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AIMS: Healthcare staff use coercive measures to manage patients at acute risk of harm to self or others, but their effect on patients' mental health is underexplored. This nationwide Swiss study emulated a trial to investigate the effects of coercive measures on the mental health of psychiatric inpatients at discharge. METHODS: We analysed retrospective longitudinal data from all Swiss adult psychiatric hospitals that provided acute care (2019-2021). The primary exposure was any coercive measure during hospitalization; secondary exposures were seclusion, restraint and forced medication. Our primary outcome was Health of the Nations Outcome Scale (HoNOS) score at discharge. We used inverse probability of treatment weighting to emulate random assignment to the exposure. RESULTS: Of 178,369 hospitalizations, 9.2% (n = 18,800) included at least one coercive measure. In patients exposed to coercive measures, mental health worsened a small but statistically significant amount more than in non-exposed patients. Those who experienced at least one coercive measure during hospitalization had a significantly higher HoNOS score (1.91-point, p < .001, 95% confidence interval [CI]: 1.73; 2.09) than those who did not experience any coercive measure. Results were similar for seclusion (1.60-point higher score, p < .001, 95% CI: 1.40; 1.79) and forced medication (1.97-point higher score, p < .001, 95% CI: 1.65; 2.30). Restraint had the strongest effect (2.83-point higher score, p < .001, 95% CI: 2.38; 3.28). CONCLUSIONS: Our study presents robust empirical evidence highlighting the detrimental impact of coercive measures on the mental health of psychiatric inpatients. It underscores the importance of avoiding these measures in psychiatric hospitals and emphasized the urgent need for implementing alternatives in clinical practice.

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BACKGROUND: Previous observational studies have suggested that there appears to be a close association between mitochondrial function and psychiatric disorders, but whether a causal role exists remains unclear. METHODS: We extracted genetic instruments for 67 mitochondrial-related proteins and 10 psychiatric disorders from publicly available genome-wide association studies, and employed five distinct MR methods and false discovery rate correction to detect causal associations between them. Additionally, we conducted a series of sensitivity tests and additional model analysis to ensure the robustness of the results. For potential causal associations, we further performed reverse MR analyses to assess the impact of reverse causality. RESULTS: We identified a total of 2 significant causal associations and 24 suggestive causal associations. Specifically, Phenylalanine-tRNA ligase was found to increase the risk of Alzheimer's disease, while Mitochondrial glutamate carrier 2 decreased the risk of autism spectrum disorder. Furthermore, there was no evidence of significant pleiotropy, heterogeneity, or reverse causality. LIMITATIONS: This study was limited to individuals of European ancestry, and the conclusions drawn are merely revelatory. CONCLUSION: This study provides novel insights into the relationship between mitochondria and psychiatric disorders, as well as the pathogenesis and treatment strategies for psychiatric disorders.

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Introduction: Depressive symptoms are linked with pain, anxiety, and substance use. Research estimating whether a reduction in depressive symptoms is linked to subsequent reductions in pain and anxiety symptoms and substance use is limited. Methods: Using data from the Veterans Aging Cohort Study, a multisite observational study of U.S. veterans, the authors used a target trial emulation framework to compare individuals with elevated depressive symptoms (Patient Health Questionnaire-9 score ≥ 10) who experienced reductions in depressive symptoms (Patient Health Questionnaire-9 score < 10) with those whose symptoms persisted (Patient Health Questionnaire-9 score ≥ 10) at the next follow-up visit (on average, 1 year later). Using inverse probability of treatment weighting, the authors estimated ORs and 95% CIs for associations between depressive symptom reduction status and improvement on the following: anxiety symptoms, pain symptoms, unhealthy alcohol use, and use of tobacco, cannabis, cocaine, and/or illicit opioids. Results: Reductions in depressive symptoms were associated with reductions in pain symptoms (OR=1.43, 95% CI=1.01, 2.02), anxiety symptoms (OR=2.50, 95% CI=1.63, 3.83), and illicit opioid use (OR=2.07, 95% CI=1.13, 3.81). Depressive symptom reductions were not associated with reductions in unhealthy alcohol use (OR=0.85, 95% CI=0.48, 1.52) or use of tobacco (OR=1.49, 95% CI=0.89, 2.48), cannabis (OR=1.07, 95% CI=0.63, 1.83), or cocaine (OR=1.28, 95% CI=0.73, 2.24). Conclusions: Reducing depressive symptoms may potentially reduce pain and anxiety symptoms and illicit opioid use. Future work should determine whether reductions achieved through antidepressant medications, behavioral therapy, or other means have comparable impact.

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New psychoactive substances (NPSs) are a heterogenous group of psychotropic molecules and diverted pharmaceutical drugs sold worldwide as legal substitutes for controlled drugs. The psychiatric consequences of NPS use are relatively unknown, although evidence of related psychotic symptoms has been described in the literature. We sought to summarize the available evidence on NPS-related psychiatric disorders, to facilitate the interpretation of the molecular mechanism underlying their specific pathologies. A literature search of Scopus, PubMed and Google Scholar was conducted including studies published between 2013 and 2024, in which a correlation between NPS consumption and psychiatric symptoms was reported. Furthermore, the short- and long-term psychopathological effects were included. The literature search resulted in 109 NPS-related intoxication cases in which acute or chronic psychiatric symptoms were reported, mostly related to synthetic cannabinoids, followed by synthetic cathinones, hallucinogens, natural NPSs and stimulants. The most common acute symptoms were hallucinations, aggressiveness, and psychotic and bizarre behavior, related to the molecular disbalance of neurotransmitters in the central nervous systems, with different mechanisms. The lack of clear diagnostic criteria and toxicological analyses has resulted in crucial complications in psychiatric diagnoses related to NPS intoxication. Hence, the implementation of toxicological screening procedures in emergency rooms, including the main NPS classes, should support the diagnosis of acute intoxication and its proper therapeutic treatment. Finally, proper follow-up should be implemented to assess the chronic sequelae.

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The review examines the long-term impact of community psychiatric care on improving the quality of life of people with schizophrenia. It addresses the global burden of this disorder and the need for effective community-based care strategies. A systematic literature search was conducted in databases such as CINAHL, Medline, Web of Science, Sage and ScienceDirect, with the search lasting until March 2024 and following the PRISMA guidelines. The inclusion criteria targeted studies that addressed the long-term effects of community mental health care for people aged 18 years and older with schizophrenia and included both quantitative and qualitative research designs. Studies unrelated to the research question or with significant methodological flaws were excluded. The risk of bias was assessed using GRADE and GRADECERqual, in addition to critical appraisal using the Joanna Briggs Institute (JBI) checklists. Independent screening and data extraction was performed, with results summarised by thematic analysis. In total, 11 studies met the inclusion criteria and included cross-sectional, cohort, qualitative and randomised controlled trial designs. The results showed that community psychiatric care significantly improves the quality of life, well-being and social integration of people with schizophrenia. Effective interventions identified include psychoeducation, cognitive behavioural therapy, social skills training and individualised care plans. However, challenges such as limited resources, labour shortages and social stigma, particularly in low-income neighbourhoods, were also identified. This study highlights the importance of continuous, personalised, multidisciplinary community-based care for sustainable mental health outcomes. Further research is recommended to investigate the long-term impact and strategies to overcome implementation challenges.

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BACKGROUND: Anxiety disorders, major psychiatric disorders (e.g., schizophrenia and major affective disorders), and neurodevelopmental disorders (e.g., autism and attention-deficit/hyperactivity disorder [ADHD]) may cluster together within families. However, whether the first-degree relatives (FDRs) of individuals with generalized anxiety disorder (GAD) are at an elevated risk of neurodevelopmental or major psychiatric disorders remains unknown. METHODS: We identified 2,378,190 FDRs of patients with GAD and 9,512,760 birth year-matched and sex-matched controls from Taiwan's National Health Insurance Research Database. Neurodevelopmental disorders, including autism and ADHD, and major psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, and GAD, were identified. RESULTS: The FDRs-parents, offspring, and siblings-of individuals with GAD were more likely to be diagnosed as having schizophrenia (relative risk: 1.22), bipolar disorder (1.36), major depressive disorder (1.29), autism (1.20), ADHD (1.52), obsessive-compulsive disorder (1.21), and GAD (1.61) than are the FDRs of individuals without GAD. CONCLUSION: Our findings support the notion of a familial coaggregation between GAD, major psychiatric disorders, and neurodevelopmental disorders. Future studies should elucidate the definitive genetic etiology of this familial coaggregation.

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Psychiatric boarding in pediatric emergency departments is a predictable outcome of escalating psychiatric acuity and inadequate mental health services in hospital systems and the community at large. Guidelines are offered to support initiating treatments in nonpsychiatric hospital settings to reduce pediatric boarding. Treatments call for interdisciplinary approaches, care coordination, and addressing systemic disparities in access and quality of care. Telemental health interventions offer a promising means of reducing inequalities in access. Creating a crisis continuum of care will help minimize strict reliance on inpatient settings, which are increasingly challenging to access and only sometimes fully address the crises, even when used.

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Collaboration between the child welfare system and health care practitioners has become increasingly necessary in order to meet the often-significant health needs of system-involved youth. Child welfare medical directors and psychiatric medical directors have been implemented as a means to address this need in several state child welfare systems. Building on the core principles of the National Guidelines for Child and Youth Behavioral Health Crisis Care, medical and psychiatric medical directors can help ensure youth receive the least-restrictive, most appropriate level of behavioral health care; prioritizing care involvement with caregivers in community-based settings.

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BACKGROUND: Inpatient psychiatric facilities have an inherently increased risk of infection transmission. This study aimed to evaluate the impact of roommate and unit mate exposures on COVID-19 transmission to inform on safest isolation practices. METHODS: A single-center retrospective study was conducted among patients hospitalized in six units of an inpatient behavioral health hospital from July 2020 through August 2023. We compared the risk of COVID-19 acquisition after exposure among patients with a contagious roommate versus those exposed to a contagious unit mate. RESULTS: During the study period, the conversion rate was 10.05% overall, 24.4% for roommates, and 9.3% for unit mates; patients exposed to a roommate were at 3.14 times higher odds (95% confidence interval, 1.42-6.92) of acquiring COVID-19 after exposure. On unit-stratified analysis, patients exposed to a roommate on the geropsychiatric unit had the highest risk of post-exposure conversion compared to unit mate exposed patients (odds ratio 6.38, 95% confidence interval 1.75-23.22). Logistic regression analysis identified a non-significant risk associated with increased time in group therapy. CONCLUSION: Exposure to a COVID-19 contagious roommate significantly increases the risk of COVID-19 acquisition among exposed patients receiving inpatient psychiatric care. Cohorting contagious and exposed individuals and avoiding multi-bedded rooms may successfully mitigate COVID-19 transmission risk during psychiatric care.

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BACKGROUND: Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context. OBJECTIVE: This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr's use would be associated with improved patient agitation and distress. METHODS: Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction. RESULTS: The most frequent modules assigned were Comfort and Skills (98% of users; n=942) and lethal means assessment (90% of patient users; n=870). Patient task completion rates for all modules ranged from 51% to 79%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8% (n=325) and 84% (n=90) of patients recommending the app to others. CONCLUSIONS: Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments.

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Objective: This study aimed to identify the prevalence of psychiatric disorders in 2 population-based cohorts of children born extremely preterm (EP) 11 years apart to ascertain whether psychiatric outcomes have changed over time following improved survival of EP children. Method: In the EPICure2 study, 200 children born EP (22-26 weeks' gestation) in England in 2006 were assessed at 11 years of age alongside 143 term-born children. Children were assessed using the Developmental and Wellbeing Assessment (DAWBA). DSM-IV diagnoses were assigned by clinical psychiatrists for 145 EP and 98 term-born children. Outcomes were compared between a subsample of children from the EPICure2 cohort (2006, n = 76) and the earlier-born EPICure (1995, n = 161) cohort born at 22 to 25 weeks' gestation in England. Results: EP children in EPICure2 were significantly more likely than term-born children to have any psychiatric disorder (39.3% vs 3.1%; adjusted odds ratio [OR] = 15.1, 95% CI = 4.4-51.1), emotional disorders (14.6% vs 2.0%; OR = 7.3, 95% CI = 1.6-32.7), conduct disorders (6.3% vs 0.0%, p = .01), attention-deficit/hyperactivity disorder (ADHD, 21.9% vs 2.6%; OR = 7.2; 95% CI = 1.5-33.6), and autism spectrum disorder (ASD, 18.9%; vs 0.0%, p < .001). There was no significant difference in the rates of any psychiatric disorder between EP children in the EPICure2 and EPICure cohorts. Conclusion: EP children remain at increased risk for psychiatric disorders at 11 years of age compared with term-born peers. Increased survival has not translated into improved psychiatric outcomes. Health care professionals need to be aware of this ongoing risk when caring for children born preterm.

Medical advances have improved the survival of extremely preterm children, but whether long-term outcomes have also improved is unclear. This study compared rates of psychiatric disorders at age 11 years among 76 children born extremely preterm in 1995 and 161 children born extremely preterm in 2006, to identify trends in psychiatric outcomes. Results showed that children born extremely preterm in 2006 were more likely than term children to have psychiatric disorders (39.3% vs 3.1%). There was no difference in rates of disorders between children born extremely preterm in 2006 and 1995. These results suggest that there has been no improvement in psychological outcomes for extremely preterm children, and healthcare professionals should continue to monitor for psychiatric disorders in this population.

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BACKGROUND: Evidence is lacking of an association between anesthetic choice and the risk of psychiatric disorders. Therefore, this study aimed to examine the impact of regional anesthesia (R/A) versus general anesthesia (G/A) on the occurrence of psychiatric disorders in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA). METHODS: Data for this population-based cohort study were sourced from the National Health Insurance Service of South Korea. The study included adult patients who underwent TKA or THA between January 1, 2016, and December 31, 2021. The endpoint was the diagnosis of postoperative psychiatric disorders within 1 year postoperative. RESULTS: This study included 411,967 patients who underwent THA or TKA. Among them, 290,476 (70.5 %) underwent THA or TKA under R/A (R/A group), while 121,491 (29.5 %) underwent THA or TKA under G/A (G/A group). In multivariate logistic regression, the R/A group had an 8 % lower incidence of postoperative psychiatric disorders (odds ratio [OR], 0.92; 95 % confidence interval [CI], 0.90-0.94; P < 0.001) than the G/A group. Specifically, a lower incidence of postoperative psychiatric disorder for depression (OR, 0.89; 95 % CI, 0.86-0.92; P < 0.001), bipolar disorder (OR, 0.88; 95 % CI, 0.83-0.94; P < 0.001), anxiety disorder (OR, 0.95; 95 % CI, 0.92-0.98; P = 0.001), and insomnia disorder (OR, 0.95; 95 % CI, 0.80-1.11; P = 0.496) was observed in the R/A versus G/A group. CONCLUSIONS: Among these South Korean patients who underwent TKA or THA, the R/A group had a lower incidence of postoperative psychiatric disorders than the G/A group.

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Objective: Despite increasing evidence of high psychopathological vulnerability in people with Autism Spectrum Disorder (ASD) and/or Intellectual disability (ID), comprehensive data on prevalence and presentation of psychiatric disorders (PD) in people with significant cognitive and communication impairment are lacking. The extent to which PD can present with behavioral/observable symptoms and include Problem Behaviors (PB) has also been scarcely evaluated through population-based studies. The paper presents the protocol of a cross-sectional study aimed at filling these gaps, referred to a large multicentric Italian population-based sample of adolescents and adults. Methods: A battery of validated scales, SPAIDD, DASH-II, DiBAS-R, and STA-DI, is used to support and control for clinical diagnoses of PD. Study population is stratified according to different independent variables such as the severity of ID and ASD, gender, age group, and source of recruitment. A network analysis will be carried out to identify the most central behavioral symptoms for the various PD and their relationship with PB. Overlap between psychiatric symptoms and ASD and ID phenotypes is also addressed. Results and Conclusion: This study should provide valuable insight into better diagnostic accuracy, leading to well-informed interventions to improve the quality of life of people with ASD and/or ID.

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Childhood-onset type 1 diabetes (T1D) is associated with substantial psychiatric morbidity in later life, but it remains unknown whether these associations are due to common underlying biological mechanisms or the impacts of living with the condition and its treatment. Here, using Czech national register data, we identified children with T1D aged ≤14 years between 1994 and 2007 and estimated the risk of psychiatric disorders up to 24 years later. We found that children diagnosed with T1D had an elevated risk of developing substance use, mood, anxiety and personality disorders, and behavioral syndromes. Conversely, we found that children with T1D had a lower risk of developing psychotic disorders. In Mendelian randomization analysis, we found an association with schizophrenia, which, however, did not persist following multiple testing adjustment. The combined observational and Mendelian randomization evidence suggests that T1D diagnosis in childhood predisposes to far-reaching, extensive psychiatric morbidity, which is unlikely to be explicable by common underlying biological mechanisms. The findings of this study highlight that monitoring and addressing the mental health needs of children with T1D is imperative, whereas glucose dysregulation and/or inflammation implicated in schizophrenia pathogenesis warrants future research.

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Introduction: Occupational therapy (OT), a vital part of psychiatric rehabilitation, encourages participation in social activities, which is critical for the recovery of people with severe mental illnesses (SMI). However, the effects of OT on the subsequent social activities of patients with SMI have not been fully clarified. We aimed to identify the factors that encourage post-discharge social activity participation among patients with SMI who received OT. Method: Patients who underwent OT at the Kyorin University Hospital between April 2016 and March 2020 were retrospectively examined for baseline data during hospitalization and social activity status 1 year after discharge. Occupational support, group adaptation, artistic activities, and exercise programs were considered. Activities requiring social interaction were defined as social activities, including employment, schooling, sheltered work, and volunteer work. Multiple logistic regression analyses using demographic and medical data, prehospitalization social activity status, and OT participation rates as independent variables were used to examine the factors encouraging social activity participation after discharge. Decision tree analysis was conducted to identify patients who specifically needed to increase OT participation. Results: Of 524 eligible patients, 247 were included in the study. The number of patients who were socially active at admission and after discharge was 116 and 188, respectively. Multiple logistic regression analyses revealed that the following factors were likely to encourage social activity participation after discharge: higher rates of OT participation to facilitate group adaptation (OR = 1.015, 95% CI 1.003-1.027), being socially active at admission (OR = 4.557, 95% CI 2.155-9.637), and no marital history (OR = 0.293, 95% CI 0.130-0.661). Decision tree analysis showed that for patients who were socially inactive at admission and had a history of marriage, increasing OT participation to 52.6% or higher may ensure social activity participation after discharge. Conclusions: This study identified patients whose social participation after discharge could be boosted by OT that facilitates group adaptation. Our findings would facilitate the development of individualized add-on rehabilitation based on the effects of real-world OT practices.

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OBJECTIVES: This study employed a national longitudinal cohort to assess expected years of life lost (EYLL) in newly diagnosed psychiatric patients. METHODS: Data from Taiwan's National Death Registry and Health Insurance Research Database were scrutinized to identify patients with various psychiatric disorders. Disorders were ranked hierarchically, and age groups were categorized as young, middle-aged, and older adults. We utilized the semiparametric survival extrapolation method to estimate life expectancy (LE) and EYLL. Modifying effect of comorbid conditions and socioeconomic characteristics were also explored. RESULTS: Among the 5,757,431 cases, young adults with dementia, alcohol use disorder, schizophrenia, and bipolar disorder experienced an excess of 15 years of EYLL. Middle-aged adults faced approximately 9 years or more of EYLL, while older adults had lower EYLL values. Comorbid conditions, low income levels, and living in rural areas were associated with higher EYLL. CONCLUSIONS: This study underscores the substantial EYLL among young adults with psychiatric disorders and the significant impact of specific disorders on EYLL. Early intervention, tailored support, and healthcare system readiness are imperative for improved outcomes. Resource allocation and targeted interventions focusing on early detection and comprehensive treatment can alleviate the economic burden.

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OBJECTIVE: Previous studies have suggested that irritable bowel syndrome (IBS) is strongly associated with psychiatric disorders. However, it is unclear whether this association is causal, concomitant, or accidental. Thus, we performed Mendelian randomization (MR) analysis to evaluate the causal effects of several psychiatric disorders on IBS. METHODS: Summary data of genome-wide association studies (GWASs) were obtained mainly from the Psychiatric Genomics Consortium (PGC) on individuals of European ancestry and from a recent GWAS on IBS. We used three MR methods, the inverse-variance weighting (IVW), weighted median (WM), and MR-Egger regression (MR-Egger). In addition, two other indicators, namely, the MR-IVW Cochran's Q statistic and MR-Egger intercept, were used to assess heterogeneity and detect directional horizontal pleiotropy, respectively. RESULTS: Heritability was high for bipolar disorder (81.18 %, 95 % CI = 73.18-148.18 %), schizophrenia (33.88 %, 95 % CI = 33.57-38.19 %), and panic disorder (30.66 %, 95 % CI = 20.74-40.58 %). For other disorders, there was a low liability-scale SNP heritability for major depressive disorder (MDD) (0.67 %, 95 % CI = 0.61-0.73 %), anxiety disorder (7.63 %, 95 % CI = 1.67-13.59 %), PTSD (0.96 %, 95 % CI = 0.12-1.8 %), and IBS (2.44 %, 95 % CI = 2.13-2.75 %). We also observed that schizophrenia had a significant causal effect on IBS according to MR-IVW. Notably, the individual causal estimates of genetic instruments for MDD and schizophrenia were heterogeneous, but no pleiotropic effects were observed. CONCLUSIONS: Our analyses revealed the causal effects of MDD and schizophrenia on IBS, a matter that has been subject to debate for decades, and also showed that IBS had causal effects on MDD.

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This concept analysis study identified attributes and defined psychiatric nursing competency among psychiatric nurses. The approach of Walker and Avant was used for concept analysis, and a literature review was completed including eight steps. The concept of psychiatric nursing competency was identified as five attributes: professional assessment, situation coping skills, communication, cooperation, and self-management. Antecedents of the concept were psychiatric nursing education and experience, and the consequences were patient outcomes, patient safety, and efficiency of care. Psychiatric nursing competency was defined as the comprehensive ability to care for psychiatric patients appropriately and effectively in the nursing situation. This study is meaningful in that it clarified psychiatric nursing competency among psychiatric nurses, and the attributes and empirical referents of this study will be the basis for development to a psychiatric nursing competency measurement tool.

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Psychiatric nurses face moral dilemmas that affect their mental health. We investigated whether sense of coherence (SOC) buffers psychiatric nurses' perceived effects of moral dilemmas on their psychological distress. A total of 418 nursing professionals in 6 psychiatric hospitals in Japan completed self-administered questionnaires. A negative correlation was observed between "patient rights" (r = -0.24, p < 0.001), "relationships other than patient" (r = -0.28, p < 0.001), "nursing care" (r = -0.25, p < 0.001) of moral dilemmas and "manageability" of SOC. Additionally, a negative correlation was observed between "patient rights" (r = -0.22, p < 0.001), "relationships other than patient" (r = -0.21, p < 0.001) of moral dilemmas and "comprehensibility" of SOC. Hierarchical multiple regression analysis used the Kessler Psychological Distress Scale-10 (K10), which assessed the degree of mental distress, as the dependent variable, and moral dilemmas and SOC as the independent variables, along with their interaction terms. The K10 scores significantly changed depending on the degree of moral dilemmas in the low SOC group, but not in the high SOC group. SOC buffers the effects of psychiatric nurses' perceived moral dilemmas on their psychological distress.

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Psychological symptoms are notably prevalent in palliative care (PC) settings, significantly impacting quality of life for patients and their families. Given the inherent multidimensionality of suffering in PC, addressing these psychological aspects is essential. This article aims to introduce and integrate discrete concepts from various schools of psychotherapy, which are directly applicable to PC practices, thereby providing clinicians with a rich toolkit to manage psychological distress. The article focuses on 10 key concepts from different psychotherapeutic traditions. They are a small sample from the vast and deep pool of wisdom contained in psychotherapeutic theory, and they were selected due to their direct applicability to PC practice. Adopting psychotherapeutic principles, along with leveraging the interdisciplinary wisdom inherent in PC practice, enhances our therapeutic relationships in PC and empowers patients to navigate their illness with greater resilience and adaptive coping.