BMC Psychiatry

BackgroundPoor patient retention and family engagement compromise the effectiveness of coordinated specialty care (CSC) for first-episode psychosis (FEP). This mixed methods study aimed to identify program-level characteristics (CSC fidelity and engagement strategies) associated with patient retention and family engagement in Massachusetts CSC programs. MethodsPrimary outcomes were rates of patient retention and family engagement ([&ge;]1 evidence-based family intervention session), based on CSC program census (October 2022 - September 2023). Quantitative analyses explored program characteristics (EPINET Program-Level Core Assessment Battery) and fidelity ratings (Massachusetts Psychosis Fidelity Scale) as predictors using t-tests or univariate linear regressions. Thematic analysis of program interviews compared patient and family engagement strategies employed by high versus low performing programs. ResultsAcross nine programs, mean patient retention was 86% (range: 58-97%) and family engagement was 40% (range: 12-100%). Higher fidelity to evidence-based services (e.g., individual therapy, family intervention, and supported education/employment) was significantly associated with both outcomes (p<.05; R2 range: .51-.72). Mixed-methods analysis showed that high performing programs used case management-related supports to meet service users practical needs. Factors associated with higher patient retention included having comprehensive intake assessments, provider visits during hospitalization, and periodic treatment reviews. Programs that conducted benefits counseling and proactively recommended family services as standard care had higher family engagement. ConclusionsHigher fidelity CSC programs had better patient retention and family engagement. Case management-related supports addressed treatment barriers. Strategies designed to strengthen therapeutic alliance and goal alignment may promote patient engagement, while family engagement may benefit from proactive recommendation of family intervention.

BackgroundUp to one-third of medical inpatients experience clinically relevant mental distress, yet many remain untreated. Stepped and collaborative care (SCC) models may improve access to mental health care, but predictors of service uptake are unclear. We examined patient- and ward-level predictors of psychosomatic-psychiatric consultation (PPC). MethodsWe analyzed data from SomPsyNet, a stepped-wedge cluster randomized trial targeting SOMatic inpatients across three Swiss tertiary hospitals, to prevent PSYchosocial distress by a care NETwork. Analyses focused on inpatients screening positive for mental distress. Multiple-imputed logistic regressions assessed predictors of four sequential service-use stages: PPC considered, offered, accepted, and received. ResultsAmong 589 distressed patients, 93.9% were offered PPC, 63.1% accepted, and 83.9% of acceptors received PPC, yielding a 50% overall receipt rate. Patients without Swiss citizenship showed higher odds of acceptance (odds ratio [OR]=1.82 [1.10, 3.00]) and eventual receipt (OR=1.62 [1.01, 2.62]). Being in a Geriatric ward facilitated PCC uptake, while patients from gynecology showed reduced progression through the care pathway. Age, gender, income, education, marital status, and living arrangement showed no statistically robust associations. ConclusionsAlmost two-thirds of mentally distressed medical hospital inpatients accepted an offered PPC, indicating high acceptability. About half ultimately received a consultation, highlighting substantial attrition along the SCC pathway. Ward specialty and nationality were key determinants of PPC uptake. These findings suggest that proactive, ward-oriented consultation-liaison models embedded in routine inpatient care may improve timely and equitable access to mental healthcare, including for migrant and minority patients who are otherwise less likely to access such care. HighlightsO_LIPsychosomatic-psychiatric consultation pathway of medically hospitalized inpatients C_LIO_LI63% accepted such a consultation when offered; overall 50% reached receipt. C_LIO_LINon-Swiss nationality increased odds of acceptance (OR 1.8) and receipt (OR 1.6). C_LIO_LIPatients at geriatrics wards showed higher, at gynecology wards lower transitions. C_LIO_LIResults support low-threshold, ward-oriented consultation-liaison models. C_LI

Abstract Background: Mental health services are shifting towards person-centred care based on collaboration and shared decision making. Yet evidence indicates that these approaches may not be consistently embedded in the assessment and management of risk or safety. Methods: We conducted a cross-sectional online survey to examine perceived barriers and enablers to shared decision-making in risk assessment and management with people living with severe mental illness. Questionnaire development and data analysis were guided by the Theoretical Domains Framework, a psychological framework used to identify and understand factors influencing behaviour change. Items were rated on a 5 point Likert scale. In total, 243 service users and mental health professionals completed the survey. Results: Most service users reported that risk or safety had been discussed with them, but only half felt involved in the risk assessment or management process. Two thirds reported not receiving a copy of their risk assessment or management plan. Service users strongly agreed that communication with professionals about risk and safety requires improvement, and that risk is a difficult and emotive topic to discuss. Professionals reported high motivation to involve service users but identified time constraints and service user related factors as key barriers. Principal component analysis identified four components: (1) motivation; (2) social influences and memory/decision making; (3) beliefs about consequences; and (4) team, environment and training factors. More experienced professionals reported fewer negative beliefs about consequences, such as concerns about causing distress or disengagement. Conclusion: Findings highlight the need for clearer communication, organisational support and targeted training to enhance shared decision-making in risk assessment and management practices.

AIM Older adults experiencing anxiety disorders, particularly those from minority ethnic backgrounds, are less likely to use formal mental health services compared to their younger counterparts. This UK multicultural qualitative study aimed to explore and compare beliefs underpinning coping strategies for anxiety among self-reporting White British, South Asian, African and Caribbean older adults, using Leventhal's Common-Sense Model of Self-Regulation. METHODS Individual semi-structured interviews were undertaken with 52 older adults aged 65 and over who self-reported (current or past) anxiety. Professional interpreters supported interviews with non-English-speaking participants (n=10). Eight public contributors collaborated on different aspects of the study. The Framework Method was used to manage and analyse the data. FINDINGS The study drew on the perspectives of 27 older adults with distressing anxiety and 25 with non-distressing anxiety. Across all cultural groups, participants adopted different strategies to manage anxiety, the most prominent of which were self-help strategies. Help-seeking behaviour was influenced by a complex interplay of factors not recognised by Leventhal's Common-Sense Model. Notably, older adults' salient identities, rather than their cultural backgrounds, influenced their selection of coping strategies. CONCLUSIONS Interventions that empower older adults to use self-help strategies more effectively can serve as acceptable adjuncts to formal therapy. Nevertheless, addressing barriers to formal help-seeking is essential, particularly among those with a perceived need to seek help. No one model can depict the complexity of coping behaviours. While applying Leventhal's Common-Sense Model yielded novel insights, it could not fully capture the motivational factors underlying participation in specific coping behaviours. To provide nuanced and accurate insights, cross-cultural research should acknowledge heterogeneity within groups rather than impose boundaries of purportedly homogeneous entities.

ObjectiveTo analyze the structure of mental disorders in children in the outpatient practice of a specialized mental health center for optimization of care organization for this patient category. MethodsA retrospective analysis of medical records of 23 children (out of 44 patients) at the Insight Mental Health Center (Dushanbe, Tajikistan) was conducted for the period from December 9, 2025, to January 8, 2026. Diagnosis was performed according to ICD-10 criteria using standardized instruments: M-CHAT-R, ADOS-2, and ADI-R for autism spectrum disorder (ASD); SNAP-IV for attention deficit hyperactivity disorder (ADHD); CGI; and pediatric versions of PHQ and GAD. ResultsChildren accounted for 52% of all patients. Primary school-age children (7-12 years) predominated at 43.5%. Disorders of psychological development (F80-F89) dominated the nosological structure at 82.6%, with ASD comprising 56.5%. ADHD was diagnosed in 30.4% of cases. Comorbidity was registered in 47.7% of patients. ConclusionThe structure of pediatric psychiatric pathology is characterized by a predominance of developmental disorders and high comorbidity levels, justifying the need for a multidisciplinary approach.

BackgroundCanadas youth are facing mental health crises due to barriers in accessing timely and affordable care. Ontarios OHIP+ pharmacare program, introduced in 2018, provided free prescription drug coverage to individuals under 25. While OHIP+ increased prescription use, its effects on perceived access and well-being among youth with mental health needs remain unclear. MethodsWe used a regression discontinuity design leveraging the OHIP+ age-eligibility cutoff at 25 to estimate its causal impact on unmet health care needs and self-perceived life stress. The sample included Ontario respondents aged 20-29 (n=1,053) from the 2018-2019 Canadian Community Health Survey who reported needing mental health support. Outcomes were self-reported unmet health care needs and a 5-point life stress scale. Models adjusted for sociodemographic factors and used age in months as the running variable. ResultsLoss of OHIP+ eligibility at age 25 was associated with a 19.0 percentage-point increase in the probability of reporting unmet health care needs (95% CI: 0.5 to 37.6 percentage points) and a 1.33-point increase in perceived life stress (95% CI: 0.45 to 2.21). These effects were consistent across subgroups and robust to multiple sensitivity tests. ConclusionOHIP+ improved access and reduced stress among youth with mental health needs while coverage was in place. However, the abrupt loss of eligibility at age 25 increased unmet needs and psychological strain, underscoring the need for continuous, inclusive pharmacare to support youth well-being. What is already known on this topicPublic drug coverage programs such as OHIP+ have been shown to increase prescription drug use among youth in Ontario, Canada. However, little is known about whether such programs improve patient-perceived outcomes. Existing evaluations have largely relied on descriptive data or aggregate prescribing trends, with few studies examining individual-level outcomes using quasi-experimental methods. What this study addsUsing a regression discontinuity design, this study provides the causal evidence that the OHIP+ pharmacare program reduced unmet health care needs and life stress among youth with perceived mental health concerns while they remained eligible for coverage. The findings show that the abrupt loss of eligibility at age 25 was associated with increased unmet needs and heightened stress, suggesting that age-based cutoffs in drug coverage may disrupt care and contribute to psychological strain during a critical life stage. How this study might affect research, practice or policyThis study suggests that universal drug coverage programs should ensure continuity through young adulthood to avoid worsening access gaps. The findings support the need for a national pharmacare framework that promotes equitable and sustained health support.

Schizophrenia (SCZ) and type 2 diabetes mellitus (T2DM) are common comorbid disorders that severely impair patient prognosis and quality of life. This study aimed to explore the association between the methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism and MTHFR promoter methylation in patients with comorbid SCZ and T2DM. A total of 120 participants were enrolled from Liaocheng Fourth Peoples Hospital between January 2025 and June 2025, comprising 30 subjects in each of the four groups: SCZ group, T2DM group, SCZ-T2DM comorbid (SCZ+T2DM) group, and healthy control (CTL) group. Corresponding primers were designed for genetic analysis, and methylation-specific PCR (MSP) was performed to detect the methylation level of the MTHFR promoter. Genotype distribution of the MTHFR C677T polymorphism was consistent with Hardy-Weinberg equilibrium (HWE) (p>0.05). The C677T polymorphism was significantly associated with an elevated risk of SCZ and T2DM comorbidity (p<0.05). Notably, the methylation rate of the MTHFR promoter in the SCZ+T2DM group (95.00%) was not significantly higher than that in the CTL group (90.00%) (p>0.05). In conclusion, the MTHFR gene may serve as a susceptibility gene for SCZ-T2DM comorbidity, whereas MTHFR promoter methylation is not associated with the pathogenesis of this comorbid condition. These results indicate that genetic variation in MTHFR, rather than promoter methylation, contributes critically to the comorbidity of SCZ and T2DM in the Han Chinese population. Our findings may provide novel molecular insights into their shared pathophysiology and inform future clinical strategies for patients with this complex phenotype.

ObjectiveDespite recommendations that young people at clinical high risk (CHR) for psychosis receive stepped treatment, few programs have published details of their clinical models or outcomes. This study describes the preliminary effectiveness of a risk calculator-informed stepped care model used at the Yale PRIME Clinic, a specialized outpatient clinic for young people at CHR. MethodsSeventy-one individuals (ages 12-25) at CHR enrolled in Yales PRIME Clinic during the first four years of the treatment program. Participants completed clinical assessments at six timepoints over two years of treatment within a care model informed by an empirically grounded psychosis risk calculator. Linear mixed-effect models were fit to examine changes in clinical symptoms over time, and sensitivity analyses evaluated differences in clinical trajectories between completers and non-completers. ResultsIndividuals engaged in treatment demonstrated significant and sustained improvements in positive, negative, general, disorganized, and depressive symptoms. Improvements in positive symptoms emerged by 6 months and continued to improve across most subsequent timepoints (6, 12, and 24 months). Pattern mixture analyses suggested that clinical trajectories did not significantly differ between completers and non-completers, though non-completers possessed more heterogeneous trajectories. ConclusionsA stepped care model informed by individualized risk calculator scores was feasible for delivery in a specialized outpatient setting, and was associated with broad symptom improvement for young people at CHR. Further controlled studies with blinded raters are needed to further confirm the efficacy of stepped care models and isolate the active components of treatment. HighlightsO_LIParticipants at clinical high risk for psychosis experienced significant reductions in attenuated psychotic symptoms and improvements in mood while enrolled in a risk-calculator-informed stepped care treatment model. C_LIO_LIParticipants who disengaged from treatment did not have significantly different clinical trajectories than those who remained in care. C_LIO_LIThe results suggest preliminary evidence for the feasibility of implementing a risk-calculator-informed stepped care model. C_LI

ObjectiveThis study aimed to identify characteristics that define population need groups with similar mental health service needs within prisons and describe the mix of services required to meet those needs. MethodsMixed methods were used, including three iterative, semi-structured focus groups, followed by an online survey, seeking information on the characteristics that define service needs, how these can identify groups of people who require mental health care in prisons and the services required by each group. Participation was sought from prison health services, prison mental health services, non-government service partners and people with a lived experience. Focus group transcripts and free text survey responses were thematically analysed. Descriptive statistics were generated for online survey responses to Likert Scales to determine the levels of agreement with survey content. ResultsThe characteristics and service needs of four distinct population groups who require mental health care in prisons were defined: indicated prevention, mild, moderate, severe and complex. These groups were delineated using characteristics including presence of a diagnosed mental illness, level of functional impairment, presence of added complexity and service response required. The required service mix varied across need groups, however service types common across all groups included assessments, psychological therapies, peer support, lifestyle interventions and carer support. ConclusionsThe identified need groups and service descriptions will contribute to the evidence required for needs-based planning of mental health care in Australian prisons. This information can be used for planning a responsive, equitable, and needs-based mental health service system within custodial environments.

BackgroundDespite widespread recognition of the value of lived experience (LE) involvement in healthcare research and increased LE involvement activity, we lack established implementation methods and instruments for reporting and evaluating impact. We present a protocol for an innovative LE-led Impact Log tool and co-production framework, which may help to address some fundamental barriers to co-production. The Impact Log will be implemented within a five-year multidisciplinary transdiagnostic research project on severe mental illness, the Brain and Genomics Hub of the UKRI Mental Health Platform, and is also designed for wider adaptation and use. Part I presents a short narrative review of literature pertaining to defining, evaluating, and enhancing the impact of co-production, to provide in-depth background and aid future development. Part II presents the Impact Log protocol. MethodsThe Impact Log framework is designed to integrate inclusive and impactful co-production throughout all research stages, and to record and evaluate its impact across three domains using an accessible short form. The three research domains are: design and delivery; interpersonal and environmental aspects; systems and processes. Impact Log design and implementation is led by LE study leads and a specialist advisory panel, who are integrated fully within the wider research team, and all have combined research experience and LE of bipolar or psychotic disorders. All Hub research participants will be offered accessible opportunities for remunerated lived experience input, and there will be outreach to ensure diverse representation, aided by the Hubs charity partners. Data collection and analysis will be LE led and will include iterative analysis to inform continuing development. Diverse formal and informal dissemination throughout the project will maximise wider stakeholder engagement. DiscussionThe potential value of this research is to implement a novel tool and framework for facilitating, recording and evaluating co-production in complex mental health research, which can be adapted for wider use. Strengths in design are LE leadership and cross-cutting LE research integration, incorporation of multiple domains, and a focus on facilitating diversity and inclusion within co-production. Potential limitations for this project and wider adaptation may include limited resources, risk of bias and health challenges. Lay SummaryWe have provided a brief lay summary to help people without a research background understand our project. This article explains our plan to develop and test a new way of understanding how research changes when people with personal experience of a mental health condition are part of the research team. We are a team of mental health researchers and many of us have direct experience of bipolar and psychosis. We work alongside other researchers, including people who might also have worked in mental health services or in charities that provide support. Our research project aims to better understand what is happening in the brain, body, lives and experiences of people who have bipolar and psychosis. Many people believe that research is better when it includes the views of people who have direct experience of the health condition being studied. This is called "lived experience". We have developed a structured approach to make sure that people with lived experience are meaningfully involved in our research team. We have also created a simple tool, called the Impact Log, to record when lived experience members contribute and to help us understand how their involvement influences the research. Finally, we wanted to better understand what other researchers have said about lived experience involvement. We reviewed many published academic studies and reports and brought their findings together in what is called a "narrative review". This review summarises what is already known about the difference lived experience involvement can make in research.

Safety is a foundational concern in adolescent behavioral health crisis units (BHCUs), where therapeutic care must be delivered in complex, rapidly evolving environments. However, limited research has explored how key personnel involved in shaping the environment of care in such units, such as clinicians and healthcare designers, understand and prioritize safety. To address this gap, one-hour, online semi-structured interviews were conducted with a panel of experts (N = 13) at a national level in the U.S., comprising of eight designers (healthcare designers and medical planners) and five clinicians (psychologists and psychiatric nurses) actively involved in designing or construction of BHCUs or providing care in these units for adolescent patients in the past five years. The interviews were recorded, transcribed verbatim, and analyzed via MAXQDA (2024) for qualitative content analysis. Analysis of interviews revealed 592 codes forming four preliminary categories related to safety in adolescent BHCUs: 1) Barriers and facilitators to patient safety and comfort (f = 52%), 2) Care processes and clinical workflows (f = 21%), 3) Care outcomes (f = 19%), and 4) Laws, regulations, and guidelines (f = 7%). Findings highlighted several points of divergence in clinicians versus designers perception of safety related to environmental features, such as nursing station designs, patients access and control over unit features, and furniture type or layout in the unit. Results also showed differences in understanding care processes and outcomes related to safety among the two groups. Addressing such discrepancies can contribute to the development of safer BHCUs that support adolescents healing.

Background: Diminished Expression (DE) and Amotivation/Apathy (AA) are widely recognized as two main factors of negative symptoms. This study aimed to 1) examine the longitudinal stability of the DE-AA structure and its variation throughout a 5-year follow-up in people with first-episode psychosis (FEP), and 2) investigate whether DE and AA have distinct predictive value compared with the unitary construct of negative symptoms. Study Design: 227 participants from the EUropean Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) and Genetics and Psychosis (GAP) studies were included at FEP and were followed up 5 years later. One-factor (global negative symptoms), uncorrelated two-factor (DE-AA), and correlated two-factor structures were modelled using confirmatory factor analysis. Regression analyses were applied to examine the associations between these factors and negative symptom trajectories, functioning, and quality-of-life outcomes. Study Results: The correlated two-factor model composed of DE and AA best fitted the data and exhibited 5-year stability. The regression model adjusted for AA accounted for more variance (59.2%) than global negative symptoms (52.8%) in explaining the enduring course of negative symptoms. Baseline AA was the only negative symptom factor that significantly predicted individuals' functional outcome at follow-up (B=-1.76, p=0.037). All negative symptom dimensions negatively predicted employment status, whereas lower educational attainment was primarily related to AA severity at baseline. Conclusions: Our findings support the validity and longitudinal stability of the two-dimensional (DE-AA) approach to negative symptoms in individuals with FEP. AA in particular exhibited distinctive predictive value, underscoring its potential clinical utility for early identification and the development of targeted interventions.

BackgroundCognitive deficits in anxiety disorders (ADs) contribute to clinical and socio-occupational dysfunction, necessitating targeted interventions. NoveltyIntegrated Cognitive Control Training (ICCT), a novel intervention, has demonstrated benefits in other disorders, however, remains unexplored in ADs. With its process-specific training and multi-pronged exercises for stimulation, metacognitive training and generalization, it has potential for enhancing cognitive functions in ADs. ObjectivesThis paper describes the study protocol for a multi-site randomized controlled trial (RCT) to test efficacy of ICCT in individuals with ADs. MethodsAdults diagnosed with ADs (n=100) will be recruited across two sites. Following baseline assessments, they will be randomized to either ICCT (8 weekly sessions) or Treatment As Usual (TAU). ICCT will be delivered through once-weekly therapist-guided, and smartphone app-based ( Cogtrain) homework (20-30 mins, 4-6 times per week). Multimodal assessments will be carried out at baseline, mid-intervention (4 weeks), post-intervention (8 weeks) and follow-up (20-24 weeks). The primary measure comprises Hamilton Anxiety Rating Scale, with secondary measures of Work and Social Adjustment Scale (socio-occupational functioning), neuropsychological tests (attention, memory and executive functions) and functional Magnetic Resonance Imaging of the cognitive control circuits. Intervention feasibility and acceptance metrics (response rate, intervention relevance) will also be recorded. Quality assurance and ethical procedures will be documented. Expected outcomeThe ICCT is expected to enhance cognitive functioning in adults with ADs, in addition to symptom reduction, changes in underlying neural circuits of cognitive control and improve overall functioning. Digital delivery through a smartphone app may provide a cost-effective and scalable intervention, useful in resource-constrained settings. Key MessagesThis multi-site randomized controlled trial evaluates a novel, smartphone-delivered Integrated Cognitive Control Training (ICCT) program for adults with anxiety disorders, targeting core cognitive deficits that contribute to functional impairment. By combining therapist-guided sessions with app-based training and multimodal assessments, the study examines both clinical and neural outcomes. Findings are expected to inform the scalability and feasibility of process-based digital cognitive interventions for anxiety disorders, particularly in resource-limited settings. Protocol RegistrationTrial registry name: Clinical Trial Registry of India URL: https://ctri.nic.in/Clinicaltrials/************** Registration number: CTRI/202*/**/******

BackgroundProlonged waiting times for Child and Adolescent Mental Health Services (CAMHS) leave many young people without structured support while awaiting specialist treatment. Social prescribing has been proposed as a community-based adjunct within CAMHS pathways; however, evidence regarding its safety and clinical impact remains limited. MethodsWellbeing While Waiting was a multi-site non-randomised controlled trial embedded within a hybrid type II implementation-effectiveness evaluation conducted across 11 CAMHS in England. The protocol was prospectively published prior to recruitment (BMC Psychiatry; 10.1186/s12888-023-04758-0). Between May 2023 and March 2025, 558 young people aged 11-18 years referred to CAMHS were enrolled (225 usual care; 333 social prescribing). Primary outcomes were anxiety and depression symptoms, total emotional and behavioural difficulties, and perceived stress. Secondary outcomes included resilience and wellbeing. ResultsNo intervention-related adverse events were observed. On average, participants had 5 sessions with a Link Worker. Compared with usual care, no significant differences were observed in anxiety or depression symptoms. However, participants receiving social prescribing demonstrated significant improvements in total emotional and behavioural difficulties over six months, driven by reductions in conduct difficulties, hyperactivity and peer problems. Significant improvements for those receiving social prescribing were also found for prosocial behaviour and resilience. ConclusionsWithin routine CAMHS pathways, no intervention-related adverse events were observed for social prescribing, and social prescribing was associated with improvements in behavioural and resilience-related outcomes, although not in anxiety or depressive symptoms. Findings suggest social prescribing may offer a valuable adjunct during delayed access to specialist treatment, with effects distinct from symptom-focused clinical therapies.

Background and HypothesisSchizophrenia is a disease characterized by various symptoms and has severe lifelong impacts on patients and their families. Despite various hypotheses and associated studies, the key mechanism in schizophrenia is not fully elucidated. In the present study, we focused on adropin, a peptide regulating energy metabolism, antioxidation, and neuroprotection. Study DesignIn both the group of healthy volunteers (HV) and the group of patients with some schizophrenia spectrum and other psychotic disorders (SZ), we evaluated adropin along with other variables such as anthropological factors, psychological well-being indicators, and laboratory test results. Study ResultsThe adropin levels in SZ were not significantly different from those in HV. Correlation analysis indicated five significant correlations beyond various natural correlations arising from fundamental proportional relationships and multifaceted psychological well-being indicators: (1) adropin versus right handgrip strength in the SZ group ({tau} = -0.82, P = 0.066); (2) adropin versus selenium in the total group ({tau} = 0.44, P = 0.053); (3) ferritin versus perceived stress in the total group ({tau} = -0.44, P = 0.053); (4) right versus left handgrip strength in the total group ({tau} = 0.70, P = 0.001) and in the SZ group ({tau} = 0.82, P = 0.075); and (5) selenium versus state anxiety in the total group ({tau} = 0.44, P = 0.053) and the SZ group ({tau} = 0.84, P = 0.066). ConclusionsThe present study provides a foundation for future studies and sheds light on the role of adropin in schizophrenia.

Nighttime agitation (NA) is a prevalent and challenging phenomenon affecting people with dementia (PwD), often resulting in premature institutionalization. Yet, informal caregivers' perspectives on this phenomenon remain underexplored. We conducted 15 in-depth interviews with informal caregivers to gain insight into their experiences and reactions to NA. Thematic analysis identified seven sub-themes related to carers' experience and eight sub-themes concerning their reactions. These themes emerged across three levels, namely, PwD, informal caregiver and the environment. Most phenomena occurred at a dyadic level between PwD and informal caregiver, highlighting the potential of interventions targeting dyadic coping. Informal caregivers feel insufficiently supported when sleep disturbances co-occur with NA. They primarily rely on self-initiated strategies and learn by experience. Caregivers mention the need for more advanced knowledge and skills in reacting to co-occurrence of sleep disturbances with NA or systemic support in terms of dealing with emergencies. Caregivers also reflect extensively on the impact of challenging behaviors during the night on their mental and physical well-being. Notably, no non-pharmacological interventions for NA adequately address the themes identified in this study, highlighting the urgent need for integrative approaches and recognition of caregiver wellbeing as a core outcome, not a secondary consideration in interventions.

Aim Anxiety disorders in older adults are commonly underdiagnosed and undertreated, especially among minority ethnic groups. This UK multicultural qualitative study aimed to explore and compare beliefs about anxiety among self-reporting White British, South Asian, African and Caribbean older adults, using Leventhal's Common-Sense Model. Methods Individual interviews were conducted with 52 older adults who self-reported anxiety (current or past). Data were managed and analysed using the Framework Method. Professional interpreters facilitated interviews with non-English speakers. Findings The study incorporated the perspectives of 27 older adults with distressing anxiety and 25 with non-distressing anxiety. Participants' beliefs mapped onto the illness-related dimensions in Leventhal's Common-Sense Model. Beliefs about anxiety differed across and within cultural groups, with notable distinctions between participants with distressing and non-distressing anxiety. Those with distressing anxiety neither normalised anxiety nor considered it as an illness trajectory. Overall, participants had a fragmented understanding of anxiety disorders. Specific aspects of older adults' beliefs were influenced by their salient identities rather than their cultural background. Two new dimensions were identified: aggravating factors, believed to trigger or exacerbate anxiety symptoms; protective factors, believed to alleviate or prevent mental health problems. Conclusions Applying Leventhal's Common-Sense Model to anxiety has yielded new insights with significant implications for understanding potential causes of low mental health services use among older adults. Grouping people into broad categories of cultural groups disregards the diversity among individuals within the same group. Cross-cultural research should embrace this diversity and employ nuanced approaches to provide meaningful, person-centred insights into people's perceptions of illness.

BackgroundAnorexia nervosa (AN) is a severe psychiatric disorder associated with profound malnutrition, multisystem medical complications, and one of the highest mortality rates among mental illnesses. Despite decades of research into its biological and neurocognitive mechanisms, effective pharmacological treatments remain limited. While systematic reviews synthesize results from published studies, clinical trial registries offer a complementary perspective by capturing ongoing research efforts, discontinued studies, and emerging therapeutic strategies that may not yet be reflected in the published literature. ObjectiveThis study aimed to characterize the landscape of clinical research in AN by systematically analyzing studies registered on ClinicalTrials.gov. MethodsWe conducted a structured analysis of studies registered on ClinicalTrials.gov related to AN. Trial characteristics, including study design, intervention type, phase classification, geographic distribution, and recruitment status, were extracted and analyzed using an automated text-based classification pipeline. ResultsNearly 400 studies investigating AN were identified over the past 25 years. Approximately 71% were classified as interventional studies; however, a large proportion were not associated with conventional clinical trial phases, suggesting that many registered trials correspond to mechanistic or exploratory investigations rather than therapeutic development programs. The geographic distribution of studies revealed a strong predominance of North America and Western Europe. A substantial proportion of trials were terminated or discontinued, highlighting the significant challenges associated with conducting interventional studies in this population. Observational studies generally included larger sample sizes than interventional trials. ConclusionsRegistry-based analyses provide valuable insights into the evolving landscape of clinical research in AN. Despite considerable scientific activity, important gaps remain between mechanistic knowledge and the development of therapeutic interventions. Understanding these gaps may help inform future translational research strategies aimed at improving treatment options for this severe disorder.

Background Negative and stigmatizing attitudes towards people suffering from mental disorders among healthcare providers often act as a barrier to mental healthcare access. To assess these attitudes in primary care physicians (PCPs), a robust, culturally tailored psychometric tool is crucial. This study aimed to translate and psychometrically validate the MICA-4 to assess negative attitudes among PCPs in Pakistan. Methods We recruited two independent samples of PCPs (n=191, n=329) using non-probability sampling. Three bilingual mental health professionals forward-translated the scale, which was then independently reviewed and back-translated. Cognitive interviews were conducted (n=15 PCPs) to assess comprehension and clarity, for the final version to be used in the study. EFA was conducted on Sample 1 to examine the underlying factor structure of the Urdu MICA-4 items. CFA was then performed on Sample 2 to cross-validate the factor structure identified in Sample 1. Internal consistency and convergent validity were also assessed. Results A three-factor solution was retained, including Views (seven items), reflecting clinicians general evaluative perspectives toward mental illness and professional roles; Stereotypes (five items) representing generalized beliefs and disclosure-related concerns regarding individuals with mental illness, and Stigma (three items) capturing social distancing and perceived threat-related attitudes. The Comparative Fit (CFI = .958) and the Tucker-Lewis Index (TLI = .946) indicated good fit. Three items (9, 13, and 12) were removed due to weak loadings (< .40). Composite reliability ({omega}) indicated adequate internal consistency for the Views ({omega} = .70) and Stereotypes ({omega} = .74) factors, and lower for stigma ({omega} {approx} .53). Convergent validity was modest (.40 to .44). Conclusion The findings support the cautious use of Urdu MICA-4 in Pakistani primary care settings. The variability in the factor structure of the scale across cultures raises a practical implication for its dissemination. When item-level instability repeatedly emerges across contexts, permitting limited, evidence-based refinement may strengthen measurement stability and comparability, as well as its reliability in diverse healthcare settings.

Background Complementary and Alternative Medicine (CAM) contributes significantly to the utilization of healthcare services in mental health care in sub-Saharan Africa. However, there is limited evidence on the utilization of CAM in the particular setting of post-conflict northern Uganda. This study sought to establish the prevalence, forms, and socio-demographic determinants of CAM use among patients attending the Mental Health Unit at Gulu Regional Referral Hospital (GRRH). Methods This is a cross-sectional study conducted in a hospital setting from June to August 2025. Convenience sampling was employed to recruit 407 participants. A structured questionnaire was employed for data collection. Data analysis was done using STATA software version 18.0. Descriptive statistics were calculated, and bivariate analysis with Prevalence Ratios (PR) with 95% confidence intervals was employed to determine factors that are significantly associated with the use of CAM. Results The lifetime prevalence of CAM use was 63.4% (258/407), with 41.3% (168/407) using CAM currently. The most frequent CAM practices used were herbal medicine (50.4%), spiritual practices (33.7%), and traditional medicine (19.8%). For current users, spiritual practices were most frequent (88.7%). The reasons for using CAM were recommendations from others (84.8%) and cultural or religious beliefs (63.4%). Predictors of CAM use were primary education (PR = 1.36, p = 0.017), living in an urban area (PR = 1.23, p = 0.007), separated (PR = 1.39, p = 0.050), and having a mental health disorder for six or more months (PR range = 1.55-1.72). Catholics (PR = 0.72, p = 0.0007) and Protestants (PR = 0.76, p = 0.011) were less likely to use CAM than Born Again Christians. Conclusion The level of CAM use among patients accessing mental health services in GRRH of northern Uganda is significantly high, while the reporting of CAM use to healthcare providers is remarkably low. This is a challenge that requires urgent attention. Recommendations include integrating the use of CAM into medical practice, developing national policy guidelines on CAM, working in collaboration with traditional/spiritual healers, and conducting public education campaigns.