Background: Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. Methods: The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. Results: Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. Conclusion: A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.

In schizophrenia, the relationship between suicide and cognition is unclear. We aimed to assess cognitive functions and insight in schizophrenia patients with and without suicide attempts. In our study consisting of 77 patients, 36 of the patients had attempted suicide at least once in their lives and the remaining 41 had never attempted suicide. Sociodemographic data scale, Beck Cognitive Insight Scale, and Cambridge Neurophysiological Assessment Battery were applied. In this study, patients with schizophrenia who attempted suicide had higher Beck Cognitive Insight Scale self-reflectiveness scores (P = .004), lower Beck Cognitive Insight Scale self-certainty scores (P = .040), and higher Beck Cognitive Insight Scale total score (P = .004). Delay aversion (P = .003) and risk-taking scores (P = .044) of Cambridge Neurophysiological Assessment Battery Cambridge gambling task were higher in patients who attempted suicide. In logistic regression analysis, as independent factors, the number of hospitalizations increased the risk of suicide 1.5 times per hospitalization (P = .021), Cambridge gambling task delay aversion increased the risk of suicide 8.4 times per score (P = .044), and the Beck Cognitive Insight Scale self-certainty score was shown as the factor that decreased the risk of suicide by 0.78 times (P = .024). The causes of suicide attempts in schizophrenia still preserve its uncertainty. Our results proposed a statistically significant relationship between cognitive insight and increased suicide attempts. This study also sustains that cognitive impulsivity is associated with suicidal behavior in patients with schizophrenia.

The aim of our study was to determine the levels of internalized stigma, perceived social support, and social functioning of schizophrenia patients who made a guardianship decision and to investigate the effects of these parameters on the guardianship decision. A total of 160 patients, including 80 patients who were hospitalized in the psychiatric inpatient services of our hospital between December 1, 2021, and November 1, 2022, between the ages of 18 and 65, who were diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnostic criteria (n = 80) and received guardianship and 80 patients (n = 80) who did not receive guardianship were included in the study. Sociodemographic data from the Internalized Stigma of Mental Illness Scale, Social Functioning Scale, and Multidimensional Scale of Perceived Social Support were administered to the study group. Fifty percent of the patients (n = 80) made a guardianship decision. The number of hospitalizations and duration of illness were significantly higher in the group of patients who took the guardianship decision, whereas the scores of interpersonal functioning and perceived social support from the family were significantly lower (P = .049, P = .009). The number of hospitalizations, substance use, interpersonal functioning, perceived discrimination, and perceived social support from family and friends were determined as factors that facilitate the guardianship decision (P < .05, P < .001). Based on the results of our study, it is necessary to reduce the number of hospitalizations, substance use, and perceived discrimination among patients with schizophrenia and to enhance the social support and interpersonal relationships provided by family and friends.

Introduction: Personality organization, defense mechanisms, psychological resilience, and treatment motivation are key psychological constructs that influence both the development and treatment outcomes of substance use disorders (SUD). The aim of this study is to investigate the relationships between treatment motivation, acute remission rates, personality organization, and psychological resilience in patients diagnosed opioid use disorder (OUD) and polysubstance use disorder (PSUD). Method: The study included 30 patients with opioid use disorder (OUD), 30 with polysubstance use disorder (PSUD), all diagnosed according to DSM-5 criteria, and 30 healthy controls (HC). Participants with OUD and PSUD were receiving inpatient treatment in this prospective case-control study. The study utilized the following instruments: Sociodemographic Data Form, Resilience Scale for Adults (RSA), Personality Organization Diagnostic Form, Motivation for Treatment Scale (MfTS), and Addiction Profile Index. MfTS and RSA were administered once more during follow-up assessments for patients who had achieved early remission. Results: PSUD group exhibited significantly higher scores for immature defense mechanisms compared to both OUD and HC groups, while mature defenses were significantly lower in both SUD groups relative to controls (p < 0.001). A significant positive correlation was identified between mature defenses and both treatment motivation and resilience levels (p < 0.05), while mature defenses showed a negative correlation with addiction severity (p < 0.05). Resilience levels emerged as a significant predictor of early remission (p = 0.011), and mediation analysis confirmed that resilience mediated the relationship between mature defenses and addiction severity (β= -0.151, 95% CI: -0.266 to -0.042). Conclusion: Mature defense mechanisms and resilience predict early remission and reducing addiction severity.

Background: Long-acting injectable (LAI) antipsychotics improve adherence and reduce relapse in severe mental illnesses. A new two-injection start (TIS) regimen of aripiprazole monohydrate LAI has recently been introduced as an alternative to the standard initiation regimen. Evidence on its clinical benefits, particularly in females with schizophrenia or bipolar disorder, remains limited. Methods: This retrospective cohort study included 87 female inpatients diagnosed with schizophrenia or bipolar disorder. Participants were divided into two groups according to initiation protocol: The standard regimen (400 mg injection plus 14 days of oral aripiprazole) or the TIS regimen (two 400 mg injections with a single 20 mg oral dose). Clinical outcomes were compared between groups, including time to discharge, rehospitalization rates, and symptom change. Results: Of the total sample, 47 patients received the TIS regimen and 40 the standard regimen. Baseline demographic and clinical features were comparable between groups. Time to discharge was significantly shorter in the TIS regimen group (mean 8.1 vs. 11.8 d, P = 0.042). Rehospitalization rates within 1 year were lower in the TIS regimen group (17.0% vs. 37.5%, P = 0.031), and time to rehospitalization was longer ( P = 0.027). Adherence patterns favored the TIS regimen, with a higher proportion of regular use. In the schizophrenia subgroup, PANSS reductions from admission to discharge were greater with the TIS regimen. Adverse events were infrequently documented. Conclusions: Aripiprazole monohydrate LAI initiation with the TIS regimen was associated with shorter hospitalization and more favorable rehospitalization outcomes compared with the standard protocol in female patients.

Objective: This study explores the diagnostic, treatment, and follow‐up approaches of neurologists, psychiatrists, and family physicians in managing late‐onset bipolar disorder (BD) in elderly patients, emphasizing the role of interdisciplinary collaboration.Methods: A cross‐sectional survey involved 300 specialists (100 from each discipline). The survey assessed diagnostic accuracy, treatment preferences, follow‐up adherence, and barriers to interdisciplinary collaboration. A pairwise z‐test with Bonferroni correction was applied for comparative analysis across specialties to evaluate differences in response proportions.Results: Neurologists demonstrated high proficiency in imaging and treatment initiation (91% correct imaging responses) but faced challenges in holistic management and follow‐up adherence (2%). Psychiatrists excelled in diagnosing organic causes of mood disorders (92%) and therapeutic decisions but struggled with non‐priority diagnostic tests (44%) and long‐term follow‐up strategies (14%). Family physicians showed strong skills in pharmacological management (96%) and follow‐up adherence (89%) but encountered barriers like stigma and referral timing for high‐risk cases. Common interdisciplinary challenges included diagnostic communication, treatment coordination, and follow‐up collaboration.Conclusion: Late‐onset BD management requires a multidisciplinary approach to address specialty‐specific gaps and foster effective interdisciplinary collaboration. Enhanced training, integrated care models, and shared guidelines are recommended to optimize outcomes for elderly patients with mood disorders. Future research should focus on developing standardized protocols and evaluating the long‐term impact of interdisciplinary interventions.