Podlipskytė, Aurelija

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.

Background: Fatigue is one of the main symptoms in anxiety or mood disorders (AMDs). Despite this, different qualitative subjective fatigue dimensions (e.g., physical fatigue, mental fatigue, etc.) have not been researched in relation to depression and especially anxiety symptom severity. The current study examined the associations between depression and anxiety symptom severity and fatigue characteristics in individuals with AMDs.

There is still insuffi cient data whether problematic internet use (PIU) is linked with physical symptoms associated with mental disorders, particularly among student demographics.

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.

Normal thyroid homeostasis is known to be altered during various critical illnesses. Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) represent acute manifestations of the same ischemic cardiovascular pathology, differing primarily in the anatomical location affected. Aim: To investigate the relationship between psychosocial status and thyroid hormone concentrations in individuals who have experienced AIS or AMI. Study Population: The analysis included 448 participants: 289 with AMI and 159 with AIS. Methods: Blood samples were collected from all participants upon hospital admission and stored at -80 °C until analysis. Serum concentrations of fT4, fT3, rT3, and TSH, obtained on admission, were measured. Upon discharge, emotional status was assessed using the HADS and EQ-5D-5L. Results: Comparison of thyroid hormone profiles between groups showed significantly higher rT3 and fT4 levels in individuals with AMI than in those with AIS (p < 0.001 and p = 0.018, respectively), whereas the fT3/rT3 ratio was significantly lower (p < 0.001). In contrast, TSH levels were significantly higher in the AIS group than in the AMI group (p = 0.002). In individuals with AIS, higher serum rT3 concentrations on admission were associated with lower emotional disturbances (HADS; β = -0.163, p = 0.046) and better QoL at discharge (WQ-5D-5L; β = 0.157, p = 0.044). Thyroid hormone concentrations were not associated with emotional status or QoL in individuals with AMI. Conclusion: Distinct thyroid hormone profiles were observed between individuals with AMI and AIS, characterized by increased rT3 and fT4 levels and a reduced fT3/rT3 ratio in AMI and higher TSH levels in AIS, while higher rT3 concentrations were independently associated with better emotional status and quality of life in AIS but not in AMI.

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: Chronic low-grade inflammation has been strongly implicated in the pathogenesis of major depressive disorder (MDD) [1]. In particular, cytokines interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α), have been associated with diagnosis of MDD and depressive symptoms in a subset of patients. Preclinical studies have demonstrated that administration of lipopolysaccharide (LPS), a pro-inflammatory component of gram-negative bacterial membranes, induces inflammation and depressive-like behaviours in animal models [2,3]. While these findings provide strong experimental support for an inflammatory component in depression, clinical data on circulating LPS levels in individuals with MDD remain limited. This study aimed to investigate whether plasma concentrations of LPS, IL-6, and TNF-α differ between patients with MDD and healthy controls. Methods: This cross-sectional study included patients with MDD and a control group of subjects without psychiatric history. MDD diagnoses were based on ICD-10 diagnostic criteria and verified by experienced psychiatrists. Participants with unstable medical comorbidities or current anti-inflammatory treatment were excluded. Each study participant completed a sociodemographic questionnaire. Fasting venous blood samples were assayed for plasma LPS, IL-6 and TNF- α using commercial ELISA kits. Descriptive statistics were used to summarize sociodemographic and clinical characteristics. Continuous variables were presented as medians with interquartile ranges (IQR), assessed by the Shapiro-Wilk test. Between-group comparisons for continuous variables were conducted using the Mann-Whitney U test, as data did not meet the assumptions of normality. The Z-score and p-value were reported for each comparison. Results: A total of 143 participants were included in the analysis – 97 subjects with MDD and 46 controls. Demographic and clinical characteristics were comparable between MDD groups and controls with respect to age (Z= –0.801, p=0.423), female proportion (Z= –0.807, p=0.931), and body mass index (BMI) (Z= –0.713, p=0.476). Smoking prevalence was significantly higher in MDD group (Z= –3.513, p<0.001). Somatic comorbidities did not differ between two groups (Z= –0.701, p=0.483). Blood plasma LPS levels were significantly elevated in all the participants with MDD (median: 148.0 pg/ml, IQR: 81.1–245.3) compared to controls (median: 95.6 pg/ml, IQR: 57.5–132.3), with a statistical result of Z = –3.525 and p<0.001. In contrast, IL-6 levels did not differ significantly between the groups (Z = –0.145, p = 0.884), with median values of 1.31 pg/ml (IQR: 0.55–3.20) for the MDD group and 1.25 pg/mL (IQR: 0.59–3.13) for the controls. TNF-α levels were mostly undetectable in both groups; however, a slight but statistically significant difference was noted (Z = –1.98, p = 0.048). Most participants in both the MDD and control groups had undetectable TNF-α levels, which may be attributed to the limited sensitivity of the immunoassay used. Conclusion: Elevated plasma LPS, but not IL-6 and TNF-α differentiates MDD patients from healthy controls. These findings support LPS as a potential biomarker and therapeutic target in MDD.

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: Impaired Health related Quality of Life (HRQoL) is a common burden among individuals with mental health conditions, especially in those with anxiety and mood disorders (AMD). Obsessive–compulsive personality disorder (OCPD) is one of the most common personality disorders in the general population, is even more prevalent in individuals with AMD, and has also been linked to excessive mental fatigue in this group. Nevertheless, there have been very few studies exploring the impact of OCPD on HRQoL in patients with AMD. Our objective was to investigate the relationship between OCPD and HRQoL in individuals with AMD. Methods: A cross-sectional study included 235 persons (with a mean age of 41 and SD of 12 years) with AMD attending the Stress Disorders Unit at Hospital Palanga Clinic, Neuroscience Institute, Lithuanian University of Health Sciences. The SF-36 scale was used to assess eight aspects of HRQoL: physical functioning, rolephysical functioning, bodily pain, general health, vitality, social functioning, role-emotional functioning, and mental health. The Compulsive Personality Assessment Scale (CPAS) was used to assess features associated with OCPD. The nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalized Anxiety Disorder scale (GAD-7) were used to assess depression and anxiety symptoms in individuals with AMD. Two-tailed Student’s t-test or Fisher’s χ2 were used to compare socio-demographic, clinical, HRQoL, depression, and anxiety characteristics between individuals with and without OCPD. Subsequently, separate multivariable linear regression analyses were performed within each group (OCPD and non-OCPD) to examine the associations between OCPD traits and HRQoL, while controlling for potential confounders. Results: Subjective social functioning, mental health, vitality and general health perception were found to be worse in individuals with OCPD in comparison to group with no OCPD. In individuals with OCPD, the links between OCPD traits and HRQoL remained significant only in the domain of vitality (β = –0.236, p < 0.042), after controlling for age, gender, education, marital status, medication use and depressive and anxiety symptoms. OCPD trait severity was not associated with HRQoL domains in individuals without OCPD. Conclusions: In individuals with AMD, the presence of OCPD was related to poorer HRQoL, particularly in the vitality domain, after controlling for socio-demographic and clinical characteristics. This study sheds new light on the impact of OCPD on quality of life in individuals with AMD and aligns with our previous findings linking OCPD to mental fatigue. Limitations of the study include its cross-sectional design and use of brief measures to assess anxiety/ depressive symptom severity. Future research should now explore mechanisms underlying these associations, and evaluate whether the findings generalise to larger, more diverse samples.