International Neuropsychiatric Disease Journal

A Systematic Review of the Cultural Adaptation of Third-wave Psychotherapies for Youth in Saudi Arabia with Common Mental Health Problems

Yousef Aljohani — 2026-07-06

This systematic review examined the cultural adaptation and reported effectiveness of third-wave psychotherapies for youth in Saudi Arabia with common mental health problems. The review followed PRISMA guidance and included studies in which at least 75% of participants were aged 15-24 years and had diagnosed mental health disorders or clinically relevant subclinical symptoms. Searches of eight international, regional and Arabic-language databases were conducted from inception to 30 April 2025. After removal of duplicates and screening, six studies met the inclusion criteria. Cultural adaptation was assessed using Bernal et al.'s framework across dimensions including language, person, metaphors, content, concept, context, goals and methods. Methodological quality was assessed using the Standard Quality Assessment Criteria for quantitative studies, and findings were synthesised narratively. The included studies evaluated mindfulness-based interventions, mindfulness-based cognitive therapy and dialectical behaviour therapy. Reported outcomes suggested reductions in stress, anxiety, depression and social anxiety, although interpretation was limited by small sample sizes, incomplete reporting, variable study quality and high dropout rates in two studies. Cultural adaptation was limited, with most studies focusing on language or minor unstructured modifications. None reported using a structured cultural adaptation model. The findings indicate a need for more systematic, transparent and culturally grounded adaptation of third-wave psychotherapies for Saudi youth.

Landau-Kleffner Syndrome (LKS) Presenting with Acquired Aphasia and Absence Seizures: A Case Report

Shabbir I. Malapara — 2026-06-22

Landau-Kleffner syndrome is an uncommon epileptic encephalopathy of childhood characterised by acquired language regression, epileptiform electroencephalographic abnormalities, seizures and variable behavioural disturbance. This case report describes a 7-year-old boy with a one-year history of recurrent absence seizures occurring approximately once every two to four days, with blank staring, unresponsiveness and bilateral eye blinking. Despite initiation of valproate therapy, the child developed progressive auditory and verbal aphasia over 7-8 months, followed by reliance on gestures for communication during the preceding 3 months. Behavioural changes included aggression, hyperactivity, tantrums and irritability. Prior development was reported as normal, with no relevant antenatal, family, psychiatric or chronic medical history. General examination, vital signs, routine laboratory investigations, fundoscopy and magnetic resonance imaging of the brain were unremarkable. Detailed neurological examination was limited by hyperactivity. Electroencephalography showed frequent focal epileptiform discharges, supporting the clinical diagnosis of Landau-Kleffner syndrome in the context of acquired aphasia, seizures and behavioural changes. Treatment included escalation of valproate from 20 mg/kg/day to 60 mg/kg/day, addition of oral clobazam at 1 mg/kg/day and intravenous methylprednisolone pulse therapy at 30 mg/kg/day for 5 days. Following treatment optimisation, seizure frequency decreased, behavioural symptoms improved and repeat electroencephalography showed reduced focal epileptiform discharges. The child subsequently regained coherent speech and was transitioned to oral prednisolone at 2 mg/kg/day for 2 weeks, followed by tapering over 4-6 weeks. At follow-up, he remained seizure-free on valproate and clobazam without further behavioural changes. Early recognition and individualised multimodal treatment may improve clinical outcomes in suspected Landau-Kleffner syndrome.

Provisional Early-onset Bipolar Disorder with Phonological Reading Disorder and Attachment-related Difficulties in a Child Exposed to Severe Parental Conflict: A Case Report

Giovanna Azevedo Rodrigues — 2026-07-27

Background: Severe mood dysregulation in childhood requires careful differentiation among episodic bipolar-spectrum illness, chronic irritability, trauma-related responses, anxiety, neurodevelopmental conditions, sleep disturbance, and environmental stress. Diagnostic uncertainty increases when learning difficulties and disrupted caregiving relationships coexist.

Case Presentation: An 8-year-old boy was admitted for inpatient psychiatric care with marked emotional lability, episodic behavioural activation, explosive irritability, insomnia, aggression, withdrawal, freeze-like episodes, and intense anxiety associated with a family-contact context. A neuropsychological evaluation identified a selective pattern of phonological decoding and phonological working-memory difficulty despite preserved general intellectual and visuospatial functioning. The family environment was characterised by prolonged parental conflict, disputed allegations of maltreatment, acute maternal psychiatric decompensation, and marked dependence on the mother for emotional regulation. The clinical team formulated a provisional early-onset bipolar-spectrum disorder with mixed and dysphoric features, a developmental learning disorder with impairment in reading, anxiety and trauma-related symptoms, and attachment-related difficulties. Management included sodium valproate, low-dose risperidone, adjunctive propranolol with cardiovascular monitoring, daily psychotherapy, multisensory phonological rehabilitation, parental guidance, school accommodations, and coordination with child-protection and legal services. During short-term follow-up, reduced fear, hypervigilance, crying, and autonomic arousal were observed after a temporary modification of family-contact arrangements, while pharmacological, psychological, educational, and environmental interventions continued concurrently.

Conclusion: The case illustrates the difficulty of assigning a single diagnosis to severe childhood dysregulation occurring in the context of neurodevelopmental impairment and chronic family adversity. The temporal sequence of improvement is clinically informative but does not establish causality. A cautious, developmentally informed, multidisciplinary formulation and longer longitudinal observation are required.

Reconstruction after Burns: Where Surgery Meets Psychological Healing

Sara Karti — 2026-06-22

Burn injuries represent among the most devastating forms of physical trauma, leaving survivors to navigate complex trajectories of surgical reconstruction, functional rehabilitation, and profound psychological adaptation. This critical review examines the convergence of reconstructive surgical practice and psychological healing in burn care, synthesising evidence published between 2010 and present. The review draws on literature spanning plastic and reconstructive surgery, clinical psychology, psychiatry, rehabilitation medicine, and health-related quality of life research to interrogate how physical restoration and mental health interact, reinforce, and sometimes conflict with one another throughout the recovery continuum. Key surgical modalities—including skin grafting, flap reconstruction, tissue expansion, and laser therapies—are evaluated alongside their documented psychological correlates, with particular attention to post-traumatic stress disorder, depression, body image disturbance, and chronic pain. The review critically appraises multidisciplinary care frameworks, psychosocial screening tools validated in burn populations, and the emerging role of psychological interventions such as cognitive behavioural therapy, acceptance and commitment therapy, and virtual reality-based treatments. Disparities in access to integrated care across high-income and low- and middle-income country contexts are examined, as are special considerations pertaining to paediatric survivors and individuals with large total body surface area injuries. The evidence collectively supports the position that surgical and psychological components of burn recovery are not sequential but deeply interdependent, and that care models failing to account for this interdependence generate measurable deficits in long-term patient outcomes. The review concludes by identifying critical gaps in the literature and proposing directions for future integrated research.

The Impact of Virtual Reality Therapy on Depressive Symptoms: A Critical Review

Nonso Francis Ifezuoke — 2026-07-23

Depression remains one of the leading causes of disability worldwide, and existing pharmacological and psychotherapeutic treatments leave a substantial proportion of affected individuals without adequate symptom relief. Virtual reality (VR) has emerged over the past decade as a candidate adjunctive or stand-alone therapeutic modality, offering immersive, controllable environments in which established psychotherapeutic techniques can be delivered with heightened experiential intensity. This critical review synthesises evidence from meta-analyses, randomised controlled trials, and scoping reviews published between 2013 and early 2026 on the effectiveness, mechanisms, safety, and implementation of VR-based interventions for depressive symptoms. The literature indicates that VR interventions produce moderate-to-large reductions in depressive symptoms relative to control conditions across adult, adolescent, and older-adult populations, with particularly consistent effects for embodiment-based self-compassion protocols, VR-adapted behavioural activation, and restorative nature-based environments. Effect sizes vary considerably according to intervention type, dose, and population, and heterogeneity across trials remains high. Adverse effects, chiefly cybersickness, are under-reported in a substantial proportion of published trials, raising concerns about the completeness of the safety evidence base. Cost, hardware accessibility, and the shortage of long-term follow-up data represent the principal barriers to widespread clinical translation. The review concludes that VR therapy constitutes a promising but still maturing intervention class, whose clinical utility depends on more rigorous trial design, standardised outcome reporting, and closer integration with established evidence-based psychotherapeutic frameworks.

Advancing Equitable Mental Healthcare: A Comprehensive Review of Existing Literature on Person-Centered, Trauma-Informed, and Culturally Adaptive Counselling Practices

Onyii Henry — 2026-07-28

Mental healthcare systems worldwide continue to struggle with the translation of therapeutic ideals into equitable practice. Three intersecting paradigms have emerged as central to this endeavour: person-centred counselling, which prioritises the therapeutic relationship and client autonomy; trauma-informed care, which reorients services around an understanding of the pervasiveness and impact of adversity; and culturally adaptive practice, which seeks to align interventions with the values, languages, and worldviews of diverse populations. This review synthesises the empirical and theoretical literature on these three approaches, examining their conceptual foundations, evidence base, points of convergence, and the structural barriers that limit their equitable delivery. Particular attention is given to the therapeutic alliance and common factors that underpin person-centred work, the implementation science of trauma-informed organisational change, the frameworks and outcomes associated with culturally adapted interventions, and the persistent disparities in access linked to race, ethnicity, sexual orientation and gender identity, geography, and digital connectivity. The review also considers the integration of Indigenous and traditional healing systems into biomedical mental health services, the global shortage of a trained mental health workforce, and the promise and limits of task-sharing and telehealth as equity-promoting strategies. Findings indicate that while each paradigm carries a substantial evidence base, that evidence is not uniformly favourable, and integration into coherent, sustainable models of care remains uneven, particularly in low-resource settings and among historically marginalised populations. The review concludes by identifying priorities for future research, training, and policy reform aimed at embedding person-centred, trauma-informed, and culturally adaptive principles as the default standard of mental healthcare rather than as optional refinements.

Influence of Cyberbullying Involvement on Psychological Distress among in-School Adolescents in Nigeria

Elizabeth Nkechi Akpunne — 2026-06-04

Background: Even though adolescents in Nigeria are increasingly using technology and internet-based devices, there is still a severe lack of research on cyberbullying and its possible effects on Nigerian students.

Aim of the study: This study investigates the prevalence of cyberbullying involvement and its predictive influence on psychological distress (PD) among in-school adolescents in Ogun State. The Online Disinhibition Theory explains how the anonymous and minimally supervised nature of cyberspace reduces inhibition and encourages cyberbullying behaviors, while the General Strain Theory explains how experiences of cyberbullying victimization may lead to psychological distress and deviant coping behaviors such as cyberbullying perpetration.

Design of the Study: Using a cross-sectional research design, Participants were selected from two public and two private secondary schools located in Obafemi Owode Local Government Area, Ogun State, South-western Nigerian. A total of 355 participants (118 male and 237 female) whose ages ranged from 13 to 19 years (mean age 15.18±1.35) were sampled using a multi-stage procedure.

Tools of the Study: Participants responded to the Cyberbullying and Online Aggression Survey (CBOAS) and General Health Questionnaire 12 (GHQ-12). Descriptive and inferential statistics were used in data analysis.

Results: A high prevalence of cyberbullying involvement was found. The findings showed that 33.2%, 37.5%, and 13.0% of the participants reporting mild, moderate, and severe levels, respectively. 13.0% of severe psychological distress was also reported. A significant relationship between cyberbullying involvement and psychological distress (r = .13, p < 0.05) was also found. Cyberbullying victimization and perpetration independently and jointly predicted psychological distress (F = 3.56, p < 0.05, R² = .02). Finally, significant gender influence on psychological distress was found (t (353) = 9.07, p < .01).

Conclusion & Recommendations: Authors conclude that that there is a high prevalence of PD among Nigerian in-school adolescents. In addition, that cyberbullying involvement is strongly linked with PD. Based on the findings of this study, there is a need for the provision of psychological services and personnel in all secondary schools in Ogun State to reduce the prevalence of cyberbullying and its related negative consequences, as cyberbullying involvement was found to be prevalent among secondary school students in Ogun State. Further study on cyberbullying involvement and PD is also recommended.

Psychological Distress and Social Burden of Infertility: A Cross-sectional Study of Women in Zamfara State, Nigeria

Oigene Sunday Michael — 2026-07-13

Background: Infertility is a major reproductive and public-health concern that may be accompanied by psychological distress, social stigma, and marital strain, particularly in pronatalist settings where childbearing is strongly linked to family continuity and social identity. This study assessed the self-reported psychological and social burden of infertility among women attending the fertility clinic at Federal Medical Centre, Gusau, Zamfara State, Nigeria.

Methodology: A descriptive cross-sectional study was conducted among women attending the fertility clinic at Federal Medical Centre, Gusau. Participants were selected using a convenience sampling technique. Of the 92 women approached, 87 completed the questionnaire, giving a response rate of 94.6%. Data were collected using a structured questionnaire covering sociodemographic characteristics, infertility-related psychological experiences, social challenges, and marital concerns. Data were analysed using descriptive statistics, including frequencies and percentages.

Results: The findings showed a substantial self-reported psychosocial burden among the respondents. Psychological challenges were common, with 81.6% of participants reporting intense stress, 76.0% reporting anxiety about the future, 74.7% reporting feelings of incompleteness, and 69.0% reporting depressive feelings following failed treatment. Socially, 80.5% of respondents reported pressure from family members, 77.0% experienced community stigma, 73.6% reported being blamed for infertility, and 65.5% reported social exclusion. Marital concerns were also frequently reported, including marital misunderstandings among 70.1% of respondents and pressure or concern related to polygamy among 68.9%.

Conclusion: Infertility was associated with substantial self-reported psychological distress, social burden, and marital strain among women attending the fertility clinic at Federal Medical Centre, Gusau. Because the study used a descriptive cross-sectional design and convenience sampling, the findings should be interpreted as clinic-based self-reported patterns rather than causal evidence. The results highlight the need to integrate psychosocial counselling, couple-focused support, and stigma-reduction education into fertility-care services in the study setting.

Psychosocial Factors Associated with Depression among Secondary School Students in Ile- Ife, Nigeria

Godknows Chiamaka Osarhiaekhimen — 2026-07-16

Background of the Study: The relationship between psychosocial factors is fundamental to understanding the rising prevalence of depressive symptoms among secondary school students globally. In sub-Saharan Africa, where adolescents navigate socioeconomic instability and restrictive cultural norms surrounding gender and emotional expression, studies examining the combined effects of psychosocial factors on adverse mental-health outcomes remain limited.

Aim: This study assessed psychosocial factors associated with depression among secondary school students in Ile-Ife, Nigeria.

Method: This study utilised a cross-sectional research design and was conducted in Ile-Ife using a multistage sampling technique. A sample size of 401 was obtained using the Cochran formula. A list of schools was obtained from the Local Education Authority, and eight secondary schools were selected in Ile-Ife. Male and female students aged 14-19 years were selected from SS1 and SS2 using simple random sampling. Three research instruments were combined to produce the questionnaire for the study. Data were collected using a facilitated self-administered technique and analysed using univariate analysis (frequency tables and charts) and bivariate analysis (chi-square test), with p < 0.05 considered statistically significant.

Results: The study found that about one-quarter of respondents had depressive symptoms: 18.0% were moderately depressed, 5.7% had moderately severe depression, and 0.5% had severe depression. The study also found that 166 respondents (41.4%) had experienced high early life adversity, 43 respondents (10.7%) were gender nonconforming in childhood, and 73 respondents (18.2%) were sexual minorities. Early life adversity was significantly associated with depressive symptoms (p < 0.001).

Conclusion: Secondary school-aged adolescents are a vulnerable population with specific mental health needs related to childhood experiences and gender-identification issues.

Public health and social policies for the prevention of child abuse should be strengthened at the federal and state levels.

Moderation and Path Analysis: Exploring Trajectories of Burden of Care, Somatization and Depression among Informal Caregivers of Children with Congenital Heart Disease

Oluwatobiloba Ajibola Okeniyi — 2026-07-20

Aims: This study investigated the relationships among burden of care, somatization and depression among informal caregivers of children living with congenital heart disease at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.

Study Design: A cross-sectional survey design was used.

Place and Duration of Study: The study was conducted at a university teaching hospital in Nigeria between April and June 2024.

Methodology: Using census sampling, 60 informal caregivers of children with congenital heart disease were recruited. Data were collected using the Zarit Burden Interview, the Patient Health Questionnaire Physical Symptom Scale (PHQ-15), and the Redeemer's University Depression Scale (RUDS). Hierarchical regression and mediation analyses were performed.

Results: The findings showed low-to-moderate levels of burden of care (71.7%), somatization (61.6%) and depression (38.4%). Burden of care significantly predicted depression (β = .54, P < .01), accounting for 29% of the variance. Somatization also significantly predicted depression (β = .50, P < .01), explaining 25% of the variance. However, burden of care did not moderate the association between somatization and depression. A significant interaction effect between age and income was found in predicting depression, with younger adults (20–40 years) in higher income brackets reporting higher depression levels. Gender and income did not independently predict depression.

Conclusion: The findings indicate relationships among caregiving burden, physical symptom reporting and mental health outcomes. Recommendations include establishing caregiver support programmes, implementing routine mental health screening and developing culturally sensitive interventions.

Effect of Psychoeducation on Mental illness Symptoms Recognition and Psychosocial Support among Relatives of Patients Admitted in Selected Psychiatric Hospitals in Southwest of Nigeria

O. I. Adeyemi — 2026-07-25

Background: Relatives of patients with mental illness play an important role in recognising symptoms, supporting treatment, and providing psychosocial care. This study assessed the effect of psychoeducation on recognition of mental illness symptoms, psychosocial support, and knowledge of treatment among relatives of patients admitted to selected psychiatric hospitals in Southwest Nigeria.

Methods: A quasi-experimental design was used at the Federal Neuropsychiatric Hospital, Yaba, Lagos State, and the Federal Neuropsychiatric Hospital, Aro, Ogun State. The calculated sample size was 171, comprising 109 participants in the experimental group and 62 in the control group; the reported analyses included 96 and 60 participants, respectively. Data were collected using a structured questionnaire with reliability coefficients of 0.82, 0.79, and 0.81 for symptom recognition, psychosocial support, and treatment knowledge. Data were analysed using SPSS version 23.

Results: Post-intervention symptom-recognition scores were higher in the experimental group (4.50 ± 0.50) than in the control group (3.60 ± 0.49; t = 9.87, df = 154, p < 0.001). The change in psychosocial support strategies was small and not statistically significant (pre-intervention: 4.60 ± 0.62; post-intervention: 4.74 ± 0.60; t = 1.648, p = 0.103). Post-intervention treatment-knowledge scores were also higher in the experimental group (4.90 ± 0.27) than in the control group (3.40 ± 0.80; t = 13.76, df = 154, p < 0.001).

Conclusion: Psychoeducation improved symptom recognition and treatment knowledge, but measurable changes in psychosocial support were limited.