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Background: Specific phobias impact over 400 million people worldwide. Digitalizing mental health could alleviate the burden. Still, although the corporate-driven Metaverse is expanding rapidly, there needs to be more momentum in harnessing virtual reality exposure therapy uptake. Objective: This study aims to conceptualize, develop, and deploy a free Virtual Reality Exposure Therapy (VRET) application specifically designed for treating acrophobia and claustrophobia. This pilot study, which holds the promise of a future where mental health is more accessible and effective, explores the feasibility of leveraging transdisciplinary collaboration among specialists to create a safe, accessible, and effective VRET solution. Methods: We conducted a Delphi heuristic approach involving bioethicists, neuroscientists, and tech developers. Second, we reviewed the existing psychological theories and therapeutic strategies for addressing phobias in VR. Third, we conceptualized a thematic analysis-derived framework for a safe, adaptive-gamified free exposure to virtual reality acrophobia and claustrophobia (SAFEvR ACT). Finally, we provide an overview of the iterative improvements made during 12 workshops and 76 weekly briefings on developmental implementations. Results: We developed the SAFEvR ACT into a proof-of-concept application freely deployed on the MentalVerse app platform. Our safety-focused approach can benefit from prevalidation perspectives within future randomized control trials. Conclusions: The resulting application derived from the SAFEvR ACT framework represents a blueprint to counter the current lack of iVR mental health uptake by offering a free VRET alternative. Future research should aim towards developing similar free platforms to lessen mental health burdens and gather quantitative data. We conclude with a call to action to researchers to fine-tune our current approach and take a stand for free digital mental health within MentalVeRse.app.

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Schizophrenia is a chronic, invalidating, and polymorphic disease, characterized by relapses and remission periods. The main treatment option in schizophrenia are antipsychotics, administered as an oral or as a long-acting injectable (LAI) formulation. Although international guidelines rarely recommend it, mood stabilizers (MS) and/or benzodiazepines (BZD) are frequently prescribed as adjunctive therapy in schizophrenia patients for various reasons. This is an observational, cross-sectional study including stabilized schizophrenia patients. A total of 315 patients were enrolled. Of these, 77 patients (24.44%) were stabilized on LAIs and 238 (75.56%) patients on oral antipsychotics (OAP). Eighty-four patients (26.66%) had concomitant treatment with MS and 119 patients (37.77%) had concomitant benzodiazepine treatment. No statistical significance was observed in MS or BZD use between LAIs and OAPs. In total, 136 patients (43.17%) were stabilized on antipsychotic monotherapy. Our study shows that the long-term use of benzodiazepines and mood stabilizers remains elevated among stabilized schizophrenia patients, regardless of the antipsychotic formulation (oral or LAI). Patients receiving second-generation LAI antipsychotics (SGA-LAI) seem to be more likely to be stabilized on monotherapy compared to those receiving oral antipsychotics. Further randomized controlled trials are necessary in order to clarify the benefits of the current drug polypharmacy trends.

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(1) Background: In the context of the COVID-19 pandemic, the educational system in Romania faced major challenges. Online knowledge development was necessary and mandatory during this time; (2) Methods: our study included a group of 140 preadolescents and used a phenomenology qualitative method to investigate if the novel online teaching, implemented in a hurry during the pandemic without any previous teacher training, managed to replace face-to-face teaching; (3) Results: The students have expressed their joy for online courses, as long as they are kept interactive. Even though they feel nervous and worried when it comes to evaluation, the students claim they feel capable to learn all of the learning materials. Most of them are pleased by classes and do not get bored during them, feeling constantly motivated to actively participate in dialogue; (4) Discussions: Despite the lack of teaching-method standardization, our learning providers succeeded in accomplishing their tasks during online courses. Even in remote rural areas, they managed to assure the means for these children to access and take part in online courses; (5) Conclusions: our learning system must offer teachers the possibility to emphasize online education using adequate training programs aiming to develop technical and online pedagogical skills.

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BACKGROUND AND OBJECTIVES: Cannabinoids are currently used in cancer patients primarily for their pain-relieving and antiemetic properties. The aim of our review was to synthesize all available data of studies evaluating the therapeutic efficacy of cannabis in combination with oncological treatments in cancer patients and to explore ongoing studies with different goals and medical areas registered in the field of oncology worldwide. MATERIALS AND METHODS: This study was performed in accordance with the PRISMA guidelines. A search using MEDLINE/PubMed database was performed between 1 January 2006 and 1 March 2022. Search terms included the following: cannabidiol, cannabis, CBD, dronabinol, endocannabinoids, medical marijuana, nabiximols, nabilone, THC, and cancer. All studies that examined the efficacy of cannabis administered during oncological treatments, regardless of cancer localization, subtype, and sample size, were considered eligible. RESULTS: In three studies, cannabis was administered to patients with glioblastoma, and in two other studies, cannabis was used in combination with immunotherapy in various cancer subgroups. The results of the clinical trials in cancer patients are not sufficient to draw conclusions at this time. Interestingly, several other studies addressing the systemic effects of cannabinoids in cancer patients are currently listed in the U.S. National Library of Medicine's registry on the ClinicalTrials.gov website. However, only one of the registered studies examined the efficacy of cannabinoids as a potential option for systemic cancer treatment. CONCLUSIONS: Although cannabis is touted to the public as a cancer cure, clinical trials need to clarify which combinations of chemotherapeutic agents with cannabinoids are useful for cancer patients.

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BACKGROUND: Medical professional liability complaints are not triggered by a single factor, but rather by multiple factors, each having more or less implications, such as the characteristics of the physician, the medical system, the patients, the complexity of their pathology, and the inherent limits of medicine. Knowledge about the factors that initiate the complaint procedure is essential to identify the targeted measures to limit their prevalence and impact. The purpose of this study was to identify the reasons behind the malpractice complaints and the factors that may influence the initiation of complaints by the patients. MATERIAL AND METHODS: This study was conducted using an online questionnaire, addressed to Romanian doctors, with questions about the reasons for patient dissatisfaction and complaints, the factors that predispose a physician to being complained against, and the protective factors against patient complaints. RESULTS: The study group included 1684 physicians, of whom 16.1% were themselves involved in a complaint, and 52.5% knew of a colleague who was complained against. The opinions of the participants regarding the reasons for the complaints, the predisposing factors to complaints, and the factors that contributed to the reported incident showed a strong link between professional liability complaints and the physician-patient/patient's family relationship. The relationship between fellow physicians is additional to this. CONCLUSION: This study reveals that the improvement in the relational aspects of medical practice (physician-patient relationship and relationship between physicians) has the highest potential to decrease the number of malpractice complaints. Its practical relevance is related to the need for training physicians in the relational aspects of medical practice during academic years and throughout their career.

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BACKGROUND: Colonoscopy related fear impairs the current gold standard screening of colorectal cancer. Compared to other minimally invasive procedures for cancer screening, colonoscopy-induced anxiety exceeds the procedure through bowel preparation. Immersive virtual reality's (iVR) role in alleviating the complex stress-pain relationship encountered during medical procedures is directly proportional to the rising affordability of state-of-the-art Head-Mounted-Displays (HMDs). OBJECTIVE: to assess the effect of iVR on patients' colonoscopy-induced anxiety and pain. MATERIALS AND METHODS: A systematic search was conducted in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase and Scopus databases up to January 2022. Clinical trials evaluating anxiety as an outcome were included without language restriction. RESULTS: Four clinical trials were included: three on the patients' intraprocedural anxiety and one on patient education. Intraprocedural iVR interventions for colonoscopy-induced anxiety and pain revealed a similar effect as conventional sedation, while a statistically significant reduction was reported for non-sedated patients. iVR patient education improved the quality of bowel preparation and reduced patient anxiety before colonoscopy. CONCLUSIONS: The current research highlights the need to use high-end HMDs and appropriate interactive iVR software content for colonoscopy-induced anxiety. Methodological frameworks regarding the eligibility of participants, double-blinding and randomization of iVR studies can facilitate the development of iVR implementation for anxiety and pain management.

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BACKGROUND: The growing closeness between psychiatry and theology may impact positively the healthcare of the religious psychiatric patients. However, some significant divergences regarding the health care religious methods and the concept and believe in the demonic possession of psychiatric patients continue to shape the relationships between these professionals. While the religions generally admit the demonic or spirit possession as real, the current views of physicians and psychiatric patients are just taken for granted and therefore demands new investigations. In this study, we have performed a targeted survey on this subject. SUBJECTS AND METHODS: The survey was based on a questionnaire addressed to 216 psychiatrists and 201 non-psychiatrists, and 408 psychiatric patients. For physicians, the questionnaire was randomized sent to hospitals in Romania. The patients received the questionnaire on paper. Except for patients with dementia and those in the acute phase of a psychiatric illness, all psychiatric disorders available at the time of the investigation were randomized included in the study. RESULTS: The results showed that about 20% of physicians and 60% of psychiatric patients considered that demonic possession might be associated to a psychiatric illness, while the later would like a priest in the therapeutic team (89.4%, CI: 0.86-0.92). In addition, the psychiatrists declared a lower attendance of religious services, although the majority would accept a priest in the therapeutic team (p>0.05, CI: 0.61-0.70). CONCLUSION: These findings invite to a more practical collaboration between psychiatrists, clinical psychologists, and theologians/priests with training in psychiatry for a more integrative mental care of the religious psychiatric patients. The results call as well for more efficient practical solutions for psychiatric patients, raise awareness towards the personal religious needs and critical beliefs of such patients, and finally might narrow the gap of the controversy between psychiatrists, non-psychiatrists, psychologists and theologians/priests on the addressed issues.

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No doubt, alcoholism represents nowadays the toxicomany with the highest expansion rate among all population groups, being recognized by the specialists from the medical, social, economic and legal field as a true "toxic pandemy". Researchers consider ethanol, this small but highly aggressive molecule, to have supremacy if we were to consider the number of pages dedicated to it worldwide on daily bases, in the medical or any other specialty literature. Nonetheless, the large volume of data regarding ethanol toxicity does not seen to simplify things, on the contrary it points out new information about the its negative effects on human body. Ethanol represents a toxic that is rapidly and completely absorbed in the intestinal tract being distributed to most tissues and organs; ethanol is recognized as an enzymatic inductor of its own metabolization but also of the metabolization of numerous therapeutic agents.

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OBJECTIVE: Investigating the behavioral and cognitive effect of memantine in moderate to severe patients with Alzheimer's disease receiving donepezil. MATERIAL AND METHOD: 43 patients were enrolled in this prospective, randomized, parallel group study. There were no significant imbalances between the treatment groups in demographic and baseline clinical characteristics. Cognitive and global measures were collected at baseline and at the end of weeks 4, 8, 12 and 24. Behavioral measures were collected at baseline, at the end of week 12 and at week 24. RESULTS: Memantine--treated patients showed significantly less deterioration in their functionality. Of patients who exhibited agitation/aggression at baseline, those treated with memantine and donepezil showed significant reduction of symptoms compared with donepezil--treated patients. CONCLUSIONS: Treatment with memantine was well tolerated and reduced agitation/aggression, irritability, and appetite eating disturbances in patients who were agitated at baseline and delazed its emergence in those who were free of agitation at baseline.

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BACKGROUND: There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. AIMS: To improve understanding of prior care-seeking and treatment of new patients seen at mental health services. METHOD: Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups. RESULTS: The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as 'gatekeeper' in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders. CONCLUSIONS: Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.

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