Editorial 1

It is my great pleasure to welcome you to the first issue of 2021. In the first highlighted article of this issue, Hans-J€ urgen M€ oller reviews the ongoing discussion on termination of life on request from a German/European perspective. Drawing from his extensive clinical and scientific experience, he outlines the ethical considerations and other problematic aspects surrounding euthanasia. Using well-documented experiences with euthanasia law in the Netherlands, he draws attention to the possible unwanted consequences of legalising euthanasia. Finally, HansJ€ urgen M€ oller emphasises the need for further ethical, psychological and legal research, notably on palliative medicine in endof-life care. In our second highlight, Zanardi et al. discuss the present and future of precision psychiatry in clinical practise. Focussing on depression, they survey current tools available to clinicians to tailor prescriptions to individual patients and point out obstacles to the broad implementation of precision psychiatry. Our thematic focus on child and adolescent psychiatry in this issue comprises five articles: Mazza et al. compared three intensive interventions for adolescents with autism spectrum disorder. All studied rehabilitation treatments decreased disease severity in this population. This study provides much-needed evidence for the effectiveness of available rehabilitation treatments for the special population of adolescents. € O g€ utl€ u et al. found that mitochondrial DNA copy number may be associated with attention-deficit/hyperactivity disorder (ADHD) severity in treatment. Between their first study and this follow-up one year on, patients’ mitochondrial DNA copy numbers did not change, irrespective of treatment. However, in the treatment group, decreased ADHD severity was associated with reduced mitochondrial DNA copy numbers. € Onder et al. retrospectively analysed the neutrophil-tolymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in children and adolescents with ADHD. Both ratios were significantly higher in children with ADHD compared to healthy children. The authors suggest the use of NLR and PLR as inflammation biomarkers in children and adolescents with ADHD. Avşar et al. measured serum zonulin and claudin-5 levels in children and adolescents with ADHD. Claudin-5, linked to bloodbrain-barrier permeability, but not zonulin, a marker of gut permeability, concentrations were higher in the serum of treatment-naive children with ADHD than in healthy controls. Future studies with larger, more heterogeneous populations should investigate the role of claudin-5 in the aetiology of ADHD. Kuscu at al. explored the relationship between the fear of being without a mobile device, nomophobia, and psychiatric symptoms in adolescents. Teens with internalising or externalising disorders and healthy controls had similar levels of nomophobia. Across all three groups, total anxiety and hyperactivity predicted nomophobia scores. As part of the thematic focus on bipolar disorder in this issue, Ç€ orekçio glu et al. probed the relationship between impulsivity, comorbid anxiety and neurocognitive functions in bipolar disorder. A comorbid anxiety disorder increased impulsivity in bipolar disorder and might have been related to more severe clinical courses. They recommend additional care be taken in the evaluation and treatment of patients with bipolar disorder if signs of anxiety spectrum comorbidity are present. Aguglia et al. assessed the impact of seasonal pattern on patients experiencing a current major depressive episode. Of the 300 patients studied, affected by either unipolar depression or bipolar disorder, 66% had a seasonal pattern in their symptoms. In both the bipolar disorder and the unipolar depression group, patients with a seasonal pattern scored higher on a scale of mania than patients without a seasonal pattern. The authors conclude that given its high prevalence, seasonality should be considered when treating all patients with a current major depressive episode. Buoli et al. investigated the factors influencing lithium versus valproate prescription preference in maintenance treatment of patients with bipolar disorder. Among Italian early career psychiatrists (ECPs) questioned, two-thirds preferred lithium over valproate for maintenance treatment. Concern about the long-term side effects of lithium was a main factor for valproate preference. Lithium preference was associated with satisfaction with education and knowledge on lithium. However, merely half of ECPs declared at least an adequate knowledge of lithium. Khosravani et al. studied the effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms and suicidal ideation in females with bipolar disorder. Childhood emotional abuse and difficulty in identifying feelings were both indirectly associated with depressive and manic symptoms and suicidal ideation. Upon further analysis, emotion dysregulation mediated the effect of childhood emotional maltreatment on clinical factors. Philip et al. assessed electrocardiogram (ECG) abnormalities in the acute psychiatric setting. They found that among patients aged 19–72 (median 35) who received an ECG during or 90 days prior to admission for a severe mental illness, 21% had a clinically relevant ECG abnormality. Nonetheless, no ECG had been performed in 42% of patients in the 90 days prior to or during admission. In patients requiring acute psychiatric care, routine ECGs should thus be performed as part of a comprehensive preventive strategy. Our next issue will be dedicated to the COVID-19 pandemic. Articles will particularly explore the psychological ramifications in patients with COVID-19, effects of the pandemic on psychiatric care and the mental health of healthcare care workers.