with DM among women. The PAFs of risk factors that contributed most to prevalent cases of DM, in both sexes, were age >60 years, self-reported hypertension and hypercholesterolemia, and obesity. In conclusion, clinical factors had the highest PAFs for DM and should be the focus of prevention and control policies.

The aim of this study was to evaluate the levels of caregiver burden among family members of patients with type 2 diabetes mellitus and to investigate the sociodemographic, clinical, and psychological factors associated with this burden.

This cross-sectional study included 125 caregivers of patients attending the Internal Medicine Outpatient Clinic at Eskişehir City Hospital, selected via consecutive sampling. Data were collected using a sociodemographic information form, the Zarit Caregiver Burden Index, and the Depression Anxiety Stress Scale-21. Statistical analyses included independent samples t-tests, Pearson's correlation, and a three-step hierarchical multiple linear regression.

Zarit Caregiver Burden Index scores were significantly higher among spousal caregivers and those caring for patients with diabetic complications (p<0.001). Caregiver burden showed moderate-to-strong positive correlations with depression (r=0.48), anxiety (r=0.42), and stress (r=0.51). Patient glycated hemoglobin levels showed a strong positive correlation with both Zarit Caregiver Burden Index (r=0.684) and depression scores (r=0.592). In the final hierarchical regression model, the presence of complications (β=0.35), higher glycated hemoglobin levels (β=0.32), spousal caregiving (β=0.28), stress (β=0.24), and depression (β=0.19) were identified as significant independent predictors of burden. The final model accounted for 51.2% of the total variance (Adjusted R2=0.484).

Caring for individuals with diabetes mellitus is associated with a substantial psychological burden on family caregivers. These findings highlight the importance of integrating systematic psychosocial assessment and targeted support into routine diabetes management, particularly for caregivers of patients with poor glycemic control and complications, to mitigate caregiver burden and distress.