Review Article | DOI: https://doi.org/10.31579/2693-4779/304

Pseudo-Neurological Disorders

  • E.I. Bon *
  • Maksimovich N.Ye
  • N.V. Kokhan
  • Sitsko A.D

Grodno State Medical University, Grodno.

*Corresponding Author: E.I. Bon, Grodno State Medical University, Grodno.

Citation: E.I. Bon, Maksimovich N.Ye., N.V. Kokhan, Sitsko A.D, (2025), Pseudo-Neurological Disorders, Clinical Research and Clinical Trials, 13(5); DOI:10.31579/2693-4779/304

Copyright: © 2025, E.I. Bon. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 10 October 2025 | Accepted: 06 November 2025 | Published: 18 November 2025

Keywords: pseudoneurological disorders; depression; anxiety; somatization

Abstract

Pseudoneurological disorders are conditions in which psychological or depressive experiences manifest as physical, seemingly neurological, symptoms. Patients complain of pain, dizziness, or other bodily ailments, while objective examinations reveal no organic abnormalities. These symptoms are often mistakenly considered exaggerated or imaginary, leading patients to miss out on the help they need. These symptoms often stem from underlying forms of anxiety and depression, disguised as somatic complaints. Understanding the psychogenic nature of such conditions allows for appropriate treatment and restoration of the patient's emotional and physical well-being. 

Introduction

A special group of depressive equivalents, often concealed behind the mask of neurological symptoms, is often not adequately reflected in the theory and practice of neuropathology. "Functional" complaints, uncorroborated by objective examination, are usually regarded as evidence of "simple suspiciousness" that does not require therapeutic intervention, or of certain self-serving attitudes on the part of the patient, which, in one way or another, relieves the attending physician of any responsibility for the patient's well-being. Even obvious affective disorders, in the absence of signs of organic damage to the central nervous system, are sometimes interpreted less from a psychopathological perspective than from a purely mundane one, which prolongs the inpatient treatment of patients who do not receive adequate pathogenetic therapy with psychotropic medications. The undeniable role of negative emotions in the occurrence of all sorts of spontaneous painful sensations in various parts of the body is sometimes not adequately reflected in the clinical thinking of modern specialists; While undisputed during the heyday of classical clinical medicine, this position does not fit into the Procrustean bed of organ pathology. The true nature of these pathological sensations (often the only clinical manifestation of latent anxiety and depression) is often either not recognized at all or is established retrospectively during successful treatment with antidepressants [1].

Increased intensity of painful sensations, reaching the level of "algic melancholia" (as opposed to a decrease or complete blocking of pain sensitivity, leading to the development of "anesthetic melancholia" in severe forms of depression) is observed primarily in depressions in borderline clinical states, hypochondriacal states with elements of vital depression, relatively mild but prolonged depressions of old age, and so-called endoreactive dysthymia. The clinical expression of anxiety and depression ultimately turns out to be all sorts of algias and paresthesias (more precisely, dysesthesias) against a background of general malaise and "inner restlessness." Various painful sensations in the trunk and limbs, back and chest, spine and lumbosacral region, headaches and dizziness, sciatica and toothache (to which the patient cannot "get used" even after prolonged presence) can thus act as "masks" of depression, requiring therapeutic intervention even in the absence of conscious anxiety and melancholy, not only in adults but also in older children. Unpleasant, oppressive painful sensations in the clinical picture of vegetative and hypochondriacal depression arise in this case, among the general series of vital experiences, as a feeling of suffering in its most primitive [removed]in the form of physical pain), as a "specific bodily echo of the patient's affective life" – that is, not just a sensation, but simultaneously a unique affective state with a specific localization of affect. At first glance, it is almost impossible to clearly distinguish it from true pain phenomena of peripheral origin, although the patients themselves often define “stomach colic” or tightness in the chest as mental, rather than physical, suffering [1,2,3].

Even in the presence of peripheral lesions or known anatomical abnormalities of local innervation, the leading role of affective disorders in the development of symptoms cannot be ruled out. For example, women with emotional disorders associated with postpartum asthenia often develop cutaneous hyperalgesia, in which pain sensations are so severe that they refuse to hold their child. These sensations are combined with pronounced hyperesthesia – increased skin sensitivity, accompanied by painful sensations reminiscent of acute myalgia or neuralgia [4,5].

Cutaneous hyperesthesia is accompanied by disintegration of sensory functions, which is confirmed by the detection of reactive algic syndrome in such patients – increased sensitivity to palpation of sensitive areas and altered pain response to needles. A disruption of the pain aftereffect and the appearance of "island" sensory disturbances are also noted [6,7,8].

Hyperesthesia in the occipital region of the head is often observed, accompanied by complaints of severe headache. Any touch to the scalp causes discomfort; even a light breeze, raindrops, or combing the hair can cause acute pain. Water treatments, especially showers, irritate the skin of the back, leading to myalgia and neuralgia along the spine [9].

At the same time, decreased tactile and pain sensitivity of the skin and mucous membranes is possible, leading to the development of zones of anesthesia and hemianesthesia. Sometimes, anesthesia of the mucous membrane of the eyes occurs – irritation does not cause lacrimation or blinking, and the pupillary response to painful stimuli is impaired. Similarly, anesthesia of the upper respiratory tract is manifested by the absence of a cough when inhaling irritants. A similar decrease in sensitivity is observed in the genital area, which is associated with frigidity in some women with hysterohypochondriac disorders [10].

Most often, we are talking about labile, "moving" anesthesia, the intensity and location of which rapidly change under the influence of emotional factors, which is not always recorded by doctors.

Sharp cutaneous hypoesthesia with decreased pain, tactile, and sometimes temperature sensitivity (sometimes combined with anesthesia of the mucous membranes) explains patient complaints of "numbness," paleness, and coldness of the extremities, numbness, and a feeling of "deadness" in certain areas of the body. In some cases, this decreased sensitivity is so pronounced that patients do not even notice burns, such as from hot water bottles or hot water bottles applied to their "icy" feet [8].

Of particular interest are localized hyperesthesias, which are often accompanied by complete or partial anesthesia in other areas of the body. The patient's psychological attitude and mental state have a significant, sometimes decisive, influence on the perception of pain stimuli, leading to extreme lability of pain sensitivity. Thus, the "terrible pain" that just caused the patient to scream can suddenly disappear for no apparent reason, as if by magic [4,5].

The connection between cutaneous sensitivity disturbances and generalized mental hypoesthesia explains cases of self-injury and self-harm. Particularly indicative is the pronounced hypoesthesia (even to the point of complete anesthesia) observed in patients with chronic alcoholism and depressive-hypochondriac disorders, which is observed precisely during moments of self-injury, whereas outside of these states, they exhibit hyperesthesia [6].

One of the most distressing manifestations of mental hyperesthesia in affective disorders is the so-called "legitimate" patient complaints of pain. For example, one of our patients was repeatedly hospitalized in somatic wards complaining of "unbearable" pain in the area of ​​a shrapnel wound. Although X-rays confirmed the shrapnel had been lodged under the left shoulder blade since 1941, this does not explain the periodicity of the pain, which occurs exclusively during the depressive phase of the cyclothymic cycle and disappears upon transition to the hypomanic phase or with treatment with antidepressants [3].

Overt or latent depression with pronounced mental hyperesthesia actually acts as an activator of existing organic or functional disorders of organs and systems, manifesting them clinically.

The organic "base," identified primarily in depression, is reflected, for example, in frequent complaints of lumbar pain when bending over, as well as cramps and painful muscle contractions with sudden or unusual movements. Patients often emphasize a clear connection between pain and specific movements, but these manifestations are typically associated with pronounced affective fluctuations, which can be identified with a thorough and qualified interview [9].

An example of overestimating the "organic" and underestimating the "functional" condition is cervical osteochondrosis, which is often attributed to any pain in the shoulder girdle or cervicoccipital region. Determining the true relationship between organic and functional disorders in a patient is a complex but extremely important task for the treating physician, as the effectiveness of therapy depends on it [5, 6, 7].

Mental Hyperesthesia

Hypersensitivity to certain sounds, light stimuli, or touch has long been known clinically in both nervous and internal and skin diseases. It is precisely this excessive mental and physical sensitivity, in its many manifestations, that makes an emotionally unstable patient feel like a "pathetic person with flayed skin" [6].

Mental hyperesthesia can turn even a simple touch into a source of pain and make any, even the most insignificant, painful sensation "hellish." It underlies numerous somatic complaints in "problem" patients, for whom "everything hurts" [7].

The intensity and disproportionate nature of pain in response to minimal stimuli, as well as the persistence of these sensations in the clinical picture, make such patients typical representatives of the group of "pain hyperpaths." They suffer from everything: a ray of sunlight shining through the curtains hurts the eyes; the smells of a spring morning cause a "scratchy throat"; A gentle knock on the door causes a shudder throughout the body and causes "unbearable" torment – ​​"as if someone were hitting my head with a hammer"; a loud word rings in the ears and triggers a sharp headache; a quiet invitation to dinner is perceived as a "rending crack"; even one's own voice sometimes seems "as disgusting as the scraping of iron on glass" [7,8].

One of the common manifestations of general hyperesthesia is diffuse or localized cutaneous hyperesthesia. Even the lightest touch of clothing can cause severe torment for patients, and often the only comfortable clothing is a loose, soft nightgown. In women with emotional disorders after childbirth, cutaneous hyperalgesia can be so pronounced that they even refuse to hold their children. Cutaneous hyperesthesia is often accompanied by painful sensations reminiscent of myalgia or neuralgia [1,2,10].

Such patients may experience reactive algic syndrome: increased sensitivity to palpation of specific areas of the skin and altered pain sensitivity, even to the point of developing "islands" of sensory impairment. Scalp hyperesthesia is often observed, with complaints of a "terrible headache." Even light touch, raindrops, or combing the hair cause severe irritation. Water treatments, especially showers, can cause significant discomfort. Back skin hyperesthesia is often accompanied by myalgia and neuralgia, and even a slight breeze or touching the back of a chair can cause pain [10].

Along with increased sensitivity, a significant decrease in tactile, especially pain, sensitivity of the skin and mucous membranes is sometimes observed, leading to the development of zones of anesthesia or even hemigemia (loss of sensation on one side of the body). For example, anesthesia of the mucous membrane of the eye may occur, in which even the introduction of a foreign body does not trigger the usual lacrimation and blinking reflexes, and pupillary responses to painful stimuli are impaired. Similarly, anesthesia may affect the mucous membranes of the upper respiratory tract – coughing is absent when inhaling irritants. Anesthesia of the mucous membranes of the genitals also occurs, which is likely associated with manifestations of frigidity in some patients with hysterohypochondriac disorders [5-10].

Most often, such anesthesia is very labile and "flexible": its intensity and location quickly change under the influence of emotional and affective factors, which is not always noticed by the treating physicians. Severe cutaneous hypoesthesia with decreased pain, tactile, and sometimes temperature sensitivity (sometimes combined with mucous membrane anesthesia) underlies patient complaints of "numbness," pallor, and coldness of the extremities (most often on the dorsal surfaces of the hands and feet), a sensation of numbness, paralysis, and even numbness in various parts of the body. In some cases, hypoesthesia is so pronounced that only after emerging from an acute affective state associated with the fear of death from cardiac arrest or cerebral hemorrhage do patients discover and "feel," to their surprise, burns from bottles and hot water bottles, which they applied to their "icy" feet [5].

Of particular interest are localized hyperesthesias, sometimes accompanied by complete or relative anesthesia of other areas. The significant, often decisive, influence of the psychological attitude and mental state of these patients on the perception of pain stimuli results in extreme lability of pain sensitivity: the "terrible pain" from which the patient was just "screaming" may suddenly disappear without any apparent reason, as if by magic. Disturbances of cutaneous sensitivity and general mental hypoesthesia are to a certain extent associated with cases of self-injury and self-mutilation. Particularly indicative in this regard is the distinct hypoesthesia (before complete anesthesia) in chronic alcoholism with depressive-hypochondriac disorders, detected in patients at moments of self-harm, whereas outside of these states, obvious hyperesthesia is observed [2].

One of the most distressing manifestations of mental hyperesthesia in affective disorders, particularly in the clinical setting of neurotic and cyclothymic conditions, is pronounced auditory hyperesthesia, usually accompanied by persistent sleep disturbances. Intolerance to loud sounds ("as if I were feeling the sound not with my ears, but with my head, with my bare brain") makes everyday life extremely difficult for such patients and leads to inevitable conflicts with others. The extreme affective tension of these patients turns their lives into "continuous torment," and their nights into true torture: extraneous noises and rustlings prevent them from sleeping, the buzzing of a fly drives them to despair or even frenzy, and someone's quiet snoring evokes anger and rage, with a desire to "take everything by storm" and "shake the soul out" of their neighbors in the ward [3,5,9,10]. 

These patients often focus on tinnitus or head noise, which highlights the labyrinthine component characteristic of senesthetic headaches. Typically unnoticeable during the day, this noise (or monotonous buzzing in the ears) intensifies sharply in the evening, as soon as the patient lays their head on the pillow (the head then hums like a beehive, like telegraph wires, or a constant buzzer sounds like a samovar, or a steam locomotive puffs, like a string ringing, or even like something rumbling). At night, all these phenomena become even more intense, and hearing acquires an "abnormal sensitivity," which in some cases leads to persistent insomnia [5.6.7].

Complaints of tinnitus are primarily based on a particular focus of attention (anyone can hear the beating of their arteries if they want to). Iatrogenic factors, usually related to some examination or medical intervention that has become the subject of the patient's hypochondriacal fixation, can also play a role.

It should also be noted that the active demand for surgery, coupled with a willingness to resort to aggression and "revenge" for "incorrect" treatment, makes some of these patients among the most difficult patients for otolaryngologists.

Severe auditory hyperesthesia is a common manifestation of asthenia with a clinical picture of irritable weakness. A striking confirmation of the affective genesis of this hyperesthesia is the so-called "wind-up spring" symptom, when any unexpected noise or sound (and not so much the sound itself as its suddenness) causes a person to flinch or almost jump, causing a more or less prolonged tachycardia ("the heart pounds with fright"). This symptom always indicates an extreme degree of affective tension in a person focused on difficult thoughts, "withdrawn" [9,10].

In clinical settings of depressive states, complaints of "hearing loss" may also arise, when all sounds seem quiet and muffled, as if coming from afar, as when falling asleep – a kind of "deafness of attention" in a patient immersed in depressing thoughts or focused on their own condition. This may be deafness due to distraction, lack of attention (when the patient is lost in thought and the speech of others "doesn't reach" them), or deafness caused by an "excess" of attention due to a hypochondriacal fixation on one's hearing or iatrogenic influence (when the patient listens so intently to every word that they miss the next). Psychogenic hearing disorders not associated with organic changes, aggravation, or simulation (sudden deafness or hearing loss that occurs during a stressful situation and persists for a long time against the background of an affective state) are found in both adults and children [4].

Complaints of deteriorating vision are no less typical of affective disorders: decreased visual acuity, increased eye fatigue when reading, a sensation of a veil or fog before the eyes. These disorders, unrelated to organic changes and true visual asthenia, often become the object of hypochondriacal fixation in patients, requiring repeated examinations and consultations with ophthalmologists. The sensation of internal dizziness is often accompanied by complaints of more or less constant or intermittent blurriness, blurred vision, fuzziness, pallor, and dullness of the usual relief of surrounding objects. Less common is pronounced visual hyperesthesia with unusually heightened vision, or more often with complaints of "lightning," "sparks," and colored circles in the eyes, which usually do not cause particular anxiety in patients, or a sharp increase in headaches from bright light, which they begin to avoid. Such patients stop reading, cannot stand television ("even my head feels sick"), and refuse to go to the cinema. It is also worth considering patients who complain for weeks about a long-removed foreign body in the eye and bring themselves to actual conjunctivitis, constantly rinsing their eyes with various disinfectant and anti-inflammatory solutions and wiping them with gauze pads or handkerchiefs [2-8].

Peculiar sensitivity or intolerance to certain foods and various odors (even at minimal concentrations in the air) are also common in psychosomatic disorders. Gustatory hyperesthesia is often associated with glossodynia. Olfactory hyperesthesia can manifest as an aversion to previously neutral or pleasant aromas (e.g., tobacco or incense), while simultaneously being accompanied by a craving for odors (e.g., gasoline or oil paint) that normally evoke no positive emotions [7].

Conclusion

Depressive and anxiety-affective disorders can manifest with a wide range of somatic symptoms – from pain and disturbances in skin, auditory, and visual sensitivity to a paradoxical combination of hyperesthesia and anesthesia, which is why the true nature of the disease often remains unrecognized. The instability of sensations, their pronounced dependence on emotional state, and the patient's tendency toward hypochondriacal fixation often lead physicians to search for organic pathology, delaying the introduction of adequate treatment. Therefore, understanding the psychogenic origin of many "functional" complaints and the ability to distinguish them from true somatic disorders is crucial: only an integrative clinical and psychopathological approach allows for an accurate assessment of the patient's condition and the provision of effective therapy aimed at both the somatic and affective aspects of their suffering.

References

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

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Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski

Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.

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Dr Farahnaz Fallahian

Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.

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Dr Victor Olagundoye

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD

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Dr Eric S Nussbaum

Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.

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Hala Al Shaikh

Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.

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Dr Rakhi Mishra

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.

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Dr Walter F Riesen

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.

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Dr Jelle Lettinga

Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora

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Dariusz Ziora

Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.

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Dr Ravi Shrivastava

Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.

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Dr Aline Tollet

Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.

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Dr Chiara Giuseppina Beccaluva

Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti

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Dr Claudio Ligresti

Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.

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Dr Matteo Bonori

I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.

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Edouard Kujawski

Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell

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Dr Andriy Sinelnyk

Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.

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Dr Meng-JouLe

Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed

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Mahmoud Kamal Moustafa Ahmed

Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.

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Dr Elena Salvatore

Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal

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Christoph Maurer

Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.

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Baciulescu Laura

Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.

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Dr Mamoun Magzoub