Jakienė, Vilma

Background. Problematic Internet use (PIU) has been defined as an umbrella concept encompassing various problematic online activities, such as excessive gaming, gambling, online shopping, pornography viewing, social networking, and other online behaviors (Burkauskas et al., 2020; Fineberg et al., 2018). Internet use is generally considered problematic when excessive engagement leads to psychological, social, educational, and/or occupational difficulties (Brand et al., 2025). Age may influence vulnerability to PIU as well as its associated psychopathological outcomes, yet comparative evidence across the lifespan remains limited (Gecaite-Stonciene et al., 2021). The aim of this study was to examine PIU profiles based on anxiety, depression, and life quality across different age groups. Methods. In total, 800 adults participated in a cross-sectional online survey and completed the 9-item Problematic Internet Use Questionnaire, the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, the World Health Organization-Five Well-Being Index. Participants were categorized into three age groups: young adults (18–35 years), middle-aged adults (36–64 years), and older adults (≥65 years). Results. Young adults showed significantly higher levels of PIU (η² = 0.073, p <0.001), depression (η² = 0.093, p <0.001), and anxiety (η² = 0.091, p <0.001), and lower psychological well-being (η² = 0.032, p <0.001) compared to the two older age groups. Significant positive correlations were also observed between PIU and distress symptoms, with the strongest associations observed among young adults (depression ρ = 0.487, p<0.001; anxiety ρ = 0.457, p <0.001), followed by middle-aged adults (depression ρ = 0.449, p<0.001; anxiety ρ = 0.374, p <0.001). Conclusions. Young adults exhibited the highest risk of PIU and the greatest burden of anxiety, depression, and reduced psychological well-being. Associations between PIU and distress symptoms weaken with age. These findings highlight age-related differences and vulnerability to PIU. Prevention and intervention strategies for PIU management should be age-tailored.

Obsessive-Compulsive Personality Disorder (OCPD) may represent a clinically significant yet understudied risk factor for suicidal behavior, particularly when comorbid with anxiety and mood disorders. OCPD is characterized by perfectionism, rigidity, and a need for control. Although frequently comorbid with anxiety and mood disorders, its relationship with suicide-related outcomes remains insufficiently examined. The objective of this review is to examine the associations of OCPD with suicidal behavior, anxiety and mood disorders, with particular attention to the risk of suicidal ideation and suicide attempts. Materials and methods. A literature search was conducted in PubMed, PsycINFO, Web of Science, Scopus, and Google Scholar from April and to May 2026. The main search terms included “obsessive-compulsive personality disorder”, “OCPD”, “anankastic personality”, “suicide”, “suicidal ideation”, “suicide attempt”, “anxiety disorders”, “depression”, and “bipolar disorder.” After removing duplicate records, 88 articles were identified. Based on the eligibility criteria, 11 articles were included in the final analysis. Results. OCPD appears to be clinically relevant in mood and anxiety disorder populations. Studies suggest associations between OCPD or OCPD-related traits and depressive symptoms, anxiety, stress-related impairment, perfectionism, hopelessness, reduced reasons for living, suicidal ideation, non-suicidal self-injury, and suicide attempts. Direct evidence remains limited, but available findings indicate that OCPD may increase suicide-related vulnerability, particularly in the context of depression. However, many studies used cross-sectional designs, assessed traits rather than formal OCPD diagnosis. Conclusion. OCPD and related traits may be important factors in suicide risk assessment, especially among individuals with mood disorders, anxiety disorders, hopelessness, and marked perfectionism. Further longitudinal research is needed to clarify causal pathways and identify which OCPD features most strongly predict suicidal behavior.

Background: Pre-pandemic meta-analyses reported problematic internet use (PIU) prevalence estimates ranging from 6% to 9.7% [1]. PIU has been defined as an umbrella concept encompassing various internet-related activities, such as video gaming, gambling, online shopping, pornography viewing, social networking, and other online behaviors that become problematic when excessive engagement leads to psychological, social, educational, and/or occupational difficulties [2], [3], [4]. Impulsivity and compulsivity play significant roles in understanding the relationship between PIU, anxiety, and depression symptoms [5]. The research aim was to test the hypothesis that PIU affects anxiety and depressive symptoms through the mediating role of impulsivity and compulsivity. Methods: The cross-sectional study comprised 523 Lithuanian residents (83.9% females and 16.1% males) with a mean age of 49 ± 11 years, who participated in an online survey from January 2024 to May 2024. Participants completed the following scales: the Problematic Internet Use Questionnaire-9 (PIUQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Barratt Impulsiveness Scale-11 (BIS-11), and the Cambridge-Chicago Compulsivity Trait Scale (CHI-T). Using structural equation modeling, the role of impulsivity and compulsivity as mediators between problematic Internet use and psychological distress was investigated, controlling for the effects of age. Results: In sum, 9.2% of the participants scored within the at-risk range of PIU, 13.4% of the subjects reported clinically significant symptoms of anxiety, and 13.4% reported moderate to severe depressive symptoms. The proportion of participants with clinically significant anxiety and depressive symptoms was significantly higher among Internet users in the at-risk PIU group (anxiety 10.3% vs. 43.8%, η2 = 0.284, p<0.001; depressive 9.7% vs. 50.0 %, η2 = 0.342, p<0.001). The structural equation model indicated a statistically significant effect of PIU on subjective anxiety and depressive symptoms, with both anxiety and depressive symptoms mediated via impulsivity (anxiety β=0.091 and depressive β=0.186) and compulsivity (anxiety β=0.284 and depressive β=0.155). Chi-square value = 5.10, df = 3, p = 0.164, SRMR = 0.012, GFI = 1.00, CFI = 0.991, RMSEA = 0.069. Conclusions: Findings suggest that relationships between PIU, anxiety, and depressive symptoms are mediated via impulsivity and compulsivity. However, several limitations worth noting. First, the sample was mainly comprised by the female, which may limit the generalizability of the results. Second, due to the cross-sectional nature of the study, we could not draw causal interpretations with regards to the relationship between PIU and mental distress, while considering the role of impulsivity and compulsivity. Therefore, future longitudinal studies with larger and more diverse samples are highly encouraged. Despite the limitations, the strength of this study is its focus on the complex interaction between PIU, mental distress, impulsivity, and compulsivity. Results underscore the importance of the inclusion of impulsivity and compulsivity factors in the studies analysing longitudinal effects of PIU on mental distress in adults.

Background Obsessive-compulsive personality disorder (OCPD) is common in individuals with anxiety and mood disorders (AMD), yet its specific impact on cognitive functioning remains underexplored. Individuals with AMD often experience persistent cognitive difficulties [1]. Meanwhile, OCPD is associated with a distinct neuropsychological profile characterized by cognitive inflexibility and executive planning impairment [2,3]. However, it is still unclear to what extent cognitive impairments in AMD population are influenced by OCPD. Therefore, the aim of our study was to compare the cognitive performance of individuals with AMD with and without comorbid OCPD. Based on previous studies [2, 3], we hypothesized that individuals with AMD and comorbid OCPD will have a distinct cognitive pattern in the areas of Intra-Extra Dimensional (IED) Set Shifting, One Touch Stockings of Cambridge (OTS), but not in Cambridge Gabling Task (CGT). Methods Overall, 24 individuals (75% women, mean age 40.0 [35.5–50.5] years) with AMD took part in the study. OCPD traits were evaluated using the observer-rated Compulsive Personality Assessment Scale (CPAS) [4]. The diagnosis of OCPD was defined as a score of three (severe) and four (very severe) on at least four of the CPAS items. Individuals that did not meet the operational criteria for OCPD but scored higher than 5 were excluded from the study. Neurocognitive testing was done with the Cambridge Automated Neuropsychological Test Battery (CANTAB) including tests of set shifting (IED Set Shifting), executive functions (OTS), and decision making and risk-taking behavior (CGT). Chi-square test and Mann Whitney U test were used for comparison within groups. Results Out of 24 participants, 13 individuals fulfilled the operational criteria for OCPD (84.6% women, mean age 41.0 [34.5–50.0]), while 11 individuals (63.6% women, mean age 39.0 [37.0–53.0]) were classified without OCPD, as they scored 0–5 points on the CPAS. The groups did not differ in regards to sociodemographic characteristics, such as age, gender, education, history of smoking, diagnosis, severity of depression and anxiety (all p > .05). Comparing neuropsychological tests scores, individuals with OCPD made less mistakes on the IED problems prior to the extra-dimensional shift (6.0 [6.0–8.0] vs. 5.0 [4.0–6.0], p = .019, effect size r = 0.478). Individuals with OCPD made less IED compound reversal errors (1.0 [1.0–2.0] vs 1.0 [1.0–1.0], p = .049, effect size r = 0.401), but made more IED extradimensional reversal errors (1.0 [1.0–1.0] vs 1.0 [1.0–3.0], p = .039, effect size r = 0.420). There were no significant differences between groups in other cognitive function domains. Conclusions Individuals with AMD and comorbid OCPD experienced difficulties in cognitive flexibility that are not present in individuals with AMD without OCPD. They showed a better performance on tasks involving rule acquisition and consistency, but had significant difficulties when task required flexibility and attentional shifting. Deficits in cognitive flexibility could be the basis for OCPD trait compulsivity, which in turn could have clinical implications for individuals with AMD. These findings expand on the neuropsychological OCPD research, highlighting cognitive inflexibility in individuals with AMD and comorbid OCPD. Nevertheless, small sample size limits the generalizability of our results, and future studies are needed to confirm these findings.

Introduction: Thyroid hormones are implicated to depression and suicidal behavior [1, 2], while testosterone may contribute to the pathophysiology of suicidal behavior due to its direct effects on mood, cognition, and aggression [3]. However, it remains unclear how thyroid hormones interact with testosterone and how these factors link to suicidal behavior in individuals with anxiety and mood disorders. Objective: The aim of this study was to investigate the association between testosterone and free triiodothyronine concentrations and suicide attempts among individuals with anxiety and mood disorders. Methods: In this cross-sectional study we recruited 147 subjects. Among them, 101 patients were diagnosed with anxiety and mood disorders (AMD) with and without a lifetime history of suicide attempts (SA) (aged 38.8±13.1 years, 30% male) and 46 controls - individuals without a lifetime history of mental disorders or history of suicide attempts (aged 48.4±12.1 years, 34% male). All subjects were interviewed for current psychiatric diagnoses and suicidal behavior using the Mini International Neuropsychiatric Interview (MINI). Biochemical blood tests were performed to measure concentrations of free thyroxine (FT4), free triiodothyronine (FT3), thyroid stimulating hormone (TSH) and total testosterone (TT). Logistic regression analyses were used to test whether FT3 or TT levels were predictive for SA. Results: A positive correlation was found between TT and FT3 in both the control and patient groups (both p < 0.001). As a group, patient with a history of SA showed lower FT3 levels compared to those without SA and to control (5.20 ± 0.65 vs. 5.52 ± 0.62 and 5.65 ± 0.71 pmol/L, respectively; p = 0.005). The serum FT3 levels were significantly lower in female patients with a history of SA, than in females without a history of SA (p = 0.007) and compared to controls (p = 0.003). Additionally, significantly higher TT concentrations were observed in females with a history of SA compared to controls (p = 0.015). A multivariate logistic regression model was used to predict SA, incorporating age, FT3, TT, gender, and the interaction term (TT × Gender). The interaction effect, indicating a moderating role of gender in the relationship between TT and SA, was statistically significant (p = 0.028). To validate this effect, the model was re-run exclusively on female patients. Among females, lower FT3 levels were associated with an increased likelihood of suicide attempts [OR = 0.28 (95% CI: 0.10–0.79)], as were higher TT levels [OR = 12.21 (95% CI: 1.34–111.11)]. These findings suggest a gender-specific hormonal influence, with a total testosterone potentially playing a more prominent role in females. Conclusion: Lower FT3 concentrations, even within the normal reference range, and elevated total testosterone levels were associated with suicide attempts in females but not in males. These results highlight the potential value of assessing FT3 and TT levels in the clinical evaluation of suicide risk, particularly in females with mood and anxiety disorders.

Background: Thyroid axis hormones, such as free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) are associated with mental disorders, especially with depression and anxiety [1, 2]. These hormones have been associated with worse cognitive functioning in individuals with coronary artery disease [3]. Cognitive dysfunction is prevalent in individuals with anxiety and mood disorders (AMD) [4, 5], however, the associations between these variables have not been studied in individuals with AMD. Therefore, the aim of our study was to investigate the correlation between fT3, fT4, the fT3/fT4 ratio, TSH and cognitive functioning in individuals with AMD. Methods: One hundred and ninety-two (age 39±12 years; 21% men and 79% women) individuals attending a Stress-related disorders day care unit of the Palanga Hospital at Neuroscience Institute of the Lithuanian University of Health Sciences, took part in this cross-sectional study. Diagnoses of AMD were established using the Mini-International Neuropsychiatric Interview. Cognitive tests were completed in order to assess cognitive functioning. Participants completed Digit Span Test to assess auditory attention and Trail Making Test (TMT) A and B to assess their perceptual speed, task-switching and executive control characteristics. Venous blood samples were drawn for evaluation of fT3, fT4, and TSH. Blood was centrifuged and serum was stored frozen at -70˚C. Serum levels of fT3, fT4, and TSH were analysed using an automated enzyme immunoassay analyser. Depression symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms were measured with the Generalized Anxiety Disorder-7 (GAD-7). For statistical analyses, univariate regression analysis was used to examine unadjusted associations of fT3, fT4, TSH, and fT3/fT4 with scores on cognitive functioning tests. Then, multivariable regression analyses were performed to determine if fT3, fT4, TSH, and fT3/fT4 remained significantly associated with cognitive functioning after adjusting for age, sex, education, depression and anxiety symptoms, smoking, and current medication use. Results: In individuals with AMD, univariate regression analyses showed that fT3 had a negative correlation with TMT Part A (b=-0.206; p=0.004), and Part B (b=-0.145; p=0.046); however, these associations were not significant in multivariable analyses after adjusting for age, sex, education, depression and anxiety symptoms, smoking, and current medication use. A univariate regression analyses also showed a negative correlation between fT4 and TMT Part A (b=-0.210; p=0.004), as well as Part B (b=-0.152; p=0.036). These associations were significant even after controlling them for aforementioned confounding factors (b=-0.192; p=0.006; b=-0.151; p=0.036 respectively). Conclusions: Overall, in individuals with AMD, lower fT4 concentrations were associated with slower perceptual speed and worsened task-switching abilities independent of socio-demographic characteristics, clinical factors as well as depression and anxiety symptoms. The results show the importance of thyroid hormones on cognitive functions in individuals with AMD. Particularly lower fT4 could be a potential biomarker of impaired cognitive functioning in individuals with AMD.

Background: Fatigue is a common complaint among individuals with anxiety and mood disorders (AMD) [1]. Subjective fatigue is closely related to cognitive functioning in healthy adult population [2], as well as in other populations, such as individuals with coronary artery disease [3]. Even though cognitive dysfunction and fatigue are both more common in individuals with AMD than in otherwise healthy individuals [4], the relationship between fatigue and cognitive functions is still underexplored. Furthermore, most research on fatigue relies primarily on self-report measures, often lacking objective assessments to compare with. Therefore, the aim of our current study was to investigate the correlations between subjective and objective fatigue and cognitive functions in individuals with AMD. Methods: Three hundred and fourteen individuals (77.7% women and 22.3% men, mean age 40.2 ± 11.9 years) attending a Stress-related disorders day care unit of the Palanga Hospital at Neuroscience Institute of the Lithuanian University of Health Sciences, participated in this cross-sectional study. Diagnosis of AMD was established using the Mini-International Neuropsychiatric Interview. Subjective fatigue was assessed using the Multidimensional Fatigue Inventory-20 (MFI-20), while objective fatigue was evaluated via an exercise capacity (EC) workload test. Cognitive functioning was measured using Digit Span Test, Digit Symbol Test, Trail Making Test (TMT) Parts A and B. Depression and anxiety symptoms were evaluated with The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale. Associations between fatigue and cognitive functioning were first analysed using univariate regression. Multivariable regression analyses were then conducted, adjusting for age, sex, education, current medication use, history of smoking, depression and anxiety symptoms. Results: In individuals with AMD, univariate regression analyses found associations between subjective and objective fatigue characteristics and cognitive functions. Specifically, higher scores on the MFI-20 subscales for reduced activity and reduced motivation were associated with lower T-scores on TMT Part A (β = −0.117, p = 0.039; β = −0.112, p = 0.048 respectively); higher EC was associated with higher numbers of pairs recalled correctly in Digit Symbol Test (β = 0.195, p = 0.001), higher TMT Part A T-score (β = 0.156, p = 0.011), and higher TMT Part B T-score (β = 0.125, p = 0.041). After completing multivariable regression models adjusting for age, sex, education, current medication use, history of smoking, depression and anxiety scores, only the association between higher EC and higher number of pairs recalled correctly in Digit Symbol Test remained statistically significant (β = 0.227, p = 0.002). Additionally, multivariable regression analysis found that higher EC was independently associated with higher TMT A/B T-scores (β = 0.152, p = 0.046). Conclusions: Overall, in individuals with AMD, objective fatigue, as measured by EC, was independently associated with poorer cognitive functioning, particularly in domains involving incidental learning, recall, and executive functioning. These findings underscore the importance of distinguishing between subjective and objective fatigue measures and their respective impact in cognitive performance. These findings have practical implications for better understanding the relationship between cognitive functions and fatigue in individuals with AMD and provide the basis for future research investigating the relationship between cognitive function and fatigue.

Introduction The relation between thyroid function and depression has long been recognized. However, studies analyzing coexistence of thyroid dysfunction and suicidal behavior still offer contradictory results. Thyroid hormones that may play an important role in suicidal behavior have not been thoroughly investigated in the sample of individuals with comorbid anxiety and mood disorders (AMD).

Objectives The aim of this cross-sectional study was to identify potential associations between thyroid function and suicide attempts (SA) in individuals with AMD.

Methods This study comprised 147 consecutive participants (mean age 42.4±13.1 years; 69% women). Thirty-five percent (n=51) of the sample was hospitalized after a suicidal attempt, 34 percent (n=50) patients with AMD and without a history of SA, and 31 percent (n=46) individuals without a life time history of mental disorders or suicidal attempt (control group). All participants were interviewed for current psychiatric diagnoses and suicidal behavior using the Mini International Neuropsychiatric Interview. The biochemical blood tests were performed for the concentrations of free thyroxine (FT4), free triiodothyronine (FT3) and thyroid stimulating hormone (TSH). All data were reported as means, standard deviations, or medians (interquartile range [IQR]). Analysis of variance (ANOVA), chi-square test, independent samples t-test, Kruskal-Wallis test, were used for the group comparisons. Multivariable logistic regression analyses were used to assess the associations between thyroid hormones parameters and SA.

Results All participants had serum FT4, FT3 and TSH level within normal range. Patients with AMD and SA were more likely to be younger than patients with AMD only and the control group (36.1 ± 13.6 vs. 41.5 ± 11.9 and 48.4±12.1 years; p<0.001). There were no significant differences according to gender, BMI, mean values of TSH and FT4 between groups. In our study, FT3, but not the other thyroid axis hormones, was independently associated with suicidal behavior. Patients with AMD and SA had lower FT3 levels in comparison to patients with AMD without SA and the control group (5.20 (0.65) pmol/L vs. 5.52 (0.62) and 5.65 (0.71, p=0.005)). A multivariable logistic regression revealed that FT3 levels of female SA were significantly lower than non-attempters (4.92 (0.64) pmol/L vs. 5.42 (0.71), p=0.029) and significantly lower than male-attempters (5.61 (0.61), p<0.001). We not found any significant differences with regard to FT3 levels between male SA and non-attempters and controls.

Conclusions Lower FT3 concentrations, even within the normal reference range, were related to SA in female gender, but not male. This finding supports the importance of evaluating FT3 levels in clinical decision-making on suicide risk of patients with AMD.

Disclosure of Interest None Declared

Short versions of problematic internet use (PIU) questionnaires may provide a convenient and effective way of assessing internet-related problems in various contexts, ranging from research to clinical practice. The aim of this study was to investigate whether single yes/no question (Q-single) regarding "functional impairment due to PIU" could serve as a screening tool to indicate the potential absence of PIU, given the lack of functional impairment.

Studies have demonstrated a negative correlation between lithium trace concentrations in drinking water and suicide rates; however, a study focused on clinical significance of lithium concentrations in individual patients was needed. Therefore, we aimed to assess lithium trace concentrations in individuals with mental disorders and compare them to healthy controls to evaluate whether lithium concentrations are associated with mental disorders and/ or suicidal behavior.