Citations

Background Pseudohallucinations (PHs), defined as perceptual experiences recognized by the individual as unreal, have historically been distinguished from “true” hallucinations. However, their conceptual validity and clinical utility remain debated, with definitions and applications varying widely. Methods A narrative review of historical and contemporary literature on PHs was conducted. Articles were identified through PubMed using the terms “pseudohallucination,” “hallucination,” “dissociation,” and “trauma,” and through reviewing reference lists of key publications. Results Historical accounts emphasized features such as insight and localization, but empirical findings challenge these distinctions and demonstrate significant overlap with hallucinations and intrusive imagery across diagnoses. PHs are observed in psychotic, trauma-related, and personality disorders, suggesting they may reflect a spectrum of perceptual experiences rather than a discrete entity. Conclusions Moving beyond binary classifications and exploring the use of specifiers to describe hallucinations may offer a more nuanced framework for understanding these experiences across diagnostic categories. Rather than seeking rigid distinctions, this approach encourages descriptions that reflect individual phenomenology and context. Such a shift may help reduce stigma, foster more compassionate clinical engagement, and preserve the perceived relevance of the PH concept while aligning it with contemporary dimensional models of psychopathology.

ABSTRACT Levator ani syndrome (LAS) explains up to 7.4% of anorectal pain cases. Classic symptoms include rectal pain or pressure with sitting. We present 2 patients, ages 32 and 25 years, presenting initially with “diarrhea” and perianal hyperhidrosis. History revealed rectal discomfort, tenesmus, urgency, and sensation of incomplete evacuation. Puborectalis tenderness was present on digital rectal examination. Therapies were tailored to each patient, including pelvic floor physical therapy with biofeedback, bowel regulation, rectal diazepam, and ileostomy. These presentations offer insights into potential pathophysiological mechanisms in LAS and highlight the importance of considering LAS in non-pain presentations.

ABSTRACT Background The available risk prediction models are inadequate to identify a true low‐risk patient for developing new‐onset atrial fibrillation (AF) after typical atrial flutter (AFL) ablation. We aimed to determine whether adding markers of atrial myopathy to HATCH score ( h ypertension, a ge ≥75 years, t ransient ischemic attack/stroke, c hronic obstructive pulmonary disease, and h eart failure) can improve prediction of new‐onset AF after ablation of typical AFL. Methods The study included 208 consecutive patients who underwent successful ablation of typical AFL at Minneapolis VA Medical Center and University of Minnesota Medical Center. Patients with history of AF prior to ablation were excluded. Results Among the 208 patients, 76 (36.5%) developed new‐onset AF post AFL ablation. Mean follow‐up duration was 62 ± 31.8 months. HATCH score was not associated with new‐onset AF. When adding atrial myopathy (presence of at least one of the following: PTFV 1 > 5000 µV*ms, interatrial block determined by biphasic inferior p wave with duration >120 ms, left atrium (LA) diameter ≥44 mm, or LA index ≥3 cm/m 2 ) to HATCH score (HATCH‐A 2 ), the combination was independently associated with new‐onset AF. The AF incidence between HATCH‐A 2 score of 0–1 and ≥2 were 6.7% and 40.5%, respectively (Odds ratio 9.04, 95% confidence interval: 2.05–39.81, p = 0.004). Particularly, when HATCH‐A 2 score was 0, none of the patients developed AF. Conclusions Adding atrial myopathy to HATCH score improved predictability and could be used to delineate a true low‐risk patient of new‐onset AF after typical AFL ablation.

Objectives To compare survival and oncological outcomes of cisplatin‐ineligible patients (Cis‐I) and cisplatin‐eligible (Cis‐E) patients with muscle‐invasive bladder cancer (MIBC) undergoing immediate radical cystectomy (IRC), as IRC is currently considered the standard‐of‐care for Cis‐I patients with MIBC. Patients and Methods Data from patients with clinical (c)T2–4cN0–1M0 MIBC undergoing IRC, between 2006 and 2021, were retrospectively analysed from four tertiary care centres in the United States. Overall, recurrence‐free and event‐free survival were described using the Kaplan–Meier method and tested using the log‐rank test. For context, we compared survival outcomes against those in Cis‐E patients with MIBC undergoing IRC from the Southwest Oncology Group (SWOG)‐8710 trial. Results Overall, 379 Cis‐I and 125 Cis‐E patients with cT2–4cN0–1M0 MIBC who underwent IRC were included. Cis‐I patients included 44.8% cT3/4 vs 60% cT3/4 in the Cis‐E group. Overall, 83.3% of Cis‐I and 79.2% of Cis‐E patients died during follow‐up. The median event‐free and overall survival were 12.1 and 14.5 months for the Cis‐I group and 28.8 and 60.1 months for the Cis‐E group ( P < 0.001). [Correction added on 10 October 2025, after first online publication: The preceding sentence has been revised in this version.] Limitations include retrospective comparison of contemporary multi‐institutional data with that of a randomised control trial. Conclusions The Cis‐I patients with MIBC undergoing IRC fared poorly, with a median overall survival of 14.5 (95% confidence interval 11.1–17.9) months, mostly due to non‐cancer‐related deaths. These results provide a benchmark for clinical trials exploring novel agents or alternative chemotherapy regimens in Cis‐I patients with MIBC.

New solvent-free polymer electrolytes are proposed based on a linear perfluorinated copolymer synthesized by enzymatic methods. The system is biphasic and exhibits two distinct conductivity pathways for long-range Na + -cation migration.

Abstract Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic condition characterized by congenital malformations of the great toes and progressive heterotopic ossification (HO) in specific anatomic patterns. Present management summarized here is focused on early diagnosis, assiduous avoidance of injury and iatrogenic harm, symptomatic amelioration of painful flare-ups, and optimization of residual function. Twenty-one members of the International Clinical Council on FOP (ICC) and seven consultants from 15 countries, chosen for their clinical expertise in FOP, developed this summary statement. Further advances in therapeutics will be based on rigorous clinical trials to assess novel and emerging treatment and prevention strategies. A detailed and updated exploration of the topics outlined in this brief perspective can be found in “The Medical Management of Fibrodysplasia Ossificans Progressiva: Current Treatment Considerations” which can be found on the International Clinical Council on FOP (ICC) website (www.iccfop.org).

Abstract Frailty is highly prevalent in cardiovascular disease and associates with poor clinical outcomes. Several cardiovascular conditions benefit from invasive interventions, but the impact of these procedures in frail patients remains unclear. We thus performed a systematic review and meta-analysis to summarize evidence and quantify the pooled effect of clinical outcomes of invasive cardiovascular interventions among frail vs. non-frail patients. Systematic search of two electronic databases from January 2015 to April 2025 was performed including all randomized controlled trials (RCTs) and prospective cohort studies examining outcomes of invasive cardiovascular interventions stratified by frailty. Outcomes included all-cause mortality, hospitalizations, and other adverse outcomes. Risk ratios (RRs) and their 95% confidence intervals (CI) were assessed using random-effects models. Thirty-one studies (10 RCTs, 21 prospective, 3 retrospective studies) with a total of 27 534 participants were included. Compared with non-frail patients, frail patients after cardiovascular procedures were at higher risks of all-cause mortality (RR 3.14, 95% CI: 2.29-4.30), and hospitalizations (RR 1.88, 95% CI: 1.29-2.73). Frail patients undergoing transcatheter aortic-valve implantation and percutaneous mitral-valve interventions did not have significant increased mortality risks compared with non-frail patients (P &gt; 0.05). Pre-frailty predicted lower mortality risks amongst patients undergoing transcatheter vs. surgical aortic valve replacement (HR 0.78, 95% CI: 0.67-0.92). Frail patients with non-ST elevation myocardial infarction derived similar mortality benefits from an invasive vs. conservative approach (HR 1.13, 95% CI: 0.64-2.01). In conclusion, frailty prognosticates adverse outcomes following invasive cardiovascular interventions and influences treatment efficacy, highlighting its significance in treatment selection

Background Catatonia in medically ill patients is rare but often unrecognized. This monograph summarizes current knowledge on the diagnosis, epidemiology, etiology, and management of catatonia occurring in the medical setting. Methods PubMed searches were used to identify relevant articles from 1962 to present. Results More than 3,000 articles were obtained and reviewed for relevance, including references of articles identified by the initial search. Several areas were identified as important, including: (1) catatonia and delirium; (2) malignant catatonia; (3) pediatric catatonia; (4) catatonia associated with another medical condition (CAMC); (5) drug exposure and withdrawal syndromes associated with catatonia; and (6) treatment of catatonia in the medical setting. Conclusions Catatonia in the medically ill appears to have numerous etiologies, although etiology does not seem to modify the general treatment approach of prompt administration of lorazepam. Delirium and catatonia are commonly comorbid in the medical setting and should not be viewed as mutually exclusive. Electroconvulsive therapy should be offered to patients who do not respond to benzodiazepines or have malignant features. Removing offending agents and treating the underlying medical condition is paramount when treating CAMC. Memantine or amantadine may be helpful adjunctive agents. There is not enough evidence to support the use of antipsychotics or stimulants in treating CAMC.

Background Anti- N -methyl-D-aspartate receptor (anti-NMDAR) encephalitis was formally described in 2007 and includes a range of psychiatric and neurologic symptoms. Most patients with anti-NMDAR encephalitis initially present to psychiatrists for diagnosis and treatment. However, there is limited literature summarizing treatment strategies for psychiatric symptoms. In an effort to improve identification and treatment, this review article provides an overview of anti-NMDAR encephalitis, with a focus on psychopharmacologic treatment strategies. Two case reports provide a clinical context for the literature review. Methods The authors conducted a PubMed search. Results Prominent psychiatric symptoms of anti-NMDAR encephalitis include psychosis, agitation, insomnia, and catatonia. Neuroleptics may be helpful for managing psychosis and agitation, but may exacerbate movement abnormalities. Diphenhydramine and benzodiazepines are helpful for agitation and insomnia. In addition, the anticholinergic affinity of diphenhydramine can improve dystonia or rigidity attributable to anti-NMDAR encephalitis, while benzodiazepines and electroconvulsive therapy have been used for catatonia associated with this condition. Conclusions Psychiatrists play an important role in the diagnosis and treatment of anti-NMDAR encephalitis. Recognizing the typical clinical progression and closely monitoring for accompanying neurologic symptoms will facilitate diagnosis and timely treatment. Careful selection of psycho-pharmacological interventions may reduce suffering.