Translation: The University of Toledo Journal of Medical Sciences

Cover Art

Sampriti Senapati — 2026-02-17

Translation Perspectives in Psychiatry:

Laya Gokula — 2026-02-17

Bridging Brain and Behavior:

Annie Y. Lei — 2026-02-17

Ventriculoperitoneal Shunt-Associated Neuropsychiatric Symptoms: A Literature Review and Two Case Reports

Olivia R. Thomas — 2026-02-17

Ventriculoperitoneal (VP) shunts are a common use for the treatment of hydrocephalus, which is a condition causing excessive cerebrospinal fluid (CSF) buildup in the brain. The shunt drains the CSF from the brain and into the abdomen, where it can be absorbed by the body. Although a widely used and successful procedure, it is unclear whether neurosurgical placement of this shunt may directly cause psychiatric abnormalities, especially regarding the dopaminergic system.

In this paper, we first review relevant literature and discuss the dopamine circuitry in the brain. The literature suggests a shunt-associated clinical syndrome, which may include a reduction in facial and/or verbal expressivity, reduced willful movement, rigidity, and vertical gaze palsy. Typical presentation occurs within three months of a shunt revision. In patients with a VP shunt, these signs may be a strong indicator of mechanical or functional shunt malfunction.

We then present two cases of hydrocephalus managed with a VP shunt, where both patients developed symptoms suggestive of psychosis and/or dopamine pathway pathology after shunt placement. We conclude that clinicians should have a suspicion for shunt-associated symptomology in patients with a history of recently treated hydrocephalus who present with psychomotor, personality, or cognitive changes.

MDMA-Assisted Therapy for PTSD: Neuroplastic Change or Psychotherapeutic Catalyst?

Aidan Butler — 2026-02-17

MDMA-assisted psychotherapy has emerged as a promising treatment for post-traumatic stress disorder (PTSD), particularly in individuals unresponsive to conventional interventions such as SSRIs and trauma-focused cognitive behavioral therapy. As recent clinical trials report durable symptom remission, ongoing debate surrounds the mechanisms underlying its therapeutic effects. This review explores two major frameworks: a neurobiological model proposing that MDMA supports trauma reprocessing through fear extinction, memory reconsolidation, and neuroplasticity, and a relational model highlighting MDMA’s prosocial and empathogenic properties that enhance therapeutic alliance and suggestibility. Evidence from both human and rodent studies indicates that MDMA reduces amygdala reactivity, increases hippocampal connectivity, and modulates serotonergic and oxytocinergic signaling. Concurrently, clinical findings suggest that the quality of the therapeutic relationship plays a critical role in treatment outcomes. Rather than viewing these processes as mutually exclusive, we propose a synergistic model in which MDMA creates a “window of emotional safety” that allows for both neurobiological and interpersonal mechanisms to support healing. Understanding this dual-action model is essential for refining treatment protocols, improving therapist training, and guiding future research in psychedelic-assisted psychotherapy.

Transcranial Magnetic Stimulation for Nicotine Dependence: A Brief Review with Focus on Emerging Non-Tobacco Products

Jacob Lyons — 2026-02-17

Transcranial Magnetic Stimulation (TMS) is a noninvasive treatment that has shown promise in reducing nicotine cravings and the risk of relapse. While TMS has been effective for treating tobacco use disorder, its application to newer modes of nicotine delivery, such as vaping and nicotine pouches, is understudied. This article highlights the need for updated TMS protocols that are responsive to current trends in nicotine use, especially in younger populations. Expanded research including a wide range of nicotine products will increase the generalizability and clinical relevance of TMS for the treatment of nicotine dependence.

Engaging Minds: A Brain Cutting Experience for Undergraduate and Pre-Medical Students

Leo Roberts — 2026-02-17

Brain anatomy is notoriously difficult to teach and visualize to first-time learners. To make neuroanatomy more digestible, our group designed an educational brain-cutting experience that used gross dissection of a cadaver brain alongside digital dissection through the Anatomage Table technology to elucidate more difficult structures in three dimensions. A slide presentation was also prepared to help guide the learners through the dissection and to teach structure, function, and pathology. Two sessions with undergraduate learners were performed, with the first having four learners and the second having eight. Pacing and improper cutting technique were the main obstacles encountered in the first session; however, this was remedied by proper communication, teaching, and changing the format of the visual presentation. We feel that Anatomage helped the learners better visualize each structure in three dimensions, which aided in understanding the content. Early exposure to anatomy and pathology can inspire students to pursue careers in medicine, so we hope that this experience inspires others to develop their own neuroanatomy program.

Mind over Microbes

Fatimah Aftab — 2026-02-17

An Essay on Parkinson’s Disease and the Gut-Brain Connection

Leena A. Ahmed — 2026-02-17

Barriers and Opportunities:

Annie Y. Lei — 2026-02-17

Impact of Wait Times on Psychiatric Outcomes: A Mini-Review

Tarak Davuluri — 2026-02-17

Prolonged wait times in psychiatric care (in the emergency department, outpatient setting, or between diagnosis and treatment initiation) have been associated with worsening clinical outcomes. This mini-review explores how wait times in psychiatric care contribute to worsening symptoms and emphasizes the need for earlier intervention. Psychiatric patients admitted through the emergency department stayed in the emergency department 3.2 times longer compared to nonpsychiatric admission. Following in-patient psychiatric care, patients are typically referred to outpatient visits. From 2011 to 2022 an increase in the median waiting time for outpatient psychiatic visits from 15 to 50 days was reported. After outpatient visits, patients still experience delays in their treatment initiation. Longer intervals between diagnosis and treatment initiation have been associated with worsening clinical outcomes. All these delays in psychiatric care highlight critical periods where early intervention can improve symptom progression and clinical outcomes.

Access to Psychiatric Medications in Unhoused Populations: Implications for Hospitalization and Readmission Rates

Peyton Roth — 2026-02-17

Persons experiencing homelessness (PEH) face disproportionately high rates of psychiatric illness and hospitalization, with mental illness prevalence reported as high as 76.2%—significantly higher than in the general population. Psychiatric treatment for PEH is often hindered by systemic barriers to care, including medication nonadherence stemming from fragmented healthcare delivery, stigma, transportation challenges, and unstable housing. This discontinuity contributes to elevated readmission rates, with studies showing 30-day psychiatric readmission rates up to 2.04 times higher for unhoused individuals. Medication access is further complicated by inappropriate prescribing patterns and difficulty in maintaining treatment regimens for chronic mental illnesses such as schizophrenia and bipolar disorder. Multifactorial barriers—spanning patient-level, treatment-related, and structural factors—worsen adherence. Evidence-based interventions such as Assertive Community Treatment, Customized Adherence Enhancement with long-acting injectables, and Housing First models have shown success in improving treatment continuity and reducing psychiatric symptomatology. Emerging solutions like street medicine and mobile outreach deliver low-barrier care directly to shelters and encampments. Addressing psychiatric medication adherence among PEH is not only a clinical priority but a public health imperative, requiring integrated, compassionate, and housing-informed care models.

Psychotropics and Psychotherapy:

Annie Y. Lei — 2026-02-17

The Potential Utility of Supportive Psychotherapy for Medically Admitted Patients

Conor Segur — 2026-02-17

The use of psychotherapy in inpatient settings is underexplored but shows promising benefits. This review summarizes the literature on its application in both inpatient psychiatric and medical units, with a focus on supportive psychotherapy as a potential modality for providing medically hospitalized patients with psychotherapeutic care. To further explore this, we piloted an acting internship in which fourth-year medical students provided supportive psychotherapy to medically admitted patients of the psychiatry consult-liaison service. The model proved feasible and anecdotally beneficial for patients. It underscores the need for further investigation into the role of psychotherapy, and particularly supportive psychotherapy, in the care of medically admitted patients.

The Utility of Metformin in the Management of Metabolic Syndrome Induced by Atypical Antipsychotics

Sweta Desai — 2026-02-17

Toward a Treatment Algorithm for Misophonia:

Grant Nelson — 2026-02-17

The P's of Women's Mental Health:

Radha Shah — 2026-02-17

Role of Stress and Inflammation in the Etiology, Treatment, and Management of Premenstrual Dysphoric Disorder (PMDD)

Nithara Murthy — 2026-02-17

According to the DSM-5, Premenstrual Dysphoric Disorder (PMDD) is defined as a mood disorder characterized by physical, emotional, and behavioral symptoms that occur during the luteal phase and cause significant distress or impairment. While epidemiological studies highlight that PMDD occurs in 1.8-5.8% of menstruating individuals, this is a vast underestimation prevalence due in part to cultural and systematic factors that impact diagnosis. That said, it is imperative to conduct research on this debilitating condition and its impact on overall wellbeing. The objective of this review is to explore the role stress and inflammation plays on etiology, treatment, and management of PMDD. To ensure a thorough review, the inclusion criteria focused on studies published in peer reviewed journals on etiology (stress and inflammation in relation to PMDD) and the treatment and management of PMDD. Studies conducted on topics pertaining to genetics and serotonin dysregulation were not included. Additionally, research conducted prior to 2005 were also excluded from the review process. Overall, existing literature demonstrates that stress and inflammation has been found in individuals with PMDD. However, more research must be done on the potential therapeutic value of Yaz, other COCs, and anti-inflammatory agents in treatment of PMDD.

Pre-eclampsia and the Risk of Development of Psychiatric Disorders

Sabrina Khuder — 2026-02-17

Pre-eclampsia (PE) is a severe disease of pregnancy occurring most often around 20 weeks gestation and marked by symptoms of new-onset hypertension, proteinuria, and end organ damage. Given its high prevalence and serious risk in causing complications, it is important to understand the etiology and potential outcomes of PE. Emerging research suggests that PE during pregnancy may be associated with an increased risk of severe psychiatric disorders in the mother. In this study, we aim to review the current literature examining whether women with PE are more likely to develop subsequent psychiatric disorders including psychosis, mania, and PTSD.

New Onset Psychosis throughout Pregnancy and Postpartum: Risk Factors and Maintenance Therapy

Sara Razoky — 2026-02-17

Early Intervention:

Puvi Venkataratnam — 2026-02-17

Pediatric Mental Health Crisis: Current Guidelines and Adjustments

Sarah Roehrs — 2026-02-17

Pediatric anxiety, depression, and suicide rates are on the rise across the U.S. and Ohio. This mental health crisis has placed significant burden on both the emergency department and primary care providers. The emergency department does not have the resources for the long-term care of pediatric patients struggling with mental health. Furthermore, primary care providers do not feel their training has equipped them to manage the psychiatric conditions plaguing today’s youth. To help address this crisis and decreased the number of patients resorting to emergency care, primary care and pediatric residency programs can implement seminars, simulations, and trauma-informed care trainings. Additionally, robust screening protocols, discussions about pediatric mental health in office, and increasing connections between physicians and mental health services will ensure patients are appropriately screened, diagnosed, and treated for psychiatric conditions.

AI and Existential Dread

Andrew Edgington — 2026-02-17

Feasting on Flesh: A Case Report and Literature Review of Cannibalistic Ideation in Children & Adolescents

Sarah Porter — 2026-02-17

Human cannibalism is an extremely rare and violent act that is poorly understood in the modern era, and pediatric cannibalism is even less understood. This is due to methodological hurdles when investigating the topic, including a lack of data from the sheer rarity of the act as well as bias in case analysis. Here, we will detail a case of an adolescent with cannibalistic ideation. This 14-year-old male presented to the ED due to ego-syntonic thoughts of cannibalism and was promptly admitted for an inpatient psychiatric stay for four days. Through this case report, we aim to improve medical providers’ understanding of pediatric cannibalism and cannibalistic ideation and provide psychodynamic context.

A Mini Review: The Impact of Family-Centered Interventions and Peer Support in Improving Mental Health Outcomes for Suicidal Youth

Angela Rooks — 2026-02-17

Mental Health in Medical Trainees: What the Data Tells Us

Sarah Toil — 2026-02-17

Closing Editorial

Dr. Emily Cooper — 2026-02-17